2000-04-07 Assigned to FORD MOTOR COMPANY, A DELAWARE CORPORATION reassignment FORD MOTOR COMPANY, A DELAWARE CORPORATION ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: RICHARD, DAVID A.
2002-10-30 Assigned to FORD MOTOR COMPANY reassignment FORD MOTOR COMPANY ASSIGNMENT OF ASSIGNORS INTEREST (SEE DOCUMENT FOR DETAILS). Assignors: FORD GLOBAL TECHNOLOGIES, INC.
A dynamic method of delivering regionally relevant information to a plurality of geographically disperse and mobile environments, such as, for example, motor vehicles, allows passengers to immediately access regionally relevant information, such as weather, traffic, points of interest, restaurants, advertisements for local establishments, etc., without incurring expensive air-time from connecting through cellular infrastructure. The invention utilizes a filtering process referred to herein as dynamic geo filter/fencing (DGFF). This involves a receiver element in a mobile environment, such as a motor vehicle, taking a geo-code reading (e.g., latitude and longitude readings obtained from a GPS satellite via a GPS receiver) for identifying the location of the vehicle, then logically drawing a fence around that location reading, for example two miles square. At a separate location (e.g., a satellite uplink facility) regionally relevant data is tagged with the geo-code of the region to which the data is relevant, then broadcast (e.g., over a satellite link) to a wide footprint. The aforementioned receiver element receives the geo-coded regionally relevant information and filters it using the aforementioned logical fence according to the aforementioned DGFF process. Thus, received information bearing a geo-code within the logical fence is kept and processed, while information bearing a geo-code falling outside of the logical fence is not kept and processed. The inventive methodology is dynamic in that the fence automatically moves as the mobile environment moves, thereby automatically changing the nature and content of the information that is allowed to pass through the DGFF filter.
The present invention relates in general to providing services to individuals in a mobile environment. More particularly, it relates to an efficient process for dynamically providing geographically relevant information to individuals in a mobile environment, such as, for example, a motor vehicle.
Efficient, fast and cost effective access to information is extremely important to a wide variety of consumers in today's marketplace. For example, the use of networked personal computers to access and/or exchange information has changed the way many industries do business. Consumer's can use a variety of networked communication tools, such as the Internet and company-based "Intranets," to obtain information on every subject from automobiles to zebras. The proliferation of wireless communications technology, such as cellular telephony and personal communications systems (PCS), has extended information access beyond the home and office to remote and/or mobile locations.
One example is a vehicular emergency message system of the type described in U.S. Pat. No. 5,890,061. The '061 patent describes a system in which a global positioning system (GPS) receiver is utilized in conjunction with a cellular telephone unit to provide positioning information to emergency service providers over a cellular link. In U.S. Pat. No. 6,012,012, so called "floating car data" (which includes, inter alia, position information from, for example, a GPS receiver) is gathered at a moving vehicle and transmitted over a mobile wireless system to a control center. The control center uses the transmitted information to judge traffic patterns and congestion, and provides the traffic information to the moving vehicles over the same mobile wireless system. In U.S. Pat. No. 5,767,795, a GPS-based information system is used to act as an electronic tour guide to overcome the monotony of automobile trips. The system includes a GPS receiver, a computer, and a database of pre-recorded information, all of which may be contained in one housing and permanently installed in the vehicle. The database contains information pertaining to various geographical regions. The computer receives a signal from the GPS receiver indicating the position of the vehicle. The computer then retrieves information from the database, the retrieved information corresponding to the position determined by the GPS receiver. The information is presented to the traveler, either on a video display or through an audio playback unit. The system can therefore provide information on the history, geography, and/or culture, relating to the region through which the vehicle is traveling.
While useful, the above-described systems suffer from several shortcomings. For example, the '795 patent provides regionally relevant information to a motor vehicle, but has no network links for carrying out any meaningful real time information exchange to and from locations outside the vehicle. The '061 and '012 patents provide network links, however they use wireless telephony paths to communicate information to and from the vehicle, thereby incurring air-time charges and requiring the time consuming and relatively inefficient step of making a telephone call to establish the communications link.
Other systems provide information to users on a broadcast basis—for example, the direct-to-home satellite systems used by companies such as DIRECTV and Dish Network, or the digital radio broadcast system used by the Sirius Satellite Radio Company. These systems don't generally have the problems associated with relying on a cellular link for data transmission (no airtime charges, and "always on" without needing a phone call to establish the link) but they are not dynamic, i.e., you get what they send and what you are authorized to receive. For example, a user will typically be required to have authorization codes that match the authorization codes in the incoming data in order for the data to be received and processed. If there is a match, the received data packet is passed for processing. If there is no match between the authorized code in the data and the authorization codes at the receiver station, the data falls on the floor.
Accordingly, there is a need for an efficient, simple and cost effective method of dynamically providing geographically relevant information to a mobile environment, such as, for example, a motor vehicle.
The present invention provides an efficient and dynamic method of delivering services to a mobile environment. More particularly, it provides a dynamic method of delivering regionally relevant information to a plurality of geographically disperse and mobile environments, such as, for example, motor vehicles. Accordingly, the invention allows passengers in an automobile to immediately access regionally relevant information, such as weather, traffic, points of interest, restaurants, advertisements for local establishments, etc., without incurring expensive air-time from connecting through cellular telephony infrastructure. The invention utilizes a filtering process referred to herein as dynamic geo filter/fencing (DGFF). This involves a receiver element in a mobile environment, such as a motor vehicle, taking a geocode reading (e.g., latitude and longitude readings obtained from a GPS satellite via a GPS receiver) for identifying the location of the vehicle, then logically drawing a fence around that location reading, for example two miles square. At a separate location (e.g., a satellite uplink facility) regionally relevant data is tagged with the geocode of the region to which the data is relevant, then broadcast (e.g., over a satellite link) to a wide footprint. The aforementioned receiver element receives the geocoded regionally relevant information and filters it using the aforementioned logical fence according to the aforementioned DGFF process. In other words, received information bearing a geocode within the logical fence is kept and processed, while information bearing a geocode falling outside of the logical fence is not kept and processed. The inventive methodology is dynamic in that the fence automatically moves as the mobile environment moves, thereby automatically changing the nature and content of the information that is allowed to pass through the DGFF filter.
The present invention may be implemented using in a wireless distribution system that securely, reliably and inexpensively distributes digital, packetized and regionally relevant information to individuals at geographically disperse and mobile locations. The wireless distribution system is preferably implemented using the up-link and air-link facilities of a known digital satellite broadcast system, such as the satellite-based, digital radio broadcast system utilized by the Sirius Satellite Radio system. Details of such a system are provided several U.S. Patents, including specifically U.S. Pat. No. 5,864,579 entitled Digital Radio Satellite and Terrestrial Ubiquitous Broadcasting System Using Spread Spectrum Modulation. Other patents describing SDARS are U.S. Pat. No. 5,319,673, U.S. Pat. No. 6,023,616, U.S. Pat. No. 5,278,863, U.S. Pat. No. 5,485,485, U.S. Pat. No. 5,592,471, U.S. Pat. No. 5,794,138, U.S. Pat. No. 5,720,039, and U.S. Pat. No. 5,745,839.
The present invention is embodied in a method of providing regionally relevant information to a mobile environment. The steps include receiving at a receiver station of the mobile environment transmitted geographically coded regionally relevant information; and filtering said transmitted geographically coded regionally relevant information based on a current position of said receiver station and a predetermined area around said current position of said receiver station. The mobile environment may be any of a variety of mobile environments, for example, a motor vehicle or a person.
The above-described filtering can comprise determining whether a geographically coded portion of said geographically coded regionally relevant information represents an area falling outside said predetermined area around said current position of said receiver station. The predetermined area is periodically updated when said current position changes.
The present invention may also be embodied in a system for providing regionally relevant information to a mobile environment. The system includes a central broadcast facility that assembles regionally relevant information and associates with said regionally relevant information geographic coding information identifying a geographic region to which said regionally relevant information is relevant. The central broadcast facility broadcasts said geographically coded regionally relevant information to a coverage area that includes receiver stations each part of a mobile environment and capable of receiving and processing said transmitted geographically coded regionally relevant information. The processing operation includes filtering said transmitted geographically coded regionally relevant information based on a current position of said receiver station and a predetermined area around said current position of said receiver station. The filtering can further include determining whether a geographically coded portion of said geographically coded regionally relevant information represents an area falling outside said predetermined area around said current position of said receiver station. The predetermined area is periodically updated when said current position changes.
