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Geriatric Emergency Departments: Why the Trend Is Here to Stay
 COMMENTARY

Geriatric Emergency Departments: Why the Trend Is Here to Stay

Robert Glatter, MD; Zia Agha, MD

Robert Glatter, MD: Hi. I'm Dr Robert Glatter, a member of the Medscape Emergency Medicine Editorial Board and attending physician in the Department of Emergency Medicine at Lenox Hill Hospital, part of Northwell Health. Today we will be discussing the growing trend of geriatric emergency departments (EDs) throughout the United States, and the reasons behind it.

Geriatric Emergency Department Statistics

Dr Glatter: According to recent estimates, up to 25% of patients seen in the ED are aged 65 years or older.[1] By 2030, this percentage may well increase, when at least 1 in 5 Americans will be aged 65 or older.[2] In 2012, the Icahn School of Medicine at Mount Sinai received an award from the US Department of Health and Human Services to implement a new model of geriatric emergency care in three large urban hospitals; Mount Sinai Medical Center in New York City; St. Joseph's Regional Medical Center in Paterson, New Jersey; and Northwestern Memorial Hospital in Chicago, Illinois.

The Geriatric Emergency Department Innovations through Workforce Informatics and Structural Enhancements project, otherwise known as GEDI WISE, received a $12.7 million grant for the project.[1,3,4] At the beginning of 2014, the ECRI institute, a nonprofit research organization dedicated to discovering the best in medical procedures, devices, drugs, and processes, estimated that there were 50 geriatric EDs in operation in the United States, with another 150 in development.[1]

In order to handle the specialized needs of geriatric patients and their unique medical conditions, many academic centers and universities have embraced evidence-based data that provide support for building these unique facilities. A reference source often cited is the Geriatric Emergency Department Guidelines.[5] It is a result of 2 years of consensus-based collaboration among representatives from the Society for Academic Emergency Medicine, otherwise known as SAEM; the American College of Emergency Physicians (ACEP); and the American Geriatrics Society, along with the Emergency Nurses Association. It is approved by the boards of directors of these four organizations.

Joining us today to discuss this growing trend is Dr Zia Agha, chief medical officer and executive vice president of clinical research, medical informatics, and telehealth, West Health, San Diego. We'll be highlighting their new geriatric ED, the Gary and Mary West Senior Emergency Care Unit at UC San Diego Health, which is set to open in 2018. Welcome, Dr Agha.

Dr Agha: Thank you. I appreciate the time, and I appreciate the focus and emphasis on geriatric emergency care.

Types of Care Provided to Seniors in the ED

Dr Glatter: What types of care are elderly patients currently getting at most EDs? What are they lacking in their care at this point in time?

Dr Agha: I think the conversation here is around what is possible. As the population grows, what types of services are possible to be presented and provided through the ED? ED physicians are some of the best doctors in terms of making a diagnosis, evaluating patients, and creating a care plan. Often, they are the ones who are deciding when a patient needs to be admitted or is discharged back into the community.

We recognize that whereas that model of care is very useful and helps with the younger population—those in their 40s and 50s, for example—when you think about seniors, it truly is a syndrome. It's a syndrome of health needs. It's obviously important to make the right diagnosis of pneumonia, for example, and understand how to treat that.

Often, however, these seniors are going to have other comorbidities. They may have functional limitations. They may have social issues that need to be addressed, and because of the type of healthcare delivery system we have today, addressing all of those different needs from an ED physician's perspective is challenging.

I think part of the work around geriatric emergency care is not only to improve the care that happens in the ED, but also to surround the ED staff with the resources that allow them to provide safe care outside of the ED facility—to onboard patients toward a better trajectory, so that they can do better and not have rebound admissions.

We know that one of the problems that EDs face is readmissions. When you look at the senior population, they have a higher readmission rate to the ED for the same condition or for a new condition.

The Care Team Approach

Dr Glatter: When you have a geriatric ED, you need a full complement of additional people, including social workers, physical therapists, and nurses specifically trained in geriatrics, as well as physicians who can come in and hopefully avoid some of these admissions. In the past, the mantra had been, "We can't figure out what's going on, so we'll just admit you." That's changing, obviously. Would you agree?

Dr Agha: Yes, I think that is changing. You're right that it is a team-based approach, because geriatrics is the ultimate team environment. You need all of these other supporting characters in the ED who are, of course, trained in the geriatric care model, but who are also then empowered by having resources that allow them to leverage things in the hospital—for instance, getting physical therapy consults in the ED—or also outside in the community.

We have a very innovative program of research with UC San Diego. They're leveraging the research on the hospital-at-home model. What this model is trying to study is the ability of an ED physician and the team in the ED to identify certain patients who have ambulatory-sensitive diagnoses, such as urinary tract infection (UTI), pneumonia, or cellulitis.

Start the care plan in the ED, but transition [elderly patients] home (perhaps with help in the home). Then provide telemedicine services as a wraparound to provide 72 hours of coverage and follow-up in the home, and then transition their care into their primary care doctor's office. Similar work has been done by Geisinger Health Plan[6] and others, who are also testing these innovative models where you have another option beyond admitting the patient.

Leveraging Technology in Geriatric ED Care

Dr Glatter: Are you incorporating telehealth as part of this model through video visits, in order to assess patients? Or is it more just a nurse providing home-based care, or another therapist?

Dr Agha: I'm using the word "telehealth" in its broadest sense. I think the most effective tool, if you talk to Dr Ted Chan and Jim Killeen from UCSD, is their ability to have this TigerText communication. It's like an instant messaging tool that allows the home nurses to connect with the ED physicians 24/7, rather than sending faxes, which is the traditional way that home healthcare teams would communicate with the doctors.

In addition to that, they are using phone calls and, when needed, simple web-based videoconferencing. Believe it or not, most of the time, it's the ability to have a quick virtual rounding on the patient through this texting mechanism that allows them to stay connected in the care paradigm.

Early Outcomes Data on the Value of the Geriatric ED

Dr Glatter: Do you have any internal data just from your ED that justify the need to have this geriatric ED? In other words, looking at a small portion of patients over the age of 65 whom you've studied, where you have used measures to reduce readmission rates, [do the data] justify the need for building this ED?

Dr Agha: I think there is some evidence that we have seen. We are looking at it from different perspectives. Some of this is looking at large data, and I'll give you an example of a very simple analysis of patient falls we did, using Medicare data from 2012 and 2013.[7] [Editor's note: This research is to be presented later this year at the ACEP Research Forum.] In the senior population, falls are a significant morbidity. You can imagine patient falls leading to hip fractures and even nursing home admissions.

[During those years], there were 400,000 ED diagnoses nationwide of primary fall—what is called a "ground-level fall"—in the 65-and-over population.[7] Of that population, guess how many received a physical therapy (PT) consult, at least on their Centers for Medicare & Medicaid Services (CMS) claim at discharge? (This is the discharge order from the ED.) It was less than 4%. Immediately, you identify that there is a need to create decision-support tools or awareness within the ED setting, so that if someone comes in with a ground-level fall, the physician will consider having the patient seen by a physical therapist or rehab specialist at some point.

The second thing we saw—and again, these aren't big numbers—but when we looked at readmission for another fall within 60 days and 180 days, we found that those people who actually got the PT consult had a lower risk for coming back to the hospital with that problem versus those who did not have a PT consultation. It's a small peek at the data. I think it's missing many critical points, so it's by far not a perfect study. However, it helps us to identify certain areas to study further.

At a smaller level, we are studying our acute care at home program. We have shown that of 50-odd patients whom we have transitioned home safely from the ED and avoided a hospital admission, more than 90% of them have successfully been managed in the home setting without requiring a revisit to the ED or readmission. I think it is possible for us to provide services outside of the hospital setting to a carefully selected group of patients and still provide the same level of outcomes that you would expect to receive in the hospital—and potentially even better outcomes, in terms of satisfaction and other things.

Dr Glatter: I want to switch gears for a second. Mark Rosenberg, who is the chief of geriatric emergency medicine at St. Joseph's Regional Medical Center in Paterson, New Jersey, made a statement in the past, and I want you to comment on this. The concept is that if the ED is designed for the most frail and vulnerable patients, it will work for the strongest patients as well—arguing that we should build all EDs to be geriatric-friendly. In other words, make geriatric care the common denominator—that this is our baseline standard level of care.[8] How would you respond to that?

Dr Agha: I know Mark really well, and I think what he is trying to say is that the types of principles that we should be using to care for our seniors are also the principles that will provide good care for everyone else. I know seniors have more falls and have bigger problems, but there are people who have falls who are younger. If we don't screen them for mobility issues and don't make the appropriate referrals, these patients are not going to receive the full benefit of that treatment.

I'm going to point out some work around medication reconciliation. There is a big emphasis in the geriatric literature and in the Geriatric Emergency Department Guidelines on medication reconciliation, because seniors are at risk for drug/drug interactions, drug/food interactions, and other adverse events. Some of the work represents good medical practice: using the Beers Criteria[5] and other screening tools to help identify those "at-risk" patients, then having a pharmacy consultation to either fine-tune their medication list, or revise the medication list.

I think that's good medical practice and should be instituted for all other patients who have polypharmacy. These patients could benefit from it also. I think there are lots of parallels between good care for a senior and good care for everyone else.

Resources to Support the Geriatric ED

Dr Glatter: What do you say to hospital systems that don't have the funds to build such facilities that aren't graced or blessed with the revenue to go forward? How would they design their ED? Any specific pointers you can give?

