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Textile that disinfects itself developed for hospital use
 Close up of a Surfaceskins device showing the tiny valves that 'pump' alcohol gel onto the surface. Credit: Surfaceskins

Scientists have developed a novel weapon in the battle against deadly hospital-acquired infections - a textile that disinfects itself.

And independent tests show it can reduce bacteria levels by more than 90 per cent.

By incorporating the specially-engineered textile in a device designed to be used on hospital doors instead of the traditional aluminium door plate, that part of the door that people push to open it - they aim to bolster hand hygiene.

The self-disinfecting device - known as Surfaceskins - has been developed by a spin out company from the University of Leeds and is the culmination of seven years research and development.

Hospital doors are recognised as a key weak link in hygiene because of the number of times people touch them.

It takes just one person with dirty hands to pass through a door to put everyone else who follows at risk of cross contamination.

Surfaceskins antibacterial door pads work by dispensing a small quantity of alcohol gel onto the pad when it is pushed, to disinfect the surface ready for the next person to use the door.

This low-cost device, which incorporates three separate nonwoven textiles is designed to be replaced after seven days or one thousand pushes, whichever comes sooner.

Surfaceskins antibacterial door pads are not meant to replace the strict handwashing rules in hospitals, but instead provide an extra line of defence by helping clean hands to stay clean. Experts expect that Surfaceskins will increase people's awareness of the importance of washing hands and hand hygiene.

A study into the effectiveness of the new technology has just been published in the Journal of Hospital Infection.

Image shows a Surfaceskins device attached to a door. Credit: Surfaceskins

At the start of the study, both the Surfaceskins and control aluminium door plates were inoculated with bacteria at levels found on the hands of hospital staff. The study concluded that the Surfaceskins door pads were more effective than standard door plates over seven days in reducing the levels of three bacteria that commonly cause hospital-acquired infections: S. aureus, E. coli and E. faecalis.

Mark Wilcox, Professor of Medical Microbiology at the University, who led the independent evaluation, said: "Our results suggest that Surfaceskins door pads can help to reduce the contamination of doors by microbes."

"They offer a new way to reduce the risk of the spread of bacteria and viruses in hospital environments and other settings where frequent contact with doors could undermine hand hygiene."

Scale of hospital-acquired infections

According to data published in 2014 by the National Institute for Care and Excellence or NICE, 300,000 patients a year in England get hospital-acquired infections.

The infections mean increased treatment costs, estimated by NHS England to be around £1 billion a year, and put patients at risk of significant harm.

Surfaceskins technology

Four patents protect the innovation behind Surfaceskins. The device is fitted into a plastic holster which is attached to the door.

Surfaceskins contain a reservoir of alcohol gel and a membrane with tiny valves that dispense the gel onto the surface where it is pressed when opening a door, self-disinfecting it within seconds.

Chris Fowler, Chief Executive of the spin out that has developed the device, said: "Surfaceskins address a definite need, in a simple, effective and low-cost way. Designed to provide protection in many high-risk situations, the global market for Surfaceskins is immense.

Image shows a Surfaceskins device fitted to a hospital door. Credit: Surfaceskins

"In addition to the successful NHS trials, many organisations outside healthcare have expressed serious interest in introducing these self-disinfecting products. Surfaceskins can play an important role wherever door users have an interest in maintaining clean hands."

The company has also developed a door handle using the Surfaceskins technology.

Surfaceskins are being targeted at other industrial sectors where there is a need for meticulous hand hygiene such as in catering and hospitality. They could also be used on cruise ships where the spread of bacteria can lead to outbreaks of sickness.

On the back of successful trials and agreed distribution deals, Surfaceskins Ltd is now looking for £600,000 investment to expand their sales network and production capability at their Leeds-based facility.

Nonwovens Innovation and Research Institute Ltd

Surfaceskins is a collaboration between the Nonwovens Innovation and Research Institute Ltd (NIRI), a spin out company from the University's School of Design, and two industrial designers, Adam Walker and Simon Scott-Harden.

NIRI helps companies bring new textile ideas to market or to enhance or improve existing products or manufacturing processes.

Since being established 12 years ago, NIRI, which has recently relocated into larger premises in Leeds City Centre, has successfully completed 400+ projects for over 200 clients.

Nonwovens is a group of textiles created by interlocking or bonding individual fibres or filaments together, and includes a wide range of products including wound dressings, nappies, filters, military clothing and imitation fur.

More information: E.L. Best et al, The potential of alcohol release doorplates to reduce surface contamination during hand contact, Journal of Hospital Infection (2017). DOI: 10.1016/j.jhin.2017.07.027

Output: Researchers at a University of Leeds spin-off have created a self-disinfecting textile that can reduce bacterial contamination by over 90%. The Surfaceskins material can be used on hospital doors to lower the risk of disease transmission from contaminated hands. Doors, in particular, are hygiene risks because of the number of times they come into contact with contaminants. When it is pushed, the material dispenses a small amount of alcohol gel from tiny valves that disinfects the surface. The device needs to be replaced after 1,000 pushes or once a week.


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3T Biosciences said to raise $12m for cancer treatment research
 A stealth start-up called 3T Biosciences has raised more than $12 million in a massive seed round led by early Facebook investor Sean Parker and including Peter Thiel, according to a person familiar with the company's financing.

Little is known about 3T Biosciences, but this person said the company is led by cancer biology PhD student and investor, Asset Management Ventures' principal Luke Lee, as well as a group of academics from Christopher Garcia's biology lab at Stanford.

3T Biosciences is in the T-cell therapy space, the person said, meaning that it is among a growing group of new start-ups working to bolster the body's own immune system to fight cancer. That's a different approach than traditional medicines like chemotherapy, which kill off both cancerous and healthy cells.

Output: Biotech start-up 3T Biosciences is said to have raised more than $12m in a seed funding round as it seeks to develop a cancer treatment that harnesses the human body's own immune system. A source said the company is led by cancer biology PhD researcher and investor Luke Lee and a group of academics from Stanford University. Investors in the seed round reportedly include entrepreneur Peter Thiel and early Facebook investor Sean Parker.


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US move to back coal, nuclear plants faces energy industry fight
 Energy Secretary Rick Perry’s demand for market-disrupting price supports for coal and nuclear power plants has broken multiple rules for how energy policy is made, from upending the facts to subverting regular order. And it’s being pushed through on a hyper-fast, 60-day review period that’s not only unjustified by the Department of Energy report it cites as justification, but “practically and legally impossible” to meet.

This is a collection of the critiques that have emerged since Friday’s shock DOE filing with the Federal Energy Regulatory Commission. In a rarely used notice of public rule making (NOPR), DOE asked FERC to create market rules to provide compensation for power plants that, among other features, have a 90-day supply of fuel on hand -- something that only coal and nuclear power plants can do.

The NOPR cited the grid reliability study ordered by Perry in April to argue that baseload power plants need compensation to shore up grid reliability. But as we covered when it was released in July, the report doesn’t actually support that conclusion, stealing some of the thunder from clean energy and environmental groups’ arguments that the report was a Trojan horse for pro-coal and nuclear power policies all along.

Friday’s NOPR seems to have vindicated those views, however, as well as drawing the fire of a much broader coalition of energy industry players. On Tuesday, FERC received a joint motion from a coalition representing literally every sector of the energy economy except coal and nuclear power, asking it to deny DOE’s request for an interim final rule to take effect within 60 days, and to extend the comment period out to at least 90 days.

The coalition includes the country’s biggest solar and wind trade groups and renewables boosters like the American Council on Renewable Energy (ACORE) and Advanced Energy Economy. But it also includes the Natural Gas Supply Association, the Interstate Natural Gas Association of America, and the American Petroleum Institute -- a highly unusual set of bedfellows.

“This is the first time we've filed a motion in conjunction with API,” Gil Jenkins, a spokesperson for ACORE, told The Washington Post. “So it’s unprecedented, just as this very action taken by DOE.”

Also joining the motion were the American Public Power Association and National Rural Electric Cooperative Association, representing municipal and co-op utilities, and the Electricity Consumers Resource Council, representing big commercial and industrial power users. Even the generator group Electric Power Supply Association -- the same one that sued FERC to overturn its Order 745 regulations allowing demand response equal play in capacity markets -- has signed on.

“This is one of the most significant proposed rules in decades related to the energy industry, and, if finalized, would unquestionably have significant ramifications for wholesale markets under the commission’s jurisdiction,” the group wrote.

This view was shared across the energy industry spectrum this week. Former FERC chairman Jon Wellinghoff, a Democrat, told Utility Dive that the DOE rule would "blow up the markets” that the agency has spent the past four decades creating. Former FERC commissioner Nora Mead Brownell, a Republican, told RTO Insider that the proposal is “the antithesis of good economics. It’s going to destroy the markets [and] drive away investment in new, more efficient technologies.”

Even energy company CEOs are crying foul. At a Gulf Coast Power Association conference Tuesday in Austin, Texas, Dynegy CEO Bob Flexon called the NOPR a "red herring for subsidies" for nuclear and coal, while NRG Energy CEO Mauricio Gutierrez said that propping up coal and nuclear power plants, while leaving other resources open to competitive forces, would be “a recipe for disaster."

