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DOE shifts focus to solar thermal after surpassing PV cost target
 Dive Brief:

The U.S. Department of Energy announced plans to expand the SunShot program after hitting its 2020 goals to trim utility-scale solar costs to $0.06/kWh — or under $1 per watt — three years early.

or under $1 per watt three years early. Under the new goals, the popular program plans to cut utility-scale solar costs in half to $0.03/kWh by 2030. The agency also plans to trim commercial solar costs to $0.04/kWh and residential solar to $0.05/kWh in the same timeframe.

The Office of Energy Efficiency and Renewable Energy (EERE), which houses SunShot, also announced $82 million in funding for early-stage research in concentrating solar power and power electronics.

Dive Insight:

Despite the Trump administration's efforts to cut funding from DOE research efforts, the agency is forging ahead with new programs to expand solar development. But the agency now frames these efforts as opportunities to boost grid reliability and resiliency — key priorities of Secretary Rick Perry and his recently-published grid study.

"Secretary Perry is certainly focused on improving the resiliency of the grid," Becca Jones-Albertus, acting deputy director for the SunShot initiative, told Utility Dive. "We’re continuing to focus innovation that can drive cost reductions to meet the 2030 goal, so that includes focusing on the hardware side; on longer lifetimes and better durability."

Jones-Albertus said focusing on durability and longer lifetimes would help drive down so-called "soft" costs associated with installations — interconnection and permitting. And they underscore the agency's efforts to use solar as a way to boost resiliency, she added.

As part of the SunShot expansion, DOE allocated $62 million for concentrated solar power technologies and $20 million for early-stage power electronic projects that would help grid operators better detect problems, while also shoring up against cyber and physical attacks. Those types of electronics will also better enable integration of variable solar power, DOE said.

Winners will have to pony up 20% of the funds to their overall project budget, which could yield a total of private and public spending of $100 million.

The expanded SunShot program still targets cost cuts, aiming to cut the installed price of various solar technologies by more than half by 2030. Current tax incentives, such as the federal investment tax credit, do not factor into these cost forecasts, Jones-Albertus said.

Currently, commercial-scale solar prices rest around $0.11/kWh and residential solar is roughly $0.16/kWh. The agency uses an average cost found in Kansas City, Missouri to model its projections. In sunnier states, the costs could fall to nearly $0.02/kWh for large-scale solar.

These prices are a stark contrast to 2011, when the program first began. At that time, utility-scale solar cost $0.28/kWh, while residential and commercial-scale solar was $0.52/kWh and $0.40/kWh respectively. Lower module prices helped drive these costs down, according to a new report from the National Renewable Energy Laboratory, also released with the funding announcements.

The new funding opportunities arrived amid a heated debate between solar companies over a request to impose a tariff and floor price on imported crystalline silicon photovoltaic solar panels. Two companies proposed a tariff of $0.40/watt and a floor price of $0.78/watt.

If enacted, these tariffs could endanger 88,000 jobs from the solar sector next year, the Solar Energy Industries Association warned, and threaten two-thirds of utility-scale solar projects expected to come online in the next five years. The tariffs could also hamper any DOE efforts to reduce costs.

Output: The US Department of Energy has announced it will expand its SunShot programme after the project hit its goal of reducing utility-scale solar costs to under $1 per watt three years early. The project has now set new goals, aiming to cut the installed price of various solar technologies by half by 2030. The department's Office of Energy Efficiency and Renewable Energy has also announced $62m of funding for concentrated solar power technology and $20m for early-stage power projects to help grid operators detect problems and defend against physical and cyber attacks.


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Anti-glare coating enables first Scandinavian airport solar PV
 Finnwind Oy has installed a 312 kW solar PV system at Finnair cargo center, Helsinki-Vantaa Airport, Finland.

The company, one of the most experienced PV installers in Finland, used Vikram Solar’s modules for the project. It is the first ever PV installation at an airport in Scandinavia and the system is expected to supply on an average 280,000 kWh of energy per year, said a press release.

Commenting on the completion, Davide Marro, Head-Sales (Europe), Modules, Vikram Solar, said: “The modules used for these types of projects must meet exceptional quality standards. We are pleased that a renowned airline like Finnair turned to our partner Finnwind Oy and chose Vikram Solar modules.”

“Sustainability is important for Finnair Cargo customers, as well as their clients,” said Janne Tarvainen, Managing Director of Finnair Cargo, on the milestone. “Our new cargo hub features advanced automation technology and has temperature-controlled areas for pharmaceuticals and other perishable products, and the solar plants support the energy efficiency of the terminal.

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“Quality, performance, and durability of the solar panels were key criteria for choosing Vikram Solar and Finnwind for this project,” Tarvainen added.

The airport authority was cognizant of the safety constraints of the aviation industry in relation to PV installations at airports. To reduce the risk of glare for air traffic at and around the airport, Vikram Solar’s modules were equipped with an anti-reflection coating (ARC) glass, absorbing 94% of incident light.

Additionally, the weather conditions played a significant role in the project. The modules can withstand the cyclic pressure loads caused by factors such as wind and snow, which are common in Finland. Vikram Solar's modules passed similar testing conditions, and were credited among the “top performer” list for 2017, released by the Norway-based DNV GL.

Output: Finnish solar company FInnwind Oy has installed a 312 kW solar power system at Helsinki-Vantaa Airport, the first such installation at a Scandinavian airport. The company used PV modules from Vikram Solar for the project, which are expected to supply an average of 280,000 kWh of energy per year. To reduce the risk of glare to aircraft, the modules were given an anti-reflection coating, which absorbs 94% of incident light. They can also withstand cyclic pressure loads from wind and snow, common weather conditions in the area. The project was carried out for Finnair Cargo, which operates from the airport.


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Prudential finds four million over-55s want to downsize homes
 More than 3.9 million over-55s are planning to downsize to a cheaper property, according to new research from Prudential.

The nationwide study found that 47% of homeowners aged over 55 were planning to sell and move to cheaper homes later in life, and on average they expected to raise around £112,000 in equity, with 11% expecting to make more than £200,000.

However, Prudential found that money wasn’t the key driver for downsizing, with 74% citing convenience as the main reason, compared with 28% who claimed they were doing so mainly to release cash for retirement.

“It is interesting to see that these figures challenge the common theory that ‘my house is my pension’,” said Vince Smith-Hughes, a retirement income expert at Prudential.

Poll As a broker, do you currently quote 'green' loan options alongside standard loan quotes for property development finance? Yes No Vote Results

“Although we see a large proportion of those taking equity from their homes to boost their retirement incomes, most people have accepted that the main reason they need to move home in later life is for convenience.

“With the average amount of equity raised likely to be just over £100,000, and with many other demands on this cash – such as helping children, paying off debts and putting money aside to pay for care in the future – it is clear that for most people the best way to fund retirement is through saving as much into a pension as early as possible in their working lives.”

However, a lack of suitable, available housing was the main reason why over-55s felt downsizing wasn’t more popular, with 24% blaming the cost of moving and 17% citing high house prices.

Output: More than 3.9 million homeowners over the age of 55 plan to downsize their properties for a cheaper home, according to insurance and financial services company Prudential. Almost half of homeowners in the age group sought to sell up in later life and could expect to raise as much as £200,000 in equity, Prudential said, citing the findings of a nationwide survey of 1,092 homeowners. The company found that funding was not the main reason for downsizing, with 74% stating that convenience was the driving factor, rather than releasing money for a pension fund.


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Bank of America and FitPay partner for wearabale payment tech
 Source: Bank of America

Bank of America (NYSE: BAC ) and FitPay, Inc., a wholly-owned subsidiary of NXT-ID, Inc. (NASDAQ: NXTD), today announced an agreement to extend contactless payment capabilities to a range of new devices, giving Bank of America customers more payment options and accelerating the adoption of new payment devices.

This collaborative effort enables Bank of America customers to use their credit or debit cards to make secure contactless payments directly from devices that are integrated with the FitPay[TM] payment platform at NFC-enabled point-of-sale locations and more than 9,000 Bank of America ATMs.

"As digital payments evolve, our goal is to give Bank of America customers access to payment options that are easy to use and highly secure," said Mark Monaco, Head of Enterprise Payments at Bank of America. "Working with FitPay will allow our customers to use a range of new contactless payment devices to improve the payment experience, provide a high level of security, and fit seamlessly into any lifestyle."

Under the agreement, Bank of America will participate in FitPay's Digital Wallet Program, which enables manufacturers of Internet of Things (IoT) and wearable devices to add contactless payment capabilities to their product, making it possible for consumers to pay for goods and services at near-field communication-enabled (NFC) point-of-sale terminals with a simple tap. The platform uses tokenization, a payment security technology that replaces cardholders' account information with a unique digital identifier (a 'token'), to transact highly secure contactless payments.

"We are very pleased to be working with Bank of America to give their customers access to the latest payment technology," said Michael Orlando, COO of NXT-ID and President of FitPay, Inc. "Broad adoption of digital payments requires fundamentally changing the payment experience and making new payments methods widely available. Our work with device manufacturers and Bank of America is driving both of these goals."

Manufacturers of 15 IoT and wearable devices are currently integrating with the FitPay payment platform. Bank of America and FitPay are working together to enable Bank of America customers to use their credit or debit cards to make contactless payments or use NFC-enabled Bank of America ATMs with these devices. This collaboration includes ensuring that the devices meet Bank of America's technical, usage, security, branding, and consumer experience requirements. Product announcements from the manufacturers of these devices are anticipated in 2017 and 2018.