Dr Agha: I think that's a very good point. When we started our geriatric initiative, we were very aware of the fact that what we are building and what we are investing in is a learning opportunity. It's a learning laboratory where we can test certain principles, but with a goal that these principles should be able to be extended and be disseminated to all EDs in the country.

There's already work happening around the guidelines that you mentioned that have been developed by the ACEP and other organizations.[5] If you review the guidelines, within each category—whether it's around education and training, staffing of a geriatric ED, or care protocols—there are some really simple "low-hanging fruit" concepts that we feel every ED in this country caring for seniors can adopt. These efforts will not require tremendous infrastructure resources or changing the physical structure.

The physical environment is an important part, and a lot of the EDs that call themselves geriatric EDs have invested some time, energy, and resources into creating a safer environment that's more patient-centered—less noisy and with nonskid floors, for example. These things are important; however, they are not the only things that are going to improve the care of seniors.

I think it is important to have care protocols that identify people at risk, with a heavy emphasis on screening and triaging patients beyond their primary complaint. Such tools as the Identification of Seniors at Risk (ISAR), which is a very simple patient checklist that can be completed at the point of entry, [can be used] to identify patients at risk.[9] This sort of triage mechanism identifies people at risk and leads to further questioning; [it] identifies a person at risk for falls, [so that] you can do a fall assessment, [or] identifies someone at risk for delirium, [so that] you can do a delirium assessment. I think those types of simple screening measures can be implemented across the nation and will pay big dividends in terms of improved outcomes, which themselves will pay for those extra steps we are taking.

Dr Glatter: I would argue that in this process of triage, before the physician or physician assistant actually sees the patient, there would already be a care team in place—whether it's case managers or social workers—already completing these types of surveys and analyses. By the time the care provider sees the patient, this has already been accomplished, and we already have a plan to go forward.

Dr Agha: Exactly. That is what we are seeing at most of the geriatric EDs that we are working with—that it is not the physician's role, or even the nurse practitioner who's taking care of the patient. It's someone even more proximal who is going to do the early screening, and with your electronic health record, you can create a screening tool set with a simple logic and decision support built into it. We are also very aware that we don't want to overburden the system.

Crowding in the ED is a big problem. We certainly don't want to slow things down. We also feel that if you identify certain issues early on, you can potentially save time. If you can identify that a patient has a mobility issue when they're checking into your ED, you can start working on getting a wheelchair ordered for them and not have to say, "Okay the patient is ready to go home, but he can't even walk." In this case, with advance planning, the wheelchair is ready.

So now we have to get some prosthetics or someone else involved. There is a little bit of an investment of time. I think it'll more than pay back in terms of how you coordinate the care and provide the right services.

The Geriatric ED and Length of Stay

Dr Glatter: To wrap this up, have you looked at any length of stay issues within the ED itself when you do have a geriatric ED? Does the time spent seem to be less in general?

Dr Agha: There was a recent study by Keyes and colleagues,[10] where they looked at three outcomes; length of stay was one of them. That was not affected. It was not better, but it wasn't significantly worse. They looked at primary hospitalizations, although that number was lower, so they had an impact on reducing the number of people who were admitted to the hospital. The third thing they looked at was readmission or recidivism rates. Those were not affected.

I think there are some early data coming out. We are very interested in studying these things at a deeper level; we've already started doing some ethnographic research to do some observation studies to look at the flow. I think length of stay is much more of an outcome of the workflow and the flow of the patient through the ED than any one specific intervention. Understanding the workflow, and then understanding how to optimize it, is critical.

Disseminating Learning to Other Sites

Dr Glatter: Is there anything else to add to the discussion?

Dr Agha: The call to action for us is that we should be able to provide good geriatric care to all seniors, no matter which ED they're going to, and it's going to be perhaps at different levels, as you pointed out. There may be some centers that are going to adopt some basic principles that will improve geriatric care, and there will be the centers of excellence that are going to be doing innovative, clinical trials, and offering these types of services to their seniors.

I'm really excited about the future of this whole geriatric care movement within ACEP and the physician community, but also on a broader perspective from the health system side, given our shift toward population health.

Dr Glatter: Can you also fill us in on any specifics of your ED that you planned for, opening in 2018—any early tidbits of information of how the layout will be, and so forth?

Dr Agha: The Gary and Mary West Senior Emergency Care Unit is going to be located in La Jolla at the University of California, San Diego, campus. It's a joint project with them. We have funded it through a capital grant, but we also provided substantial funding to start to do education and training and also health services research, and to look at outcomes.

It's going to be a physical build-out of around 18 new beds—a dedicated space in this ED. This is a large ED, with 40,000+ visits currently. Their capacity is going higher and higher. It will definitely take off some of the pressure in terms of having more beds available. What's more important is that we will also have specially trained nurses. That work is already under way—specially trained and focused clinicians.

We're going to bring together geriatric pharmacologists, rehabilitation specialists, and geriatric doctors to provide the full set of services, including social work, that a senior requires. We're truly excited about this opportunity not only because of what we will do here, but also as to how the learning will then be disseminated to other sites.

Dr Glatter: Then you plan to have video-based conferencing—taking advantage of all the technology that exists right now to interface with providers at home as well as in the ED?

Dr Agha: Yes, that is definitely in the works. As I mentioned, we've already started one project where we're using video-based technology to connect with assisted living sites in San Diego.

I think when you look at telehealth and video as a tool to an end, it's not about doing telehealth; it's about how you provide the right care at the right time to patients.

Output: The creation of Geriatric Emergency Departments to tackle the number of elderly patients being seen in emergency departments is likely to continue. Predictions for 2030 indicate an increase of the 25% ratio of the elderly to non-elderly patients in current ED data. There are currently around 50 geriatric EDs in the US, with a further 150 in development. The specialized departments provide care for the unique issues seen in geriatric patients, such as comorbidity, functional limitation, social issues, complications from falls and more in addition to general health problems. Elderly adults have higher readmission rates to emergency departments, making a more specialized service necessary to provide the correct care for first admission. These EDs have regular care staff but are also supplemented with social workers, geriatric-trained nurses and physical therapists to augment the care provided and to tailor the diagnosis and care process. Help at home, acute care at home and telemedicine services are also provided where needed to decrease the rates of readmission and to ensure ongoing care is accurately delivered. Many geriatric EDs refer to the Geriatric Emergency Department Guidelines, a document that encompasses a two-year, consensus-based collaboration between the American Geriatrics Society, the Society for Academic Emergency Medicine, and the American College of Emergency Physicians. Care protocols are being put into place to ensure that patients are triaged properly and to reduce the time patients have to spend in emergency department care. Further work and research will be completed with the aid of geriatric pharmacologists, geriatric doctors and rehabilitation specialists to better care for the elderly population and to put protocols into motion that will help with the increasing number of older Americans who will need emergency department assistance.


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Tank inspections being carried out by 'crawler' drones: Maersk
 The offshore industry has been quick to embrace unmanned aerial vehicles (UAVs), or drones, for visual inspection tasks.

The technology ticks a lot of boxes in these cost-conscious times - they are fast, inexpensive, and require far fewer people on deck and in transit. They improve safety while delivering better data, users say.

Maersk Oil recognised the advantages of UAVs early on and made them part of its offshore inspection back in 2013.

“You could say we were early adopters of the technology,” says Mark Fotheringham, director of facilities and projects in the company’s UK business.

Output: Tank inspections have evolved from just flying a drone overhead to creating a "crawler" device, designed to navigate the tank's walls with an ultrasonic probe, gathering measurements of stiffeners and steel plates, and identifying signs of corrosion, according to Mark Fotheringham, director of facilities and projects in Maersk Oil's UK business. The company is also looking to utilise drone technology to generate detailed 3D maps of offshore assets, he said.


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Oxford University AI spin-off raises $22m
 South East Deals, Technology Muhammad Aldalou

An Oxford-based artificial intelligence (AI) specialist has raised $22m (£17.15m) in funding one year after its spin-out from the University of Oxford.

Diffblue's series A round was led by Goldman Sachs Principal Strategic Investments, alongside Oxford Sciences Innovations (OSI) and Oxford Technology and Innovations Fund (OTIF).

The company is described as "a world leader in AI for code". Diffblue's core AI builds an exact mathematical model of any code base, which allows a "very deep semantic understanding" of what a programme is trying to do.

The business is launching three products that are built on this core engine: a testing product that automatically generates human-readable tests for an existing codebase; a security product that automatically discovers security holes and generates actual runnable exploits; and a refactoring product that automatically rewrites badly expressed or out of date code.

Founder and chief executive Daniel Kroening, who is also professor of Computer Science at University of Oxford, said: "Software is becoming increasingly complex, interdependent and vulnerable and it’s unrealistic to believe that humans can guarantee its safety and security. We believe that the suite of tools we are developing at Diffblue has immense potential to help address these issues.

"Studies show that coders spend up to 30 per cent of their time writing tests. Automation will provide great returns both in terms of achieving much broader test coverage, and also freeing up significant developer time. Furthermore, many legacy codebases suffer from very deficient test coverage, which removes any chance of lifting them out of legacy and into nimbleness – again, we believe automation in this space will have powerful beneficial effects."

Barnaby Martin, chairman, added: "We're proud to have closed one of Europe's largest Series A rounds for an AI company. The fact that this has been completed inside just one year since the company’s inception is testament to Daniel and his incredible team.

