The Wall Street Journal: Drugmaker Led By Ex-CEOs Of Pfizer, Celgene Buys Three Painkillers STAT: Drug Makers Paid Fewer Fines For Bad Behavior In Recent Years The Wall Street Journal: Valeant Asks Its Lenders For Some Slack Study: Drugmakers Paying Fewer Fines For Breaking Federal Health Laws In its analysis, Public Citizen found that financial penalties paid by pharmaceutical manufacturers have declined in recent years. The watchdog organization is calling for an increase in enforcement efforts. In other pharmaceutical news, the Federal Trade Commission is calling for more information on a merger pending between Pfizer and Allergan. News outlets also report the latest on Valeant’s challenges. This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. Pain treatment maker Centrexion Therapeutics, founded by former chief executives at Pfizer Inc. and Celgen Corp., agreed to acquire three new painkilling candidates from Germany’s Boehringer Ingelheim GmbH in a bid to expand its proprietary pipeline. Financial terms weren’t disclosed in the deal for nonopioid and nonsurgical chronic pain treatments. (Steele, 3/30) Pfizer Inc. and Allergan PLC on Wednesday said federal regulators are seeking more information on their pending merger deal, a so-called inversion that would create the world’s biggest drugmaker and move one of the top names in corporate America to a foreign country. The request from the Federal Trade Commission was “fully anticipated as part of the regulatory process,” the companies said. They still expect the deal to close in the second of this year. (Steele, 3/30) The Wall Street Journal: FTC Seeks More Information On Pfizer-Allergan Merger Valeant Pharmaceuticals International Inc. said Wednesday it was seeking more room from lenders to stave off a potential default. But stock investors were unnerved, as Valeant inched back from earlier assurances about its ability to hit financial targets required by its lenders. The Canadian drug company, struggling in recent months with questions over its accounting and business practices, said it had begun seeking a deal with lenders to give it more time to file its delayed 10-K annual report. Valeant also said it was seeking “additional cushion” from lenders on some terms of its debt. (Rapoport and McNish, 3/30) The amount of money big U.S. pharmaceutical manufacturers have paid to settle charges for violating federal health care laws has declined sharply in recent years, prompting a non-profit watchdog group to call for an increase in enforcement efforts. In a new analysis that chronicles 25 years worth of pharmaceutical industry settlements and court judgments, the group, known as Public Citizen, found that just $2.4 billion in federal financial penalties were recovered from 2014 to 2015 – a figure that is less than one third of the $8.7 billion recovered from 2012 to 2013. (Lynch, 3/31) Reuters: Decline In Financial Settlements With U.S. Big Pharma: Report After a decade in which drug makers regularly paid huge fines for various fraudulent practices, there was a noticeable drop over the past two years, according to a new analysis by Public Citizen, the consumer advocacy group. (Silverman, 3/30)
Free Webinar | July 31: Secrets to Running a Successful Family Business Next Article Three former Tesla workers have told The Guardian in on the record interviews that they were unfairly dismissed for matters concerning pregnancy and time off for childcare.Devon Beccera worked for Tesla’s Gigafactory in Nevada for 11 months from February 2018. She found out she was pregnant in July of that year, and informed the company of her plans to take maternity leave in February 2019. However, she was fired in December 2018.”Nevada is a right-to-work state, so they didn’t need any sort of reason for firing me, but it was very convenient to fire me two weeks before Christmas, and about 50 days before my maternity leave started,” she told The Guardian.A Tesla spokeswoman told Business Insider that the company terminated Becerra’s employment due to performance issues, despite The Guardian reporting that she was promoted to be a supervisor last year.Customer care agent and mother of four Jennifer Peercy worked for Tesla in Las Vegas. She was more than five months pregnant when colleagues started offering her their time off to help with childcare.When management found out, it told her the time off wasn’t transferable. Peercy said she stopped taking it. Nonetheless, she was fired two weeks later.”If I knew that, I never would have taken it. I’m 22 weeks pregnant without a job or income and four girls to care for,” Peercy told The Guardian.Tesla said it was sympathetic to Peercy’s personal situation, but said she broke company rules by using a colleague’s personal information to take time off.”Ms. Peercy was terminated following an internal investigation where it was confirmed she had used another employee’s personal information to wrongfully access their family care benefits,” a spokeswoman said.”While we’re sympathetic to her personal situation and work hard to do the right thing by our employees, using another employee’s personal information to obtain their benefits — with or without their permission — violates the benefit policy, jeopardizes employee’s access to those benefits and is not appropriate behavior we can support.”An aerial shot of the Tesla Gigafactory in Nevada.Image credit: Reuters | Bob StrongMaggie Aranda worked at the company’s Fremont, California, plant for 19 months when she was fired for using her cellphone at work. Aranda said she had obtained permission from her supervisor in order to call her husband, who also worked at Tesla, but was sick at the time.”My supervisor then told me two hours into a shift to clock out and go home. They did an ‘investigation’ and then fired me for cellphone usage,” she said.A Tesla spokeswoman confirmed Aranda was terminated for using her cellphone. Her husband Carlos tried to tender his resignation on June 24, but was informed he had already been terminated effective June 26, Tesla said.Tesla’s spokeswoman said he had been fired over a tweet that violated company policy. Maggie Aranda told The Guardian that the couple are now homeless.The Guardian also interviewed anonymous workers who said the company is stringent on time off, and that it uses a points-based attendance system. The Guardian said it obtained documents, dated June 23, that confirmed the policy, which said workers can be fired if they accrue more than 4.5 attendance points in a six-month period.A Tesla spokeswoman contradicted this, saying it isn’t policy or practice at the company, and that employees can take sick leave regardless of the amount of paid time off they have. This story originally appeared on Business Insider 3 min read Add to Queue 3 Former Tesla Workers Claim They Were Fired After Becoming Pregnant, Taking Childcare Leave and Making a Phone Call Register Now » A Tesla store. Learn how to successfully navigate family business dynamics and build businesses that excel. 34shares Tesla July 10, 2019 Image credit: Justin Sullivan | Getty Images Isobel Asher Hamilton Tesla disputes the employees’ claims, saying they were terminated for performance-related issues.
