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Disney acquires BAMTech, aims to launch sports streaming in 2018
 The Walt Disney Company announced today that it has agreed to acquire majority ownership of BAMTech, LLC and will launch its ESPN-branded multi-sport video streaming service in early 2018, followed by a new Disney-branded direct-to-consumer streaming service in 2019.

Under terms of the transaction, Disney will pay $1.58 billion to acquire an additional 42% stake in BAMTech—a global leader in direct-to-consumer streaming technology and marketing services, data analytics, and commerce management—from MLBAM, the interactive media and Internet company of Major League Baseball. Disney previously acquired a 33% stake in BAMTech under an agreement that included an option to acquire a majority stake over several years, and today’s announcement marks an acceleration of that timetable for controlling ownership.

“The media landscape is increasingly defined by direct relationships between content creators and consumers, and our control of BAMTech’s full array of innovative technology will give us the power to forge those connections, along with the flexibility to quickly adapt to shifts in the market,” said Robert A. Iger, Chairman and Chief Executive Officer, The Walt Disney Company. “This acquisition and the launch of our direct-to-consumer services mark an entirely new growth strategy for the Company, one that takes advantage of the incredible opportunity that changing technology provides us to leverage the strength of our great brands.”

The ESPN-branded multi-sport service will offer a robust array of sports programming, featuring approximately 10,000 live regional, national, and international games and events a year, including Major League Baseball, National Hockey League, Major League Soccer, Grand Slam tennis, and college sports. Individual sport packages will also be available for purchase, including MLB.TV, NHL.TV and MLS Live.

The new service will be accessed through an enhanced version of the current ESPN app. In addition to the multi-sport service, the ESPN app will include the news, highlights, and scores that fans enjoy today. Consumers who are pay TV subscribers will also be able to access the ESPN television networks in the same app on an authenticated basis. For many sports fans, this app will become the premier digital destination for all their sports content.

The new Disney-branded service will become the exclusive home in the U.S. for subscription-video-on-demand viewing of the newest live action and animated movies from Disney and Pixar, beginning with the 2019 theatrical slate, which includes Toy Story 4, the sequel to Frozen, and The Lion King from Disney live-action, along with other highly anticipated movies. Disney will also make a significant investment in an annual slate of original movies, TV shows, short-form content and other Disney-branded exclusives for the service. Additionally, the service will feature a vast collection of library content, including Disney and Pixar movies and Disney Channel, Disney Junior and Disney XD television programming.

With this strategic shift, Disney will end its distribution agreement with Netflix for subscription streaming of new releases, beginning with the 2019 calendar year theatrical slate.

Plans are for the Disney and ESPN streaming services to be available for purchase directly from Disney and ESPN, in app stores, and from authorized MVPDs.

“We’re very proud of the content distribution innovations driven by MLBAM and BAMTech over the past 15 years,” said Commissioner of Baseball Robert D. Manfred, Jr. “Major League Baseball will continue to work with Disney and ESPN to further grow BAMTech as it breaks new ground in technologies for consumers to access entertainment and sports programming.”

“This is an exciting validation of our team, its achievements and the customer-centric platform it’s built,” said Michael Paull, Chief Executive Officer of BAMTech. “Yet, we’ve merely scratched the surface of what can be accomplished in a future where we combine Disney and ESPN’s world-class IP and our proprietary direct-to-consumer ecosystem.”

The BAMTech transaction is subject to regulatory approval, and upon closing, Mr. Iger will serve as Chairman of the BAMTech Board. MLBAM and NHL will continue as minority stakeholders in BAMTech, with seats on the Board. Mr. Paull will report to Kevin A. Mayer, Senior Executive Vice President and Chief Strategy Officer, The Walt Disney Company. John Skipper, ESPN President and Co-Chairman, Disney Media Networks, will manage the new ESPN-branded service.

The BAMTech transaction is expected to be modestly dilutive to Disney’s earnings per share for two years. Additional dilution as the Company implements its direct-to-consumer strategy will be dependent on the Company’s licensing approach and the level of investment in original programming.

Output: The Walt Disney Company is buying a majority stake of BAMTech, a direct-to-consumer streaming tech firm. In 2018, Disney plans to offer a video streaming service for sports under the ESPN brand. The company will also premiere a streaming platform in 2019, featuring its most popular animated films. Having already purchased a 33% stake in BAMTech, Disney only has to buy a 42% stake to take control of the firm. The deal will cost Disney $1.58bn.


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Pizza Hut focusing on digital delivery tech
 Ordering pizza doesn’t mean calling Pizza Hut anymore. You can go to the company’s website or download an app, then track your delivery. You can speak your order to Amazon Echo by saying, “Alexa, ask Pizza Hut for a pizza.” You’ll soon able to do the same on Google Home.

The Yum! Brands-owned pizza chain with 13,000 restaurants in 130 countries has been playing tech catch-up at a time when its competitors like Domino’s consider themselves more like e-commerce companies than fast-food chains.

“We are always a pizza company, but we view tech as a way to help customers get better pizza,” said Chris Dargis, chief e-commerce officer for Pizza Hut U.S. “Pizza Hut understands that digital, especially mobile, is where consumers are, and we want to step up the game around that.”

Dargis has hired web developers, engineers, user experience designers and product managers. Today, tech is Pizza Hut’s biggest department, with more than 200 full-time employees, roughly double its size in November.

This week, Pizza Hut introduced its first U.S. loyalty program that rewards online customers with points for every dollar spent on food. This May, the company developed a pizza-delivery tracker that automatically sends consumers texts when their orders are received, their pizzas are being made and their orders are on their way. In April, Pizza Hut made its pizza builder — a desktop and mobile tool that lets you customize pies by size, sauce, cheese and toppings — faster and more intuitive. In December, Pizza Hut also made it possible for people to order on Amazon’s home device Echo.

Lisa White, associate editor for Restaurant Business, said fast-food takeout and delivery has grown sharply in the past three years, especially among younger people. Domino’s was early in bringing technology to ordering, and Pizza Hut is moving fast to give consumers multiple ways to place orders, she said.

“Pizza Hut is offering not only customization with their food, but customization in how you order it, whether it be through Facebook, a mobile app or tracking your order online,” said White.

These digital efforts come as Pizza Hut’s business is struggling. In the first two quarters of this year, Yum! Brands reported same-store sales losses for Pizza Hut while its two other restaurant brands, Taco Bell and KFC, grew. David Gibbs, president and CFO for Yum! Brands, said in an earnings call in May that the company would spend around $130 million in 2018 on the chain’s equipment, delivery technology, e-commerce and advertising.

Pizza Hut spent around $237 million on paid media last year, compared to $201 million in 2015, according to Kantar Media, and Yum! Brands said it would increase Pizza Hut’s media spend by $25 million for the rest of this year and $12.5 million for 2018, Gibbs said in the earnings call last month.

To transform its business, the Plano, Texas-based Pizza Hut must compete with other tech firms, financial institutions and local startups for talent. Dargis said the company has a strong work culture and growth potential in its favor.

“When it comes to digital, the pizza category that requires quick delivery outpaces other categories,” he said. “So if you want to work for a consumer brand, pizza is a great vertical.”

Output: Pizza Hut is turning to technology to help stop a sales decline. The pizza chain has recruited developers, UI designers and engineers to work on its digital platform, doubling the size of its tech department in under a year. Recently, Pizza Hut has launched an online loyalty programme, rolled out delivery trackers for customers, streamlined its pizza builder web tool and enabled users of Amazon Echo devices to place orders with them. "Pizza Hut is offering not only customisation with their food, but customisation in how you order it", said Lisa White, associate editor for Restaurant Business.


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Imaging technique produces 3D scans of live embryos
 When imaging histology samples using a microscope at high resolution, 3D scans are often acquired by shining a flat beam of light through the target volume. While this has allowed for a multitude of discoveries, the technique still suffers greatly from the light scattering through the sample and washing out the sharpness of the image. This is most noticeable in thicker specimens that require light to travel through a lot of material. Tagging markers can be used to overcome some of this fuzziness, but they are often incompatible with the future viability of a living sample. Now researchers at the University of Illinois have developed a new imaging technique that significantly improves the quality of such microscopy images by controlling and taking into account the scattering of the light.

Dubbed as gradient light interference microscopy (GLIM), the technology modulates the depth of the sample through which the light beam is allowed to penetrate through. Light is passed through at different intensities, effectively lighting up different volumes of the sample. The sample is also rotated to allow the scanning system to image it from different angles. All this data is then compiled and a 3D rendering is generated by a computer.

To wow the world with the new capability, the Illinois researchers were able to peer into a live embryo of a cow at high resolution and without harming the organism.

A bit about the technology according to a study abstract in Nature Communications:

GLIM exploits a special case of low-coherence interferometry to extract phase information from the specimen, which in turn can be used to measure cell mass, volume, surface area, and their evolutions in time. Because it combines multiple intensity images that correspond to controlled phase shifts between two interfering waves, gradient light interference microscopy is capable of suppressing the incoherent background due to multiple scattering.

Study in Nature Communications: Gradient light interference microscopy for 3D imaging of unlabeled specimens…

Via: University of Illinois…

Output: Researchers at the University of Illinois have developed a method to improve the quality of microscopy images by allowing for the scattering of light, and tested it by scanning a live embryo, according to Nature Communications. Using gradient light interference microscopy (GLIM), the team was able to suppress light scattering by passing it through a sample at different intensities, before using the data to build up a 3D image. The researchers demonstrated GLIM's abilities by examining a cow foetus at high resolution, without harming the animal in any way.