Output: The Bank of America and contactless payment provider FitPay are working together to offer contactless payment options across a range of devices, encouraging adoption of the technology. Customers will be able to make secure contactless transactions through integrated devices at approved point-of-sale locations and across 9,000 Bank of America ATMs. 15 Internet of Things and wearable device manufacturers are working on integration with the FitPay platform to enable further payment options.


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Indian online learning platform Unacademy raises further $11.5m
 Unacademy Plans To Onboard More Than 10,000 Educators Globally In 18 Months

Bengaluru-based edtech startup Unacademy has raised $11.5 Mn in its Series B round of funding led by Sequoia India and SAIF Partners. Existing investors and angels including Nexus Venture Partners and Blume Ventures also participated in the round.

The startup will use the proceeds to accelerate its product and technology as well as scale to other categories including personality development, new languages and job interviews. It will also invest in producing its own knowledge based content with its top educators on the platform. With this round of funding, Unacademy plans to grow 10X and onboard more than 10,000 educators across the globe in 18 months.

Gaurav Munjal, CEO and co-founder, Unacademy stated, “Our vision is to build the world’s largest online knowledge repository by empowering great educators. With the backing of Sequoia and SAIF, we are poised to significantly gain momentum and create the first global education technology product out of India. I’m very excited to kickstart this new phase of growth for Unacademy.”

Unacademy is an online learning platform that empowers educators to create courses on various subjects. The platform currently has more than 50,000 lessons online and over 1.3 Mn registered users and more than 4,000 educators. Over 25% of the educators are active monthly. It is also one of the largest education channels on YouTube India with 1 million subscribers.

Alok Goel, Managing Director, SAIF Partners, said, “Unacademy democratises access to personalised learning by connecting educators and students directly on its platform. We believe it has the potential to disrupt the status quo that limits access to quality education at a global level. With very limited investment, the team has built a strong brand and word-of-mouth reputation. We are delighted to support the team in realising their mission.”

Unacademy And The $1.96 Bn Edtech Market

Unacademy was founded by Gaurav Munjal (ex-founder and CEO Flatchat) along with Roman Saini, Hemesh Singh and Sachin Gupta. It was initially launched as an educational YouTube channel in 2011 and as a free learning platform Unacademy in January 2016.

It allows educators to create courses using their app on various subjects, including exclusive content for various competitive exams. All educators go through an interview process and selection is based on their experience.

The startup also recently added billionaire and serial entrepreneur Bhavin Turakhia to the board.

Here’s a look at its funding history-

As per Inc42 Datalabs Report for H1 2017, edtech took the fourth spot with 23 deals in the sector. In June 2017, another edtech platform Coursera raised $64 Mn Series D funding led by GSV Asset Management.

Online education in India will see approximately 8x growth in the next five years, says a recent report by Google, KPMG. This will have a significant impact on the edtech market that has a potential to touch $1.96 Bn by 2021 from where it stands now i.e. $247 Mn. India is poised to be the third-largest online market for education, with a plethora of web- and mobile-based courses and tools available in the currently. Also, India is home to 19% of the world’s youth. No wonder edtech startups like Unacademy are banking on this growing market as using technology as a growth driver.

Output: Indian online education provider Unacademy has raised $11.5m in a series B funding round, which it will use to help develop and scale its products. The investment round, led by Sequoia India and SAIF Partners, was also joined by existing backers, including Nexus Venture Partners and Blume Ventures. The funding will be used to begin producing Unacademy's own content on its platform and add more than 10,000 educators in the next 18 months. The start-up's learning platform has more than 50,000 lessons online and in excess of 1.3 million registered users, with its YouTube channel one of the largest in India.


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Fleet Secure product could enable cyber insurance for shipping
 Inmarsat launches Fleet Secure The new cyber security service was unveiled in partnership with Singtel and Trustwave.…

Inmarsat has officially launched its Fleet Secure cyber security service, which has been constructed and delivered in partnership with Singtel and Trustwave, at its UK headquarters as part of London International Shipping Week.

Fleet Secure will provide customers with a 24/7 monitoring, consultancy and response provision, with four key components.

Via Trustwave, Inmarsat will facilitate round-the-clock connectivity to participating superyachts, which ensures real-time monitoring of any anomalies or potential attacks.

This has been referred to as ‘cyber risk visibility’, which equates to real-time threat monitoring, analysis and expert mitigation guidance, which the company says has ‘never happened before’.

The key value propositions are that both the bandwidth provision, and associated costs, will be shouldered by Inmarsat, with no impact on the vessel’s allowance, and incorporated into the Fleet Xpress package without the need for any additional hardware.

Speaking at the London event, Peter Broadhurst, Senior Vice President of Safety & Security explained that, in a recently commissioned independent study, 44 per cent of respondents believed their vessels’ defences were not sufficient. Furthermore, an alarming 39 per cent had been the victim of some level of cyber attack in the last 12 months.

Citing the vulnerability human error on board can trigger in a vessel’s cyber defences, “The majority of crew are unaware of how greatly they compromise security; it’s about awareness and training. You really have to follow up to make sure people [are following best practice].”

When quizzed about clause 380, which excludes cyber attacks from maritime insurance contracts, and has left many in the industry concerned owners are leaving themselves unnecessarily exposed, Broadhurst intimated that Fleet Secure was the sort of best practice that could potentially underwrite cyber security in the future.

With yacht crew bringing more and more devices on board, with huge quantities of unlicensed content, a yacht’s cyber security is frequently compromised. But, for this nascent paradigm, there is a need for education and infrastructure. “If we can get to the point where we achieve an ISO or IMO standard, we will be able to get to the point where we have crew with cyber training certificates. And we need to get there as quickly as possible.”

Inmarsat also used the event to allude to the launch of its new Fleet Broadband service in 2018, and then the launch of the I6 satellite constellation in 2019/2020. A single satellite of this L-band/Ka-band hybrid system will be more powerful than the entire I4 and I5 constellations.

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Output: Satellite and communications firm Inmarsat has launched Fleet Secure, a maritime cyber security product. The offering provides round-the-clock monitoring for anomalies hinting at a potential cyber attack, an industry first, as well as expert guidance. The deployment of Fleet Secure may be a step towards cyber insurance for shipping companies; many maritime insurance contracts exclude cyber risks in their coverage.


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Carmaker McLaren seeks productivity gains with Holmes AI platform
 Indian information technology (IT) firm Wipro signed up with British company McLaren Technology Group, on Tuesday to deploy its Holmes artificial intelligence platform to increase the productivity and high-tech business of the automobile company.

"Wipro, with its deep domain expertise and vast application services portfolio, will help us achieve excellence as well as drive innovation in artificial intelligence," said Craig Charlton, Chief Information Officer at McLaren Technology Group in a statement.

After the sign-up, Wipro got the title of 'official technology partner' of McLaren. This will help the car maker boost digitisation across its businesses and also help Wipro to expand its artificial intelligence business.

"Digitisation is a great opportunity for renowned brands like McLaren to re-imagine and redesign their products and services from their customer's perspective," said N S Bala, president of Manufacturing & Technology at Wipro Limited.

Wipro's AI platform -- Holmes

Holmes is a cognitive computing system developed by Wipro in 2016. This artificial intelligence platform of Wipro, gives direct competition to rival IBM and its product IBM Watson.

Last year, Wipro said it will use Holmes to automate several aspects of its fixed price projects that will save up to $46.5 million and free over 3,000 engineers from usual and boring software maintenance activities.

That move was part of Wipro's bigger plan to generate $60-$70 million in revenue by selling the platform to new and existing clients.

"The extensive use cases addressed by Wipro Holmes enable faster time to market for application services, minimum human touchpoints in IT infrastructure operations and enhanced process efficiencies across key business processes through theme-driven AI and automation offerings," said Rohit Adlakha, vice-president and Global Head at Wipro Holmes and Automation Ecosystem.

However, such mass expansion of the automation platform will also raise fears of job cuts in the future. Earlier in May, top seven IT companies in India, that include Wipro, said they had plans to ask at least 56,000 engineers to leave in 2017.

In fact, according to reports, the IT major Wipro has sacked about 600 employees early this year on achieving greater process automation and following performance appraisals.

Reports also suggested that Wipro's homegrown AI platform Holmes will soon automate jobs done by 10,000 engineers across 20,000 projects from various business verticals. This means that more engineers would become redundant as their tasks would be now done by codes and algorithms.

However, mass layoffs can be addressed if the big IT companies takes the initiative to reskill the engineers and upgrade their knowledge to handle roles that will require diverse skillsets and expertise.

But with more automation coming in, it is not clear how companies like Wipro will manage to create non-automated work profiles for their engineers who face the threat of losing their work as digitisation makes further strides within the software services companies.

Output: UK car firm McLaren Technology is turning to artificial intelligence (AI) to digitise its business and improve productivity. Indian IT firm Wipro will deploy its Holmes AI platform to help McLaren re-imagine and redesign its products and services, and will be known as the company's "official technology partner". Holmes is a direct rival to IBM's Watson AI software.


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IBM launches AI-powered tool for maths teachers
 Teaching STEM

IBM Rolls Out Free AI Tool for Math Teachers

IBM is launching a free new tool powered by artificial intelligence specifically for teachers.

Teacher Advisor with Watson 1.0 uses artificial intelligence from Watson, IBM's Jeopardy!-playing robot, now trained by math experts with feedback from more than 1,000 math teachers, to help K-5 teachers with targeted math resources for their students.

