#Manchester Triage System

[infinitemonkeytheory]

The 2022 Shkreli Awards have been released! Each year, the Lown Institute passes out awards as a way of reporting on dysfunction in the US health care system. Dysfunction in healthcare is one of our foundational pillars here at Healthcare Triage, and these awards highlight some of the worst examples.

2022 Shkreli Awards

VIDEO: The 2022 Shkreli Awards, featuring guest hosts Dr. Uché Blackstock, CEO of Advancing Health Equity, and Amy Holden Jones, Executive Producer and Creator of Thre Resident.

JANUARY 10, 2023 — Welcome to the 6th annual Shkreli Awards, the Lown Institute’s top ten list of the worst examples of profiteering and dysfunction in healthcare, named for the infamous “pharma bro” Martin Shkreli.

Nominees for the Shkreli Awards are compiled by Lown Institute staff with input from readers of Lown Weekly. An esteemed panel of patient activists, clinicians, health policy experts, and journalists help determine the winners. (press release | previous winners)

#10

Dentist bags a bundle by breaking patients’ teeth

How did Wisconsin dentist Scott Charmoli go from fixing 434 crowns a year to more than 1,000? By purposely breaking patients’ teeth, according to federal prosecutors. Charmoli allegedly drilled into patients’ teeth unnecessarily and submitted photos of the damage to insurance companies to justify expensive procedures. This move elevated his salary by $1.1 million, according to the Washington Post. The scheme was uncovered when Charmoli sold his practice in 2019 and the new owners reviewed his files, noting the absurdly high rates of crown procedures. Charmoli was convicted of healthcare fraud and sentenced to 54 months imprisonment and over $1 million in fines.

SOURCE: Jonathan Edwards, The Washington Post; U.S. Attorney’s Office, Eastern District of Wisconsin

JUDGES’ COMMENTS:

Talk about supplier-induced demand! Oy, pass the laughing gas.

#9

“Dangerous” doctor deemed a star by leadership despite disgraceful malpractice record

Image caption: A February 1999 advertisement for CMC’s New England Heart Institute in the Boston Globe, featuring Baribeau. Source: The Boston Globe

Leaders of Catholic Medical Center in Manchester, NH knew their renowned cardiac surgeon Dr. Yvon Baribeau had one of the worst malpractice records in the country. Yet they continued to support Baribeau, featuring him in hospital advertisements and allowing him to keep operating over the objections of other CMC doctors, the Boston Globe reported. Examples of Baribeau’s alleged harmful behavior include surgical errors that led one patient to require blood transfusions of nearly five times her blood volume, and keeping another patient whose chest cavity had turned “black and necrotic” on life support as a possible ploy to protect his surgical 30-day survival rate.

Throughout Baribeau’s career, he racked up 21 medical malpractice settlements, including 14 related to patient deaths. In a statement provided by his lawyer to the Globe, Baribeau said, “I performed over 10,000 procedures at CMC, always with patient safety as my first priority.”

SOURCE: Rebecca Ostriker, Deirdre Fernandes, Liz Kowalczyk, Jonathan Saltzman, and Patricia Wen, The Boston Globe

JUDGES’ COMMENTS:

The protection of doctors who are known to be dangerous is a national scourge that must be exposed and ended.

When a hospital administration puts “heads in beds” ahead of patient safety, it should be called to account—and not just by the media.

#8

Medical labs bilk Medicare for $300 million in elaborate bribery scheme

Three laboratories in North Texas allegedly found a way to score $300 million in extra Medicare reimbursements, the Dallas Morning News reported. In collaboration with two marketing firms, they bribed physicians to order unnecessary drug tests and blood work, according to a federal indictment. Some physicians got as much as $400,000 in kickbacks. In one case, even a physician’s spouse got an illegal bonus. The founders of all three labs pleaded guilty to the fraud in April 2022.

SOURCE: Aria Jones, The Dallas Morning News

JUDGES’ COMMENTS:

Unnecessary tests and procedures are bankrupting us and harming patients. There is nowhere near enough coverage of this.

Unnecessary “care” is a huge part of the $1 trillion (that’s trillion-with-a-T) the US wastes in healthcare.

#7

Patients qualified for financial assistance; hospital sends them to debt collection instead

Nonprofit hospitals are required to provide financial assistance to low-income patients. Providence health system, however, did the opposite in many cases. Rather than ensuring that low-income patients received the financial assistance they were due, Providence hounded them to pay and sent debt collectors after them when they didn’t, according to a New York Times investigation. These actions were part of an official campaign to boost revenue called “Rev-Up” developed with help from corporate consultant McKinsey. The “Rev-Up” campaign directed employees to tell patients about financial assistance only as a last resort. The result: more than 55,000 patients were pursued by debt collectors when they should have been given a discount.

In response, a Providence spokesperson told the Times that they stopped sending Medicaid patients to debt collection, and said that they will issue refunds to about 760 patients eligible for assistance who were previously charged for their medical care.

*Note: The Lown Institute provided data to the New York Times about Providence Health System’s tax exemption for this piece.

SOURCE: Jessica Silver-Greenberg and Katie Thomas, New York Times

JUDGES’ COMMENTS:

Large consulting companies like McKinsey are hospitals’ accomplices in revenue maximization.

Catholic hospitals have come a long way since the nuns of the Sisters of Providence provided services to the poor.

#6

When smokers get sick, this tobacco company has the treatment

Philip Morris has spent 175 years selling products that cause heart disease, chronic obstructive pulmonary disease (COPD), and other serious health problems. Now the tobacco giant is poised to make more money treating the very conditions it helped create by acquiring companies that develop inhaled therapeutics, according to a STAT News report.

Experts told STAT News they are concerned that Philip Morris could potentially use research on inhalation developed by these newly acquired companies to hook even more people on their products. But don’t worry—a representative from Philip Morris stated they have no plans to do so.

SOURCE: Olivia Goldhill, STAT News

JUDGES’ COMMENTS:

When your corporation creates both the problem and the solution to it, you clearly care about one thing: finding and making profits by any means possible.

In the 1980s, the hospital I worked in still used machinery made and branded by Philip Morris to treat lung-cancer patients. This is NOT a novel abuse— it must be stopped.

#5

Pharma giant exploits bankruptcy loophole to avoid legal responsibility for cancer-causing product

Johnson & Johnson had known for decades that asbestos, a deadly carcinogen, could be contaminating their talc baby powder products but continued selling them anyway. Now J&J faces lawsuits from 40,000 cancer patients, many of them Black women, as J&J allegedly marketed its talc-based products specifically to this population. To avoid the lawsuits, J&J created a subsidiary company with all of the baby powder-related liabilities and then declared this shell company bankrupt, NPR reported. Despite this “bankruptcy,” J&J ranked in the top 50 of Fortune’s largest companies last year. The fate of J&J and the lawsuits await appeals. According to the J&J corporate attorney, the bankruptcy will benefit victims by producing a faster settlement.

SOURCE: Brian Mann, NPR; Casey Cep, The New Yorker

JUDGES’ COMMENTS:

Especially egregious because of delay in acknowledgement at the expense of patients

Big Pharma has become an evil conspiracy against public health.

#4

Hospice CEO allegedly tells employees to hasten patient death to avoid caps on government reimbursements

Bradley Harris, the CEO of Novus Hospice in Frisco, Texas, and a dozen other Novus employees were sentenced to a combined 84 years in prison for committing healthcare fraud, according to D Magazine. The US Department of Justice reported that Novus staff were provided with pre-signed prescription pads and directed to dispense powerful medications like morphine and hydrocodone to patients, without guidance or oversight from physicians.

According to an earlier FBI investigation reported by NBC Dallas, Harris allegedly told employees to dose patients with more than the maximum allowed amount of painkillers to hasten patient death, with the goal of reducing the average patient stay to avoid caps on government reimbursement. The FBI investigation revealed that a Novus employee was allegedly sent a text message by Harris, “You need to make this patient go bye-bye.” It is unclear whether any patients were actually given overdoses or died from Harris’ instructions.

SOURCES: Will Maddox, D Magazine; US Department of Justice

JUDGES’ COMMENTS:

This behavior is abhorrent, cold and heartless

Individual and corporate greed, meet well intentioned yet perverse financial incentives.

#3

System keeps community hospital on life support to cash in on drug discount program meant to serve the poor

Image caption: Richmond Community Hospital.

The 340B drug program provides safety net hospitals with deep discounts on medications to ensure access to care for low-income patients. Richmond Community Hospital in Virginia, owned by Bon Secours Health System, has profited heavily off of this program, yet they don’t have an intensive care unit, maternity ward, or even a consistently-working MRI machine. That’s because Bon Secours has been diverting the profits from Richmond Community to its other hospitals in wealthier, whiter neighborhoods, according to a New York Times investigation. “Bon Secours was basically laundering money through this poor hospital to its wealthy outposts,” said a former Richmond ER doctor.

A spokeswoman for Bon Secours Mercy Health told the Times the hospital system spent $10 million on improvements to Richmond Community Hospital over the past decade. But that doesn’t seem like much considering the $108 million expansion at neighboring St. Francis Hospital, a nearby Bon Secours hospital.

*Note: The Lown Institute provided data to the New York Times about Providence Health System’s tax exemption for this piece.

SOURCE: Katie Thomas and Jessica Silver-Greenberg, The New York Times

JUDGES’ COMMENTS:

Skimming profits from the poor is the sleaziest kind of theft.

Care facilities are thin on the ground in low-income areas nationally, which makes this story even more painful.

#2

Private equity-backed firm runs rural hospitals into ground, leaves patients in unsafe conditions and employees without health insurance

When Noble Health, a private equity-backed startup, bought two rural hospitals in Missouri, residents hoped this might offer a lifeline to the struggling institutions. Instead, hospital employees faced shortages in supplies and drugs, leading to unsafe conditions for patients, Kaiser Health News reported. Noble Health also stopped paying for employees’ health insurance despite deducting money out of their paychecks that was supposed to be for premiums. Some staff members now face hundreds of thousands in medical bills because they did not know they were uninsured, according to Kaiser Health News. Noble Health closed the hospitals two years later, after taking $20 million in federal COVID relief funds. The company is currently under federal investigation.