But the Edison Electric Institute utility trade group, which did not join the rest of the energy trade groups in Tuesday’s FERC filing, took a more neutral stance. In a Tuesday statement, EEI vice president of energy supply Richard McMahon said the NOPR shows that the DOE recognizes that "a balanced energy mix that includes 24/7 energy sources is vital to sustaining a secure, reliable and resilient energy grid,” and that ”new market rules should recognize the role that all generation sources play in maintaining the reliability and resiliency of the energy grid.”

Coal- and nuclear-reliant FirstEnergy Corp. was one of the lonely voices in support of the ruling. “Correcting the faulty market conditions and keeping essential baseload generating plants operating will help ensure customers continue to receive safe, reliable and affordable supplies of electricity while maintaining the security of the electricity grid,” CEO Charles Jones said in a prepared statement.

Why 90 days of fuel supply doesn’t make the grid more resilient

These views are complicated by the fact that DOE’s proposed "Grid Resiliency Pricing Rule” is lacking in so many details. Ari Peskoe, senior fellow in electricity law at the Harvard Law School Environmental Law Program Policy Initiative, pointed this out in a Monday Interchange discussion with GTM Research head Shayle Kann.

In simple terms, the rule does two things, Peskoe said. First, it defines reliability and resiliency attributes, including the 90-day fuel supply requirement. That in and of itself is a conclusion unsupported by the facts at hand, however, he said -- a point echoed by multiple parties since Friday.

“A lot of the arguments in the DOE proposal -- well, they’re certainly cherry-picked, but they’re also often specious,” said Devin Hartman, electricity policy manager at R Street, a free-market think tank in Washington, D.C. For example, the NOPR cites FERC and grid operators’ market design concerns as reasons for including 90-day fuel supply as a requirement -- but what evidence does exist indicates that fuel-supply problems are only a minor cause of power outages in the U.S., he said.

To back that up, he pointed to an analysis published Tuesday by the Rhodium Group, which crunched DOE data on the causes of the 3.4 billion customer-hours of major electricity disruptions from 2012 to 2016. Of that time, only 2,815 hours, or 0.0007 percent of the total, was due to fuel supply problems, it found -- and of those, 2,333 hours were due to fuel supply disruptions at a coal-fired power plant in northern Minnesota.

The real culprits for outages are instead severe weather, with Hurricane Sandy accounting for nearly-one third of the total hours of power lost over that period, and severe weather accounting for nearly all the rest. Puerto Rico’s nearly complete power outage in the wake of Hurricane Maria has already accounted for nearly twice the total number of outage hours in 2016.

DOE’s choice of 90 days of fuel stockpiles as the sole metric of reliability also fails to take into account the much deeper analysis presented in the DOE’s report, he noted. This built on existing work at FERC and the country’s big grid operators, calling for improvements in energy price formation and valuation of essential reliability services such as voltage support and frequency response.

Natural Resources Defense Council senior attorney John Moore told the House Energy and Commerce Subcommittee on Energy on Tuesday that the DOE proposal is “sowing confusion and suggesting the power grid will be imperiled if we don’t pay large subsidies to keep specific types of generators afloat. We can achieve a higher level of reliability at a lower cost and with less pollution by defining reliability and resiliency needs first.”

Kann asked Peskoe whether DOE or FERC are under legal obligation to consider these alternative metrics for reliability and resiliency. Peskoe replied that "FERC rules have to be non-discriminatory -- that's a really fundamental premise they operate under." But that only strictly applies to rules that are "unduly discriminatory -- they can discriminate if there's some valid purpose.”

From “flimsy and vague” proposal to final rule in 60 days?

Second, DOE’s NOPR seeks to define a special rate that these resources should provide, Peskoe said, which “kind of suggests that these resources are going to be taken out of the competitive market construct and are now going to be compensated based on cost-of-service rate-making principles.” That’s the general view being taken by industry observers, since the rule would only apply to power plants in competitive wholesale markets, not those already subject to state or federal cost-of-service regulations.

That's not entirely clear, however, because the NOPR also cites the need for markets to support the benefits and services of reliability and resiliency, and “being compensated for benefits and services is different than cost of service,” he said. That could open the options for other methods, such as some kind of “value of coal tariff” to mimic the value-of-solar tariff proposals being fleshed out by a handful of states and utilities, or defining a new set of reliability and resilience attributes and creating a new market for them.

Unfortunately, the DOE’s NOPR is quite vague on what it’s asking FERC to undertake, he said. The questions left unanswered by the NOPR, according to a series of tweets he published after its release, include: “Is this cost-of-service ratemaking or is DOE suggesting that rate should be based on a plant’s ‘benefits and services? Does an eligible generator always receive this rate, or do they normally get paid LMP but receive this rate under certain circumstances? How does dispatch work if an eligible plant is not bidding into the market? Or is an eligible plant ‘bidding’ this special rate?”

These kinds of details, so common to traditional FERC rulemakings, are completely absent from DOE’s NOPR, he said. That would make it “practically and legally impossible” for FERC to actually comply with DOE’s request to have a final rule completed within the 15 days left between the end of the public comment period and the 60-day deadline it set out, he said.

NRDC clean energy attorney Miles Farmer agreed in a Friday blog post, noting that “DOE’s proposal is so vague that FERC could not possibly adopt it as is, making it hard to see how FERC could possibly advance it in a manner that complies [with] the procedural requirements for a formal rulemaking proposal.”

That’s the same reason that the 11 energy trade groups asked FERC to extend the comment period for the new rule. Despite the NOPR’s claims, the groups said, “both DOE and NERC recently released reports categorically concluding that there is no reliability emergency” that would require such a speed-up.

FERC this week filed notice that it was taking comments on the NOPR on the accelerated schedule, with Oct. 23 as the deadline for initial comments and Nov. 7 for reply comments. But it still hasn't ruled on the groups' proposal, leaving open the potential for extending its timeline.

Jason Johns, partner in Stoel Rives’ energy practice, suggested in a blog post that the short timeframe could be “perhaps intended to allow Interim Chairman Chatterjee and Commissioner Powelson to take action on this notice alone before FERC has a full set of commissioners.” Chatterjee has already expressed his support of recognizing baseload power “as an essential part of the fuel mix” that must be “properly compensated to recognize the value they provide to the system.”

But to remain legal, any action FERC takes will have to be rooted in several fundamental principles, Peskoe noted. First, it will have to find that existing grid operator tariffs are “unjust and unreasonable,” something that DOE’s NOPR does not take up. Second, it would have to show that the new rules being promulgated are “just and reasonable,” which is again difficult given that "FERC is going to have to address the total lack of detail in this document” on that matter.

--

Output: A coalition of groups from across the US energy production spectrum have made an unprecedented move to block government efforts seen as propping up the coal and nuclear industries. Organisations from the natural gas, oil and renewables industries filed papers urging the Federal Energy Regulatory Commission (FERC) to deny the Department of Energy's (DoE) recent request to compensate power plants that have a "90-day supply of fuel on hand" -- essentially, coal and nuclear producers. The coalition questioned the basis for the move and former FERC commissioner Nora Mead Brownell said it would "drive away investment in new, more efficient technologies".


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Clean-energy tariff created for Facebook data centre
 At least some portion of electricity consumed by the future Facebook data center in Richmond, Virginia, will be offset by solar energy generated by plants the utility that serves the area is planning to build in the Commonwealth. Facebook will be buying the energy under a new renewable-energy tariff the social media company worked with the utility, Dominion Energy Virginia, to create.

While hyper-scale data center operators like Facebook, Alphabet, and Microsoft may be keen to power their massive computing facilities with renewable energy, it’s not a product that’s readily available from all energy providers in the US. Because matching energy supply with demand while ensuring their rates comply with regulations is a difficult balance utilities have to maintain, many of them have been resistant to adding a new product like renewable energy, which adds an extra layer of complexity in rate-setting to ensure extra costs a utility incurs doesn’t affect all its customers’ rates.

Related: How Renewable Energy is Changing the Data Center Market

This is why Google (now a subsidiary of Alphabet) spent years lobbying Duke Energy in North Carolina to adopt its renewable-energy tariff concept, where the utility sells renewable energy to customers that want it, while fully passing any additional costs to those specific customers. In 2015, Google became the first customer of Duke’s renewable-energy tariff.

Now, Facebook appears to have successfully lobbied Dominion to add a renewable-energy tariff to its product portfolio, which may have much wider implications for the data center industry than Google’s deal in North Carolina. About 130 miles north of Richmond, in Northern Virginia, is one of the largest and most active data center markets in the world. The largest data center operators there, including Amazon Web Services, Equinix, and Digital Realty Trust, have all pledged to power their infrastructure with 100 percent renewable energy, which means there are lots of potential future customers for Dominion’s new tariff besides Facebook.

First, however, state regulators have to approve the tariff, called Schedule RF. Dominion said it plans to file for approval with the Virginia State Corporation Commission this month. An approval, which is enjoying some strong political tailwind, is likely. Announcement of Facebook’s data center plans that came out of Virginia Governor Terry McAuliffe’s office highlights the project’s solar-energy aspect; Representative Donald McEachin and Senator Mark Warner also made statements praising Facebook’s renewable-energy plans for the future facility.