Teacher Advisor has more than 1,000 math lessons, teaching strategies and videos available for targeted recommendations. Teacher advisor is designed to help teachers:

Access quality resources to meet diverse classroom needs;

Understand the standards and prerequisites for each lesson to better close gaps for students;

Apply new teaching techniques; and

Receive targeted recommendations for specific math concepts.

Teaching materials available through the online tool come from Achieve, AFT's Share My Lesson, CPALMS, EngageNY, Illustrative Mathematics, Student Achievement Partners and UnboundEd.

"Time is of the essence for teachers," said Sheena Lee, an elementary school teacher at Umana Academy in Boston, MA, in a prepared statement. "With a classroom full of third through fifth graders who have had inconsistent education in their lives, I need to help my students learn math in different ways, at different levels. Teacher Advisor With Watson offers a one-stop shop for the most trusted resources, enabling me to decide how best to meet my students where they are."

"Teachers shoulder endless challenges and responsibilities — mastering content, standards and curriculum, and meeting the diverse needs and abilities of each of their students," said AFT President Randi Weingarten in a news release. "Too often, teachers are expected to do all this single-handedly, but Teacher Advisor could help change that. The AFT worked hand-in-glove with the IBM Foundation to hone this tool and see how it empowers teachers and benefits students. This effective public-private partnership is a testament to what can be achieved when educators are entrusted with innovative technology to support powerful learning."

Visit teacheradvisor.education to learn more.

Output: IBM is launching a tool for maths teachers powered by artificial intelligence (AI) to help them with targeted resources for students. The Teacher Advisor with Watson 1.0 uses AI from IBM's Watson's Jeopardy!-playing robot system and provides access to more than 1,000 maths lessons, teaching strategies and videos. The materials are offered by a range of providers, including AFT's Share My Lesson, Illustrative Mathematics, Student Achievement Partners and UnboundEd, among others.


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Indian engineer creates world's cheapest ventilator
 The world’s cheapest and smallest ventilator, which looks like a clunky cellphone and can easily slip into your back pocket, has been developed by a young robotics engineer in Delhi in collaboration with a neurosurgeon at the All India Institute of Medical Sciences. This machine is 450 times smaller than the conventional ventilators and can easily slip into your back pocket.

“It is almost 450 times smaller than the conventional ventilators and can be moved around easily,” said the 25-year-old inventor Diwakar Vaish.

He developed it with Dr Deepak Agrawal, professor of neuroscience at AIIMs, who have seen scores of such patients living in hospital because the family cannot afford to buy a portable ventilator, which costs about Rs 2 lakh.

When the pocket ventilator hits the market after clinical trials and approval from the drug controller general of India, it will cost between Rs 15,000 and Rs 20,000, which is less than the Rs 5-15 lakh that a traditional ventilator would cost.

The cheapest portable ventilator also costs between Rs 2 lakh and Rs 2.5 lakh.

“There is an FDA-approved disposable ventilator that costs between Rs 10,000 and Rs 15,000, but it has a maximum life of four weeks. This will be a one-time investment and since it runs on room air, and not oxygen, the operational costs are close to zero,” said Dr Deepak Agrawal, professor of neurosurgery at All India Institute of Medical Sciences (AIIMS).

“There is no requirement for oxygen cylinders, which cost between Rs 3,000 and Rs 4,000 a day,” said Dr Vaish.

Controlled with an android app, the ventilator uses an artificial intelligence algorithm to adjust air supply to the normal breathing pattern of the patient.

“It works by pushing the atmospheric air into the lungs of the patients who cannot breathe on their own. The disposable ventilators currently in use also push in air, but they do it at a fixed frequency that does not necessarily match the patient’s breathing pattern, which may cause low oxygen saturation. This device synchronises ventilator air support with the normal breathing pattern,” said Dr Agrawal.

“We have successfully used it for a couple of hours on six fully paralysed patients at AIIMS who have been unable to return home for the want of affordable ventilators,” said Dr Agrawal.

As a safety measure, the ventilators were attached to FDA-approved disposable ventilators during the trial. India faces a huge shortage of ventilator beds needed to support critically-ill patients who cannot breathe on their own. According to norms, at least 10% of all hospital should have ventilators, but even Delhi, which has the best health infrastructure in India, has 200 ventilators for over 10,000 beds.

“The oxygen supplied to the patients through conventional ventilators is usually diluted to 40% concentration, air contains 20% oxygen. Nine in 10 of all patients, barring the ones with severe lung problems, can breathe in the normal atmospheric air because the problem is in their diaphragm, not lungs,” said Dr Agrawal.

For the 10% who need more oxygen, the pocket ventilator can also be hooked to an oxygen-supply system.

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Output: A 25-year-old Indian engineer and a neurosurgeon at the All India Institute of Medical Sciences have invented the world's smallest, cheapest ventilator. Diwakar Vaish and Dr Deepak Agrawal hope the device could solve India's chronic shortage of hospital ventilator beds. The device uses an algorithm to intelligently adjust a patient's air supply, resulting in negligable operating costs. The FDA-approved device costs between INR15,000 ($234) and INR20,000, and will be made available following clinical trials and Indian regulatory approval.


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New York University uses VR classrooms to train teachers
 Coming out of preservice training, many soon-to-be teachers register the same complaint: They didn’t get enough practice managing a classroom.

Researchers at New York’s University at Buffalo, in conjunction with a local public charter school and a digital-media company, are working to help ease that transition using virtual reality.

The technology offers a middle ground “between what can happen in the university context and the real classroom,” said Lynn Shanahan, an associate professor at the university who is currently working as an administrator at Enterprise Charter School, which serves K-8 students. “It’s a safe space because they’re practicing not on real kids.”

Although several companies are already building virtual environments to simulate the classroom experience, those scenarios have tended to use avatars, which look a bit like cartoon characters, in place of real students. As part of the new effort, teachers watch videos of actual students, shot with 360-degree cameras in the classroom.

The idea is that incoming teachers can feel what it’s like to be confronted with challenging behaviors—for instance, students yelling, pulling out their cellphones, jumping on desks—without having to step into a physical classroom. And they can do so at any time on their own by using a smartphone and VR headset, which can cost as little as $10.

But the use of real video for VR does pose some financial and ethical concerns: It’s quite expensive to shoot; a single 360-degree camera costs about $5,000. And it can reinforce racial, ethnic, or gender stereotypes—especially when there’s limited footage featuring a small pool of students.

The project, underwritten by a $20,000 innovation grant from New York’s state university system, is still in its early stages, but preservice teachers at the University at Buffalo, as well as some practicing teachers at Enterprise, located in the city’s downtown area, will use a pilot of the basic technology this fall.

“We’re not saying to replace those [student-teaching] field experiences, but the VR is another tool that can enhance the clinical preparation of the preservice teacher,” said Elisabeth Etopio, the director of the Teacher Education Institute and the interim assistant dean for teacher education at the university. “You can rack up the hours of experience and actually master skills prior to when you go to interact with students.

Amber Grzechowiak, a K-2 teacher at Enterprise Charter School, had never used VR before putting on a headset during a demonstration of the technology last month.

“This is the craziest thing I’ve ever seen in my life,” she said, turning her head from left to right, up and down, to see the virtual classroom in its entirety.

In one of the scenarios, which were created by Crosswater Digital Media, a Buffalo, N.Y.-based audio- and video-production studio, and filmed at Enterprise Charter, a middle school boy is irritating a classmate—balling up paper and throwing it at her, pulling her hair, teasing her. Eventually, she stands up and slaps him on the back. (The students were acting.) In another, students enter a classroom shouting, and one girl hops up on a desk to challenge another girl.

The technology is still in proof-of-concept stage and far from fully interactive right now. VR users can turn their heads and see the classroom all around them, but they cannot walk closer to students or talk to them and get a response. An assessment appears on the screen asking the teachers how they would respond, but as of now, the VR doesn’t capture their answers.

A ‘Visceral Feeling’

As some will point out, the current technology is not so different from watching a regular video—except that it surrounds the user.

“When you’re watching it on [a flat] screen, it’s a window and it’s somebody else, it’s not me,” said Grzechowiak. “You don’t get the same connection as you do when you’re actually standing and you look down and can see the floor right in front of you.”

The VR gave the university’s Shanahan a “visceral feeling.”

“I teach with video, and it’s different. I just think it’s the encompassed-body piece,” she said.

Richard Lamb, an associate professor of education at Buffalo and the director of the Neurocognition Science Laboratory there, who is leading the cross-organizational project with Etopio, has some data.

Through brain-imaging and physiological tests, such as measures of heart rate, blood pressure, and galvanized skin response, Lamb has shown that the body and mind respond similarly to virtual reality and real life.

For instance, he said, whether teachers are doing a lesson in front of a real group of students at his laboratory or in front of a VR class, the test results follow the same general trend. “It’s looking like the brain doesn’t care,” he said.

Authenticity is important, though, which is why he thinks it’s best to use video.

Teach Live, a program created by the University of Central Florida that is now in use at dozens of teacher education institutions across the country, including Buffalo, has a similar concept—but instead of using video, it’s a simulated environment. The students are computer-generated characters, or avatars, whose movements and speech are controlled on the other end by a professional actor.

Within that kind of animated simulation, the students and teacher can engage in a natural back-and-forth, which isn’t yet possible with the video VR project. But the sessions have to be scheduled to accommodate parties on both ends, unlike the VR, which teachers can pick up and practice with at any time using even a cheap cardboard headset.

