Can nutrition support healthy cognitive ageing

by Amy Jennings .. Senior Postdoctoral Fellow

Around 50 million people worldwide have dementia, the main form of which is Alzheimer’s disease. Dementia is a major cause of disability and dependency in older adults and, owing to expanding and ageing populations, its prevalence is expected to almost triple by 2050. This increase is being partly offset by decreasing age standardised dementia rates in some high income countries, attributed to more years of education and improved cardiovascular health.1 In England and Wales, dementia is the first and second leading cause of death in women and men, respectively, responsible for 16.3% and 8.7% of total mortality in 2017 (www.ons.gov.uk). Almost two thirds of cases of dementia are in women. The cause of this difference between the sexes is poorly understood.2

Interventions to improve cognition and reduce dementia risk
No licensed drugs are available that prevent or reverse dementia. For Alzheimer’s disease four drugs are used to treat symptoms temporarily (donepezil, rivastigmine, galantamine, and memantine). Therefore, behaviour which prevents or delays progression of neuropathology and brain vascular dysfunction could help to reduce the individual risk and population burden of the disease. The 2014 report, “The trajectory of dementia in the UK–making a difference,” estimated that a two or five year delay in the onset of dementia would reduce the number of people with the disease in the UK by 19% and 33%. respectively, by 2050.3 In a US based analysis, Brookmeyer and colleagues predicted that interventions associated with a five year delay would almost halve cases of dementia over 50 years.4

It is estimated that about one third of cases of Alzheimer’s disease worldwide are attributable to modifiable risk factors,5 many of which are nutrition and lifestyle dependent (depression, mid-life obesity, mid-life hypertension, and type 2 diabetes). Cardiometabolic health is a major determinant of age related cognition function and risk of dementia. Research into the role of nutrition in age related cognitive decline is in its relative infancy compared with other chronic conditions, such as cardiovascular diseases, type 2 diabetes mellitus, osteoporosis, and gastrointestinal disorders.

Although the results are not fully consistent,6 a growing body of prospective cohort evidence shows that bioactive components of food are associated with a reduced risk of dementia.78 Much of the research has considered dementia as a composite, despite the recognition that owing to differences in pathology, dementia subtypes (eg, Alzheimer’s disease, vascular dementia, dementia with Lewy bodies) are probably influenced by differing dietary factors. Furthermore, a large retrospective cohort study9 has shown that behaviour, including a healthy diet, partly mitigates the penetrance of a high dementia genetic risk score. Model systems have provided insight into the potential underlying molecular and physiological mechanisms for the associations observed, including improved cardiometabolic health and brain perfusion, and direct effects within the brain on neuronal function, energy metabolism, and β amyloid processing.

The randomised controlled trial evidence is more limited and less convincing,710 with cognition and brain volume (as assessed by MRI) as the main study endpoints, and few primary prevention randomised controlled trials with incident dementia as an outcome measure.

Nutrition and cognition

Some evidence suggests that individual food bioactive components protect cognitive health (for review see Scarmeas et al8), including B vitamins, antioxidant vitamins, selenium, vitamin D, medium chain triglycerides, and long chain omega-3 fatty acids (see supplementary table on bmj.com). This evidence is not conclusive, however. Any effects of intervention with such individual components are most likely to appear after long term exposure, and in those with a low baseline habitual intake. Evidence that nutrition has a beneficial effect on brain function is stronger for healthy dietary patterns, probably because the synergistic effect of several bioactive components affects many physiological processes and signalling pathways underlying cognitive function and decline. Intuitively, one would predict that the effect of nutrition would be more evident in people who are still cognitively healthy or prodromal, rather than in those with diagnosed dementia, where significant neuronal loss has already occurred, but this has not been rigorously tested.

Here we focus on fish/the omega-3 fatty acid docosahexaenoic acids (DHAs), ketogenic interventions, and a plant based dietary pattern (eg, Mediterranean diet) as approaches to nutrition with a strong potential to mitigate age related cognitive decline. The state of advancement of knowledge and inconsistencies in these areas provide insight into the research approaches used and the challenges encountered in confirming nutrition-cognition causal relations, especially during ageing.

Omega-3 fatty acids and improved brain function

Oily fish, which includes salmon, mackerel, herring, fresh tuna, and sardines, are the almost exclusive dietary source of the long chain n-3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid (DHA). Algal oil capsules provide a vegan source of DHA. The brain is highly enriched in DHA, which constitutes 15% of brain lipids compared with less than 5% in most other tissues.11 The role of DHA in the developing fetal and infant brain is widely accepted. In prospective cohort studies, high fish and DHA intake has been consistently associated with improved cognitive health in older age, with a 10-30% reduced risk of Alzheimer’s disease and death, brain atrophy, and cognitive decline, and effect sizes equivalent to two to four years of ageing1213141516; there is some indication of greater effects in women.15 In a meta-analysis of 21 cohort studies, a 100 mg increment of dietary DHA was associated with lower risks of dementia (relative risk 0.86, 95% confidence interval 0.76 to 0.96) and Alzheimer’s disease (0.63, 0.51 to 0.76).14 Fish is also a source of multiple nutrients needed by the brain, including vitamin B12, selenium, and vitamin D, which may contribute to the observed cognitive benefits. Thus, where possible, fish itself rather than fish oil supplements is recommended as a source of DHA.

For a dietary component such as DHA/fish, which could be considered a signature of an overall healthy diet (such as a Mediterranean-style diet discussed below) and healthy behaviour, the possibility of residual confounding should be considered, as some of the cognitive benefits associated with DHA seen in prospective cohorts could be due to a yet unknown factor associated with intake,17 and the benefits associated with eating fish and DHA could be biased.18

A number of randomised controlled trials have reported mixed findings with DHA supplementation over periods of up to three years (see supplementary data). DHA is one of the bioactive ingredients in Souvenaid (Fortasyn Connect) medicinal food, designed to support cognitive ageing. In the LipiDiDiet trial, Souvenaid had no effect on the primary outcome measure, but was associated with an improved clinical dementia rating score and reduced hippocampal (a main brain region affected in Alzheimer’s disease) atrophy.19