“Facebook’s partnership with Virginia and this significant investment in Henrico County are great news for the region,” U.S Senator Mark Warner said. “This not only is a validation of the Commonwealth’s position as a leader in the tech economy. It also supports our investments in building a modern fiber and renewable energy infrastructure to maintain Virginia’s competitive edge for additional job creation and investment.” "I am so pleased to see Facebook invest in our community, bringing more than 100 tech job opportunities for the hardworking people of the Commonwealth," said Congressman Donald McEachin. "Not only will Facebook bring more tech jobs to the 4th Congressional District, but this project will include solar panels to power this facility with 100 percent renewable energy. Virginia is once again an innovative leader in creating jobs and using renewable energy to power our community's bright future.”

One of the proposed tariff’s requirements is that new renewable-energy generation plants built to support it are located in Virginia. However, like in most other such cases, the solar farms Dominion is planning to construct will not be supplying energy directly to the Facebook data center. They will offset the facility’s consumption of energy from the local electrical grid.

It’s unclear what portion of the data center’s total energy consumption will come from these solar farms. Companies typically use a combination of renewable energy credits and in some cases on-site generation to get to 100-percent renewable goals for hyper-scale data centers.

Facebook’s data center campus in Richmond is expected to take up nearly 1 million square feet. The company plans to invest $750 million in the project directly.

Output: Virginia-based utility Dominion Energy has worked with Facebook to develop a renewable-energy tariff for the social media site's one-million sq ft, $750m data centre, to be built in Richmond. Dominion is set to file the tariff, called Schedule RF, with regulator the Virginia State Corporation Commission later this month. If approved, it could be adopted by firms including Amazon Web Services, Equinix and Digital Realty Trust, which also operate data centres in the state and have all pledged to use a 100% renewable energy supply.


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Ikea's indoor mini farm promises fast home-grown produce
 Eat Lokal

Ikea is no longer content to help people simply design their kitchens — the Scandinavian retailer is now considering ways to help customers grow the food cooked in them through Lokal, a prototype mini-farm capable of growing greens and herbs indoors.

Developed by Ikea's Space10 innovation lab, Lokal is based around a hydroponic farming system that uses LEDs to grow produce on stackable trays. The system's designers claim that Lokal greens grow roughly three times more quickly than those found in a traditional garden, using 90 percent less water in the process.

Image Credit: Space10

The design team is currently testing out a method of integrating sensors into the system's growing trays, which would allow at-home farmers to check the status of their crop from their smartphone via Google Home. The idea of using machine learning to analyze data collected by the community of Lokal gardeners is also being considered.

Growing Up

Ikea has yet to decide whether or not Lokal will be sold in stores, and according to Michael La Cour, Managing Director of IKEA Food Services, the project is still in its early stages and needs more development before it could be ready for retail.

However, whether or not Lokal makes it to an Ikea near you, vertical farming is clearly on the rise. This new methodology can be incredibly efficient and has already been employed in a retail environment in an effort to give customers access to the freshest possible produce. It also has the potential to help solve the growing food shortage crisis as the world's population continues skyward.

Many people like to be as self-sufficient as possible when it comes to their food, but not everyone has the space for a traditional garden or access to an allotment. Vertical farming gives just about anyone access to home-grown produce, so if a major company like Ikea can develop a straightforward kit to help would-be agriculturists get started, it has the potential to be a big success.

Output: Ikea's innovation arm, Space10, has developed a prototype vertical farming kit for growing food at home, even with minimal space. Dubbed Lokal, the stackable system employs hydroponics and LEDs, and is claimed to be three times faster growing and use 90% less water than a traditional garden. The team is working on integrating internet of things sensors into the planters so users can track the progress of their produce from the Google Home app. While it is currently unknown whether Ikea will sell them in-store, such systems are touted as having the potential to help to address the issue of food security.


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Power retailers could derail Modi's 2018 electrification plan
 The success of Prime Minister Narendra Modi’s ambitious plan to electrify all households in India by December 2018 faces a familiar hurdle: the money-losing state power retailers Modi earlier this week announced the government will spend 163.2 billion rupees ($2.5 billion) to provide electricity connections to every home in India by the end of next year, ahead of an earlier deadline of March 2019. The bulk of the cost for providing equipment such as power cables and electricity meters to every poor household will be borne by the federal government and partly by the states and the power retailer.“The key is not the scheme but the political will to allow for commercial operations of discoms,” CLSA analyst Bharat Parekh said in a report on Tuesday, referring to electricity distribution companies. “The key issue is that after electrifying the households, how much power will discoms supply and how will they recover the money.”Several power retailers are losing money on selling electricity below cost, and turning them around is in the hands of the state governments, which have traditionally used cheap power to shore up popular support and advance their political goals. Convincing states to allow profitable power tariffs will be Modi’s biggest challenge in fulfilling the pledge that helped him rise to power in New Delhi in 2014. Modi is up for re-election in 2019.“The onus now lies with the states,” according to Debasish Mishra, a partner at Deloitte Touche Tohmatsu LLP in Mumbai. “The federal government is paying for connections, but the purpose will be defeated if the states fail to supply reliable power to people. And for that to happen operational autonomy of the distribution companies and timely payment of subsidies is a must.”The announcement follows a 2015 proposal to reform power distribution, which sought to transfer three-quarters of utilities’ debt to their respective state governments. The utilities were set targets to bring down losses. As a result, total losses of utilities that signed up for the plan dropped 21.5 percent from a year earlier to 403 billion rupees in the year ended March 31.There’s pressure on state governments to bring losses down even further. Starting this financial year, states will begin sharing a part of the losses their retailers make, according to the plan to turn around power distributors. In the year ending March, provincial governments will take over 5 percent of their retailers’ losses in the previous year. The state’s share of losses will rise each year, reaching up to 50 percent in the year ending March 2021.Years of selling electricity below cost has eroded discoms’ ability to invest in infrastructure, buy enough power from generators and repay bank debts. Power generation plants operate at just about half their capacity, unable to sell all the power they can produce. The power-for-all plan could “act as a major stimulus for the ailing power sector in India, with demand revival,” Deutsche Bank analyst Abhishek Puri said in a Sept. 26 report.“Our analysis suggests that power demand could potentially grow by 20 percent to 35 percent from current levels in two years, if the government is able to meet its target, as against the tepid 15% cumulative growth in the past five years,” Puri said.Monday’s announcement supplements an earlier program to invest 760 billion rupees in rural electrification . Modi’s administration embarked on the plan in 2015, beginning with electrifying more than 18,000 un-electrified villages. About 3,000 villages still remain to be electrified, which means creating the infrastructure to take electricity to villages, making sure at least 10 percent of the households and public buildings there have power connections. Taking electricity to every home is the next phase of the plan.Retailers have coped with losses by limiting power supplies to consumers in rural areas, who are heavily subsidized, and selling more expensive electricity to industrial consumers to help fund a part of the losses. Even if all rural households get power, making adequate returns on their investment will be a challenge for retailers given the low-usage pattern.“This ambitious scheme needs to be followed up with equal emphasis on actual hours of supply, otherwise there’ll be a danger of people not getting the true benefits of electrification, which can reduce their willingness to pay,” said Ashwini Chitnis, a researcher at Prayas, a non-profit advocacy group that focuses on energy, health and education. “Poor cost recovery can result in poor maintenance and thus huge investments in network infrastructure can go waste.”

Output: Prime Minister Narendra Modi's ambitious INR163.2bn ($2.5bn) plan to electrify the whole of India by December 2018 could be scuppered by state electricity distribution companies. Many have lost money by selling power below cost prices to win political support, leaving them unable to invest in infrastructure or pay off debt. Modi's plan could result in annual power demand rising from the current 15% to as much as 35% within two years, according to a Deutsche Bank report. But convincing the states to charge higher tariffs could put Modi in a precarious political position as he seeks re-election in 2019.


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Sadiq Khan asks BMW, Mercedes and VW to fund air pollution scheme
 The mayor of London, Sadiq Khan, has written to three leading car manufacturers asking them to contribute to the fund set up to tackle the capital’s air pollution crisis.

Khan has accused BMW, Mercedes-Benz and Volkswagen of “double standards” after it emerged they had paid £223m to the German government’s Sustainable Mobility Fund for Cities earlier this year, but have given nothing to the UK.

“Londoners will be baffled by the double standards of these car manufacturers. On the one hand, they admit they’ve got to cut emissions from their vehicles, but they confine their funding to Germany alone.”

VW has also paid $15bn compensation in the US after the dieselgate scandal – when it was found to have fitted millions of cars with “defeat devices” that made their cars appear less polluting in emissions tests than they were on the road.

Khan said: “In July, the UK managing director of VW sat in my office and said they couldn’t contribute anything to fund cleaning up London’s air, but their German colleagues are providing money. Londoners will find that unacceptable.”

The scale of London’s air pollution crisis was laid bare on Wednesday, with new figures showing that every person in the capital is breathing air that exceeds global guidelines for dangerous toxic particles.

The research revealed that every area in the capital exceeds World Health Organisation (WHO) limits for PM2.5s – ultra-fine particles of less than 2.5 microns which have serious health implications, especially for children.

London is widely recognised as the worst area for air pollution in the UK, although there is growing evidence that dangerously polluted air is damaging people’s health in towns and cities across the country.

Khan has also written to the secretary of state for transport, Chris Grayling, to ask the government to do more.

