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Context: Inappropriate pain documentation is likely to be an important contributor to the poor management of pain in elderly patients in the emergency department (ED). Failure to assess pain limits ability to treat pain. Objectives: The objectives of this study were to examine the relationship between visit characteristics of elderly patients and pain score documentation in the ED, and to determine predictors of analgesic use in the ED. Methods: This was a cross-sectional analysis of documented ED visits by elderly patients from the National Hospital Ambulatory Medical Care Survey (2003-2006). The study included 5661 ED visits by patients aged 65 years and older, representing an estimated 18 million ED visits during the four-year study period. Univariate logistic regression was used to analyze associations among independent variables and documentation of pain. Multivariate logistic regression was used to determine whether nonopioid and opioid analgesic prescribing disparities existed and were associated with pain level. Results: Pain score documentation was found to be suboptimal in the elderly population in this study, with only 75% of visits having documented pain scores. Older age, self-pay, patients residing in the Western region of the United States, and emergent ED visits were associated with decreased pain score documentation. Documentation of pain score was associated with increased odds of an analgesic prescription and opioid analgesic prescription. Odds of prescribing an opioid increased significantly with increasing level of pain severity. Conclusion: ED pain score documentation is suboptimal in the elderly population. Disparity in the use of analgesic prescriptions and opioid analgesics exists and may result in patients not receiving analgesics. Improving pain assessment and documentation, changes in attitude toward analgesic prescribing, and recognition of ethnic, racial, and age differences in patients with pain have the potential to contribute to effective management of pain in the ED. © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

As brick-and-mortar commerce continues to shift online — whether that’s to competitors like Amazon, through online ordering systems or into instant delivery apps — traditional retailers are looking for new ways to accommodate a customer base that now wants the increased convenience that comes with not having to park their cars, then wander around the store, cart in hand. Case in point: Today CVS announced an investment in Palo Alto-based shopping startup Curbside, along with plans to further roll out to CVS’s 9,600 retail pharmacy locations curbside pickups powered by the service. Details of the investment were not disclosed, but it’s being described by the companies as a strategic partnership that will allow the two to work more closely together on expansions of the technology to other areas of CVS’s business, including its pharmacies and MinuteClinics. CVS is also introducing its new curbside pickup option as a branded experience called “CVS Express,” which will be accessible within its own CVS mobile application. This is currently available in 350 locations in San Francisco, Charlotte, NC, and Atlanta, GA, allowing customers to select from close to 10,000 SKUs — or about three-quarters of CVS’s inventory, save for some locally distributed items. The investment and launch of CVS Express follows what were before pilot tests with the startup in the San Francisco Bay Area, beginning last summer. In October, CVS decided to launch a co-branded experience with Curbside. And based on those trials, CVS opted to deepen its relationship with the startup. While the retailer isn’t talking about how many of its customers have used the service to date, or what impact it has had on sales, it does see the promise and potential in the convenience mobile ordering and store pickup provides. To use the service — which is also available from Curbside’s own mobile application — customers can place items in their basket while shopping from their smartphone, then head over to their local retail location where the order is ready for pickup within an hour. There’s no additional fee for using this option, which benefits a range of customers, from busy professionals to moms with babies or small kids they don’t want to have to wrangle in the stores or even the mobility-impaired. Orders are sent to CVS staff inside the stores when placed through Curbside’s mobile software running on a company-owned mobile device, and store employees then pick the items and fill customers’ bags. When they’ve finished, they mark the order as ready in the app, which alerts the user. And when the customer arrives, Curbside’s geo-location technology again alerts the staff who will bring the order out to the car. Today, many of the top sellers are things like diapers and other baby items, or everyday necessities like milk. CVS says it hasn’t had to increase headcount to accommodate mobile orders at this time — it’s just repurposing existing store staff. In addition, what impressed CVS the most and encouraged its investment was that it saw customers returning to use this pickup service multiple times. “The thing that got us so excited about our initial pilots over the last summer — and that has continued — is that we see that over two-thirds of our customers who try it actually repeat usage of it in a very short period of time,” says Brian Tilzer, Chief Digital Officer at CVS Health. “Customers like it a lot.” Though CVS won’t talk about its repeat usage numbers, the Curbside app itself has seen repeat usage of 55 percent among a largely female customer base (65 percent). This is to some extent influenced by its work with retailers like Target. Curbside today has relationships with other retailers, including Target (100 locations), Sephora, and Levi’s, and some Bay Area malls — in total reaching more than 500 stores across the U.S. However, CVS is the first to integrate Curbside’s software into its own mobile application. This integration was made possible through help from CVS’s digital innovation lab in Boston, which allowed them to bring the technology to market in a matter of months. For a traditional retailer, being able to adjust to the changes in the e-commerce landscape is a must, Tilzer explains. “Moving at digital speed and innovating sort of like Silicon Valley companies innovate is a critical priority of ours at CVS,” he says. “The technology capabilities and the expertise that [Curbside CEO Jaron Waldman] and his team have are going to allow us to invent things that don’t exist in the name of a better pharmacy and healthcare experience.” “The investment aligns our interests on this and allows us to collaborate more deeply,” he adds. Curbside generates revenue through a SaaS model — meaning CVS pays a metered rate based on transaction volume when orders come in through the CVS app. Meanwhile, Curbside app orders work on more of an affiliate model. To date, Curbside had raised $34.5 million prior to the CVS investment. The CVS Express branded experience is now live in select markets, with further rollout planned for this year.