Author Liberty Access TechnologiesPosted on October 23, 2018Categories Electric Vehicle News Guillaume Pelletreau, Vice President and Managing Director, Nissan Center Europe, said:“We strongly believe in an emission-free future Leaf batteries could make an important contribution to energy transition in Germany and a sustainable future.”Nissan LEAF uses V2G through CHAdeMO charging standard (the concept and bi-directional chargers are shown at the Move360 fairs in Munich). German manufacturers, on the other hand, use CCS Combo charging standard and so far we haven’t seen much interest in V2G from them.The drawback of V2G is that bi-directional chargers are expensive and there are almost none besides those used in pilot projects.eMove360 2018 starting pic.twitter.com/2rqtuoeSOF— CHAdeMO (@CHAdeMO_eu) October 16, 2018 Europe Overtakes Japan In Number Of CHAdeMO Chargers Source: Reuters But is there a market for V2G already?Vehicle-To-Grid (V2G) is the concept that enables bi-directional energy flow between an electric car and the electric grid (or building), which at scale could enable cars to become disposable energy storage systems (while connected) to help the grid at peak demand or emergency situations.The possibility to use EV’s batteries is more tempting as more cars with big batteries hit the roads. For example, 1 million EVs that would (if needed) discharge to the grid just 10 kW through a bi-directional DC charger would provide 10 GW of power in a matter of seconds.Currently, the V2G concept is tested in various countries in pilot projects. Recently, the Nissan LEAF was approved for V2G in Germany (athe s first car), which suggests that new projects are in the pipeline.See Also China Turns To CHAdeMO For Fast Charging: Single Unified Standard Source: Electric Vehicle News Nissan Joins Forces With E.ON For V2G And Renewable Energy
14 photos Deep Blue Metallic Tesla Model 3 Gets Aftermarket ADV.1 Wheels The Dark Knight is back, this time with 21″ Strasse WheelsFor the recent few months, there’s been a steady flow in of rather interesting looking Tesla Model S aftermarket builds. This is mostly due to the vehicle’s popularity, but also, the more acceptable price point of used Model S vehicles. For this particular Model S, going dark is the theme. And we have nothing against it- whatever some may say.Take a look at more Tesla tuning projects Matte Blue Tesla Model S P90D With ADV.1 Wheels And Aftermarket Parts This particular vehicle is a Tesla Model S P100D. Coming with a well-familiar dual-motor setup, the P100D excels in straight line performance. The vehicle uses a massive 760 horsepower and it affords the owner with the all-too-familiar tire screeching sonata at the tune of 722 lb-ft of torque. The Model S P100D will sprint from 0-70mph (0-100km/h) in just 2.68 seconds, making it one of the fastest street legal, mass-produced vehicles in the world.The Model S comes with a dual motor setup delivering 760 horsepower, while the same setup in the Volkswagen I.D R Pikes Peak delivers 670 horsepower. Torque wise, the difference is even more pronounced. The Tesla plays the all-too-familiar tire screeching sonata at the tune of 722 lb-ft of torque. On the other hand, the VW I.D R will utilize “just” 479 lb-ft of torque. However, the VW’s racer weighs a little over a metric tonne (2,204lbs) – less than half the weight of the 2,241kg (4,940lbs) Tesla P100D.For this Model S, the owner wanted to give his vehicle a more menacing look. This is done due to a completely blacked out exterior, matched with red details such as the Tesla logo in the front and in the rear. Furthermore, the most impacting part of this build are the directional Strasse Wheels. Coming in at a whopping 21×9 at the front and 21×10.5 at the rear, these wheels help fill out those huge wheel arches perfectly. Naturally, the wheels come in Gloss Black, perfectly revealing the bloodshot red brake calipers behind them.You can view the full build gallery of this Model S P100D right below. Source: Carscoops Check Out This Matte Black Tesla Model X With HRE S209 Wheels Source: Electric Vehicle News Author Liberty Access TechnologiesPosted on November 7, 2018Categories Electric Vehicle News
Author Liberty Access TechnologiesPosted on November 24, 2018Categories Electric Vehicle News Source: Electric Vehicle News Following long-term speculation regarding a race in the Australasian region, the consortium will make a serious play to get Auckland on the season six schedule.The consortium, led by Vector Energy, the New Zealand International Convention Centre, the Auckland University of Technology and Drive Electric, will look to stage a race on a yet-to-be-confirmed downtown site, with either late 2019 or early 2020 the desired timeframe.Discussions with Formula E have begun, with the focus now on getting local and central government to increase its involvement in the bid.According to Craig Cotton, the CEO of the NZ Innovation Council and a senior member of the Auckland bid, an e-Prix would help Auckland reach its targets of being 100 per cent renewable by 2035 and carbon neutral by 2050.“From our discussions, Formula E is motivated to come here and has shown an appreciation for our inherent affinity for the environment – and our ambitious sustainability targets,” he said.“There is a crucial role for electric transportation to play in achieving those targets. We need to start delivering the technology to create a mobility system that actually improves the lives of New Zealanders.“We have an opportunity to excite and engage Kiwis in a smarter, cleaner, more connected and economically sustainable future.“How do we ease congestion, drive down fuel costs, display global leadership by achieving our 2035 and 2050 environmental goals, and improve access to mobility for all Kiwis? Formula E is the ideal stage to help us engage, learn and push for solutions and outcomes.“It will also provide Auckland with a sporting event that will show the world what a spectacular city it is, positioning New Zealand as not just the best place on the planet, but the best place for the planet.”Read Also:Seven female racers named in Saudi FE test line-upToro Rosso target Albon named on FE entry list Former Formula 1 driver Mark Webber has also thrown his support behind the bid.“It’s imperative that this part of the world – Australia and New Zealand – doesn’t get left behind by the rest of the world as it forges ahead developing technology and infrastructure for the future,” said the Porsche ambassador.“Someone needs to lead the charge here, and I’m pleased that Auckland appears to be jumping at the chance.“When you look at the list of cities involved, and the companies involved, you can see that Formula E is where the future of personal transportation is being shaped, I can certainly speak on behalf of Porsche’s commitment to the championship and its vision.“On top of that, having a local in Mitch Evans in a factory team competing at the front end of such an exciting and high-profile championship will be absolutely fantastic for Kiwi fans to get behind.”Autosport/Motorsport.com understands FE is keen to add a race in New Zealand or Australia to its current calendar.The championship would also like to visit additional cities in Asia, with Seoul and Tokyo high on its list of priority venues.It is understood that any plans for a Tokyo race are made complicated by the city’s roads being owned by the police and not a local authority. An Auckland-based consortium has formally launched a bid to bring Formula E to the New Zealand city in either 2019 or 2020.