FIG. 1 is a diagram of broadcast satellite system that implements the method and apparatus of the present invention.
FIG. 2 is a diagram illustrating more details of the receiver station shown in FIG. 1.
FIG. 3 is a flow diagram illustrating a dynamic geo fencing and filtering (DGFF) process embodying a method of the present invention.
FIG. 4 is another flow diagram illustrating an overall process that incorporates the DGFF process shown in FIG. 3, and that further embodies a method of the present invention.
Referring to the drawings, FIG. 1 is a block diagram of a satellite-based transmission and reception system 10 that distributes geo-coded, regionally relevant data (GRRD) to a mobile environment, such as an automobile, in accordance with the principles of the present invention. The illustrated system 10 includes a transmission station 12, a relay stage 14, terrestrial repeaters 16 and a plurality of receiver stations, one of which is shown at reference numeral 18. A wireless air-link provides the communications medium between the transmission station 12, the relay stage 14, the repeaters 16 and the receiver stations 18.
The transmission station 12 includes an information source 20, an encoding system 22, an up-link frequency converter 24, and an uplink satellite antenna 26. The relay station 14 is preferably at least one geosynchronous satellite, along with at least one GPS satellite. The receiver station 18 includes a satellite receiver 42 and a GPS receiver 40, both connected to a central processor 44 (all shown in FIG. 2). The central processor 44 may be a so-called telematics communications module (TCM), which generally manages digital data (e.g., VIN, latitude, longitude, direction, speed, etc.) sent over a cellular link to a vehicle. In the present invention, the TCM 44 is modified in accordance with the methodologies described and illustrated herein (see FIGS. 3 and 4) to also manage regionally relevant digital data sent over a satellite link to the mobile environment. In accordance with the present invention, the aforementioned regionally relevant digital data would be geo-coded to associate it with one or more geographic regions, and the aforementioned data management function would include, inter alia, the DGFF operations described herein.
The present invention may be incorporated into any wireless transmission system capable of transmitting and/or broadcasting packetized digital information. Preferably, the present invention is incorporated into a broadcast satellite digital audio radio system (known generally as "SDARS") of the type used commercially by Sirius Satellite Radio. The details of an exemplary SDARS system are described in several U.S. Patents, including specifically U.S. Pat. No. 5,864,579 entitled Digital Radio Satellite and Terrestrial Ubiquitous Broadcasting System Using Spread Spectrum Modulation. Other patents describing SDARS are U.S. Pat. No. 5,319,673, U.S. Pat. No. 6,023,616, U.S. Pat. No. 5,278,863, U.S. Pat. No. 5,485,485, U.S. Pat. No. 5,592,471, U.S. Pat. No. 5,794,138, U.S. Pat. No. 5,720,039, and U.S. Pat. No. 5,745,839. Other possible broadcast systems include direct-to-home satellite television systems of the type used commercially by companies such as DIRECTV and Dish Network. The details of a direct-to-home satellite television system are disclosed in several U.S. Patents, for example U.S. Pat. No. 5,844,636 and U.S. Pat. No. 5,801,751. The entire disclosure of each patent listed in this paragraph is incorporated herein by reference.
Referring again to FIG. 1, the transmission station 12 can receive information from a number of sources. For example, audio programming can come from other satellites, terrestrial fiber optics, cable, or tape. The regionally relevant information can include traffic, weather, points of interest, restaurants, and other information, gathered from a variety of sources. For example, several companies gather traffic-related information and present it in a single format. A company called TrafficStation provides personalized traffic and traveler information via the Internet, telecommunications (e.g., radio stations) and mobile wireless devices.
The various categories of information are gathered at the source element 20 and sent, along with other related data (e.g., conditional access information for subscription purposes), to the video/audio/data encoding system 22 where they are digitally encoded and multiplexed into a packetized data stream using a number of conventional algorithms, including convolutional error correction and compression. With respect to the so-called "regionally relevant" category of information, the aforementioned "other" information that is added thereto (preferably in the data packet's header) via the encoding system 22 includes geo-codes that tie the regionally relevant information to a particular region. For example, where the regionally relevant information is a popular restaurant in downtown Chicago, that information is encoded or packetized with geo-codes (latitude and longitude data) identifying the location of the popular restaurant. Or, where the regionally relevant information is a road construction project tying up traffic on Interstate 75 between exits 256 and 275, that information is encoded or packetized with one or more geocodes (latitude and longitude data) identifying the various areas that are affected by the traffic delays. Or, where the regionally relevant information is the location and other information about the World Headquarters of Ford Motor Company in Dearborn, Mich., that information is encoded or packetized with one or more geocodes (latitude and longitude data) identifying the location of Ford's World Headquarters.
In a conventional manner, the encoded data stream is modulated and sent through the uplink frequency converter 24 which converts the modulated encoded data stream to a frequency band (e.g., 4-20 GHz) suitable for reception by the SDARS satellite 30. The modulated, encoded data stream is then routed from the uplink frequency converter 24 to an uplink satellite antenna/dish 26 where it is broadcast toward the SDARS satellite 30 over the air-link. The SDARS satellite 30 receives the modulated, encoded data stream and re-broadcasts it downward toward an area on earth that includes the repeaters 16 and the various receiver stations 18.
In addition to the SDARS satellite 30, the relay stage 14 of the system 10 according to the present invention includes a GPS satellite 32. In a conventional manner, the GPS satellite 32 transmits signals (or geo-codes) related to latitude and longitude of a particular area, for example, the continental United States. A GPS receiver 32 (shown in FIG. 2) located on the ground receives the GPS signals from the GPS satellite 32 and converts them into very accurate latitude and longitude data identifying with amazing accuracy the location of the GPS receiver 32.
FIG. 2 is a diagram illustrating more details of the receiver station 38 shown in FIG. 1. In general, the receiver station 38 includes a GPS receiver 40, an SDARS receiver 42 and a telematics control module (TCM) 44. The TCM 44 includes a front-end processing module 46, a DGFF processing module 48, a decompression module 50, and an information processing module 52.
The GPS receiver 40 receives GPS position signals representing generally the latitude and longitude of the receiver station 38. The received GPS signals are provided to the DGFF module 48 of the TCM 44. In a similar fashion, the SDARS receiver 42 receives the signal from the SDARS satellite 30. A demodulator (not shown) in the SDARS receiver 42 recovers the broadcast streaming packetized data, which has two major component categories, SDARS data and GRRD (geo-coded, regionally relevant data). The SDARS receiver 42 may also perform certain conditional access checks on the incoming signal to make sure that the receiver station 38 is an authorized subscriber to the data service that provides the SDARS data and the GRRD. In general the SDARS audio/data is routed using identifying header information to an audio/data processor (not shown) for processing and outputting the digital audio transmission and its associated data (e.g., song title, artist, music category, etc.). The GRRD is routed, also using identifying header information in each data packet, to the TCM front end processor 46. The TCM processor 46 is a conventional microprocessor that ordinarily receives and processes various types of data inputs received from a cellular receiver (not shown). According to the present invention, the TCM front-end processor 46 is modified to also receive and process the GRRD and pass it to the DGFF module 48.
The DGFF module performs 48 what the present disclosure describes as dynamic geo fencing and filtering, or DGFF. This involves taking the geocode reading (e.g., latitude and longitude) obtained from the GPS satellite 32 via the GPS receiver 40 for identifying the location of the receiver station 38, then logically drawing a fence around that location reading, for example two miles square. The GRRD, which has been tagged with the geocode of the region to which the GRRD is relevant, is filtered using the aforementioned logical fence according to the aforementioned. DGFF process. In other words, received GRRD bearing a geocode within the logical fence is kept and processed, while GRRD bearing a geocode falling outside of the logical fence is not kept and processed. The inventive methodology is dynamic in that the fence automatically moves as the mobile environment moves, thereby automatically changing the nature and content of the information that is allowed to pass through the DGFF filter.
A decompression module 50 receives the filtered GRRD and decompresses it. Digital information is often compressed before broadcasting to conserve bandwidth. Digital video is often compressed according to the so-called "MPEG" compression standards, and audio signals are often compressed using the so-called "MP-3" compression standards. An information processing module 52 receives the decompressed packets and, in a conventional manner, reconstructs the broadcast information. The reconstructed information is then passed to the presentation module 54, which provides the information to the user. This module 54 may be any one of a variety of output devices (e.g., loudspeakers, video/text display) depending on the nature of the GRRD.