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Great British Chefs uses research to lift branded content sales
 The branded-content supply has become crowded. So U.K. foodie site Great British Chefs is trying to stand out by offering in-depth audience research.

The site, featuring articles and recipes by its editorial staff and network of Michelin-star chefs, has always hosted some form of branded content since its launch in 2010. It boasts an above-average 80 percent renewal rate for campaigns with brands, which typically last about 12 months with seasonal peaks. According to branded-content platform Polar, the majority of publishers see renewal rates between 25 and 50 percent.

Great British Chefs started taking consumer research more seriously 12 months ago after a number of ad campaigns revealed a disconnect between what brands thought they knew about their audience and audience behavior.

The publisher regularly surveys its readers on their food-buying and cooking habits and compares them to the rest of the country with third-party research. For starters, the research found that while 15.5 percent of the U.K. classifies themselves as committed foodies, fully 59 percent of the publisher’s audience falls into this category. With key advertisers, Great British Chefs tracks specific aspects of its audience more regularly and maps this onto a national picture.

Great British Chefs’ branded-content sales have increased more than 35 percent this year, largely thanks to this research. The publisher said this research helped it win a £200,000 ($260,000) campaign last year, its biggest to date. It expects to make £2 million ($2.6 million) in 2017, about three-quarters of it coming from branded-content deals.

“We start with deep insight into a segment of U.K. consumers, help brands understand which area is most relevant, what content consumers are looking for, then design the content to trigger the right engagement for audiences,” said Ollie Lloyd, Great British Chefs founder and former Unilever brand marketer.

For pasta brand Barilla, Great British Chefs surveyed readers on the ingredients in their cupboards and how often they cook with them. The publisher then came up with easy weekday pasta recipes, articles and how-to videos about cooking with rarely used ingredients, like rabbit. Ad placements also supplemented the campaign.

Ten months after working with Barilla, which re-entered the U.K. market last year, Great British Chefs found 11 percent of its audience buys the brand regularly, compared to 4 percent at the national level.

“For publishers who want deep strategic partnerships with brands, the ambition cannot just be click-through rates,” said Lloyd. “If you claim to own an audience, you need show movement, whether that’s purchase, equity or awareness.”

Great British Chefs joins other publishers that have formalized their audience research work, like Vice and Quartz.

“It opens up deals, then secures the right conversation. It builds loyalty and helps us secure renewals,” said Lloyd.

Image courtesy of Great British Chefs via Facebook

Output: Food site Great British Chefs has increased branded content sales by more than 35% this year after using research to develop a deeper understanding of its audience. The company regularly surveys its readers, enabling brands such as Barilla to sell its products to 11% of the Great British Chefs audience, compared with 4% nationally. "We start with deep insight into a segment of UK consumers, help brands understand which area is most relevant, then design the content to trigger the right engagement for audiences,” said Ollie Lloyd, the site's founder and a former Unilever brand marketer.


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European ad industry to create viewability standard
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The vexed question of who, if anyone, sees online ads has maybe moved on a bit. The European Viewability Steering Group (EVSG), a cross-industry body originally formed towards the end of 2015 by the Interactive Advertising Bureau Europe (IAB Europe), the European Association of Communications Agencies (EACA) and the World Federation of Advertisers (WFA), has announced the launch of a supposedly comprehensive European Viewability Certification Framework.

This includes the publication of the first set of European Viewability Measurement Principles and will soon be followed by the launch of a Request for Proposals (RFP) process to identify suitable auditors across the region. Which is a nice job for someone.

The Measurement Principles have been created to help reduce discrepancies in the data provided by different viewability measurement tools.

Its definition of a viewable impression is:

A served ad impression can be classified as a viewable impression if the ad was contained in the viewable space of the browser window, on an infocus browser tab, based on pre-established criteria such as the percent of ad pixels within the viewable space and the length of time the ad is in the viewable space of the browser. It is recognised that an ‘opportunity to see’ the ad exists with a viewable ad impression, which may or may not be the case with a served ad impression.

Screen Media Daily

Clear so far? Maybe. You’ll note there’s no mention of the minimum time spent viewing the ad, not yet anyway. And, rather crucially, this only pertains to desktops although a version for mobiles is promised later in the year.

EACA Media Agencies Council chair Jon Chase says: “EACA are committed to helping shape and implement the drive towards improved viewability measurement standards across Europe and beyond. The ultimate objective being to establish a fully viewable digital ad environment. Whilst other challenges in the digital advertising ecosystem also require increased focus, reducing data discrepancies between the different viewability tools is a crucial step towards enhanced accountability and trust in digital media metrics.”

IAB Europe’s Alison Fennah says: “With digital ad spend surpassing €40bn it’s ever more critical to reinforce the quality of the digital advertising environment to underpin the delivery of free content. Ensuring that viewable impressions are measured correctly and consistently is a key first step. This initiative is designed to enable Europe’s varied markets to collaborate and create regional standards and deliver local growth.”

WFA global head of marketing services Rob Dreblow says: “Whilst advertisers investing online often work with their own definitions of a viewable impression, it is critical to have a baseline of quality in terms of how to measure a genuine opportunity to see. Building on the excellent work in the US and UK, we hope this initiative will serve to help markets around the world reduce discrepancies and improve the quality of viewability measurement as this project develops into global guidance.”

Let’s hope so. €40bn is an awful lot of money to disappear (possibly) down an online drain. Online advertising has helped to build some of the world’s biggest companies – Facebook and google for example – and it’s beyond odd that nobody (apart from them) seems to know what they’re selling.

Output: The European Viewability Steering Group, an organisation for the regulation of advertising viewability, has launched the European Viewability Certification Framework, and a first set of measurement principles. It states a viewable impression is an "ad contained in the viewable space of the browser window, on an in-focus browser tab, based on pre-established criteria such as the percent of ad pixels within the viewable space and the length of time the ad is in the viewable space of the browser". However, it does not specify length of time viewed, and only applies to desktops.


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ThirdEye unveils AR smartglasses for education
 Augmented Reality

ThirdEye Debuts 3-Screen AR System for Education

Education will shortly have a new option in the augmented reality (AR) segment. A company that has built its reputation in the defense industry is releasing a bundle that includes AR smartglasses and an app that allows for remote instruction. ThirdEye's X1 "smartglass" is a headset that allows the wearer to experience a 1,280 x 720 pixel binocular display that is equivalent to viewing a 90-inch screen at 10 feet.

Coupled with the company's enterprise application, users can receive instruction through a three-screen view. When wearers look straight ahead, the view is clear; they see what's in front of them. With a turn to the left, wearers view a video screen allowing them to communicate with and view a remote person. With a turn to the right, users see "data" screens, displaying instruction. For example, if somebody is repairing a piece of equipment, he or she can share the view with a remote person, communicate with that individual and then view a diagram with the part circled that needs to be dealt with next in the process.

In the case of education, ThirdEye suggested that the glasses can be programmed to guide a student across campus, to help identify components in a textbook illustration or to instruct virtual operations such as medical procedures. Currently, the company is developing custom education AR content — including 3D AR renderings of course curriculum and interactive campus tours where AR information is overlaid onto the user's point of view.

Currently, the company is taking pre-order contact information. The shipping date and pricing haven't been announced.

Output: Tech firm ThirdEye has developed augmented reality glasses which could be used in education. The X1 offers unimpaired vision when the wearer looks straight ahead, but turning the head allows video communications or access to data. ThirdEye suggested the glasses could be programmed to instruct virtual surgical procedures or enable a student to navigate a campus. No release dates or pricing details for the X1 have been announced.


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AI developed to spot and track student plagiarism
 A few years back, Harry Potter author J.K. Rowling penned a detective novel titled The Cuckoo’s Calling under the pen name Robert Galbraith, choosing to conceal her own identity. When people started to notice a couple of stylistic similarities between the “two” authors, experts were called in to investigate — in the form of some smart AI software. Its conclusion? That Rowling was indeed Galbraith, and the author of the book in question. She subsequently revealed her ploy online.

Jump forward to 2017, and a publicly available AI application called Emma Identity promises to do the same thing for whoever needs it. It’s the world’s first web application capable of determining the authorship of a particular text based on a person’s writing style.

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“To run the check, one needs to upload a text of at least 5,000 words by one author,” CEO Aleksandr Marchenko told Digital Trends. “Then Emma analyzes and learns the author’s writing style, and can determine whether all the subsequent texts you upload belong to the same author. The technology will render its verdict in the form of a percentage.”

Marchenko explained that the technology combines natural language processing (NLP) and machine learning with the techniques of stylometry, a study of linguistic style rooted in the 15th century. He claims that the result is an AI that’s capable of exhibiting 85 percent accuracy in correctly determining an author.

“More than 50 mathematical parameters stand behind every author’s writing identity,” he continued. “So the issue is of a striking complexity: it’s extremely difficult to define and assess style features of a vexing number of authors, and to implement the extracted knowledge into an NLP technology. Our team of researchers, scientists and engineers have set out to create an algorithm that could surmount that challenge and develop such a technology that could operate on minimal sets of texts and reach an accuracy level worthy of a successful commercial product.”

While you may simply want to upload some sample texts for fun, Marchenko thinks that the real benefit of Emma Identity will be as an anti-plagiarism tool for use in schools, colleges, and universities. It could also be useful in fields like publishing and as a tool for law enforcement. Historians and literature researchers could also benefit from it.