“The government must act urgently to secure a meaningful amount of funding from these manufacturers, which could help people to scrap the most polluting diesel vehicles and take these off our streets,” said Khan.

The mayor has set out a range of plans to tackle pollution from diesel cars in the capital. The first stage, the new T-Charge, which will charge older, more polluting vehicles entering central London, starts later this month.

Clean air campaigners have welcomed the moves but called on him to go further and take more immediate action to tackle the crisis.

They are also calling on him to halt major road developments – such as the Silvertown Tunnel project – which they say will increase pollution in the capital.

Areeba Hamid, clean air campaigner at Greenpeace said: “Asking car manufacturers to take responsibility for their part in London’s air pollution crisis is an essential first step towards holding them accountable.

“A clean air fund that major car manufactures contribute towards could help, provided manufacturers agree to ditch diesel completely. In the meantime, new Euro 6 cars should be subject to ULEZ regulations if we are to clean up London’s air and keep it that way.”

Output: BMW, Mercedes-Benz and Volkswagen have been accused of “double standards” by London Mayor, Sadiq Khan, after it emerged that the firms had paid £223m ($290m) to the German Sustainable Mobility Fund for Cities, but nothing to the UK. Khan has written to the car manufacturers asking them to contribute to a fund designed to tackle London’s air pollution crisis. Figures released on Wednesday revealed that every inhabitant of the capital is breathing air in breach of global guidelines for PM2.5 particle pollution.


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Sadiq Khan asks BMW, Mercedes and VW to fund air pollution scheme
 Together with the German Federal, state and municipal governments and German automakers, the Volkswagen Group will make a decisive contribution to a swift and sustained reduction in NOx emissions. A key element of this package is the trade-in incentive for Euro 1 - Euro 4 diesel models which will apply across all brands in the Group. In addition, the software update for Euro 5 and some Euro 6 diesel vehicles will be available throughout Europe and not just in Germany.

“With the incentive to trade in their vehicles we are giving our customers strong motivation to switch to a modern, more environmentally compatible vehicle powered by an internal combustion engine or an alternative drivetrain technology“, Matthias Müller said. “This incentive can be implemented quickly and will have a swift, quantifiable and sustained effect on significantly reducing NOx emissions and significantly improving air quality.”

The incentive is currently being prepared by the Group’s Volkswagen Passenger Cars, Audi, SEAT, ŠKODA, Porsche and Volkswagen Commercial vehicles brands and will be on offer soon.

Pan-European software update for Group vehicles

In Germany, the Volkswagen Group will install a software update on approx. four million Euro 5 and some Euro 6 diesel vehicles in total as agreed in order to reduce NOx emission levels. This figure also includes the approx. 2.5 million vehicles already being recalled, of which more than 70 percent have already been refitted.

In addition, the Volkswagen Group will be offering the software update to its diesel customers throughout Europe. As a result, NOx emissions from Euro 5 and some Euro 6 diesel vehicles currently on the market can be reduced by an average 25 to 30 percent.

Furthermore, the Volkswagen Group will contribute to the €500 million “sustainable mobility fund for cities”. The auto industry and the Federal government will each contribute €250 million. The Volkswagen Group’s contribution to the fund will be proportionate to its market share in Germany and will therefore represent a substantial amount.

Output: BMW, Mercedes-Benz and Volkswagen have been accused of “double standards” by London Mayor, Sadiq Khan, after it emerged that the firms had paid £223m ($290m) to the German Sustainable Mobility Fund for Cities, but nothing to the UK. Khan has written to the car manufacturers asking them to contribute to a fund designed to tackle London’s air pollution crisis. Figures released on Wednesday revealed that every inhabitant of the capital is breathing air in breach of global guidelines for PM2.5 particle pollution.


Instruction: create a high quality summary of the given input

Input:
Battery-storage licence rethink mulled to end generation breaches
 The energy regulator has proposed modifying the existing generation licence to accommodate storage as a distinct subset of electricity generation. The government intends to make the same change to the underlying primary legislation, the 1989 Electricity Act, when parliamentary time allows.

This is part of our series analysing the challenges and opportunities ahead for companies embracing smart energy technologies. For more, sign up to receive an exclusive Pinsent Masons research paper on smart energy technology, supply, storage and investment.

One of the effects of the change would be to stop distribution network operators (DNOs) from operating storage, as they are not permitted to own generation for competition reasons. However, Ofgem intends to permit DNOs to operate storage in specific circumstances where this would not be anti-competitive, such as for time-limited emergency restoration and maintenance.

The consultation closes on 27 November 2017, and Ofgem anticipates that the changes would take effect by summer 2018.

Separately, the UK government has announced the seven universities that will be founding partners of the £65 million Faraday Battery Institute, to be funded with part of the £246m that the government has set aside for battery technology investment over the next four years through its Industrial Strategy. The partner universities will work together with industry partners and other academic institutions to research and develop market-ready battery technologies.

The founding partners are Imperial College London, Newcastle University, University College London, University of Cambridge, University of Oxford, University of Southampton and University of Warwick.

Currently, electricity storage is not defined in primary legislation, making its regulatory status within the electricity system and planning regimes unclear. When parliamentary time allows, the government intends to amend the 1989 Electricity Act and other legislation to explicitly define electricity storage as a distinct subset of generation. Health and safety standards will also be updated.

In the meantime, Ofgem's proposed changes would allow for this to be done through the electricity generation licensing system, as indicated in the Smart Systems and Flexibility Plan it published in the summer. It intends to base its definition of storage on that proposed in the government's call for evidence on storage: "the conversion of electrical energy into a form of energy which can be stored, the storing of that energy, and the subsequent reconversion of that energy back into electrical energy in a controllable manner". The condition will require the licensee to ensure that 'self-consumption' is not the primary function of the storage facility.

The way the changes work would also address the issues faced by storage facilities regarding final consumption levies (FCLs), which under the current structure could effectively be charged twice at the time that storage providers both import from and export to the grid. 'Double counting' adds to the operational cost of storage projects and may be passed on to the end consumer, potentially making storage less competitive than other forms of generation.

Smart energy expert Nick Shenken of Pinsent Masons, the law firm behind Out-Law.com, explained that the potential for FCL double-charging arises because storage assets technically 'consume' electricity in order to store it and then the same electricity is similarly consumed by the end user when it is released from storage. FCLs are, in effect, a contribution towards the cost of market support mechanisms, such as the Renewables Obligation, feed-in tariffs, contracts for difference and the capacity market.

"Technically, in this scenario, there are at least two 'consumers' – the storage asset and the final consumer," Shenken said. "It was felt that the financial impact of this would likely fall on those final consumers, thus making storage uncompetitive in the market."

"The current proposals therefore set out a plan under which storage would become a subset of generation and potentially be able to receive a generation licence which only requires compliance with those of the general licence conditions which are relevant to storage, and not those conditions which are only relevant to conventional generation. In addition, storage assets with this kind of licence would be under an obligation to ensure that their primary function was in fact storage for injecting electricity back to the grid, and not for consumption at a later date on site," he said.

"Compliance with this condition ensures the storage asset is not in fact the end consumer, thus avoiding the FCLs. If the primary function is simply to store energy which is then used by the generator later, then the thinking is that they are in fact the end user and should pay FCLs. It will be interesting to watch whether the definition of 'primary function' becomes more detailed, or whether it will simply be left wider to encapsulate as much as possible," he said.

Output: Battery storage could be considered a "distinct subset of electricity generation" if proposals from UK energy regulator Ofgem are accepted. The move aims to bring clarity to the battery storage industry and stop distribution network operators, which are prevented from owning generation capacity, from operating in the sector. Changes to electricity generation licence descriptions could also reduce levies passed onto consumers. The consultation period is set to end on 27 November, with Ofgem's anticipated changes in place for summer 2018. The UK government is also planning similar amendments to the 1989 Electricity Act.


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Google Sidewalk Labs is favourite for Toronto waterfront project
 The Toronto skyline as seen from an inbound Porter airlines flight on Feb, 4, 2017.Fred Lum/The Globe and Mail Share

Google's Sidewalk Labs has been selected as the top candidate to turn part of Toronto's waterfront into a smart neighbourhood designed to integrate new technology and advance sustainable architecture and urban design, The Globe and Mail has learned.

The project, known as Quayside, aims to turn 4.9 hectares (12 acres) of waterfront land near Parliament Street and Queens Quay East into a mixed-use community that Waterfront Toronto says will use advanced technology, innovative building techniques and funding to encourage "climate-positive urban development."

Waterfront staff selected Sidewalk Labs LLC, a unit of Google's parent company Alphabet Inc. that imagines, designs, tests and builds urban innovations, pending approval from the agency's board in the coming weeks, according to a source close to the negotiations.

The project would allow the tech company to work toward its stated goal of "reimagining cities from the Internet up," by integrating technology and urban design to create a 21st century neighbourhood that uses innovation to address common city problems, such as traffic congestion and a shortage of affordable housing.

According to a request for proposals issued by Waterfront Toronto, 20 per cent of the residential units built must be designated as affordable, and the development is meant to accommodate a range of income and age groups.

A spokesman for Google Canada declined to comment, as did Toronto Mayor John Tory. Waterfront Toronto spokeswoman Carol Webb declined to comment on Sidewalk's potential involvement.

