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HDFC Bank's merger with parent to create Indian mortgage powerhouse | The proposed merger of India's leading mortgage lender with the nation's biggest private-sector bank will create a financial services powerhouse with economies of scale and the ability to raise funds at competitive rates.
HDFC Bank Ltd. said April 4 that it will merge with its parent, Housing Development Finance Corp. Ltd., to grow its home loans portfolio as housing demand is poised to drive the Indian economy. The combination will also help the bank reduce the proportion of its unsecured loans and the expanded balance sheet will allow it to underwrite larger ticket loans, according to a company announcement.
`` As the son grows older, he acquires his father's business, '' HDFC Chairman Deepak Parekh said after the announcement.
The merger will increase the bank's product offering and ability to cross-sell to HDFC's customer base, said Darpin Shah, a banking analyst with Haitong International, a securities firm. `` The higher share of mortgages would also mean having sticky customers, not only on the asset side, but on the liability side as well, '' Shah said.
The mortgage segment makes just 11% of HDFC Bank's loan book, with an even smaller share in the high-growth rural and semi-urban areas.
India's housing sales registered a 7% year-over-year growth in the first three months of 2022, according to real estate consultancy firm PropTiger.com. The increase in activity is fueled by record-low home loan interest rates and government-sponsored subsidy programs. In the same period, supply surged by 50% year over year as the economy continues to recover from the drag of the COVID-19 pandemic.
HDFC Bank's rivals State Bank of India, ICICI Bank Ltd. and Axis Bank Ltd. have a bigger chunk of their loan books dedicated to mortgages, according to Sumeet Singh, head of research at Aequitas Research, a research firm.
The combined entity's earnings could improve over the next three to five years, S & P Global Ratings said in a note April 4. The merger will provide the bank with profitable cross-selling opportunities to HDFC's large pool of customers, `` especially for high-yield products such as unsecured loans. It would also generate more fee income from insurance and investment products, '' Ratings said.
HDFC Bank's loans will rise 42% to 18 trillion rupees, or about US $ 237 billion, Ratings said. The bank will remain the second-biggest lender in India after government-run State Bank of India, though its size will become twice that of ICICI Bank, the third biggest. HDFC Bank's market share in loans will rise to 15% after the merger, from 11% at present.
The merger is expected to complete within 18 months.
Currently, HDFC and HDFC Bank have a combined market capitalization of about 12.8 trillion rupees, making it the third-largest entity in India, according to S & P Global Market Intelligence.
The merger could attract greater international investments into India's financial sector. Foreign shareholding in the combined entity will be at 65% -67%, leaving a 7% gap to the limit of 74% of foreign ownership in India's banks, HDFC Bank's management team said on an April 4 call with analysts.
`` The [ foreign institutional investor, or FII ] 74% limit became an albatross around the neck from a market positioning perspective, '' said Amit Kumar Gupta, a portfolio manager with Adroit Financial Services, an Indian securities firm. `` Most FIIs couldn't buy more due to the limit and whenever they had to reduce allocation to India... they sold HDFC bank aggressively. ''
The additional 7% float that will likely become available will be lapped up by funds, portfolio management services and retail investors, Gupta said.
The merger may also trigger a trend as the central bank has urged larger nonbanking financial companies to convert into banks and tightened rules for the shadow banking sector, Gupta said.
The Reserve Bank of India has been narrowing the regulatory gap between commercial banks and NBFCs as part of its efforts to prevent a repeat of the nation's shadow banking crisis in 2018 when a string of shadow banks failed, triggering systemic risks for all lenders in the economy.
As of April 4, US $ 1 was equivalent to 75.42 Indian rupees. | business |
US solar industry in 'existential crisis ' from Commerce solar tariff investigation | In this week's highlights: Oil markets to focus on monthly reports from OPEC and the International...
The NYMEX Henry Hub prompt-month contract burst through what has been an impassable resistance point...
Pacific Gas and Electric is telling customers to be prepared for potential power outages as strong...
The US Department of Commerce's decision to investigate circumvention tariffs on solar products from Cambodia, Malaysia, Thailand, and Vietnam has already caused the cancellation or delay of solar panel deliveries, according to 74% of the 200 companies the Solar Energy Industries Association surveyed.
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The department initiated the investigation March 28, four months after the agency rejected a similar petition that increased solar prices and threatened the livelihoods of tens of thousands of workers, SEIA said. The move threatens the Biden Administration's climate goals.
Commerce `` based its case on the industry-killing claims of a single company, '' SEIA President and CEO Abigail Ross Harper said during an April 5 webinar. `` It happened eight days ago and we are already seeing significant impacts [ of ] this decision. ''
In two business days, SEIA received 200 responses to its market-impact survey, which shows how swiftly impacts are being felt from the Commerce decision, said Justin Baca, SEIA vice president of markets and research.
The April 5 webinar had over 800 registrants, the most of any SEIA webinar, said John Smirnow, SEIA general counsel and vice president of market strategy.
`` This is the biggest threat I 've seen in my 15 years in the solar industry, '' Smirnow said about why the case has garnered so much interest.
Solar installment prices have already risen due to supply chain constraints stemming from the coronavirus pandemic. Year-on-year prices have risen across all market segments for three consecutive quarters, leaving utility-scale solar prices 18% higher than a year ago, Baca said.
`` About three-fourths of survey respondents have already been told their shipments are delayed or canceled, '' Baca said, adding another 15% don't know the impact yet while 11% have not been notified. `` Across all sectors we see major impacts being felt. Some of these look worse than the comments we got from COVID when projects were shut down.... The levels of impacts here are still not visible to everyone downstream. ''
Half of the respondents reported that 80% or more of their current-year solar pipeline is at risk because of the investigation, according to survey results.
Companies expect damage across the value chain with all domestic manufacturers who responded to the survey saying they expect `` severe '' or `` devastating '' impacts, according to SEIA. In addition, since most energy storage projects are paired with solar, energy storage components are likely to become uneconomical without the solar components.
US domestic module supply is not adequate and it would take years to build the supply chain needed, Baca said. It takes up to a year or more for siting and permitting a US plant, and an additional one to three years for construction and production, he added.
`` This sets us way back from where we need to be to achieve our climate goals, '' Baca said. `` We're not going to replace our supply overnight. ''
Harsh tariffs lead to job loss, less solar deployment, and provide little benefits to US solar manufacturing, Ross Harper said, adding the `` disastrous decision '' is causing an `` existential crisis '' to the US solar industry.
`` The damage is real and the damage is happening right now, '' Ross Harper said. `` To us, Commerce actions simply do not make sense. We are calling on the Department of Commerce to immediately issue a negative determination, which essentially means to dismiss the case. ''
Axion Solar, a solar module manufacturer based in California, filed a petition Feb. 8 asking Commerce to initiate an anti-dumping investigation into solar panel imports from Cambodia, Malaysia, Thailand, and Vietnam, which account for 84% of US solar module imports. Axion alleged the solar module parts used in manufacturing by the four countries come from Chinese companies to avoid anti-dumping tariffs.
`` We believe the Department of Commerce has enough information to make a decision and make it quickly, '' Julia Eppard, SEIA counsel with Akin Gump Strauss Hauer & Feld, said about dismissing the case, which is similar to a case Commerce rejected a few months ago.
In a March 7 letter, SEIA requested the department reject the anti-circumventive petition as it `` does not meet the minimum requirements for initiation. '' The investigation would unfairly hit crystalline silicon photovoltaic cells and modules from Cambodia, Malaysia, Thailand, and Vietnam with duties ranging from 50% to 250%, according to SEIA.
It is unlikely the US solar industry will hear anything about rates until the preliminary decision is expected Aug. 29, Eppard said.
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20 Ukrainian evacuees arrive in Tokyo on government plane | In a rare move for Japan, a country not known for accepting many refugees, 20 Ukrainians who had initially fled to neighboring Poland arrived in Tokyo on Tuesday on a government aircraft in hopes of finding a safe and secure place away from their war-torn country.
The move to fly in refugees is part of Japan’ s diplomatic efforts to highlight its willingness to provide support to Ukraine despite its geographical distance from the country compared with other Group of Seven nations.
Following a 12-hour flight on a backup government jet, the Ukrainians, some of whom do not have family or friends in Japan, arrived at Haneda Airport just before noon. Foreign Minister Yoshimasa Hayashi, who has just wrapped up a visit to Poland, flew back to Tokyo on a separate government jet before them.
“ We will provide various types of support to the evacuees after their arrival, ” Chief Cabinet Secretary Hirokazu Matsuno said in a news conference.
The group is made up of five men and 15 women between the ages of 6 and 66. After getting a COVID-19 test on board the plane, they emerged before the assembled media at the airport. They then headed to their accommodation, either the home of friends or family if they have them or a nearby hotel, for a required three-day quarantine.
The government will cover the cost of their stay for the time being, including accommodation, meals and medical fees. They will eventually be connected to the municipalities where they plan to live.
Some 679 municipalities and companies had offered to provide support to Ukrainians as of Monday, according to the government.
Ukrainian refugees arrive at Haneda Airport in Tokyo on Tuesday. | REUTERS
On Tuesday, Japan revealed a breakdown of the additional $ 100 million it is providing in humanitarian aid, which will cover food and health care supplies for Ukraine, neighboring countries and international organizations.
Since Prime Minister Fumio Kishida’ s announcement in early March that Japan intends to accept Ukrainians fleeing the country, they have come to Japan only sporadically, with the initial arrivals being those who have family or friends in Japan.
The government later expanded eligibility to those who have no acquaintances in Japan as well. The Ukrainians are at first granted a 90-day visa, which can be switched to a one-year residential status that allows them to work here.
According to the U.N. refugee agency, about 4.2 million Ukrainians have fled the country, making it the fastest-growing refugee crisis since World War II. Of them, about 2.5 million fled to Poland, 640,000 to Romania and 400,000 each to Moldova and Hungary.
G7 countries are also accepting refugees, with the United States saying it will accept up to 100,000 Ukrainian refugees and those fleeing Russia, while the United Kingdom had issued 29,200 visas to such refugees as of Thursday. As of Sunday, Japan had accepted 404 Ukrainians.
For Ayano Niijima, the protection and assistance unit manager at the nonprofit Japan Association of Refugees, it is important to think long-term when assessing the needs of incoming evacuees.
“ Their arrival is not an end in itself, ” she said. “ This could potentially be the start of a long life for them in Japan. ”
Ukrainian refugees arrive at Haneda Airport in Tokyo on Tuesday. | REUTERS
Beyond basic provisions such as accommodation, health care checkups and initial financial assistance, it is therefore necessary to provide a framework for Ukrainian evacuees to support themselves, learn Japanese and adapt to Japanese culture.
This, Niijima feels, will help offset some of the mental health issues associated with rapid displacement as a result of war.
“ For Ukrainians fleeing the conflict in their home country, it was impossible to imagine the war as little as six weeks ago, ” she said. “ Now they have left their loved ones behind for a distant country. Many of them will experience feelings of guilt at having escaped, while others will feel bewildered by a new culture.
“ Long-term mental health care and continuous case work on an individual basis is therefore required to help each evacuee adjust to life here as best they can. ” | tech |
COVID-19 pandemic shaping children's career aspirations, survey shows | Doctors and nursery school teachers are among the most popular jobs among girls who are entering elementary school in Japan, an annual survey showed Tuesday, perhaps reflecting the impact of the coronavirus pandemic on their young minds.
Police officer remained the top pick for boys for the second year in a row, while the job was also a popular choice among girls, ranking in fifth, according to the survey by Kuraray Co., a supplier of synthetic leather used to make school backpacks.
In the latest survey, doctors, nursery school teachers and police were among the jobs that were more popular this year than last for girls.
A Kuraray representative attributed this to “ heightened attention on essential workers deemed indispensable to people’ s lives amid the coronavirus pandemic, ” without elaborating.
Baker and cake shop owner accounted for 26.4% and retained the top spot for girls for the 24th year in a row, according to the survey, which began in 1999 and covered 2,000 girls and 2,000 boys whose guardians bought its backpacks.
For girls, doctor moved up to fourth from seventh last year and police officer moved up one spot from sixth, with both careers at record highs, while nursery school teacher climbed to sixth from 10th.
Boys who voted police officer as their dream job accounted for 16.8%, followed by 16.1% saying they want to be a professional athlete — perhaps a reflection of the impact of the Tokyo Olympics and Paralympics held last year.
YouTuber ranked at a record-high sixth for boys at 5.1%, up one spot from last year, likely a result of children increasingly watching the video-sharing website from an early age. | tech |
Soaring prices weigh on economy and keep wallets shut | Japan's household spending rose for a second consecutive month year-on-year in February, helped by a flattering comparison with last year's sharp pandemic-induced slump, but the consumer sector is now facing growing headwinds from soaring prices.
Households cut spending from the previous month as pandemic curbs, rapid food and fuel price rises and the coronavirus kept wallets shut, casting a shadow over the world's third-largest economy.
In a sign of trouble for consumer sentiment, real wage growth stagnated in February as global inflationary pressures weighed on household purchasing power.
`` Prices will outpace wage gains from now on, so consumption will be on a sluggish trend, '' said Takeshi Minami, chief economist at Norinchukin Research Institute.
`` While service spending is expected to pick up from April onwards, the likelihood is big that higher prices will weigh on other areas of consumption, '' Minami said, adding that spending was likely to pick up nonetheless.
Household spending increased 1.1% in February from a year earlier, government data showed, much weaker than the market forecast of a 2.7% gain in a Reuters poll.
The month-on-month figures showed a sharp 2.8% decline, also weaker than a forecast 1.5% drop.
The data raises some concerns for policymakers looking for ways to offset the hit households are taking from soaring global inflation and a weakening yen, which is pushing up import costs, as the economy shakes off the pandemic's drag.
Households increased spending on mobile phones as well as car insurance and parts such as batteries on pent-up demand due to price hikes, a government official said.
But slower spending on eating out, including on sushi, weighed on expenditures, as authorities prolonged pandemic curbs in response to a wave of omicron infections during the month.
A separate survey showed that activity in Japan's service sector continued to shrink in March, though the pace of contraction slowed as domestic demand got a lift from the subsequent easing of the pandemic curbs last month.
Other government data on Tuesday showed inflation-adjusted real wages hit a standstill in February, as growth of consumer prices offset gains in nominal wage growth.
Inflation-adjusted real wages, a barometer of households ' purchasing power, were flat in February from a year earlier, as price rises stripped out a gain in nominal wages, labor ministry data showed.
The consumer price index that the ministry uses to calculate real wages, which includes fresh food prices but excludes owners ' equivalent rent, rose 1.1% in February, almost double the previous month's 0.6% gain. Nominal total cash earnings increased 1.2% in February, though the gain was largely driven due to a flattering comparison to February last year, a labor ministry official said.
The economy is projected to grow in the current quarter following an expected contraction in the first three months of the year, though it is facing an unpredictable outlook in part due to the situation in Ukraine and the weak yen. | tech |
With each new crisis in Hong Kong, pressure built on a Beijing loyalist | HONG KONG – Under the watch of Carrie Lam, Hong Kong’ s chief executive, huge citywide protests deepened political divisions. A national security law silenced a once-vibrant civil society. And restrictive pandemic policies threatened Hong Kong’ s status as Asia’ s world city.
With each crisis, Lam tried to serve the will of Beijing, which controls the territory, and navigate competing pressures from residents and an international community leery of China’ s growing authoritarian grip over Hong Kong.
On Monday, those pressures appeared to boil over as Lam announced that she would not seek a second five-year term, marking the end of one of the most tumultuous periods of governance in Hong Kong’ s recent history.
Lam cited her family as the reason for her plans, saying that they were her priority and that `` they think it is time for me to go back home. ” But for some of her critics, it was Lam’ s failure to guide the city through a devastating coronavirus outbreak that was her final undoing.
In recent weeks, Lam, 64, has faced rebuke from Hong Kong residents, pro-Beijing lawmakers and the city’ s powerful business community for mishandling an omicron outbreak that has ravaged hospitals, nursing homes and public services. The surge laid bare the city’ s lack of preparedness as it struggled to deal with more than 1 million cases and over 8,000 deaths in just the past couple of months alone.
But even before the pandemic, there was mounting criticism of Lam.
Demonstrators demanding the resignation of Carrie Lam, the chief executive of Hong Kong, pack a street in Hong Kong in 2019. | LAM YIK FEI / THE NEW YORK TIMES
Once known in the Hong Kong Civil Service, where she began her career 42 years ago, as a `` good fighter ” who never backed down, Lam has struggled as chief executive to navigate Hong Kong’ s unique relationship with Beijing.
Hong Kong, a former British colony, was promised partial autonomy when it was returned to China in 1997. But its democratic traditions have often been at odds with Beijing. Lam has mostly erred on the side of seeking approval from Chinese officials, who have been accused of redefining the `` one country, two systems ” framework that was agreed upon as part of the handover.
The system was meant to allow Hong Kong to maintain some freedoms distinct from the mainland.
`` She has been one of the key actors who have buried ‘ one country, two systems’ as we understood it in the first 25 years of the handover, ” said Jean-Pierre Cabestan, a political scientist at Hong Kong Baptist University.
To many in Hong Kong, it appears that Lam has done little to respond to the growing frustrations among residents during the pandemic, failing to change rigid coronavirus policies after a fast-moving outbreak tore through the city’ s world-class hospital system and further isolated Hong Kong from other countries.
Two years into the pandemic, many of those policies have contributed to widespread unemployment and the shuttering of thousands of small businesses.
`` It seems that the government is very removed from the lives of everyday people, and can’ t seem to gauge how the policies they introduce would make our lives difficult, ” Carmen Chan, a 45-year-old office worker in the Wan Chai commercial district, said Monday.
Chan said she had been disappointed by Lam’ s administration and was somewhat relieved to hear that she would not seek another term.
Health care workers transfer a patient to a hospital in Hong Kong on March 2, during the fifth wave of the coronavirus. | BILLY H.C. KWOK / THE NEW YORK TIMES
Lam became chief executive in July 2017 after pledging her loyalty to Beijing and promising to foster a stronger sense of Chinese identity among young Hong Kong residents. But deepening polarization of Hong Kong society two years later left her the target of huge street protests in 2019. Demonstrators demanded her resignation over an extradition bill that would allow the city to detain and transfer people to mainland China.
The bill was met with strong opposition and demonstrations that lasted months.
In the wake of the protests, Beijing imposed a sweeping new national security law over Hong Kong. It also drastically revamped election rules, giving pro-Beijing lawmakers even greater power to choose the city’ s top leader and members of its legislature.
Foreign politicians were openly critical of the new law. The United States imposed sanctions on Lam and other senior officials, and Mike Pompeo, the secretary of state at the time, pledged that the United States would `` treat Hong Kong as ‘ one country, one system.’ ”
Lam referred to the protests, as well as the coronavirus and `` nonstop interference of foreign forces, ” as contributing to her decision to step down on Monday.
`` I have faced unprecedented and enormous pressure, ” she said.
As Lam rose through the Hong Kong Civil Service, first under British rule and later under Beijing, she became known for defending policy stances and refusing to back down from arguments. But over the past few months, as Hong Kong tried to hew to China’ s `` zero COVID ” policy, she was criticized as sending mixed signals regarding how the city would manage the outbreak.
Hong Kong has some of the strictest travel restrictions in the world. Uncertainty over when those restrictions would end led to the largest exodus of residents since the beginning of the pandemic. While facing increased criticism from the city’ s business sector and expatriate community, Lam doubled down on social distancing measures and an effort to make the city’ s 7.4 million people test for the virus, something that mainland public health researchers had advised the city’ s government to do.
Lam later backed away from mass testing. In late March, she said the city would lift a flight ban on nine countries and begin to relax restrictions, citing concerns that the financial sector was `` losing patience ” after officials indicated that the worst of the latest outbreak was most likely over.
News coverage of Carrie Lam, the chief executive of Hong Kong, on a television at a restaurant in Hong Kong on Wednesday. | LAM YIK FEI / THE NEW YORK TIMES
`` The problem with the chief executive in Hong Kong is that you’ ve got the left hand and the right hand, ” said Allan Zeman, an adviser to Lam and a member of the election committee that will decide the city’ s next chief executive. `` You’ ve got the international community on the one side, and China on the other hand, and you’ re in the middle. Both have different aspirations. ”
Hong Kong has reported nearly 1.2 million COVID-19 cases and 8,262 deaths, most of them tied to the recent outbreak, and many of them among Hong Kong’ s older and unvaccinated population. The city’ s fatality rate from the virus was at one point among the highest in the world, at 3 per 100,000 residents, in large part because so many older people were not vaccinated, seen as an example of Lam’ s failure to prepare for the outbreak.
`` Her authority and ability to govern have been severely eroded, ” said Lau Siu-kai, a Hong Kong scholar who advises Beijing on policy, referring to her handling of the protests and pandemic. `` Her departure will allow Beijing to form a new and more powerful team to attain a stronger and more effective government. ”
Addressing speculation on Monday that Hong Kong’ s No. 2 official, John Lee, would be a favorite to replace her, Lam said that she had yet to receive a resignation from any government officials, a precursor to making a bid for the job.
She also said that she would focus on pandemic-related work until the end of her term on June 30. On Saturday, government officials issued a statement exempting candidates for chief executive from some social distancing rules while campaigning.
Hong Kong’ s chief executive is determined every five years in a vote closely managed by Beijing and determined by an election committee made up of nearly 1,500 officials who back the Communist Party. The election was to take place on March 27, but was postponed until May 8 amid Hong Kong’ s omicron surge.
With Lam’ s announcement on Monday, questions about her desire for a second term were put to rest. But little else was certain beyond that. `` Plans keep changing. Everything is unstable. I don’ t know who will be next. I hope it will get better, ” said Chan. `` But I don’ t really expect it to. ”
This article originally appeared in The New York Times. © 2022 The New York Times Company | tech |
Cork Prison adopts new restrictions after 90 Covid cases | Cork Prison. File picture
Around 90 prisoners have tested positive for Covid-19 in Cork.
The Irish Prison Service ( IPS) confirmed that `` a number of prisoners have tested positive '' for the virus in Cork and Arbour Hill Prison.
In a statement, the prions service said that 87 prisoners in Cork Prison had tested positive for the virus yesterday. | general |
Balkanization is the future of the global economy | A U.S.-China trade war, the COVID-19 pandemic and Russia’ s invasion of Ukraine are three blows that spell, for a growing number of observers, an end to globalization.
While there is a powerful rebuttal, I’ m with the pessimists. The terms of international engagement, and economic activities in particular, are changing. That’ s natural and proper as power and principles themselves evolve.
Key to this world order is the role of new and emerging technologies. Ironically, these tools and the connectivity that they facilitated encouraged globalization; now, they are seen as sources of vulnerability. The resulting suspicion and fear are splintering — Balkanizing — the global economy. It isn’ t quite deglobalization but it’ s just as pernicious.
A long-simmering debate among academics and policy folks burst into the real world a few weeks ago when Larry Fink, head of BlackRock, the world’ s largest asset management company, sent a letter to investors arguing that the end of globalization was nigh. The COVID-19 pandemic raised awareness of dangers associated with global supply chains for crucial goods, and the war in Ukraine turbocharged that sense of vulnerability.
“ While dependence on Russian energy is in the spotlight, ” Fink explained, “ companies and governments will also be looking more broadly at their dependencies on other nations. ”
The combination he said, “ has put an end to the globalization we have experienced over the last three decades. We had already seen connectivity between nations, companies and even people strained by two years of the pandemic… ( this has) had profound effects on political, economic and social trends. The impact will reverberate for decades to come in ways we can’ t yet predict. ”
Not everyone agrees. Ngozi Okonjo-Iweala, director-general of the World Trade Organization, counters that trade diversification is the best way to build resilience. “ This is not the time to retreat inward, ” she said last week. She continues to believe that international supply chains are the best way to diversify risk. “ This is the time to stress the importance of multilateralism, global solidarity and cooperation. ”
U.S. Treasury Secretary Janet Yellen flatly disagrees with charges that the U.S. is turning inward. “ I really have to push back on that, ” she said last month. “ We’ re deeply involved in the global economy. I expect that to remain, it is something that has brought benefits to the United States and many countries around the world. ”
Many executives agree with her. Despite calls to decouple from China, Apple now uses more suppliers from China than it does from Taiwan. Apple is not unique. According to the Peterson Institute for International Economics, China’ s inbound foreign direct investment in 2021 rose by a third to reach $ 334 billion, an all-time high.
Pressures to disconnect remain formidable, however. First, there is geopolitics. The U.S.-China trade war has separated the world’ s leading economies, but that is the expression of more fundamental forces. The two countries are locked in a struggle for supremacy in the Indo-Pacific region, a competition with consequences for global power and position. In this world, interdependence is often viewed as a means of creating vulnerability. Domestic capability is to be nurtured to decrease threats; engagement is promoted as a way of increasing access to and vulnerability in a rival.
While the U.S. has taken the most heat for pushing for decoupling, China isn’ t blameless. Beijing has promoted self-reliance throughout its reform and opening period; fears about hypothetical economic security risks became real in the sanctions campaign against Russia. ( Keyu Jin makes this case in last weekend’ s JT article, although I don’ t think one can blame the U.S. for China’ s pursuit of self-reliance to the extent that the author does.) Europe too, is alert to these dangers and is trying to minimize them by adopting “ strategic autonomy, ” as is Japan as it incentivizes companies to reshore manufacturing at home.
Technology is a second driver. Divisions widen as threats flow to and through technology. Some governments worry about the free flow of information that undermines their precious national narratives; limiting access to media sources — the Great Firewall — is the result. Governments are sensitive to who manufactures equipment in critical infrastructure, fearful that adversaries will install backdoors or kill switches that can be used in times of crisis. The fear that technology will create an advantage in military situations results in trade controls that limit foreign access to cutting-edge innovations.
Then there are the new technologies’ economies of scale, which not only maximize utility, but create revenue for R & D and lay the ( literal) foundation for future generations of tech. Since mastery of the frontiers of emerging technology is central to strategic competition and economic success, governments have more incentive to promote indigenous technologies and discourage adoption by competitors. This makes international standard setting — which promotes certain technologies — an increasingly feverish arena of competition.
The third pressure comes from the business community. Geopolitical risk has become a weightier consideration in the C-suite. In some cases, governments force this on businesses, as when the West sanctions Russian entities and those who choose to do business with them.
In other cases, companies internalize those concerns on a more permanent basis. This is most evident in the vogue for ESG ( environmental, social and governance) to measure and evaluate business performance. ESG principles reflect the efforts of businesses to act consistent with social goals. Once the province of “ do-gooders, ” ESG principles are big business. Global ESG assets ( invested to meet those metrics) exceeded $ 35 trillion in 2020, and may, according to one estimate, top $ 41 trillion by 2022 and $ 50 trillion by 2025, about one-third of projected total assets under management worldwide. Executives ignore them at their peril.
David Lee, a business consultant who teaches at Hong Kong University, roots ESG investing in the long-standing debate over business purpose. ESG principles empower stakeholder interests, challenging the predominant paradigm ( in the U.S. at least) that puts shareholder interests first.
As companies internalize ESG values, decoupling will be reinforced. While some ESG standards, like those dealing with the environment, align with Chinese government interests, others, like those for labor, do not. ( China isn’ t the only government likely to object; it is hard to see many of the countries that abstained on the United Nations vote to condemn Russia’ s invasion of Ukraine backing ESG standards.) ESG compliance also depends on independent audits, an increasingly fraught activity in some countries as a result of political sensitivities.
Financial segregation looks inevitable and is already gaining steam. As the U.S. calls to cut China off from U.S. stock markets, Beijing is trying to price its purchases of vital commodities in yuan. Edward Alden, a senior fellow at the Council on Foreign Relations, spelled out the implications in The New York Times: “ What we’ re headed toward is a more divided world economically that will mirror what is clearly a more divided world politically …. I don’ t think economic integration survives a period of political disintegration. ”
Attentive readers will note a shift in language when I noted that ESGs will encourage decoupling. Decoupling is a very specific form of economic re-engineering: It is focused on China. To be more precise, current trends will encourage the rerouting of supply chains out of problematic countries; global production networks will persist. To be even more precise, the most intense pressure ( at least from governments) will concern particular high-tech products. There is little concern about supply chains for many consumer goods. ESG investors won’ t be as sanguine, however.
The result will be a patchwork, with a thin weave of connections spanning the entire world and thicker links joining like-minded societies. The image that comes to mind is of a barbell, not a web. The big question is whether the centripetal force that holds each group together is stronger than the centrifugal force that binds them all. That will be the difference between peaceful coexistence or increasingly violent confrontation.
Brad Glosserman is deputy director of and visiting professor at the Center for Rule-Making Strategies at Tama University as well as senior adviser ( nonresident) at Pacific Forum. He is the author of “ Peak Japan: The End of Great Ambitions ” ( Georgetown University Press, 2019). | tech |
FDA pulls authorization for GSK-Vir's COVID therapy as BA.2 cases rise | The U.S. health regulator said on Tuesday GlaxoSmithKline and Vir Biotechnology's antibody therapy was no longer authorized as a COVID-19 treatment, with data suggesting it was unlikely to be effective against the dominant Omicron sub-variant in the country.
The move by the agency, which had already pulled its authorization for the sotrovimab therapy in much of the U.S. northeast last month, sent shares in Vir Biotechnology 11.5% lower.
The highly contagious BA.2 coronavirus sub-variant is estimated to make up about three of every four COVID-19 cases in the United States, according to the latest government data.
GlaxoSmithKline and Vir have said treatment with sotrovimab retains neutralizing activity against the BA.2 sub-variant, but others, including researchers from Columbia University, disagree.
Vir Biotechnology in a filing with the Securities and Exchange Commission said the two companies were preparing a package of data to support the use of a higher dose of sotrovimab for the Omicron BA.2 sub-variant, which will be shared with regulators globally, reiterating the companies ' plan from last month.
Vir still expects to recognize about $ 1.1 billion in collaboration revenue when sotrovimab doses are delivered in the first half of 2022.
The companies also plan to submit an application for full approval of the drug in the second half of the year, and expect to start two late-stage trials in the second quarter to assess whether sotrovimab can prevent symptomatic COVID-19 infection in immunocompromised patients, Vir said.
GSK spokeswoman Lyndsay Meyer said the company will continue to work with governments and health systems, and ensure ongoing access to sotrovimab. ( Reporting by Leroy Leo and Bhanvi Satija in Bengaluru; Editing by Shounak Dasgupta and Vinay Dwivedi) | business |
NIKE, INC. MANAGEMENT 'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND RESULTS OF OPERATIONS ( form 10-Q) | OVERVIEW
For more information, see Note 14 - Restructuring within the accompanying Notes to the Unaudited Condensed Consolidated Financial Statements.
COVID-19 UPDATE
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© Edgar Online, source Glimpses | business |
Future factories will thrive with big data, Toyota exec says | DETROIT — Assembly plants will become more flexible and agile thanks to the rise of big data, the shift to electric vehicles and increased visibility into the supply chain, a Toyota Motor Corp. manufacturing executive said Tuesday.
Brian Eggleston, Toyota general manager, strategy and planning, told attendees at SAE International's World Congress Experience in Detroit that the industry's transformation is giving companies an `` amazing opportunity to re-imagine the infrastructure '' they have come to rely on in recent decades.
He said assembly plants are beginning to leverage huge amounts of data from their machines, giving the company more insight into how to make their production lines more efficient — potentially changing the role of humans in the factory.
`` We are going to be able to get the work force further and further away from repetitive action that takes less thought and move towards decision-making, '' Eggleston said. `` How we present the data to the work force is going to be so important. We have to use the most important part of the human: their brains, not their hands or their feet. ''
Eggleston's remarks come during a period of intense new investment in factories, as automakers electrify their lineups to meet growing demand for EVs and looming government mandates. But at the same time, manufacturers are dealing with unprecedented challenges, including the impacts of the COVID-19 pandemic and supply chain disruptions stemming from the semiconductor shortage and the war in Ukraine.
Given the outlook for ongoing uncertainties, Eggleston said it will be critical for automakers and suppliers to become `` more integrated, '' moving forward by sharing real-time data on how many parts a supplier has on hand, as well as greater insight into the supplier's supply chain.
It will be important for all to be visible to automakers, he said `` and even to our dealer network, so that they can give our consumers a better idea of what's available now and what sort of wait times they might expect given that entire supply chain. ''
SAE International kicked off its World Congress Experience on Tuesday in downtown Detroit. It will run through Thursday. | general |
Bills to alter Florida's car titling law fail in state Legislature | Two bills aimed at giving Florida auto dealers more leeway in turning over vehicle titles to car buyers fizzled out last month in the Florida Legislature.
Florida's current titling statute says dealers `` must '' obtain vehicle titles in purchasers ' names and transfer them within 30 days of sale. At the start of the year, a small handful of Florida lawmakers sought to loosen that deadline and ease penalties for COVID-19 pandemic-affected dealers who don't make it.
The bills made it to committees in the state Senate and House, but they ultimately did not move forward because the Legislature was preoccupied, according to state Rep. Andrew Learned, who in January joined as a state House co-sponsor of the legislation.
`` I don't think [ titling issues are ] top of mind for a lot of people, so it's definitely something that takes a little education, '' said Learned, a Tampa Democrat, who spoke with Automotive News on Monday. `` Whenever something takes a little education, you got 120 members that all need a little education. ''
State Sen. Tom Wright, a Republican, filed S.B. 1346, the first version of the bill, in the state Senate on Dec. 21. An identical bill, H.B. 1517, was filed in the state House by Rep. David Smith on Jan. 10.
The legislative session, which ended March 11, was dominated by lawmakers focusing on bread-and-butter issues that affect Floridians and hyperpartisan matters, Learned said. As a result, he said, the vehicle titling bills were moved to the back burner.
The changes proposed in the set of bills attracted a bit of concern from regulators. The initial version of the legislation would have revised the statute to say dealers `` should '' apply for those titles within 30 days, not `` must '' obtain. | general |
Over 4,000 people apply to be astronauts with Japan's space agency | The Japan Aerospace Exploration Agency said Tuesday a record 4,127 people applied to become astronauts for the agency as it opened recruitment for the first time in 13 years with an eye on sending people to the International Space Station and on U.S.-led lunar exploration missions.
The all-time-high number comes as the agency for the first time dropped the requirement that candidates have a university education. The change was made in the hope of recruiting people with a wide range of experience.
However, applicants were required to have at least three years of work experience as of late March, with some academic qualifications being considered as meeting this requirement.
Of the 4,127, 919 were women, or 22.2%, falling short of the agency's goal to have female candidates account for 30% of the entire applicants.
Those selected after an initial screening will go through four rounds of examinations. JAXA aims to finish the recruitment process by February next year, with the number of successful applicants not decided in advance.
The average age of JAXA's active astronauts is over 52. With their retirement age set at 60, there may be only two active astronauts left by 2030, the agency said.
`` We hope people with extraordinary talent will be selected so they can take charge of lunar exploration in the future, '' science minister Shinsuke Suematsu said at a news conference.
The number of hopefuls is about 4.3 times higher than the 963 in the previous recruitment opening in 2008, with that number likely impacted by a JAXA decision to extend a deadline for the submission of medical reports, taking into account that health checks may have been delayed by the coronavirus pandemic. | tech |
Vivek Vadoliya’ s book Mallakhamb is a study of movement and light | found a troupe of Mumbai’ s young mallakhamb practitioners brimming with nothing but pride and confidence.
Mallakhamb is an ancient practice originating in the Indian subcontinent that sees people perform remarkable aerial movements, usually atop a pole or suspended by rope. The London-based imagemaker had come across the practice by chance during an extended stay in India prior to the pandemic. “ I have some friends that live next to this park, called Shivaji Park, and it’ s absolutely packed with thousands of kids playing cricket, but in the corner there’ s kids that do mallakhamb, ” he tells us.
It was a stroke of luck, since it tied into themes he had been exploring through his visual practice, namely “ the body and representation, and particularly looking at masculinity quite a lot ”, explains Vadoliya, whose portfolio of fashion collaborations and personal series have often examined those dynamics in relation to south Asian identity.
Mallakhamb is often described as a blend of gymnastics and yoga but was in fact born from centuries-old martial arts. “ As I started researching it I realised it was used as a way for men, warriors, to train their bodies for combat. I found that quite mesmerising, and thought there was a visual language that came from that as well: of strength, but also there’ s a lot of vulnerability in the body movements, the way they have to let go and tie their bodies onto ropes and hope they fell into this particular position. I found that very poetic. ”
In this body of work, there is a beautiful symmetry in the way Vadoliya captures the young people and their equipment – from a torso twisted like fibres of a rope, to a cord threaded as artfully as mallakhamb position.
Though it is an intensely physical practice, Vadoliya captures the seemingly effortless composure and sense of pride in its young practitioners. It was something that happened naturally, he says: “ I didn’ t really ask them to pose a lot. It was really how they presented themselves. ”
It’ s perhaps a by-product of his openness towards the direction of the shoots. “ I think there was a lot of collaboration with that. They were like, ‘ oh we love going up this tree’, so they really just wanted to climb it and show that, and I think for me I found that tree to be so beautiful. ”
Vadoliya felt inclined to capture an art that has been overlooked on a world stage, despite its parallels with other physical activities that translated to the global mainstream, such as yoga. “ I thought there was something quite beautiful about showing the origins of some of the [ yoga ] moves, ” he says. “ And I don’ t think many people know about mallakhamb, as I didn’ t at the time either. From my research I’ m understanding that during British rule, it was not practised as much – I think like other things … people just didn’ t get a chance to practise it. I think during that time it was definitely more cricket and other sports. ”
However, mallakhamb has been enjoying a resurgence, thanks to the likes of Uday Deshpande, the director of the local club Vadoliya worked with, who is making strides in promoting it around the world. A proportion of the profits will go back to the club ( and Covid-19 relief in India), and Vadoliya hopes it will serve as a “ nice document for them to use and to help celebrate the sport ”.
For Vadoliya the project was an exercise in representing movement. “ Something that I’ m working on quite a bit in my work is: how can I make my stills projects more moving, and my moving projects more still? ” he explains, mentioning plans to go back to create an accompanying film.
“ Some of the poles are really high and the girls that work on the ropes, it’ s really quite high up, so it was challenging to capture that in a way that didn’ t feel too overwhelming, ” he explains. In a small sequence of black and white edits, Vadoliya isolates their moves, their bodies dislocated from the surrounding cityscape. But for the most part, the aerial movements and the intervening moments of camaraderie are cushioned by trees, architecture, and a palette of warm clay and sand.
Those colours were achieved largely through timing; they practise around school hours, particularly in the evenings after the hot Mumbai sun has retreated, though Vadoliya opted to shoot across several mornings instead to get that “ golden light ”. The photographs may take young people and their acrobatic art as the subject, but all the while Vadoliya is performing his own dance of light and shadow.
vivekvadoliya.com | business |
The 3 simple steps to better FX rates for your business, forever. | In the world of foreign currency and cross border payments, SMEs are the worst off every time and frankly, I’ m tired of it. In my 25+ years working closely with SMEs, their needs and knowledge gaps on the subject have stayed the same and unfortunately, so have the significant losses that come from poor or no foreign exchange strategy. Last year alone, a whopping average $ 32,500 was overspent on foreign exchange rates by SMEs - this would never be the case for large corporations, and it’ s overdue for change. FX issues affecting SMEs There’ s a lot tied up in the knowledge and motivation void when it comes to SMEs and their international payments, particularly as so much is in flux, like rates, business goals, individual opinion. At the same time, so much remains dependent on the style of each business and its owners. This means it’ s different for everyone, at every stage. It’ s definitely not a one size fits all, or even a few, when it comes to managing and planning foreign currency. This only adds to the complication and high task of understanding it all. Unhelpfully, the foreign currency market has become even more volatile over the last decade and to add to that, every other year we have various socio-economic and political events that shift the currency market further. Things like the Trump victory, Brexit and the Covid-19 pandemic have caused seismic changes in one single day and figures show there’ s been an average annual move of about 20% in the AUD and 14% in the GBP. This sort of volatility can effectively wipe out one year’ s profitability for a small business. While business owners understand their most obvious needs with foreign currency - better rates that reduce their costs – my experience has shown me time again they’ ve never prioritised taking the time to understand and define what a better rate looks like for them, let alone planning how to get it. I understand why, but it’ s time for change now. What SMEs can do to get a better FX rate The most important step is to look at what you’ re doing with foreign currency and reframe its importance in your business. If you’ ve read this far, it probably plays a big part and deserves more attention. Here’ s a brief breakdown of the steps for some decent analysis of your existing currency strategy. Step1: Who are you using for your foreign currency? Using just one provider, which likely will be your bank, can be a problem. In 2020, the loyalty tax on SMEs exclusively using their banks saw them paying on average 10x more than their corporate counterparts for foreign currency. Instead, using smart technology to help assess your future foreign invoice requirements is the best method here for a well-rounded review of your foreign currency posture. With analysis of previous rates and invoice amounts next to your upcoming invoices enables you to take advantage of tech that provides intelligence on foreign currency. ‘ Am I using the right providers for this invoice?’ Growth is huge for SMEs. Doing $ 20,000 one month to $ 200,000 in the next means the business needs to evolve and change too. By continuously questioning ‘ am I using the right providers for this invoice?’ and leaning on smart tech, you’ ll be getting more out of your sales. Step 2: How are you getting your foreign currency? Hoping you get a good rate on the day of your payment doesn’ t make for a strong strategy. But, buying little and buying often is. The idea - and goal - is to achieve an averaging effect to smooth out the substantial peaks and troughs in the market to really make your business resilient. When going to your providers, remember it’ s a marketplace: knowledge is power and it’ s all about leverage. It’ s important to know beforehand exactly how much you need and what rate you need it at. Remember, you’ re not asking for ‘ the rate’, you’ re asking for ‘ their price’. There’ s a difference. Step 3: What am I risking with my foreign exchange? Those first two steps will get you in good stead quickly, but the best gains come to the business with a long term plan. Foreign currency is intrinsic to your business’ success, so your plan has to start with what matters most to your unique business. The best plans address these three business risks first before they finally set a goal for their FX plan. Risk 1: Your customer. How quickly can you change your pricing if your costs increase? Insight: You risk losing market share by changing pricing too often. Customer loyalty is a two-way street. Much like we would prefer consistent income figures, the customer also wants this in their purchases. As your pricing changes to account for currency fluctuations, it’ s likely your customers will move on to those whose prices are stable, leaving you at high risk of diminishing market share in your sector. Risk 2: Your business margin. How much of your FX risk are you willing to absorb? Insight: When you hide your losses in your margin, you’ re reducing the sale value of your entire business by a multiple of 2 to 4 times that amount. For many, absorbing the fallout isn’ t a conscious decision and if it is, it’ s not often considered a choice when it comes to foreign exchange. As with all things associated with the bottom line, we only want the best but hiding FX losses can seriously reduce the overall value of your business and have negative long-term repercussions affecting external investment, strategy and planning. Risk 3: How much change in the rate can you and your business stomach? Insight: 90% of business owners risk way too much and then panic buy currency at a worse rate. Fear and business don’ t mix well and I’ m sure in all other facets of your business, your risks are limited or they’ re at least far more calculated. This comes back to the lack of expertise and time that SMEs have in the realm of FX affecting more than just a “ less than ideal ” rate on a single month’ s invoice. After understanding your risk, develop a strategy that reflects your business objectives and strategy, as well as the style of you, the business owner. If you’ re not comfortable with it, it won’ t work. Optimistic words to finish I get it, dealing with foreign currency is hard, time consuming and the rewards aren’ t always instantly felt. Your situation changes as does the market so it can feel like you’ re continuously peddling on the spot. But the good news is that we are in a different age now, one of better technology and more automation. So then, utilise your accounting software’ s analytics, and any add-ons in their marketplace to help view your foreign invoices in a different light. Ultimately though, making the time to reflect and assess how big a part foreign currency plays in your business will drive the change for better FX rates.
821 | tech |
How Sonic Boom Risk Informs 'Physical Loss ' For COVID Era | The COVID-19 business interruption coverage battles often center on whether there has been tangible direct physical loss or damage to insured property. [ 1 ] Insurers argue that the mere presence of a virus that can not be seen either in transmission or on property, such as tables and countertops, can not cause property damage as defined in their policies.However, for at least 60 years, the industry has recognized that direct physical loss or damage is a flexible term and utilized language to either include such damages or exclude it by specifically requiring, for example, direct physical contact and loss. [ 2 ] We traced this origin, or... | general |
Cato Networks Adds Risk-Based Access Controls to SASE Platform | Cato Networks today revealed it has added risk-based access controls to its managed secure access service edge ( SASE) platform.
Eyal Webber-Zvik, vice president of product marketing at Cato Networks, said this capability makes it possible to automatically apply security policies in real-time to any device that connects to the network and can limit access or the amount of bandwidth that might be allocated.
This capability has been embedded within a Cato single pass cloud engine ( SPACE) to provide more contextual awareness, he added. Security teams can grant levels of access without having to completely disrupt an end user’ s experience, noted Webber-Zvik. The goal is to strike a balance between the need for security and the productivity of the end user, he added.
Cato SPACE achieves that goal by continuously assessing the posture of any device attached to the network. Policies can be automatically applied based on identity, network, data use or whenever a device falls out of compliance, said Webber-Zvik.
With more employees working from home in the aftermath of the COVID-19 pandemic, enforcing security policies has become more challenging. Cato Networks is making a case for a managed SASE platform that provides secure access to the software-defined wide area network ( SD-WAN) it manages for a wide range of organizations. Rather than requiring organizations to backhaul network traffic through a local data center, it becomes possible to give remote users direct access to a wide range of cloud services and on-premises IT environments. Each organization can either opt to rely on Cato Networks to manage the entire service or continue to manage end-user access to that network themselves.
It’ s not clear at what rate organizations are shifting toward SASE-based approaches for managing remote access. However, even as employees begin to return to the office more regularly, the number of employees that work from home has substantially increased. Many of those end users will at some point attempt to connect a new device to a corporate network. Keeping track of which users are accessing IT resources in what has become a much more dynamic environment presents a major challenge as more organizations attempt to enforce zero-trust security policies. As a result, the number of organizations that are opting to rely on network services that are managed and secured by a third party is steadily increasing.
Bring-your-own-device ( BYOD), of course, represented a significant security challenge even before the pandemic. Today, BYOD within organizations is often the rule rather than the exception. Organizations need a level of flexibility that is difficult to attain and maintain by an internal IT team on their own, noted Webber-Zvik.
One way or another, the way applications are accessed has forever changed in the era of the cloud. The lingering issue is how those applications will be safely accessed at a time when both the volume and sophistication of cyberattacks only continue to increase.
Mike Vizard is a seasoned IT journalist with over 25 years of experience. He also contributed to IT Business Edge, Channel Insider, Baseline and a variety of other IT titles. Previously, Vizard was the editorial director for Ziff-Davis Enterprise as well as Editor-in-Chief for CRN and InfoWorld.
mike-vizard has 389 posts and counting.See all posts by mike-vizard | general |
Qualys Extends Scope and Reach of EDR Cloud Service | Qualys this week updated its multi-vector endpoint detection and response ( EDR) service to add additional threat-hunting and risk mitigation capabilities along with improved alert prioritization capabilities.
Hiep Dang, vice president of endpoint security solutions for Qualys, said the 2.0 release of the multi-vector EDR service from Qualys now makes it easier to operationalize tactics and techniques identified with the MITRE ATT & CK knowledge base by providing security teams with insights into the actual severity of a potential threat in real-time.
Armed with those insights, Dang said it then becomes simpler to orchestrate responses based on vectors such as asset criticality, type of vulnerabilities, misconfigurations and recommended patches.
The multi-vector EDR service is an extension of the Qualys Cloud Platform that employs a single agent to drive a wide range of security and compliance workflows, all of which are managed via a unified dashboard. That approach significantly reduces the level of effort security operations teams would otherwise expend to integrate multiple security platforms based on agents provided by different vendors, noted Dang.
The Qualys Cloud Platform also helps prioritize which incidents security operations teams should focus on based on the actual risk represented using its integration with a vulnerability and patch management service, added Dang. Finally, a security team can also more easily move beyond a single malware incident to easily identify all the existing endpoints that might be susceptible to a similar attack, he noted.
In contrast, Dang claimed rival EDR platforms still focus solely on endpoint activity to detect attacks based on the techniques identified in the MITRE ATT & CK knowledge, but not the tactics employed. In the absence of that tactical insight, most organizations will find they need to acquire additional tools to gain the level of visibility required to thwart attacks against endpoints, he added.
Dang said there are now more than 70 million instances of the Qualys agent installed. The sizeable install base provides the foundation upon which the company can extend the security and compliance services it delivers via the cloud. In the wake of the COVID-19 pandemic, a shift toward centralizing the management of security and compliance in the cloud has been greatly accelerated at a time when the endpoints that need to be managed and secured have never been more distributed.
There is, of course, no shortage of options when it comes to cloud security services. The real issue is to what degree organizations can rationalize the number of agents deployed on endpoints. Each new type of agent not only consumes additional CPU resources on the endpoint but also presents security operations teams with an integration challenge as they attempt to normalize the data collected by various agents.
In the meantime, it’ s apparent that cybercriminals are getting more adept at infesting various types of endpoints with malware that might not lie dormant for weeks or even months before being activated. Cybersecurity teams, as a result, are in a perennial race against time to discover and neutralize that malware before it ever gets activated.
Mike Vizard is a seasoned IT journalist with over 25 years of experience. He also contributed to IT Business Edge, Channel Insider, Baseline and a variety of other IT titles. Previously, Vizard was the editorial director for Ziff-Davis Enterprise as well as Editor-in-Chief for CRN and InfoWorld.
mike-vizard has 389 posts and counting.See all posts by mike-vizard | general |
The medical algorithmic audit - The Lancet Digital Health | Artificial intelligence systems for health care, like any other medical device, have the potential to fail. However, specific qualities of artificial intelligence systems, such as the tendency to learn spurious correlates in training data, poor generalisability to new deployment settings, and a paucity of reliable explainability mechanisms, mean they can yield unpredictable errors that might be entirely missed without proactive investigation. We propose a medical algorithmic audit framework that guides the auditor through a process of considering potential algorithmic errors in the context of a clinical task, mapping the components that might contribute to the occurrence of errors, and anticipating their potential consequences. We suggest several approaches for testing algorithmic errors, including exploratory error analysis, subgroup testing, and adversarial testing, and provide examples from our own work and previous studies. The medical algorithmic audit is a tool that can be used to better understand the weaknesses of an artificial intelligence system and put in place mechanisms to mitigate their impact. We propose that safety monitoring and medical algorithmic auditing should be a joint responsibility between users and developers, and encourage the use of feedback mechanisms between these groups to promote learning and maintain safe deployment of artificial intelligence systems.
Artificial intelligence systems for health care, like any other medical device, have the potential to fail. However, specific qualities of artificial intelligence systems, such as the tendency to learn spurious correlates in training data, poor generalisability to new deployment settings, and a paucity of reliable explainability mechanisms, mean they can yield unpredictable errors that might be entirely missed without proactive investigation. We propose a medical algorithmic audit framework that guides the auditor through a process of considering potential algorithmic errors in the context of a clinical task, mapping the components that might contribute to the occurrence of errors, and anticipating their potential consequences. We suggest several approaches for testing algorithmic errors, including exploratory error analysis, subgroup testing, and adversarial testing, and provide examples from our own work and previous studies. The medical algorithmic audit is a tool that can be used to better understand the weaknesses of an artificial intelligence system and put in place mechanisms to mitigate their impact. We propose that safety monitoring and medical algorithmic auditing should be a joint responsibility between users and developers, and encourage the use of feedback mechanisms between these groups to promote learning and maintain safe deployment of artificial intelligence systems.
Advances in artificial intelligence have attracted substantial interest for their potential applications in health care, particularly systems based on deep learning and neural networks. A large body of literature has been published proposing solutions based on artificial intelligence or machine learning for disease detection, classification, or prediction, or even as therapeutic interventions, including titration of drug dosages or offering mental health support through artificial intelligence chatbots.1Liu X Faes L Kale AU et al.A comparison of deep learning performance against health-care professionals in detecting diseases from medical imaging: a systematic review and meta-analysis.Lancet Digit Health. 2019; 1: e271-e297Google Scholar, 2Nagendran M Chen Y Lovejoy CA et al.Artificial intelligence versus clinicians: systematic review of design, reporting standards, and claims of deep learning studies.BMJ. 2020; 368: m689Google Scholar
In the past 2 years, there has been a shift in emphasis from reporting impressive performance results to active investigation of algorithmic errors and failure modes.3Wiens J Saria S Sendak M et al.Do no harm: a roadmap for responsible machine learning for health care.Nat Med. 2019; 25: 1337-1340Google Scholar, 4Schulam P Saria S Can you trust this prediction? Auditing pointwise reliability after learning.Proc Mach Learn Res. 2019; 89: 1022-1031Google Scholar, 5Pooch EHP Ballester P Barros RC Can we trust deep learning based diagnosis? The impact of domain shift in chest radiograph classification.in: Petersen J Estépar RSJ Schmidt-Richberg Thoracic image analysis. Springer, Cham2020: 74-83Google Scholar, 6Mahajan V Venugopal VK Murugavel M Mahajan H The algorithmic audit: working with vendors to validate radiology-AI algorithms—how we do it.Acad Radiol. 2020; 27: 132-135Google Scholar Indeed, the analysis of error cases is a minimum reporting requirement of the SPIRIT-AI ( Standard Protocol Items: Recommendations for Interventional Trials–Artificial Intelligence) and CONSORT-AI ( Consolidated Standards of Reporting Trials–Artificial Intelligence) guidelines for clinical trial protocols and reports of artificial intelligence interventions.7Liu X Cruz Rivera S Moher D et al.Reporting guidelines for clinical trial reports for interventions involving artificial intelligence: the CONSORT-AI extension.Nat Med. 2020; 26: 1364-1374Google Scholar, 8Rivera SC Liu X Chan A-W et al.Guidelines for clinical trial protocols for interventions involving artificial intelligence: the SPIRIT-AI extension.Nature Med. 2020; 26: 1351-1363Google Scholar This change in focus from evaluating the best performance an artificial intelligence system can achieve, to identifying the worst mistake it could make, aligns with the foundational maxim embedded in medical safety: first, do no harm. The question of medical artificial intelligence safety is being asked at a crucial time, when this is no longer a theoretical concern but an immediate issue as, increasingly, artificial intelligence systems are receiving regulatory approval and being implemented in clinical care.
Why are artificial intelligence systems different from other medical interventions? Concerns have been raised that, unlike other interventions, artificial intelligence systems can yield errors that are difficult to foresee or prevent, due to the very nature of these systems. Modern artificial intelligence systems, particularly those based on deep learning, establish complex and opaque mathematical relationships between the input data and the output predictions, with little to no human control over how predictions are generated. Although this gives rise to a powerful machinery for learning patterns in the data, there is also a considerable risk of learning spurious correlations: relationships that appear useful in training but are unreliable when applied to real-world data. For example, an artificial intelligence system might learn to detect surgical skin markings to diagnose skin cancer, rather than looking for features related to the lesion itself.9Winkler JK Fink C Toberer F et al.Association between surgical skin markings in dermoscopic images and diagnostic performance of a deep learning convolutional neural network for melanoma recognition.JAMA Dermatol. 2019; 155: 1135-1141Google Scholar Importantly, the errors of artificial intelligence systems appear to be quite distinct from the errors of human experts. In medical imaging, the majority of human errors ( 60–70%) are related to perceptual failure, caused by factors such as the subtlety of visual findings, incomplete search of the entire image, and so-called satisfaction syndrome ( in which finding an abnormality makes the reader less likely to find a second one).10Degnan AJ Ghobadi EH Hardy P et al.Perceptual and interpretive error in diagnostic radiology—causes and potential solutions.Acad Radiol. 2019; 26: 833-845Google Scholar By contrast, artificial intelligence is not susceptible to incomplete searches or satisfaction syndrome. In this context, it is entirely reasonable to expect that artificial intelligence systems of equal performance to human readers will produce different errors, which can lead to different clinical outcomes.
The concept known as the artificial intelligence performance gap can be caused by a variety of factors, including those related to the algorithm's development, the input data, and interactions with users and the deployment environment. During development, the model design and training strategies, as well as the choice of training data ( eg, poorly labelled or under-representative data) can directly influence the algorithm's performance. Mismatch or incompatibility of input data used during deployment can arise from various types of dataset shift ( including population shift, annotation shift, prevalence shift, manifestation shift, and acquisition shift).11Du-Harpur X Arthurs C Ganier C et al.Clinically relevant vulnerabilities of deep machine learning systems for skin cancer diagnosis.J Invest Dermatol. 2021; 141: 916-920Google Scholar Interactions with users and the deployment environment are subject to automation bias, human error, and unintended or intended misuse.12Lyell D Coiera E Automation bias and verification complexity: a systematic review.J Am Med Inform Assoc. 2017; 24: 423-431Google Scholar Additionally, the reasons for unexpectedly poor performance can be non-obvious even after human inspection, and subtle or even unnoticeable differences in the input data might lead to catastrophic failure. This occurrence relates to the underlying mathematical approximations that artificial intelligence systems use to map input data ( eg, a medical scan) to target outputs ( eg, a diagnostic label). Generally, we can assume that artificial intelligence systems will operate well within the space mapped out by the training data ( a process called interpolation), but perform poorly on out-of-distribution data that require extrapolation. Intuitively, the further an input sample is away from the statistical distribution of the training data, the more unpredictable becomes the behaviour and outputs of the artificial intelligence system. Unfortunately, given the complexity of most medical data, it can be difficult to define which cases are in-distribution and which are out-of-distribution. Furthermore, this drop in performance might not be obvious at the aggregate level of typical artificial intelligence testing, but rather in subsets of the target cohort or specific strata within the input data, a concept that has been described as hidden stratification.13Oakden-Rayner L Dunnmon J Carneiro G Ré C Hidden stratification causes clinically meaningful failures in machine learning for medical imaging.Proc ACM Conf Health Inference Learn. 2020; 2020: 151-159Google Scholar These factors all contribute to the performance gap between preclinical testing and real-world deployment, and current evaluation strategies are ill-suited to identifying the problem.14McCradden MD Stephenson EA Anderson JA Clinical research underlies ethical integration of healthcare artificial intelligence.Nat Med. 2020; 26: 1325-1326Google Scholar
We define algorithmic errors as any outputs of the artificial intelligence system which are inaccurate, including those which are inconsistent with the expected performance and those which can result in harm if undetected or detected too late. Within these, there is a category in which the output might be correct but the algorithm is clearly informed by a flawed decision-making process. We suggest that these should also be considered algorithmic errors, because they indicate a high risk of future errors and should therefore be treated with similar levels of caution to standard output errors. If there is a pattern or systematic nature to the occurrence of errors, we refer to this as a failure mode: the tendency to malfunction in the presence of certain conditions. Whereas an error can be a single occurrence, failure modes represent errors which will repeatedly occur and often have similar consequences. Although individual errors might not always result in direct harm, their frequency or the summation of multiple errors could reach above an acceptable threshold and result in overall harm. By proactively investigating algorithmic errors and failure modes, the auditor becomes better placed to monitor artificial intelligence systems effectively and to understand the potential failure modes and their consequences.
