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Male eating disorders in UK rise by 70% in six years: NHS
 The number of adult men being admitted to hospital with an eating disorder has risen by 70% over the past six years – the same rate of increase as among women.

NHS Digital data analysed by the Guardian shows the number of hospital diagnoses in male over-19s rose from 480 in 2010-2011 to 818 between April 2015 and March 2016.

The rate of increase was slightly higher among older men, at 70% for the 41-60 age group, compared with 67% in the 26-40 category and 63% among 19- to 25-year-olds. In the same period, there was a 61% increase among women aged 19 to 25 and a 76% rise among middle-aged women.

The figures come after it was revealed that steroid use among young people quadrupled in the past year. The Home Office’s crime survey found the biggest rise in anabolic steroid use was among 16- to 24-year-olds, with an extra 19,000 taking the drug.

Medical leaders and health experts have put the growing numbers down to pressure from popular culture and social media. But more awareness about eating disorders may be encouraging life-long sufferers to come forward and talk about their problems, they believe.

Dr William Rhys Jones, of the Royal College of Psychiatrists’ eating disorders faculty, said: “Pressure for body perfection is on the rise for men of all ages, which is a risk factor for developing an eating disorder. Images of unhealthy male body ideals in the media place unnecessary pressure on vulnerable people who strive for acceptance through the way they look.”

He said a continued lack of understanding and sometimes sympathy for men suffering from eating disorders remained a barrier for some who needed help. “We must continue to address the ongoing gender bias around eating disorders so every man who is suffering feels comfortable to get help when they need it.”

Prof Helen Stokes-Lampard, chair of the Royal College of GPs, said the rise was not surprising “when you consider the unrelenting pressures placed on people by popular culture and social media”.

She called for schools, universities and employers to be more aware of the danger signs. “[These] can include excessive dieting or daily trips to the gym, eating large amounts of food, the inappropriate use of laxatives and obsessions around weight and appearance,” she said.

Stokes-Lampard said there was a growing awareness that eating disorders affected both men and women. “Increased awareness among sufferers and health professionals has likely meant that men are starting to recognise their symptoms more and are being diagnosed more, meaning that they are more likely to be referred to eating disorders services,” she said.

The eating disorder charity Beat said increases in hospital admissions may be a positive sign. Tom Quinn, its director of external affairs, said: “It’s possible [the increase] indicates an increasing awareness that these illnesses affect people regardless of gender.”

Earlier diagnosis and treatment would lower the chance of an illness developing to the point when they required hospital treatment, he added. “There is still a long way to go to ensure that all sufferers get the treatment they need as quickly as possible.”

Figures released last year showed people with eating disorders in England could wait for up to 182 days for treatment. Patients surveyed by Beat expressed concern about GPs who were failing to refer people for specialist assistance. Half of those with some experience of an eating disorder rated GP care as poor or very poor, and 30% said they were not referred to mental health services after their appointment.

Sam Thomas, the founder of the charity Men Get Eating Disorders Too, said the UK had no dedicated facilities for male patients. “Usually places will have two separate rooms they prioritise for men but that can reinforce any sense of isolation, and eating disorders thrive on that,” he said. “Some services literally cannot admit men. One guy I know has been waiting months and months. He has had a heart attack and is desperately unwell and he is still waiting for a referral. He is on about seven waiting lists.”

Data shows that men still account for a small proportion of the total patients diagnosed in hospital, with 1,098 male adults and children admitted in 2015-16 and 12,054 female adults and children. More than 300 boys and girls aged 12 or under were admitted to hospital with an eating disorder in 2015-16.

The fastest rate of change among all ages over the six-year period was in 13- to 15-year-olds. Diagnosis numbers over the period more than doubled, from 565 to 1,383.

Rhiannon Lambert, a Harley Street nutritionist, said: “One key marker between men and women is that women tend to be more honest in their symptoms whereas men typically suggest they are on a physique transformation journey.

“There is a stereotype that eating disorders still only apply to privileged, appearance-obsessed women. This huge misconception exists which pushes the harmful notion that a great many others are not at risk. I have met people of every race, gender, sexuality and personality with disordered eating patterns. Eating disorders do not discriminate, they are a complex mental health illness that can affect everyone.”

Case study: Dave Chawner, 28, from London

When I was 17, I got a role in a play and I had to appear topless. It was the only time I had ever really thought about my body and so I lost a bit of weight. People started saying “you look good” and that made me feel great. Losing weight gave me approval and meant “being good” in my mind.

It came at a time when I had a lot of other stuff going on – including applications, exams and deadlines. Everything felt intense and my grades were not good but losing weight was.

Eventually the people around me picked up on it, and took me aside for a quiet word. But I didn’t acknowledge I had a problem. It was only when I was 21 that I first said that I had anorexia. I got a job over the summer in a boarding school which was completely catered for. It really affected me how little control I had over the food. I started exercising during the night, binging and purging. One of the teachers, who had experienced bulimia herself, asked me if I was anorexic. I thought: “I do have anorexia.”

At my worst I was weighing myself four or five times a day, coffee loading, exercising during the night. I would have mood swings and constantly feel thirsty because when you’re not eating your brain thinks you must need a drink. I was also constantly freezing.

Over the years, it faded in and out of prevalence. How bad things were depended on how much I wanted to escape life and numb myself. I am a comedian and I started doing shows about my illness when I was about 23. It went better than I thought but people said “you don’t look anorexic” and that made me feel like a fraud. So I had a relapse and ended up needing outpatient treatment at the Maudsley hospital in London. I was treated there for two and a half years and finished therapy about three or four months ago. I found it really helpful.

It is still an open book in terms of what will happen in terms of my eating disorder, but I feel the furthest away from anorexia that I ever have.

As a man, I never found it hard to get help because I am very open and can talk about what is going on. I could go to my GP and explain what was on my mind and they did take me seriously. I know not everyone can be so open.

Although it’s awful to see more men suffering from eating disorders it’s great that more are having the balls to stand up and come forward, saying they don’t feel stigma anymore. If a man came into the doctor with cancer or heart disease, would we treat them differently to a woman? It’s easy to create a barrier that doesn’t need to be there.

I think it’s lazy to blame social media for the rise in eating disorders – they existed before Facebook. However, now it’s like people have someone looking over their shoulder as everything is documented. It’s not helpful that people Photoshop their photos and present an unrealistic image to the world that is unobtainable.

Having an eating disorder is like a constant background noise, a hum that is never completely there but also never ever taken away. It’s not that I didn’t like food. I was always thinking about how I could eat and feel full without having any calories. It is like being an alcoholic, it’s not something that ever goes away. It’s a kind of colour to your existence but it makes life so unstable.

For hundreds of thousands anorexia isn’t sexy, interesting or exciting – it’s just a shit, boring, mundane, anxiety-ridden hell for them. I am trying to help make that clear, to present a more authentic portrayal of it.

Output: There has been a 70% rise in the number of UK men admitted to hospital with eating disorders during the past six years. The rate of increase is the same as among women. The number of hospital diagnoses in men over 19 rose from 480 in 2010-2011 to 818 in 2015-2016. The figures' publication followed revelations that anabolic steroid use among 16-24 years-olds has quadrupled over the past year, with an additional 19,000 young people taking the drug, whose use is linked to muscle building. Pressure from social media and popular culture have been blamed for the increases.


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Regus [4]: Serendipity Labs and China's UrWork announce JV
 Serendipity Labs, the self-defined “upscale hospitality brand” in the increasingly competitive co-working industry, has entered the international business world in a deal that will take the 6-year-old company far beyond its roots in Westchester and Fairfield counties.

Serendipity in July announced a joint venture with Chinese co-working titan UrWork in the opening of a 34,000-square-foot office at 28 Liberty St. in the Manhattan Financial District. The two companies also will connect their networks to allow their members to use any of their locations throughout the U.S. and China.

Using an app, members can make reservations for meeting space, have a place to work for the day, house remote teams or have a reliably accessible local address.

UrWork serves 2,400 companies across 24 cities in China and started its overseas expansion last year, which to date includes the opening of co-working offices in Singapore, London, and Taiwan.

Serendipity Labs CEO John Arenas, who launched his company in 2011 at 80 Theodore Fremd Ave. in Rye, said that UrWork first approached him about two years ago to learn about the U.S. co-working landscape.

“We ultimately agreed that a joint venture was the way to go,” Arenas said at Serendipity’s Stamford operation at 700 Canal St. “We’re co-branding (the New York City location) and will offer the same language skills, in this case Mandarin, for our clients.”

Arenas described the venture as that of “two fast-growing, established companies” who will both benefit by the deal – and perhaps fire a shot across the bow of WeWork, a similar company that provides shared workspace, community and services for entrepreneurs, freelancers, startups and small businesses. Founded in 2010 and headquartered in New York City, WeWork has locations in 19 U.S. cities and 12 countries, including China, India, Germany, France and the U.K., and has a valuation of about $20 billion.

Backed by such investors as Sequoia Capital, Zhen Fund, Noah Wealth Management and Sinovation Ventures, UrWork had a valuation of $1.3 billion as of June. It has 78 locations in 20 cities, serving over 3,000 enterprises and 30,000 members.

Serendipity has attracted over $125 million in capital, including $24 million in private equity and over $100 million committed from its area franchise developers, Arenas said. The firm has about 4,000 members at its six established locations in Rye; Stamford; Ridgewood, New Jersey; Aventura, Florida; Bethesda, Maryland; and Chicago.