David Cantaffa, an assistant provost for educator preparation for the State University of New York, the project funder, was surprised by the extent to which the VR made him feel transported to the classroom.

But to be most powerful for classroom-management training, “I think it would need to be interactive so that you could step forward, step back, interact with kids, kneel down, and have a conversation of some sort,” he said.

The producers and programmers at Crosswater Digital say they’re getting there. Companies like IBM are making advances in natural-language processing to allow computers to better understand human speech, which Crosswater is exploring incorporating into its VR scenarios.

Forward movement in virtual reality is also possible, but quite complicated. “When you take a 360-degree camera shot, the camera is in one position, and you’re taking data from that position,” said Lauren Innes, a video editor at Crosswater. “If you wanted to move, you would literally have to take camera shots of [every position].”

Armin St. George, the senior vice president at Crosswater, which is creating the pilot VR for the university-charter collaboration at a much-reduced rate, estimated there would be some minimal interaction capabilities within the next four to six months. The ability to speak to the system, though, is likely more than a year away.

Julie Schwab, the school superintendent for Enterprise, is eyeing using the VR scenarios both for in-service teacher training this school year and during the teacher-hiring process.

Most of the teachers who come in to her school are white, middle-class women, she said, and many have never worked in an urban setting.

“They don’t have the background knowledge to understand where these kids are coming from,” Schwab said.

‘Stereotyping Threat Is Real’

With the VR, teachers could practice responding to challenging behaviors without the risk of causing emotional harm to real students, she said.

Ideally, they’d be more measured in their reactions to tough situations when they got to the classroom, she said. “From a cognition side, I’ve already processed this before, so I have some experiences I can draw on,” explained Lamb, the researcher.

But a problem with this work is that it can also potentially reinforce stereotypes about students.

The majority of students at Enterprise are black—and the half-dozen students featured misbehaving in the videos are all black. Research has consistently shown that black and Latino students are disciplined at disproportionately higher rates than their white peers.

“I do get nervous about putting my kids out there and the stereotypes that could come,” said Schwab.

The training programs that use avatars have a leg up here, said Christopher Dede, a professor of learning technologies at the Harvard Graduate School of Education. Within those simulations, it’s easy to change students’ races and genders—so the programs can even be used to help teachers recognize their own biases, he said.

With video, in particular, because it’s so expensive to shoot, “I think the stereotyping threat is real because it’s just harder to show so many alternatives that you’re not stereotyping,” said Dede.

Cantaffa of SUNY sees a lot of promise in the video-based VR technology beyond the fraught area of classroom management. Perhaps education schools can use it for practice administering literacy tests, running special education meetings, or delivering lessons.

“Having been a teacher, there are many moments in which it’s quite anxiety-ridden to be in front of a class,” he said. “But if the VR experience can help create those anxieties, it might help me in terms of muscle memory when I encounter that pedagogical moment in which I’m also anxious.”

Output: Researchers at New York's University at Buffalo are partnering with Enterprise Charter School and Crosswater Digital Media to develop virtual reality (VR) videos aimed at helping trainee teachers learn to manage students. The proof-of-concept 3D films enable trainee teachers to practise dealing with challenging behaviour, although limitations include not being able to approach or interact with the children. Critics have argued the high cost of 3D filming means a limited number of video scenarios, potentially leading to the reinforcement of student stereotypes. Buffalo teachers will begin using a pilot of the technology this autumn.


Instruction: create a high quality summary of the given input

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Bernie Sanders: Why We Need Medicare for All
 This is not a radical idea. I live 50 miles south of the Canadian border. For decades, every man, woman and child in Canada has been guaranteed health care through a single-payer, publicly funded health care program. This system has not only improved the lives of the Canadian people but has also saved families and businesses an immense amount of money.

On Wednesday I will introduce the Medicare for All Act in the Senate with 15 co-sponsors and support from dozens of grass-roots organizations. Under this legislation, every family in America would receive comprehensive coverage, and middle-class families would save thousands of dollars a year by eliminating their private insurance costs as we move to a publicly funded program.

The transition to the Medicare for All program would take place over four years. In the first year, benefits to older people would be expanded to include dental care, vision coverage and hearing aids, and the eligibility age for Medicare would be lowered to 55. All children under the age of 18 would also be covered. In the second year, the eligibility age would be lowered to 45 and in the third year to 35. By the fourth year, every man, woman and child in the country would be covered by Medicare for All.

Needless to say, there will be huge opposition to this legislation from the powerful special interests that profit from the current wasteful system. The insurance companies, the drug companies and Wall Street will undoubtedly devote a lot of money to lobbying, campaign contributions and television ads to defeat this proposal. But they are on the wrong side of history.

Guaranteeing health care as a right is important to the American people not just from a moral and financial perspective; it also happens to be what the majority of the American people want. According to an April poll by The Economist/YouGov, 60 percent of the American people want to “expand Medicare to provide health insurance to every American,” including 75 percent of Democrats, 58 percent of independents and 46 percent of Republicans.

Now is the time for Congress to stand with the American people and take on the special interests that dominate health care in the United States. Now is the time to extend Medicare to everyone.

Output: This is a pivotal moment in American history. Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right? Or do we maintain a system that is enormously expensive, wasteful and bureaucratic, and is designed to maximize profits for big insurance companies, the pharmaceutical industry, Wall Street and medical equipment suppliers?


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Asian glaciers to shrink by 36% by 2100, reducing water supply
 Asia’s mountain glaciers will lose at least a third of their mass through global warming by the century’s end, with dire consequences for millions of people who rely on them for fresh water, researchers have said.

This is a best-case scenario, based on the assumption that the world manages to limit average global warming to 1.5C (2.7F) over pre-industrial levels, a team wrote in the journal Nature.

“To meet the 1.5C target will be a task of unprecedented difficulty,” the researchers said, “and even then, 36% (give or take 7%) of the ice mass in the high mountains of Asia is projected to be lost” by 2100.

With warming of 3.5C, 4C and 6C respectively, Asian glacier losses could amount to 49%, 51% or 65% by the end of the century, according to the team’s modelling study.

The high mountains of Asia comprise a geographical region surrounding the Tibetan plateau, holding the biggest store of frozen water outside the poles.

It feeds many of the world’s great rivers, including the Ganges, the Indus and the Brahmaputra, on which hundreds of millions of people depend.

Nearly 200 nations adopted the Paris agreement in 2015, which sets the goal of limiting warming to a level “well below” 2C, while “pursuing efforts” to achieve a lower ceiling of 1.5C.

Earth’s surface has already warmed by about 1C, according to scientists.

For high warming scenarios, experts predict land-gobbling sea-level rise, worsening storms, more frequent droughts and floods, species loss and disease spread.

The Asian high mountains, the new study said, were already warming more rapidly than the global average.

A global temperature rise of 1.5C would mean an average increase in the region of about 2.1C, with differences between mountain ranges – all of which will warm by more than 1.5C.

The Hindu Kush mountain range would warm by about 2.3C and the eastern Himalayas by 1.9C, the study forecast.

“Even if temperatures stabilise at their current level, [glacier] mass loss will continue for decades to come,” the researchers added.

For the high mountain glaciers to survive, “it is essential to minimise the global temperature increase”.

Swaths of south Asia and China depend on meltwater from Himalayan glaciers for drinking water, electricity generation and irrigation.

At the same time, the regions are also vulnerable to more intense flooding from accelerated glacier melt, combined with heavier rains and superstorms boosted by global warming.

A study in July in the journal Nature Climate Change said there was only a 5% chance of holding global warming under 2C. For 1.5C, the odds were about 1%.

On current trends, some experts project Earth is on track to warm by about 3C.

Output: Mountain glaciers in Asia are warming more rapidly than the global average and will lose at least a third of their mass by the end of the century, according to research. If the world does not manage to restrict global warming to an average 1.5C above pre-industrial levels, the loss will be even greater. The region surrounding the Tibetan plateau holds the largest store of frozen water outside of the poles. Large areas of China and south Asia depend on glacial meltwater for drinking water, electricity and irrigation.


Instruction: create a high quality summary of the given input

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Asian glaciers to shrink by 36% by 2100, reducing water supply
 Glaciers in the high mountains of Asia are a crucial water resource, but are at risk from global warming. Modelling suggests that the glaciers will shed mass in direct proportion to the warming to which they are exposed. See Letter p.257

The 2015 Paris climate agreement aspires to limit the average global temperature rise to 1.5 °C above pre-industrial levels by the end of this century (see go.nature.com/2efxikg). Intensive work is under way to determine what return we would get for the formidable effort required to achieve this goal. On page 257, Kraaijenbrink et al.1 contribute to this work by modelling glaciers in the high mountains of Asia (HMA) and showing how these glaciers respond to different levels of warming. The authors demonstrate that even if the 1.5 °C target is met, about one-third of the present-day mass of HMA glaciers will be lost by the end of this century. The work could have major consequences for communities in the region that depend on glacial meltwater for domestic use, hydropower and irrigation.

Output: Mountain glaciers in Asia are warming more rapidly than the global average and will lose at least a third of their mass by the end of the century, according to research. If the world does not manage to restrict global warming to an average 1.5C above pre-industrial levels, the loss will be even greater. The region surrounding the Tibetan plateau holds the largest store of frozen water outside of the poles. Large areas of China and south Asia depend on glacial meltwater for drinking water, electricity and irrigation.


