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Tag: Mountain Mike's Pizza
Mountain Mike's Pizza Opens in Costa Mesa
Leading Family-Style Pizza Chain Debuts New Restaurant Design in Orange County Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, a leading family-style pizza chain known for its legendary crispy, curly pepperoni, Mountain-sized pizzas and dough made fresh daily for over 40 years,…
Mountain Mike's Pizza Named a Top Ten Franchise Deal
Leading Family-Style Pizza Chain Named One of the Best Franchise Deals in the Nation by QSR Magazine Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, a leading family-style pizza chain known for its legendary crispy, curly pepperoni, Mountain-sized pizzas and dough made…
Mountain Mike's Pizza Opens First Temecula Location
Now Serving Temecula its Legendary Crispy, Curly Pepperoni Pizzas Via Contactless Delivery, Takeout & Dine-In Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, a leading family-style pizza chain known for its legendary crispy, curly pepperoni, Mountain-sized pizzas and dough made fresh…
Mountain Mike's Pizza Named One of America's Top Performing Restaurant Chains
Leading Family-Style Pizza Chain Debuts at #189 on NRN's Top 200 Report Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, a leading California-based family-style pizza chain known for its legendary crispy, curly pepperonis, Mountain-sized pizzas, and dough made fresh daily for…
Mountain Mike's Pizza Ranks High in Top 500 Restaurant Report
Leading Family-Style Pizza Chain Jumps 16 Places in Restaurant Business' 2020 List of Highest-Grossing Restaurant Chains Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, a leading family-style pizza chain known for its legendary crispy, curly pepperoni, Mountain-sized pizzas and dough made fresh…
May 27, 2020 · ·
Mountain Mike's Pizza Opens Fifth Oakland Location
Now Serving its Legendary Crispy, Curly Pepperoni Via Contactless Delivery & Carryout Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, a leading family-style pizza chain known for its legendary crispy, curly pepperoni, Mountain-sized pizzas and dough made fresh daily for over 40…
Mountain Mike's Pizza Opens First Eureka Location
Now Serving its Legendary Crispy, Curly Pepperoni Pizzas Via Contactless Delivery & Curbside Pick-Up Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, a leading family-style pizza chain known for its legendary crispy, curly pepperoni, Mountain-sized pizzas and dough made fresh daily…
April 15, 2020 · ·
Mountain Mike's Pizza – Offers and Contactless Delivery
Mountain Mike's Pizza – a leading family-style pizza chain known for its legendary crispy, curly pepperoni, Mountain-sized pizzas and dough made fresh daily for over 40 years, is now offering contactless delivery in tamper-resistant packaging. Place your order online or…
March 28, 2020 · ·
Mountain Mike's Pizza Opens Doors to Second Los Banos Location
Family-Friendly Pizza Spot Serves Up More Crispy, Curly Pepperoni in Central California Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, a leading family-style pizza chain known for its legendary crispy, curly pepperonis and Mountain-sized pizzas, is excited to announce the opening of…
Mountain Mike's Pizza Expands in Orange County
Leading Family-Style Pizza Chain Announces Two New Restaurant Prototype Locations & New National Franchise Support Center Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, a leading Southern California-based family-style pizza chain known for its legendary crispy, curly pepperoni, Mountain-sized pizzas and…
February 18, 2020 · ·
Mountain Mike's Pizza Opens First Redding Location
Home of Crispy, Curly Pepperoni Pizza & Family Fun Makes Shasta County Debut Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, a leading family-style pizza chain known for its legendary crispy, curly pepperonis and Mountain-sized pizzas, is excited to announce the opening…
February 7, 2020 · ·
Mountain Mike's to Offer Heart Shaped Pizza All of February
Leading Family-Style Pizza Chain Sharing the Pepperoni Love All Month Long Newport Beach, CA (RestaurantNews.com) Love is in the air and it smells like pepperoni pizza! Mountain Mike's Pizza, a leading family-style pizza chain known for its legendary crispy, curly pepperonis…
Mountain Mike's Pizza Named a Top Franchise by Entrepreneur Magazine
Leading Family-Style Pizza Chain Jumps Four Places to Earn #4 Spot in the Pizza Category Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, LLC, a leading California-based family-style pizza chain known for its legendary crispy, curly pepperonis and Mountain-sized pizzas, is…
January 21, 2020 · ·
Local Morgan Hill Resident Opens New Mountain Mike's Pizza
Leading California-Based Family-Style Pizza Chain Now Open in the Condit Shopping Center Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, LLC, a leading California-based family-style pizza chain known for its legendary crispy, curly pepperonis and Mountain-sized pizzas, is proud to announce…
Mountain Mike's Pizza Now Open in Menlo Park
Family-Friendly Pizza Chain Known for Crispy, Curly Pepperoni Opens Newest San Francisco Peninsula Location Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, LLC, a leading California-based family-style pizza chain known for its legendary crispy, curly pepperonis and Mountain-sized pizzas, is proud…
Mountain Mike's Pizza Is Now Open in Redlands
Home of Curly Pepperoni Pizza & Family Fun Comes to the Packing House District Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, LLC, a leading California-based family-style pizza chain known for its legendary crispy, curly pepperonis and Mountain-sized pizzas, is proud…
November 25, 2019 · ·
Mountain Mike's Pizza Opens 12th Sacramento Location
Family-Friendly Pizza Spot Serves Up More Curly Pepperoni in the Strawberry Creek Shopping Center Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, LLC, a leading California-based family-style pizza chain known for its legendary crispy, curly pepperonis and Mountain-sized pizzas, is proud…
Mountain Mike's Pizza Now Open in Santa Maria
Famous Curly Pepperoni Pizza Chain Makes Its Inaugural Opening in California's Central Coast Region Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, a leading family-style pizza chain known for its legendary crispy, curly pepperonis and Mountain-sized pizzas, is proud to announce the…
Hundreds Affected by Kincade Fire Provided with Free Meals at Santa Rosa Mountain Mike's Pizza
Chandi Hospitality & Redwood Credit Union Joined Forces with Mountain Mike's to Feed Community During Kincade Fire Santa Rosa, CA (RestaurantNews.com) With thousands forced to evacuate their homes due to the Kincade Fire, Mountain Mike's Pizza, LLC banded together with…
November 8, 2019 · ·
Mountain Mike's Pizza Reopens Paradise Location Closed Since 2018 Camp Fire
Family-Friendly Pizza Franchise Committed to Helping Butte County Thrive Again Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, a leading family-style pizza chain known for its legendary crispy, curly pepperonis and Mountain-sized pizzas, is proud to announce the reopening of its Paradise…
October 11, 2019 · ·
"Kick It" with Mountain Mike's Pizza for a Chance to Win $49,000!
Official Pizza of the San Francisco 49ers Hosting the MVP of Sweepstakes Newport Beach, CA (RestaurantNews.com) With $49,000* on the line, football fans have even more reason to love Mountain Mike's Pizza, a leading family-style pizza chain known for its legendary…
When the San Francisco 49ers Score, Mountain Mike's Pizza Fans Do Too!
Official Pizza Partner of the 49ers to Offer 49% Off any Large 1-Topping Pizza When the Team Scores Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, a leading family-style pizza chain known for its legendary crispy, curly pepperonis and Mountain-sized pizzas,…
September 4, 2019 · ·
Mountain Mike's Pizza Identifies Humboldt County as Prime Growth Market
Family-Style Pizza Franchise Offering Exclusive Franchise Deals in Eureka & Surrounding Areas Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, LLC, a leading California-based family-style pizza chain, known for its legendary crispy, curly pepperonis and Mountain-sized pizzas, is focusing its expansion…
Mountain Mike's Pizza Opens First Location in Menifee
Family-Friendly Pizza Franchise Continues Inland Empire Expansion Newport Beach, CA (RestaurantNews.com) Mountain Mike's Pizza, LLC, a leading California-based family-style pizza chain is proud to announce the opening of its first restaurant in Menifee, California. Located in the Shoppes at the…
August 5, 2019 · ·


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#Solar100's Katherine Hamilton: The Steve Kerr of Renewable Energy
In this interview Richard Matsui, founder of kWh Analytics, speaks with Katherine Hamilton, Co-founder and Chair of 38 North Solutions.
Image: kWh Analytics
Energy veteran Katherine Hamilton reminds us of basketball veteran Steve Kerr (and vice versa). Here's why:
Both are grounded in years of technical expertise: In the '90s, Kerr was as a basketball player before becoming a coach, and Hamilton worked as an energy engineer before becoming an energy policy expert.
Both are respected as industry experts: As the head coach of the winning team of the 2015 and 2017 NBA finals, Kerr is sought out for his insights on his team as well as the broader sport. Known for her energy expertise, Hamilton has testified before the House Science Committee on renewables, advises world leaders on how to accelerate the global transition to clean energy, and serves as Ambassador to the Secretary of Energy's Clean Energy Education Empowerment (C3E), President of GRID Alternatives Mid-Atlantic, and Co-Chair of the World Economic Forum's Global Future Council on Energy.
