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To Prevent Deadly Infections, F.D.A. Approves the First Disposable ‘Scope’

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Following a series of deadly outbreaks in hospitals around the country, the Food and Drug Administration on Friday approved the first fully disposable version of the medical device implicated in the infections.

Reusable versions of the device — a long, snakelike tube with a fiber-optic camera at one end, called a duodenoscope — are inserted in one patient after another to diagnose and treat diseases of the pancreas and bile duct, like tumors and gallstones.

Duodenoscopes are used in 700,000 medical procedures each year. Yet tests showed that the devices could not be properly decontaminated between procedures because they cannot be sterilized by the usual methods.

After the outbreaks caused by duodenoscopes came to light, the F.D.A. had urged hospitals to use models with disposable parts and had called on manufacturers to produce fully disposable models.

The new device, called Exalt and made by Boston Scientific, is designed to be used only once before being discarded or recycled. The device should eliminate “the risk of potential infection due to ineffective reprocessing,” the arduous cleaning process, said Dr. Jeff Shuren, head of the F.D.A.’s Center for Devices and Radiological Health.

The disposable duodenoscope was designated a “breakthrough” device, indicating it provides for more effective treatment or diagnosis of life-threatening conditions. Its review at the F.D.A. was expedited in order to get it to market as soon as possible.

Since 2012, contaminated duodenoscopes have been implicated in dozens of infectious outbreaks affecting hundreds of hospital patients in the United States and Europe. Many were infected with bacteria resistant to powerful antibiotics.

More than 30 patients in Seattle with infected with resistant bacteria following duodenoscope procedures between 2012 and 2014. Eleven of them died. In 2015, two patients in Los Angeles died and five were sickened by contaminated duodenoscopes.

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The devices are used to perform a procedure, called endoscopic retrograde cholangiopancreatography, needed to diagnose and treat diseases of the pancreas, bile duct and gallbladder, such as life threatening jaundice, tumors, blocked bile ducts and stones.

The long tube, with a camera at the tip, is inserted through the patient’s mouth and stomach, and then into the first part of the small intestine, called the duodenum.

Many different reusable scopes are used in medicine, but duodenoscopes — which have a movable mechanism at the tip — are particularly difficult to clean. Though they are disinfected with chemicals, they have tiny nooks where bodily fluids and bacteria can lodge.

Cleaning, also called reprocessing, between patients involves nearly 100 steps, including both hand-scrubbing the device and inspecting it visually to check for biological debris clinging to the scopes.

Recent tests performed by manufacturers at the F.D.A.’s request found that even after the proper cleaning procedures were followed, one in 20 duodenoscopes retained disease-causing microbes like E. coli.

Whether the new disposable duodenoscope will be widely adopted remains to be seen. The Exalt is expected to carry a price tag of approximately $3,000, and insurance coverage is still uncertain.

Health care systems already have a full inventory of durable, reusable duodenoscopes, which cost between $35,000 and $45,000. Some of the durable devices already have disposable parts.

The disposable models will also have an environmental impact, creating a new stream of medical waste if they cannot be recycled. A spokesman for Boston Scientific said the company planned to offer a recycling program and was “currently finalizing plans with a medical waste recycle company to facilitate this process.”

Art Butcher, senior vice president of Boston Scientific Corp., said the new device would represent a “unique solution to a complex problem.”

Six experts who used the disposable scope in a clinical trial of 60 patients gave it satisfactory scores. Ninety percent said the disposable scope was as good as the reusable scope, and 2 percent said it was preferable. Eight percent said it was inferior to the reusable scope.



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6 essential marketing trends for 2020 | Smart Insights

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Examples of digital marketing tools and techniques to give you an edge in the year ahead

Well, we’ve nearly made it! For years I’ve been looking to the future, predicting how innovations in digital media, platforms and technology will shape marketing in 2020. The cutting edge examples certainly show the exciting opportunities available – there is almost too much choice…

In this article, I’ll explore six key marketing trends based on examples and research on the adoption of the latest marketing techniques and technology marketers can use.

For recommendations on tapping into the innovations in different digital marketing channels, including email, social media and search engine marketing, see all the other posts from the Smart Insights team covering channel-specific digital marketing trends for 2020.

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In 2020, we can see the huge impact that digital marketing has had over the last decade, and more. Looking at advertising alone, these eMarketer predictions show how the duopoly of Facebook and Google dominate paid media investments online, although offline media buys remain important for many larger brands.alfred

Trend 1. Lifecycle marketing

Although it’s often said that the ‘funnel is dead’ since consumer follows non-linear journeys, regardless of the product or service you’re involved with marketing, it will always be the case that to grow a business, your primary focus is growing awareness, closely followed by increasing customer leads and prospects.