Here, we propose an audit-based approach for investigating algorithmic errors. An algorithmic audit focuses on developing processes and embedding organisational principles and values in the algorithm design, and these values can vary widely depending on the organisation and context of the deployment. In medical artificial intelligence, the audit process focuses closely on the safety and quality of medical systems, the outcomes and perceptions of the patient and the general public, the responsible use of health-care resources, and the equitable distribution of health care and health-care outcomes.
The importance of safety and quality for medical algorithms is embedded in the principles of medical ethics, which describe the obligations of clinicians to patients and the general public. Evidence-based practice reflects the ethical imperative to act to promote the patient's best interests ( beneficence) while minimising harm ( non-maleficence), with empirical data forming part of the foundation upon which these judgments are made in consort with patient values. Typically, the information gathered through the process of prospective evaluation is contextualised to a clinical setting based on factors relating to each individual patient.15Kimmelman J London AJ The structure of clinical translation: efficiency, information, and ethics.Hastings Cent Rep. 2015; 45: 27-39Google Scholar For interventions like drugs, the intervention itself is identical for all iterations ( eg, the chemical structure of a single pharmaceutical agent is the same for every patient who takes it) and it is within individuals that responses vary. With artificial intelligence systems, the intervention is acutely sensitive to between-individual and within-individual feature variation, because the very power of the computational technique is in its ability to use feature variations to make individual-level predictions. However, artificial intelligence systems can not apply clinical knowledge and domain expertise ( including previous experience, contextual understanding, and causal knowledge) or common sense to distinguish between relevant feature variation due to disease versus irrelevant feature variation due to other biological confounders or non-biological sources, potentially resulting in unreliable predictions. Therefore, to translate algorithms into clinical practice, more nuanced information is required on the algorithm's performance across a range of relevant features, which is the goal of medical algorithm auditing. This information then guides effective and beneficial translation of interventions.15Kimmelman J London AJ The structure of clinical translation: efficiency, information, and ethics.Hastings Cent Rep. 2015; 45: 27-39Google Scholar
An often overlooked concern with artificial intelligence is that of fairness. As long as bias and social determinants of health exist, these patterns will entrench themselves within health care machine learning. In many cases, the performance of an artificial intelligence model differs across patient identities or social determinants of health ( often proxies for identities), which can pose a threat to another core ethical principle: justice. In this case, we might consider distributive justice as a desirable property of artificial intelligence-enabled care delivery ( ie, whether the benefits afforded by machine learning are conferred equally to all). Distributive justice also points us to the necessity of redressing disparities. If an audit reveals disparate performance among certain groups, compensatory mechanisms might help to ensure these patients are not disadvantaged by use of the algorithm. Medical algorithmic auditing can reveal areas in which these mechanisms are required and point to how potential disadvantages may be redressed ( panel 1).Panel 1Why should we monitor for algorithmic errors? Within the broader mandate to ensure artificial intelligence systems are safe, undertaking regular systematic analyses of the observed errors is helpful for a number of reasons: •It is an essential component of safety monitoring and adverse event reporting.16US Food & Drug AdministrationGuidance documents ( medical devices and radiation-emitting products).https: //www.fda.gov/medical-devices/device-advice-comprehensive-regulatory-assistance/guidance-documents-medical-devices-and-radiation-emitting-productsDate accessed: December 4, 2020Google Scholar, 17European UnionRegulation ( EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation ( EC) no 178/2002 and Regulation ( EC) no 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC.https: //eur-lex.europa.eu/legal-content/EN/TXT/? uri=CELEX% 3A32017R0745Date: 2017Date accessed: March 16, 2022Google Scholar•It allows quantification of risk for the artificial intelligence system, which can be weighed against the potential benefits, to inform decision making around whether it is appropriate to apply the model clinically. Benchmarks might already exist within clinical practice ( eg, estimated human radiologist error rates for a diagnostic task), which would inform the risk–benefit ratio for deploying the artificial intelligence system.•It could reveal unknown failure modes of the artificial intelligence system, such as a tendency to produce higher error rates in certain populations, diseases, or settings, or in the presence of specific input data characteristics.9Winkler JK Fink C Toberer F et al.Association between surgical skin markings in dermoscopic images and diagnostic performance of a deep learning convolutional neural network for melanoma recognition.JAMA Dermatol. 2019; 155: 1135-1141Google Scholar, 11Du-Harpur X Arthurs C Ganier C et al.Clinically relevant vulnerabilities of deep machine learning systems for skin cancer diagnosis.J Invest Dermatol. 2021; 141: 916-920Google Scholar, 18Wang P Berzin TM Glissen Brown JR et al.Real-time automatic detection system increases colonoscopic polyp and adenoma detection rates: a prospective randomised controlled study.Gut. 2019; 68: 1813-1819Google Scholar•Before deployment, it can be used to derive a measurable adverse event rate, which can inform how closely safety monitoring and post-deployment auditing should be performed. It can also provide a baseline measurement against which ongoing performance can be benchmarked.•It can inform risk mitigation strategies so that those overseeing deployment of the artificial intelligence system can anticipate errors if the conditions known to trigger failure do occur, implement measures to avoid failure modes, and pre-emptively set hard stop thresholds in high-risk situations.•It can provide valuable feedback and information for future artificial intelligence development and model improvement, and also highlight the potential need for post-deployment calibration or localisation of artificial intelligence systems.•It can reveal systematic differences in performance across features mapping onto a protected identity or social determinant. Insight into these performance differences can prevent a systematic disadvantage to those groups resulting from the implementation of the algorithm.
•It is an essential component of safety monitoring and adverse event reporting.16US Food & Drug AdministrationGuidance documents ( medical devices and radiation-emitting products).https: //www.fda.gov/medical-devices/device-advice-comprehensive-regulatory-assistance/guidance-documents-medical-devices-and-radiation-emitting-productsDate accessed: December 4, 2020Google Scholar, 17European UnionRegulation ( EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices, amending Directive 2001/83/EC, Regulation ( EC) no 178/2002 and Regulation ( EC) no 1223/2009 and repealing Council Directives 90/385/EEC and 93/42/EEC.https: //eur-lex.europa.eu/legal-content/EN/TXT/? uri=CELEX% 3A32017R0745Date: 2017Date accessed: March 16, 2022Google Scholar•It allows quantification of risk for the artificial intelligence system, which can be weighed against the potential benefits, to inform decision making around whether it is appropriate to apply the model clinically. Benchmarks might already exist within clinical practice ( eg, estimated human radiologist error rates for a diagnostic task), which would inform the risk–benefit ratio for deploying the artificial intelligence system.•It could reveal unknown failure modes of the artificial intelligence system, such as a tendency to produce higher error rates in certain populations, diseases, or settings, or in the presence of specific input data characteristics.9Winkler JK Fink C Toberer F et al.Association between surgical skin markings in dermoscopic images and diagnostic performance of a deep learning convolutional neural network for melanoma recognition.JAMA Dermatol. 2019; 155: 1135-1141Google Scholar, 11Du-Harpur X Arthurs C Ganier C et al.Clinically relevant vulnerabilities of deep machine learning systems for skin cancer diagnosis.J Invest Dermatol. 2021; 141: 916-920Google Scholar, 18Wang P Berzin TM Glissen Brown JR et al.Real-time automatic detection system increases colonoscopic polyp and adenoma detection rates: a prospective randomised controlled study.Gut. 2019; 68: 1813-1819Google Scholar•Before deployment, it can be used to derive a measurable adverse event rate, which can inform how closely safety monitoring and post-deployment auditing should be performed. It can also provide a baseline measurement against which ongoing performance can be benchmarked.•It can inform risk mitigation strategies so that those overseeing deployment of the artificial intelligence system can anticipate errors if the conditions known to trigger failure do occur, implement measures to avoid failure modes, and pre-emptively set hard stop thresholds in high-risk situations.•It can provide valuable feedback and information for future artificial intelligence development and model improvement, and also highlight the potential need for post-deployment calibration or localisation of artificial intelligence systems.•It can reveal systematic differences in performance across features mapping onto a protected identity or social determinant. Insight into these performance differences can prevent a systematic disadvantage to those groups resulting from the implementation of the algorithm.
Here, we build on the algorithmic audit approach proposed by Raji and colleagues,19Raji ID Smart A White RN et al.Closing the AI accountability gap: defining an end-to-end framework for internal algorithmic auditing.in: Proceedings of the 2020 Conference on Fairness, Accountability, and Transparency. Association for Computing Machinery, New York, NY2020: 33-44Google Scholar who describe a qualitative structured audit process applying the SMACTR framework ( scoping, mapping, artifact collection, testing, and reflection) to artificial intelligence, as a general purpose technology. Although this framework was originally proposed as a way of assessing whether artificial intelligence development was conducted in alignment with the principles of an organisation, its structure is highly applicable to local auditing of artificial intelligence performance due to its orientation towards internal auditing ( and thus led by those closest to implementation). Each step of the SMACTR framework has its own set of documentation requirements, thus facilitating accountability and iterative, ongoing safety monitoring. There is also emphasis on other established auditing practices in medicine and other industries, including process mapping, failure modes and effects analysis ( FMEA), risk prioritisation, and planning mitigating actions. We adapt this framework for use in medical artificial intelligence applications ( figure 1) and approach the problem from two perspectives: that of the developer, who can modify the artificial intelligence system in response to audit results; and that of the user, who can not modify the artificial intelligence system but has the means to implement risk mitigation plans specific to the deployment setting. We apply the principles of the FMEA tool, a known mechanism in engineering, to facilitate assessment, prioritisation, and mitigation of risk. For illustrative purposes, an example of an audit for a hip fracture detection algorithm is published as supplementary information in a study by Oakden-Rayner and colleagues,20Oakden-Rayner L Gale W Bonham TA et al.Validation and algorithmic audit of a deep learning system for the detection of proximal femoral fractures in patients in the emergency department: a diagnostic accuracy study.Lancet Digit Health. 2022; ( published online April 5.) https: //doi.org/10.1016/S2589-7500 ( 22) 00004-8Google Scholar alongside a detailed breakdown of the FMEA. The benefits of performing the FMEA is to initiate and guide a critical thought process, rather than to establish whether the artificial intelligence system is acceptable or unacceptable or to provide certainty that all risks can be anticipated and minimised. FMEA has previously been applied to clinical settings, although it must be interpreted with care due to issues around reproducibility and incompleteness.21Shebl NA Franklin BD Barber N Failure mode and effects analysis outputs: are they valid?.BMC Health Serv Res. 2012; 12: 150Google ScholarFigure 1Overview of the medical algorithmic auditShow full caption ( A) Overview of the internal audit framework, reproduced from Raji and colleagues.19Raji ID Smart A White RN et al.Closing the AI accountability gap: defining an end-to-end framework for internal algorithmic auditing.in: Proceedings of the 2020 Conference on Fairness, Accountability, and Transparency. Association for Computing Machinery, New York, NY2020: 33-44Google Scholar Grey boxes represent processes; red boxes represent documents produced by the auditors; blue boxes represent documents produced by the engineering and product teams; and green boxes represent jointly developed documents. ( B) Proposed modifications for the medical algorithmic audit. FMEA=failure modes and effects analysis.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
( A) Overview of the internal audit framework, reproduced from Raji and colleagues.19Raji ID Smart A White RN et al.Closing the AI accountability gap: defining an end-to-end framework for internal algorithmic auditing.in: Proceedings of the 2020 Conference on Fairness, Accountability, and Transparency. Association for Computing Machinery, New York, NY2020: 33-44Google Scholar Grey boxes represent processes; red boxes represent documents produced by the auditors; blue boxes represent documents produced by the engineering and product teams; and green boxes represent jointly developed documents. ( B) Proposed modifications for the medical algorithmic audit. FMEA=failure modes and effects analysis.
The medical algorithmic audit might be conducted by developers but it is also likely to be conducted by stakeholders with no involvement in algorithm design, such as health-care workers. During deployment, a myriad of human factors combined with a poor understanding of artificial intelligence systems could create a situation in which all errors are assumed to be a fault of the algorithm's design. Therefore, clinical auditors must have the necessary tools to identify error sources that are preventable ( input data factors or user factors) and not preventable ( factors that are intrinsic to the algorithm itself). Although those outside the development team might have no opportunity to change the algorithm, they might be able to control or influence the circumstances under which it is deployed, which is intrinsically tied to the likelihood of errors, as well as the ability to avoid them. To consider the medical algorithmic audit from both perspectives, table 1 describes tasks undertaken by users and developers for each audit step.Table 1Actions for developers and users at each stage of the medical algorithmic auditDeveloper and user actionsDeveloper actionsUser actionsScoping.. Define intended useAnticipate intended impact ( s) Identify intended useDefine intended impact ( s) MappingMapping of the artificial intelligence systemDefine data flowSummarise risks in a risk priority numberIdentify known risks of the artificial intelligence system in existing published and unpublished evidence and through knowledge of the training dataIdentify known risks of the artificial intelligence system in existing published evidenceIdentify known risks of the health-care taskMapping of the health-care task, including elements before and after the artificial intelligence system in the clinical pathway, such as: relevant patient or data subgroups; potential sources of atypical input data; and relevant outcomes to be measured and how they will be captured in the auditArtifact collectionIntended use statementIntended impact statementFailure modes and effects analysis: clinical pathway mapping, clinical task risk analysis, and risk priority number documentData flow diagramThe artificial intelligence systemModel summaryData for direct assessment, including explainability artifacts and adversarial testing artifactsPrevious evaluation materials ( including performance testing or user experience artifacts) Datasheet for datasets ( training and test data) Datasheet for datasets ( deployment data) TestingExploratory error analysis: false positives and false negatives, and explainability methods ( saliency maps and feature weights) Subgroup testing: patient-specific subgroup analysis and task-specific subgroup analysisAdversarial testingAdversarial testing if possibleReflectionCompile algorithm audit summary report and share with relevant stakeholdersRisk mitigation actions: retrain the model, modify the model threshold, or modify the workflow or intended useRisk mitigation actions: continue use with additional human oversight, modify or limit use, or withdraw use Open table in a new tab
Scoping is the process of defining the intended purpose of the artificial intelligence system and anticipating potential harms. In the work by Raji and colleagues,19Raji ID Smart A White RN et al.Closing the AI accountability gap: defining an end-to-end framework for internal algorithmic auditing.in: Proceedings of the 2020 Conference on Fairness, Accountability, and Transparency. Association for Computing Machinery, New York, NY2020: 33-44Google Scholar the framework is intended for any domain in which artificial intelligence might be applied. In the setting of medical artificial intelligence, the scope of the audit is more clearly defined: the ethical and clinical motivation is common across medical artificial intelligence studies, with the intention to improve health-care outcomes ( ie, quality and length of life, financial outcomes, and organisational outcomes) and to promote distributive justice. Therefore, scoping in medical algorithmic audit should focus on two key elements: the intended use and the intended impact.
The intended use is a regulatory requirement22US Food & Drug AdministrationPMA labelling.https: //www.fda.gov/medical-devices/premarket-approval-pma/pma-labelingDate: 2018Date accessed: September 29, 2020Google Scholar, 23International Organization for StandardizationIEC 62366-1:2015. Medical devices—part 1: application of usability engineering to medical devices.https: //www.iso.org/standard/63179.htmlDate: 2020Date accessed: September 29, 2020Google Scholar that describes how the algorithm ( as a medical device) is to be applied. The US Food & Drug Administration premarket approval guidance states: “ Indications for use for a device include a general description of the disease or condition the device will diagnose, treat, prevent, cure, or mitigate, including a description of the patient population for which the device is intended. Any differences related to gender, race/ethnicity, etc should be included in the labeling. ” The intended use specification is defined by the developer, who has knowledge of any previous evidence supporting indications for legal and safe use. It should also be known to the user, who decides whether the intended use statement matches the clinical task and clinical pathway in which the algorithm is intended to be deployed. For example, in the hip fracture audit,20Oakden-Rayner L Gale W Bonham TA et al.Validation and algorithmic audit of a deep learning system for the detection of proximal femoral fractures in patients in the emergency department: a diagnostic accuracy study.Lancet Digit Health. 2022; ( published online April 5.) https: //doi.org/10.1016/S2589-7500 ( 22) 00004-8Google Scholar scoping of the intended use refers to the function of the algorithm ( detecting proximal femoral fractures) as well as its integration into a clinical pathway ( in which detection leads to admission under an orthopaedic team and booking of further imaging if necessary). Other considerations include any limits on the health-care environment for use ( eg, inpatient or outpatient) and the intended users or oversight ( eg, health professionals, patients, or autonomous). A clear understanding must be established as to whether the current application falls within the artificial intelligence system's intended use, or if there are areas of ambiguity ( eg, from missing or poorly defined intended use descriptions). Identified mismatches can motivate a targeted error analysis during the algorithmic audit.
The intended impact identifies the clinical or health-care target of the artificial intelligence system, accompanied by the ensemble of information that describes the boundaries within which the system is efficacious.15Kimmelman J London AJ The structure of clinical translation: efficiency, information, and ethics.Hastings Cent Rep. 2015; 45: 27-39Google Scholar This statement describes how the artificial intelligence system will affect health-care outcomes if it is working as intended. The developer might be able to define, in theory, the intended impact, but the user is better placed to consider this. The hip fracture audit20Oakden-Rayner L Gale W Bonham TA et al.Validation and algorithmic audit of a deep learning system for the detection of proximal femoral fractures in patients in the emergency department: a diagnostic accuracy study.Lancet Digit Health. 2022; ( published online April 5.) https: //doi.org/10.1016/S2589-7500 ( 22) 00004-8Google Scholar has several intended impacts, including reduced time to admission and surgery, reduced resource use in the emergency department and unnecessary imaging, and downstream improvement in health outcomes. Different users of the same algorithm might have different target impacts specific to their health setting and needs. They might choose to implement the algorithm in different ways to produce different results and therefore their measures of success ( and failures) will also be different. The auditor should define any unacceptably high-risk outcomes or adverse events; such events in medical safety are distinct, because they are considered so severe that they should never occur, such as surgical procedures performed on the wrong limb. It could be helpful to consider possible risks in the context of non-artificial intelligence systems with similar intended use and intended impacts.
Both the intended use statement and intended impact statement are used during the next phase ( mapping), because they define the scope of algorithmic errors related to use of the artificial intelligence system.
The mapping phase considers two main topics: the mapping of personnel and resources necessary for the audit, and the mapping of the risks and known vulnerabilities of the intended use as the first stage of the FMEA.
Personnel who might be helpful for a medical algorithmic audit include developers, users, and domain experts, particularly those who have experience with the artificial intelligence system. Developers have a substantial role to play in terms of providing periodic evaluations to guarantee expected performance, as is the case with other medical devices such as medical scanners, which often include 24-h service and support plans to ensure the device continues to meet operational, regulatory, quality, and safety requirements. If possible, developers should design mechanisms which allow users to carry out audits independently, at a local level. Resources required include, but are not limited to, access to suitable training or testing data and the associated labels ( including non-target labels such as demographic information and hospital process factors); access to model predictions on the test data; access to any interpretability tools produced for use with the artificial intelligence model; and access to the model itself if a more in-depth introspection or further data challenges ( such as adversarial testing) are required.
FMEA is a prospective risk analysis tool which first maps out a process or task, and then is used to identify foreseeable failures that could occur. In the mapping phase, there are two important elements of FMEA: mapping of the artificial intelligence system itself and mapping of the health-care task.
Mapping of the artificial intelligence system itself is a detailed expansion on the intended use statement and analysis of previous evidence documenting risks intrinsic to the artificial intelligence system by design, or which the artificial intelligence system has encountered previously. It could include an evaluation of the existing literature on known risks, or a scoping of other artificial intelligence systems with similar intended use for potential risks. Mapping the artificial intelligence system also involves mapping any prerequisite steps or minimal requirements that are essential to achieving expected performance. Crucial to this is the process for handling and selecting input data, which is sometimes underspecified and poorly reported.1Liu X Faes L Kale AU et al.A comparison of deep learning performance against health-care professionals in detecting diseases from medical imaging: a systematic review and meta-analysis.Lancet Digit Health. 2019; 1: e271-e297Google Scholar
Mapping of the health-care task is a contextualised analysis of the artificial intelligence system as a component of clinical care. It requires clinical knowledge of the use-case, the clinical workflow ( including existing safeguards for detecting errors), user behaviour ( health-care provider, patient, and the general public), and knowledge about potential consequences of errors. This knowledge can complement mapping of the artificial intelligence system, to anticipate when and how failure modes can arise. Mapping the clinical pathway can identify upstream factors that might increase the chances of algorithmic error, and downstream consequences that could occur because of algorithmic error. It also involves identifying important patient or data subgroups and specific features of the input data that are atypical.
It can be helpful to map the artificial intelligence system in relation to the clinical task and intended impacts in the form of a causal diagram, to determine the direction of causality between variables measured in the audit.24Castro DC Walker I Glocker B Causality matters in medical imaging.Nat Commun. 2020; 113673Google Scholar This will inform the metadata required for the artifact collection phase and can help auditors in making sense of relationships between relevant components of the health-care task in the reflection phase.
The risks which are mapped out are summarised in a risk priority number, which ranks the identified risks ( panel 2). It is crucial to understand that the actual risk priority number value is not a measure of safety, nor should there be an attempt to create arbitrary thresholds to determine the acceptability of risks. Rather, the risk priority number enables relative ranking of all risks to prioritise those which need urgent attention and to serve as a baseline for re-evaluation in future audits.Panel 2The risk priority numberThe risk priority number is an arbitrary value calculated through ranking and combining three elements: severity ( severity of the failure effects), occurrence ( likelihood of occurrence), and detection ( effectiveness of mechanisms to detect the failure before it results in adverse consequences). The ranking of each item is subjective, but a scale should be defined so that risk priority numbers in future audits can be compared.For example, in the hip fracture audit,20Oakden-Rayner L Gale W Bonham TA et al.Validation and algorithmic audit of a deep learning system for the detection of proximal femoral fractures in patients in the emergency department: a diagnostic accuracy study.Lancet Digit Health. 2022; ( published online April 5.) https: //doi.org/10.1016/S2589-7500 ( 22) 00004-8Google Scholar severity and occurrence were scored between 1 to 4. A severity score of 4 was catastrophic ( failure could cause injury or death, and extreme loss of trust) and 1 was minor ( no intervention needed and no injury to patient). An occurrence score of 4 was frequent ( several times in 1 day) and 1 was remote ( maximum frequency of once in 6 months). The auditor should decide whether all three elements ( severity, occurrence, and detection) are applicable to the artificial intelligence system, and whether there are additional elements that should be added. In the hip fracture audit, only severity and occurrence elements were included because most risks could not be easily detected in the current clinical workflow ( resulting in homogeneous scoring).
The risk priority number is an arbitrary value calculated through ranking and combining three elements: severity ( severity of the failure effects), occurrence ( likelihood of occurrence), and detection ( effectiveness of mechanisms to detect the failure before it results in adverse consequences). The ranking of each item is subjective, but a scale should be defined so that risk priority numbers in future audits can be compared.
For example, in the hip fracture audit,20Oakden-Rayner L Gale W Bonham TA et al.Validation and algorithmic audit of a deep learning system for the detection of proximal femoral fractures in patients in the emergency department: a diagnostic accuracy study.Lancet Digit Health. 2022; ( published online April 5.) https: //doi.org/10.1016/S2589-7500 ( 22) 00004-8Google Scholar severity and occurrence were scored between 1 to 4. A severity score of 4 was catastrophic ( failure could cause injury or death, and extreme loss of trust) and 1 was minor ( no intervention needed and no injury to patient). An occurrence score of 4 was frequent ( several times in 1 day) and 1 was remote ( maximum frequency of once in 6 months). The auditor should decide whether all three elements ( severity, occurrence, and detection) are applicable to the artificial intelligence system, and whether there are additional elements that should be added. In the hip fracture audit, only severity and occurrence elements were included because most risks could not be easily detected in the current clinical workflow ( resulting in homogeneous scoring).
The artifact collection phase involves gathering documents and materials identified in the mapping phase that might inform the audit ( table 1). There are three components to consider for medical artificial intelligence systems ( aside from those already identified in scoping and mapping): relevant datasets ( training data, previous evaluation data, or prospectively collected audit data for the current audit); the model itself; and results of previous evaluations of the model or task.
The datasets are of primary importance in determining both the performance of the artificial intelligence system, and the potential limitations and failure modes. Various datasets are used throughout the development, evaluation, and monitoring of artificial intelligence systems, and all are relevant for the algorithmic audit, but they might reveal different information about errors and failure modes. The relevant datasets are the algorithm training data ( for developing the algorithm, which might include data for internal validation), previous test data ( for evaluation or validation of the algorithm), and deployment data ( data generated as a by-product of the algorithm being used). Both the test data and deployment data can be used in an algorithmic audit, but the information provided within them might vary. Note that evaluation data, and in particular labelled evaluation data, can be difficult or impossible to obtain in live deployment situations ( or in certain evaluation designs, such as randomised controlled trials of effectiveness), in which the ground truth for each case is not routinely collected. In these settings, the identification of sources of weak labels ( such as adverse event registers and user feedback) will be important, and the limitations of these labels should be clearly indicated.
There is often little relationship between errors on the training set and errors that occur during deployment; therefore, access to the complete training data is a low priority in an algorithmic audit. Although training data might be used for conducting exploratory error analyses ( discussed later), deep learning models can achieve negligible training errors but still perform poorly in a test or deployment environment. Access to training data can also be problematic for users and external auditors, given the commercial value of these data and the sheer size of datasets.
Although direct access to the relevant data is likely to be useful, understanding the data processes is equally important. This information can be formalised with a datasheet25Gebru T Morgenstern J Vecchione B et al.Datasheets for datasets.arXiv. 2018; ( published online March 23.) ( preprint).http: //arxiv.org/abs/1803.09010Google Scholar and a data flow diagram. A datasheet provides an extensive description of the data generating process, dataset collection, dataset composition, and dataset processing and labelling. Datasheets can be extremely valuable during an audit, because the dataset composition ( in particular, the training data composition) can suggest likely failure modes ( for example, patient subgroups that are under-represented in the training data). Access to datasheets rather than the dataset itself should not be problematic and should be provided by the developers whenever possible. In addition to the datasheet, a data flow diagram should be available, which outlines the handling of data from point of acquisition to presentation to the algorithm. This flow diagram should include any preprocessing steps, such as data transformation and normalisation, as well as exclusions based on data quality and a traceability mechanism for unusable or discarded data.
The model itself is also important in the audit process. Basic information about the model design, version, and model developers should be collected as a minimum. Such information can be summarised in a model card.26Mitchell M Wu S Zaldivar A et al.Model cards for model reporting.in: Proceedings of the Conference on Fairness, Accountability, and Transparency. Association for Computing Machinery, New York, NY2019: 220-229Google Scholar If the artificial intelligence system consists of multiple components ( eg, a segmentation step followed by a classification step27De Fauw J Ledsam JR Romera-Paredes B et al.Clinically applicable deep learning for diagnosis and referral in retinal disease.Nat Med. 2018; 24: 1342-1350Google Scholar), artifacts should be collected for each individual component. If multiple audits have been conducted over time spanning updated versions of the artificial intelligence model, documentation regarding changes between updates and any published evaluations since the last audit should also be collected.
Although direct access to the model code and parameters ( known as a white box audit) can be useful—for example, by performing stress-testing of the artificial intelligence system by intentionally modifying input data to induce errors—this is rarely possible due to intellectual property concerns. Most of the benefit that access would provide can be equally obtained with the ability to test the model on new cases and receive model outputs, usually via a web portal or application programming interface ( known as a black box audit). Developers should provide such a mechanism for users to perform independent local testing using representative data samples, to ensure performance is as expected.
The evaluations performed previously on a given artificial intelligence system are extremely important during the preparation of an algorithmic audit. Typically, medical artificial intelligence development goes through several phases of evaluation, and artifacts of this process include internal and external evaluation summaries, published materials on preclinical and proof-of-concept testing, and summaries of any previous qualitative assessments or audits. Qualitative assessments might include developer and user experience materials, such as interviews, surveys, or other forms of feedback. Any results from previous explainability methods, such as saliency or attention maps, per-case feature importance measures, or feature visualisations, should also be collected at this stage.
In the context of the hip fracture audit,20Oakden-Rayner L Gale W Bonham TA et al.Validation and algorithmic audit of a deep learning system for the detection of proximal femoral fractures in patients in the emergency department: a diagnostic accuracy study.Lancet Digit Health. 2022; ( published online April 5.) https: //doi.org/10.1016/S2589-7500 ( 22) 00004-8Google Scholar the components of the scoping and mapping phases were all collated, but additionally, the auditor secured access to the validation and test datasets with explainability artifacts or saliency maps for these cases, the hip fracture model itself, and documents related to model development and previous testing,28Gale W Oakden-Rayner L Carneiro G Bradley AP Palmer LJ Detecting hip fractures with radiologist-level performance using deep neural networks.arXiv. 2017; ( published online Nov 17.) ( preprint).http: //arxiv.org/abs/1711.06504Google Scholar, 29Gale W Oakden-Rayner L Carneiro G Palmer LJ Bradley AP Producing radiologist-quality reports for interpretable deep learning.in: 2019 IEEE 16th International Symposium on Biomedical Imaging. Institute of Electrical and Electronics Engineers, Piscataway, NJ2019: 1275-1279Google Scholar including design documents for each component of the algorithm.
The most important part of the audit process, other than the implementation of recommendations, is the testing phase. It is also the hardest part of the process to standardise, because each artificial intelligence system faces different risks. Institutions are accountable for the choice to incorporate artificial intelligence systems into their clinical pathways, which necessitates the need to ensure their appropriateness and functionality for the patients they serve. Should an algorithm not perform as expected or if harm were to occur, an audit would provide a clear mechanism of showing institutional accountability.
We suggest several key components of testing of medical artificial intelligence systems during an algorithmic audit: exploratory error analysis, subgroup testing, and adversarial testing.
The auditors will review each example of algorithm error that has been provided ( either from previous evaluations, or from detected errors or adverse events in deployment). Auditors will systematically examine false positive and false negative groups in the case of classification systems, or outliers with high numerical errors in the case of regression models. The aim of this process is to identify common elements among the errors ( ie, specific types of case that might be more prone to error, as shown in the hip fracture detection example in figure 2), as well as examples of surprising errors ( eg, a fracture detection model missing an extremely obvious fracture, as shown in figure 2E, F). Given the contrastive nature of this method, access to cases correctly analysed by the artificial intelligence system can also be helpful.Figure 2Audit of a hip fracture detection systemShow full captionAn example audit of a hip fracture detection system20Oakden-Rayner L Gale W Bonham TA et al.Validation and algorithmic audit of a deep learning system for the detection of proximal femoral fractures in patients in the emergency department: a diagnostic accuracy study.Lancet Digit Health. 2022; ( published online April 5.) https: //doi.org/10.1016/S2589-7500 ( 22) 00004-8Google Scholar showed that cases with abnormal bones or joints ( Paget's disease and femoral head deformity) were overrepresented among the errors. The overall error rate was 2·5%, but the error rate for this subset was 50%. ( A, B) True negatives. ( C) True positive. ( D) False positive. ( E, F) False negatives.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
An example audit of a hip fracture detection system20Oakden-Rayner L Gale W Bonham TA et al.Validation and algorithmic audit of a deep learning system for the detection of proximal femoral fractures in patients in the emergency department: a diagnostic accuracy study.Lancet Digit Health. 2022; ( published online April 5.) https: //doi.org/10.1016/S2589-7500 ( 22) 00004-8Google Scholar showed that cases with abnormal bones or joints ( Paget's disease and femoral head deformity) were overrepresented among the errors. The overall error rate was 2·5%, but the error rate for this subset was 50%. ( A, B) True negatives. ( C) True positive. ( D) False positive. ( E, F) False negatives.
Because this analysis is exploratory in nature, access to additional tools can be useful, which might require access to the algorithm itself or support from the algorithm developers. Examples of useful tools include artificial intelligence explainability methods, such as saliency maps and feature visualisations for image data, attention maps, feature weights, or importance measures for text and tabular data. Similarly, data clustering methods have been shown to be useful for some audit tasks, such as cryptic subset detection.30Sohoni N Dunnmon JA Angus G Gu A Ré C No subclass left behind: fine-grained robustness in coarse-grained classification problems.arXiv. 2020; ( published online Nov 25.) ( preprint).https: //arxiv.org/abs/2011.12945Google Scholar An example of the use of data visualisation is shown in figure 3A, where, in the absence of data normalisation, the largest modes of variation in brain MRI data after principal component analysis on the input images is between hospital sites. There is a high risk that a disease classification model trained on such data might pick up features associated with the site rather than the pathology ( for example, if one site contributes more cases than controls). A careful data normalisation pipeline could mitigate such site differences, as shown in figure 3B. A model trained on the normalised data might be more robust when employed on new data. Although these exploratory tools are not powerful for risk assessment in isolation, they can be very useful during exploratory error analysis.Figure 3Principal component analysis of brain MRI data, with ( A) and without ( B) data normalisation, across four hospital sitesShow full captionCam-CAN=Cambridge Centre for Ageing and Neuroscience dataset. IXI=information extraction from images dataset. UK Biobank data were accessed under application number 12579; Cam-CAN data were made available upon application; the IXI datasets are publicly available.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
Cam-CAN=Cambridge Centre for Ageing and Neuroscience dataset. IXI=information extraction from images dataset. UK Biobank data were accessed under application number 12579; Cam-CAN data were made available upon application; the IXI datasets are publicly available.
Subgroup testing, or secondary performance analysis, is widely used in medical and epidemiological research to investigate the possibility of confounding or stratification: patient or data variables that indicate a subset of cases in which performance will significantly differ from the overall cohort.
Importantly, subgroup analysis is not performed to test hypotheses. Given the reduction in power due to the lower sample sizes in subsets, as well as the inflated type 1 error rate ( false positives) caused by multiple testing, these results should not be considered reliable or definitive in the same way that a primary analysis might be. Instead, the goal is to identify possible high-risk subpopulations within the target group. Although the subgroup analyses can be useful for identifying possible error patterns, these findings should be confirmed through investigation in a sufficiently powered sample.
There are three main forms of subgroup testing: patient-specific subgroup analysis, task-specific subgroup analysis, and exploratory error analysis-discovered subgroup analysis.
In a patient-specific subgroup analysis, the baseline characteristics table is used to describe important forms of variation in the dataset that might cause confounding relationships within the data or have wider implications on the results. Almost all studies report demographic and non-demographic characteristics of the study population, such as age, sex, ethnicity, socioeconomic status, disease severity, and comorbidities, and some studies also include information on geographical location and study site. Because these variables are often reported in the first table of a study manuscript, this is sometimes referred to as a table 1 subgroup analysis. These variables are highlighted during audit because they have well-known stratifying relationships with disease and treatment outcomes, and, if they are included in a table, the data are readily available and the subgroup analysis is straightforward to perform. Many studies already report this information31Ting DSW Cheung CY-L Lim G et al.Development and validation of a deep learning system for diabetic retinopathy and related eye diseases using retinal images from multiethnic populations with diabetes.JAMA. 2017; 318: 2211-2223Google Scholar, 32Gulshan V Peng L Coram M et al.Development and validation of a deep learning algorithm for detection of diabetic retinopathy in retinal fundus photographs.JAMA. 2016; 316: 2402-2410Google Scholar, 33McKinney SM Sieniek M Godbole V et al.International evaluation of an AI system for breast cancer screening.Nature. 2020; 577: 89-94Google Scholar and an example is shown from the evaluation by Ting and colleagues31Ting DSW Cheung CY-L Lim G et al.Development and validation of a deep learning system for diabetic retinopathy and related eye diseases using retinal images from multiethnic populations with diabetes.JAMA. 2017; 318: 2211-2223Google Scholar of a retinal imaging artificial intelligence system ( table 2).Table 2Example of a patient-specific subgroup analysis by dataset source or settingExternal validation dataset: non-referable eyesExternal validation dataset: referable eyesDiagnostic performance of artificial intelligence system in external validationNo diabetic retinopathyMild non-proliferative diabetic retinopathyModerate non-proliferative diabetic retinopathySevere non-proliferative diabetic retinopathyProliferative diabetic retinopathyDiabetic macular oedemaUngradableAUC ( 95% CI) Sensitivity ( 95% CI) Specificity ( 95% CI) Community-basedGuangdong56651235737015401080·949 ( 0·943–0·955) 98·7 ( 97·7–99·3) 81·6 ( 80·7–82·5) Population-basedSingapore Malay Eye Study114321511318953280·889 ( 0·863–0·908) 97·1 ( 95·1–99·9) 73·3 ( 70·9–75·5) Singapore Indian Eye Study163942212551771480·917 ( 0·899–0·933) 99·3 ( 95·1–99·9) 73·3 ( 70·9–75·5) Singapore Chinese Eye Study759131601717100·919 ( 0·900–0·942) 100 ( 92·5–100·0) 76·3 ( 72·7–79·6) Beijing Eye Study493411401220·929 ( 0·903–0·955) 94·4 ( 72·7–99·9) 88·5 ( 85·4–91·2) African American Eye Disease Study807503751628410·980 ( 0·971–0·989) 98·8 ( 93·5–100·0) 86·5 ( 84·1–88·7) Clinic-basedRoyal Victoria Eye and Ear Hospital4321211591231912491250·984 ( 0·972–0·991) 98·9 ( 97·5–99·6) 92·2 ( 89·5–94·3) Mexican38284192511822330·950 ( 0·934–0·966) 91·8 ( 88·4–94·4) 84·8 ( 80·4–88·5) Chinese University of Hong Kong22411423543119600·948 ( 0·921–0·972) 99·3 ( 97·3–99·8) 83·1 ( 77·9–87·3) University of Hong Kong1984148515514021410·964 ( 0·958–0·970) 100 ( 99·0–100) 81·3 ( 80·0–82·6) These data are taken from a study by Ting and colleagues31Ting DSW Cheung CY-L Lim G et al.Development and validation of a deep learning system for diabetic retinopathy and related eye diseases using retinal images from multiethnic populations with diabetes.JAMA. 2017; 318: 2211-2223Google Scholar and show the performance of their artificial intelligence model stratified by the clinical origin of the data. Reproduced with permission from JAMA 2016. 316: 2402–10. Copyright © 2016 American Medical Association. All rights reserved. AUC=area under the receiver operating characteristic curve. Open table in a new tab
These data are taken from a study by Ting and colleagues31Ting DSW Cheung CY-L Lim G et al.Development and validation of a deep learning system for diabetic retinopathy and related eye diseases using retinal images from multiethnic populations with diabetes.JAMA. 2017; 318: 2211-2223Google Scholar and show the performance of their artificial intelligence model stratified by the clinical origin of the data. Reproduced with permission from JAMA 2016. 316: 2402–10. Copyright © 2016 American Medical Association. All rights reserved. AUC=area under the receiver operating characteristic curve.
The number of possible confounding and stratifying factors in medical artificial intelligence evaluation is near to infinite. A task-specific subgroup analysis seeks to analyse the most concerning of these factors and is informed by the FMEA risk analysis and risk priority number. Like the patient-specific subgroup analysis, the subgroups in the task-specific subgroup analysis are defined prospectively, based on an understanding of the clinical task, often informed by domain experts. The main difference between a patient-specific subgroup analysis and a task-specific subgroup analysis is that the subgroups are often cryptic ( unlabelled) in task-specific subgroup analysis. It is often necessary to undertake additional labelling to identify data that are part of the subgroup of interest. Because it might require considerable time and resources to undertake the labelling of relevant data, the risk prioritisation performed in the FMEA might inform which additional labelling should be prioritised. Factors that might be considered in task-specific subgroup analysis include collision groups ( such as a combination of features from the patient-specific subgroup analysis) and process variables, such as the scanner used to obtain medical images or the presence of artifacts of medical care within the data ( eg, a chest drain on a chest x-ray for a patient being treated for pneumothorax [ figure 4 ],13Oakden-Rayner L Dunnmon J Carneiro G Ré C Hidden stratification causes clinically meaningful failures in machine learning for medical imaging.Proc ACM Conf Health Inference Learn. 2020; 2020: 151-159Google Scholar or a surgical mark on the skin of a patient suspected of melanoma9Winkler JK Fink C Toberer F et al.Association between surgical skin markings in dermoscopic images and diagnostic performance of a deep learning convolutional neural network for melanoma recognition.JAMA Dermatol. 2019; 155: 1135-1141Google Scholar). Special consideration should be given to data subgroups which would not be captured in a typical patient-specific subgroup analysis, such as visually distinct subsets in a medical image analysis task ( eg, subsolid vs solid lung nodules).34Ciompi F Chung K van Riel SJ et al.Towards automatic pulmonary nodule management in lung cancer screening with deep learning.Sci Rep. 2017; 746479Google Scholar The task-specific subgroup analysis might also be informed by important clinical implications associated with certain subgroups, such as the need for diagnostic certainty when differentiating infectious from non-infectious skin lesions ( because the treatment for non-infectious lesions, topical steroids, will often worsen infectious lesions and might make subsequent diagnosis more difficult).35Liu Y Jain A Eng C et al.A deep learning system for differential diagnosis of skin diseases.Nat Med. 2020; 26: 900-908Google ScholarFigure 4Example of a task-specific subgroup analysis for a model detecting pneumothorax on chest radiographsShow full captionIn this example, reproduced from Oakden-Rayner and colleagues,13Oakden-Rayner L Dunnmon J Carneiro G Ré C Hidden stratification causes clinically meaningful failures in machine learning for medical imaging.Proc ACM Conf Health Inference Learn. 2020; 2020: 151-159Google Scholar the artificial intelligence model learns to detect the artifacts of clinical care ( chest drains) and fails to adequately learn the features of the pathology itself. AUC=area under the receiver operating characteristic curve.View Large Image Figure ViewerDownload Hi-res image Download ( PPT)
In this example, reproduced from Oakden-Rayner and colleagues,13Oakden-Rayner L Dunnmon J Carneiro G Ré C Hidden stratification causes clinically meaningful failures in machine learning for medical imaging.Proc ACM Conf Health Inference Learn. 2020; 2020: 151-159Google Scholar the artificial intelligence model learns to detect the artifacts of clinical care ( chest drains) and fails to adequately learn the features of the pathology itself. AUC=area under the receiver operating characteristic curve.
During the exploratory error analysis process, distinct subgroups of error cases or error features might be identified, which are not considered during patient-specific subgroup analysis or task-specific subgroup analysis. Of note, whereas the subgroups in a task-specific subgroup analysis are defined prospectively based on expert knowledge, exploratory error analysis might identify new subgroups, which should then be evaluated as if for a task-specific subgroup analysis or a patient-specific subgroup analysis. However, unlike prospectively defined subgroups, subgroup cases identified during the exploratory error analysis are even less likely to be labelled and the auditor might need to invest time and resources to carry out further targeted labelling of the audit dataset. The risk priority number is helpful in this context, to help the auditor rationalise whether this investment is necessary. In the hip fracture detection audit,20Oakden-Rayner L Gale W Bonham TA et al.Validation and algorithmic audit of a deep learning system for the detection of proximal femoral fractures in patients in the emergency department: a diagnostic accuracy study.Lancet Digit Health. 2022; ( published online April 5.) https: //doi.org/10.1016/S2589-7500 ( 22) 00004-8Google Scholar the discovery of algorithmic errors in cases with abnormal bones prompted an additional labelling exercise of all hips with abnormal bones and joints to find that the error rate in those cases was 50%, compared with 2·5% in the overall dataset ( figure 2).
Major unpredictable changes to input data are generally less of a concern in medical settings ( in which data generation and processing are heavily standardised and monitored), but considering worst-case scenarios for targeted testing can be useful. The term adversarial here means actions that a hostile actor might take to break the artificial intelligence system, but in the medical context we could consider adversarial testing analogous with counterfactual reasoning, in which users can explore or simulate changes in data inputs to observe how the model behaves. This can be done in a safe environment to simulate high-risk situations and their potential consequences. For example, DeGrave and colleagues36DeGrave AJ Janizek JD Lee S-I AI for radiographic COVID-19 detection selects shortcuts over signal.medRxiv. 2020; ( published online Oct 8.) ( preprint).https: //doi.org/10.1101/2020.09.13.20193565Google Scholar used multiple adversarial testing approaches for a COVID-19 detection model for chest radiographs to show that the model can be misled by laterality markers and shoulder positioning.
Unlike subgroup analyses, adversarial testing might require access to the model itself. It could also be tested empirically through gathering real-world examples of specific subgroups for which performance is known to be poor, or by the use of simulated data that are expected to challenge the model. Although this is more common in tabular data, recent advances in generative models can allow for the simulation of more complex data, such as images and text. With either real-world or simulated data, the purpose of adversarial testing is to better understand the prevalence and source of errors in worst-case subgroups.
The final stage of the audit is a reflection on test results in light of the intended use and the intended impact as outlined in the scoping step. A final assessment of risk is formalised at this stage, risk mitigation strategies are proposed, and recommendations are made on whether the errors fall above the threshold for continued use of the artificial intelligence system. This decision will be specific to the clinical setting and the ability of the responsible team to mitigate risks. Those overseeing the algorithmic audit should be vigilant to deviations from the artificial intelligence system's intended use. It might become apparent during testing when a mismatch between intended use and actual use has occurred, but additional auditing measures such as root cause analysis might be required to retrospectively determine whether errors were due to gaps between the intended and actual use. In any case, errors should be reported to the relevant regulatory bodies, especially if the errors found invalidate the artificial intelligence system's intended use claims. It is also important to report errors even if adverse outcomes were mitigated through other measures in the health system ( ie, near misses), because other deployment sites might not have the same mitigation measures in place.
The feasibility of risk mitigation strategies will be specific to the deployment setting and they require regular review as clinical systems change over time. The measures that can be put in place also depend on who the auditor is and which aspects of the artificial intelligence system and health-care system they are able to modify. Developers might be limited by legal requirements, such that substantial changes to the artificial intelligence model, deployment infrastructure, or the intended use could require reconsideration by regulatory agencies.
Potential risk mitigation strategies to be taken by developers include modifying the artificial intelligence model, modifying the model threshold, or modifying the instructions for use or intended use.
Modifications of the artificial intelligence system could target any part of the system, but they might involve targeted retraining of the model itself. In general, the intention would be to train an improved version of the artificial intelligence model using more diverse and representative data, targeting areas of weakness by enriching the training dataset with examples of cases associated with errors. If further data are not available, a similar effect might be achieved by reweighting training examples ( amending the attributed value of one case versus another) or rebalancing the training data to increase the relative value of these cases ( amending the number of positive and negative cases), or by producing simulated examples of these error cases.
The model threshold in classification systems determines the cutoff to discriminate between positive and negative cases, and it is also known as the operating point. This can be altered without retraining the model—for example, if user feedback suggests that the model produces too many false positives, shifting the threshold can reduce these ( at the expense of increasing the rate of false negatives). The operating point of a model might be prespecified or suggested by the developers, but could also need tuning after deployment based on the specific clinical needs or performance at a particular site.
Modifications can also affect the non-model components of the deployed infrastructure and artificial intelligence workflow. These could include changes to data acquisition and preprocessing steps, or, in more extreme cases, modifying the intended use of the system. Such modifications could involve excluding some types of input data from the artificial intelligence system, changing how the model outputs are presented to the users, or even redefining the intended user group ( eg, by increasing training requirements for users).
Clinical actions can also be taken to mitigate risk, including continuing use with additional human oversight, modifying or limiting use of the model, or withdrawing its use. Some errors might be acceptable for continued use if the likelihood of harm is very low, or if the consequences can easily be mitigated given adequate human oversight. Depending on the use-case, reducing the level of autonomy of the artificial intelligence system and necessitating human verification might be sufficient to mitigate risks. In the FMEA, the risk prioritisation number could be informative because such errors would score low for severity or high for detection ( or both). Human oversight might be implemented for all use or reserved for certain subgroups in which performance is known to be lower.
If modifiable risks are identified ( eg, confounding visual features, such as laterality markers on chest radiographs), processes can be implemented to prevent recurrence ( in this example, by standardising placement or the removal or digitisation of laterality markers in chest x-ray images). Thus, modifying the input data acquisition protocol or integrating additional preprocessing steps into the workflow to minimise the effects of spurious input data elements might be required.
If modifications are unfeasible or insufficient, limiting use of the artificial intelligence system on certain input data or subgroups that are prone to errors is another option. This strategy can be implemented if the subgroup can be identified upstream in the clinical pathway ( eg, subgroups of certain demographic, input data type, or known task-specific feature variants that could be identified by the imaging technicians performing a scan) and those patients can be routed to an alternative care pathway. In the hip fracture detection audit,20Oakden-Rayner L Gale W Bonham TA et al.Validation and algorithmic audit of a deep learning system for the detection of proximal femoral fractures in patients in the emergency department: a diagnostic accuracy study.Lancet Digit Health. 2022; ( published online April 5.) https: //doi.org/10.1016/S2589-7500 ( 22) 00004-8Google Scholar the risk of false positives in cases of femoral deformities was found to require further monitoring, with a potential modification of the intended use ( to exclude cases with deformities) as an appropriate mitigation action, if they were confirmed to cause a failure mode. However, this option is not always feasible if the subgroups are not readily identifiable prior to analysis by the artificial intelligence system. There should also be consideration as to whether such modifications inadvertently legitimise a two-tier health system, with particular groups receiving worse care, compromising the principle of distributive justice.
The last option is withdrawal of the artificial intelligence system altogether and reverting to previous care models. If the likelihood of errors is so severe that continued use of the algorithm is no longer safe or ethical, the only option is to stop use of the artificial intelligence system until modifications can be made. The potential harms of sudden and complete withdrawal of the artificial intelligence system should be weighed against the harms caused by continued use with or without modifications and limitations.
An alternative method to consider is the use of so-called hard stop thresholds, which are common components of medical device deployments.37US Food & Drug AdministrationRecalls, corrections and removals ( devices).https: //www.fda.gov/medical-devices/postmarket-requirements-devices/recalls-corrections-and-removals-devices # 4Date: 2020Date accessed: November 26, 2020Google Scholar These involve prespecified minimum performance levels, and if performance falls below the threshold during ongoing and active monitoring, then the device is immediately removed from use. These thresholds can be jointly agreed with all relevant stakeholders and informed by relevant organisational values ( including equity and justice). Prespecification of actions can simplify the often complex decisions on whether to stop use if the hard stop threshold is met.
Findings of the medical algorithmic audit are summarised in a report, which includes all collected artifacts, the FMEA, datasets, test results, risk mitigation plans, and final decisions made. Any learning derived from the audit process that extends beyond the current application should be recorded to assist future artificial intelligence evaluations or deployments. Key audit findings that carry direct implications on clinical care should also be disseminated to users. Updates or changes made to the artificial intelligence system should be made apparent to the user, ideally with reasons reported. A frequent and open dialogue of findings from the algorithmic audit summary report should be shared between developers and users.
Artificial intelligence systems for health care could bring considerable benefits to patient care, but, like any other medical intervention, they also have the potential to cause harm. For artificial intelligence systems, the nature of errors might make them particularly difficult to identify, explain, and mitigate. At a time when artificial intelligence systems are being rapidly adopted into clinical care, providing a framework for ongoing performance monitoring and scrutiny of error and harm is essential. Implementation of artificial intelligence systems can be especially high risk, given that it often coincides with the establishment of new clinical pathways with no clear comparators for expected outcomes or standards for quality ( such as the creation of new telemedical and virtual care pathways).
Of note, although many artificial intelligence systems are supported by evidence showing superior or equivalent performance compared with human experts, such monitoring of human performance is not routinely carried out in a task-specific fashion in clinical practice. In fact, whereas clinical artificial intelligence evaluations have provided valuable insights into human performance by measuring and benchmarking human performance at specific diagnostic tasks, routine monitoring of human grader accuracy, such as those introduced by UK national screening programmes for diabetic retinopathy38Public Health EnglandDiabetic eye screening: participation in the grading test and training system.https: //www.gov.uk/government/publications/diabetic-eye-screening-test-and-training-participation/diabetic-eye-screening-participation-in-the-grading-test-and-training-systemDate: Nov 25, 2020Date accessed: December 9, 2020Google Scholar and breast cancer screening,39NHS Cancer Screening ProgrammesQuality assurance guidelines for breast cancer screening radiology. National Health Service Cancer Screening Programmes, Sheffield2011Google Scholar is not performed for most other clinical tasks. Gaining an understanding of human performance will not only reveal for which tasks artificial intelligence systems truly provide value, but should also drive improvements to the standards of care among clinicians.
The medical algorithmic audit proposed here is a process to investigate and pre-empt errors and harms that could be caused by artificial intelligence systems. It is a general framework which promotes thoughtful interrogation of errors and unexpected results in evaluations both before and during real-world deployment. Performing the audit requires clinical and technical expertise and contextual knowledge for anticipating the potential effects of the deployment environment, which might expose vulnerabilities of the algorithm and increase the likelihood of errors.
One question yet to be answered is who should conduct the medical algorithmic audit. The skills and knowledge required to undertake such an audit cross computational, bioinformatics, and clinical skill sets, and are not taught in combination in standard medical curricula. In order to fulfil this responsibility, health providers need to invest in upskilling clinical personnel to oversee the piloting, deployment, and ongoing monitoring of artificial intelligence systems, broadly described as the science of algorithmovigilance.40Embi PJ Algorithmovigilance—advancing methods to analyze and monitor artificial intelligence-driven health care for effectiveness and equity.JAMA Netw Open. 2021; 4e214622Google Scholar In the UK, the need to invest in digital leaders with the necessary capabilities ( such as clinical information officers) has been recognised by the National Health System and Health Education England.41Topol E The Topol review: preparing the healthcare workforce to deliver the digital future. National Health Service Health Education England, 2019Google Scholar, 42National Health ServiceThe NHS long term plan.https: //www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdfDate: 2019Date accessed: March 16, 2022Google Scholar In Australia, the Royal Australian and New Zealand College of Radiologists have recommended that medical imaging departments and practices appoint a responsible radiologist with the necessary skills and knowledge to perform regular algorithmic audits of artificial intelligence systems in deployment.43The Royal Australian and New Zealand College of RadiologistsStandards of practice for artificial intelligence.https: //www.ranzcr.com/documents-download/quality-and-standards-except-professional-documents/5187-standards-of-practice-for-aiDate: 2020Date accessed: November 25, 2020Google Scholar In both nations, concerns have been raised that appropriately trained clinicians are rare, and that there remains considerable work to build an artificial intelligence-ready workforce. Structured processes and guidelines, such as the ones described here, are necessary to accelerate the development of quality and safety assurance capabilities for artificial intelligence in clinical settings.
Ultimately, the responsibility and benefits of investigating and improving the safety of the artificial intelligence system is shared between developers, health-care decision makers, and users, and should be part of a larger oversight framework of algorithmovigilance to ensure the continued efficacy and safety of artificial intelligence systems. For the medical algorithmic audit to have the highest chance of success, we advocate for the process being carried out jointly between these stakeholders, so that each party enables the other in developing a deeper and more contextualised insight into the findings and possible mitigation strategies.
LO-R, XL, BG, AKD, MG, and MMM were responsible for project conception, study design, and drafting and review of the manuscript. LO-R did the example algorithmic audit.
BG is a part-time employee of HeartFlow and Kheiron Medical Technologies and holds stock options with both as part of the standard compensation package. He was a part-time employee at Microsoft Research until May, 2021 and a scientific advisor for Kheiron Medical Technologies until September, 2021. All other authors declare no competing interests.
We acknowledge Inioluwa Deborah Raji and her co-authors for their seminal work on internal algorithmic auditing,19Raji ID Smart A White RN et al.Closing the AI accountability gap: defining an end-to-end framework for internal algorithmic auditing.in: Proceedings of the 2020 Conference on Fairness, Accountability, and Transparency. Association for Computing Machinery, New York, NY2020: 33-44Google Scholar upon which we based our medical algorithmic audit. We are grateful for her comments and feedback on our adaptation of this framework. XL and AKD receive a proportion of their funding from the Wellcome Trust, through a Health Improvement Challenge grant ( 200141/Z/15/Z). BG receives funding from the European Research Council under the EU Horizon 2020 research and innovation programme ( grant agreement number 757173, project MIRA, ERC-2017-STG).