Both are quick to recognize their colleagues (and have a sense of humor): When Kerr was asked to compare himself to Gregg Popovich, he reportedly responded, "Pop's one of the greatest coaches of all time, certainly top three. I'm not… I think I'm fourth." Similarly, Hamilton introduced her industry colleague Amy Harder as an, "Awesome new entrant to #Solar100. I dropped down one; like to think was making room…"
Both are thoughtful advocates: Whether it's speaking about gun violence and the need to keep citizens safe or commending player Kevin Love for speaking about mental health, Kerr is known for his ability to speak to the core issue in a way that can reach across partisan lines. Similarly, whether it's casually describing her experiences as an expectant mother testifying before a male-dominated House Science Committee in the '90s or speaking about the importance of renewables in local job development, economic growth, and community redevelopment, Hamilton has dedicated her career to finding innovative energy solutions across partisan lines.
Katherine Hamilton's at the top of her game and is this month's #Solar100 thought leader.
Starting in Renewable Energy
Richard Matsui: I read that before 38 North Solutions and your current work in energy policy, you were an English major and then an engineer. What first drew you to working in energy?
Katherine Hamilton: My grandfather started as a surveyor for Virginia Electric and Power Company, and worked his whole career at what he called "The Company." He was the family engineer and always wanted another engineer in the family. Given my interest in energy, I was the closest thing, even though I have degrees in English and French.
I ended up taking a summer internship with Virginia Power. Practically speaking, my grandfather also saw that utilities were great companies to work for, providing long-term stability, good retirement benefits, and a career trajectory. After I graduated from Cornell and the Sorbonne, I decided to apply for a full time job at Virginia Power.
The utility was looking for distribution design engineers (and I was obviously not one), so I took night classes in engineering. I had to take a test every six months for three years to ensure that I was doing my design calculations right, that I knew the difference between a wye and delta-connected transformer, etc. It was the best possible training on how electricity works and how systems work. I had to really learn the business, and I enjoyed it.
We were very innovative for our time—this was in the late '80s and we were implementing energy storage—ice storage systems—with thermal energy storage rates to deal with growing demand.
Following my desire to work with clean technologies, after a decade at the utility I moved to the National Renewable Energy Laboratory (NREL). There I started new programs for the Department of Energy's Federal Energy Management Program, including energy audits for federal buildings, water efficiency programs, and increased renewables for federal sites.
Richard Matsui: Wow, that's an interesting backstory. How did those experiences with energy engineering then lead to your later work in solar?
Katherine Hamilton: When I was at NREL, because of my background in creative writing, I was adept at translating what NREL's scientists were doing into language that policymakers could understand. As a result, I was called upon as an expert on renewable energy, testifying as a witness for the Republicans on the House Science Committee in the '90s. That is now sadly the committee that does not seem to believe in science. Back then, Newt Gingrich was Speaker of the House, and Republicans and Democrats were still certainly much closer to the middle then than they are now. The Science Committee had a Ph.D. physicist on it who was a Republican.
[Laughs] At the time, I was also pregnant with the third of my four kids, and I thought those House Members were going to have a heart attack when I walked into the hearing room. But they were still interested in science, and, as a result, I was able to tell the story of renewables on behalf of NREL. Those were the days when renewable energy was not politicized to the point that it is now. It was considered innovative to talk about renewables in the context of science.
Policy Landscape After 201
Richard Matsui: Section 201 dominated headlines and lobbying resources for months, and now our industry needs to quickly pivot to the next policy struggles. What are the biggest policy issues that a solar developer should be concerned about today?
Katherine Hamilton: The best thing about having this 201 case done and having the tax bill done is that we have more certainty on pricing of modules and projects as well as duration of the tax credits. Now we need to watch out for statutes like PURPA.
Richard Matsui: What level are you most concerned about PURPA, the state or federal level?
Katherine Hamilton: While PURPA could probably use some updating, I view PURPA as a tool that has been used to allow competition in states where there is a utility monopoly. PURPA allows other resources to come in and compete, and both solar and wind have benefitted from PURPA. If you could tweak that statute to allow more distributed energy resources, including storage, you could use PURPA to create even more competition.
The problem with touching PURPA is that—just like the Clean Air Act—in opening the statute, it could be tweaked for the better, but it could also be tweaked for the worse. Because Congress is so polarized, it may be that FERC is a safer place to revisit PURPA.
Richard Matsui: If you take the three-year view on this, in what ways do you see PURPA changing?
Katherine Hamilton: Some of the calculations on cost benefits are up for discussion based on new applications and services, as is the one-mile rule. But in both cases, opening up the legislation brings us to a slippery slope. At this point, it is better to not revisit PURPA until we have more support in Congress, to ensure that it is managed very carefully and to the benefit of innovative resources and consumers.
Opportunities and Challenges for States
Richard Matsui: What are some of the opportunities in solar from a state perspective?
Katherine Hamilton: We can start with the states that already have high renewable portfolio standards—Hawaii, California, and New York.
Then, we can look at states that are considering raising their RPS, like Arizona, which may be creating interesting opportunities for energy storage as well.
And then there are states that might seem like unlikely candidates but that are opening up dockets on distributed energy resources. I think that is the path by which solar is going to grow more—as part of a distributed energy resource. Those proceedings are happening in Missouri, Arkansas, Louisiana, and other states in the Midwest. Even Florida is opening up a bit. We're going to start seeing solar in states that are looking at the resource in a context that's broader than just net metering or RPS, but as a key part of a more distributed, flexible, demand-side resource.
Richard Matsui: I had not heard of this trend. What's driving these states to see solar from the lens of distributed energy resources, as opposed to an RPS or other "tried-and-true" approaches?
Katherine Hamilton: These states see that demand response is having an impact. Demand response used to be just load shedding—you would call customers, they would drop their load, and you would the lower the peak, saving consumers money and benefitting the grid. Demand response has become a lot more sophisticated and now enables resources of all types, including storage and solar + storage, to be more dispatchable and flexible. Solar and other demand-side resources—whether CHP or fuel cells or small wind—create more dispatchable services at the edge of a grid. And those customer-sited resources are only growing.
Regulators know that they want to get ahead of the curve, so they're responding: "What does this mean? How do we value it?"
A lot of states are currently going through their integrated resource planning. Utilities have to think several years in advance, so when they look down the road, that's what they're seeing for the grid: consumer engagement, solar usage, and technologies in combination with solar that change the way residential, industrial and commercial consumers are interacting with the grid.
Richard Matsui: How is the advent of energy storage shaping solar policy?
Katherine Hamilton: Storage is like bacon; it makes everything better. You can't limit storage to just being for solar, although solar certainly has a lot to gain from the use of storage. We can get away from relying on NEM all the time, and instead look at the full value stack of what behind-the-meter solar + storage can bring. It starts to look more like straight-up generation, just from the "load" side.
Richard Matsui: I tend to be quite cautious when thinking about the future of solar. Yes, we have tremendous tailwinds in favor of our industry, but I'm also always waiting for the other shoe to drop. You mentioned that you are an optimist, and I'm wondering—what makes you an optimist?
Katherine Hamilton: Innovation is moving so fast, costs are coming down, we're starting to see solar become much more dispatchable with smart inverters, energy-storage technologies, and with tools like demand response. I also do a lot of international work, and globally, the trends are all toward a huge increase in solar energy. The scale of this change and the trends of costs coming down paired with integrating technology costs dropping makes me incredibly optimistic.
Richard Matsui: What are the top three states that the industry ought to be most worried about from a state policy standpoint?
Katherine Hamilton: I think we need to worry about Virginia, North Carolina, and states that are talking about rate-basing grid modernization.
Instead of rate-basing nuclear plants that may never run (like in South Carolina), utilities are trying to find other assets to rate-base—for example, unnecessarily undergrounding high-voltage transmission lines. These investments can suck the air out of the ability for a consumer to benefit from investment in more distributed technologies like solar and other non-utility offerings. Utilities are rightly nervous about their revenue model changing, so they are going to protect what they have and attempt to control their own future. This can certainly have an impact on consumer choice and distributed solar.
Finding Allies and Advocates
Richard Matsui: Vote Solar recently came out with this campaign against the Duke Energy Power/Forward plan for grid modernization, though at the time I didn't appreciate why this was an issue for our industry. Now I see it. Is this the right strategy for our industry, to advocate on issues like net metering or RPS that extend beyond traditional solar issues?
Katherine Hamilton: Absolutely. You have to be able to look at the whole system because it's all interconnected. I think the industry needs to find allies on the ground and those allies can be unconventional. Allies can include the Chambers of Commerce, groups who believe in competition and the free market. Certainly environmental groups have been traditional allies, but an ally can include those who want to protect consumers and allow for increased local innovation. So yes, look to your state Solar Energy Industry Association (SEIA) chapter, but also other allied organizations to make sure that you craft the messages that work in that state. Particularly in red states, those arguments can be about economic growth, local jobs, and keeping costs lower for consumers.
Richard Matsui: Which organizations are our most effective advocates?
Katherine Hamilton: I think Vote Solar has done a lot of really good work with quality analysis to back it up. Different regions have a variety of grassroots non-profit and business organizations that help take the lead, so there are a lot of groups combining forces on the ground.