Response to DHA interventions is heterogeneous and may partly depend on DHA and cognitive status at baseline. Cognitive benefits are reported for healthy younger adults20 and in mild cognitive impairment,21 in contrast to those with more advanced disease.22 Early indications are that APOE4 carriers (25% of white populations), and particularly older women with the APOE4 variant, may have lower brain DHA uptake and status, and would benefit from higher dose DHA supplementation.22324 For DHA and other dietary components, several variables need to be considered, including delivery to the brain and time taken to reach a steady state, and whether the cognitive benefits are direct effects on brain structure, perfusion, or metabolism, or an indirect effect attributable to, for example, cardiometabolic health. Brain DHA half life is estimated to be 2.5 years,25 and thus supplementation periods of at least a year are probably needed to detect the cognitive benefits associated with DHA enrichment of neuronal cells, and effects on β-amyloid and tau protein metabolism and synaptic plasticity.226

Brain glucose use, ketones, and cognitive health

One of the challenges facing the ageing brain is a chronic deficit in brain glucose uptake. Cognitively healthy older adults have about 7-8% lower brain glucose uptake than younger adults, a decline accentuated in mild cognitive impairment (the prodromal phase of Alzheimer’s disease) and even more so in Alzheimer’s disease itself.27 Although low brain glucose could be a consequence of the disease process, two facets of the declining glucose uptake, brain cell loss, cognitive decline continuum suggest that this interpretation should be reconsidered. Firstly, brain glucose uptake is already lower in those at risk of Alzheimer’s disease (that is, older age but still cognitively normal, carriers of the presenilin mutation or APOE4, or type 2 diabetes) but before their cognition declines.28

Secondly, studies with positron emission tomography imaging and a ketone tracer (11C-acetoacetate) show that, unlike glucose, brain ketone uptake is normal during ageing, mild cognitive impairment, and Alzheimer’s disease.293031 Ketones are the brain’s second most important fuel and, as for glucose, brain ketone uptake is an active, transporter mediated process. Hence, many of the brain cells in which glucose metabolism is deteriorating owing to age or Alzheimer’s disease are not apoptotic (or dead) because they can still metabolise ketones. Rather, they are gradually becoming energy (glucose) starved, but perhaps their function could be revived or maintained by ketones, an emerging therapeutic concept called “brain energy rescue”.32

Under normal circumstances, glucose supplies about 95% of the brain’s fuel. It is, however, effectively replaced by ketones (β-hydroxybutyrate and acetoacetate) when dietary carbohydrate or total dietary energy is limited. Furthermore, when a ketogenic supplement is included in the diet, the brain of someone with mild cognitive impairment or Alzheimer’s disease uses ketones in direct proportion to the increased ketones provided by the circulation, thereby sparing brain glucose use.3334

Recent experimental clinical studies have shown that brain energy rescue with ketones is associated with improved cognitive outcomes in both mild cognitive impairment and Alzheimer’s disease. These studies used either a very low carbohydrate (ketogenic) diet353637 or 20-30 g/day of ketogenic medium chain triglyceride supplement.343839 With ketone positron emission tomography imaging, two of these studies showed that not only did ketones access the brain of someone with mild cognitive impairment37 but that improvement on several cognitive tests was directly proportional to the rise in plasma ketones,34 implying a direct mechanistic link between restoration of brain energy levels by ketones and the improved cognitive performance. Ketogenic interventions may also be disease modifying because preclinical and clinical reports show that the neuropathological process involving accumulation of the dementia associated proteins, amyloid β and phosphorylated tau, can be partially blocked by ketogenic supplements.374041 These results are encouraging but compliance is low with ketogenic diets, and ketogenic medium chain triglycerides can cause gastrointestinal discomfort. Thus more work is needed to optimise ketogenic interventions (dose, duration, formulation) and test them in larger randomised controlled trials in order to convincingly assess their efficacy in improving cognitive outcomes in people with mild cognitive impairment or Alzheimer’s disease. Ketogenic interventions may indirectly affect cognitive outcomes, in part, by improving insulin sensitivity or stimulating weight loss; they would also be predicted to be more efficient in slowing down Alzheimer’s disease if combined with exercise.42 Given the emerging evidence for the cardiometabolic safety of the ketogenic diet and the growing interest in its use to treat type 2 diabetes,43 a long term controlled intervention assessing its effect on cognitive outcomes and risk of Alzheimer’s disease is warranted.

Dietary patterns and cognitive health

Recent research has moved away from the reductionist approach to nutrition, health, and chronic disease,17 and focused on the effect of dietary patterns, such as the Mediterranean diet, DASH (Dietary Approaches to Stop Hypertension) diet, and the hybrid MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet. Additionally, the World Health Organization and Public Health England have advocated whole diet approaches to delay or prevent cognitive decline.744 A Mediterranean diet is high in fruits, vegetables, olive oil, whole grains, unsaturated fatty acids, and fish, with restrictions of red meat, and moderate but regular drinking of alcohol. A meta-analysis of 34 168 participants showed that higher adherence to a Mediterranean diet was associated with a 21% reduced risk of developing cognitive disorders and a 40% reduced risk of Alzheimer’s disease.45 In a recent analysis of the EPIC (European Prospective Investigation into Cancer and Nutrition)-Norfolk cohort, the global cognitive benefit of high versus low adherence to a Mediterranean diet was equivalent to 1.7 fewer years of cognitive ageing.46

Numerous foods in modern Western-style diets are not traditionally included in a Mediterranean diet, such as high fat dairy products, processed meats, carbonated drinks, sweets, and pastries. The PREDIMED, MIND, and DASH diets are Mediterranean-style diets and all three improved cognitive outcomes,4748 with respectively a 53%, 54%, and 39% lower incidence of Alzheimer’s disease after 4.5 years.49 A multidomain lifestyle intervention trial (FINGER), which included modified eating behaviour as one of four concurrent interventions, improved cognitive outcomes. After two years, a 25% improvement in global cognition (as assessed by the neuropsychological test battery), and higher executive function (150%) and processing speed (89%) was evident in the intervention versus control group.5051 These findings indicate that whole diet approaches that encourage Mediterranean-style elements and discourage energy dense foods typical of a Western-style diet are beneficial for cognitive health. Although the PREDIMED study reported a lower prevalence of mild cognitive impairment after a Mediterranean diet,52 longitudinal randomised controlled trials, with incident mild cognitive impairment/Alzheimer’s disease as the primary end point, are still lacking.

