Instruction: create a high quality summary of the given input

Input:
Colorado encourages apprenticeships to tackle labour shortages
 Colorado leaders are painfully aware that they need to find skilled workers to fill thousands of jobs. And they’re betting big on their new secret weapon: an apprenticeship program for high school students.

This fall, 116 teenagers from four districts have fanned out to 40 companies in Colorado in the inaugural year of the state’s apprenticeship program. Three days a week, the junior and senior students are at school, and two days a week, they’re earning minimum wage or more while they learn the ins and outs of finance, information technology, business operations, or advanced manufacturing.

Colorado has a grand vision for the outcome of this project: By 2026, 20,000 apprentices from all across the state will have finished high school with transferable college credit, at least one postsecondary credential, three years of work experience, and in most cases, an associate degree.

The program fits into an expanding national conversation about how schools can do a better job with the career side of the well-known mantra “college- and career-readiness.” A changing economy demands a workforce with sophisticated technical skills, and at least some training or education after high school.

Even with low national unemployment, many jobs are going unfilled as companies search for the talent with the skills they need . Searching for answers, policymakers are encouraging schools to use internships, work-based learning, and apprenticeships to expose young people to career ideas and build work experience. President Donald Trump is likewise urging high schools to offer apprenticeships .

In Colorado, the aim is to arm students with general work skills like good communication and time management, which can pay off in a wide variety of jobs, and industry-specific skills like software development or accounting. Each apprenticeship is based on a curriculum developed jointly by business, colleges, and K-12 schools.

The goal is to better position students to save time and money in college and compete for jobs and to supply a bigger pool of skilled workers for Colorado companies.

“We literally have tens of thousands of jobs every week that go unfilled,” said Ellen Golombek, the executive director of Colorado’s labor and employment department, which helped shape the apprenticeship program. “We’re taking a look at the entire work-based-learning spectrum to train, retrain, and ‘upskill’ the workforce to meet our current and projected needs.”

Colorado officials are also hoping to not-so- subtly make another point: Apprenticeships aren’t just for young people aspiring to traditional trade jobs like plumbing or electrical work.

Byoncé Reyna illustrates that point. The Denver 16-year-old hopes to be an elementary school teacher. But she’s over-the-top excited about her apprenticeship at an insurance company. Since early August, she’s been working two days a week at Pinnacol Assurance, which provides worker-compensation policies.

“Insurance is not exactly what I want to do in my life, but knowing how to take on tasks, how to work and thrive in a business environment, will help me in whatever I do,” she said.

Her apprenticeship has brought a bachelor’s degree within her reach, the 11th grader said.

“Coming from a single-parent household, college is really a stressful topic,” said Byoncé, whose mother works at an auto-financing company.

“With all the debt, it seemed like a crazy idea. But now that I can get halfway through college with no debt and a paid position, it’s mind-blowing. It’s more than I could ask for at such a young age.”

In her first few weeks at Pinnacol, Byoncé started with workplace skills, such as learning the Microsoft Office suite of computer tools, and, as she puts it, “how to maintain this young-professional persona and make sure people know we mean business.”

Now, under the watchful eye of a Pinnacol adviser, she’s rotating through underwriting, claims adjustment, and other departments. Over the next three years, Byoncé, a junior, will try her hand at various posts, spending more time at work, and less on her high school campus, as she gets closer to graduation.

By her third year, she’ll be taking community college classes and working three or four days a week at Pinnacol, building expertise in one specific area of the company.

Twenty-two other apprentices are working at Pinnacol, too. They all learn the 26 workplace competencies Colorado has built into the program, such as being a self-starter, teamwork, and thinking logically. But beyond that, they will find unique niches in the company as they rotate through various departments.

Some might gravitate toward working with clients over the phone, and others might take a shine to underwriting. Still others might choose to build their technology skills by developing content for Pinnacol’s website, said Mark Tapy, who is overseeing the company’s apprenticeship program.

Wading into the program is no small matter for companies. Pinnacol has agreed to pay 23 apprentices $9.60 per hour for two full days a week and as much as $12 or $15 per hour, three days a week, as they progress through the program.

Participating companies also pay $2,000 to $5,000 per apprentice for their courses at community colleges and other training providers.

There’s also the time and effort of writing the curriculum, which lays out specific weekly goals, and supervising teenagers as they learn. Pinnacol’s is a blend of general workplace competencies agreed upon by business, K-12, and higher education, and an insurance-specific course it developed with The Institutes , an organization that confers credentials for the insurance industry.

The way Pinnacol sees it, the effort is worth the payoff. The company and the industry nationwide anticipate a big wave of retirements in the coming decade, Tapy said, so Pinnacol can’t just wait around to see what happens.

“We’re trying to create a new talent-acquisition strategy for our organization, and our industry, to ensure that we retain some of the institutional knowledge we’ve had,” he said.

These kinds of economic shifts were on the minds of leaders in Colorado’s business and education sectors as they started to explore the apprenticeship idea last year. Led by Gov. John Hickenlooper, they organized a trip to Switzerland , where 40 percent of companies offer apprenticeships in more than 200 professions. About 70 percent of Swiss students participate in the world-renowned program.

They learned that companies make a net profit on their apprenticeship investments. Over three years, a Swiss economics professor told the delegation, companies spend $86,000 on average on each apprentice but get contributions valued at $95,000.

Research shows that Swiss students who take part in apprenticeships have lower unemployment and higher earnings than peers who stick to the exclusively academic track. Apprentices don’t end up stuck with their early job choices, either; Swiss research shows that later occupational changes are common.

With the Swiss system as a model, Colorado began planning its program as a way to keep students in the school pipeline, set them up for good jobs, and serve industry’s need for a skilled workforce. It decided to put businesses in the driver’s seat, using their needs as a starting point.

“If they’re not at the table, if they can’t tell us what they need, we’re flying blind” in trying to provide it, said Golombek, the state labor and employment director.

The state chose four focus areas for the apprenticeship program—finance, information technology, advanced manufacturing, and business operations—based on which businesses expressed interest in being part of the new system, she said. But they also had to be areas with high growth potential in Colorado’s economy.

A nonprofit organization, CareerWise Colorado , coordinates the many moving parts of the system. The organization convenes conversations with business and education to define apprenticeship competencies and figure out how to monitor and assess students’ progress.

It works with K-12 schools to infuse career exploration and specific career skills into coursework.

And it’s working with the state’s two- and four-year colleges to create articulation agreements that guarantee that students can transfer the credits they earn in the program.

“This requires new thinking, new models, and new partnerships, but this is a new economy,” said Kim Hunter Reed, the executive director of Colorado’s department of higher education.

The project has pushed education and business into a new, positive kind of relationship, said Gretchen Morgan, CareerWise Colorado’s president.

“In the United States, it’s hard for business and schools to have a practical way to be connected to each other to ensure that schools know enough about changing industry to be responsive,” she said. “When they share responsibility for apprentices, they have this very practical way to be in touch about the relevant competencies.”

Colorado has set ambitious goals for its initiative, and national experts are watching to see how it unfolds. One such expert sees big challenges ahead.

“The biggest challenge is getting employers to seriously play in this game,” said Robert B. Schwartz, who leads the Pathways to Prosperity Network , a group of states that work on career-readiness policies with Harvard University and Jobs for the Future.

In the United States, employers tend to “wait around to see what shows up on their doorstep,” while Swiss companies “get in at the front end” and help shape the education system so it produces the talent pool they need, said Schwartz, who has studied the Swiss apprenticeship system .

Creating a nationwide Swiss-style apprenticeship system would require that big shift in thinking from U.S. companies, he said.

And it would demand a radical restructuring of high schools that Schwartz said he doubts most schools would embrace: a “lower secondary” and “upper secondary” model, in which students spend the first two years on academics and career readiness, and the second evenly divided between work and study.

Output: Colorado's labour and employment department has partnered with non-profit organisation CareerWise Colorado to develop an apprenticeship initiative based on a successful Swiss model. The state apprenticeship programme allows K-12 students to work part-time with firms in the information technology, finance, business operations and advanced manufacturing sectors, earning at least the minimum wage and gaining college credits. The state hopes the scheme will not only encourage students to stay in education but also address a skills gap, which has left tens of thousands of job openings unfilled.


Instruction: create a high quality summary of the given input

Input:
Facebook pricing dynamics said to favour divisive political ads
 As the debate intensifies around Russian ad buys in the US election, a fundamental aspect of Facebook’s platform has gone mostly overlooked. Facebook’s auction-based system rewards ads that draw engagement from users by making them cheaper, serving them to more users for less money. But the mechanics that apply to commercial ads apply to political ones as well. Facebook has created a powerful system that dynamically, and unpredictably, changes the prices of political ads. The system also encourages polarization by incentivizing ads that users are predisposed to agree with.

Unless Facebook makes its internal data public, it’s impossible to say which ads reach which audiences, or how much candidates spend to reach them. After the 2016 presidential election, a senior Facebook employee said that Trump’s cost of reaching voters was substantially lower than Clinton’s, according to communications reviewed by The Verge. Trump was able to reach a larger audience than Clinton for less money, the employee said, illustrating the power of mastering Facebook’s ad platform. At a time when the company’s advertising business is under increasing scrutiny, Facebook’s platform dynamics could represent a new avenue for regulators to investigate.