Certainly, on the federal level, SEIA advocates for the solar industry. SEIA did a great job on 201, organizing diverse groups, leveraging the industry collectively, and creating the right messaging. For small companies with limited reach, it is difficult to be engaged with federal policy on a one-on-one level. You're managing your own business, so you rely on your trade group for advocacy.
Showing Up, A Free Rider Problem, and the Roles of Companies in Shaping Policy
Richard Matsui: A couple months ago, an energy policy expert came in and spoke at one of our company's weekly Lunch and Learns. He told us that when it comes to policy, "Companies are either at the table, or they're on the menu." Would you agree? If so, what are the for-profit companies that are taking a leadership role?
Katherine Hamilton: I don't think that if your company can't engage directly in policy work, you're necessarily on the menu.
I think a better way to put it is: Regardless of your size, you need to show up. Showing up could mean going to your local SEIA meeting and ensuring that the issues you care about are included on their list of priorities, or it could mean attending a town hall meeting, or writing your member of Congress a letter on what you care about. It is important to show up and participate.
You may not have to be in every single proceeding in every single state and in Congress. You just need to ask: "Look, if I don't have the time and resources to do this, who does? I better figure out who does, and work to ally myself with them."
Richard Matsui: So, there are different ways of being at the table, without hiring a policy team.
Katherine Hamilton: There are companies that have big policy teams. It's great that they have those resources, but not everybody does. So the reality is, you need to be able to work with what you've got.
Richard Matsui: But I wonder about the free rider problem that our industry has always had. Policy teams are a business function that only large companies can afford, and historically, we've had publicly-traded giants like SolarCity and SunEdison that would invest in policy on behalf of the whole industry. With the collapse of some of those leaders and, therefore, their policy teams, have we seen a reduction in our industry's ability to advocate successfully?
Katherine Hamilton: We are seeing that impact on the state level, because some companies used to be in every state but no longer have the bandwidth. We had more companies on the ground in every state, and then they could work together and leverage resources.
The reduction in the number of companies in each state policy battle increases the importance of finding allies. When we're the last solar policy group left in a state, we better find allies. We need to ask: "Who else is out here that maybe is not doing solar specifically, but with whom we have shared goals?"
Solar in the Trump Years
Richard Matsui: How can our industry effectively advocate for itself in the Trump years?
Katherine Hamilton: Good question. SEIA and other coalitions worked hard to reach the administration in the tariff case and explain that Republicans should care about solar.
What has been most upsetting to me over the last fifteen years is that renewables have become partisan. Part of that has nothing to do with renewables, but it has to do with interest groups influencing Congress and previous Administrations to create a zero sum game between renewables and traditional energy resources. This has polarized the industries—fossil to Republicans and clean energy to Democrats.
I think part of our job is making sure that we change that narrative. For example, 85% of wind projects are in red states. Let's make sure that we talk about solar in a way that's very much about jobs, economic growth, and community redevelopment, rather than only about cleaning the planet or having a green resource. We need to be strategic, using words with different policymakers that speak to their concerns.
With the current administration, we need to lead with our business-first points and speak in that language. We have cost-competitive technologies that are challenging and beating the incumbents.
Interview conducted by Richard Matsui, KWh Analytics.
The views and opinions expressed in this article are the author's own, and do not necessarily reflect those held by pv magazine.

redpajama_set_name: RedPajamaCommonCrawl


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Boliwię na Zimowych Igrzyskach Olimpijskich 1980 reprezentowało 3 zawodników, byli to sami mężczyźni.

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Vital Signs: Digital Health Law Update | Summer 2021
The "dog days of summer" certainly provide a welcome, if brief, break in the extremely rapid pace of statutory, regulatory, and various other policy and industry efforts applicable to digital health. Just in time for us to collectively catch up on the impacts of the recent actions.
As is the hallmark of our Vital Signs effort to bring you this curated, one-stop resource quarterly on the most notable digital health law updates from our contributors globally, the level of activity during the past quarter has truly outpaced any to date. As the volume and breadth of topics identified below indicate, digital health policy is a "KEY HEALTH POLICY TOPIC" in most jurisdictions, so stay alert as changes continue, and we collectively seek to understand and apply these new policies to innovative digital health offerings.
Given that we wanted to make room for some notable multinational developments, we are taking a break from Industry Insights in this issue, but we will be back with more in the future. In the meantime, it may be a good time to revisit some of our prior, yet very relevant, Industry Insights features on Digital Health Dealmaking: Challenges and Opportunities, The Intersection between Telehealth and Fraud, Abuse, and Enforcement, and IP Protection for Virtual Health Treatment Modalities.
MULTINATIONAL DEVELOPMENTS
WHO Is Working to Create Ethical Standards for Machine Learning and Artificial Intelligence
On June 28, 2021, the World Health Organization ("WHO") issued guidance titled "Ethics and Governance of Artificial Intelligence for Health," which identifies ethical challenges and lays out ethical principles for the use of artificial intelligence ("AI") in medicine. WHO stated that although technologies which utilize AI hold tremendous promise to improve patient care, provide accurate diagnoses, optimize treatment plans, and support pandemic preparedness and response, those technologies must "put ethics and human rights at the heart of its design, deployment, and use." The guidance emphasizes that humans should remain in control of health care systems and medical decisions, and that AI technologies should be transparent, explainable, and do no harm to patients. WHO also seeks to foster responsibility, accountability, equity, and sustainability in the utilization of AI in medicine. This follows similar efforts earlier this year by the Consumer Technology Association, an industry group, who introduced "self-policing" accreditation standards focused on core requirements for health care AI to be deemed trustworthy.
OECD Global Tax Adds to Growing Trend of Taxation of International Digital Health Services
As of July 9, 2021, the United States, France, Germany, China, India, and 127 other countries subscribed to a new framework for international taxation-the OECD Global Tax Proposal-intended to address: (i) the taxation of revenue generated by digital services and other consumer-facing businesses by firms that have no or limited physical presence in a country and (ii) competition amongst countries to tax the income of the world's largest multinational enterprises. An increasing number of large health care systems are now offering international digital health care services, and this new tax framework may affect the revenues they generate. This includes, for example, telemedicine-based second opinion services and virtual clinical visits offered to international patients. "Pillar 1" of the new framework is projected to apply only to revenue generated by the very largest multinational enterprises with global revenue over ?20B. Even the largest health care systems are unlikely to reach that revenue threshold. "Pillar 2" of the new framework is projected to introduce a global minimum tax meant to address income tax competition among participating countries. A preliminary version of Pillar 2 exempted nonprofit organizations and their subsidiaries (including certain for-profit subsidiaries); but the July 2021 agreement is silent on this point, making it unclear whether this exemption will ultimately apply. Moreover, although Pillar 1 is intended to replace country-specific digital services taxes, it is not clear whether countries will be willing to withdraw their digital services taxes. Indeed, the European Union is still contemplating adopting a levy on digital goods and services sold online for firms with annual revenues of at least ?50M, despite simultaneously supporting adoption of Pillar 1. As such, even if health care organizations are not subject to taxation under the new framework, it is important to anticipate the growing application of digital services taxes and value-added taxes on revenue generated from international telemedicine and virtual health services.
UNITED STATES DEVELOPMENTS
Health Information Blocking Rules Went Into Effect as of April 5, 2021
After previous postponements, the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program Final Rule (as modified by an interim final rule) went into effect on April 5, 2021. While certain provisions have later compliance dates, compliance with the information blocking rules was immediately required. Any individual or entity that meets the definition of an "actor" (i.e., health care provider, health IT developer of certified health IT, or health information network ("HIN") or health information exchange ("HIE")) is subject to the rules. Providers, HINs, and HIEs are subject to the rules even if they do not use certified health IT.
These rules generally prohibit actors from engaging in activities that are likely to interfere with access, exchange, or use of electronic health information ("EHI"), unless an exception applies. For example, with respect to the licensing exception, if a developer intends to license interoperability elements for EHI access, exchange, or use, the license agreement must comply with the requirements of the exception. Among other things, the agreement must not include noncompetition terms or otherwise discriminate against competitors. Given the breadth of the rule and the detailed requirements of the exceptions, all actors should carefully assess their existing data sharing policies and practices, as well as relevant contracts, and modify them as needed to avoid engaging in prohibited information blocking.
COVID-19 Public Health Emergency Extended Through October 17, 2021
The United States Department of Health and Human Services ("HHS") again renewed the COVID-19 public health emergency ("PHE") declaration for another 90 days, effective July 19, 2021, thereby allowing the agency to continue Section 1135 waivers and other telehealth flexibilities during the pandemic. The current expiration date is, therefore, set for October 17, 2021. As highlighted in our last issue of Vital Signs, former Acting Secretary of HHS Norris Cochran indicated in a January 2021 letter to governors that the PHE will likely continue until the end of 2021, and this latest renewal aligns with that letter. In a recent interview with the Washington Post, HHS Secretary Beccera said that he was "absolutely supportive of efforts to give [HHS] the authority to utilize telehealth in greater ways." Health care providers should continue to monitor both the expiration of the PHE and proposed legislative and regulatory flexibilities that may provide for long-term telehealth flexibilities.