“This is a huge step forward for us,” Arenas said of the international joint venture. “It definitely puts us on the global map.”

Arenas attributed Serendipity’s momentum to both his personal experience in the hospitality space and a little luck.

“When I started in Rye four-and-a-half years ago, most people didn’t know what co-working was. Today there’s so much more awareness across the board, with both individuals and companies recognizing the value of a dedicated offsite workspace.”

Co-working spaces are designed both to relieve a person’s isolation and lack of human interaction by placing him or her alongside employees of other companies and entrepreneurs in individual workspaces and to offer large event and meeting spaces for established firms looking for an offsite change of scenery.

“We’re all about recognizing the value of community,” Arenas said. “We provide a place where people can arrive and feel they’re part of a community of similar people.” The company rotates work by local artists on its walls and strives to promote local events it believes will be of interest and relevance to its members, along with hosting lectures, meetups and the like.

On the corporate side, Serendipity’s client list includes Philips, GE Healthcare and PepsiCo.

At Philips North America, Liz Scarnati, assistant to the vice president of sales, called Serendipity’s Stamford office at 700 Canal St. “an excellent resource” utilized by the technology company’s New York City and Connecticut team.

The son of an urban planner, Arenas started out as a civil engineer before moving to a relationship manager position at Citigroup. By 1996, he had gone off on his own to form Stratis Business Centers, which grew to be an 11-state network of office centers. When international workspace provider Regus (now IWG) acquired Stratis in 2001, Arenas moved to Westchester County to serve as president and general manager of Regus Americas.

In 2005, he founded another on-demand workspace company, Worktopia, which at its height had over 1,000 venues in 50 countries. It was acquired by a company called SignUp4 in 2011, which in turn was acquired by CVent for $22.4 million in 2015.

Then came Serendipity, which its CEO believes is built to last.

“What differentiates us is our ability to fuse the needs of the workspace with hospitality,” he said. “Most co-working spaces, including others here in Stamford, provide the expected amenities and the ability to brainstorm with other residents who may not be in the same line of business but from whom you can learn.”

Serendipity’s m.o. is to create a network where on-the-go members can take advantage of the same kind of support, security and compliance with regulatory requirements in any of the firm’s offices.

Having essentially created such a network in the tri-state area — a Princeton office is due to open in August and Garden City on Long Island is another target, Arenas said — Serendipity has expanded its East Coast network with its Maryland and Florida offices and plans to open in Miami later this year. The firm also plans openings in Nashville; Sugar Land, Texas, and at two locations in Columbus, Ohio.

In Stamford, Serendipity Labs is about to add 9,000 square feet to its existing 13,000-square-foot space.

The plan from the start was to have a network of 100 labs, and Arenas said the company is well on the way to reaching that goal.

Also working in Serendipity’s favor is the Financial Accounting Standards Board’s Accounting Standards Update, issued last year. Intended to improve financial reporting about leasing transactions, it affects all companies and other organizations that lease assets such as real estate, airplanes, and manufacturing equipment.

Having to report such leasing activity can affect a company’s bottom line. Combined with the move toward mobility, Arenas said the new accounting standards make an option like Serendipity all the more attractive.

“That all counts towards debt now,” he said of those leased assets. “Companies are now trying to get out of those smaller leases but still maintain a satisfactory environment for employees who work there. We are a good solution for that.”

Arenas said Serendipity was “a little ahead of the curve” with the co-working phenomenon.

“We always believed that this industry should be recession-resistant. The thinking was that in an economic downturn, companies would reduce their headcount and turn more towards individuals as freelancers or part-timers — with us providing the professional environment that they need.”

However, economic swoons in 1986, 1992 and 2001 didn’t generate that expected activity. But in the wake of the 2011 downturn, Arenas said, “Our industry didn’t break. Instead it was the employee-employer relationship that broke, with people becoming free agents and companies learning that they could lease space at an outsourced office until they could afford to bring people back full-time, if they ever did.”

Five years from now, said Arenas, he expects the co-working industry will be well into the merger and joint venture phase exemplified by Serendipity’s deal with UrWork.

“Over the next year, I see us in Canada and making inroads in countries like the U.K., Netherlands, Germany and France, probably with local partners on a franchise basis,” he said. “We’re absolutely on track to increase our global footprint significantly.”

Output: Serendipity Labs has announced a joint venture with Chinese co-working heavyweight UrWork, opening a 34,000 sq ft office at 28 Liberty Street, Manhattan. The companies' networks will be connected for members to use any of their locations throughout China and the US. As of June, UrWork's valuation was $1.3bn, it had 78 locations in 20 cities, serving over 3,000 enterprises and 30,000 members. Serendipity has over $125m capital, six US locations, and serves roughly 4,000 members, including Philips, GE Healthcare and PepsiCo. Serendipity Labs CEO John Arenas, previously president and general manager of Regus Americas, expects to see increasing M&A and JVs in the co-working industry.


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Twitter trials monthly subscription plan for tweet promotion
 Twitter is currently testing a $99 (£75) a month subscription plan which helps power users and small businesses to increase their reach by auto-promoting tweets onto the timelines of people that aren’t followers.

The plan is, at least for the time being, aimed at those that lack advertising-savvy or are too lazy to implement their own strategies – hence why hasn’t been pushed to big brands. It differs from Twitter ads, where the user is in charge of creating and optimising their own campaigns, because it enables the user to continue tweeting as normal while Twitter automatically promotes some of those tweets.

As part of the beta program, those invited get to try the feature for free for a month. This will see up to the first 10 tweets each day promoted, though not every tweet will be pushed and the extent of promotion ‘may vary based on performance’. Retweets, replies and quoted tweets won’t be promoted but individual tweets cannot be turned off – so, it’s all a bit of a lottery really.

Tweets are promoted to people based on either their interest or metro area, but not both, depending on which is chosen by the user.

The move from Twitter could be in response to its eight per cent drop in ad revenues in Q2 2017, compared to the year prior. Although, it had plans for a very different subscription model earlier this year. Back in March, it was revealed that the microblogging platform was looking to introduce a plan for $19.99 – which would have been more-or-less an extended version of TweetDeck.

Output: Twitter is beta-testing a monthly subscription plan for auto-promoting tweets, aimed at small and medium-sized businesses that lack the capability to advertise effectively. The scheme costs $99 per month, while beta users can sign up for a free trial, during which the first 10 tweets each day are promoted. Twitter added the caveat that results "may vary based on performance". The move may be an answer to the company's 8% drop in ad revenues during Q2 2017.


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Amazon explores healthcare expansion with 1492 lab
 It’s not particularly surprising that it wants to muscle in on the industry, which is ripe for innovation, given that other tech giants have already made similar intentions clear. Google makes no secret of the fact that it wants to shake up the sector, with its spinout Verily Life Sciences building health-tracking hardware and launching large-scale medical studies. Apple, too, has been trying to get folks to use its hardware to track health-related data, and behind-the-scenes discussions with the FDA hint that it has grander plans to come.

None of the ideas being explored by Amazon are particularly revolutionary, either. Online consultations with doctors already happen, provided in the U.K. by companies like Dr Thom, and more complex versions, for say, physical therapy, have been tested. DeepMind, meanwhile, is currently building out a blockchain-inspired system to securely manage digital health records in London hospitals. And projects by Apple and Google are already trying to use existing or available hardware for health purposes.

Even so, no tech firm has so far managed to disrupt health care, and the industry remains fit for technological upheaval. It’s worth remembering that Amazon has a key advantage over other firms, with its sophisticated retail and distribution network—indeed, earlier this year, CNBC also reported that Amazon was contemplating a move into selling pharmaceuticals. It may hope to offer a more comprehensive service than Apple or Google could right now.

(Read more: CNBC, “FDA E-mails Reveal Apple’s Long Game for Health Tech,” “Google’s Verily Unveils a Health Watch for Research,” “Google’s Verily Unveils a Health Watch for Research,” “DeepMind’s New Blockchain-Style System Will Track Health-Care Records”)

Output: Amazon has formed a team called 1492, whose aim is to research healthcare-related projects, according to a report by CNBC. It said the 1492 team is looking into finding uses for Amazon hardware, including the Echo speaker, as well as projects relating to digital medical records and online doctor's appointments. CNBC also speculated that Amazon's sophisticated retail and distribution network could give the company the edge over Apple and Google, which are also exploring ways to disrupt the healthcare sector.


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Indian insurance mega-merger pulled after IRDAI douses plan
 HDFC Standard Life Insurance Co. Ltd and Max Life Insurance Co. Ltd have called off their proposed merger after failing to win regulatory approval for a union that would have created an insurance giant with Rs1.1 trillion in assets.

In a statement on Monday, Max Financial Services Ltd, Max India Ltd and Max Life confirmed that the proposed merger with HDFC Life has been called off.

The exclusivity agreement with HDFC Life was valid until 31 July 2017 (Monday), and will not be renewed, Max said.

In November, the Insurance Regulatory and Development Authority of India (IRDA) referred the deal to the Union law ministry after raising concerns about its structure being in violation of a section of the Insurance Act.

Max Financial Services was created in 2016, after a demerger of the erstwhile Max India. Both firms had initially proposed the merger of Max Life with Max Financial Services.

This structure was found to be in violation of Section 35 of the Insurance Act, which does not allow merger of an insurance firm with a non-insurance firm.