The Hyundai Kona is considered by many as the mainstream, completely ordinary, and easy to live with compact battery-powered SUVFor many, the dawn of the electric revolution in the automotive world meant flashy and high-powered Tesla’s, packed with impressive additions from the likes of the Model S and Model X. However, for most of us, until the electric vehicle becomes mainstream, it could all be considered just a fad. Not a steady course for the automotive industry.In turn, the advent of a vehicle such as the Hyundai Kona, signifies that mainstream entry of a model that might be electric, but it’s not expensive, it’s not overwhelming (or underwhelming for that matter) in any area, it does its job well, and it brings the electric revolution to the middle of the market.More about the Hyundai Kona Author Liberty Access TechnologiesPosted on January 8, 2019Categories Electric Vehicle News Canadian Hyundai Kona Electric Buyers Observe Delays, Poor Communication 61 photos Mainstream EVThe Hyundai Kona starts at $37,495 – or $29,995 once you factor in the $7,500 federal tax credit – it promises an EPA rated 258-mile range on a single charge and to many, is the best bang for buck electric vehicle out there. Yes, in some areas, it may even surpass the highly coveted Tesla Model 3 – the entry level model from the California based carmaker.In all, the Kona pretty much makes the EV normal. And that’s a good thing. It brings not the performance figures as the staple of its existence. It doesn’t push forward with fancy autonomous driving technology. And it certainly doesn’t offer luxurious gizmos like a huge front touchscreen, highly refined leather seats or an all-encompassing glass roof. But, it does bring EVs into the mainstream, that’s for sure.The appeal of the Kona is underlined in an article by the Automobile Mag. It’s this article where the South Korean EV gets most of its praises. And to be frank, most of them are highly warranted. It’s a good read that gives us a rather objective look at one of the most appealing EVs on the market today. Furthermore, it shows us that nothing will stop the electric revolution, no matter how hard some try. And to put matters into perspective, as stated earlier, the Kona is not some highly expensive luxurious piece of electric motoring that most can only dream of owning. It’s a vehicle that costs just a bit more than a VW Golf, does exceptional mileage and looks good enough to appeal to the younger crowds. And by that, the Kona is bringing the EV to the mainstream in a rather spectacular way. Hyundai Kona Electric Defrost Test: Video Winter Driving Kills Hyundai Kona Electric Efficiency: Video Source: Electric Vehicle News Source: Automobilemag
The biggest plug-in manufacturers (as automotive groups)Here is one more look at the plug-in electric car sales in 2018 – by automotive groups, which in the case of multi-brand manufacturers is interesting.The first two places are occupied by Tesla (12% share) and BYD (11% share), but the third is the Renault-Nissan-Mitsubishi Alliance with 9% (it was 10% the previous year). RNMA is so far the biggest player among established manufacturers. The EV Sales Blog notes that the disruption comes from China (most sales and five manufacturers in Top 10), and start-ups (Tesla).Sales reports Author Liberty Access TechnologiesPosted on February 4, 2019Categories Electric Vehicle News Global Sales December & 2018: 2 Million Plug-In Electric Cars Sold US Plug-In Electric Car Sales Charted: December 2018 Source: Electric Vehicle News In 2018 Over 386,000 Plug-In Electric Cars Were Registered In Europe Interesting is that Volkswagen Group dropped two positions in 2018, and is now behind Hyundai-Kia. In fact, Volkswagen’s position is not that bad compared to Toyota which is now #15 with a sales drop by 10% (a rare sight that sales actually decrease).World’s Top 10 Plug-In Automotive Groups – 2018Source: EV Sales Blog
Source: Charge Forward Tesla is trying to sell and deliver as many Model 3s as possible this quarter in China before the temporary relief on import tariff ends in April. It is now making an unusual move to help: making the Enhanced Autopilot package standard. more…The post Tesla makes Autopilot standard on Model 3 in China, again reducing the price in the country appeared first on Electrek.
Source: Charge Forward Nissan has just announced pricing for their upcoming 62kWh Leaf Plus model, which will be available in the US starting later this month.The starting price comes in just around the expected level, at $36,550. The Leaf SV Plus will be $38,510, and the top trim, the Leaf SL Plus, is priced at $42,550. more…The post The Nissan Leaf Plus starts at $36,550 appeared first on Electrek.