The mechanics that apply to commercial ads apply to political ones as well

Most media outlets do not routinely set prices based on the content of the advertising, or how much their audiences are expected to enjoy it. But Facebook does: the company adjusts the number of people an ad will reach after it is posted and users began interacting with it. This approach has upended traditional approaches to political advertising, in ways that campaigns are only beginning to reckon with.

The Trump campaign’s mastery of Facebook advertising is well established. Speaking to Bloomberg Businessweek in the run-up to Election Day, the campaign’s digital agency, Giles-Parscale, said it generated more than 100,000 ad variations. Trump paid Giles-Parscale about $90 million to run ads, the majority of which ran on Facebook, where they were micro-targeted to an unknown number of disparate audiences. Clinton’s digital marketing efforts were led by Bully Pulpit Interactive, which the campaign paid $100 million.

A Facebook spokesperson said ad costs fluctuated for both candidates during the campaign, and that at different times each candidate had the advantage. The spokesperson argued that Facebook’s ad platform usually limits the spread of polarizing messages — messages that reflect the views of a minority of the population — by making them more expensive to distribute. This occurs naturally, because News Feed algorithms resist sharing items that are likely to drive people away.

But even as Facebook makes unpopular messages more expensive to distribute, it can still promote polarization on a grander scale: thanks to Facebook’s microtargeting capabilities, voters can see fewer viewpoints that they might disagree with, because Facebook algorithms treat disagreement as bad for the user experience. On one hand, the actual impact of these dynamics is unknown; public data simply isn’t available. But on its face, the ad engine would seem to promote the creation and exploitation of filter bubbles.

News Feed algorithms resist sharing items that are likely to drive people away

In the pre-digital era, political candidates seeking to buy advertising competed on a relatively even playing field. Candidates buying airtime on television shows, ad space in newspapers, or postage for direct mail, are charged roughly equivalent prices to reach the same amount of people. Since 1927, the equal-time rule has required radio and television stations to offer equivalent time to political candidates if they ask for it, and at the same price. It originated out of fears that broadcasters would refuse to sell time to political candidates — or sell it to them at unfair rates.

The fact that one of the country’s dominant political ad platforms throttles messaging based on its shareability is a fact political campaigns must reckon with, and adapt to. “It’s the same dynamic that BuzzFeed and Jonah Peretti really mastered,” says Tim Wu, author of The Attention Merchants, an examination and critique of ad technology on Facebook and other platforms. “Vitality depends on strong emotional responses, hence polarized messages, whether advertising or news or whatever, travel further.”

The Trump campaign did not respond to a request for comment. It has previously said the company’s advertising tools were essential to its strategy. “Without Facebook, we wouldn’t have won,” Trump digital campaign official Theresa Wong said in a BBC documentary last month. Representatives of the Clinton campaign declined to comment.

To place an ad on Facebook, a political campaign has to win an automated auction. At any given time, millions of advertisers are competing to place ads in front of Facebook’s 2 billion-plus daily users. Advertisers can price their ads by the number of people who see it, the number of people who click on a link, or the number of people who engage with the ad, such as by watching a video or installing an app. Facebook averages out the cost of these various ads into a figure it calls an “eCPM” — the effective cost per 1,000 impressions.

The CPM is a standard measurement in the advertising industry. But Facebook’s ads differ from traditional ads in an important way: the company offers advertisers a monetary incentive to create more engaging ads. As users begin to click, share, and engage with an ad, Facebook begins showing it to more people. That lowers the eCPM, often allowing advertisers to reach a larger audience for the same amount of money. In some cases, Facebook’s automated systems will choose to display ads that had lower bids, if it believes the content of the ad will draw more engagement from users. The monetary goal of this system is to keep users scrolling through the News Feed, maximizing the number of ads that they encounter.

Facebook offers advertisers a monetary incentive to create more engaging ads

It’s the same approach that Facebook takes to the News Feed generally. Your friends’ status updates, links from publishers, and longform videos all compete for slots in the News Feed. Facebook shows each one to a subset of the account’s friends or followers, and expands that number as people read, watch, comment, and share. It’s the system that has turned the News Feed into one of the most engaging and lucrative products of all time — one that generated $17 billion in ad revenue in the first half of this year.

But the incentive structure that works so well for commercial advertising has unintended consequences when applied to political advertising. Over the past year, problems caused by the spread of more “engaging” content have repeatedly put Facebook on the defensive. Hoaxes and fictional news stories about the election were among the most engaging stories on Facebook in 2016, and the company’s algorithms generated a fire hose of readers for them as a result, generating as much as $10,000 a month in ad revenue for some solo publishers pushing fake news.

The form and content of political ads are largely unregulated — unlike commercial ads, where advertisers can be held accountable for the claims they make. Treating commercial and political speech as equals by rewarding viral posts can foster polarization.

“If you think of this as a game of incentives, that would incentivize campaigns to not only target their messages, but to target them in ways that would further inflame and polarize opinions,” said Michael Franz, co-executive director of the Wesleyan Media Project, which archives and analyzes political messages, “not only as a mechanism to increase support among your base, but also as a mechanism to make it cost-efficient.”

“Facebook’s profits depend on people coming back, clicking and sharing things.”

“Facebook’s profits depend on people coming back, clicking and sharing things,” said Alex Howard, deputy director of the Sunlight Foundation, which advocates for transparency in political advertising. “It’s not based on, ‘did we arrive at a resonated discourse on this policy proposal?’ or ‘did the best questions get asked at this town hall?’ or ‘did this politician get fact-checked on the lies that he or she was propagating?’”

Recently, Mark Zuckerberg laid out a nine-point plan primarily aimed at reducing the influence of foreign governments and other bad actors — requirements like labeling ads with disclosures about who paid for them and collecting them on pages where the public can inspect them. The steps, he said, would work “to protect election integrity and make sure that Facebook is a force for good in democracy.”

Despite the changes, the ads themselves will still be sold and distributed in the same way, offering the broadest and least expensive reach to the most-clicked and shared ads that candidates create.

Whether or not promoting built-to-share political ads swayed the 2016 election, it appears that, at the very least, Facebook’s algorithms granted them a wider reach. The tactic perfected by the Trump campaign — creating countless variations of ads, and then targeting them narrowly to as many niche groups as possible — will likely be studied and adopted by candidates around the world.

In the meantime, public interest groups and observers have called on the FEC to initiate a new rulemaking proceeding to create new regulations for political advertising on social media platforms. “They need to reexamine all the federal campaign finance laws and how they apply to new technology,” said Paul S. Ryan, vice president for policy and litigation at Common Cause. Ryan noted that the last such proceeding took place a decade ago. Former FEC commissioner Ann Ravel called for such a rulemaking proceeding three years ago, but was rejected by the commission’s Republican members.

Wu recently told New York magazine, “Facebook should be required to screen and disclose what their advertising practices are, how much people are paying, whether people get the same rates.”

Output: Facebook's advertising price structures reward provocative and polarised messages, according to analysts. The platform's systems respond to ads that gain shares and likes, showing them to more users and reducing the overall cost to the client. In the 2016 US election, this led to Donald Trump's messages reaching more Facebook users than those of Hillary Clinton, despite his campaign spending less money on them. Campaigners for transparency have called for federal regulations on online advertising to ensure that all candidates are charged the same rate for adverts, as is the case for TV advertising.


Instruction: create a high quality summary of the given input

Input:
Make School raises $10m for practical computer science learning
 According to a recent SEC filing, edtech startup Make School has raised $10.1 million in financing from an undisclosed investor.

Make School aims to create a replacement for computer science degrees. Its Product Academy is a two-year college alternative where students can learn mobile and web development, computer science theory, AI, IoT and development-focused career skills. The year culminates with an internship at a tech startup.

Make School’s curriculum has been used to teach courses at three of the top four universities for computer engineering. More than 500 students have taken its in-person courses and more than a million people have used its online tutorials.

Output: San Francisco edtech start-up Make School has raised $10.1m in funding from an undisclosed investor, according to a recent US Securities and Exchange Commission filing. Through its two-year Product Academy, which it bills as an alternative to college, Make School offers courses on everything from computer science to artificial intelligence. The company has had more than one million online tutorial users and upwards of 500 in-person students.


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Input:
China's surge in breast cancer cases expected to continue
 Stay ahead of the trend in fashion and beyond with our free weekly Lifestyle Edit newsletter Stay ahead of the trend in fashion and beyond with our free weekly Lifestyle Edit newsletter Please enter a valid email address Please enter a valid email address SIGN UP I would like to be emailed about offers, events and updates from The Independent. Read our privacy notice Thanks for signing up to the

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Breast cancer is the most common cancer among women in China, according to the latest data from China’s national cancer registry. An analysis of the data reveals that the cancer has increased at a rate of around 3.5 per cent a year from 2000 to 2013, compared with a drop of 0.4 per cent a year over the same period in the US.

The analysis also reveals that breast cancer rates are higher in urban areas of China than in rural areas. And the higher the population density, the higher the rate. For small cities (population below 500,000), the incidence of breast cancer is 30 per 100,000. For medium-sized cities (population between 500,000 to one million), it is 40 in 100,000. And for large cities (population above one million), the incidence rate is 60 per 100,000 women.

With the rapid development of China’s economy, more and more people have moved from rural areas and towns to large cities. As a result, many “megacities” have sprung up. By 2014, China had six megacities with populations above 10 million. It is very likely that urbanisation is having a big impact on breast cancer incidence in China.

Below is a list of some of the factors that may be behind the rise in breast cancer incidence in China.