The law ministry, in turn, sought an opinion from then attorney general Mukul Rohatgi. As per the original scheme, the deadline for IRDA approval was to expire in June, while that for court approval was to end in February 2018. When Rohatgi declined to give his view on the matter, IRDA in its final decision refused to give the go-ahead to the transaction.

“The prospective partners had evaluated several alternative structures over the last month. However, the inordinate time associated with finalization and approval of these structures led to this decision," the statement said.

Mint reported in June that both companies had begun working on an alternative structure while HDFC Life had also simultaneously begun working on its proposed initial public offering (IPO).

In July, HDFC Life’s board approved a proposal to sell as much as 20% of the insurer through an IPO even as it reiterated its commitment to a potential merger with Max Life at a later date.

While both sides could not subsequently agree on an alternative structure, Mint reported in June that the approval process for a new structure could potentially take another 12 to 18 months, which some HDFC Life investors were not amenable to.

HDFC Life and Max Life had announced their merger plans in August last year. The potential merger would have created India’s largest private sector life insurer, surpassing ICICI Prudential Life Insurance Co. Ltd, and second only to state-run Life Insurance Corp. of India, which has a 70% share of new business premiums in the country.

The merger had been seen as the first sign of a long-awaited consolidation in an industry with assets under management of Rs22.4 trillion, of which the 23 private sector insurers account for only Rs4.61 trillion, according to IRDA.

Output: The merger of two financial giants to create India's largest private insurer has been abandoned after it failed to get regulatory approval. HDFC Standard Life Insurance and Max Life Insurance had announced their merger earlier this year to create a business with INR1.1tn ($17.1bn) in assets. But the Insurance Regulatory and Development Authority of India said the arrangements put in place for the merger would have meant an insurer merging with a non-insurer, which is prohibited by Indian law.


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Facebook enables public sharing on Stories
 Facebook Stories, the platform's ephemeral video and image-sharing service, has enabled public sharing in a move that could present a further challenge to Snapchat.

The social network has confirmed to TechCrunch that Stories settings have been tweaked to allow users to share updates with a public following, rather than just their friends. The ability to do so could allow social media influencers and public figures to share updates with fans.

Facebook launched Stories in March, affording users the chance to stitch a chronological slideshow of videos and pictures to share with friends. The opening up of the service - which effectively nabbed Snapchat's USP – has the potential to let celebrities give fans a peek behind-the-scenes of their day, or for influencers with Facebook followers to share content – giving users a reason to stay tuned to Facebook.

While Snapchat has previously been reported to have less cosy relationships with creators and celebrities than other social networks, the upstart has tried to make itself more open in recent months. It recently made it easier for users to share public Snaps and has built out its search capabilities with Snap Maps so they can explore newsworthy and publicly shared content. It's even launched a feature within Snapchat Stories that opens the service up to third-party links, something Facebook has yet to explore.

Facebook has 1.3 billion daily active users against Snap's 166 million, meaning there's plenty of room to scale public Stories and encourage users to migrate from Snapchat in the process.

Facebook's sister platform Instagram, meanwhile, has opened up its own Stories format to brands and pages – it's used natively by media outlets like BuzzFeed as well as brands like Nike and Coast. As with Snapchat, ads are served between Stories within Instagram's walls to the service's 250 million daily active users.

Some believe that Facebook is heading towards the same path and that the latest update will give the world's biggest social network greater leverage to monetise the service.

For now though, business pages are unable to use Facebook Stories, with a Facebook spokesperson telling TechCrunch there is "no specific timing to share there quite yet," on when this will change. Given Instagram's success in the arena it's likely to be something Facebook is keen to explore the future, though.

“It’s safe to assume that this move to drive usage of Stories is a route to eventually drive ad revenue from the format," said Matt Linstead, content manager at digital agency 360i Europe.

“Facebook will have the most success if it can get celebrities and media outlets to jump on this as a new way to share with audiences, in the same way they have with live video on the platform.

“If Facebook can drive the kind of numbers it is seeing with Instagram Stories, the format will become an attractive opportunity for advertisers. But for now, it has a long way to go.”

Output: Facebook has enabled users to publicly share images and videos with its Stories feature, in an attempt to encourage more of its 1.3 billion active daily users to engage with the tool and follow celebrities and influencers. The social media giant has also opened up Instagram's Stories to brands, including Nike and BuzzFeed, but has no plans to allow businesses access to the Facebook Stories feed.


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Cannabis payment company launches mobile service
 CanPay, which calls itself the first legitimate debit payment product for the cannabis industry, is partnering with Harborside, the leading national medical cannabis dispensary, to provide a cashless payment option for delivery transactions originating from its Oakland and San Jose locations.

Harborside claims it has more than 200,000 registered patients, according to a press release.

When paying for their medicine, a CanPay user signs into the mobile app to generate a secure, single-use payment token that includes no personal identifiable information. The Harborside delivery employee then scans that payment token into their mobile delivery device and the funds for the purchase are transferred directly from the patient's checking account to Harborside's account.

"Patients who rely on cannabis for preexisting medical conditions should not have to be inconvenienced or have their safety put at risk by a cash-only model," said Dustin Eide, CEO of CanPay, in the release. "Delivery is a mainstream solution and payments should be able to keep up with the industry. By partnering with Harborside, we are providing their patients the benefits of more secure, transparent transactions."

Output: CanPay is teaming up with Harborside, a medical cannabis dispensary, to offer cashless payment options for deliveries to its 200,000 registered patients. CanPay describes itself as the first legitimate debit payment solution for the cannabis industry in the US, and aims to allow users to simply sign into the mobile app to create a secure payment token, which holds no personal information.


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'Smart pill' reminds patients to take their medication
 Pills. Credit: Public Domain

Forget to take your medication? Now you can get a reminder to find your pills - sent by the pill itself.

Chicago's Rush University Medical Center has become one of the few health care providers in the United States to use a grain-of-sand-sized sensor that, after being swallowed, can alert patients when they've forgotten to take medication.

Developed by Proteus Digital Health, the FDA-approved sensor is made from microscopic quantities of copper and magnesium. Powered by the human body (no batteries or antennas required), the tiny sensor turns on after reaching patients' stomachs, where it begins sending signals to a Band-Aid-like, Bluetooth-enabled patch worn on the torso. The patch then decodes those signals into meaningful health information and sends it to users and physicians in an app.

Tony Perry, vice president of Rush's ambulatory transformation program, said the hospital has been using the Proteus technology since January, hoping it could eventually better guide care for patients with chronic illnesses like hypertension or congestive heart failure.

As many as half of all patients undergoing drug therapy for chronic illnesses fail to regularly follow prescription instructions, Perry said.

"We know from a data perspective that when we write prescriptions, a good number of those prescriptions either don't get filled or don't get taken by people," he said. "The 'click in the head' was that this is a behavioral tool that was meant to help people help themselves, and that really seemed like a neat opportunity."

In addition to reminding patients to take their meds, the Proteus technology also tracks heart rate and other important health markers, said Perry, whose clinical practice is in geriatric medicine.

More than a dozen Rush patients are currently using the digital medicine tool. The cost to patients is "net neutral" after insurance, he said.

Rush is the first health care provider in Illinois and the eighth nationally to partner with Proteus; Barton Health in California was the first. Children's Health in Texas is also among Proteus' list of health care providers.

Amanda Tosto, director of system integration and population health at Rush, said the hospital's efforts have so far focused on how to successfully incorporate the tech into its operations. It has mostly begun using the Proteus sensor, patch and app with its more technologically friendly patients through hospital-provided iPads, she said.

"You've got your patients who are really going to like this and see it as an extension as their Fitbit or their MyFitnessPal app," Tosto said. "But we've also got a couple of patients who have really benefited from being able to work with their families on medication delivery."

The Proteus sensor is sealed into a capsule along with a patient's normal medication by the specialty mail-order pharmacy Avella; it is the only pharmacy that distributes the "smart pill" for Rush.

Proteus has raised more than $284.5 million since 2013. Kaiser Permanente, Medtronic, Novartis and Otsuka are among the privately held company's investors.

Although startups have introduced smart pill bottles and similar innovations that deliver medication reminders, Proteus considers itself the only company that does so through technology that's ingestible, according to Andy Thompson, co-founder and CEO of Proteus.

"What we are delivering in this industry is the ability to integrate silicon and software into its innovation toolkit," Thompson said. "Those are levers that every other industry has been using to massively boost their rate of innovation, and we think that same is true for pharma."

About half of all U.S. adults have one or more chronic health conditions, according to the Centers for Disease Control and Prevention. Treating patients with chronic diseases accounts for 86 percent of all health care spending, the CDC estimates.

The FDA cleared the Proteus sensor for marketing as a medical device in 2012. The agency rejected an application for a Proteus investor, Otsuka, to pair the sensor with the antipsychotic drug Abilify in 2016, however, citing the need for more data. Otsuka submitted a new application in May.

In 30 years, Thompson said that he believes every drug that's built is going to have some sort of active silicon inside.

"We're delighted to work with a leading medical center in Chicago," he said. "When we look at institutions like Rush, we believe they're magnifying their physical footprint with a digital footprint and helping folks who are sick manage their conditions where they live, work, play and pray."

©2017 Chicago Tribune

Distributed by Tribune Content Agency, LLC.