SOURCE: Sarah Jane Tribble, Kaiser Health News

JUDGES’ COMMENTS:

Private equity too often puts profits over patients, and is using the proceeds to swallow up the US healthcare system.

Private equity corporations are one of the biggest threats to healthcare quality and justice.

#1

Insurers systematically overbill Medicare Advantage, siphoning billions of taxpayer money

The majority of large Medicare Advantage insurers have been accused of fraud or overbilling by the US government, a New York Times investigation finds. Overpayments to Medicare Advantage insurers were estimated to cost taxpayers as much as $25 billion in 2020. Because the Medicare Advantage program pays private insurers a set amount per patient based on their risk, there is an incentive for insurers to “mine” patients for diagnoses—for example, adding diagnoses for old or resolved conditions.

While Mark Hamelburg, an executive at AHIP, an industry trade group, said to the Times that some coding differences were due to doctors “look[ing] at the same medical record in different ways,” some of the diagnoses were clearly inaccurate. In one case, insurer Independent Health added a diagnosis for prostate cancer to a woman’s record, because “when a married couple has any disease, both were assigned to that disease,” Bloomberg reported.

Among the top 10 Medicare Advantage providers by market share, the following have been accused of fraud or overbilling by the US government or Inspector General and have ongoing lawsuits as of 2022, according to the Times: UnitedHealth Group, CVS Health, Elevance Health, Kaiser Permanente, Blue Cross Blue Shield of Michigan, Cigna, and Highmark. These insurers have disputed the claims.

SOURCE: Reed Abelson and Margot Sanger-Katz, New York Times; John Tozzi, Bloomberg

JUDGES’ COMMENTS:

The overbilling of Medicare Advantage has become nothing but a big game that private insurers play. There are no rules, no morals, no sense of right or wrong.

The “advantage” in Medicare Advantage plans seems to go to the insurers who exploited Medicare for billions.

Weekly news for people who want a radically better health system

Judges for Shkreli Awards

Carole Allen, MD, MBA, FAAP

Immediate Past President

Massachusetts Medical Society (follow)

Special advisor to the president of the Lown Institute and lecturer at the George Washington University School of Public Health (follow)

Director of the Centre for Health Policy at University of Melbourne and senior fellow at the Lown Institute (follow)

Professor and chair emeritus at Duke University School of Medicine (follow)

Chair of the Lown Institute board of directors, former CEO of Denver Health

Assistant professor, NYU School of Medicine (follow)

Associate professor at Yale School of Public Health (follow)

Creator and showrunner,

“The Resident” (follow)

President of Physicians for a National Health Program and retired internist at Cook County Hospital (follow)

President of the Minority Health Institute, Clinical Professor of Medicine at UCLA School of Medicine, author of Blacks in Medicine (follow)

[stemlyns]

Triage: The sorting hat of Emergency medicine, but what are we really seeking? St.Emlyn's.

Triage: The sorting hat of Emergency medicine, but what are we really seeking? St.Emlyn’s.

The word “Triage” comes from French roots, the origin word “trier” meaning “to sort”.1 This is a process vital to emergency medicine. The idea was born on the battlefields by Baron Dominique Jean Larrey2,a chief surgeon in Napoleon’s Imperial guard, because the number of casualties demand exceeded resources available. The need for a way of prioritising patients was described beautifully by Larrey…

[classyfoxdestiny]

Secret proposals to ration care by age in pandemic branded ‘unacceptable’

Secret proposals to ration care by age in pandemic branded ‘unacceptable’

Secret plans to withdraw hospital care from over-70s in the case of a catastrophic pandemic have been branded “totally unacceptable” by charities representing older people.

Confident documents produced following a pandemic planning exercise in 2016 proposed a “triaging” system to be put into operation if healthcare resources were exhausted, under which people in nursing homes could be offered “end of life pathways” instead of medical assistance.

The government said the proposals related to “hypothetical scenarios” and had never been adopted as official policy.

But Age UK charity director Caroline Abrahams told The Independent that Britain had come “perilously close” to an approach of this sort at the height of the Covid-19 pandemic last year.

And she said that the government and NHS should be clear that treatment decisions must always be based on clinical need.

The documents on “NHS surge and triage” and adult social care in the case of a pandemic, labelled “confidential” and “official sensitive”, were obtained by an NHS doctor under freedom of information legislation and published on Saturday by the Daily Telegraph.

Written in 2017 and 2018, they suggested that in the case of a serious flu outbreak which overwhelmed the NHS’s ability to respond, patients could be “triaged” – or prioritised for treatment – based on their “probability of survival” rather than “clinical need”.

In a severe pandemic, the health secretary could authorise medics to prioritise some patients over others and even stop providing critical care altogether, the documents suggested.

Ms Abrahams expressed deep concern that the approach had even been considered.

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“Whatever the status of this planning document may be, we know from other reports that during the early part of this pandemic we got perilously close to triage approaches being introduced in hospitals that took age heavily into account,”she said.

“If they had been put into practice the result would have been that a relatively healthy 70-year-old would not have got access to the intensive treatment they needed – they would effectively have been written off.

“At that time there was huge uncertainty and fear, as doctors struggled to cope with a virus that was threatening to overwhelm the NHS.

“However, we said at the time and repeat now that there is no place for treatment decisions based on age in a civilised society. Whatever the pressures, these decisions should always be based on clinical need.

“To do otherwise is blatantly ageist and totally unacceptable.”

Prof Martin Green, chief executive of Care England, which represents independent providers of adult social care, told The Independent: “The NHS should not have blanket policies and every single person should be assessed on the basis of need.

“The NHS should be available to all citizens and any scenario planning for a pandemic should focus on the needs of citizens, not the needs of organisations.”

Dr Moosa Qureshi, who obtained the plans, said it was “unprofessional” that they were not given to medics.

“The Information Commissioner held that clinicians must be supported by a clear framework when allocating care during a severe pandemic, and that the framework needs public debate,” he said. “The NHS triage paper provides real guidance for front-line staff if NHS services are overwhelmed. Why did the Department of Health, NHS England and BMA keep it secret from healthcare professionals?”

An NHS spokesman said: “The NHS was asked to produce this discussion document based on a specific and extreme hypothetical scenario to inform the Government’s pandemic flu preparedness programme rather than for operational use and it did not form the basis of the NHS response to coronavirus.”

A government spokesman said the reports were “historical draft briefing papers that include hypothetical scenarios which do not and have never represented agreed government policy”.

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[surejaya]

Emergency Triage: Manchester Triage Group

Download : Emergency Triage: Manchester Triage Group More Book at: Zaqist Book

Emergency Triage: Manchester Triage Group by Manchester Triage Group

The Manchester Triage System (MTS) is the most widely used triage system in the UK, Europe and Australia, with tens of millions of patients being processed through hospital emergency departments. It is also used in hospitals throughout Brazil. Emergency Triage is the core text for the MTS, which utilises a risk averse system of prioritisation for patients in all unscheduled care settings. As such, it is an essential text for all emergency department staff using the MTS, in particular triage nurses. The book is both a training tool and a reference for daily use in the Emergency Department and prehospital settings. This edition features revised protocols that reflect new approaches to prioritisation, with accompanying revised flowcharts - the core part of the book. Table of Contents Presentation flow charts index 1: Introduction 2: The decision-making process and triage 3: The triage method 4: Pain assessment as part of the triage process 5: Patient management, triage and the triage nurse 6: Auditing the triage process 7: Telephone triage 8: Beyond prioritisation to other applications

Download : Emergency Triage: Manchester Triage Group More Book at: Zaqist Book

[actutrends]

Booker scales back campaign in New Hampshire

” It’s increasingly apparent that prospects that regular N.H. venues, living rooms and bigger, are those that pull ahead in support here,” Democratic previous state Senate President Sylvia Larsen stated in an email. “If you’re a prospect that prevents this close-up examination it will reflect in poll numbers. NH citizens track and support those happy to participate in close conversation with us. Cory is an inspirational orator who, possibly due to lack of uniqueness, has not resonated with our citizens. While Booker’s departure from NH is easy to understand, his NH outcomes will show this early departure.”

Booker hasn’t been to New Hampshire considering that previously Thanksgiving. While he had actually three occasions scheduled for Friday, he missed them because he had the influenza, according to his project.

The senator also recently downsized his New Hampshire operation, which included considerably restructuring local staffing and closing an office in Portsmouth– among the bluest parts of the state. They now have 2 campaign workplaces left, in Manchester and Nashua, the 2 largest cities. By comparison, top-tier projects have more than a lots offices throughout the state.

Spending figures highlight the early state triage: His project has actually revealed plans to invest $500,000 into TV and digital marketing in Iowa, but nothing similar is planned for New Hampshire at the minute. The very PAC connected with Booker, United We Win, has only acquired TELEVISION ads up until now in Iowa, where it recently spent about $200,000 in Des Moines and Cedar Rapids.

Booker hasn’t written off New Hampshire completely– he just recently secured his field-high 117 th recommendation Tuesday when 14 activists announced their support for him.

And some of the state’s leading elected officials who have endorsed Booker question whether ballot showing him at 1 percent in the first-in-the-nation primary state is precise– echoing a point the prospect makes himself.

However with restricted resources and the clock ticking toward the Feb. 3 Iowa caucuses, he’s required to depend on regional surrogates to spread his message. In interviews with half a lots state senators and agents who are supporting Booker, the lawmakers insisted the lack of face time in New Hampshire won’t injure his opportunities.

” I think that you’ll see us simply go into overtime,” said state Sen. Jon Morgan. “We’ll be working overtime to magnify that message and make sure that citizens become aware of Cory.”

” We’re not Cory Booker however we’re also not mice on the streets,” said state Rep. Kathy Rogers, who spent Tuesday afternoon in a downtown coffeehouse sitting throughout the table from a campaign staffer calling prospective citizens. “If we head out and we are talking passionately about our candidate, that makes a distinction.”

According to Booker’s campaign, its largest personnel existence is in Iowa, where it has about 50 staffers, followed by New Hampshire.