"Our process includes a blackout period that must be observed … until our board of directors has approved the recommended proponent and the formal announcement is made," she said. "We expect to make that announcement later this fall."

Waterfront Toronto, the agency set up in 2001 by federal, provincial and city governments to transform 800 hectares in and around Toronto's port lands, issued an unusual request for proposals in March: It asked for an "innovation and funding partner" for the project. The particular form of development on the site was not fully determined. The project is intended to generate a financial return but also "use the waterfront as a test bed for how we construct the future city," Waterfront Toronto CEO Will Fleissig said in an interview in March.

The development, Mr. Fleissig suggested, could help make Toronto a global leader in addressing climate resiliency and the "smart city."

The Quayside land, currently home to low-rise industrial or office buildings surrounded by parking lots, is made up of tracts owned either by the city or Waterfront Toronto itself, plus one that is privately owned. Its development would carry forward to projects on nearby land, some of which is made possible because of the June announcement of a $1.185-billion flood protection plan.

"Our objective with Quayside is to advance new models for addressing pressing urban challenges, such as the increasing disparity in housing affordability, congestion on our roads and the imperative to address climate change," said Waterfront Toronto's Ms. Webb. "Beginning with Quayside, we aim to design a new kind of mixed-use, complete community that will combine forward-thinking urban design and new technologies to create people-first neighbourhoods that help address these challenges."

Sidewalk Labs develops what are often referred to as "smart cities" systems. It aims to use data collection and new technologies to solve urban problems. For example, it says it is working on an adaptive traffic light system that could "detect pedestrians, cyclists, cars, and transit vehicles to facilitate safe, seamless movement through congested urban intersections."

But the first project it mentions on its website is called "Building a District." Toronto is not mentioned by name but the site says Sidewalk is "pursuing a large-scale district that can serve as a living laboratory for urban technology – a testbed for co-ordinated solutions, a foundation for people to build on, and a vision for other cities to follow."

Bloomberg News reported earlier this year that Sidewalk CEO Dan Doctoroff – a former Bloomberg LP CEO who was the deputy mayor of New York under Michael Bloomberg – laid out the concept in a speech at a New York conference.

"I'm sure many of you are thinking this is a crazy idea," Mr. Doctoroff was quoted as saying in remarks first reported by a website called StateScoop. "We don't think it's crazy at all. People thought it was crazy when Google decided to connect all the world's information. People thought it was crazy to think about the concept of a self-driving car."

Sidewalk, which is about two years old, says its aim is to spin off any urban technologies or systems it creates into separate companies. Its most visible project to make that jump is called LinkNYC, a network of Wi-Fi kiosks to replace New York's payphones run by a Sidewalk-supported company called Intersection.

Output: Toronto's waterfront district is set to be transformed into a smart city neighbourhood after Alphabet-owned Google Sidewalk Labs topped the shortlist of potential development partners. The Quayside project will turn 12 acres of land into a mixed-use community and is intended to be a "climate-positive urban development", with an emphasis on sustainable architecture and urban design. Sidewalk Labs's goal is to reimagine "cities from the internet up" to create neighbourhoods that use new technology to solve common urban problems such as congestion and a shortage of affordable houses. An official announcement and more detailed plans of the scheme are expected later in the year.


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Energy Impact Partners guides technology investment by utilities
 How do you bet on the next big thing when your job is to keep the lights on no matter what?

Utility business models are changing after a century of general continuity, and some companies are looking beyond the already well-proven technologies. Enter the investment firm Energy Impact Partners, a group of 16 global energy companies, including major utilities such as Southern Company, National Grid and Xcel Energy, that represent a cumulative $263 billion in market value.

For the past two years, the group has sought out companies and entrepreneurs looking for an infusion of capital and large-scale energy expertise. In exchange, EIP’s companies get a direct line to cutting-edge technology that could pose threats -- or opportunities -- to their business.

“Quite frankly, for up to 100 years, it has not changed all that much. The basic fundamentals of the utility power generation have remained fairly stable,” said Hans Kobler, EIP’s CEO. “That is about to change dramatically.”

Kobler calls EIP “a hybrid between a corporate and a financial investment arm.” The fund grew out of a similar concept of strategic technology investment pioneered by some members of the team while at General Electric -- and, like many venture funds, EIP is looking for a special sauce.

But its goals differ from the flashy, next-big-thing tendencies of Silicon Valley investors. Because the partnership is pioneered for and by utilities, a notoriously traditional and risk-averse group, EIP is more cautious in its investments.

“We’d like to find companies ready for prime time,” said Kobler. “We are conservative investors.”

They’ve selected businesses such as energy storage company Advanced Microgrid Solutions and smart energy monitor company Sense. And in July, they offered a “significant investment” to charging company Greenlots, EIP’s first step into the electric-vehicle sector.

So far, the rigorous bottom-up and top-down process EIP uses has yielded investments in just 12 companies.

First, researchers devise a long list of companies making a name in the sectors that utility partners want to pursue. Next, the partners weigh in on any individual experience they’ve had with the companies. Then comes a round-robin-style pitch session, where companies meet with a group of representatives from the utilities.

They’re then ranked and stacked against each other. Those that rise to the top get the money.

The process may sound similar to what many venture funds go through, but Kobler insists there are added barriers -- physics, for one.

Rather than considering a product’s viral potential alongside its high risk of failure, utilities also have to weigh the distribution of electricity because they have to keep the lights on -- not a simple task -- and, as Kobler says, “You cannot FedEx electrons.” Then there’s the constantly shifting regulatory landscape (take Rick Perry’s recent request for rules to buoy nuclear and coal, for example) to contend with.

Still, much like their counterparts at Google and Facebook, EIP’s investors do have a penchant for tech trends. When asked what sectors of the clean energy industry will be of particular focus for the fund in the next year, Kobler rattles off a list of sensible choices including electric vehicles, distributed energy resource management systems (DERMS), storage, and then one area that has the Valley atwitter as well: artificial intelligence.

EIP’s interest in hot areas like AI may seem a bit trendy for an investment fund that prides itself on its cautious choices, but wading into less-traversed territory also makes sense in an industry that’s notoriously difficult to invest in. Right now, the winners in renewables are still being decided and the contest could go any way. Utilities know the ball is still in the air.

And though Kobler says EIP will maintain its conservative strategy, he also says it’s not all about the financials.

Of course, utilities buying into a venture fund want to see a return on their investment. But utilities also want to get closer to the customer experience, and learn strategies for hardening their systems and changing infrastructure as the energy industry moves to its next chapter. By investing now, they hope they’ll continue to lead the tide instead of getting left behind.

“They all know their culture has to change,” said Kobler, adding that the fund’s innovation working group, which focuses on groundbreaking technology, has the broadest attendance of any.

“They know something is coming; they know they have to change,” said Kobler. “They are very, very eager and active to learn.”

Output: Collaborative investment firm Energy Impact Partners (EIP) is helping traditional utilities seek out and invest in technologies that could reshape the industry for the first time in a century. Comprising 16 global energy companies with a total market value of $263bn, including National Grid, Xcel Energy and Southern Company, the fund has already made several cautious investments in the clean energy sector. EIP CEO Hans Kobler said the fund would focus on artificial intelligence, electric vehicles and distributed energy resource management systems.


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Gene therapy using HIV seen halting degenerative brain disease
 For the first time, doctors have used gene therapy to stave off a fatal degenerative brain disease, an achievement that some experts had thought impossible.

The key to making the therapy work? One of medicine’s greatest villains: HIV.

The patients were children who had inherited a mutated gene causing a rare disorder, adrenoleukodystrophy, or ALD. Nerve cells in the brain die, and in a few short years, children lose the ability to walk or talk.

They become unable to eat without a feeding tube, to see, hear or think. They usually die within five years of diagnosis.

The disease strikes about one in 20,000 boys; symptoms first occur at an average age of 7. The only treatment is a bone-marrow transplant — if a compatible donor can be found — or a transplant with cord blood, if it was saved at birth.

Output: A deactivated form of HIV has been used by scientists in a successful gene therapy trial of 17 boys with fatal degenerative brain disease adrenoleukodystrophy (ALD), according to a study published in the New England Journal of Medicine. The disabled form of the virus was used as a means of inserting genes into cells. Trial sponsor Bluebird Bio of Massachusetts revealed that after two years, 15 of the boys exhibited no obvious symptoms of ALD. The company hopes to market a gene therapy for ALD, but did not say how much it would cost.


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Greenko to diversify with $750m investment in Indian power T&Ds
 New Delhi: Given the uncertainties surrounding India’s renewable energy industry, Hyderabad-based Greenko Group is planning a $750 million equity investment for buying power transmission and distribution (T&D) assets to diversify.

Greenko, backed by Singapore’s sovereign wealth fund GIC Holdings Pte and Abu Dhabi Investment Authority, wants to become an integrated energy firm, founder, president and joint managing director Mahesh Kolli said in a telephone interview.

The firm is in talks to acquire several electricity transmission, distribution and hydropower projects, added Kolli. Greenko, which acquired SunEdison’s Indian assets last year, is also evaluating the electric vehicles charging business.