News Article | March 8, 2016
Site: www.fastcompany.com

Three weeks ago the Metropolitan Museum of Art—known colloquially and now formally as "the Met"—unveiled a new logo and identity system designed by the international firm Wolff Olins. The response from critics was swift and fierce. Influential typographer Erik Spiekermann harped on the logo's proportions and "forced curvy shapes"; New York Times critic Michael Kimmelman accused the museum of pandering to younger audiences; and Justin Davidson, of New York magazine, compared it to a typographic bus crash. Ouch. It’s a familiar scenario with logo and identity reveals—the images get passed around the Internet, critics weigh in, and the peanut gallery follows. Such was the case with Google, Airbnb, Hillary Clinton's campaign logo, the Olympics, and the rebrand that (arguably) sparked incendiary "logogate" culture: Gap. Designers and clients are understandably spooked. In private, some designers speak of clients who refuse daring work. In public, they gently rue the armchair critiques that undermine months, sometimes years, of work. Others are more forthright. "I think the Internet and the press should shut up and allow the identities to find their audiences," says Paula Scher, a partner at Pentagram and the mind behind Shake Shack's branding among many others. "They will ultimately determine the success and failure." Maybe so. But the Internet isn't going to shut up any time soon. Here's how the industry has adapted with the times—and how identity design itself has changed. "We can rail against [logo bashing] if we want, but it won’t get us anywhere because it’s not going to stop," says Howard Belk, co-CEO and chief creative officer at Siegel+Gale, the New York firm whose clients include HP, CVS Health, and Monster. "What it shows is enormous passion about logos. A fair amount of the hue and cry is coming from the design community, but a lot comes from customers and consumers." In the past, logos only had to look good in print. Today, brands exist on dozens of platforms, many of which are very small, like smartphones. This logistical challenge has limited what designers can do. Sixty years ago, the Met probably only needed to emblazon its logo on signs, admission buttons, and printed ephemera. Today, its logo is on mobile apps, the favicon on desktop web-browsing tabs, Twitter avatars, and elsewhere. Efficiency matters more than flourish, adaptability more than cleverness. One has to wonder if the FedEx logo, with its sly arrow hidden in the word mark, would be invented nowadays, at a time when logos have to be legible on screens as small as a watch face. So branding agencies have adapted. "We're still holding up the logo as the ace of a rebrand or restructure," says Jim Bull, cofounder and chief creative officer of Moving Brands, a global creative company that counts Sony, Google, and Netflix, among others, as clients. "It is important, but there's so much more—the color, the system, the tone of voice—and then we're getting into the product." Take the Met's identity. It's conceived as infrastructure that offers the institution a way to build and grow—a set of building blocks that can evolve along with the museum’s new experience-design initiatives. "In an increasingly digital world, one in which the Met wants to go out to the world as much as it brings people in, the visual system needed to be much more robust and less reliant on just a symbol alone to carry the personality and the experience that the museum wants to create," Amy Lee, a strategy director at Wolff Olins, says. Susan Sellers, head of design at the Met, says of the museum's rebranding, put it this way: "It’s not an easy story to tell at this point, and frankly the logo does not tell the story." The conundrum plagues designers all over the industry. As Pentagram partner Michael Bierut wrote in a recent essay for Design Observer, "How do you design for potential meaning? How do you convince a client to view a new identity not as a purchase, but as an investment?" (He went on to defend the Met's logo saying, "If this thing was 45 years old, it would be the most beloved logo in New York.") Some designers go too far trying to create practical identity systems. "I worry about a generation of designers that believe in formulas," Moving Brands's Bull says. "That's why everything looks the same and there's no difference between most brands." That might be a bit of an overstatement, but certainly there are industries that suffer from what Bull calls "sheepism." In a recent talk for Designers + Geeks, he pointed out that the home pages for Internet of Things companies—August and Nest—look very similar. The same for food-delivery apps Munchery, Sprig, Caviar, and SpoonRocket. "Over the last decade, there's been a rise in the need for proof of effectiveness and data points to judge if a thing is effective or not," Bull says. "It inhibits some design firms from thinking about whether something's actually good." Siegel+Gale's Belk noticed a more, shall we say, spirited audience for new logos six or seven years ago. Since then, the company has incorporated preemptive measures into its identity launch plans. "The first task is to sensitize clients to the fact that this could happen," he says. "The higher the profile, the more global, the more connected, the more established [the client], the more likely it is to happen. Logos are a lightning rod for attention. When I look at stumbles, a common thread is it appears that the agency and client did not appreciate the power of their logo and the passion people have and the strength of familiarity bias. People don’t like change even when it’s good for them, no matter what." Some companies try too hard to control a new visual identity's launch and come off as heavy-handed. Take Uber, which timed the release of its new branding with a piece in Wired that detailed CEO Travis Kalanick's involvement in the redesign in excruciating detail. The logo was widely mocked (so was the article). "As a company that needs to be seen as trustworthy and reliable, to choose this moment to walk away from a logo people knew, recognized, and remembered was questionable," Belk says. "They tried to focus on the internal aspects of the story. The CEO was hip-deep into the logo design. It was inside baseball rather than what it represents for customers." Moving Brands oftentimes takes an entirely different approach. The firm says nothing about a launch, conducts zero PR, and doesn't attach its name to a project or add it to its portfolio. "Saying nothing on social, launch softly, don't comment, eventually everything goes away," Bull says. "Where you get into trouble is when you get too self-important. It's putting a big target up. The glorified days of launching a brand are less and less." Of course, the true test of an identity begins after the news cycle dies down. For the most part, the design systems work, the world keeps revolving, and no one gets hurt. Riders keep ordering Ubers; vacationers still book rentals on Airbnb; Hillary is still in the race. If anything, all the fuss does is cause graphic-design fatigue. Ironically, it may also persuade the design industry to fight for its best ideas. Thirty years ago, you could get away with pretty much anything. Today, not so. It stands to reason, then, that the more we argue and critique and throw daggers, the better it is for the industry as a whole. "Implicit with criticism is that standards are higher," Belk says. "That demand will elevate the craft. If you want to win votes from a knowledgeable cohort, your standards will get better. This is good—even if it does pose some challenges." All images except Gap: via Wolff Olins