HHS and FDA Withdraw Trump Administration Plan to Eliminate Regulatory Review of Connected Health Devices
On April 16, 2021, the HHS and the Food and Drug Administration ("FDA") withdrew a January 15, 2021, HHS notice that, among other things, would have exempted 83 class II devices and one unclassified device from premarket notification requirements under 510(k) of the Food, Drug, and Cosmetic Act. After reviewing the notice, comments from within HHS, and complaints from mHealth and telehealth companies, the agencies determined that the proposed exemption was flawed and could have put the lives of Americans using that technology in danger. The decision affects dozens of connected health tools, including (among others) mHealth apps that assess skin lesions for signs of cancer, wearable devices that track heart rhythms, and digital health platforms for behavioral health and substance abuse.
Government Accountability Office Cautions Lawmakers on Permanently Adopting Temporary COVID-19-Related Telehealth Expansions While Others Urge Congress to Press Forward
In a 27-page report and testimony before the Senate Finance Committee on May 19, 2021, representatives from the Government Accountability Office ("GAO") said that, though telehealth services have been crucial to expanding access to care during the COVID-19 PHE, lawmakers should wait and gather more data before deciding on whether to permanently expand telehealth coverage for Medicare and Medicaid programs beyond the pandemic. In particular, GAO representatives requested further information related to spending, program integrity, patient health and safety, and equity in the use of telehealth services.
Meanwhile, in a statement submitted the same day to the Senate Finance Committee, the American Hospital Association ("AHA") urged Congress to make permanent certain health care flexibilities granted for the COVID-19 PHE, including telehealth, hospital-at-home flexibilities, and site-neutral payment exceptions. Similarly, on April 28, 2021, the AHA issued a statement before a House Ways and Means Subcommittee on Health hearing, urging Congress to continue granting telehealth flexibilities beyond the PHE, including eliminating geographic and originating site restrictions and reimbursement for audio-only services. Related sentiments were shared by the American Academy of Neurology in their May 13, 2021, position statement, wherein they asked Congress for a "permanent expansion of telehealth services to improve safety and access to care and to reduce health care costs for people with neurologic disease." Advocacy by stakeholders is beginning to translate to Congressional action, evidenced by a bipartisan effort of U.S. Representatives Liz Cheney (R-WY) and Debbie Dingell (D-MI) to codify COVID-19 telehealth waivers and critical telehealth policies implemented during the pandemic through proposed legislation titled the "Advancing Telehealth Beyond COVID-19 Act of 2021." However, whether telehealth flexibilities originating during the PHE will be made permanent remains a hot debate.
Federal Enforcement Update: OIG and DOJ Target Telemedicine Companies That Exploited COVID-19 Telemedicine Regulation Flexibilities
As examined in our team's recent client Alert, on May 26, 2021, the Department of Justice ("DOJ") announced a series of coordinated law enforcement actions against 14 defendants across seven federal districts. These actions targeted alleged fraudulent health care schemes relating to exploitation of the COVID-19 PHE that resulted in more than $143 million in false billings.
One particular indictment included what DOJ described as "first in the nation charges," which involved the exploitation of Centers for Medicare & Medicaid Services ("CMS") policies expanding access to telemedicine services during the PHE. As highlighted in our last issue of Vital Signs, prior DOJ enforcement actions involving telehealth services have primarily focused to date on "telefraud," i.e., "scams that leverage aggressive marketing and so-called telehealth services" to sell expensive items like durable medical equipment and genetic testing. The most recent indictment is unique, however, as it appears to involve fraud charges relating to the actual provision of telemedicine services themselves, alleging that defendants offered telehealth providers access to Medicare beneficiaries for whom they could bill consultations, in exchange for referrals of medically unnecessary cancer and genetic testing.
This notable uptick in DOJ enforcement actions is reflective of a broad agency focus on alleged health care fraud arising from the COVID-19 pandemic, including a novel focus on fraud and abuse within the sphere of legitimate provision of telemedicine services.
Supreme Court Ruling Eases Burdens on Text Messaging Between Health Care Providers and Patients
In a 9-0 decision authored by Justice Sonia Sotomayor, the Supreme Court resolved a contentious circuit split over the definition of an "automatic telephone dialing system" under the Telephone Consumer Protection Act ("TCPA"). The Court held on April 1, 2021, in Facebook v. Duguid, that to qualify as an "automatic telephone dialing system" under the TCPA, a device must have the capacity either to store, or to produce, a telephone number using a random or sequential number generator. As such, the decision significantly limited the scope of automated calls and messages that violate the TCPA, giving health care providers more leeway to send automated text messages to patients without obtaining prior patient consent. Regardless of the Supreme Court's clarification on this topic, providers should still be cognizant of adherence to Health Insurance Portability and Accountability Act privacy and security requirements, among other constraints, when sending health-related messages by text.
Medicare 2022 Physician Fee Schedule Proposals Extend Telehealth Coverage and Act on Recent Statutory Authority for Certain Mental Health Treatment via Telehealth
Among other actions, on July 13, 2021, CMS issued proposals for the 2022 Physician Fee Schedule, including several notable proposals for telehealth services.
Starting with the 2021 Physician Fee Schedule, CMS created a third category for temporarily adding services when provided via telehealth under waivers given the special circumstances of COVID-19. These "Category 3" services are those allowed during the PHE given the likely clinical benefit when furnished via telehealth, yet a service without sufficient evidence at the time (to meet Medicare's requirements for Categories 1 and 2). To provide additional time for coverage of these services as of a date certain (potentially following the expiration of a PHE), CMS proposes to extend these Category 3 services to December 31, 2023. Further, CMS included several proposals related to the 2020 Congressional actions in the Consolidated Appropriations Act, 2021 to expand Medicare telehealth services for patients with mental health disorders while in their homes, including when utilizing audio-only technology, although Medicare coverage for most telehealth services is limited to patients in rural health facilities utilizing real-time video and audio capabilities. Notably, as with the statute, the proposals would only cover telehealth services provided to established mental health patients of providers who previously met with the patient in person and so long as certain ongoing periodic services are provided in person. CMS will accept comments on the proposed rule until September 13, 2021.
Studies Evaluating the Use and Quality of Telehealth Services Across the United States Continue to Proliferate
Over a year after the PHE began, additional studies and data regarding both telehealth usage and quality of care continue to be published. According to data released by CMS highlighting the continued impact COVID-19 is having on Medicaid and Children's Health Insurance Program beneficiaries and utilization of health services, the number of services delivered via telehealth surged 2,700% during the PHE to nearly 68 million between March and October 2020. This increase, however, was not enough to offset the decline in service utilization in other areas, as beneficiaries forewent millions of primary, preventive, and mental health care visits during the same time period. In addition, a recent Kaiser Family Foundation analysis found that more than a quarter of all Medicare beneficiaries had a telehealth visit between the summer and fall of 2020, and among them, a majority (56%) reported accessing care using a telephone only. A smaller group of Medicare beneficiaries reported accessing telehealth services via video visit (28%) or through both video and telephone (16%). In a July 2021 analysis, McKinsey reports that telehealth usage has stabilized at a rate around 38 times higher than it was before COVID-19. Regarding benefits for telehealth users, a new study published in the Orthopaedic Journal of Sports Medicine shows patients who received much of their physical therapy using telehealth reported the same high-quality outcomes compared to those who only did in-person physical therapy. The research, which was conducted pre-COVID, also discovered a cost savings for patients who used telehealth.
Actions in Several States Pave Way for More Telehealth Modality Flexibility
Arkansas, Arizona, Delaware, Mississippi, and Oklahoma (effective November 1, 2021) all took steps enabling more telehealth modality flexibility, especially in the context of real-time services with legislative or regulatory actions incorporating the use of "audio-only" telehealth in some way. For example, Arizona and Delaware legislative changes now allow for "audio only" if audio-visual telehealth is not reasonably available. Mississippi adopted regulations including a broader definition of "telemedicine" that may demonstrate a preference for real time, but directly conveys options for utilizing various modalities in addition to real-time video-a preference previously conveyed in medical board rules inferring that an exam incorporated a "face-to-face" element.
Mississippi Regulatory Updates Require Special State Registration for Telehealth Services
Effective May 19, 2021, each provider organization (including "organizations, institutions, and business entities, including online service entities") offering telehealth services in the State of Mississippi must register with the Mississippi State Department of Health, Office of Licensure before providing telehealth services in the state.
New Jersey Makes It Legal to Prescribe Medical Marijuana via Telehealth
New Jersey Governor Phil Murphy signed into law S 619, allowing health care providers to prescribe medical marijuana via telehealth. The new law permits providers to use telehealth to authorize patients for medical cannabis and to prescribe medical cannabis to people who face barriers to in-person care, including children in long-term care facilities and patients who are developmentally disabled, housebound, terminally ill, or in hospice care.