“The FCPA Institute provided an in-depth look into the various forces that have shaped, and that are shaping, FCPA enforcement. The diverse group of participants provided unique insight into how, at a practical level, various professionals evaluate risk and deal with FCPA issues on a day-to-day basis. The small group setting, the interactive nature of the event, and the skills assessment test all set the FCPA Institute apart from other FCPA conferences or panel-based events.” (John Turlais, Senior Counsel, Foley & Lardner)FCPA Institute participants not only gain knowledge, practical skills and peer insight, but can also elect to have their knowledge assessed and earn a certificate of completion upon passing a written assessment tool. In this way, successful completion of the FCPA Institute represents a value-added credential for professional development. In addition, attorneys who complete the FCPA Institute may be eligible to receive Continuing Legal Education (“CLE”) credits. (King & Spalding LLP, the sponsor of the FCPA Institute – Houston, will be seeking CLE credit in CA, GA, NY, TX and if needed in NC and VA. Actual CLE credit will be determined at the end of the program based on actual program time. Attorneys may be eligible to receive CLE credit through reciprocity or attorney self-submission in other states as well).Click here to register for the FCPA Institute – Houston. “The FCPA Institute is very different than other FCPA conferences and seminars I have attended. It was interactive, engaging, thought-provoking and at the completion of the Institute I left feeling like I had really learned something new and useful for my job. The FCPA Institute is a must-attend for all compliance folks (in-house or external).” (Robert Wieck, CPA, CIA, CFE – Forensic Audit Senior Manager, Oracle Corporation) Elevate your Foreign Corrupt Practices Act knowledge and practical skills in Houston at the FCPA Institute on May 4th – 5th. The FCPA Institute – Houston also provides participants the opportunity to earn CLE credit as well as a value-added professional credential.The FCPA Institute is different than a typical FCPA conference. At the FCPA Institute, information is presented in an integrated and cohesive manner by an expert instructor with FCPA practice and teaching experience.Moreover, the FCPA Institute promotes active learning by participants through issue-spotting video exercises, skills exercises, small-group discussions and the sharing of real-world practices and experiences. To best facilitate the unique learning experience that the FCPA Institute represents, attendance at each FCPA Institute is capped at 30 participants.In short, the FCPA Institute elevates the FCPA learning experience for a diverse group of professionals and is offered as a refreshing and cost-effective alternative to a typical FCPA conference. The goal of the FCPA Institute is simple: to develop and enhance fundamental skills relevant to the FCPA, FCPA enforcement, and FCPA compliance best practices in a stimulating and professional environment with a focus on learning.The FCPA Institute presents the FCPA not merely as a legal issue, but also as a business, finance, accounting, and auditing issue. The FCPA Institute is thus ideal for a diverse group of professionals such as in-house and outside counsel; compliance professionals; finance, accounting, and auditing professionals; and others seeking sophisticated knowledge and enhanced skills relevant to the FCPA.Here is what diverse FCPA Institute participants had to say about their FCPA Institute experience.“Unlike other FCPA conferences where one leaves with a spinning head and unanswered questions, I left the FCPA Institute with a firm understanding of the nuts and bolts of the FCPA, the ability to spot issues, and knowledge of where resources can be found that offer guidance in resolving an issue. The limited class size of the FCPA Institute ensured that all questions were answered and the interactive discussion among other compliance professionals was fantastic.” (Rob Foster, In-House Counsel, Oil and Gas Company) “The FCPA Institute was a professionally enriching experience and substantially increased my understanding of the FCPA and its enforcement. Professor Koehler’s extensive insight and practical experience lends a unique view to analyzing enforcement actions and learning compliance best practices. I highly recommend the FCPA Institute to practitioners from all career stages.” (Sherbir Panag, MZM Legal, Mumbia, India) The FCPA Institute is a top-flight conference that offers an insightful, comprehensive review of the FCPA enforcement landscape. Professor Koehler’s focus on developing practical skills in an intimate setting really sets it apart from other FCPA conferences. One of the best features of the FCPA Institute is its diversity of participants and the ability to learn alongside in-house counsel, company executives and finance professionals. (Blair Albom, Associate, Debevoise & Plimpton)
Top lawmakers in Washington largely exempt themselves from the state’s public records law, and their offices did not release emails sent and received by their government accounts when requested.As part of a nation-wide project by The Associated Press, a week of emails and daily schedules of Gov. Jay Inslee and four leading lawmakers in Olympia were requested to examine what extent they’re free from releasing their communications.Emails and schedules from the week of Feb. 1 to Feb. 7 were not provided by the offices of Speaker of the House Frank Chopp, D- Seattle, House Minority Leader Dan Kristiansen, R-Snohomish, Senate Majority Leader Mark Schoesler, R-Ritzville, and Senate Minority Leader Sharon Nelson, D-Maury Island. Inslee’s office released 39 emails and his daily schedules.The Associated Press contributed this story.
by, Christina Pierpaoli, ChangingAging ContributorTweet19Share24Share3Email46 SharesFor better or for worse, I hail from New Jersey—from a terrifyingly loud, frenetic Italian family no less. At risk of propagating stereotypes about my people, I should pause to admit a few things: (1) I speak quickly, (2) talk frequently, and (3) gesticulate wildly. And if we’ve ever talked at length, please know that my tendency to interrupt (I’m sorry) comes from nothing more than my benign inability to control the thoughts a-bubbling at the tip of my tongue.As a trainee of clinical psychology (working with older adults, no less) these tendencies sometimes present a few problems. Here’s why:Effective psychologists listen more than they speak. Also, interruptions frustrate people, compromise rapport, and contaminate process.Most clients, particularly older folks, struggle to process content delivered quickly or loudly.Indiscriminate gesturing distracts.Thankfully, I noticed these patterns very early in my training while reviewing session tapes, humbly digesting lessons from each of the seemingly thousands of blunders I committed. These lessons, beyond providing humbling fodder, invited me to evaluate my interactions with older folks in the lab, too. To be sure, these tendencies have high costs both on the couch and in the lab, but may be uniquely expensive in experimental contexts where even small missteps can introduce error to the assessment situation. And few assessment situations rival the delicateness of those with older adults.Classical test theoryAlbeit obvious, the point must be made: psychology is a science of constructs, not of tangibles like biology or geology. And because psychologists cannot directly poke and prod the things they want to study—like anxiety, depression, dementia, intelligence—they attempt to tap these constructs psychometrically—using testing, measurement, and assessment.This approach, admittedly, has its flaws. Classical test theory, sometimes known as true score theory (Allen et al., 2002), posits that a person’s observed score on any given assessment represents an additive composite of two components: a true score (error-free score) and an error score:X = T(true) + E(error)In more human terms, this means that the variability in measurement stems from the sum of variability due to true score and the variability due to error—or, error