"We are delighted to welcome Goldman Sachs as an investor and we look forward to working closely with them and our existing investors as we continue to expand Diffblue's market-leading capabilities and product suite."

Output: Diffblue, an artificial intelligence company from Oxford, has successfully generated $22m in a funding round, a year after it split off from the University of Oxford. The Series A round, led by Goldman Sachs Principal Strategic Investments, will provide funding for the launch of three products: a testing product that auto-generates readable tests for a codebase, a security product that detects security weaknesses and runs actual exploits, and a refactoring product that rewrites bad or outdated code.


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Tech industry expansion favours skills over traditional learning
 ROCKET CENTER, W.Va. — A few years ago, Sean Bridges lived with his mother, Linda, in Wiley Ford, W.Va. Their only income was her monthly Social Security disability check. He applied for work at Walmart and Burger King, but they were not hiring.

Yet while Mr. Bridges had no work history, he had certain skills. He had built and sold some stripped-down personal computers, and he had studied information technology at a community college. When Mr. Bridges heard IBM was hiring at a nearby operations center in 2013, he applied and demonstrated those skills.

Now Mr. Bridges, 25, is a computer security analyst, making $45,000 a year. In a struggling Appalachian economy, that is enough to provide him with his own apartment, a car, spending money — and career ambitions.

“I got one big break,” he said. “That’s what I needed.”

Mr. Bridges represents a new but promising category in the American labor market: people working in so-called new-collar or middle-skill jobs. As the United States struggles with how to match good jobs to the two-thirds of adults who do not have a four-year college degree, his experience shows how a worker’s skills can be emphasized over traditional hiring filters like college degrees, work history and personal references. And elevating skills over pedigree creates new pathways to employment and tailored training and a gateway to the middle class.

Output: The tech industry has revealed a preference for skills over traditional learning, with the "new-collar" or "middle-skill" job sector granting less weight to college degrees and career history, according to a feature in the New York Times. Microsoft has been championing a skill-centred approach, giving hiring firm Skillful $25m to foster more opportunities for those struggling to keep pace with the market shifts attendant to the digital economy. Developments in the technology industry could lead to a wider skills-based approach throughout other sectors. Numerous tech companies, such as Facebook, have also launched their own educational software.


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UK branch banking predicted to shrink rapidly as mobile booms
 Mobile banking transactions in the UK are expected to more than double by 2022, while branch visits will dwindle to just four visits each year for the average consumer in the same period, according to figures produced by industry analyst group CACI.

As mobile banking continues to dominate the agenda for banks of all shape, branch visits are forecast to forecast to drop significantly across a number of demographics, with customers who do use their branch visiting less frequently, and some consumers less likely to use their branch at all.

Households without children will see their visits decline from almost eight a year in 2017, to around three per year in 2022, says CACI. Those aged 18-24 and starting out in life will visit their bank around six times this year, and this again will dip to just two visits annually in 2022.

The predicted rise in mobile transactions is partly driven by the adoption of technology by customers who have previously relied heavily on a physical branch presence. CACI predicts that there will be five times more elderly, low income customers using mobile banking in 2022 than in 2017, and consumers aged 50+ will account for almost a third of all mobile banking log-ins in 2022.

Additionally, mobile growth will be helped by the shift from desktop online banking to smartphone apps amongst many customers - 42% of high-income professionals will move away from desktop banking in the next five years.

Although pointing to an obvious upward curve in mobile interactions, Jamie Morawiec, associate partner at CACI says the data present a conundrum for British banks. "With more than half of the population still expected to visit a branch in 2022, the branch still has an important role to play," he says. "Banks and FIs must ensure that the function of the branch remains relevant, complements the digital channels, and meets the specific needs of the demographics that are using them.”

Output: Mobile banking will dominate branch banking in the UK, with mobile transactions due to more than double by 2022 whilst branch visits are predicted to drop to four per year for the average customer, according to industry analysts CACI. The rise in mobile transactions is largely due to more widespread technology adoption by older age groups – CACI expects there will be five times more elderly, low-income customers using mobile banking in 2022 than in 2017. Online banking will be helped by the move from desktop to mobile as smartphone apps become more ubiquitous. However, bank branches are expected to remain relevant as a complementary service.


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UK building regulations need reform to limit heatwave deaths: CCC
 The government must reverse its opposition to new building regulations that ensure homes, hospitals and schools do not overheat as the number of deadly heatwaves rises, according to its official climate change advisers.

The Committee on Climate Change (CCC) recommended the new regulations in 2015 but ministers rejected the advice, citing a commitment to “reduce net regulation on homebuilders”. Without action, the number of people dying as a result of heat is expected to more than triple to 7,000 a year by 2040, the CCC warns in its annual report on the UK’s progress on tackling global warming.

Earlier in June, Britain experienced its longest period with temperatures above 30C since 1976. Heatwaves are known killers in the UK and the number of hot days is rising. On the hottest day of the year in 2016 there were almost 400 extra deaths, while a heatwave in 2006 led to 680 people dying and another in 2003 contributed to the deaths of about 2,000 people.

“What we need from government is a willingness to accept that building regulations, properly done, are not an incubus [problem] – they are in fact an opportunity to enable people to build for the future,” said Lord Deben, chair of the CCC and a former Conservative environment secretary.

“It is absolutely essential to recognise that we will not deal with the problems of climate change unless we have tougher building regulations,” he said. “The government has a real opportunity to do that as it is going to have to look at its building regulations in any case because of the tragic events [of the Grenfell Tower fire] and I think it is very important that they should take the opportunity to look at them in this wider sense.”

The CCC’s head of adaptation, Daniel Johns, said: “We said [in 2015] there is a compelling case for a new building standard to avoid new homes overheating. But [the government] response said there was clearly a trade-off here and they were also mindful of burdens on developers. So this is an area where they consider the potential small additional cost that could be borne by developers and what that might mean for the price of houses, being traded off against the potential long term cost for people occupying these properties in the hotter summers and heatwaves in years to come.”

The CCC identifies hospitals and care homes as particularly vulnerable to heat, as the UK’s ageing population suffers most in hot temperatures, as well as schools and prisons. The best solutions for keeping buildings cool involve good ventilation at night and shading of windows during the day, said Johns.

Air conditioning should not be the first choice, said Deben: “If buildings are properly built in this country there is very little need for air conditioning. The problem with air conditioning is that it heats the area round about, so it has a disadvantage for the community as a whole. It’s a constant pushing out of hot air.”

Julie Hirigoyen, chief executive at the UK Green Building Council, said: “The issue of overheating in buildings is of increasing concern. Clearly, there is a risk that our building regulations are no longer fit for purpose without robust protections against overheating.”

The CCC’s annual progress report says that the UK has done well in tackling climate change, cutting emissions by 42% since 1990 while GDP has risen by 65%. But it warns that the transition to a resilient, low carbon economy is in danger of being “derailed” by delays in important policies caused by the Brexit referendum and recent general election.

“The events of the past year have been, by almost any measure, exceptional,” said Deben. “However, it is now time for government, and for parliament, to act. Climate change is happening, not waiting. It is neither justifiable nor wise to delay further.”

The UK is on track to miss its legally binding targets for cuts in carbon emissions and the plan to address this, expected in late 2016, will not now be published until autumn 2017. Emissions from energy have fallen, although key policies promoting this end in 2020. But emissions from transport and heating are rising and need to be urgently addressed, the CCC said.

Furthermore, the overall state of the UK’s natural environment is worsening, reducing its ability to withstand climate change. The government target is for 50% of land habitats to be in good condition by 2020, but only 25% currently are, crucial pollinator insects are declining and the government has repeatedly missed targets to plant 5,000 hectares of woodland a year.

Progress to tackle river and coastal flooding has been made, the CCC says, but the widespread problem of flash flooding has not been adequately addressed.

A government spokesman said: “The government is a world leader in tackling climate change and committed to meeting the UK’s targets. Our industrial strategy continues to support our burgeoning low carbon sector which is helping deliver high-skilled jobs across the country.”

“We’ve implemented the majority of recommendations from the first National Adaptation Programme report.” he said. “But we agree there is a need to do more.”

Output: New building regulations must be adopted by the UK government in order to avoid fatalities due to an increase in heatwaves, according to the annual report from official climate change advisers, the Committee on Climate Change (CCC). The new regulations relating to homes, hospitals and schools were proposed in 2015, but were rejected by ministers to “reduce net regulation on homebuilders”. The CCC report, which states that hospitals and care homes are particularly vulnerable, argues that if no action is taken the number of annual deaths in the UK due to heat will triple to 7,000 by 2040.


Instruction: create a high quality summary of the given input

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UK building regulations need reform to limit heatwave deaths: CCC
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Output: New building regulations must be adopted by the UK government in order to avoid fatalities due to an increase in heatwaves, according to the annual report from official climate change advisers, the Committee on Climate Change (CCC). The new regulations relating to homes, hospitals and schools were proposed in 2015, but were rejected by ministers to “reduce net regulation on homebuilders”. The CCC report, which states that hospitals and care homes are particularly vulnerable, argues that if no action is taken the number of annual deaths in the UK due to heat will triple to 7,000 by 2040.


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Cisco to lead Las Vegas smart city plan
 The City of Las Vegas has unveiled a partnership with networking giant Cisco to become a smart city.

Announced by Las Vegas Mayor Carolyn Goodman and Cisco SVP of IoT and Applications Rowan Trollope during Cisco Live Las Vegas, the partnership will involve using Cisco's connected cameras, sensors, and platforms to collect and analyse data across environment, traffic, water, crowd control, transit, lighting, waste management, security, and parking.