This focus is shown by the latest Altimeter / Prophet State of Digital Marketing report, which shows a primary focus on increasing awareness.

The role of digital in creating a unified customer experience is also high in the response, but it’s shocking that digital marketing isn’t seen as a driver of boosting revenue from existing customers. It’s an artefact of the question since digital marketing is effective in achieving all of these goals, including customer retention.

A more practical way to plan to integrate online marketing into marketing activities is to consider communications from a customer point-of-view through the customer journey. I call this always-on lifecycle marketing and recommend you review your use of online AND offline media across the customer lifecycle.

An example of an audit is shown by this example of the use of marketing activities by a B2B company, which although strong at the top-of-funnel in terms of activities used, is less strong in the middle and bottom-of-funnel nurture and re-targeting activities. Many businesses are adopting marketing automation and account-based marketing technology to implement these touchpoints. See the article linked to above for all of the potential activities that can be audited.

Trend 2. Conversational marketing

For me, this is the most exciting trend in marketing today, bringing together rapid consumer adoption of smart speakers and innovation in search query processing, conversational interfaces and messaging.

Conversational marketing was highlighted as a key innovation in the latest Gartner hype cycle alongside Artificial Intelligence, which often fuels it.  You can see that of the technologies on the Innovation Trigger slope, many aren’t expected to become mainstream for 5 to 10 years. Of those forecast to hit the mainstream within the next 2 to 5 years, the three most significant for marketers to consider are personification, real-time and conversational marketing.

Gartner explains:

Conversational marketing technologies enable interactions between companies and customers that mimic human dialogue and do so at scale. This category is near the Peak of Inflated Expectations phase”.

Personally, I think the hype about smart speakers to support the purchase journey is just that. While some products lend themselves to purchase, where a choice is to be made amongst complex products, they just won’t cut it until we have truly intelligent comparison bots. However, the research suggests I may be wrong. A study of 2,000 British adults commissioned by Artefact UK, an AI and data-driven agency, reveals that:

“Six out of ten smart speaker owners (60%) have used them to make a purchase in the past year. In fact, nearly a quarter (22%) said they have done so within the past week”.

I believe that building in more relevant to web, email and mobile-based conversations can have a bigger impact by boosting relevance and speaking in a more personal tone. Persado is an interesting tech here.

Persado uses a copy impact classification applied to existing copy, which is used to tailor copy and calls-to-action on an individual basis.

For example, using Persado Natural Language Generation to run an experiment, Air Canada sparked a higher response using Anxiety language getting a 3% engagement lift, compared to a 5% drop using Exclusivity language, and a 3% drop using Safety language.

Another example of  AI application is nutrition and wellness retailer Holland & Barrett using AI to provide better-targeted emails. This Machine Learning approach from Tinyclues goes beyond optimizing copy using a tool like Persado, instead, it also involves targeting based on the behaviour of individuals to create more micro-targeted campaigns.

Speaking at a session I chaired at the Email Innovation Summit, Richard Lallo, Head of Digital Marketing, described what he calls ‘strategic promotions and mono-product pushes’ in a campaign. The business was able to drive campaign revenue and increase re-purchase rate while sending emails. Campaign revenue increased by 27%, open rates increased by 19%, while email send volume decreased by 23%, which also gives cost savings.

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Trend 3. Insights-driven marketing

At Smart Insights we’re huge fans of using analytics and insight to drive business performance and optimize the results from digital marketing. It’s why we’re called what we are.

Improving their data-driven marketing is an aim of many businesses indicated by the most desired skill amongst digital marketers revealed by the Altimeter/Prophet State of Digital Marketing report.

Data-driven marketing

Businesses using this approach are trying to gain the benefits reported by Mckinsey research that suggested that:

Intensive users of customer analytics are 23 times more likely to clearly outperform their competitors in terms of new customer acquisition than non-intensive users, and nine times more likely to surpass them in customer loyalty.

In addition to advances in customer analytics supported by CDPs described in the next section, new Voice of the Customer (VoC) techniques, such as online-hosted customer communities, can improve customer preferences for future products and how they are delivered.

For example, Red Bull used insight platform Vision Critical to launch a community of consumers passionate about the energy drink category. By providing a deeper understanding of consumer preferences, the community challenges widely-held assumptions. The company, for instance, learned who consumes Red Bull drinks — and how and when they buy — were changing. Data from the community provides insight on the competitive landscape, revealing channels the company can enhance to improve growth. The community also helps Red Bull deliver more value to retailers.

Trend 4. Marketing technology

Today, Marketing Technology (Martech for short) presents a bewildering choice of software services for businesses looking to improve their management of digital media, experiences and supporting data. If your business and your agencies adopt the right blend of Martech, it can help give you an edge against competitors, but if not, you may be missing out on the insights and automation processes they are using.