The totality of evidence supports the protective effect of adherence to diets rich in whole foods for dementia and cognitive function, but there are inconsistencies within and between diets.45 Contradictory findings may be due to the geographical region, with a recent systematic review reporting that 80% of cohort studies conducted in Mediterranean regions showed significant associations with cognitive health, compared with only 50% in non-Mediterranean regions.53 Possible reasons for this geographical disparity are firstly, diet adherence scores may reflect different food patterns in Mediterranean versus non-Mediterranean countries—for example, olive oil, fish, and legumes are more commonly eaten in Mediterranean regions; secondly, adherence scores do not consider foods reflective of Western-style diets in non-Mediterranean regions; or, thirdly, in Mediterranean regions the Mediterranean diet score is “capturing” a lifestyle with characteristics protective of cognitive decline, including increased social interactions when eating, and physical activity.5455

Heterogeneity in dietary response could also be due to individual differences in nutrient metabolism. Beneficial changes in the gut microbiome, together with taxonomic shifts in microbiota composition, have been seen in those following plant based diets.56 A higher intake of plant based foods is associated with lower trimethylamine oxide levels and increased faecal short chain fatty acids, fibre degrading microbiota, and gut microbial diversity.5758 These gut microbial changes are linked to the gut-brain axis. Thus short chain fatty acids—in particular, butyrate, enhance brain derived neurotrophic factor expression, and trimethylamine oxide is linked to reduced expression of synaptic plasticity related proteins, including N-methyl-D-aspartate-receptors, both important factors for learning and memory.5960 If the microbiome can affect the gut-brain axis then diet induced changes in the gut microbiota, through plant based or Mediterranean diets associated with higher consumption of fibre, polyphenols, and probiotics could affect development of cognitive impairment. Equally, microbiome speciation and metabolism could influence the cognitive response to dietary change and may emerge as a tractable target for interventions.

In addition to the nutrients needed for brain function, the reduced content of refined sugars in Mediterranean-type diets may also help to improve glucose tolerance. This would help the ageing brain meet its energy needs (both glucose and ketones) by reducing creeping insulin resistance during ageing, thereby improving the chance of maintaining optimal cognition.

Conclusions

Prospective cohort evidence suggests that a change in eating behaviour may delay the onset of dementia, possibly by several years. The trial evidence to date is reliant on cognitive or other surrogate markers of dementia risk with often, uncertain prognostic value, and lacking sensitivity and specificity to dementia subtypes. Longitudinal randomised controlled trials with robust cognitive outcomes are still needed, ideally, with incident disease (either dementia or mild cognitive impairment) as the primary outcome. Metabolic and preclinical studies will help to provide insights into mechanisms so as to collectively provide the evidence needed to make causal inferences, fully establish efficacy, and inform policy.17 Randomised controlled trials are often expensive and long term. They should be supported by validated imaging and biochemical biomarkers of disease, both to select at risk and responsive subgroups, and to screen potentially effective interventions.

Are we yet in a position to provide dietary guidelines specifically to promote cognitive health and reduce the risk of dementia in later life? Global and national dietary macronutrient (particularly fat and carbohydrate) and food guidelines (eg, eating fruit and vegetables and reducing salt) are, in large part, based on the management of cardiometabolic risk (obesity, cardiovascular diseases, and type 2 diabetes mellitus). Given the established importance of cardiometabolic health on cognitive function (especially in mid-life), greater adherence to existing dietary recommendations is likely to reduce the incidence of dementia. To develop dietary guidelines specifically focused on prevention of dementia or improving mild cognitive decline, further research is needed to gain insight into which dietary strategies most effectively improve neuronal function and reduce neuropathology.

Controversies and research gaps

Strong associations between dietary patterns and food bioactive components in prospective cohort studies and experimental preclinical studies are often not replicated in human randomised controlled trials Randomised controlled trial design should assess whether the intervention indirectly affects systemic processes, such as cardiometabolic function or inflammation, or whether it directly affects neuronal function, brain energy metabolism, or the “hallmarks” of dementia, such as amyloid β and tau protein metabolism. The time and dose needed to produce meaningful increases in brain function must be considered in the trial design to preclude the risk of a type 2 error (false positive findings) Longitudinal follow-up randomised controlled trials are needed, ideally with incident disease as the primary outcome measure It is unclear when to intervene in the cognitive course from health to diagnosed dementia, and which interventions are best suited to dementia subtype and disease progression Little is known about the overall effect of neuropathology on the brain uptake and metabolism of dietary components Identification is needed of targeted approaches to nutrition for at risk subgroups, such as women with the APOE4 gene or insulin resistant individuals

Key messages

Global prevalence of dementia is predicted to almost triple by 2050 and no current treatments are effective Improved eating behaviour could reduce the risk and population prevalence of dementia Owing to dementia’s multifactorial aetiology, multiple dietary components that target several physiological pathways and risk factors simultaneously are needed

Changes to dietary patterns and foods (rather than single dietary components) therefore hold most promise to meaningfully improve cognition Randomised controlled trials with robust validated cognitive outcomes are needed to support the prospective cohort evidence, establish efficacy and effect size, and inform public health policy

Tell all the truth - Emily Dickinson

Tell all the truth but tell it slant —

Success in Circuit lies

Too bright for our infirm Delight

The Truth's superb surprise

As Lightning to the Children eased

With explanation kind

The Truth must dazzle gradually

Or every man be blind —

The much needed fiscal policy during covid 19 lockdown in india

There are multiple measures implemented by the government to stimulate the economy in the covid 19 induced pause in the economic activity. The question is whether they are effective and is there a magic pill which could resolve all the issues

All stimulus should have the desired effect on increased spending and resultant surge in economic activity. Unlike a developed economy, India cannot afford to provide unemployment packages like PPP (paycheck protection programme) as their tax collections are abysmally low. Indias tax to GDP ratio is c.10% as compared to US-24% UK- 34%. Also a significant majority of the labor force is outside of the payroll system in India which is evidenced by the low personnel registered for employee security schemes like EPF,NPS etc. It means that it is virtually impossible for India to have a payroll based stimulus as it would basically ignore most of the labor force.The fact that India dont have an universal health care system compounds the impact in case of surge of covid 19 cases. Thereby it is prudent for the government to have a strict lock-down to prevent a pandemic and the medical resources of State and Central Governments being overwhelmed. It provides the government a breather and focus their initiative in mitigating the constraints imposed on the economy by such strict lockdown measures.

FISCAL MULTIPLIER

Any macroeconomic study is incomplete without analysis of the desired fiscal multiplier effect of a stimulus package. It is defined by the marginal propensity to consume ("MPC") of the beneficiaries of the scheme. If the government has limited resources as is the case for India with lower tolerance for increased fiscal deficit, they should look for a package which could act like a adrenaline shot to the comatose economy.