Output: Proteus Digital Health has developed a US Food and Drug Administration-approved sensor, the size of a grain of sand, which is swallowed like a pill and provides an alert to patients with chronic illnesses reminding them to take their medication, via a wearable patch and a connected app. The Proteus technology also monitors heart rate and other health markers, and is being used by eight national partners across the country. The sensor is powered by the human body and is made from copper and magnesium. The Centers for Disease Control has estimated half of US adults have one or more chronic health conditions.


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UK’s FCA considers ban on unarranged overdraft charges
 The review provides clear evidence that FCA regulation of high-cost short-term credit (often known as ‘payday lending’) has delivered substantial benefits to consumers. The review found that 760,000 borrowers in this market are saving a total of £150m per year, firms are much less likely to lend to customers who cannot afford to repay and debt charities are seeing far fewer clients with debt problems linked to high-cost short-term credit.

The FCA has therefore decided to leave the existing payday loan price cap in place, and to review it again in 2020.

However, the review has also established clear concerns with other forms of high-cost credit. In particular, the FCA believes that fundamental changes in the way that unarranged overdrafts are provided may be necessary. Charges for unarranged overdrafts are often high after taking into account the risks to lenders, and can be complex and thus hard for consumers to understand.

The FCA also identified particular concerns in the rent-to-own, home-collected credit and catalogue credit sectors. While there are similarities between high-cost credit markets and products, there are also significant differences in how they work and how people use them. The FCA is developing tailored solutions to these issues, and will consult on action to address these concerns in Spring 2018.

Andrew Bailey, Chief Executive of the FCA, said:

“High-cost credit products remain a key focus for us because of the risks they pose to potentially vulnerable customers. We are pleased to see clear evidence of improvement in the payday lending market after a period when firms’ treatment of customers and their business models were often unacceptable.

“However, there is more that we can do, and this review is about identifying the areas where consumers may be suffering harm so that we can focus our efforts accordingly.

“In particular, the nature and extent of the problems that we have found with unarranged overdrafts mean that maintaining the status quo is not an option. We are now working to resolve these issues while preserving the parts of the market that consumers find useful.”

Alongside the review, the FCA is publishing proposals to clarify its rules on creditworthiness and affordability. Most credit firms understand the FCA’s rules regarding checks on prospective customers’ creditworthiness, including whether they can afford consumer credit products. However, there is some uncertainty in parts of the market, so the FCA is proposing a number of changes to clarify its expectations.

The FCA has also published more detail on its work on motor finance, setting out the issues that it is considering and the steps it is taking to develop its understanding of the market. The FCA will publish an update on this work in the first quarter of 2018.

Notes to editors

Output: Unarranged overdraft fees could be banned in the UK, according to a review by the country’s regulatory body, the Financial Conduct Authority (FCA). Lloyds, the UK’s largest lender, said earlier this month that it would abandon such charges from November. Barclays has already ceased unauthorised lending. Charges for those who go into debt without prior agreement can be up to £6 ($8) per day. Fees for such overdrafts were frequently “significantly higher” than for payday loans, said FCA CEO Andrew Bailey. Other options under consideration include a cap on charges or affordability checks.


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Redrow Redrow funds final £400 of fundraising to buy school a defibrillator
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A Hartford primary school has been able to purchase lifesaving equipment after a housebuilder stepped in to help boost their fundraising efforts.

Redrow Homes donated the final £400 needed to the Young PTA at St Wilfrid’s Catholic Primary School so they could buy a defibrillator.

The Young PTA group, made up of children between the ages of five and 11 with a small additional group of youth leaders aged 11-14, was set up four years ago to raise funds for a variety of causes.

This year’s chosen cause is The Oliver King Foundation, founded after the death of 12 year-old Oliver King from Sudden Arrhythmic Death Syndrome - a hidden heart condition which kills 12 young people a week.

Headteacher Anne Weir said: “The school had a visit from Oliver’s dad, Mark, who told us all about the condition and the fact that Oliver had suffered a cardiac arrest while taking part in a swimming race. After Mark’s talk, the children voted unanimously to raise funds to provide a defibrillator to the school which previously didn’t have one at all.

“The children were fantastic at their own fundraising and had raised £600, but the funds fell short of the target so the donation from Redrow has meant that we’ve been able to purchase a defibrillator that could save the life of a child or any adults at the school.

“Once we’d bought the defibrillator we had a special assembly at school and invited Mark along so he could see the results of Oliver’s legacy.”

Area sales manager for Redrow (NW), Caroline Thompson Jones, also attended the special assembly and added: “We’ve been helping out various causes in Hartford for a couple of years now and when the school contacted us about this, we knew we had to help.

“It’s great to know that we could boost the sterling fundraising efforts of the children at the school and now there is equipment on site that could actually save a life.”

Redrow is no stranger to having defibrillators on site, having installed 110 of them across its own housing developments across the UK, as well as in the company’s divisional offices, giving staff, contractors and the local community access to the equipment in the event of a medical emergency.

The company was presented with the Outstanding Organisation Award at the North West Construction Safety Group (NWCSG) Health and Safety Awards 2016.

Output: Redrow Homes donated the final £400 of a £1,000 fundraising effort by the Young PTA at St Wilfrid’s Catholic Primary School in Hartford to buy a defibrillator. Set up four year's ago, the Young PTA raises funds for various causes, it is made up of children between the ages of five and 11 and a small group of youth leaders aged 11-14. The Oliver King Foundation, was chosen as its cause this year following a visit from the father of 12 year-old Oliver King who died from Sudden Arrhythmic Death Syndrome while taking part in a swimming race.


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Allianz creates UBI drone policy with insurtech start-up Flock
 The first product will be a mobile app for pay-as-you-fly drone insurance.

Allianz Global Corporate & Specialty (AGCS) has teamed up with InsurTech start-up Flock to develop digital insurance solutions for the drone market.

The insurer stated that the partnership’s first product, a mobile app enabling operators to buy pay-as-you-fly drone insurance, would be launched in the UK later this year.

According to a report by AGCS the number of drones, or unmanned aircraft systems (UAS), is set to triple by 2020.

The insurer noted that the increasing number of drones also

Output: Insurer Allianz Global Corporate and Speciality (AGCS) has joined forces with insurtech start-up Flock to offer a digital insurance solution for drones. The insurer will offer a mobile app which allows drone operators to purchase pay-as-you-fly insurance, to launch later in 2017. According to AGCS the number of drones in the air will triple by the year 2020, bringing new risks to be mitigated. The new app will provide simple policies that will suit both commercial and recreational drone operators.


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Eurobank launches Masterpass-integrated mobile wallet
 Source: Mastercard

Eurobank, one of the leading banks in Greece, recently launched a mobile wallet integrating Mastercard’s Masterpass, in an effort to reduce abandonment rates in e-commerce payments.

The Bank has decided to integrate the wallet in its core Banking app (the “Eurobank Mobile App”) in order to capitalize on the existing user base and authentication mechanisms, aiming to provide optimum experiences and increase adoption rates. App users are able to perform their purchases either through the web or in-app, in online shops around the world that co-operate with Masterpass and validate their payments using the same credentials they already use for their core online banking transactions: their fingerprint or strong 4-digit pin ("one pin solution"). This omnichannel experience is further enhanced by the fact that Eurobank Masterpass service automatically hosts all customer Eurobank cards, of any kind and any scheme, as well as the addresses that the user has registered with the Bank. Therefore, online shoppers do not need to register cards or enter shipping or billing addresses while performing their purchases.

Eurobank customers can activate their wallet instantly, either at the Bank's digital channels (e-Banking, Mobile App) or directly on the merchant’s web site. This "digital by default" strategy led to a significant activation rate, where almost 25% of the app's customer base has already activated its wallet during the first month of operation.

According to Mr. Sotiris Sirmakezis, Eurobank's Group Chief Digital & Technology Officer, "to make customers change the way they perform their daily transactions and to foster engagement, we need to design attractive and frictionless experiences, simplifying their everyday lives. Our implementation of Masterpass provides a seamless payment experience to our app users, from any touchpoint they select to make their purchases

The new wallet service of the Bank caters for payments convergence, thus it will soon also include proximity payments through NFC technology, providing the same experience to app users as for e-commerce transactions. Ms. Aspa Palimeri Country Manager for Greece, Cyprus & Malta, Mastercard commented: "Eurobank’s wallet is a best-in class Masterpass implementation, offering to consumers intuitive, high quality and convergent user experience. We are proud for the result of a very productive cooperation between Eurobank, Mastercard and Mastercard Advisors”

Greece is still among the European countries with the lowest adoption rates in digital transactions usage per capita. However, recent government legislations that force merchants to adopt digital means of receiving payments, together with providing incentives to citizens for paying online in their daily transactions, are expected to give boost to digital payments in the country."

Output: Greek bank Eurobank has launched a mobile wallet that uses Mastercard's Masterpass to boost adoption of e-commerce payments. App users can make purchases on global online stores that offer Masterpass payments, either via the web or in-app, validating payments using their four-digit banking pin or their fingerprint. The platform also plans to add proximity payments using near field communication technology.


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Monese partners with PrePay Solutions to boost mobile banking
 Source: Monese

Monese, provider of instant mobile current accounts, has today announced a significant collaboration with PrePay Solutions, Europe’s leading prepaid and digital banking services provider.

Monese has been disrupting the traditional banking scene since its launch in 2015 by enabling customers to open current accounts in two minutes, and providing essential financial services to the estimated 138 million people in Europe that are unbanked and might find it hard to access the more rigid traditional banks.