” We’re investing a substantial amount of our prospect’s time in Iowa and South Carolina, however we’re not by any ways divesting from New Hampshire and Nevada,” a campaign aide said.

Booker’s Iowa and South Carolina orientation was evident from a Sunday meet-and-greet, and Monday ‘man-to-man’ conversation on issues that affect black guys in South Carolina, before he applied for the state’s tally. He launched his strategy to support and safeguard historically black institution of higher learnings– only 4 states have more HBCUs than South Carolina’s 8– the following day.

He started a four-day tour through Iowa last week, which began with a major speech in which he criticized a system that allowed California Sen. Kamala Harris to suspend her project without any votes being cast. The next day, his campaign started airing a 60- second advertisement on African-American radio stations in South Carolina.

Booker’s focus on South Carolina, where black voters make up approximately 60 percent of the Democratic electorate, is proof that he understands where his “political bread” could be buttered, according to Democratic strategist Antjuan Seawright.

” I do believe that no matter what happens before South Carolina, the narrative and the story can be reworded if you succeed in South Carolina,” Seawright stated. “My advice to the Booker project is to play a numbers video game, and the numbers certainly might be on his side moving forward with a full-blown effort concentrated on South Carolina and competing for, to this point, 2nd place to Vice President Biden.”

Booker just recently unveiled his strategy to purchase rural America before wrapping up his Iowa swing, the exact same day his project released a digital ad to run in Iowa and South Carolina as part of a six-figure buy.

Jeff Link, a long time Iowa-based Democratic strategist, yielded that it’s probably sensible for Booker to prioritize Iowa over New Hampshire.

” Iowa’s very first, and he will have an extra week prior to Iowa and New Hampshire to barnstorm the state of New Hampshire after we get finished,” Link stated. “So it probably is the best sort of order of top priority.”

Booker has consistently boasted about his 117 New Hampshire endorsements on national tv.

” That does not come without candidate time,” a campaign assistant said. “He has actually spent a great deal of time on the phone to locations like New Hampshire and Nevada when he can’t be there.”

While Booker is piling up the endorsements of regional chosen authorities in New Hampshire, some who made his list are lesser-known figures — at least four are in high school. The campaign stated some, however not all of them, are of voting age.

His New Hampshire supporters state they back the project’s choice to zero in on Iowa, which votes 8 days earlier.

” Definitely he has actually invested more time in Iowa and I think that becomes part of the technique,” said state Sen. David Watters. “They recognize they have to do well enough in Iowa to be practical a week later in New Hampshire.”

” What I would state to him is we will be prepared to catch the wave when you are available in here out of Iowa,” he stated.

Booker stopped working to certify for next week’s PBS NewsHour/POLITICO debate.

In an interview on CBS News’ live streaming platform CBSN on Tuesday, Booker argued that debates shouldn’t center around “imprecise ballot.” He said his project leads the field in endorsements from local leaders in Iowa and New Hampshire, has among the best organizing teams in Iowa and insisted he is seeing momentum on the ground in the first-in-the-nation caucus state with “record” and “overruning” crowds during his last swing.

Booker also dismissed his low polling across the early states. He sits at 2 percent nationally and in South Carolina, between 1 and 3 percent in Iowa and 1 percent in New Hampshire, according to current polling.

Rogers, the New Hampshire state legislator, cautioned not to count Booker out: “Don’t judge New Hampshire early. We’re an ornery state. We like to shock individuals.”

The post Booker scales back campaign in New Hampshire appeared first on Actu Trends.

[thisdaynews]

Booker scales back campaign in New Hampshire

New Post has been published on https://thebiafrastar.com/booker-scales-back-campaign-in-new-hampshire/

Booker scales back campaign in New Hampshire

“It’s increasingly obvious that candidates that frequent N.H. venues, living rooms and larger, are those that pull ahead in support here,” Democratic former state Senate President Sylvia Larsen said in an email. “If you’re a candidate that avoids this close-up scrutiny it will reflect in poll numbers. NH voters track and support those willing to participate in close conversation with us. Cory is an inspirational orator who, perhaps due to lack of specificity, has not resonated with our voters. While Booker’s departure from NH is understandable, his NH results will reflect this early departure.”

Booker hasn’t been to New Hampshire since before Thanksgiving. While he had three events scheduled for Friday, he missed them because he had the flu, according to his campaign.

The senator also recently downsized his New Hampshire operation, which included significantly reorganizing local staffing and closing an office in Portsmouth — one of the bluest parts of the state. They now have two campaign offices left, in Manchester and Nashua, the two largest cities. By comparison, top-tier campaigns have more than a dozen offices throughout the state.

Spending figures underscore the early state triage: His campaign has revealed plans to invest $500,000 into TV and digital advertising in Iowa,but nothing similar is planned for New Hampshire at the moment. The super PAC affiliated with Booker, United We Win, has only purchased TV ads so far in Iowa, where it recently spent about $200,000 in Des Moines and Cedar Rapids.

Booker hasn’t written off New Hampshire entirely — he recently secured his field-high 117th endorsement Tuesday when 14 activists announced their support for him.

And some of the state’s top elected officials who have endorsed Booker question whether polling showing him at 1 percent in the first-in-the-nation primary state is accurate — echoing a point the candidate makes himself.

But with limited resources and the clock ticking toward the Feb. 3 Iowa caucuses, he’s forced to rely on local surrogates to spread his message. In interviews with half a dozen state senators and representatives who are supporting Booker, the lawmakers insisted the lack of face time in New Hampshire won’t hurt his chances.

“I think that you’ll see us just go into overtime,” said state Sen. Jon Morgan. “We’ll be working overtime to amplify that message and make sure that voters hear about Cory.”

“We’re not Cory Booker but we’re also not mice on the streets,” said stateRep. Kathy Rogers, who spent Tuesday afternoon in a downtown coffee shop sitting across the table from a campaign staffer calling prospective voters. “If we go out and we are talking passionately about our candidate, that makes a difference.”

According to Booker’s campaign, its largest staff presence is in Iowa, where it has about 50 staffers, followed by New Hampshire.

“We’re spending a significant amount of our candidate’s time in Iowa and South Carolina, but we’re not by any means divesting from New Hampshire and Nevada,” a campaign aide said.

Booker’s Iowa and South Carolina orientationwas evident from a Sunday meet-and-greet, and Monday ‘man-to-man’ conversation on issues that impact black men in South Carolina, before he filed for the state’s ballot. He released his planto support and protect historically black colleges and universities — only four states have more HBCUs than South Carolina’s eight — the following day.

He began a four-day tour through Iowa last week, which commenced with amajor speechin which he criticized a system that allowed California Sen. Kamala Harris tosuspend her campaignwithout any votes being cast. The next day, his campaign began airing a60-second adon African-American radio stations in South Carolina.

Booker’s focus on South Carolina, where black voters make up roughly 60 percent of the Democratic electorate, is evidence that he understands where his “political bread” could be buttered, according to Democratic strategist Antjuan Seawright.

“I do think that no matter what happens before South Carolina, the narrative and the story can be rewritten if you do well in South Carolina,” Seawright said. “My advice to the Booker campaign is to play a numbers game, and the numbers definitely could be on his side going forward with an all-out effort focused on South Carolina and competing for, to this point, second place to Vice President Biden.”

Booker recentlyunveiled his planto invest in rural America before wrapping up his Iowa swing, the same day his campaignreleased a digital adto run in Iowa and South Carolina as part of a six-figure buy.

Jeff Link, a longtime Iowa-based Democratic strategist, conceded that it’s probably wise for Booker to prioritize Iowa over New Hampshire.

“Iowa’s first, and he will have an extra week before Iowa and New Hampshire to barnstorm the state of New Hampshire after we get finished,” Link said. “So it probably is the right kind of order of priority.”

Booker has repeatedly boasted about his 117 New Hampshire endorsements on national television.

“That doesn’t come without candidate time,” a campaign aide said. “He has spent a lot of time on the phone to places like New Hampshire and Nevada when he can’t be there.”

While Booker is piling up the endorsements of local elected officials in New Hampshire, some who made his list are lesser-known figures— at least four are in high school. The campaign said some, but not all of them, are of voting age.

His New Hampshire supporters say they back the campaign’s decision to zero in on Iowa, which votes eight days earlier.

“Certainly he has spent more time in Iowa and I think that’s part of the strategy,” said state Sen. David Watters. “They realize they have to do well enough in Iowa to be viable a week later in New Hampshire.”

“What I would say to him is we will be ready to catch the wave when you come in here out of Iowa,” he said.

Booker failed to qualify for next week’s PBS NewsHour/POLITICO debate. He met the Democratic National Committee’s 200,000-donor threshold, but fell short of meeting the polling requirement. To qualify, Booker needed to hit at least 4 percent in four approved surveys. Henever garnered 4 percent in any of the two-dozen-plus qualifying polls.

In an interview on CBS News’ live streaming platform CBSN on Tuesday, Booker argued that debates shouldn’t center around “imprecise polling.” He said his campaign leads the field in endorsements from local leaders in Iowa and New Hampshire, has one of the best organizing teams in Iowa and insisted he is seeing momentum on the ground in the first-in-the-nation caucus state with “record” and “overflowing” crowds during his last swing.

Booker also dismissed his low polling across the early states. He sits at 2 percent nationally and in South Carolina, between 1 and 3 percent in Iowa and 1 percent in New Hampshire, according to recent polling.

Rogers, the New Hampshire state legislator, warned not to count Booker out: “Don’t judge New Hampshire early. We’re an ornery state. We love to surprise people.”

Read More

[coopdigitalnewsletter]

5 Nov 2019: Cities and boxes. Health data. Political ads.

Hello, this is the Co-op Digital newsletter - it looks at what's happening in the internet/digital world and how it's relevant to the Co-op, to retail businesses, and most importantly to people, communities and society. Thank you for reading - send ideas and feedback to @rod on Twitter. Please tell a friend about it!

[Image: Brittainy Newman/NYT]

Cities and boxes: convenient delivery is a growing problem

It’s all in the delivery: Amazon makes grocery delivery free with Prime, ends $15/month fee under pressure from Walmart, whose rival click and collect service was cheaper. Wider picture: the first map of America’s food supply chain.