According to Michael Sherwood, CIO for the City of Las Vegas, creating a smart city is all about improving the experience and lifestyle of the 42 million yearly visitors, 650,000 city residents, and 2.2 million Las Vegas valley citizens.

With Cisco already providing the government's phone and networking systems, Sherwood said it was about simply extending this partnership into the city itself.

"Having a partner like Cisco that was able to help us with sensor technology, help us understand dynamics operation and how we could find new ways of efficiency, made it an ideal partnership," he explained.

Cisco's smart city solutions are being trialled in Las Vegas' innovation district, also known as the "digital playground", which was itself launched in March last year as a starting point for digitising the city.

"Instead of going out and doing what others might do, which is go ahead and buy one system and just plonk that into their entire city, we test it in a small pilot area, we get reactions from the community, we get reactions from the government leaders, and see how that technology works," Sherwood said.

"We're able to work with them in that playground and sort of refine it, hone it, and test it out, and then, once it's good, we can expand it out throughout the community."

One of the primary aims of creating a smart Las Vegas is to improve congestion at major intersections for vehicles, pedestrians, and bicycles, Sherwood said, which will involve using the data collected to reroute vehicles, improve the efficiency of traffic lights, and increase public safety.

"Using IoT technology now, we're able to look at the intersection in ways we've never looked at it before, using assets we already own. We own streetlights, we own these signal interchanges," he said.

"We're able to look at intersections now and count the number of vehicles that go through an intersection. Not only count the number of vehicles, [but also] the number of bicyclists, and the number of pedestrians ... with this intelligent architecture, we're able to see how people use the street.

"We're actually able to use the analytics now to look at the intersection at night and see that you're the only car there, so instead of the timer-basis that we use today -- that's just a timer, which is why you experience that 1-in-the-morning [red light] when you're there for what feels like years -- now the camera technology can look at that and make changes."

Sherwood said the city could also use that data to prepare for autonomous vehicles, including for choosing trucking routes in and out of the city, with the traffic cameras to also be used to improve safety.

"The same traffic and analytic cameras also allows us to look at the intersections and see if someone leaves a backpack behind, something that's out of character. It gives us the ability to be forward thinking instead of reactionary ... those type of analytics change dynamics of how cities operate, and how we can become more efficient as a government."

In terms of security, Sherwood explained that the primary reason for undertaking the pilot within the innovation district is to ensure the security of the systems before deploying them across the entire city.

"That's why we created the innovation district, where we can test these technologies out in a smaller but real-life environment, and it gives us an opportunity to see the security concerns we might have, how we can guard against those threats before we scale it out to the community," he said.

"Security is definitely a number one priority."

Sherwood confirmed that the city is looking into deploying blockchain in future, with an announcement expected by the end of 2017 on this.

"We are looking at a seamless payment transaction system, so it's something on the horizon. Again, we're very forward thinking, very aggressive in all the technology we're looking at deploying."

The smart city initiative is also a good opportunity to publish additional open data, with Sherwood saying Las Vegas is the number one city in the United States on providing open data under an effort to improve transparency and boost economic outcomes.

"We're able to publish that data openly," Sherwood said, adding that Cisco's platform will allow it to push more data out into the community.

The City of Las Vegas will be soft launching a smart city tie-in app called Go Vegas in August to provide mapping, weather, parking, and traffic information to residents. The city will also gather information from the app's users to analyse how it can be improved and individualised.

"It will actually have mapping components, the air temperature at the park, so you'll be able to get an idea of what the park conditions are like, you'll be able to see the number of parking spots or the availability, whether it's 10 percent availability, 50 percent, or completely available," the CIO explained.

"We'll start building profiles on individuals, so if we know you use a certain parking lot every week, and that lot is going to be resurfaced or closed for a special event, we'll be able to send you a push notification letting you know about another lot that's available."

Trollope added that Cisco will additionally be providing funding for startups and companies to expand operations into Las Vegas' innovation district.

Cisco has been focused on creating smart cities worldwide, with its Smart+Connected digital platform -- which consolidates data from sensors and information systems to provide an overarching view of a city -- already having been deployed in Kansas City, Copenhagen, Paris, Adelaide , Bucharest, Hungary, Dubrovnik, and Bengaluru.

Its smart cities program has seen it work with Adelaide, South Australia, on transforming the region into a smart city, after signing a memorandum of understanding for an IoT innovation hub designed to leverage Adelaide's free Wi-Fi network as a test bed for new applications and projects back in 2015.

The networking giant similarly announced plans to deploy a smart city framework throughout Kansas City, Missouri, in partnership with telecommunications carrier Sprint two years ago. Kansas City initially used a 2-mile Wi-Fi network and 93,000 sensors to begin improving efficiency for parking, traffic, lighting, water, and waste management.

Cisco also signed a "country digitisation" agreement with the French government in February 2015, committing to help accelerate the digital transformation of France through investments in smart cities, education, startups, national infrastructure, and cybersecurity.

An investment of $100 million followed, along with Cisco's partnership with French startup accelerator NUMA on the DataCity project in Paris; an open innovation project for future smart cities with NUMA; the opening of a new Innovation and Research Center at Cisco's HQ in Paris; and a further $100 million investment that October.

In March last year, Cisco similarly outlined plans with Berlin's Senate Department of Economics, Technology, and Research to transform Berlin into a smart city as part of the $500 million "Deutschland Digital" initiative that aims to digitise all of Germany, with telemedicine, public safety, security, and network infrastructure improvements the main areas of focus.

Cisco last month also formed a smart cities "alliance" with KPMG Australia to meld its technology and solutions with KPMG's IoT capabilities and provide an end-to-end open framework including the provision of advisory, technology, platform, support, and operations services.

The focal points of the smart city alliance will be developing tools for such services as smart city architecture; cybersecurity; data and analytics; change management; master service integration; design thinking; solution design and implementation; optimisation and operational services; and financial and business case modelling.

Disclosure: Corinne Reichert travelled to Cisco Live in Las Vegas as a guest of Cisco

Output: The city of Las Vegas is set to become a smart city, thanks to its partnership with Cisco, according to Mayor Carolyn Goodman and Cisco SVP of IoT and Applications Rowan Trollope. In an announcement at Cisco Live Las Vegas, the duo revealed smart city solutions would be tested and perfected in Vegas' innovation district, before being rolled out citywide. Improving congestion for bicycles and pedestrians and readying the city for autonomous vehicles are two key areas the trial will focus on.


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Banks must disclose carbon-related lending risks: TCFD
 Banks should disclose lending to companies with carbon-related risks, according to recommendations in a new report by the Task Force on Climate-related Financial Disclosures.

The TCFD report – part of a G20 initiative led by governor of the Bank of England Mark Carney and former mayor of New York City Michael Bloomberg – outlines how companies should disclose climate-related information in their financial filings, with the aim of allowing economies to properly value climate-related risks.

It recommends companies disclose all of their direct and and indirect greenhouse gas emissions, and describe the risks and opportunities caused by climate change under a range of potential scenarios.

More than 100 businesses with over $2 trillion of combined annual revenue have publicly committed to adopting the voluntary recommendations.

The report follows a draft published in December 2016, for which the TCFD received hundreds of submissions from respondents in 30 countries.

“Climate change presents global markets with risks and opportunities that cannot be ignored, which is why a framework around climate-related disclosures is so important,” Bloomberg said in a statement.

“The task force brings that framework to the table, helping investors evaluate the potential risks and rewards of a transition to a lower carbon economy.”

The recommendations were intended to be adopted by all companies, however there was extra guidance given to the financial sector, as well sectors likely to be most affected by climate change or the transition to a lower carbon economy – energy, transportation, construction and agriculture, food, and forestry

“Widespread adoption will provide investors, banks and insurers with that information, helping minimise the risk that market adjustments to climate change will be incomplete, late and potentially destabilising,” Carney said in a statement.

The TCFD, led by Bloomberg, was established at the COP21 in Paris by the Financial Sustainability Board (FSB). The FSB was created by the G20 in the aftermath of the 2007-08 global financial crisis and is chaired by Carney.

Christian Thimann, head of regulation sustainability at the insurer AXA and a member of the TCFD, said the financial sector had a particular interest in taking up the recommendations.

He said insurers like AXA had several reasons to adopt the voluntary code. “We of course have an intrinsic interest in the world fighting against climate change. We see the frequency and intensity of natural disasters linked to climate change augmenting every year,” he said.

“We consider a world of plus two degrees may still be insurable but a world of plus four degrees might not be.”

He said banks have a shorter outlook than insurers but have an important role in steering the entire economy: “They too can use these recommendations because they will need to steer their lending between sectors aligned with a 2-degree world and sectors not aligned. They need to know which are the sectors with a high risk of stranded assets in the future and those with a low risk of stranded assets in the future.”

Yeo Lian Sim, a special advisor to the Singapore Exchange and member of the TCFD said although the recommendations were made as a voluntary code for which there is a compelling business case to adopt, she thought they might one day become regulated for in some economies if they are widely adopted.

Over the next year, the TCFD would work to monitor and assist companies implementing their recommendations.

Philippe Defosses, chief executive of French pension fund ERAFP and vice chair of the UK’s Institutional Investor Group on Climate Change said: “The more companies report effectively on climate related risks and opportunities, the easier it becomes for investors to allocate the substantial amounts of capital required to implement the Paris Agreement and to work on their own climate risk disclosure.”