Well, we guess “plagiarist” is yet another job to suffer in the face of the AI takeover! Is nothing sacred?

Editors' Recommendations

Output: Artificial intelligence application Emma Identity can identify authorship of a text from a sample of 5,000 words by combining natural language processing, machine learning, and stylometry. The tool analyses a series of mathematical parameters that underlie an author's particular writing style to determine their identity with 85% accuracy, said Emma CEO Aleksandr Marchenko. Schools, colleges, and universities will be able to use Emma Identity as an anti-plagiarism tool, Marchenko said. The publishing, law enforcement, and research sectors could also benefit.


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Orlando commits to fully renewable power by 2050
 US city Orlando has approved on Tuesday the new target of reaching 100 per cent clean and renewable energy by 2050.

US city Orlando has approved on Tuesday the new target of reaching 100 per cent clean and renewable energy by 2050.

Orlando is 40th US city to make the commitment, and the largest city in Florida to join the movement.

Carol Davis, Co-President of the League of Women Voters of Orange County (LWVOC) – which leads the First 50 Coalition – said: “Today, Orlando takes its place on the regional, state and national stage as a forward-thinking city committed to a healthier, sustainable future. This is a first, important step, and we plan to continue to support and encourage the city to follow with concrete measures that solidify this commitment.”

Buddy Dyer, Mayor of Orlando, had already signed the Mayors National Climate Action Agenda a few months ago, and has been involved in various green energy initiatives, including the Sierra Club’s Mayors for 100% Clean Energy campaign.

Beverlye Colson Neal, President of the NAACP’s local branch – a key member of the First 50 Coalition – said: “We stand in support with the Orlando city commission in realizing the importance of renewable energy to it residents by taking the necessary actions to begin the transformation. We look forward to working with the city to educate the residents of the importance and advantages of renewable energy as we move into the future.”

Phil Compton, Senior Organizing Representative with the Sierra Club’s Ready for 100 Campaign in Florida, and a member of the First 50 Coalition, also said: “All across our state and our nation, cities are committing to a future powered by 100 percent clean and renewable energy for all. Today, Orlando joins this growing movement of cities that are ready for 100 percent clean, renewable energy.

It is hoped that Orlando’s commitment will encourage other cities to do the same.

Output: Orlando, Florida's largest city, has announced its goal of using 100% renewable, clean energy before 2050. The decision makes Orlando the 40th city in the US to commit to the target. "This is a first, important step, and we plan to continue to support and encourage the city to follow with concrete measures that solidify this commitment”, said Carol Davis, Co-President of the League of Women Voters of Orange County.


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Intel to construct and test over 100 autonomous vehicles
 Intel isn't wasting any time now that it officially owns Mobileye. The Mobileye team has unveiled plans to build a fleet of 100 or more self-driving vehicles to conduct tests in both its native Israel as well as the US and Europe. They'll meld Mobileye's sensor, mapping and driving technology with Intel's computing platforms, data center tech and 5G wireless to make Level 4 autonomous cars (they can do all the driving themselves but may ask for intervention) that talk to the cloud. They won't be tied to any one brand -- sorry, BMW. As Intel explains, it's as much about selling the concept as actual experimentation.

The fleet will show would-be customers how self-driving cars behave in real-world circumstances, including mapping and safety features, and will give Intel a better way to talk to regulators. Intel wants to prove that its self-driving tech can work around the world, and that it can tweak its formula to suit what companies want

It'll take a while before you see the fruits of this effort. The first vehicles don't deploy until later in 2017, and the magic 100 mark is coming "eventually." And of course, any customers sold on the tech will take a while after that to make use of it. Still, it's an important step toward a widely available platform for self-driving cars.

Output: Following its acquisition of Israeli sensor company Mobileye, Intel intends to roll out over 100 fully autonomous test vehicles by the end of 2017. The company aims to use the vehicles to attract would-be customers to self-driving cars, by demonstrating the full capabilities of both their computer systems and Mobileye's advanced self-driving technology. The fleet will not be tied to any specific brands, instead including a variety to showcase the dexterity and flexibility of Intel's platform.


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Hospitals Slashed Use Of Two Heart Drugs After Huge Price Hikes
 Even before media reports and a congressional hearing vilified Valeant Pharmaceuticals International for raising prices on a pair of lifesaving heart drugs, Dr. Umesh Khot knew something was very wrong.

Khot is a cardiologist at the Cleveland Clinic, which prides itself on outstanding heart care. The health system’s pharmacists had alerted doctors about the skyrocketing cost of the drugs, nitroprusside and isoproterenol. But these two older drugs, frequently used in emergency and intensive care situations, have no direct alternatives.

“If we are having concerns, what is happening nationally?” Khot wondered.

As it turned out, a lot was happening.

Following major price increases, use of the two cardiac medicines has dramatically decreased at 47 hospitals, according to a research letter Khot and two others published Wednesday in the New England Journal of Medicine.

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

The number of patients getting nitroprusside, which is given intravenously when a patient’s blood pressure is dangerously high, decreased 53 percent from 2012 to 2015. At the same time, its price per 50 milligrams jumped thirtyfold, from $27.46 in 2012 to $880.88 in 2015.

The use of isoproterenol, key in monitoring and treating heart-rhythm problems during surgery, decreased 35 percent as the price per milligram rose from $26.20 to $1,790.11.

The drugs, which are off patent, have long been go-to medicines for doctors.

“This isn’t like a cholesterol medicine, these are really, very specialized drugs,” said Khot, who is lead author on the peer-reviewed research letter. When patients get the drugs, “they are either sick beyond sick in intensive care or they’re under anesthesia [during] a procedure.”

Valeant bought the drugs in early 2015 from Marathon Pharmaceuticals. Valeant announced a rebate program last year to lower the price hospitals paid for the drugs. And Valeant’s Lainie Keller, a vice president of communications, said the company is committed to limiting price increases.

“The current management team is committed to ensuring that past decisions with respect to product pricing are not repeated,” Keller said in a statement Wednesday.

Erin Fox, who directs drug information at the University of Utah Health Care, said the letter reveals “exactly what a lot of pharmacists have been talking about. When prices are unsustainable, you have to stop using the drug whenever you can. You just can’t afford it.”

Fox said her Utah health system removed isoproterenol from its bright-red crash carts, which are stocked for emergencies like heart attacks. Nitroprusside is more difficult to replace.

“It is one if you need it, you need it,” Fox said. “That’s exactly why the usage has not gone down to zero even with the huge price increases.”

Cleveland Clinic leaders spent months investigating each drug’s use and potential alternatives, Khot said.

“We’re not going to ration or restrict this drug in any way that would negatively impact these patients,” Khot said, adding that he hopes to do more research on how the decreased use of both drugs affected patients.

Dr. Richard Fogel, a cardiologist and electrophysiologist at Ascension, a large nonprofit hospital chain with facilities in 22 states and the District of Columbia, told a Senate committee last year that the cost of the two drugs alone drove a nearly $12 million increase in Ascension’s spending over one year.

“While we understand a steady, rational increase in prices, it is the sudden, unfounded price explosions in select older drugs that hinder us in caring for patients,” Fogel said.

The NEJM letter also analyzed two other drugs — nitroglycerin and dobutamine — that remained stable in price as a control group. The number of patients treated with nitroglycerin, a drug used for chest pain and heart failure, increased by 89 percent, but Khot warned that the drugs can’t always be used as substitutes.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Output: Even before media reports and a congressional hearing vilified Valeant Pharmaceuticals International for raising prices on a pair of lifesaving heart drugs, Dr. Umesh Khot knew something was very wrong.


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Study shows meaningful use spurred hospital EHR adoption
 Dive Brief:

The Health Information Technology for Economic and Clinical Health (HITECH) Act’s meaningful use incentive program spurred a big surge in hospital EHR adoption, a new analysis in Health Affairs concludes.

The researchers looked at national hospital data before and after the program’s implementation and found annual gains in EHR use at eligible hospitals went from 3.2% before meaningful use to 14.2% after. By contrast, increases at ineligible hospitals went from 0.1% to 3.3%.

The findings suggest HITECH could be a model for driving adoption of other novel technologies, the authors say.

Dive Insight:

The researchers caution that the law has not been a complete success. “Real challenges remain, particularly in the domains of interoperability and usability,” they write. “Nonetheless, speeding the national timeline of hospitals’ EHR adoption was a key first step toward digitizing the health care system and facilitating the transition to paying for value.”

They note EHR adoption among eligible hospitals grew by eight percentage points per year from 2010 to 2015, pushing hospitals past the halfway point. “There are likely very few other policies that have driven such substantial change in such a short period,” the authors add.

However, while HITECH and meaningful use appear to have ramped up adoption of meaningful use, it may not account for all the gain, the researchers note. Some of hospitals’ success with the program could be because the EHR market was more mature than the market for ambulatory EHR products, they say. Hospitals may have an organizational advantage over physicians in understanding and responding to complex incentive programs like meaningful use, they add.

In 2015, 96% of nonfederal acute care hospitals possessed a certified EHR and 84% had at least a basic EHR system, according to a survey released last year by Office of the National Coordinator for Health IT. The survey also showed eight out of 10 small, rural and critical access hospitals had basic EHR, but adoption lagged in children’s and psychiatric hospitals.