The poor families usually tend to have the highest MPC as they usually spend most of their revenues on sustenance. It is the same essential goods and services which are allowed to operate in the lockdown. Thereby it would be an accurate assessment that any stimulus directed toward the families of the Public distribution system (PDS) i.e ration card holders below a certain level of income should have the desired impact of increased economic activity. Grocery stores also employ labor with a higher MPC thereby leading to the compounding effect of the stimulus i.e the fiscal multiplier.

CONSTRAINTS

Will the families be allowed to spend primarily on the essential goods - what if they have a outstanding loan and rental payments

The Government did announce a moratorium on rental collections but it needs to be strictly implemented and extended till the lock-down restrictions are eased. A prolonged moratorium is required on both rental and loan repayments (inc. interest) as it defeats the purpose of any benefit package if most of it used to pay a landlord or loan shark who doesnt have the desired MPC/fiscal multiplier effect.

If only essential goods and services are available then people with higher income usually tend to save as there are basically limited avenues to spend other than food during the lockdown

Thereby any benefits directly provided to individuals or families should be directed towards increased propensity to buy groceries and eliminate any redirection to leverage or rental costs.

FIRMS

The above direct stimulus to individuals through PDS or bank accounts can help to sustain the poorer section of society who are the hardest hit for a few months but what about firms. The actual engine of production for the economy, what is the impact of strict lockdown measures on them

There are three key factors which needs to be considered

a) Low margin industry - High fixed cost

b) High inventory

c) Largest employment - direct and indirect

First we need to accept that the government cannot allow a large number of firms to go bankrupt due to the govt lockdown as it would create a comatose climate which would be far more difficult to recover than the covid 19 pandemic. Thereby the Government should drive the initiative to hit the above three factors.

Any industry with high fixed cost ratio would be crippled and are most likely to go bankrupt. Even-though they can prevent working capital issues by reducing inventory or even laying off temporary staff but they cannot avoid the fixed costs like borrowing, property,plant and equipment maintenance and depreciation.

Firms carrying large unsold inventory either in the form of raw materials or finished goods would find it difficult to restart operations as the carrying cost of inventory would significantly impair their cash flows.

Large employers primarily in the manufacturing sector would require the most support as they would be the most likely to lay off permanent staff and reduce their purchase orders which would in turn precipitate a vicious cycle of supplier side unemployment who are primarily in the medium and small sector

FISCAL MEASURES

The government needs to announce a funding mechanism where the RBI directly invests in firms based on the above factors. A designated bank needs to be created under the supervision of RBI which is government funded. This "Covid 19 Bank" should extend long dated instruments carrying a reasonable coupon rate with contingent convertible and a mandatory redemption feature after 5 years. This would be the much need capital infusion required for the indian industry.

The current blanket announcement of 20 lakh crore loans targetting small and medium sector through an already struggling banking sector would only add to the ever increasing NPA issues. It is difficult for a listed banking institution to carry such higher risk on their balance sheet even if it is guaranteed by the RBI/Govt due to the higher capital costs associated with the same and its resultant impact on capital ratios.

Thereby this stimulus needs to be extended by the government directly through its segregated "covid 19 bank" rather than putting the onus on the banking sector. also there is no point in targetting small and medium enterprises as evidenced in the manufacturing sector they are usually engaged in the supplier or distribution side of large enterprises. If the orders from large enterprises dry up then there is no point of any stimulus. It is imperative that we target firms based on the above three key factors and target them for covid 19 financing instruments.

Usually financing for Large industries would help them to maintain their purchase orders and also meet the sale orders when demand picks up post easing of lockdown which brings us to the next important point ...... timing.

TIMING

The above fiscal measures shouldnt be implemented at the same time. Cause there is an inherent synergy between lockdown, stimulus and increased demand. In the initial phase of intense lockdown where only essential goods and services are allowed to operate, the focus should be on the fiscal multiplier stimulus like direct money transfer to high MPC families through the PDS and banking infrastructures with strict implementation of rent and loan moratorium which needs to be extended till the end of lockdown.

During the next phase of the lockdown when the restrictions are eased for industries to operate with minimal or reduced capacity, the first tranche of funding through the Covid 19 bank needs to be extended to firms based on the above three key factors. It is important that the funding is extended in a staggered manner which is coinciding with the gradual easing of the lockdown. There is no point in a giving a bulk amount to an enterprise with no vision on when they will have the opportunity to restart their operations.

This staggered cash flow funding which is in effect a capital instrument would provide the much needed breathing space for the industry to meet the increased demand on the projected consumption post lockdown.

In case there is extended lock-down due to non flattening of the covid 19 spread then the above industry fiscal stimulus needs to be on hold.

To reiterate i believe the following key features are required to restart the Indian economy

a) Immediate and regular stimulus to PDS families during lockdown.

b) Strict implementation of Rent and Loan payment holidays during lockdown

c) A Separate Covid 19 bank created with govt funding under the supervision of RBI

d) Staggered funding timed with the easing of lockdown of long dated instruments with contingent convertible and mandatory redemption feature after 5 years

e) Targeted funding to firms based on the three key factors

The Power of Retained Earnings

In 1924, Edgar Lawrence Smith, an obscure economist and financial advisor, wrote Common Stocks as Long Term Investments, a slim book that changed the investment world. Indeed, writing the book changed Smith himself, forcing him to reassess his own investment beliefs.

Going in, he planned to argue that stocks would perform better than bonds during inflationary periods and that bonds would deliver superior returns during deflationary times. That seemed sensible enough. But Smith was in for a shock.

His book began, therefore, with a confession: “These studies are the record of a failure – the failure of facts to sustain a preconceived theory.” Luckily for investors, that failure led Smith to think more deeply about how stocks should be evaluated.

For the crux of Smith’s insight, I will quote an early reviewer of his book, none other than John Maynard

Keynes: “I have kept until last what is perhaps Mr. Smith’s most important, and is certainly his most novel, point. Well-managed industrial companies do not, as a rule, distribute to the shareholders the whole of their earned profits.

In good years, if not in all years, they retain a part of their profits and put them back into the business. Thus there is an element of compound interest (Keynes’ italics) operating in favour of a sound industrial investment. Over a period of years, the real value of the property of a sound industrial is increasing at compound interest, quite apart from the dividends paid out to the shareholders.”

And with that sprinkling of holy water, Smith was no longer obscure.