This is a great read, and shows you what online shopping does to cities: 15% of New York City households receive a package every day - that’s 1.5 million packages, and it’s putting the city under a lot of stress.  

“In some neighborhoods, Amazon’s ubiquitous boxes are stacked and sorted on the sidewalk, sometimes on top of coverings spread out like picnic blankets. ‘They are using public space as their private warehouse [...] That is not what the sidewalk is for.’” 

The delivery networks (Amazon, Fedex etc) are building warehouses closer to customers, to cover the “last mile” more efficiently. But even so there are traffic, carbon/pollution emissions and safety arguments in favour of click and collect, as long as the collect bit reduces the number of car and van journeys.

It feels as if internet-era retailing is now back to being a last-man-standing game of tremendous capital spending and lowered gross margin to win and keep customers who want speed and convenience. You wonder if all of this can ever be sustained.

Health data

Google is buying fitness-tracker company Fitbit, the second-largest product in the “wearables” sector (and the company would probably still be independent and thriving had Apple not done so well with its Watch). There’s an interesting question about the data though. 

“Similar to our other products, with wearables, we will be transparent about the data we collect and why. We will never sell personal information to anyone. Fitbit health and wellness data will not be used for Google ads. And we will give Fitbit users the choice to review, move, or delete their data.”

Now, some readers might be suspicious about that. There’s history of arms-length health tech acquisitions eventually being absorbed into the corporate parent (see Deepmind, though maybe they’ve been diligent about keeping the Deepmind data separated, you cannot know). 

There are wider health concerns because Fitbits are used by some insurance companies to provide proof of activity, which makes your insurance premia lower. Here’s a UK/US example: Vitality. It isn’t crystal clear what data Fitbit sends to Vitality, but their page for a different device says “The Vitality Member app takes your step and heart rate workout data from Apple Health and uses that data to reward Vitality activity points [...] Opening and refreshing your Vitality Member app is the only way to send Apple Health data to Vitality to sync your activity.” (There were also some concerns a few years ago about a Facebook-owned app getting access to Vitality data.)

But you’d hope that the potential reputational risk would be really significant if it later came out that Google just scooped up the Fitbit data and used it to target you with ads for hedge trimmers and retirement planning. Significant enough that it wouldn’t be worth doing, you’d hope! Maybe this whole thing is just a big tech company fearful that it might miss the next big thing, so it’s trying a bit of... everything. Or preventing someone else buying Fitbit.

The wider context for Google is that it’s about search: Google is “looking to make it easier for doctors to search medical records, and to improve the quality of health-related search results for consumers across Google and YouTube”.

Is anything else happening in Big Tech x Health Data? Yes.

Amazon is buying Health Navigator, which does “online symptom checking and triage tools to companies that are looking to route patients to the right place”. Amzn will offer Health Navigator to employees as part of its internal pilot of Amazon Care clinics.

Facebook vows strict privacy safeguards as it rolls out preventive-health tool.

Sustainable John Lewis

“John Lewis has stopped selling 5p single-use plastic carrier bags at its Oxford store as part of a major trial to test and change shoppers’ behaviour. The sustainability initiatives, which were unveiled on Monday, are aimed at encouraging a “reduce, reuse and return” culture among customers and could provide a model for its other shops.”

Facebook and political advertising

Following on from last week, Facebook decided to leave all political speech and ads up [1] and said it’s about free speech and debate, and “it’s not about the money”. It probably *isn’t* about the money - it’s that Facebook are culturally allergic to activities that don’t scale or aren’t algorithmable (so eg effective content moderation will always be resisted at some level).

Twitter took a better position, and one that’s a decent swipe at FB, Twitboss pointing out that “it‘s not credible for us to say: “We’re working hard to stop people from gaming our systems to spread misleading info, buuut if someone pays us to target and force people to see their political ad… well… they can say whatever they want! ””.

[1] There are exceptions though. Someone made some pro-Brexit ads that FB rejected because the ads didn’t say who were promoting them. And in the US someone announced they’d stand as a candidate and deliberately use fake ads - FB didn’t like that. 

(Also from Facebook: a new logo for the parent company, to distinguish the company from the product. The logo has both a shouty ALL-CAPS style and a retro all-of-the-colours 2014 feel. 2014 was a simpler, easier time for FACEBOOK.)

Money

Perhaps all platforms eventually expand until they include financial services? Facebook has a patent for a method of comparing a user’s financial transactions to their peers. If you own several social platforms that are about performative showing-off communicating with friends, it probably makes business sense to lean in to “keeping up with the joneses”.

And Uber announces deeper push into financial services with Uber Money.

Other news

Co-op Bank starts trial of Good Loop’s ethical ad tech.

Tesco and Co-op bosses join forces with plan to fix unfair system: Our solution to reform business rates and save the High Street - “First, cut business rates for all retailers by 20 per cent. Second, level the playing field on tax between online and high street shops by introducing an online sales levy of 2 per cent on the sale of physical goods.”

Why internet-era CTOs hire developers (rather than outsourcing).

News for all of Office365’s fans! Microsoft is combining Word, Excel and Powerpoint into a single mobile app for Android users. And Yammer is being updated and integrated more closely with Outlook, Sharepoint etc.

“The farm has both left- and right-wing troll accounts. That makes their smear and support campaigns more believable: instead of just taking one position for a client, it sends trolls to work both sides, blowing hot air into a discussion, generating conflict and traffic” - life working on a troll farm.

History of the design of the Bloomberg keyboard (the Bloomberg terminal is the Wall Street trader’s computing workhorse). This story is surprisingly interesting as it goes from mad, custom designs to something more like a standard computer keyboard.

Previous newsletters:

Most opened newsletter in the last month: Uber buys grocery delivery co. Most clicked story: Workshop Tactics kit.

News 1 year ago: Just walk out - unintended consequences in checkoutless stores.

News 2 years ago: Politically weaponised social media and election influence.

Co-op Digital news and events

Co-operate: why we prioritised ‘What’s happening’ - “Balancing and satisfying user needs and commercial needs is our top priority in Co-op Digital. But in Co-operate’s case, it was more efficient for us to lay some groundwork first. Choosing to focus on What’s happening as the first product meant we could move quickly and boost team and stakeholder morale, and thinking ahead about what would be sensible and beneficial to us in the future influenced what we built first.”

Public events, most of them at Federation House:

Human values in software production - Tue 5 Nov 6pm.

SenseMaker workshop: exploring the potential for sensor journalism - Wed 6 Nov 6pm.

Practitioners Forum: vital lessons for key co-operators - Thu 7 Nov at the Studio, Manchester.

Northern Azure User Group November Meetup - Tue 12 Nov 6pm.

Content Design Manchester Public Meet-up - Wed 13 Nov 6.30pm. 

Pods Up North , an event for podcasters - Sat 23 Nov 9am..

Mind the Product - MTP Engage - Fri 7 Feb 2020 - you can get early bird tickets now.

Internal events:

All hands - Tue 5 Nov 2pm at Fed defiant.

Co-operate show & tell - Wed 6 Nov 3pm at Fed 6.

Data management show & tell - Thu 7 Nov 2.30pm at Angel Sq 13th floor breakout.

Membership show & tell - Fri 8 Nov 3pm at Fed 6 kitchen.

Food ecommerce show & tell - Mon 11 Nov 10.15am at Fed 5.

Delivery community of practice - Mon 11 Nov 1.30pm at Fed house.

Health show & tell - Tue 12 Nov 2.30pm at Fed 5 kitchen.

Targeted marketing and data ecosystem show & tell - Wed 13 Nov at Angel Sq 13th floor breakout.

Membership show & tell - Fri 15 Nov 3pm at Fed 6 kitchen.

More events at Federation House - and you can contact the events team at  federation.events@coopdigital.co.uk. And TechNW has a useful calendar of events happening in the North West. 

Thank you for reading

Thank you, beloved readers and contributors. Please continue to send ideas, questions, corrections, improvements, etc to the newsletterbot’s keyboard gerbil @rod on Twitter. If you have enjoyed reading, please tell a friend!

If you want to find out more about Co-op Digital, follow us @CoopDigital on Twitter and read the Co-op Digital Blog. Previous newsletters.

[nurmedics]

Emergency Triage : Telephone Triage and Advice

Emergency Triage : Telephone Triage and Advice

Emergency Triage: Telephone Triage and Advice complements the highly successful Emergency Triage. The algorithms are rooted in the Manchester Triage System (MTS), which is used in hospitals around the world and which is acknowledged as an effective means of clinical prioritisation.

This telephone iteration of a triage system which prioritises millions of patients each year provides a robust,…

[coopcoopbware]

Experiments in productivity: the shared bug queue

Maybe you have this problem too

You manage or are part of a team that is responsible for a certain functional area of code. Everyone on the team is at different points in there career. Some people have only been there a few years, or maybe even only a few months, but they're hungry and eager to learn. Other team members have been around forever, and due to that longevity, they are go-to resources for the rest of your organization when someone needs help in that functional area. More-senior people get buried under a mountain of review requests, while those less-senior engineers who are eager to help and grow their reputation get table scraps.

This is the situation I walked into with the Developer Workflow team.

This was the first time that Mozilla had organized a majority (4) of build module peers in one group. There are still isolated build peers in other groups still, but we'll get to that in a bit.

With apologies to Ted, he's the elder statesman of the group, having once been the build module owner himself before handing that responsiblity off to Greg (gps), the current module owner. Ted has been around Mozilla for so long that he is a go-to resource for not only build system work but many other projects, e.g. crash analysis, he's been involved with. In his position as module owner, Greg bears the brunt of the current review workload for the build system. He needs to weigh-in on architectural decisions, but also receives a substantial number of drive-by requests simply because he is the module owner.

Chris Manchester and Mike Shal by contrast are relatively new build peers and would frequently end up reviewing patches for each other, but not a lot else. How could we more equitably share the review load between the team without creating more work for those engineers who were already oversubscribed?