On 2 October, The Economic Times reported that Greenko is seeking to acquire Reliance Infrastructure’s Mumbai electricity business for an enterprise value of $2.15 billion. Kolli confirmed his firm’s interest in the assets.

A Reliance Infra spokesperson, in an email response, said, “We do not comment on speculations." Greenko currently has over 2.7 gigawatts (GW) of operating capacity with plans to achieve 3GW capacity by December. The firm plans to reach 5GW capacity by 2019. “In generation (projects) itself, we have put in a $1 billion worth of long term equity. That is giving us an Ebitda (earnings before interest, tax, depreciation and amortization) of close to $550 million. The long-term plan is to build an Ebitda of $1 billion," said Kolli.

To reach the $1 billion Ebitda target, an additional $150 million is planned from generation assets, with around $300 million expected from the T&D space that the firm is actively evaluating.

“For that (T&D) we will invest another up to $750 million of equity into that diversification track. For generation (assets), 3GW cash flow is sufficient," said Kolli.

The strategy is to ready Greenko to tap India’s rapidly evolving decarbonized, digitised and decentralised energy economy.

This comes at a time when the government seeks to reduce import of fossil fuels, boost underutilized power plants and meet its climate change commitments by providing universal access to electricity.

The firm is currently pursuing two transmission deals, added Kolli, while refusing to name them. Experts believe that given the disruptions in the Indian power sector, integration holds the key.

“Large players have to increasingly think of integrated utility play as they look for profitable and sustainable growth opportunities," said Manish Aggarwal, partner and head of corporate finance at consulting firm KPMG in India.

“Renewables surely is a huge play but will also witness headwinds. Focus of government is increasingly going to be towards transmission and distribution which offers immense opportunity going forward," added Aggarwal.

India’s low green energy tariffs have caused disruptions with some states looking to renege on their offtake commitments for projects awarded at comparatively higher tariffs.

Greenko has been acquiring assets in the Indian energy space. In 2016, it acquired SunEdison’s Indian assets at an enterprise value of $392 million.

The deal involved an equity investment of $42 million and required Greenko to assume project-level debt of $350 million. “If you look at our strategy, it has always been diversification.... Remember even when there was this complex scenario, I did acquire the TAQA hydro asset. I am still doing hydro. There are a couple of more hydros (projects), people are talking to us. Diversification is a key theme to whatever we do," said Kolli.

Greenko is also evaluating the electric-vehicle charging business even as there is rapidly emerging competition in the space. Utilities such as state-run NTPC is eyeing it, given the lucrative market potential of around 90 billion units of power.

“Mobility is also converging into power and that’s why we are looking at all these things," said Kolli, adding that the firm was not looking at the electric-vehicle charging space as a standalone business but would leverage its discom entry for the same.

India has drawn up an ambitious plan for a mass shift to electric vehicles by 2030 with state-owned Energy Efficiency Services Ltd going ahead with the first stage of procuring 10,000 electric cars.

“Therefore, I see more large players (including pure play renewables, transmission companies) increasingly thinking of more of a ‘integrated utility’ play, which will drive consolidation and also provide exit to many stand-alone platforms," said KPMG’s Aggarwal.

Output: Indian clean energy firm Greenko Group is in talks to acquire at least two transmission and distribution assets as part of a $750m equity investment, according to President Mahesh Kolli. The purchases would be part of Greenko's plans to become an integrated energy firm, Kolli said, adding that he is also examining the electric-vehicle charging space. The moves come amid increased uncertainty in the Indian renewable energy market as some states have attempted to backtrack on offtake agreements.


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FDA Issues Complex Generics Guide, Gottlieb Frames As Drug-Pricing Move
 FDA released draft guidance Monday (Oct. 2) aimed at facilitating development of one class of high-cost, widely sold complex drugs that currently lack generic competition. The agency also released guidance decoding complex generic-related Generic Drug User Fee Amendments (GDUFA) II commitments. The agency framed the release of these new guides as a part of the agency's generic competition plan. "We're undertaking a number of efforts to ensure that the pathways for approval for generic versions of complex drug products are...

Output: FDA released draft guidance Monday (Oct. 2) aimed at facilitating development of one class of high-cost, widely sold complex drugs that currently lack generic competition. The agency also released guidance decoding complex generic-related Generic Drug User Fee Amendments (GDUFA) II commitments.


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Anthem’s exit leaves thousands on Central Coast with one health plan option
 For about 60,000 Covered California customers, choosing a health plan next year will be easier, and possibly more painful, than ever: There will be only one insurer left in their communities after Anthem Blue Cross of California pulls out of much of the state’s individual market.

That means they could lose doctors they trust, or pay higher premiums.

Anthem’s departure is also a blow for the Covered California exchange, which has often boasted that healthy competition among its plans helped lower costs and improve its members’ access to care.

Competition won’t be so healthy next year for Covered California enrollees in six counties: Monterey, San Benito, San Luis Obispo, Santa Barbara, Inyo and Mono. For them, it will be Blue Shield of California — or bust.

Portions of seven other counties will also be served only by Blue Shield.

Californians in those areas who buy their plans outside the Covered California exchange may also be limited to one insurer. It’s not clear how many people that includes.

“If one of [Covered California’s] goals … was to provide a competitive marketplace where people will have options and real choices, then there is a failure to meet that goal” in those areas, said Kevin Knauss, an insurance agent based in Granite Bay, outside Sacramento.

The lack of competition means “there are definitely going to be people who will have to pay more for their health insurance,” Knauss said.

Consumers who live in the one-plan areas and don’t receive federal tax credits to lower the cost of their premiums will be the most affected, he added. They will have to shoulder the full amount of the increase if the Blue Shield premiums are higher than what they are paying now.

Covered California enrollees whose incomes qualify them for the tax credits won’t bear the entire rate increases because as premiums rise, so do the credits. The increase in premium assistance would absorb a significant portion of the rate hikes.

Anthem cited uncertainty at the federal level and an unstable marketplace in its decision to withdraw from 16 of 19 pricing regions in the individual market. The 28 counties where it will continue to offer plans are mostly in the rural parts of Northern and central California.

Blue Shield is the only insurer that will offer plans statewide on the exchange in 2018.

Overall, 153,000 Anthem policyholders in Covered California will have to find new plans. About 144,000 people who purchase their policies outside the exchange will also be forced to switch insurers, Anthem reported.

But the state insurance market remains broadly competitive despite Anthem’s impending departure, and most people will have choices, said Tam Ma, a legal and policy director for the advocacy group Health Access California.

According to Covered California, 96 percent of its enrollees will have at least two plans to choose from next year, and 82 percent will have three or more. Still, choice will be more restricted than this year, when all enrollees had at least two carriers to choose from and 93 percent could pick from three or more.

For the four percent who won’t have a choice in 2018, “it is a huge inconvenience for them to have to sign up for another plan … particularly people who are in the middle of treatment or have ongoing health care needs,” Ma said.

Covered California said in an email that it will strive to bring choice and competition to those people in the coming years. It also said a new provider directory will help enrollees search for doctors by plan. The directory is expected to be available on the agency’s website before consumers start renewing their plans in October, said Covered California spokeswoman Lizelda Lopez.

About 80 percent of doctors on Anthem’s network are also on Blue Shield’s network, said Covered California spokesman James Scullary, who added that Blue Shield has a larger list of providers. For every doctor on Anthem’s network, there are about 3½ doctors on Blue Shield’s, he said.

In August, Covered California’s board voted to boost the agency’s marketing budget by $5.3 million, partly to target people affected by Anthem’s pullout.

“While there is ongoing uncertainty and a lack of clarity at the federal level, consumers who need affordable health insurance will continue to have good choices in Covered California next year,” Peter Lee, the agency’s executive director, said in August when he announced proposed rate hikes for 2018.

But Sandy Halverson of Goleta is among that four percent who won’t have any choice, because she lives in Santa Barbara County, where Blue Shield will be the only insurer next year.

In Santa Barbara, as in most places where it is the only carrier, Blue Shield will offer only a Preferred Provider Organization (PPO). But it will offer a Health Maintenance Organization (HMO) option in some locations, including San Luis Obispo County.

Halverson, who works at a car dealership, currently has an Anthem plan through the exchange. She likes the fact that her primary care doctor of 15 years is familiar with her medical history.

She gets her care from Sansum Clinic, a large nonprofit group with 22 locations, serving about 130,000 patients on the state’s Central Coast. Sansum does not contract with Blue Shield, which means that next year Halverson and about 7,000 other patients now covered by Anthem in the individual market will have to find new doctors or pay out-of-network costs if they want to keep their current ones.

Halverson does not relish having to choose a new doctor. She imagines she’ll just pick one randomly from a list — and then hope it’s a good match, she said.

Kelley Lovejoy, an insurance agent in Santa Barbara, said many of her clients chose Anthem because of its relationship with Sansum, and they have been confused and frustrated since learning their insurer is pulling out.

“That is my primary concern, my clients not being able to see the physicians and specialists that are important to them,” Lovejoy said.

There might be hope, however. Sansum wants to establish a relationship with Blue Shield, said the group’s spokeswoman, Jill Fonte.

Blue Shield already has a network of providers in Santa Barbara, but it is open to discussions with Sansum and other health care providers throughout the state, said Lauren Bartlett, a spokeswoman for the insurer.