It’s difficult to understand why retained earnings were unappreciated by investors before Smith’s book was published. After all, it was no secret that mind-boggling wealth had earlier been amassed by such titans as Carnegie, Rockefeller and Ford, all of whom had retained a huge portion of their business earnings to fund growth and produce ever-greater profits. Throughout America, also, there had long been small-time capitalists who became rich following the same playbook.

Nevertheless, when business ownership was sliced into small pieces – “stocks” – buyers in the pre-Smith years usually thought of their shares as a short-term gamble on market movements. Even at their best, stocks were considered speculations. Gentlemen preferred bonds.

Though investors were slow to wise up, the math of retaining and reinvesting earnings is now well understood. Today, school children learn what Keynes termed “novel”: combining savings with compound interest works wonders.

**********

An extract from Warren Buffet's letter to shareholders of Berkshire Hathaway in annual report 2019.

Lack of testing lead to patients being discharged with Covid 19 infections

Many patients in hospitals with covid-19 may have been discharged to care homes in March and April because of a lack of testing capacity at the time in England, auditors have reported.

The National Audit Office said that actions taken by the NHS to increase capacity meant there were enough beds and respiratory support nationally at the peak of the outbreak in April.1 Actions included postponing elective procedures, contracting with private hospitals to secure extra beds, and advising hospitals on 17 March to urgently discharge all inpatients who were medically fit to leave.

But the watchdog said that the government’s testing strategy led to some patients being discharged to care homes without being tested for covid-19 between mid-March and mid-April.

The NAO reported: “Due to government policy at the time, not all patients were tested for covid-19 before discharge, with priority given to patients with symptoms. On 15 April, the policy was changed to test all those being discharged into care homes. It is not known how many patients discharged to care homes had covid-19 at the point they left hospital.” Before the new policy of testing everyone before their admission to care homes was rolled out, around 25 000 people were discharged from NHS hospitals to care between 17 March and 15 April, the NAO said.

The auditors highlighted government guidance from 2 April that stated that care homes needed to make their full capacity available and that they could admit patients with covid-19. But it said there was a lack of data on “the extent to which care homes successfully isolated staff with confirmed or suspected covid-19.”

The NAO noted that testing of care workers with symptoms was not rolled out on 15 April. And it wasn’t until 28 April that all care home staff were eligible for tests, and the health department capped the daily number of care home tests at 30 000, to be shared among staff and residents. Testing of NHS staff with symptoms was also delayed but started on 27 March.

Until mid-April the government’s policy was to test no more than five residents with symptoms in any one care home. On 11 May the health department announced that, of around 400 000 care home residents, more than 45 000 had been tested by health protection teams. But it is not known how many residents have had covid-19, the NAO concluded.

Around 5900 care homes in England (38%) reported an outbreak of covid-19 between 9 March and 17 May, the NAO said. This peaked at just over 1000 homes in the first week of April, with some regions such as the North East more affected than others.

The NAO said it had also heard concerns from a range of health and social care organisations about the supply of personal protective equipment (PPE), with central sources up to mid-May meeting only around half of the modelled requirement.

Gareth Davies, the head of the NAO, said, “While we have not sought to evaluate government’s response in this report, our work raises some important considerations.

“Government’s ability to increase beds, ventilators, PPE, and testing has varied in part because of the number of other bodies, both national and international, with which it has had to engage. All of these issues need to be taken into account as the government plans for the later phases of the pandemic and future emergencies.”

Has Sweden’s controversial covid-19 strategy been successful?

Sweden has stood out in the global pandemic by eschewing lockdown and seemingly aiming for herd immunity. Heba Habib reports that Sweden’s public was supportive of the strategy, but is now paying a heavy price.

For months Swedish public health authorities have defended their controversial decision not to lock down the country in response to the global covid-19 pandemic. Schools were closed to children under 16 and gatherings of more than 50 people were discouraged, but bars, restaurants, and other public spaces remained open, and citizens were trusted to distance themselves.

At the heart of the government’s strategy was the implicit and controversial idea that, rather than contain the spread of disease, a country could achieve herd immunity by allowing a proportion of the population to be infected—at the expense of deaths among the vulnerable. “They did not want to put it bluntly, but seeking herd immunity was always inherent in the Swedish strategy,” says Anders Bjorkman, a professor of infectious diseases at the Karolinska Institute in Stockholm.

Herd immunity occurs when a large section of the population (generally considered to be between 50% and 90% depending on how contagious the infection is1) becomes immune to a disease or virus, therefore stopping its spread. This occurs when people have enough antibodies to repel the virus—either through having been exposed to the virus and survived, or through vaccination. Advocates claimed that the Swedish approach would be more sustainable in the long run than other countries’ harsher measures. And at first it seemed to be working.

Speaking at a press conference on 26 April, Anders Tegnell, the epidemiologist credited with the Swedish strategy, said that the rise in infections was beginning to flatten and had reached a plateau in Stockholm—the centre of the Swedish outbreak—as well as in other parts of the country.

As case numbers proliferated around the world and death tolls rose in neighbouring European countries, Swedish experts, and indeed the public, still seemed largely supportive of the strategy. According to a poll conducted between 17-19 April by independent agency Novus, 73% of 1000 respondents said they trusted the strategy of the Public Health Agency of Sweden.

But time has told a different story.

Explosive numbers
Sweden has the largest number of cases and fatalities in Scandinavia—around 37 000 confirmed cases at the time of writing, compared with its neighbours Denmark, Norway, and Finland which have 12 000, 8000, and 7000 cases, respectively. All three neighbouring countries adopted a lockdown approach early in the pandemic, which they are now slowly lifting. All three have since re-opened their borders, but not to Sweden.

Sweden recorded the most coronavirus deaths per capita in Europe in a seven day average between 25 May and 2 June. The country’s mortality rate was 5.29 deaths per million inhabitants a day (the UK ranked second with 4.48) according to Our World In Data,2 an online research publication based at the University of Oxford.

And what of herd immunity? An ongoing nationwide study conducted by the Public Health Agency of Sweden on 20 May found that just 7.3% of Stockholm residents had developed covid-19 antibodies by late April—and that was the largest number of positive results found in the country.

“It means that just like other European cities in hard hit countries, it will take a long time before the majority of the population has gone through the infection and are likely immune,” said Tove Fall, professor in epidemiology at Uppsala University.

On 11 May, the World Health Organization said that global studies had found antibodies in only 1-10% of the global population, with similar findings emerging from Spain and France. The agency warned against any country depending on herd immunity as a strategy.