States Make Permanent Many of the Temporary Digital Health Measures Enacted in Response to the COVID-19 Public Health Crisis
Arizona Governor Doug Ducey signed H.B. 2454 into law, making permanent telehealth services enacted during the COVID-19 pandemic and expanding access for low-income families and those living in rural areas. Texas Governor Greg Abbott also signed H.B. 4, effective June 15, 2021, that makes permanent some of the emergency health measures put in place over the past year to address the COVID-19 pandemic. The enrolled bill opens the door for Medicaid and public health plans to use telehealth platforms for preventive health and wellness screenings; case management services; physical, occupational, and speech therapy; nutritional counseling; assessment services; and behavioral health services, including those delivered by audio-only telehealth if appropriate.
Illinois Approves Permanent Telehealth Access With Limited Payment Parity
Like several other states, the Illinois General Assembly acted to keep patients from abruptly losing access to the health care services they relied on during the COVID-19 pandemic. On June 29, 2021, the Illinois House sent House Bill 3308 to Governor Pritzker to sign into law. The bill amends the Illinois Insurance Code to require health care services that are covered under an accident or health insurance policy to be covered when delivered via telehealth, when clinically appropriate and subject to specified conditions. The bill eliminates geographical barriers to telehealth delivery, clarifies that patient cost-sharing must not exceed the amount such cost-sharing would be if the health care services were delivered in person, and permits substance use disorder professionals and those providing early intervention services for children to use telehealth. The bill uses the Illinois Telehealth Act's definition of "telehealth services" and adds that as used in the insurance coverage section, "telehealth services" include services delivered by telephone, but do not include asynchronous store and forward systems, remote patient monitoring technologies, e-visits, or virtual check-ins. ("Telehealth" means the evaluation, diagnosis, or interpretation of electronically transmitted, patient-specific data between a remote location and a licensed health care professional who generates interaction or treatment recommendations. "Telehealth" includes telemedicine and the delivery of health care services provided by way of an interactive telecommunications system, as defined in subsection (a) of Section 356z.22 of the Illinois Insurance Code.)
Industry Challenge to Eye Care Consumer Protection Act in South Carolina Can Proceed
In an unpublished opinion filed on May 5, 2021, the Court of Appeals of South Carolina held that Opternative has standing to proceed with its constitutional challenge to South Carolina's Eye Care Consumer Protection Act (the "Act"). The Act prohibits a prescription from being based "solely on the refractive eye error of the human eye or be generated by a kiosk" (i.e., automated equipment or an automated application designed to be used on a phone, computer, or internet-based device), and has stifled the expansion of ocular telehealth in the state. Opternative sought a declaratory judgment that the Act violated its rights under the South Carolina Constitution because it could no longer operate its business there after the Act was enacted in 2016. The trial court held that Opternative lacked the requisite standing to challenge the Act without reaching the merits. However, even though Opternative could change its business model to comply with the Act, the appellate court found that Opternative had indeed suffered an injury in fact and remanded the case to the trial court with instructions to consider the Act's constitutional validity. Interested parties should continue to monitor the trial court proceedings to see how the challenge is resolved.
GLOBAL DEVELOPMENTS
European Commission Proposes to Regulate Artificial Intelligence
On 21 April 2021, the European Commission ("Commission") adopted a proposal for regulating artificial intelligence ("Artificial Intelligence Act", or "AIA") with the purpose of establishing a clear legislative framework for developing, commercializing, and using AI systems in the European Union ("EU"). AI systems are identified by the AIA as software relying on certain techniques and approaches (e.g., machine learning, "ML") to generate "outputs such as content, predictions, recommendations or decisions influencing the environments they interact with." The AIA proposes to promote development of AI technologies while preserving individual rights and mitigating potential threats to their health and safety. First, the Commission proposes to create "AI regulatory sandboxes" to provide controlled environments for developing and testing new technologies. Second, the Commission proposes prohibiting certain types of potentially dangerous AI practices. Specifically, for example, the AIA would prohibit the use of AI systems deploying subliminal techniques (i.e., those going beyond individuals' consciousness) to materially distort human behavior, or exploit the vulnerabilities of specific groups, where physical or psychological harm is likely to occur. The Commission's draft also intends to prevent public authorities from using AI systems for the so-called "social scoring" and real-time remote biometric identification systems in publicly accessible spaces, subject to certain exceptions. Third, the Commission proposes to permit but heavily regulate other certain types of "high-risk" AI systems. For example, the AIA proposes a series of obligations on developers of high-risk systems, including technical, recordkeeping, oversight, risk mitigation, accuracy, robustness, cybersecurity, and postmarket surveillance requirements. Sanctions for noncompliance are also projected to be particularly high. There is no specific expected timeline for the European Parliament and Council to discuss and vote upon the Commission's proposal.
European Union Launches Public Consultation Period for Feedback About the European Health Data Space
On May 3, 2021, following a specific request for feedback on the "Inception Impact Assessment," the Commission launched a public consultation ("Consultation") on the European Health Data Space ("EHDS"). The Consultation seeks input from stakeholders about their experiences with the collection, access, use, and reuse of health data. Interested parties can provide feedback by filling in a specific questionnaire which is divided into three sections: (i) Use of health data for research, innovation, policy and regulatory decision-making; (ii) Development and use of digital health services and products; and (iii) Development and use of AI systems in health care settings. Comments were due on July 26, 2021, and will serve as help for the Commission to shape the EDHS legal framework, which is planned for the fourth quarter of 2021.
Joint EMA/HMA Workshop on AI in medicines regulation
On May 25, 2021, the European Medicines Agency ("EMA") and the Heads of Medicines Authorities ("HMA") published a report on their "Joint Workshop on Artificial Intelligence in Medicines Regulation" held in April 2021. The workshop brought together a broad range of stakeholders who discussed the innovative uses of AI and ML. They pointed out the necessity for EMA and EU institutions to develop a regulatory framework that could grant access to and validate AI. To achieve the goal, the stakeholders recommended building partnerships with academia and research centers, fostering the dialogue across international institutions, and upskilling the staff across the EU regulatory network. The complete list of compiled recommendations is provided in Annex I to the report, while Annex II lays down a priority mapping of such recommendations.
EMA Issues Draft Guideline on Computerized Systems and Electronic Data in Clinical Trials
On June 10, 2021, the EMA published a draft "Guideline on computerised systems and electronic data in clinical trials" ("Draft Guideline"). The Draft Guideline is open for consultation for six months, from June 18 to December 17, 2021, and is expected to be formally adopted by the EMA next year, taking into account the comments received. EMA's goal is to provide sponsors, clinical research organizations, investigators, and other interested parties appropriate guidance on the latest changes occurring throughout the past decade in the clinical trials landscape due to the introduction of computerized systems and the collection of electronic data. This includes, for example, the growing use of electronic health records, electronic tools used for recording and collecting patients' clinical data (e.g., mobile devices, automatic event capture tools for blood pressure, respiratory measures, etc.), electronic case report forms, tools that automatically capture data related to transit and storage temperatures for the investigational medicinal product and clinical samples, and electronic informed consent. The Draft Guideline specifically sets forth guidance related to use of such systems in clinical trials, including pretrial justification for use; system validation processes; clarifications on key principles, concepts, and definitions; outsourcing and subcontracting of certain processes; user management; and information technology security. Stakeholders are encouraged to review and provide comments during the consultation period.
EU Digital COVID Certificate Becomes Effective in EU
On July 1, 2021, the Commission announced the entry into force of the EU Digital COVID Certificate Regulation. In practice, this means that EU citizens and residents can now have their Digital COVID Certificates ("Certificates") issued and verified across the EU to facilitate travels across Europe. The Certificate is available in either digital or paper format, containing a QR code, and is issued by national authorities free of charge. The Certificate certifies whether a person has been vaccinated against COVID-19, has a recent negative test result, or has recovered from the infection. In addition, any processing of personal data must comply with the General Data Protection Regulation ("GDPR"), and in any event, personal data will not be retained.
European Union Agency for Cybersecurity Launches Online Tool on Procurement Guidelines for Cybersecurity in Hospitals
On April 7, 2021, the European Union Agency for Cybersecurity ("ENISA") launched an online tool on Procurement Guidelines for Cybersecurity in Hospitals. The new tool aims to help health care organizations identify the most relevant guidelines to their procurement context, whether they offer products or services. The new tool also aims to foster the importance of a robust procurement process to ensure the implementation of appropriate security measures. The new tool should be read in light of the ENISA Procurement Guidelines for Cybersecurity in Hospitals published in 2020, which have now been summarized by ENISA in each of the 24 EU official languages.
Italian Medicines Agency Issues Guidance on the Submission of Applications for Clinical Trials Involving the Use of AI or Machine Learning Systems
In June 2021, the Italian Medicines Authority ("Agenzia Italiana del Farmaco", "AIFA") adopted guidance on the submission of applications for clinical trials involving the use of AI and ML systems. The AIFA acknowledges the constant and significant increase in the number of clinical trial applications ("CTAs") based on the use of AI and ML. In the absence of an EU-wide harmonized regulatory setting, the agency deemed necessary to outline the state of the art and provide a "living" guidance to sponsors with the aim of optimizing the submission of CTAs relying on new technologies to be updated on the basis of new scientific findings. The guidance clarifies that in case AI/ML tools are meant to be used in the context of a clinical study, sponsors have to provide AIFA additional information on, inter alia, information on the IT system to be used, the level of interaction foreseen, and the expected impact deriving from the use of AI/ML with regard, in particular, to patients' rights, safety, and trial data/results. Moreover, the AIFA requires CTAs to include a specific assessment of the benefit/risk associated with the use of the AI/ML model and to include such information in the informed consent form. Stakeholders are encouraged to review the guidance in full.