This partnership will power the launch of Monese’s upgraded mobile-only banking account, equipping users with a contactless Mastercard and, uniquely, full direct debit functionality. The current account service will be accessible in 20 European countries, in eight languages and is the first of its kind to stretch across Europe in this way.

Monese customers will now benefit from a complete suite of banking services. Utilising pioneering onboarding technology, customers can open an account in minutes, and enjoy all the benefits of a local bank account even if they are not a resident in a given country.

Newcomers to a country can start payments and transactions immediately, even without proof of address or credit history.

Ray Brash, CEO of PrePay Solutions, said,

“Monese is one of the UK's pioneering challenger banks, which makes us very proud to announce this collaboration. Together we’ve developed and launched a truly innovative mobile banking solution, tailored to fit the needs of a mobile community.

We are focused on developing new and flexible solutions that enable our clients to appeal to modern customers - with Monese, this means an entirely mobile banking experience. We are confident that the partnership will evolve with the creation of more high quality digital banking products, as we find new ways to cater for the specific needs of varying consumer groups.”

Founder and CEO of Monese, Norris Koppel, said:

“We believe that people should be able to live, travel, and work freely, without the administrative burdens and restraints of legacy banking systems. This upgrade is evidence of how we are able to combine technology and creative thinking to respond to the needs of a mobile user group in an on-demand economy.

PPS really understood our vision and we were impressed by their knowledge and professionalism. Despite our complex list of requirements for this important undertaking, they successfully migrated an existing customer base, to deliver the integrated account on time. This is the start of an exciting collaboration.”

Output: Mobile bank Monese has partnered with digital banking services provider PrePay Solutions (PPS) to launch its upgraded mobile-only banking account. As part of the collaboration, PPS migrated Monese's existing customer base to the digital bank's integrated account. Monese users will receive a contactless Mastercard and full direct direct debit functionality with the account upgrade, even if they are not a resident within a given country.


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Thousands of Ola and Uber drivers sell their cabs in India
 Neha Alawadhi, Durba Ghosh & Priyanka Sahay Moneycontrol News Thousands of financially distressed cab drivers in India registered with taxi aggregators Ola and Uber are listing their vehicles online for sale as trip incentives by companies dry up. Cab owners from Gurgaon to Kolkata, Navi Mumbai to Hyderabad have listed cars with commercial licenses, with prices ranging from as low as Rs 50,000 to about Rs 8.5 lakh for sale, depending on the condition and age of cars. “Gud condition recently changed clutch assembly EMI continue 22 months pending 12,350 per month,” says a listing by a Bangalore based cab owner on Olx. A quick search for “Ola” or “Uber” throws up plenty of listings on the popular listing portal Olx. Unable to make ends meet with the tightening of Ola and Uber’s incentive structure, drivers and taxi operators are looking to sell these cars, and recover whatever money that they can. Many white collar professionals who had used this as an investment route to earn a side income by financing cars and attaching them with Ola and Uber are also feeling the heat. "My cab's owner is unhappy as his income has fallen. I have not taken a salary cut but have to work all 30 days now to make up for the decline," says Dharm, a Delhi-based driver whose cab is attached with Uber. A Bengaluru-based owner of a fleet of six cars, all of which are attached to one of the two cab hailing companies said that some of the drivers he hired for the purpose have quit. "They are not happy. The kind of money that attracted them to this business is no longer there," he said, requesting not to be named. "Getting a driver for Uber, Ola has become a bit difficult now. If that continues, I will have to pull back to offline," he added. Drivers in other cities are also feeling the pain. “It is no longer sustainable,” Thirupati, an Uber driver in Mumbai told Moneycontrol. “The incentives were great in the beginning, but now if I make Rs 100, I have to give them (Uber) Rs 25, the maintenance, upkeep, servicing and fuel cost of the car is separate. We used to lease cabs to two three drivers in the good days, but now it just doesn’t make sense for us so we are selling our vehicles,” he said. Multiple cab owners hardest hit A large part of the cab fleet under Uber and Ola is sourced from the erstwhile local taxi operators, who now directly recruit one or more drivers or offer them a cab on a lease, to attach it to the on-demand cab hailing companies. These fleet owners typically charge a commission or a fixed fee from each driver. Additionally, there are a number of independent drivers also under Uber and Ola, who have bought a car of their own with a commercial licence to cash in on the earning opportunity created by both the companies. In an email response to the question sent by Moneycontrol, Uber said that the listings on OLX were a minuscule part of their fleet in India. “We currently have 2,45,000 active driver partners (who would have taken at least one ride in a week) and are seeing new sign ups every day. We are not seeing any significant churn,” said an Uber spokesperson. An Ola source agrees that with 'rationalization' of incentives between the two competitors, earnings have come down for drivers. "It is unlikely that drivers who ran their own vehicles on our platform would be selling off. Instead, they are either driver association heads or even individuals who were plying multiple vehicles and were then paying salaries to the drivers. Initially, they must be making a good amount of money. But with a rationalisation that has now come down," said a senior Ola executive on the condition of anonymity. However, Moneycontrol also came across cases of individual drivers who have put up their commercial licensed vehicles for sale. For instance, 41-year-old Krishna in Bengaluru has also put up his Indica car up for sale, as his commissions and incentives gradually dwindled. Krishna bought his car on EMI two years ago and attached it to both Uber and Ola. Ola did not respond to an email seeking comment at the time of publishing. Falling incentives continue to haunt drivers Declining incentives and lower earnings have been major issues for drivers affiliated with the cab aggregators since the past few months. Early this year, several drivers with Uber and Ola went on an infinite strike to protest against the steep fall in their earnings. "The incentives initially were very good. I managed to make at least Rs 70,000-80,000 per month. Now I get only about Rs 40,000. It is difficult to manage EMIs, household costs and education of children," said Krishna. He heard a few of his colleagues consider selling their cars online, so he listed his car on OLX, hoping to get rid of monthly instalments and other maintenance costs. OLX did not respond to Moneycontrol’s query on the rise in the number of such listings in the past 12 months in the major Indian cities- Delhi, Mumbai, Bengaluru, Chennai, Hyderabad and Kolkata. According to a report released by research and advisory firm RedSeer Consulting, the cab hailing platforms are struggling with a demand and supply mismatch. The report states that the number of registered cabs registered a decline of 20 percent between January and March, as the driver incentives fell by almost 40 percent. Uber said that “barring a few isolated incidents,” it hasn’t heard from drivers registered on its platform about issues they may be facing with vehicle maintenance costs. Asked about whether Uber helps its drivers for vehicle upkeep, fuel and so on, the spokesperson said: “Given the strong demand from riders, we are seeing sustainable earning opportunities for driver partners and are committed to supporting them. Our idea is to ensure we help driver partners improve their organic earnings as we move forward in our journey from being a startup to a sustainable business." The spokesperson also said that Uber works with lenders as well to find terms most attractive for driver partners.

Output: Many Ola and Uber drivers in India are selling their licensed vehicles online as the ride-hailing companies' tightened incentive structure causes incomes to fall. Global online marketplace OLX is being used to sell the vehicles. White collar professionals who finance cars for use with Ola and Uber are also struggling to recover investments.


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Total looks for capex reduction of 50% for new projects
 In these cost-conscious times, paring down the capital costs of a new deep-water project by 20% is quite a feat.

But Total has a much more ambitious goal in mind — a capex reduction of 50% for new projects.

It will not happen overnight — savings on that scale will require technologies not yet in use, and further refinement of existing practices.

However, there are significant incremental cost reductions that can be achieved now, says Luc Riviere, senior adviser in Total’s Deep Offshore business.

Barring

Output: Energy company Total is aiming to reduce capital expenditure (capex) by 50% for new deep-water oil drilling projects. As part of Total's plan, the company will evaluate how currently used technologies would have reduced capex for previous projects. For example, improved flow modelling demonstrated that it could have saved 4% on its operation off Shetland by forgoing an unnecessary service line, among other measures. Total is publicising the savings it could have made to the rest of the industry to bring down the cost of deep-water projects, said Luc Riviere, a senior adviser at Total's deep offshore business.


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How seniors can avoid the emergency room — and what to do if they end up there
 No one wants to end up in the emergency department of a hospital. While you can’t prevent all accidents and health emergencies, you can improve your odds of avoiding them. Here are some research-based tips for protecting your safety and health as you age:

1) Remember those check-ups: See your doctor regularly and make sure you’re up to date on recommended tests and screenings. Discuss any health issues you’re experiencing, such as vision or hearing difficulties, balance problems, dizziness or feeling faint. Ask your doctor or pharmacist to review medications you’re taking for possible conflicts or side effects.

2) Don’t put off care: If you have unusual symptoms, don’t wait until your annual check-up to consult your doctor. Symptoms such as unexplained weight loss, fever, fatigue, unusual bleeding, skin changes or odd bowel movements can signal disease. Catching and treating the problems early could help prevent life-threatening consequences later.

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3) Check your eyesight: Vision problems can increase your risk of falling. Have your eyesight checked by a professional at least once a year.

4) Go easy on pain medications: Regularly popping prescription or over-the-counter painkillers such as ibuprofen has been tied to an increased risk of heart attack and stroke. Don’t take pain pills unless you have to and, if you do, stick to the lowest dose possible.