FIG. 3 is a flow diagram illustrating the DGFF process embodying a method of the present invention. FIG. 4 is another flow diagram illustrating an overall service process, further embodying a method of the present invention, that provides continuous, always-on regionally relevant data to geographically dispersed remote receivers and incorporates the DGFF process shown in FIG. 3. As shown in FIG. 3, the DGFF process 60 begins at block 62 by loading the current GPS geo-code information from the GPS receiver 40. The current geo-code identifies the current position of the receiver station 38. If the receiver station 38 is part of a mobile environment 36 (e.g., a motor vehicle) the current position information may also include the direction in which the mobile environment 36 is heading. At block 64, the current position geo-code is compared with the previous position geo-code. Decision block 66 determines whether the current position geo-code is different from the previous position geo-code, preferably measured within some selected range. If no change is determined at decision block 66, the process 60 returns to block 62 and again loads the current position geo-code. If a change is determined at decision block 66, the process 60 proceeds to blocks 68 and 70 which load the current logical fence boundaries (as predetermined, or as selected by the system user) and calculate a DGFF table using the current position geo-code, the geo-codes corresponding to and covered by the selected logical fence boundaries, and the receiver station's direction, if applicable. The DGFF table, so calculated, will include all the geo codes that fall within the fence boundaries around the current position geo-code. At power-up, the previous position geo-code is cleared to null, thereby forcing the process 60 through steps 68 and 70 at least once at start up. At block 72, the new DGFF table, as calculated at block 70, is loaded to a memory location and made available for use in the overall GRRD broadcast process 78 shown in FIG. 4.
As shown in FIG. 4, the overall GRRD broadcast and DGFF filtering process begins at a block 80 at which regionally relevant information is assembled. The regionally relevant information can include traffic, weather, points of interest, restaurants, and other information, gathered from a variety of sources. For example, in the category of traffic information, several companies gather traffic-related information and present it in a single format (e.g., text, maps, voice, diagrams, still pictures, moving video). A company called ETAK provides personalized traffic and traveler information via the Internet, telecommunications (e.g., radio stations) and mobile wireless devices. At block 82, the regionally relevant information is digitized (or packetized) and associated with a geo-code for the region to which the information is relevant. The geo-code may be placed in the header information of the data packets.
The geo-coded, packetized regionally relevant data (GRRD) is then broadcast at blocks 84 and 86. In the preferred embodiment, the broadcast includes uplinking the GRRD to satellites that relay the GRRD to a coverage area on the ground. An exemplary broadcast system for use with the present invention is disclosed in U.S. Pat. No. 5,864,579 (the entire disclosure of which has been incorporated herein by reference). As described and illustrated in the '579 patent, the broadcast signal, consisting of one or more music, voice or ancillary data programs, originates in a programming center and is sent to a geosynchronous satellite by the Uplink Earth Station using a radio-frequency typically in the 4-20 GHz range. The same transmission may be sent to one or more additional geosynchronous satellites as described in U.S. Pat. No. 5,485,485 to mitigate service outages from multipath fading and blockage. The signal transmitted to the satellite is retransmitted by the satellite to the service coverage area on the earth using a UHF radio-frequency typically in the 0.3-3 GHz range. The geographical service coverage area for such radio broadcast systems is often large (e.g., the contiguous United States).
As shown in FIG. 1 of the '579 patent, mobile and fixed terminals in the service coverage area with clear line of sight to the satellite(s) receive their service directly from the satellite(s). In core urban areas, there will be too much blockage from buildings. Such blockage creates more service outages than would be tolerable to broadcast radio listeners. There is insufficient signal power from the satellite to penetrate reliably modem buildings, so service would be unavailable to listeners in apartments and offices. Such reliable penetration would require satellites over a thousand times more powerful than those now available. Such satellites would be very costly. This problem can be solved by using terrestrial repeaters in the urban cores and in other high blockage situations (e.g., tunnels). The terrestrial repeater receives the low power broadcast signal from the satellite and rebroadcasts the signal at high power. The number of terrestrial repeaters required to provide service throughout a specific core urban area can be one or more, depending on the transmitter radiated power of the terrestrial repeater, the severity of the blockage conditions and the geographical extent of the core urban area desiring service. The terrestrial repeaters, due to their high radiated transmit power, can additionally serve fixed receivers inside modern apartment buildings and offices as well as portable receivers (e.g., Walkman). Thus, a mobile terminal in less dense urban areas can receive good service coverage by intermittently using either the satellite transmission or one of the terrestrial repeater transmissions.
Returning to the overall flowchart description in FIG. 4, block 88 shows the receiver station receiving the GRRD. At block 90, the received GRRD is compared to the current DGFF table that was determined by the DGFF process 60 shown in FIG. 3. More particularly, the geocode in the header information of each packet in the incoming GRRD is compared with the geo-codes in the current DGFF table. If no match is found at block 92, the system concludes that the GRRD is relevant to a geographic region falling outside of the region in which the receiver station 38 is currently located, and the non-matching data packet is therefore allowed to fall on the floor at block 94. If a match occurs at block 92, the system concludes that the GRRD is relevant to a geographic region falling within the region in which the receiver station 38 is currently located, and the matching data packet is therefore passed through at block 96 for re-assembly and processing and presentation to the system user.
Thus, the above detailed description describes an advantageous system that uses data broadcasting and dynamic, geo-code-based filtering and fencing (referred to herein as DGFF) to provide a wide variety of regionally relevant services to a mobile environment. An uplink facility assembles and broadcasts a wide variety of data that is only relevant to individuals in or traveling through a certain geographic region. Prior to broadcast, the regionally relevant data is tagged with a geo-code identifying the region(s) to which it pertains. Receiver stations are provided at geographically dispersed locations, preferably in a mobile environment such as an automobile. The receiver stations continuously receive the GRRD, position data representing its current location, and so-called "fence" information defining an area of interest around the receiver station's (and hence, the automobile's) current location. The system is dynamic in that when the receiver station moves, the fence boundaries are recalculated and changed. The receiver station uses a snapshot of the current dynamic fence boundary information and the receiver's current position to determine whether or not the received GRRD should be kept or discarded. Thus, the present invention provides convenience and simplicity, while avoiding the complexity (connecting a telephony link) and costs (cellular airtime) associated with using a wireless telephony communications path.
Of course, it should be understood that a range of changes and modifications can be made to the preferred embodiment described above. For example, the present invention is described in connection with a particular hardware and processing structure for transmitting and receiving digital audio and related data. However, a wide variety of transmitting and receiving structures could be utilized as long as the essential dynamic geo-code fencing and filtering features described herein are present. Some exemplary transmission media include cable or terrestrial broadcast, LMDS, MMDS, or other similar formats. Also, the invention is described in connection with GPS based geo-codes, however several other geographically coded position data systems would be applicable, including Cellular triangulation and Road-side beacons. It is therefore intended that the foregoing detailed description be regarded as illustrative rather than limiting and that it be understood that it is the following claims, including all equivalents, which are intended to define the scope of this invention.
automatically filtering said transmitted geographically coded regionally relevant information based on a current position of said receiver station and a predetermined area around said current position of said receiver station in order to process the information having geographically coded portions corresponding to regions within the predetermined area around said current position of said receiver station while ignoring the information having geographically coded portions corresponding to regions outside of the predetermined area around said current position of said receiver station.
2. The method of claim 1 wherein said predetermined area is periodically updated when said current position changes.
3. The method of claim 1 wherein processing the information includes placing this information in a format suitable for presentation to a user.
4. The method of claim 3 wherein said regionally relevant information comprises traffic information, weather information, points of interest, historical information or advertisements.
5. The method of claim 3 wherein said format comprises text.
6. The method of claim 3 wherein said format comprises audio.
7. The method of claim 3 wherein said format comprises video.
8. The method of claim 3 wherein said format comprises graphics.
9. The method of claim 1 wherein said mobile environment comprises a motor vehicle.
10. The method of claim 1 wherein said mobile environment comprises a person.
said data portion comprises said regionally relevant information.
12. The method of claim 11 wherein said geographically coded portions comprise global positioning system geo-codes.
said processing comprising filtering said transmitted geographically coded regionally relevant information based on a current position of said receiver station and a predetermined area around said current position of said receiver station in order to process the information having geographic coding information corresponding to geographic regions within the predetermined area around said current position of said receiver station while ignoring the information having geographic coding information corresponding to geographic regions outside of the predetermined area around said current position of said receiver station.