Editor's note: This article was originally published by California Healthline on August 18, 2017.

Output: For about 60,000 Covered California customers, choosing a health plan next year will be easier, and possibly more painful, than ever: There will be only one insurer left in their communities after Anthem Blue Cross of California pulls out of much of the state’s individual market.


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California Today: A Drug Crisis Proposal
 Good morning.

(Want to get California Today by email? Here’s the sign-up.)

San Francisco’s drug problem is in your face. Walk around long enough and you may well kick a used syringe or see someone shooting up in plain view.

The visibility of the scourge is one reason city leaders are starting to move seriously toward creating so-called supervised injection sites. It would be among the first American cities to do so.

Supervisor London Breed has been a champion of the idea. In an interview, she recounted some of the efforts so far to address the drug problem: outreach, a needle exchange program and cleanup crews that collect thousands of syringes a month.

Output: San Francisco’s drug problem is in your face. Walk around long enough and you may well kick a used syringe or see someone shooting up in plain view. The visibility of the scourge is one reason city leaders are starting to move seriously toward creating so-called supervised injection sites. It would be among the first American cities to do so.


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Disrupting care coordination: Turning patient-generated health data into a call to action
 Leaders within the health IT space are continuously innovating to bring care outside of a hospital's walls and into patients' homes. Many questions remain unanswered, however, including how to relieve physician administrative burden related to EHRs and how to implement the necessary IT infrastructure for data sharing. Despite the many challenges at play, stakeholders across the care continuum are striving to answer these questions to elevate patient care.

In a webinar sponsored by Nokia Technologies and hosted by Becker's Hospital Review, John Halamka, MD, CIO of Boston-based Beth Israel Deaconess Medical Center, a 651-bed teaching hospital, and Alexis Normand, director of healthcare business for Nokia Technologies, weighed in on the many factors driving progress in the health IT space and how effectively leveraging patient-generated health data will transform care delivery.

Challenges and trends in the high-tech era of healthcare

"No other industry has moved so fast as healthcare in the high-tech era," Dr. Halamka said. In 2016, The Office of the National Coordinator for Health Information Technology found 96 percent of hospitals had a federally tested and certified EHR meeting CMS' Medicare and Medicaid EHR Incentive Program. This figure is up from 71.9 percent in 2011.

"Healthcare moved a little faster than culture would allow," Dr. Halamka said. Integrating IT systems into daily workflows can take both time and energy. Other challenges with using data effectively include creating user-friendly patient portals, improving EHR interoperability and a steady decrease in innovation by EHR vendors due to government mandates.

Despite the many challenges impeding seamless data sharing, various trends are taking hold to eliminate challenges clinicians face in optimizing EHRs and other technological platforms. For example, Dr. Halamka predicted third parties will come into the mix and improve existing EHRs by adding unique functionalities. Dr. Halamka added this collaboration between EHR vendors and third parties will be the "real centerpiece of innovation."

IoT in 2017 and beyond

Many CIOs and other health systems executives are interested in IoT devices due to their potential for overcoming connectivity issues and sharing crucial information. Beth Israel Deaconess Medical Center recently implemented an application, BIDMC @ home, targeted for its congestive heart failure patients. The hospital employed middleware applications by connecting EHRs to smartphones to facilitate communication between patients and their care team. When patients open BIDMC @ home on their mobile devices, the app will show patients their care plan for that day, including medication dosages and recommended foods. The app's success in improving outcomes is contingent on a patient's willingness to engage in their care, as they are charged with inputting both objective and subjective data into BIDMC @ home. The application then shares that information with the EHR and BIDMC @ home will analyze the variances in data to see if an intervention is necessary. If the app deems an intervention is needed, it will provide patients a number to call to seek additional care, which may include sending a visiting nurse to the patient's home. BIDMC @ home also contains embedded links displaying the raw data that triggered that alert.

"Patient-generated healthcare data shows [a care team] what variance occurred. Unless you implement programs that incorporate some kind of subjective and objective patient data into care management, it will be hard to survive the transition to value-based purchasing," Dr. Halamka said.

Patient care teams within Beth Israel Deaconess Medical Center prioritize patient education. Providers will show patients graphs generated from BIDMC @ home, which will give them a better picture of how they are doing in adhering to their care plan.

"It is not just about showing the data," said Dr. Halamka. "It is about interpreting that data to provide wisdom [leading to] a call to action."

How data is changing care delivery

To drive optimal patient outcomes and change care delivery, the industry needs to prioritize "social" precision medicine, including allowing patients to readily communicate with their care team over a secure platform. Precision medicine encompasses a social element, which entails identifying how patients and providers prefer to interact with technology; baby boomers may prefer a phone call while a 24-old patient opts for a text message.

Dr. Halamka shared his wife's personal experience with hyperthyroidism to illustrate this point. After continually experiencing an elevated heart rate of 110 beats per minute throughout the day and losing a notable amount of weight, Dr. Halamka's wife contacted her physician over a secure texting platform to say she may have a thyroid issue. The physician ordered tests at a lab in close proximity to her and she received lab results minutes after they were completed, indicating escalated triiodothyronine and thyroxine levels. Her physician used an app to locate a reputable endocrinologist nearby, who prescribed her medication that alleviated the symptoms within two weeks. A process that previously could extend months or beyond happened in a few days through collaboration and the use of a secure communication platform.

"[The industry should] knit together all the devices in a home with primary care providers, labs, pharmacists, specialists and others at almost no-cost in a system that pays [clinicians] for high-quality outcomes," Dr. Halamka said.

The power of predictive medicine — Creating care plans of the future

Innovators within the healthcare sector are devising ways to use data to change healthcare delivery to a model focused on prevention. Preventive medicine is not only key to improving Americans' health, but it also fulfills another vital purpose: slashing healthcare costs. Simply put, healthcare costs are spiraling out of control, with healthcare accounting for 17.8 percent of Gross Domestic Product in 2015 for a total of $3.2 trillion dollars. Healthcare costs accumulate in the traditional healthcare system because it is designed to treat people after they're already ill.

"In a sense, medicine is always too late," Mr. Normand said. "You always to go to a doctor when you [are] already sick. There are a lot of cases where if you have data beforehand, you can prevent undesirable health events through intervention."

Nokia Technologies is working on solutions allowing patient data to disrupt the way care is coordinated, with the overall goal of driving early interventions. The company is targeting consumers with technology they already use, including watches and other wearables. New solutions hitting the market allow everyone to be an active participant in their health. With patients becoming more involved in their care and technology rapidly evolving to meet consumer demand, Mr. Normand predicted care delivery will look vastly different in the coming years.

"Digital health will take place less in a hospital setting," he said. "It will happen everywhere. It will be less visible, but it will be more pervasive."

To view the webinar recording, click here.

To view the webinar slides, click here.

Output: Leaders within the health IT space are continuously innovating to bring care outside of a hospital's walls and into patients' homes. Many questions remain unanswered, however, including how to relieve physician administrative burden related to EHRs and how to implement the necessary IT infrastructure for data sharing.


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Healthcare executives: Improving the patient experience is key to a healthy bottom line
 Hospital and health system reimbursement is more closely tied to patient satisfaction than ever before, and the link between patient satisfaction and revenue is expected to strengthen in years to come.

There has been a major push in recent years for more price transparency in the healthcare industry as patients shoulder more medical costs. "There are a lot of people who have concerns about how they're going to pay for the care they receive," said Aaron Kull, managing director and North America revenue cycle offering lead at Accenture, during an executive roundtable Sept. 21 at the Becker's Hospital Review 3rd Annual Health IT + Revenue Cycle Conference in Chicago.

In addition to patients with high out-of-pocket costs, Mr. Kull said patients 55 and younger are also a force behind the price transparency movement. He said millennials, Gen-Xers and Gen-Zers are more than three times as likely to price shop for care as older generations.

How hospitals are addressing the push for more transparency

Provider organizations have responded to the demand for more transparency. However, there is still significant work to be done.

Although most patients want to be told how much their medical care will cost, the majority of providers are not offering pre-treatment cost estimates. Mr. Kull said about 50 percent of patients know their estimated out-of-pocket costs prior to seeing a medical professional, but only about one in four got that information from their provider. When healthcare organizations fail to provide patients with price information, they sometimes resort to using third-party price estimators or other online tools which may provide inaccurate information. When this happens, patients may end up using low-quality information to influence important health decisions, potentially causing adverse financial consequences for patients and their families.

While there is still a lot of room for improvement when it comes to price transparency, some hospitals and health systems have made it a top priority. The vice president of finance at a rural hospital in the south said his organization tries to give patients clarity about what they will owe as soon as possible. He said his hospital sometimes provides patients with out-of-pocket cost estimates three to four weeks prior to a procedure. This allows patients to prepare for any financial burden.

The vice president of managed care at a seven-hospital system in the northeast said it is important to improve transparency in all areas that could affect the amount a patient pays. For example, he said patients do not want to find out after the fact that there was an out-of-network provider involved in their care.

Engaging patients as early as possible not only helps boost patient satisfaction but also helps ensure provider organizations receive payment. Although patients are enrolling in health plans that require them to pay more out-of-pocket for their care, it is ultimately up to providers to collect that payment.