5) Keep moving: Exercise is a powerful tool for improving and maintaining health as we age. Walking, dancing, exercise classes and other physical activities can boost cardiovascular health, strength, flexibility and balance, reducing the risk of health problems and falls. Ask your doctor what kind of activity is best for you.

6) Fall-proof your home: Loose rugs, bad lighting and slippery floors or bathtubs at home can all present a fall risk. Remove rugs or fix them to the floor, install bright lights where needed and consider putting up handrails in the bathroom and along stairs. Visit SanDiegoFallPrevention.org for a list of home modification programs for seniors and people with disabilities.

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7) Get enough sleep: Studies show getting less than six hours of sleep a night almost doubles your risk of heart attack and stroke. Try to get between seven and nine hours of sleep per night. Almost half of seniors experience insomnia. You can help improve your sleep by getting regular exercise. And work with your doctor if you have a medical condition that’s disrupting your sleep.

8) Make friends: Loneliness can increase your risk of functional decline and early death, studies show. Keep in touch with friends and family, get to know your neighbors, participate in social activities at your local senior center, attend a class, volunteer or join a club or special-interest group. Even interacting with friends online can help you live longer, according to a UC San Diego study.

9) Adopt a pet: A four-legged friend can help ward off loneliness and keep you physically active. Some studies have found that owning a pet reduces anxiety and lowers blood pressure and heart-disease risk.

10) Eat healthy: Keep a balanced diet made up of nutrient-dense foods such as fruits and vegetables, whole grains, fish and nuts. Limit consumption of sugar, salt and processed food. Healthy eating may reduce the risk of heart disease, stroke, Type 2 diabetes, bone loss and some kinds of cancer.

Of course, staying out of the hospital isn’t always possible. These pointers can help minimize problems during and after you or a loved one visits the hospital or emergency room:

* Bring items you need: Take items such as glasses, hearing aids and dentures. Being able to hear, see and eat properly at the hospital helps reduce the risk of delirium. For comfort, it may help to bring familiar objects from home such as family photos or a favorite blanket or book.

* Know your meds: Doctors need information about all the medications you’re taking — including over-the-counter pills and supplements — to identify possible side effects and avoid prescribing the wrong drugs. It may help to bring your medication bottles with you to the hospital (or get a friend or relative to bring them).

* Have information ready: Create a “medical information sheet” you can take to the hospital. List allergies, known medical conditions, names and phone numbers of your doctors, and your usual pharmacy.

* Say no to sedatives and tranquilizers: It’s common for older people to become confused and delirious in the hospital, which can further damage their health. Sedatives and tranquilizers — even mild ones such as Benadryl — can increase the risk of delirium. Try to find ways to relax without drugs, such as listening to music, drinking a cup of herbal tea or talking with a loved one.

* Bring a loved one: Having a family member with you at the hospital is both comforting and helpful. Your loved one can speak up for you if you’re in need and be there for you if you get confused or require help getting to the bathroom. They can also listen in when the doctor is giving instructions on what to do after you leave the hospital.

* Get some sleep: If you spend a night or more at the hospital, try to maintain your regular sleep schedule. Ask the nurse if you can avoid blood-pressure checks during the night, and don’t take sleeping pills as these increase the risk of delirium. If possible, try to get a room with natural lighting.

* Move around: If you’re staying in the hospital for awhile, get up and move around (if necessary, with the help of a nurse or family member so you don’t fall). Spending too much time in bed can lead to physical decline.

* Create an advanced directive: These legal documents allow you to appoint a representative such as a family member to speak for you if you can’t speak for yourself, and to specify the types of treatments you’re willing to receive or not if you become incapable, such as CPR and mechanical ventilation. Keep in mind that emergency medical personnel cannot honor these requests until they’ve stabilized a person for transfer to the hospital. Advanced directives vary by state. Visit www.caringinfo.org for more information.

* Plan for when you leave: Ask hospital staff if they have special planners available to help you plan your departure from the hospital, including whether they’ll be communicating with your primary care provider about follow-up care. Ask about what medications to take or avoid, and how to get help if you need it after returning home. Ask for this information in writing.

Boyd-Barrett writes for the Center for Health Reporting at USC’s Leonard D. Schaeffer Center for Health Policy & Economics.

RELATED

Output: No one wants to end up in the emergency department of a hospital. While you can’t prevent all accidents and health emergencies, you can improve your odds of avoiding them.


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California Nurse Practitioners Lose Battle For Independent Practice, Again
 About Capitol Desk Capitol Desk delivers the latest in health care policy and politics from Sacramento and around the state. Have an idea? Let us know.

Legislation to allow California’s nurse practitioners more independence in treating patients has fizzled for the year — and it’s not the first time.

A proposed bill to expand the scope of nurse practitioners was scheduled to be heard by an Assembly committee this week, but was pulled by the measure’s author, state Senator Ed Hernandez (D-West Covina), after he determined that it did not have the votes needed to pass.

Expanding the medical role of nurse practitioners has long been opposed by doctors – some say for economic reasons. Proponents of the idea say it can help address the shortage of primary care doctors in the state by making treatment more accessible — and more affordable.

“We have been trying for a really long time … to allow NPs to practice to the fullest extent of their scope and training,” says Donna Emanuele, President for the California Association for Nurse Practitioners.

Use Our Content This story can be republished for free ( details ).

Under current state law, nurse practitioners can independently provide basic primary care, such as assessing a patient’s health status or diagnosing ailments. But they must follow physician-approved guidelines to prescribe medication, order tests or otherwise manage patients.

Nurse practitioners are among the most highly trained nursing professionals and must have at least a master’s degree. Registered nurses, are only required to hold an associate’s degree at minimum, and they don’t diagnose or prescribe on their own.

Nurse practitioners say they provide quality care that’s comparable to that provided by physicians. They want California lawmakers to allow them to practice without the supervision of a doctor.

‘We continue to hit the same road blocks in terms of some turf wars that I think are unnecessary in today’s age, because there are enough patients to go around,” said Emanuele.

The California Medical Association, which lobbies for the state’s physicians, has vehemently opposed allowing the nurses to treat patients without using standardized medical procedures approved by them.

“Team-based care led by a physician is the safest, most cost-effective way to treat patients,” CMA officials said in a press release after the defeat of a 2013 bill to expand nurse practitioners’ scope of practice.

The California Medical Association did not comment for this story but it did provide a copy of the letter it had filed opposing this year’s measure to lift restrictions on the nurse practitioners.

“[The bill] reverses 40 years of policy that has maintained high quality health care for every Californian by allowing lesser trained practitioners to practice medicine without providing adequate patient protections and medical standards,” the letter said.

A 2010 report by the Institute of Medicine recommended that nurses should be allowed to practice at the full scope of their training, and should achieve higher levels of education.

Since 2013, five states have lifted restrictions on nurse practitioners, raising to 21 the number of states that have expanded nurse practitioners’ legal “scope of practice,” according to the National Council on State Legislatures. The District of Columbia has also done so.

“There is yet to be a study that shows, based on these restrictions, there [are] better primary care outcomes, or better safety or better referrals or anything else,” says Joanne Spetz, associate director of research at Healthforce Center at the University of California at San Francisco, and a professor at the University’s School of Nursing.

Spetz co-authored a recent study that suggests state policies allowing independence for nurse practitioners have resulted in a slight drop in the price of services and a minor increase in overall outpatient, physician and pharmacy costs. The uptick in those costs may be due to expanded patient access and an increase in the volume of services provided, the research suggests.

Nurse practitioners are sometimes paid less than physicians for providing the same health care service, Spetz says. Medicare reimburses nurse practitioners at a lower rate than doctors. The economics of more providers offering the same services may be one reason physicians oppose the idea, says Spetz.

“If you have more competition in the market, the prices will drop, and those dropped prices are great for consumers and patients, but…mean someone’s going to lose money. And that may be a doctor,” says Spetz.

The prospect of lower health care costs compelled business groups to support easing restrictions on nurse practitioners.

“Small businesses continue to really struggle with being able to afford health insurance for themselves and their employees,” says David Chase, California Director of the Small Business Majority, a national policy advocacy group for small businesses. “The ACA has taken a lot of steps to control costs, but we think a lot more needs to be done.”

Hernandez, chairman of the Senate Committee on Health who has championed the nurse practitioner bills during the past two legislative sessions, says he will consider next year whether to reintroduce the proposal.

“We are always searching for solutions to the shortage of primary care providers,” he said.

Output: Legislation to allow California’s nurse practitioners more independence in treating patients has fizzled for the year — and it’s not the first time.


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Why Health Care Policy Is So Hard
 “Nobody knew that health care could be so complicated.” President Trump said that in February, yielding more than a few chuckles from pundits and late-night comedians.

In fact, anyone who has spent some time thinking about the issue sees its complexity. With the collapse of the Senate health care bills this week, the president has certainly been reminded of it.

But Mr. Trump’s epiphany raises some questions: Why is health care so complicated? How does it differ from most of the other goods and services that the economy produces? What makes health policy so vexing?

In Econ 101, students learn that market economies allocate scarce resources based on the forces of supply and demand. In most markets, producers decide how much to offer for sale as they try to maximize profit, and consumers decide how much to buy as they try to achieve the best standard of living they can. Prices adjust to bring supply and demand into balance. Things often work out well, with little role left for government. Hence, Adam Smith’s vaunted “invisible hand.”

Output: “Nobody knew that health care could be so complicated.” President Trump said that in February, yielding more than a few chuckles from pundits and late-night comedians. In fact, anyone who has spent some time thinking about the issue sees its complexity. With the collapse of the Senate health care bills this week, the president has certainly been reminded of it.