14. The method of claim 13 wherein said predetermined area is periodically updated when said current position changes.
a filtering module of said receiver station that automatically filters said transmitted geographically coded regionally relevant information based on a current position of said receiver station and a predetermined area around said current position of said receiver station in order to process the information having geographically coded portions corresponding to regions within the predetermined area around said current position of said receiver station while ignoring the information having geographically coded portions corresponding to regions outside of the predetermined area around said current position of said receiver station.
16. The system of claim 15 wherein said predetermined area is periodically updated when said current position changes.
said processing comprising filtering said transmitted geographically coded regionally relevant information based on a current position of said receiver station and a predetermined area around said current position of said receiver station in order to process the information associated with geographic coding information corresponding to geographic regions within the predetermined area around said current position of said receiver station while ignoring the information associated with geographic coding information corresponding to geographic regions outside of the predetermined area around said current position of said receiver station.
19. The system of claim 18 wherein said predetermined area is periodically updated when said current position changes.


First of all, 90% of elderly make medication mistakes. In fact, outdated thinking that anyone should be able to remember to take their medicine can be dangerous. Most caregivers have experienced medication enlightenment. Hence. people need to routinely use use an electronic pill dispenser alarm reminder. First, Using a weekly pill box is crucial. Second, use a day planner to track insulin and diuretic doses. What most seniors do not realize, is that people forget all the time. By the same token, routine actions are more easily forgotten then remembered. For example, it will escape your recall. . Furthermore, the aging process doesn't help. In fact, it makes it worse. To sum up, just because the senior doesn't remember what she had for breakfast this morning doesn't mean they will remember their prescription medications.
Information for Prescription blister packs.
Most people hate them. For example, an OTC medication that comes in foil blisters packs. However, I must use a sharp tools to cut them out. Moreover, the packs in the research study created major problems. To illustrate, it was almost certainly because of increased adherence. People have become comfortable with blister packs. To sum up, blster packs are better than an old fashion pharamcutical bottle.
In the past, i used an old fashion pill box. First of all, i was missing about 25% of my pills. Second of all, when. I started taking Blood Pressure medication, I couldn't afford to miss my pills. Third of all, I needed to know if I had taken them or not. To illustrate, if I think I have forgotten I can call the wife while on the way to work. Hence, she would then check. This being said, I could usually feel the change if I forget my prescription.
I have seen other types of medication service. For example, you submit all your prescriptions list and they send you a box of all you medications in individual packets. However, this does not help with the forgetting problem. In addition, companies can add any OTCs or supplements..
An electronic pill dispenser alarm is a neat idea. The pill dispenser has found its place. Again, Justin hoped the pill dispenser would help the majority of his patients. First, he persuaded the patents to try the medication dispenser. Second, he placed the meds into the proper daily pill compartments of a pill reminder. It's a bit of a chore I don't particularly enjoy, but it is only once a week.
I used a electronic pill dispenser like that. First, no more forgetting. Second, no more overdosing. In fact, it so much easier for me. Yes, load the pills into my medication an organizer. This is much simpler. I can just take the individual pill compartment with, rather than the entire organizer.
I'm not a doctor, however, I transcribe f pharmaceutical advisory boards.
The information gathered, it is not uncommon for healthcare professionals to raise dosage. In fact, they do not realizing that the user is non being medically adherent. Henry says, " I'm not sure how someone would design it, but there may be ways to do "real-world" studies on this using data from refills from the PBMs" . Again, he believes research studies have been done to investigate this area. This being said, It wouldn't work for the pill organizer question.
As a healthcare provider, insurance companies are the last entity that should be between the provider and my patients. Moreover, they are already there. Health care providers worry about how they would measure their own "performance". No two medical practices will ever have the exact same patients. For example, these differences in patient profiles raise questions about the best way to evaluate any specific practice's performance. For example, I once practiced with a physician who would not see a patient if they were "non-compliant". On the other hand, many will see anyone. Hence, tried to encourage them to care for themselves.
Now is the time to take a proactive stance with medications. Again, 90% of seniors regularly make medication mistakes. Most caregivers need the help of a modern medication dispenser. Hence. people need to routinely use use an electronic pill dispenser alarm reminder. Remember, an electronic Pill dispenser with alarm saves lives.


One of the most complex and daunting challenges facing competition regulators is the evolving intersection of antitrust and intellectual property law. Given that both antitrust law and patent law seek to enhance consumer welfare and promote innovation, but do so through very different mechanisms, it is natural for regulators to struggle when harmonizing monopoly-granting patent law with competition-enforcing antitrust law.
Notwithstanding these hurdles, representatives from the Department of Justice Antitrust Division, the Federal Trade Commission, and the European Commission made it clear in a recent series of speeches that they intend to broaden their patent and competition focus to go beyond traditional challenges such as patent misuse, or price fixing through licensing. I applaud the thought leaders within these organizations for recognizing that the intersection of IP and antitrust is not static, and I believe it is an encouraging sign for consumers that the agencies are stepping up to the plate on these issues.
Business practices of unwilling licensees within the standard-essential patents (SEP) context, and whether an unwilling licensee may be subject to equitable relief for failure to negotiate in good faith.
Fiona Scott Morton, the deputy assistant attorney general for economic analysis, commented at the Georgetown conference that there are two high-level concerns when companies acquire patents. First, there is the threat that the firm will use the patents to raise the operating costs of rivals. This may occur in a variety of ways, but the most important element for regulators is to understand the context and business model of is the party acquiring the patent, at which point "you can apply the vertical harm theory of your choice." Secondly, Dr. Scott-Morton explained that every transaction of intellectual property has the potential to distort the balance in the ecosystem, and that this threat is particularly present in high tech industries. FTC Chief Economist Howard Shelanski agreed with these views, and also stressed that the question of patent acquisition becomes increasingly more complicated when you introduce non-practicing entities into the equation, particularly when there may be a relationship between a NPE and a traditional competitor.
With respect to NPEs, Assistant Attorney General Joseph Wayland remarked "Some have raised concerns about business entities that do not develop patented technologies or incorporate them into their products, but purchase and assert patents, through licensing or litigation, against firms who manufacture products … While being respectful of the benefits of business models that facilitate the transfer of patent rights, we continue to monitor these activities and their effects on innovation and competition." FTC Chairman Jon Leibowitz also acknowledged that his agency is receiving complaints about non-practicing entities.
On the issues of SEPs and fair, reasonable, and non-discriminatory (FRAND) licensing, many of the issues with respect to the patentee are well known, and the agencies appear committed to ensuring that companies do not wield undue market power as a result of SEP abuse. In her remarks prepared for an International Telecommunication Union patent roundtable, Department of Justice Deputy Assistant Attorney General Renata Hesse gave policy suggestions standards bodies could implement to promote competition. These suggestions included improving advance identification of patented technology that could be involved in a standard, making it clear that FRAND commitments apply to all future purchasers of the patent, and either establishing guidelines for what constitutes a FRAND rate or establishing an arbitration process to resolve FRAND rate disputes. In addition, Hesse suggested two bargaining limitations on companies that have agreed to license their patents on FRAND terms. First, these companies should have a limited ability to seek an injunction. Second, FRAND licensors should be prohibited from demanding mandatory cross-licensing agreements where FRAND licenses are exchanged for non-FRAND licenses.
It also appears that enforcers are beginning to more closely scrutinize the behavior of would-be licensees who take advantage of a FRAND encumbered patent without negotiating licensing terms in good faith. The European Commission's Deputy Director-General for Antitrust Cecilio Madero Villarejo expressed concern that some technology companies who complain of being denied a license on FRAND terms never truly intended to acquire a license, but rather "wanted to create conditions for a competition case to be brought." This reflects a more sophisticated understanding of the relationship between SEP holders and potential licensees, and bodes well for consumers who increasingly use products that rely on standards.
The approach suggested by the agencies in these statements demonstrates two important aspects of this field. First, firms are deploying intellectual property in new ways. Oftentimes this is proof of innovation, but sometimes firms use intellectual property rights and the idiosyncrasies of the patent system to gain undue advantages, unfairly harm competitors, and limit economic growth. Second, the harm that results from these practices is best prevented rather than dealt with after-the-fact. Regulators recognize the importance of framing behavior with respect to intellectual property before it harms competition. This is the best way to ensure that consumers reap the benefits of competition. Others have recognized the need for the antitrust agencies to take a stand on these issues, including Bert Foer of the American Antitrust Institute's who delivered remarks before the Seoul International Competition Forum. I am glad to see the agencies are listening to the voice of consumers.