Backlash

“I think we’re starting to see that the Swedish model maybe wasn’t the smartest,” said former state epidemiologist Annika Linde in a 19 May interview with newspaper Dagens Nyheter.3

More than half the deaths in Sweden have occurred in care homes for older people, something Tegnell has admitted is a “failure,” especially since a cornerstone of the strategy was protecting those over 70.

Anders Vahlne, a professor of virology at Karolinska, thinks that government advice misinformed the public by implying that those who don’t have symptoms are not contagious (the Public Health Agency of Sweden’s website states “as long as siblings or other members of the family do not show symptoms of disease they can go to school, preschool, or their workplace.”). “I think this amongst other things has caused a lot of older people in care homes to get sick and die and it’s quite unnecessary,” Vahlne told The BMJ.

IVO, the Health and Social Care Inspectorate, reported4 that 75% of the complaints it had received from the public and from care workers were about the lack of protective equipment such as facemasks in care homes. One care home worker, speaking anonymously, told The BMJ that “staff often work for 14 hours with substandard protection and continue working despite exhibiting symptoms.” The guidelines keep changing in accordance with the availability of material, they added.

“One should have known what poor preparedness we had in both healthcare and care of older people,” said Linde. “A lockdown could have given us a chance to prepare, think things through, and minimise the spread of infection.”

More worryingly, Swedish doctors have expressed alarm over the matter-of-factness with which authorities seem to be treating the plight of older and vulnerable people.

Yngve Gustafsson, professor of geriatric medicine at Umea University, noted that the proportion of older people in respiratory care nationally was lower than at the same time a year ago, despite people over 70 being the worst affected by covid-19. He expressed concern about the increasing practice of doctors recommending by telephone a “palliative cocktail” for sick older people in care homes.

“Older people are routinely being given morphine and midazolam, which are respiratory-inhibiting,” he told the Svenska Dagbladet newspaper,5 “It’s active euthanasia, to say the least.”

Last chance
Jon Tallinger, a specialist in general medicine and operations manager at a hospital in Tranås, believes that Sweden’s high death toll, particularly among older people, has less to do with the covid-19 strategy and is more a consequence of decades of privatising the healthcare system.

“The power has been taken away from the doctors and healthcare specialists and given to politicians,” Tallinger told The BMJ, “So now municipalities lack the resources to save the lives of older people and those at risk.” He added that thousands of lives could be saved if people in care homes with the virus received oxygen supplies. “Older people die because they do not receive the treatment they need.”

The government insists that Sweden’s high per capita death toll can’t be attributed to the lack of a lockdown. In a press conference on 29 May, Tegnell said the comparisons were unfair as “other countries are not reporting the actual death rates. Sweden is the best in the world in reporting the actual number of dead.” The government has given no indication that it will change its strategy beyond a ramping up of testing.

Yet even on that, Tove Fall said, “What is not so much discussed so far, is why Sweden is among the worst countries in Europe when it comes to testing.” According to Our World in Data, Sweden had carried out 23.64 tests per 1000 people as of 24 May, compared with 31.59 in the UK, 31.88 in Finland, and 44.75 in Norway.

Until April, only high priority groups—patients in hospital, high risk groups such as people over 70 or with underlying conditions, healthcare staff, and key workers—were being tested, and even then only those with severe symptoms. Minister of health Lina Hallgren pledged to increase to 100 000 tests per week by mid-May, but the government has fallen far short of that goal—recent numbers ranged from 28 000 to 33 000—sparking criticism from opposition party members and even the prime minister Stefan Lofven.6

Anders Tegnell said in a 3 June press conference that there had initially been problems with laboratory capacity “but also healthcare capacity because testing is a very complicated chain of events. You need to have staff and resources in each part of the chain.” He said that while the laboratory issue had now been fixed, the resources and training are still lacking.

Fall said the restricted and low levels of testing could have consequences for tracing and isolation efforts, and that this problem isn’t being prioritised by the authorities. “Testing of symptomatic cases in the population has not been done if the patient is not in need of hospital care or is not a healthcare worker,” said Fall. “Right now, recommendations for isolation of cases are based on symptoms only, and no household quarantine is recommended.”

Meanwhile, contact tracing has been largely abandoned since the beginning of March. This despite the fact that, according to Carina King, an epidemiologist at the Karolinska Institute, Sweden is very well positioned for contact tracing thanks to its commonplace digital identity system used to access public services and more.

Remorse?

On 2 June, Anders Tegnell was interviewed by Sverige Radio, and admitted there was “quite obviously a potential for improvement in what we have done.”6
Yet in a separate interview with the Dagens Nyheter, he said he still believed the basic strategy had “worked well.” “I do not see what we would have done completely differently,” he said, “Based on the knowledge we had then, we feel we made the appropriate decisions.”
“Other countries started with a lot of measures all at once,” he told Sverige Radio, “The problem with that is that you don’t really know which of the measures you have taken is most effective.”

“If we were to encounter the same disease again, knowing exactly what we know about it today, I think we would settle on doing something in between what Sweden did and what the rest of the world has done.”

Footnotes Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed

Uber results for Q1 2020

Revenue of $3.5 billion, growing 14% year-over-year or 16% on a constant currency basis

Rides Adjusted EBITDA of $581 million

SAN FRANCISCO--(BUSINESS WIRE)-- Uber Technologies, Inc. (NYSE: UBER) today announced financial results for the quarter ended March 31, 2020.

Financial Highlights for First Quarter 2020

Gross Bookings grew to $15.8 billion, up 8% year-over-year, or 10% on a constant currency basis, with Rides declining 3% and Eats growing 54% year-over-year, respectively, on a constant currency basis.
Revenue growth of 14% year-over-year, or 16% on a constant currency basis.
Adjusted Net Revenue (“ANR”) growth year-over-year of 18%, or 19% on a constant currency basis. Adjusted Net Revenue and segment Adjusted Net Revenue excludes the impact of COVID-19 response initiatives.
Net loss attributable to Uber Technologies, Inc. of $2.9 billion, which includes $277 million in stock-based compensation expense and pre-tax impairment write-downs of $2.1 billion. Net loss attributable to Uber Technologies, Inc. excluding the impairment write-downs, net of the tax benefit would have been $1.1 billion.
Rides Adjusted EBITDA delivered $581 million in profit, up $389 million year-over-year, and down $161 million quarter-over-quarter, and 23.5% margin as a percentage of ANR.
Eats Adjusted EBITDA of $(313) million, down $4 million year-over-year and up $148 million quarter-over-quarter.
Adjusted EBITDA of $(612) million, up $257 million year-over-year, and up $3 million quarter-over-quarter. Adjusted EBITDA excludes the impact of COVID-19 response initiatives.
Unrestricted cash, cash equivalents and short-term investments were $9.0 billion.
COVID-19 response initiatives impact on GAAP revenue of $19 million and impact on GAAP cost of revenue of $5 million. (details and reconciliation below)

“While our Rides business has been hit hard by the ongoing pandemic, we have taken quick action to preserve the strength of our balance sheet, focus additional resources on Uber Eats, and prepare us for any recovery scenario,” said Dara Khosrowshahi, CEO. “Along with the surge in food delivery, we are encouraged by the early signs we are seeing in markets that are beginning to open back up. Our global footprint and highly variable cost structure remain an important advantage, as our expectation is that the Rides recovery will vary by city and country.”