French Data Protection Authority Issues an Opinion on the Creation of a List of Unvaccinated Patients
On July 4, 2021, the French Data Protection Authority ("CNIL") issued an opinion on the contemplated creation of a list of unvaccinated patients by the National Public Health entity to be used within the French government vaccination program. Even though the CNIL explained that doctors may access and use COVID vaccine-related information, provided that such information relates to their patients only, the CNIL stated that it disagrees with the creation of lists of their patients according to certain characteristics (illness, vaccination status, etc.) for use by doctors.
French Data Protection Authority Releases Interim Recommendations on Clinical Trials Data Processing Activities
On June 24, 2021, the CNIL updated its interim recommendations (source document in French) on the processing of data within the frame of remote monitoring of clinical trials data, applicable until September 30, 2021. Further to the authorization by the French Health Security Authority of a limited list of clinical trials allowing for remote monitoring, the CNIL issued recommendations on remote monitoring. CNIL recommendations include guidance on French formalities required and on security measures.
French Data Protection Authority Releases an Opinion on the French "Health Pass" Bill
On May 12, 2021, the CNIL issued (source document in French) an opinion on the contemplated implementation by the French government of a "health pass." The CNIL stated that the use of a health pass must be limited to the duration of the pandemic crisis and to the events involving a large number of people. Also, purposes of processing and categories of recipients must be clearly determined to prevent any risk of data privacy violation.
German Federal Office for Information Security Publishes Report on Digital Consumer Protection Regarding Health Apps
On June 16, 2021, the Federal Office for Information Security published a report on digital consumer protection in 2020 ("Report"). The Report highlights consumer risks in the digital space, identifies current challenges in the digital consumer market, and provides suggested actions for digital consumer protection. Following the COVID-19 pandemic in 2020, the Report focused on health apps and highlighted that the majority of health apps lack sufficient IT security measures.
Spanish DPA Publishes Report on Access to Patients' Medical Record
On May 24, 2021, the Spanish Data Protection Agency ("DPA") published a report on access to patients' medical history ("Report"), according to Article 9 (2) (f) GDPR (i.e., processing special categories of personal data for the establishment, exercise, or defense of legal claims). The Report assesses the scope of Article 9 (2) (f) GDPR under three different circumstances: (i) preparing a defense upon legal proceedings initiated by a patient; (ii) providing information to insurance companies to cover the liability of health care organizations' employees; and (iii) responding to a claim for breach of Article 76 of Law 50/1980 on the Insurance Contract.
Swedish DPA Fines Swedish Medical Counseling Company Approximately 1.2 Million Euros for GDPR violation
On June 7, 2021, the Swedish DPA fined a Swedish medical counseling company approximately 1.2 million euros for a personal data breach that occurred in the context of telephone medical advice. In particular, the calls operated by the company's hotline were accessible online and thus were not protected with appropriate security measures.
Dutch DPA Objects to Bill on Electronic Data Exchange in Health Care Sector
On May 28, 2021, the Dutch DPA released a statement with objections to the bill on electronic data exchange in the health care sector ("Bill"). The DPA highlights that the Bill would require health care providers to exchange patient data electronically in certain circumstances. In addition, health care providers may be forced to breach their obligation of professional secrecy in order to exchange patient data electronically.
UK Evidence Standards Framework and an Office for Digital Health
The National Institute for Health and Care Excellence ("NICE"), as part of a working group led by the National Health Service ("NHS") England, published an updated version of the evidence standards framework for digital health technologies in May 2021. The framework is to be utilized for digital health technologies which may be commissioned by the NHS. These updates intend to make it easier for manufacturers in the sector to understand the relevant evidence requirements for their digital product. Further updates are expected in late 2022. NICE also recently announced that it is establishing a new Office for Digital Health which will focus on increasing innovation in the sector and continuing to work with the Medicines and Healthcare Products Regulatory Agency, the UK regulator.
UK Guide to Good Practices for Digital and Data-Driven Technology
The Department of Health and Social Care updated its guidance for digital technology in line with NHS England's plan to increase the use of digitally enabled care. The guide covers topics such as data transparency, clinical safety, and data protection.
Australian Government Will Invest AUD 870.5 Million to Transform Digital Health in Australia
As part of the 2021-2022 budget, the Australian government plans to make significant investments in digital health across several areas. Notably, the government will allocate AUD 301 million to fund the next wave of My Health Record ("MHR"), Australia's online database of individuals' health information. The MHR upgrade will streamline the platform to create an "easy-to-use interface" and will include COVID-19 test results and immunization status. The government is also making significant investments in telehealth. Following a successful campaign by industry groups and consumer organizations, Medicare (Australia's universal health insurance scheme) will continue to cover telehealth services provided by general practitioners, specialists, nurses, midwives, and allied health professionals until December 31, 2021. Other digital health initiatives targeting aged care and mental health resources will also share a significant proportion of the funding package. The Australian government anticipates that its investment in Australia's digital health landscape will deliver innovative new methods to provide care and "continue the momentum for embracing new technologies achieved during COVID-19."
By Jones Day |2022-03-15T07:19:32+00:00 August 13th, 2021 ||


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text:
Q: Backbone.js vs Pusherapp - What is the difference? What's the main difference between Backbone.js and a service like Pusher or socket.io?
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redpajama_set_name: RedPajamaStackExchange


To work with a group of 15-17 year old members of a County Cricket Academy to improve their self awareness regarding their mental skills.
Getting each player to complete a mental skills profile using categories such as enthusiasm, determination, confidence, mental preparation, reading the game, self awareness etc. Each player chose the categories which were relevant to them and then scored themselves on a scale of 1-10. Then each player scored where they would like to be by the end of the season. Individual action plans were then agreed and implemented.
Players who were able to demonstrate improved self awareness and performance to their coaches. Increased quality of dialogue regarding mental skills and their applications.


text:
Nutrish and other advertisers are kow-towing to an 18-year-old bully named David Hogg
Saturday, March 31, 2018 by: JD Heyes
Tags: advertisers, anti-gun, boycott, bullies, bullying, Censorship, cowards, Crybullies, David Hogg, economic sabotage, fox news, gun control, Laura Ingraham, livelihood, Second Amendment, threat
(Natural News) In the days following Fox News host Laura Ingraham's slight jab at the Left's latest gun-control darling, David Hogg, for being rejected by four University of California campuses, the angry little waif called for a boycott of her advertisers.
He tweeted out to his 600,000-plus followers a list of a dozen show sponsors and advertisers and asked his flock of sheep to "pick a number between 1-12" and give those companies what for.
Pick a number 1-12 contact the company next to that #
Top Laura Ingraham Advertisers
1. @sleepnumber
2. @ATT
3. Nutrish
4. @Allstate & @esurance
5. @Bayer
6. @RocketMortgage Mortgage
7. @LibertyMutual
8. @Arbys
9. @TripAdvisor
10. @Nestle
11. @hulu
12. @Wayfair
— David Hogg (@davidhogg111) March 29, 2018
In large part, the call-to-action has worked. As the poster child of Left-wing "mainstream" news, the New York Daily News, gleefully reported, as of Friday seven advertisers had pulled the plug on Ingraham's show:
Toxic TV talking head Laura Ingraham offered a tuchus-covering mea culpa Thursday after advertisers fled her Fox show because she mocked a Florida high school shooting survivor.
Nestle, Johnson & Johnson, TripAdvisor, Hulu and Rachael Ray's pet food company and home furnishing website Wayfair, announced that they were pulling their ad dollars from the show after Ingraham tried to Twitter-shame Marjory Stoneman Douglas High School senior David Hogg for getting turned down by four colleges.
As of this writing, others have also pulled their advertising, feigning 'outrage' over Ingraham's spot-on observation that young Mr. Hogg was "whining" on Twitter earlier about being rejected from the four schools (which, frankly, stunned me; I thought to get into a University of California school you were required to be a Left-wing lemming — a stipulation even more crucial that your grade-point average).
As Debra Heine at PJ Media reported:
The 17-year-old is determined to "change the world," and in fact believes he is already doing so. In a recent interview with TMZ, during which Hogg revealed he had been rejected by four University of California campuses, he stated: "At this point, we're already changing the world. If colleges want to support us in that, great, if they don't, it doesn't matter, we're still going to change the world."
Apparently one of the ways he aims to change the world is by deplatforming conservatives through advertiser boycotts.
This isn't new. The Left "deplatforming" conservative voices has been tried before and in large part has failed to quell our voices of reason. The most recent Fox News host to face the Left's advertiser boycott drive was Sean Hannity who reported some never-before-aired information about twists in the case of murdered former DNC staffer Seth Rich.