Brendan Coffman is an attorney in Mr. Balto's office.


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redpajama_set_name: RedPajamaGithub


text:
SUBSCRIBE WITH iTUNES SUBSCRIBE WITH YOUTUBE SUBSCRIBE WITH STITCHER
Download The Podcast MP3
James Hong is one of the founders of the infamous site Hot or Not. What started out as an innocent experiment turned into a cultural phenomenon and lucrative business.
Hot or Not was a website that allowed users to upload their photos to the site so that other users could rate them as "hot" or "not." Soon after, a dating site was added, and a new form of internet speed dating began.
Hot or Not was part of the dawn of social media, preceding Youtube, Facebook, and sites like Tinder.
James shares his observations of human nature and how the site proved age-old truths about attraction.
People who submitted the photos were, for the most part, confident enough to know the site was all in good fun. Others took it too seriously. In the long run, "hotter" people found the site and stayed based on the reaction to their photos.
James and his partner built the site as a side project that started out with an invite to friends – and grew to 30 thousand visitors.
Online source photos were used to begin the concept of the site. James estimates about 100 photos were used. Within 7 hours, the site was populated with real users wanting to be rated.
The instant success was a little overwhelming for James and his partner.
Machines and internet service were much more expensive in the early 2000s. So much so, the site was almost shut down because the equipment couldn't keep up with the site!
They moved Hot or Not to GeoCities, and changed the future of the site. They made a deal with Ophoto as an affiliate. The final step was a business deal with Rack Space, which hosted the site for an exchange of publicity.
Companies called, wanting to buy this new business, but James and his partner wanted to see where it was going.
James says that the first year was all hard work. The dating service was the first attempt at monetizing the site. The dating site was linked to Hot or Not, and to go on with the site required one participant to be a paid member.
James compares the success of Hot or Not to the early days of reality shows. Hot or Not has been credited with creating 5 to 10 marriages a day.
Hot or Not was eventually sold in February of 2008. With the financial crash of 2008, James and his partner decided liquidizing the company was the wisest move.
James has always considered the future of business to be entrepreneur-focused rather than capital-focused. Hot or Not is a prime example of how the internet can make this possible.
James's suggestion to the newcomers in this business would simply be:
Concepts don't have to be complex to work.
If the interface works, then don't complicate it.
Resources and Links:
You can reach out to James directly on Twitter @JHong.
To learn more about Cakey, James' new app that helps parents find kid-friendly video playlists, head over to cakeyvillage.com.
Book Recommendation 46
Impression Technique 27
Ambition 10
Ep. 208:…

redpajama_set_name: RedPajamaCommonCrawl


As much as one might desire that tax burden simply does not exist, the living reality is to pay taxes but reduce the burden. Tax evasion is an offence but tax planning is not. Tax planning is important for every businessman big or small and every person who comes under tax bracket. Supreme Laws is the taxation law firm which help its clients not only to plan their taxes which in turn saves them form tax penalties, etc.


text:
Delirium: A podcast with Sharon Inouye
In this week's GeriPal podcast we discuss delirium, with a focus on prevention. We are joined by internationally acclaimed delirium researcher Sharon Inouye, MD, MPH. Dr Inouye is Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center in the Institute for Aging Research at Hebrew SeniorLife.
Dr. Inouye's research focuses on delirium and functional decline in hospitalized older patients, resulting in more than 200 peer-reviewed original articles to date. She has developed and validated a widely used tool to identify delirium called the Confusion Assessment Method (CAM), and she founded the Hospital Elder Life Program (HELP) to prevent delirium in hospitalized patients.
We are also joined by guest host Lindsey Haddock, MD, a geriatrics fellow at UCSF who asks a great question about how to implement a HELP program, or aspects of the program, in a hospital with limited resources.
You can also find us on Youtube!
Listen to GeriPal Podcasts on:
Eric: Welcome to the GeriPal podcast, this is Eric Widera.
Alex: This is Alex Smith.
Eric: And Alex, we have a large in-studio audience today.
Alex: Large in-studio audience. We are joined by a guest host today, Lindsey Haddock, who's one of the geriatrics fellows. Welcome to the GeriPal podcast.
Lindsey: Thank you. I'm so happy to be here.
Alex: And we are honored to have Sharon Inouye who is Professor of Medicine at Harvard Medical School and geriatrician at Hebrew Senior Life in Boston, and is an internationally famous delirium researcher among many other things. Welcome to the GeriPal podcast, thank you so much for coming.
Sharon: Thank you. I'm thrilled to be here.
Eric: And we're very excited, we're going to be talking about the prevention and delirium mainly, but before we get into this topic we always ask do you have a song request for Alex to sing?
Sharon: Definitely. I would love to hear the rendition of Help that you did at AGS last year.
Alex: (singing)
Eric: That was awesome. We'll have more of that song in the end. Is there more verses?
Alex: There's another verse.
Eric: There's another verse. Excited to hear that. I love the CAM part.
Alex: Actually the second verse is unaltered, but as you'll hear at the end it works well unaltered for delirium.
Sharon: It really does.
Alex: My independence seems to vanish in the haze, right?
Eric: Sharon, you are the delirium expert in my mind. When I think of delirium your name is synonymous not because you're delirious but because you have done so much for this field. Is it okay that we kind of take a big step back and just think how did you first get interested in delirium and which this is your main research area?
Sharon: Sure. Well, it's actually a really good question. It really stemmed out of my work at the bedside when I was just starting out. In fact, my very first attending stent which was at the VA in West Haven on the general medicine service I had a large group of patients. I was feeling very responsible for their care, and this was now over 35 years ago. On my service I had the six patients that I distinctly remember who became very confused during the course of their hospitalization.
Sharon: I was an internist on the geriatric unit. At that time, I didn't have any formal geriatric training yet. I noticed these older people coming to the hospital, being okay, and then getting acutely confused while they were in the hospital. They ended up not doing well, these six patients. Two of them went to the ICU, two of them ended up dying. Two went to a nursing home. I turned to all my colleagues, the chief of service, and I said, "What's going on with these older people that come to the hospital and get really confused?"
Sharon: Every single one said to me some version of, "Sharon, that just happens to older people when they come to the hospital. Don't worry about it. It just happens." I couldn't stop worrying about it, and I think that sense of responsibility you have when you have your first service, so after I rotated off I pulled every chart. I made these huge graphs of everything we did to every patient every single day. Then I looked at my note about when they became confused, and I concluded that actually we had contributed to that with psychoactive medications, with Foleys and infections and immobility and all the kind of things that happen to people in the hospital.
Sharon: I went back, and I told my chief of service with my graph papers, "I really think we contributed to this confusion." He looked at it, and he kind of nodded his head and said, "Wow." I pointed out, "Look, we gave this Benadryl for blood transfusion, and, look, two hours later they're really confused. We gave these high doses of opioids, and then they were zonked, and then went to the ICU with an aspiration pneumonia." I said, "I think we contributed to this." He said, "Well, Sharon, I think you need to give a lecture on prudent drug therapy to the residents." I said, "Yeah, good idea. I'll do that."
Sharon: Then he thought that was the solution to the problem, the problem not being the delirium, the problem being the young attending who was like, "Oh, my God. We've got to do something." That's really what launched my career. Really that whole thought that this was an inevitable part of hospitalization, and it was okay for older people to come to the hospital and lose their minds, it didn't feel okay to me. That's what launched my career. I realized I had to go back and get research training because you know the graph papers just weren't going to really convince anyone. That's why I then had to learn how to do research.
Alex: Hopefully we moved the needle now due to work from you and others in this field and we realize we should worry about it. We should worry about it. We should care deeply about it. It has important consequences in patients that you cared for and we've all cared for I'm sure including mortality.
Sharon: That's right.
Alex: Big, big deal.
Alex: I wonder as far as getting into the topic a little bit deeper from here thinking of where to start. We sort of had a little bit of email conversation about this in advance. It seems like one place to start is who are the highest risk people. Who do we care for who's at highest risk? What are the sort of services they're on or procedures they're getting or types of diagnoses they have who are our antenna should be really, really up and sensitive to delirium and we should start thinking about taking routine preventative measures?