Validation and algorithmic audit of a deep learning system for the detection of proximal femoral fractures in patients in the emergency department: a diagnostic accuracy studyThe model outperformed the radiologists tested and maintained performance on external validation, but showed several unexpected limitations during further testing. Thorough preclinical evaluation of artificial intelligence models, including algorithmic auditing, can reveal unexpected and potentially harmful behaviour even in high-performance artificial intelligence systems, which can inform future clinical testing and deployment decisions. Full-Text PDF Open Access | tech |
Automated virtual reality therapy to treat agoraphobic avoidance and distress in patients with psychosis ( gameChange): a multicentre, parallel-group, single-blind, randomised, controlled trial in England with mediation and moderation analyses | BackgroundAutomated delivery of psychological therapy using immersive technologies such as virtual reality ( VR) might greatly increase the availability of effective help for patients. We aimed to evaluate the efficacy of an automated VR cognitive therapy ( gameChange) to treat avoidance and distress in patients with psychosis, and to analyse how and in whom it might work.MethodsWe did a parallel-group, single-blind, randomised, controlled trial across nine National Health Service trusts in England. Eligible patients were aged 16 years or older, with a clinical diagnosis of a schizophrenia spectrum disorder or an affective diagnosis with psychotic symptoms, and had self-reported difficulties going outside due to anxiety. Patients were randomly assigned ( 1:1) to either gameChange VR therapy plus usual care or usual care alone, using a permuted blocks algorithm with randomly varying block size, stratified by study site and service type. gameChange VR therapy was provided in approximately six sessions over 6 weeks. Trial assessors were masked to group allocation. Outcomes were assessed at 0, 6 ( primary endpoint), and 26 weeks after randomisation. The primary outcome was avoidance of, and distress in, everyday situations, assessed using the self-reported Oxford Agoraphobic Avoidance Scale ( O-AS). Outcome analyses were done in the intention-to-treat population ( ie, all participants who were assigned to a study group for whom data were available). We performed planned mediation and moderation analyses to test the effects of gameChange VR therapy when added to usual care. This trial is registered with the ISRCTN registry, 17308399.FindingsBetween July 25, 2019, and May 7, 2021 ( with a pause in recruitment from March 16, 2020, to Sept 14, 2020, due to COVID-19 pandemic restrictions), 551 patients were assessed for eligibility and 346 were enrolled. 231 ( 67%) patients were men and 111 ( 32%) were women, 294 ( 85%) were White, and the mean age was 37·2 years ( SD 12·5). 174 patients were randomly assigned to the gameChange VR therapy group and 172 to the usual care alone group. Compared with the usual care alone group, the gameChange VR therapy group had significant reductions in agoraphobic avoidance ( O-AS adjusted mean difference –0·47, 95% CI –0·88 to –0·06; n=320; Cohen's d –0·18; p=0·026) and distress ( –4·33, –7·78 to –0·87; n=322; –0·26; p=0·014) at 6 weeks. Reductions in threat cognitions and within-situation defence behaviours mediated treatment outcomes. The greater the severity of anxious fears and avoidance, the greater the treatment benefits. There was no significant difference in the occurrence of serious adverse events between the gameChange VR therapy group ( 12 events in nine patients) and the usual care alone group ( eight events in seven patients; p=0·37).InterpretationAutomated VR therapy led to significant reductions in anxious avoidance of, and distress in, everyday situations compared with usual care alone. The mediation analysis indicated that the VR therapy worked in accordance with the cognitive model by reducing anxious thoughts and associated protective behaviours. The moderation analysis indicated that the VR therapy particularly benefited patients with severe agoraphobic avoidance, such as not being able to leave the home unaccompanied. gameChange VR therapy has the potential to increase the provision of effective psychological therapy for psychosis, particularly for patients who find it difficult to leave their home, visit local amenities, or use public transport.FundingNational Institute of Health Research Invention for Innovation programme, National Institute of Health Research Oxford Health Biomedical Research Centre.
Automated delivery of psychological therapy using immersive technologies such as virtual reality ( VR) might greatly increase the availability of effective help for patients. We aimed to evaluate the efficacy of an automated VR cognitive therapy ( gameChange) to treat avoidance and distress in patients with psychosis, and to analyse how and in whom it might work.
We did a parallel-group, single-blind, randomised, controlled trial across nine National Health Service trusts in England. Eligible patients were aged 16 years or older, with a clinical diagnosis of a schizophrenia spectrum disorder or an affective diagnosis with psychotic symptoms, and had self-reported difficulties going outside due to anxiety. Patients were randomly assigned ( 1:1) to either gameChange VR therapy plus usual care or usual care alone, using a permuted blocks algorithm with randomly varying block size, stratified by study site and service type. gameChange VR therapy was provided in approximately six sessions over 6 weeks. Trial assessors were masked to group allocation. Outcomes were assessed at 0, 6 ( primary endpoint), and 26 weeks after randomisation. The primary outcome was avoidance of, and distress in, everyday situations, assessed using the self-reported Oxford Agoraphobic Avoidance Scale ( O-AS). Outcome analyses were done in the intention-to-treat population ( ie, all participants who were assigned to a study group for whom data were available). We performed planned mediation and moderation analyses to test the effects of gameChange VR therapy when added to usual care. This trial is registered with the ISRCTN registry, 17308399.
Between July 25, 2019, and May 7, 2021 ( with a pause in recruitment from March 16, 2020, to Sept 14, 2020, due to COVID-19 pandemic restrictions), 551 patients were assessed for eligibility and 346 were enrolled. 231 ( 67%) patients were men and 111 ( 32%) were women, 294 ( 85%) were White, and the mean age was 37·2 years ( SD 12·5). 174 patients were randomly assigned to the gameChange VR therapy group and 172 to the usual care alone group. Compared with the usual care alone group, the gameChange VR therapy group had significant reductions in agoraphobic avoidance ( O-AS adjusted mean difference –0·47, 95% CI –0·88 to –0·06; n=320; Cohen's d –0·18; p=0·026) and distress ( –4·33, –7·78 to –0·87; n=322; –0·26; p=0·014) at 6 weeks. Reductions in threat cognitions and within-situation defence behaviours mediated treatment outcomes. The greater the severity of anxious fears and avoidance, the greater the treatment benefits. There was no significant difference in the occurrence of serious adverse events between the gameChange VR therapy group ( 12 events in nine patients) and the usual care alone group ( eight events in seven patients; p=0·37).
Automated VR therapy led to significant reductions in anxious avoidance of, and distress in, everyday situations compared with usual care alone. The mediation analysis indicated that the VR therapy worked in accordance with the cognitive model by reducing anxious thoughts and associated protective behaviours. The moderation analysis indicated that the VR therapy particularly benefited patients with severe agoraphobic avoidance, such as not being able to leave the home unaccompanied. gameChange VR therapy has the potential to increase the provision of effective psychological therapy for psychosis, particularly for patients who find it difficult to leave their home, visit local amenities, or use public transport.
National Institute of Health Research Invention for Innovation programme, National Institute of Health Research Oxford Health Biomedical Research Centre.
Research in contextEvidence before this studyImmersive virtual reality ( VR) has been tested in a small number of clinical studies in patients with psychosis. VR has been used in these studies by cognitive-behavioural therapists as a supplementary aid in treatment. Our aim was to advance the use of VR for patients with psychosis by automating the delivery of therapy. Successful automation within VR could enable the provision of psychological interventions on a large scale. We searched PubMed on Dec 4, 2021, with no date or language restrictions, using the terms ( “ Psychosis ” OR “ Psychotic ” OR “ Schizophrenia ”) AND ( “ Virtual reality ” OR “ VR ”) AND ( “ head mounted display ” OR “ HMD ” OR “ CAVE ”) AND “ Automated ” AND “ Treatment ”. 63 papers were identified. There were no studies reporting the use of automated VR therapy for patients with psychosis. We did a second search of PubMed on the same date using the terms ( “ Psychosis ” OR “ Psychotic ” OR “ Schizophrenia ”) AND ( “ agoraphobia ” OR “ anxious avoidance ”) AND ( “ treatment ” OR “ therapy ”) AND “ randomised controlled ”, and 42 papers were identified. There were no randomised controlled trials that had evaluated the treatment of agoraphobic avoidance and distress in patients with psychosis. However, there were two potentially informative studies. A randomised trial in 116 patients with paranoia that tested 16 sessions of VR-based cognitive behavioural therapy with a therapist did not find a significant end-of-treatment difference in social participation ( assessed by time spent with other people) compared with a waiting-list control group, but did find a significant difference at 6-month follow-up. A randomised controlled trial in 20 patients with schizophrenia that tested an eight-session group-based cognitive behavioural therapy intervention indicated that the intervention was associated with potential reductions in avoidance of social phobia situations compared with a waiting-list control group.Added value of this studyTo our knowledge, this is the first randomised controlled trial of automated VR therapy for patients with psychosis. The VR therapy in this study, gameChange, was designed to reduce agoraphobic avoidance and distress, which had not previously been the target of intervention for patients with psychosis. This study is also the largest test of any VR therapy for a mental health condition. The simulations in gameChange VR therapy helped trial participants practise leaving the home, being in a café, shop, doctor's surgery, or pub, and getting on a bus. The situations had been identified during the treatment design stage of the project by individuals with lived experience of psychosis. Compared with usual care alone, gameChange VR therapy significantly reduced agoraphobic avoidance of, and distress in, everyday situations. The therapy was especially effective in reducing agoraphobia for patients with severe difficulties, who had moderate-to-large improvements that persisted for 6 months. The therapy worked via reduction of a wide range of threat cognitions and within-situation defence behaviours, which are key elements in the cognitive account of anxiety.Implications of all the available evidencegameChange VR therapy works for patients with psychosis who have anxiety about entering everyday situations. However, we recommend that it is best used with patients with substantial avoidance of or distress in everyday situations ( eg, finding it difficult to leave the home). With suitable supervision arrangements, the therapy can be supported by peer support workers, assistant psychologists, or cognitive-behavioural therapists. The increasing availability and affordability of standalone VR headsets means that patients could keep the device at home for some time, thereby substantially increasing the amount of therapy received. Automated therapy delivered in easy-to-use standalone VR headsets, with support possible from a large proportion of the mental health workforce, means that gameChange is a therapy that could be delivered on a large scale in clinical services.
Immersive virtual reality ( VR) has been tested in a small number of clinical studies in patients with psychosis. VR has been used in these studies by cognitive-behavioural therapists as a supplementary aid in treatment. Our aim was to advance the use of VR for patients with psychosis by automating the delivery of therapy. Successful automation within VR could enable the provision of psychological interventions on a large scale. We searched PubMed on Dec 4, 2021, with no date or language restrictions, using the terms ( “ Psychosis ” OR “ Psychotic ” OR “ Schizophrenia ”) AND ( “ Virtual reality ” OR “ VR ”) AND ( “ head mounted display ” OR “ HMD ” OR “ CAVE ”) AND “ Automated ” AND “ Treatment ”. 63 papers were identified. There were no studies reporting the use of automated VR therapy for patients with psychosis. We did a second search of PubMed on the same date using the terms ( “ Psychosis ” OR “ Psychotic ” OR “ Schizophrenia ”) AND ( “ agoraphobia ” OR “ anxious avoidance ”) AND ( “ treatment ” OR “ therapy ”) AND “ randomised controlled ”, and 42 papers were identified. There were no randomised controlled trials that had evaluated the treatment of agoraphobic avoidance and distress in patients with psychosis. However, there were two potentially informative studies. A randomised trial in 116 patients with paranoia that tested 16 sessions of VR-based cognitive behavioural therapy with a therapist did not find a significant end-of-treatment difference in social participation ( assessed by time spent with other people) compared with a waiting-list control group, but did find a significant difference at 6-month follow-up. A randomised controlled trial in 20 patients with schizophrenia that tested an eight-session group-based cognitive behavioural therapy intervention indicated that the intervention was associated with potential reductions in avoidance of social phobia situations compared with a waiting-list control group.
To our knowledge, this is the first randomised controlled trial of automated VR therapy for patients with psychosis. The VR therapy in this study, gameChange, was designed to reduce agoraphobic avoidance and distress, which had not previously been the target of intervention for patients with psychosis. This study is also the largest test of any VR therapy for a mental health condition. The simulations in gameChange VR therapy helped trial participants practise leaving the home, being in a café, shop, doctor's surgery, or pub, and getting on a bus. The situations had been identified during the treatment design stage of the project by individuals with lived experience of psychosis. Compared with usual care alone, gameChange VR therapy significantly reduced agoraphobic avoidance of, and distress in, everyday situations. The therapy was especially effective in reducing agoraphobia for patients with severe difficulties, who had moderate-to-large improvements that persisted for 6 months. The therapy worked via reduction of a wide range of threat cognitions and within-situation defence behaviours, which are key elements in the cognitive account of anxiety.
gameChange VR therapy works for patients with psychosis who have anxiety about entering everyday situations. However, we recommend that it is best used with patients with substantial avoidance of or distress in everyday situations ( eg, finding it difficult to leave the home). With suitable supervision arrangements, the therapy can be supported by peer support workers, assistant psychologists, or cognitive-behavioural therapists. The increasing availability and affordability of standalone VR headsets means that patients could keep the device at home for some time, thereby substantially increasing the amount of therapy received. Automated therapy delivered in easy-to-use standalone VR headsets, with support possible from a large proportion of the mental health workforce, means that gameChange is a therapy that could be delivered on a large scale in clinical services.
Providing effective psychological therapy on a large scale to patients with psychosis is a recognised challenge.1Ince P Haddock G Tai S A systematic review of the implementation of recommended psychological interventions for schizophrenia: rates, barriers, and improvement strategies.Psychol Psychother. 2016; 89: 324-350Google Scholar, 2Xanidis N Gumley A Exploring the implementation of cognitive behaviour therapy for psychosis using the Normalization Process Theory framework.Psychol Psychother. 2020; 93: 241-257Google Scholar There is a limited number of therapists and there are issues of adherence and competence in the delivery of current evidence-based approaches. Internationally, clinical services are seldom organised to give therapists the time to carry out the direct active learning in real-world situations with patients that is often important for clinical improvement. Immersive virtual reality ( VR) —interactive three-dimensional computer-generated worlds that produce the sensation of actually being in life-sized new environments—is a potentially powerful therapeutic tool that can overcome these barriers. Patients more readily partake and learn in simulations of anxiety-provoking situations because they know the recreations are not real. By automating delivery of therapy in VR, the reliance on trained therapists is removed.3Freeman D Haselton P Freeman J et al.Automated psychological therapy using immersive virtual reality for treatment of fear of heights: a single-blind, parallel-group, randomised controlled trial.Lancet Psychiatry. 2018; 5: 625-632Google Scholar In automated delivery, techniques are implemented consistently and trial outcomes are highly likely to be replicated. Automated VR therapies are therefore scalable. In this Article, we report the evaluation of an automated VR therapy designed to help patients with psychosis re-engage with everyday situations.
Everyday situations can be anxiety-provoking for many patients with psychosis. Patients might fear, for example, negative judgements, observation, embarrassment, failure, rejection, panicking, deliberate social or physical harm from others, or being unable to cope with verbal auditory hallucinations. The result is that patients avoid everyday situations, such as walking in the street, going to a local shop, or getting on a bus, or find these activities intensely distressing. This anxiety leads to withdrawal from everyday situations, which adversely affects both mental and physical health. Many patients find it difficult even to leave their home. Lives can become restricted to locations and activities that are perceived as sufficiently safe because they can be left easily. When situations are feared or avoided because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms, this is defined as agoraphobia.4American Psychiatric AssociationDiagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Association, Arlington, VA2013Google Scholar We view agoraphobic avoidance of, and distress in, everyday situations as a final common pathway for a variety of fears experienced by most patients with psychosis. In a survey of 1809 patients with non-affective psychosis who were attending mental health services in the UK National Health Service ( NHS), we found anxious avoidance classed as agoraphobia in 64·5% of patients.5Freeman D Taylor KM Molodynski A Waite F Treatable clinical intervention targets for patients with schizophrenia.Schizophr Res. 2019; 211: 44-50Google Scholar
We used a user-centred design process to create a six-session automated VR cognitive therapy ( gameChange) to directly target anxiety about everyday situations.6Lambe S Knight I Kabir T et al.Developing an automated VR cognitive treatment for psychosis: gameChange VR therapy.J Behav Cogn Ther. 2020; 30: 33-40Google Scholar, 7Knight I West J Matthews E et al.Participatory design to create a VR therapy for psychosis.Design Health ( Abingdon). 2021; 5: 98-119Google Scholar The cognitive perspective on problematic anxiety places unfounded fearful thoughts as the central cause.8Clark DM Anxiety disorders: why they persist and how to treat them.Behav Res Ther. 1999; 37: S5-27Google Scholar Importantly, the fearful thoughts persist because of the use of defence ( or safety-seeking) behaviours that block the processing of disconfirmatory evidence.9Salkovskis PM The importance of behaviour in the maintenance of anxiety and panic: a cognitive account.Behav Psychother. 1991; 19: 6-19Google Scholar For example, people avoid entering feared situations or, when in them, rush to leave early, are vigilant for danger, or avoid eye contact ( within-situation defences). The threat beliefs are not updated because the absence of harm is attributed to the use of defences. The treatment implication is that defences must be dropped so that the anxious cognitions can be fully evaluated in the feared situations. When this occurs in behavioural experiments, new beliefs and memories of safety are formed that counteract the old fear-based memories and thoughts.10Craske MG Treanor M Conway CC Zbozinek T Vervliet B Maximizing exposure therapy: an inhibitory learning approach.Behav Res Ther. 2014; 58: 10-23Google Scholar In two previous studies in patients with psychosis, therapists have successfully conducted behavioural experiments using VR simulations of anxiety-provoking situations to reduce fears.11Freeman D Bradley J Antley A et al.Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study testing how to reduce delusional conviction.Br J Psychiatry. 2016; 209: 62-67Google Scholar, 12Pot-Kolder RMCA Geraets CNW Veling W et al.Virtual-reality-based cognitive behavioural therapy versus waiting list control for paranoid ideation and social avoidance in patients with psychotic disorders: a single-blind randomised controlled trial.Lancet Psychiatry. 2018; 5: 217-226Google Scholar This is the traditional use of VR in mental health, as an aid within cognitive therapy. gameChange was designed so that the therapy is embedded in the VR programme, and a virtual therapist guides the participant through simulations intended to limit the use of defences. A variety of mental health staff, including peer support workers, can then support patients to use the VR therapy, which greatly expands the size of the mental health workforce who could contribute to the provision of psychological therapy for patients with psychosis.
We aimed to determine the potential benefit of the automated VR therapy in patients with psychosis. The primary hypothesis was that, compared with usual care alone, gameChange VR cognitive therapy added to usual care would reduce agoraphobic avoidance of, and distress in, real-world situations.13Freeman D Yu L-M Kabir T et al.Automated virtual reality ( VR) cognitive therapy for patients with psychosis: study protocol for a single-blind parallel group randomised controlled trial ( gameChange).BMJ Open. 2019; 9e031606Google Scholar The secondary hypotheses were that, compared with usual care alone, gameChange VR cognitive therapy added to usual care would reduce psychiatric symptoms ( eg, paranoia, depression, suicidal ideation), increase activity, and improve quality of life ( after end of treatment). It was also hypothesised that treatment effects would be maintained at follow-up. Mediation and moderation were built into the trial design to test how the VR therapy might work and in whom it might work. It was hypothesised that the mediators of VR therapy would be safety beliefs, threat cognitions, and defence behaviours, and that the moderators would be the occurrence of negative auditory hallucinations in social situations, hopelessness, appearance concerns, and threat cognitions.
We did a parallel-group, single-blind, randomised, controlled trial across nine NHS trusts in England. The trial was approved by an NHS Research Ethics Committee ( NHS South Central—Oxford B Research Ethics Committee, 19/SC/0075) and was registered prospectively, and the protocol ( appendix pp 2–51) was published at the start of the trial.13Freeman D Yu L-M Kabir T et al.Automated virtual reality ( VR) cognitive therapy for patients with psychosis: study protocol for a single-blind parallel group randomised controlled trial ( gameChange).BMJ Open. 2019; 9e031606Google Scholar A Lived Experience Advisory Panel ( LEAP), comprising individuals from all trial sites, advised on the conduct of the trial throughout.
Research assistants sought referrals from nine NHS mental health trusts associated with the five trial sites ( Bristol, Manchester, Newcastle, Nottingham, Oxford): Avon and Wiltshire Mental Health Partnership NHS Trust; Oxford Health NHS Foundation Trust; Berkshire Healthcare NHS Foundation Trust; Northamptonshire Healthcare NHS Foundation Trust; Central and North West London NHS Foundation Trust ( Milton Keynes); Cumbria, Northumberland, Tyne, and Wear NHS Foundation Trust; Greater Manchester Mental Health NHS Foundation Trust; Pennine Care NHS Foundation Trust; and Nottinghamshire Healthcare NHS Foundation Trust.
Eligible patients were adults aged 16 years or older, who were attending an NHS mental health trust for the treatment of psychosis, with a clinical diagnosis of schizophrenia spectrum psychosis ( ICD-10 codes F20–29) or an affective diagnosis with psychotic symptoms ( F31.2, 31.5, 32.3, 33.3),14WHOICD-10: international statistical classification of diseases and related health problems, tenth revision. World Health Organization, Geneva2004Google Scholar had self-reported difficulties going outside the home primarily due to anxiety ( for which they would like to have treatment), and were willing and able to provide informed consent for participation in the trial. Exclusion criteria were an inability to attempt an Oxford-Behavioural Assessment Task ( O-BAT) 11Freeman D Bradley J Antley A et al.Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study testing how to reduce delusional conviction.Br J Psychiatry. 2016; 209: 62-67Google Scholar at baseline for practical reasons ( eg, due to not being permitted to leave a psychiatric ward); photosensitive epilepsy; substantial visual, auditory, or balance impairment; current receipt of another intensive psychological therapy; insufficient comprehension of English; currently in a forensic setting or Psychiatric Intensive Care Unit; organic syndrome; primary diagnosis of alcohol or substance use disorder or personality disorder; clinically significant learning disability; or current active suicidal intent with plans ( ie, a crisis point). Written informed consent was obtained before participation.
Participants were randomly assigned ( 1:1) to gameChange VR therapy plus usual care or usual care alone. Randomisation was done by the trial coordinator in each centre using a validated online system ( Sortition) developed by the University of Oxford Primary Care Clinical Trials Unit. Randomisation used a permuted blocks algorithm, with randomly varying block size, stratified by site ( Bristol, Manchester, Newcastle, Nottingham, or Oxford) and service type ( inpatient, early intervention, or community mental health team).
Trial assessors were masked to group allocation. If group allocation was revealed, another masked assessor replaced the unmasked assessor. Assessors were unmasked on 35 occasions ( 29 by 6 weeks and six by 26 weeks) and all assessments were successfully remasked.
gameChange is a VR application that is recommended for adults ( age ≥16 years) who are anxious about everyday situations because of agoraphobic-type fears. The software is intended to reduce anxiety around other people. The software was programmed by Oxford VR. The application is a CE-marked class I active medical device ( device code Z301; standalone software), in conformity with the essential requirements and provisions of the European Commission Directive 93/42/EEC ( medical devices). The hardware used was an HTC Vive Pro headset ( HTC Corporation, New Taipei City, Taiwan) and Dell G5 15 5590 laptop ( Dell Technologies, Round Rock, TX, USA).
The therapy was designed to be delivered in approximately six sessions, each involving 30 min of VR, over 6 weeks. The prespecified minimum ( protocol-adherent) dose of VR therapy was three sessions. A mental health worker ( either peer support worker, assistant psychologist, or clinical psychologist) was in the room when the therapy was provided. Staff who delivered the therapy did not need to have previous experience of cognitive therapy. There was a wide range of clinical experience in the delivery team, including staff who had not been involved before in any type of therapy provision. The staff members had half a day of training in the delivery of the VR therapy, and weekly supervision during the trial. There was a written therapy manual for staff and a video showing how to set up the hardware used in the trial. A number of staff had opportunities to observe more experienced members of the team deliver the VR therapy. Staff members set up the hardware, briefly introduced the therapy concepts ( including explaining fearful thoughts, defences, and the rationale for the use of VR), helped the participant put on the VR headset, and started the programme. Staff members encouraged participants to apply the learning from VR in the real world by setting homework tasks to be carried out between sessions. Completion of homework tasks was then reviewed by the staff member. Staff members were tasked with helping participants maximise the learning from the VR programme. The VR sessions were conducted in the participant's home or in an NHS clinic room.
The gameChange VR therapy aims for participants to relearn safety by testing their fear expectations around other people. The therapy is not designed as simple exposure therapy ( participants are not asked to remain in situations until anxiety reduces), but instead as repeated behavioural experiments in which defences are reduced in order to create belief change ( ie, to learn that they are safer than they had thought). The therapy was designed in collaboration with the LEAP team, who, for example, helped choose the scenarios to be programmed.6Lambe S Knight I Kabir T et al.Developing an automated VR cognitive treatment for psychosis: gameChange VR therapy.J Behav Cogn Ther. 2020; 30: 33-40Google Scholar, 7Knight I West J Matthews E et al.Participatory design to create a VR therapy for psychosis.Design Health ( Abingdon). 2021; 5: 98-119Google Scholar Participants usually stand during the VR therapy, and are able to walk a few paces in the scenarios. A virtual coach, within the VR environments, guided the participant through the therapy. The coach encouraged participants to let go of defence behaviours, and elicited feedback to tailor the progression of the therapy. When first entering the VR environment, participants entered the coach's virtual office and were guided in how to use VR ( eg, the basic functions). At the beginning of the first session, the virtual coach explained the rationale behind the therapy, and the participant selected one of six VR social scenarios ( café, general practice waiting room, pub, bus, opening the front door of the home onto the street, and small local shop). Each scenario comprised five levels of difficulty ( based on the number and proximity of people in the social situation and the degree of social interaction) and participants worked their way through each level. Getting closer to other people and making eye contact are encouraged by the coach in many of the scenarios, and sometimes participants were the centre of attention within a situation ( eg, being asked to ring the bell at the front of the bus). Therapeutic game-type tasks are included within several levels. These tasks are designed to help the participant let go of defence behaviours and thereby make new learning. For example, in the café, the participant is asked to burst bubbles blown by a child from a wand; the virtual characters all look at the participant who is required to move closer to the characters, and the participant has the opportunity to learn that they can cope even when they are close to people and the centre of attention. In a small number of the scenarios, the participant was asked to speak to a computer character ( eg, respond to a barista asking whether they would like tea or coffee to drink or to call to someone that a wallet had been left on a counter) and voice recognition detected that a response had been made. The participant could choose a different scenario in each session or repeat a previous scenario ( and level within the scenario). Throughout the sessions, participants responded to questions from the virtual coach by moving a virtual slider or touching a virtual ball labelled with the option that appeared at the appropriate time. A belief rating for confidence in social situations was repeated within VR at the beginning and end of each treatment session. Pictures of the gameChange VR programme are provided in the appendix ( pp 243–46).
Usual care was recorded using the Client Service Receipt Inventory,15Beecham J Knapp M Costing psychiatric interventions.in: Thornicroft G Brewin CR Wing JK Measuring mental health needs. Gaskell, London1992: 163-184Google Scholar and usually comprised prescription of antipsychotic medications, regular visits from a community mental health worker, and occasional outpatient appointments with a psychiatrist.
Assessments were done at 0, 6 ( at end of treatment), and 26 weeks after randomisation.
The primary outcome was avoidance of, and distress in, everyday situations, assessed using the Oxford Agoraphobic Avoidance Scale ( O-AS).16Lambe S Bird J Loe B et al.The Oxford Agoraphobic Avoidance Scale.Psychol Med. 2021; ( published online Aug 23.) https: //doi.org/10.1017/S0033291721002713Google Scholar Secondary outcomes were agoraphobia measured by the Agoraphobia Mobility Inventory-Avoidance scale,17Chambless DL Caputo GC Jasin SE Gracely EJ Williams C The Mobility Inventory for Agoraphobia.Behav Res Ther. 1985; 23: 35-44Google Scholar suicidal ideation measured by the Columbia Suicide Severity Rating Scale,19Posner K Brown GK Stanley B et al.The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults.Am J Psychiatry. 2011; 168: 1266-1277Google Scholar paranoia measured by the Revised Green et al Paranoid Thoughts Scale,20Freeman D Loe BS Kingdon D et al.The revised Green et al. Paranoid Thoughts Scale ( R-GPTS): psychometric properties, severity ranges, and clinical cut-offs.Psychol Med. 2021; 51: 244-253Google Scholar paranoia worries measured by the Paranoia Worries Questionnaire,21Freeman D Bird JC Loe BS et al.The Dunn Worry Questionnaire and the Paranoia Worries Questionnaire: new assessments of worry.Psychol Med. 2020; 50: 771-780Google Scholar depression measured by the Patient Health Questionnaire-9,22Kroenke K Spitzer RL Williams JB The PHQ-9: validity of a brief depression severity measure.J Gen Intern Med. 2001; 16: 606-613Google Scholar and activity levels measured using actigraphy ( over 7 days), and a time budget assessing meaningful activity ( that considers complexity of activities and effort required).23Jolley S Garety PA Ellett L et al.A validation of a new measure of activity in psychosis.Schizophr Res. 2006; 85: 288-295Google Scholar Agoraphobic avoidance was also assessed using a behavioural assessment task, the O-BAT.11Freeman D Bradley J Antley A et al.Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study testing how to reduce delusional conviction.Br J Psychiatry. 2016; 209: 62-67Google Scholar The O-BAT was administered by a research assistant. A personalised hierarchy of five real-world situations was created and participants were asked to enter them in order of difficulty ( stopping when unable to progress). Ratings of distress were obtained for each step completed. Quality of life was assessed with the five-level EQ-5D,24Herdman M Gudex C Lloyd A et al.Development and preliminary testing of the new five-level version of EQ-5D ( EQ-5D-5L).Qual Life Res. 2011; 20: 1727-1736Google Scholar Recovering Quality of Life questionnaire,25Keetharuth AD Brazier J Connell J et al.Recovering Quality of Life ( ReQoL): a new generic self-reported outcome measure for use with people experiencing mental health difficulties.Br J Psychiatry. 2018; 212: 42-49Google Scholar and Questionnaire about the Process of Recovery.26Neil ST Kilbride M Pitt L et al.The questionnaire about the process of recovery ( QPR): a measurement tool developed in collaboration with service users.Psychosis. 2009; 1: 145-155Google Scholar For mediation, we assessed threat cognitions and use of within-situation defence behaviours ( using the Oxford Cognitions and Defences Questionnaire [ O-CDQ ]) 27Rosebrock L Lambe S Mulhall S et al.Understanding agoraphobic avoidance: the development of the Oxford Cognitions and Defences Questionnaire ( O-CDQ).Behav Cogn Psychother. 2022; ( published online Feb 15.) https: //doi.org/10.1017/S1352465822000030Google Scholar and strength of safety beliefs.28Freeman D Emsley R Diamond R et al.Comparison of a theoretically driven cognitive therapy ( the Feeling Safe Programme) with befriending for the treatment of persistent persecutory delusions: a parallel, single-blind, randomised controlled trial.Lancet Psychiatry. 2021; 8: 696-707Google Scholar Moderators were assessed at baseline by a brief assessment of negative hallucinations when outside, the Beck Hopelessness Scale,29Beck AT Steer RA Manual for the Beck Hopelessness Scale. Psychological Corp, San Antonio, TX1988Google Scholar the Body-Esteem Scale for Adolescents and Adults,30Mendelson BK Mendelson MJ White DR Body-esteem scale for adolescents and adults.J Pers Assess. 2001; 76: 90-106Google Scholar and the O-CDQ.27Rosebrock L Lambe S Mulhall S et al.Understanding agoraphobic avoidance: the development of the Oxford Cognitions and Defences Questionnaire ( O-CDQ).Behav Cogn Psychother. 2022; ( published online Feb 15.) https: //doi.org/10.1017/S1352465822000030Google Scholar The O-CDQ has two key subscales of threat cognitions and within-situation defences. The threat cognitions scale assesses 14 threat cognitions when outside, including “ I will embarrass myself ”, “ People will judge me negatively ”, “ I will panic ”, “ Everyone will watch me ”, “ People will try to upset me ”, and “ I won't be able to cope with voices ”. The within-situation defences scale assesses ten behaviours when outside, including “ I avoid making eye contact ”, “ When out, I did everything as quickly as possible ”, and “ When out, I kept my distance from other people ”. Each subscale forms a single factor and each has very high internal reliability.
At the end of trial participation, we checked medical notes for serious adverse events, defined by the ISO14155:2011 guidelines for medical device trials as serious if the event resulted in death or was a life-threatening illness or injury, required hospitalisation or prolongation of existing hospitalisation, resulted in persistent or clinically significant disability or incapacity, required medical or surgical intervention to prevent any of the aforementioned outcomes, led to foetal distress, foetal death, or a congenital anomaly or birth defect, or was otherwise considered medically significant by the investigator. An independent data monitoring and ethics committee chair rated whether any serious adverse event was related to treatment or trial procedures. We also checked medical notes for adverse events that were not serious.
Developed with the guidance of people with lived experience of psychosis, the O-AS is a new scale designed to capture the chronic difficulties with anxiety often seen in patients attending mental health services. The scale is brief, easily understandable, free to use without permissions, and has severity ranges that can guide assessment in clinical services. The O-AS was designed using the principles of behavioural avoidance tasks. It lists eight simple tasks progressing in difficulty from “ Stand outside your home on your own for 5 minutes ” through “ Travel on your own on the bus for several stops ” to “ Sit in a café on your own for 10 minutes ”. Participants were asked whether they could do the task now or whether they could not because of anxiety ( score 0 for yes, 1 for no), which provided the avoidance score ( 0–8). A reduction of 1 point for an individual on the avoidance scale ( ie, being able to do a new discrete task) is considered a clinically meaningful improvement. Avoidance scores can be interpreted as: 0=average avoidance, 1–2=moderate avoidance, 3–5=high avoidance, and 6 or greater=severe avoidance. For each task, participants were also asked how anxious they would feel doing that task, on a scale from 0 ( no distress) to 10 ( extreme distress). These distress scores were summed to provide an overall distress score; 23 or less was interpreted as average distress, 24–46 as moderate distress, 46–66 as high distress, and 67 or greater as severe distress. The psychometric properties of the scale are excellent,16Lambe S Bird J Loe B et al.The Oxford Agoraphobic Avoidance Scale.Psychol Med. 2021; ( published online Aug 23.) https: //doi.org/10.1017/S0033291721002713Google Scholar including the test-retest reliability. The avoidance and distress scores have been shown to correlate positively with O-BAT scores,11Freeman D Bradley J Antley A et al.Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study testing how to reduce delusional conviction.Br J Psychiatry. 2016; 209: 62-67Google Scholar Agoraphobia Mobility Inventory scores,17Chambless DL Caputo GC Jasin SE Gracely EJ Williams C The Mobility Inventory for Agoraphobia.Behav Res Ther. 1985; 23: 35-44Google Scholar Generalised Anxiety Disorder-7 scores,18Spitzer RL Kroenke K Williams JBW Löwe B A brief measure for assessing generalized anxiety disorder: the GAD-7.Arch Intern Med. 2006; 166: 1092-1097Google Scholar and overall activity levels assessed by actigraphy. We did not choose the commonly used Agoraphobia Mobility Inventory17Chambless DL Caputo GC Jasin SE Gracely EJ Williams C The Mobility Inventory for Agoraphobia.Behav Res Ther. 1985; 23: 35-44Google Scholar ( which was developed in the context of anxiety disorder research and asks about anxious avoidance of 26 situations) as the primary outcome measure, because many of the situations assessed in the scale, such as theatres, restaurants, museums, auditoriums, aeroplanes, and boats, are remote from everyday life experiences for many patients with psychosis.
We aimed to enrol 432 participants into the trial, with 216 in each group. This sample size took into consideration an attrition rate of 20%, and would provide 90% power to detect a difference of around 8 ( SD 23) in O-BAT anxiety score ( using the 0–100 scaling from Freeman and colleagues11Freeman D Bradley J Antley A et al.Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study testing how to reduce delusional conviction.Br J Psychiatry. 2016; 209: 62-67Google Scholar) from randomisation to 6 weeks ( ie, a standardised effect size of 0·35) at a two-sided 5% level of significance. The sample size was reconsidered due to recruitment being interrupted by the COVID-19 pandemic and a lower attrition rate being observed. 350 participants, 175 in each group, with an attrition rate of 10%, would provide 87% power to detect the same effect size. The statistical analysis plan was approved before any analysis of post-randomisation data and it is provided with the full statistical report in the appendix ( pp 52–239). The primary analysis included all participants for whom data were available and according to the group participants were randomly assigned to, regardless of any deviation from the protocol. Analyses were done after the last follow-up assessment was completed ( with no interim analyses).
Analysis of the primary outcome was done using linear mixed-effects regression, modelling the response at 6 weeks and 26 weeks simultaneously. The baseline outcome measure, stratification variables, time ( ie, 6 weeks or 26 weeks), and treatment assignment were fitted as fixed effects with a patient-specific random intercept. An interaction between time and randomised group was also fitted as a fixed effect to allow estimation of treatment effect at each timepoint. A similar approach was used for the secondary outcome analysis. The linear mixed-effects model implicitly accounted for missing data, assuming data were missing at random. A p value of less than 0·05 was used as the level of significance for all tests. Results are reported as mean differences between treatment groups, with 95% CIs. Treatment differences estimated from the linear mixed-effects models were additionally reported as standardised mean differences ( mean group difference divided by whole group SD at baseline).
Structural equation models and linear mixed-effects regression models were used to test for mediation of VR therapy effects on the outcome through the putative mediators. Analyses were adjusted for baseline measures of the mediator, outcomes, and possible measured confounders. We included repeated measurement of mediators and outcomes to account for classical measurement error and baseline confounding. The moderation analyses were done using linear regression, modelling the baseline outcome measure, treatment assignment, stratification factors, the moderator, and an interaction between randomised group and the moderator as a fixed effect. The p value for the interaction is reported.
We also performed post-hoc moderation analyses testing whether age, gender, and severity of agoraphobic avoidance and distress at baseline affected treatment response.
Stata ( SE) version 16.1 was used for all analyses. This trial is registered with the ISRCTN registry, 17308399.
Due to the COVID-19 pandemic, three main changes to the protocol were required. First, the original primary outcome measure, a real-world behavioural assessment task ( O-BAT),11Freeman D Bradley J Antley A et al.Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study testing how to reduce delusional conviction.Br J Psychiatry. 2016; 209: 62-67Google Scholar had to be replaced part way through the trial. Due to the COVID-19 lockdown measures implemented in March, 2020, we were not allowed to continue to administer the O-BAT. The assessment involved face-to-face contact with research staff members, which was prohibited by the NHS trusts. Also, many locations ( eg, cafés, shops) used in the O-BAT were closed. We had already developed a new self-report questionnaire version of the O-BAT—the O-AS16Lambe S Bird J Loe B et al.The Oxford Agoraphobic Avoidance Scale.Psychol Med. 2021; ( published online Aug 23.) https: //doi.org/10.1017/S0033291721002713Google Scholar—for clinical services to use after the trial. The O-AS was being completed as a secondary outcome measure, including in the period before the pandemic, and became the primary outcome measure on Sept 3, 2020. The need to change the primary outcome was approved by the trial Data Monitoring and Ethics Committee on April 22, 2020, and the protocol amendment was approved by the trial sponsor on Aug 5, 2020, NHS South Central—Oxford B Research Ethics Committee on Aug 24, 2020, and the Health Research Authority on Sept 3, 2020. The amendment was made before any analysis of trial outcome data, and the O-BAT data collected before the lockdown began are reported as secondary outcomes. Second, because recruitment had to be suspended for several months in 2020 during the first lockdown, we extended the recruitment period and brought forward the 26-week assessment by up to 6 weeks for the last patients enrolled into the trial ( a sensitivity analysis indicated this had no effect on our results; appendix p 140). Third, when recruitment resumed in September, 2020, we added another exclusion criterion: moderate or high risk for a severe course of COVID-19. This criterion was modified in February, 2021, so that when an individual at moderate or high risk had been vaccinated, they could then enter the trial.
The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Recruitment took place from July 25, 2019, to May 7, 2021. During this period, recruitment was suspended on March 16, 2020, due to the COVID-19 pandemic, and a staggered return across sites, depending on local circumstances, began from Sept 14, 2020. Final follow-up data were collected on Sept 30, 2021. 551 patients were assessed for eligibility and 346 were enrolled and randomly assigned to the gameChange VR therapy plus usual care group ( n=174) or the usual care alone group ( n=172; figure). 231 ( 67%) patients were men and 111 ( 32%) were women, 294 ( 85%) were White, the mean age was 37·2 years ( SD 12·5), and most patients were single, unemployed, and receiving prescribed antipsychotic medication ( table 1).FigureTrial profileShow full captionO-BAT=Oxford-Behavioural Assessment Task. VR=virtual reality.View Large Image Figure ViewerDownload Hi-res image Download ( PPT) Table 1Baseline characteristicsgameChange VR therapy plus usual care group ( n=174) Usual care alone group ( n=172) Age, years36·6 ( 12·8) 37·8 ( 12·2) GenderWomen58 ( 33%) 53 ( 31%) Men116 ( 67%) 115 ( 67%) Other01 ( 1%) Prefer not to say02 ( 1%) Missing01 ( 1%) Marital statusSingle131 ( 75%) 138 ( 80%) Married or civil partnership21 ( 12%) 14 ( 8%) Cohabiting6 ( 3%) 10 ( 6%) Separated2 ( 1%) 1 ( 1%) Divorced9 ( 5%) 7 ( 4%) Widowed3 ( 2%) 1 ( 1%) Missing2 ( 1%) 1 ( 1%) EthnicityWhite152 ( 87%) 142 ( 83%) Black British1 ( 1%) 1 ( 1%) Black African1 ( 1%) 2 ( 1%) Black Caribbean04 ( 2%) Black Other1 ( 1%) 0Indian02 ( 1%) Pakistani3 ( 2%) 3 ( 2%) Other16 ( 9%) 17 ( 10%) Missing01 ( 1%) Service typeCommunity mental health team107 ( 61%) 102 ( 59%) Early intervention64 ( 37%) 69 ( 40%) Inpatient3 ( 2%) 1 ( 1%) Employment statusEmployed full-time ( paid) 10 ( 6%) 9 ( 5%) Employed part-time ( paid) 4 ( 2%) 4 ( 2%) Working full-time ( voluntary) 00Working part-time ( voluntary) 2 ( 1%) 3 ( 2%) Unemployed ( claiming benefits) 112 ( 64%) 122 ( 71%) Unemployed ( not claiming benefits) 8 ( 5%) 5 ( 3%) Student or in training full-time5 ( 3%) 6 ( 3%) Student or in training part-time3 ( 2%) 1 ( 1%) Self-employed4 ( 2%) 1 ( 1%) Homemaker2 ( 1%) 1 ( 1%) Carer1 ( 1%) 1 ( 1%) Retired5 ( 3%) 2 ( 1%) Other03 ( 2%) Missing18 ( 10%) 14 ( 8%) Usual living arrangementLiving alone ( with or without children) 72 ( 41%) 72 ( 42%) Living with husband or wife16 ( 9%) 13 ( 8%) Living with partner8 ( 5%) 9 ( 5%) Living with parents40 ( 23%) 42 ( 24%) Living with other relatives9 ( 5%) 10 ( 6%) Living with others ( eg, friends) 10 ( 6%) 11 ( 6%) Missing19 ( 11%) 15 ( 9%) Mental health diagnosis ( F-code) Schizophrenia74 ( 43%) 64 ( 37%) Schizotypal disorder1 ( 1%) 2 ( 1%) Delusional disorder2 ( 1%) 2 ( 1%) Brief psychotic disorders5 ( 3%) 9 ( 5%) Schizoaffective disorder15 ( 9%) 11 ( 6%) Other psychotic disorder2 ( 1%) 3 ( 2%) Unspecified psychosis62 ( 36%) 54 ( 31%) Bipolar disorder with psychotic features3 ( 2%) 5 ( 3%) Depressive disorders with psychotic features7 ( 4%) 13 ( 8%) Major depressive disorder with psychotic features3 ( 2%) 3 ( 2%) Prescribed an antipsychotic medicationYes161 ( 93%) 156 ( 91%) No12 ( 7%) 16 ( 9%) Missing1 ( 1%) 0Prescribed an antidepressant medicationYes103 ( 59%) 96 ( 56%) No70 ( 40%) 76 ( 44%) Missing1 ( 1%) 0Prescribed an anxiolytic medicationYes15 ( 9%) 13 ( 8%) No157 ( 90%) 159 ( 92%) Missing2 ( 1%) 0Data are mean ( SD) or n (%). Percentages might not sum to 100% due to rounding. Open table in a new tab
O-BAT=Oxford-Behavioural Assessment Task. VR=virtual reality.
Data are mean ( SD) or n (%). Percentages might not sum to 100% due to rounding.
Provision of VR therapy was unaffected by NHS trust pandemic restrictions on face-to-face contact for 147 ( 84%) of 174 patients in the VR therapy group. These patients received a mean of 5·6 VR sessions ( SD 2·0; median 6, range 0–9), with a mean total time spent in VR of 145·2 min ( SD 63·4) and total session time of 392·3 min ( 170·9), and entered a mean of 4·6 ( SD 1·6; median 5) of the six VR scenarios. Only five of these patients attended none of the VR sessions. 131 ( 89%) of these 147 patients had at least the minimum dose of VR therapy ( ie, attended three or more sessions). Eight patients assigned to VR therapy could not have the intervention because of COVID-19 pandemic restrictions. They were offered support over the telephone and received a mean of 2·6 telephone sessions ( SD 3·6; median 0) for a mean total time of 103·1 min ( SD 145·0). 19 patients had their VR therapy curtailed by COVID-19 restrictions. These patients had a mean of 2·8 VR sessions ( SD 1·5; median 2) and 4·2 telephone sessions ( 3·7; 4). Their mean total therapy time was 361·4 min ( SD 184·5), with a mean of 71·7 min ( 35·7) spent in VR.
Overall, 13 ( 7%) of 174 patients in the VR therapy group attended no VR sessions, 74 ( 43%) had VR sessions at home, 74 ( 43%) had VR sessions at trust sites, four ( 2%) had VR sessions at home and trust sites, and nine ( 5%) had VR sessions in other settings. The likelihood of home visits varied by whether patients had severe avoidance ( n=23, 61%), high avoidance ( n=21, 49%), moderate avoidance ( n=21, 41%), or average avoidance ( n=9, 32%). The most commonly tried VR scenarios were practising opening the front door and being on a street ( n=133), visiting a shop ( n=133), visiting a café ( n=132), getting on a bus ( n=113), being in a doctor's surgery ( n=120), and being in a pub ( n=103).
The level of agoraphobic avoidance at baseline in the usual care alone group was average in 33 ( 19%) of 172 patients, moderate in 40 ( 23%), high in 51 ( 30%), and severe in 48 ( 28%), and in the VR therapy group was average in 29 ( 17%) of 174 patients, moderate in 55 ( 32%), high in 50 ( 29%), severe in 39 ( 22%), and missing in one ( 1%). Compared with the usual care alone group, the VR therapy group had a significant reduction in both agoraphobic avoidance ( O-AS adjusted mean difference –0·47, 95% CI –0·88 to –0·06; Cohen's d –0·18; p=0·026) and distress ( –4·33, –7·78 to –0·87; Cohen's d –0·26; p=0·014) at 6 weeks ( table 2). There were larger effect size reductions in agoraphobic avoidance ( adjusted mean difference –0·89, 95% CI –1·38 to –0·39; Cohen's d 0·68; p=0·0004) and distress ( –0·86, –1·72 to 0·01; Cohen's d 0·43; p=0·052) as assessed by the original primary outcome measure, the O-BAT, in the VR therapy group compared with the usual care alone group among patients who provided end-of-treatment data before the COVID-19 pandemic than with the O-AS. The differences between groups in O-AS scores were not significant at 26 weeks ( appendix pp 122–123). There were no significant differences in secondary outcomes between the study groups, except for improvements in the VR therapy group ( vs the usual care alone group) in recovery as assessed by the Questionnaire about the Process of Recovery at 6 weeks and in O-BAT avoidance scores at 6 weeks and 26 weeks, in the small number of patients who provided such data ( table 2, appendix pp 123–124).Table 2Summary statistics for the primary and secondary outcomesgameChange VR therapy plus usual care groupUsual care alone groupAdjusted treatment difference ( 95% CI) * VR versus control; mean difference estimated from a linear mixed-effects model adjusting for site, service type, and baseline values of the outcome as fixed effects and participant as the random effect for all outcomes. Standardised effect size=estimated mean difference divided by baseline SD.p valuePrimary outcomesO-AS avoidanceBaseline3·2 ( 2·5) [ 173 ] 3·4 ( 2·7) [ 172 ].... 6 weeks1·9 ( 2·2) [ 160 ] 2·5 ( 2·6) [ 160 ] −0·47 ( −0·88 to −0·06); standardised effect size −0·18 ( −0·34 to −0·02) 0·026O-AS distressBaseline51·4 ( 16·4) [ 174 ] 52·6 ( 17·2) [ 172 ].... 6 weeks41·3 ( 18·8) [ 160 ] 45·8 ( 20·4) [ 162 ] −4·33 ( −7·78 to −0·87); standardised effect size −0·26 ( −0·46 to −0·05) 0·014Secondary outcomesO-BAT avoidanceBaseline2·7 ( 1·3) [ 95 ] 2·8 ( 1·3) [ 96 ].... 6 weeks1·6 ( 1·7) [ 59 ] 2·3 ( 1·6) [ 55 ] −0·89 ( −1·38 to −0·39) 0·000426 weeks1·1 ( 1·8) [ 9 ] 2·2 ( 2·1) [ 11 ] −0·87 ( −1·63 to −0·11) 0·025O-BAT distressBaseline5·5 ( 1·9) [ 94 ] 5·5 ( 2·1) [ 95 ].... 6 weeks3·1 ( 2·4) [ 55 ] 3·9 ( 2·6) [ 52 ] −0·86 ( −1·72 to 0·01) 0·05226 weeks2·4 ( 2·9) [ 8 ] 2·6 ( 2·8) [ 8 ] −0·32 ( −1·97 to 1·33) 0·70O-AS avoidance26 weeks2·0 ( 2·3) [ 157 ] 2·5 ( 2·6) [ 159 ] −0·37 ( −0·78 to 0·05); standardised effect size −0·14 ( −0·30 to 0·02) 0·083O-AS distress26 weeks40·7 ( 20·6) [ 156 ] 43·9 ( 21·6) [ 161 ] −2·50 ( −5·98 to 0·97); standardised effect size −0·15 ( −0·36 to 0·06) 0·16Agoraphobia Mobility Inventory-AvoidanceBaseline3·3 ( 0·7) [ 167 ] 3·2 ( 0·8) [ 164 ].... 6 weeks2·9 ( 0·8) [ 152 ] 3·0 ( 0·9) [ 152 ] −0·13 ( −0·27 to 0·00) 0·05526 weeks2·9 ( 0·8) [ 146 ] 3·0 ( 0·9) [ 145 ] −0·11 ( −0·25 to 0·03) 0·12R-GPTS-A ( paranoia, reference) Baseline14·1 ( 9·3) [ 158 ] 12·6 ( 9·1) [ 161 ].... 6 weeks10·6 ( 8·5) [ 142 ] 10·7 ( 8·4) [ 146 ] −1·37 ( −2·94 to 0·20) 0·08726 weeks11·0 ( 9·6) [ 133 ] 10·4 ( 9·1) [ 134 ] −0·39 ( −2·00 to 1·22) 0·64R-GPTS-B ( paranoia, persecution) Baseline17·3 ( 12·7) [ 158 ] 14·2 ( 12·9) [ 161 ].... 6 weeks13·0 ( 11·9) [ 142 ] 12·2 ( 12·6) [ 146 ] −1·66 ( −3·73 to 0·40) 0·1226 weeks12·8 ( 12·6) [ 133 ] 11·7 ( 12·6) [ 134 ] −0·62 ( −2·74 to 1·49) 0·57R-GPTS total ( paranoia) Baseline31·3 ( 20·7) [ 158 ] 26·7 ( 20·8) [ 161 ].... 6 weeks23·6 ( 19·3) [ 142 ] 22·9 ( 19·9) [ 146 ] −3·14 ( −6·49 to 0·21) 0·06626 weeks23·8 ( 21·3) [ 133 ] 22·1 ( 20·4) [ 134 ] −1·10 ( −4·52 to 2·33) 0·53Paranoia Worries QuestionnaireBaseline9·8 ( 6·2) [ 158 ] 8·9 ( 6·2) [ 156 ].... 6 weeks7·7 ( 6·1) [ 141 ] 7·5 ( 6·1) [ 145 ] −0·47 ( −1·60 to 0·66) 0·4226 weeks7·3 ( 6·1) [ 127 ] 7·1 ( 6·5) [ 134 ] −0·15 ( −1·32 to 1·01) 0·79Patient Health Questionnaire-9 ( depression) Baseline15·1 ( 6·0) [ 166 ] 14·1 ( 6·5) [ 162 ].... 6 weeks12·5 ( 6·2) [ 147 ] 12·1 ( 6·0) [ 150 ] −0·24 ( −1·48 to 0·99) 0·7026 weeks12·5 ( 6·7) [ 134 ] 11·6 ( 6·6) [ 137 ] 0·11 ( −1·17 to 1·39) 0·87Columbia Suicide Severity Rating Scale ( suicidal ideation) Baseline1·1 ( 1·3) [ 155 ] 0·9 ( 1·3) [ 154 ].... 6 weeks0·9 ( 1·3) [ 121 ] 0·8 ( 1·4) [ 123 ] −0·14 ( −0·33 to 0·04) 0·1326 weeks0·8 ( 1·3) [ 110 ] 0·7 ( 1·3) [ 113 ] −0·06 ( −0·25 to 0·14) 0·57Time budgetBaseline51·9 ( 17·4) [ 151 ] 53·2 ( 16·8) [ 142 ].... 6 weeks55·8 ( 16·0) [ 124 ] 57·6 ( 15·5) [ 119 ] −1·75 ( −4·73 to 1·23) 0·2526 weeks57·3 ( 18·2) [ 85 ] 57·7 ( 17·5) [ 85 ] −1·01 ( −4·55 to 2·52) 0·58Actigraphy, mean number of steps per dayBaseline4727·4 ( 3016·6) [ 95 ] 4942·9 ( 3107·3) [ 89 ].... 6 weeks5260·7 ( 3528·8) [ 57 ] 4717·4 ( 3647·5) [ 63 ] 578·7 ( −333·8 to 1491·1) 0·2126 weeks5856·1 ( 2568·1) [ 26 ] 5603·9 ( 2838·3) [ 27 ] 751·1 ( −533·6 to 2035·8) 0·25EQ-5D-5L indexBaseline0·5 ( 0·3) [ 172 ] 0·5 ( 0·3) [ 170 ].... 6 weeks0·6 ( 0·3) [ 152 ] 0·6 ( 0·3) [ 155 ] 0·03 ( −0·02 to 0·08) 0·2326 weeks0·6 ( 0·3) [ 142 ] 0·6 ( 0·3) [ 145 ] −0·00 ( −0·05 to 0·05) 0·86EQ-5D visual analogue scaleBaseline51·6 ( 19·2) [ 171 ] 53·2 ( 19·1) [ 170 ].... 6 weeks56·6 ( 19·7) [ 153 ] 54·9 ( 20·7) [ 156 ] 3·06 ( −1·18 to 7·30) 0·1626 weeks56·1 ( 21·3) [ 145 ] 56·7 ( 22·4) [ 146 ] −0·29 ( −4·65 to 4·06) 0·89Recovering Quality of Life totalBaseline33·6 ( 13·3) [ 166 ] 35·5 ( 13·2) ( 163 ].... 6 weeks38·1 ( 13·8) [ 149 ] 39·4 ( 14·5) [ 147 ] 1·06 ( −1·53 to 3·65) 0·4226 weeks39·5 ( 15·1) [ 136 ] 40·8 ( 15·2) [ 137 ] 0·57 ( −2·10 to 3·25) 0·67Questionnaire about the Progress of Recovery totalBaseline27·2 ( 10·7) [ 173 ] 28·1 ( 11·1) [ 170 ] ].... 6 weeks32·4 ( 11·2) [ 159 ] 31·0 ( 11·3) [ 159 ] 2·83 ( 0·90 to 4·75) 0·003926 weeks33·1 ( 11·7) [ 148 ] 32·6 ( 12·1) [ 151 ] 1·71 ( −0·25 to 3·67) 0·088Data are mean ( SD) [ n assessed ] unless otherwise stated. VR=virtual reality. O-AS=Oxford Agoraphobic Avoidance Scale. O-BAT=Oxford-Behavioural Assessment Task. R-GPTS=Revised Green et al Paranoid Thoughts Scale. * VR versus control; mean difference estimated from a linear mixed-effects model adjusting for site, service type, and baseline values of the outcome as fixed effects and participant as the random effect for all outcomes. Standardised effect size=estimated mean difference divided by baseline SD. Open table in a new tab
Data are mean ( SD) [ n assessed ] unless otherwise stated. VR=virtual reality. O-AS=Oxford Agoraphobic Avoidance Scale. O-BAT=Oxford-Behavioural Assessment Task. R-GPTS=Revised Green et al Paranoid Thoughts Scale.