The latest 2019 Martech supergraphic from Scott Brinker, a specialist who hosts Martech conferences and has advised on technology for HubSpot, has created this somewhat scary map of all the potential categories and services that companies can use.

To highlight the range of great services available and to simplify the options a little, we designed this essential digital marketing tools infographic to recommend the categories of tools you should consider across the Smart Insights RACE Planning system and highlight the most popular, most capable tools.

We will create the annual update for this in early 2020, discussing it recently on LinkedIn has highlighted some of the latest trends that aren’t evident from this version of the wheel. Raviv Turner, Co-Founder, of B2B service @CaliberMind said:

“No MarTech stack is complete these days without the third leg of CRM, MAP & CDP. The only way to map, store, analyze and act on the complete end-to-end customer journey is having all the data in one place using a Customer Data Platform (CDPs).”

I’m not sure ‘the only-way’ is accurate, but that is the sentiment.

Kristen Obaid, Always On digital marketing campaigns manager for an international Education company, added:

“The Salesforce and Adobe MAPs are underrepresented here (eg Pardot can be used for email, social, CRM, CMS, audience management, analytics. Krux is now SF. They can both be used as DMPs if the data is configured properly.) BI with simple data integrations (like Domo, Tableau) are also missing, plus Intercom for service CMS eg FAQs, and Drift for automated service chat”.

Trend 5. Consumer Privacy and KYC

Repeated privacy faux-pas by Facebook, Google and security breaches at other brands leading to the release of customer details have highlighted to consumers that their data isn’t as safe with online brands as they may have once thought. Privacy regulations like GDPR have been enacted to improve data privacy with increased fines.

Record fines have arisen in 2019 from the maximum penalty for contraventions increasing under GDPR to up to €20m (£17.5m) or four percent of global turnover – whichever is the greater.

British Airways, was issued with a proposed fine of £183m for a breach of customer data and a £99 million fine on hotel chain Marriott for failing to protect personal data contained in approximately 339 million guest records.

While these may be more the concerns of the CIO or CFO rather than the CMO, it shows the need for marketers to work with colleagues to mitigate the potential impact of security breaches and reassure customers.

At the same time, we have seen a decreasing effectiveness of traditional identification methods such as cookies for tracking, which makes media ROI determination – supposedly one of the key benefits of digital channels – more difficult.

Emerging technologies can potentially help with both of these challenges.

New Identify Management or Know Your Customer solutions are being developed that can both improve security, reduce fraud and improve insight about customers across multiple devices.

For example, UK startup Hooyu blends traditional methods of customer verification such as database checks (where available) with ID document validation, digital footprint analysis, geo-location and facial biometrics. While this is most relevant for banks and other gambling applications, it indicates the range of data points that are now available.

With these consumer concerns and new legislation such as the EU ePrivacy legislation about to be launched and the inaccuracy of tracking online with increasing restrictions built into browser like Chrome and Safari it seems like the days of the cookie (and particularly third-party cookies) and digital fingerprinting may be numbered. This means that businesses should be considering other alternatives if they aren’t already.

Discussing Unified ID – Why Identity becomes a key success factor in the post-cookie era era – Alwin Viereck, Head of Programmatic Advertising and Ad Management, United Internet Media estimates that

More than 20% of all cookies in a desktop environment do not live longer than a day and a further 15–20% do not survive a month. For vendors in a third party context (which are typically all participants of the programmatic ecosystem), the problem might even be worse.

Multiplatform consent solutions like Sourcepoint and Identity and Access Management integration solutions like Auth0 and OneIdentity will be adopted more widely. Within AdTech new solutions will have to be found in response to Google and Apples Ad-targeting limitations.

Trend 6. Digital transformation and Marketing Transformation

Our managing digital marketing research revealed many challenges in terms of how digital marketing is run in companies today. Problems included a lack of focus on integrated strategy, testing, and optimization and structural issues like teams working in silos or a lack of skills in integrated communications.

To counter these types of problems and to make the most of the opportunities for growing a business through digital marketing, many businesses are now putting a digital transformation programme in place.

Digital Transformation research

The aim of digital transformation is to develop a roadmap to improve digital capabilities and skills, while at the same time, integrating ‘always-on’ digital marketing activities with brand and product marketing in the business.

This chart from the research shows that many businesses are active in transformation to try to achieve this aim through the success factors covered in this briefing.

Despite some talk that we might be in a post-digital world by 2020 and some traditional marketers suggesting that “it’s time to shut down digital marketing for good” the reality is that many specialist digital job roles and are needed to run digital marketing activities as my post ‘10 reasons you still need a digital team‘ shows.