Instruction: create a high quality summary of the given input

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Leading medical societies, health systems collaborate to improve geriatric emergency care
 Four national medical societies and nine leading health systems announced today they have established a new national geriatric emergency department collaborative (GEDC) to help improve emergency care for our nation's older adults.

The American College of Emergency Physicians (ACEP), American Geriatrics Society (AGS), Emergency Nurses Association (ENA) and Society for Academic Emergency Medicine (SAEM) will work with a team of experts in geriatric emergency care to support health systems across the United States in identifying, studying and sharing best practices in emergency care for seniors, with about half of all older adults visiting the emergency department (ED) each year.

The four societies previously developed expert guidelines on geriatric emergency care in 2014. Those guidelines and new educational activities will help partners at Aurora Health Care System (Wis.), Emory University/Grady Memorial Hospital (Ga.), Magee Women's Hospital (Pa.), Mount Sinai (N.Y.), UC San Diego Health (Calif.), Northwestern (Ill.), St. Joseph's Regional Medical Center (N.J.), University of Chicago (Ill.), and University of North Carolina (N.C.) to promote a variety of proven techniques for improving care for older patients--from coordinating expertise among various professionals to ensuring that older people can transition from the hospital to outpatient settings (like homes or community-based settings) whenever and wherever safely possible.

The research collaborative is supported by a grant of $3 million from The John A. Hartford Foundation and the Gary and Mary West Health Institute, two national non-profit organizations focused on improving care for us all as we age.

"Today, 20 million seniors visit our nation's emergency departments," said Shelley Lyford, president and CEO of the Gary and Mary West Health Institute. "With the number of older adults growing rapidly as a result of our aging demographic, there is a critical need for more senior-focused care. This pioneering collaborative is an urgent prescription for innovation and shared learning, which will benefit our nation's seniors in emergency rooms across the country."

Added Terry Fulmer, PhD, RN, FAAN, president of The John A. Hartford Foundation: "This dynamic initiative is committed to ensuring that age-friendly best practices in theory become best practices in practice--advancing large-scale changes in clinical care and ED policies to improve the health, safety, and independence of older adults."

The GEDC will continue to add more health centers and partners, contributing to an alliance of national stakeholders who will help promote national adoption of geriatric emergency care best practices.

###

About The John A. Hartford Foundation

Founded in 1929 by John and George Hartford of the Great Atlantic & Pacific Tea Company (A&P), The John A. Hartford Foundation, based in New York City, is a private, nonpartisan philanthropy dedicated to improving the care of older adults. As 10,000 people turn 65 every day, the largest-ever generation of older adults is living and working longer, redefining later life, and enriching our communities and society. Comprehensive, coordinated, and continuous care that keeps older adults as healthy as possible is essential to sustaining these valuable contributions. The John A. Hartford Foundation believes that its investments in aging experts and innovations can transform how care is delivered, lowering costs and dramatically improving the health of older adults. For more information, visit https://www.johnahartford.org/.

About The Gary and Mary West Health Institute and West Health

Solely funded by philanthropists Gary and Mary West, West Health includes the nonprofit and nonpartisan Gary and Mary West Health Institute and Gary and Mary West Foundation in San Diego, and the Gary and Mary West Health Policy Center in Washington, D.C. These organizations are working together toward a shared mission dedicated to enabling seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life and independence. For more information, visit westhealth.org and follow @westhealth.

Output: Four national medical societies and nine leading health systems announced today they have established a new national geriatric emergency department collaborative (GEDC) to help improve emergency care for our nation's older adults.


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Is California Doing Enough To Protect Patients From Bad Doctors?
 This is KPBS Midday Edition. I am Maureen Cavanaugh. Some lawmakers believe patients should be notified if the doctor is on probation for a serious offense. That is the idea behind a measure that has not been able to clear this date legislature. The medical Association has tried to kill the bill two years in a row. Kenny Goldberg says supporters are not ready to give up.Marion Hollandsworth needed a colonoscopy. Her primary care doctor referred her to an introit just who performed a procedure. Everything was okay.A few years later, Hollandsworth learn how to research doctors on the medical board website. She decided to check the records of the doctor who did her colonoscopy.I about fell over because he was about to start a 30 day suspension and seven years probation for a decade long history of drug and alcohol abuse but what got the attention of the medical board is that he went after a patient with a hatchet.The medical board investigated this doctor before expect in the early 2000, he was recommended for the medical board diversion program they had at that time. He failed other diversion programs. He tried voluntarily and he failed the medical board version and nothing was done.Any disciplinary action taken against a physician in California is listed on the medical board website but it is not user friendly. Hollandsworth takes us through a search of a doctor who has public records.Click to Sir theTo see what he did. Here, for the five years probation, you have to click there. You have to know to click here.Even if a doctor is punished for being drunk on the job, they are not required to tell patients about it.A bill would have changed that. It would have required doctors to notify patients in writing if the medical board with them on probation or a serious offense like sexual misconduct with a patient or operating under the influence of drugs. The California medical Association said no. He lobbied to kill the bill. The CMA did not agree to be interviewed for the story. Any written statement, a spokeswoman said such notification would erode the fundamental right to due process by basing notification on accusation rather than a finding of fact.That is false.Writ budget directs the law at Sandy go.They have stipulated with the medical board that they did commit the conduct that they are accused of or that the board could prove the case or certain elements of the case.Grammy says the CMA is wrong on this.They are trying to make it sound like there is a good reason but they do not have a good reason. They do not want to tell patients because it would be embarrassing. That is not a good enough reason.There are an estimated 137,000 licensed physicians. In that is in California. They put 124 doctors on probation each year. The failed bill would have applied to a subset of those doctors. The CMA helped kill a measure that would have affected 2/100 of a percent. Jeffrey Gordon has a unique perspective. He not only spent 35 years in private practice but he also served on the state medical board for eight years in the 1970s. He says the board has an obligation to protect patients from bad doctors expect to put their names on our website is not adequate. Each physician ought to be responsible for notifying his patients that he has not been morally responsible.Marion has become a pursuit or for more public disclosure. She thinks the medical board does not have the priority straight.The investigator in my case told me it is the medical board's job to make sure they remain in practice for as long as practice.I thought it was to protect patients.She says that to.KPBS news.Joining me is Jerry Hill the sponsor of SB 798. Welcome to the program.Thank you.What is this is of the bill ?This was approved by the Senate yesterday. It will go to the governor. It is a different bill than the bill the Senate approved in May of this year.When it came to the Senate from the assembly, the patient protection issues, they were able to get removed from the California medical Association.The patient notification of doctors on probation, that was removed from the bill ?That was removed from the bill. I have been fighting for this issue it came up last year when we saw the egregious violations of medical practice and from physicians who caused patient harm. They were given probation to serve or the sanction from the medical board. They would do the job and see patients and patients would not know. Many of these physicians are discipline for a sexual misconduct and a lot of times, the condition of probation is that they cannot see female patients if they are male and chaperone. The patient does not know that. Many doctors us are practicing in Seoul practices where there is no one to monitor them. To me, this most significant aspect is that we find the medical board, 30% of the physicians recidivate. They do it again. The patient should have an has a right to know to be told upfront before they see the doctor that that Doctor is on probation and here are the conditions and terms and that probation.Center Hill, this is not the first time that legislation that you sponsored to strengthen Doctor the closure has come up against the California medical Association.Why is the CMA such a powerful group?I cannot explain why. Every person who makes a decision based on their influence or the lab he -- the lobby, they have to look at why they made that decision. They are very powerful and we have been fighting to try to protect the patient and we are only talking about in California, 137,000 doctors, they practice and there are only 600 you are on probation. And of that number, many less are there for the three issues that we are concerned with with this gross negligence, sexual misconduct or substance abuse that will affect the Mac practice in medicine. Right now, if a doctor is on probation, they are required by law to notify the insurance company and required by law to notify the hospital that they are affiliated with but the most important person in the healthcare continuum is the patient. They are not required to be notified. There is something wrong with that.If doctors were required to tell patients they are about to be suspended or put on probation, would that kill the Mac practice ?It could but that is not something that we should be concerned with. That is the argument that the medical Association makes that this would put them out of business. I think that my responsibility as the chair of the business and profession committee is to protect patients and consumers and to over see the human affairs.What benefit would this have on patients besides them saying I do not want to affiliate with this Doctor?I do not know if that is the case.There are physicians who have long relationships and good relationships with patients that this may not affect them. They may be able to have that relationship. I am fascinated by the argument. This bill came forward is to why a psychiatrist should not be -- should not have to disclose probation status is that this would breach the trust that is necessary between the patient and the position if you notify them.That makes no sense to me.Shouldn't you be honest with your patient and let them know the circumstances around her practice? That is the trust that should be built, not deceive them by not telling them of the proms you have.You put forward a disclosure law last year and a disclosure law this year. They have not made it into the final legislation. Do you intend to keep doing it ?I do. I will continue this fight because it is most important for the people of California and the good thing is that the California medical board on this legislation, they were supportive of the legislation with the amendments that we placed in allowing for and requiring patient notification of doctors on probation but that is a good first step. They had previously not felt that it was necessary to notify patients. This information is available today on a medical board website. It is not easy to find and that is the problem. Most of us do not look at or think to look at a website or go to the medical board when we go to a position, to see if they have a license and if there has been disciplinary actions. We take it to granted and we hold them in highest esteem. I feel there should be a better level of transparency and information that is provided to patients.I have been speaking with Jerry Hill. Thank you.Thank you. It is my pleasure.