Childbearing: having more than one child lowers breast-cancer risk. With the one-child policy in place since 1979, most women – especially if they worked in the city – had to strictly follow the policy in order to avoid being fined. Although the one-child policy rule was replaced in 2015 with a two-child policy rule, the possible benefit on breast cancer incidence will probably take 15 to 20 years to show.

A broadcast television awareness event in Hangzhou in 2015 (Getty)

Research also shows that the women who have their first child at age 35 or younger tend to have a protective benefit from pregnancy. However, in China, many women have chosen to delay having a child as a result of work pressure and cultural change.

Women are also less likely to breastfeed than previous generations, which may be another contributing factor. Research has shown that both pregnancy and breastfeeding reduce a woman’s risk of developing cancer, because they reduce the lifetime number of menstrual cycles. As a result, women are exposed to less oestrogen. (Oestrogen can stimulate breast cancer cells to grow.) It has also been hypothesised that breast cells need to mature in order to produce milk and mature cells are more resistant to becoming cancer cells.

Mastectomy: Stand Up To Cancer launches powerful photo campaign Show all 13 1 / 13 Mastectomy: Stand Up To Cancer launches powerful photo campaign Mastectomy: Stand Up To Cancer launches powerful photo campaign Joanna, Newcastle (Image: Ami Barwell) Mastectomy: Stand Up To Cancer launches powerful photo campaign Mel, Merseyside (Image: Ami Barwell) Mastectomy: Stand Up To Cancer launches powerful photo campaign Lucy, Wakefield (Image: Ami Barwell) Mastectomy: Stand Up To Cancer launches powerful photo campaign Sharon, Bath (Image: Ami Barwell) Mastectomy: Stand Up To Cancer launches powerful photo campaign Jan, Hereford (Image: Ami Barwell) Mastectomy: Stand Up To Cancer launches powerful photo campaign Gillian, London (Image: Ami Barwell) Mastectomy: Stand Up To Cancer launches powerful photo campaign Fiona, Northampton (Image: Ami Barwell) Mastectomy: Stand Up To Cancer launches powerful photo campaign Anon S, West Midlands (Image: Ami Barwell) Mastectomy: Stand Up To Cancer launches powerful photo campaign Debbie W, Worcestershire (Image: Ami Barwell) Mastectomy: Stand Up To Cancer launches powerful photo campaign Debbie B, York (Image: Ami Barwell) Mastectomy: Stand Up To Cancer launches powerful photo campaign Clare, North Lincolnshire (Image: Ami Barwell) Mastectomy: Stand Up To Cancer launches powerful photo campaign Caroline, Brancaster (Image: Ami Barwell) Mastectomy: Stand Up To Cancer launches powerful photo campaign Anon (Image: Ami Barwell)

Researchers in China have found associations between these “reproductive factors” – including oral contraceptives and hormone-replacement therapy – and the rise in breast cancer incidence in China.

Stress: this is more likely to be experienced in large cities and has been linked to increased risk of developing cancer. Although stress may not directly cause cancer, it does affect the levels of various hormones and it suppresses the immune system. And, once cancer has developed, stress is believed to aid its progression.

Lifestyle: in modern China, women are generally less physically active than they were in previous generations. A study published in the International Journal of Behavioural Nutrition and Physical Activity, shows that levels of physical activity for adults in China fell by nearly half between 1991 and 2011, and they declined more rapidly for women than for men.

An unhealthy diet is also increasingly common in urban China, with a proliferation of fast-food outlets. This has resulted in an increase in obesity among Chinese women.

Increased alcohol assumption has long been associated with the increased risk of developing breast cancer and a World Health Organisation bulletin notes that, in China, alcohol consumption is increasing faster than in other parts of the world.

Ageing: this is the biggest risk factor for breast cancer. Women are living longer in China, which is a key factor related to the increased incidence of breast cancer in the country. As people get older, there is more genetic damage and less ability to repair the damages.

Even though the prevalence of breast cancer among women in China is lower than in many developed countries, the rapid increase in incidence of the disease – which is also being witnessed in India – is cause for great concern.

An awareness event in Pudong in 2013 where participants tried to break the record for the world’s largest ball pit (Reuters)

Because of China’s large population, even with a small percentage of improvement on cancer prevention, a sizeable number of women’s lives could be saved. There are many risk factors that can be reduced by raising cancer awareness and having better education on diet, exercise, stress reduction as well as improving breast cancer screening. Public health authorities can play a crucial role in developing well-defined strategies to tackle the issue and reduce the breast cancer burden in China.

Jin-Li Luo is a senior bioinformatician at the University of Leicester. This article first appeared on The Conversation (theconversation.com)

Output: Breast cancer rates have risen at a rate of around 3.5% annually in China between 2000 to 2013, according to data from China's national cancer registry. Potential reasons for the rise include the after-effects of China's one child policy, increased stress of living in urban cities, performing less physical activity than before and increasingly unhealthy diets, including a rise in alcohol consumption, which is prevalent in the urban areas.


Instruction: create a high quality summary of the given input

Input:
Michelin envisages 3D-printed airless tyre that won't go flat
 Bridgestone's "Air Free Concept" tires may represent the future of bicycle tires. Or not.

The most common bike malady, a flat tire, isn't necessarily that hard or costly to repair, but it also seems to often occur at the most inopportune moments, so even if you're prepared with a patch kit, tire tool, and pump, it still requires a bit of time and effort. And if you're not equipped to handle it when it happens, a flat tire can be a real pain in the gear.

However, if your bike tires were airless, as some companies are promising for the near future, then flats could be a thing of the past, as they won't need inflation, patching, or tube replacements. It's not just a fringe manufacturer thing, either, as a major tire manufacturer is looking to enter the market with a new non-pneumatic bike tire within the next two years.

Bridgestone, which is said to be the world’s largest tire and rubber company, is revisiting a tire technology initially developed for cars, with the aim of getting its bicycle "Air Free Concept" tires into production by 2019. While Michelin also worked to develop an airless car tire (the Tweel, which is an available upgrade for lawn tractors now) over ten years ago, and Bridgestone has presented its version at car shows over the last few years, the company's focus on developing an airless bike tire seems to be gaining more traction now.

According to the company, "The “Air Free Concept” is a technology that eliminates the need for tires to be inflated with air to support the weight, using a unique structure of spokes stretching along the inner sides of tires. In addition, the resins that are used in the spokes and rubbers help realize more efficient use of resources."

© Bridgestone

At first glance, these new tires look a bit odd, but the idea itself seems sound, as eliminating a common pain point for casual cyclists could make bike transportation a bit easier. And if the price was right, investing in a pair of airless tires could work out to be a better deal over the long run, when considering the cost of new tubes and tires, plus the time spent patching or replacing them over the years.

However, a few things came to mind when considering the "Air Free Concept" tire, such as the potential added drag from "spokes" that are more like fan blades than spokes, and the fact that they require a whole new wheel to use. You can't just replace your current bike tire with one of these, as everything from the hub out to the rim is an entirely different system, and because every single bicycle shop on the planet is set up to build and repair conventional spoke wheels that roll on a standard tube and tire combination, getting a new type of tire and wheel to a certain critical mass of adoption might be an epic effort. The Nexo tires look like a much easier sell to cyclists, as they can be fitted to existing wheels, but who knows, with Bridgestone behind this new tire concept, perhaps the company will be able leverage its massive influence to boost adoption rates.

As for me, I kinda like being able to adjust the inflation level on my mountain bike tires to match the riding conditions on the trail, so I would probably steer clear of a tire design that couldn't do that, even with the risk of flats. And as any cyclist who lives in flat tire country knows (goatheads are my personal bicycle nemesis), a tire liner and some goo (True Goo is the shiz) will keep you rolling through most minor punctures, and is a cheap and effective remedy that can be applied to pretty much any bike tire. But your mileage may vary, in which case a non-pneumatic bike tire might just be what you need.

h/t Core77

Output: A new 3D-printed car tyre that won't go flat and can be easily retreaded has been proposed by Michelin. Its Vision tyre could be produced from organic recyclable compounds instead of petroleum-based materials and would consist of a solid sponge-like structure, removing the need for it to be filled with air, the company said. The concept model would also contain smart sensors to monitor wear, and could be retreaded by 3D-printing a new layer on top of the existing tyre, reducing waste.


Instruction: create a high quality summary of the given input

Input:
China's tourists shift towards local destinations
 Tourists from China visit Ephesus, an ancient Greek city located near present-day Selcuk, Izmir Province, in Turkey, on Aug. 27, 2017. Mikhail Svetlov | Getty Images

Last week 6 million Chinese tourists traveled abroad during a national holiday, and that likely meant big paydays for traditional tourist destinations, such as London or Paris. But, increasingly, China's travelers are taking their families — and their money — to less conventional locales. All told, more than 700 million in China traveled during the semi-annual Golden Week holiday from Oct. 1 to Oct. 8, according to the government. And while the couple million tourists who took the week to go abroad mostly visited longtime Asia favorites, there're indications that new countries are catching their attentions. That is, four of the five most popular international destinations among Chinese tourists during the eight-day holiday were located in Asia, according to travel bookings platform Trivago . Those locations included Hong Kong, Tokyo, Osaka and Bangkok, with Paris the lone European city in the top five.