“Our ample liquidity provides us with substantial flexibility to navigate the current crisis, but we are being proactive and taking actions to emerge stronger and more focused as a company,” said Nelson Chai, CFO. “We have recently exited eight unprofitable Eats markets, significantly reduced the size of our customer support and recruiting teams, and merged our JUMP unit into Lime. Building on the steps we have already taken, we are continuing to look at all levers to ensure our core Rides and Eats businesses emerge from this crisis stronger than ever.”

First Quarter 2020 Financial and Operational Highlights

Operating Highlights for the First Quarter 2020

COVID-19 Initiatives

Launched programs to support drivers: We launched a program to support drivers or delivery people who are diagnosed with COVID‑19, or individually asked to self-isolate, providing up to 14 days of financial assistance while their Uber account is on hold. We also accelerated cross-dispatch from Rides to Eats, as well as surfaced other earning opportunities on and off the Uber platform via the Uber Work Hub. Providing cleaning supplies and PPE: We are working with manufacturers and distributors to provide drivers and delivery people with cleaning supplies and PPE including face coverings and disinfectants. We have distributed millions of pieces of PPE and are working to secure more supplies and are prioritizing active drivers in the cities with the greatest need.
10 million free rides and deliveries: We have committed to provide 10 million rides and meals to healthcare workers, seniors and people in need, free of charge, and have started offering those services around the world. For instance, we’ve begun providing $1 million in rides and food to healthcare workers in New York City, and up to 200,000 free rides for NHS staff in London.
Vulnerable populations: Working with partners, we are delivering medication to housebound patients and essential goods to those in need around the world. We have also partnered with domestic violence organizations in 35 cities to provide free rides to shelter and safe spaces, and free meals. We introduced a dedicated phone number for people without a smartphone to get assistance with ordering a meal.
Supporting restaurants: We waived new restaurant activation fees in a number of markets and have made it quicker and easier for restaurants around the world to join Eats. We also launched a global feature allowing eaters to provide direct support to restaurants, resulting in over $3 million in direct contributions.
Freight relief efforts: Over 10 thousand relief loads of critical goods booked on the shipper platform in the U.S. were hauled at cost. Platform

Uber Rewards gained traction: Uber rewards has grown to more than 31 million members, and is now live in France, our sixth country, in addition to the U.S., Brazil, Mexico, Australia, and New Zealand.
Uber for Business (“U4B”) grows customer relationships: U4B now has relationships with 46% of the Fortune 500 and continues to gain traction among governmental organizations, including the U.S. Federal government as of April 2020. U4B deals increasingly include both Rides and Eats following the launch of Eats within U4B earlier this year, in certain jurisdictions, including in Brazil, Canada, France, and the United Kingdom. Launched Uber Direct and Uber Connect: Uber Direct is a delivery platform for retail items; Uber Connect is a peer-to-peer package delivery service, for sending goods to family and friends. These offerings highlight the flexibility of the Uber platform, while also providing additional earnings opportunities to drivers and delivery people.

Rides

Driver app enhancements improve cross-dispatching: During the quarter, we made enhancements to the Uber Rides Driver App that make it easier for drivers to become Eats delivery people. Nearly 40% of U.S. and Canada Drivers active on the platform cross-dispatched to Eats in the month of April.
Uber for Health scales rapidly: Uber for Health has grown more than 200% YoY as we build out enhanced capabilities, including the ability to order rides to medical appointments and other health services over the phone. Other Segments
Eats added key new accounts: Signed partnerships with Chipotle (2,500 locations) in U.S. and Canada, along with Dunkin’ (4,000+ locations) and Shake Shack (150 locations).
Eats enabled grocery and convenience options: Uber Eats has enhanced the ability for grocery and convenience partners to sell a limited menu of everyday essentials via our restaurant platform. The offering is live with nearly 4,000 partners in 35 countries, including partnerships with Carrefour in France, Sysco in the U.S., and Shell in the UK.
Freight improved load bundle and multi-stop load product features: Added improvements to the Uber Freight application that are intended to improve match of available loads with available carriers.
Uber Transit continued expansion: Uber users now have access within the Rides app to the transit system of more than 15 cities, including two new cities that have also added ticketing capabilities within our app. To date, more than 2 million Uber Riders have used Transit. Uber Works expanded: Expanded from Chicago and Miami to its third market, Dallas. We are supporting COVID-19 response efforts through Uber Works Hub, reinforcing Uber’s role as platform for independent work opportunities, including for existing drivers and delivery people; and providing essential personnel for light industrial and grocery supply chain customers.
Next generation JUMP hardware deployed: Within New Mobility, our fifth generation of hardware, which includes shared swappable batteries between bikes and scooters, is being tested in an effort to increase durability and reduce operational costs. Recent Developments

Uber Eats: On Monday, consistent with our long-term strategy, we announced a change to the geographic footprint of Uber Eats operations affecting 8 markets. We will discontinue Uber Eats in the Czech Republic, Egypt, Honduras, Romania, Saudi Arabia, Uruguay and Ukraine, and will transfer Uber Eats operations to our Careem subsidiary in the United Arab Emirates. The discontinued and transferred markets represented 1% of Eats Gross Bookings and 4% of Eats Adjusted EBITDA losses in Q1 2020.
Headcount: On Wednesday, due to lower trip volumes and our current hiring freeze, we announced a reduction of our customer support and recruiting teams by approximately 3,700 full-time employee roles.
New Mobility: Today, we announced we are folding our JUMP e-bike and e-scooter business into Lime. Our customers will continue to have access to e-bikes and e-scooters in our apps. As part of the transaction, we made an additional convertible note investment of $85 million in Lime. The transferred business represents the vast majority of Gross Bookings, Adjusted Net Revenue and Segment Adjusted EBITDA loss for our Other Bets segment.