A common practice that we can expect to continue in the future is a move to a hybrid approach to managing digital marketing with digital marketing skills being developed in marketing teams as suggested by this structure.

Digital marketing governance modelHowever, the label of a ‘digital department’ is outmoded, since the creation of large digital teams has caused silos to develop with other marketing and product teams. Instead, we can expect a continued move to a digital/marketing Centre of Excellence model. The DCoE will be smaller ‘digital services units’ that track the latest developments in development, advising on new digital techniques and technologies.

Through the year, we’ve been adding to our tools to help all members assess how well their businesses are adapting to using digital media and technology as part of Digital Transformation. To review your digital readiness, either for integrated digital marketing or individual channels, download our benchmarks or take our interactive capability graders.

All the best for grasping the opportunities from digital marketing in 2020 and beyond! To help you on your way take a look at our benchmarking templates, each of which will give you a quick review for digital marketing governance and the key channels like search, social, email marketing plus analytics, content marketing and experience.

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‘Tokenized’: Within Black Employees’ Struggles at Coinbase

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The following day, Mr. Armstrong, 37, summarized the tone of what he had heard. “There was once simply this outpouring of, like, Why does the corporate now not have my again?” he stated at a personnel assembly, in keeping with a recording of the consultation shared with The New York Occasions. In an organization electronic mail he despatched later, which was once additionally shared with The Occasions, he agreed to redesign the diversity-and-inclusion plan and build up mentoring.

However in September, Mr. Armstrong revealed a public weblog submit telling staff to depart issues for problems like racial justice on the door. He stated that whilst the corporate embraced range, the personnel wanted to concentrate on Coinbase’s venture of benefit and advancing cryptocurrencies. They must renounce if they didn’t agree, he stated.

“We don’t interact right here when problems are unrelated to our core venture,” Mr. Armstrong wrote.

The submit drew instant blowback from staff. “Why keep and put effort into this paintings if it’s simply tokenized into recruiting issues and now not in reality making improvements to the sense of belonging and mental protection,” Lauren Lee, who was once chargeable for range and inclusion, wrote in a Slack message that was once seen via The Occasions.

Ms. Lee, who didn’t reply to requests for remark, resigned closing month. So have a minimum of 60 others.

Mr. Armstrong, a former Airbnb engineer, and Fred Ehrsam, a former Goldman Sachs dealer, based Coinbase 8 years in the past to supply a spot to shop for and promote cryptocurrencies. They constructed the start-up right into a cryptocurrency chief, earning money via taking charges on trades positioned via its consumers. (Mr. Ehrsam left daily operations in 2017.)

These days, Coinbase is using a brand new wave of passion in cryptocurrencies, with the worth of the digital forex Bitcoin coming near a brand new top as buyers more and more deal with it like a substitute for gold.

A lot of Coinbase’s tradition stems from the only round Bitcoin, present and previous staff stated. Bitcoin, which embodies a libertarian philosophy that snubs its nostril on the pieties of mainstream establishments, has attracted a technology of enthusiasts referred to as “crypto bros.” Many have propagated a brash male-dominated way of living, dealing with complaint for sowing racism and sexism.



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Driven through Pandemic, Amazon Is going on a Hiring Spree With out Equivalent

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Over the summer time, Amazon transformed many of the 175,000 brief staff to everlasting workers and ended the additional pay bumps for all staff. Since then, it has persevered with waves of hiring.

The corporate has additionally virtually tripled the choice of U.S. warehouses used for last-mile deliveries this 12 months, stated Marc Wulfraat, founding father of the logistics consulting company MWPVL Global, who tracks Amazon’s operations. The supply drivers are in most cases contractors, so Amazon does no longer expose their numbers in regulatory filings.

“They have got constructed their very own UPS within the final a number of years,” Mr. Wulfraat stated. “This tempo of trade hasn’t ever been observed prior to.”

Ms. Williams stated Amazon additionally constructed relationships with firms that have been decreasing workforce, comparable to Uber, American Airways and Marriott, to advertise its hiring.

“We devoted a gaggle that did not anything however hook up with organizations who have been furloughing other people, whether or not it was once brief or everlasting,” she stated. “That allowed us to take a talented, high quality paintings pressure, and in no time and simply transfer them into alternatives that have been suitable at Amazon.”

The hassle has been aided through 1,000 generation staff who create device for Amazon’s human assets groups, many construction portals and algorithms that automate hiring, she stated. Potential workers can to find jobs, practice and be employed totally on-line, with out chatting with a unmarried particular person.

To develop such a lot, Amazon must also suppose long run, Ms. Williams stated. Consequently, she stated, the corporate was once already running with preschools to ascertain the basis of tech training, in order that “as our hiring call for unfolds over the following 10 years, that pipeline is there and able.”

Michael Corkery contributed reporting from New York.



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