“There should be no resistance to the widespread adoption on the TCFD’s recommendations given how – in most G20 countries – companies already have legal obligations to disclose material risks in their routine financial filings, including those that related to climate change,” Defosses said.

Emma Herd, chief executive of Australia and New Zealand’s Investor Group on Climate Change, said investors see climate change as a material financial risk and are calling on business to disclose their 2C strategy.

“Boards need a plan for managing climate change risks and opportunities that shareholders can see. Having a globally consistent framework for reporting on material climate change risks will accelerate this trend,” she said.

Among the companies that publicly supported the recommendations were big miners and resource companies like BHP Billiton, Shell and Glencore; energy businesses like Engie Group; and major banks like HSBC, Bank of America and Citigroup.

Output: Banks should disclose their lending to firms associated with carbon-related risks, according to the final report from the Task Force on Climate-related Financial Disclosures, a G20 initiative headed by Michael Bloomberg and Bank of England Governor Mark Carney. The report calls for the disclosure of all direct and indirect greenhouse gas emissions by companies and assesses the risks and opportunities associated with climate change. Over 100 businesses, with more than $2tn in combined annual revenues and including Bank of America, BHP Billiton, Citigroup, Engie, Glencore, HSBC and Shell, have so far pledged to adopt the report’s recommendations.


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Three German companies to pool counter-drone expertise
 LE BOURGET, France — Three German companies made their joint debut at the Paris Air Show to present a counter-drone system designed to foil anything from explosive-laden aerial robots to protecting against corporate espionage from the skies.

Rohde & Schwarz, ESG and Diehl Defence inked an agreement earlier this month to further develop the Guardion suite of systems, which already was deployed to guard the 2015 G-7 summit in Elmau, southern Germany, and the 2016 visit of U.S. President Barack Obama in Hannover.

Click here to get full coverage from the Paris Air Show.

The system consists of various sensors — radio, radar, acoustic and optical — to detect the presence of drones in the nearby air space. A command and control system, a derivative of the Bundeswehr's own Taranis suite, processes the sensor data and offers situational awareness of any incoming threats through a map-like visualization.

Depending on the drone type, system operators can initiate countermeasures ranging from shutting down the specific frequency band of the threat aircraft's radio link, jamming the GPS signal or, in the case of fully autonomous aircraft operation via inertial navigation, fry the approaching drone's electronics with a high-power electromagnetic pulse.

Goetz Mayser, Rohde and Schwarz's, director of C-UAV detection and counter solutions, said the company is "very active in China" in collecting radiofrequency signatures of commercial unmanned aerial systems. Knowing the specific technology is important for jamming only drone targets during an operation, leaving all other civilian radio communications undisturbed, he said.

Cataloging the characteristics from drone makers Parrot and DJI alone means covering 90 percent of the market, Mayser said during an interview at the company's exhibit here. Guardion clients are supplied with periodic updates to the radio signatures database, a process resembling the subscription to a computer antivirus application, he explained.

According to Daniela Hildenbrand, ESG's product manager for counter-drone systems, the market is expected to see a significant uptick as the robots become ubiquitous in people's everyday lives.

"It's growing along with the threat scenarios," she said.

Potential clients from countries in Europe and Southeast Asia have expressed interest in the technology, though officials declined to offer specifics.

Engineers are still studying the possibility of offering a fourth method of countermeasures called spoofing. That tactic would allow Guardion operators to send fake navigational signals to incoming drones, effectively taking them over.

But the technology is still a ways from being operationally deployable, said Mayser. Plus, taking control of someone else's drone poses a potentially thorny legal question. "Once you take it over, you're responsible," he said.

Sebastian Sprenger is associate editor for Europe at Defense News, reporting on the state of the defense market in the region, and on U.S.-Europe cooperation and multi-national investments in defense and global security. Previously he served as managing editor for Defense News. He is based in Cologne, Germany.

Output: German companies Rohde & Schwarz, ESG and Diehl Defence have signed an agreement to further develop a radio, radar, acoustic and optical command and control system called Guardion. The system, which was used to protect the G-7 Summit in southern Germany in 2015, can detect the presence of drones in the surrounding airspace and issue countermeasures including shutting down radio frequency bands, jamming GPS signals or releasing high-powered electromagnetic pulses to destroy an aircraft's electronics.


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TP ICAP backs start-up LiquidityChain's trade-alert platform
 TP ICAP has invested in a FinTech start-up aimed at unlocking liquidity in global credit markets through its web-based application.

LiquidityChain allows users to be connected using a dark pool, non-execution platform, which incorporates an alert system to highlight potential trading opportunities.

Parties will be able to connect through broker Mirexa Capital, part of TP ICAP’s institutional services business, to negotiate and execute trades and align trading interests.

LiquidityChain uses the same hybrid model used across all of TP ICAP’s brands, which combines market experience and relationships provided by voice brokers alongside electronic services.

Global head of electronic broking at TP ICAP, David Perkins, explained numerous factors, including regulation, low interest rates and balance sheet constraints have impacted bond market liquidity in recent years.

“A number of technology and trading platforms have tried to solve these issues, yet liquidity still remains a problem in the market. That is why LiquidityChain is so important; it combines smart technology with human expertise,” he said.

Richard Smith, CEO at LiquidityChain, added the partnership with TP ICAP as both an investor and provider of trade execution services, will be “invaluable as we continue to help users in the credit markets looking for additional liquidity”.

Output: The world's largest interdealer broker, TP ICAP, has invested in fintech start-up LiquidityChain, as the company aims to steer clients toward additional liquidity amid balance-sheet restrictions and low interest rates. London-based LiquidityChain connects users via its dark pool, non-execution platform, and will enable them to negotiate and execute trades and align trading interests via broker Mirexa Capital.


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SambaCry flaw exposes WannaCry-like weakness in Linux systems
 The SambaCry vulnerability is to Linux what WannaCry and Petya are to Windows: big security threats. Linux users are immune to most vulnerabilities and malware outbreaks that affect Windows users. But the recent discovery of a vulnerability in Samba (dubbed SambaCry) brought them back to reality. The vulnerability has since been fixed, but the discovery warrants a little discussion.

What is SambaCry?

SabmaCry is not malware like WannaCry or Petya. Instead, it is considered a vulnerability, which presents malware with a possible avenue for attack. The vulnerability–officially called CVE-2017-7494–was named SambaCry due to similarities to the vulnerabilities that WannaCry took advantage of.

SambaCry is a vulnerability in the Samba server service, which provides SMB/CIFS capability in Linux and Unix-based systems. SMB/CIFS is, basically a file and printer-sharing protocol that Windows uses. Linux systems are capable of using several file sharing protocols, but Samba is often used in mixed environments because Windows has a hard time reading Network File System (NFS) shares.

When a Linux server is running Samba, folders called CIFS shares will appear as a network folder for Windows users. Linux and Mac users can see these shares as well, but they must be running an SMB client. (Samba can serve as both a server and client.)

The SambaCry vulnerability allows a remote user to send executable code to the server hosting the CIFS share, and execute arbitrary code. That code can encrypt a file system and hold it for ransom, for instance. Needless to say, this was a big problem that had to be taken care of pronto.

Am I affected?

If you’re wondering if your Linux system is affected, the answer is, “probably.”

Affected systems can look very different. Any server that uses Samba to host files is potentially affected. That means if you share files from your Linux laptop, you could be affected. If you’re using a Raspberry Pi as a file server, it could be affected. If you’re using a Network Attached Storage (NAS) device, you could be affected.

While a system that is behind a firewall (i.e. not exposed to the Internet) is safer, all Samba users should be wary of this vulnerability.

Okay, I’m scared. What do I do?

The first thing to know before you get too freaked out is that Samba has already been patched for its 4.6, 4.5, and 4.4 branches. If you’re running a recent Linux OS (released in the past year or so), you’ll be running one of those branches. To protect yourself, you should simply upgrade the software on your device.

Normally, I’d be concerned about devices like NAS appliances because device manufacturers can be slow to provide updates. However, this vulnerability strikes at the core of NAS functionality, and major NAS providers have already offered patches to their operating systems. I checked my own Synology device (DS416j), which was updated to fix the vulnerability on May 25. I also checked QNAP’s website for an update to a random 4-bay NAS, and the software had been patched on May 27.

If you own a NAS, I highly recommend taking the time to update your NAS’s software immediately. If you don’t already have it enabled, enable automatic updates so that future vulnerabilities can be patched. Even though I have automatic updates enabled on my Synology, I’m the kind of person who wanted to check to ensure that the update didn’t silently fail.

If you’re running a home server on a Raspberry Pi or an old PC, take the time to update the system. If you’re running Ubuntu Server, simply type the commands sudo apt update and sudo apt upgrade into a terminal.

A friendly reminder

Although Linux systems rarely suffer the same type of desktop malware that affects Windows users, Linux is not completely secure purely by virtue of being Linux. Remember that just like Windows users, one of your best defenses is keeping your system up-to-date.

Output: Linux users are being urged to update their systems following the discovery of a vulnerability in the Samba server service, according to tech hacker Alex Campbell. He revealed the flaw had been dubbed SambaCry, as it exploits software in a similar fashion to the WannaCry virus which attacked Windows users, by allowing a remote user to send an executable code which can then encrypt and hold files to ransom. Campbell noted that Samba had been patched for its 4.6, 4.5, and 4.4 branches.