Enter the shared bug queue

When I first came up with this idea, I thought that certainly this must have been tried at some point in the history of Mozilla. I was hoping to plug into an existing model in bugzilla, but alas, such a thing did not already exist. It took a few months of back-and-forth with our reisdent Bugmaster at Mozilla, Emma, to get something setup, but by early October, we had a shared queue in place.

How does it work?

We created a fictitious meta-user, core-build-config-reviews@mozilla.bugs. Now whenever someone submits a patch to the Core::Build Config module in bugzilla, the suggested reviewer always defaults to that shared user. Everyone on the teams watches that user and pulls reviews from "their" queue.

That's it. No, really.

Well, okay, there's a little bit more process around it than that. One of the dangers of a shared queue is that since no specific person is being nagged for pending reviews, the queue could become a place where patches go to die. As with any defect tracking system, regular triage is critically important.

Is it working?

In short: yes, very much so.

Subjectively, it feels great. We've solved some tricky people problems with a pretty straightforward technical/process solution and that's amazing. From talking to all the build peers, they feel a new collective sense of ownership of the build module and the code passing through it. The more-senior people feel they have more time to concentrate on higher level issues or deeper reviews. The less-senior people are building their reputations, both among the build peers and outside the group to review requesters.

Numerically speaking, the absolute number of review requests for the Core::Build Config module is consistent since the adoption of the shared queue. The distribution of actual reviewers has changed a lot though. Greg and Ted still end up reviewing their share of escalated requests — it's still possible to assign reviews to specific people in this system — but Mike Shal and Chris have increased their review volume substantially. What's even more awesome is that the build peers who are *NOT* in the Developer Workflow team are also fully onboard, regularly pulling reviews off the shared queue. Kudos to Nick Alexander, Nathan Froyd, Ralph Giles, and Mike Hommey for also embracing this new system wholeheartedly.

The need for regular triage has also provided another area of growth for the less-senior build peers. Mike Shal and Chris Manchester have done a great job of keeping that queue empty and forcing the team to triage any backlog each week in our team meeting.

Teh Future

When we were about to set this up in October, I almost pulled the plug.

Over the next six months, Mozilla is planning to switch code review tools from mozreview/splinter to phabricator. Phabricator has more modern built-in tools like Herald that would have made setting up this shared queue a little easier, and that's why I paused...briefly

Phabricator will undoubtedly enable a host of quality-of-life improvements for developers when it is deployed, but I'm glad we didn't wait for the new system. Mozilla engineers are already getting accustomed to the new workflow and we're reaping the benefits *right now*.

[samanthasroberts]

The making of a hangover: the true impact of one night out

Six reporters in city centres across the country report on one night of British drinking and its impact on the National Health Service

The calm before the storm

8.20pm, Cardiff

Police officers at Cardiff Central police station listen to the Cardiff After Dark briefing before heading out into the city. Photograph: Gareth Phillips for the Guardian

Were at the Cardiff ATC alcohol treatment centre; a collaboration between Cardiff and Vale University health board, local councils, South Wales police, the Welsh ambulance service and Cardiff Street Pastors. Right now, the police are preparing for the evening with a Cardiff After Dark meeting in the Welsh capitals main police station.

Sgt Gavin Howard briefs his team on what theyre doing tonight, with a slideshow with some interesting facts and figures. Last month, there were 145 people treated at the ATC, which is designed to ease pressure on hospital A&E staff by treating people with minor injuries and people suffering from too much drink.

Howard reminds officers to look out for revellers who pre-load drink heavily and cheaply at home before heading into the city centre. Pre-loading is seen as a particular problem for the emergency services the kids call it prinking pre-drinking. Steve Morris

9.09pm, Southampton

Consultant Dr Diana Hulbert, working in University hospital, Southampton, in the accident and emergency. Photograph: Antonio Olmos for the Guardian

Emergency consultant Diana Hulbert, who is in charge tonight, explains that not all alcohol-related attendances happen after a night on the town. A classic one is people waking up the next day and finding their wrist turned the wrong way, says Hulbert. So people are just as likely to present on the morning after.

She doesnt judge people who turn up in the department because of alcohol-related injuries or accidents, but says over the past 20 years she had noticed changes that are concerning.

People drink differently. Spirits is more a young persons drink and they can make people profoundly drunk very quickly. A beer is two units and you cant drink that many, maybe 10 pints. But if youre drinking shots, you can down five in five minutes. Thats what young people do. Lisa OCarroll

Keeping people out of A&E

Across the country, teams of people tour the streets treating relatively minor injuries suffered by people out on the town. In Manchester, they are called the Street Angels; Cardiff and other cities have their Street Pastors and, in Leicester, they are the Polamb.

Members of the Manchester Street Angels call a young womans father in order to help her get home. Photograph: Gary Calton for the Guardian

9.15pm, Leicester

On some nights the Polamb police-ambulance alcohol treatment vehicle in Leicester is a hub for treating people with alcohol-related injuries, attending up to 15 incidents in a night. It gets to the point that some of the local people recognise the Polamb and the paramedics who drive it. Jane Squire, East Midlands ambulance service paramedic, says one man she used to see regularly in the streets, a heavy drinker who would often call the ambulance for help, called her his green angel, for the dark green of the ambulance service uniform.

Sometimes theyll come up have a conversation with you and say: Ive cut my finger, can I have a plaster? says Squire. Other times theyll come up and say: Ive hurt my hand, can you take me to hospital? and Ill say: It says ambulance, not taxi.

Emergency services in Leicester city centre. Photograph: Kate Lyons for the Guardian

But the first call-out the Polamb has received now that the policeman for the evening, Const Joe Couchman, is on board is more serious treating a man in his 40s who suffered a cardiac arrest on the street. This isnt a typical call-out for the Polamb, not being alcohol-related, though it is believed the man was a heavy drinker, but they go where the need arises. Kate Lyons

11.13pm, Edinburgh

Tony Clapham (left) with his team of Edinburgh Street Pastors out on the streets. Photograph: Murdo Macleod for the Guardian

At Greenside parish church on Royal Terrace, in the centre of Edinburgh, the citys Street Pastors are preparing for the night with tea, home baking and a rousing hymn or two.

Street Pastors is an initiative of the Ascension Trust and was pioneered in London in 2013. It is now active in 270 towns and cities across the UK.

Street Pastors are volunteers from local churches who patrol in teams of men and women, usually from 10pm to 4am on a Friday and Saturday night, to care for, listen to and help people who out on the streets, whether celebrating on a hen night or homeless.

Two teams are going out tonight, one to the Grassmarket and another to George Street, with backpacks containing flasks of hot drinks and biscuits.

As team leader Tony Clapham explains, some of these volunteers have been working on the night time streets and have built up strong relationships with homeless people, as well as police and paramedics and other concerned with health and safety of the night time economy. Libby Brooks

Midnight, Stoke

Senior sister Nicola Beckett tries to wake a man who has come into A&E with suspected alcohol abuse issues at Royal Stoke University hospital in Stoke-on-Trent. Photograph: Alicia Canter for the Guardian

One man, a regular alcohol abuser, has run off from hospital, and senior sister Nicola Beckett has to send police to find him, because he is now deemed a vulnerable adult as he has not had full medical checkups.

The hospital now has so many regular attendees they have a special group for them all, which flags up if someone has been in more than three times a month. Sometimes Beckett sees someone twice a day.

Paramedic Tracy Proud (2nd left, purple hair) along with paramedic colleagues care for an unconscious man who is admitted to A&E with suspected alcohol abuse issues at Royal Stoke University hospital in Stoke-on-Trent. Photograph: Alicia Canter for the Guardian

You do get friendly with them, they are as nice to you as you are to them. You do see them decline, the physical decline. You admit them to rehab but you just know youll see them again. Its an addiction, an illness. So many, you are discharging them and they say: Ive got no home to go to. You sometimes do get a sense they are here for a hot meal and a bed and a kind face.

Beckett has seen some terrifying moments too. I dont want to make it too dramatic. But yes, I have feared for my life. You are trained in conflict management, self-defence. But if someone is drunk and aggressive, I cant handle that myself.

Elsewhere, she reported, patients were queuing on beds in the corridor at the ambulance triage. Paramedic Tracy Proud was liaising with A&E staff to speed up the transfer of people.

Paramedic Tracy Proud. Photograph: Alicia Canter for the Guardian

Its ridiculous, she said, looking over her shoulder at the queue of beds behind her. One patient has a can of Skol under the trolley.

I think if you went through most of the patients, 85% shouldnt be here. People have a different view about what an emergency is. If Im called to look after a teenager or young person who is drunk, I call their parents straight away. Parents dont realise it, but its not our job to just be watching a drunk person who has passed out.

Agitated patients have lashed out in the back of moving ambulance. I had one patient who I thought was asleep and he came to, and he turned on me. I had to jump out the side door of the van. Jessica Elgot

A nurse attends to a young female student from Keele University who has been taken to A&E with suspected alochol abuse issues and is treated in resus at Royal Stoke University hospital in Stoke-on-Trent Photograph: Alicia Canter for the Guardian

12.17am, Manchester

Josh Halliday speaks with chief Angel, Rachel Goddard.

12.58am, Southampton

Nurse Katherine Chipande working in A&E at University hospital, Southampton. Photograph: Antonio Olmos for the Guardian

A night out in Southampton has turned into a night in A&E for one young woman who has just been admitted with a head injury. She had been at a party and fell and hit her head. There was alcohol and drugs, said nurse Catherine Chipande.

There are about 20 other patients in the majors area with two sleeping off the alcohol and a third about to be assessed.

Trouble 1.17am, Liverpool

Two Mikes, 23 and 32, a Carl, 18 and a Tom, 23, are sitting in a pub in the small hours. None has ever ended up in A&E, though Toms ended up in the drunk and disorderly, you know, the police. He got tangled up in the theft of a plastic ornament and jostled a plain clothes police officer leaping from a Vauxhall Corsa, five years ago. This is my time, he says triumphantly, to get my story out. If Id known he were a copper, things would have gone very differently. I was at my aunties 40th.

Mike the younger said: Things happen when youre drunk. I hit my cousin in the face on my 20th birthday.