Sharon: Right. Again, really, really good question to know who are the patients you really need to pay close attention to. You want to think about your vulnerable older adults. For instance, if someone has cognitive impairment at baseline, if they have vision and hearing impairment, if they have multi-morbidity, if they have underlying renal or hepatic insufficiency that will cause them not to be able to metabolize drugs well, those are all things that place people at high risk. You also asked about settings. Definitely things like major surgery with general anesthesia, that could place a person at very high risk. Also, other high risk areas that you want to think about are the intensive care unit where people are obviously very ill, but also are being exposed to a huge number of medications and procedures and sleep deprivation and so forth. The palliative care setting as well, very high rates of delirium.
Sharon: I think if you look at the NICE guidelines out of the UK that are the sort of latest standard in the field as well as the American Geriatrics Society Guidelines, they identify the high risk patients as those age 70 and older, anyone who has underlying cognitive impairment, admitted for a hip fracture and then with multi-morbidity. Those are the key things. They say any one of those, but others say two or more put people at high risk.
Eric: How important is it to identify risk versus... I've given a couple of talks on delirium. When we talk about, which we'll talk about soon, about what preventative measures do we have in place, people say, "That just... Good medicine? Shouldn't we be doing this for everyone who comes to the hospital? Should it just be limited to those people who are at high risk?"
Sharon: Right. My argument is it should be everyone, but because a lot of times resources are limited or staff time is limited, you can help prioritize to the even higher risk patients. I agree with you. I feel like these types of prevention programs should be in the place for all older adults, even some may argue for all adults period. It's expensive and time consuming for staff in some cases.
Alex: Lindsey, it's hard to think of a patient that we've seen in this time -- we're working on palliative care right now currently --who's over 70 years old who doesn't meet one of those criteria.
Lindsey: That's exactly right. Yeah. That's all of our patients.
Alex: It's a huge swath of hospitalized older adults.
Sharon: That's true. You've seen quite a bit of delirium I would wager on the palliative care service?
Lindsey: Absolutely. Every day.
Sharon: Yes.
Eric: Are there any risks of screening? Should we just be doing this right away?
Sharon: So there are risks to screening. I'm really glad that you asked that because I have found when hospitals approach me asking or saying, "We want to make delirium a quality target for our hospital. What can we do?" I always start saying, "Not just screening." Because most of them just want to put into place a screening program, and then that's it. The problem is that... To give you a real world example. The Netherlands mandated screening in all of their hospitals I think about four or five years ago. It became required on every shift at admission, and on every shift people had to undergo a delirium screening.
Sharon: What they found was that the rate of antipsychotic prescription in the hospitals throughout the Netherlands went up four to five fold.
Alex: Oh, no.
Lindsey: Wow.
Sharon: Yeah. I was recently reaching out to the person who presented that work at the IAGG meeting last year to find out if they had published that result and also if there was any follow up as to outcomes of the patients with the five-fold increased risk of antipsychotics because as you know from the literature antipsychotics often worsen the clinical outcomes for persons with delirium. They are not routinely recommended. The risk for screening is if you don't have a system set up and a workforce that's educated to know what to do if delirium is identified, then unfortunately what happens is sort of these automatic things. If a nurse comes to a trainee and says, "Listen, this patient has delirium, see my CAM score, it's positive," they're just going to go, "Well, okay, what do you do for delirium?" Well let's prescribe Haldol or Olanzapine or something without knowing that the first steps are you need to really diagnose it, put into place non-pharmacologic strategies.
Sharon: And also screening it's almost too late because the most effective thing for delirium is prevention. By the time someone screens positive, it's too late in that chain of events. It should have been that all the stuff was in place before then. That would be the ideal. That's the danger to screening for me. I think it's that systems feel they're doing something, and that's what they're going to target as their delirium effort, but it's too little too late rather than building systems that will prevent the delirium from occurring. If you have those systems built, then really you should rarely have to get a screen positive for delirium. You know if it really works.
Eric: What are some of the proven systems that we can put in place to decrease the risk?
Alex: Help.
Sharon: Yes. It's the song.
Alex: That's right.
Eric: We should sing to more patients?
Eric: Music therapy.
Sharon: That is true. That can be part of a delirium prevention. The Hospital Elder Life Program is a very well tested strategy, cost effective for prevention of delirium. What HELP involves is first and foremost a trained interdisciplinary team that comes to help older persons throughout hospitalization it really is to create a system that focuses on prevention. But there are some protocols that you put into place with the HELP program. The most important ones are mobility, so making sure people get up and walk three times a day at least if possible and that they have orientation and therapeutic activities. That's just a fancy word for enjoyable, cognitive stimulating activities that keep people engaged with the environment.
Alex: Do you mean watching the TV right in front of them in the hospital bed?
Sharon: Not a TV. Really things like reminiscence activities, current events, reading activities where you discuss it. We had really fun... I'm trying to think of some of the activities that I've heard people really enjoy. We had these really old time photos of actors, actresses and then different old time cars and clocks and washboards and things. Then you would just have a reminiscence about that. We would write prompts to ask people about on the back of the photo. They would allow people to really reminiscence about the actor or the actress or the item. Have they ever seen one? Have they ever used one? Did they ever have an experience with it? It's really fun and enjoyable but also keeps people engaged in reality.
Sharon: And then a variety of games, music therapy, pet therapy could be part of that. Really what you're trying to do is keep people engaged in time and place, socializing, keeping them in the present. They can think back to the past, but pulling them to the present. That can really help. We also do feeding, hydration, vision and hearing adaptations and making sure staff know how to communicate with patients who have vision and hearing impairment, and sleep. We try to do a non-pharmacologic sleep protocol.
Alex: What is that?
Sharon: That's a glass of warm milk or herbal tea, not chamomile because I think chamomile interferes with Coumadin. It has to be something like peach spice, something like that. An herbal tea. Relaxation music or sounds and a back rub or a hand massage.
Alex: Sounds great.
Sharon: It's very relaxing.
Eric: Who's doing all of these things? Is the nurses? I'm guessing it's not the doctors.
Sharon: It's not the doctors. At many HELP sites it's trained volunteers. So many, many HELP programs utilize trained volunteers. That's not true at all hospitals. In some hospitals it is the nurses incorporating things as part of their routine or the aides. Some places have multi staff like PT aides who will do the mobility, and then they may have... Some places actually have massage therapists that come in on the night shift as volunteers to do the massage. There's different ways that hospitals solve it. HELP does provide training on doing all those kinds of interventions, which has been very successful.
Alex: That's terrific.
Eric: Going back to when you were an intern and the chief said, "Oh, let's talk about medications," is there a component around proper medications and medication debridement?
Sharon: Yes, yes. That is another very vital and important part of HELP is to do regular medication reviews. That interdisciplinary team will meet at least twice a week to go over ideally upon admission and then on an ongoing basis reviewing all the meds, making sure we don't have Beers Criteria meds. These are medications that the American Geriatrics Society puts out the Beers Criteria, just recently updated as you probably know in 2019. On it they utilize what's called potentially inappropriate medications for the elderly. Obviously, many of the meds we have to use, but they let you know that there could be safer versions of that class of meds that for instance might be less anticholinergic. If you have to use an antidepressant for instance, please choose one with the least toxic potential.
Lindsey: Sharon, I love hearing about your vision for what hospitalization should look like for all patients but especially our vulnerable older adults. I'm also thinking about the constraints that we sometimes practice in and how a lot of our listeners may not have the HELP team or this interdisciplinary team. I'm wondering what would you recommend to maybe individual providers? Are there small things they could do if they're not lucky enough to have this whole team of resources?
Sharon: That's a really good question, really good to think about what we can do already on our own as well as hopefully work to building systems that could integrate this. I think that there are a lot of things that individual practitioners can do. Even as you write your admitting orders, please rather than... I know a lot of times clinicians tell me they don't know if someone's safe to ambulate. They'll put bed rest or clearance from PT rather than trying to screen. My rule of thumb... One thing we do in the HELP program is try to train every nurse so they feel comfortable knowing if a patient can walk. Chances are if the patient was walking up until they came to the emergency room, and they didn't break their hip or something, that they can still walk later that night when they're in the hospital.