'Hot new locations'

Besides those mainstays, mainland tourists bitten by the travel bug are also increasingly adventurous. Some are looking farther afield for their next vacation and others eschewing the traditional package tours in favor of self-planned trips. These were the "hot new locations" that saw greater than 50 percent growth in the number of tourist bookings this year, according to Ctrip , one of the largest travel services providers in China. Expedia-owned Trivago also mentioned similar trends: Morocco

Turkey

The United Arab Emirates

The Czech Republic

Finland

Austria

Germany

Vietnam

Cambodia

Italy Accompanying the growing desire to visit those destinations is the increased demand for more personalized holiday experiences, market research shows. Tailor-made travel services are fast becoming customary among wealthy travelers looking to escape cookie-cutter vacation packages. According to Ctrip, factors that more Chinese tourists are seeking out from their holidays include "avoiding big crowds," "no shopping" and private travel guides. When travelers visit places others haven't, they can derive "social cachet," and that's become a trend among the middle class, according to Ben Cavender, a principal at consultancy China Market Research Group. "Increasingly, we are seeing well-heeled Chinese travel to hard-to-reach destinations for the bragging rights and WeChat pictures [to] show they've been somewhere exotic," he said.

The big picture

Still, overall travel patterns for the year show that major Asian countries continue to make up most of the top destinations visited by mainland travelers. Both Trivago and Ctrip said Japan, Singapore, Vietnam, Hong Kong and Taiwan were among the most in-demand locations for Chinese tourists traveling overseas. More than 70 percent of Chinese tourists traveling abroad will visit other Asian countries this year, according to Ctrip. Of those Asia-bound travelers, 45 percent will head to countries in Southeast Asia, with Thailand proving the most popular destination in that region, a Ctrip spokesman told CNBC. Meanwhile, those tourists are also willing to spend more — and not just on shopping.

watch now

"We see that Chinese travelers are spending more and more," Trivago CEO Rolf Schromgens told CNBC's "Squawk Box" on Monday. Chinese tourist expenditure on hotel rooms has increased 23 percent compared to the year before, he added. Contrary to the "stereotype of Chinese tourists," an increasing number of mainland travelers are now more willing to spend on experiences, with luxury hotels and unique travel services starting to form a larger expenditure item for many, according to Ctrip.

Staying local

Still, for most Chinese travelers, domestic destinations took the crown, especially during Golden Week. About 59 percent of searches on Trivago were for domestic travel during the period, a spokeswoman said. Destinations that Chinese tourists were most interested in visiting for the holiday included Beijing, Xi'an, Chengdu, Chongqing and Shanghai, according to Trivago. Those results fit in the wider trend of a pick-up in domestic travel: Domestic trips made by Chinese tourists increased 13.5 percent in the first half — exceeding the 5.1 percent rise in overseas travel recorded in the same period, Reuters said.

Tourists view the Qiantang River Tide at Haining during the National Day holiday on Oct. 7, 2017 in Jiaxing, Zhejiang Province, China. Domestic travel destinations were popular among Chinese tourists during the Golden Week holiday this year. VCG | Getty Images

Output: Chinese tourists are increasingly opting for more local destinations for their overseas holidays. During the semi-annual Golden Week holiday, during which over 700 million Chinese citizens travelled abroad, four of the five most popular overseas cities were located in Asia - Hong Kong, Tokyo, Osaka and Bangkok - with Paris the only European city listed in the top five. Figures by Trivago also showed that Chinese tourists are expanding to new locations such as Morocco, Turkey, UAE, the Czech Republic, Finland, Austria, Vietnam and Cambodia. Furthermore, there is an increasing call for exclusive, tailor-made travel services rather than vacation packages, said Ctrip.


Instruction: create a high quality summary of the given input

Input:
How Amazon becoming a pharmacy could lower the price of drugs, according to Morgan Stanley
 Morgan Stanley has a new report out for investors that outlines how Amazon 's potential push into pharmacy would benefit consumers.

In the first phase, the authors speculate that Amazon could open "virtual retail pharmacies," leveraging its Prime Now network for millions of U.S. consumers to buy drugs online.

"Amazon could use a lighter brick and mortar footprint to drive pricing down," the report reads.

It would not be a huge challenge for Amazon to become a pharmacy and get added to existing pharmacy benefits managers' networks, the authors suggest. The reason for that is that "employers are already inquiring about Amazon's potential role," which means that pharmacy benefits managers would be unlikely to lock Amazon out.

Secondly, the company could establish relationships with manufacturers of inexpensive generic drugs.

And finally, and most critically, Amazon would build partnerships with makers of branded drugs.

If the company is successful, Morgan Stanley expects that the rebates and other discounts that are currently retained by companies including the pharmacy benefits managers could "pass back to consumers."

All of this could take a "long time," according to the researchers, but it's doable for a company with Amazon's resources and scale.

Late last week, CNBC reported that Amazon will make a final decision in the next four to six weeks about whether it will move into the drug supply chain. It's still an open question for the company, as pharmacy is a huge market but is highly complex.

Pharmacy stocks plummeted in the wake of the news report.

While CVS Health, Rite Aid and Walgreens are considered to be most at risk, Morgan Stanley suggests that some companies in the drug supply chain are more insulated. These include Diplomat, as Amazon might not touch the specialty drug market, and UnitedHealth's Optum, which may be a potential partner rather than a competitor.

Output: Morgan Stanley has a new report out for investors that outlines how Amazon's potential push into pharmacy would benefit consumers.  In the first phase, the authors speculate that Amazon could open "virtual retail pharmacies," leveraging its Prime Now network for millions of U.S. consumers to buy drugs online.


Instruction: create a high quality summary of the given input

Input:
House Republicans Ramp Up Scrutiny of Providers in Drug Discount Program
 House Republicans are intensifying scrutiny of a federal program that gives thousands of safety-net providers hefty discounts on prescription drugs but that they say doesn’t have effective tools to track where the savings are going.

The 340B Drug Pricing Program makes some providers, such as children’s hospitals, federal health centers and specialty clinics, eligible for discounts of between 25 to 50 percent on outpatient drugs. Providers are supposed to use the generated savings to ensure low-income patients have access to essential health services and treatments.

The 340B program has had bipartisan support in Congress since it was signed into law in 1992, and lawmakers from both parties have opposed a reimbursement rate cut to the program that the Trump administration proposed in order to generate what it says would be $900 million in savings in the 2018 calendar year.

But some GOP lawmakers do have concerns about how providers are using the savings they get on drugs. Drugmakers, which can only participate in Medicaid if they agree to sell outpatient drugs at discounts to 340B providers, have also raised concerns about how the savings are handled.

Republicans’ concerns spurred the House Energy and Commerce Subcommittee on Oversight to begin an investigation in July into federal oversight of the program.

At a hearing on Wednesday, the committee’s chairman, Greg Walden, (R-Ore.) said some providers recently interviewed by the committee don’t have policies in place to ensure all their eligible patients directly benefit from the program or track their 340B savings on a regular basis.

“This lack of transparency and coherent reporting requirements is concerning,” Walden said. “Frankly, without the data it is hard to know whether this program is working.”

The Health Resources and Services Administration, which oversees the program, says participating entities are supposed to use the savings to “stretch scarce federal resources as far as possible,” but federal law doesn’t clarify where the savings should go, nor does it require providers to then prescribe outpatient drugs at discounted prices to uninsured patients.

Officials from five 340B providers spoke at the Wednesday hearing on how they use the savings. While all the officials who testified said under oath that their organizations sell the drugs at a discount to all eligible patients, Rep. Ryan Costello (R-Pa.) said inconsistencies between providers makes it impossible for federal oversight officials to ensure there is compliance across the board.

The investigation could lead to legislative action, said Rep. Buddy Carter (R-Ga.), a member of the oversight subcommittee.

“We need to make some changes to it and yes, we’re looking at legislation to do just that,” he said in a brief interview on Wednesday.

Rep. Frank Pallone of New Jersey, the top committee Democrat, said he could support action to improve transparency in the program, but he and other Democrats pushed back against concerns that hospitals are misusing the savings, citing recent interviews conducted by the committee’s minority members with safety-net providers.

“While I am always happy to have a conversation about strengthening the 340B program, it is plain from the responses we have received that 340B-covered entities are using their savings to serve the community, and Congress should commend and support these efforts,” Pallone said in an opening statement, according to a transcript of his prepared remarks.

Output: House Republicans are intensifying scrutiny of a federal program that gives thousands of safety-net providers hefty discounts on prescription drugs but that they say doesn’t have effective tools to track where the savings are going.


Instruction: create a high quality summary of the given input

Input:
'Trump effect' will double prices of many California Obamacare health plans next year
 Threats by President Donald Trump to ax crucial payments to health insurers will double, on average, the price of most Obamacare plans in California next year.

Obamacare officials in the Golden State on Wednesday said they are slapping a 12.4 percent surcharge on the prices of so-called silver individual health plans in 2018 because of uncertainty over whether Trump will continue making those payments.

And it will be taxpayers, not the insurance customers themselves, who will end up footing much of the bill.

Without the surcharge, silver plans sold on Covered California, the state's Obamacare marketplace, would have risen an average of just 12.5 percent next year, officials said as they revealed overall prices statewide.

With the surcharge, the average price hike is just shy of 25 percent.

For individual insurers, the actual added surcharge per plan will be anywhere from 8 percent to 27 percent.

About 6 out of 10 customers of Covered California are enrolled in silver plans, which cover 70 percent of enrollees' health costs.

Covered California said that even with the surcharge, 78 percent of customers who qualify for federal subsidies to reduce their monthly premiums will "either see no change in what they would pay for insurance in 2018, or would pay less than what they would have paid if there had been no ... surcharge."