The bottom line, said Mike the older, is that if youre trouble, trouble will find you. Yes, said the younger Mike resoundingly. My cousin went to Krazy House … Is that with a C or a K? How can you ask that? (they all shake their heads). And the next thing you know, hes had his nose broken. Is this the same cousin you punched in the face? I gave him a black eye. Someone else broke his nose. Theres levels. I know this, I studied law at A level.

The older Mike takes control. This is a beautiful place. This isnt a degenerate place. Independent bars, independent clubs, independent eateries. The transformation of Liverpool, the systemic regeneration of every part of this city, is almost beyond compare. I love this city and the people of this city. Zoe Williams

The view from the professionals

1.26am, Southampton

All has been calm in the assessment area in Southampton until now when a very aggressive drunk man is admitted with a cut to his face, swearing at anyone in sight. He is being held down by two policemen. We are advised not to go near him. Fuck off, he shouts to a female ambulance crew member accompanying him.

The man is refusing to cooperate as he is placed in a bay next to an elderly lady, beaming with a grateful smile towards the two nurses attending to her.

It takes a while for experienced staff to calm down the 29-year-old. Then its all sweetness and light, with a friendly hello for staff as he is wheeled in to majors for further assessment.

Sometimes its like that but sometimes they dont calm down at all and they get carried out in handcuffs. If it gets too bad and they have been assessed and they are not too bad they are just taken away by police, said receptionist Sarah Jones. Lisa OCarroll

1.46am, Manchester

Outside Deansgate Locks, a popular party spot with several bars and clubs, its not quite kicking out time but were already seeing a couple of early casualties. A drunk girl has fallen and cut her knee badly. Shes crying on the phone to her parents while being treated by the Street Angels. Another job saved from paramedics. Josh Halliday

1.51am, Stoke

Dr Ben Arnold in A&E at Royal Stoke University hospital in Stoke-on-Trent. Photograph: Alicia Canter for the Guardian

Dr Ben Arnold, a senior house office in emergency medicine, loves a Friday night in the minor injuries section.

I like drunk people when they are not so unwell, you can joke with them. Their friends have brought them in because theyre worried about them, but from a medical point of view, theyre healthy, you can have a chat. Theres a common theme which colours the excuses made by revellers as they come round in A&E.

They say their drink has been spiked, their friends say: They always drink this much, it must be something in the drink. But it obviously is because they have had more than usual or havent eaten enough.

Its younger ones, 18-year-olds, who are more honest about it. They do get very embarrassed especially if they have had a loss of continence. And they have to go home in a hospital gown.

Sometimes, its not just the patients causing Arnold all the bother. Its friends and relatives who might be a bit drunk. They get bored, they dress up in the gloves and gowns, mucking about and you have to go and remind them that a hospital is a serious place. Jessica Elgot

1.55am, Cardiff

A nurse helps a very drunk teenager at the ATC in Bridge Street, Cardiff. Photograph: Gareth Phillips for the Guardian

An 18-year-old student is found lying alone, clearly drunk, on the pavement close to the university. There were a series of sexual assaults on women in this area last year so passersby are worried and dial 999.

She has not been assaulted but has simply drunk too much at a house party. An ambulance crew arrives and takes her to the alcohol treatment centre ATC. She is sick on the way and sick several times at the ATC.

At the ATC she is assessed and given water. Ceri Martin, a sister, and Charlotte Pritchard, a healthcare support worker tend to her. She is joined by a friend at the ATC and they sit together, slumped in a corner, waiting for her to recover.

Shell be here for two or three hours while she gets herself together, said Martin. Well get her to drink water, observe her and keep her warm. Then well make sure she gets home safely.

Im just glad that theres a place like this for young women like that. Shes in a safe place and were helping keep pressure off A&E.

A street pastor radios in to say she is bringing someone in to the ATC. So it begins, says Pritchard. It still could be a long night/morning here.

But its not always a thankless task, as this note at the ATC indicates:

steven morris (@stevenmorris20) January 23, 2016

A grateful patient cared for at the alcohol treatment centre in Cardiff. pic.twitter.com/CiLLATTFIV

2am, Manchester

Josh Halliday talks to Street Angel volunteer Paul Jones

2.01am, Southampton

Suspected drunk male brought into the assessment area of A&E in University hospital, Southampton. Photograph: Antonio Olmos for the Guardian

Two more alcohol admissions in Southampton in the space of 10 minutes, one so inebriated he is semi-conscious.

The worry here is that the alcohol might mask a head injury, says nurse Sam Carter. So we do a set of neuro obs [observations] and lactate assessment to see if he is dehydrated. We might also resort to pain stimuli, squeeze his trapezium really hard to check his responses, she adds. Ouch. Lisa OCarroll

2.10am, Stoke

Back in Stoke, there are 99 patients in A&E at 2am, which is an achievement for the staff, the first time numbers have dropped below 100 since 4.30pm yesterday. Patients are being discharged, or waiting to be admitted to other departments as beds there become available. Though some staff are beginning to end their shifts, many others are here until the morning. More than 100 people have come through the doors already since midnight; some who have overindulged tonight are on trollies in the corridor making emotional phone calls. There is more work to do before the night is over for A&E staff five more ambulances are on their way. Jessica Elgot

Source: http://allofbeer.com/the-making-of-a-hangover-the-true-impact-of-one-night-out/

from All of Beer https://allofbeer.wordpress.com/2018/01/02/the-making-of-a-hangover-the-true-impact-of-one-night-out/

[adambstingus]

The making of a hangover: the true impact of one night out

Six reporters in city centres across the country report on one night of British drinking and its impact on the National Health Service

The calm before the storm

8.20pm, Cardiff

Police officers at Cardiff Central police station listen to the Cardiff After Dark briefing before heading out into the city. Photograph: Gareth Phillips for the Guardian

Were at the Cardiff ATC alcohol treatment centre; a collaboration between Cardiff and Vale University health board, local councils, South Wales police, the Welsh ambulance service and Cardiff Street Pastors. Right now, the police are preparing for the evening with a Cardiff After Dark meeting in the Welsh capitals main police station.

Sgt Gavin Howard briefs his team on what theyre doing tonight, with a slideshow with some interesting facts and figures. Last month, there were 145 people treated at the ATC, which is designed to ease pressure on hospital A&E staff by treating people with minor injuries and people suffering from too much drink.

Howard reminds officers to look out for revellers who pre-load drink heavily and cheaply at home before heading into the city centre. Pre-loading is seen as a particular problem for the emergency services the kids call it prinking pre-drinking. Steve Morris

9.09pm, Southampton

Consultant Dr Diana Hulbert, working in University hospital, Southampton, in the accident and emergency. Photograph: Antonio Olmos for the Guardian

Emergency consultant Diana Hulbert, who is in charge tonight, explains that not all alcohol-related attendances happen after a night on the town. A classic one is people waking up the next day and finding their wrist turned the wrong way, says Hulbert. So people are just as likely to present on the morning after.

She doesnt judge people who turn up in the department because of alcohol-related injuries or accidents, but says over the past 20 years she had noticed changes that are concerning.

People drink differently. Spirits is more a young persons drink and they can make people profoundly drunk very quickly. A beer is two units and you cant drink that many, maybe 10 pints. But if youre drinking shots, you can down five in five minutes. Thats what young people do. Lisa OCarroll

Keeping people out of A&E

Across the country, teams of people tour the streets treating relatively minor injuries suffered by people out on the town. In Manchester, they are called the Street Angels; Cardiff and other cities have their Street Pastors and, in Leicester, they are the Polamb.

Members of the Manchester Street Angels call a young womans father in order to help her get home. Photograph: Gary Calton for the Guardian

9.15pm, Leicester

On some nights the Polamb police-ambulance alcohol treatment vehicle in Leicester is a hub for treating people with alcohol-related injuries, attending up to 15 incidents in a night. It gets to the point that some of the local people recognise the Polamb and the paramedics who drive it. Jane Squire, East Midlands ambulance service paramedic, says one man she used to see regularly in the streets, a heavy drinker who would often call the ambulance for help, called her his green angel, for the dark green of the ambulance service uniform.

Sometimes theyll come up have a conversation with you and say: Ive cut my finger, can I have a plaster? says Squire. Other times theyll come up and say: Ive hurt my hand, can you take me to hospital? and Ill say: It says ambulance, not taxi.

Emergency services in Leicester city centre. Photograph: Kate Lyons for the Guardian

But the first call-out the Polamb has received now that the policeman for the evening, Const Joe Couchman, is on board is more serious treating a man in his 40s who suffered a cardiac arrest on the street. This isnt a typical call-out for the Polamb, not being alcohol-related, though it is believed the man was a heavy drinker, but they go where the need arises. Kate Lyons

11.13pm, Edinburgh

Tony Clapham (left) with his team of Edinburgh Street Pastors out on the streets. Photograph: Murdo Macleod for the Guardian

At Greenside parish church on Royal Terrace, in the centre of Edinburgh, the citys Street Pastors are preparing for the night with tea, home baking and a rousing hymn or two.

Street Pastors is an initiative of the Ascension Trust and was pioneered in London in 2013. It is now active in 270 towns and cities across the UK.

Street Pastors are volunteers from local churches who patrol in teams of men and women, usually from 10pm to 4am on a Friday and Saturday night, to care for, listen to and help people who out on the streets, whether celebrating on a hen night or homeless.

Two teams are going out tonight, one to the Grassmarket and another to George Street, with backpacks containing flasks of hot drinks and biscuits.

As team leader Tony Clapham explains, some of these volunteers have been working on the night time streets and have built up strong relationships with homeless people, as well as police and paramedics and other concerned with health and safety of the night time economy. Libby Brooks

Midnight, Stoke

Senior sister Nicola Beckett tries to wake a man who has come into A&E with suspected alcohol abuse issues at Royal Stoke University hospital in Stoke-on-Trent. Photograph: Alicia Canter for the Guardian

One man, a regular alcohol abuser, has run off from hospital, and senior sister Nicola Beckett has to send police to find him, because he is now deemed a vulnerable adult as he has not had full medical checkups.