As the structural equation models failed to converge, mediation analyses based on parametric regression models alone are shown in table 3. For avoidance and distress, there was significant mediation of treatment outcomes at 6 weeks by threat cognitions and within-situation defence behaviours but not safety beliefs. VR therapy reduced threat cognitions and use of within-situation defence behaviours and each of these mechanisms separately explained approximately one-third of the VR treatment effect. The pattern was similar at 26 weeks but did not reach significance.Table 3Treatment mediation6 weeks26 weeksO-AS avoidanceThreat cognitionsTotal effect−0·53 ( −0·95 to −0·12); p=0·011−0·43 ( −0·85 to −0·02); p=0·042Direct effect−0·38 ( −0·79 to 0·03); p=0·066−0·30 ( −0·72 to 0·12); p=0·16Indirect effect−0·14 ( −0·27 to −0·02); p=0·022−0·11 ( −0·23 to 0·02); p=0·089Proportion mediated * Indirect effect divided by total effect.0·270·25Within-situation defence behavioursTotal effect−0·50 ( −0·91 to −0·08); p=0·019−0·40 ( −0·81 to 0·02); p=0·063Direct effect−0·35 ( −0·76 to 0·05); p=0·087−0·23 ( −0·65 to 0·18); p=0·27Indirect effect−0·15 ( −0·29 to −0·02); p=0·027−0·14 ( −0·28 to 0·00); p=0·054Proportion mediated * Indirect effect divided by total effect.0·310·35Safety beliefsTotal effect−0·57 ( −0·99 to −0·15); p=0·0082−0·50 ( −0·92 to −0·08); p=0·021Direct effect−0·50 ( −0·92 to −0·08); p=0·019−0·45 ( −0·89 to −0·02); p=0·040Indirect effect−0·04 ( −0·12 to 0·04); p=0·32−0·06 ( −0·15 to 0·02); p=0·15Proportion mediated * Indirect effect divided by total effect.0·070·13O-AS distressThreat cognitionsTotal effect−4·58 ( −8·06 to −1·09); p=0·010−2·89 ( −6·40 to 0·61); p=0·11Direct effect−2·54 ( −5·86 to 0·79); p=0·14−1·36 ( −4·78 to 2·05); p=0·43Indirect effect−1·62 ( −2·96 to −0·27); p=0·018−1·21 ( −2·58 to 0·16); p=0·084Proportion mediated * Indirect effect divided by total effect.0·350·42Within-situation defence behavioursTotal effect−4·38 ( −7·87 to −0·89); p=0·014−2·60 ( −6·11 to 0·91); p=0·15Direct effect−2·17 ( −5·42 to 1·07); p=0·19−0·61 ( −3·94 to 2·72); p=0·72Indirect effect−1·81 ( −3·38 to −0·24); p=0·024−1·60 ( −3·21 to 0·00); p=0·050Proportion mediated * Indirect effect divided by total effect.0·410·62Safety beliefsTotal effect−4·89 ( −8·49 to −1·29); p=0·0077−3·14 ( −6·75 to 0·47); p=0·088Direct effect−4·23 ( −7·80 to −0·67); p=0·020−2·23 ( −5·90 to 1·45); p=0·24Indirect effect−0·45 ( −1·31 to 0·42); p=0·31−0·68 ( −1·60 to 0·23); p=0·14Proportion mediated * Indirect effect divided by total effect.0·090·22Data are point estimate ( 95% CI); p value, unless otherwise stated. O-AS=Oxford Agoraphobic Avoidance Scale. * Indirect effect divided by total effect. Open table in a new tab
Data are point estimate ( 95% CI); p value, unless otherwise stated. O-AS=Oxford Agoraphobic Avoidance Scale.
Greater severity of threat cognitions ( assessed by the O-CDQ) at baseline resulted in greater treatment benefits with the VR therapy at 6 weeks ( avoidance interaction effect –0·06, 95% CI –0·11 to –0·01; p=0·012; distress interaction effect –0·37, –0·74 to 0·01; p=0·054; appendix pp 135–136), which indicates that severity of agoraphobia is likely to moderate outcomes. In the post-hoc analysis of the outcome effects on the primary outcome measure by severity of agoraphobic avoidance and distress, treatment benefits with VR therapy were only seen in the groups with severe and high agoraphobia at baseline, and these benefits were maintained at 26 weeks ( table 4). There was no evidence of moderation of treatment effects by the occurrence of negative verbal auditory hallucinations ( avoidance interaction effect 0·01, 95% CI –0·05 to 0·07; p=0·68; distress interaction effect 0·08, –0·40 to 0·56; p=0·74), hopelessness ( avoidance interaction effect 0·05, –0·02 to 0·13; p=0·17; distress interaction effect 0·17, –0·44 to 0·79; p=0·58), or appearance concerns ( avoidance interaction effect 0·01, –0·01 to 0·04; p=0·36; distress interaction effect 0·10, –0·12 to 0·32; p=0·35; appendix p 135). Post-hoc analyses provided no evidence of moderation of treatment effects by age ( avoidance interaction effect –0·03, 95% CI –0·06 to 0·01; p=0·11; distress interaction effect –0·12, –0·39 to 0·14; p=0·35) or gender ( avoidance interaction effect in women –0·73, –1·45 to –0·00; avoidance interaction effect in men –0·22, –0·73 to 0·29; p=0·26; distress interaction effect in women –5·79, –11·56 to –0·03; distress interaction effect in men –2·95, –7·03 to 1·13; p=0·43; appendix p 242).Table 4Moderation of VR therapy outcomes by baseline severity of O-AS avoidance and distressgameChange VR therapy plus usual care groupUsual care alone groupAdjusted mean difference ( 95% CI); Cohen's dInteraction p valueO-AS avoidance at 6 weeks0: average avoidance27320·26 ( −0·74 to 1·25); 0·10.. 1–2: moderate avoidance53370·08 ( −0·75 to 0·91); 0·03.. 3–5: high avoidance4348−0·34 ( −1·14 to 0·47); −0·13.. ≥6: severe avoidance3643−1·63 ( −2·49 to −0·77); −0·630·014O-AS avoidance at 26 weeks0: average avoidance2531−0·00 ( −1·02 to 1·01); 0·00.. 1–2: moderate avoidance50380·10 ( −0·73 to 0·93); 0·04.. 3–5: high avoidance45480·33 ( −0·45 to 1·12); 0·13.. ≥6: severe avoidance3642−2·06 ( −2·91 to −1·20); −0·790·0003O-AS distress at 6 weeks≤23: average distress711−0·78 ( −15·51 to 13·95); −0·50.. 24–46: moderate distress5643−0·30 ( −6·49 to 5·88); −0·02.. 46–66: high distress6371−4·11 ( −9·44 to 1·22); −0·24.. ≥67: severe distress3437−10·17 ( −17·34 to −3·00); −0·610·22O-AS distress at 26 weeks≤23: average distress7117·36 ( −9·48 to 24·20); 0·44.. 24–46: moderate distress53443·78 ( −3·33 to 10·88); 0·23.. 46–66: high distress6369−6·37 ( −12·48 to −0·27); −0·38.. ≥67: severe distress3337−8·47 ( −16·73 to −0·21); −0·500·050Data are n unless otherwise stated; n is the number of participants assessed. VR=virtual reality. O-AS=Oxford Agoraphobic Avoidance Scale. Open table in a new tab
Data are n unless otherwise stated; n is the number of participants assessed. VR=virtual reality. O-AS=Oxford Agoraphobic Avoidance Scale.
There were 25 adverse events ( in 21 patients) in the VR therapy group and 29 adverse events ( in 19 patients) in the usual care alone group ( p=0·66; table 5). There were 12 serious adverse events ( in nine patients) in the VR therapy group and eight serious adverse events ( in seven patients) in the usual care alone group ( p=0·37). Of the serious adverse events in the VR therapy group, ten were rated by the Data Monitoring and Ethics Committee as “ Not related-definitely not ”, two as “ Not related-probably not ”, and none as “ Related-possibly related ”, “ Related-probably related ”, or “ Related-definitely related ”.Table 5Adverse eventsgameChange VR therapy plus usual care group, events ( patients) Usual care alone group, events ( patients) Adverse eventsMen17 ( 14) 25 ( 15) Women8 ( 7) 4 ( 4) Serious adverse eventsMen10 ( 8) 8 ( 7) Women2 ( 1) 0Data are n ( n). VR=virtual reality. Open table in a new tab
Data are n ( n). VR=virtual reality.
The treatment target of one of the first randomised controlled trials testing psychological therapy, published in 1966, was severe agoraphobia.31Gelder MG Marks IM Severe agoraphobia: a controlled prospective trial of behaviour therapy.Br J Psychiatry. 1966; 112: 309-319Google Scholar Three-quarters of the patients in the pioneering trial were unable to leave their home unaccompanied. After more than 60 sessions of an early form of face-to-face behavioural therapy, provided over 6 months, four of ten patients showed good improvements in symptoms of agoraphobia. In the gameChange trial, significant benefits in agoraphobic avoidance and distress were obtained after six sessions of automated VR therapy supported by various mental health professionals. Uptake of the VR therapy was very high. Overall, the treatment effect sizes were small, due in part to a high proportion of the intervention group scoring low at baseline on anxious avoidance, leading to floor effects ( ie, there was little or no room to show improvement on the scale). The effects were specific to agoraphobia symptoms, with the majority of secondary outcomes showing no significant differences between the groups, although there were improvements in perceptions of recovery. Moderation analyses indicated that the VR therapy principally helped patients with severe agoraphobia. Patients with severe avoidance at baseline showed large effect size benefits with VR therapy at the 6-month follow-up. On average, patients with severe avoidance at baseline were able to complete two more O-AS activities, such as walking down the street or going to a shopping centre on their own, 26 weeks after VR therapy. There were also broader outcome benefits with VR therapy in the severe avoidance group, notably improvements in paranoia and recovering quality of life. There were also treatment benefits for reducing distress in everyday situations for those with high baseline agoraphobia. The therapy was designed for patients with difficulties leaving the home or visiting a local shop or taking a local bus due to agoraphobia, and for this group of patients, gameChange VR therapy showed significant benefit. For patients with lower baseline anxiety, who were able to go out locally and perhaps only struggled with complex social interactions, there was less evidence for treatment benefit on agoraphobia symptoms. Our recommendation would be to focus gameChange VR therapy provision initially for patients with high or severe avoidance. gameChange VR therapy is an intervention that has the potential to be deliverable on a large scale for patients with some of the most severe mental health symptoms. The primary outcome measure, the O-AS, has established cutoff scores, which enable services to identify the most suitable patients. The development of this measure, the design of the therapy, and the conduct of the trial all greatly benefited from having the lived experience perspective embedded into every stage of the project from the beginning.
This trial aimed to reduce agoraphobic avoidance of everyday situations and distress when in those situations. Approximately halfway into recruitment, the COVID-19 pandemic occurred. Avoidance of social situations by the public was actively encouraged, which had multiple effects on the trial. First, recruitment was paused, which meant the original planned sample size could not be reached, although the effects of this pause in recruitment were mitigated by our high participant retention rate. Second, there was an enforced change to the primary outcome measure. Fortunately, we were able to substitute a self-report version of the original behavioural avoidance task outcome measure. There is clear consistency in the outcome results obtained by the behavioural avoidance task and the self-report questionnaire, although treatment effects with the behavioural avoidance task were somewhat greater. Behavioural avoidance tasks are more likely to be sensitive to change, because fewer people will show floor effects as an individual hierarchy is constructed. Third, it is plausible that during the pandemic, as trial procedures moved online, fewer patients with severe avoidance were recruited. Fourth, VR therapy delivery was greatly affected for patients who were enrolled into the trial immediately before the lockdown. Several patients were prevented from receiving a dose of therapy because of prohibition of face-to-face contact with staff for research. Opportunities to practise the learning made in VR became more limited. Together, these factors could have reduced the overall treatment effects. Finally, it is not possible to determine whether the overall public messaging to decrease in-person contact, and the long periods when access to public spaces was restricted, might have reduced the treatment effects.
The VR therapy was derived from a cognitive theoretical perspective on anxiety. The therapy reduced a wide range of threat cognitions concerning being outside and the within-situation defence behaviours ( eg, avoiding eye contact, scanning faces for signs of judgement or criticism, leaving when starting to get anxious) that maintain them. The change in these two psychological processes mediated treatment benefits, although reverse causation can not be ruled out from the study design. The therapy therefore seems to have largely worked as intended. However, the development of new beliefs concerning safety did not mediate outcomes. Future research on how to increase such safety beliefs might be a key route to improve clinical effects. The hypothesised psychological processes only explained a proportion of the treatment effects. The contribution of the contact with the mental health professional is unknown, but we presume it was important. Guided digital interventions have greater engagement than unsupported approaches.32Fairburn CG Patel V The impact of digital technology on psychological treatments and their dissemination.Behav Res Ther. 2017; 88: 19-25Google Scholar The degree to which the outcome effects are explained by the VR or by the contact with the mental health professional could not be determined by this trial. A qualitative peer-research investigation with 20 trial participants in the VR therapy group will detail the gameChange experience.33Bond J Robotham D Kenny A et al.Automated virtual reality cognitive therapy for people with psychosis: protocol for a qualitative investigation using peer research methods.JMIR Res Protoc. 2021; 10e31742Google Scholar It is also unknown whether there are any longer-term benefits for patients beyond the 6-month time period assessed in this trial. With the availability of inexpensive, easy-to-use, standalone headsets, which do not need a computer, we believe that there is now the opportunity to leave VR headsets with patients, which would allow patients to increase treatment time and to use the programme at the most opportune times ( eg, to gain confidence immediately before going out). This delivery method could be combined with regular review with mental health staff, to help apply the learning to everyday life. Staff support to patients is likely to be important in delivery of successful VR therapy, combined with regular supervision for delivery staff to ensure that the best guidance is provided to patients. gameChange VR therapy could be of great benefit for patients preparing to be discharged from psychiatric hospital,34Brown P Waite F Lambe S et al.Automated virtual reality cognitive therapy ( gameChange) in inpatient psychiatric wards: qualitative study of staff and patient views using an implementation framework.JMIR Form Res. 2022; 6e34225Google Scholar and for patients with other diagnoses that involve severe anxious avoidance. The therapy could be developed further by expanding the range of everyday scenarios simulated in VR, including those with greater social interaction, and adding further challenges to consolidate the learning. Providing a greater range of content and allowing patients more time with that content is likely to produce even greater clinical benefits. VR is inherently a therapeutic digital medium; patients know they are experiencing simulations, which enables a psychological distance from problematic reactions and provides an opportunity to practise new responses. The process of finding the best uses and implementation methods of this immersive technology at scale in mental health is only beginning.
James Altunkaya, Humma Andleeb, Aislinn Bergin, Emily Bold, Jessica Bond, Kate Bransby-Adams, Susan Brown, Cindy Chan, Nisha Chauhan, Michael Craven, Jason Freeman, John Geddes, Andrew Goodsell, Lucy Jenner, Alex Kenny, José Leal, Joanna Mitchell, Heather Peel, Maryam Pervez, Eloise Prouten, Eva Roberts, Dan Robotham, Harry Walker, Jonathan West.
DF conceived the project, led the design of the therapy and the trial, was the chief investigator, and wrote the first draft of the manuscript. FW, DMC, L-MY, TK, CH, JMa, MC, JGe, and JL contributed to the design of the trial. SL, TK, FW, JF, JW, and DMC contributed to the design of the therapy. TK led patient involvement, with contributions from AK, HA, DR, and JB. AR contributed to the programming of the treatment. AG and AR provided hardware support to staff who delivered the therapy. JMa, SB, MC, and AB led study of therapy implementation. JL and JA led the health economic aspects of the trial. AP, SL, LR, CA, JJ, EM, and RP coordinated the trial. RD, KC, AM, EO ' R, FW, and DF led trial sites. KB-A supported research at the Nottingham site. L-MY and UG led and conducted the statistical analysis. JGr and AP led the data management processes. RD, KC, CA, JJ, LJ, EM, RP, EB, HP, ER, HW, SL, and LR delivered the therapy. SL, LR, FW, and DF provided treatment supervision across study sites. CC, NC, JMi, MP, and EP conducted assessments. UG, L-MY, JGr, AP, and SL had full access to all the data in the study and, together with DF, take responsibility for the integrity of the data and the accuracy of the data analysis. JGr, UG, AP, and SL accessed and verified the data. All authors contributed to critical review and editing of the manuscript.
Deidentified participant data will be available in anonymised form from the corresponding author upon reasonable request ( including a study outline), subject to review and contract with Oxford Health NHS Foundation trust, following the publication of results. The trial protocol has been published and is available in the appendix ( pp 2–51). The statistical analysis plan and the full statistical report are available in the appendix ( pp 52–239).
DF is a founder and a non-executive director of Oxford VR, which will commercialise the therapy; holds equity in and receives personal payments from Oxford VR; holds a contract for his university team to advise Oxford VR on treatment development; and reports grants from National Institute for Health Research ( NIHR), Medical Research Council ( MRC), and International Foundation. CH reports grants from NIHR and MRC; and was chair of the National Institute for Health and Care Excellence Guideline for psychosis and schizophrenia in children and young people ( CG155). The University of Oxford, Oxford Health NHS Foundation Trust, McPin Foundation, NIHR MindTech MedTech Co-operative, and the Royal College of Art received a share of the licencing fee from Oxford VR for the gameChange software. DMC reports a Senior Investigator Award from the Wellcome Trust and is National Clinical and Informatic Advisor for the NHS Improving Access to Psychological Therapy ( IAPT) programme. RD reports a grant from the NIHR, is a clinician working in the NHS delivering cognitive therapy, and receives payments for workshops of cognitive behavioural therapy and royalties from books on cognitive behavioural therapy. SL reports consultancy work and fees from Oxford VR. AP reports a grant from the NIHR. All other authors declare no competing interests.
The trial was funded by the NHS NIHR Invention for Innovation ( i4i) programme ( project II-C7-0117-20001). It was also supported by the NIHR Oxford Health Biomedical Research Centre ( BRC-1215-2000). DF is an NIHR Senior Investigator. DMC is an Emeritus NIHR Senior Investigator. CH is an NIHR Senior Investigator. AB, SB, MC, CH, and JMa are supported by the NIHR Nottingham Biomedical Research Centre and NIHR MindTech MedTech Co-operative. This paper presents independent research funded by the NIHR. The views expressed are those of the authors and do not necessarily represent those of the NHS, NIHR, or Department of Health and Social Care. FW is funded by a Wellcome Trust Clinical Doctoral Fellowship ( 102176/B/13/Z). We thank the trial participants; the gameChange LEAP team members ( including Debbie Butler, Susie Booth, Len Demetriou, Zach Howarth, Mary Mancini, Cheryl Williams, and Christopher Wright [ based in the UK ]); the trial research assistants ( Lydia Carr, Chiara Causier, Anna East, Miriam Kirkham, Sapphira McBride, Sophie Mulhall, Simone Saidel, Megan Smith, Ashley-Louise Teale, Eve Twivy [ University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK ]; Naomi Coulthard, Kelly Grieve, Negar Khozoee, Robert Nirsimloo [ Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK ]; Nikki Dehmahdi, Emma Izon [ Greater Manchester Mental Health NHS Foundation Trust ]; Mariella Henderson, Genevieve Quartey, Naomi Thrower, Kira Williams, Charlotte Way [ Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK ]); additional trial therapy deliverers ( Poppy Brown [ University of Oxford and Oxford Health NHS Foundation Trust ], Rory Byrne [ Greater Manchester Mental Health NHS Foundation Trust ], Jason Horeesorun [ Nottinghamshire Healthcare NHS Foundation Trust ], Lyndsey Tunney [ Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust ]); research and development support teams ( Andrea Cockram, Veronica French, Corinne Hendy [ Nottinghamshire Healthcare NHS Foundation Trust ]; Nick Raven, Bill Wells [ Oxford Health NHS Foundation Trust ]); the independent members of the Data Monitoring and Ethics Committee ( David Kingdon, Issy Reading [ University of Southampton, Southampton, UK ]; Tom Craig [ King's College London, London, UK ]; Andrew Gumley [ University of Glasgow, Glasgow, UK ]); and the clinical teams in the participating NHS trusts.
Download.pdf ( 4.18 MB) Help with pdf files Supplementary appendix | tech |
Making IFI Debt Relief for Ukraine Work | Ukraine has close to $ 2.7 billion in principal and interest payments due to the World Bank and IMF in 2022. The government of Ukraine should not be expected to repay its debt to the international financial institutions ( IFIs) while it is mobilizing all its resources to fend off the Russian invasion and provide vital services to its citizens.
As part of a slew of bills on Ukraine, the US House Financial Services Committee passed the Ukraine Comprehensive Debt Repayment Relief Act that would instruct the US Treasury to advocate that the IFIs “ immediately suspend all debt service payments owed to the institution [ s ] by Ukraine. ”
Debt relief is often the fastest, most direct route to provide a country fiscal support. But the path to IFI payment relief isn’ t always straightforward. IFIs and their shareholders will need get creative so that the Ukrainian government does not fall into arrears with the IFIs, which would perversely hinder its ability to secure more funding and keep its government operating. Given the uncertainty of the situation on the ground and the outcome of the war the international community should not get distracted with proposals for a full Ukrainian IFI write-off or restructuring. Such considerations should be left for after the war, if the Zelenskyy government prevails. Instead, the priority should be to provide fast cash-flow relief as payments come due.
There is no direct mechanism for the IFIs to provide debt service suspension to a member country. The G20 exempts the IFIs from the recent Debt Service Suspension Initiative ( DSSI) it rolled out for the world’ s poorest countries during the COVID-19 pandemic. For the World Bank’ s International Development Association ( IDA), the rationale was to maximize new financing and maintain positive net financing to pandemic-affected countries. Debt suspension would have negatively affected IDA reflows and cut back IDA’ s ability to surge its program. ( See here for why we thought that was a good idea at the time.) On the IMF side, the Fund expanded its donor-funded Catastrophe Containment and Relief Trust ( CCRT) and provided grants to its lower-income borrowers at high risk of debt distress to cover debt falling due to the IMF. Ultimately, this was a better deal for countries than DSSI, since CCRT provided a cash flow write-down rather than a deferral.
The options at the IMF are broadly the same as for the World Bank, with the addition of a possible special drawing rights ( SDR) option. Ukraine’ s loan repayments at the IMF will be upward of $ 2 billion over the course of 2022. Here are some other options:
The IFIs weren’ t first movers on debt issues during COVID. Taking an early and principled stance to this crisis could galvanize others to follow suit, including the private sector. The World Bank/IMF Spring Meetings, happening in a couple weeks, provide a unique moment for the IFIs to announce comprehensive payment relief plans. They should seek to do this alongside Paris Club creditors. And together they should pressure others, including private sector and non-Paris Club creditors to do their part.
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions. | general |
Auction companies thinking hard about AI | Something of a common theme emerged at the NADA Show this year: Auction companies have artificial intelligence on their minds. They 've cast aside science fiction-inspired apprehension about AI replacing humans, and now they want to see how this technology can be used to hone the vehicle imaging and inspection process.
Take ACV Auctions, for example. The used-vehicle online auction company recently spent $ 19 million to acquire Monk, a Paris-based AI solutions company. On the NADA Show floor, Monk demonstrated a guided photo capture that can be done remotely. Users with an enabled smartphone can scan a vehicle exterior, then get a damage report on it in about 60 seconds, the company said.
Such AI-enabled tools are useful, but they won't kick humans out of the vehicle inspection process, according to Michael Pokora, ACV Auctions ' senior director of research and development. That's not the purpose, he said.
`` It's something that's going to help us chew through all this variation, all this data, get it right the first time, '' he told me.
While AI tools are becoming more incorporated in the industry — even by Manheim, the largest auction network in the U.S. — they still have plenty of evolution to undergo.
Such tools can provide convenience — for instance, during the COVID-19 pandemic, as a larger portion of vehicle bidding shifted online — but the technology does not yet provide 100 percent accurate readings that would allow auction companies to feel comfortable cutting out human assessment in the inspection process.
It's a matter of learning: The more data points the auction houses collect and feed into their systems, the smarter their output can become.
Dealers, did AI get your attention at the show? Do you see it becoming a tool at auctions or in your own dealership processes? Email me at [ email protected ]. | general |
Norwegian seafood exports defy war to hit new high | For all the latest industry news, markets and jobs in aquaculture
Despite the war in Ukraine and rising global tension, Norwegian seafood exports again hit new records last month and during the first quarter of this year.
Once again salmon was the main export engine with sales in March totalling an all-time monthly high of NOK 8.5bn ( £745m).
This means that Norway sold 283,200 tonnes of salmon worth NOK 23.2bn ( £2bn) in the first quarter of this year. Volumes were down by 5%, but the value rose by 33% or NOK 5.7bn ( £500m).
The average price for fresh whole salmon reached NOK 78.37 per kilo during the quarter, up from NOK 54.29 12 months ago.
All this was achieved in a period beset by conflict, the re-emergence of coronavirus in parts of China and major disruption to air routes.
Overall seafood exports, which include cod and haddock pelagic species and shellfish, totalled NOK 34bn ( almost £3bn) during the January to March period.
Renate Larsen, CEO of the Norwegian Seafood Council, said: “ We had the lowest export volume of Norwegian seafood in a first quarter of six years.
“ The value record is therefore driven by strong price growth for many species. The salmon price has remained at a high level, at the same time as we have a record value for cod and saithe so far this year. ”
She added: ” The value record must also be seen in connection with higher costs related to energy, fuel, shipping and other input factors for the capture and production of seafood in various parts of the value chain. ”
The United States, significantly, became the largest growth market followed by France and China.
Seafood Council analyst Paul T, Aandahl said the war and sanctions had led to a halt in seafood exports to Belarus and Ukraine, but added that the loss of salmon exports to those two countries had had a relatively small impact.
Closed airspace over Russia, on the other hand, has complicated the export of live king crabs to Asia, which plunged 74 percent in March.
The value of farmed trout exports rose by 26% to NOK 945m ( £82m) during the quarter, | general |
Why Chhattisgarh has the lowest unemployment rate in India — Quartz India | Chhattisgarh, an Indian state located in the east-central region, has the country’ s lowest unemployment rate.
It is estimated to have a population of 32.19 million, according to government data, of which tribals such as Gond, Kanwar, and Uraon constitute 30.6%.
Over the past few years, the state government has launched several job schemes for its youth. This is in line with the central government’ s Mahatma Gandhi National Rural Employment Guarantee Act ( MGNREGA), according to the Centre for Monitoring Indian Economy ( CMIE), an independent think tank.
These schemes seem to have helped bring down Chhattisgarh’ s unemployment rate to 0.6% by March this year, even as India ‘ s overall unemployment rate stood at 7.8%.
“ Under the overarching objective of uplifting economy, economy, the state government has created new employment opportunities through the implementation of programmes such as Godhan Nyay Yojana, the constitution of Tea-Coffee Board, equal status of fisheries and production of agriculture, Millet Mission and commercial plantation, ” Sanjeev Prashar, senior faculty at Indian Institute of Management, Raipur, wrote in The Times of India newspaper last month.
On the other hand, Haryana topped the chart at 26.7%, followed by Rajasthan ( 25%), Jammu and Kashmir ( 25%), and Jharkhand ( 14.5%).
India’ s overall national unemployment rate had shot up sharply during the first wave of the covid-19 pandemic in 2020, hobbled by lockdowns and curtailed economic activity.
It was more acute in urban areas ( 8.6% in March) than in rural ( 7.3%). This was likely due to a lack of employment opportunities, employers’ hesitation to hire more, and an increased risk aversion among workers in crowded areas, experts say.
Besides, there are no MNREGA-like schemes for urban workers in India. | tech |
Work isn't working for women. Here's how to fix it. — Quartz at Work | There’ s a reason the post-covid labor market has been dubbed a “ she-cession. ” A February 2022 report from the National Women’ s Law Center calculates that women account for 63.3% of US jobs lost since the pandemic began. Two years later, American men’ s employment rate has returned to baseline, yet there are more than 1.1 million fewer women in the US labor force compared to early 2020.
Black women have been particularly hard-hit, with an unemployment rate more than twice that of white women. Hispanic/Latinx women have fared slightly better, but they still have a higher unemployment rate than white or Asian women.
While the pandemic has had a disproportionate impact on working women, especially women of color and women in frontline industries like healthcare, retail, and education, gender inequality on the job is nothing new. In many ways, covid simply exacerbated long standing problems, but it also opened a gateway of empathy for solving them with urgency.
Breaking down barriers and making workplaces more equal helps women and their families, but it benefits the corporate bottom line, too. According to a 2019 Pipeline report, companies today see a 1-2% revenue increase for every 10% increase in intersectional gender equity.
Overcoming decades of discrimination and broken systems isn’ t easy, but meaningful change is possible, says Accenture’ s North America CEO Jimmy Etheredge. “ As more leaders commit to equality and to creating a sense of belonging in their businesses, it gives me hope that we are building momentum in a movement, not just a moment. And if we keep pulling together, we’ ll push forward to a better place. ”
Based on insights from Etheredge and the female business leaders below, here are five ways leaders and managers can make work better for women right now.
Some people love working from home. Others can’ t wait to return to the office. But according to Accenture’ s 2021 Future of Work report, the majority of workers—83% —prefer a hybrid model, but widespread participation in this new way of working is essential.
“ We have to be careful that we don’ t create a dynamic where women are taking advantage of flexible work and men aren’ t, ” says Dee Poku-Spalding, founder and CEO of female networking platform The WIE Suite, in a recent episode of Accenture’ s Change Conversations podcast. “ You could end up with an imbalance where women aren’ t in a position to advance their careers because they’ re not networking the same way or they’ re not accessing opportunities in the same way, because they’ re not [ in the office ] on Fridays. ”
Managers can avoid this imbalance by asking all employees to work remotely for part of the week and by scheduling one-to-ones consistently and always via video-call. Team-building activities like lunch and learns, book clubs, and coffee hours can be virtual, too. A 2021 study showed that in-person networking events can, in fact, put women at a disadvantage, whether that’ s from time constraints on women with dependent family members or different after-work interests than their male counterparts.
A 2021 Gallup study revealed troubling statistics about just how increasingly stressed women are these days. Gallup’ s 2019 survey found that 30% of women and 27% of men said they “ always ” or “ very often ” felt burned out at work. That gender gap quadrupled from March to December 2020 ( 34% of women and 22% of men) and averaged an eight-point difference in 2021.And in March 2022 a collaboration of Berlin Cameron, Eve Rodsky’ s Fair Play, and Kantar, surveyed more than 1,000 employees and found that 68% of US women experienced burnout in the previous seven days; 50% of US men reported the same.
These reports and others uncover a perfect storm of burnout factors, including pandemic-related health concerns and discontent with the division of chores and caregiving at home to fears of being judged for taking advantage of flexible work policies and the emotional labor spent tending to the well-being of colleagues.
In another Change Conversations episode, LeanIn.org CEO Rachel Thomas sums it up like this: “ Women aren’ t burned out because we’ re less resilient, ” she says. “ Women are burned out because we’ re doing more at home, and we’ re doing more at work. ”
That much burnout takes a toll on women’ s mindsets, which in turn affects their outlook on work. Accenture’ s 2021 Future of Work study found that fatigue and pessimism go hand-in-hand; because of these negative emotions, 46% of survey respondents described themselves as “ disgruntled ” or “ apathetic. ”
Managers can ease the burden by recognizing the value of invisible work and stepping in to reassign tasks as needed to allocate fairly to female and male direct reports. But don’ t launch anti-burnout initiatives without first consulting the experts: women themselves. Create space for women to lead honest conversations about their experiences and recognize that there’ s no one-size-fits-all solution. Women face different challenges depending on their race, sexual orientation, age, and seniority.
Then let these ideas determine next steps, and commit to engaging everyone, regardless of gender, in taking action. As she put it on the Change Conversations podcast, “ I’ m concerned when leaders at all levels don’ t take into account the need to listen, the need to invite women to the table and let us design what works for us, ” says United Way Worldwide CEO Angela F. Williams, “ as opposed to saying, ‘ This is what we think is appropriate for you.’ ”
It’ s time to get rid of that old HR benchmark—the seamless history of employment—which penalizes women who take time off for caregiving, personal health issues, or burnout. Post-covid, résumé gaps have become the norm, not the exception, especially among women with kids. In the first months of the pandemic, the US Census Bureau found that 3.5 million US moms stopped working, and by April 2020, 45% of American mothers with school-age children were out of the workforce.
A year and a half later, workers of all genders are stepping back from their jobs due to exhaustion and frustration. The World Economic Forum found that voluntary quitting in the US hit a record high of 3% of the total workforce in September 2021, with the highest resignation rates among mid-career workers.
The Mom Project is making the case for hiring differently—and showing how it can be done. The platform helps people find work on their own terms, providing resources and connections with top companies. It’ s paying off: In 2021, Accenture announced that it would hire 150 Mom Project members in tech, strategy, and consulting roles, with an emphasis on people who have been out of the workforce.
Recruiting from networks like The Mom Project, instead of traditional pipelines, requires buy-in from individual managers as well as HR teams, but it’ s also a step toward long-term business health. A September 2021 Accenture/Harvard Business School study found that companies that hire “ hidden ” labor like part-time workers, caregivers, and people with employment breaks are 36% less likely to face talent and skill shortages.
Finding these unconventional paths into the knowledge economy is especially important for women of color, who are more likely than white women to hold lower-paying jobs. These jobs in healthcare, retail, and education may be called “ essential work, ” yet they are less likely to provide benefits, paid leave, and schedule flexibility. Making the leap to careers with better pay will benefit women and their families, too; according to The Center for American Progress, 67.5% of Black moms and 41.4% of Latinx moms are primary breadwinners, compared to 37% of white moms.
Making a statement of support for working women is nice, but reversing inequity requires money and action. The Accenture Black Founders Development program was created to link Black entrepreneurs with capital and mentorship, a direct response to the fact that Black founders—male and female combined—receive about 1% of all VC funding. By leveling the playing field, the program helps Black women build businesses, creating new talent pipelines and job opportunities within their own networks and communities.In February 2022, the program announced its first investment: SwayBrand, a Los Angeles-based platform that connects companies with multicultural influencers. It’ s co-led by Century Williams, who left her corporate job to pursue her passion for media and brand-building. Now, SwayBrand is forging deals with diverse partners like Black Girls Golf, Yanique Holder, and Briona Lamback. “ When you invest in people of color, when you invest in women, you are going to get a return that is beyond belief, ” Williams says.
Businesses can also amplify their investments by collaborating. That’ s the idea behind NPower’ s Command Shift Coalition, a nationwide consortium that brings women of color into the tech industry. Currently, only 5% of tech workers are Black and Latinx women. Accenture is one of Command Shift’ s latest partners, joining a roster that includes Fortune 500 firms as well as nonprofits. By combining resources and expertise, the coalition impacts recruiting, hiring, and pay equity in tech.
It’ s important to think past entry-level stages, too. The Hispanic IT Executive Council ( HITEC) connects senior business and tech executives looking to advance their careers and mentor new leaders. Nellie Borrero, Global I & D Senior Strategic Advisor at Accenture, joined the HITEC board in 2020, saying: “ I’ m excited to be part of an organization whose mission is to close the gap of Hispanic representation in leadership roles in the technology industry. ”
On a personal level, allyship as a verb, not a mindset, is an essential shift, Thomas explains. “ What I see in my research is that 80% of white employees see themselves as allies to women of color, ” she says. “ But when you start to ask about specific allyship actions, like speaking out when you see discrimination or publicly advocating for racial equity or mentoring a woman of color, the numbers drop like a rock. Only one in 10 white employees say they’ ve mentored or sponsored even a single woman of color. ”
Legacy inequalities create barriers to professional development, which in turn hinders career growth. In some skill-intensive industries, even getting a foot in the door is daunting: the proportion of women working in tech is 32%, and only 5% of tech workers are Black and Latinx women. Meanwhile, women are over-represented in service, education, and care industries, which often lack opportunities for learning and advancement.
FutureofU: Skills. Job. Growth. is a new platform that represents the next wave of on-demand upskilling, helping women identify opportunities in high-growth areas such as data science and AI. From there, candidates begin role-specific skill training, receiving pay, benefits, and personalized coaching to prepare them for success. Upon completing the FutureofU program, participants are ready to step into their new jobs full-time.
“ We’ re very proud that Solutions.AI for talent and skilling is powering FutureofU, ” says Lan Guan, senior managing director and global lead for this division of Accenture. “ It’ s helping people who left the workforce due to covid master new skills and find work in a new digital career. ”
Giving employees the chance to grow positively impacts promotions and retention, too. “ Intake is really important, ” says Lisa Skeete Tatum, recent Change Conversations guest and founder and CEO of personalized career-pathing platform Landit, which focuses on increasing the success of women and diverse groups in the workplace.
“ But equally if not more important is what happens when someone gets there. Do they stay? Do they thrive? Do they progress? ”
This content was produced on behalf of Accenture by Quartz Creative and not by the Quartz editorial staff. Sources are provided for informational and reference purposes only. They are not an endorsement of Accenture or Accenture’ s products. | tech |
Russia’ s COVID-19 cases surge by almost 14,000, a new low since June 16 | Russia’ s COVID-19 case tally rose by 13,947 over the past day to 17,926,104, the anti-coronavirus crisis center reported on Tuesday, Trend reports with reference to TASS.
In absolute terms, the growth rate was the lowest since June 16, 2021. In relative terms, the growth rate reached 0.08%.
As many as 4,288 people were hospitalized with COVID-19 in Russia over the past day, up 172.9% from a day earlier. The number of hospitalized patients increased in 76 regions, while in 9 regions the figure decreased. A day earlier, 1,571 people were rushed to hospitals.
Moscow’ s COVID-19 cases surged by 596 over the past day versus 698 cases a day earlier, reaching 2,743,957, according to the anti-coronavirus crisis center. St. Petersburg’ s COVID-19 cases increased by 700 over the past day versus 759 a day earlier, reaching 1,504,382. | general |
Hybrid meetings: Do we still need conference tables? — Quartz at Work | Out with the giant conference table, in with the big screen.
The traditional layout of meeting rooms is undergoing a radical rethink as companies grapple with ways to create optimal collaboration spaces for hybrid teams.
At the newly-designed offices of the pharmaceutical giant GSK, architects at FCA reconfigured a key boardroom to look more like a small movie theater. Multiple projection screens are intended to create a sense of parity among virtual and in-person participants; carpeting and acoustical panels are installed to improve a meeting’ s sound quality; and plush seating makes marathon sessions more comfortable.
“ I think this type of meeting room is going to become much more prevalent moving forward, ” says John Campbell, president of the Philadelphia-based architecture firm. As technology becomes the ever-present element in business meetings, Campbell believes that sitting around a hulking table won’ t be necessary. “ We’ re not walking into a room with piles of paper anymore, ” he explains. “ The table was a place to hold papers to be passed around, but now we tend to share information through digital screens. ”
He imagines meetings where people will no longer have to strain to hear remote callers on a speakerphone or squint to see slides if they happen to sit at the far end of a conference table.
But having watched the workplace evolve over the past 50 years, Campbell is quick to add that conference tables won’ t disappear entirely. “ When you’ re negotiating, you’ ll need a table, ” Campbell explains, noting that conference tables can be instruments to create psychological distance and a sense of power, as Russian president Vladimir Putin does with his ridiculously long meeting tables.
The upheavals caused by the covid-19 pandemic presents a rare blank slate for architects and companies. “ This is actually one of the most exciting times in my career, ” Campbell says. “ When I first started, lots of people had [ fixed ] standards and we had to follow a cookie-cutter approach.
The crisis in office space compels organizations to think more broadly and boldly, Campbell observes. “ The beauty is that old ideas have been blown apart and our job now is to work with clients to help them understand who they are, what’ s their culture, what is really the right solution for them, ” he explains.
Designing for flexibility is essential at this juncture says Campbell. He tells Quartz that more offices in Europe and Asia are adopting raised floors—a construction model that leaves a gap between the slab and flooring to conceal power and data cables. This allows offices to move furniture without having to drill holes in the floor or disturb people, he explains.
Movable partitions, like the “ dancing wall ” produced by the Swiss furniture company Vitra, are also proving useful, says Campbell. Once marketed as privacy barriers for overcrowded open-plan offices, the mobile fixture that transforms into a bookshelf, coat rack, rolling coffee station, or plant stand allows companies to experiment with new space configurations as employees trickle back to the office.
“ We’ re in interesting times, ” Campbell says. “ It’ s all a big experiment. ” | tech |
Biden will extend student loan forgiveness again, reports say — Quartz | US president Joe Biden plans to extend the pause on federal student loan payments through August, according to reports in Politico and the Wall Street Journal citing unnamed sources. An official announcement could come as soon as tomorrow ( April 6).
Roughly 37,000 borrowers have not had to make payments on their student loans for more than two years, under a government policy that was first instituted in March 2020 due to the coronavirus pandemic. While the US economy has picked up since then, Biden is facing pressure from Democrats to extend the freeze, or even cancel student loans altogether. The president already has extended the loan freeze three separate times, most recently in December.
While an extension would give borrowers more time before they have to start paying down their debt again, it falls short of a request by nearly 100 lawmakers asking Biden ( pdf) to extend the student loan freeze until at least the end of 2022, and to “ provide meaningful student debt cancellation. ”
When Biden campaigned for president he expressed support for canceling $ 10,000 of federal student debt per person. But given that Biden still doesn’ t have enough votes to pass his signature social spending agenda, meaningful legislative action on student debt this year seems unlikely.
Federal student loans account for the majority of student debt in the US. Most borrowers eligible for automatic forbearance have taken advantage of the freeze.
An estimated $ 195 billion worth of student loan repayments have been waived since the moratorium began, a March 23 study published by the New York Federal Reserve found, with 97% of direct federal student loan borrowers electing to hold off on paying back their debt. | tech |
Former Unifor president Jerry Dias being investigated by Toronto Police Financial Crimes Unit | The Toronto Police Service says its Financial Crimes Unit is investigating former Unifor President Jerry Dias after the union handed over money he allegedly accepted from a supplier of COVID-19 rapid test kits he promoted to members.
`` The investigation is in its preliminary stages and we would not comment on specifics at this time, as to not compromise the investigation, '' Police spokesperson Laura Brabant said in an email to The Canadian Press.
Unifor said on Monday that it turned over to the Toronto Police Service the money the union says was given by a third party to Dias and led to an investigation into his conduct. Unifor has refused to name the supplier and Dias committed to enter a rehabilitation facility in the wake of the incident. | general |
Commercial prices continue to increase in Q1: MarketScout | BI’ s Article search uses Boolean search capabilities. If you are not familiar with these principles, here are some quick tips.
To search specifically for more than one word, put the search term in quotation marks. For example, “ workers compensation ”. This will limit your search to that combination of words.
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Commercial insurance rates continue to rise as the composite rate increase for the first quarter of 2022 was 6%, compared with 5.8% for the fourth quarter of 2021, according to insurance exchange MarketScout Corp. on Tuesday.
While rates in January and February were consistent with the last quarter of 2021, rates did start to move up even more in March 2022, “ which could be the beginning of stronger increases for the next several quarters, ” said Richard Kerr, CEO of MarketScout.
Aggressive rate increases in the first quarter included 19.7% for cyber, 9.7% for umbrella and excess, and 8.7% for directors and officers liability.
Commercial property was up 7.6%, business interruption up 6.3% and commercial auto up 7.3%.
Among smaller increases, workers compensation was up only 1% and crime and surety were each up 1.3%.
Rates for large and jumbo accounts were steady at an increase of 6.7% while small and medium-size account rates moved up 5.3% and 6.3%, respectively.
By industry class, transportation led the increases up 10.3% with habitational next up 8% and then contracting up 6%.
Founded in 2000, MarketScout is an insurance distribution and underwriting company headquartered in Dallas. The company is a Lloyd’ s coverholder and MGA for U.S. insurers.
Global commercial insurance prices increased 15% in the third quarter, according to Marsh LLC’ s latest Global Insurance Market Index, released Tuesday.
1. Lockton recruits cyber leader from AIG
2. Munich Re tightens up cyber insurance policies to exclude war
3. Lakers can proceed with COVID property case against Chubb unit
4. Commercial prices continue to increase in Q1: MarketScout
5. Navigators adds former Everest wholesale property exec
6. Burger King accused of whopper of a lie | general |
Most Americans are worried about a recession hitting the U.S. in 2022 | After two years of the coronavirus pandemic, a recession and a rapid recovery, Americans are worried that the economy may swiftly decline once again.
Some 81% of adults said they think the U.S. economy is likely to experience a recession in 2022, according to the CNBC + Acorns Invest in You survey, conducted by Momentive. The online survey of nearly 4,000 adults was conducted from March 23 to 24.
Certain groups are anticipating a potential economic downturn more than others, the survey found. That includes Republicans, who are more likely to think there will be a recession than Democrats, as well as those who see themselves as financially worse off this year than they were last year.
The National Bureau of Economic Research, the arbiter of calling recessions, defines one as `` significant decline in economic activity that is spread across the economy and lasts more than a few months. ''
The last recorded recession took place in 2020, when the coronavirus pandemic spurred mass shutdowns and layoffs across the U.S.
Since, however, the U.S. economy has seen a stunning recovery. The labor market has added back millions of jobs and is nearing its pre-pandemic state. In addition, wages have gone up for many workers, including those in lower-paying jobs.
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Because of this, many economists aren't too concerned that a recession is on the horizon.
`` If you look at the labor market data right now, you 'd be hard pressed to find any indication of recession, '' said Nick Bunker, economic research director for North America at the Indeed Hiring Lab. `` Maybe a relative slowdown, but that's from really hot to just hot. ''
Even though the labor recovery is still going strong, there are other forces impacting consumers.
Inflation, for example, has hit many Americans hard and could hinder the economic recovery. In February, the consumer price index surged 7.9% on the year, the highest since January 1982. Prices have gone up in many categories such as housing, food and energy.
`` Inflation is the boogeyman when it comes to recoveries, '' said Robert Frick, corporate economist at the Navy Federal Credit Union.
That's because if prices continue to climb — as they're projected to — people may begin to pull back on spending, which could lead businesses to halt hiring. The Federal Reserve is also poised to continue to raise interest rates, which will slow down the economy to curb inflation.
This is a blunt tool, however, according to Bunker. The central bank must be careful to cool the economy enough to bring prices back down without tipping the U.S. into another recession.
There's also geopolitical uncertainty around the war in Ukraine, which has contributed to rising fuel prices and will likely continue to pressure the global economy. In addition, the yield curve between the 2-year and 10-year U.S. Treasury bonds recently inverted for the first time since 2019, a signal that has preceded recessions in the past.
Still, this isn't a sure sign that a recession is on the horizon, said Frick.
`` Of all the things you have to worry about, I don't think that the yield curve inverting is one of them, '' he said.
While it may be too early for Americans to prepare for a recession, they could take steps now to better their financial situation regardless.
That includes boosting emergency and retirement savings, as well as trimming budgets to keep spending down amid inflation that's likely to continue.
`` It pays to take a step back and look at the positives and weigh the negatives against historical evidence, '' Frick said. `` If you do that with the odds of recession, they're still relatively low, but risks are high, and uncertainty is high. ''
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Disclosure: NBCUniversal and Comcast Ventures are investors in Acorns. | business |
ATEEZ Around the World: A Journey Through the K-Pop Group’ s First World Arena Tour | On a freezing January night in New York City, a crowd braves the icy-cold evening to gather outside Brooklyn Music School to see K-pop megastars ATEEZ. “ I love your Mingi backpack, ” one girl tells another amid the gust winds, and that simple opening unchains a conversation that, after only a few minutes, will have them chatting as if they’ ve known each other for ages. In a split second, several others have joined the group, all total strangers to each other up until 20 minutes ago, now forever bonded over their shared devotion to all eight members of ATEEZ.
Simultaneously, seven of those eight members get ready and glammed up together inside the venue in anticipation of what will be their first fansign outside of Korea since 2019. Over the past few years, their exponential growth has landed them a few different milestones: high rankings on various Billboard charts, countless no. 1 iTunes chart rankings all over the world, millions of views on YouTube, and a recently-completed sold-out tour across some of the most renowned arenas in the U.S. But even though they’ ve achieved a lot, this is only the beginning — they’ re still reaching for the stars.
As I make my way through the school’ s backstage area en route to an empty dressing room, muffled, lively voices approach. All of a sudden, a soft but confident hello from Hongjoong, the group’ s leader and versatile rapper, announces their arrival. As they enter the room and sit in front of me, their outfits for the night are far from fire-red latex, military-inspired uniforms, or enigmatic fedoras. Instead, muted hues, leather jackets, statement accessories, and classic silhouettes showcase their head-to-toe impeccable, yet effortlessly cool, style.
“ Your hands are so red! What happened? ” San utters as soon as he sits down, causing all of their eyes to focus on my flushed fingers and palms. I vaguely recite the drawbacks of Raynaud’ s syndrome and explain it’ s simply a consequence of standing outside in the cold for too long, which causes Hongjoong to worry about their fans lining up outside the venue. “ Are they waiting out in the cold? ” he asks a crew member, but much to his relief, he's informed they’ re already entering the building.
Only Hongjoong, Seonghwa, Yunho, Yeosang, San, Wooyoung, and Jongho are sitting in front of me. A few hours earlier, an official statement revealed the eight-member, Mingi, was experiencing muscle aches and therefore skipping that night’ s fansign event to be in top shape for their Newark concert happening two days later.
In November 2020, Mingi went on a hiatus due to psychological anxiety, sitting out of the group’ s promotions for an eight-month period until July 2021, when KQ Entertainment — the group’ s agency — announced he was ready to come back. “ We’ ve learned the hard way that we can’ t work continuously, ” Hongjoong tells Teen Vogue after explaining Mingi’ s absence at the fansign. Their busy schedule doesn't allow much downtime, but they’ ve learned to prioritize rest when the chance for it pops up. “ Our fans are always asking us to rest more, but I swear we do! ” Yunho claims.
Trying to decode the recipe behind ATEEZ’ s exploding success is not a simple task, but authenticity, empathy, and drive are vital components of the formula. There’ s a sense of normalcy in the way they present themselves to their fans, a sort of level-headed compass that helps blur the idol-fan hierarchy, which allows both sides to be comfortably vulnerable.
All these elements have been essential to mold the unbreakable bond that ties ATEEZ with their fans — known as ATINY— and although social media has been a crucial part of it, going utterly digital for the past two years was tough. “ For so long it was only the cameras and us, it feels surreal to perform in front of them again, ” says San. “ To be honest, I feel nervous, ” Seongwha chimes in, admitting multiple emotions are running through him. “ But I’ m also very eager to show our fans how much we’ ve grown as artists since the last time they saw us. ”
Just as every other human inhabiting the earth at the moment, ATEEZ found themselves struggling with the distress of living in lockdown. For a squad of eight young men who have a lot of irons in the fire, the virus that put the world on pause in 2020 interrupted what was to have been their first worldwide arena tour. “ We were just days, literally only a few days away from kicking off our tour, so it was hard to bear, ” Hongjoong recalls. “ It was sad and frustrating, but our fans got us pumped up, ” San says. “ We communicated through social media and kept the communication going, and I think that allowed us to push through and have fun every day with them. ”
For Wooyoung, the extra time opened the door to dig deeper into filming and editing, a passion he’ s always had but never got the chance to devote time to. “ Now that we’ re traveling overseas after a long break, I have lots of scenes I want to film, ” he says. “ That’ s why I bring a camera with me everywhere now. ”
Parallel to our chat, a small auditorium on the opposite side of the venue slowly fills up. Only 100 fans gained access to the fansign, and while they patiently wait for the clock to hit seven, anticipation is high. A long table and 14 empty chairs tease what’ s about to go down on stage. Traditionally at a K-pop fansign, fans get the chance to sit — or stand — right in front of their idols for about one or two minutes, ask questions, get their albums autographed, take selfies, and even hold hands. Due to Covid-19 safety measures, however, clear acrylic panels stand in between the group and the fans, though the extra precaution doesn’ t have an impact on the joyful atmosphere.
With no need for a dramatic entrance, ATEEZ walks in, waving to their fans and handing out a healthy quota of flying kisses and hearts. They sit behind the plastic screens and invite fans to join them on stage. There are no pre-made speeches or planned performances throughout the night; there’ s no sense of time, no expectations beyond simply interacting and breathing the same air for a couple of hours. There’ s only the thrill of an artist and the people who love them the most sharing a rare moment of intimacy.
ATEEZ’ s music has served as a source of inspiration for many of these fans. “ When I was struggling with school and deciding what I wanted to do with college, just seeing them follow their dreams inspired me to push forward and apply to the colleges I wanted to go to, ” 19-year-old fan Cici recalls while waiting for her turn to go up on stage. 26-year-old Katherine remembers being between jobs, not sure about her next steps, and hearing a couple members sharing stories about how they moved to Seoul and became K-pop idols. “ That resonated with me. I moved 17 hours from my parents, so I felt like I had somebody out there that got it. ”
In a way, the familiar ambiance and casual milieu establish a friendly environment where they feel as if they’ ve known each other forever. “ It’ s like if we had been stargazing separately, each one of us from our windows, and tonight those stars guided us here, only now we’ re all looking at them together, ” says 34-year-old Natasha a few minutes before the night comes to an end.
Natasha’ s choice of metaphor isn’ t random. Stars play a fundamental role in the ATEEZ universe. These perpetual comrades through the dark night embody hope and guidance in the group’ s music, but also a sense of self-dependence. Just as those shining orbs of plasma are held together by the power of their own gravity, ATEEZ hopes whoever listens to their music knows they have the ability to emit their own magnetic energy.
Back in the dressing room, only minutes before going on stage, Hongjoong chooses the lyrics of their recently released song “ Turbulence ” to convey the encouragement and support they’ d like to offer to their fandom. “ At the end of this road / If we must become something in this form / I hope to be myself / I hope you feel the same way, ” he quotes. “ No matter where they are, no matter who they are, I just hope they know we’ ll always be there, like a star shimmering light. ”
As we wrap up, they all head back to their chambers for some final glam touches, and I’ m left alone to grab my things before heading to the auditorium. “ Excuse me, ” Yunho murmurs as he walks back into the dressing room. Extending his arm, he hands me a disposable hand warmer. “ We thought you could use this. ”
“ It’ s nice to talk without masks on this time, ” Hongjoong says as soon as they show up on my screen. It’ s been 10 days since our chat in Brooklyn and two days since their last concert in L.A. It’ s now midafternoon in California as we jump on a chill Zoom call, and they reveal although the U.S. leg of their tour is over, they’ re still feeling the live-performance high.
After touring five cities for two weeks, and setting foot in five arenas, they’ ve performed in front of over 83,000 ATINY. For Wooyoung, standing in front of so many fans again was a shot of much-needed energy. “ They showed us so much more love and support than I could have ever expected. I was able to feel their excitement from the stage, so now we have a reason to come back ASAP, ” he says while bringing his hands to his chest. “ We’ ve energized the fans, but they’ ve energized and motivated us so much, as well. ”
The jump from virtual concerts to thousands screaming their names and singing along to every song certainly gave them all the feels. Yunho compares the fans’ cheers to some sort of high-octane, joyous fuel, “ They’ re loud! And the louder they get, the more powerful my performance gets, ” he explains with a laugh. As for Hongjoong, there’ s something magical in being able to look into fans ' eyes while on stage: “ I can’ t wait for the day when I can see their full faces without a mask, ” he says.
“ I personally found it mind-blowing that the fans were singing along to every single song, ” Mingi adds. “ I was deeply moved by how they made an effort to communicate with us and understood our Korean. ”
The rush of feelings, the excitement, and the thrill they feel on stage can get dizzying, Yeosang says, but in the best of ways. Performing in front of cameras involves a plan that most times will go just as anticipated, but standing in front of a crowd, “ there’ s always room for the unexpected, ” Yeosang explains, “ a quota of improvisation and spontaneity that feeds our live performer's souls. ”
But arm-in-arm with that fizzy stage bliss comes a lump-in-your-throat mood once the stage lights go out. This feeling is a familiar one for avid concert-goers. It's commonly known as post-concert depression, a gloomy temper that takes over once a concert you’ ve been waiting for is over. They admit they’ re not acquainted with the phrase, but “ we know exactly what you’ re talking about, ” says Yunho.
“ I’ d be lying if I said I don’ t feel somewhat empty or blue after a concert, ” Wooyoung says. Still, with time he’ s found ways to alleviate the feeling, such as talking with other members about their favorite moments or joking around while they have a meal together.
After hours surrounded by the chants of a roaring crowd singing along with every anthem, the quietness of their hotel rooms can feel overwhelming. “ Maybe that’ s why we enjoy after-concert live streamings so much, ” Hongjoong chuckles. These YouTube live sessions he refers to are a sort of post-concert depression hangover cure for their fans as well, who mass joined every single one of the eight streamings the group broadcasted throughout the 2-week long tour. These are also some of ATINY’ s most cherished moments: when their idols eat, when there’ s no need for hair or makeup, when there’ s no deliberate plan and they can make mistakes or laugh until they cry. Right then and there, ATINY and ATEEZ feel connected by the bond of being human.
While San and Yeosang enlist their favorite after-concert meals — steak, candy, and noodles are part of the menu — I pop two images on their screen. Side by side, the photo they took at the end of their very first concert in New York back in early 2019 in front of an audience of 800 people, and the one they took a week ago, in a sold-out Prudential Center in front of a crowd of nearly 20,000. There’ s silence for a moment, filled with muted gasps and muffled wows while they stare at both pictures. After a few seconds, Hongjoong looks straight at the camera. “ Not fair. You’ re making us feel emotional, ” he says jokingly.
A myriad of memories run through their minds. “ It feels surreal, ” Yunho suddenly utters. “ There are just so many moments with our fans that have deeply touched my heart during those three years. So many memories I share with the other members too. ” As Mingi examines both pictures, he reveals sometimes it feels as if his memories were dreams. “ I know I saw our fans with my own eyes and performed in front of them, but in my mind, some of those memories appear ethereal, ” Mingi explains.
This trip down memory lane hits all of them differently. They strongly believe their growth is a consequence of the unconditional support of their fans, on top of determination and the strong mindset each member displays on stage and behind the scenes. San brings the spotlight to Jongho’ s strong will to overcome adversities: “ He’ s a constant reminder of how there’ s always a way to be better. ” They quickly exchange some finger hearts. Mingi praises Hongjoon’ s showmanship and his ability to connect with the fans through words and body language. “ He’ s such a cool guy, ” he says while Hongjoong shakes his hand in appreciation for the kind words.
Yeosang has found a source of energy inspiration in San. “ When we’ re performing, sometimes I think, ‘ Yeah, everyone must feel tired by now,’ but then I look at San, and he’ s always pouring his heart and soul into every performance. I truly admire that. I should learn from him. ”
Both during our in-person convo a week earlier, and the after-tour Zoom call, they bring up their love and appreciation for ATINY any time they get the chance. Still, and knowing it’ ll be hard, I ask about the things that make them happy these days besides ATINY — strongly emphasizing on besides.