Output: In 2011, Marian Hollingsworth needed to get a colonoscopy. Her primary care doctor referred her to a gastroenterologist, who performed the procedure. It went well. A few years later, Hollingsworth learned how to research doctors on the California Medical Board’s website. She decided to check the records of the doctor who did her colonoscopy.


Instruction: create a high quality summary of the given input

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Making sense of Covered California and Medicare during open enrollment
 “Selecting the traditional Medicare provides full choice of physicians and facilities, but entails out-of-pocket co-pays, and many buy supplemental insurance to cover the costs that Medicare does not cover,” says Dr. Michael Brant-Zawadzki of Hoag Hospital.

It’s that time of year when we all have to start thinking about health insurance plans and options.

Not only do I need to figure out if my current plan will be offered again next year, and with what changes, but my husband is over 65, so I also have to research the latest Medicare plans as well.

As a columnist, research is my thing, but this insurance stuff makes my head spin.

Like it or not it’s time to start researching as open enrollment begins. Covered California open enrollment is Nov. 1 to Jan. 31, and Medicare’s is Oct. 15 to Dec. 7.

At healthcare.gov, there’s information about the various open enrollments, including for a Special Enrollment Period, due to a life event like losing other coverage, getting married or having a baby, as well as Medicaid or the Children’s Health Insurance Program (CHIP).

The government site also provides tips regarding the Health Insurance Marketplace and what’s required to be eligible to use these programs.

Making the right insurance choices can be confusing.

So I asked my pal Dr. Michael Brant-Zawadzki, FACR senior physician executive at Hoag Hospital, for some thoughts on how to maneuver through this medical insurance muddle.

Hoag is part of a 50, non-profit hospital system, the second largest west of the Mississippi, so I thought he’d have some good advice, and he did.

Brant-Zawadzki agrees that “Uncertainty about healthcare abounds, and it clouds our choices.”

He says it’s important to look at options, as it can come down to a tradeoff: choice versus cost.

Even with workplace health plans, this is the case as, “as employers increasingly select health plans that package hospitals and clinicians in a ‘narrow’ network,” hoping to spend less while “maintaining quality and patient satisfaction.”

I asked the good doctor about Medicare, as information is showing up in the mail, and from what I can see, it’s a bit confusing.

Brant-Zawadzki explained Medicare has two options.

“Selecting the traditional Medicare provides full choice of physicians and facilities, but entails out-of-pocket co-pays, and many buy supplemental insurance to cover the costs that Medicare does not cover,” he says.

The other choice, Medicare Advantage, is marketed to seniors by insurance companies and large health plans like Kaiser.

He says this is “attractive because it promises low or no out-of-pocket costs for doctors, hospitalization and drugs.”

But those choosing this option should be aware that Medicare Advantage plans offer members a network of physicians and facilities that they must use, according to the plan guidelines.

“Medicare Advantage plans typically require access for all care through an assigned primary care physician, who directs the care plan, including which tests and specialists the member will need,” says Brant-Zawadzki.

He explained these managed plans have contracted specialists, and sites of service, so patients’ choices of specialists is limited.

An unexpected emergency could find a patient here in a hospital not in their plan, resulting in transfer to a hospital within their plan.

“Likewise, an on-call specialist seeing that ER patient may not be on the plan, and may bill separately for professional services,” says Brant-Zawadzki.

“This scenario causes confusion and frustration, as well as unexpected bills for the patient, not to mention the disruption in the continuum of care,” he says.

Brant-Zawadzki says if Medicare Advantage is your preference, it’s a good idea to choose a plan that bundles the hospital, its facilities and the specialists you trust.

“Just because your favorite hospital is ‘in network’ on your plan does not mean that that hospital’s out-patient lab, imaging, colonoscopy or even ambulatory surgery facilities are also in your plan,” says Brant-Zawadzki.

Ask your primary care physician what contractual obligations he or she has within the plan you’ve chosen and what facilities and specialists to which you’d likely be directed.

“You may find yourself in a facility operated by an unfamiliar entity with an unknown diagnostician” Brant-Zawadzki says.

Medicare and Medicare Advantage plans can be confusing.

Patients should access all care from the hospital network of their choice and ensure that the plan they select gives them access to not only inpatient hospital care, but all of the additional services, such as imaging, physical therapy and other outpatient services.

Cover your bases, as you research health insurance choices.

Speak to an independent insurance broker.

And you might want to attend Hoag Hospital’s free seminars about the basics of Medicare, Medicare benefits, Medicare Supplemental Insurance Plans, Medicare Advantage HMO and PPO plans and Medicare Part D prescription drug coverage.

Classes begin in September and run through November at all three campuses in Newport, Irvine and Huntington Beach.

Reservations are a must and to find the location and times in your area visit hoagmedicalgroup.com/for-patients/classes/

BARBARA VENEZIA lives in Newport Beach. She can be reached at bvontv1@gmail.com.

Output: It’s that time of year when we all have to start thinking about health insurance plans and options. Not only do I need to figure out if my current plan will be offered again next year, and with what changes, but my husband is over 65, so I also have to research the latest Medicare plans as well.


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Yes, patients want to discuss pricing, payment options before treatment
 More than three-quarters of healthcare consumers say it's important or very important that they know their costs before treatment, and 53 percent want to discuss financing options before care. But the vast majority of healthcare providers are not satisfying these demands, according to the HealthFirst Financial Patient Survey, a survey conducted by ORC International and commissioned by patient financing company HealthFirst Financial.

[Also: Employers sending patients to top-performing providers with bargain prices for routine surgeries]

Only 18 percent of the 1,011 U.S. adults surveyed across the country said that any of their healthcare providers had spoken to them, at any time, about patient financing options in the past two years. Patients are especially interested in affordable payment programs, with 57 percent saying it's important or very important that their healthcare provider offer ways to extend payments over time with no interest charged. Yet, just 8 percent received zero- or low-interest financing from a healthcare provider.

"These findings highlight a huge gap in what patients want and what hospitals, medical groups and other healthcare providers are delivering," said KaLynn Gates, president and corporate counsel of HealthFirst Financial, in a statement. "Providers that care for the financial as well as clinical needs of their communities are much more likely to thrive in this era of rising out-of-pockets costs and growing competition for patients among traditional and non-traditional providers."

[Also: Despite providers posting prices, patients still not shopping around for services]

Disappointed patients are prepared to vote with their feet. A full 40 percent of millennials 18 to 36 years old said they'd be very likely or likely to switch providers if a competitor offered low- or zero- interest financing for medical bills. They aren't alone: Overall, 29 percent said they'd move to different providers that offer attractive payment programs.

People at all income brackets worry about covering the cost of care. A full 42 percent are very concerned or concerned about their ability to pay out-of-pocket medical bills in the next two years, according to the survey. That number jumps to 54 percent among those with incomes of less than $35,000 a year, and falls to 24 percent among those with incomes of $100,000 or more annually.

[Also: Battle over price transparency rages in Ohio, where new laws like Ohio's Healthcare Price Transparency Law are in limbo]

As a result, consumers also want know what they will owe as early as possible: 77 percent said it's important or very important that providers give the cost before a procedure, while 63 percent said it was important or very important that providers publish pricing lists of common procedures.

And with consumer debt on the rise, people have even less room in their budget for medical bills. Anxiety over covering unexpected medical expenses rises with the amount: 53 percent of survey respondents voiced concern about the ability to pay a medical bill of less than $1,000; 35 percent worried about the ability to pay a bill of less than $500; and 16 percent are concerned about the ability to pay a bill of less than $250.

"We commissioned this independent survey to learn more about how consumers are coping with their medical expenses," said Gates. "Without providing and communicating these viable financing options, they are likely to delay care or switch providers to find financial help. In either case, providers will be hurt by those choices, and they need to develop a strategy to meet these consumers' needs."

The August survey was conducted by ORC International among a sample of 1,011 adults comprising 504 men and 507 women 18 years old and older. The interviews were weighted by age, sex, geographic region, race and education to ensure reliable and accurate representation of the total U.S. adult population.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com

Output: More than three-quarters of healthcare consumers say it's important or very important that they know their costs before treatment, and 53 percent want to discuss financing options before care. But the vast majority of healthcare providers are not satisfying these demands, according to the HealthFirst Financial Patient Survey, a survey conducted by ORC International and commissioned by patient financing company HealthFirst Financial.


Instruction: create a high quality summary of the given input

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Appetite for digital advice grows 80% among advisers
 Financial firms using Fidelity’s Wealthscape adviser technology platform now have access to the robo adviser the company has developed with eMoney Advisor.

Fidelity’s clearing and custody arm has concluded the pilot of the Fidelity AMP (Automated Managed Platform) and is making the robo service available generally, a company spokesperson said. In a release, the company noted that the number of advisers whose firms are exploring the addition of digital advice has grown by more than 80% in a year, with 40% considering the digital advice options now available.

Fidelity said that its robo integrates with eMoney’s widely used tools and that the two firms plan to add enhancements to Fidelity AMP, including more options for customized investment models. Advisers can apply their own branding to an end-investor portal and marketing materials, Fidelity said.

Output: The number of financial advisory firms considering the adoption of digital advice has increased by more than 80% in the last year, according to Fidelity. 40% are currently considering digital advice options, the investment company added. Fidelity recently released a robo-advice service to customers of its Wealthscape adviser technology platform, developed in partnership with financial planning software provider eMoney.