That is because the value of those premium subsidies, which are in the form of federal tax credits, rises with the retail price of the health plan. In "many" cases, Covered California said, subsidized silver plan customers will see their subsidies rise more than the amount of the surcharge.

Output: Threats by President Donald Trump to ax crucial payments to health insurers will double, on average, the price of most Obamacare plans in California next year. Obamacare officials in the Golden State on Wednesday said they are slapping a 12.4 percent surcharge on the prices of so-called silver individual health plans in 2018 because of uncertainty over whether Trump will continue making those payments.


Instruction: create a high quality summary of the given input

Input:
California Slaps Surcharge On ACA Plans As Trump Remains Coy On Subsidies
 California’s health exchange said Wednesday it has ordered insurers to add a surcharge to certain policies next year because the Trump administration has yet to commit to paying a key set of consumer subsidies under the Affordable Care Act.

The decision to impose a 12.4 percent surcharge on silver-level health plans in 2018 means the total premium increase for them will average nearly 25 percent, according to Covered California. Taxpayers, not consumers, will bear the brunt of the extra rate hike because federal premium assistance for policyholders, which is pegged to the cost of coverage, will also increase.

Statewide, rate increases will vary by insurer and region. What consumers pay depends on where they live, their income, what level of coverage they want and which insurer they choose.

Californians can get their first look at next year’s health plan prices and options on the state’s rate calculator, released Wednesday.

The state’s open enrollment period, which is longer than that for the federal exchange, runs from Nov. 1 to Jan. 31. About 1.4 million Californians buy their own coverage through the state marketplace and nearly 90 percent receive financial assistance that reduces what they pay.

In August, Covered California announced that 2018 premiums would rise by 12.5 percent, on average, statewide. That ticked down slightly to 12.3 percent during regulatory review. But the exchange also warned that the additional increase, averaging 12.4 percent, would be added to the silver-tier plans if President Donald Trump failed to commit to continued funding for the so-called cost-sharing subsidies that help reduce some consumers’ out-of-pocket expenses. Those payouts total about $7 billion this year nationwide.

Trump has continued paying them on a month-to-month basis while repeatedly threatening to cut them off and repeal the entire health law. He has referred to the payments as “bailouts” for insurance companies.

Peter Lee, executive director of Covered California, said the surcharge is far from ideal but that the uncertainty in the nation’s capital left the state with no other option.

“Covered California worked hard to come up with a plan that ensures a stable market and protects as many consumers as possible from an unnecessary price hike,” Lee said in a statement Wednesday.

The exchange took several measures in an attempt to shield consumers from the effects of the surcharge. One of them was to create a new silver plan to be sold outside the exchange to individuals and families who make too much money to qualify for federal subsidies. The surcharge will not be applied to those plans, sparing unsubsidized consumers that extra cost.

The surcharge will apply only to the silver-level plans, the second-least expensive option among the exchange’s four tiers of coverage. That’s because only people enrolled in silver plans benefit from the cost-sharing subsidies that Trump has threatened to terminate.

Covered California said that 78 percent of subsidized consumers will see no change in what they pay or may pay even less despite the surcharge being imposed. The remaining 22 percent of consumers will see higher net premiums. About half of those consumers will get increases of less than $25 per month, according to the exchange.

John Baackes, chief executive of L.A. Care Health Plan, said his 2018 rates will be 11 percentage points higher because of the added surcharge — a 23 percent average increase instead of 12 percent. His health plan has about 26,000 exchange enrollees. He said the higher premiums would be “totally avoidable” if the Trump administration implemented the ACA.

“We have to lay the blame for this at the foot of the Trump administration for being so irresponsible about this major portion of the law,” Baackes said. “This will not be a burden on most consumers, but it will be a higher cost to the U.S. Treasury. It all seems so ridiculous.”

Anthony Wright, executive director of the advocacy group Health Access California, criticized the Trump administration for playing “political games” with people’s health coverage and forcing Covered California’s hand.

“Even with Covered California’s workaround, consumers are facing additional complexity and confusion, if not costs, all because of the Trump administration’s contemptuous actions,” Wright said.

The last-minute changes, less than three weeks before the start of open enrollment, are likely to confuse some consumers.

In addition to higher rates, Covered California faces the loss of a major insurer across much of the state. In August, Anthem Blue Cross said it was pulling out from about half of California’s counties, forcing 153,000 customers to find new coverage.

The state has boosted its marketing budget by $5.3 million for the coming year to help Anthem customers research their options and to deal with questions stemming from the surcharge.

California’s Obamacare rates have been a key barometer of how the Affordable Care Act is working since coverage began in 2014. The state held rate increases to 4 percent the first two years and then premiums jumped 13.2 percent, on average, for 2017.

These rate increases apply to people who purchase their own coverage in the individual market, not the majority of Americans who get their health insurance through work or government programs such as Medicare and Medicaid.

Some members of the U.S. Senate have attempted to craft a bipartisan deal to fund the cost-sharing subsidies for up to two years in a bid to stabilize the exchange markets nationwide. But those negotiations stalled last month when Senate Republicans pursued the Graham-Cassidy legislation, the latest GOP attempt to roll back President Barack Obama’s signature law. Like previous repeal attempts, it failed to muster enough support in the Senate.

State officials and health insurers across the U.S. have faced tough decisions on whether to proceed with higher rates to compensate for the uncertainty swirling around the Affordable Care Act. Deadlines were pushed back repeatedly as insurance commissioners and exchange directors pleaded with Trump and Congress to shore up the existing market so insurers would stick around and rate increases could be minimized.

“Carriers across the country need certainty, and a federal commitment to funding [cost-sharing reduction] payments would lower rates in many states,” Lee said Wednesday.

In Idaho, for example, the average rate for silver plans will increase 40 percent in 2018, double what the rate hike would have been had the Trump administration committed to funding the cost-sharing subsidies, according to Dean Cameron, director of the state’s Department of Insurance.

If the cost-sharing subsidies are continued into next year, the added surcharges could mean insurers will end up collecting too much in premiums, and some arrangement will have to be made to return the excess money.

Trump has continued to rail against Obamacare, pointing to huge rate increases around the country and insurance companies fleeing the market. Rather than amending the Affordable Care Act, Trump favors other proposals to help make health insurance more affordable for individuals and families.

This week, he is expected to issue an executive order that would allow people and small businesses to join together and buy health insurance through what are known as association health plans.

Details haven’t been released yet, but some health-policy experts say these new health plans could further destabilize the ACA’s insurance markets if they aren’t subject to the health law’s regulations.

On Tuesday, Trump tweeted that “since Congress can’t get its act together on HealthCare I will be using the power of the pen to give great HealthCare to many people — FAST.”

Kaiser Health News reporter Rachel Bluth in Washington, D.C., contributed to this story.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Output: California’s health exchange said Wednesday it has ordered insurers to add a surcharge to certain policies next year because the Trump administration has yet to commit to paying a key set of consumer subsidies under the Affordable Care Act.


Instruction: create a high quality summary of the given input

Input:
Telehealth picks up speed as providers see value despite challenges
 KLAS partnered recently with the College of Healthcare Information Management Executives to ask more than 100 healthcare organizations about their plans for telehealth deployments.

Despite ongoing questions about reimbursement and regulation, virtual care platforms are finding favor for scheduled and patient-focused visits, on-demand and consumer-focused meetings and telespecialty consults, the groups found.

[Also: CIO shares keys to a successful telehealth program]

The benefits to patients have been worth the efforts to expand their reach, KLAS and CHIME said, even given the continuing uncertainty and financial challenges.

Cost, reimbursement levels, issues with the technology itself and its impact on the patient experience were among the concerns voiced by those providers surveyed. Nonetheless, most said they planned to either expand their telehealth programs to improve patients' access to care.

The report sees telehealth being used for three main purposes: patient-focused visits, enabling patients to schedule clinical meetings virtually; on-demand or consumer-focused purposes, to decrease the costs for patients and providers by dealing remotely with urgent or non-emergency care, and telespecialty consultations, connecting patient with specialists by video.

Patient convenience was one of the top drivers for telehealth, according to KLAS and CHIME – who noted that the success of the medium depends on patients having a high opinion of its value.

"Telehealth offers a great opportunity to enhance the lives of patients by making healthcare accessible to them wherever they may be," said Russell P. Branzell, CEO and president of CHIME. "Our members are advocates for improving patients' lives through innovations like telehealth. But it needs to be carefully implemented to meet its potential and we still face headwinds with reimbursement and integration issues."

Indeed, about half of those interviewed for the study said reimbursement was a challenge, with payers – whether private insurers, Medicare or Medicaid – often slow to reimburse virtual visits at rates comparable to face-to-face care. That often makes it hard for hospitals to make a compelling business case for telehealth, even if it's valuable for patients.

"Billing and reimbursement are factors that limit our ability to expand our telehealth program," said one director interviewed for the report. "There are things that we would like to expand to, but we just can’t get paid for them yet, so that is the major hurdle for us at the moment. In our state, we get reimbursed for the vast majority of telemedicine. We are getting reimbursed for about 90 percent of our telehealth visits. But there are some things that we would like to do that we can’t get the health plans to pay for and that the state doesn’t reimburse us for."

"The funding for telehealth, in general, is not where it needs to be," said another VP. "There is an out-of-pocket component, but if our most vulnerable populations who need telehealth don’t have the financial resources to pay for that care, they go without it. So telehealth services should be available for everyone. That is where the reimbursements need to come in."