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How to Repair the Health Law
 Republicans have failed to repeal and replace the Affordable Care Act. Now, can it be repaired?

The seven-year-old law has survived Supreme Court decisions and aggressive attempts to extinguish it by Republicans in Congress and the White House. But even people who rely on its coverage agree that it still has big problems. The question for the roughly 20 million Americans who buy their own health coverage — and for millions of others who remain uninsured — is what can realistically be done to address their main concerns: high prices and lack of choice in many parts of the country.

“Everyone feels really scrunched by the prices we’re paying, and we have no options in Iowa,” said Catalina Ressler, 39, a psychologist outside Des Moines who pays $1,567 in monthly premiums. “Next year is going to be even worse.”

Ms. Ressler’s plan, which covers her family of four, also comes with a $7,000 deductible. Their insurer, Wellmark Blue Cross and Blue Shield, is pulling out of the Affordable Care Act marketplace in Iowa next year, leaving just one company, Medica, to possibly remain.

Citing the protracted uncertainty over the law’s future, many insurers have proposed big rate increases again for next year even though many are no longer incurring big losses in its marketplaces. People covered by one insurer in Maryland could see premiums rise by more than 50 percent if proposed rate increases go into effect, and premiums for plans in Virginia and Connecticut could increase more than 30 percent. In North Carolina, where rates are already among the nation’s highest, Blue Cross and Blue Shield of North Carolina wants an increase of nearly 23 percent but said it would have sought less than half that amount under more predictable circumstances.

Output: Republicans have failed to repeal and replace the Affordable Care Act. Now, can it be repaired? The seven-year-old law has survived Supreme Court decisions and aggressive attempts to extinguish it by Republicans in Congress and the White House. But even people who rely on its coverage agree that it still has big problems.


Instruction: create a high quality summary of the given input

Input:
How the Republican Effort to Repeal Obamacare Came Crashing Down
 At about 1:40 on Friday morning, Mitch McConnell, the Senate Majority Leader, stood behind a lectern in the U.S. Senate, his left hand in his pocket, and said, “So, Mr. President, this is clearly a disappointing moment.” A few minutes earlier, the Senate had narrowly voted down a so-called skinny-repeal bill, which was McConnell’s latest ploy to keep alive the Republican Party’s seven-and-a-half-year effort to dismantle the Affordable Care Act. The bill would have eliminated some parts of Obamacare, including the individual mandate. Perhaps more importantly, its passage would have tossed the ball to a House-Senate conference committee, where a more comprehensive demolition plan could have been worked up.

The historic vote was fifty-one to forty-nine against the bill, with three Republican senators joining the Democrats in opposing it. Two of the G.O.P. dissidents were Maine’s Susan Collins and Alaska’s Lisa Murkowski. Both of them had bravely resisted their party’s previous efforts to pass damaging health-care bills. The other Republican no vote was cast by the cancer-stricken John McCain, of Arizona, who, in an astonishing piece of political drama, helped deliver a monumental blow to his party’s leadership and to President Trump, who once mocked and grievously insulted him.

Shortly before the vote was taken, C-SPAN’s cameras showed McCain engaged in warm conversations with a group of Democrats. He also had some seemingly frostier exchanges with some of his Republican colleagues. At one point, McConnell walked by McCain and the two men appeared to ignore each other. Shortly before the vote, Vice-President Mike Pence—who was in the room to break a tie in case of a fifty-fifty vote—left the chamber. When the roll-call vote was taken and McCain’s name was called out, he gave a thumbs-down sign and said, “No.” Democrats cheered and applauded.

Skinny repeal had been McConnell’s fallback strategy: during the previous couple of weeks, the Senate had already rejected a bill that would have replaced Obamacare and another that would have repealed it without providing any replacement. On Friday morning, the Senate Majority Leader acknowledged that the jig was up. Referring to Democratic efforts to stymie the Republican repeal push, he said, “I regret to say they have succeeded in that effort. So, now I think it is appropriate to ask: What are their ideas? It will be interesting to see what they suggest as the way forward.”

McConnell posed the question more out of pique than because the spirit of coöperation had overcome him. But the fact is, he and other Republicans now have little choice but to engage in some sort of negotiation process with the Democrats. The G.O.P.’s signature policy initiative has collapsed under the weight of its own shortcomings and contradictions.

As McConnell indicated, the Senate Democrats, who stayed united under their leader, Chuck Schumer, deserve some of the credit for instigating this collapse. So do all the activists, protesters, and policy wonks who have spent much of the past six months working to frustrate the Republicans’ heartless and ill-considered designs. Also deserving credit are ordinary Americans, who, as the details of the various Republican proposals became clear, decided in very large numbers that they would be better off sticking with Obamacare, for all its problems.

But above all else, the collapse reflects a failure of the Republican Party and its President. Trump’s rise to power has undermined his party’s internal cohesion. And his ignorance of basic health-care-policy details hampered efforts to win over public support for the repeal effort. The G.O.P. is now a conservative political organization that favors small government and abhors the expansion of the welfare state, yet it has come to rely on the votes of less affluent white voters, many of whom depend on government programs—particularly Medicaid—that would have been slashed under the Party’s repeal plans.

As long as repealing Obamacare was merely a slogan used to rally disaffected voters, the G.O.P. leadership could afford to ignore this tension. But after a President from their own party was unexpectedly voted into the White House, Republicans were forced to put an actual policy proposal on the table. In the end, the tension was too difficult to resolve, even for McConnell, who employed secrecy, subterfuge, and clock-management to try to railroad any bill he could though the Senate. His office didn’t even publish the skinny-repeal bill until 10 P.M. on Thursday, just two hours before the vote was scheduled to take place.

As the senators prepared to cast their votes, most observers assumed that the bill would pass. With just forty-eight votes of their own, the Democrats didn’t have the numbers to stop it. Still, some of them did get the chance to state a few truths. “This is nuclear-grade bonkers, what is going on here tonight,” Chris Murphy, of Connecticut, said during the brief debate. “We are about to reorder one fifth of the American health-care system, and we are going to have two hours to review a bill … that is lighting the American health-care system on fire with intentionality.” “Why is this being run this way?” Schumer asked. "Why is this being done in the dead of night. I can’t believe that my”—Republican—“colleagues are proud of this.” Cory Booker, of New Jersey, said, “This is not what the people want. This is a betrayal of our values. This is a betrayal of our history.”

The Republicans, for their part, appeared barely more enthusiastic about the contents of the bill, which the Party leadership openly presented as a ruse. “We intend to pass a bill and to conference with the House to make the bill better,” John Cornyn, the Majority Whip, said in closing the debate. According to an instant analysis from the Congressional Budget Office, the bill would have increased the number of uninsured by fifteen million over ten years and raised premiums by twenty per cent. “It is not perfect but it is better than the status quo,” Cornyn added.

Earlier in the day, some of Cornyn’s colleagues were highly critical of the proposal they were being asked to support. Four of them—McCain; Lindsey Graham, of South Carolina; Bill Cassidy, of Louisiana; and Ron Johnson, of Wisconsin—held a press conference at which they threatened to vote against the bill unless they received firm assurances that it wouldn’t become law. (Although this press conference took place before McConnell’s office published the bill, the major elements it would contain were already known.) “The skinny bill as policy is a disaster,” Graham said. “It is not a replacement in and of itself.”

A few hours later, Paul Ryan, the Speaker of the House, issued a statement in which he confirmed that he was willing to set up a House-Senate conference committee to hash out a broader bill, which would then be sent back to the Senate. This satisfied three of the Republican doubters, who indicated that they would support McConnell’s measure. Shortly before 9 P.M., however, McCain said that Ryan’s statement was “not sufficient,” thus raising the possibility that he would join with Collins and Murkowski to defeat the bill.

On Tuesday, McCain had returned to the Senate for the first time since being diagnosed with brain cancer, and he’d delivered a speech upbraiding his colleagues for acting out of partisanship. He called for a return to “regular order” and for coöperation with the other party. Yet despite the laudable rhetoric of this speech, McCain voted for a procedural motion that allowed McConnell to bring various Obamacare-repeal measures to a vote. Later in the week, he also voted for McConnell’s repeal-and-replace bill, which was drawn up in secrecy with very little consultation.

On Thursday, even after McCain said that he wasn’t satisfied with Ryan’s assurances, many observers assumed it was another head fake—that he would ultimately align himself with his party’s leadership. As he made his way toward the Senate chamber, a reporter asked him which way he would cast his vote. “Wait for the show,” he replied. It turned out to be worth waiting up for.

“I thought it was the right thing to do,” he told reporters as he left after the vote. A bit later, in a statement, he said, “We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of the aisle, heed the recommendations of the nation’s governors, and produce a bill that finally delivers affordable health care for the American people.”

To be sure, McCain’s statement didn’t address the many complexities of achieving the goal that he laid out. But it was his vote that mattered, not his words. Together with the votes cast by Collins and Murkowski—not to mention every Democrat in the Senate—it has hopefully killed the Republican Party’s misguided effort to destroy the A.C.A. and turn back history.

Output: At about 1:40 on Friday morning, Mitch McConnell, the Senate Majority Leader, stood behind a lectern in the U.S. Senate, his left hand in his pocket, and said, “So, Mr. President, this is clearly a disappointing moment.” A few minutes earlier, the Senate had narrowly voted down a so-called skinny-repeal bill, which was McConnell’s latest ploy to keep alive the Republican Party’s seven-and-a-half-year effort to dismantle the Affordable Care Act.