The hospital now has so many regular attendees they have a special group for them all, which flags up if someone has been in more than three times a month. Sometimes Beckett sees someone twice a day.

Paramedic Tracy Proud (2nd left, purple hair) along with paramedic colleagues care for an unconscious man who is admitted to A&E with suspected alcohol abuse issues at Royal Stoke University hospital in Stoke-on-Trent. Photograph: Alicia Canter for the Guardian

You do get friendly with them, they are as nice to you as you are to them. You do see them decline, the physical decline. You admit them to rehab but you just know youll see them again. Its an addiction, an illness. So many, you are discharging them and they say: Ive got no home to go to. You sometimes do get a sense they are here for a hot meal and a bed and a kind face.

Beckett has seen some terrifying moments too. I dont want to make it too dramatic. But yes, I have feared for my life. You are trained in conflict management, self-defence. But if someone is drunk and aggressive, I cant handle that myself.

Elsewhere, she reported, patients were queuing on beds in the corridor at the ambulance triage. Paramedic Tracy Proud was liaising with A&E staff to speed up the transfer of people.

Paramedic Tracy Proud. Photograph: Alicia Canter for the Guardian

Its ridiculous, she said, looking over her shoulder at the queue of beds behind her. One patient has a can of Skol under the trolley.

I think if you went through most of the patients, 85% shouldnt be here. People have a different view about what an emergency is. If Im called to look after a teenager or young person who is drunk, I call their parents straight away. Parents dont realise it, but its not our job to just be watching a drunk person who has passed out.

Agitated patients have lashed out in the back of moving ambulance. I had one patient who I thought was asleep and he came to, and he turned on me. I had to jump out the side door of the van. Jessica Elgot

A nurse attends to a young female student from Keele University who has been taken to A&E with suspected alochol abuse issues and is treated in resus at Royal Stoke University hospital in Stoke-on-Trent Photograph: Alicia Canter for the Guardian

12.17am, Manchester

Josh Halliday speaks with chief Angel, Rachel Goddard.

12.58am, Southampton

Nurse Katherine Chipande working in A&E at University hospital, Southampton. Photograph: Antonio Olmos for the Guardian

A night out in Southampton has turned into a night in A&E for one young woman who has just been admitted with a head injury. She had been at a party and fell and hit her head. There was alcohol and drugs, said nurse Catherine Chipande.

There are about 20 other patients in the majors area with two sleeping off the alcohol and a third about to be assessed.

Trouble 1.17am, Liverpool

Two Mikes, 23 and 32, a Carl, 18 and a Tom, 23, are sitting in a pub in the small hours. None has ever ended up in A&E, though Toms ended up in the drunk and disorderly, you know, the police. He got tangled up in the theft of a plastic ornament and jostled a plain clothes police officer leaping from a Vauxhall Corsa, five years ago. This is my time, he says triumphantly, to get my story out. If Id known he were a copper, things would have gone very differently. I was at my aunties 40th.

Mike the younger said: Things happen when youre drunk. I hit my cousin in the face on my 20th birthday.

The bottom line, said Mike the older, is that if youre trouble, trouble will find you. Yes, said the younger Mike resoundingly. My cousin went to Krazy House … Is that with a C or a K? How can you ask that? (they all shake their heads). And the next thing you know, hes had his nose broken. Is this the same cousin you punched in the face? I gave him a black eye. Someone else broke his nose. Theres levels. I know this, I studied law at A level.

The older Mike takes control. This is a beautiful place. This isnt a degenerate place. Independent bars, independent clubs, independent eateries. The transformation of Liverpool, the systemic regeneration of every part of this city, is almost beyond compare. I love this city and the people of this city. Zoe Williams

The view from the professionals

1.26am, Southampton

All has been calm in the assessment area in Southampton until now when a very aggressive drunk man is admitted with a cut to his face, swearing at anyone in sight. He is being held down by two policemen. We are advised not to go near him. Fuck off, he shouts to a female ambulance crew member accompanying him.

The man is refusing to cooperate as he is placed in a bay next to an elderly lady, beaming with a grateful smile towards the two nurses attending to her.

It takes a while for experienced staff to calm down the 29-year-old. Then its all sweetness and light, with a friendly hello for staff as he is wheeled in to majors for further assessment.

Sometimes its like that but sometimes they dont calm down at all and they get carried out in handcuffs. If it gets too bad and they have been assessed and they are not too bad they are just taken away by police, said receptionist Sarah Jones. Lisa OCarroll

1.46am, Manchester

Outside Deansgate Locks, a popular party spot with several bars and clubs, its not quite kicking out time but were already seeing a couple of early casualties. A drunk girl has fallen and cut her knee badly. Shes crying on the phone to her parents while being treated by the Street Angels. Another job saved from paramedics. Josh Halliday

1.51am, Stoke

Dr Ben Arnold in A&E at Royal Stoke University hospital in Stoke-on-Trent. Photograph: Alicia Canter for the Guardian

Dr Ben Arnold, a senior house office in emergency medicine, loves a Friday night in the minor injuries section.

I like drunk people when they are not so unwell, you can joke with them. Their friends have brought them in because theyre worried about them, but from a medical point of view, theyre healthy, you can have a chat. Theres a common theme which colours the excuses made by revellers as they come round in A&E.

They say their drink has been spiked, their friends say: They always drink this much, it must be something in the drink. But it obviously is because they have had more than usual or havent eaten enough.

Its younger ones, 18-year-olds, who are more honest about it. They do get very embarrassed especially if they have had a loss of continence. And they have to go home in a hospital gown.

Sometimes, its not just the patients causing Arnold all the bother. Its friends and relatives who might be a bit drunk. They get bored, they dress up in the gloves and gowns, mucking about and you have to go and remind them that a hospital is a serious place. Jessica Elgot

1.55am, Cardiff

A nurse helps a very drunk teenager at the ATC in Bridge Street, Cardiff. Photograph: Gareth Phillips for the Guardian

An 18-year-old student is found lying alone, clearly drunk, on the pavement close to the university. There were a series of sexual assaults on women in this area last year so passersby are worried and dial 999.

She has not been assaulted but has simply drunk too much at a house party. An ambulance crew arrives and takes her to the alcohol treatment centre ATC. She is sick on the way and sick several times at the ATC.

At the ATC she is assessed and given water. Ceri Martin, a sister, and Charlotte Pritchard, a healthcare support worker tend to her. She is joined by a friend at the ATC and they sit together, slumped in a corner, waiting for her to recover.

Shell be here for two or three hours while she gets herself together, said Martin. Well get her to drink water, observe her and keep her warm. Then well make sure she gets home safely.

Im just glad that theres a place like this for young women like that. Shes in a safe place and were helping keep pressure off A&E.

A street pastor radios in to say she is bringing someone in to the ATC. So it begins, says Pritchard. It still could be a long night/morning here.

But its not always a thankless task, as this note at the ATC indicates:

steven morris (@stevenmorris20) January 23, 2016

A grateful patient cared for at the alcohol treatment centre in Cardiff. pic.twitter.com/CiLLATTFIV

2am, Manchester

Josh Halliday talks to Street Angel volunteer Paul Jones

2.01am, Southampton

Suspected drunk male brought into the assessment area of A&E in University hospital, Southampton. Photograph: Antonio Olmos for the Guardian

Two more alcohol admissions in Southampton in the space of 10 minutes, one so inebriated he is semi-conscious.

The worry here is that the alcohol might mask a head injury, says nurse Sam Carter. So we do a set of neuro obs [observations] and lactate assessment to see if he is dehydrated. We might also resort to pain stimuli, squeeze his trapezium really hard to check his responses, she adds. Ouch. Lisa OCarroll

2.10am, Stoke

Back in Stoke, there are 99 patients in A&E at 2am, which is an achievement for the staff, the first time numbers have dropped below 100 since 4.30pm yesterday. Patients are being discharged, or waiting to be admitted to other departments as beds there become available. Though some staff are beginning to end their shifts, many others are here until the morning. More than 100 people have come through the doors already since midnight; some who have overindulged tonight are on trollies in the corridor making emotional phone calls. There is more work to do before the night is over for A&E staff five more ambulances are on their way. Jessica Elgot

from All Of Beer http://allofbeer.com/the-making-of-a-hangover-the-true-impact-of-one-night-out/ from All of Beer https://allofbeercom.tumblr.com/post/169240948782

[tennissurfacingspecifications]

Detailed guide: Cervical screening: education and training

This guide sets out education and training resources available to healthcare professionals working in the NHS cervical screening programme (CSP).

E-learning

E-learning developed by the NHS screening programmes is available on the e-Learning for Healthcare (e-LfH) website.

Read about CSP e-learning and sign up for e-Learning for Healthcare.

E-learning for GPs

Complete the British Medical Journal’s screening for cervical cancer module to learn about:

how to advise women worried about cervical cancer

what information to give women

how to advise women who have questions about the NHS cervical screening programme

Physicians: video learning modules

Watch 4 medical animations for health professionals showing cervical anatomy and the development of cervical cancer.

Cervical sample taker training

Read the guidance for the training of new cervical sample takers.

Download presentations for each of the training modules within the publication.

Primary human papillomavirus (HPV) testing: pilot site sample taker training

The NHS CSP is piloting primary HPV testing.

Resources are available to train sample takers working in pilot sites. These include a:

primary HPV testing leaflet for sample takers

training presentation on primary HR-HPV testing and cytology triage

flowchart of the pilot protocol

flowchart of the colposcopy management system for women having primary HPV testing

primary HPV testing screening invitation letter sent to women

primary HPV testing information leaflet sent to women with their invitation

cervical screening leaflet ‘Helping you decide’

Cervical cytology training

There are 5 NHS CSP approved cervical cytology training centres. 4 in England and 1 in Scotland.

Birmingham Cytology Training Centre.

Cytology Department Birmingham Women's Hospital Mindelsohn Way Edgbaston Birmingham B15 2TG

North of England Pathology and Screening Education Centre.

Unit 3, Wakefield Office Village Fryers Way Silkwood Park Wakefield WF5 9TJ Ground Floor, Clinical Sciences Building 2 Manchester Royal Infirmary Oxford Road Manchester M13 9WL

London Regional Cytology Training Centre.