"Nobody tells me what to say on my show. They never have and frankly they never will," he said in an interview with Alt-Left HuffPost. And today, he remains on the air with ratings stronger than before.
But as you can see, there is no shortage of corporate cowards more than willing to put their investors at risk by dumping advertising on a program with great reach (Ingraham's audience is in the low millions every night) to support the latest foul-mouthed, Left-wing flavor of the month. (Related: Graham: Media should ask every congressional Democrat if they want to repeal the Second Amendment as floodgates open to ban guns.)
I have refrained from being too harsh on young Mr. Hogg a) because I have kids of my own; and b) because I have no doubt that what he and his classmates endured was horrific for them and something no child of any country should ever have to endure.
But when he begins to attack another person's livelihood, he's crossed a line.
He tweets out a list of advertisers for his lemming followers to assail; they do so and said advertisers wither like the sniveling cowards they are. That could have direct and profound financial implications for Laura Ingraham and her family.
That's not just irresponsible, that is cruel, pure and simple. And yet he claims he's in this to solve problems and bring us all together for a nice healthy policy chat.
Like the button on his jacket says, "I call BS."
Stay current at HoggWatch.com.
J.D. Heyes is a senior writer for NaturalNews.com and NewsTarget.com, as well as editor of The National Sentinel.
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More news on advertisers
Elon Musk calls for probe of left-wing, Soros-linked groups trying to pressure Twitter advertisers to leave platform
Facebook and Twitter stocks plunge as advertisers leave
Academic left-wing fascist Melissa "Mish" Zimdars behind authoritarian attempt to blacklist all conservative news outlets by labeling them "unreliable" … but fake news NYT, CNN, WashPost all given thumbs up
Smart Meters to start tracking dementia patients in the U.K. as Big Brother wields medical surveillance tech against its own citizens
Scumbag left-wing online terrorist "Sleeping Giants" took money from powerful corporations while secretly attacking them with an online lynch mob
"Sleeping Giants" exposed as an online demonetization "terrorism" group, run by a radical left-wing activist (of course)
Let the bullying begin: NBC News releases army of trolls against Hoggwatch.com in pathetic attempt to "intimidate" advertisers that don't even exist
https://www.naturalnews.com/2018-03-31-nutrish-and-other-advertisers-are-kow-towing-to-an-18-year-old-bully-named-david-hogg.html
Nutrish and other advertisers are kow-towing to an 18-year-old bully named David Hogg


text:
Unravelling surface and interfacial structures of a metal–organic framework by transmission electron microscopy
Yihan Zhu, Jim Ciston, Bin Zheng, Xiaohe Miao, Cory Czarnik, Yichang Pan, Rachid Sougrat, Zhiping Lai, Chia-En Hsiung, Kexin Yao, Ingo Pinnau, Ming Pan, Yu Han
Advanced Membranes & Porous Materials Center
Chemical Science
Metal–organic frameworks (MOFs) are crystalline porous materials with designable topology, porosity and functionality, having promising applications in gas storage and separation, ion conduction and catalysis1, 2, 3. It is challenging to observe MOFs with transmission electron microscopy (TEM) due to the extreme instability of MOFs upon electron beam irradiation4, 5, 6, 7. Here, we use a direct-detection electron-counting camera to acquire TEM images of the MOF ZIF-8 with an ultralow dose of 4.1 electrons per square ångström to retain the structural integrity. The obtained image involves structural information transferred up to 2.1 Å, allowing the resolution of individual atomic columns of Zn and organic linkers in the framework. Furthermore, TEM reveals important local structural features of ZIF-8 crystals that cannot be identified by diffraction techniques, including armchair-type surface terminations and coherent interfaces between assembled crystals. These observations allow us to understand how ZIF-8 crystals self-assemble and the subsequent influence of interfacial cavities on mass transport of guest molecules.
https://doi.org/10.1038/nmat4852
10.1038/nmat4852
Zhu, Y., Ciston, J., Zheng, B., Miao, X., Czarnik, C., Pan, Y., Sougrat, R., Lai, Z., Hsiung, C-E., Yao, K., Pinnau, I., Pan, M., & Han, Y. (2017). Unravelling surface and interfacial structures of a metal–organic framework by transmission electron microscopy. Nature Materials, 16(5), 532-536. https://doi.org/10.1038/nmat4852
Zhu, Yihan ; Ciston, Jim ; Zheng, Bin ; Miao, Xiaohe ; Czarnik, Cory ; Pan, Yichang ; Sougrat, Rachid ; Lai, Zhiping ; Hsiung, Chia-En ; Yao, Kexin ; Pinnau, Ingo ; Pan, Ming ; Han, Yu. / Unravelling surface and interfacial structures of a metal–organic framework by transmission electron microscopy. In: Nature Materials. 2017 ; Vol. 16, No. 5. pp. 532-536.
@article{487f69d75a3b4c1da2444e2750856397,
title = "Unravelling surface and interfacial structures of a metal–organic framework by transmission electron microscopy",
abstract = "Metal–organic frameworks (MOFs) are crystalline porous materials with designable topology, porosity and functionality, having promising applications in gas storage and separation, ion conduction and catalysis1, 2, 3. It is challenging to observe MOFs with transmission electron microscopy (TEM) due to the extreme instability of MOFs upon electron beam irradiation4, 5, 6, 7. Here, we use a direct-detection electron-counting camera to acquire TEM images of the MOF ZIF-8 with an ultralow dose of 4.1 electrons per square {\aa}ngstr{\"o}m to retain the structural integrity. The obtained image involves structural information transferred up to 2.1 {\AA}, allowing the resolution of individual atomic columns of Zn and organic linkers in the framework. Furthermore, TEM reveals important local structural features of ZIF-8 crystals that cannot be identified by diffraction techniques, including armchair-type surface terminations and coherent interfaces between assembled crystals. These observations allow us to understand how ZIF-8 crystals self-assemble and the subsequent influence of interfacial cavities on mass transport of guest molecules.",
author = "Yihan Zhu and Jim Ciston and Bin Zheng and Xiaohe Miao and Cory Czarnik and Yichang Pan and Rachid Sougrat and Zhiping Lai and Chia-En Hsiung and Kexin Yao and Ingo Pinnau and Ming Pan and Yu Han",
note = "KAUST Repository Item: Exported on 2020-10-01 Acknowledged KAUST grant number(s): FCC/1/1972-19, URF/1/2570-01-01 Acknowledgements: This research was supported by competitive research funds (FCC/1/1972-19 and URF/1/2570-01-01) to Y.H. from King Abdullah University of Science and Technology. Work at the Molecular Foundry was supported by the Office of Science, Office of Basic Energy Sciences, of the US Department of Energy under Contract No. DE-AC02-05CH11231. Additional support for B.Z. was provided by the NSF of China (Grant 21503165). We thank C. T. Koch from Humboldt-Universit{\"a}t zu Berlin and C. Ophus from Lawrence Berkeley National Laboratory for helpful discussions.",
doi = "10.1038/nmat4852",
journal = "Nature Materials",
publisher = "Nature Research",
Zhu, Y, Ciston, J, Zheng, B, Miao, X, Czarnik, C, Pan, Y, Sougrat, R, Lai, Z, Hsiung, C-E, Yao, K, Pinnau, I, Pan, M & Han, Y 2017, 'Unravelling surface and interfacial structures of a metal–organic framework by transmission electron microscopy', Nature Materials, vol. 16, no. 5, pp. 532-536. https://doi.org/10.1038/nmat4852
Unravelling surface and interfacial structures of a metal–organic framework by transmission electron microscopy. / Zhu, Yihan; Ciston, Jim; Zheng, Bin; Miao, Xiaohe; Czarnik, Cory; Pan, Yichang; Sougrat, Rachid; Lai, Zhiping; Hsiung, Chia-En; Yao, Kexin; Pinnau, Ingo; Pan, Ming; Han, Yu.
In: Nature Materials, Vol. 16, No. 5, 20.02.2017, p. 532-536.
T1 - Unravelling surface and interfacial structures of a metal–organic framework by transmission electron microscopy
AU - Zhu, Yihan
AU - Ciston, Jim
AU - Zheng, Bin
AU - Miao, Xiaohe
AU - Czarnik, Cory
AU - Pan, Yichang
AU - Sougrat, Rachid
AU - Lai, Zhiping
AU - Hsiung, Chia-En
AU - Yao, Kexin
AU - Pinnau, Ingo
AU - Pan, Ming
AU - Han, Yu
N1 - KAUST Repository Item: Exported on 2020-10-01 Acknowledged KAUST grant number(s): FCC/1/1972-19, URF/1/2570-01-01 Acknowledgements: This research was supported by competitive research funds (FCC/1/1972-19 and URF/1/2570-01-01) to Y.H. from King Abdullah University of Science and Technology. Work at the Molecular Foundry was supported by the Office of Science, Office of Basic Energy Sciences, of the US Department of Energy under Contract No. DE-AC02-05CH11231. Additional support for B.Z. was provided by the NSF of China (Grant 21503165). We thank C. T. Koch from Humboldt-Universität zu Berlin and C. Ophus from Lawrence Berkeley National Laboratory for helpful discussions.