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Why Bernie Sanders’s plan for universal health care is only half right
 Sen. Bernie Sanders plans to introduce his universal health care bill Wednesday; it is likely to serve as a litmus test for Democrats with presidential aspirations. The legislation is bold and simple, which makes it very appealing. A recent survey by the Pew Research Center found that 60 percent of Americans believe the federal government should ensure health coverage for all Americans.

But Sanders’s bill only gets it half right.

The part that’s right is that every American would automatically get health insurance. If that came to pass, the door would be open to lowering costs while eliminating the highly complex regulations needed to police our current system and the inequitable tax treatment that sustains it.

The part that Sanders gets wrong is that he would turn Medicare into a single-payer system for all, supplanting private insurers.

That approach has lots of problems, not least of which is an enormous price tag. Consider what happened in California earlier this year when the state legislature briefly considered a single-payer bill. An appropriations committee estimated it would cost $400 billion, over twice the state’s annual budget. Such complications make the Sanders bill — and other Medicare for all proposals — virtually impossible to enact.

People also forget that Medicare is a hidebound system. It took Congress more than 40 years to offer a prescription drug benefit, for example. Physicians are paid using an arcane system developed decades ago and that has now ballooned to more than 140,000 procedure codes, all of which is supervised (and gamed) by physicians themselves. Standard private sector cost-saving measures, like competitive bidding for routine services, are rarely used.

There is a better way — called universal catastrophic coverage — which borrows from both progressive and conservative playbooks. It would combine the federal guarantee of insurance for all with the cost-controlling benefits of insurers competing for that business.

From the consumer viewpoint, universal catastrophic coverage would look like this: All Americans not covered by Medicaid and Medicare would be placed in a single, massive risk pool. The government would assume the risk of insuring everyone, using a high-deductible policy that would guarantee that no one would be without care in the event of a health care crisis.

To keep the plan progressive and affordable for all, deductibles would be tied to income. Services that are very effective would be exempt from the deductible and fully covered. This includes many prevention services — like flu shots — but also medications for chronic disease, certain vaccines, and the like.

This would eliminate a host of problems in the current system: no more worries about preexisting conditions, no more losing insurance when changing jobs, no more mandated buy-in, and no more upward spiraling of premiums for those buying policies because healthy people are staying uninsured and not paying their share.

From the point of view of insurers, the new system would look like Medicare’s prescription drug plan, in which they compete for market share by offering different networks, deductibles, premiums, and supplemental coverage.

A version of universal catastrophic coverage that I devised with my colleague, Kip Hagopian, would cost the government about 15 percent less than the Affordable Care Act while insuring 115 million more people, according to a RAND study. Premiums would be about $3,000 annually, about 40 percent less than the ACA silver plans.

This approach borrows from liberal dreams for health care as a right, and from conservative conviction that market forces are the most efficient way to deliver health care and keep costs under control. That is why both sides can support it.

Being bold means asking for big changes. The current system of employer-based insurance would lose its tax-protected status, which currently costs the federal government $236 billion (about the same as the mortgage interest deduction, charitable deductions, and retirement benefit exclusions combined, according to the Tax Policy Center). Those savings would be used to underwrite the new system.

Vested interests will find many reasons to oppose change. But the bottom line is that we can cover everyone if we are smart about it.

Output: Sen. Bernie Sanders plans to introduce his universal health care bill Wednesday; it is likely to serve as a litmus test for Democrats with presidential aspirations. The legislation is bold and simple, which makes it very appealing. A recent survey by the Pew Research Center found that 60 percent of Americans believe the federal government should ensure health coverage for all Americans.


Instruction: create a high quality summary of the given input

Input:
Medicare for All or State Control: Health Care Plans Go to Extremes
 WASHINGTON — In one Senate office building, some of the leading lights of the Democratic Party gathered Wednesday to embrace what was once a proposal only of the far left: a huge expansion of Medicare, large enough to open the popular, government-run health program to all Americans.

In another Senate office building, a smaller but equally adamant group of Republican senators stood together to take one last stab at dismantling the Affordable Care Act. They proposed instead to send each state a lump sum of federal money, along with sweeping new discretion over how to use it.

Important elements in both parties are trying to move beyond President Barack Obama’s health care law, which has always been a complicated, politically difficult mix of government and private health insurance. But they are moving in radically different directions.

The proposals appeared to have only one thing in common: Neither is likely to be enacted any time soon.

Output: In one Senate office building, some of the leading lights of the Democratic Party gathered Wednesday to embrace what was once a proposal only of the far left: a huge expansion of Medicare, large enough to open the popular, government-run health program to all Americans.


Instruction: create a high quality summary of the given input

Input:
How the Bernie Sanders Plan Would Both Beef Up and Slim Down Medicare
 The Sanders plan — which has no near-term chance of advancing with Republicans in power — would change that. Most crucially, it would expand the program so that every American would eventually get insurance from Medicare instead of private companies or other public programs. The employer health insurance system, the Affordable Care Act exchanges and most of Medicaid would be eliminated.

Mr. Sanders says that the transition to the Medicare program would achieve several goals: It would ensure universal coverage, it would improve the affordability of health care for many Americans and it would save the country money.

Whether it can achieve that third goal depends a great deal on how the new Medicare-for-all system would be managed, and the Sanders plan leaves a lot of those details unclear for now. Covering everyone would not, by itself, make the health care system in the United States as inexpensive as those of other nations with universal health care systems. That sort of cost control would require its own set of policies and difficult choices.

In his news conference introducing the bill on Wednesday, Mr. Sanders focused his ire on insurance and drug companies, two profitable sectors of the health care system. But insurance and drug company profits don’t make up the bulk of America’s health care spending. Single-payer advocates argue that the simplicity of a single, government payer would reduce paperwork and office staff, and that is almost certainly true. But most spending in the health care system is on medical care from doctors and hospitals — and squeezing savings there may be harder.

Output: In his big new single-payer health care bill, Senator Bernie Sanders says he wants to turn the country’s health system into “Medicare for all.” But his bill actually outlines a system very different from the current Medicare program.


Instruction: create a high quality summary of the given input

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How the Trump administration is reshaping health care — without Congress
 The sheer scale of the effort has surprised and thrilled health care lobbyists, some of whom described feeling inundated by Health and Human Services leadership’s appeals for recommendations on any and all federal rules they would like to see trimmed.

“We have been shooting for the moon, just bringing up every possible issue we think they have the ability to change,” said Vinita Ollapally, manager of regulatory affairs for the American College of Surgeons. “This is the first time that any administration has seemed to be so focused on regulatory relief.”

However, the effort has raised alarms among patient advocates and policy experts, who fear it could erase several years of gains aimed at modernizing the health care system and tipping the balance of power away from providers and toward patients.

“It’s consistent with a general orientation to try to find significant accomplishments of the Obama administration and to undo them,” said Eliot Fishman, who spent nearly four years at the Centers for Medicare & Medicaid Services’ Center for Medicaid and CHIP Services, including two as Medicaid waiver chief, before leaving the agency in April. “It’s disappointing, but not surprising.”

Led by HHS Secretary Tom Price and CMS Administrator Seema Verma, the initiative appears aimed at rewriting or outright eliminating a slew of regulations imposed on doctors, hospitals and other providers.

Price, an orthopedic surgeon who has long criticized health care regulation as too heavy-handed, has in some cases dispatched top staffers to work closely with doctors’ groups on changes further easing regulatory scrutiny of physicians.

Verma, formerly a Medicaid consultant who worked primarily with red states, has wasted little time targeting a pair of far-reaching Medicaid rules that tightened supervision of insurers and home health care facilities, multiple sources familiar with the process said. The agency has spent months reviewing those regulations as part of a much larger effort seen as laying the groundwork for a policy shift that hands back to states more regulatory power over Medicaid.

The work fits with an administrationwide mission to reverse scores of Obama-era rules, and Price and Verma’s vow early on to re-examine every federal health care rule in search of waste.

“The Trump administration is working tirelessly to get Washington out of the way, bring down the cost of coverage, expand health care choices and improve quality,” an HHS spokesperson said in response to a series of questions for this article, highlighting the agency’s emphasis on abolishing rules it deems “burdensome across all spectrums of the health care system.”

The effort has also given rise to an apparatus within President Donald Trump’s health department dedicated to the so-called burden reduction initiative — one that multiple staffers characterized as a massive effort to solicit, evaluate and implement industry-backed ideas for slashing regulations.

“It’s not really a reducing-burden issue,” one CMS staffer said. “It is a deregulation issue. It’s a deregulation intent.”

In the process, HHS’ tiny but influential Office of Health Reform — originally created to aid Obamacare’s implementation — has been transformed into one of the agency’s central deregulatory hubs, meeting with industry groups and developing its own recommendations, multiple current and former CMS staffers said.

The office at one point maintained a spreadsheet listing roughly 200 potential regulatory changes, according to one staffer.

Exactly what those ideas are and how they’ll be implemented remains closely held among HHS’ and CMS’ top political appointees and their aides — a point of frustration for career employees who have spent months gathering recommendations.

“When you ask, ‘What is the organizing principle here? How are we prioritizing?’ And try to put some structure around this, nobody has an answer. The only answer people give is, ‘Reduce burden,’” another CMS staffer said. “There’s got to be more to this than that.”

But officials have laid out a two-track strategy in meetings with industry groups and lobbyists: quickly overhauling smaller rules to make life easier for providers, while developing longer-term projects aimed at fundamentally changing the way the federal government regulates health care.