Level 6X, Room 005 St Marks Building The North West London Hospitals NHS Trust Northwick Park Hospital Watford Road Harrow Middlesex HA1 3UJ

South West Regional Cytology Training Centre in Bristol.

Department of Cellular Pathology Pathology Sciences Building Southmead Hospital Bristol BS10 5NB

Scottish Cytology Training School.

1st Floor, Building 9 Edinburgh Bioquarter 9 Little France Road Old Dalkeith Road Edinburgh EH16 4XU

Education and training: all programmes

Read and download education and training resources for all screening programmes.

This includes:

the screening timeline

events

Health Knowledge: screening overview

The interactive learning on screening available from Health Knowledge is helpful for new and non clinical staff or those returning after a long period absent.

from Public Health England - Activity on GOV.UK https://www.gov.uk/guidance/cervical-screening-education-and-training via IFTTT

[apprenticeshipsinlondon]

Apprentice Cyber Intrusion Analyst

16 Hestham Cres, Morecambe, Morecambe, Lancashire LA4 4QF, UK Anonymous A fantastic opportunity has arisen for an Apprentice Analyst working for our Design & Engineering division in Salford, Manchester. The role involves being part of a 24x7 Security Operation Centre (SOC) team, with responsibility for monitoring the company`s networks for security issues (using SIEM/log analysis toolsets), assisting with vulnerability scanning, threat intelligence and security incident response. The purpose of the role is to ensure that the company`s information and systems are protected, in accordance with the needs of the business and according to Information Security principles of availability, integrity and confidentiality. The SOC Apprentice Analyst will work with the SOC Specialist/shift leader day to day and the IT Forensics Specialist. As an Apprentice Cyber Intrusion Analyst, your job includes: Protective Monitoring -Monitor the company`s networks for malicious activity using Security Incident and Event Management (SIEM) toolsets. This will include responding to and investigating alerts, assisting with developing new security monitoring use cases, and ensuring all investigative activity is properly documented in our ticketing systems and followed up with relevant support teams. Triage -Triage issues escalated to the information security team, and ensure that appropriate followup actions are taken by the SOC. Development of Documentation -Assist the SOC Specialist in developing and maintaining SOC documentation and processes. Threat Intelligence -Assist the SOC Specialist in monitoring open source intelligence sources for potential threats against the company, and ensure appropriate defensive actions are taken with respect to these. Vulnerability Assessment -Assist the SOC Specialist in running vulnerability scans against the company`s infrastructure, interpreting these and following up issues with relevant support teams. Incident Response -Form part of the company`s Security Incident Response team, assisting with whatever activities are deemed necessary by the incident leader. Project Support -Provide support to projects undertaken by the company`s Information Security function. What experience and skills do I need? You`ll need at least five GCSEs (or equivalent) at Grade C or above including Maths, English and either IT or Science. Essential: -Highly motivated individual with a genuine enthusiasm for information security and technology; -Willingness to work shifts (including unsociable hours and bank holidays where these fall into your shift pattern) as part of a 24x7 team. -Sound understanding of information security principles and best practices; -Good communication skills both written and verbal; -Ability to prioritise workloads and to know when to seek guidance. Desirable -Good infrastructure and technology experience including demonstrable understanding of security operations; -Good knowledge of security issues inherent in common corporate environments; -Experience working with 1st line ticketing/triage -Experience using Security Incident and Event Management (SIEM) toolsets; -Specific experience in Splunk / big data forensic technologies; -Specific experience using Alienvault SIEM toolsets; -Experience using vulnerability scanning tools; -Experience identifying and reporting on open source threat intelligence; -Proven technical ability in Unix/Linux/etc; -Proven technical ability in Microsoft Windows; -Proven technical ability in networking systems; -Experience with VMware virtualisation; -Experience of system forensics; -Experience of malware analysis. Vetting -Due to the sensitive nature of the role successful candidates will be subject to background checks (including criminal records checks). Your Accelerated training programme Firebrand offers a unique Higher Level 4 IT Apprenticeship scheme. We provide the fastest award-winning industry training and certifications with on-going support - all with the ultimate goal of securing a long-term IT career. During your two-year programme, Firebrand provides residential training at our distraction-free training centre. Our accelerated training means you'll achieve training with partners like CompTIA, ITIL and Microsoft faster, giving you more time to put your new skills into practice within a professional working environment. When you complete your programme, you'll have enough industry-recognised qualifications for a great career in IT. You'll be registered by the British Computer Society (BCS) to the Register of IT Technicians, confirming SFIA level 3 professional competence. Future career prospects By working hard and demonstrating your ability, drive and commitment throughout your 24 month apprenticeship scheme, upon completion you may be offered a permanent contract ensuring you have further opportunities to continue growing within this exciting organisation from Youth In Jobs https://youthinjobs.co.uk/job/47494/apprentice-cyber-intrusion-analyst/

[coopdigitalnewsletter]

Co-op Digital newsletter 16 Oct 2017: Retail adapting, maintaining code and fixing values, pretend to be an AI

Hello, this is the Co-op Digital newsletter. Send us feedback at CoopDigitalNewsletter@co-operative.coop.

[Image: ElSaid et al]

.

Futuretail

An interesting long read about how retail is changing as it adapts to the challenge of the internet. Cheaper discounters like Lidl. Staff-less shops (“All of this means it only takes four members of [BingoBox] staff to run 40 stores”). Integrating retail and online experiences (Alibaba’s Hema). Self-driving shops.

.

Maintaining code, maintaining values

Google shrank its translation code by a factor of 1,000 by replacing most of it with machine learning. At first read this is a good thing, because a smaller codebase is probably more efficient and easier to maintain. But perhaps bugs or biases are *harder* to find and fix in machine learning systems because by definition you don’t know exactly how your ML black box works?

If you ran an organisation and needed to change its values, you wouldn’t write a new Important Statement of Our Values. Culture and values are about people and behaviour, not documents. You’d need to retrain (or maybe replace) the people with the bad values, and make sure you hired people with the desired values. What’s the equivalent for algorithms and AIs? If you discover your AI has biases, do you tear it down and start again? Retrain it with new, unbiased data? Related: The Seven Deadly Sins of AI Predictions.

.

Pretend to be an AI!

Google's new browser experiment lets you learn about basic AI. But this is more fun: Paperclips - a “clicker” game based on an AI thought experiment. Paperclips is so moreish and popular that the website might not work, so here’s a description (spoilers!): you click buttons and numbers go up, making you feel good, and every so often there are new buttons to click, and eventually an existential abyss. It’s quite fun though it slightly makes you feel like you’ve been duped into being the treadmill in a bitcoin mining scan. Games like this provide intermittent variable rewards, and the same psychological mechanism is what keep people checking their mobiles and playing Facebook.

.

Social media and politics

The problem of Russian meddling on Google and Facebook is much greater than has been previously revealed.

Trump digital director says “Twitter is how [Trump] talked to the people” but Facebook staffers helped with targeted advertising. “Among other services, Facebook’s elections advertising allows campaigns to take lists of registered voters drawn from public records and find those people on Facebook."

Ofcom chair’s personal view is that Facebook, Google and others are publishers rather than neutral technology platforms, a hint that she thinks they should be regulated.

.

Whole Foods may eat Amazon Fresh (but Prime rules all)

Amazon says that Fresh may shut down as a result of the Whole Foods deal, which perhaps simply means that it’ll be rebadged as Whole Foods. But Prime goes from strength to strength: “We are going to try to do a lot to make Prime really valuable for when you’re shopping at Whole Foods [...] make Amazon Prime the customer rewards program at Whole Foods Market.”

Prime is becoming more family friendly: monthly payments for students, shopping support for teens on parental Prime accounts.

.

Corbyn: what if Uber were co-operatively run?

Jeremy Corbyn: “Imagine an Uber run co-operatively by their drivers, collectively controlling their futures, with profits shared or re-invested.” Of course, Uber actually runs at a loss (investors have to keep putting money in so Uber can offer rides at below-cost as part of its plan to own a big percentage of All Future Journeys Taken), so the snarky comeback is asking whether a co-op would be happy to keep pouring money in to achieve Uber’s goals. Though of course a co-operative Uber might not have VC-economics driving it forward, and so might have different goals.

.

In brief

Hello Fresh planning its IPO with 1.3m active customers. Customer retention has been a challenge for a few of the meal delivery companies, so their choice of a punchy definition of “active” is interesting: “the number of uniquely identified customers who received at least one box within the last 13 weeks, as of June 2017 (including [...] customers who ordered during the relevant period but discontinued their orders)”.

Amazon’s experimenting with delivery all the way to your fridge - a couple of weeks ago, we talked about Walmart doing the same.

Shell is buying an electric charging network - gradual fossil fuel divestment.

Transport for London is considering selling its expertise with open data.

Smart watch sensors are getting good enough for life-saving monitoring.

A year ago in this newsletter: Ocado was using Machine Learning to triage customer support for its 0.5m active customer.

Last week: Ghostface Killah’s Cream cryptocurrency Initial Coin Offering (the ICO we’re all waiting for is Ol’ Dirty Blockchain). This week technology-shy football manager Harry Redknapp is recommending one.

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CoopDigital news

Steve Foreshew-Cain: the Funeralcare service exits beta and Design Manchester has begun.

Co-op Digital talks service design at Design Manchester.

We held a massive retro and this is what we learnt - retrospectives for 50-people teams need more structure and planning than a simple What to keep doing/stop doing/change? meeting.

Events

Federation beta Tue 17 Oct 1pm at Federation House 1st floor.

Membership Wed 18 Oct 2pm at Federation House 6th floor.

Food Leading the Way - Thu 19 Oct 11am at at 1 Angel Square 4th Floor Blue Zone.

Co-op platform - Wed 25 Oct 11.30am at 1 Angel Square 8th floor.

Location services - Wed 25 Oct 3pm at Federation House 6th floor.Food Leading the Way - Thu 26 Oct 11am at 1 Angel Square 4th Floor Blue Zone.

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