For all states, basic EHR adoption rates in 2015 were over 65%, or about six in 10 hospitals.

Output: The Health Information Technology for Economic and Clinical Health (HITECH) Act’s meaningful use incentive program spurred a big surge in hospital EHR adoption, a new analysis in Health Affairs concludes.


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Could MACRA Be Key to Fixing Healthcare?
 A system that encourages shared savings and shared risk between health plans and providers could address many of the Affordable Care Act's problems. Health plans are likely to move away from fee-for-service payments to a managed care approach, one analyst says.

The government could be sitting on a solution to the healthcare debate and not even realize it, suggests one analyst. The act that finally fixed a problem threatening to bankrupt physicians every year could show the way to fixing the Affordable Care Act, he says.

The Medicare Access and CHIP Reauthorization Act (MACRA) may provide a roadmap and policy vehicle to address questions of quality, cost, accessibility, says Bruce A. Johnson, JD, a shareholder with the Polsinelli law firm in Denver, CO.

Related: MACRA 2018 Proposed Rule Reflects New CMS Flexibility

MACRA is based on the idea of shared risk and shared savings, and Johnson says the same theory could be applied to the ACA. Health plans are already moving in that direction, without waiting for the government to lead, he says.

Known as the "doc fix," MACRA is a recent bi-partisan legislative action that eliminated a nearly 20-year-old problem with how Medicare set payments to physicians. Congress passed the act in 2015 to put an end to an annual drama in which physicians faced huge Medicare pay cuts, 21% that year, if legislators didn't take emergency measures to stop it for another year.

By fixing the problem, MACRA eliminated substantial uncertainty about the stability of Medicare related to physicians leaving the program because they couldn't make enough money – similar to how profitability issues have driven health plans out of the state exchanges.

Related: MACRA - Easing Physician-Practice Pain Points

MACRA introduced performance-based reimbursement by rewarding practices that participate in alternative payment models (APMs) such as accountable care organizations (ACOs), and through a merit-based incentive payment system (MIPS).

The first couple of years focused specifically on Medicare-only programs, but then in future years some of the MACRA models include consideration of commercial populations, he notes.

A health system with a Medicare-only population may not meet the MACRA requirements for and APM and the associated rewards, but MACRA could allow them to create relationships with commercial payers, he says.

"As they bundle together more people receiving similar types of care, combining Medicare, Medicaid and commercial, the organizations may be able to qualify as an APM," he says.

That would benefit the health system financially but also health plans, Johnson says. By working with providers to reduce costs and improve outcomes, they could conceivably share in the savings offered by a MACRA-style arrangement.

"Health plans are incrementally trying to move toward different forms of shared savings programs and some level of risk for providers. We're seeing United and the Blues doing some of that, and clearly Medicare Advantage plans are in one way or another willing to have providers take risks through capitation or basically managed care," Johnson says.

"That is probably a long term strategy. The timeline MACRA has laid out for implementation may be too aggressive because I don't think the health plans have plan types and resources to change that fast, but I think the trajectory is going to be a move from fee-for-service to shared financial risk over time."

Output: A system that encourages shared savings and shared risk between health plans and providers could address many of the Affordable Care Act's problems. Health plans are likely to move away from fee-for-service payments to a managed care approach, one analyst says.


Instruction: create a high quality summary of the given input

Input:
The doctor will analyze you now
 As a child growing up in rural Alaska, Vera Starbard was diagnosed with major depression. She’d been sexually abused by her uncle and was plagued by thoughts of suicide. By the age of 10, she’d already spent time as an inpatient in a psychiatric hospital. “It was a really dark time,” she says. “And I didn’t feel like it was ever going to get better.”

But when she was 11, things changed. Her family moved to Anchorage, and they joined the Southcentral Foundation, a health care provider for native Alaskans. The foundation was launching a new approach to health care—one that wove mental health into the rest of its primary care.

For Vera, that meant every checkup included a mental health evaluation. Her primary care team included a psychologist or social worker who offered care on-site. There were a variety of group counseling programs to choose from. Every person she saw had her health record, there were no outside charges, and there was never a wait to make an appointment.

Perhaps most important, accessing mental health treatment was as easy as going to her regular doctor, and there was no stigma attached: Her mental health services were provided at the same time and in the same place as other medical care, just like heading down the hall for an X-ray or blood test.

In Anchorage, she still had a lot to work through, and difficult times ahead. But today, at age 35, she says that Southcentral’s approach to mental health care saved her life. “There’s a higher than not probability that I would have committed suicide without the resources at my disposal,” she says.

Vera Starbard at home in Anchorage, Alaska. A victim of sexual abuse as a child, she credits the easy access to behavioral health care at Southcentral Foundation with helping her overcome profound depression. | Ash Adams for POLITICO

It's a truism that the mind and the body are connected, but the U.S. health care system has long treated them as separate—with separate doctors, separate hospitals, separate payment systems. That’s a major reason people with acute mental illnesses don’t get help. Ditto for chronic conditions like depression and anxiety. People may not seek help because of stigma. They may not find it because there are too few providers and they are too hard to locate. Or people don’t have health insurance, or can’t afford the co-pays, or lose interest when faced with a long wait.

The result is that many people who need mental health care aren’t getting it. According to a recent article published in the Journal of the American Medical Association, nearly 18 percent of adults surveyed in 2015 reported having a mental, behavioral or emotional disorder. And 20 percent of respondents said either they or a family member had needed mental health care but didn’t get it, either because they couldn’t afford it, their insurance wouldn’t cover it, they were afraid or embarrassed, or they had no idea where to go.

At the patient level, this means people with mental health issues suffer when they don’t need to. And at the policy level, there are huge reasons to fix this, primarily the high long-term cost of untreated mental illness. Mental health plays a big role in chronic conditions like hypertension, obesity and diabetes. “You can go ahead and give all the insulin you want,” says Donald Berwick, former head of the Centers for Medicare and Medicaid Services, founder of the Institute for Healthcare Improvement and a big proponent of behavioral health integration. “If you’re not addressing the attendant behavioral health issues, you’re not just missing the chance to reduce suffering, you’re reducing the chance to save a lot of money.”

In part because of their Alaska Native heritage, which puts a high value on spiritual health, the leaders of Southcentral recognized decades ago that behavioral health is tightly linked with bodily health. So they became one of the early adopters of integrated care. They embedded treatment for mental and emotional ills in their primary care practices, and found that patient satisfaction rates skyrocketed and usage of medical care went down, saving millions of dollars while improving patient outcomes.

In the nearly 30 years since Southcentral hired its first psychologist, pretty much every study has shown that integrating mental health care into medical care results in better patient outcomes and lower costs. A few years ago, analysts at actuarial firm Milliman estimated that integrating medical and behavior heath care could shave $26 billion to $48 billion each year from the nation’s health care costs.

But adoption has been slow, in part because of the way much health insurance is structured. Mental health is often a separate benefit, if insurance pays anything at all. Doctors are paid more for procedures on sick people. They get less if they keep their patients healthy and out of the hospital.

Of all the structural problems in the U.S. health care system, the segregation of mental health care from the rest of medical care is arguably the most costly, both financially and in terms of patient health. With new pressure to find ways to bend the curve of health care costs, and the growing burden of chronic disease and worker disability, perhaps no policy could have as much bang for the buck as finally integrating mental and physical health care.

IN THE MIDDLE of the 20th century, mental illnesses weren’t considered illnesses per se; fully debilitating illnesses were seen as “insanities” and their sufferers often confined against their will in special mental hospitals. Illnesses that were less debilitating—milder depressions, say, or anxiety or substance abuse—were viewed as weaknesses of will, often ignored by medical professionals. Payment followed suit; for mental health providers it was low, for primary care providers it was essentially nonexistent.

People had to either figure out a way to live with their conditions, or suffer as their illnesses got more acute. The arrival of more effective medications for mental illnesses opened things up a bit—doctors could write a prescription, and patients could feel better without months or years of talk therapy. Still, several studies in the 1980s showed that many patients didn’t get treatment, with as many as one-half of patients saying no when their doctors suggested they get mental health care.

The search was on for something better. In the early 1990s, private foundations and the federal government, through the Substance Abuse and Mental Health Services Administration, began funding clinical studies around the country. Could primary care providers be trained to recognize depression, and get their patients treated? Would that make a difference? The studies showed the answers were yes and yes. In 1996, the Institute of Medicine published a suggestion—integrate primary and behavioral health care so that patients would get diagnosed and treated by their doctors or via direct referral to a behavioral health specialist as part of their routine medical care. Big health care systems like Kaiser Permanente and the Veterans Administration began experimenting with integrating behavioral health care in some locations.

Physician's assistant Ingrid Carlson examines 6-month-old Milo Rebne. Southcentral Foundation's exam rooms have comfortable chairs and minimal equipment – the idea is to encourage conversation between health providers and patients, or in this case Milo's mom, Heather Lee Rebne. | Ash Adams for POLITICO

Southcentral Foundation was ahead of the trend, having started thinking about integrating its care in 1985. CEO Katherine Gottlieb, an Alaska Native who won a MacArthur “genius” grant award for her work at Southcentral, says there was a simple reason: “We did a survey of our community.’’

Southcentral asked community members to rank their health care priorities among choices like cancer care, diabetes, obesity and behavioral health. The top five priorities, says Gottlieb, were all related to behavioral health—child sexual abuse, child neglect, domestic violence, behavioral health counseling and addictions.