from the thing you’re actually measuring and how you are measuring it.Systematic error and random errorRandom and systematic errors characterize the two types of measurement errors. Random errors describe statistical fluctuations in the data due to precision limitations of the measurement, resulting from the researcher’s inability to take the same measurement in exactly the same way to yield identical results. Random errors, unlike their systematic counterparts, typically stem from individual differences at the time of test taking—like level of arousal (i.e., anxiety), preparedness, or even physical health.Systematic errors, then, represent reproducible inaccuracies inherent to the system—divorced from the individual—due to problems persisting throughout measurement. In terms of psychological research, these errors might include poor wording of test items, the salience of stimuli, or even the validity of the constructs themselves.Sources of error to consider when testing older adultsSensory ImpairmentsConsidering the sensory, physical, and cognitive changes accompanying aging, making thoughtful modifications to the testing environment can help not only to optimize older adults’ performance, but also to reduce measurement error.“Typically, sensory acuity declines with age,” notes Sheila R. Black, Associate Professor of Psychology at the University of Alabama. “Keeping this in mind, researchers should anticipate that older adults will not be able to hear and see as well as younger adults,” she explains.To ignore this as researchers would be only at our peril. Dual sensory impairment (DSI)— only anticipated to spike as the population ages— refers to the presence of both hearing and vision loss. According to the Centers for Disease Control and Prevention, at least 1.7 million people report DSI, with between 9% and 21% of adults over 70 having some degree of it (Saunders & Echt, 2007).And presumably—if someone doesn’t have both visual and hearing impairments — (s)he likely has impairment in at least sight or hearing. Don’t buy it? Take that one out of six Americans over 70 has low vision due to common eye pathologies including macular degeneration and glaucoma (Elliott, McGwin, Kline, & Owsley, 2015) or that 59-76% have mid to high frequency clinical hearing loss, respectively (Helzner et al., 2005).Why does it matter? Because you can’t encode what you can’t sense.“Obviously, you want to make sure that your older participants can see and hear the stimuli,” says Kyle Kraemer, PhD student of cognitive psychology at the University of Alabama, “because otherwise, what are you really measuring?”But as others have pointed out, age related declines in sensory acuity may produce difficulties in performing cognitive tasks, even when visual or auditory stimuli presentation exceeds threshold levels that can be seen or heard (Baldwin & Ash, 2011).“Psychologists, both clinical and experimental, must therefore be sensitive to these differences across the lifespan, making adjustments in the lab or clinic when necessary,” emphasizes Black. “They also need to consider these changes when discussing experimental results.”Cognitive ImpairmentsThough sensory-acuity mediated performance provides another explanatory framework for age-related cognitive decline, another rests in widely accepted findings that prospective memory, episodic memory, and executive processing fade over time (Baldwin & Ash, 2011). Accordingly, some researchers have proposed that these age-related declines reflect impaired cognitive functions such as slowed information processing (Cerella, 1985; Salthouse, 1994) or decreased attentional capacity (Park et al., 2002, Salthouse, 1992).“I find that many older adults don’t like to participate in cognitive studies because the procedures often involve some sort of cognitive testing,” observes En Fu, PhD candidate of cognitive psychology at the University of Alabama. “Participants tend to recall how their cognitive capacity has declined, developing negative attitudes and feelings toward themselves that they may or many not bring to the study.”Tarek Amer, PhD student of psychology at the University of Toronto, echoes this: “I find it rewarding to work with older adults because they tend to be interested in my research questions,” he says, “but challenges include making sure that I am extremely careful with those who are concerned, sensitive, or anxious about their cognitive abilities,” he adds.And anxiety matters.Older adults, on average, harbor more negative beliefs and anxieties about their memory than younger adults. Most importantly, these anxieties actually appear to impair memory performance through the allocation of processing resources, strategy selection, motivation, or a combination of these factors (Chasteen et al., 2005). Concerns about being negatively stereotyped impact performance too. Per Steele’s (1997) notion of stereotype threat, older adults performing in a situation in which negative stereotypes about aging and memory are activated show impaired memory performance (Chasteen et al., 2005).“Accordingly, I often reassure older adults that tasks are designed to challenge participants, and that it is very normal for participants of all age groups to find them difficult,” says Amer.He adds, “That said, the cognitive literature tends to focus on cognitive decline and how brain changes with age contribute to that decline. But many older adults are, in fact, major contributors to society and fully capable of performing tasks encountered in daily settings. My research focuses on how these cognitive changes can actually be beneficial in certain contexts, and I often share that.”Other health and physiological factors to consider: Circadian arousal & painTo complicate matters, individual differences in chronobiology also appear to influence experimental outcomes. Variation in circadian arousal correlates with performance on a variety tasks (e.g. performing simple arithmetic), such that performance peaks at a certain level of arousal—a peak that occurs more or less regularly at a specific point in the day (Yoon, May, & Hasher, nd). Clear age differences appear to exist in circadian arousal patterns too, with older adults tending strongly toward morningness (vs. eveningness) than their younger counterparts—seemingly reaching their mental peak early in the day.Pain’s another important—but often ignored— variable to consider, particularly because it represents one of the most widely cited symptoms underlying disability among older adults (Patel et al., 2013). Pain draws attention— draining valuable, scarce cognitive resources away from the individual (Seminowicz & Davis, 2006). In fact, several converging lines of evidence suggest that pain processing can interfere with cognitive processes and visa versa, with many studies demonstrating deficits in cognitive ability among older chronic pain suffers (Seminowicz & Davis, 2006). Medication side effects may exacerbate contributions of pain to performance, too.“I remember when I was a student running older participants,” recalls Black, “I would have to adjust their seats in the lab so that they could be comfortable, not having to constantly tilt their heads to see the screens or sit for so long that their pain would start to distract them from the task.”“I remind my students to make similar adjustments,” she adds.So what?Overarching the enterprise of science— psychological or otherwise— is the goal of reducing measurement error. Why? Simply put, error of any kind (random or systemic) reduces validity—our ability to measure what we claim, or purport, to be measuring. Even more importantly, it compromises our ability to detect true effects. Methodological flaws perpetuate Type I and Type II errors— false positives and false negatives respectively—that can transmit (dangerous) falsehoods throughout science and beyond.Of course, we can’t ignore error—we’ve got to do the exact opposite: recognize that sucker and manage it.Some errors, like those endogenous to individuals, are largely unpreventable. No matter what we do as researchers, we’ll probably never eliminate participants’ anxieties, reverse their hearing loss, or quell the knee pain that they inevitably bring to the testing situation. But we can make adjustments to accommodate those limitations. And of course, failure to consider sources of random error may eventually translate to systemic error, contaminating the study itself.