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Daimler issues corporate debt of €100m using blockchain
 German multinational automotive corporation Daimler AG and Landesbank Baden-Württemberg (LBBW), a commercial banking company, have jointly utilized blockchain technology in order to execute a financial transaction.

Both the companies tested blockchain successfully for capital markets along with the process needed by regulatory authorities. Daimler launched €100 million 1 year corporate Schuldschein through LBBW, within which Esslingen-Nürtingen, Ludwigsburg and Ostalb savings banks and LBBW, acted as lenders.

“This pilot project is our first step in testing the wide variety of possibilities for using blockchain technology and assessing this technology’s potential for future transactions and financial processes,” Bodo Uebber, member of the Board of Management of Daimler AG responsible for Finance & Controlling and Daimler Financial Services, said. “Simultaneously with launching the Schuldschein, we conduct other projects to determine where blockchains could also be used to increase efficiency and support our business models. LBBW has been our partner for many years. It has extensive experience in this field, and its innovative projects are helping to shape the future of the financial markets.”

The entire transaction right from the origination, distribution, allocation and execution of Schuldschein loan agreement was digitally carried out using blockchain technology in cooperation with the IT subsidiaries TSS (Daimler) and Targens (LBBW).

With this blockchain pilot project, Daimler as well as LBBW wants to test the potentials of blockchain and gather know-how for the creation of new business models. LBBW is further exploring addition areas of applications. The Schuldschein product is an ideal type of application and serves as the initial point for the development of banking services in the corporate and capital market business, the release stated.

“Blockchain technology will change the role of banks as intermediaries in the economic process. We don’t want to merely observe this development; we want to proactively shape this field. The Schuldschein is especially well-suited for our entry into the use of blockchain technology. As the market leader for corporate Schuldscheine for more than a decade we have extensive expertise. In addition within this business segment we are able to generate substantial added value for our corporate customers and for investors because the process becomes more efficient and the processing time is significantly shorter,” Joachim Erdle, Head of Corporate Finance at LBBW, said.

The pilot project of Daimler and LBBW shows that blockchain will increase the automation of financial transactions so that they can be concluded much faster and more cost-efficient manner.

Output: German car maker Daimler has partnered with commercial bank Landesbank Baden-Württemberg (LBBW) to issue corporate debt of €100m ($114m) using blockchain as part of a pilot project. Daimler is also conducting other blockchain projects to determine how the technology can be used to increase efficiency and support its business models, said Bodo Uebber, head of finance and controlling at Daimler Financial Services. By making banking processes more efficient with blockchain, LBBW is able to add value for its corporate customers, said Joachim Erdle, head of corporate finance at LBBW.


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3D scanning and printing gives patients personalised teeth
 Jun 29, 2017 | By David

3D printing has now firmly established itself as a great way to make life-changing prosthetics and implants for patients in need, but what about people just looking for a little cosmetic improvement here or there? A new dental surgery program called Digital Smile Design is making use of 3D technology to enable patients to design their own smile. They can try on a 3D printed version of their new teeth before the operation goes ahead, so they can test out how they will look and see if any modifications might need to be made.

Digital Smile Design (DSD) was invented back in 2007 by Brazilian dental surgeon Christian Coachman. The pioneering technique allows dentists to create a prototype version of the real set of teeth they are planning for patients. The digital workflow initially involves a detailed 3D scan of the patient’s mouth being taken with an intraoral scanner. This 3D model is then imported into the DSD Nemo software, where the dentist and their patient can choose from a large digital library of different, more aesthetically-pleasing shapes and forms to overlap their original teeth.

The process gives patients improved confidence in the surgery and vastly improves communication between patient and practitioner. It’s also great for diagnostics and treatment planning, allowing the dentist to choose the most effective, least invasive treatment that will fulfil the patient’s cosmetic requirements.

A desktop SLA 3D printer can then be used to make a real prototype version, based on the digital model created in the Nemo software. We've previously reported on the DFAB dental 3D printer from DWS, which is specifically designed for dental restorations and is potentially capable of building a prosthetic in under 20 minutes. The Digital Smile Design process at the state-of-the-art dental practice in the Canary Islands, Spain, run by Pablo Ramírez and his brother Alejandro, makes use of Formlabs’ Form 2 3D printer. ‘’We then place the model in a silicone index, which creates a negative of the teeth within the index,’’ says Ramirez. ‘’Then we use a thin layer of temporary acrylic to form the teeth directly in patient’s mouth.’’ Formlabs Standard Grey and White Resin is used, which prevents any layer lines showing on the teeth.

Digital videos and photos are then taken of the patient’s mouth with the model, so they can plan out what changes will be happening. Before 3D printing technology was as accessible to dentists as it is now, an analog method was used to create the model of the patient’s teeth. A dental technician would have to drop a special type of wax into a physical impression of the mouth, which could take up to 10 days to complete. Now, a patient can get a preview of their new smile within a few days of the first visit. This breaking down of the time barrier simplifies the whole workflow, allows for better planning, and saves on costs.

According to Ramirez, ‘’Digitally trained technicians and dentists are becoming the standard nowadays, and their collaboration is a must in order to achieve the best results. But even though technology has changed our daily workflow and is here to stay, the basic principles like respecting biology and treatment planning will always be crucial in dentistry.’’

Posted in 3D Printing Application

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Output: A high-tech dental surgery in the Canary Islands is pioneering a 3D printing technique to enable people to customise their teeth. Digital Smile Design (DSD), first invented in 2007, is being used by siblings Pablo and Alejandro Ramírez to offer clients a digital way to correct their teeth with optimal precision. After a digital scan is taken of the patient's mouth, it is imported into the DSD Nemo software, allowing the dentist to choose from a library of shapes and forms. DSD enables better diagnostic and treatment planning and is a less invasive, faster way to offer cosmetic dentistry than traditional analogue models.


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Diabetes management platform Glooko raises $35 million
 Diabetes data management company Glooko has raised $35 million in new funding. The company already had strategic investments from Samsung and Medtronic; in this new round the Mayo Clinic and insulin pump maker Insulet join those ranks. Toronto-based Georgian Partners led the round, with participation from existing investors Canaan Partners and Social Capital, in addition to the aforementioned health and tech stakeholders.

This is the company's largest funding round to date and it more than doubles the company's coffers, bringing its total funding to $71 million. It most recently raised $8 million in connection with its merger with European counterpart Diasend.

Glooko has always been in the business of helping patients, providers, and tech companies manage diabetes data, but what exactly that means has changed as the technology has evolved. The company started out making adapter cords to connect glucometers to smartphones. Nowadays, it's more about data analytics and artificial intelligence, not only to collect data, but also to analyze it and turn it into actionable insights that can help people better manage their diabetes.

"This additional funding will help us to further our mission: to improve the lives of people with diabetes,” Rick Altinger, CEO of Glooko, said in a statement. “With this capital, we will accelerate our investments in clinical solutions that aim to increase medication adherence, provide personalized insights and prompts that drive behavior change for people with diabetes, and deliver clinical decision support to thousands of clinicians and coaches so they can better support people with diabetes in between office visits.”

Glooko works with a wide array of provider, payer, and pharma customers, as well as with other technology companies in the diabetes management space like Dexcom, with whom they recently expanded their longstanding partnership.

The company says it plans to use the new funding for a little bit of everything: to expand its sales and marketing teams; to increase international commercialization efforts in France, Germany, the UK, Asia, and the Middle East; and to continue to invest in research and development to improve its platform.

Output: California-based diabetes data management company Glooko has generated $35m in a funding round led by Georgian Partners, and featuring participation from Mayo Clinic, Insulet and existing investors Samsung and Medtronic. Glooko uses data analytics and artificial intelligence to turn patient data into practicable insights and develop personalised treatment plans. The funding will be used to expand sales and marketing teams, boost commercialisation efforts across Europe, Asia and the Middle East, and invest in R&D.


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Dubai Police deploys robot cars with built-in drones
 Living in Dubai these days must feel a bit like Detroit circa 2043, minus the shadowy megacorporation turning murdered cops into baddie-slaying cyborgs. Fresh off the oil kingdom's plans to create an autonomous drone taxi service—and an attempt at their very own RoboCop—the Dubai Police Force has announced the creation of a fleet of self-driving, drone-deploying miniature police cruisers that can scan their surroundings for wanted criminals, and more ominously, "persons of interest."

If that sounds a little dystopian for your taste, well, the rest of the details won't do much to change that. Created by Singapore robotics firm OTSAW, the O-R3 units will send a live video feed via a 360-degree camera to a central monitoring station so Dubai Police can see what's going on at any time. Thanks to biometric software and scanners, the robot will also be able to "identify suspicious objects and track suspects," according to Brigadier Khalid Nasser Al Razooqi, the director of the police force's Smart Services program.

But should one of those suspects attempt a quick getaway, or just hop a fence as seen in the demonstration video below, the O-R3 is also capable of launching a camera-carrying drone at the touch of a button to continue the pursuit. The whole package is about the size of a Power Wheels toy, so it should be able to use paths and alleyways that are too small for the Dubai Police's fleet of supercars.

Output: The Dubai Police Force has said it will deploy a fleet of miniature autonomous cars, built by Singapore robotics company OTSAW, to patrol the city's streets. The vehicles, called O-R3 units, will transmit a live video feed back to a central monitoring station and come equipped with biometric software and scanners to help them identify suspicious persons and objects. The cars also carry an onboard drone, which can be released to get an aerial view of a scene or track suspects. Dubai Police has a target of replacing 25% of its patrol force with robots by 2030.