N2 - Metal–organic frameworks (MOFs) are crystalline porous materials with designable topology, porosity and functionality, having promising applications in gas storage and separation, ion conduction and catalysis1, 2, 3. It is challenging to observe MOFs with transmission electron microscopy (TEM) due to the extreme instability of MOFs upon electron beam irradiation4, 5, 6, 7. Here, we use a direct-detection electron-counting camera to acquire TEM images of the MOF ZIF-8 with an ultralow dose of 4.1 electrons per square ångström to retain the structural integrity. The obtained image involves structural information transferred up to 2.1 Å, allowing the resolution of individual atomic columns of Zn and organic linkers in the framework. Furthermore, TEM reveals important local structural features of ZIF-8 crystals that cannot be identified by diffraction techniques, including armchair-type surface terminations and coherent interfaces between assembled crystals. These observations allow us to understand how ZIF-8 crystals self-assemble and the subsequent influence of interfacial cavities on mass transport of guest molecules.
AB - Metal–organic frameworks (MOFs) are crystalline porous materials with designable topology, porosity and functionality, having promising applications in gas storage and separation, ion conduction and catalysis1, 2, 3. It is challenging to observe MOFs with transmission electron microscopy (TEM) due to the extreme instability of MOFs upon electron beam irradiation4, 5, 6, 7. Here, we use a direct-detection electron-counting camera to acquire TEM images of the MOF ZIF-8 with an ultralow dose of 4.1 electrons per square ångström to retain the structural integrity. The obtained image involves structural information transferred up to 2.1 Å, allowing the resolution of individual atomic columns of Zn and organic linkers in the framework. Furthermore, TEM reveals important local structural features of ZIF-8 crystals that cannot be identified by diffraction techniques, including armchair-type surface terminations and coherent interfaces between assembled crystals. These observations allow us to understand how ZIF-8 crystals self-assemble and the subsequent influence of interfacial cavities on mass transport of guest molecules.
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Zhu Y, Ciston J, Zheng B, Miao X, Czarnik C, Pan Y et al. Unravelling surface and interfacial structures of a metal–organic framework by transmission electron microscopy. Nature Materials. 2017 Feb 20;16(5):532-536. https://doi.org/10.1038/nmat4852


text:
Q: Objective C - UIActivityIndicatorView positioning I have a UIActivityIndicatorView that I create and position in loadView function.
It works fine except that I can see for a split second the UIActivityIndicatorView on the top left corner before reposition itself to the center of the screen.
Why does it do that? And how can I prevent that?
I also try creating the UIActivityIndicatorView in viewDidLoad function and the same thing happens.
BTW, I'm using UIActivityIndicatorView as an example, but I also have a UIImageView that I alpha 0 and I also see it for a split second before it goes away.
Please enlight.
Thank you,
Tee

A: Try adding it to the view before you change its position:
[self.view addSubview:spinner];
spinner.center = self.view.center;


text:
Book Review: Decoding China's Export Miracle
Reviewed by John West
Participation in global value chains has been the key factor driving China's exports and economic development, according to Professor Yuqing Xing. But America's trade and tech war with China, along with COVID-19, are threatening the global-value-chain development model.
"Everything is made in China these days", according to my 93-year-old mother. And she is basically correct. Way back in 2009, China surpassed Germany to become the largest exporting nation in the world — even though it was just a middle-income country with per capita GDP less than $4000, and it had virtually no globally known product brands. By 2019, China's exports, valued at $2499 billion, were 50 percent higher than the second-placed US, and it is widely known as the factory of the world.
To understand China's export miracle, one must delve into the details of global value chains (GVCs), as does Yuqing Xing, a Professor of Economics at the Tokyo-based National Graduate Institute for Policy Studies, in his recent book, Decoding China's Export Miracle: A Global Value Chain Analysis. He argues that China's export miracle has been driven by its active participation in GVCs.
Today, virtually all manufactured goods are produced in GVCs, which are typically led by multinational enterprises (MNEs), writes Xing. The production of Apple's iPhones represents the classic example of a GVC. They are designed in California, incorporate components from Japan, Korea, Germany, and elsewhere, assembled in China, and then California takes over marketing and branding. A low-tech country, as China was when the iPhone was created in 2007, can enter GVCs by exploiting its abundant cheap labour to perform a simple task like product assembly. It is no longer necessary for one country to build production capacities for an entire industry in order to participate in global trade. GVCs can thus offer a shortcut to economic development.
Xing writes that China's participation in GVCs started when its modern economic development was launched by great leader Deng Xiaoping in 1978. One of his initial steps was the creation of special economic zones along the coastal areas which were free of trade barriers and offered other investment incentives. These zones attracted "processing trade" activities, meaning that China imported all the necessary raw materials and inputs for a product, processed or assembled them, and then exported them for an MNE. Processing exports rose from less than 10 percent of China's total exports in the early 1980s to a peak of 58 percent in 2006, and even as recently as 2018 that share exceeded one-third.
But as Xing argues convincingly, China is not stuck doing low-value-added activities like product assembly. It has exploited the dynamic learning curve of GVC participation such that it is now manufacturing relatively sophisticated parts and contributing more value added. This has seen "a remarkable increase" in China's contribution to the iPhone — from a mere 1.3 percent of the retail value of the iPhone 3G in 2009 to 10.4 percent for the iPhone X in 2018.
China's rise up the smartphone GVC has been even more impressive through the development of home-grown global brands, namely, Huawei, Xiaomi, OPPO, and Vivo, which are among the world's top smartphone brands. China may yet have relatively little technological capacity to produce core components such as processors and memory chips. But these mobile phone makers have been able to enter the industry by sourcing core components from foreign MNEs and focusing on incremental innovation, marketing, and brand building. It is illustrative that Chinese value added in the Huawei P30 Pro is 38 percent, and only about 15 percent in the cases of OPPO R11s and Xiaomi's MIX 2.
In short, notwithstanding the hype surrounding the Chinese smartphone industry, foreign technology is still indispensable for the manufacture of Chinese brand smartphones, even those made by the most innovative Chinese company, Huawei. In other words, China is still a long way from being a high-tech champion.
China's seemingly unrelenting rise, thanks to its GVC-based development, has been thrown into question by its trade war with the US and COVID-19. The import tariffs imposed by the Trump administration and maintained by the Biden administration have adversely affected GVCs as they have increased the costs of assembling goods in or sourcing goods from China. As a result, some MNEs have been shifting parts of their GVCs out of China, either back home or to third countries, notably in Southeast Asia, India, or Mexico. And as the trade war morphed into a tech war, some Chinese tech companies which had become dependent on core technology modules of American companies have been blacklisted by the US government and deprived of these products, thereby severely disrupting their GVCs.
The COVID-19 pandemic has also highlighted the high concentration of the world's manufacturing activities in China, and the risks entailed for countries dependent on China for supplies. The outbreak of COVID and initial lockdown in Wuhan disrupted some GVCs, since Wuhan is a major industrial centre, especially for motor vehicle production. COVID-19 also highlighted the world's dependency on China when there were disruptions for medical supplies like sanitisers, ventilators, and personal protective equipment. This has led many countries to view these items as being important for national security, and thus reduce their dependence on China as a supplier by either reshoring production or turning to third countries.
All things considered, looking ahead China will need to rely more on its domestic economy to drive future economic growth, as is already envisaged by 14th Five-Year Plan for 2021-2025. This will be a more challenging future.
If there is one thing missing in Decoding China's Export Miracle, it is the failure of China's inefficient services sector to plug into GVCs. While this may not be key to Xing's mission to explain China's export miracle, the continued future development of the Chinese economy may depend on it. All that said, Xing's book represents a major contribution to understanding China's past and future economic development, and is a must-read for all students of China and China-watchers from business, government and civil society.
This is a review of Yuqing Xing, Decoding China's Export Miracle: A Global Value Chain Analysis (World Scientific, 2021). ISBN: 978-981-122-962-6 (hardcover) & ISBN: 978-981-122-964-0 (eBook).
John West is adjunct professor at Tokyo's Sophia University and executive director of the Asian Century Institute. His book Asian Century … on a Knife-Edge was reviewed in Australian Outlook.
This article is published under a Creative Commons License and may be republished with attribution.
Book Review: Australia, Menzies and Suez: Australian Policymaking on the Middle East Before, During and After the Suez Crisis
By Peter Hamburger
Robert Bowker uses long-secret cabinet notebooks to throw light on Australian political decision-making in the Suez Crisis of 1956, when Prime Minister Menzies took out insurance with a great power partner by giving conspicuous but token support for British action against Egypt, at some cost to Australia's international reputation.
Book Review: Values in Foreign Policy: Investigating Ideals and Interests
By Professor Derek McDougall
Srinivasan, Mayall, and Pulipaka offer a thorough insight into how cultural values, supranational institutions, and ideology influence foreign policymaking.
Book Review: China Panic: Australia's Alternative to Paranoia and Pandering
David Brophy's new book, China Panic, offers a nuanced and insightful analysis of the deterioration of Australia's relations with China. By challenging many old shibboleths, he offers much food for thought for salvaging this critical relationship.