Technology integration challenges were another big concern. Many respondents reported that integration between their electronic medical record and virtual care platform was "nonexistent or unidirectional," according to KLAS and CHIME.

"Telehealth holds enormous promise," said Adam Gale, president of KLAS. "However, the underlying technology needs to evolve faster. In particular, integration of telehealth with provider EMR's is still at a primitive level. Vendors need to step up in terms of technology and improved support."

Those challenges aside, telehealth's forward momentum seems to be continuing as more and more providers see the value it creates for their patients and for their own population health management strategies.

"We are going to provide a level of convenience for our patients that they want," said one healthcare executive. "Providing an opportunity for patients to receive care is what patients are going to appreciate. Another benefit is the care outcome for patients. Telehealth helps increase compliance rates for patients who are discharged and need follow-up appointments."

Twitter: @MikeMiliardHITN

Email the writer: mike.miliard@himssmedia.com

Output: KLAS partnered recently with the College of Healthcare Information Management Executives to ask more than 100 healthcare organizations about their plans for telehealth deployments.


Instruction: create a high quality summary of the given input

Input:
HIMSS issues interoperability ‘Call to Action’
 HIMSS issues interoperability ‘Call to Action’

HIMSS ‘CALL TO ACTION’ ON INTEROPERABLITY: The giant health IT trade group’s board approved late last week a six-point “call to action” to serve as guiding principles for policymakers and the broader EHR community as it races to achieve interoperability nirvana. Morning eHealth has the first look at the key elements:

1) Integrate different interoperability approaches and exchange frameworks — While players working on different approaches are collaborating and leveraging each other’s skills, they still too often work in silos.

2) Educate the community on the appropriate use of standards — “Understanding of the adoption and use of these standards is limited at best, and inconsistency in the implementation of these standards has created challenges in producing interoperable exchange.”

3) Ensure participation from by all providers, including patients and caregivers — Too often, interoperability efforts focus on doctors and hospitals, creating gaps in long-term care, post-acute providers and behavioral health. “These gaps must be addressed.”

4) Identify the “minimum necessary” business rules for exchange — There needs to be a baseline set of practices to simplify working with more outlets to exchange patient data. “There is no existing one-size-fits-all interoperability solution.”

5) Standardize patient matching approaches — As disparate exchange solutions emerge, health IT needs ways to ensure patients are accurately linked to their records.

6) Improve data usability — Information that’s more easily digested is more likely to be folded into decision-making and research.

Get the full document here.

Q&A WITH HIMSS LEADERS: Carla Smith, HIMSS’s executive vice president, told reporters while in town last week that HIMSS’s updated list of priorities for Congress is “a reflection of the realities that we’re living in today that overwhelmingly provider organizations have adopted technologies.” None of the three priorities — which includes the creation of a chief information security officer at HHS, telehealth legislation and expanded broadband funding — deal directly with EHRs. “It’s now harnessing the power of those technologies, turning it into actionable, relevant information.”

—The groups’ vice president of government relations, Tom Leary, answered several other questions about HIMSS’s work in Washington, including how they’ve dealt with the hyper-focus on Obamacare, the priorities of new HHS leadership and advancing cybersecurity. The full Q&A here.

eHealth tweet of the day: Kathryn Wickenhauser @KAWickenhauser: #EHRs are glorified cash registers with patient information tacked on. We can do better. We should do better. - @ZDoggMD #MGMA17

Welcome to Wednesday Morning eHealth where are grateful to the kind worker at the local AT&T store. On Monday, your author visited an outlet hoping to troubleshoot a problem with his iPhone that had stopped charging. The worker pulled out a tool and spent only a few seconds fishing around the phone’s charging port when out popped a giant piece of lint. The phone has worked like a charm ever since. Pocket lint is apparently the biggest destroyer of iPhones. Pass along your thoughts and news tips to [email protected] and connect with us on Twitter @David_Pittman, @athurallen202, @DariusTahir, @POLITICOPro, @Morning_eHealth.

WHAT ABOUT THE PATIENTS?: The health IT world needs to focus more on how patients spend their time outside of discrete 15-minute doctors’ visits, a blog post published by UCSF’s Center for Digital Health Innovation argues. It’s signed by the notable Bob Wachter of UCSF and a trio from the school’s digital health center, including policy head Mark Savage and executive director Michael Blum. The school views it as an alternative to dueling New England Journal of Medicine opinion pieces ( here and here) last month on health IT life post-HITECH Act.

In their own words: “Harnessing the full potential of health IT will require new focus on people and their data collected outside the walls of the hospital and doctor’s office, and on uses and interventions that help patients as they are living their lives.

“The emphasis on the experience of doctors in using their EHRs may lead us to ignore the equal importance of winning the hearts and minds of patients who seek the digital access and tools needed for shared care and care planning with their doctors.

“We see great opportunity and synergy in creating digital tools that allow individuals and providers to engage with each other and with a comprehensive set of health-related data in their shared pursuit of improving the health of the individual.”

SO THAT’S A NO?: FDA Commissioner Scott Gottlieb told Reuters in an interview Tuesday. he’s “most effective” in his current role but didn’t say if he’d been approached about possibly succeeding departed HHS Secretary Tom Price. “I feel like I want to continue to follow through on the policies we’ve put out and it’s where I think I can be most effective,” Gottlieb told the wire service.

COMMON RULE’S OUTLOOK COMES INTO FOCUS: Changes contained in HHS’s revised rule outlining safeguards for people participating in medical research have been on hold since the Trump administration took over. A revised “Common Rule” was published literally on the last day of ex-President Barack Obama’s tenure, which the new White House immediately froze. The research community has been waiting with bated breath on what will happen. We may now have an answer as OMB is now reviewing a rule that — according to its title — would delay changes by a year and enact three “burden-reducing provisions during the delay year.” The changes were to have taken effect in 2018.

—Among the changes in the January final rule were an updated consent form, making it easier to understand, and a requirement to use a single institutional review board.

Final rules currently under White House review: It’s a lot of bear with us.

— Rules of the road for MACRA in 2018.

—The combined rule for the 2018 physician fee schedule, Medicare ACOs and Diabetes Prevention Program.

—2018 hospital payment rules.

Not to be forgotten, but still in the proposed-rule stage, expedited Coverage of Innovative Technology.

POLITICO’s Agenda: The Data Issue: Data has emerged as a powerful tool for business and governance, and nobody collects more data than Washington. This issue of POLITICO Agenda goes deep on data and looks at the public challenges and opportunities that emerge as “big data” expands the possibilities for society and for government. From financial data ownership, to thwarting digital thieves and hackers, be sure to read the full edition here.

WALDEN TO DEMS: LET’S WORK TOGETHER ON CHIP: House Energy and Commerce Chair Greg Walden said his panel will delay floor action on a bill to extend funding for the Children’s Health Insurance Program to work with Democrats on paying for the bill. Walden, in a statement, said nothing of reworking the policies, which don’t touch expanding Medicare payments for telemedicine. “If we are unable to reach a deal by the end of this week, I would expect the House to take up the committee marked bill immediately following the district work period,” Walden said.

A NEW MAN IN HEALTH-CYBER LAND: A new body that hopes to serve as a liaison between the private sector and government to improve cybersecurity in health care has its first leader. Greg Garcia will serve as the executive director of the Healthcare and Public Health Sector Coordinating Council, which is the HHS-designated body to help coordinate against cyber threats. Garcia was the first assistant secretary for cybersecurity at the Department of Homeland Security in 2006, served as executive director of the Financial Services Sector Coordinating Council and was co-founder of the Information Technology Sector Coordinating Council. The announcement.

The House Energy and Commerce Committee, which held a hearing in April on improving cybersecurity in health care, praised the appointment saying it “looks forward to learning more about the council’s efforts.”

ELSEWHERE ON POLITICO PRO: Twitter reversed its initial decision and will instead allow Rep. Marsha Blackburn to promote her work investigating Planned Parenthood. The social media company at first deemed the ads “inflammatory”…Former chief of staff to Vice President Mike Pence, Josh Pitcock, has landed a new job at the tech giant Oracle…New Jersey Sen. Bob Menendez sought whomever had the “best juice at CMS” to help a campaign donor under Medicare fraud investigation.

WHAT WE’RE CLICKING:

—ONC announces security challenge using FHIR API.

—AMIA’s Jeff Smith pens a Medium post on the state of information sharing in health care.

—Late Cerner CEO Neal Patterson honored at the company’s users conference this week.

— JAMA Viewpoint highlights the importance of cybersecurity in health care.

Tips, comments, suggestions? Send them along via email to our team: Arthur Allen ([email protected], @ArthurAllen202), David Pittman ([email protected], @David_Pittman) and Darius Tahir ([email protected], (@DariusTahir).

Follow us on Twitter Mohana Ravindranath @ravindranize

Darius Tahir @dariustahir

Output: The giant health IT trade group’s board approved late last week a six-point “call to action” to serve as guiding principles for policymakers and the broader EHR community as it races to achieve interoperability nirvana. Morning eHealth has the first look at the key elements:


Instruction: create a high quality summary of the given input

Input:
The high price of the Trump administration's waffling on healthcare
 Covered California, a health insurance market for those not covered by large group plans, announced Wednesday that premium increases will double for many of its customers because the Trump administration hasn’t committed to reimbursing insurers for out-of-pocket cost subsidies.