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Purplebricks claims it's on track for UK's top estate agent spot
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Purplebricks this morning announced UK revenues of £43.2m for the year to the end of April and an operating profit of £200,000.

Revenues were way over double achieved in the same period the previous year, which stood at £18.6m.

In Australia, Purplebricks had revenue of £3.5m but made an operating loss of £6.1m.

Altogether, Purplebricks lost £6m across both operations, which brought in £46.7m.

Average income per instruction in the UK stood at £1,035, and Purplebricks claimed it sold and completed on over £5.8bn worth of UK property, with a sale agreed every nine minutes, 24/7. It did not say how many properties it sold, but claimed its current conversion from instruction to sale is 83%.

This morning, City analyst Anthony Codling of Jefferies was sceptical.

He said: “Purplebricks is not, in our view, a shy and retiring company, until it comes to disclosing how many homes it sells.

“However, whilst we do not know the number of homes it has helped to sell, a key performance indicator in our mind, we do know that it delivered losses of £6m in FY2017 against our estimate of a loss of £4m. We hope that at the results presentation we can coax the shy company to reveal the number of homes it has helped to sell.

“Marketing spend in FY16 was £12.9m rising to £18.2m in FY17 and it will start with a ‘2’ in FY18. The digital model may not have to fund a branch network, but it appears to us that the virtual high street is not as cheap as one might imagine.”

Purplebricks chief executive Michael Bruce said: “This has been a very successful year in the early development of the Purplebricks model and brand.

“We have materially grown our national footprint and have built a growing brand awareness and reputation for delivering customers a more convenient, transparent and cost effective service. In tandem with our growth we have invested in the business and strengthened the management team.

“This has allowed us to significantly grow our number of positive reviews on the independent review site Trustpilot (currently with over 20,000). We have retained our rating of excellent.

“Purplebricks is now in a strong position to become the no.1 estate agent in the UK for both listings and sales.

“With the UK business now in profit it is encouraging to see Australia following a similar growth trajectory. Just eight months in and Purplebricks already operates in five key states, which represent 85% of all Australian property transactions. The launch of our Commisery campaign in Australia from May 2017 will further accelerate progress.

“All of this bodes well for the US, where plans to launch, first in California, in the second half of the calendar year are progressing at pace.”

Purplebricks also said it is confident about its prospects and of meeting the board’s “increased expectations”.

Output: Online estate agent Purplebricks announced UK revenues of £43.2m ($56.2m) for the year to end April, more than double last year's £18.6m. Purplebricks completed over £5.8bn worth of UK property sales, agreeing a sale every nine minutes, said CEO Michael Bruce, adding that the results show the company is on track to become the number one estate agent in the UK. The firm delivered a total loss of £6m for FY2017 across its UK and Australian operations; Jefferies had estimated a loss of £4m and noted that Purplebricks had yet to divulge the number of properties it helped to sell.


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Cozmo's Anki robot to help kids learn to program
 Plenty of toys on the market promise to provide the next generation of coders and engineers with the foundation they’ll need to compete in the rapidly-changing job market. But in a sea of coding-for-kids products, an update to Anki’s holiday-shopping darling, Cozmo the robot, offers a chance for young would-be coders to tap into a complex machine capable of advanced feats, like facial recognition.

Since its release last year, the almost-too-cute tread-traveling bot, which was designed to spark an emotional, Wall-E-like connection with people, has become wildly popular, so it represents a well-established platform. It’s also a complex machine, with 1.6 million lines of code running between the robot itself and its companion app. The adorable bot can recognize individual faces, expressions, and imitate human emotions. Its “personality engine” leverages AI to allow it to emulate a human by doing things like losing interest in a specific game after playing it multiple times.

Since Cozmo’s launch, university students and others have been programming it through a software development kit. But to do that, they had to know the common coding language Python. That changed on Monday, when Anki opened up Cozmo’s brain to novice code-writers via a simple visual system based on Scratch, a graphical programming language developed at the MIT Media Lab. They call the new feature Code Lab.

Programming with pictures

With Code Lab, users can create basic programs by dragging and dropping blocks that symbolize advanced concepts. For example, a child could build a simple program that begins with a block that tells Cozmo to wait (symbolized by an hourglass) until it sees someone smile (depicted by a happy face). The next block in the sequence might tell the bot to drive. When the beginning coder executes the program, Cozmo won’t go until it detects a grin.

Right now, that graphical code runs left to right in what’s known as a “horizontal grammar.” The next release in Code Lab will run a “vertical grammar” that goes from top to bottom, and can incorporate more complex actions, including well-known commands like conditional “if-then-else” statements that coders use in professional programming languages.

Languages like Python are text-based, but Anki has based Code Lab off the decade-old graphical programing language Scratch. (Think pictographs, not words.) The result is that Anki is making it very easy to program a complex robot to do advanced stuff, like recognize faces and expressions.

“We’re trying to figure out how to give people, in this case even kids or complete beginners, access to real robotics tools and functions,” says Hanns Tappeiner, the president and cofounder of Anki. “And when I say ‘real,’ I don’t mean lights blinking, or your robot driving straight, but we’re really talking about things like face recognition, face tracking, facial expression recognition,” and more.

A simple program. Anki

Robots that do kids’ bidding

Cozmo joins other kid-friendly programmable robots already on the market, like LEGO Mindstorms EV3. Aspiring coders can program that system using a LEGO-developed visual language that also uses graphical blocks to symbolize functions like actions. In August, the company will release a new system called LEGO Boost, also with its own visual programming language that’s geared towards kids aged 5 to 12. But neither of those systems are capable of doing facial recognition, even if EV3 does have sensors that allow it to respond to stimuli like touch and color.

And children can also program robots called Dash and Dot by using a Google-made visual programming language called Blockly, or an other one called Wonder that Wonder Workshop, the company behind those robots, created. Dash has distance sensors and microphones and can do things like turn towards a person who is speaking, and has awareness of other robots around it.

Using tech for creativity

MIT Media Lab created Scratch in 2007, and Anki is utilizing an open-source version called Scratch Blocks that was developed as a collaboration between Google and MIT. Kids who use Scratch are “learning the core computational concepts that are important for any other type of programming language,” says Mitchel Resnick, a professor of learning research at the MIT Media Lab and one of Scratch’s creators.

Ultimately, Resnick says that how tech is incorporated into toys matters. “I think it’s really important that we use new technology not just to deliver entertainment, or to deliver instruction,” he says, “but more to provide opportunities for kids to design, create, experiment, and explore.”

Output: San Francisco-based robotics firm Anki has launched Code Lab, a feature which opens up its robot toy Cozmo to budding programmers. Based on the Scratch visual system co-developed by Google and the Massachusetts Institute of Technology, users can drag and drop blocks that symbolise concepts, including facial recognition, to program the robot. The initial stage uses a very simple sequential language, but Anki said the subsequent version will allow for more complex loops and conditional statements. The aim is give "even kids or complete beginners access to real robotics tools and functions,” said Anki co-founder Hanns Tappeiner.


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Robot with gecko-like grip could help remove space junk
 Litter picker for the space age Ger Bosma/Getty

In space, grabbing onto things is hard. A new robot that uses grippers inspired by gecko feet could solve that problem, helping clear up the mess of debris that orbits Earth.

The toaster-sized device can grip, hold onto and move around even large, smooth surfaces in microgravity, on both flat and curved objects. To do this, it uses a “dry adhesive” material created by Hao Jiang at Stanford University in California and his colleagues.

“This ability to grab onto an object nearly anywhere, instead of needing a specific grapple point that may not even be there, is really advantageous,” says Matthew Spenko at the Illinois Institute of Technology in Chicago. “It means you don’t need a precision approach.”

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In an environment where an accidental nudge can send something flying and space debris can be travelling faster than the speed of sound, agility is key.

Get a grip

Geckos can hold onto almost any smooth surface with just a few toes, which are covered in tiny rubbery hairs. The ends of those hairs split off into such small strands that they interact with the molecules of any surface the gecko is climbing. This produces a Velcro-type effect that acts as an adhesive only when the gecko’s toes are pulling along a surface and bending – an action that increases the area of the touching hairs.

The researchers mimicked this trait for their gripper, which features a thin sheet covered in protruding wedges one-tenth of a millimetre wide. These micro-wedges stick to a smooth surface when they bend as they are pulled across it. Single sheets of this type of material have been used before to create tiny robots that can climb smooth walls while dragging heavy loads.

Jiang and his colleagues used two wedge-covered sheets with a robotic pulley that pulled the sheets together once they touched an object. This made the system stronger than the single-sheet version by locking the object between two sets of wedges. Attached to a robotic arm, the device could gently grab and secure even large pieces of debris.

Remains of decay

Space junk in Earth’s orbit is a growing problem. Bits and pieces of dead satellites, spacecraft and other discarded or broken-down equipment whizz around our planet, all potentially hazardous to working satellites and the International Space Station.

Of the hundreds of thousands of pieces of debris, more than 20,000 are larger than 10 centimetres across – big enough to smash a piece off a satellite and create even more orbiting junk.

Ideas proposed for collecting the junk include sweeping it up with a giant magnetic net or vaporising it with laser beams, but none have yet worked out – and for now, nobody is picking up the trash.