In practice, that’s translated into a series of industry-friendly moves targeting Obama-era rules and protecting companies’ bottom lines. HHS plans to restore nursing homes’ ability to require that patients pre-emptively give up their right to sue for negligence — reversing a major win for consumer advocates — after saying that a 2016 ban on mandatory arbitration agreements “underestimated the financial burdens placed on providers” forced to defend themselves against lawsuits.

Medical equipment companies will get a boost from a pending rule likely to halt Medicare’s move to a new bidding program that would cut government payments to the industry. Prior to taking the helm at HHS, Price, as a Georgia congressman, sponsored legislation delaying the competitive bidding program, which aimed to bring Medicare’s spending on medical equipment more in line with the private sector.

As for the shift in the way Medicare pays doctors to focus on the quality, rather than the quantity, of services they provide — a broadly bipartisan goal that Price supported during his time in Congress — HHS has repeatedly slowed the process to accommodate small and rural providers. That includes plans to kill off a pair of Obama-era experiments making hospitals more financially responsible for patients’ care during and after certain joint-replacement surgeries and cardiac procedures.

“They recognize that there’s some complexity, and that’s why they’ve turned to physician groups,” said American Association of Hip and Knee Surgeons President Mark Froimson, who said his group is working with CMS to simplify the metrics used to measure the quality of physicians’ care. “We believe we have a good partner and set of partners in the administration.”

Two of the agencies’ most ambitious projects are still in the works: a rewrite of a 2016 rule that updated federal requirements for Medicaid managed-care plans for the first time in over a decade, and a similarly sweeping 2014 rule tightening oversight of residential care facilities, including those for adults with disabilities.

Two red-state Medicaid experts — former Tennessee Medicaid Director Darin Gordon and former Ohio Medicaid Director John McCarthy — have consulted on the policy work, according to two people familiar with their involvement.

In an email, McCarthy said the two are subcontracted to the Mitre Corp. Mitre declined to comment on its work with CMS.

Early discussions within CMS about the Medicaid managed-care rule centered on giving states more leeway in how they direct federal funding — a shift consistent with Republicans’ attempts to give states more control over the entitlement, including imposing conditions like work requirements on beneficiaries.

Changes to the regulation regarding residential care facilities, known as the Home and Community-Based Services rule, could potentially have ripple effects, according to people familiar with the agency’s discussions. A rewrite is likely to focus on easing the federal standards for facilities that care for disabled adults and shifting more oversight responsibility back to the states.

That would represent a sharp reversal from the Obama era, which sought to toughen federal regulation over concerns about abuse and subpar living conditions in homelike facilities for the disabled.

That could take years to accomplish — CMS has already spent months just sifting through the regulations to determine what elements it can change and how to do it, said multiple people familiar with the process.

But the intent is plain: to loosen federal control over Medicaid and give states more flexibility to run their own programs.

“There is clearly a new discomfort with federal regulatory power in Medicaid, and an assumption that state concerns about, particularly, Obama-era regulations have a presumption of being valid,” Fishman said.

Output: While Congress tussles over Obamacare, the Trump administration is quietly pressing ahead with plans to gut major Obama-era rules and relax federal oversight of swaths of the health care industry.


Instruction: create a high quality summary of the given input

Input:
The Use of Real-World Evidence in Health Care Decision-Making
 Health care experts are schedule to gather in Washington, D.C., on Sept. 13 to discuss how we can harness the data we gather in routine health care delivery in the real world and apply that information to support drug approvals, inform safety monitoring, and accelerate new health care innovations. Although many decision-makers are already using real-world data, the Food and Drug Administration is poised to take a significant step forward in how it considers and uses this information.

Understanding how treatments work in the “real world” can help improve the new health care innovation and inform health care decision-making. For example, real-world data can be used to identify unmet needs with existing medications, understand the potential safety and effectiveness of treatments in other forms of cancer, or accelerate the conduct of clinical trials. Real-world evidence has been in use for a long time, but it has grown in importance through investment in health information technology and more sophisticated approaches to collect and analyze data.

Under the 21st Century Cures Act, the FDA must consider how real-world evidence could support the approval of a new indication of a drug or support or satisfy post-approval study requirements. RWE is meant to complement, not replace, knowledge from randomized clinical trials — studies most commonly used for FDA approval of a treatment — and accelerate and add to what we already know about how a treatment works.

In fact, the FDA is already using RWE, but not for new biopharmaceutical indications. Through the FDA’s Sentinel Initiative, the FDA monitors the safety and emerging safety concerns of medical products in use in the marketplace. The Sentinel Initiative database, with more than 170 million lives, is one of the largest uses of this type of information. In July, the FDA cited RWE as a critical factor in its decision to expand the initial approval for transcatheter aortic valve replacement to now include valve-to-valve procedures. And at the end of August, the FDA issued a final guidance on how it intends to utilize real-world data to support regulatory decision-making for medical devices, offering a glimpse at how the agency could use the data for biopharmaceutical-related decisions.

Yet as the FDA has acknowledged, there is a need for rigorous and reliable information. When done correctly, by using high-quality data and strong methodologies, RWE can provide meaningful information; when done poorly, misinterpretations and poor health outcomes for patients are possible. Recent systematic reviews that compared treatment effects results from RCT and RWE studies for the same condition found few differences among high-quality studies based on the study type (RCT vs. RWE) alone. The quality of some data and methods have improved such that RWE can reliably answer many research questions.

High-quality data and credible analytic methods are critical. Over the past decade, several professional societies and research consortium have developed best practices and standards for conducting analyses and using RWE. However, as the National Pharmaceutical Council has outlined in research, there is little agreement among researchers and other stakeholders on how to optimally do this. A consensus-based set of methods and standards for collecting RWE developed in consultation with multiple stakeholders could provide greater clarity. An iterative process would allow these standards to rapidly incorporate new methods innovation, yet still encourage other stakeholders to accept high-quality studies and disregard poor-quality studies.

The regulatory context, decisions, and needs of the FDA are unique — however, recommendations and evidence included in the FDA-approved label serve as a guiding light for many stakeholders. For RWE to be fully accepted and utilized, it will require all stakeholders, including the biopharmaceutical industry, to encourage a learning health system using real-world data. While payers are using data in a variety of applications, from value-based contracting to medication adherence, broader and more consistent use of RWE to update coverage policies based on effectiveness in the real-world is needed. Clinical practice guideline organizations and clinical pathways that serve as a foundation for translating knowledge into clinical practice could more routinely use high-quality RWE to expand the knowledge about treatment effects in broader patient populations and improve the certainty of their recommendations. Patients also are becoming more aware of how their data is being collected and used. Going forward, it will be important to ensure that patients understand what RWE is and determine when it can be trusted to guide patient and provider treatment decisions.

The September meeting, bringing together these diverse stakeholders, is an important next step toward expanding the quality and reliability of real-world evidence for health care decision-making. NPC is looking forward to the conversation.

Jennifer Graff is a PharmD and vice president for comparative effectiveness research at the National Pharmaceutical Council, which sponsors and participates in research on the appropriate use of pharmaceuticals and the clinical and economic value of pharmaceutical innovation.

Morning Consult welcomes op-ed submissions on policy, politics and business strategy in our coverage areas. Updated submission guidelines can be found here.

Output: Health care experts are schedule to gather in Washington, D.C., on Sept. 13 to discuss how we can harness the data we gather in routine health care delivery in the real world and apply that information to support drug approvals, inform safety monitoring, and accelerate new health care innovations. Although many decision-makers are already using real-world data, the Food and Drug Administration is poised to take a significant step forward in how it considers and uses this information.


Instruction: create a high quality summary of the given input

Input:
Caregiver Fatigue Increases Healthcare Costs
 Emergency department visits are higher among patients whose family caregivers felt sad or fatigued.

Tired family caregivers are associated with more ED visits and higher overall healthcare costs for the person they care for finds a new University of Michigan study published in Journal of the American Geriatrics Society.

Researchers studied 3,101 couples over the age of 65, each with one spouse acting as caregiver for their disabled partner. They looked at Medicare payments and ED visits for the disabled spouses in the six months after the caregiver spouses took standard tests to measure their fatigue, mood, sleep habits, health and happiness.

In those six months, ED visits were 23% higher among patients whose caregivers scored high for fatigue or low on their own health status. Over the same time frame, patients with fatigued or sad caregivers had higher Medicare costs—$1,900 more if the caregiver scored high for fatigue, and $1,300 more if the caregiver scored high for sadness.

“Informal caregivers, including spouses, enable older adults with functional disability to stay out of the nursing home and live at home where they’d prefer to be,” says senior author Deborah Levine, MD, MPH, an assistant professor of internal medicine and neurology at University of Michigan. “Our findings suggest that we need to do a better job of identifying and supporting caregivers experiencing distress, in order to help caregivers feel better and hopefully improve outcomes in older adults with disability.”

Respite Support Needed

Nearly 15 million older adults receive help with activities of daily living from spouses and other family or friend caregivers, but Medicare does not pay for or offer formal respite coverage for family or friends who regularly care for older adults.

Given the increased use of healthcare resources when caregivers are unsupported, it may make financial sense to change this policy.

“I definitely think there are specific services that could help caregivers, if we can identify those people who are highest risk and provide a basic level of support such as an around-the-clock geriatric care call line that could help caregivers feel less isolated and talk to a nurse about whether, for example, to go to the emergency department,” says lead author Claire Ankuda, MD, MPH. “This is a high-cost, vulnerable population.”

Output: Tired family caregivers are associated with more ED visits and higher overall healthcare costs for the person they care for finds a new University of Michigan study published in Journal of the American Geriatrics Society.