News Article
Site: news.yahoo.com

The New York Stock Exchange is seen in the background of this Wall Street sign 16 August 2007 in New York. The Dow Industrials closed in the positive numbers after dropping almost 340 points earlier in the day on concerns from investors on the bads news of credit and mortgages. (AFP Photo/Timothy A. Clary) More New York (AFP) - Wall Street stocks finished a banner October on a down note Friday, as shares of Canadian pharmaceutical company Valeant plunged again. The Dow Jones Industrial Average ended at 17,663.54, down 92.26 points (0.52 percent) for the day, but up 8.5 percent for October. The broad-based S&P 500 dropped 10.05 (0.48 percent) to 2,079.36, while the tech-rich Nasdaq Composite Index fell 20.53 (0.40 percent) to 5,053.75 Peter Cardillo, chief market economist at Rockwell Global Capital, said US stocks were "consolidating" after the October equity surge and ahead of the monthly jobs report and other key data next week. Valeant Pharmaceuticals International slumped 15.9 percent as it announced it was severing ties with mail-order pharmacy Philidor RX, which has been criticized for predatory pricing of drugs. Dow members ExxonMobil and Chevron rose by 0.6 percent and 1.1 percent respectively after reporting earnings that were much lower than a year ago, but still better than expectations. Both companies said they were cutting capital spending due to lower oil prices. Baidu, China's answer to Google, surged 10.9 percent despite a slump in profit as earnings per share came in 12 percent over expectations and the company said it expects a new travel services partnership to help drive future revenue. CVS Health fell 4.8 percent on disappointment over the pharmacy chain's 2016 outlook. Credit Suisse said the projections for 10-14 percent earnings-per-share growth suggests "momentum has slowed." Drugmaker AbbVie bolted 10.1 percent higher as third-quarter net income more than doubled to $1.2 billion due to strong sales of the arthritis medicine Humira and other drugs. Online travel site Expedia jumped 7.3 percent as third-quarter net income rose 7.6 percent to $283.2 million behind higher booking and advertising revenues. Online professional networking site LinkedIn surged 11.0 percent on a 37.2 percent rise in third-quarter revenues to $779.6 million. Bond prices rose. The yield on the 10-year US Treasury fell to 2.14 percent from 2.18 percent Thursday, while the 30-year dropped to 2.93 percent from 2.96 percent. Bond prices and yields move inversely.