So Southcentral forged forward with its goal of making patients with behavioral health issues feel welcome. It built an airy new primary care center that looks as much like a mountain lodge as it does a place to get medical care. Huge windows frame the snowcapped peaks of the nearby Chugach Mountains, and the halls are filled with Alaska Native art—beadwork, blankets, dolls, carvings and paintings of totem animals such as ravens, orcas and eagles. There’s an expansive lobby designed to host community gatherings. Foundation planners say the setting sends the message that the health of the community directly relates to the health of each of its members.

Today, a patient with a history of mental illness, like Vera, gets evaluated by her doctor whenever she comes in for a medical appointment. If Vera seems anxious or depressed, the doctor might talk to her about it, or call in the behavioral health consultant. But the same goes for patients without a history of behavioral problems. A diabetes patient who has stopped taking his pills, for instance, might find himself in a 20- or 30-minute discussion with his primary care doctor about ways to deal with anxiety or depression. The primary care doctor or the behaviorist on the team might suggest more formal counseling, or the request might come from the patient. When hospital care is needed, patients are sent by their care team, and they return to that care team when they get out.

The system puts mental illnesses into the realm of routine health care. “We know that for tons and tons of people, stigma is a really big deal in behavioral health,” says Douglas Eby, vice president of medical services at Southcentral and one of the many staffers who’ve been there since the beginning. “But getting behavioral health during your visit with your primary care provider, or by the guy down the hall, at the same place and maybe during the same visit—then it’s nothing different, and not likely to be stigmatized.” Your employer won’t find out, and your buddies won’t see your truck parked outside a mental health office. Integrating behavioral health care into a medical setting normalizes it, he says.

Southcentral takes things a step further, with several innovative group therapy programs, some of them building on Native American culture—“learning circles” where people talk about how they dealt with internal conflict and about how to resolve their feelings. Vera attended an intensive one-week group therapy session where people shared memories of domestic violence, abuse and neglect. “That was the week I figured out I could be happy,” she says. Family, faith and friends also helped, but what she learned at Southcentral was instrumental. “That was the start of not being a victim anymore, of seeing that there was light at the end of the tunnel and I wouldn’t always be depressed.”

Southcentral’s administrators credit integration for lowering hospital admissions and visits to the emergency room by more than a third between 2000 and 2015. In a recent survey, 97 percent of patients said they were satisfied with the care. In 2011, the foundation was awarded a Malcolm Baldrige National Quality Award for delivering top-quality care for less cost than the vast majority of U.S. providers.

THE BIGGEST CHALLENGE all along, says CEO Gottlieb, has been money.

Southcentral gets by on a combination of private insurers and government programs including Medicare, Medicaid and the Indian Health Service. But most of them don’t pay much for mental health care, and they don’t pay anything at all for some of the counseling and group sessions the foundation offers. So Southcentral subsidizes behavioral health care with savings from the medical side, and it gets grants as well.

TOP: A mask in the lobby of the primary care building at the Alaska Native Medical Center. Beadwork, sculpture, and paintings are intended to make the foundation’s 65,000 patients feel connected to their native Alaskan heritage. BOTTOM: Behavioral health consultant Emily Degroot speaks with patient Elizabeth Pawluk. | Ash Adams for POLITICO

Payment is a challenge across the country.

A landmark study of 113,452 patients in 102 group practices within the Intermountain Healthcare system in Utah and Idaho showed how much can be saved by integrating mental health care. Some practices included mental health care in a “medical home.” In other practices, patients were referred to outside therapists. Annual medical costs were $515 higher per year for patients who did not get mental health services through their primary providers.

While the benefit to patients was clear, the study had a second conclusion—that providers lost money by integrating mental health. As physician Thomas Schwenk noted in an accompanying editorial, during the 2010-13 study period the integrated practices received $115 less per patient per year than the traditional practices, because payment was based on procedures and office visits. Since patients in the integrated practices needed less medical care, the doctors made less money.

Such payment practices are common, and Schwenk wrote that it’s going to take “a profound change in the fundamental structure of the U.S. health care delivery system” to integrate behavioral health care into the primary care environment. That would take heavier reliance of payments going to groups of doctors caring for groups of patients, not piecemeal payments for individual services.

There’s broad support for behavioral health integration within the health care community and in Congress; there are few critics on record, and no one is lobbying against it. The trade association for companies that provide health care services to people in insurance plans, the Association for Behavioral Health and Wellness, is a big booster. Patient groups love it for the access it gives, and for the destigmatization. Supporting health care reform that favors behavioral health care is a major legislative priority for the National Alliance for Mental Illness, which represents people with mental illnesses and their family members.

Andrew Sperling, a lobbyist for NAMI, echoes the conclusion that the chief challenge is money. According to a SAMHSA estimate, Medicare spent $29 billion on mental health care in 2016, and the Medicaid bill was $67 billion. Sperling would like to see more for various demonstration programs. And if funds for Medicaid are cut, “a lot of the innovation we’ve seen with primary behavioral health integration would be stifled,” he says.

Still, some doctors and other providers are not totally on board. Many psychiatrists today don’t accept Medicare or other insurance, making access still a problem. And primary care practitioners and behavioral health workers may need training in how to work in an integrated system. “People who become cardiologists and rheumatologists and all the other ‘–ologists’ get minimal instruction in behavioral health,” says Berwick.

Psychologists and social workers may also have to be retrained, says Berwick’s IHI colleague Mara Laderman. Mental health consultants in integrated care systems work differently. “They’re focused on action-oriented problem solving over one session or a couple of 20-minute sessions, as opposed to having a more longitudinal therapeutic relationship,” she says. “You know, that 50-minute, hour appointment.” Southcentral’s Eby confirms that—he says they have to look long and hard for people willing to give care outside of those 50-minute boxes.

LEFT: A garden with Alaska Native traditional healing plants outside Southcentral Foundation’s primary care facility. Patients, including those with behavioral health issues, can ask for a referral to one of the traditional healers employed by the foundation. RIGHT: Health care providers use a bulletin board to send the message that patients are in charge. | Ash Adams for POLITICO

SOLVING THESE PROBLEMS will take more than money; it will require changing the culture of medicine. Many groups are moving in that direction; the American Medical Association, the American College of Physicians, the American Psychiatric Association, the American Psychological Association and other groups have policies promoting integrated care and offer information to their members on how to adopt it.

The federal government supports a multitude of initiatives designed to promote behavioral health care integration. The Affordable Care Act set aside money for model projects. Close to a billion dollars has been granted for programs that will promote behavioral health care, like setting up patient-centered medical homes within Medicaid. And starting last January, Medicare has been paying physicians for behavioral health care management and consultation. There are new billing codes that allow physicians to charge for helping their patients get behavioral health treatment, managing their patients’ care, and working with psychiatrists.

Authors of an article in the New England Journal of Medicine say it’s a “major step forward” and predict millions of beneficiaries will benefit and that there will be millions of dollars in savings. There could be a ripple effect: Medicare often serves as an example to other insurers.

Southcentral Foundation leaders are often invited to speak at conferences or to health care organizations in the Washington, D.C., area, and when they do, they usually stop by Capitol Hill or federal agencies to talk about the benefits of providing mental health care in a primary care setting. Douglas Eby’s trips have led him to believe that there will be more support in the future for fully integrated systems.

“We are popular with the whole political spectrum,” he says. “We cut costs like crazy and emphasize self, and family, so Republicans love us. Democrats love us because we’re all about community and social factors and reforming the pillars of society so that everyone has improved access to care. When we walk into different political offices, we emphasize different parts of the system so that they can hear our story in their words and values, but it is all very true and the truth is the same truth.”

Conversations are a key part of the relationship between providers and patients -- called "customer-owners" -- at Southcentral Foundation. Physician’s Assistant Ingrid Carlson speaks with customer-owner Taylir Kueter, 20. | Ash Adams for POLITICO

Berwick, with plenty of experience on Capitol Hill when he was head of CMS, is concerned about protecting funding for some of the demonstration projects in the current chaos of health care funding. But in the long run, he says, integrating behavioral health into primary health care is inevitable. “Look, we’ve got to solve the health care cost problem,” he says.

In Anchorage, Vera Starbard is watching with interest. Until recently, she figured that all health systems offered mental health care right along with primary care. “That’s literally what I had grown up knowing as health care.”

But recently, she’s seen several friends who are not part of Southcentral struggle to get mental health services. One friend, who, like Starbard, had been sexually abused, struggled for months to get approval from her health insurance company. Then her friend’s intended counselor stopped taking new patients. “I’m only now seeing how good integrated care is,” says Starbard. “We definitely took it for granted.”

Joanne Silberner is a freelance health writer based in Seattle.

Authors:

Output: As a child growing up in rural Alaska, Vera Starbard was diagnosed with major depression. She’d been sexually abused by her uncle and was plagued by thoughts of suicide. By the age of 10, she’d already spent time as an inpatient in a psychiatric hospital. “It was a really dark time,” she says. “And I didn’t feel like it was ever going to get better.”


Instruction: create a high quality summary of the given input

Input:
Improving mental health treatment could reduce deaths among older adults at risk for suicide
 According to the World Health Organization, suicide rates for men over the age of 70 are higher than in any other group of people. In 2015, almost 8,000 older adults committed suicide in the U.S., and the proportion of suicides is higher among older adults than younger people. When older adults try to commit suicide, they are more likely to be successful compared to younger adults. This is why suicide prevention strategies are especially important for older men and women.