Covered California made it official Thursday: The Trump administration’s waffling will raise health insurance premiums an additional 12.4% for many Californians not covered by large employer plans. In some cases, the Trump-induced surcharge will be 27%. Those increases are on top of an average premium increase of 12.5% due to other factors.

In other words, premium increases will be twice as high next year for many Californians, simply because the Trump administration (and Congress) won’t commit to reimbursing insurers for the payments the government requires them to make.

But don’t cry for these people. Most of them won’t feel the increase. Instead, the higher costs will be passed on to you, Mr. or Ms. Taxpayer.

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The administration actions are shifting the burden of the cost-sharing reductions from taxpayers to insurers to consumers, then back to taxpayers.

Ouch. At issue is the administration’s refusal to commit to making the “cost sharing reduction” payments that the 2010 Affordable Care Act requires. Under the ACA, insurers must slash the out-of-pocket payments demanded from customers with very low incomes. The law also requires the federal government to reimburse insurers for these reductions, which are expected to total about $7 billion this year.

It’s a simple idea: If you want healthcare to be accessible to all Americans, you’ll need to help those living near the poverty line with more than just their premiums. They can’t afford the deductibles and co-payments most policies charge, preventing them from obtaining care. Hence the cost sharing reductions.

The problem is that Congress (under partial and then full GOP control) didn’t put up the money to reimburse insurers, leading the Obama administration to fund the payments out of the pot for premium subsidies. Although the House of Representatives sued (successfully) to stop the administration from making the payments, the ruling is on hold pending an appeal. The Trump administration has kept them going on a month-to-month basis, even as it has regularly threatened to terminate them.

Remember, insurers still have to make the cost-sharing reductions regardless of what Washington does. So as the open enrollment period approached for 2018, they had a choice: Act as if the reimbursements won’t end, or assume they will and raise premiums to compensate for the loss — or stop selling policies through Covered California and the other Obamacare exchanges.

To avoid the latter scenario, Covered California persuaded insurers to impose a surcharge just on the “silver” tier policies eligible for cost-sharing reductions (that is, the policies that cover about 70% of the average customer’s projected medical expenses). This surcharge will range from 8% to 27%, depending on the insurer, with an overall average of 12.4%.

The arrangement — unique to California, and a credit to the state Legislature’s decision to make the exchange an active negotiator for consumers — is designed to minimize the cost to customers. The vast majority of those hit with the surcharge (78%, by Covered California’s count) won’t pay it. That’s because they receive ACA subsidies that limit their premiums to a fixed percentage of their income, which means the subsidy will increase to absorb the surcharge. And that, in turn, means that the cost of the surcharge will be passed on to taxpayers.

The Californians who buy silver-tier policies through Covered California but do not qualify for subsidies will feel the sting of the surcharge. That’s about 65,000 of the exchange’s 1.4 million enrollees. But those who buy virtually identical policies outside Covered California won’t face the surcharge, which is a pretty strong incentive to bypass the exchange. In fact, insurers are encouraging consumers who don’t qualify for premium subsidies to do just that.

In sum, the administration actions are shifting the burden of the cost-sharing reductions from taxpayers to insurers to consumers, the vast majority of whom will pass the cost back to taxpayers. The money flows in a big circle, albeit probably in a way that winds up costing the taxpayers more. (By the Congressional Budget Office’s calculation, ending the reimbursements outright, rather than just leaving them in limbo, would cost the taxpayers $194 billion over 10 years.)

So why is the Trump administration doing this, again? Some Republicans say the reimbursements are a “bailout” for insurers, which is every bit as accurate as saying the Defense Department’s payments for weapons and supplies are a bailout for defense contractors. If critics want to stop the reimbursements, they should repeal the requirement that insurers give low-income customers a break on their out-of-pocket expenses. Failing that, the administration — or better yet, Congress — needs to commit to paying the reimbursements and stop the senseless cost-shifting.

jon.healey@latimes.com

Twitter: @jcahealey

Output: Covered California made it official Thursday: The Trump administration’s waffling will raise health insurance premiums an additional 12.4% for many Californians not covered by large employer plans. In some cases, the Trump-induced surcharge will be 27%. Those increases are on top of an average premium increase of 12.5% due to other factors.


Instruction: create a high quality summary of the given input

Input:
11 days and counting: Why hasn't Congress renewed health insurance program for 9 million children?
 We know that Congress is just unimaginably busy right now, so perhaps it’s understandable that 11 days after funding for a crucial children’s healthcare program expired, the lawmakers still haven’t gotten around to restoring it.

We’re talking about the Children’s Health Insurance Program, a state-federal program serving 9 million children and their mothers. We reported earlier, as the Sept. 30 deadline for federal reauthorization of CHIP was closing in, that delay was placing state programs in dire jeopardy.

There’s still no schedule for a vote on CHIP in either chamber on Capitol Hill.

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What has Congress and the Trump administration been tied up with, while CHIP renewal has languished?

Let’s see. There was the tax cut proposal, mooted on Sept. 27, and discussed endlessly since, even though the drafters didn’t bother to fill in a multitude of blanks covering who gets the tax cuts and who gets hammered. (Spoiler alert: The rich get almost all the tax breaks, and everyone else gets shortchanged.) That has sucked up a lot of congressional mind share.

Over at the White House, President Trump has been fuming over the collapse of the Senate’s Obamacare repeal bill and about the National Football League players’ taking a knee during the national anthem. That who-cares issue prompted Vice President Mike Pence to take time out of his busy weekend to fly halfway across the country for a symbolic show of support for the flag, so he could fly halfway back across the country immediately for a California fundraiser. Pence’s theatrics cost taxpayers nearly $250,000.

Meanwhile, Trump spent his time picking fights with Sen. Bob Corker (R-Tenn.), the mayor of San Juan, Puerto Rico, and NBC. He also stopped in Puerto Rico, where he praised his performance in disaster relief without apparently noticing that half the island still is without power or water. The Washington press corps kept its eye on whether Secretary of State Rex Tillerson called Trump a “moron” and if so, what variety of moron.

CHIP was enacted in 1997 with bipartisan support, which it has continued to enjoy more or less since. So nothing should have interfered with its reauthorization. What did, as we reported, was the Senate’s preoccupation in the last week of September with one more fruitless attempt to repeal the Affordable Care Act. By the time that measure was dead and buried, there was no room left to enact a CHIP measure that already had been agreed on by Sens. Orrin Hatch (R-Utah), one of CHIP’s original sponsors, and Ron Wyden (D-Ore.).

The House was poised to vote on a CHIP reauthorization this week but put it off because Democrats complained about terms inserted by the GOP, which included taking money from a public health fund under the Affordable Care Act.

Congress may be sanguine about renewing CHIP because most states have enough in their budgets to continue the program until the end of the year or the first quarter of 2018. But some are on the brink. They include Utah — Hatch’s home — which warned legislators that it would have to start rolling up its program almost as soon as the deadline passed without a vote.

Minnesota Human Services Commissioner Emily Piper warned the state’s Washington delegation that its money would run out virtually on deadline day, and followed that up with a public warning that on Oct. 1, the state would have to start taking “extraordinary measures” to keep the program moving along, even if on one cylinder. Among other steps, she said, “pregnant women covered by the program [will] be cut off altogether, losing coverage for prenatal and postpartum care.”

Few other states can rest easy. The longer Congress dithers, the more uncertain every state program becomes. CHIP operates with long-term planning, and without assurances that the funding will appear eventually, services will be pared back, professional contracts canceled and enrollments slashed.

It should go without saying too that the longer Congress dithers, the greater the chances that some other priority will elbow CHIP out of the way, as the remaining legislative days dwindle. Between now and the end of the year, Congress will be taking three weeks off for holidays; the Senate also will take a knee on four of the remaining 12 Fridays and eight of the remaining Mondays. The House will be in session for only four more Fridays and four Mondays. Think of that the next time a federal politician tells people they need to work harder.

Somewhere in its busy schedule Congress surely can find the time for a routine reauthorization of health insurance for sick children and mothers. In video game terms, this is a move with the lowest difficulty level one can imagine. What does it say that Congress can’t get even that much done?

Keep up to date with Michael Hiltzik. Follow @hiltzikm on Twitter, see his Facebook page, or email michael.hiltzik@latimes.com.

Return to Michael Hiltzik’s blog.

Output: We know that Congress is just unimaginably busy right now, so perhaps it’s understandable that 11 days after funding for a crucial children’s healthcare program expired, the lawmakers still haven’t gotten around to restoring it.


Instruction: create a high quality summary of the given input

Input:
Facebook releases $199 stand-alone version of Oculus VR headset
 Facebook has unveiled a stand-alone virtual reality headset designed to extend the appeal of the company’s Oculus technology to the masses.

The headset, called Oculus Go, won’t require plugging in a smartphone or a cord tethering it to a personal computer like Oculus Rift or its competitor HTC’s Vive do.

“I am more committed than ever to the future of virtual reality,” said Facebook’s CEO, Mark Zuckerberg, to a crowd of computer programmers gathered in San Jose, California, for Oculus’s annual conference.

“This all-in-one device makes VR more accessible than ever and represents a huge leap forward in comfort, visual clarity, and ease-of-use,” added Oculus in a blogpost.

The headset is lightweight and features a high-resolution LCD screen and speakers built in to deliver “spatial audio”.