“ Besides the fans? ” Wooyoung asks while comically stroking his shin as if to say, “ Is there really anything else? ” Still, they feel the need to clarify their primary source of happiness is their fans and the genuine connection they’ ve built over the years. “ Also, my brothers, my members, they make me happy, ” Hongjoong adds, earning him a round of Awwws, finger hearts, and pats on the shoulder. “ And food! ” he quickly says in an attempt to draw attention away from him. “ Oh yeah, steak. Steak makes us happy, ” San can’ t help but loudly blurt out — and they all effusively agree.
“ I’ d say protein shakes, ” Yeosang shouts, which evokes a moment from our chat in Brooklyn the week before when they all assigned themselves a drink that represents them. “ I’ d be protein milk, ” Yeosang admits with a laugh. “ It’ s not only strong in its formula but helps make others feel strong too. ” “ I think I’ d be Pepsi, ” says Yunho. “ It’ s sweet and bubbly like me. ” Wooyoung would be an iced Americano with no sugar because “ it’ s simple but so energetic. ” Seongwha assigns himself water. “ It’ s totally transparent and the one thing everyone needs, ” he proudly says as everyone else claps. “ He wins, Seonghwa wins, ” says San.
After thinking about it for a while, Jongho concludes he’ d be red wine. “ The depth and maturity of red wine well-represent me. And red wine can taste different depending on the variety you choose, ” he explains. “ Just like wine, I’ d like to be a multifaceted person. I’ d like to show various sides of myself while also being deep and mature. ” Another round of slow claps surfaces, now for the youngest member’ s eloquent answer.
On the other hand, San describes himself as a warm cup of milk, while Hongjoong chooses plain yogurt “ because it’ s versatile, it can adapt and enhance everything. It’ s simple yet multifunctional. ” Finally, Mingi — who answered this question during our Zoom call — goes for Powerade. “ It’ s not something essential, but once you decide to have it, boom! Energy booster, ” Mingi says.
At first, these drinks don’ t seem to go well together, but that’ s precisely the secret behind ATEEZ’ s dazzling magnetism — an eccentric menu that ultimately fills you up with the best of eight worlds.
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Are labour markets in the rich world too tight? | LAST MONTH Jerome Powell, the chairman of the Federal Reserve, identified the most uncomfortable trade-off in economics. “ Today’ s labour market ”, he said at a press conference, is “ tight to an unhealthy level ”. In most places and at most times a fall in unemployment, or a rise in the number of people in work, is welcome. But labour markets can become too strained—creating worker shortages that stop production and cause wages to spiral, which can feed in to overall inflation.
Mr Powell fears that America has crossed the threshold from good-tight to bad-tight, one reason why the Fed is signalling that higher interest rates are on the way. Increasingly, though, labour markets elsewhere in the rich world are also straining at the seams.
Almost nobody saw this coming. When the pandemic struck in 2020, most economists believed that the rich world was in for a long spell of high unemployment, similar to what happened after the financial crisis of 2007-09. In April 2020 America’ s unemployment rate hit 14.7%. Had joblessness declined at its post-financial-crisis pace, the unemployment rate in March this year would have been over 13%.
In fact it is 3.6%. And America, by many standards, is a laggard. A rise in the number of Americans who have decided they do not want to work at all, and who therefore do not count as unemployed, means that the share of 15- to 64-year-olds with a job is slightly below its level at the end of 2019 ( see chart 1). In one-third of rich countries, however, this share is at an all-time high. Even among the other two-thirds, which includes America, the median shortfall in the employment rate is just one percentage point. It adds up to the quickest and broadest-based jobs boom in history.
Canada and Germany are among the countries with all-time-high employment rates. The same is true of France, known for its high joblessness. The working-age employment rate in Greece is three percentage points above its level in 2019. Across the OECD group of mostly rich countries there are 20m or so more jobs than had been forecast in June 2020. There have never been so many vacancies: 30m, by The Economist’ s count. Even as pricey energy and rising interest rates provoke concern about the world economy, there is little sign from “ real-time ” indicators that demand for labour is dropping.
Why is the jobs recovery so fast? One reason is the nature of the shock that hit the economy in 2020. History shows that financial crunches—tight monetary policy, banking disasters and so on—cause prolonged pain. But economies usually recover speedily from “ real ” disruptions such as natural disasters, wars and, in this case, a pandemic. In 2005 Louisiana’ s unemployment rate soared after Hurricane Katrina but quickly fell back ( though part of the adjustment came from people moving away). After the second world war European labour markets rapidly absorbed soldiers returning from the front lines.
Government policy has also boosted jobs. In 2020 countries including Australia, Britain, France and Germany launched or expanded job-protection or furlough schemes. At the peak over a fifth of European workers remained technically employed even as they sat at home. When lockdowns lifted, they could quickly return to their roles, rather than having to search and apply for work, which takes time and thus keeps unemployment elevated. America launched a modest job-protection scheme, but its efforts were largely targeted at maintaining peoples’ incomes via stimulus cheques and topped-up unemployment benefits.
Stimulus schemes of one sort or another shored up families’ finances. Many also reined in spending in 2020, allowing them to accumulate huge savings. The stockpile is now being spent on everything from consumer goods to housing, raising demand for workers in areas such as online retail and property services ( including an extra 200,000 estate agents in America).
With labour demand so strong, employers are having not only to increase the number of jobs but also to improve the quality of them. Amazon exaggerated when, last year, it said it would try to be “ Earth’ s best employer ”, but many other companies are promising similar things, whether by offering employees better in-office benefits ( such as tastier cafeteria food) or better compensation packages ( free college tuition). In 2021 venture investors put more than $ 12bn into global HR tech startups, roughly 3.6 times the capital invested in them in 2020, according to PitchBook, a data provider.
Bad employers are having a tough time. The share of Americans worried about poor job security is near a historical low. In Britain the share of full-time workers on a “ zero-hours contract ”, where there are no guaranteed hours, soared after the financial crisis but is now falling. Many of the gig-economy firms that grew rapidly in the early 2010s by relying on an army of underemployed workers are now struggling to find staff. Whether in London, Paris or San Francisco, hailing a ride a lot harder than it used to be.
The best measure of labour-market tightness is pay, which distils the relative bargaining power of workers and firms into a single number. In some places the situation is clearly getting out of hand. Wheeler County, Nebraska, is a heavily agricultural place a long way from anywhere. In December unemployment fell to around 0.5%. Jobs at a nearby Chipotle Mexican Grill pay $ 15-16.50 an hour, at least twice the federal minimum. Some firms claim to be raising wages by 30% or more.
Some countries still look decidedly un-Nebraskan. Japanese wage growth is easing, not accelerating. In December the “ special wage ”, which includes winter bonuses and typically makes up about half of total cash wages in that month, fell by 1% year on year. German wage growth is doing nothing special. Canada’ s is respectable but it is hard to make the case that things are out of control.
On average, however, labour markets across the rich world are clearly getting tighter. America’ s is plainly overheating. In February the average wage was 5.8% higher than a year earlier, according to the Atlanta Fed, with the lowest-paid seeing bigger raises ( see chart 3). Goldman Sachs, a bank, produces a wage tracker that corrects for various pandemic-related distortions. It is more than 5% higher than a year ago, the fastest rate of increase since the data began in the 1980s. Almost all wage measures in America show unusually rapid growth ( by comparison, manufacturing wages in the country rose by an annual average of 4.1% between 1960 and 2019).
Before the pandemic, underlying French wage growth was in the region of 1-2% a year. Now it is close to 3%. Italy looks similar. On March 23rd Norway’ s central bank noted that “ wage inflation has been higher than projected, and wage expectations have risen. ” Britain is particularly striking. On Goldman’ s measure, underlying pay there is rising at an annual rate of about 5%. Surveys of businesses suggest that even faster growth over the coming year can not be ruled out. Across the G10 as a whole wages are rising by at least 4% a year.
Is this sustainable? To most people wage growth of 4% hardly sounds malign. But the arithmetic is inescapable. At 4% wage growth, labour productivity ( ie, the value of what workers produce per hour) must grow by at least 2% a year in order to be consistent with an inflation target of 2%. Businesses would pass on half their extra hourly wage costs to customers in the form of higher prices, but would absorb the other half since they would be selling more goods and services, or producing them more efficiently.
Productivity growth of 2% a year is not unachievable, but it would be a lot stronger than it was before the pandemic. Although productivity growth does seem faster than normal, our analysis of data from OECD countries suggests that it falls short of 2%. It may yet rise as companies reap the gains from their large investments in remote-working technologies and digitisation. Hopes of higher productivity, however, must be weighed against fears of still-higher wage growth.
If heady wage growth can not be sustained, how might it fall? One long-floated possibility in those countries with lagging overall employment rates is that people who have left the workforce return, boosting the supply of labour. Fear of covid-19 might eventually fade and child care might become easier to find, easing worker shortages and causing wage growth to fall.
This hope is receding, however. Although many Americans have returned to the workforce over the past six months, wage growth has not slowed—in fact, it has sped up. The Economist calculates that as of September there were nearly 1.9m “ missing ” workers aged 25 to 54, based on participation rates in January 2020 and adjusting for population growth. By March 2022 this had fallen by more than half to about 750,000—or less than two months’ worth of job growth at the recent pace. There are another 1.3m missing older workers, but most are over 65 and likely to have retired permanently ( and the number of missing over-65s has recently been growing).
It is likely, therefore, that in America and elsewhere labour markets will have to be cooled the old-fashioned way: by central banks raising interest rates, making it a little more attractive to save than spend and thereby choking off demand for labour. The Fed has already raised rates by 0.25 percentage points, and is expected to raise them by a total of 2.5 points this year. America may well prove an example of what happens when policymakers respond to a labour market that has become dangerously hot.
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The violinist of Lutsk: a Ukrainian spy story | At 4.30am on February 24th, in the opening salvo of war, Russian missiles hit the military airbase at Lutsk, a city in the province of Volyn in western Ukraine. Footage of the aftermath showed wrecked buildings and a burning car. No one died. Several days later, Ukrainian television broadcast a video confession by Ilya Smetanin, a 35-year-old violinist and aviation enthusiast from Lutsk who admitted passing military information to the Russians before the attack. In the video, Smetanin wears a dark sweater and a parka. He looks pale and tired, with shadows under his eyes.
Smetanin said he had met a Russian military officer on social media in 2010 and gave him video and photos of flight paths and defensive structures at the airfield. “ I admit my guilt, ” he said. “ I apologise to the Ukrainian people. ”
“ When the airbase exploded my hair turned grey. I don’ t know if it was from the bombing or the shock of what Ilya did ”
But who was this unremarkable individual? When prompted, his fellow musicians offered a symphony of observations.
“ He always wanted to fly. It was his childhood dream to fly… ” “... but his parents pressured him to be a musician. ” “ He spoke really loudly. He was a big-headed kind of guy. ” “ He had his good side. He would always help me carry my things. ” “ He was into healthy living. He went to the gym. He didn’ t drink and he didn’ t smoke. ” “ He was handsome. People would ask me to be introduced to him. ” “ He never had a girlfriend. He said he had decided he would never get married. ” “ But his parents wanted him to get married and have children, that’ s for sure. ” “ You know he was born in 1986, but he had this strong nostalgia for the Soviet Union, even though he had no memory of it. It was very strange. ” “ Somehow he was the odd one out, because everyone else was looking forward and he was looking backward. ” “ His father is Russian. ” “ He spoke Russian. He didn’ t like Ukraine or Ukrainian culture. He said, ‘ why should I have children so they can suffer in this place?’ ” “ But he spoke Ukrainian really well. ” “ He said he would only have the Russian Sputnik covid vaccine. I heard all the family went to Brest [ in Belarus ] to get it. ” “ He was a big fan of Deep Purple. ”
We spent three days in Lutsk talking to Smetanin’ s parents, friends, colleagues and former teachers to find out how a violinist from a small city came to be accused of spying.
Lutsk is a city of over 200,000 people, with a 13th-century castle, a military base and Habsburg façades interspersed with Soviet blocks. It was built in the wide Ukrainian steppe of shifting frontiers, alternately the vassal of Polish kings and grand dukes of Lithuania. It was sacked by the Tartars and annexed by the Russian Empire. During the second world war, around 25,000 Jews from Lutsk were killed in the “ holocaust by bullets ”, the slaughter that happened following the German invasion of the Soviet Union. After the war, the Polish population was expelled when the town was ceded to the Soviet Union.
One Thursday morning, three weeks into the war, the Cantabile Chamber Music Orchestra of the Volyn Regional Philharmonic, where Smetanin once played the violin, was rehearsing for a series of patriotic recordings. Concerts had been cancelled, explained Toviy Rivets, the director, and several of the players had left Ukraine. But the scant dozen who remained felt it their duty to continue as best they could.
We sat in the small rehearsal room lined with concert posters and listened as they played a musical score by Myroslav Skoryk, a Ukrainian composer who died in 2020, that has become an unofficial national anthem. It was from “ High Pass ” ( 1981), a film about a family in the Carpathian mountains during the second world war. The music swelled and soared, the high notes of the violins gave way to the sad sweep of the cellos against the burr of the double bass. The music was deeply melancholic but it contained hope.
Smetanin, who was unmarried and lived with his parents, had played with the Cantabile orchestra for several years. His father had taught a number of the violinists. The musicians knew Smetanin more as a colleague than a friend, but they were still shocked by his confession. “ We couldn’ t understand it, ” said Roman, a double-bassist. Nina, a cellist, lived close to the base. “ I was having a cigarette outside when it exploded. Everything shook. My hair turned grey. I don’ t know if it was from the bombing the first day or the shock of what Ilya did. ”
Smetanin is the only child of two music teachers: Marina, who teaches the piano to school children, and Igor, who teaches violin at the local music college. “ From the age of five ”, Smetanin told a local reporter in 2015, “ my dad stuck a violin in my face and said, no matter what, you’ re going to learn to play. ” Most people in western Ukraine speak Ukrainian as their first language; the Smetanins spoke Russian at home and Ilya attended the only Russian-speaking school in Lutsk. An old school friend of his, Vova ( not his real name), remembered that Smetanin was young for his class and bullied for being small.
“ Someone knew how to push him and use him. The video made him look like a grand spy, but all he had was a telephone and an old bicycle ”
In the district where they both grew up, there were a lot of military families who had been posted to the air base during Soviet times.
“ Ilya’ s friends were the sons of pilots or former pilots, ” his father told me.
“ When he was a child, two or three years old, ” his mother remembered, “ he would always point up at the sky at the planes and follow their flight. ”
“ Perhaps it was in his genes, ” said his father. “ My grandfather’ s brother, who was killed in the second world war, was a pilot. ”
Smetanin’ s bookshelves were filled with memoirs of pilots and aviation encyclopedias, as well as the work of French writer and aviator Antoine de Saint-Exupéry. His greatest ambition was to be a fighter pilot, but he failed the medical exam – he had allergies, a heart irregularity and his eyesight was poor. His father said Smetanin was disappointed. Instead, he studied the violin at the Lviv Conservatory. A year after graduating he went to Kyiv and played for several orchestras there, including the National Symphony Orchestra.
Vova moved to Kyiv and often met up with Smetanin. “ At the beginning ”, Vova remembered, “ everything went well. ” Smetanin rented an apartment with a friend who worked as a tamada ( a toastmaster). They topped up their salaries by performing at private events. When the Maidan revolution closed Kyiv down for several months in 2013-14, the concerts stopped and work dried up. Vova said he and Smetanin went to the protests but only to observe the spectacle, not because they were politically engaged. Smetanin attempted to make money as an estate agent and by writing articles for music publications. Neither venture worked out.
Smetanin eventually returned to Lutsk. He moved in with his parents and joined the Cantabile Chamber Music Orchestra, which paid a scant $ 150 a month. He still had connections to the music scene in Kyiv and from time to time he went to play abroad, to Dubai, France and Germany. He told people that everything was fine, but it was obvious that he felt thwarted. His friends were getting married and having families. “ We were waiting for him to grow up, ” his father told me.
Smetanin returned to his old obsession with aviation. He spent much of his time with retired military men who had been posted to Lutsk during the days of the Soviet Union ( the original air base had closed in 2004). They compared Ukraine’ s penury and lassitude unfavourably with the old days of rigour and discipline. They rued Ukraine’ s relinquishment of its nuclear weapons in the Budapest Memorandum of 1994 and bemoaned the enfeebled state of the Ukrainian army. Smetanin began to echo the old-timers’ frustrations. “ But he was right, ” Vova said – the Ukrainian army had been neglected, in particular by President Viktor Yanukovych, deposed in the Maidan revolution and widely considered a Moscow stooge.
Smetanin joined a local aviation club called the Wings of Volyn, made up of civilian pilots who flew gliders and sports planes from a small aerodrome in a village outside Lutsk. He took on the administration of their Facebook page, uploading photographs of old Soviet pilots and planes, and snaps of recent club outings. Vova remembered Smetanin riding around on the same old bicycle he had at school to take pictures of planes. “ It was the funniest thing…At the beginning it was interesting, but after a while we began to laugh – like grow up, you’ re still taking pictures of fighter jets? ”
More than once, Smetanin went to the annual international MAKS air-show in Moscow – despite the fact that, after conflict began between Ukraine and Russian-backed separatists in 2014, direct flights to Russia were suspended. Many Ukrainians considered Russia to be enemy territory.
After the Russian annexation of Crimea in 2014, the Ukrainian Air Force’ s 204th Tactical Aviation Brigade was relocated to the newly reopened airbase in Lutsk. Smetanin befriended the pilots and found flats for some of them. He was always helping people, said his parents. He would take presents from his retired military pals to their friends in Russia whenever he visited. When an old pilot died last year, Ilya helped his granddaughter, who came from Russia, sell his apartment.
“ He spoke Russian. He didn’ t like Ukraine or Ukrainian culture. He said, ‘ why should I have children so they can suffer in this place?’ ”
Smetanin’ s interest in Soviet-era aviation was seen as reactionary. He joined a Facebook group called Save Old Lutsk that served as a forum for local activism. Participants griped about everything from the overpowering smell of sewage works and inept tree-pruning to new housing developments. Smetanin complained that it was not appropriate to hold a vintage-car rally at the military base – “ it’ s like putting a balalaika in the middle of a symphony, ” said his father.
To many locals, Smetanin seemed to disparage the national pride that had begun to emerge after the Maidan revolution. His friends rolled their eyes, as Ilya’ s online presence grew increasingly stubborn, embittered and derogatory. More than one person we spoke to in Lutsk had stopped talking to him.
“ He said he wanted to do something good for Lutsk but that no one appreciated him or listened to him, ” Vova told us. “ He felt frustrated by everyone. First it was Lutsk then it was all of Ukraine. ” The pair fell out. “ For the past couple of years I just phoned him on his birthday. ”
In 2018 Ilya joined a small delegation from the Volyn region which took part in the International Forum of Victors in Bryansk, a Russian city near Ukraine’ s north-eastern border. The event was styled as a celebration of the “ 75th anniversary of the liberation from Nazi invaders ”. One of the Volyn attendees gave a speech that chimed with the Kremlin’ s view and appeared to condemn the Maidan revolution and subsequent election.
On their return, many of the delegates were called in for questioning by the SBU, the Ukrainian security service. Then in March 2020, Vitaly Sinelnikov, a former pilot stationed on the Lutsk base, was arrested on the Polish border leaving Ukraine with a memory stick full of aerial photographs of the military site. Sinelnikov had been caught on tape describing the layout and condition of the runway and discussing how best to penetrate the perimeter fence. He was a member of Wings of Volyn and Smetanin had given him some of the photographs he was caught with. The security services interrogated Smetanin and seized his laptop and phone. No charges were brought against him, but he must have known that he would remain under surveillance.
We met Smetanin’ s parents in a small restaurant in Lutsk. His father had short white hair and a short white beard, and wore a black polo-neck; his mother had the tidy, demure, kindly air one would expect of a piano teacher. They were both modest and spoke to us in flawless Ukrainian. Clearly they were worried about their son. Smetanin was being held in solitary confinement in a pre-trial detention centre without being able to make or receive phone calls, or write letters. “ He can not even have his violin with him because it is a suicide risk, ” said his father.
In the days leading up to the war Smetanin had run back and forth to the pharmacy for medication because his parents had both come down with covid-19. We asked which vaccine the family had taken ( one of the orchestra members had insisted they received the Russian Sputnik one). “ I think it was AstraZeneca, ” said Igor.
The whole family was woken by the explosions on the base in the early hours of February 24th. “ I could hardly understand what was happening, ” Smetanin’ s father said. “ Ilya said to me, ‘ This is war.’ ” Smetanin called his pilot friends, who told him, “ Don’ t worry. We are all alive. We left several hours ago. We are not at the base. ”
On March 1st in the middle of the afternoon, an SBU investigator and two armed agents came to the family’ s apartment. They searched it, removed Smetanin’ s phone and laptop and took him away for questioning, telling his parents that he would probably return in a few hours. His parents spent two days searching for him. After a series of frantic phone calls and visits to the SBU, they were finally contacted on the morning of March 3rd by a lawyer. She told them that she had just been appointed to defend Smetanin and that they had only a few hours before the first court appearance to collect character references from his workplace and neighbours.
Under the conditions of martial law, imposed by President Volodymyr Zelensky on the first day of the war, Smetanin’ s parents were not allowed in the courtroom. They saw him briefly in the corridor outside as he arrived and then again as he left. They had only time to ask him how he was. Smetanin replied “ I’ m ok! ” and smiled, cheered a little by their presence.
That evening his confession was aired on TV. This would have been illegal in ordinary times; under martial law, broadcasting such a video was permitted, a spokesman for the security services told us. His parents thought that the video seemed odd. They noticed a scratch on their son’ s forehead. Smetanin was talking more slowly than usual; his father had the impression that he was reading from a script. Smetanin’ s lawyer told us she had seen a medical report which indicated that Smetanin had been beaten in custody.
The lawyer then recused herself as she was leaving town; a second lawyer was appointed. ( We talked to both lawyers, but neither wanted to be identified because of the amount of public outrage surrounding the case.) The new lawyer met Smetanin briefly before a hearing on March 11th, in which a request was made for Smetanin to be put under house arrest pending trial. This was refused on the grounds that he posed an ongoing risk of passing information.
His parents were present in the courtroom for this hearing, but Smetanin appeared via a video link. He was still wearing the same clothes he had been arrested in. After the opening formalities, the judge allowed his parents to speak to him for two minutes. Smetanin told them that he was fine, but that they shouldn’ t send him so much food.
His parents hope that his trial will take place in the next two months, but there is an expectation that it will be delayed because of the war. According to a written statement given to us by the Ukrainian security service, the SBU has “ established that the traitor passed information to the enemy special services about the types and number of military aircraft, their locations and training flights, and the personal data of airfield servicemen. From February 24th to 28th, he constantly leaked information about the impact of the Russian invasion on the Volyn region. ”
Smetanin’ s current lawyer has not yet seen the prosecution’ s case. When this lawyer asked him why he had made a video confession, Smetanin said that he was in a state of shock and had been put under pressure. He has since refused to admit his guilt on the charge of treason.
Lutsk air base was hit again with Russian missiles two weeks after the first strike, and again the day we left town. An oil depot was targeted the following day. The invasion has united Ukrainians; it has also meant that, in Lutsk, Ilya Smetanin and those connected to him have been vilified. Members of the Wings of Volyn aviation club and the Save Old Lutsk Facebook group have been detained and questioned by the security services.
Many of the townsfolk revile the family as Russian-speaking and therefore somehow pro-Russian. But almost all Ukrainians flow back and forth between the two languages. And the Smetanins are not as Russian as some people claim. Igor’ s mother’ s family is Ukrainian, as is Marina’ s on both sides. “ Ilya is 75% Ukrainian. So it’ s ridiculous to say he could have done this, ” Igor said. “ All of our relatives are here. We have relatives sitting in shelters in Chernihiv who can’ t get out. ” As Marina put it, “ Why would we live here for so long if we didn’ t want to be here? ”
People have shunned the Smetanins in the street. Marina told us that the university where she works as an accompanist has made it clear to her they would prefer her to leave. Igor’ s students have stayed loyal – he clasped his hands together gratefully – but he is glad that classes are, at present, online. Both parents still worry that they could lose their jobs. “ The only thing I can do is play the violin, ” said Igor. “ What am I supposed to do, just sit at home? My life will have no meaning – and it’ s the same for my wife. ”
Marina and Igor Smetanin miss their boy. “ There’ s no one to scold now, ” said his father, sadly. They worry that, even if he is released, his reputation will have been blotted. They sincerely believe in his innocence. They pointed out that there had been an air base in Lutsk since 1941: the Russians hardly needed a spy to point this out. “ His first enemy is the fact that he talks too much, ” said Igor. “ He is naive. ”
Innocent plane spotter, unwitting patsy, traitor. It is hard to judge amid the differing perspectives. Smetanin’ s parents maintained he never visited the military base. Vova said he remembered being on the base with him – but only once and it was eight years ago. Ivan Savych, the editor of the Volyn News, who knows Smetanin well, told us that “ Ilya had very good access to the military airfield and close personal contact with officers. He used to go to the command centre and even took me there with him. It’ s no secret. ”
Only a trial will reveal whether Smetanin betrayed his country. I asked his friends if they thought he had done it: some thought he could have; others demurred. Vova felt sorry for him. “ All of us, those who knew him, who saw the video, we understood that someone knew how to push him and use him. Maybe Ilya just wanted to pretend to be an important person. The video made him look like a grand spy, but all he had was a telephone and an old bicycle. ” ■
Wendell Steavenson has reported on post-Soviet Georgia, the Iraq war and the Egyptian revolution. She is sending regular dispatches for 1843 magazine from Ukraine, which you can read here, along with the rest of our coverage of the war. Marta Rodionova has worked as a television journalist and creative producer
Russia’ s president thought Ukraine would fold when invaded. History shows its people come together in adversity
Published since September 1843 to take part in “ a severe contest between intelligence, which presses forward, and an unworthy, timid ignorance obstructing our progress. ”
Copyright © The Economist Newspaper Limited 2022. All rights reserved. | business |
Fauci: Herd immunity to SARS-CoV-2 may be 'unattainable ' | It may be impossible to reach herd immunity given the wily nature of SARS-CoV-2, and federal health officials say the goal should instead be figuring out ways to live with the virus going forward.
That’ s according to a new
article
written by Dr. Anthony Fauci, President Joe Biden’ s chief medical adviser and the director of the National Institute of Allergy and Infectious Diseases, and two NIAID officials that published Thursday in The Journal of Infectious Diseases.
Fauci has long questioned herd immunity as a benchmark to end the COVID-19 pandemic, often describing the epidemiological concept as
“ elusive ” or “ mystical. ”
Herd immunity is the idea that a virus is no longer considered a major public health threat once a certain percentage of the population is immune as the result of natural infection or vaccination. But the evolving nature of SARS-CoV-2 and waning immunity from the COVID-19 vaccines or natural infection all complicate the ability to hit any type of immunity threshold that would definitively signal an end to the pandemic.
“ There are significant obstacles to achieving complete herd immunity with COVID-19, ” the NIAID officials wrote. “ ‘ Classical’ herd immunity, leading to disease eradication or elimination, almost certainly is an unattainable goal. ”
The idea of herd immunity swiftly went mainstream in the early months of the pandemic, and it has since become a politically loaded term that has been used to push for reopening businesses, schools, and workplaces.
Scott Atlas, an adviser to the Trump administration,
reportedly made the case
for the U.S. to pursue herd immunity, as did Sweden, though that’ s never been confirmed. ( “ The Swedish pandemic strategy seemed targeted towards ‘ natural’ herd immunity and avoiding a societal shutdown, ” researchers wrote in
research
published in Nature last month.)
A
study
from 2020 estimated that the herd immunity threshold for the original strain of the virus was about 67%.
But during the surge caused by the more infectious delta variant in mid-2021, some infectious-disease experts attempted to recalculate what percentage of the population would need to be “ immune ” to achieve herd immunity, moving the target up to 80% and 90% from previous estimates of 50%, 60%, or 70%.
“ The more infectious the strain, the higher the number, ” Dr. Gabor Kelen, who chairs the department of emergency medicine at Johns Hopkins University,
told MarketWatch
last summer.
The summer surge also revealed how quickly immunity can wane. An estimated 72.2% of adults in Los Angeles County had protective antibodies either through infection or vaccination in April 2021; but within three months, the county was well into a surge of cases caused by the delta variant, according to a
research letter
published in JAMA Network Open in January.
“ Reaching herd immunity might be more difficult than anticipated, ” the researchers concluded.
The NIAID officials say that immunity to viruses like SARS-CoV-2 and influenza is more of a “ fluid concept, ” meaning some people may have long-lasting immunity against COVID-19 infection, while others may be more likely to be protected against the kind of severe disease that leads to hospitalization and death.
Then there’ s the nuance of this particular virus. We know now that new variants could elude natural or vaccine-induced immunity, asymptomatic transmission still occurs, immunity from vaccines or past infections can wane, and there has been “ substantial ” resistance to public-health tools like wearing masks and vaccination, according to the NIAID officials.
We still experience outbreaks associated with the 1918 influenza pandemic, most recently with the H1N1 outbreak in 2009, and that may be why SARS-CoV-2 is likely here to stay.
“ Viral spread may continue indefinitely, albeit hopefully at a low endemic level, ” they wrote. | business |
The U.S. plans to further invest in care and research for long COVID | White House officials on Tuesday announced new plans to address the impact of long COVID, a constellation of prolonged symptoms including brain fog and shortness of breath that can occur after a COVID-19 infection.
People with long COVID, who are sometimes called “ long-haulers, ” report a range of symptoms, including fatigue, brain fog, pain, headaches, and shortness of breath. The condition is also referred to as post-acute sequelae of SARS-CoV-2 infection ( PASC).
Estimates vary as to how many people have long COVID. The American Academy of Physical Medicine and Rehabilitation estimates that
more than 23 million Americans have PASC
, while preliminary
research
out of Denmark found that 30% of people who had tested positive for the virus had at least one symptom 6 to 12 months later.
It’ s thought at least 1 million Americans aren’ t able to work as a result of post-COVID symptoms,
according to the Government Accountability Office
.
“ Americans of all ages and background are experiencing long COVID, ” Xavier Becerra, secretary of the Department of Health and Human Services, said Tuesday during a White House briefing. “ Long COVID is real, and there is still so much we don’ t know about it. Millions of Americans may be struggling with lingering health effects. ”
The Biden administration’ s plan for a national research agenda around long COVID is wide-reaching and comes the day after
Senate bargainers reached agreement
on a $ 10 billion COVID-19 treatment package.
The plan aims to fund research into how health care providers can best care for people with long COVID, establish more care centers that will focus on caring for those with long COVID, educate health care providers about long COVID, and strengthen requirements for insurers to cover the costs of care associated with long COVID.
It also builds on the work that other federal agencies have done to address long COVID over the past year or so. HHS and the Justice Department issued
guidance
last summer that says long COVID can sometimes be considered a disability. The National Institutes of Health is funding a
study
examining the long-term effects of COVID-19 among 15,000 people. Even an ICD-10 code has been established for long COVID. ( This is a kind of diagnosis and billing code used in electronic medical records.)
The administration said Tuesday that the interagency national research action plan on long COVID will be spearheaded by HHS, the federal agency that oversees the Food and Drug Administration, the Centers for Disease Control and Prevention, and Medicare and Medicaid.
“ This coordinated effort will help ensure our research is being directed toward the people who need care the most, ” Becerra said. | business |
COVID outbreak 'extremely grim ' as Shanghai extends lockdown | The COVID-19 outbreak in China’ s largest metropolis of Shanghai remains “ extremely grim ” amid an ongoing lockdown confining around 26 million people to their homes, a city official said Tuesday.
Director of Shanghai’ s working group on epidemic control, Gu Honghui, was quoted by state media as saying that the outbreak in the city was “ still running at a high level. ”
“ The situation is extremely grim, ” Gu said.
China has sent more than 10,000 health workers from around the country to aid the city, including 2,000 from the military, and is mass testing residents, some of whom have been locked down for weeks.
Most of eastern Shanghai, which was supposed to reopen last Friday, remained locked down along with the western half of the city.
Officials would reevaluate preventative measures after the results of tests on all city residents are analyzed, Gu said.
“ Before that, citizens are asked to continue following the current lockdown measures and stay in their homes except for medical and other emergency situations, ” Gu said.
Shanghai has reported more than 73,000 positive COVID-19 infections since the resurgence of the highly contagious Omicron variant in March.
Shanghai recorded another 13,354 cases on Monday — the vast majority of them asymptomatic — bringing the city’ s total to more than 73,000 since the latest wave of infections began last month. No deaths have been ascribed to the outbreak driven by the omicron BA.2 variant, which is much more infectious but also less lethal than the previous delta strain.
A separate outbreak continues to rage in the northeastern province of Jilin and the capital Beijing also saw an additional nine cases, just one of them asymptomatic. Workers shut down an entire shopping center in the city where a case had been detected.
While China’ s vaccination rate hovers around 90%, its domestically produced inactivated virus vaccines are seen as weaker than the mRNA vaccines such as those produced by Pfizer-BioNTech and Moderna that are used abroad, as well as in the Chinese territories of Hong Kong and Macao. Vaccination rates among the elderly are also much lower than the population at large, with only around half of those over 80 fully vaccinated.
Meanwhile, complaints have arisen in Shanghai over difficulties obtaining food and daily necessities, and shortages of medical workers, volunteers and beds in isolation wards where tens of thousands are being kept for observation.
Shanghai has converted an exhibition hall and other facilities into massive isolation centers where people with mild or no symptoms are housed in a sea of beds separated by temporary partitions.
Gu said about 47,700 beds are available for COVID-19 patients, with another 30,000 beds to be ready soon. It wasn’ t clear how many beds were available for patients placed under observation, who number more than 100,000 according to city health authorities.
Public outrage has been fueled by reports and video clips posted on the internet documenting the death of a nurse who was denied admittance to her own hospital under COVID-19 restrictions, and infant children separated from their parents.
Circulation of footage showing multiple infants kept in cots prompted the city’ s Public Health Clinical Center to issue a statement saying the children were being well looked after and had been in the process of being moved to a new facility when the footage was taken.
At a virtual town hall Monday, the U.S. Consulate in Shanghai warned of possible family separations amid the lockdown, but said it had an “ extremely limited ability ” to intervene in such cases.
Concern is growing about the potential economic impact on China’ s financial capital, also a major shipping and manufacturing center. Most public transport has been suspended and non-essential businesses closed, although airports and train stations remain open and the city’ s port and some major industries such as car plants continue to operate.
International events in the city have been canceled and three out of five foreign companies with operations in Shanghai say they have cut this year’ s sales forecasts, according to a survey conducted last week by the American Chamber of Commerce. One-third of the 120 companies that responded to the survey said they have delayed investments.
Despite those concerns and growing public frustration, China says it is sticking to its hardline “ zero-tolerance ” approach mandating lockdowns, mass testing and the compulsory isolation of all suspected cases and close contacts. | business |
Student Loan Pause Is Extended Through August 31, White House Says | This story is published as part of Teen Vogue’ s 2022 Economic Security Project fellowship.
The Biden administration is expected to extend the student loan moratorium until August 31, according to reporting by Bloomberg and The Hill. An official announcement is set for Wednesday. This will be the fourth payment pause since President Biden took office less than two years ago, and the seventh pause since the federal COVID relief bill was first implemented in 2020. As with earlier extensions, the interest rates on loans are expected to remain at 0% for the duration of the pause.
Repayment had been set to restart on May 1 for the country’ s more than 43 million federal student loan borrowers. Recently, though, the White House hinted that it might be open to extending the repayment pause, but nothing had been confirmed at that time. Progressive Democrats have continued to push for the president to use executive action to cancel at least $ 50,000 in student debt, but there is little indication that Biden intends to use that option — or forgive that amount — signaling that he’ d support congressional action on student debt cancellation of just $ 10,000 instead. On March 31, more than 90 Democratic members of Congress sent a letter to President Biden “ urging ” him to “ extend the pause on federally-held student loan payments until at least the end of the year and to provide meaningful student debt cancellation. ”
This extension news comes the day after the Debt Collective, a debtors ' union at the forefront of the student debt cancellation movement, and dozens of allied organizations and labor unions rallied for full student debt cancellation in front of the U.S. Department of Education in Washington, DC. The day of action included music, dancing, a debtors ' assembly, and a debt burn, and featured comments from organizers and advocates alongside former State Senator Nina Turner and Philadelphia city council member Kendra Brooks from the Working Families Party. The rally, called Pick Up the Pen, Joe!, even featured a larger-than-life puppet of President Biden, complete with an oversized pen.
Also, the Debt Collective recently announced a student loan debt strike set for the administration’ s previously set May 1 date. In response to news of the payment pause extension until August 31, the collective tweeted simply: “ Pausing a crisis doesn't end it. ”
This content can also be viewed on the site it originates from.
Despite differing cancellation amounts proposed in recent years and the sustained limbo-status brought by repeated extensions, the movement for full student debt cancellation hasn't budged on its original demand.
Supporters of the payment pause have long argued that ending the moratorium might harm the Democratic Party's electoral prospects, so it's perhaps surprising, then, that the administration is expected to set the new payment pause expiration date to just two months before the 2022 midterms.
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CDC, stinging from criticism of its handling of the pandemic, announces review and revamp | Dr. Rochelle Walensky says the CDC needs an overhaul.
J. Scott Applewhite-Pool/Getty Images
The U.S. Centers for Disease Control and Prevention is planning to revamp itself following a one-month review by an outside senior federal health official, according to its head, Dr. Rochelle Walensky.
The move comes after criticism of the agency for its handling of the pandemic, for issuing confusing guidance over masking, isolation and quarantine, and for changing tack repeatedly.
The CDC botched
the initial rollout of a diagnostic kit
that was sent to state laboratories and had to be replaced. It later
flip-flopped on face mask wearing
and was late to understanding that the virus was airborne. In May of 2021, for example, Walensky said vaccinated people could remove face masks indoors, just weeks
before a surge of breakthrough cases
that showed they could spread the virus.
The CDC, long considered a gold standard in public health care, has seen its reputation take a battering from the missteps.
Walensky said Jim Macrae, a veteran of the Health Resources and Services Administration and the Department of Health and Human Sources, will conduct the review. Several other senior CDC staffers will also gather feedback on the agency’ s structure and hear ideas for change.
“ At the conclusion of this collective effort, we will develop new systems and processes to deliver our science and program to the American people, along with a plan for how CDC should be structured to facilitate the public health work we do, ” Walensky said in emailed comments.
The news comes at a time when the U.S. is averaging 27,573 cases a day,
according to a New York Times tracker,
down 6% from two weeks ago. But cases are rising in states in the Northeast and South as the BA.2 omicron subvariant is spreading fast.
The country is averaging 15,692 hospitalizations a day, down 27% from two weeks ago. The daily death toll has fallen below 700 to 633.
In fact, the BA.2 variant now accounts for 72% of new cases in the U.S.,
the CDC said separately.
The subvariant in recent weeks has overtaken the original omicron variant to become the most dominant strain of the virus circulating in the U.S.
There was some positive news late Monday, when the Senate reached agreement on a slimmed-down $ 10 billion package for countering COVID-19 with treatments, vaccines and other steps,
as the Associated Press reported.
But lawmakers removed all of the funding intended to help countries overseas combat the pandemic, a move experts have consistently argued is shortsighted.
As long as vast swaths of the earth’ s population are unvaccinated, or under-vaccinated, new variants can emerge that may prove more resistant to vaccines.
Dr. Anthony Fauci, President Joe Biden’ s chief medical adviser and the director of the National Institute of Allergy and Infectious Diseases ( NIAID), said it may prove impossible for the world to reach “ herd immunity ” given the wily nature of the virus.
In a new
article
written with two NIAID officials that published Thursday in The Journal of Infectious Diseases, Fauci said the goal should be figuring out ways to live with the virus going forward.
See:
UK adds nine more COVID symptoms to official list as its struggles with record case load
Fauci has long questioned herd immunity as a benchmark to end the COVID-19 pandemic, often describing the epidemiological concept as
“ elusive ” or “ mystical. ”
Herd immunity is the idea that a virus is no longer considered a major public health threat once a certain percentage of the population is immune as the result of natural infection or vaccination. But the evolving nature of SARS-CoV-2 and waning immunity from the COVID-19 vaccines or natural infection all complicate the ability to hit any type of immunity threshold that would definitively signal an end to the pandemic.
“ There are significant obstacles to achieving complete herd immunity with COVID-19, ” the NIAID officials wrote. “ ‘ Classical’ herd immunity, leading to disease eradication or elimination, almost certainly is an unattainable goal. ”
For more, see:
Fauci: Herd immunity to SARS-CoV-2 may be ‘ unattainable
’
What is an endemic and how will we know when Covid-19 becomes one? WSJ’ s Daniela Hernandez breaks down how public-health experts assess when a virus like Covid-19 enters an endemic stage. Photo: Michael Nagle/Zuma Press
Other COVID-19 news you should know about:
• The COVID-19 outbreak in China’ s largest metropolis of Shanghai remains “ extremely grim ” amid a continuing lockdown confining around 26 million people to their homes, a city official said Tuesday, the AP reported. Director of Shanghai’ s working group on epidemic control, Gu Honghui, was quoted by state media as saying that the outbreak in the city was “ still running at a high level. ” China has sent more than 10,000 health workers from around the country to aid the city, including 2,000 from the military, and is mass testing residents, some of whom have been locked down for weeks.
• South Africa’ s national state of disaster, in place for more than two years in response to COVID-19, will end from midnight local time on Monday, President Cyril Ramaphosa said,
as Reuters reported.
“ While the pandemic is not over, while the virus remains amongst us, these conditions no longer require we remain in a national state of disaster, ” he said in a televised address, referencing far lower rates of hospitalization and deaths during the country’ s fourth wave of infections.
• UK budget airline EasyJet PLC
ESYJY,
-1.44%
EZJ,
+0.77%
expects to cancel hundreds more flights this week because so many of its crew members are sick with COVID,
the Guardian reported.
The airline canceled some 222 flights over the weekend and pulled 62 scheduled for Monday because of staff shortages. The UK is currently suffering record numbers of COVID cases with one in 13 of its residents infected in the latest week.
Hong Kong, which has faced a record surge in Covid-19 cases and the world’ s highest death rate, has been under strict restrictions. WSJ’ s Diana Chan reports on how everyday life has changed in the city, from panic buying to an exodus of residents. Photo: Emmanuel Serna/Zuma Press
• Cruise operator Carnival Corp.
CCL,
-2.13%
said that the week of March 28 was its busiest booking seven-day period ever as demand picked up after two years of a global pandemic. The week showed a “ double-digit ” increase from the previous record 7-day booking total, the company said. Twenty-two out of Carnival’ s 23 ships are back in year-around guest operations. Its final ship will return to service on May 2, and the company will have its newest ship in November and another new ship expected for 2023, it said. “ By year-end 2022, Carnival will have more capacity sailing ( as measured by ALBDs — available lower berth days) than it was sailing in 2019, ” it said.
Here’ s what the numbers say
The global tally of confirmed cases of COVID-19 topped 492.9 million on Monday, while the death toll rose above 6.15 million,
according to data aggregated by Johns Hopkins University
.
The U.S. leads the world with 80.2million cases and more than 982,309 fatalities.
The
Centers for Disease Control and Prevention’ s tracker
shows that 217.9 million people living in the U.S. are fully vaccinated, equal to 65.6% of the population. But just 98 million are boosted, equal to 45% of the vaccinated population. | business |
U.S. trade deficit dips to $ 89.2 billion, but stays near record high | The numbers:
The U.S. posted a near-record $ 89.2 billion trade deficit in February, reflecting an ongoing surge in imports and ramped-up efforts to offload foreign goods at congested West Coast ports.
The trade gap fell a slight 0.1% from an all-time high in January. Economists polled by The Wall Street Journal had forecast a $ 88.5 billion trade gap.
Imports rose 1.3% in February to a record $ 317.8 billion. Exports climbed 1.8% to $ 228.6 billion — also a record.
Last year, the U.S. posted the highest international trade deficit ever. The U.S. economy has recovered faster than other countries and that’ s allowed Americans to spend more on imported goods. Exports have rebounded more slowly.
Big picture:
The U.S. economy is likely to show a paltry increase in growth in the first quarter — at least officially — and the record trade deficit is a big reason why. High deficits subtract from gross domestic product, the official scorecard for the economy.
Yet by most other measures, the U.S. is still expanding at a fairly strong pace. Consumer spending, the main driver of the economy, has accelerated and
most businesses are hiring
.
The U.S. has run large trade deficits for years without much effect on the broader economy.
Key details:
U.S. imports topped $ 300 billion in November for the first time ever and have now exceeded that benchmark for four months in a row.
The U.S. bought less foreign oil in February, but higher oil prices drove up the value of petroleum imports. The U.S. also imported more chemicals and capital supplies.
The amount of exports rebounded from a decline in January, led by increases in drugs such as coronavirus vaccines.
The U.S. also exported more oil and coal, a response to the Russian war on Ukraine and the need in Europe and elsewhere for alternative sources of fossil fuels.
The surge in the trade deficit since last fall partly reflects U.S. ports trying to clear a backlog of goods that have piled up in nearby warehouses or on ships waiting to unload.
Market reaction:
The Dow Jones Industrial Average
DJIA,
+0.40%
and S & P 500
DJIA,
+0.40%
were set to open lower in Tuesday trades. Stocks have rebounded in the past few weeks after a recent “ correction ” that sent shares sharply lower. | business |
Logan Paul's $ 5m Pokémon Card Necklace Breaks Records ( & Taste) | Breaking news — Logan Paul is a clown. Beyond his irritating social media presence and pay-per-view boxing bouts, the perpetual attention-seeker enjoys typically douche-y financial hobbies ( no wonder he's a big NFT guy), which is how he got into Pokémon cards.
Now, I don't care if you're an OG Pokéfreak who played Red and Blue on your GameBoy ( not even Color) in the '90s, if you 've been collecting cards for decades, or if you just got into the franchise, it's all gravy.
It's just that enjoying any element of culture through a purely financial route sucks. By squeezing out any possible conceit of personality for the sake of maximizing profit, you lose personality; hence why blue-chip avatar-centric NFTs are all ugly and embarrassing — their only value is in the money they make their owners.
Paul, of course, doesn't just collect tacky NFTs. He's also a connoisseur of Pokémon TCG cards, a fairly young and highly profitable market that started gaining lots of eyeballs around the early days of the COVID-19 pandemic, causing secondhand prices to surge as shortages shrink the number of available boxes.
just dropped $ 3,500,000 on this sealed & authenticated box of 1st Edition Pokémon cards 😯 pic.twitter.com/rMY2bVnKV2
Memorably, Paul was fleeced out of a couple million dollars for some fake Pokémon cards he bought earlier this year, a nice counterpoint to the fake Richard Mille that his equally uncool brother Jake bought in 2021.
But you can't keep a good himbo down.
Logan has re-entered the chat with an even lamer purchase: a $ 5m Pokémon card that he made into a necklace for his WWE debut ( as if the WWE wasn't problematic enough as is).
WRESTLEMANIA TONIGHT @ WWE pic.twitter.com/d9mteAIq8Q
So, yeah, Paul is in the WWE and I don't care because we're talking Pokémon cards.
Paul confirmed on his Twitter that he traveled to Dubai to purchase the card — a Pikachu Illustrator graded to be perfect by the authenticators at the PSA — and then had it set in a `` $ 80k diamond pendant. ''
the real star of Wrestlemania — my 1/1 PSA 10 Pikachu Illustrator that I purchased for $ 5,275,000, officially setting the Guinness World Record for “ most expensive Pokémon trading card sold at a private sale ” pic.twitter.com/nrAyvrytCB
The previous owner was extremely private, and it’ s existence was only a rumor. With a connection made by collectible expert @ JeremyCom, I finally found the seller and insisted he sell it to me.I travelled to Dubai last year to secure it after five months of negotiation ( cont’ d)
It’ s held in an $ 80k custom diamond pendant with a Pokéball bail. This is the pinnacle of Pokémon.YouTube video coming later this month pic.twitter.com/el7lMOS0q3
Then, Paul brought in Guinness World Records to give him an award for the `` most expensive Pokémon trading card sold at a private sale, '' which is a meaningless title that he had the award company bestow upon himself because when you're rich, nothing matters.
The social media star wore the card around his neck as he made his # WrestleMania debut in Dallas, Texas. pic.twitter.com/Ax0Oai9rGY
It's not clear if Paul asked GWR to give him the prize through conventional application methods ( which costs up to $ 5 and takes at least 12 weeks to process) or if he ponied up $ 1k to expedite the new record process, which ought to be pennies for him, really.
An absurd amount of $ $ for cardboard, but let me explain: the Pikachu Illustrator is the rarest Pokémon card in the world. Only 39 of them exist, and this is the ONLY PSA 10 ( perfect condition). Until this weekend, there were no pictures or videos of this card ANYWHERE ( cont’ d)
In an attempt to justify his purchase, Paul explains that the Pikachu Illustrator that he bought is the rarest of all the Pokémon TCG cards, with only 39 ever manufactured, his being the only one rated a 10/10.
However, the Pokémon experts at PokéBeach helpfully poke some holes in his story.
For one, the Pikachu Illustrator is indeed extremely rare — only 24 are actually known to exist from that initial run created for winners of a 1998 contest — and one recently just sold for $ 900k earlier this year, becoming the most valuable Pokémon card ever sold until Paul's purchase.
$ 900k to $ 5m is a massive and pointless jump, though there's a ( dumb) reason behind Paul's pointless purchase.
His justification is that the Pikachu Illustrator that he bought is the only one that's graded a 10/10 by the PSA.
As PokéBeach explains, however, the card that Paul bought was actually well-known in the Pokémon TCG community as a certified 9/10, having been owned by several collectors and picking up a small scrape in the corner over time.
This card was once a psa 9 and failed to make 10 multiple timesCorrect?
Just learned about Logan Paul buying the ONLY PSA 10 Illustrator card that exists. Man... what has this hobby become? Just a way to make money? Disgusted...
Paul had a solution for this, one that's — quite frankly — extra whack.
Paul traded the card's owner his own PSA 9 Pikachu Illustrator ( estimated value: $ 1.2m) plus $ 4m ( the `` the cost of the pristine Grade 10 Pikachu Illustrator card, '' according to Guinness itself).
Thus, Paul artificially bumped up the value of his newly purchased Pikachu Illustrator by coughing up several million bucks, changing its value to a 10/10 through the power of wealth alone.
Paul has a history of wearing pricey Pokémon cards around his neck for some reason, including the above $ 150k first edition Charizard card he fashioned into a different piece of jewelry.
It's on the level of stuff you ought to expect from the guy who filmed corpses inside Japan's `` suicide forest, '' I guess.
Now that we 've gotten to the point where these kinds collectibles are stripped of any meaningful value ( if there was any to begin with) and used as sign of all-too-conspicuous consumption for the sake of impressing simpletons whose jaws drop at dollar signs, the heat death of the universe doesn't seem all that bad.
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Dr. Scott Gottlieb believes omicron BA.2 subvariant unlikely to cause 'national wave ' in U.S. | Dr. Scott Gottlieb told CNBC on Tuesday that he believes the U.S. this spring will avoid a `` national wave '' of infection related to the more contagious omicron BA.2 subvariant.
However, the former Food and Drug Administration commissioner said on `` Squawk Box '' that he thinks cases are being `` dramatically '' underreported in some parts of the country. Given the reliance on at-home testing now, he estimated that in the Northeast, as few as one in seven or one in eight infections are actually showing up in official case counts.
`` I think we're further into this than we perceive, '' Gottlieb said, pointing to Germany and the U.K., where cases have started to decline quickly from their recent, BA.2-related peak.
In the U.S., BA.2 is the dominant version of Covid, according to the Centers for Disease Control and Prevention. Some expect that within two weeks, it may displace the earlier version of omicron, which caused a surge in cases and hospitalizations late last year and into 2022.
Both Covid infections and hospitalizations have retreated more than 90% since their January highs during the omicron wave.
`` It's probably not going to be a national wave of infection '' from BA.2, predicted Gottlieb, who led the FDA from 2017 to 2019 in the Trump administration and now serves on the board of Covid vaccine maker Pfizer. `` It's probably going to be centered in the Northeast, maybe Florida. I think by the time it starts to spread nationally, we 'll already be deep into the summer, and that 'll provide a seasonal backstop. ''
The picture may change once fall rolls around for a few reasons, Gottlieb said. `` We 'll have to contend with this in the fall, '' he said. `` If [ BA.2 ] is still the dominant variant in places in the country that it really didn't get in right now, it 'll start to spread in the fall as people's immunity starts to wane, they get further out from their vaccination and their prior infection from omicron. ''
Disclosure: Dr. Scott Gottlieb is a CNBC contributor and is a member of the boards of Pfizer, genetic testing start-up Tempus, health-care tech company Aetion and biotech company Illumina. He also serves as co-chair of Norwegian Cruise Line Holdings ' and Royal Caribbean's `` Healthy Sail Panel. '' | business |
Going Home Again, to Gold’ s Gym - The Santa Barbara Independent | Our Cardio Confidential Columnist Pumped Up to Return to Gold’ s Gym in Santa Barbara
In my first column, I promised to return to my longtime gym and report on what it was like for those of you still on the indoor fitness sidelines. Beyond lingering COVID concerns, I had my own trepidations to overcome: Would the classes and instructors be the same? Had my lockdown workouts kept me in decent shape? And how safe would it feel to share air with a roomful of hard-breathing exercisers? In search of answers, I ordered a bag of KN95 masks in assorted colors to match my workout wear and headed back to Gold’ s Gym, where I’ ve been a member since 1991.
Even if you’ re not a member, you probably know Gold’ s. The original in Venice Beach helped bring bodybuilding into mainstream culture, but the offerings these days are a lot more diverse than the cartoonish bodybuilder in their logo suggests.
What makes it a gym and not a club? As far as I can tell, it’ s the lack of a pool — and the marked absence of exclusivity. I run into everyone from high school students to my elderly neighbor at the gym, and while the weight floor is mostly men, the fitness classes I take are made up of ( and taught by) mostly women.
Membership in Gold’ s is the fitness equivalent of a cable subscription: Sure, you’ re paying for some stuff you never use — for me, the cardio machines — but if you were to cut the fitness cord, where else would you find yoga, mat Pilates, spinning, free weights, and elliptical machines all under one roof?
I was disappointed to find that some of my favorite classes, like Friday evening yoga and Saturday barre, didn’ t survive the pandemic. But I was delighted to find that others — such as Thursday evening Hip-Hop Cardio and Sunday morning Retro Aerobics — were still on the schedule. The cardio machines and weight benches were in high demand, while popular classes like Hector’ s Zumba and Hattie’ s BodyPump packed the group fitness room.
I caught up with instructors and workout buddies I hadn’ t seen in many months. Cat Myklebust started her own online fitness site, but she still likes trying out her hip-hop choreography in live classes. During lockdown, Veronika had exercised with her grandkids on the machines at the Cabrillo Ball Field, in the shadow of the Chromatic Gate. It was fantastic to work up a sweat with friends and to do the cumbia without crashing into the printer in my home office.
I ventured out of my comfort zone to try some classes I’ d never taken before, like the ominous-sounding BodyCombat. I was half expecting a workout inspired by cage-fighting, so I was relieved when instructor Melissa announced at the start, “ You’ re not going to punch anybody. ” With the Beastie Boys on the playlist, we were just fighting for our right to party. Following the combinations of punches and kicks was like learning a dance routine — after all, the bottom half of what boxers do is called “ footwork. ” And there was no equipment to put away at the end of class. Consider me a BodyCombat enlistee.
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One of my reasons for belonging to a gym has always been my suspicion that I wouldn’ t push myself as hard if I worked out on my own. I report with chagrin that my hypothesis has been proved correct. After taking Suzie’ s barre class for the first time in almost two years, I was sore for four days — despite having done barre workouts at home during the pandemic. Yeah, it’ s not the same.
I appreciate how Gold’ s instructors emphasize safety and good form, demonstrating how to avoid injury and vary your workout according to your fitness level. Regarding COVID safety, it’ s more of a mixed bag. Spray bottles of disinfectant and rags are prominently displayed, and some people use them to wipe down equipment after a class. On the other hand, I’ m the only one wearing a mask in the classes I’ ve been attending, even though masks are still strongly recommended indoors even for the vaccinated. And there’ s no requirement to show proof of vaccination, so if you want assurances that the person using the decline bench or mounted on the spinning bike next to you is fully vaxxed, you’ re probably not going to be comfortable working out at Gold’ s.
How will other gyms in Santa Barbara compare on all these fronts? Stay tuned.
411
A platinum Gold’ s Gym membership gives you access to the three Santa Barbara-Goleta locations as well as all 24 Southern California locations. All S.B.-area locations offer free weights; cardio and resistance machines; group fitness classes, including spinning; and towel service. Add-ons include Bikram hot yoga and Pilates Reformer at Uptown, and personal training at all three locations. Uptown and Goleta locations have free parking and dry saunas in the locker rooms. There will be a grand reopening of all three locations in June with promotions and membership specials. See goldsgym.com.
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Logarithmic Finance ( LOG) Up 23% In Presale Whilst Ethereum ( ETH) & XRP ( XRP) Suffer Dips | Join Our Telegram Channel for More Insights. Join Now
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Now could be one of the best times to invest in cryptocurrency with the market experiencing a small pullback. Ethereum ( ETH) and XRP ( XRP) have both suffered losses in value over the past 24 hours so is it time to start looking for exciting new projects with tremendous upside potential?
Logarithmic Finance ( LOG) is a state-of-the-art cryptocurrency that is just a week into its presale. The DeFi platform has already made its earliest investors a 23% profit and shows no signs of slowing down.
At the time of writing, Ethereum ( ETH) is trading at $ 3,440.67 and has been moving sideways all weekend. The smart contract blockchain giant is currently 29% down from its all-time high price of $ 4,878.26.