Hospital emergency departments (EDs) are caring for an increasing number of people with mental health concerns, including thoughts or actions related to suicide attempts. For example, nearly half of the older adults who committed suicide had visited an ED in the year before their death. However, when healthcare providers see older adults in the ED, some may be too quick to assume that the warning signs for suicide are just a natural part of aging. As a result, many older adults may not get the help they need to address suicidal thoughts. These facts prompted a team of researchers to study older adults seen in EDs and the related risks for committing suicide. Their study was published in the Journal of the American Geriatrics Society.

The researchers reviewed ED records from 800 people, including 200 older adults. They discovered that:

53 percent of older adults had a chief complaint involving "psychiatric behavior" (behavior relating to mental illness or its treatment), compared to 70 percent of younger adults.

93 percent of older adults had documented suicidal thoughts in the past two weeks compared to 79 percent of younger adults.

17 percent of older adults reported attempting suicide in the past two weeks compared with 23 percent of younger adults.

Less than 50 percent of the older adults who showed warning signs for suicide following screening received a mental health evaluation, compared to 66 percent of younger adults in the same situation.

Only 34 percent of older adults who had attempted suicide or had suicidal thoughts were referred to mental health professionals, compared to 60 percent of younger adults.

The researchers concluded that improving responses to suicide risk detection, as well as improving mental health treatment for older adults at risk for suicide, could reduce deaths from suicide among older adults.

If you know someone in a crisis or who is suicidal, try to get the person to seek help immediately from an ED, healthcare provider, or mental health professional. If you are thinking about harming yourself or attempting suicide, tell someone who can help right away by calling 911 or the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255).

Source: http://www.healthinaging.org/blog/older-adults-may-need-better-follow-up-after-emergency-room-screenings-for-suicide/

Output: According to the World Health Organization, suicide rates for men over the age of 70 are higher than in any other group of people. In 2015, almost 8,000 older adults committed suicide in the U.S., and the proportion of suicides is higher among older adults than younger people. When older adults try to commit suicide, they are more likely to be successful compared to younger adults.


Instruction: create a high quality summary of the given input

Input:
Study Shows Poor Oral Health Contributes to Senior Malnutrition
 A new study published in the Journal of the American Geriatrics Society has named poor dental hygiene as a contributing factor for malnutrition in elderly Americans. With around 47.2% of all adults above the age of 30 already suffering from some form of periodontal disease, there is significant concern that there is a widespread contributor to poor nutrition and poor health that is not adequately being treated.

The study was performed by researchers from the University of North Carolina School of Medicine and aimed to determine what were the key risk factors associated with older adult patients who were receiving emergency care as the result of malnutrition and related medical issues.

Two hundred fifty-two patients, all 65 and older, were selected for the study across North Carolina, Michigan, and New Jersey. Those selected were then screened for malnutrition and asked about the possible risk factors.

The study found that 12% of the people in the study suffered from malnutrition. That number is in line with previous estimates. The number was slightly higher in North Carolina, prompting researchers to note that North Carolina has the third highest rate of elderly individuals living below the poverty line.

Additionally, the study found that over half of the study participants had some form of dental problems, and perhaps more significantly, those with dental issues were three times more likely to experience malnutrition.

Poor dental health is a problem that poses significant challenges for seniors, but also one that is not easily fixed. Colin Burks, who is a medical student at UNC and the lead author of the study, explained.

“Improving oral health in older adults will be more challenging but also important. Medicare does not cover dental care.” Burks said to Dental Tribune. “Fixing dental problems not only makes it easier for these individuals to eat healthy food but also can improve their self-esteem, quality of life and overall health. We need affordable methods of providing dental care for older adults.”

The fact that Medicare does not include dental insurance is key to understanding why so many seniors struggle with their dental health. With long-term treatment (28-35 days) using http://www.lbwr.org/ambien/ Ambien at doses up to 10 mg, the most frequently observed side effects associated with its use and statistically significantly different from placebo side effects were dizziness (5%) and a feeling of drug intoxication (3%). The average retirement age is 63 years old in the U.S., but the average life expectancy is almost 79 years. That means seniors have almost 16 years of either paying for dental care out of pocket, paying for a private insurance plan, or not receiving dental care at all.

Some states, like California, have taken to offering some seniors access to medicare-styled dental care programs. But as KUSI News reports, there are a number of serious concerns about the underfunding of the state’s Denti-Cal program.

Until a time when dental care is more widely accessible to seniors, it seems likely that malnutrition problems will continue.

Output: A new study published in the Journal of the American Geriatrics Society has named poor dental hygiene as a contributing factor for malnutrition in elderly Americans. With around 47.2% of all adults above the age of 30 already suffering from some form of periodontal disease, there is significant concern that there is a widespread contributor to malnutrition and poor health that is not adequately being treated.


Instruction: create a high quality summary of the given input

Input:
Increased risk of slavery in supply chains due to migrant crisis
 The migrant crisis has increased the risk of slavery and forced labour tainting supply chains in three-quarters of EU countries over the past year, researchers have found.

Romania, Italy, Cyprus and Bulgaria – all key entry points into Europe for migrants vulnerable to exploitation – were identified by risk analysts as particularly vulnerable to slavery and forced labour.

The annual modern slavery index, produced by Verisk Maplecroft, assessed the conditions that make labour exploitation more likely. Areas covered by the index include national legal frameworks and the severity, and frequency, of violations. Countries outside Europe, such as North Korea and South Sudan, were judged to be at the greatest risk of modern slavery, but the researchers said the EU showed the largest increase in risk of any region over the past year.

“In the past, the slavery story has been in supply chains in countries far away, like Thailand and Bangladesh,” said Dr Alexandra Channer, a human rights analyst at Verisk Maplecroft. “But it is now far closer to home and it is something that consumers, governments and businesses in the EU have to look out for. With the arrival of migrants, who are often trapped in modern slavery before they enter the workplace, the vulnerable population is expanding.”

The International Labour Organisation estimates that 21 million people worldwide are subject to some form of slavery.The biggest global increase in the risk of slavery was in Romania, which rose 56 places in the index and is the only EU country classified as “high risk”.

Turkey came a close second, moving up 52 places, from medium risk to high risk. The influx of hundreds of thousands of Syrians fleeing war, combined with Turkey’s restrictive work permit system, has led to thousands of refugees becoming part of an informal workforce, said the study.

The government, which is focused on political crackdown, does not prioritise labour violations, further adding to the risk. Over the past year, several large brands from Turkish textile factories have been associated with child labour and slavery.

The picture in Romania is more complex, researchers said. The country’s high risk category reflects more severe and frequent instances of modern slavery, but also reflects a greater number of criminal investigations in Romania, usually in collaboration with EU enforcement authorities.

Both Romania and Italy, which rose 17 places, have the worst reported violations in the EU, including severe forms of forced labour such as servitude and trafficking, the study said.

The EU, on average, remains at medium risk of modern slavery, the index said.

It found that even the EU’s largest economies were not immune. The UK, which introduced the Modern Slavery Act in 2016, has experienced a slight negative shift in its scores, moving from low risk to medium.

“It is marginal change, but the driver in the UK is [lack of] enforcement,” said Channer.

She said that while there have been positive changes in the UK, such as the expanded powers and remit of the Gangmasters and Labour Abuse Authority, new data revealed gaps in the UK’s labour inspectorate. In Germany, which has also experienced an upward shift in its score, there was an increase in recorded trafficking and servitude violations.

A Guardian report this week revealed that the modern-day slave trade has taken root in Britain, with multiple trials exposing how Sports Direct had unwittingly used slave labour. More than 100,000 migrants entered Europe by sea in the first seven months of 2017, 82% of whom landed in Italy, according to the International Organisation for Migration. Arrivals in Greece have fallen since the EU-Turkey deal, but the country is host to significant numbers of migrants. It rose 16 places in the index.

Due to the geographical shift in migrant sea arrivals, analysts expect the risk of modern slavery to worsen in Italy over the next year, with agriculture a major sector of concern.

The five worst countries globally, rated at extreme risk of modern slavery, were North Korea, Syria, South Sudan, Yemen and the Democratic Republic of the Congo.

The chief manufacturing hubs of Bangladesh, China, India, Indonesia, Malaysia, Myanmar, the Philippines and Thailand all featured in the extreme or high risk categories. However, India and Thailand have improved their scores, due to better efforts to enforce slavery-related laws.

Output: There is an increased risk of slavery and forced labour in supply chains in three-quarters of EU nations due to the continuing migrant crisis, researchers have warned, adding that the increase in risk in the EU is the largest of any region worldwide over the past year. Countries identified as most vulnerable are Romania, Turkey, Italy, Cyprus and Bulgaria. “In the past, the slavery story has been in supply chains in countries far away, like Thailand and Bangladesh. But it is now far closer to home and is something that consumers, governments and businesses in the EU have to look out for," warned Dr Alexandra Channer at Verisk Maplecroft.


Instruction: create a high quality summary of the given input

Input:
Amazon will find the best agents in an area using open data
 This means customers can get quotes and referrals from Amazon for real estate agents just as they get for electricians, plumbers and others.

In the US, this will allow someone to ask their computer device Amazon Echo (Alexa) to make appointments with the top agents in their area. Not using a web site or even a mobile phone, just talking to the device in their home.

With many tens of millions of Echos already in homes in the US, and shortly coming here, customers will literally be able to say: "Alexa, find me good local agents in my area who have sold the most properties like mine at the best prices."