Sharon: A lot of patients may be at risk for falls, but those patients... I know that the instinct right now is, "Oh, we got to put them in bed with the bed rolls up and a bed and chair alarm." I know you did a whole show on bed and chair alarms, which I love, and I play for my students. That is exactly not what you want to do with someone who maybe at falls risk. You do want them to continue to ambulate regularly and you want to make that possible and safe for them. It's actually the opposite. What I like to ask practitioners to do is please actually write a mobility order.
Alex: Great idea.
Lindsey: I love that idea.
Sharon: Out of bed to chair, and please walk three times a day minimum. Rather than ad lib or bed rest that we specify activity.
Sharon: The other thing is as you're writing the med order list, please be aware or I hope many hospitals have in place now little cheat sheets or even things that come up as you enter the orders about Beers Criteria meds. So if that's not something available at the hospital, maybe that's something that could be advocated for. They would get an automatic warning if they're prescribing a Beers Criteria med.
Sharon: Being attentive if they're vision or hearing impaired. There are a lot of ways the room can be set up or making sure the family is bringing in the hearing aids and the dentures. There's a lot that we can do about that. Ordering supportive services if they're needed. If they do need a walker, then please get the PT in to do the walker, get them up and walking. Start all the different therapies that hopefully should be in place for good holistic care. There's a lot we can do.
Lindsey: That's really helpful. I love the idea of writing a mobility order and that we can feel really safe to do that as clinicians if the patient was just walking a few hours before admission.
Eric: Then from a systems standpoint, HELP program or Acute Care for the Elder ACE units, it sounds like there's a lot of more overlap than I thought there was between the two. Is that right?
Sharon: Yes. HELP programs in ACE units are extremely complementary. There is quite a bit of overlap. In fact, of our HELP programs across the country, many are in place in hospitals that also have ACE units. The ways that they're complementary is that an ACE unit is one targeted unit on a hospital, which is wonderful, and the staff there are often very well trained in how to care for older adults. There's often many similar protocols in place to what we have in HELP.
Sharon: The problem is that the staff aren't always able even on an ACE unit to do things like the ambulation three times a day, the non-pharmacologic sleep protocol, the hearing and vision adaptations, all the things that HELP is designed to do. They love it when there's volunteers available to help with that. The other thing is that the HELP program tends to be hospital wide. It is a way to kind of spread the influence of the ACE unit throughout the organization, and it really does help HELP if there is a home base with this kind of geriatric expertise. Because believe it or not some hospitals... some of our HELP programs don't have geriatricians or geriatric nurse practitioners or even that sort of well spring of geriatric expertise, but they're trying to do a HELP program without that. That's another way that the ACE/HELP combination really strengthens both programs.
Eric: Let's say I'm now totally convinced I want to start a HELP unit, do I just read one of your articles and kind of make it up as I go or is there a resource that I could go to?
Sharon: Definitely. We do have a central HELP office right now and we have a website. If you just Google hospital elder life program, or you put in hospital elder life program all one word dot org, you will get to our website. There's Google groups where you can reach other HELP sites for questions. We have training materials on the site. I have a really exciting announcement that everyone will hear very soon. HELP is now going to be taken over the American Geriatrics Society.
Eric: Oh, wow.
Sharon: We're having an all day HELP conference. It's actually our second one. It's a full day preconference at the American Geriatrics Society meeting, and the American Geriatrics Society will soon be developing a whole very robust program where HELP sites can become official HELP sites and have CMEs and CEUs for staff training. We've developed a set of 14 training modules that are going to actually make it much easier to set up a HELP program because it will actually walk you through that process.
Sharon: That is all available, but right now it comes to you as a 120 page manual that you have to read. This way, it's actually going to be these training modules that are really nicely done and that people can go through. There's a pretest and a post test. You'll get credits for hours spent in the training, and it's going to be official and really I think make the program what it should be.
Eric: Let's say we've done all this stuff. We got HELP and ACE, we got geriatricians, and we're getting them up three times a day, and they're delirious now. Is this when I jump to the antipsychotic and just call it a day? I just read an article in JAMA Psychiatry. It was a, I'm seeing these all over the place, network meta-analysis that said, "The best treatment is a benzodiazepine." Should I just load people up with benzos?
Sharon: No, please don't do that. I think, yes, there were a lot of problems with that network meta-analysis. We should say that up front. I think those are not best practices and not accepted in the field. I think there's plenty of evidence that particularly benzos should be reserved for alcohol or benzo withdrawal related delirium. In other forms of delirium, they should not be the first line choice.
Sharon: I think the way that delirium should be managed after it occurs is first and foremost you need to figure out what the underlying causes are. Generally, there's one or two or three or more things contributing. You want to address those features first. You want to educate the family, the patient, and the staff that while these things are being addressed the patient is going to be delirious, and here are some approaches to use to try to manage that. There's actually a very nice video put out about the TADA Method, T-A-D-A Method, about how you deescalate an agitated patient. It's designed for the long-term care setting, but it's absolutely wonderful just how you do the communication, how often it centers around a device or an IV or a tube that's really agitating the person. Then what happens is it escalates, and they wind up needing to be physically restrained at least one arm or both arms. Then that leads to more agitation and then you get into this crisis situation where you have to prescribe the pharmacology.
Sharon: Really what we want to try to do is avoid that escalation. Really it takes a lot of training to be able to do that because it is frightening. The patient is frightened. The nurse is frightened. The family is frightened. We all get kind of caught up in that. Our natural reaction is to want to sedate the patient. I think if everyone can remain calm and then try to deescalate as you can see in that TADA video, which is very nice, and try to get through that time and really educating the family to get through that time, it can really make all the difference.
Sharon: One thing that I learned from Meera Agar who is a palliative care expert out of Australia... She deals in palliative care with people who are in agitated delirium all the time. She said that actually the fact that we assume that patients and families really would rather themselves or their loved one be sedated rather than agitated, she said that that's actually untrue in qualitative studies that have explored that. That patients a lot of times would rather be awake and alert even if agitated rather than sedated at all times but especially at the end of life when every moment is so precious, and they would rather be in that state rather than sedated.
Eric: Is it true looking at all the studies of really any pharmacological therapy, when it does help it mainly helps by just sedating folks actually not reversing the underlying delirium? Is that right?
Sharon: That's absolutely true.
Eric: I think that was the issue with the network meta-analysis is that it was positive for benzos mainly because benzos do a good job of sedating folks at high enough doses.
Sharon: Correct. All of our current drug treatments for delirium treat it by sedating. We don't yet understand enough about the pathophysiology of delirium to really be able to do definitive targeted treatments that will limit the pathophysiology. That's where we need to get, but unfortunately we're not there yet.
Alex: Can we just do quick hits? Really quick.
Alex: All right. Thirty seconds or less. What do you think about the term "terminal delirium"?
Sharon: I dislike that term. I'd much rather say delirium at the end of life, and we need to separate that delirium is inevitable as a part of death and is okay as a part of death. They concur highly, but the important thing is that delirium even at the end of life is treatable and reversible in 50% of cases. We still have to look for the dehydration, the urinary retention, the constipation, the easily treatable thing that could be contributing. So that's why I think it's important for us to have a different terminology.
Alex: Last lightning round question. Many patients in hospice, many hospices use benzodiazepines, Haldol, antipsychotics like water for the patients near the end of their life. Not all, but many it's common practice. Somebody is agitated delirium at home to give them those medications. Thoughts about that common approach?
Sharon: Yes. Well, of course, comfort is key. I don't at all want to say... There are very appropriate situations where we must do that for comfort and for safety. One spin on it that Meera Agar again has alerted me to is that because of this realization that many patients actually don't want to be sedated and would like to tolerate some pain and some agitation in order to be alert, there is a movement to actually gain informed consent for sedation at the end of life. I think that's actually... Even if it's not like a strict informed consent, I feel like having that discussion is really important to know what the patient's preferences are and the family's preferences. If the alertness is something that's so important to the patient and the family, then I think we really need to honor that. We really need to honor that. That's just what I want to advocate for.
Eric: Great quick hits. We're coming up at the end of our time. Sharon, I really want to thank you for joining us.
Alex: Thank you so much.
Lindsey: Thank you.
Eric: It was absolutely fabulous. I learned a lot. I learned a lot about HELP, and I think we have a little bit more of that song. Maybe?
Alex: I'm hoping that there will be some help with the song at the very end. When I sing please, please help me, they'll be a "help me," or something like that.
Lindsey: We'll do our best.
Eric: That was wonderful. Sharon, again, thank you very much for joining us. I want to thank everybody else for listening. We look forward to having you listen to us … I forgot how to end our podcast Alex.