Ethereum ( ETH) is the second-largest cryptocurrency in terms of market cap. The Covid pandemic put the much-anticipated release of ETH 2.0 on hold which saw several “ Ethereum Killers ” such as Solana ( SOL) and Avalanche ( AVAX) explode in price.
Throughout 2022, Ethereum ( ETH) is expected to steadily grow in value. When ETH 2.0 is finally released and many of the speed and price issues with the network are fixed, predictions are being made that it could shoot to $ 10,000 per ETH and even overtake Bitcoin ( BTC) as the number one rated cryptocurrency.
XRP is the native token of the company Ripple Labs. The token is used to facilitate cross-border payments between banks and institutions at a lightning-quick speed. Currently, to send money abroad it can take up to 5 days to reach your recipient and cost you a considerable amount of money. With XRP, the transaction is made in under a second and only cost a fraction of XRP ( Currently valued at $ 0.82).
For many years XRP and Ethereum ( ETH) were neck and neck with each other in a battle to become the number one altcoin ( Alternatives to Bitcoin). In December 2020, Ripple Labs were taken to court by the Securities & Exchanges Commission ( SEC) over reports of miss-sold shares of XRP many years ago.
As a result of this, the price of XRP suffered heavily, falling to as low as $ 0.22. Whilst nearly every single crypto broke its all-time high record during the bull run of 2021, XRP remained stagnant and only reached a high of $ 1.84.
The utility XRP provides will be used by many of the major banks used worldwide. Once the lawsuit with the SEC is over, there are expectations that the price of XRP will explode with some suggesting it could get to $ 100.
Logarithmic Finance ( LOG) promises to be the next-generation Decentralised Finance ( DeFi) and Swapping Protocol. It seamlessly links early-stage blockchain innovators with investors. Its simple-to-use interface and Web 3.0 technology infrastructure will enable innovators to raise capital and develop products that would quickly attract the attention of the largest investors.
The presale of Logarithmic Finance ( LOG) has gotten off to a fantastic start. In less than a week it has risen in value by 23% meaning that a $ 1000 investment would now be worth $ 1230. With 5 weeks left of stage one of the presale and another 2 stages to follow after that, there is incredible upside potential for Logarithmic Finance ( LOG).
Some experienced cryptocurrency investors are saying the DeFi token could see at least another 5000% growth before its initial coin offering ( ICO) on the major decentralised exchanges ( DEX).
Enter Presale: https: //presale.logarithmic.finance/
Website: https: //logarithmic.finance/
Telegram: https: //t.me/LOGARITHMIC FINANCE OFFICIAL
Twitter: https: //twitter.com/LOGARITHMIC FI
Disclaimer: The information posted in the article is for educational purposes only. By using this, you agree that the information does not constitute any investment or financial advice. Do conduct your own research and reach out to financial advisors before making any investment decisions.
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The huge service side of the U.S. economy speeds up in March, ISM finds | The numbers:
An ISM barometer of business conditions at service-oriented companies such as restaurants and theaters rose 1.8 points in March to 58.3%, signaling a faster expansion in the U.S. economy after an omicron-induced slowdown earlier in the year.
Yet prices of oil, grains, metals and other supplies rose even faster and indicated little relief from high inflation. Ongoing supply-chain bottlenecks were also complicated by the Russian invasion of Ukraine.
Still, the increase last month broke a string of three straight declines in the Institute for Supply Management’ s services sector index. Economists polled by The Wall Street Journal had forecast a reading of 58.3%.
Numbers over 50% are viewed as positive for the economy and anything over 55% is considered exceptional.
A similar
ISM survey of manufacturers
showed that growth slowed a bit in March, but not enough to set all any alarm bells.
The war in Ukraine added to greater uncertainty for manufacturers, many of which are major exporters. Most service companies are not big exporters.
Big picture:
The scores of service-providing companies that dominate the modern U.S. economy have gotten a lift from the decline in coronavirus cases and removal of government restrictions. People are going out more to eat, shop or entertain themselves.
Yet companies are still struggling with shortages of labor and supplies and can’ t always keep up with customer demand. These problems have contributed
to the highest U.S. inflation in 40 years
and are not expected to ease quickly.
Key details:
New orders rose 4 points to 60.1%, ISM said, and production also edged higher.
After turning negative in February, employment recovered as more people went back to work or got hired. The employment barometer increased to 54% from 48.5%.
Businesses got no relief from inflation, however. The prices-paid index moved up to 83.8% from 83.1%, just a tick below a record high.
“ Pricing pressures are stronger than ever due to the Russia-Ukraine [ war ], and energy costs are skyrocketing, ” an executive at a construction company said.
“ Constrained supply of many key product groups continues. Inflation worsening, ” a wholesale executive said. “ Overall sales and profitability continue to be strong. ”
Looking ahead:
“ The ISM survey doesn’ t suggest that the U.S. economy is sliding into a recession, ” said senior economist Jennifer Lee of BMO Capital Markets. “ But soaring inflation and a Fed that is bent on tightening a lot this year, might have an influence on how activity fares over the next year and half. ”
Market reaction:
The Dow Jones Industrial Average
DJIA,
+0.40%
rose in Tuesday trades and the S & P 500
SPX,
-0.27%
was down slightly. | business |
A big shift is under way for markets, and old Warren Buffett shareholder letters point to which companies will survive | Given a war and inflation have marked the start of 2022, investors would be forgiven for holding their breath over the rest of the year’ s offerings.
Our
call of the day
from a team at Saxo Bank sees a “ wild ride ” ahead for the second quarter, and offers advice on which companies will best survive the upheaval.
The world is living through nothing less than “ the arrival of the endgame for the paradigm that has shaped markets since the advent of the Greenspan Federal Reserve put in the wake of the LTCM [ Long-Term Capital Management ] crisis of 1998, ” said Saxo’ s chief investment officer Steen Jakobsen, in the bank’ s second-quarter outlook on Tuesday.
Read:
Get ready for a ‘ new world order’ that drives stocks and bonds: BlackRock
Supply-side shocks from Russia’ s invasion of Ukraine and COVID-19 have “ accelerated our path toward more productivity. Policy simply must take us toward more price discovery and positive real yields as market and government actors fight for investment in a world, we now understand is highly constrained by absolute energy, environmental and capital limits, ” he wrote.
Saxo sees three cycles simultaneously affecting markets — ongoing supply crunches from COVID-19, the war in Ukraine and the “ world’ s physical limits, ” repricing of assets as inflation rises and a new Fed tightening cycle that began in March.
The result of these will be more spending on energy, defense, supply-chain diversification, and negative real rates turning positive as the global economy readies for a productivity boost.
Here’ s where equities come in. “ With a large-scale war back in Europe and commodity markets in upheaval, this has aggravated inflationary pressures and equities have entered an environment not seen since the 1970s. High inflation is essentially a tax on capital and raises the bar for return on capital, and thus inflation will filter out weaker and nonproductive companies in a ruthless fashion, ” said Saxo’ s head of equity strategy, Peter Garnry.
And one only needs to look at 1970s-era shareholder letters from Berkshire Hathaway’ s
BRK.B,
-0.55%
BRK.A,
-0.65%
billionaire chairman Warren Buffett, which pointed to productivity, innovation or pricing power as a survival tool kit for companies, Garnry said.
“ The largest companies in the world are the last to get hit from tighter financial conditions, and they also have the pricing power to pass on inflation to their customers for a longer time than smaller companies, ” Garnry said. That means bye-bye to zombie companies kept alive by low interest rates and excess capital.
Garnry said one way to gauge productivity is by looking at adjusted net income to employee, on the theory that the larger a companies grows, the smaller its profit per employee.
“ If a company is trying to maximize profits then that will often naturally lead to sacrificing productivity; but what is lost in productivity is gained through economies of scale in its operations, and this allows for higher levels of aggregated profits, ” said Garnry.
Topping the ranks of companies that are the most productive relative to size — above the regression line — is Apple
AAPL,
-3.00%
,
he said.
Here’ s a sampling of the best companies for productivity and innovation, with Amazon
AMZN,
-2.47%
,
Microsoft
MSFT,
-2.71%
,
Nestlé
NSRGY,
-0.89%
NESN,
+0.29%
and Alphabet
GOOGL,
-2.44%
at the top of those lists.
Saxo Bank
Click
here
for more companies and Saxo’ s full outlook.
The buzz
Ukrainian President Volodymyr Zelensky has warned of finding more atrocities after
more evidence showed Russian forces massacred civilians in Bucha
, near Kyiv. He will address the United Nations Security Council on Tuesday. The European Union may be ready to
ban Russian coal imports
, while the U.S. Treasury has
reportedly halted
Russian debt payments via U.S. accounts.
Tesla
TSLA,
-3.66%
CEO and Twitter’ s
TWTR,
-1.68%
new biggest stakeholder Elon Musk asked users to vote on an edit button for tweets — it was a resounding yes. Twitter, incidentally, is
worth $ 8.5 billion more
, thanks to Musk.
Read:
Can Elon Musk change the way people tweet now that he’ s Twitter’ s largest single shareholder?
The foreign trade deficit
dipped to $ 89.2 billion
, but is sticking near a record high. Still to come is the Institute for Supply Management services index, then three Fed speakers — Fed Gov. Lael Brainard, San Francisco Fed President Mary Daly and New York Fed President John Williams.
Read:
U.S. economy will fall into a recession this summer, as inflation eats into consumer spending, former Fed official warns
The markets
Stocks
DJIA,
-0.33%
SPX,
-1.21%
COMP,
-2.14%
a re tilting lower. The Treasury yield curve remains inverted, with the 2-year
TMUBMUSD02Y,
2.451%
slightly higher than the 10-year
TMUBMUSD10Y,
2.829%
.
Oil prices
CL00,
+2.20%
BRN00,
-0.04%
are up, while the dollar
DXY,
+0.12%
is edging lower.
The chart
“ It turns out that when consumers are frightened about buying stocks, one of
the best investments is consumer stocks! ” That was Jim Paulsen, chief investment strategist at The Leuthold Group, in a note to clients. Here’ s a chart gauging that pessimism.
“ When the consumer bull-bear indicator is lowest quintile, consumer discretionary
stocks have outpaced by an annualized +9.4% compared to slight underperformance of -0.8% for the four other confidence quintiles, ” he said, noting that it is a less great time for financials, utilities and communications.
The tickers
These were the top-searched tickers on MarketWatch as of 6 a.m. Eastern Time:
Ticker
Security name
GME,
+0.05%
GameStop
TSLA,
-3.66%
Tesla
AMC,
-2.75%
AMC Entertainment
NIO,
-3.77%
NIO
TWTR,
-1.68%
Twitter
MULN,
-10.00%
Mullen Automotive
ATER,
-2.12%
Aterian
AAPL,
-3.00%
Apple
BABA,
-4.54%
Alibaba
HYMC,
-7.80%
Hycroft Mining
Random reads
Rockchalk! Kansas Jayhawks men’ s basketball defeats North Carolina for National Championship title in
biggest comeback in history
.
Can you smell a painting? A Madrid gallery will attempt that
with a 17th century work by Jan Brueghel the Elder
.
A former German tax inspector is on trial for
alleged $ 306 million fraud
.
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Top 10 AI Jobs in Big Tech Companies to Apply for in April 2022 | Join Our Telegram Channel for More Insights. Join Now
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Artificial intelligence, machine learning, and data science are the most popular fields for job search among the current tech-savvy generation. Digital transformation and the advent of the coronavirus pandemic have unlocked immense opportunities for AI/ML to enhance workflow with appropriate business insights. As the need for innovative solutions is increasing to tackle various issues, so is the need for skilled AI professionals. Several talented tech professionals are aiming for jobs in top tech companies. Are you also looking for AI jobs at big tech companies? Then you are in the right place, this article features the top AI jobs in big tech companies to apply for in April 2022. | tech |
High raw material costs, COVID-19 measures challenge China's NEV industry | Asia’ s carbon markets are on a trajectory of rapid growth as demand for carbon offsets rises and...
Global tanker freight is seen steady over the next few months as oil buyers replenish inventories,...
Facing a fresh wave of COVID-19 outbreaks, China's strict lockdown measures are dealing a huge blow to the NEV industry, just two weeks after the industry was left reeling over record-high nickel prices on the London Metal Exchange.
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High raw material prices and logistical problems have led to a pessimistic outlook for the NEV industry, and market sources are not expecting any significant improvements at least in the next two weeks or so, as China continues to monitor domestic infection rates and adjust its lockdown measures.
Domestic demand for copper, used as wiring in electric vehicles, was expected to increase on the back of strong EV sales in China, but the outlook for cathode imports has been dim as the import arbitrage remained largely closed through March, in addition to increased trade financing pressure.
Demand plummeted further since strict lockdown measures were implemented in Shanghai as sellers faced additional transport hurdles in withdrawing or moving stocks across cities.
`` The increased time and effort required for testing is causing truck drivers to avoid Shanghai for now, '' a Chinese trader said.
Market sources added that it was unlikely for demand to pick up until Shanghai emerges from its lockdown as it is home to many key warehouses due to its role as a financial hub.
From a macroeconomic perspective, the ongoing COVID lockdowns would also have a significant impact on China's economy, which generally leads to weaker copper consumption.
All this makes a slowdown in April copper imports highly likely, with lockdown measures and the Russia-Ukraine conflict as key factors to keep an eye on.
S & P Global Commodity Insights assessed Chinese copper import premiums at $ 20/mt plus LME cash, CIF China, April 1, unchanged since March 23.
Market sentiment was strongly affected for battery metals as well, though trading had already been slowing through March due to high salt prices.
Chinese lithium chemistries ended a half-year long rally to stabilize at around Yuan 500,000/mt in the last two weeks of March, as precursor and cathode makers began resisting high offers in the hopes that prices would eventually adjust, though producers maintain that supply would not outpace demand anytime soon.
Production cuts have been heard for midstream and downstream players in the industry, with battery makers in the computer, communications, and consumer electronics ( also known as 3C industry in China) sector reported to have trimmed run rates significantly due to low profit margins.
Many ports were heard to be congested due to restrictions, which could impact the inflow of spodumene- the key raw material for lithium salts - which usually comes into China via ports in the south, said a trader.
`` This would lend further support to lithium salt prices if refiners can't secure material for salt production, '' the trader added.
S & P Global assessed battery-grade lithium carbonate at Yuan 500,000/mt, and battery-grade lithium hydroxide at Yuan 496,000/mt April 1, both on a DDP China basis.
While nickel and cobalt salts were less impacted by port congestion, demand remained weak as nickel prices on the LME `` have yet to fall to normal tradable levels, '' said a Chinese trader.
For nickel sulfate, logistics was less of a concern, with high metal prices taking the spotlight.
Uncertainties in nickel price directions have kept buyers off the market, despite three-month prices on the LME having fallen by 30% to $ 33,223/mt April 1, compared to March 7's closing price of $ 48,078/mt.
`` I think the market expects nickel prices to fall back to $ 25,000/mt, and the current situation is only temporary, '' said a trader.
Market sources said it was difficult to say when sulfate prices would fall, and that logistical issues arising from COVID-19 restrictions could stifle demand recovery.
S & P Global assessed battery-grade nickel sulfate at Yuan 48,000/mt April 1 on a DDP China basis, unchanged since March 29.
Cobalt sulfate was the most affected of the three, as restrictions had resulted in tight raw material supply and manpower shortages.
China's Huayou Cobalt had earlier announced that it was trimming smelting operations at its Quzhou plant from March 17, with other producers also heard to be in similar straits.
`` Cobalt hydroxide imports usually come in from the Ningbo port, which is not badly impacted, '' said a Chinese refiner. `` However, shipments coming out of Durban are still being delayed, which is a huge problem. ''
While hydroxide remained tight, demand was also sluggish on account of weak sulfate consumption, as nickel-cobalt-manganese ( NCM) battery makers struggle with surging raw material costs.
S & P Global assessed battery-grade cobalt sulfate at Yuan 118,500/mt April on a DDP China basis, down Yuan 1,500/mt on the week.
Even if restrictions are lifted, market sources said the key challenge of high salt prices would continue to hamper the NEV industry, and it remains to be seen how well end-users would respond to higher EV prices come April, though the economic strain from the current lockdown measures could dampen demand in the short term.
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The DNA of an adaptive enterprise: Opportunity in a digital economy | This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them. Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 3099067.
Over the past two years, enterprise leaders around the world have had to respond to disruption, unpredictability, and unprecedented challenges. The way the world interacts and transacts has changed, and across millions of businesses using Stripe, we’ ve noticed that the capacity for businesses to adapt has been a major determinant of resilience and growth.
An adaptive business initiates change; an agile business reacts to it. The next generation of industry leaders will be companies that anticipate and take action to capture emergent opportunities, using their flexibility as a competitive advantage. They execute on strategies to find new revenue streams, pursue global expansion, and partner to scale faster. According to a recent study from Forrester, adaptive businesses grow at more than three times the industry average.
Stripe worked with The Economist Impact ( formerly known as The Economist Intelligence Unit) on a research study that takes a deeper look into the core characteristics that make enterprises adaptive, the strategies leaders are pursuing as online commerce expands, and how the ability to navigate change is an enduring competitive advantage.
The analysis in the report is based on a survey of 600 C-level executives, and around a third of the respondents ( 34%) are based in Europe, with another third ( 33%) in North America, and the balance in Asia-Pacific. Their companies are distributed across a wide range of industries, with the largest representation from the financial services ( 15%), technology ( 15%) and retail ( 11%) sectors. Just over half ( 53%) of the respondents work in companies earning annual revenue of over US $ 500m, with the rest earning between US $ 100m and US $ 500m. Most of the companies represented ( 83%) are no older than 20 years, and 44% have existed for fewer than ten years.
The Covid-19 pandemic brought about profound change, affecting long- standing consumer behaviours and preferences, and in some cases permanently changing competitive landscapes. Businesses had to make consequential decisions in short order—rapidly modifying business models, accelerating digital transformation, seeking out new revenue streams, moving or re-thinking supply chains, entering new product or geographic markets, and improving online customer experiences.
The past two years have created an inflection point for enterprises—one that is likely to define business success for the next decade. Risks to business are considerable, yet organizations that are able to successfully navigate disruption while positioning themselves for growth can be a competitive advantage in today’ s global economy. The findings in this report detail characteristics of an adaptive enterprise.
Adaptability is decisive. Businesses able to maintain or grow revenue under the difficult conditions of the pandemic appear to have made proactive choices in adapting to widespread change. When asked about chief factors enabling success, CxOs point to their firms’ ability to change or adopt new business models, serve customers online, and scale in short order to shifts in customer behavior and demand. Companies suffering revenue declines, by contrast, highlighted struggles with some of these same areas.
Going for growth. The pandemic has not slowed, but instead seemingly accelerated businesses’ pursuit of growth or new revenue streams. Survey respondents indicate a strong intention to boost investment in technology and show little support for cost-cutting. Rather than contract their businesses, a majority of CxO respondents—80% —believe global expansion is central to their business viability. Over half—52% —plan to increase the number of countries they trade in over the next year. Only 13% said they would decrease.
Digital is integral. The flight of consumers to digital channels was dramatic in 2020, and CxOs in the survey expect the consumer trends that accelerated during the crisis to gain additional momentum. Among the surveyed companies, 28% say half or more of their company sales came via online channels before the pandemic, 46% indicate the same was true during the pandemic ( as at October 2020), while 54% anticipated half of their revenue to come from online channels by the end of 2021. A majority—82% —believe that their customer’ s shift to online purchasing during the crisis will continue, even after the pandemic is over.
Anticipation is key. Far from all companies were ready for a digital acceleration: 69% of CxOs say their firms under-invested in online strategies before the pandemic. A majority—53% —say they now plan to boost investment in digital transformation over the next 12 months, aiming to improve processes or operations, innovation and customer experiences. The maintained or increasing digital budgets imply a CxO outlook that it’ s never too late to adapt.
Check out the full version of the report to gain more insights.
This is a sponsored post by Stripe, Gold sponsors of FinovateEurope 2022. Stripe is a financial infrastructure platform for businesses. Millions of companies—including financial organisations like Hargreaves Lansdown, Klarna, and AJ Bell—use Stripe to accept payments, grow their revenue, and accelerate new business opportunities. Headquartered in San Francisco and Dublin, the company aims to increase the GDP of the internet. Check out Stripe’ s website to learn more, and contact sales when you’ re ready to have a conversation.
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CDC director says high immunity in U.S. population provides some protection against omicron BA.2 | CDC Director Rochelle Walensky on Tuesday said there is enough immunity in the U.S. population to provide some protection against the more contagious omicron BA.2 subvariant, which could help stave off another Covid wave that slams hospitals.
`` The high level of immunity in the population from vaccines, boosters and previous infection will provide some level of protection against BA.2, '' Walensky said during a White House Covid briefing. White House chief medical advisor Dr. Anthony Fauci said last month that infections might rise due to BA.2, but he doesn't expect another surge.
BA.2 now represents 72% of circulating Covid variants in the U.S., according to the Centers for Disease Control and Prevention. It has rapidly displaced the earlier version of omicron, BA.1, that caused the massive wave of infection over the winter. At the beginning of February, BA.2 represented about 1% of Covid variants in the U.S.
BA.2 is now the dominant Covid variant in every region of the country, with circulation the highest in the densely populated Northeast, a repeated epicenter of the pandemic in the U.S. BA.2 makes up more than 80% of circulating variants in New England, New York, New Jersey, Puerto Rico and the Virgin Islands, according to the CDC.
An estimated 95% of the U.S. population ages 16 and older had developed antibodies against the virus either through vaccination or infection as of December, according to a CDC survey of blood donor samples. However, simply having antibodies against the virus does not necessarily stop an infection. Omicron, with its many mutations, has an enhanced ability to infect both the vaccinated and people who were previously infected.
However, people who are vaccinated, boosted and those who recovered from a prior infection all have high levels of protection against hospitalization from BA.2, according to a study published by scientists in Qatar affiliated with Weill Cornell Medicine in Doha. The study has not undergone peer review.
The scientists found that people who received three Pfizer shots had the highest protection against hospitalization from BA.2 at 98%. People who received two Pfizer doses and those who recovered from a prior infection had similar levels of protection against hospitalization at 76% and 73% respectively. People who had two Pfizer doses and recovered from a breakthrough infection had 97% protection.
The data suggests that even if BA.2 fuels an increase in infections in the U.S., there might be enough immunity in the population to prevent a major outbreak of severe disease that overwhelms hospitals.
BA.2 is anywhere from 30% to 80% more transmissible than the earlier version of omicron, according to public health authorities in the U.K. and Denmark. Scientists in the U.K., South Africa and elsewhere have found that BA.2 generally does not make people more sick than BA.1, which was less severe than the delta variant.
BA.2 has fueled outbreaks in Europe, including in the United Kingdom and Germany. China is battling its worst wave since 2020, locking down major cities such as Shanghai.
However, Covid infections in the U.S. are steady right now even as BA.2 makes up a growing proportion of virus variants in circulation around the country. The U.S. reported an average of about 25,000 new infections on Monday, down 4% from the week prior, according to data from the CDC. However, new infections are likely underreported as many people use at-home tests that aren't captured by the data.
The number of people hospitalized with Covid has fallen to the lowest since 2020. More than 10,700 patients were hospitalized with the virus on Tuesday as a seven-day average, a 92% drop from the peak of the omicron wave in January, according to data from the Health and Human Services Department.
The CDC has adjusted its Covid guidance to focus more on hospitalizations as a measure of how severely the virus is impacting the country. More than 97% of the U.S. population lives in counties with low-to-moderate Covid levels, which means people there do not need to wear masks under the CDC's guidance.
Read CNBC's latest global coverage of the Covid pandemic: | business |
Universal Periodic Review Submission on Bahrain | Help us continue to fight human rights abuses. Please give now to support our work
Fourth Cycle of the Universal Periodic Review, 41st Session
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Correction April 8, 2022: In an earlier version, we mistakenly reported that Mohamed Ramadan and Hussein Ali Moosa were executed in July 2020. This submission has been corrected to reflect that in July 2020 the Court of Cassation upheld the convictions and death sentences of Mohamed Ramadan and Hussein Ali Moosa.
Bahrain has failed to live up to the recommendations that it supported and pledges it made in the past three cycles of the Human Rights Council’ s Universal Periodic Review ( UPR). In 2021, Bahraini activists commemorated the 10th anniversary of the 2011 uprisings amid continuing heavy repression. Oversight mechanisms are not independent of the government and officials are not held accountable for torture and ill-treatment of prisoners. Bahrain continues to arbitrarily imprison individuals for participating in protests and to deny activists and human rights defenders fair trials. There is no independent media and the draft press law of 2021 has expanded restrictions to digital space. The authorities continue to deny access to independent rights monitors and the United Nations special procedures, including the special rapporteur on torture.
No independent media has operated in Bahrain since the Information Affairs Ministry suspended Al Wasat, the country’ s only independent newspaper, in 2017. Foreign journalists rarely have access to Bahrain, and Human Rights Watch and other rights groups are routinely denied access.
In April 2021, the Cabinet approved amendments to the 2002 Press, Printing, and Publishing Law to expand its jurisdiction [ i ] to internet and digital content. The law now requires that electronic media outlets obtain approval from the Ministry of Information Affairs. Acquiring and renewing one-year licenses require declaration of all the outlets’ social media accounts and the names of employees overseeing them. Publishing without authorization is punishable with six months of imprisonment, a fine of 5,000 Dinars, or both.
According to a Freedom House report, between June 2020 and May 2021, at least 58 people [ ii ] were arrested, detained, or prosecuted for their online activities. The charges included “ dissemination of false news, ” “ challenging the state’ s efforts to confront COVID-19 pandemic, ” and “ misuse of social media. ”
In July 2021, Bahrain, already believed to be a customer [ iii ] of the NSO Group’ s Pegasus spyware, [ iv ] reportedly had entered phone numbers of potential targets into a database, which was leaked. In August 2021, Citizen Lab reported that the iPhones of nine Bahraini activists were successfully hacked with NSO Group’ s Pegasus spyware between June 2020 and February 2021. NSO Group has repeatedly denied [ v ] the news reports.
Thirteen prominent dissidents have been serving lengthy prison terms since their arrest in 2011 for their roles in pro-democracy demonstrations. They include Abdulhadi al-Khawaja, a founder of the Bahrain Center for Human Rights, as well as Hassan Mushaima and Abduljalil al-Singace, leaders of the opposition group Al Haq; all three are serving life terms.
Al-Singace began a hunger strike on July 8, 2021, to protest inhumane prison conditions and to demand that a book that he wrote in prison, and which prison authorities confiscated, be returned to his family. Between July and September 2021, al-Singace lost nearly 20 kilograms and is suffering from pre-existing medical conditions, his family says, for which he has not received adequate treatment.
Shaikh Ali Salman, leader of Al-Wifaq, Bahrain’ s largest opposition political society but forcibly dissolved in 2016, is serving a life term after an appeals court reversed his acquittal on trumped up charges of allegedly spying for Qatar.
In June 2020, authorities released from prison prominent human rights defender Nabeel Rajab to serve the rest of his 5-year sentence for speech offenses under the 2017 alternative sentencing law.
Very few persons sentenced to long prison terms for their roles in the 2011 protests, and none of the most prominent, have been released under the alternative sentencing law.
During the 2008 UPR, Bahrain pledged that it “ is fully committed to supporting non-governmental organizations through legal and other instruments so as to develop a constructive dialogue with these organizations and other stakeholders. ” [ vi ] However, Bahrain has shut down almost all non-governmental organizations that have been at all critical of the government and its policies.
Bahrain has executed six men since it ended a moratorium in 2017 on use of the death penalty.
The Bahrain Institute for Rights and Democracy ( BIRD) and Reprieve found that since the 2011 uprising, 51 people have been sentenced to death. Of those, 26 individuals are currently on death row, all at imminent risk of execution, having exhausted all legal remedies. At least 31 were convicted under Bahrain’ s overbroad terrorism law, and of those, 20 have alleged they were subjected to torture.
On July 13, 2020 the Court of Cassation upheld the convictions and sentences of Mohamed Ramadan and Hussein Ali Moosa, despite their unfair trials and credible evidence that their convictions were based on confessions obtained under torture. A criminal court sentenced the two men to death on December 29, 2014. The Court of Cassation confirmed the death sentences in November 2015 but subsequently overturned them in October 2018 after Bahrain’ s Special Investigations Unit ( SIU) found previously undisclosed medical reports documenting harm and concluded that there is a “ suspicion of the crime of torture…which was carried out with the intent of forcing [ Moosa and Ramadan ] to confess. ” Nevertheless, without further investigation and based on the same suspect evidence, the High Criminal Court of Appeal reinstated their convictions and death sentences on January 8, 2020, and the Court of Cassation upheld them on July 13, 2020.
In re-instating the death sentences, the court failed to account for the very serious due process violations in the men’ s initial trial and the shortcomings of the SIU’ s torture investigation.
Although the SIU investigation did not definitively establish whether security forces tortured Moosa and Ramadan, the investigation failed to comply with the Istanbul Protocol.
Dr. Agnes Callamard, the United Nations special rapporteur on extrajudicial, summary or arbitrary executions, provided written comments to the Court of Appeals stating that Moosa and Ramadan’ s “ conviction resulting in the death penalty would be arbitrary and a clear violation of their right to life ” given the failure to properly investigate their torture allegations and the failure to afford other fair trial guarantees.
Bahrain supported the recommendations in its 2017 UPR to ensure accountability for perpetrators of torture and the independence and impartiality of the SIU.
Authorities have failed to credibly investigate [ vii ] and prosecute officials and police officers who allegedly committed serious violations, including torture, since the 2011 protests.
Authorities continue to deny Bahraini prisoners adequate medical care [ viii ], causing unnecessary suffering and endangering the health of prisoners with chronic medical conditions, including unjustly imprisoned such as Hassan Mushaima and Abdel Jalil al-Singace.
Bahrain released 1,486 prisoners [ ix ] in March 2020 due to the health risk posed by Covid-19, but the releases excluded [ x ] opposition leaders, activists, journalists, and human rights defenders—many of whom are older and/or suffer from underlying medical conditions.
Overcrowded conditions in Bahrain’ s prisons compound the risk of Covid-19 spreading. The lack of adequate sanitation led to scabies outbreaks in Jau Prison [ xi ] —Bahrain’ s largest prison—and the Dry Dock Detention Center [ xii ] in December 2019 and January 2020.
At least three prisoners died during 2021, allegedly from the lack of adequate medical care.
On April 6, 2021, the Police Media Center announced [ xiii ] that Abbas Malallah died of a heart attack, but Malallah’ s family claimed [ xiv ] that during his 10 years in prison he had been suffering from chronic illnesses, and other prisoners told [ xv ] Bahraini rights groups that the Jau prison authorities did not respond to Malallah’ s pleas for medical attention before he lost consciousness.
Malallah’ s death prompted protests, [ xvi ] including an April 17 sit-in in Jau Prison [ xvii ] protesting the prison authorities’ alleged medical negligence, particularly during the Covid-19 pandemic. The UN high commissioner for human rights expressed concern that security forces used “ unnecessary and disproportionate force ” [ xviii ] to dismantle the peaceful sit-in at the prison on April 17 and reportedly held many prisoners incommunicado. [ xix ]
In an apparent response to the Covid-19 pandemic, the Public Prosecution announced [ xx ] on April 8, 2021, the release of 73 detainees under the alternative sentencing law. A Covid-19 outbreak at Jau Prison led to the death of Husein Barakat [ xxi ] on June 9. Rights groups [ xxii ] said scores of detainees had contracted Covid-19 and that detainees were not provided with personal protective equipment, adequate medical care, or the ability to communicate with their families.
On July 25, 2021, Hasan Abdulnabi, who suffered from sickle cell disease, died amid allegations [ xxiii ] that he was denied adequate medical treatment at the Dry Dock Detention Center.
In its 2017 UPR, Bahrain was urged by a number of states to ensure the effective protection of migrant workers, especially domestic workers, through legislative measures.
Abuses against migrant workers, especially migrant domestic workers, worsened during the Covid-19 pandemic. Bahrain included irregular migrants in its Covid-19 vaccination program. However, it discriminated against migrant workers during the pandemic.
In 2020, the authorities paid the salaries of 100,000 citizens working in the private sector whose salaries had been suspended during Covid-19 closures between April and June but did not provide similar benefits to migrant workers, who comprise most of Bahrain’ s workforce. Migrant workers reported facing dismissal, wage theft including reduced or unpaid wages, and evictions from their accommodation. [ xxiv ]
Bahrain continues to enforce the kafala ( sponsorship) system that ties migrant workers visas to their employers which means if they leave their employer without their consent, they lose their residency status and can face arrest, fines, and deportation for “ absconding. ” In 2009, Bahrain allowed migrant workers to terminate their employment contracts after one year with their first employer as long as they give reasonable notice to their employer of at least 30 days. However, in January 2022, the Parliament voted to extend this to two years, the amendment to the law is now being considered by the Shura Council. The workers are also expected to bear their own fees for the two-year work permit, which has been too onerous for many resulting in little take-up.
Bahrain’ s Labor Law includes domestic workers but excludes them from protections within it such as weekly rest days, a minimum wage, and limits on working hours. In 2017, Bahrain introduced a unified standard contract for domestic workers which requires detailing the nature of the job, rest hours, and days off. But the standard contract does not limit working hours, set out the minimum wage, or specify what rest days workers are entitled to.
Despite the support that Bahrain has shown to recommendations in its 2017 UPR to address restrictive citizenship and family laws, and to bolster its protection of women and minorities, the authorities have not delivered on these promises.
Bahrain passed a unified family law in July 2017, but it continues to discriminate against women’ s rights to marry, divorce, and inherit on an equal basis to men. Women are required to obey their husband as the head of the household. The 1963 citizenship act prohibits women from conferring their nationality to their children from a non-Bahraini father.
Article 353 of the penal code exempts perpetrators of rape from prosecution if they marry their victims. Bahrain’ s parliament proposed to repeal that article in 2016, but the cabinet rejected the proposal. Article 334 of the penal code reduces the penalties for perpetrators of so-called honor crimes.
Bahrain’ s penal code article 316 criminalizes adultery, a violation of the right to privacy which disproportionately harms women and migrant women. Women who are pregnant outside marriage, as well as women who report rape, can find themselves prosecuted for consensual extramarital sex. Although no law explicitly criminalizes same-sex relations, authorities have used [ xxv ] vague penal code provisions against “ indecency ” and “ immorality ” to target sexual and gender minorities.
In December 2018, Bahrain amended its labor law [ xxvi ] to ban discrimination based on sex, origin, language or creed, and sexual harassment in the workplace, but the law does not refer to sexual orientation, gender identity, disability, or age.
Police beat children [ xxvii ] arrested in protest-related cases in early February 2021, in the lead up to the 10th anniversary of the 2011 uprising in Bahrain, and threatened them with rape and electric shocks. Prosecutors and judges, who refused to allow the children’ s parents or lawyers to be present during their interrogations and ordered their detention, enabled the abuses. A government report denied that security forces beat, insulted, or threatened to rape the boys.
In December 2021 and January 2022, Bahraini authorities arrested and detained [ xxviii ] six boys, ages 14 and 15, in a child welfare facility. The authorities did not provide the boys or their families with any written justification for their weeks-long detention until a hearing on February 20, when the boys rejected their confessions and denied the accusations against them, and they denied parents’ requests to be present during interrogations and to visit their sons. Prior to their arrests, the boys had appeared when summoned for questioning, but the authorities repeatedly renewed their weekly detention and rejected requests that the children be allowed to return home with pledges to appear if requested. On March 13, the boys were sentenced under the Restorative Justice Law for Children of 2021 to one year in detention for throwing a Molotov cocktail and for participating in an unlicensed gathering, primarily on the basis of their confessions. As of March 14, the children had been denied access to education while in detention.
Bahrain has been abusing children’ s rights under its Restorative Justice Law for Children. The law raises the age of criminal responsibility from 7 to 15, defines a child as anyone under 18, and provides for special child courts and separate detention facilities for children. However, it fails to guarantee children access to a lawyer and their parents during interrogations, and provides that children may be detained if they participate in unlicensed protests.
Despite the supported recommendation in the 2017 UPR cycle to prohibit corporal punishment against children in all settings, Bahrain did not comply. The Children’ s Act of 2012 does not address corporal punishment.
[ i ] Freedom House, “ Freedom of the Net 2021: Bahrain, ” Undated, https: //freedomhouse.org/country/bahrain/freedom-net/2021 ( accessed March 29, 2022).
[ ii ] Ibid.
[ iii ] Bill Maczak, John Scott-Railton, Sarah McKune, Bahr Abdul Razzak, and Ron Deibert, “ Hide and Seek: Tracking NSO Group’ s Pegasus Spyware to Operations in 45 Countries, Citizen Lab, ” September 18, 2018, https: //citizenlab.ca/2018/09/hide-and-seek-tracking-nso-groups-pegasus-spyware-to-operations-in-45-countries/ ( accessed March 29, 2022).
[ iv ] Stephanie Kirchgaessner, Paul Lewis, David Pegg, Sam Cutler, Nina Lakhani, and Michael Safi, “ Revealed: Leak Uncovers Global Abuse of Cyber-surveillance Weapon, ” The Guardian, July 18, 2021, https: //www.theguardian.com/world/2021/jul/18/revealed-leak-uncovers-global-abuse-of-cyber-surveillance-weapon-nso-group-pegasus ( accessed March 29, 2022).
[ v ] “ Unchecked Spyware Industry Enables Abuse, ” Human Rights Watch New Release, July 30, 2021, https: //www.hrw.org/news/2021/07/30/unchecked-spyware-industry-enables-abuses.
[ vi ] “ Implementation According to National Reports at the 13th UPR Session, ” UPR Info, Undated, https: //www.upr-info.org/followup/index/page/13th UPR session ( accessed March 29, 2022).
[ vii ] Human Rights Watch, World Report 2022, Bahrain Chapter, https: //www.hrw.org/world-report/2022/country-chapters/bahrain.
[ viii ] “ Bahrain: Prisoners Denied Medical Care, ” Human Rights Watch News Release, October 8, 2019, https: //www.hrw.org/news/2019/10/08/bahrain-prisoners-denied-medical-care.
[ ix ] Aya Majzoub, “ Bahrain’ s Prison Release Positive but Insufficient, ” Human Rights Watch Dispatch, March 23, 2020, https: //www.hrw.org/news/2020/03/23/bahrains-prison-release-positive-insufficient.
[ x ] “ Bahrain: Free Imprisoned Rights Defenders and Opposition Activists, ” Human Rights Watch News Release, April 6, 2020, https: //www.hrw.org/news/2020/04/06/bahrain-free-imprisoned-rights-defenders-and-opposition-activists.
[ xi ] “ الإصلاح والتأهيل يؤكد على تقديم الرعاية الصحية لكافة النزلاء, ” Bahraini Police Media Center, December 30, 2019, https: //www.policemc.gov.bh/news/ministry/99333 ( access March 29, 2022).
[ xii ] “ Scores of Prisoners in Bahrain Launch Hunger Strike over Scabies Outbreak, ” The New Arab, January 22, 2020, https: //english.alaraby.co.uk/english/news/2020/1/22/scores-bahraini-prisoners-launch-hunger-strike-over-scabies-outbreak ( March 29, 2022).
[ xiii ] “ الإصلاح والتأهيل تعرب عن خالص العزاء لأهل نزيل توفي وفاة طبيعية إثر تعرضه لأزمة قلبية, ”
Bahraini Police Media Center, April 6, 2021, https: //www.policemc.gov.bh/news/ministry/115360 ( March 29, 2022).
[ xiv ] “ Continued Medical Negligence Claims the Life of a Political Prisoner, ADHRB Demands the Immediate Release of All Political Prisoners, ” Americans for Democracy & Human Rights in Bahrain, April 8, 2021, https: //www.adhrb.org/2021/04/continued-medical-negligence/ ( March 29, 2022).
[ xv ] Ibid.
[ xvi ] “ المعامير – تظاهرة غاضبة لاستشهاد المعتقل عباس مال الله في سجون البحرين, ” YouTube Video, April 6, 2021, https: //www.youtube.com/watch? v=2u0mOTIH7Mo ( accessed March 29, 2022).
[ xvii ] Americans for Democracy & Human Rights in Bahrain’ s Twitter Account, April 6, 2021, https: //twitter.com/ADHRB/status/1379471188775346179? s=20 ( March 29, 2022).
[ xviii ] “ Press Briefing Notes on Bahrain, ” OHCHR Press Briefing Notes, April 30, 2021, https: //www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx? NewsID=27042 & LangID=E ( March 29, 2022).
[ xix ] “ Over 50 Political Prisoners Subject to Enforced Disappearances at Jau Prison After Riot Politce Attack Inmates, ” Bahrain Institute for Rights & Democracy, April 26, 2021, https: //birdbh.org/2021/04/over-50-political-prisoners-subject-to-enforced-disappearance-at-jau-prison-after-riot-police-attack-inmates/ ( accessed March 29, 2022).
[ xx ] “ Jail Terms Commuted into Alternative Penalties for 73 Inmates, ” Bahrain News Agency, April 8, 2021, https: //www.bna.bh/en/Jailtermscommutedintoalternativepenaltiesfor73inmates.aspx? cms=q8FmFJgiscL2fwIzON1% 2bDvJPohps1cG0rtQwLJgbXlQ% 3d ( accessed March 29, 2022).
[ xxi ] Miriam Berger, “ Death of Prisoner from Covid-19 Sparks Protests as Bahrain Battles Oubreak, ” Washington Post, June 11, 2021, https: //www.washingtonpost.com/world/2021/06/11/bahrain-prisoner-barakat-death-covid-protest/ ( accessed March 29, 2022).
[ xxii ] “ Bahraini Authorities Flouting Prisoners’ Rights to Health amid Rise in Covid-19 Cases at Jaw Prison, ” Amnest International News Release, April 9, 2021, https: //www.amnesty.org/en/latest/press-release/2021/04/bahraini-authorities-flouting-prisoners-rights-to-health-amid-rise-in-covid-19-cases-at-jaw-prison/ ( March 29, 2022).
[ xxiii ] “ Rights Groups Call for Impartial Investigation into Death of Inmate in Bahrain amid Reports of Medical Negligence, ” Bahrain Institute for Rights & Democracy, August 11, 2021, https: //birdbh.org/2021/08/rights-groups-call-for-impartial-investigation-into-death-of-inmate-in-bahrain-amid-reports-of-to-medical-negligence/ ( accessed March 29, 2022).
[ xxiv ] “ Bahrain: Migrant Workers Face Homelessness amid Covid-19 without Rent & Accomodation Protections, ” business & Human Rights Resource Centre, September 17, 2020, https: //www.business-humanrights.org/en/latest-news/bahrain-migrant-workers-face-homelesssness-amid-covid-19-without-rent-accommodation-protections/ ( accessed March 29, 2022).
[ xxv ] Habib Toumi, “ Bahrain Arrests Scores in Raid on Gay Party, ” Gulf News, February 5, 2011, https: //gulfnews.com/world/gulf/bahrain/bahrain-arrests-scores-in-raid-on-gay-party-1.757328 ( accessed March 29, 2022).
[ xxvi ] Robert Anderson, “ Bahrain Bans Discrimination, Sexual Harassment at Work, ” Gulf Business, December 10, 2018, https: //gulfbusiness.com/bahrain-bans-discrimination-sexual-harassment-work/ ( accessed March 29, 2022).
[ xxvii ] “ Bahrain: Stop Denying Abuse of Detained Children, ” Human Rights Watch Press Release, June 7, 2021, https: //www.hrw.org/news/2021/06/07/bahrain-stop-denying-abuse-detained-children.
[ xxviii ] “ Bahrain: Boys Arbitrarily Detained in Orphanage, ” Human Rights Watch Press Release, February 7, 2022, https: //www.hrw.org/news/2022/02/08/bahrain-boys-arbitrarily-detained-orphanage.
Correction April 8, 2022: In an earlier version, we mistakenly reported that Mohamed Ramadan and Hussein Ali Moosa were executed in July 2020. This submission has been corrected to reflect that in July 2020 the Court of Cassation upheld the convictions and death sentences of Mohamed Ramadan and Hussein Ali Moosa.
Killings, Abductions, Torture, and Sexual Violence Against LGBT People by Armed Groups in Iraq | general |
Amazon Union’ s Chris Smalls Is Part of the Legacy of Black Labor Organizing | On April 1, 2022, Jeff Bezos received some news that he wished was an April Fools ' joke: Amazon warehouse workers in Staten Island won their vote to create a union, beating the odds and making history in the process. The face of the “ Shut Down Amazon ” movement, a working-class Black man named Christian Smalls, is building on the legacy of Black labor leaders whose efforts define generations.
While there are countless articles profiling Smalls, few have acknowledged the long history of Black labor leaders taking the helm of workers ' rights movements. Smalls, who was subjected to a smear campaign by Amazon and dismissed as “ not smart or articulate ” by company leaders, is reminiscent of a lineage of Black American labor organizers and scholars who have always recognized the liberation of all workers begins with the Black worker.
African Americans have participated in labor activity since before the Civil War, as documented by the National Archives. Like many American institutions in the century following that war, organized labor often excluded or marginalized Black people, despite workers’ shared interest in advocating for better conditions, especially in occupations that failed to dignify their labor.
During The Great Migration of 1916 to 1960, millions of African Americans relocated from the South to the Northeast and Midwest in pursuit of employment in industries including steel, automotive, shipbuilding, and meatpacking. Yet these gains occurred alongside the government’ s refusal to extend rights to many workers of color. In 1938, Congress passed the Fair Labor Standards Act ( FLSA), a landmark piece of legislation enshrining protections for workers, yet it excluded domestic, agricultural, and tipped workers, purposefully denying many Black and brown people the same rights and protections given to white workers. Additionally, according to the National Employment Law Project, `` Nearly half of all Black men, Mexican American men, and Native American men and women…were excluded from Social Security, unemployment insurance, and the right to organize ” in the National Labor Relations Act of 1935. The effects of this exclusion fell disproportionately on Black women because of their concentration in agriculture and domestic work. Perhaps this is why the first Black woman economist in the U.S., Dr. Sadie Tanner Mossell Alexander, focused her dissertation on the economic outcomes of families that participated in The Great Migration. She also advocated for recentering the economy on Black women workers as one way to promote economic growth and progress for the Black community.
Like Alexander, Smalls deeply understands that improving labor conditions for Black workers could and would unlock more equitable outcomes for all. Consider that in 2019, at nearly every educational level, Black workers were twice as likely to be unemployed. Historically, on average, the Black unemployment rate changes by 1.7 percentage points for every 1 percentage point of change in the national unemployment rate. Given well-documented and persistent patterns of racial inequality in employment, when the unemployment rate soared during the early months of the COVID pandemic, Black workers, and especially Black women, were disproportionately affected. And those workers have experienced the slowest economic recovery.
Chris Smalls holds a sign during a protest outside an Amazon facility on Staten Island on May 1, 2020, after he was fired by the company.
In 2020, Amazon's own demographic data also revealed that nearly 63% of its warehouse and call-center workers were Black, Latino, Native American, or multiracial, compared to approximately 21% of its corporate workforce. The Pew Research Center found that the majority of jobs that are being lost amid the pandemic are concentrated in the service sector where, in 2018, Black or African American workers and Latinos were overrepresented. Ironically, these workers are considered unskilled and, to some, unworthy of a living wage, health care, and/or financial security. Yet, unprotected workers in these jobs are coming together to fight for better wages and working conditions as we have seen at Amazon.
This is why it matters that Christian Smalls is a leader of a historic union-organizing movement: His persistence and frankly unapologetic Blackness honor the past, present, and future of workers who are fighting for their dignity. Smalls has remained humble about his role in the collective organizing drive, telling Labor Notes, “ It’ s not my union. It’ s the people’ s union. ” But it’ s worth noting the outsized role he played in the successful campaign because it was Amazon’ s general counsel, David Zapolsky, who suggested that “ [ making Chris Smalls ] the most interesting part of the story and, if possible, making him the face of the entire union-organizing movement ” would kill the movement itself.
No one can deny that ordinary people taking on Big Tech is the epitome of fighting the power — a power that made billions during the pandemic shares little to nothing with frontline workers and fails to correct horrific working conditions. The anti-Blackness built into so much of our technology makes this win, spearheaded by a working-class Black man, that much more symbolic.
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Technology stocks in Asia slip; 10-year U.S. Treasury yield surges | SINGAPORE — Technology stocks in Asia-Pacific declined on Wednesday, mirroring losses seen among their peers on Wall Street following an overnight surge in the U.S. 10-year Treasury yield.
Chinese tech stocks in Hong Kong dropped, with Alibaba falling 5.36% and Meituan declining 3.65% while Tencent shed 2.31%. The Hang Seng Tech index slipped 3.82% to 4,587.73.
In Japan, shares of SoftBank Group shed 2.81%. Over in South Korea, Kakao shares declined 2.33% and Naver slipped 3.65% while SK Hynix fell 3%.
Those losses in Asia came after the tech-heavy Nasdaq Composite lagged overnight on Wall Street, dropping 2.26% to 14,204.17.
The broader Asia-Pacific markets also declined on Wednesday.
Hong Kong's Hang Seng index dropped 1.87% on the day to 22,080.52. Hong Kong's chief secretary John Lee resigned on Wednesday, two days after incumbent Hong Kong leader Carrie Lam announced Monday she will not pursue a second term in office. Local media reports have cited unnamed sources saying Lee is set to join the chief executive race.
Mainland Chinese stocks closed mixed as they returned to trade following holidays earlier in the week. The Shanghai composite was marginally higher at 3,283.43 while the Shenzhen component shed 0.45% to 12,172.91.
Chinese services sector activity saw a sharp contraction in March, a private survey showed Wednesday. The Caixin services Purchasing Managers ' Index declined to 42.0 in March, well below February's reading of 50.2 as well as the 50 mark that separates growth from contraction on a monthly basis. Wednesday's reading was also the lowest since February 2020.
That data release comes as China continues to battle its worst Covid outbreak since the beginning of the pandemic in early 2020.
`` The Covid-zero policy is probably the most important uncertainty that we're watching at Eastspring right now but generally speaking, we do think there's a good opportunity for investors that want to get back in to China, '' Sarah Lien, client portfolio manager at Eastspring Investments ( Singapore), told CNBC's `` Street Signs Asia '' on Wednesday.
`` Even though … there's a lot of worry in the markets, we do think it's priced in, we do think there're opportunities … and we think China's just a great diversifier … in global portfolios, '' Lien said.
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In Japan, the Nikkei 225 slipped 1.58% to close at 27,350.30 while the Topix index fell 1.34% to end its trading day at 1,922.91. South Korea's Kospi dipped 0.88% to end the trading day at 2,735.03.
Elsewhere, the S & P/ASX 200 in Australia declined 0.5%, closing at 7,490.10.
MSCI's broadest index of Asia-Pacific shares outside Japan dropped 1.25%.
Investors continued to monitor moves in U.S. Treasurys on Wednesday. The 10-year Treasury rose to its highest level since May 2019 on Tuesday, hitting a high of 2.562% before settling at 2.55%.
The yield on the benchmark 10-year Treasury note last sat at 2.605%, well above the 2-year Treasury note's yield of 2.5653%. Yields move inversely to prices.
A topping of the 2-year Treasury yield against the 10-year rate, which happened last week before the recent reversal, has historically been observed ahead of recessions.
The 10-year Treasury yield jumped overnight after comments from U.S. Federal Reserve Governor Lael Brainard suggested an aggressive approach to shrinking the central bank's balance sheet.
`` Brainard peppered her comments on balance sheet reduction with adverbs that added to the hawkish perception. In addition, that the reduction may start in May is earlier than expected, '' Frances Cheung and Terence Wu of Singapore's OCBC Treasury Research wrote in a note.
`` We are likely not at peak-hawk at the Fed yet. This dynamic could still extend, '' they said.
Oil prices were higher in the afternoon of Asia trading hours, with international benchmark Brent crude futures up 1.25% to $ 107.97 per barrel. U.S. crude futures jumped 1.18% to $ 103.16 per barrel.
The U.S. dollar index, which tracks the greenback against a basket of its peers, was at 99.621 following a recent jump from below 99.
The Japanese yen traded at 123.85 per dollar, weaker as compared with levels below 123.3 seen against the greenback yesterday. The Australian dollar changed hands at $ 0.7581 after a recent drop from above $ 0.762. | business |
Canadian dollar pulls back from 5-month high on hawkish Fed outlook | In this article
The Canadian dollar was little changed against its U.S. counterpart on Tuesday, giving back its earlier gains, as hawkish comments by a Federal Reserve policymaker pushed U.S. bond yields and the greenback sharply higher.
The loonie was nearly unchanged at 1.2490 to the greenback, or 80.06 U.S. cents, after earlier touching its strongest level since Nov. 10 at 1.2404.
`` The Canadian dollar initially strengthened... piggybacking on the strength of the Australian dollar, '' said Erik Nelson, a currency strategist at Wells Fargo in New York. `` It has since relinquished those gains after the Fed's Brainard was much more hawkish than expected. ''
The U.S. dollar rallied against a basket of major currencies after Fed Governor Lael Brainard said she expects a combination of interest rate increases and a rapid balance sheet runoff to bring U.S. monetary policy to a `` more neutral position '' later this year.
Earlier, the Reserve Bank of Australia dropped its pledge to be `` patient '' on hiking interest rates, boosting the Australian dollar.
Canadian data showed that exports rose 2.8% in February to a record high. It was driven mostly by energy products, including oil.
The price of oil settled 1.3% lower at $ 101.96 a barrel, pressured by the rising U.S. dollar and growing worries that new coronavirus cases could slow demand.
Meanwhile, Canada's Liberal party government finds itself in a bind ahead of this week's budget: The economy has recovered from the pandemic, yet Prime Minister Justin Trudeau has pledged billions in new stimulus, a political poker chip that could further torch runaway inflation.
Canadian government bond yields moved higher across the curve, tracking the move in U.S. Treasuries. The 10-year was up 7.5 basis points to 2.551%. | business |
Why the stock market could be in for a 'rough ride ' as Fed prepares to shrink balance sheet | Tough talk Tuesday on the Federal Reserve’ s balance sheet from a key policy maker could signal rough sledding ahead for equity investors, a Wall Street economist warns.
“ Fedspeak has become increasingly more hawkish with a noted dove hinting that balance-sheet reduction could begin as soon as next month, ” said Joe LaVorgna, chief economist for the Americas at Natixis CIB. “ This led to a bearish steepening in rates, but thus far stock market investors are unperturbed, ” at least for now, he said.
On Tuesday, Fed Gov. Lael Brainard told a conference in Minneapolis that the central bank, in an effort to cool down inflation, will “ continue tightening monetary policy methodically through a series of interest-rate increases and by starting to reduce the balance sheet at a rapid pace as soon as our May meeting. ”
Read:
Fed’ s Brainard says inflation is ‘ much too high’ with risks it might go even higher
The Fed’ s balance sheet has doubled to nearly $ 9 trillion as a result of a resumption of asset purchases at the onset of the COVID-19 pandemic. The liquidity provided by an expanded balance sheet has been cited as a factor in the stock-market rally that followed the short, COVID-induced bear market in the spring of 2020, as well as
the rise in the value
of a range of other assets.
“ This was tough talk from a monetary dove, ” LaVorgna said, referring to Brainard, in a note. “ Furthermore, when a policy maker states ‘ as soon as our May meeting’ that is Fedspeak for the action to come at that meeting. It is no wonder there was a bearish steepening of the Treasury yield curve. ”
Indeed, the yield on the 10-year Treasury note
TMUBMUSD10Y,
2.715%
jumped 14.5 basis points to 2.554%. That lifted the 10-year yield back above the 2-year Treasury yield
TMUBMUSD02Y,
2.523%
,
which rose 7.6 basis points to 2.502%, momentarily erasing a rare inversion of that part of the yield curve.
Meanwhile, stocks weren’ t
weren’ t entirely unperturbed
. The jump in yields was blamed for sinking rate-sensitive tech shares and other so-called growth stocks, with the Nasdaq Composite
COMP,
-1.34%
slumping 2.3%, while the S & P 500
SPX,
-0.27%
fell more than 1% and the Dow Jones Industrial Average
DJIA,
+0.40%
lost around 281 points, or 0.8%. U.S. stocks opened lower on Wednesday.
Still, as of Tuesday’ s close, the S & P 500 remained less than 6% below its record closing high set on Jan. 3.
The Fed previously moved to shrink its balance sheet in 2017. Over the next two years, it fell to $ 3.6 trillion from $ 4.2 trillion before a bout of volatility in money markets brought the process to a halt. The Fed has backstops in place this time around that policy makers expect to prevent a repeat.
“ Given that the recovery has been considerably stronger and faster than in the previous cycle, I expect the balance sheet to shrink considerably more rapidly than in the previous recovery, with significantly larger caps and a much shorter period to phase in the maximum caps compared with 2017-19, ” Brainard said.
Caps refer to the amount of securities that would be allowed to run off the balance sheet each month.
Brainard’ s remarks likely whetted investor appetite for minutes of the Fed’ s March policy meeting, due Wednesday, which are widely expected to offer more specific details on the central bank’ s tactics around shrinking its asset portfolio.
See:
Markets are hankering to find out the Fed’ s plan to shrink its $ 9 trillion balance sheet. They should get their wish Wednesday
The prospect of a more rapid balance-sheet reduction is what should have stock-market bulls concerned, LaVorgna said.
He said the Fed could start with a roll-off of $ 15 billion in June ( $ 10 billion in Treasurys and $ 5 billion in mortgage-backed securities, or MBS), increasing that amount each month by $ 10 billion for Treasurys and $ 5 billion for MBS until reaching caps of $ 50 billion on Treasurys and $ 30 billion on MBS. In 2017, the Fed started at just $ 10 billion a month ( $ 6 billion Treasurys and $ 4 billion MBS), the economist recalled.
Assuming the Fed also allows $ 260 billion in bills to mature, the balance sheet could shrink $ 645 billion in just eight months, LaVorgna said. In the previous episode, it took 22 months to hit the same target.