“I cannot emphasize enough the importance of making adjustments for your participants,” reminds Black.“For example, if the goal of the study is to assess central rather than perceptual processing, you need to ensure that older adults will be able to process stimuli as well as a younger adult- otherwise you’re not really measuring what you’re trying to measure” she adds.Error management strategiesAdmittedly, attempting to manage these complexities may feel dizzying. So, where do you start and how can you do it?General strategies“First things first,” warns Black, “older adults are quite perceptive and don’t respond well to being patronized or infantilized. Always be patient, empathetic, and respectful.”And before getting down to the whole business of testing, don’t hesitate to initiate conversation—it builds rapport and reinforces motivation.“Older adults also tend to be more personal than college-aged students,” observes Kraemer. “They seem much more interested in the research than college aged students.”Amer agrees: “Motivation can sometimes be an issue with younger adults who are participating for course credit—such typically isn’t the case for older adults,” he explains. “And because older adults generally tend to be more interested in learning about my research, I always make sure that I spend as much time as I can discussing any issues that interest them as well as answering any questions that they may have.”The American Psychological Association’s (APA) working group on the older adult makes a similar suggestion, urging researchers to familiarize older adults with the purpose and procedures of testing. Older adults, especially those with little formal education, may be more cautious in responding otherwise.“Older adults with a low level of education may also struggle with tasks that involve certain words as stimuli, instructions or informed consents written in language that is not easily understandable,” adds Kraemer. “For your sake and theirs, keep everything simple.”Also do what you can to ensure optimal performance, like reminding older adults prior to their testing appointment to bring all necessary assistive devices with them, including hearing aids or eyeglasses. I’ve even known a few researchers who kept bifocals on site.Strategies for managing sensory impairmentsComputer-based protocols, like many in experimental psychology, can exacerbate visual symptoms commonly causing discomfort among older users (Ko et al., 2014).“Some, but not all, adults also have limited experience with computers,” warns Kraemer. “A few express displeasure or apprehension toward even completing a study once they find out it involves a computer, others simply just require time to adjust to it,” he explains.One option, of course, includes administering paper assessments—but that obviously isn’t always feasible and can quickly get messy. Another management option includes altering features of the interface itself.Sound ophthalmological evidence suggests that because of their lower visual performance, older adults may be more susceptible to reduced visibility from glare than younger adults (Ko et al., 2014). Additional research indicates that they make take longer to perform visual tasks requiring repetitive transitions between brighter and dimmer areas than their younger counterparts (Ko et al., 2014).Creating a well-lighted environment, aimed at reducing glare and uneven luminance includes one simple approach to accommodating the visual limitations common among older adult participants.“Enlarging the font on documents and digital interfaces can also help ease eye strain due to presbyopia in this population,” adds Dr. Jack Parker, ophthalmologist at the Callahan Eye Hospital in Birmingham, Alabama.“On the other hand,” shares Kraemer, “I know researchers who have personally used the mouse or keyboard for their participants, simply using verbal communication to respond to tasks” if and when these adjustments cannot be made or if participant discomfort persists.“I just try to keep everything simple—using only two buttons for instance, and labeling them with brightly colored stickers so that they’re user friendly,” he adds.Regarding managing hearing deficits, the National Institute on Aging (NIA) recommends talking slowly, clearly, and in a normal tone—particularly because speaking in a raised or high-pitched voice actually distorts language sounds and can give the impression of anger. Other suggestions include facing the person directly, at eye level, so that (s)he can lip-read or pick up visual clues.Strategies for managing cognitive impairments“If I sense that a participant appears to approach cognitive tasks with some apprehension or anxiety,” shares Black, “I often reassure them that they will perform fine. I also emphasize how much their participation contributes to science and our knowledge about cognitive aging generally.”“Reassuring them that their results will remain confidential also eases some anxiety,” she adds.Accordingly, many experts recommend using encouragement and verbal reinforcement liberally throughout testing with older adults, not only to quell uneasiness, but also to sustain motivation and rapport. And because older adults tend to tire more easily than youngsters, designing rest breaks into your protocol appears to help manage some the ‘brain drain’-associated fatigue participants may experience over the course of testing. You might also consider using multiple testing sessions to reduce participant burden.Another strategy for optimizing performance includes scheduling testing appointments earlier (versus later) in the day, when cognitive arousal tends to be highest for older adults. Of course, asking what your participants would prefer never hurts either.Finally, deemphasizing the assessment of memory during the instruction phase of the study may be another way of reducing anxiety. In a study of younger and older adults, researchers varied the instructions they gave to participants before completing a memory task, either emphasizing that memory was going to be assessed or deemphasizing the memory component of the task (Rahhal et al., 2001). Specifically, when older adults were told that the experiment was testing their ability to learn facts instead of remember them, they performed as well as young adults; the exact inverse, however, emerged when older participants were asked to remember (Chasteen, 2005). Thus, subtle but sensitive alternations in language may reduce the anticipatory anxieties that tend to subvert older adults’ cognitive performance. Of course, this strategy may require participant debriefing.Strategies for managing physical and physiological impairments“Finally, some older adults have limited mobility,” reminds Kraemer. “More than likely, you will encounter people with wheelchairs, assistive devices, or tremors.”For this reason, whenever possible, the assessment space should be arranged to accommodate wheelchairs or other assistive devices for those with physical limitations. Accessibility of the space itself should also be considered: Are there ramps? Elevators? Is parking convenient, close, well-lit, and safe?“Limited mobility can also mean that the older adults do not drive, in some cases,” Kraemer adds. “In order to get a large enough sample in a typical college town, it may be best to design an experiment that can travel and be conducted in a home, church, or another community that older adults have regular access to, rather than asking them to all come to an existing lab space.”Assessing and reducing pain when possible, as well as considering the effects of medication on performance, include other effective management techniques.ConclusionWorking with older adults is in equal measure rewarding and complex. The solution? KISS: Keep it simple, stupid.Kisses, CReferencesAllen, M.J. & Yen, W.M. (2002). Introduction to Measurement Theory. Long Grove, IL: Waveland Press.American Psychological Association (1998). What practitioners should know about working with older adults. Professional Psychology: Research and Practice, 29(5) 413- 427.Baldwin, C. L., & Ash, I. K. (2011). Impact of sensory acuity on auditory working memory span in young and old adults. Psychology and Aging, 26(1), 85–91. http://doi.org/10.1037/a0020360Cerella J. Information processing rates in the elderly. Psychological Bulletin. 