To ensure timely collection of payment, it is vital for healthcare organizations to provide price information to patients before the point of care, according to Dave Gaydosh, managing director and North America revenue cycle offering lead at Accenture. He said about 36 percent of patients are willing to pay for care up front, which "significantly reduces the [revenue cycle] burden on the back end." He also noted that more than half of patients do not pay their medical bills by the due date, which further underscores the importance of offering patient payment options prior to care and at the point of service.

Patient satisfaction must be a top priority

Providing a great consumer experience is a challenge in every industry, especially in healthcare. From receiving cost of care information to putting a post-discharge plan into place, patients want their healthcare experience to mirror interactions they have in other industries. However, meeting patient demands can be difficult for hospitals and health systems, which are facing cost pressure and are simultaneously trying to change their strategy and innovate to remain competitive.

Patients want their experience to be "seamless, simple, transparent, coordinated, personalized and secure," said Mr. Kull. Although healthcare organizations are facing a number of challenges, they cannot afford to falter when it comes to patient satisfaction. Hospitals that fail to alter their revenue cycle to respond to patients' expectations will likely see bad debt rise, as they will fail to collect from patients who are either frustrated by the process or confused by their bill. Provider organizations that fail to respond could also see some of their patients seek care elsewhere.

During the roundtable, executives emphasized that improving patient satisfaction goes beyond making hospital billing more patient friendly. From improving care coordination to providing patients with cost information prior to a planned procedure, the executives discussed various initiatives their organizations have undertaken to improve the patient experience.

"When you start to look at all of the individual pieces consumers want … it is not simple," said Mr. Gaydosh from Accenture. However, the changing healthcare landscape makes it necessary for provider organizations to focus on improving the patient experience. "We're not going to be in fee-for-service … for the next 30 years. [Healthcare] is going to evolve. So we have to address these things," he said.

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Output: Hospital and health system reimbursement is more closely tied to patient satisfaction than ever before, and the link between patient satisfaction and revenue is expected to strengthen in years to come.


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Low-cost, high-volume services make up big portion of spending on unneeded health care
 Credit: Pixabay

Low-cost, high-volume health services account for a high percentage of unnecessary health spending, adding strain to the health care system, new UCLA-led research suggests.

Analyzing data on 5.5 million patients in Virginia, the researchers found that services providing no net health benefits to patients cost that state's health care system more than $586 million in 2014. Of that amount, 65 percent went to low-cost, high-volume services such as unnecessary lab tests.

The findings are published in the October issue of the peer-reviewed journal Health Affairs.

The researchers relied on a large Virginia claims database because it is one of the few datasets that reflect payments from nearly all types of sources, said lead author Dr. John Mafi, assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. These sources include fee-for-service Medicare, Medicare Advantage, Medicaid, private insurance and out-of-pocket costs.

These findings, he said, can serve as a microcosm for the nation's health system as a whole.

"Rising health care costs are putting an increasing strain on U.S. families, and from a taxpayer perspective we spend $3.2 trillion each year on health care," said Mafi, who is also a natural scientist in health policy at RAND Corporation. "That's nearly 18 percent of the nation's gross domestic product and of that $3 trillion, up to 30 percent is considered wasteful."

He said that instead of cutting coverage for all services, which could harm people who truly need them, policymakers should focus on reducing the health services of little health value to more safely reduce costs.

"Among the measures we studied, it was the low-cost, high-volume services that contributed the most to unnecessary health spending," Mafi said. "This is very important because it suggests that minor actions by all clinicians can play a major role in reducing unnecessary health care spending."

The researchers analyzed 44 services that are "low value" in specific clinical situations according to evidenced-based guidelines. These services do not represent all low-value care, and likely represent only a small proportion of care having little or no health benefits. They included lab tests for low-risk patients undergoing low-risk surgeries; stress cardiac or other cardiac imaging in low-risk patients without symptoms; routine head CT scans for simple dizziness; and imaging within the first six weeks of onset for low back pain that typically resolves itself.

They found that the 5.5 million people in the database received 5.4 million of the 44 services. Of that number, 1.7 million were low value, meaning they were medically unnecessary, and 3.4 million were high-value services that carried health benefits. Looking at the low-value services, they found that 1.6 million (93 percent) were very low cost and low cost, compared with 119,000 (7 percent) that were high and very high cost.

The cost for low- and very-low-cost, low-value services totaled $381 million, compared with $205 million for high- and very-high-cost, low-value services. This $586 million represented 2.1 percent of Virginia's total $28 billion in health care costs for the year.

Overall, about 20 percent of the 5.5 million people received at least one low-value service during the year analyzed.

"Given current levels of health care spending, the only way we can create headroom for innovation is to identify and eliminate low-value care," said Dr. A. Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design, and the study's senior author. "An initial approach that targets the reduction of high-volume and less costly items might be a more strategic way to spark the movement to tackle the problem of low-value care."

More information: John N. Mafi et al. Low-Cost, High-Volume Health Services Contribute The Most To Unnecessary Health Spending, Health Affairs (2017). DOI: 10.1377/hlthaff.2017.0385 Journal information: Health Affairs

Output: Low-cost, high-volume health services account for a high percentage of unnecessary health spending, adding strain to the health care system, new UCLA-led research suggests.


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Impact looks to launch second Australian solar investment fund
 Australia’s Impact Investment Group is planning to launch a second solar investment fund, following the runaway success of its first solar fund last year.

On Thursday, Impact celebrated the formal opening of the 11MW Williamsdale solar farm in the ACT, one of three solar farms contracted by the ACT government at the start of its goal to source the equivalent of 100 per cent of its electricity from renewable energy by 2020.

Williamsdale, which actually came on line earlier this year, was the first asset in the original solar fund, which attracted $100 million in less than two days from high net worth individuals, self-managed super funds and one institution, Future Super.

That fund aimed to deliver a return to investestors of 10 per cent per annum, and such was its success that Impact is now looking at a second fund, with the first asset likely to be the 15MW Swan Hill solar farm in Victoria, that is building on a “merchant basis”. A pipeline of other assets is also being put together.

“The smartest investors and developers in the country aren’t trying to eke another few years out of old unreliable, polluting coal-fired infrastructure,” said Lane Crockett, IIG’s head of renewable energy infrastructure.

“They are building the clean generators that will deliver reliable electricity, crucial environmental benefits, health benefits and attractive financial returns. Meanwhile, our investors have confidence knowing that the ACT government has committed to buying the farm’s electricity for 20 years.”

Crockett told RenewEconomy that the second fund would likely be launched next year, aiming for between $100 million and $200 million, once the pipeline of proposed solar projects in Victoria, Queensland and NSW is in place.

He said that there are two sweet spots in the Australia large scale solar market right now – one between 10MW and 30MW in size, and the bigger installations of 100MW plus.

“The benefit of the smaller solar farms is their speed to market …. and the ability to locate them in places where you can’t put bigger ones,” Crockett said.

“Solar costs have come down significantly over the last 3-4 years, it’s advantaged by its time of day generation portfolio, and its speed to market. It’s predictable, reliable technology, and it is well received by communities in regional areas.”

ACT climate and energy minister Shane Rattenbury said Williamsdale is the fourth large-scale solar farm built in the ACT. It joins the Royalla Solar Farm, Mt Majura Solar Farm and Mugga Lane Solar Park in completing the “solar highway”.

“The future is here, and it is clean, green and renewable. The clean power generated by Williamsdale Solar Farm takes us another significant step towards achieving our target of 100% renewable electricity by 2020 in the ACT,” he said in a statement.

“The ACT is establishing itself as a world leader when it comes to investment in renewable energy and action on climate change. Already, renewable energy has driven around $500 million of investment into the local economy.”

“By 2020, the ACT will produce 100% of our electricity from renewable sources like wind and solar and, by 2050 at the latest, our city will produce zero net greenhouse gas emissions.”

Output: Australia's Impact Investment Group (IIG) said it plans to create a second solar investment fund after debuting an 11 MW solar farm developed with proceeds from its first fund, launched last year. The company said the second pool would open next year with the aim of raising between AUD100m ($78m) and AUD200m. Its first asset will probably be the 15 MW Swan Hill solar farm in the southern state of Victoria, according to Lane Crockett, IIG’s head of renewable energy infrastructure.


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Price Matters, in Patients’ Minds
 When people believe a medicine is expensive, they may show a greater response to it.

Researchers told 49 volunteers that they were testing two anti-itch creams — one that was costly, and one cheap — that contained the same ingredient known to reduce itch, but that the ingredient sometimes increased sensitivity to heat.

Then they showed them the two medicines, one in an expensive-looking brand-name box with fancy lettering, the other in a plain generic-looking container. They did not tell them that neither cream contained any medicine, and that both contained only the same inert ingredient.

They randomly assigned them to try either the expensive or cheap cream. All participants knew which cream they were using. The study is in Science.

When exposed to heat, the volunteers using the expensive cream felt consistently more pain than those using the cheap one, and the effect increased over time. Using fMRI brain scans, researchers were able to show exactly which parts of the brain were involved in modifying how price information affects pain.

Output: When people believe a medicine is expensive, they may show a greater response to it. Researchers told 49 volunteers that they were testing two anti-itch creams — one that was costly, and one cheap — that contained the same ingredient known to reduce itch, but that the ingredient sometimes increased sensitivity to heat.