Natixis
“ What will it mean for equities? ” LaVorgna asked. Referring to the chart above, he argued that the size of the Fed’ s balance sheet and the level of the S & P 500 have been highly correlated. “ Hence, stocks could be in for a rough ride ahead, ” he wrote. | business |
Biden invokes Defense Production Act to bolster domestic battery manufacturing | Biden took a two-part path on Thursday to addressing rising energy costs: releasing up to 1 million barrels a day for six months from the Strategic Petroleum Reserve and using the DPA, a Cold War relic, to bolster domestic battery production.
The United States imports most of the minerals used in lithium-ion batteries, according to a February report from the Department of Energy.
`` We need to embrace all the tools and technologies that can help free us from our dependence on fossil fuels and move us toward more homegrown clean energy technologies made by American companies and American workers, '' Biden said during a press briefing Thursday. `` We need to end our long-term reliance on China and other countries for inputs that will power the future. ''
The Biden administration's action invoking the DPA is `` limited in scope, '' but sends a markets signal, according to the National Mining Association.
`` The minerals supply chain that will drive the electrification of our transportation sector and the energy transition is not only at risk from a perilous and growing import dependence, but the approaching minerals demand wave is set to strain every sector of the economy and requires an urgency in action from government and industry never before seen, '' Rich Nolan, NMA CEO, said in a statement Friday. `` Unless we continue to build on this action, and get serious about reshoring these supply chains and bringing new mines and mineral processing online, we risk feeding the minerals dominance of geopolitical rivals. ''
A DPA determination issued Thursday authorized the Defense Department to conduct feasibility studies for `` mature mining, beneficiation, and value-added processing projects; by-product and co-product production at existing mining, mine waste reclamation, and other industrial facilities; mining, beneficiation, and value-added processing modernization to increase productivity, environmental sustainability, and workforce safety. ''
Biden is considering using the DPA to address other parts of the energy sector, according to the White House statement.
Russia and China control significant amounts of the minerals needed to build batteries and it is `` imperative '' that the U.S. be able to produce them to shift to a clean energy future, Sheila Hollis, United States Energy Association acting executive director, said in a statement.
Sen. Bill Cassidy, R-La., said the move was `` encouraging, '' but said it wouldn’ t be effective without permitting reforms.
`` Enacting the DPA without addressing the bureaucratic logjam of permitting would be little more than symbolism, '' Cassidy said in a statement. `` We have to also streamline the permitting process that could delay any effort by years. ''
The Natural Resources Defense Council urged the Biden administration to focus on recycling minerals needed for batteries.
`` Rather than just digging up or importing more, we should start with improved recovery and waste reduction throughout supply chains, '' Bobby McEnaney, NRDC senior lands analyst, said in a statement.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more.
The retailer's acquisition of a middle- and final-mile carrier as the COVID-19 pandemic took hold has allowed it to take more control over its delivery process.
Adopters face marketing, data and governance challenges before they can reap the technology's full benefits.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more.
The retailer's acquisition of a middle- and final-mile carrier as the COVID-19 pandemic took hold has allowed it to take more control over its delivery process.
Adopters face marketing, data and governance challenges before they can reap the technology's full benefits.
Topics covered: logistics, freight, operations, procurement, regulation, technology, risk/resilience and more. | general |
Biden administration expected to extend student loan payment pause through August | The Biden administration plans to announce another extension to the payment pause for federal student loan borrowers, sources tell CNBC.
The pause is likely to last through August. This would be the sixth extension of the break, which has now spanned two presidencies.
Currently, the pandemic-era relief policy suspending student loan bills is scheduled to lapse in May.
Former President Donald Trump first announced the stay on bills for the millions of Americans with education debt in March 2020, when the coronavirus pandemic brought the U.S. economy to its knees and joblessness soared. Nearly all borrowers eligible for the pause have used it, with just around 1% of them continuing to pay, according to an analysis by higher-education expert Mark Kantrowitz.
More from Personal Finance: These states have the highest and lowest tax burdensHere's how to get relief at the gas pump nowThe Great Resignation is still in full swing
The country has emerged from the darkest days of the pandemic, and the unemployment rate has come back down. Yet the Biden administration has expressed reluctance to resume the payments before it makes its decision on student loan forgiveness.
`` The president is going to look at what we should do on student debt before the pause expires, or he 'll extend the pause, '' White House Chief of Staff Ron Klain said last month on the podcast `` Pod Save America. ''
`` Joe Biden right now is the only president in history where no one's paid on their student loans for the entirety of his presidency, '' Klain said.
Democrats and advocates had warned that resuming the payments after more than two years could have signaled to some that Biden was turning away from his vow to forgive at least $ 10,000 in student debt for all, leading to damaging headlines and lower turnout at the polls come November.
Senate Majority Leader Chuck Schumer, D-N.Y., and Sen. Elizabeth Warren, D-Mass., are pushing the president to cancel closer to $ 50,000 per borrower.
Nearly 66% of likely voters are in support of the president forgiving student debt, with more than 70% of Latino and Black voters in favor, a recent poll found.
Even prior to the public health crisis, student loans were a major challenge for many households. Outstanding education debt exceeds $ 1.7 trillion, burdening families more than auto or credit card debt. Some 40 million people in the U.S. have loans from their schooling, and more than a quarter are past due.
Yet Scott Buchanan, executive director of the Student Loan Servicing Alliance, a trade group for federal student loan servicers, warned that the repeated extensions will cause their own issues for the lending system.
`` What's a borrower to believe or plan for anymore when the government keeps changing its mind? '' Buchanan said. `` When the inevitable resumption does finally happen, millions of borrowers will likely miss it and go delinquent because of the false expectations the government is now setting. ''
How will more time without student loan payments impact you? If you're willing to talk for a story, please email me at annie.nova @ nbcuni.com | business |
War, Inflation Have Lighter Impact on Healthcare Stocks | Threat of U.S. policy changes fading.
With the recent market pullback, the trailing 12-month performance has decelerated with the Morningstar's US Healthcare Sector Index up 15%, a tad ahead of the broader equity market's 14% gain. We believe the outperformance is partly due to the relative safety healthcare stocks provide against the backdrop of the war in Ukraine and inflationary trends. Most healthcare companies generate less than 2% of sales in Ukraine and Russia, so the war isn't having a big impact on the group.
Further, we expect most of our healthcare coverage ( especially firms with moats) will be able to pass along price increases due to any inflationary pressures given the strong pricing power, thanks to patents and high switching costs. As the war in Ukraine and inflation have shifted the focus of the Biden administration and Congress, we don’ t expect near-term movement on major U.S. healthcare policy, which should ease some pricing pressure risk on the Big Biopharma group.
Within the healthcare sector, we see just over 30 buys in the sector, with one third of our coverage rated 4 or 5 stars. However, on a capitalization-weighted basis, overvalued large-cap healthcare stocks skew our price/fair value for the sector higher than its median.
However, we continue to view the valuation in the sector as split between a general undervaluation in the larger biopharma group and an overvaluation in the device and diagnostics industries. While the biopharma valuations imply a high degree of risk involving potential changes in U.S. healthcare policies targeting drug prices, we see this threat as fading, especially as other priorities increase in the U.S. Further, the fundamental outlook for biopharma firms remains strong, with low patent exposure and several new innovative drugs launching and gaining market share ( Exhibit 9d).
On the opposite side of the healthcare valuation spectrum, many diagnostic and tool companies look overvalued. We believe this is partly because of strong recent results from pandemic-related activities being extrapolated too far into the future. While we think achieving global herd immunity to the coronavirus seems increasingly unlikely, we expect a return to near normal over the next two years in most developed markets as vaccinations climb and new effective oral treatments reach the market. We expect the demand for COVID-related products to fall substantially by 2024, and the redeployment of capital by firms gaining a windfall from COVID will be an important growth driver for several firms.
The market is overly concerned with the increasingly challenging outlook for Alzheimer's drug Aduhelm, but Biogen is well positioned elsewhere. The firm leads the $ 20 billion global multiple sclerosis market with Avonex, Plegridy, Tysabri, and Tecfidera, and the launch of Vumerity partly protects the Tecfidera franchise from generic headwinds. Biogen also receives royalties and profit share from Roche on MS drug Ocrevus and cancer therapies Rituxan and Gazyva, boosting Biogen's profitability. Further, Biogen's neurology portfolio outside of MS, including Spinraza in spinal muscular atrophy, should help diversify revenue and boost sales growth.
The market underappreciates Ionis ' growing pipeline of assets. Ionis ' antisense technology and intellectual property estate have allowed the firm to create an entirely new class of therapeutics for difficult-to-treat diseases. Antisense therapeutics have the potential to gain access to well-studied targets in the cell that are currently deemed `` undruggable, '' and Ionis could capture this low-hanging fruit in a wide range of diseases. Further, Ionis has attracted big-name partners like Biogen and Roche, and it has one of the broadest pipelines in the biotech sector.
With the addition of smaller competitor Biomet, Zimmer is the undisputed king of large-joint reconstruction, by far. We expect favorable demographics, which include aging baby boomers and rising obesity, to fuel solid demand for large-joint replacement that should offset price declines. However, Zimmer stumbled into a series of pitfalls in 2016–17, including integration issues, supply and inventory challenges, and quality concerns that have caught the attention of the U.S. Food and Drug Administration. However, new management has tackled these issues, and the firm is poised to ramp up its growth.
Damien Conover does not own ( actual or beneficial) shares in any of the securities mentioned above. Find out about Morningstar’ s editorial policies.
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To further protect the integrity of our editorial content, we keep a strict separation between our sales teams and authors to remove any pressure or influence on our analyses and research.
Read our editorial policy to learn more about our process. | business |
4 ways to reduce your environmental impact when you travel—and save money, too | This
article
is reprinted by permission from
NerdWallet
.
There’ s no way around it: Travel has a big environmental impact. If commercial aviation were its own country, it would rank sixth in terms of total carbon dioxide emissions ( between Japan and Germany), according to a 2019 fact sheet from the Environmental and Energy Study Institute.
Whoa.
The onus of reducing the carbon impact of travel rests on many shoulders, from corporations to countries. But the fact remains that the decisions of individual travelers matter as well. So what can environmentally conscious travelers do to
reduce their impact
?
Flying less frequently or less far is one option, but not an attractive or feasible one for many travelers. And buying carbon offsets or other price-intensive measures can help ( in theory), but not everyone can afford them.
Thankfully there are many low-cost or free ways to reduce the environmental impact of travel. In fact, some of them can even save you money.
1. Skip premium cabins
Yes, flying at the front of the plane is the dream. And
using points and miles
makes this dream a possibility for many. But it’ s expensive — both in terms of cost and carbon impact.
An analysis by the World Bank’ s Environment and Energy Team, Development Research Group estimates that first-class fares can cause up to nine times more emissions than economy fares because of the space they require on aircraft.
So, taking a single flight in first class could be the equivalent of nine flights of the same distance in economy.
This one’ s a win-win for budget- and eco-conscious travelers. Avoiding the markup on premium seats can reduce both the cost and carbon impact of air travel. Your knees might not thank you for cramming into an economy seat, but the climate might.
2. Use Google Flights’ new carbon feature
Google’ s
GOOGL,
-1.91%
flight search tool is an excellent choice for travel experts and newbies alike. And it has recently added a carbon emissions feature that makes it invaluable for environmentally minded travelers.
Source: Google
The best part of this feature is that you don’ t have to do anything to use it: It’ s baked into the flight search results automatically. Google shows the estimated carbon dioxide emissions for each flight and highlights the option with the lowest emissions.
This acts as a behavioral nudge that lets you choose the most environmentally conscious option with all other variables being the same. In the example pictured, the Qatar Airways flight costs a bit more and has slightly lower emissions than the Singapore Airlines flight.
However, in many cases, the lowest-cost flight is also the least carbon intensive. This makes it easy to make a small difference on the impact of your flight without spending much ( or any) more.
Don’ t miss:
Processed foods like ramen packets and frozen pizza can hurt your heart — and the globe, study says
3. Don’ t accept a rental car upgrade
Have you ever booked the cheapest ( and smallest) rental car available, only to receive a much bigger vehicle at the counter? This can feel like a small victory — akin to being upgraded on a flight — but it comes with a carbon cost. In addition to being cheaper, economy cars are also generally more fuel efficient. So getting upgraded to a sport-utility vehicle isn’ t always a good thing.
Just ask the rental car agent if any smaller cars are available. You might get some arched eyebrows in response, but there’ s no issue with taking the “ downgrade. ” Sometimes there are no small cars available, which is the reason for the upgrade, but it’ s worth asking.
This carbon-conscious trick is not only free —
it can save you gas money
.
You might like:
IKEA will pay you to return its old furniture for resale
4. Turn down the hotel AC and heat when you leave
All in all, hotel rooms are pretty efficient. They’ re much smaller and easier to heat, cool and light than a typical home. And they’ re generally built with energy conservation in mind ( since hotel companies foot the bill).
Yet, for the most part, hotel rooms are under constant climate control, even when unoccupied. This means you’ re always stepping into a perfectly room-temperature environment when returning, but it’ s also a waste of energy.
This one’ s easy: Simply turn down your heat or air conditioning when leaving the hotel room for the day. The minor inconvenience of a chilly or warm room is easily offset by the energy savings.
You might even take your eco-consciousness a step further and consider booking hotels that are committed to
protecting the environment
.
Read
:
SEC’ s landmark climate-change ruling could demand companies account for pollution they don’ t directly create
The bottom line
Being an environmentally responsible traveler is not a zero-sum game. You don’ t have to travel less, or buy a bunch of carbon offsets, to make a difference. Small behavioral nudges such as turning down the AC or rental car upgrade can make a meaningful difference.
In fact, you can have it both ways — saving money and reducing your carbon footprint at the same time.
More From NerdWallet
Travel Insurance Might Not Cover COVID-19 — Unless You Upgrade
6 Ways Technology Is Evolving Travel in 2022
Can Your First Credit Card Be a Travel Card?
Sam Kemmis writes for NerdWallet. Email: skemmis @ nerdwallet.com. Twitter: @ samsambutdif. | business |
HelloFresh: Notes on the Rights of Shareholders | Virtual Annual General Meeting of HelloFresh SE on May 12, 2022
Explanations regarding the Rights of Shareholders pursuant to Articles 53, 56 of the SE Regulation, Section 50 ( 2) of the German SE Implementation Act, Sections 122 ( 2), 126 ( 1) and 127, 131 ( 1) of the German Stock Corporation Act as well as Article 2 Section 1 of the COVID-19 Mitigation Act
The invitation to the Virtual Annual General Meeting already contains information on shareholders ' rights according to Article 56 Council Regulation ( EC) No 2157/2001 of 8 October 2001 on the Statute for a European company ( SE) ( `` SE Regulation ''), Section 50 ( 2) of the German act implementing the SE Regulation ( SE-Ausführungsgesetz, `` SE Implementation Act ''), Section 122 ( 2) of the German Stock Corporation Act ( Aktiengesetz), Section 126 ( 1) of the German Stock Corporation Act, Sections 127, 131 ( 1) of the German Stock Corporation Act in connection with Article 2 Section 1 of the Act to Mitigate the Consequences of the COVID-19 Pandemic under Civil, Insolvency and Criminal Procedure Law ( Gesetz zur Abmilderung der Folgen der Covid-19-Pandemie im Zivil-, Insolvenz- und Strafverfahrensrecht,) of March 27, 2020 as amended by the Act of September 10, 2021 on the establishment of a special fund `` Aufbauhilfe 2021 '' and on the temporary suspension of the obligation to file for insolvency due to heavy rainfall and flooding in July 2021 and on the amendment of other laws ( Gesetz zur Errichtung eines Sondervermögens `` Aufbauhilfe 2021 '' und zur vorübergehenden Aussetzung der Insolvenzantragspflicht wegen Starkregenfällen und Hochwassern im Juli 2021 sowie zur Änderung weiterer Gesetze vom 10. September 2021) ( `` COVID-19 Mitigation Act '').
The relevant provisions of the German Stock Corporation Act for stock companies with their registered office in Germany apply to HelloFresh SE in accordance with the referring provisions of Articles 53 and 56 of the SE Regulation, to the extent that the provisions of the SE Regulation do not provide otherwise.
The Management Board of the Company, with the approval of the Supervisory Board, has resolved to hold this annual general meeting on May 12, 2022 as a virtual meeting without the physical presence of the Company's shareholders or their proxies on the basis of the COVID-19 Mitigation Act. A physical participation of shareholders or their proxies in the Virtual Annual General Meeting is excluded.
Holding this annual general meeting of shareholders in the form of a virtual general meeting in accordance with the COVID-19 Mitigation Act leads to modifications with respect to the procedures of the general meeting of shareholders as well as to the rights of the shareholders.
The following information complement the information already contained in the invitation to the Virtual Annual General Meeting and serve as an additional explanation of the shareholder's rights.
1.
Motions by shareholders to supplement the agenda pursuant to Article 56 of the SE Regulation in conjunction with Section 50 ( 2) of the SE Implementation Act, Section 122 ( 2) of the German Stock Corporation Act
Shareholders whose shares, alone or in the aggregate, represent one-twentieth of the share capital or amount to EUR 500,000.00 may demand that items are added to the agenda and published. Pursuant to Article 56 sentence 3 of the SE Regulation in conjunction with Section 50 ( 2) of the SE Implementation Act, this quorum is required for supplementary requests by the shareholders of a European stock corporation ( SE); the content of Section 50 ( 2) of the SE Implementation Act corresponds to the provisions of Section 122 ( 2) of the German Stock Corporation Act. However, the minimum holding period of days prior to the receipt of the motion and through the date of the decision by the Management Board on the motion, which applies to German stock corporations, is not applicable to shareholders of the Company. Each new item must be accompanied by a statement of reason or a draft resolution.
Motions to supplement the agenda must be received by the Company in writing at least 30 days before the Virtual Annual General Meeting - not taking into account the date of receipt and the date of the Virtual Annual General Meeting - i.e., no later than by
Monday, April 11, 2022
( 24:00 CEST).
Motions to supplement the agenda received thereafter will not be taken into account. The shareholders are kindly asked to direct such motions to supplement the agenda to the following address:
HelloFresh SE
- Management Board -
Prinzenstraße 89
10969 Berlin
Germany
Motions to supplement the agenda which must be published will be published in the Federal Gazette ( Bundesanzeiger) promptly after receipt of the motion and forwarded for publication to such media as may be expected to spread the information throughout the European Union. They will also be announced promptly on the Company's website at
https: //ir.hellofreshgroup.com/agm
and will be communicated to the shareholders pursuant to Article 53 of the SE Regulation in conjunction with Section 125 ( 1) sentence 3 of the German Stock Corporation Act.
The main provisions of the SE Regulation, the SE Implementation Act and the German Stock Corporation Act underlying these shareholders ' rights are as follows:
Article 56 of the SE Regulation ( Request to supplement the agenda)
One or more shareholders may request that one or more additional items are added to the agenda of any general meeting, provided their aggregate shares amount to at least 10% of the subscribed share capital. The procedure and time limits applicable to such requests are laid down by the national laws of the state where the SE is domiciled or, if no such provisions exist, by the articles of association of the SE. The articles of association or the laws of the state where the SE is domiciled may provide for a lower percentage under the same conditions as applicable to stock corporations.
Section 50 ( 2) of the SE Implementation Act - Convening and Supplementing the agenda at the request of a minority
( 2) One or more shareholders may request that one or more items be added to the agenda of a General Meeting, provided that his or her shareholding reaches 5 percent of the share capital or the pro rata amount of EUR 500,000.
Section 122 ( 2) of the German Stock Corporation Act - Convening the General Meeting upon a Corresponding Demand being Made by a Minority
( 2) In the same manner, shareholders whose combined shares amount to at least one-twentieth of the share capital or a proportionate ownership of at least EUR 500,000 may request that items be placed on the agenda and be published. Each new item must be accompanied by a statement of reason or a draft resolution. The request within the meaning of sentence 1 must be received by the company no later than 24 days, in the case of stock exchange listed companies no later than 30 days prior to the meeting, excluding the day of receipt.
2.
Countermotions and election proposals pursuant to Article 53 of the SE Regulation in conjunction with Sections 126, 127 of the German Stock Corporation Act and Article 2 Section 1 ( 2) sentence 3 of the COVID-19 Mitigation Act
In addition, shareholders may submit countermotions to proposals from the Management Board and/or the Supervisory Board for specific agenda items to the Company and submit proposals for the election of the auditor. They may also bring proposals for the election of members of the Supervisory Board, provided that corresponding elections are on the agenda, which is currently not the case. Countermotions and election proposals do not have to be supported by a reasoning.
Countermotions and election proposals by shareholders that have been received by the Company at the address specified below at least 14 days before the Virtual Annual General Meeting - the date of receipt and the date of the Virtual Annual General Meeting are taken into account -, i.e. no later than by
Wednesday, April 27, 2022
( 24:00 CEST)
will promptly be made available on the website of HelloFresh SE at
https: //ir.hellofreshgroup.com/agm
along with the name of the shareholder as well as any reasoning and/or any statement by the administration ( Article 53 of the SE Regulation in conjunction with Sections 126 ( 1) sentence 3, 127 sentence 1 of the German Stock Corporation Act).
The Company may refrain from making available a countermotion ( including any reasoning) or election proposal if circumstances for exclusion set forth in Section 126 ( 2) of the German Stock Corporation Act ( for countermotions and election proposals) orSection 127 sentence 3 of the German Stock Corporation Act ( for election proposals) apply.
Countermotions along with any reasoning and election proposals by shareholders for the Virtual Annual General Meeting must be directed exclusively to one of the following addresses:
HelloFresh SE
- Legal Department -
Prinzenstraße 89
10969 Berlin
Germany
E-mail: cr @ hellofresh.com
Countermotions/election proposals addressed otherwise will not be made available. Shareholders are requested to prove their shareholding as of the date they submit the countermotion or election proposal.
Countermotions or election proposals can not be brought during the Virtual Annual General Meeting. However, a countermotion or election proposal that has to be published by the Company in line with the requirements described above is deemed to be made at the Virtual Annual General Meeting if the shareholder bringing the countermotion properly registered for the Virtual Annual General Meeting and provided special evidence of his shareholding ( Article 2 Section 1 ( 2) sentence 3 of the COVID-19 Mitigation Act).
The provisions of the German Stock Corporation Act underlying these shareholders ' rights, which also specify under which conditions counterproposals and election proposals need not be made available, are as follows:
Section 126 of the German Stock Corporation Act - Motions by shareholders:
( 1) Motions by shareholders must be made accessible to the beneficiaries set out in section 125 ( 1) to ( 3), subject to the pre-requisites listed therein, including the name of the shareholder, the reasons for which the motions are being made, and a statement, if any has been made, by the management regarding its position, provided that the shareholder has sent, at the latest fourteen days prior to the date of the general meeting, a countermotion opposing a proposal or guidance by the management board and the supervisory board regarding a certain item of business set out in the agenda, specifying the reasons therefor, to the address set out for this purpose in the invitation convening the general meeting. The date on which the countermotion is received shall not be included in calculating the period. In the case of companies listed on the stock exchange, the countermotion shall be made accessible via the company's website. Section 125 ( 3) shall apply mutatis mutandis.
( 2) A counterproposal and its supporting information need not be made available if:
1. the management board would become criminally liable by granting accessibility;
2. the counterproposal would result in a resolution of the general meeting that would be illegal or would violate the articles of association;
3. the reasoning contains statements which are obviously false or misleading in material respects or if it contains insults;
4. a counterproposal of such shareholder based on the same facts has already been made available with respect to a general meeting of the company pursuant to section 125;
5. the same counterproposal of such shareholder based on essentially the same reasoning was already made available pursuant to Section 125 to at least two general meetings of the company within the past five years and at such general meetings less than one-twentieth of the share capital represented voted in favor of such counterproposal;
6. such shareholder indicates that he will neither attend nor be represented at the general meeting; or
7. within the past two years at two general meetings such shareholder has failed to submitted, or cause to be submitted, a counterproposal he transmitted.
The supporting information need not be made available if it exceeds a total of 5,000 characters.
( 3) If several shareholders submit counterproposals with respect to the same resolution item, the management board may combine such counterproposals and the respective reasoning.
Section 127 of the German Stock Corporation Act - Election proposals by shareholders ( excerpt):
Section 126 applies mutatis mutandis to a nomination by a shareholder for the election of members of the supervisory board or auditors. Such nomination need not be supported by a reasoning. The management board is not required to make such nomination accessible if the nomination does not contain information pursuant to section 124 ( 3) sentence 4 and section 125 ( 1) sentence 5.
Section 124 ( 3) sentence 4 of the German Stock Corporation Act:
The proposal for the election of members of the supervisory board or auditors must state their names, practiced profession and place of residence.
Section 125 ( 1) sentence 5 of the German Stock Corporation Act:
In case of publicly listed companies, any nomination for the election of members of the supervisory board must be accompanied by information on the membership in other legally required supervisory boards; information on their membership in comparable domestic and foreign controlling bodies of business enterprises should also be provided.
Article 2 section 1 ( 2) sentence 3 of the COVID-19 Mitigation Act:
Countermotions or election proposals by shareholders that has to be published in accordance with section 126 or section 127 of the German Stock Corporation Act are deemed made at the Virtual Annual General Meeting if the shareholder bringing the
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HelloFresh SE published this content on 06 April 2022 and is solely responsible for the information contained therein. Distributed by Public, unedited and unaltered, on 06 April 2022 08:31:01 UTC. | business |
BENIN: In the police and the army, Talon turns to his tried and trusted old guard | More than half of the individuals imprisoned in the case of the seizure of 150kg of cocaine at the port of Cotonou in May 2021 have been released after eight months in jail, including three Bolloré employees and two from MSC. [... ]
Faced with a two-part security challenge of tensions surrounding the presidential election coupled with rising terrorism on its northern borders, Benin plans to redefine the scope of action of its special border surveillance units, the USSF. [... ]
Benin president Patrick Talon's security advisers, who pleaded against confining the population to combat the Covid-19 pandemic, are the ones who, last month, ordered 20 or so arrests to respond to a plot…which was hatched in less than three weeks. [... ]
In mid-February, the Beninese security services apprehended some twenty people, [... ]
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TD Bank opens offices for staffers as COVID cases ease | The second-largest Canadian lender said in an internal memo seen by Reuters that it was preparing for the return of more than 65,000 employees to its offices in the months ahead.
Financial institutions across North America, which were forced to put their return-to-office plans on the back burner late last year after COVID cases surged due to the rapidly spreading Omicron variant, are now looking to bring employees back.
TD said in the memo while it expects the virus to remain in circulation with case counts moving higher and lower, public health units were now better equipped to handle new waves.
The bank added it will monitor and make adjustments to guidelines and mask mandates in its locations in line with local laws and conditions.
Canadian lender Bank of Nova Scotia issued a similar guidance in February allowing employees to return to the majority of its domestic offices on a voluntary basis from mid-March.
( Reporting by Manya Saini in Bengaluru; Editing by Shinjini Ganguli) | business |
GHANA: Europeans all in but Russians cold shouldered: Tema LNG's shifting alliances | Tema LNG Terminal Co, the company which owns the Tema LNG import terminal, was over-optimistic in its forecast of the date for Shell's first LNG delivery to the terminal. [... ]
Luxembourg-based Ghanaian financier Kwaku Boakye-Adjei, who is a key figure in Ghana's Tema LNG gas import project, is also organising the construction of storage and regasification facilities in neighbouring countries to which he hopes to export gas from Ghana. [... ]
Already once postponed from April to June, the delivery of the first LNG cargo imported by Shell to supply the Tema LNG terminal will not take place before the end of July as rescheuled. [... ]
Business in Ghana is dismal: production is low and exploration at a standstill. Companies are becoming more vocal about their exasperation with the state and some are even pulling out entirely. [... ]
Tema gas terminal is getting ready to receive its first delivery of LNG from Shell, the Anglo-Dutch major having already agreed its price with the state-owned GNPC. [... ]
The Belgian cement magnate turned oil tycoon Eddy Van Den Broeke is struggling to get his first small-scale LNG project off the ground in Nigeria. On top of which, he is facing a $ 9m claim from his subcontractor Baker Hughes. [... ]
The Covid-19 pandemic is a welcome excuse for the Norwegian company to suspend financial aid for Ghanaian state initiatives. [... ]
The Anglo-Dutch major Shell has taken advantage of the deterioration in relations between the state-owned GNPC and its longstanding partner ENI, whom the government has accused of manoeuvring it into signing an unfavourable contract on Sankofa. [... ]
The choice of Shell in Ghana to import gas for the Tema LNG terminal has raised eyebrows, as local producers have the capacity to supply the country's power plants. [... ]
The Spanish operator Reganosa has already picked out a dream team to operate and maintain Ghana's Tema LNG terminal days after winning the contract. [... ]
The discreet Ghanaian company Lyndhurst Corp has actively invested in the Tema LNG import project, whose 2020 launch has now been compromised by the Covid-19 crisis. [... ]
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Yellen says Russia should be expelled from G20, U.S. may boycott some meetings | Her comments at a U.S. House Financial Services Committee hearing raised questions about the G20's future role in the wake of Russia's invasion of Ukraine.
Since 2008, the club has served as a key international forum for issues from COVID-19 relief to cross-border debt and also includes China, India, Saudi Arabia and other countries that have been reluctant to condemn Russia's actions.
Yellen told lawmakers Russia's invasion of Ukraine and the killings of civilians in Bucha `` are reprehensible, represent an unacceptable affront to the rules-based global order, and will have enormous economic repercussions in Ukraine and beyond. ''
The United States and its key allies have placed greater emphasis in recent months on the G7 grouping of industrial democracies, whose interests are more aligned, using G7 meetings to coordinate their response to Russia's war in Ukraine.
Yellen said the Biden administration wants to push Russia out of active participation in major international institutions, but acknowledged it was unlikely that Russia could be expelled from the International Monetary Fund given its rules.
`` President Biden's made it clear, and I certainly agree with him, that it can not be business as usual for Russia in any of the financial institutions, '' Yellen said. `` He's asked that Russia be removed from the G20, and I 've made clear to my colleagues in Indonesia that we will not be participating in a number of meetings if the Russians are there, '' Yellen said.
Indonesia holds the presidency this year and will host a finance meeting in July and a leaders summit in November.
A Treasury spokesperson later said that Yellen was referring to an April 20 G20 finance ministers and central bank governors meeting on the sidelines of the IMF and World Bank Spring Meetings in Washington and associated deputies meetings.
The April finance meeting will be held both in-person and virtually and Russia's participation is unclear at present.
Russia has said that President Vladimir Putin intends to attend the G20 summit in Bali this year and has received China's backing to stay in the group.
Indonesia could not expel or `` disinvite '' any G20 members, including Russia, a government official familiar with the matter said, adding whether a country attended was up to that nation.
ENERGY FLEXIBILITY
Yellen's testimony came as the Biden administration announced a new round of sanctions to punish Russia, including banning Americans from investing in Russia and locking Sberbank, Russia's largest lender and holder of a third of its bank deposits, out of the U.S. financial system, along with other institutions.
But transactions allowing European allies to purchase Russian oil and natural gas were exempted through special Treasury licenses.
Yellen said that flexibility on Russian energy transactions was needed because many European countries `` remain heavily dependent on Russian natural gas, as well as oil, and they are committed to making the transition away from that dependence as rapidly as possible. ''
But she acknowledged that this would take time.
A complete ban on oil exports from Russia, the world's third-largest producer after the United States and Saudi Arabia, would likely prompt `` skyrocketing '' prices that would hurt both the United States and Europe, Yellen said.
She added that she hoped that currently high prices would entice oil companies in the United States and elsewhere to ramp up production in the next six months, which, along with the Biden's release of oil from the U.S. Strategic Petroleum Reserve, may allow for tougher restrictions on Russian oil.
CHINA WARNING
Yellen also issued a warning to China that Treasury was prepared to turn its sanctions tools against Beijing in the event of Chinese aggression against Taiwan, which China claims as a wayward province.
Asked if the United States would take such steps if Taiwan was threatened, she said: `` Absolutely. I believe we 've shown that we can. In the case of Russia, we threatened significant consequences. We 've imposed significant consequences. And I think that you should not doubt our ability and resolve to do the same in other situations. ''
( Reporting by David Lawder and Dan Burns; Additional reporting by Gayatri Suroyo in Jakarta; Editing by Andrea Ricci, Ed Davies)
By David Lawder and Dan Burns | business |
MOROCCO: Nigeria's Cellulant plugs into Moroccan mobile money | The French firm Square Facts, which specialises in risk management and compliance, opened a subsidiary in Rabat in September. [... ]
The daughters of Morocco's agriculture minister Aziz Akhannouch have in recent months embarked on a range of e-commerce ventures, a move that will also boost their parents ' businesses. [... ]
Huawei Technologies Morocco, which does business with some of the kingdom's most influential figures - from the king's private secretary Mounir el-Majidi to police chief Abdellatif Hammouchi -, is feeling the heat of the US's retaliation measures against its parent company. [... ]
The national operator Maroc Télécom has just sacked Mehdi Housni, chief executive of its specialist subsidiary MT Cash, just as the country's late mobile money roll-out is hampering its response to the coronavirus crisis being led by Mohammed VI. [... ]
Inwi, the telecommunications group owned by Mohammed VI's holding company [... ]
A pioneer in the technology for secure payments over mobile, [... ]
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NIGER: Sonatrach wins its bid for another 10 years on Kafra | China is revving up the bulldozers on its huge Agadem oil pipeline project now that it has lifted its Covid-19 ban. This massive undertaking will stretch 2,000km from south-east Niger to Benin. [... ]
Senior figures in the entourage of President Mohamed Bazoum and his oil minister who have the ability to influence decision-making on hydrocarbons can be counted on the fingers of one hand. [... ]
As part of the one-off renewal of their shared production contract, the Nigerien authorities have agreed to some flexibility with the oil companies in exchange for fast-tracked production plans. [... ]
Major talks are set to begin soon between China's state-owned CNPC and the new government in Niamey. [... ]
The oil major China National Petroleum Corp ( CNPC) plans to start exporting part of the crude oil produced on its Nigerian field Agadem by 2022. It seems to have discarded the option of building an export pipeline through Chad, much [. [... ]
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SENEGAL/WORLD BANK: World Bank boss David Malpass to visit Dakar | The UAE Minister of State for African Affairs, Shakhboot bin Nahyan, was in Paris this week to discuss East Africa. [... ]
The Senegalese president could carry out the long-awaited cabinet reshuffle after the 31 July elections this year and his camp is already considering alliances with some parties of the opposition, starting with Abdoulaye Wade's APR. [... ]
The decision of the Senegalese air force to drop its plans to buy four L-39 NG training and attack aircraft brings to an end a series of setbacks which have caused major delivery delays. The order would have been the Czech company's first export order for the aircraft. [... ]
Riding on the wave of the national team's victory at the Africa Cup of Nations and before he heads to France tomorrow, the head of state has spent the last few days in Dakar finalising the details of a reshuffle designed to breathe new life into a government whose standing was greatly diminished last month. [... ]
The Senegalese president, who is due to take over as chairman of the African Union in February, is relying on a select group of diplomats to organise his programme as head of the pan-African body. [... ]
The appointment of its Covid special envoy Ngozi Okonjo-Iweala as head of the WTO has deprived the African Union of a key player in the already complex process of funding the rollout of vaccines in Africa, and the regional organisation is now counting heavily on her former employer, the World Bank. [... ]
No less than seven international firms, among them Gide Loyrette Nouel, Fidal and DS Avocats, have been short-listed by the World Bank for a contract to help Senegalese economic minister Amadou Hott with his public-private partnership reform. [... ]
Africa Intelligence uses cookies to provide reliable and secure features, measure and analyse website traffic and provide support to the website users.Apart from those essential for the proper operation of the website, you can choose which cookies you accept to have stored on your device.Either “ Accept and close ” to agree to all cookies or go to “ Manage cookies ” to review your options. You can change these settings at any time by going to our Cookie management page.
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A pioneer on the web since 1996, Africa Intelligence is the leading news site on Africa for professionals. | general |
BURUNDI: As big players move in, govt shores up a mining code written for shovels and picks | Burundi is looking to reform its mining code as quickly as possible to make it better suited to deal with growing interest from foreign investors in its strategic rare earth and nickel resources. The government has nevertheless asked for changes to be made to the first draft of the revised code. [... ]
In order to ensure France's supply of critical metals, a report submitted to the French government on 10 January recommends that the country should create a fund to take minority shares in mines. It sees Africa as a key territory. [... ]
To boost its forex reserves and thereby shore up its struggling currency and economy, Burundi's central bank is planning to make better use of its gold reserves. [... ]
Bujumbura has hired a consulting firm to help it find financial partners to develop the Musongati nickel mine. [... ]
Steve de Cliff Juru's findings led Burundi's president Evariste Ndayishimiye to call for a moratorium on mining and suspend permits held by Rainbow Rare Earths, chaired by Cyprus magnate Adonis Pouroulis. [... ]
Fierce global competition for control of rare earths is exacerbating geopolitical tensions. A planned French study could be a game-changer as it will explore how to produce the increasingly sought-after minerals from more abundant by-products of other processed materials. [... ]
Tinkisso Ressources, a new Guinean company, in mid-April applied for a permit to look for nickel and platinum near Dinguiraye, which is better known for its gold mines. [... ]
Southern Africa's nickel miners are in the starting blocks after billionaire Elon Musk recently voiced concerns that supply may not match a future boom in electric batteries. [... ]
Feeling targetted by certain Rwandan activities, the Burundi secret services have hired UAE security systems specialist Al Hamra to examine the use of a mobile phone tracking system. [... ]
Construction has not yet started on the 147-MW Ruzizi III hydropower plant but that hasn't stopped the Economic Community of the Great Lake Countries ' initiative Energie des Grands Lacs ( EGL) from looking at the idea of a Ruzizi IV. [... ]
Since the beginning of the Covid-19 pandemic, Burundi's mining companies have been unable to export their production, as regularly closed borders make it impossible for them to reach the port in Dar es-Salaam. [... ]
The pending confirmation of Melanie Higgins as the new US ambassador to Burundi, a post left vacant for the past 18 months, spells the final phase of a discreet but important bridging of ties between the United States and Burundi. [... ]
Tanzania, Burundi, and the DRC are working out how to finance studies for the cross-border line that would allow freight and minerals to be exported by train via the port of Dar es Salaam. [... ]
Emmerson Mnangagwa, who has struggled to find investors to spearhead the country's recovery since stepping into power after Robert Mugabe's fall, is happy to see the Cypriot family Pouroulis making progress in the country. For its part, this entrepreneurial clan [. [... ]
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IVORY COAST: Ouattara troubled by Ukrainian war's impact on gas, wheat and oil | The halt in Russian and Ukrainian wheat exports has opened a window of opportunity for French grain producers in North and West Africa, who in recent weeks have been able to act as substitute suppliers at short notice. [... ]
Shortly before its dissolution on 30 March, the fund responsible for financing public infrastructure in Ivory Coast arranged a loan of 326bn FCFA ( €497m) for four industrial zones in Abidjan, in association with the country's budget. [... ]
Many Western nations have closed their borders to travellers from southern Africa following the identification of the new coronavirus variant. Pretoria has since applied diplomatic pressure and launched a media counterattack, with the support of influential doctors and the WHO. [... ]
For weeks frequent power cuts have put pressure on the country and industry unions have held several meetings with the ministry of energy to review its rolling blackout plan. [... ]
As we understand, the French minister for the economy and [... ]
Africa Intelligence uses cookies to provide reliable and secure features, measure and analyse website traffic and provide support to the website users.Apart from those essential for the proper operation of the website, you can choose which cookies you accept to have stored on your device.Either “ Accept and close ” to agree to all cookies or go to “ Manage cookies ” to review your options. You can change these settings at any time by going to our Cookie management page.
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UK has detected a new Covid variant. Here’ s what we know so far about omicron XE | LONDON — A new omicron subvariant has been detected in the U.K. as the country faces a renewed surge in Covid-19 hospitalizations.
The XE variant, as it is known, has so far been detected in 637 patients nationwide, according to the latest statistics from the U.K. Health Security Agency, which said there is currently not enough evidence to draw conclusions on its transmissibility or severity.
XE contains a mix of the previously highly infectious omicron BA.1 strain, which emerged in late 2021, and the newer `` stealth '' BA.2 variant, currently the U.K.'s dominant variant.
It is what's known as a `` recombinant, '' a type of variant that can occur when an individual becomes infected with two or more variants at the same time, resulting in a mixing of their genetic material within a patient's body.
Such recombinants are not uncommon, having occurred several times during the coronavirus pandemic.
Data on the new variant's severity and ability to evade vaccines is not yet clear, though early estimates suggest it could be more transmissible than earlier strains.
UKHSA data shows XE has a growth rate of 9.8% above that of BA.2, while the World Health Organization has so far put that figure at 10%.
Health authorities have said they are continuing to monitor the situation.
`` This particular recombinant, XE, has shown a variable growth rate and we can not yet confirm whether it has a true growth advantage. So far there is not enough evidence to draw conclusions about transmissibility, severity or vaccine effectiveness, '' UKHSA's chief medical advisor, professor Susan Hopkins, said.
The earliest confirmed XE case in Britain has a specimen date of Jan. 19 of this year, suggesting it could have been in circulation in the population for several months. It has also been detected beyond the U.K. in Thailand.
It comes as the U.K. faces a new surge in infections. Still, the XE variant currently accounts for less than 1% of total Covid cases that have undergone genomic sequencing there.
According to the Office for National Statistics, 4.9 million people in Britain, or 1 in 13, were infected with Covid as of March 26 — a record high since its survey began in April 2020. Hospitalizations, meanwhile, have risen more than 7% in the last week to over 16,500.
Older adults have proven particularly susceptible to the latest wave amid waning booster immunity and easing Covid restrictions.
According to Imperial College's latest React study, an estimated 8.31% of the over-55 age group tested positive as of the end of March — nearly 20 times the average prevalence recorded since the survey started in May 2020. Cases among children and younger adults, meanwhile, appear to be plateauing.
The findings mark the 19th and final round of the study as Covid restrictions and surveillance systems are unwound in the U.K. and beyond.
Read CNBC's latest global coverage of the Covid pandemic:
The British government on Friday pushed ahead with plans to cease two virus surveys and scale down a third. Meanwhile, Israel and Denmark, two front-runners in research and vaccines in the early days of the pandemic, have dramatically cut back testing.
The scaling back of Covid data could make it more difficult to predict surges and understand new variants.
It comes as China — itself in the midst of its latest surge which has seen Shanghai enter into an extended lockdown — also recorded a new subvariant labeled BA.1.1.
The variant does not match other Covid types sequenced in China or reported to the global variant database, and was found in a mild Covid case in Suzhou, a city near Shanghai. | business |
MOROCCO: Financial compliance expert Square Facts sets up shop in Rabat | Nairobi-based fintech Cellulant Corp is setting its sights on Morocco and its burgeoning mobile and online payments market. [... ]
Karim Benabdelkader, the founder of Zynecoin, is focusing his investments on a property company that is now owned by a brand-new holding company. [... ]
The national operator Maroc Télécom has just sacked Mehdi Housni, chief executive of its specialist subsidiary MT Cash, just as the country's late mobile money roll-out is hampering its response to the coronavirus crisis being led by Mohammed VI. [... ]
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WEST AFRICA: Obiang plans his AU summit in Malabo | The foreign minister's announcement of the donation of a million Covid-19 vaccines to Africa was intended to show that Israel is reviving its cooperation with the continent. [... ]
Under the watchful gaze of the Nigerian president Muhammadu Buhari, his special envoy for the Lake Chad basin, Baba Gana Kingibe, is continuing to do his best to contain the instability in Chad, which could pose a threat to Nigeria's borders. [... ]
The foreign minister's major diplomatic reshuffle is aimed at restoring Algeria's pre-eminence in the Sahel and in the handling of the crisis in Libya, where arch rival Morocco is trying to muscle in. [... ]
The opening of a new Turkish embassy in Equatorial Guinea has crowned an already vigorous partnership between Ankara and the Obiang family, cemented by numerous contracts for Turkish companies, including the Summa conglomerate. [... ]
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BURUNDI: Central bank to process its own gold to stabilise Burundian franc | Burundi is looking to reform its mining code as quickly as possible to make it better suited to deal with growing interest from foreign investors in its strategic rare earth and nickel resources. The government has nevertheless asked for changes to be made to the first draft of the revised code. [... ]
The reopening of the Ugandan-Rwandan border could lead to a trade corridor to Burundi. Neighbours and rivals in the Great Lakes are determined to put aside their differences to revive badly affected economies. [... ]
Rainbow Rare Earths is highlighting the indirect presence of the US government in its capital, as Burundi seeks to position itself as an alternative to China for the supply of rare earths to Western countries, primarily the United States. [... ]
Bujumbura has hired a consulting firm to help it find financial partners to develop the Musongati nickel mine. [... ]
First he suspended parliament and sacked the prime minister. Now the president plans to turn up the heat on his political enemies by co-opting military intelligence agents in a renewed bid to recover embezzled billions. [... ]
Current legislation is ill-equipped to cope with the advent of mechanisation brought about by investors ' needs for new supplies of rare earths and nickel. Time for a re-write. [... ]
Since the beginning of the Covid-19 pandemic, Burundi's mining companies have been unable to export their production, as regularly closed borders make it impossible for them to reach the port in Dar es-Salaam. [... ]
The institution's latest report on combating fraud and corruption is due to be published in October. Internally, it began taking steps to crack down harder earlier this year. [... ]
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DJIBOUTI: Djibouti's business leaders to visit the principality | Following the dismissal of the managing director of the Sovereign Fund of Djibouti in the second quarter of 2021, the fund's board meetings have become a rarity and its management structure is hazy. [... ]
The Djibouti budget for 2022, passed last December, contains several tax increases. The economy of the small port country has been hit hard by the combined consequences of Covid-19 and, in particular, the civil war in neighbouring Ethiopia. [... ]
Tunisian politician Slim Feriani will replace Mamadou Mbaye, dismissed in May following numerous disagreements with certain members of FSD's board. [... ]
The president of Djibouti wants to strengthen diplomatic, but above all economic, relations with the principality of Monaco. [... ]
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AFRICA: Africa Intelligence in court: JetMagic founder Antoine Hayem's defamation case flops | Having already seen several of the aircraft he managed change ownership last year, the private jet operator Antoine Hayem has been trying for some time to sell his shares in his company JetMagic. However, he has not had much success yet, and a proposed sale last year fell through. [... ]
A Bombardier Global Jet frequently chartered by the presidency has been bought by Turkish interests. It's the third such aircraft sale in recent months. [... ]
Yuzal has become the main air service provider for the Congolese presidency, while at the same time bringing a lot of business into the country. [... ]
A string of offshore companies with no identified owner have been linked to transactions within the presidential couple's entourage. All were incorporated by the same financiers who also happen to be associates of Gabon's sovereign wealth fund. [... ]
Gabon's presidential family had until now been blissfully unaware that it does not actually own the two Boeings and Bombardier Global that it uses to jet around. After recently learning otherwise, it is having trouble working out who does control the planes. [... ]
Despite borders being closed as part of the measures taken to combat the Covid-19 pandemic, the Gabonese presidency is making greater use than ever of its favourite private aviation service provider, Frenchman Antoine Hayem. Publicity-shy but highly active, he began working for Russian oligarchs and now spends his time meeting the demands of African presidencies and rock groups. [... ]
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GABON: Canada Energy Partners in bid to bag Konzi block | The country's three main oil companies have chosen different strategies to encourage, or even force, their staff to be vaccinated against Covid-19 [... ]
The Carlyle-financed junior Assala Energy is determined to avoid export interruptions. This is how it plans to go about it. [... ]
With a new round of negotiations between Gabon and oil trader Augusta due to begin in the coming weeks, Africa Intelligence reveals the secrets of the contract between the trader and the Gabonese refinery SOGARA, which Libreville abruptly broke off in June. [... ]
The former Total Gabon director Etienne Lepoukou was confirmed as the technical advisor in charge of oil and gas matters [... ]
Alilat Antseleve Oyima, who has been appointed the special advisor on oil, mines and industry to the Gabonese president [... ]
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TUNISIA/MOROCCO: After Cloud Temple and Inwi, Mohamed Ali Chouchane sits on cloud nine in Casablanca | Though there are still very few data centres on the African continent, in no small part due to a lack of reliable power, a few independent groups have managed to break into the sector. But they are now facing a serious challenge with the arrival of the world's internet giants, which are targeting South Africa to place their infrastructure. [... ]
The king's private secretary, who owns GSM Al-Maghrib, Maroc Télécom mobile services exclusive distributor, is gunning for the business services market. He has also taken control of Sahatel, a dealer for the royal operator Inwi. [... ]
Maroc Télécom is firing on all cylinders to get its mobile payment activity off the ground. As Africa Intelligence understands, [... ]
The national operator Maroc Télécom has just sacked Mehdi Housni, chief executive of its specialist subsidiary MT Cash, just as the country's late mobile money roll-out is hampering its response to the coronavirus crisis being led by Mohammed VI. [... ]
Telecoms operator Inwi, a subsidiary of Mohammed VI's holding company Al Mada, plans to conquer the corporate market. Nizar Bouguila, [... ]
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ANGOLA: KPMG, Miranda, CMS... the ENI-BP merger mobilised an army of lawyers | No transaction between the two European majors is likely to be concluded any time soon in the face of opposition from the Algerian authorities. [... ]
The government is pampering the operators still active in the country in a bid to avoid a rapid decline in production. [... ]
The Italian major ENI is working to consolidate its stature as Algeria's future leading private oil and gas producer. It is preparing to buy BHP Billiton's assets, as well as BP's. [... ]
As the two firms are about to set up a joint entity in Angola, employees of the British major expect to be laid off with no hope of a transfer. [... ]
The planned merger between BP and ENI has put Total under pressure but the French major, which has been Angola's leading producer since 2013, does not intend to give up its position easily. [... ]
After a wait of five years, the decree providing for greater local company involvement in the oil industry is set to come into force at a difficult time, with the country still in the throes of the Covid-19 crisis. [... ]
After six partners of the Portuguese law firm Miranda & [... ]
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What Are the Benefits of Working Together in the Industry? | In the early days of challenger banks, new arrivals to the market were seen as a threat to incumbents; a similar scenario in almost every sector.
Fresh faces once meant fresh competition in the world of finance, but as challenger banks continue to cement themselves as industry figures in their own right, both sides are beginning to move away from the initial feelings of threat and distrust.
This is a topic that has been thoroughly unboxed earlier into our challenger bank focus, so today we’ re going to be looking at the picture from a different angle, to further understand the benefits of the two sides working together; as seen through the eyes of on-the-ground industry professionals.
Vinay Prabhakar, VP of global marketing at Volante Technologies, opens the discussion with: “ The benefits are clear, as they are in the tech world: increased value for customers, greater revenue, higher market share. But co-opetition has to be done right – good partnership structures will create more than the sum of their parts; bad structures will destroy value. ”
According to Julia McColl, chief product officer at Chetwood Financial, speed to market, risk management and the sharing of industry knowledge are all examples of the benefits collaboration could bring: “ There are some obvious benefits for traditional banks to work with challenger, or digital banks. Let’ s take speed to market as an example. We know that, despite ongoing digital transformation projects, traditional banks just aren’ t as agile as challengers. Being able to drive projects to market much more quickly, means a quicker route to revenue and ultimately profit.
“ Another interesting benefit is the ability to open up propositions to new customers without taking on the risk – where a bank might typically cap their annual percentage rate ( APR) for loans at 29.9 per cent pricing ‘ riskier’ near-prime customers out, our banking as a service ( BaaS) proposition would enable them to offer loans at say 39.9 per cent APR without taking on the credit risk. In this instance, the customer would sit on our balance sheet, but to all intents and purposes have a loan with a high-street brand.
“ You’ ve also got softer benefits such as learning and sharing best practices – how you deal with Covid regulations, diversity inclusion, financial inclusion and vulnerability are all examples of areas that transcend competition. It’ s these areas where collaboration works in the interests of the individual businesses and drives consumer interest – and isn’ t that what we all want – to do the right thing by our customers? ”
Mike Kraus, principal at CMFG Ventures, the venture capital arm of the US insurance company CUNA Mutual Group, largely agrees with the points raised by McColl, and provides an interesting US-specific approach to the benefits: “ In the US, a clear benefit for challenger banks partnering with traditional banks is leveraging a banking charter. This provides the challenger with the ability to provide banking services with far fewer regulatory obstacles. The banks ‘ renting’ their charter are typically compensated via a monthly program fee.
“ Traditional banks may be able to grow loan volumes with lending partnerships or provide its customers with an enhanced user experience if technology capabilities are outsourced. Partnering with challengers can also allow traditional FIs to rapidly accelerate time to market for new products. ”
Stacey Conti, VP of global strategy, sales and partnerships at Sybal.io, added to this with: “ Allowing Fintechs to work in the same space coexisting with banks creates a new audience or group of bankable clients that otherwise may have avoided the traditional banking system. There is a large percentage of underbanked in the US because of the economic structure and lack of fintech to attract more tech-savvy consumers with trust in the financial system. ”
The benefits of working together are accentuated when we look at the wider image of what both sides are able to achieve when partnering with others who do not work in their immediate field of banking. For example, Santander has recently been able to establish new payment corridors between Spain and the emerging markets of Brazil through its work with PagoNxt.
On a similar note, Starling Bank recently joined the lending panel of Funding Option to provide UK SMEs with more comprehensive and efficient lending options. The benefits of working together in the banking field are further put forward by Disruption, a book by Ignacio Garcia Alves, Philippe de Backer and Juan Gonzalez. In it, they identify collaboration as the new survival plan for banks on both sides who might be falling behind.
David Royle, chief operating officer and MD of financial services consulting at SRM Europe explains how the emergence of fintechs has inspired traditional players to rise to a new level of digital: “ The rise of fintechs has undoubtedly raised the bar in terms of usability and digitally rich functionality to improve overall customer experience, which has driven huge investment in innovation and digital catch-up activities by the high street brands, to the greater benefit of customers across the sector.
“ In a BaaS environment, successfully combining the innovation, culture, technology, absence of legacy and regulatory constraints that fintechs enjoy on the one hand, with the entrenched market knowledge, technical skills, balance sheet strength, brand and data of traditional banking brands on the other, can result in positive outcomes that place the resolution of customer needs and problems at their heart. ”
However, Royle also highlights how the hype around challenger banks is now, as he sees it, beginning to fizzle out, and that the pools of consumer interest are flowing back into traditional hands: “ However, as ‘ innovation’ becomes ubiquitous, so the points of difference start to fade and with UK customers generally quite unwilling to switch banks, there becomes less to differentiate banks of all kinds and, therefore, less to compete on, ” he continues.
“ The early adopters were attracted to a differentiated digital experience and bright coloured cards and were quick to get onboard, however the market has reverted to valuing more traditional dimensions including service, ease of use and value for money. ”
Tyler is a Fintech Junior Journalist with specific interests in Online Banking and emerging AI technologies. He began his career writing with a plethora of national and international publications.
The Fintech Times is the world’ s first and only newspaper dedicated to fintech.
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WEST AFRICA: OECD prepares to enlist banks in fight against gold fraud | The foreign minister's announcement of the donation of a million Covid-19 vaccines to Africa was intended to show that Israel is reviving its cooperation with the continent. [... ]
In addition to reshuffling the government, Burkinabe President Roch Marc Christian Kaboré is pushing other initiatives to curb the Islamic militant threat in his country. He has urged the National Anti-Gold Fraud Brigade to mobilise and become more effective. [... ]
The Senegalese president, who is due to take over as chairman of the African Union in February, is relying on a select group of diplomats to organise his programme as head of the pan-African body. [... ]
The French president has been trying to get China on board his summit of African economies for months but Beijing has yet to RSVP his invitation. US Secretary of State Anthony Blinken should represent Joe Biden at the 18 May event, to which several African heads of state have been hastily invited at the last minute. [... ]
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Raspberry Pi: Where to buy the hard-to-find latest model and its alternatives | ZDNet’ s recommendations are based on many hours of testing, research, and comparison shopping. We gather data from the best available sources, including vendor and retailer listings as well as other relevant and independent reviews sites. And we pore over customer reviews to find out what matters to real people who already own and use the products and services we’ re assessing.
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The highly-in-demand Raspberry Pi 4 has been hit by the ongoing component shortages harder than most electronics. Let us help you navigate the scarce supplies, price gouging, and available alternatives to find the best option for your DIY electronics project.
Michael is a veteran technology writer who has been covering business and consumer-focused hardware and software for over a decade.
Raspberry Pi boards are tiny, incredibly versatile computers that have been put to an increasing number of practical, fun, and diverse uses by hobbyists. This exceptional flexibility has only been increased over the years by manufacturers coming out with a plethora of add-ons like sensors, touchscreens, wireless connectivity modules, and purpose-built cases.
All of this popularity created strong demand even before the world's supply chain was struck by the impacts of the COVID-19 pandemic and the subsequent chip shortages still plaguing every industry from auto manufacturing, to medical devices, to Raspberry Pi production. Matters were made even worse by the increasing interest of hobbyists with unexpected free time over the pandemic scooping up boards for use in their various projects.
Today, finding a Raspberry Pi board of any sort to buy can be a frustrating and, ahem, fruitless experience. To help you out in your quest to track down these elusive mini PCs, we 've created this handy guide for the best retail sites to check for a reasonably priced Raspberry Pi board, locations to acquire alternative Pi boards that can be used for some projects, and even alternatives from other manufacturers that can serve similar purposes.
This latest main-line generation from the Raspberry Pi Project includes the Raspberry Pi 4 with 1GB to 8GB of onboard RAM as well as the Pi 400 and Pi Pico, which we 'll cover in separate sections below. As the latest model, the Pi 4 is among the hardest to find. It launched about two years ago with an MSRP of $ 35- $ 70, depending on the amount of RAM included.