Alex: Next week.
Eric: Next week.
Alex: Thanks, folks. Bye.
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Delirium is a serious disturbance in mental abilities that results in confused thinking and reduced awareness of the environment. This is great topic, I rarely seen blog that really dig-deeper to discuss about Delirium. Good Job, Sharon. Your podcast is great. Many now can understand what is Delirium is all about. Internal Medicine Doctor in Houston
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Not everyone thinks the new Kia logo is a disaster
By Daniel Piper
All press is good press, right?
(Image credit: Kia)
Ah, the new Kia logo. Despite being unveiled in 2021, the updated wordmark became the most contentious design topic of last year when Google data showed that around 30,000 Google searches for 'KN car' are being made a month. But is the supposedly illegible logo as disastrous as people think?
In a new interview, a sociologist specialising in logo design trends has claimed that things perhaps aren't as bad as they seem – and in actual fact, the slightly confusing design could even be – whisper it – a good thing. (Looking for inspiration? Check out the best logos of all time.)
Kia or KN? (Image credit: Kia)
In an interview with Marketplace (opens in new tab), James I. Bowie claims that despite those erroneous Google searches, Kia doesn't seem to be suffering too much. "It's been two years. Their stock appears okay," he claims. Bowie also shed some light on what he believes to be the rationale behind the design. "I think they're maybe looking to project more of an upscale feel," he says. "They focused on this idea of mobility and movement, I think, looking to the future, and the logo was a handy way to signal that change that they were looking for."
And Bowie even suggests the confusion might not be all bad. "I think the fact that 30,000 people a month are Googling "KN Car" because they don't seem to be able to read the logo might sound initially like a bad thing. But I think it shows that people are curious, like, 'Hey, what's that cool car I saw?' In my opinion, that's better than people ignoring your product altogether."
The old logo (left) vs the new design (right) (Image credit: Kia/Future owns)
Still, there's no denying that the design has got designers talking – and even coming up with hilariously ingenious solutions to the problem. And Kia can take some solace from the fact that it isn't the only car manufacturer to have caused road rage recently. The subtly rebranded Audi logo recently upset traditionalists, and the less said about Volkswagen Italy's Instagram bio, the better. But when it's time for the next rebrand, Kia's designers might want to check out our guide on how to design a logo.
The latest Aston Martin logo makes perfect sense
TikTok still can't get over that terrible Hershey's logo redesign
New Apple logo revives iconic colours for major store launch
Daniel Piper
Senior News Editor
Daniel Piper is Creative Bloq's Senior News Editor. As the brand's Apple authority, he covers all things Mac, iPhone, iPad and the rest. He also reports on the worlds of design, branding and tech. Daniel joined Future in 2020 (an eventful year, to say the least) after working in copywriting and digital marketing with brands including ITV, NBC, Channel 4 and more. Outside of Future, Daniel is a global poetry slam champion and has performed at festivals including Latitude, Bestival and more. He is the author of Arbitrary and Unnecessary: The Selected Works of Daniel Piper (Selected by Daniel Piper).
This optical illusion is doubly confusing


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Gigi Hadid and Zayn Malik are Reportedly Back Together After Spending Weekend Together in NYC
They were even matching!
By Carolyn Twersky Jan 13, 2020
Gotham// Getty Images
Gigi Hadid and Zayn have been on-and-off for years, but they most recently broke up last January.
Lately, there have been hints that the pair is back together.
Over the weekend, they were spotted together twice, adding more fuel to the reconciliation rumors.
Zigi stans are starting the year off right, because after months of speculation, it seems like exes Gigi Hadid and Zayn Malik may be back together after a year apart.
The pair was spotted not once, but twice this weekend in NYC. On Saturday night, Zayn joined Gigi and the rest of the Hadids for dinner celebrating Yolanda Hadid's 56th birthday. The pair almost patched in their pale green looks as they walked arm in arm.
But the fun didn't end there. The next night, the pair was spotted out again in the city, this time opting for darker looks. Considering yesterday was Zayn's 27th birthday, they were probably out celebrating the occasion.
According to E!, Gigi and Zayn are, indeed, back together, and they have been since the holidays. "Zayn has been reaching out to Gigi for the last month and she is giving him another chance," a source said.
"She has always loved him and the break between the two was needed," the source continued. "Zayn has been working on his past music and focusing on his health and is in a really good place currently."
Apparently, both Gigi's sister and mom are very happy about the reconciliation. "Everyone is happy for them and Yolanda and Bella have always loved Zayn," the source said. "They all have always treated him like part of the family."
This reunion comes after weeks of speculation that the pair may have gotten back together. Back in November, there were rumors that the exes were talking again following Gigi's breakup with Tyler Cameron. Then, in December, Gigi shared some pics of her cooking on her Instagram story, tagging Zayn's mom in the post. Zayn's mom then shared a video of Gigi where the model admits that her favorite restaurant is "her boyfriend's mom's house."
gigihadid// Instagram
Follow Carolyn on Instagram.
Carolyn TwerskyAssociate Editor
Carolyn Twersky is an associate editor for Seventeen covering celebrities, entertainment, politics, trends, and health. On her off time, she's probably watching Ru Paul's Drag Race, traversing NYC for the best donuts, or, most likely, enjoying time in her favorite place in the world: her bed.


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history of Marxism
John on KYMS: It's About Power and Control
Before giving an update on the martyred church, John and Lee discuss the border crisis and the real reason behind the Biden administration's strategy there, the history of Marxism and the lead-up to critical race theory, and the media's continued false narrative about January 6. Whatever the 'for public consumption' narrative is, the reality is almost assuredly about power and control.
John Loeffler as Guest: Learning from History
Broadcast Running Time: 1:23:43
Recently, John was a guest on an Australian show called 'Discernible with Matt Wong' and on today's extended podcast, we play that interview. John covers a variety of topics including speech in a race-focused society, the history of Marxism, the hijacking of racial issues that has led to cancel culture, the detailed steps involved in creating a socialist society and why it has never worked, and the persecution of Christians. John also answers the question of why, when things look so bleak, he continues to fight the good fight against those who would destroy our freedoms.


Del Rio, Texas - Eagle Pass Border Patrol agents made two drug seizures totaling more than 170 pounds of marijuana, with an estimated street value of approximately $137,000.
Thursday evening Border Patrol agents encountered three subjects as they were walking from the Rio Grande River toward an area south of Eagle Pass. Two of the three subjects were carrying large green military-style duffle bags on their backs. When the subjects were confronted by the agents, they dropped the bags and ran back across the river into Mexico. Agents recovered two bags containing more than 132 pounds of marijuana with an estimated value of approximately $105,000. The narcotics were turned over to Immigration and Customs Enforcement.
About an hour later, an agent patrolling in Eagle Pass observed two subjects on the corner of First Street and Madison carrying backpacks. When the subjects saw the agent, they began running toward the Rio Grande River utilizing a cement spillway inside of the Eagle Pass Water Treatment Plant. The agent pursued the subjects on foot while other agents began to converge on the area. Agents managed to apprehend one of the subjects; however the second subject managed to evade arrest by fleeing across the Rio Grande River. Agents recovered a backpack that contained 40 pounds of marijuana valued at $32,000 and arrested one subject. The subject and marijuana were turned over to the Maverick County Sheriff's Department.


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Calls going straight to Voicenail This has happened more than 10 times while the phone is sitting next to me but the call goes straight to Voicemail. Does anyone else have this problem?... When you're trying to reach someone on a cellphone or landline phone, it can be a pain if the call goes straight to voicemail. Sometimes, you may simply want to send a voice message without having a conversation. In that case, it is useful to know how to call someone and go straight to voicemail or use another method to send a voice message.
Recently switched to Plusnet but experiencing a service issue. My callers are reporting that most calls are ringing 1/2 rings then going to Plusnet VM.
The most direct and simplest way to make your call go directly to voicemail is by using an app. We review two apps below: Slydial and WhatCall. While Slydial used to be the market leader, it's since been flooded with poor reviews due to the service not working. WhatCall, however, still consistently performs well – and the reviews reflect that.
When you're trying to reach someone on a cellphone or landline phone, it can be a pain if the call goes straight to voicemail. Sometimes, you may simply want to send a voice message without having a conversation. In that case, it is useful to know how to call someone and go straight to voicemail or use another method to send a voice message.