1985;98(1):67–83.Chasteen, A. L., Bhattacharyya, S., Horhota, M., Tam, R., & Hasher, L. (2005). How Feelings of Stereotype Threat Influence Older Adults’ Memory Performance. Experimental Aging Research, 31(3), 235–260. http://doi.org/10.1080/03610730590948177Elliott, A. F., McGwin, G., Kline, L. B., & Owsley, C. (2015). Vision Impairment Among Older Adults Residing in Subsidized Housing Communities. The Gerontologist, 55(Suppl 1), S108–S117. http://doi.org/10.1093/geront/gnv028Helzner EP, Cauley JA, Pratt SR, Wisniewski SR, Zmuda JM, Talbott EO, et al. Race and Sex Differences in Age-Related Hearing Loss: The Health, Aging and Body Composition Study. Journal of the American Geriatrics Society. 2005;53(12):2119–2127Ko et al. (2014). Effect of font size and glare on computer tasks in young and old adults. Optometry and Vision Science, 91(6), 682-689.National Institute on Aging (2016). Talking with your older patient: A clinician’s handbook.Patel, K. V., Guralnik, J. M., Dansie, E. J., & Turk, D. C. (2013). Prevalence and Impact of Pain among Older Adults in the United States: Findings from the 2011 National Health and Aging Trends Study. Pain, 154(12), 10.1016/j.pain.2013.07.029. http://doi.org/10.1016/j.pain.2013.07.029Park DC, Lautenschlager G, Hedden T, Davidson NS, Smith AD, Smith PK. Models of visuospatial and verbal memory across the adult life span. Psychology and Aging. 2002;17(2):299–320Rahhal TA, Hasher L, Colcombe SJ. Instructional manipulations and age differences in memory: Now you see them, now you don’t. Psychology and Aging. 2001;16:697–706.Salthouse TA. Working-memory mediation of adult age differences in integrative reasoning. Memory & Cognition. 1992;20(4):413–423.Salthouse TA. The nature of the influence of speed on adult age differences in cognition. Developmental Psychology. 1994;30(2):240–259.Seminowicz, D.A., & Davis, K.D. (2007). Interactions of Pain Intensity and Cognitive Load: The Brain Stays on Task. Cereb Cortex 2007; 17 (6): 1412-1422. doi: 10.1093/cercor/bhl052Saunders, G. H., & Echt, K. V. (2007). An Overview of Dual Sensory Impairment in Older Adults: Perspectives for Rehabilitation. Trends in Amplification, 11(4), 243–258. http://doi.org/10.1177/1084713807308365Steele CM. A threat in the air: How stereotypes shape intellectual identity and performance. American Psychologist. 1997;52:613–629Yoon, C., May, C.P., & Hasher, L. (nd). Aging, circadian arousal patterns, and cognition.Related PostsWise Up: Study AgingI am certainly not blind to how fortuitously my interest in aging aligns with the needs of an aging world—and I certainly don’t need additional convincing that my decision to forgo law school was in equal measure, wise and slightly prescient. But maybe you do.Elderspeak: Babytalk Directed at Older AdultsExperts found when older adults are exposed to the patronizing language of elderspeak their performance on tasks decreases and their rates of depression increase.What’s In A Name?I have been following the “Seniors, Elders, Oldsters” exchange that was launched by Ronni Bennet’s letter to the New York Times. I don’t have an answer but I do have some opions and and couple of guidelines that I use when I am thinking about this question. 1) The world…Tweet19Share24Share3Email46 SharesTags: Ageism research
Source:https://wolterskluwer.com/ May 18 2018Recent updates in evidence-based recommendations have led to changes in the use of steroid and hyaluronic acid injection for patients with osteoarthritis of the knee, reports a study in the May 16, 2018 issue of The Journal of Bone & Joint Surgery. The journal is published in partnership in the Lippincott portfolio by Wolters Kluwer.Although guideline revisions based on new evidence have stopped or reversed trends towards increased use of injections for knee osteoarthritis, these treatments remain commonly used, according to the new research by Nicholas A. Bedard, MD, of University of Iowa Hospitals and Clinics, Iowa City, and colleagues.Guideline Changes Reflect Questions on Injections for Knee ArthritisThe researchers evaluated the impact of updated guidelines for nonsurgical treatment of knee osteoarthritis, issued by the American Academy of Orthopaedic Surgeons (AAOS) in 2008 and 2013. The study focused on two common treatments to reduce knee pain: corticosteroid (steroid) injection, intended to reduce inflammation; and hyaluronic acid, intended to supplement the natural fluids within the knee joint.Dr. Bedard and colleagues analyzed an insurance database of more than 1 million patients with knee osteoarthritis treated between 2007 and 2015. Overall, about 38 percent of patients received at least one steroid injection and 13 percent had at least one hyaluronic acid injection.Before the first clinical practice guideline, the rate of steroid injections was rising steadily. In the 2008 guideline, the AAOS suggested that steroid injection could be given for short-term pain relief of knee. After this “Grade B” recommendation – reflecting some limitations of the evidence – the rate of increase in steroid injection slowed significantly.By 2013, there was new conflicting evidence on effectiveness of steroid injection. In response, the AAOS stated that it could not make any recommendation for or against the use of steroid injection. After this revision, the trend in steroid injection leveled off. Use of steroid injection continued to increase in patients under age 50 – perhaps reflecting attempts to avoid total knee replacement surgery in this younger age group.Related StoriesNew type of treatment for osteoarthritis shows promise for use in humansLow-income patients at increased risk of catastrophic amputation after knee joint replacementMortality risk from cardiovascular disease higher for people with osteoarthritisRecommendations for injection of hyaluronic acid were also revised during the study period. In 2008, the AAOS stated that there was no evidence on which to base a recommendation on hyaluronic acid injection, either for or against. This recommendation slowed a previous trend toward increased use of hyaluronic acid.By 2013, there was new evidence showing no benefit of hyaluronic acid compared to inactive placebo, prompting a strong recommendation against the use of this treatment. After this revision, the rate of hyaluronic acid injection declined significantly.There was a significant decrease in hyaluronic acid injections performed by orthopaedic surgeons and pain specialists – but not by primary care physicians (such as general internal medicine doctors) or non-surgeon musculoskeletal specialists (such as rheumatologists or sports medicine physicians). Overall, orthopedic surgeons performed two-thirds of hyaluronic acid injections. Trends in steroid injection did not differ by specialty.Evidence-based guidelines play an important role in ongoing evaluation of medical treatments. The new findings suggest that guideline updates for knee osteoarthritis have had a “subtle but significant” impact on clinical practice. Rates of steroid injection leveled off after the AAOS concluded that no recommendation could be made, while the rate of hyaluronic acid injection decreased in response to a recommendation against this procedure.Some of the same studies that questioned the effectiveness of these treatments also reported that they account for a large proportion of treatment costs for knee osteoarthritis. Injections given shortly before total knee replacement surgery may even increase the risk of infection. Dr. Bedard comments, “We hope that this project helps to shed light on the important clinical practice guidelines created by AAOS and further encourages providers to follow these recommendations, share them with their patients, and utilize them as a guide to improve the value of care provided to patients with knee osteoarthritis.”