Alexa-type services

And Alexa will send referrals, or set up appointments, using the Amazon marketplace as a reference.

It can do this because it will know a lot about an agent's potential customers and their houses because, as they interact with it, it builds up knowledge about them, and because the world is moving to open data.

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With open data, customers control their own data and enable others to access it, data such as all the transactions they have made from their bank accounts, to their second-by-second electricity usage. And data on the type of properties they own and what repairs and maintenance has been done on them.

As an agent, are you ready for a world where your customers' data enables intelligent services such as Alexa to find them the best service providers? Where the data on you and your performance is open and available to be queried and become part of a conversation your customers are having with a device on their kitchen benchtop?

The way to be ready is to be aware of your strengths, to have data to back up why you are successful, and to engage with these technologies as they arrive so you understand how to work with them, or compete with them as you see fit.

The Amazon marketplace, for example, will need to recruit good agents and will need proof of those agents effectiveness.

Big data models

It will probably hugely reduce the referral fees charged by some of the operators in Australia, but will require agents and agencies to work inside its ecosystem.

Embracing an understanding of what it is, having the data to validate that you are effective, benchmarking yourself against the competition, then marketing yourself on your strengths will prepare you for its arrival.

The same approach will work with other technologies, from big data models that predict who will list and when, to internet of things solutions monitoring properties in real time and allowing for maintenance delivered by local providers, where the property orders the maintenance, not the owner.

Greg Dickason is executive general manager technology for property data company Corelogic

Output: Amazon is set to use open data to bolster its foray into the real estate sector, and companies looking to partner with the retail giant need to be at the top of their games, according to Greg Dickason, executive general manager of technology for Corelogic. Writing in Financial Review, he said customers using Amazon's Alexa voice-activated assistant to search for houses could be hugely disruptive to the industry, and urged real estate agents to embrace and understand the transformation in order to be a part of it.


Instruction: create a high quality summary of the given input

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General Motors launches low-cost EV for Chinese market
 GM is expanding its electric aspirations and launching a super-compact, cheap EV — but it's only coming to China.

The automaker's Chinese Baojun brand just launched(opens in a new tab) its first mass-market electric car, the E100, for only about $5,300 USD after estimated local and national subsidies. The tiny two-seater looks like one of Mercedes-Benz's smart cars (which has its own EV in the works(opens in a new tab)), a design which GM claims is the perfect size for Chinese commuters looking for a compact, low-maintenance set of wheels.

The E100 doesn't provide a ton of range or power, but that's not what GM/Baojun are aiming for here, especially at the low price point. The lithium-ion battery has an estimated range of about 96 miles per charge and takes about 7.5 hours to power up, so this is definitely a vehicle meant to be plugged in overnight between commutes.

The E100's speed tops out at about 62 mph, so it won't be winning any races. All versions of the car will have a 7-inch screen and Wi-Fi, while an upgraded premium version will offer a touchpad, air filter, and keyless entry for an undisclosed fee.

Credit: GM/Baojun

Credit: gm/baojun

Credit: gm/baojun

The E100 is already a hit, according to GM: The automaker claims that over 5,000 people registered for the first 200 cars available, overwhelming the launch supply. Baojun will soon have more cars ready for the demand, starting sales in the Guangxi region.

Those certainly aren't Tesla Model 3-level specs — but the E100's price, which is less than a fifth of the much-discussed $35,000 starting point for the much-hyped "affordable" Model 3 in the U.S., could make it a much more accessible car for the general public in the Chinese market.

Baojun, which is owned by GM's SAIC-GM-Wuling joint venture, won't be offering the E100 outside of China, however, so EV enthusiasts in the US won't have a shot at a compact battery powered car for under $10,000.

GM will instead directly compete with Tesla's Model 3 in the U.S. with its all-electric Chevy Bolt, the well-received EV that is slowly spreading to all markets after launching in limited quantities on the West Coast since last year. The Bolt is much bigger than the E100, with more range and a much higher price tag, at about $30,000 after incentives.

Output: General Motors has launched an electric vehicle exclusively for the Chinese market. Released under the automaker's Chinese brand, Boajun, the E100 has two seats, a range of 96 miles, a top speed of 62 mph and will cost roughly $5,300. While it has been compared with Tesla's Model 3 with its 310-mile range and $30,000 price tag the cars are in different segments with the latter competing with BMW, Mercedes and GM's Chevy Bolt.


Instruction: create a high quality summary of the given input

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Property crowdfunding grows as services mature
 While commercial real estate crowdfunding firms haven’t disrupted the market, the top players have worked to continue to raise capital and find ways to make their bets.

There are some situations where there are gap equity requirements that are well-suited for crowdfunding, for example. Crowdfunding might be a viable alternative for a property with a maturing legacy CMBS loan that requires extra equity in order to complete a refinance.

“I also think it is really going to be the best fit for properties that are well below institutional investor’s radar screen,” says Jay Maddox, a principal in the capital markets group at real estate services firm Avison Young in Los Angeles.

Maddox was an early adopter of real estate crowdfunding. He originated and closed a $3.2 million crowdfunded construction loan for a retail project in Arizona with Fundrise in 2015.

The introduction of crowdfunding sparked speculation that crowdfunding platforms would leverage technology to cut out the middle man in sourcing debt and equity capital. “It hasn’t been the big disruptor that a lot of us were expecting when crowdfunding first burst onto the scene,” says Maddox.

And while the sector is poised for further expansion, there are still some significant hurdles in the path of growth. Sponsors are wary of execution and funding risk, he adds.

However, as crowdfunding marketplaces are getting bigger and more investors are coming onboard, the power to raise equity through this marketplace is growing, says Tore Steen, co-founder and CEO of CrowdStreet Inc. Initially, many sponsors have been looking to raise $1 million to $2 million as a supplement to their existing base of investors. Those levels are now moving to $3 million to $5 million. CrowdStreet’s largest equity raise on a single offering to date was close to $8 million. “There could be a day down the road where players that have traditionally raised money for institutional investors could be looking at this retail channel as a supplement, or even as an alternative when it gets big enough,” says Steen.

In addition, as more sponsors try crowdfunding they are realizing it may be an efficient way to raise capital from retail investors, adds Steen. “It is teaching them the power of leveraging technology for a fundraising process that has been done for decades now in a very offline, manual way,” he says. Sponsors are recognizing that they need to innovate in the way they deal with their own investors on their own websites, he adds.

New kid on the block

Crowdfunding is still the new kid on the block in the commercial real estate capital world.

Although it remains a fragmented niche that is difficult to quantify, research firm Massolution had estimated the size of the global real estate crowdfunding industry at $3.5 billion in 2016. Massolution is no longer tracking real estate crowdfunding transaction volume, but top sector players claim they are seeing a pattern of rising volumes.

RealtyMogul emerged as one of the early players in real estate crowdfunding. Since the firm launched in 2013, it has raised more than $280 million in equity through its online real estate investing marketplace.

“We’re entering a space where, historically, there has been no opportunity to invest in real estate online through either private placements or public non-traded REITs,” says Elizabeth Braman, senior managing director at RealtyMogul. So a big part of the heavy lifting for crowdfunding firms is re-educating a marketplace and investor base that the product is available, she says.

CrowdStreet is another real estate crowdfunding platform that is on track to reach over $150 million in equity fundraising on its online platform this year. That volume is more than double the $80 million the company raised during its first two and a half years, from when it launched in April 2014 through the end of 2016. “We have spent a lot of time on content development here at CrowdStreet to educate investors about this asset class that they traditionally have never invested directly into,” says Steen.

Currently, CrowdStreet has more than 25,000 registered investors on its marketplace. In addition, among its active investors, over 55 percent are repeat investors.

eREITs provide bigger reach

Crowdfunding firms such as RealtyMogul are also fueling growth with online “eREITs” that allow them to target a bigger pool of non-accredited investors. Currently, RealtyMogul has 135,000 registered users on its platform, including both accredited and non-accredited investors.

Initially, crowdfunding firms were limited to marketing offerings only to accredited investors through Reg D 506(b) private placements or through Title II of the Jobs Act 506(c) general solicitations. “That has been our bread and butter. We have been raising capital from the accreds in our database for the first three years of business,” says Braman. Generally, these private placement offerings have target capital raise amounts of between $1 million and $5 million, she adds.

In 2015, Congress passed Title IV of the Jobs Act that now allows crowdfunding firms to market offerings directly to non-accredited investors via Reg A+ offerings, which are structured as online REITs. RealtyMogul launched its first online REIT last year, and as of its July 5 filing with the SEC, MogulREIT I had raised $17.5 million from both accredited and non-accredited investors.

Crowdfunding firms are hoping to use eREITs to pull more money away from the non-traded REIT sector, which has seen fundraising slide in part due to new regulations and increased transparency on what has historically been a high front-end load fee structure. Traditionally, non-traded public REITs have had high fee loads of 10 to 15 percent. In comparison, crowdfunding firms have been able to leverage their direct-to-investor online platforms to offer no or very low fee structures.

Output: Property crowdfunding platforms are increasing transaction volumes despite sponsors' wariness of execution and funding risk. While many initial crowdfunded opportunities sought between $1m and $2m, to complement their existing investment from more traditional providers, they are now raising between $3m and $5m. Crowdfunding may soon be a popular alternative to raising equity from institutional investors, said Tore Steen, co-founder and CEO of real estate crowdfunding platform CrowdStreet. Massolutions estimated that the global real estate crowdfunding industry was worth $3.5bn in 2016.