Instruction: create a high quality summary of the given input

Input:
Reduction in dental care and inferior oral health subsequent to dementia diagnosis
 Subsequent to a diagnosis of dementia, the patient's contact with the dental care services diminishes and oral health is impaired. This has been revealed by a major register-based study from Karolinska Institutet published in the scientific journal Alzheimer's & Dementia.

Researchers at Karolinska Institutet, using register data, have examined utilisation of dental health services and oral health among a large number of individuals before and after a dementia diagnosis. Information on diagnoses and cognitive function has been compiled for around 58,000 persons registered in the Swedish Dementia Registry, SveDem, from 2007 to 2015. Information relating to dental health was obtained from Tandhälsoregistret (dental health registry).

"We observed that the number of visits to dentists saw a dramatic decrease after a dementia diagnosis and that the reduction in utilisation of dental health services was more predominant with patients who experienced a more rapid degeneration in cognitive function," explains Maria Eriksdotter, Professor of Geriatrics at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.

A low MMSE score (Mini-Mental State Examination) – a method used to indicate cognitive impairment – represented a risk factor in terms of losing teeth. Poor oral health, tooth decay and loosening of teeth may cause pain, reduced quality of life and difficulties eating, resulting in poor nutrition.

"It may be the case that patients forget to visit the dentist or put other types of health care first, as dental care is separate from other medical services. We require better organisation to detect these patients and ensure that they attend their dental health check-ups," says Gunilla Sandborgh Englund, Professor at the Department of Dental Medicine, Karolinska Institutet.

More information: Seyed-Mohammad Fereshtehnejad et al. Dental care utilization in patients with different types of dementia: A longitudinal nationwide study of 58,037 individuals, Alzheimer's & Dementia (2017). DOI: 10.1016/j.jalz.2017.05.004

Output: Subsequent to a diagnosis of dementia, the patient's contact with the dental care services diminishes and oral health is impaired. This has been revealed by a major register-based study from Karolinska Institutet published in the scientific journal Alzheimer's & Dementia.


Instruction: create a high quality summary of the given input

Input:
How Technology Is Changing Nursing: The Impact of Telehealth
 How Technology Is Changing Nursing

Within the past decade, many advances in technology have been made available to help nurses and clinicians perform their jobs and care for patients more efficiently and safely. Consequently, nursing today isn't the same as it was 30 years ago. From such inventions as tablet computers and mobile electronic charts, to radio-frequency identification (RFID)-enabled devices, the healthcare landscape is becoming more advanced and efficient, and the field of nursing has adapted along with these advances.

Naturally, many of these technologies did and still do require education, training, and a period of adoption for nurses to fully embrace them; implementation doesn't simply happen overnight. Evolving care delivery processes in such areas of the hospital as intensive care units (ICUs), emergency/trauma treatment, and recovery rooms have created a need for nurses with advanced clinical skills and technical savvy. Today, nurses are adapting along with the industry to take advantage of new career opportunities and expand their roles across the care continuum.

Nurses and Telehealth: An Ideal Match

As a relatively new healthcare delivery approach, telehealth is transforming how nurses approach and deliver care. Telehealth is currently on the rise, and experts predict that the industry could become a $34 billion market by the end of this decade. Telehealth comes in many flavors, from monitoring patients with chronic conditions through video chat, to providing critical care to patients in remote areas. For example, some healthcare systems have created an eHospital care delivery model in which a small team of nurses and intensivists can remotely monitor and support patient care for more than 100 beds in multiple ICUs. The remote team is stationed around the clock in a "bunker," from which they serve as the clinical resource for smaller hospitals. Moreover, with cameras in all rooms, the remote team can view and interact with patients and their nurses in this version of telehealth.

While this is a common application of telehealth, the care delivery approach can also be as simple as a health system leveraging a mobile application that allows clinicians to collaborate remotely. Increasingly, the objective of telehealth is efficiency, with asynchronous workflows that are highly mobile as opposed to the traditional real-time, provider-to-patient encounter that relies on video or voice technology. In an asynchronous situation, nurses can use telehealth to communicate directly (although not simultaneously) with remote physicians for questions or consultations. This improves the quality and efficiency of patient care in an increasingly dynamic healthcare environment.

The Power of Telehealth

At a time when the aging population is increasing and chronic conditions are becoming more prevalent, the cost of care is also rising. Now more than ever, the healthcare industry needs to prioritize its activities using more cost-effective care delivery processes to streamline clinical workflows and improve patient outcomes. In addition to reducing costs, telehealth and remote monitoring will effectively extend nursing care to a larger and more diverse patient population, which is especially important for areas where clinical resources are limited. This ability to fill in gaps and provide direct care regardless of location means that telehealth can greatly benefit nurses, patients, and health systems.

In rural areas, hospitals face two types of challenges at both the patient and caregiver levels. Nurses and clinicians in remote areas may be responsible for delivering general care to patients, while specialists are centralized in the nearest urban setting. Telehealth offers an alternative means of providing the best care possible should these nurses find themselves in situations in which they need a specialist's assistance to assess and treat certain patients. For example, a pregnant woman might live more than an hour's drive away from the obstetrician managing her high-risk pregnancy. Through leveraging telehealth, she can be monitored remotely from home with self-administered non-stress tests, obviating the need to travel hours to reach a clinic. This can reduce the unnecessary transporting of patients, an undertaking that can worsen their conditions and increase costs.

Telehealth: An Enabler

Telehealth technology is only an enabler. To be successful, telehealth must fit into nurses' workflows. While some nurses may prefer to care for patients at the bedside or lack confidence in describing patient conditions to doctors over the phone, the reality is that technology is becoming embedded into everyday life, including the workplace, because it has a uniquely positive influence on the way nursing is practiced. However, as with any medical technology, telehealth tools need to meet the high standards that nurses require to protect and care for their patients.

First and foremost, telehealth must meet HIPAA standards for privacy, security, and auditing. Nurses deal with private patient data that cannot be at risk of getting lost or sent to the wrong person. The consequences of such an error are costly and potentially painful for patients.

The second requirement is for nurses to have the proper training and resources to confidently use these tools. Because nurses spend their days multitasking to address the needs of multiple patients, new tools—no matter how well intentioned—need to fit seamlessly into the workflow. Everything must work. Proper training upfront and the availability of resources to troubleshoot problems are critical components of successful telehealth adoption and, subsequently, improved patient care. Also, protocols and standards of practice must be established to define nursing roles and expectations in various telehealth settings.

Adapting to the Workflow

Telehealth and smart devices are challenging nurses to adopt technology that will sharpen their ability to care for multiple patients. By checking an app, a nurse may be able to determine that the alarm going off in another room is actually a false alarm and that there is no need to rush from the bedside of one patient to assess another. Or perhaps, in the middle of the night, a patient in a community hospital requires urgent care that isn't available from an in-house specialist. Instead of rousing the on-call clinician or making a best judgment, telehealth provides access to a specialist who can give advice after reviewing the patient's chart and near-real-time data.

Certain telehealth applications, such as mobile devices that foster clinician communication, can be directly embedded into any nurse's daily workflow. Laws, regulations, and policies that govern the use of other types of telehealth can differ from state to state and faculty to facility.

No certification for telehealth nursing is yet available, but the American Academy of Ambulatory Care Nursing (AAACN) recognizes telehealth as a subspecialty with defined competencies for various care delivery models. Regardless of the type of technology, as leaders in healthcare, nurses will be expected to master the latest technology and information systems designed to improve care and patient outcomes, presenting a real opportunity to benefit patients and the nurses who care for them.

Output: Within the past decade, many advances in technology have been made available to help nurses and clinicians perform their jobs and care for patients more efficiently and safely. Consequently, nursing today isn't the same as it was 30 years ago.


Instruction: create a high quality summary of the given input

Input:
Calls for Court Reform as Legal Guardians Abuse Older Adults
 Terri Black had always planned to care for her widowed father in her home if he ever became too frail to care for himself. In June 2013, Mrs. Black, an only child, decided it was time: Her father’s longtime companion in Las Vegas had informed her that she could no longer handle his dementia, diabetes and other health issues, and asked the daughter to take him.

Not long before, Mrs. Black discovered that the companion, Helen Natko, had transferred $200,000 from her father’s bank account — a move that would eventually end in a criminal conviction.

But when Mrs. Black and her husband, Richard, flew to Las Vegas to take her father, Delford Mencarelli, to their home in Cornelius, N.C., Ms. Natko refused to let them in the house, according to an account Mrs. Black filed with the Clark County District Court, in Nevada. The Blacks called the Las Vegas police, and the officers who showed up told Mrs. Black that her only recourse was obtaining legal guardianship.

And thus began a harrowing two-year odyssey in the guardianship system. Soon after Mrs. Black filed a court petition, Ms. Natko countered with her own petition. A judge ordered a trial and appointed a temporary professional guardian. Mr. Mencarelli continued to live with Ms. Natko.

Output: Terri Black had always planned to care for her widowed father in her home if he ever became too frail to care for himself. In June 2013, Mrs. Black, an only child, decided it was time: Her father’s longtime companion in Las Vegas had informed her that she could no longer handle his dementia, diabetes and other health issues, and asked the daughter to take him.