That’s where a new robot comes in. The harsh environment of space makes the methods we use to grab things on Earth ineffective. A suction-based system can’t be used, because there’s no air for it to suck up. Robotic arms with grasping “fingers” only work if there’s something to grab onto, but many pieces of debris have smooth, flat sides.

Normal adhesives stop being sticky in the cold vacuum, and even sticking down a piece of tape requires enough force to make the object you’re adhering it to float away. More sophisticated schemes are often too big and heavy to launch into orbit.

Garbage grabber

The researchers tested their gecko-inspired grabber in the temporary weightlessness of a parabolic aeroplane flight, and using pressurised air at NASA’s Jet Propulsion Laboratory (JPL). They even sent a pared-down version for astronauts to try out on the International Space Station.

On the aeroplane, the device was able to grasp and move around cube, cylinder, and sphere-shaped objects and then gently release them without affecting their motion. At the JPL, it autonomously attached to drifting objects more than 100 times its size and mass. On the space station, it held on to a wall for weeks at a time.

“It’s hard to get all those little gecko pads in contact with the surface and evenly distribute the load, especially if it’s going to work with both flat and curved objects,” says Spenko. “What’s really impressive in this work is that they scale it up and show that it works in a larger size.”

The gripper may be put to use collecting pieces of drifting space debris for disposal, but it could also be used on a robot that can climb on the outside of spacecraft, or to help with autonomous docking between spacecraft.

Journal reference: Science Robotics, DOI: 10.1126/scirobotics.aan4545

Read more: ‘Soccer-ball’ robots to patrol space for deadly junk

Output: Researchers at California's Stanford University have developed a robot capable of holding smooth-sided objects, thanks to grippers that mimic gecko feet. The animal's toes are covered in tiny rubbery hairs that produce a Velcro-type effect when they pull and bend along other surfaces. The researchers covered the gripper in a thin sheet with protruding micro-wedges one-tenth of a millimetre wide, and concluded that this could produce an improved system for securing big pieces of debris. Tests were conducted in a parabolic aeroplane flight, in NASA’s Jet Propulsion Laboratory, and inside the International Space Station.


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Ant unveils AI-driven car-damage claims tool
 Imagine a world where automobile damage can be assessed by an algorithm in six seconds, and you'd be where Ant Financial is today.

The Alibaba Group financial affiliate on Tuesday rolled out an artificial intelligence-driven, image-recognition system to aid vehicle insurance claims adjustors in operating faster and more-efficiently.

Exterior damage claims comprise about 60% of the 45 million private-vehicle insurance claims filed in China each years, so the AI system is expected to save insurers significant time and resources. The AI system is also aimed at making assessment of external vehicle damage more-standardized and objective, reducing the potential for human claims adjusters on the scene to be influenced by the parties involved in the accident.

'It is a technology that we are constantly working on to improve, therefore we are offering it for free to insurance companies. We are opening up our AI capabilities to our partners, so that they can reduce cost and better serve small and micro-businesses,' said Yin Ming, president of Ant Financial's Insurance Business Unit.

[Attachment] Rolling out a new service for insurers

Ant is initially offering the AI damage-assessment system only to insurers, but plans to make the product available to car owners within a year.

The idea is that, if you've been involved in an accident, you would no longer have to wait for a claims adjuster to arrive on the scene to assess the damage to your car. Instead, you'd simply take a photo with your smartphone and send it to your insurer. AI would then enable the insurance company to assess the extent of the damage, cost of repair and list nearby repair shops and their different prices to fix the damage.

In its rollout demonstration in Beijing, Ant pitted man against machine, with its algorithm squaring off against six experienced human claims adjusters in 12 separate cases. The machine took six seconds to assess the damage and set claim amounts for the 12 cases. The human claims adjusters took 6:48 to reach their conclusions. Both machine and humans judged that one of the 12 cases required further investigation.

Initial reaction from insurers was positive.

'We have been trying everything to improve efficiency. Ant's team achieved what we have done in the past five years by working on this for a year,' said Yu Ze, general manager of China Taiping Property Insurance Co., who was attending the event.

Ant's launch of the system came on the same day that the MIT Technology Review named the company to its list of the 50 Smartest Companies of 2017.

Companies on the list exhibit technological leadership and business acumen. Ant made the list for applying AI technologies to financial services online and exploring blockchain technolgies to build a more-transparent charity platform.

'The companies on the list combine a high level of technology innovation with a business model that will help them make the most of it,' said Nanette Byrnes, the publications' senior editor for business. 'Public and private, large and small, based in countries around the globe, this group of companies is creating new opportunities and pouncing on them. These are the ones that competitors must follow.'

Ant said its technology is pushing out the borders of the financial services sector's technological infrastructure and making the sector more-accessible.

'As technologies, including AI, security, computing infrastructure, blockchain and biometrics continue to evolve, we have the opportunity to work with our partners and collaboratively redefine a new technology infrastructure for financial services. This will make global financial inclusion possible,' said Cheng Li, CTO of Ant Financial.

Output: Ant Financial, the finance unit of Chinese e-commerce giant Alibaba, has created an artificial intelligence (AI)-driven tool that will allow insurers to assess car-accident damage and establish repair costs within seconds. The system requires claimants to use their smartphones to photograph damage, which will then be assessed by the AI's image-recognition software. The technology can estimate repair costs and suggest suitable mechanics. In tests against six human assessors, the AI system came up with the same result in six seconds, compared with almost seven hours for the humans. The platform is expected to eventually be offered to individuals as well as insurers.


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Redrow Anwyl secures £23m contract in Prescot, Merseyside
 Housebuilder and contractor Anwyl has secured its first deal through its new Lancashire business.

The firm has won a £23m contract to build 122 homes on the former home of the Prysmian Cable Factory in Prescot, Merseyside.

Mathew Anwyl MD housing

‘An easy sell’ – Read the full interview with Anwyl’s MD on how his firm poached top housing talent

The site forms part of the wider Prescot Park development, which will deliver around 750 homes alongside major public realm improvements.

The deal is the first project that Anwyl’s new Lancashire housing division has secured since its launch in April.

Anwyl poached former Redrow Homes North-west managing director John Grime (pictured above, left) to head up the business earlier this year, which has a turnover target of £75m within three to five years. The new division also plans to be completing more than 300 homes annually within the same timescale.

Work on the Prescot Park site is expected to start in early 2018 and take around four years to complete, with a sales office opening on the site in spring next year.

Mr Grime said: “We are delighted to have acquired our first piece of land for the new region. The plans for the development are really exciting and we are confident that our first venture in the area will be well received.

”Prescot is a fantastic location to live, providing many facilities as well as having excellent communication, being accessible via the nearby motorway network and the wider Liverpool area.”

Alongside its homes business, Anwyl is also plotting two developments in the Merseyside area: a £60m PRS development on Pall Mall in Liverpool city centre, and a £35m student accommodation project, also in the city centre.

The £60m PRS scheme, which ranges up to 22 storeys in height and contains 366 homes, was given the green light by city planners in March this year.

Output: Housebuilder and contractor Anwyl's new Lancashire housing division has secured its first contract: a £23m deal to build 122 homes on a development site in Prescot, Merseyside. The announcement followed Anwyl's poaching of former Redrow Homes northwest managing director John Grime to head the business. Work on the four-year Prescot site is set to begin early in 2018 and is expected to take about four years.


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UK, Irish shares may be worst hit by Mifid II dark pool trade cap
 Research has found 89% of stocks in the FTSE 100 and FTSE 250 will breach MiFID II’s dark trading market-wide cap come January 2018.

A report from Rosenblatt Securities measured how the dark trading caps would affect trading in 757 stocks across 18 major European indexes, with data provided by Bats Europe.

It found just fewer than three-quarters of stocks would hit the 8% threshold, with UK and Irish stocks hit hardest.

MiFID II’s dark pool restrictions will see the introduction of a double volume-cap, which will trigger bans on certain types of dark trading when a transaction accounts for 4% of the total activity on a single dark venue, or 8% of total trading market-wide.

Trades breaching the 4% venue-specific cap will be subject to a 6-month ban on the venue in question, while issues exceeding the 8% market-wide cap trigger a 6-month dark trading ban across Europe.

Market participants have slammed the dark pool caps as restricting the most effective method of trading.

Panellists at TradeTech earlier this year agreed dark pool trading allows for minimal market impact and often provides the best price for clients, but MiFID II will stifle this with the introduction of double volume caps.

“Any regulation that limits buyers and sellers coming together at an agreed price is wrong for the market place. The volume caps are very arbitrage numbers,” said Ralston Roberts, co-head of electronic trading at Goldman Sachs in Europe.

The report also fund less-liquid issues will suffer disproportionately under the caps, with 83% of mid-cap index constituents set to breach the 8% threshold, compared with 67% of large-cap index constituents.

“These names are already difficult to trade, which makes dark pools an appealing alternative for buy-side traders seeking to minimise information leakage and market impact,” said Anish Puaar, author of the report and European market structure analyst at Rosenblatt Securities.

“It will be interesting to see how restrictions on trading these stocks in the dark affect investor outcomes under MiFID II.”

Output: UK and Irish stocks will be among the hardest hit by EU regulations that seek to limit off-exchange securities trading, according to a report based on data from one of the digital venues for the so-called dark pools. A trading volume threshold will be introduced when the Mifid II rules come into force in January, potentially limiting trading in 757 stocks across 18 European indexes. Trade in 89% of FTSE 100 and FTSE 250 stocks are likely to be affected, said the report by brokerage Rosenblatt Securities, based on Bats Europe data.