Unfortunately, acquiring a Raspberry Pi 4 as a bare board right now will require a lot of patience, a deep pocket book, or both. The original price range has been impacted by price increases at the Raspberry Pi Project ( brought on by increasing chip costs) as well as resellers attempting to exploit the scarcity to hike prices up.
While the Raspberry Pi Project does price control the cost of the units at authorized merchants, those sellers frequently see their stock emptied within minutes of posting new availability, especially now that bots are being applied to the task of buying out boards for later scalping. Reliable outlets like Adafruit ( one of the earliest and most trusted sources for Rasperry Pi hardware) have put buying limits and verification technologies in place to prevent being wiped out by bots. But, even then, enough legitimate, human customers remain to drain supplies rapidly.
If you need a Pi 4 board immediately, expect to pay anywhere between $ 150 and $ 250, depending on the RAM included. If you must have a main-line Pi 4 board, but simply can't stomach that level of price gouging, I 'd recommend signing up for email notifications at Adafruit or Micro Center. Both companies offer retail prices far closer, if not in line with, the original MSRPs for Pi 4 boards at various memory levels.
If you choose to purchase your Raspberry Pi 4 from a seller not listed in this article, please make sure it is a reputable, well-reviewed retailer. The scarcity of Pi boards has led to an explosion in scams surrounding them. If a seller's price for the board you're seeking seem too good to be true, it probably is. Try to have patience, or save up some extra cash, and purchase your board through a reputable retailer, or at least from a reseller offering the product via a website that provides buyer protections in the event your order is not delivered, or is not as described.
The Raspberry Pi 400 is essentially a modified 4GB model of the Raspberry Pi 4 board with additional cooling which makes it safe for the unit's CPU to run at a slightly different clock speed. Rather than being sold as a bare board, the entire Pi 4 is loaded into a compact 60% keyboard with its included I/O ports on the keyboard's top edge.
The inclusion of the keyboard may make this solution less than ideal for many applications one would want a Raspberry Pi 4 unit for. However, many other uses ( gaming, text editing, media server applications, etc.) would have required the connection of a keyboard for control or text entry purposes anyway. Not only does the Pi 400 mean you don't have to add an external peripheral for this purpose, but its unique supply means it also tends to be in stock for MSRP far more frequently than its bare-board cousins.
The Pi 400 is also commonly offered as part of kits, frequently for the same price or less than the unit itself. The Adafruit option below includes a microSD card, data cable, power supply, mouse, and a beginner's guide.
This even tinier-than-usual board includes only a single MicroUSB port and lots of solder points for headers or components of your choice. While it's not well suited for the more advanced applications its larger brethren can handle, it's perfect for tiny projects such as wearable electronics, single-use sensors, remote monitoring devices, and other uses that require minimal processing power.
The Pi Pico can also be expanded via a variety of accessories designed to work with its headers, as well as via custom-designed breadboards for custom-designed electronics projects, and various other accessories to increase versatility.
It's also, by far, the cheapest option available right now, and is generally more readily available at its MSRP. Even at double the original $ 4 price point, it's still an excellent value for the right project.
The Raspberry Pi Zero line has been around since 2015 to offer a lower-cost option for users that don't need the full computing power and I/O port selection of the full-sized Pi. Over the years, it's been revised to add improved processors, new wireless connectivity options, and other improvements.
The latest version in the line is the Pi Zero 2 W. Launched in late 2021, this model includes a system in a package ( SiP) design based on the previous-generation Pi 3. This means it's very close in capability ( for the right project) to the Pi 4, and is often more easily acquired due to being a slightly less versatile option than its top-of-the-line siblings.
You should definitely check to see if the project you have in mind can be handled by the less powerful Pi Zero 2 W. But, if it can, you can generally purchase the units for something closer to $ 75. This still represents a massive premium over the intended MSRP of around $ 15, but it may, nonetheless, be the most cost-effective and readily available option for the right buyer.
One of the most well-liked entries on our Best Raspberry Pi alternatives list, the NDVIDIA Jetson Nano aims to fill many of the same roles as the Raspberry Pi 4. It provides a similar set of I/O ports, 2GB of RAM, and a fairly identical set of extremely diverse applications.
Unfortunately, this resemblance to the Raspberry Pi 4 means that it is also being bought up at an alarming rate. But, if you happen to have a project that can make use of either the Pi 4 or this similar all-in-one mini PC like this, then the extra option means you have another chance of successfully snagging one. Just make sure whatever plans you have for the NVIDIA Jetson Nano are compatible with its included chipset and I/O.
The NVIDIA Jetson Nano Developer Kit isn't the only alternative available. Also consider these options below if you need something right now.
Unfortunately, there's no reliable way to predict this. Like all manufacturers currently struggling with ongoing global chip shortages, the Raspberry Pi Project is attempting to increase its production volume, but it's being constrained by its suppliers ' struggles. This chain reaction of scarcity goes all the way up the manufacturing chain, right to the companies providing the raw materials used in these devices.
As more and more companies continue to react to the flaws and fragility in the supply chain that have recently been revealed, supplies should increase to the point where they are once again able to meet demand. Whether this takes months or years is anyone's guess, and is largely dependent on what other disruptions ( foreseeable and unforeseeable) take a swipe at supply levels.
This depends largely on the types of projects you 'd like to pursue.
If you're aiming for something simple, like teaching kids about coding and electronics, something as cheap as the Pi Pico is more than enough to create many fun and educational projects ranging from wearable devices to simple games and even interactive PC peripherals.
If you want something a bit more complex but still affordable, consider the Pi Zero family, which offers a much wider array of add-ons such as digital and LCD displays, wireless communication modules, speakers, microphones, and more.
If you think this is likely to be a long-term hobby for you or the intended recipient, it might be worth going through the extra effort or cost of buying a full-on Pi 4. This will offer the maximum amount of power, versatility, and flexibility to grow alongside the user as they become more experienced and adventurous. Everything from basic smart-home devices, to remote camera setups, and even retro gaming consoles can be created with just a bit of extra hardware connected to the Pi 4.
The answer is a very qualified yes. While the I/O ports of a Pi 4 and its onboard processor can indeed replace a PC for basic computing needs, it does not have anywhere near the power required for more advanced operations.
For example, simple web-browsing, video playback ( even at 4K resolutions), retro gaming ( think Playstation 1 era and older), and a multitude of other activities you could normally get up to on a PC are completely possible.
However, more advanced things like video editing, modern gaming, and advanced productivity tasks will tend to run into some walls. Whether those limitations come from a lack of computing power, incompatible peripherals, or a lack of required I/O, the Pi 4 can not replace a PC in all situations. But, it can get pretty dang close in a shocking number of them.
If you really want to replace a desktop-class PC, consider the tricked out UDOO BOLT V8 in the Alternatives to Consider section above. It markets itself as `` Almost twice as fast as the MacBook Pro 13 '', for VR, AR, and AI projects. ''
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Buyout space trends upwards in the aftermath of Covid-19 | Powering European private equity
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The PE business model works. 2021 was a record year for global M & A activity, but also for initial public offerings ( IPOs) and corporate fundraising. In 2022, the biggest trends in the private equity market will be sector pay, dealmaking, ESG and China.
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Walt Disney World's latest attraction may appeal to its own workers: Affordable housing | Living near the House of Mouse can cost you an arm and a leg. And now Disney
DIS,
is taking a page out of Silicon Valley’ s book to address the problem.
Walt Disney World is setting aside roughly 80 acres on its property for a new affordable-housing development. The resort expects that the development will include more than 1,300 housing units, and it will be constructed by a third-party developer.
The housing will be made available to “ qualifying applicants ” in the Central Florida region, Disney
said in the press release
, including Walt Disney World employees, also known as cast members.
“ The lack of affordable housing is affecting many people across our country, including right here in Central Florida, ” Jeff Vahle, president of Walt Disney World Resort, said in the announcement.
Disney’ s affordable-housing plans follow similar efforts made by its primary rival, Universal Parks & Resorts. Comcast-owned
CMCSA,
+0.57%
Universal has teamed up with a local developer to build 1,000 rent-controlled apartments in Orlando, and
released details
of the plan at the end of March.
Read more:
Apple, Facebook, Google and Amazon are putting billions of dollars toward affordable housing — but that money may be too little, too late
Rent prices have risen 26% in Orlando since the COVID-19 pandemic began in March 2020,
according to a March report
from real-estate website Apartment List. That puts Orlando among the top 10 cities nationwide for rent growth, behind places like Phoenix, Las Vegas, and Miami.
Over the past six months alone, rents have increased 6% in Orlando — the third-fastest rate of growth in the country over that time span.
The high cost of housing in Central Florida has represented a major headache for Disney’ s theme-park workforce, especially in the wake of the COVID-19 crisis. Many Walt Disney World employees were laid off or furloughed as the theme parks remained closed for months. Disney subsequently struggled to rehire many of those workers and began to offer incentives such as hiring bonuses to attract applicants. In October, Disney raised the minimum wage for its Florida workers to an hourly rate of $ 15.
“ We’ re proud of the bar we set to raise the minimum wage to $ 15 an hour by 2021, which is among the highest in the country for entry-level employees in the service industry, ” a Disney spokeswoman told the Orlando Sentinel in 2019, when the company announced its $ 15 an hour wage. Employee benefits include health insurance, an on-site health clinic, and discounted groceries sold at an on-site store, the Sentinel reported.
But even before COVID struck, many theme-park workers
struggled to afford housing
near their jobs when earning that rate. Some Disney employees have experienced homelessness, and some are forced to reside in nearby motels or sleep in their cars due to the lack of affordable housing in the area. The Coalition for Homeless of Central Florida
has estimated
that the region is in need of some 25,000 homes.
In that sense, Disney and Universal are following the lead of other industries that have grappled with the adverse impact of rising housing costs. In recent years, multiple companies in Silicon Valley, such as Apple
AAPL,
-1.19%
,
Google parent Alphabet
GOOGL,
-1.91%
and Facebook parent Meta
FB,
-0.28%
,
have created funds or set aside land to promote affordable housing in the California region. | business |
BURUNDI: Government hires Advisum Expertise to help develop nickel | Burundi is looking to reform its mining code as quickly as possible to make it better suited to deal with growing interest from foreign investors in its strategic rare earth and nickel resources. The government has nevertheless asked for changes to be made to the first draft of the revised code. [... ]
To boost its forex reserves and thereby shore up its struggling currency and economy, Burundi's central bank is planning to make better use of its gold reserves. [... ]
Steve de Cliff Juru's findings led Burundi's president Evariste Ndayishimiye to call for a moratorium on mining and suspend permits held by Rainbow Rare Earths, chaired by Cyprus magnate Adonis Pouroulis. [... ]
Current legislation is ill-equipped to cope with the advent of mechanisation brought about by investors ' needs for new supplies of rare earths and nickel. Time for a re-write. [... ]
Since the beginning of the Covid-19 pandemic, Burundi's mining companies have been unable to export their production, as regularly closed borders make it impossible for them to reach the port in Dar es-Salaam. [... ]
The opposition in Burundi wants current mining contracts to be modified. Leonard Nyangoma, chairman of the CNARED coalition ( it stands [... ]
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Questions Loom as FDA Ponders a Covid Vaccine to Prevent Fall Wave | The FDA faces some difficult decisions on how to ward off Covid-19 this fall.
Sarah Silbiger/Getty Images
Heading off a serious Covid-19 wave this fall could take a new kind of Covid-19 vaccine that targets variants of the virus, not the original strain. Determining which variant to target, and how to design the booster, could be the most complex and difficult decision of the entire Covid-19 vaccination campaign.
That is the takeaway from a meeting Wednesday of the Food and Drug Administration’ s vaccines advisors, which highlighted the extraordinary challenges that face regulators and drugmakers as they prepare for a widespread round of Covid-19 vaccine boosting this fall.
The meeting, the committee’ s first in months, comes just a week after the FDA authorized a fourth round of boosters for older adults. The committee discussion was focused not on the fourth booster round, which an FDA official dismissed as “ not a major expansion ” early in the meeting, but on the complicated problem of the fall vaccines.
The currently authorized Covid-19 vaccines were designed to protect against the original strain of the virus, but the past two years have seen the virus evolve rapidly.
Pfizer
( ticker: PFE) and
Moderna
( MRNA) are now testing updated versions of their vaccines that would protect specifically against the Omicron variant. But the advisors’ discussions on Wednesday suggests that authorizing a booster of an Omicron-specific vaccine remains an enormous logistical and scientific challenge.
“ This, as my colleagues have said, is a very complex situation, ” said Oveta Fuller, a professor of microbiology and immunology at the University of Michigan medical school and a member of the committee, toward the end of the daylong meeting. “ I don’ t think the public understands how complex it is, and I don’ t think we understood until a number of things came up today. ”
The implications for
Pfizer
,
Moderna
,
and other drugmakers aren’ t immediately clear. But the meeting suggests that the coming months will be fraught, and assumptions about the fall booster campaign could be quickly overturned.
Chief among the challenges described by committee members and FDA staff is that the speed of the virus’ s evolution, coupled with the lack of what’ s known as a correlate of protection for the virus, or a level of immune response known to confer protection, make it unclear how there will be enough time to test a variant-specific vaccine before rollout.
“ We are concerned about the timeline, ” said the committee’ s acting chair, Dr. Arnold Monto, a professor emeritus of public health at the University of Michigan, in closing remarks at the Wednesday meeting. “ We would love to have a correlate of protection, but we don’ t have it. We realize that clinical trial data will be necessary, but we might have to use surrogates. ”
There is no guarantee that the variant-specific vaccines currently in trials will match the strain the FDA and its advisors ultimately decide the fall booster should target. The virus mutates quickly enough that there is no predicting exactly what strain will be dominant by the fall, and efficacy trials take months. Scientists have generally been using antibody responses as a stand-in for the amount of protection a vaccine provides, but the specific level of immune response needed for an effective vaccine hasn’ t been established.
“ It’ s going to be hard to generate all the data we want in short order, when a new variant emerges, ” said Dr. Ofer Levy, a professor at the Harvard Medical School and a committee member, in comments toward the end of the meeting. “ The practical path is to go with safety and immunogenicity ” data, Levy said, but established correlates of protection are needed to make decisions on that basis, and those don’ t exist yet.
Monto, in summarizing the committee’ s discussions, said that members felt that the focus of the vaccination program should be on preventing hospitalization and death, rather than infection. He said that the committee wasn’ t comfortable with boosting every eight weeks, and that while they “ would like to see ” 80% efficacy, “ we realize you can’ t prevent everything, ” and that antivirals could play a role in treating people who are infected.
The committee didn’ t vote on any specific question, but both Monto and the director of the FDA’ s Center for Biologics Evaluation & Research, Dr. Peter Marks, who is responsible for its vaccine decisions, suggested that the committee will be called back frequently in the coming months.
A theme throughout the day was that, while there is a risk of another major wave of the virus this fall and winter, its details are impossible to predict. In one presentation, Trevor Bedford, a faculty member at the Fred Hutchinson Cancer Center, said to expect “ additional flulike drift ” in the evolution of BA.1 and BA.2, but said that there was also a possibility of the emergence of an entirely distinct variant, as Omicron did last fall.
Bedford called the evolution of Covid-19 “ remarkably fast ” as compared with the seasonal flu. A key question, he said, is how often wildly divergent variants like Omicron will emerge. Based on it happening once over the just over two years that the virus has been circulating, Bedford said something like this could happen once every 1½ years, or once every 10 years.
Over the next year, Bedford said that it’ s more likely that BA.2 will continue to evolve, and increases in cases will be driven by waning immunity, seasonality, and, to some degree, changes in the BA.2 strain. A less likely scenario, Bedford said, is that a new, very distinct strain emerges, as Omicron did, leading to “ high attack rates. ”
Write to Josh Nathan-Kazis at
josh.nathan-kazis @ barrons.com | business |
UK shares break 3-day winning streak on U.S. rate hike worries | The blue-chip FTSE 100 index closed 0.3% lower, dragged down by Unilever which fell 1.1% after Barclays cut its price target on the Dove soap maker's stock.
However, gains in AstraZeneca and consumer staple stocks helped limit losses on the index.
Tobacco company Imperial Brands gained 3.3% to top the FTSE 100 after it forecast higher first-half profit.
Shares of rival British American Tobacco also rose 2.4%.
Market participants were cautious ahead of the minutes of the Fed's March meeting due at 1800 GMT which may indicate just how fast and how far policymakers will proceed in shrinking the size of its massive balance sheet and hiking interest rates to tackle inflation.
`` Interest rates are definitely a risk but they are more of a risk in the United States. We suspect the outcome for Europe will be slightly more benign because it is structurally more at the risk of a recession, '' said Francis Ellison, portfolio manager at Columbia Threadneedle Investments.
A survey showed British households ' financial situation is now the most precarious since the depths of the COVID-19 pandemic in the second quarter of 2020, due to a surging cost of living.
The domestically-focused mid-cap FTSE 250 index ended 1.2% down, while a gauge of euro zone stocks fell 2.3%.
Overall, the FTSE 100 has outperformed this year as surging commodity prices boosted mining and energy stocks, while financials got a lift from rate hikes from the Bank of England.
Hyve Group jumped 8.2% after the events group said it would sell its Russian business following boycott warnings from customers.
Design and engineering company Avon Protection slumped 19.1% after it said first-half profitability was hit by weaker-than-expected sales and higher costs.
Meanwhile, Britain froze the assets of Russian banks Sberbank and Credit Bank of Moscow, and said it would end all imports of Russian coal and oil by the end of 2022.
( Reporting by Sruthi Shankar and Devik Jain in Bengaluru; Editing by Subhranshu Sahu, Uttaresh.V and Emelia Sithole-Matarise)
By Sruthi Shankar and Devik Jain | business |
The Opportunities Ahead for Small-Cap Investors | Dreamstime
About the authors:
Chuck Royce
is chairman and portfolio manager of Royce Investment Partners.
Francis Gannon
the firm’ s co-chief investment officer. Royce Investment Partners is a subsidiary of Franklin Templeton.
Geopolitics
,
inflation
, and market
volatility
are, by necessity, top of mind for investors these days, so we think it’ s important to put recent events into perspective. Since beginning to manage portfolios and opening our firm in 1972, we have invested through the double-digit inflation of the late 1970s and early 1980s as well as the deflationary period of the great financial crisis. From the end of the Vietnam War to the collapse of the Soviet Union, through two Persian Gulf wars to the 9/11 terror attacks, and now Russia’ s invasion of Ukraine, we have always believed in the critical importance of focusing on what we know and not worrying about what we can not control.
Here’ s how we put that into practice as small-cap specialists.
The principle that anchors our investment strategy
After years of accommodative monetary policy, the Federal Reserve board elected to raise the federal funds rate by
25 basis points
, its first increase since December 2018. With the U.S. recording its highest rate of inflation since the 1980s at a hot 7.9% in February 2022, the Fed’ s focus has shifted from liquidity to curbing runaway inflation. This transition has sparked a good deal of market volatility, with investors looking to protect their portfolios against not only inflation, but also a reduction in liquidity and a global geopolitical conflict.
So far in 2022,
small caps
have been no exception to this volatility, with the small-cap Russell 2000 Index starting the year with its worst performance since 2009. Nevertheless, small caps have had an impressive record of rebounds from declines of 20% or more from previous peaks. The recent January 2022 low marked the 12
th
such decline since the 1979 launch of the Russell 2000. The average subsequent one-year return from the first day of the 11 previous declines was 19.6%.
The principle that informs each of our investment strategies is that, in every decade since the 1930s, small caps have beaten inflation. This is based on a comparison of the average annual U.S. consumer price index to returns for the Center for Research in Security Prices 6-10 Index, a proxy for small caps with a much longer history than the Russell 2000.
Large caps are vulnerable to higher inflation and rising interest rates
Despite these facts about small caps, large and mega caps have gotten all the glory over the past decade. In fact, amid the economic uncertainty of the Covid-19 crisis, it seems that investors have flocked from small caps to mega caps in a flight to safety. But looking forward, we expect mega caps to struggle as their valuations are particularly vulnerable to rising interest rates and constrained liquidity.
We think that the inflationary and economic growth environment of 2022 poses an opportunity for investors to increase their exposure to small caps, specifically small cap value. Select small caps are already pricing in today’ s high inflation. And, given their size, small caps also tend to be nimbler than large caps, allowing them to potentially act more quickly in a climate of contracting liquidity and Fed tightening.
Small caps are also a promising opportunity because we believe they are cheap, especially compared to large and mega cap companies. Small cap value, specifically, is priced near the bottom of its 20-year valuation range versus small-cap growth, making these companies particularly good opportunities for investors who share our view of their medium- to long-term potential.
Treat small-cap value and small-cap growth as two related, but distinct, asset classes
Not all small caps should be treated equally, though. Because there are significant differences in sector exposure between small cap value and small cap growth, we expect the two indexes—the Russell 2000 Value and the Russell 2000 Growth—will behave differently in inflationary market environments. In fact, we believe these differences warrant treating them as two separate asset classes.
Small cap value could be a good investment in 2022 because of its sector exposure. Above-average inflation and economic growth are likely to favor sectors like banks and real estate, both of which are overweight in the index.
In addition, the Russell 2000 Value is also underweight in industries like software and services, pharmaceuticals, biotechnology and life sciences, and health care equipment and services—all areas whose performance has struggled historically with high inflation.
It’ s normal to see divergent performance between these two sister indexes. In nearly three-quarters of calendar years, the spread between Russell 2000 Growth and Russell 2000 Value has been at least 5%. The frequency and magnitude of these performance differences illustrate how their compositions interact differently depending on economic conditions.
The
Russell 2000 Value Index
had a fantastic year in 2021, advancing 28.3% and beating the large-cap Russell 1000 Index. Last year marked the first calendar year outperformance of the Russell 2000 Value over the Russell 2000 Growth since 2016.
Given recent performance, active management will be key
While we see a lot of opportunity in this space, investors can not ignore recent performance. Small cap investors were underwhelmed by the class’ s performance in 2021, and we’ ve seen a dismal start to 2022.
The Russell 2000 enjoyed a strong year in 2021 on an absolute basis, rising 14.8%. The problem was that nearly all of 2021’ s gains came in the first quarter. In the first three months of 2021, the Russell 2000 outperformed the Russell 1000 12.7% to 5.9%, respectively. This performance was followed by a return of only 1.9% for the Russell 2000 over the rest of the year.
A lot of small cap companies are also not profitable at present; 44% of the Russell 2000 is composed of loss-making entities. If investors can bear some performance pain in the near term, they should consider a re-allocation to small cap value, as we think there may be years left in this current outperformance trend for the asset class.
With so much uncertainty—and additional volatility—around the war in Ukraine, we also think it’ s important for investors to remain focused on the long term, which we define as an investment horizon of at least two to five years. We are also mindful that small-caps typically have less international exposure than their large-cap siblings.
We remain confident that active management will be the key to success in the small cap space. Stock pickers who prioritize strong fundamentals and underlying quality in an increasingly noisy market environment should ultimately benefit.
Guest commentaries like this one are written by authors outside the Barron’ s and MarketWatch newsroom. They reflect the perspective and opinions of the authors. Submit commentary proposals and other feedback to
ideas @ barrons.com
. | business |
UGANDA: Museveni's ousted former confidant Amama Mbabazi back in the game | Advised by the children of the Ugandan leader, the Kaguta Foundation is very active in promoting the president's track record and has been focusing on two issues in particular on social media: east African integration and the revival of inter-generational dialogue. [... ]
The legal battle enjoined between Yoweri Museveni and his main political rival Bobi Wine, who is contesting the Ugandan president's re-election, looks like being short-lived. More than anything else, it has allowed a myriad of young lawyers to hog the media spotlight. [... ]
The vice president Edward Ssekandi is currently the favourite to represent Museveni in Beijing. A Sinophile, he is one of the many big guns of the National Resistance Movement who lost their seats in parliament and are now eyeing a diplomatic career. [... ]
Behind Judge Simon Byabakama, the very embodiment of the Uganda Electoral Commission, it is its secretary Leonard Mulekwah who is laying down the rules for the 14 January presidential poll and Covid-19 campaign restrictions hated by opponents Bobi Wine and Patrick Oboi Amuriat. [... ]
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EU to help sponsors and CROs mitigate disruption caused by Putin’ s war | This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them. Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 3099067.
Sponsors testing drugs in Eastern Europe will need to take a flexible approach and be willing to adjust trial plans as a result of current Russian president Vladimir Putin’ s war in Ukraine.
The European Commission ( EC), the European Medicines Agency ( EMA) and the Heads of Medicines Agencies ( HMA) issued the advice last week, suggesting sponsors should expect disruption.
“ The ongoing war in Ukraine may require sponsors to adjust the way clinical trials are run in this region, and sponsors may need advice on how to deal with the impact of protocol deviations and other consequences of the disruptions.
“ Certain changes and protocol deviations in the current situation are unavoidable, when for example scheduled study visits can not take place, or arrangements need to be made to transfer trial participants who are fleeing Ukraine to other investigator sites of the same trial in the EU. ”
They also said certain adaptations will be needed to protect the participants’ right and safety, including the continuation of ongoing treatment if possible, as well as to preserve the quality of trial data.
According to the EC, EMA and HMA sponsors and CROs need to use strategies developed in response to the coronavirus pandemic to mitigate against disruption.
“ Where applicable, sponsors are advised to use the experience gained during the COVID-19 pandemic and apply the approaches and flexibilities agreed in this context ” the organizations wrote, citing guidance documents on trial management and study methods.
The EC also said the EMA and HMA are developing specific advice.
“ In view of the specific circumstances linked to the war in Ukraine, the Clinical Trials Coordination Group clinical trials is developing additional recommendations for sponsors.
“ EMA will develop additional recommendations on the methodological aspects of data stemming from clinical trials impacted by the war in Ukraine. ”
Copyright © 2022 Informa Connect Limited. Registered in England & Wales with number 01835199, registered office 5 Howick Place, London, SW1P 1WG. | tech |
US businesses have more physical locations now than pre-pandemic — Quartz | US businesses now have more physical locations than before covid-19, another sign of the blistering pace of the economic recovery.
Companies shut down offices, stores, and warehouses across the country in the first year of the pandemic. But by the third quarter 2021, the number of physical locations had bounced up 7% above what it was two years prior, pre-covid, according to an analysis by the Economic Innovation Group ( EIG), a Washington think tank.
That’ s a much faster recovery than after the Great Financial Crisis. Post-2008, it took five years for 44% of US counties to return to the number of physical locations they had before the crisis. This time around, 74% of US counties recovered the level of business establishments they had prior to covid-19 in under two years.
“ In fact, the share of counties actively shedding business establishments fell over the last two years compared with the prior, pre-pandemic, two-year window, ” wrote Connor O’ Brien, a research and policy associate at EIG.
Part of the reason why companies have bounced back more quickly from the pandemic is the federal government’ s much bigger stimulus package, which helped keep businesses afloat. The jump in physical locations also reflects pandemic-related spikes in demand for certain services. The number of establishments related to freight trucking, for example, rose 19% as consumers turned towards online orders during the pandemic.
The increase in physical locations was led by the services industry, even though US consumers spent more on goods than services during the pandemic. While retail and restaurants were badly hit from covid-19 restrictions, activity in information, professional, and social services picked up. This included computer programming, administrative and management consulting, and computer design. Research and development in biotechnology, nanotechnology, and physical sciences each grew by more than 20%.
In contrast, home services services including cooks, gardeners, and home cleaning declined. Home and car repairs, dry cleaners, and nail and hair salons also suffered.
Whether these trends continue going forward will depend on work-from-home dynamics, supply chain snags, and labor supply O’ Brien wrote. “ For now, the economic effects of the pandemic and its aftermath continue to substantially alter the landscape of American business growth, ” he said. | tech |
Yield Curve Inversion Doesn't Mean Automatic Recession | The Federal Reserve is expected to undertake one of the fastest tightening cycles in history this year, raising the question as to whether the Fed will be able to avoid recession.
Daniel Slim/AFP/Getty Images
About the author:
Gregory Daco
is the chief economist at EY-Parthenon and former board director at the National Association of Business Economics.
Views expressed in this article are those of the author and do not necessarily represent the views of Ernst & Young LLP or other members of the global EY
. organization.
The
yield curve inversion
has resurfaced as the topic du jour with many questioning whether it implies an imminent recession for the U.S. economy.
While the yield curve serves as an important recessionary signal, there are four key reasons why it should be interpreted with discernment in this unusual business cycle.
The yield curve is the spread between long-term and short-term bond yields. During times of economic expansion, yields for longer-term bonds tend to be higher than yields for shorter-term bonds as investors demand extra compensation for the risk related to their longer-term investment. As a result, long-term yields will reflect short-term yields plus a premium for risk and duration.
When the long-term yields fall below short-term yields, the yield curve is said to “ invert. ” This typically reflects the fact that short-term rates are expected to decline because of a forthcoming slowdown in economic activity.
The closely watched spread between the 2-year Treasury yield and the 10-year Treasury yield ( 2s10s) fell below zero last week. Many observers claimed that a
recession
is around the corner.
Not so fast!
First, it’ s important to remember that while a yield curve inversion has preceded each of the past eight recessions since the 1970s, the most recent inversion in 2019 didn’ t predict the coronavirus pandemic, but instead indicated the economy was slowing down—and hence was susceptible to downside risks.
Second, the duration between the yield curve inversion and a recession has varied between 10 months and 3 years. The average duration is around 1.5 years. So, even if the yield curve signal were taken literally, a recession would be unlikely until 2023. Indeed, the U.S. economy can only be described as robust with GDP
growth
trending around 4%, the labor market adding a healthy 600,000 jobs each month over the past six months, and the unemployment rate falling to
3.6%
in March—just above its pre-pandemic 50-year low of 3.5%.
Third, the particulars of this business cycle make reading any economic signal a particularly delicate exercise. With the Fed’ s favored inflation gauge—core
personal consumption expenditure
—rising to 5.4% year over year in February, its highest level since 1982, market participants are increasingly pricing a rapid Fed tightening of monetary policy. The prevalent view is that the Fed is behind the curve in combating record-high, persistent inflation, and that it will need to play catch up by raising the federal funds rate rapidly in the coming months.
Markets are currently pricing 215 basis points of additional
Fed rate hikes
this year, and EY-Parthenon anticipates the Fed will want to front-load rate increases with a strong possibility of 50 basis points incremental hikes at the upcoming Federal Open Market Committee meetings in May and June. This would represent one of the fastest tightening cycles in history, raising the question as to whether the Fed will be able to manage a so-called soft-landing of monetary policy—in other words, whether a recession can be avoided.
In this context, the yield curve inversion is signaling that there is a real risk that the Fed will tighten monetary policy excessively, and perhaps too rapidly. Doing so would trigger a significant tightening of financial conditions, with real rates rising, stock prices falling, the dollar strengthening, and volatility surging. There would be severe negative spillovers onto the real economy. Indeed, in their recent communication, Fed policymakers led by Chair Jay Powell signaled an intent to regain control over inflation by cooling demand and addressing the
“ unhealthy ”
labor market tightness.
The paradox, however, is that markets are already starting to price Fed rate cuts in late 2023 and into 2024 on the belief that the Fed will tighten policy excessively. Indeed, it has long been our view that after pushing the federal funds rate to 3% in 2023, the Fed would be forced to cut the policy rate in 2024 ( and even late 2023 if activity slows too dramatically next year).
Fourth and finally, recession indicators that only factor economic data and abstract from any subjective interpretation don’ t signal an imminent recession. One of EY-Parthenon’ s recession indices uses the 3-month/10-year spread to calculate the probability of a recession 12 months ahead, similar to the New York Fed’ s recession index. It points to odds around 4%. This is well below the 30% threshold after which a recession has generally occurred. EY-Parthenon’ s second recession gauge with predictive power 6-months ahead is even more reassuring. This measure—using the 3-month/10-year spread, the Chicago Fed National Activity Index, and the real federal funds rate as drivers—points to odds of a recession below 1% in the next six months, well below the 50% threshold for this indicator. Our third recession gauge uses a regime-switching methodology defining two separate regimes—recessions and expansions—in which economic variables behave inversely. The probability of switching between regimes is driven by the Conference Board’ s Leading Economic Index and business cycle recessions and expansions defined by the National Bureau of Economic Research and points to odds of a recession in the next 3-months being close to zero.
A recession is by no means unavoidable. But the economy remains robust despite the headwinds from higher inflation, increased financial market volatility, and geopolitical uncertainty. Panicking today would only serve to reinforce the risk of a self-fulfilling prophecy.
Guest commentaries like this one are written by authors outside the Barron’ s and MarketWatch newsroom. They reflect the perspective and opinions of the authors. Submit commentary proposals and other feedback to
ideas @ barrons.com
. | business |
Shanghai's eight-day lockdown is stretching into multiple weeks — Quartz | There’ s no clear end in sight to the lockdown in Shanghai.
China’ s financial hub, home to nearly 26 million people, entered a two-part lockdown last week originally meant to last only eight days. First, its eastern side Pudong would shut down, followed by Puxi, west of the river Huangpu. But on Tuesday when the lockdown was due to lift, the city announced they would extend the confinement for the whole city indefinitely.
Despite its strict covid-19 controls, Shanghai saw more than 17,000 new cases on Tuesday, surpassing the highest daily tally in Wuhan set in the early days of the pandemic. Most are asymptomatic or mild but anyone who tests positive is sent to mass quarantine centers. This week, outrage sprang up on social media ( link in Chinese) over covid-19 positive toddlers getting separated from their parents who did not also have the virus, although at least some centers seem to have since relaxed that policy.
Chaotic access to food and basic necessities and poor coordination between government agencies ( link in Chinese) is fraying people’ s nerves. In the days leading up to the citywide lockdown, many of the city’ s residents had experienced some shorter form of quarantine on a building or compound basis. A single confirmed case would lead to the entire block getting quarantined for 48 hours but these lockdowns could be extended multiple times leaving residents exasperated.
It’ s not only Shanghai either. Various large hubs including Jilin City, Changchun, Xuzhou, Tangshan have barred their populations totaling in the tens of millions from setting foot outside their homes too, showing that China doesn’ t have a roadmap out of its zero-covid policy. | tech |
Opinion: Palliative care vs. hospice -- here's how they differ | When most people hear the term palliative care, they look worried or confused. Introducing myself to patients and families as a
palliative medicine physician
, I commonly hear things like, “ Does this mean I am dying? ” or “ I am not ready for hospice. ”
I respond by acknowledging these common fears, but emphasizing that palliative care and hospice care
are two very different things
.
Hospice care
is a Medicare-covered benefit for people whose doctors believe they are in the last six months of life, and who want to stop treatments targeting their disease – such as chemotherapy for cancer – to focus on comfort. In contrast,
palliative care
is appropriate for people at any stage of serious illness and is provided alongside treatments aimed at curing disease.
Palliative-care specialists like me are experts in
treating physical symptoms
like pain and nausea. But just as important, we listen to patients’ stories and find out what is most important to them. We help make difficult treatment decisions and address
the sadness and uncertainty
that often accompany serious illness. We walk alongside patients and their families at a time that can be frightening and overwhelming, offering comfort, information, guidance and
hope
.
Palliative care recognizes that
ethical and compassionate care for serious illness
requires supporting the whole person in addition to fighting the disease.
Mounting evidence
The field of palliative care is still relatively new. In the early 1990s, research demonstrated substantial shortcomings in the quality of care for patients with serious illnesses.
One 1995 study of nearly 5,000 people in the U.S.
found that half of patients who died in the hospital experienced moderate to severe pain in their last days of life. More than half of the time, doctors did not know when their patients preferred to avoid CPR at the end of life.
These types of findings helped inspire the field of palliative care over the course of the 1990s and early 2000s.
It began
at a handful of hospitals as a specialty consult service working alongside primary teams – such as oncologists, cardiologists, surgeons and neurologists – to improve the experience of serious illness and ensure patients’ needs were met.
According to the
State-by-State Report Card on Access to Palliative Care
, which is compiled by researchers at
the Center to Advance Palliative Care
, only 7% of U.S. hospitals had a specialty palliative-care service in 2001. Today, 72% of hospitals with 50 or more beds have a palliative-care service, and palliative-care specialists are increasingly available in other settings as well, including outpatient clinics, nursing homes and home-based programs. For example, it is now possible to see an oncologist for cancer treatment or a cardiologist for heart failure, followed by an appointment with a palliative-care specialist who treats related symptoms such as
fatigue
and
depression
.
This growth is fueled in part by growing evidence of the benefits that palliative care provides for patients and families.
Our research team at the University of Pittsburgh
led a
2016 review
of results from 43 randomized trials with nearly 13,000 patients – meaning that some patients received palliative treatment, and others did not. We found that palliative care was associated with significant improvements in patients’ quality of life and reductions in their physical symptoms one to three months afterward.
Importantly, palliative care
was not associated
with shortened survival, pushing back against a popular assumption that pursuing palliative care means “ giving up ” on fighting disease. In fact, one
influential study
found that patients with advanced lung cancer who receive specialty palliative care in addition to standard oncology care lived almost three months longer than patients who received standard oncology care only.
Palliative care is now recommended in many national guidelines as a critical component of high-quality care for serious illnesses. For example, in 2016
the American Society of Clinical Oncology recommended
that all patients with advanced cancer receive dedicated palliative care services early after diagnosis, while also receiving treatment to target the disease. Increasingly, palliative care is viewed as an essential part of ethical and compassionate medical care.
Not the norm
One might suspect that an evidence-based service recommended by national guidelines would be available to everyone with serious illness. When it comes to palliative care, however, this is not the case.
Nationally, palliative-care teams are vastly
understaffed
.
Workforce shortages
are projected to worsen in the future, as
the U.S. population ages
and therapeutic advances mean people can live longer with serious illness. Even now, with COVID-19 surges having caused
as many as 154,000 new hospitalizations weekly
and made other patients sicker because of
pandemic-related delays in care
, palliative teams are stretched to the limit.
Whether you or a loved one has access to palliative care may also depend on where you live and where you receive your medical care. According to the
State-by-State Report Card
, a hospital in New Hampshire is three times more likely to have a palliative care service than a hospital in Mississippi. Another
recent analysis
found that a not-for-profit hospital is two times more likely to have a palliative care service than a for-profit hospital.
A
2019 study
found that palliative-care consults were less frequent at hospitals that serve the largest proportions of Black and Hispanic patients. These
structural inequities
risk worsening
known disparities
in the care of serious illness.
Educating doctors
Patients and families can request palliative care, but palliative-care specialists usually are brought in once the primary clinical team recommends it. Yet many physicians do not, either because they mistakenly
equate palliative care with hospice
or do not recognize the value that palliative care can bring.
One approach to expanding palliative care access is to enhance palliative training and support for every clinician who cares for patients with serious illness – an approach sometimes called
“ primary ” palliative care
. Another approach is to leverage newer care-delivery models,
such as telemedicine
, to
expand the reach
of palliative care specialists.
These solutions would require
changing medical reimbursement and training models
to make palliative care fundamental – for everyone.
Yael Schenker is a professor of medicine at the University of Pittsburgh Health Sciences. This was first published by
The Conversation
— “
What is palliative care? How is it different from hospice?
“ | business |
Tesla, BMW shutdowns in China drag on; microchips pile up as lockdowns continue | Tesla Inc.’ s factory shutdown has stretched out to at least 12 days, much-needed semiconductors are piling up at manufacturers amid a shortage of truck drivers, and bankers are camping in their offices as Shanghai’ s Covid-19 lockdown disrupts businesses in China’ s financial hub.
Cases are at a record in the city, now the epicenter of China’ s worst outbreak since the start of the pandemic, and the lockdown has been extended indefinitely. While the country is sticking to its rigid Covid-Zero containment playbook, President Xi Jinping’ s request to limit the economic consequences is becoming harder to achieve in the face of the highly transmissible omicron variant.
The lockdowns and virus containment measures threaten to slow China’ s economic growth this year to below the government’ s 5.5 percent target, according to Bloomberg Economics. They also risk further havoc on already stressed global supply chains, with companies from chip giant Semiconductor Manufacturing International Corp. to a South Korean noodle maker caught up in the fallout.
Electric-car pioneer Tesla on Tuesday told some suppliers and workers that its Shanghai factory -- which has been shuttered since the city went into a phased lockdown on March 28 -- will remain closed at least through Thursday, according to people familiar with the matter, who asked not to be identified because the information isn’ t public.
Following a separate a two-day shutdown in March, Tesla has now lost 12 days of production in recent weeks, including this week’ s holiday. The first Gigafactory outside Tesla’ s home country produced half of its vehicles last year, and builds cars not just for the lucrative Chinese market, but for export to Europe and elsewhere in Asia.
A spokesperson for Tesla China didn’ t immediately respond to a request for comment.
Staff at banks and fund management firms that were called back to work before the lockdown started remain stuck in their offices.
One fund manager said he and colleagues plugged up a floor drain on concern it could facilitate viral spread after a few people on the level above tested positive but were delayed moving into a quarantine facility, mandatory for all Covid cases in China regardless of severity.
Workers are worried about an outbreak emerging, and while the firm has been trying to come up with a solution it’ s a difficult problem to solve, said the person, who asked not to be named talking about private company matters.
Some companies, including chip giants Taiwan Semiconductor Manufacturing Co. and SMIC, as well as iPhone assembler Pegatron Corp. have been able to keep plants running by implementing a so-called closed loop system where workers live on-site and are tested regularly. For the likes of SMIC, a new headache is emerging: securing the trucks they will need to get their chips to clients. A representative for SMIC declined to comment on logistics.
South Korean companies are also being affected, with operations at the Shanghai plants of noodle maker Nongshim Co., confectionery manufacturer Orion Corp. and cosmetics producer Amorepacific Corp. suspended since early this month. The companies all told Bloomberg News that they have been following instructions from local authorities and don’ t know when they can reopen.
Singapore’ s Spindex Industries Ltd., which supplies precision components used by the automobile industry, has extended the closure of its Shanghai plant until April 10 or whenever local authorities allow work to resume. The uncertainty over the extension of the lockdown is expected to have a negative impact on the company’ s financial performance, it said in an exchange filing. | general |
When will China move on from its zero-covid policy? — Quartz | For much of the pandemic, China saw its zero-covid strategy as proof of its political system’ s superiority in dealing with the virus. But Shanghai’ s struggles show Beijing is now clinging to a strategy whose costs and dangers are mounting.
In previous waves of covid, the strategy of mass testing and quarantining positive cases, along with partial lockdowns and border measures, was able to outpace the spread of the virus. But the highly transmissible nature of the omicron variant and its subtypes means it’ s moving faster than China’ s tried-and-tested methods to control it. Despite the financial hub’ s two-stage lockdown—now extended indefinitely—China’ s covid cases shot up from double digits in early March to over 20,000 on Tuesday ( April 5).
Nevertheless, the consensus seems to be that China won’ t relax its prevention tactics until 2023, because of a key political event that will take place in October or November. At this year’ s Communist Party Congress, which takes place every five years, Chinese leader Xi Jinping is expected to announce his third term. Until it’ s over, the whole system is even more geared than usual to maintaining stability and to avoiding a potential embarrassment to the party.
“ I don’ t think they are going to abandon it before the party congress because of the political risks of having the hospital system overrun or severely compromised, ” independent economist George Magnus, a former chief economist at Swiss bank UBS, told Quartz. “ …My hunch is the politics will demand mostly pretty stern commitment to zero-covid with flexibility where possible in terms of economic impact. ”
Over the weekend, photos of dozens of infants in cradles without their parents in a Shanghai clinic sparked anger on Chinese social media, where users call the government’ s behavior “ inhumane. ” Parents said they were denied the right to accompany their children who had tested positive due to government rules, according to China’ s Caixin publication. After the public backlash against the separation of children and their guardians, Shanghai’ s authorities tweaked the policy this week to allow a small number of parents with negative results to live with the kids in a quarantine hospital.
With many essential workers also under lockdown, people stuck at home have reported groceries are running low. And as in previous lockdowns, some people have failed to get life-saving medical care, such as a nurse who died from asthma. While Shanghai’ s broader lockdown only came in last week, earlier spot lockdowns, or the so-called “ closed-off ” management style ( link in Chinese), mean some people have been under movement restrictions for two weeks.
“ Everyone is fed up with the lockdown, there is nothing to do other than eat, work, sleep, and post ‘ fuck the government’ online, ” said a person who has been under lockdown since mid-March.
Despite the painful measures, Shanghai reported 40,000 covid cases in March in total, making it the new epicenter of the virus in the country. It recorded more than 17,000 new cases on Tuesday, up from around 13,000 a day earlier. It’ s unclear when new cases are expected to peak.
In March, China’ s manufacturing activity slumped to a two-year low due to covid disruptions, as well as canceled export orders in the wake of Russia’ s invasion of Ukraine, according to a monthly index by Caixin/Markit. One tally put the lost productivity from China’ s patchwork of covid lockdowns at nearly $ 50 billion a month, using reductions in trucking traffic to estimate the losses. Authorities have tried to ease the impact by allowing ports, factories, and some offices to have their workers live at work sites.
Strict border rules, including lengthy quarantines, have also halted China’ s aviation and tourism industries, and been a blow to countries that depended on Chinese tourists before the pandemic. And while China maintains port operations are continuing as normal despite the lockdown, a supply chain tracking firm says ocean shipment volumes reduced.
All of this—along with uncertainty from Russia’ s war in Ukraine—means China will face pressure meeting its economic growth target of 5.5% for 2022. French investment bank Natixis in March predicted that the sharp reduction in mobility in China could shave off 1.8 percentage points from its first-quarter GDP, due later this month.
Many had viewed the end of the Beijing Winter Olympics, which began in early February, as a possible turning point for China’ s covid policy. In late February, Zeng Guang, the former chief scientist of China’ s Center for Disease Control and Prevention, said that “ dynamic clearance ” of covid will not remain unchanged forever, sparking hope that China would soon soften its stance. Around the same time, China’ s vice premier Li Keqiang and the president Xi Jinping vowed to minimize the economic impact of the policy.
But last week, an editorial from state news agency Xinhua reiterated Xi’ s mandate to stick to “ dynamic zero covid, ” as the strategy began to be referred to late last year, urging citizens to overcome their “ weariness ” toward covid prevention measures. Wu Zunyou, chief epidemiologist of the Chinese CDC, also said that the country must stick to the approach because the more transmissible BA.2 sub-variant of omicron can “ still cause severe peril. ” Over the weekend, Chinese vice premier Sun Chunlan, who is in charge of the country’ s covid response, urged Shanghai to “ make resolute and swift ” moves to curb the outbreak, while stressing “ unswerving adherence ” to dynamic zero-covid policy, crushing any remaining doubt about China’ s stance on the issue.
A major concern is that China must not repeat the fate of Hong Kong, where cases and deaths have soared since January due to low vaccination rates of the elderly. The mainland shares these risk factors. Immunity from the outbreak in 2020 would have waned by now, and only half of the Chinese population aged 80 or have received two shots in China, compared to around 88% for the whole population.
“ Hong Kong has set a good example of what not to do, ” Gary Ng, Asia-Pacific economist at Natixis, told Quartz. “ …the most likely scenario is China will seek to identify as many infections as possible, buying time to ensure enough medical capacity and boost the vaccination rate. ”
In place of covid-zero, “ there is a viable, more effective alternative approach available, which can not prevent what’ s inevitable—the rise of cases—but could avoid the worst scenario, ” said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations. A “ mitigation-based approach ” would prioritize the protection of the elderly by making sure they get three covid vaccine doses—or have access to free anti-covid pills, Huang said ( though China’ s vaccines are less effective than mRNA vaccines, three doses can significantly reduce severe illness). Meanwhile, hospitals should no longer treat mild covid cases, and authorities also need to educate the public so they don’ t panic and flood hospitals even with mild symptoms.
“ This is a much more cost-effective approach, ” said Huang.
Ng, meanwhile, points at the Civil Aviation Administration of China’ s new five-year development plan issued in January, in which the organization described 2023-2025 as a growth period for domestic and international travels, offering a potential clue to China’ s timeline. “ Given the current situation, the government will probably keep on-and-off restrictions for the rest of 2022, and more significant changes may only come in 2023, ” he said. | tech |
2022 EEO-1 Reporting Requirements | Every year, employers with 100 or more employees ( and federal contractors with 50 or more employees) must file EEO-1 Component 1 data, which consists of demographic information, such as race, gender, and ethnicity information, of the employer’ s workforce by job category.
In recognition of the crisis precipitated by the COVID-19 pandemic, the EEOC delayed the reporting requirements and deadlines for 2019 and 2020. Now, however, the EEOC is not delaying reporting. Instead, deadline for 2022 for reporting 2021 numbers is May 17, 2022, giving employers a shorter filing period.
Timely and correct EEO-1 reporting is a must for employers with 100 or more employees. Failure to do so can result in significant negative consequences for employers.
In this webinar we will discuss the fundamentals of EEO-1 filing and how to ensure timely and correct filing.
⭐ Areas to be covered include, without limitation: ⭐ What exactly is EEO-1 reporting and what is the reporting period? ⭐ Who must file the EEO-1 report? ⭐ How to file EEO-1 reporting? ⭐ Race, ethnicity, and job categories ⭐ Confidentiality requirements ⭐ What must federal contractors include? ⭐ Collecting data from your workers while ensuring your methods are compliant ⭐ Certifying results ⭐ Recordkeeping requirements ⭐ Collecting information when you have multiple locations ⭐ How penalties can be avoid for non-compliance? ⭐ How the EEO-1 report can spot potential pay discrimination? ⭐ New requirements that came into force in 2022, and more.
The EEOC and the Office of Federal Contract Compliance Programs ( OFCCP) use the information you enter into your EEO-1 form, to determine whether your company is in compliance with EEO and of applicable Affirmative Action laws. Failure to either submission of the EEO-1 in a timely manner or failure to report your information accurately, could result in an audit. If one of your employees or a third party submits a discrimination or harassment complaint about your company with the EEOC, one of the first things agency representatives will do as part of their investigation is to review your company’ s EEO-1 report. Your company’ s history of compliance and transparency could impact the outcome of current or future investigations. Additionally, if your company is a federal government contractor, you could lose your contract by not submitting your company’ s report by the deadline. Since the deadline is only weeks away, this is the time to get the information you need to discharge your requirements correctly. It is now vital that you prepare this form correctly as it lets the EEOC, and the OFCCP use your information to determine whether your company should be audited.
Notes During the Q & A session following the live event, ask a question, and get a direct response from our expert speaker. You will get access to the Recording link and E-Transcript; in your account and at your registered email address, in the next 2 -3 days once the webinar is accomplished.
Credits 1.5 CEUs HRCI | 1.5 PDCs SHRM APPROVED
Founded in 2010, CCI is the web’ s premier global independent news source for compliance, ethics, risk and information security.
Got a news tip? Get in touch. Want a weekly round-up in your inbox? Sign up for free. No subscription fees, no paywalls. | general |
Fiscal Policy for Inclusive Growth in Asia | This paper discusses how fiscal policy can help foster more inclusive growth in developing Asia. On average, government expenditures in developing Asia are higher, as a share of gross domestic product, than those in Latin America and the Caribbean. Relative to Latin America, developing Asia spends more on social benefits, but less on education and health. While general government revenues have risen since 2000, they are still not sufficient to fully fund targeted transfer programs and provide adequate in-kind benefits to the population. Against this background, this paper discusses priorities for policy reforms as countries in the region seek more inclusiveness and confront the effects of the coronavirus disease ( COVID-19). The paper finds that eliminating inefficiencies in health, education, and public investment, for example, would generate the equivalent of 3 percent of gross domestic product. Savings from curtailing subsidies for fossil fuels would also generate resources for expanding redistributive spending. Reallocating health spending toward primary care, and education spending toward primary and secondary education, would help lead to more equitable growth. There is also scope to raise spending on social benefits and better target them to the poor.
You may use and disseminate CGD’ s publications under these conditions. | general |
Four Global Health Challenges and Solutions on World Health Day | World Health Day 2022 is centered on “ our planet, our health, ” invoking the interconnected importance of pandemic risks, pollution, climate change, and shifting disease burdens. We are using this moment to shine a light on innovative solutions for many of the world’ s most pressing global health problems, from pandemic preparedness financing to priority-setting for universal health coverage. From all of us at CGD, we wish you a happy # WorldHealthDay.
Amid the ongoing climate crisis and over two years into COVID-19, funding for global challenges that transcend borders, like outbreak response and climate change mitigation, is grossly insufficient. With biodiversity losses and increased spillover of infectious disease from wildlife to humans, the frequency and severity of pandemic threats is steadily increasing.
According to recent modeling, there is a 47 to 57 percent chance of another global pandemic as deadly as COVID in the next 25 years. Collective action through a “ One Health ” approach and increased financing for global public goods are needed to address global problems like pandemic and climate risks. Stay tuned for more from CGD on the role of multilateral development banks in advancing global public goods in the coming months.
Whether deciding which COVID-19 vaccines to buy, which health services should be publicly funded to achieve UHC, or how to invest in systems to track novel pathogens, policymakers lack information on the comparative cost effectiveness of their options. To fulfill UHC goals, health systems must strengthen regional and country capacity to generate and use health technology assessment and related economic evaluation so that they can prioritize the health interventions and products with the greatest impact. To this end, the International Decision Supportive Initiative ( iDSI) network and its secretariat based at CGD help countries prioritize scarce resources for the best uses.
Source: “ Who Gets a COVID-19 Vaccine and Who Pays? The Need for Economic Analysis, ” February 2021.
For millions of people in low- and middle-income countries, life-saving medicines and other health products remain out of reach because policies and incentives to drive their development and delivery are lacking, especially for antibiotics. People living in LMICs are 1.5 times more likely to die from antimicrobial resistance than those in high-income countries.
Source: “ Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis, ” The Lancet, February 2022.
Greater investment in research and development that primarily benefits LMICs is needed. New financing and policy approaches can kickstart pharmaceutical research, spur competition, promote quality assurance, and increase supply chain efficiency. Specifically, pull financing mechanisms like Advance Market Commitments can help motivate investment in high-value innovations.
Approximately 800 million children around the world have dangerously high levels of lead in their blood—harming their health, stymying their learning, and preventing them from reaching their full potential.
But with better research, more funding, and policymaker prioritization, the world could dramatically reduce—and eventually eliminate—lead poisoning as a threat to all children.
CGD’ s new initiative on global lead poisoning seeks to generate new evidence on the educational and economic costs of lead poisoning in LMICs and mobilize support for mitigation and remediation. Watch this space for more over the coming months.
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions. | general |
Vapotherm Announces Preliminary Revenue for First Quarter of 2022 and Withdraws 2022 Annual Guidance | EXETER, N.H. -- ( BUSINESS WIRE) -- Vapotherm, Inc. ( NYSE: VAPO) ( “ Vapotherm ” or the “ Company ”), today announced preliminary unaudited revenue for the quarter ended March 31, 2022. The Company also announced withdrawal of its full year 2022 revenue guidance ( issued on January 12, 2022 and reiterated on February 24, 2022) together with its full year 2022 gross margin, operating expense and adjusted EBITDA guidance.
Preliminary First Quarter 2022 Financial Results
Preliminary revenue for the first quarter of 2022 is expected to be in the range of $ 20.5 million to $ 21.5 million, compared to $ 32.3 million for the first quarter of 2021.
Fiscal 2022 Outlook
The Company is withdrawing its previously announced annual revenue, gross margin, operating expense, and adjusted EBITDA guidance. This guidance was based in part on the assumption there would be two COVID-19 surges in 2022 with resulting revenue at 50% of prior surges. Based on what appears to be the diminishing virulence of COVID-19 ( resulting in less need for acute respiratory intervention), as well as a reduction of seasonal hospitalization patterns related to flu and RSV in the first quarter, the Company has elected to withdraw its guidance at this time.
“ The initial COVID-19 surge of 2022, related to the Omicron variant, as well as trends in flu and RSV cases played out as we expected in the first half of the quarter. However, in mid to late February we began to see signs of a slowdown in the number of COVID-19 related hospitalizations, especially of patients needing acute respiratory interventions. This slowdown significantly accelerated in March, as did the decline of hospitalizations due to flu or RSV. As a result, we are re-examining the assumptions which underlay our original 2022 guidance, ” commented Joe Army, President and CEO of Vapotherm. “ Despite the near-term uncertainty, we remain very enthusiastic about the long-term prospects of this business. We will continue to focus on educating our customer base on the benefits of our technology as a front-line therapy for all cause respiratory distress and work to drive the adoption of new product offerings, including HVT 2.0, Vapotherm Access and the Oxygen Assist Module. ”
The preliminary net revenue results are based on current expectations. Actual results are subject to completion of the Company’ s quarter-end financial closing procedures and review procedures by the Company’ s independent registered public accounting firm.
First Quarter Results Conference Call
Vapotherm plans to release financial results for the first quarter of 2022 after the close of trading on Wednesday, May 4, 2022. Vapotherm’ s management team will host a conference call beginning at 4:30 p.m. ET to discuss the financial results and recent business developments.
Website Information
Vapotherm routinely posts important information for investors on the Investor Relations section of its website, http: //investors.vapotherm.com/. Vapotherm intends to use this website as a means of disclosing material, non-public information and for complying with Vapotherm’ s disclosure obligations under Regulation FD. Accordingly, investors should monitor the Investor Relations section of Vapotherm’ s website, in addition to following Vapotherm’ s press releases, Securities and Exchange Commission ( “ SEC ”) filings, public conference calls, presentations and webcasts. The information contained on, or that may be accessed through, Vapotherm’ s website is not incorporated by reference into, and is not a part of, this document.
About Vapotherm | general |
Republicans block Senate debate on COVID-19 compromise legislation | WASHINGTON ( AP) — Republicans blocked a Democratic attempt Tuesday to begin Senate debate on a $ 10 billion COVID-19 compromise, pressing to entangle the bipartisan package with an election-year showdown over immigration restrictions that poses a politically uncomfortable fight for Democrats.
A day after Democratic and GOP bargainers reached agreement on providing the money for treatments, vaccines and testing, a Democratic move to push the measure past a procedural hurdle failed 52-47. All 50 Republicans opposed the move,...
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