News Article | March 21, 2016
Site: www.fastcompany.com

We’ve reported that it’s a great time to be looking for a job. Unemployment is low, many companies anticipate adding more staff this year, and over 100 occupations have more openings than actual hires month-over-month. For those looking to switch jobs, it’s hard to deny the lure of a big name company. This is especially true in the tech sector, where company names can be synonymous with big innovation: Facebook, Amazon, Apple, Google, and the like. But it’s also the case at other businesses where the focus on developing world-changing products and services can be just as laser-like. With that in mind, we scoured Fast Company's current list of 2016‘s Most Innovative Companies to bring you the inside scoop on what it takes to snag a job at five of the top employers. Growing from a dorm experiment in 2004 to the platform actively used by more than a billion people every day, Facebook landed in the No. 2 spot by virtue of the fact that it's never let size stand in the way of acting like a startup. Even as its umbrella has widened to include the spun off Messenger (800 million users), acquired Instagram (400 million users), and WhatsApp and Oculus VR. This year virtual reality headset Oculus Rift is due to ship to consumers, broadening Facebook’s realm further into computer interfaces. Not surprisingly, Facebook touts itself as a place for new recruits to "do the most meaningful work of their career." Given its reach, that’s not hyperbole. According to the company, staff work in small, nimble teams and it values the authenticity and diversity of its 13,000+ global workforce. In addition to telling Fast Company that engineers should "be prepared to write code on a whiteboard during your interview," Facebook’s global head of recruiting recently shared a favorite interview question with Business Insider "On your very best day at work—the day you come home and think you have the best job in the world—what did you do that day?" Not every interviewee should expect to get that question, but Kalinowski advised candidates to be ready to explain what they do when they lose track of time during the work day. This, she says, is a good indicator of what they truly enjoy and are good at. CVS Health came in at No. 3 (right behind Facebook) on Fast Company’s Most Innovative Company list this year. That’s because in addition to operating over 7,800 pharmacies, the company has expanded to developing new products in its Digital Innovation Lab. Among them: an Apple Watch-compatible mobile app, and a new feature that lets users scan paper prescriptions and insurance cards to fill medications remotely and set reminders to take medications. It also has partnered with IBM to use Watson's artificial intelligence system to predict which customers need interventions to avoid health crises. Alphabet is the newly created holding company that’s home to Google and all of its web-based properties, as well as other ventures such as driverless cars. Google cofounders Larry Page and Sergey Brin created Alphabet and Page serves as CEO while Eric Schmidt serves as executive chairman. What’s notable at the No. 8 ranked Most Innovative Company is its expansive vision for the future, even as Google enters its third decade. We’ve covered Google’s recruiting process before, most recently revealing how one software engineer was recruited through a secret coding challenge. Three million candidates applied for a few coveted positions at the company between 2013 and 2014. Those that didn’t make the cut were often culled when recruiters reviewed their resumes riddled with oversharing, objective statements, and a too-template-like approach. Laszlo Bock, Google's head of people operations, tells Fast Company that Alphabet is looking for some very specific traits. "Four things: general cognitive ability... Not just raw (intelligence) but the ability to absorb information; emergent leadership: the idea there being that when you see a problem, you step in and try to address it. Then you step out when you're no longer needed. That willingness to give up power is really important; cultural fit—we call it 'Googleyness'—but it boils down to intellectual humility. You don't have to be warm or fuzzy. You just have to be somebody who, when the facts show you're wrong, can say that; expertise in the job we're gonna hire you for." An addictive exercise class that began in a single studio in 2006, SoulCycle now attracts a "cultish following of spinners" across the country. As the company prepares for an IPO, SoulCycle's team continues to launch new locations with a signature approach to connecting with locals to build communities. The company is also looking to bring SoulCycle into spinners' homes, riding against its competitor Peloton. SoulCycle’s company mantra "bring soul to the people" is reflected on its career page which states: "SoulCycle isn’t just in the business of changing bodies; we’re in the business of changing lives." As such, CEO Melanie Whelan tells Fast Company, "We look for people who are passionate about the brand, and about helping people. And naturally positive people." Now in its fifth year, Snapchat’s becoming known for more than just its fast-disappearing messages. Over 100 million daily active users view over 7 billion videos every day. Now music combines with Live Stories to bring viewers glimpses of Coachella, the iHeartRadio Music Festival, and 2015 MTV Video Music Awards among others. BuzzFeed, National Geographic, Comedy Central and others have signed on to bring short form content to the millions of millennials who are more attached to their mobiles than ever. The exponential growth has Snapchat’s ranks swelling. Currently, dozens of jobs are listed from tech to HR, finance, operations, and legal. A video on its site highlights the company's culture which some of the staff described as fun and crazy, in part because Snapchat’s home base in Venice Beach, California, while far from Silicon Valley, is equally informal. The video frequently makes mention of coworkers being like family, and indeed Snapchat’s job descriptions emphasize collaboration and ability to work well with others, which extends beyond engineering to roles in other departments such as finance. You wouldn’t necessarily put entrepreneurial skills down for a job in payroll, for example, but it’s important to team Snapchat. As one job description puts it:

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