When it hits the market next year it will cost $199, which is a big drop from the Rift, which originally sold for $599 and required a powerful computer costing at least $500 to power the virtual reality experiences and games. Recent discounts lowered the Rift’s price to $399 at various times during the summer, a markdown Oculus now says will be permanent.

“The strategy for Facebook is to make the onboarding to VR as easy and inexpensive as possible,” said Brian Blau, an analyst with the Gartner research company. “And $199 is an inexpensive entry for a lot of people who are just starting out in VR. The problem is you will be spending that money on a device that only does VR and nothing else.”

The Oculus Go will straddle the market between the Rift and the Samsung Gear, a $129 headset that runs on some of Samsung’s higher-priced phones. It will be able to run the same VR as the Samsung Gear, leading Blau to conclude the Go will rely on the same Android operating system as the Gear and probably include similar processors as Samsung phones.

The Gear competes against other headsets, such as Google’s $99 Daydream View, that require a smartphone. Google is also working on a stand-alone headset that won’t require a phone, but the company hasn’t specified when that device will be released or how much it will cost.

Zuckerberg promised the Oculus Go would be “the most accessible VR experience ever” and help realize his new goal of having 1 billion people dwelling in virtual reality at some point in the future.

Two days earlier, a cartoon version of Zuckerberg visited hurricane-damaged Puerto Rico, in a livestream that was part disaster tourism, part product promotion. He and Facebook’s head of social virtual reality, Rachel Franklin, appeared as avatars within the broadcast from his profile as they “teleported” to different locations using Facebook’s “social VR” tool Spaces. In reality they were at the company’s Menlo Park, California, headquarters wearing virtual reality headsets.

After many people criticized the VR broadcast in the comments on his Facebook profile, Zuckerberg apologized.

“One of the most powerful features of VR is empathy. My goal here was to show how VR can raise awareness and help us see what’s happening in different parts of the world,” he said, adding that he intended to publicize a partnership with the Red Cross where Facebook helps create population maps that can be used by rescue workers.

“Reading some of the comments, I realize this wasn’t clear, and I’m sorry to anyone this offended.”

Facebook and other major technology companies such as Google and Microsoft that are betting on VR have a long way to go.

About 16m head-mounted display devices were shipped in 2016, a number expected to rise to 22m this year, according to Gartner. Those figures include headsets for what is known as augmented reality.

Zuckerberg, though, remains convinced that VR will evolve into a technology that reshapes the way people interact and experience life, much as Facebook’s social networks and smartphones already have. His visions carry weight, largely because Facebook now has more than 2 billion users and plays an influential role in how people communicate.

But VR so far has been embraced mostly by video game lovers, despite Facebook’s efforts to bring the technology into the mainstream since buying Oculus for $2bn three years ago.

Facebook has shaken up the Oculus management team since then in a series of moves that included the departure of its founder, Palmer Luckey, earlier this year.

The former Google executive Hugo Barra now oversees Facebook’s VR operations.

Output: Facebook has released a stand-alone version of its Oculus virtual reality (VR) headset, which doesn't require connection to a smartphone or computer. The device, Oculus Go, will be priced at $199, significantly cheaper than the company's previous headset, the Oculus Rift, which originally retailed at $599, but has since been discounted to $399. Facebook CEO Mark Zuckerberg has said the "accessible" device will help towards achieving his goal of one billion people experiencing VR. The total number of all VR headsets sold worldwide is expected to rise from 16 million to 22 million this year.


Instruction: create a high quality summary of the given input

Input:
The Washington Post paints a false picture of elderly Americans
 Last week the Washington Post offered a harsh portrait of the “new reality of old age in America.” Its reporters described the pinched circumstances of older couples searching for temporary work in order to top up their meager Social Security checks. A 74-year-old tells readers “I’m going to work until I die, if I can, because I need the money.” The Post reports the stories of these struggling job seekers with warmth and compassion.

The stories reflect a bleak reality facing some aged Americans, those whose retirement incomes are scanty and whose retirement years are anything but golden. The broader reality, however, is that economic deprivation in old age is increasingly rare. Over the past several decades the material circumstances of America’s elderly have improved, both absolutely and relative to the circumstances of the nonelderly. Contrary to the implication of the Post story, the current reality for most older Americans is that old age is more comfortable and longer lasting than it was for earlier generations.

Over the past several decades the material circumstances of America’s elderly have improved, both absolutely and relative to the circumstances of the nonelderly.

Careers nowadays last beyond age 65 for an increasing number of workers, but the evidence suggests delayed retirement is more common for those with college degrees and advanced diplomas than it is for the less educated. Many of us remain employed later in life as a result of choice and conviction rather than necessity. As a result, the surge in late-career earnings has tended to boost the incomes of the most affluent elderly, thereby increasing old-age inequality.

To be sure, public and private institutions that should assure workers a comfortable old age leave big holes in worker protection. Several of these receive well-deserved criticism in the Post’s story. Too few wage earners are given the opportunity to save for retirement at their workplace. Many employers offer retirement plans with inadequate incentives to save or a lousy menu of saving options. On the whole, however, both public and private retirement programs have delivered steadily rising living standards and falling poverty rates to the population past 65.

According to Census statistics, the inflation-adjusted income of the median family headed by an older American increased 64 percent between 1979 and 2016. In comparison, among households headed by someone between 35 and 44, median income edged up just 9 percent. Over the same period, the poverty rate of older Americans fell almost 6 percentage points, while poverty rates among children and nonaged adults increased. Under the official poverty guidelines, the poverty rate among the elderly (9.3 percent) is now noticeably lower than it is among children (18.0 percent) and nonelderly adults (11.6 percent). While the Post article describes a tough, hand-to-mouth existence for the aged workers it profiles, the story fortunately describes the situation of a shrinking percentage of older Americans. A better piece of reporting would have alerted readers to this key fact.

The incomes of the aged are actually higher and improving faster than Census statistics suggest. The best known income and poverty numbers are based on an annual Census Bureau survey. Unfortunately, respondents’ answers in the survey give a misleading picture of the incomes flowing into families headed by retired breadwinners. The problems of the interview responses have been known for some time. The Census survey gathers reasonably accurate information about income from wages and Social Security, but it collects much less reliable data about interest and dividends, workplace pensions, and withdrawals from retirement savings accounts. Further, pension underreporting has grown worse over time, leading to a growing understatement of retirees’ incomes.

Two Census Bureau statisticians, Adam Bee and Joshua Mitchell, recently compared household income reports in the Census survey with the income records compiled by the Social Security Administration and IRS. Their paper compares interview responses on the Census Survey to administrative income reports for five key income sources – earnings, Social Security benefits, Supplemental Security Income (SSI), interest and dividends, and income from workplace retirement plans (including IRAs). They find that earnings and Social Security benefits are well reported in the survey while the other three income sources are seriously understated. In 2012, respondents past 65 failed to report more than one-quarter of their SSI benefits, about one-third of their interest and dividend income, and over half of their workplace pensions and retirement savings plan withdrawals.

The underreporting of workplace pensions and other income items has grown worse in recent years. According to the Census Bureau’s income survey, only 40 percent of Americans past 65 received a workplace pension or withdrew funds from a retirement savings account in 1990, and this percentage shrank to 36 percent in 2012. In contrast, the IRS administrative records show that the fraction of aged respondents receiving pensions and savings withdrawals climbed from 45 percent to 61 percent over the same period. One reason that so many observers are gloomy about the workplace retirement system is that they accept without question the income amounts reported on Census surveys. When the erroneous income reports are corrected, both the income levels and the income trends are much more encouraging.

As colleagues and I also discovered in an earlier research project, Bee and Mitchell find that income underreporting is a worse problem for respondents past 65 than it is for younger respondents. The reason is simple: Income items that tend to be underreported account for a bigger percentage of older respondents’ total incomes. This implies that the relative well-being of the nation’s elderly is much closer to that of the nonaged than one would conclude based on Census survey estimates.

Bee and Mitchell’s new analysis allows us to pinpoint the population groups for which underreporting is a major problem. When corrected income amounts are substituted for incorrect survey responses, the median income of aged households increases by similar percentage amount across all races and ethnic groups.

While income underreporting is significant at both the top and bottom of the old-age income distribution, its biggest impact is in the middle (Chart 2). The two analysts find that, when incorrect survey responses for 2012 are replaced with more accurate Social Security or IRS reports for the same year, the median cash income of aged households increased from $33,800 to $44,400, a rise of 30 percent. Measured income at the bottom of the distribution increased, too, but by a smaller proportional amount. Even so, Bee and Mitchell find that the estimated old-age poverty rate in 2012 fell by more than 2 percentage points when incorrect survey responses are replaced by correct income amounts derived from administrative records.

Over the past half-century trends in the well-being of America’s elderly have been more favorable than has been the case for any other age group. The income poverty rates of the aged have declined sharply, their health insurance coverage is broader and more secure than it is among the young, and their incomes have continued to improve, even as the incomes of many younger age groups have stagnated. Fueling the income gains of Americans past 65 have been increases in their employment rate and an improvement in their weekly pay relative to that earned by young and prime-age breadwinners. Whether the gains of the elderly can be sustained is an open question. Nonetheless, their relative and absolute economic gains in recent decades are impossible to deny.

Output: Last week the Washington Post offered a harsh portrait of the “new reality of old age in America.” Its reporters described the pinched circumstances of older couples searching for temporary work in order to top up their meager Social Security checks. A 74-year-old tells readers “I’m going to work until I die, if I can, because I need the money.” The Post reports the stories of these struggling job seekers with warmth and compassion