Jun 4 2018New research presented at this year’s Euroanaesthesia congress in Copenhagen, Denmark shows that hypnosedation is a valuable alternative to conventional general anesthesia.Hypnosedation is a technique which combines hypnosis, conscious sedation (where drugs are used to make the patient comfortable and relaxed while remaining conscious), and local anesthesia to block pain. It has previously been shown to decrease the need for medication, reduce adverse effects, and to accelerate postoperative rehabilitation when compared to general anesthesia in which the patient is rendered unconscious.This research team led by Dr Aurore Marcou and colleagues from the Institut Curie, Paris, France, say: “By minimizing effects of anesthesia on vital functions while preserving the patients’ well-being, it contributes to a sustainable development of anesthesia.”The authors performed a retrospective study of 150 cancer patients who were treated at the Institut Curie between 2011 and 2017, and whose operations were performed under hypnosis. Procedures were conducted with the usual safety conditions and monitoring in place, however they excluded all premedication or hypnotic drugs. A continuous supply of the opioid remifentanil was given during each operation to keep the patients comfortable, and they were provided with the usual anti-sickness drugs and a painkiller as a preventative measure. Local or locoregional anesthesia was performed depending on the type and location of surgery, but the patient remained conscious throughout the procedure.Related StoriesResearch sheds light on sun-induced DNA damage and repairScientists develop universal FACS-based approach to heterogenous cell sorting, propelling organoid researchSleep quality and fatigue among women with premature ovarian insufficiencyHypnosedation was used in breast surgeries (including total mastectomies), which represented 90% of the surgeries in this study, and also gynaecological surgeries, colonoscopies, and superficial plastic surgeries (representing 10% between them). The mean duration of procedures was 60 minutes (30 to 160 minutes), and the mean length of stay in the recovery room was 35 minutes. Patients were aged from 18 to 100 years with a mean of 60.5 years, with 22% older than 75 years. Individuals were grouped according to the severity of their condition, with 2% being classified as having severe cardiac, respiratory, or renal failures that seriously questioned the benefit of using traditional general anesthesia.The authors found that in 99% of cases, hypnosedation provided comfortable conditions for both the patient and the surgeon operating on them. Patient discomfort happened in just two cases, and in both of these, general anesthesia was quickly and easily implemented.The authors conclude that: “Hypnosedation can be proposed as a useful alternative to general anesthesia in various types of surgeries including major breast surgeries. By minimizing effects of anesthesia, this technique is particularly valuable for vulnerable patients. Hypnosis benefits the patient as well as the caregivers.”Source: https://www.esahq.org/
Using food balance and nutrient composition datasheets from the UN Food and Agriculture Organization (FAO), the researchers measured calories, protein, fat, amino acids, and micronutrients across the entire supply chain, from “field-to fork.”FAO regional waste data were used to assess food and nutrient losses and calculate the average loss per person per day.The metrics were compared to average nutritional requirements to see whether they would be sufficient by time food arrives in households.As reported in the journal Frontiers in Sustainable Food Systems, the study found that not just calories, but all nutrients, exceeded the requirements.Some nutrients were up to five times the average requirement, reports Ritchie.However, food wastage and nutrient losses in the supply chain mean that by time certain nutrients reach the household, they are insufficient.Richie says: “With large inequalities in food availability, we know that many people will be deficient in several essential nutrients.”Co-author David Reay says the work highlights the difficulties in supplying a balanced food system and the need for a holistic approach to meeting food targets: By Sally Robertson, B.Sc.Sep 14 2018Reviewed by Kate Anderton, B.Sc. (Editor)Researchers at the University of Edinburgh have conducted a study showing that a different approach is needed to assess the nutrient sufficiency of the global food system if the targets of the United Nation’s second Sustainable Development Goal are going to be met.Image Credit: nehophoto / ShutterstockThe aim of the Sustainable Development Goal is to end all forms of malnutrition by the end of 2030.The study is the first to map the supply of protein, fat, energy, essential amino acids and micronutrients at a global level and pinpoint where nutrients are deficient.Hannah Ritchie and colleagues showed that although nutrients are produced in excess of what is required for the population worldwide, the food supply chain is inefficient and leaves many people deficient of nutrients.The study flags up two main problems that arise with the delivery of a balanced food system.The first one, says Ritchie, is that food security is measured in terms of calories (energy), while micronutrient malnutrition affects more than 2 billion people worldwide.The second problem is that food is reported on in tonnes or kilograms, which is difficult to interpret in terms of how many people this can feed. With population growth, intensifying climate change impacts and rapidly changing diets, the need for evidence-based, holistic assessments of our food system have never been more urgent,” he concludes.David Reay, Co-author We wanted, for the first time, to assess the full food system in useful metrics – average nutrients per person – across all the nutrients that are essential to good health.”Hannah Ritchie, Study Author Source:This new article is based on a Frontiers press release and the research study itself.
The U.S. Congress has proposed new protections for farm animals used in scientific research. The move comes in response to an exposé published in The New York Times last month, which documented numerous cases of animal suffering and death at a Department of Agriculture facility that has been trying to create larger and more fecund farm animals for several decades. Lawmakers from both parties are backing a bill—called the AWARE Act—that would expand the scope of the Animal Welfare Act, which governs the humane treatment of laboratory animals. Farm animals are currently excluded from the act, unless they’re used in biomedical research or exhibition. The new law would require closer monitoring—and more inspections—of research involving cows, pigs, and other livestock.