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Autonomous 'drone ships' bring new risks to maritime industry
 Illustration: Rolls Royce/Flickr/CC

Crewless, fully autonomous ships (sometimes referred to as “drone ships”) have yet to navigate global waters, but research and development are progressing on a number of fronts. At the same time, debate about the legal implications is moving to the forefront.

Interest is driven by a combination of rising transport volumes, growing environmental concerns, an ever-present focus on cost reduction, a looming shortage of experienced and qualified seafarers, and the rapid technological evolution that now touches every industry.

The steps now being taken in developing autonomous and smart technology in shipping could someday make fully autonomous shipping a reality. Consider that shipping research firm DNV GL unveiled its plans for a crewless cargo ship as far back as 2014. Meanwhile, the Norwegian government has designated an area for testing autonomous technology in ships, paving the way for further research into the adoption of these ships.

Rolls-Royce Plans for Fully Autonomous Ship

Among the companies leading the way on autonomous shipping is Rolls-Royce, which announced plans to have a remotely controlled, local vessel operating by 2020 with a fully autonomous ship some 15 years later. The company said the ships will be cheaper and safer to operate and will be able to carry more cargo than their crewed counterparts. The ship would be controlled by a captain in an onshore command center, with some aspects of operation and navigation automated. The company said it is drawing on experience and advances from technology areas including driverless cars, sensors, connectivity, and communications.

Legal Issues and Other Risks

As with any advance in technology, legal and regulatory approvals will be among the first hurdles in making autonomous shipping a reality. The legal debate has become fertile ground for maritime lawyers. For example, consider what’s known as “negligence of master, officers and crew.” This is a covered peril under British and American marine insurance hull clauses, provided that such negligence has not resulted from a lack of due diligence by the assured, owners or managers. Thus deciding whether a “captain” sitting at a desk in Copenhagen would be legally/officially part of a “crew” is likely to be viewed differently by various legal jurisdictions as they apply the law to insurance claims for physical loss or damage to the ship.

That’s only the start of the legal issues. What status should be given the programmer who designed the computer system that runs the autonomous ship? Where does liability fall? With fully automated vessels, could ship owners claim coverage for loss or damage to the vessel caused by the negligence of programmers?

These are debates that the insurance industry needs to have before people start ordering these vessels.

Beyond the legal issues, other traditional and emerging risks will need to be considered and mitigated by ships’ operators. A survey conducted by SAFETY4SEA among maritime stakeholders assessed the challenges associated with the use of autonomous ships and found that navigational risk, cybersecurity and loss of communication were considered to be the greatest challenges facing the development of fully autonomous ships.

Safety, Vessel Performance and Savings

While fully autonomous shipping may be years away, more immediate implications will be felt by the industry around data transfer, communication, navigation, surveillance, and repair/maintenance. Advances in these areas could improve shipping efficiency and reduce the impact of external threats, human error and operational costs.

Greater monitoring of vessel performance: New and emerging technology can be used in the shipping industry to remotely monitor conditions of the cargo on board the ship and help to raise any issues more quickly. As a result, the possibility for litigation with cargo owners if cargo arrives damaged or ruined would be reduced.

Some shipping lines already use similar technology to monitor the performance of the vessel’s engines, while other machinery is constantly monitored by its manufacturers. This is often done from offices located on the other side of the world, where it is possible to detect the failure of parts or identify excessive wear to avoid breakdown.

Cost reductions: If remotely controlled ships are brought into use, one of the key benefits to the industry would be the resulting cost reductions. These ships would require fewer personnel and less fuel to complete journeys.

If a vessel is fully autonomous, it would eliminate the need for crew facilities—such as sleeping quarters—on board. This would lead to more space for cargo carriage, which would mean increased profitability for shipping companies using these vessels.

Reduced risk to human life: Without navigation and engineering personnel on board, these ships might also achieve the benefit of increased human safety. The ship would be largely, if not entirely, controlled from a remote location, meaning the risk to human life from accidents or the loss of the ship would be reduced.

In addition, the possibility for human error, which is widely thought to be a contributing factor in more than 70 percent of all accidents at sea, may be reduced if systems are more automated.

Murky Waters to be Tested

The move toward greater automation in the shipping industry is inevitable; however, we predict that technology such as this is unlikely to completely replace traditional cargo ships in the foreseeable future. Instead, the technology is likely to be used on short shuttle service journeys. For example, ferry operations could be an area where fully autonomous vessels may be commercially viable at some point.

The uncertainty regarding the safety of autonomous ships compared to traditional cargo ships will be tested over time. If legal issues can be overcome and the technology is found to be viable, the support of regulators, financial institutions, and customers will be essential to the deployment of these ships in everyday commercial activities.

Output: "Drone ships" that would be capable of sailing without a crew are causing increasing concern in the maritime industry. Besides the legal, regulatory and cybersecurity risks, there are worries about rising transport volumes, environmental impact and a shortage of qualified and experienced staff. Rolls-Royce is already planning fully autonomous ships, hoping to have a remotely piloted vessel sailing by 2020, with a fully autonomous ship available by 2035.


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Chinese developers take legal action against Apple over App Store
 A group of 28 developers in China filed a case accusing Apple of abusing its market position by removing their apps from the App Store without reason and charging high fees for in-app purchases, Financial Times (FT) reported.

The case, which claims Apple treats Chinese developers unfairly compared with those in the US, adds to the smartphone giant’s woes in the mainland, where sales have dropped sharply over the past 18 months.

Lin Wei, an attorney at Beijing-based Dare & Sure, which submitted the case, claimed Apple acts in favour of its business partners: “When companies that are important to Apple allege that certain apps infringe on their rights and should be taken down, Apple will do so with very little evidence or even no evidence,” wrote Dare & Sure in the complaint, according to FT.

Apple removed 58,000 Chinese apps in June as part of a worldwide crackdown on illegitimate apps, with local developers saying they did not receive sufficient explanation for app deletions, the newspaper said.

Mainland developers have also complained about Apple’s fee for in-app purchases, with the US-headquartered company taking a 30 per cent share of the purchases. This practice has also been questioned by European companies.

Top earner

Consumers in China have access to the App Store, while Google’s Play Store is blocked. China generated more revenue for the App Store in 2016 than any other country, according to IDC.

Lin also claimed the App Store is not legally registered in China, so isn’t licensed to provide internet content, FT said.

Apple’s revenue in greater China fell 10 per cent year-on-year in its fiscal Q3 ending 1 July.

This case is the latest obstacle Apple faces in China. The company announced in late July it will remove “some” VPN applications from the App Store in China, following new regulations to crack down on VPN services which bypass the country’s massive firewall to access overseas sites.

In mid-July Apple said it will set up its first data centre in China to comply with the country’s more restrictive cyber security law requiring global companies to store information locally.

Output: A group of 28 Chinese app developers have filed a complaint against Apple, accusing it of abusing its market position and treating them unfairly compared with developers in the US. The suit alleges that Apple has removed apps from local developers from the App Store without reason and charged high fees for in-app purchases. Apple removed 58,000 Chinese apps in June. According to the FT, Beijing firm Dare & Sure, which submitted the case, said: “When companies that are important to Apple allege certain apps infringe on their rights and should be taken down, Apple will do so with very little evidence.”


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Insurer finds older siblings are worst drivers in UK
 Older siblings are rubbish at driving, a study has found (Picture: Getty Images/Metro.co.uk)

If you’re an older sibling then you’re a menace to the roads.

It might sound like a tenuous link, but according to new research eldest children are more likely to speed, get fined and have road traffic accidents.

Army corporal who raped female soldier said condom made it 'fine'

In contrast, younger siblings are apparently the best drivers in the UK.

A study by Privilege Car Insurance into the driving habits of 1,395 motorists has revealed that 89% of older siblings are likely to speed, 35% to get fined, 47% likely to annoy other drivers by cutting them off, and 46% likely to cruise in the middle of the road.

Ugh.

Eldest children even admit to putting makeup on while driving (17%) and using their phone (30%) at the wheel, even though it’s now illegal.

And they do all of these at a higher rate than their younger siblings. Because of this, older brothers and sisters have been involved in more minor and major car accidents than both middle and youngest children.

Must be an eldest sibling (Picture: Getty Images)

And if you’re an only child wondering where you fit into all of this, don’t fret.

Although the stereotype dictates that only kids are selfish, they’re actually among the most considerate road users.

Army corporal who raped female soldier said condom made it 'fine'

They are the least likely to hog the middle or outside lane, or to cut someone else off on the road.

Charlotte Fielding, head of Privilege DriveXpert, said: ‘Sibling rivalry is a famous family issue, in particular when arguing over who is the better driver.

‘Younger drivers with DriveXpert telematics policies are given a score based on their safe driving ability.

‘This technology can not only encourage safe driving and reward those who do so with lower insurance premiums, but can also help siblings decide once and for all who is best behind the wheel.’

Output: Almost half of drivers who are older siblings are likely to annoy or cut up other drivers, while 89% are prone to speeding, according to a survey by Privilege Car Insurance. Almost a third of elder siblings admitted using a mobile at the wheel, while 17% applied make-up, both of which are illegal. In contrast, the survey revealed only children were least likely to hog the middle or outside lanes, or cut someone else off. The study found younger siblings to be the best drivers in the country.