Webcast and conference call information A live audio webcast of our first quarter 2020 earnings release call will be available at https://investor.uber.com/, along with the earnings press release and slide presentation. The call begins on May 7, 2020 at 1:30 PM (PT) / 4:30 PM (ET). This press release, including the reconciliations of certain non-GAAP measures to their nearest comparable GAAP measures, is also available on that site.

We also provide announcements regarding our financial performance, including SEC filings, investor events, press and earnings releases, and blogs, on our investor relations website (https://investor.uber.com/).

About Uber

Our mission is to ignite opportunity by setting the world in motion.
We revolutionized personal mobility with ridesharing, and we are leveraging our platform to redefine the massive meal delivery and logistics industries.
We are a technology platform that uses a massive network, leading technology, operational excellence and product expertise to power movement from point A to point B. We develop and operate proprietary technology applications supporting a variety of offerings on our platform. We connect consumers with independent providers of ride services, restaurants and food delivery services, public transportation networks, e-bikes, e-scooters and other personal mobility options. We use this same network, technology, operational excellence and product expertise to connect shippers with carriers in the freight industry. We are also developing technologies that will provide autonomous driving vehicle solutions to consumers, networks of vertical take-off and landing vehicles and new solutions to solve everyday problems.

Forward-Looking Statements

This press release contains forward-looking statements regarding our future business expectations which involve risks and uncertainties. Actual results may differ materially from the results predicted, and reported results should not be considered as an indication of future performance. Forward-looking statements include all statements that are not historical facts and can be identified by terms such as “anticipate,” “believe,” “contemplate,” “continue,” “could,” “estimate,” “expect,” “hope,” “intend,” “may,” “might,” “objective,” “ongoing,” “plan,” “potential,” “predict,” “project,” “should,” “target,” “will,” or “would” or similar expressions and the negatives of those terms. Forward-looking statements involve known and unknown risks, uncertainties and other factors that may cause our actual results, performance or achievements to be materially different from any future results, performance or achievements expressed or implied by the forward-looking statements. These risks, uncertainties and other factors relate to, among others: developments in the COVID-19 pandemic and the resulting impact on our business and operations, competition, managing our growth and corporate culture, financial performance, investments in new products or offerings, our ability to attract drivers, consumers and other partners to our platform, our brand and reputation and other legal and regulatory developments. For additional information on other potential risks and uncertainties that could cause actual results to differ from the results predicted, please see our Annual Report on Form 10-K for the year ended December 31, 2019 and subsequent Form 10-Qs or Form 8-Ks filed with the Securities and Exchange Commission. All information provided in this release and in the attachments is as of the date of this press release and any forward-looking statements contained herein are based on assumptions that we believe to be reasonable as of this date. Undue reliance should not be placed on the forward-looking statements in this press release, which are based on information available to us on the date hereof. We undertake no duty to update this information unless required by law.

Non-GAAP Financial Measures

To supplement our financial information, which is prepared and presented in accordance with generally accepted accounting principles in the United States of America (“GAAP”), we use the following non-GAAP financial measures: Adjusted Net Revenue; Rides Adjusted Net Revenue; Eats Adjusted Net Revenue; Adjusted EBITDA; Adjusted EBITDA margin as a percentage of ANR; and net loss attributable to Uber Technologies, Inc. excluding the impairment write-downs, net of the tax benefit, as well as, revenue and Adjusted Net Revenue growth in constant currency. The presentation of this financial information is not intended to be considered in isolation or as a substitute for, or superior to, the financial information prepared and presented in accordance with GAAP. We use these non-GAAP financial measures for financial and operational decision-making and as a means to evaluate period-to-period comparisons. We believe that these non-GAAP financial measures provide meaningful supplemental information regarding our performance by excluding certain items that may not be indicative of our recurring core business operating results.

We believe that both management and investors benefit from referring to these non-GAAP financial measures in assessing our performance and when planning, forecasting, and analyzing future periods. These non-GAAP financial measures also facilitate management’s internal comparisons to our historical performance. We believe these non-GAAP financial measures are useful to investors both because (1) they allow for greater transparency with respect to key metrics used by management in its financial and operational decision-making and (2) they are used by our institutional investors and the analyst community to help them analyze the health of our business.

There are a number of limitations related to the use of non-GAAP financial measures. In light of these limitations, we provide specific information regarding the GAAP amounts excluded from these non-GAAP financial measures and evaluating these non-GAAP financial measures together with their relevant financial measures in accordance with GAAP.

For more information on these non-GAAP financial measures, please see the sections titled “Key Terms for Our Key Metrics and Non-GAAP Financial Measures,” “Definitions of Non-GAAP Measures” and “Reconciliations of Non-GAAP Measures” included at the end of this release.

How Instacart works : The Complete revenue and business model

Instacart is an on-demand grocery delivery platform facilitating doorstep deliveries of groceries and other home essentials in major cities of USA. The technology driven business model of Instacart boosts of delivering groceries to customers in as little as 1 hour, making it one of the most promising and futuristic company of USA which is based on sharing economy model.

This grocery delivery startup has become so famous in the on-demand sector that a lot of budding entrepreneurs are interested to learn more about Instacart business model and understand its overall working in order to develop the next big thing in the sharing economy. This post from Juggernaut will show you how Instacart works and makes money along with some interesting facts and figures about this $2 billion valuation company.

Founders, Funding received, Facts and Timeline

Instacart was founded in year 2012. It is one of the most recent technology developments which has shaken the world by its business model. Being considered as a leader in on-demand economy, Instacart has received massive funding to expand its grocery delivery operations all across USA. Here are few facts about Instacart:

Founded by: Apoorva Mehta (CEO / Founder) and Max Mullen (Co-Founder)

Funding received: $275 million (Till the mid of year 2015)

Company Valuation: $2 Billion. (As per Jan 2015)

Revenue: $100 million (As of Jan 2015).

Headquarters: San Francisco, California, USA.

The amount of funding received by Instacart clearly shows the trust of investors in this start-up and its projected future. To understand what makes Instacart a promising company, let me quickly take you through the salient features and the value propositions of Instacart. Thereafter, we’ll move on to understand Instacart’s core working and its customer segments.

Salient Features of Instacart:
Available in major areas of the USA including SF Bay Area, San Jose, NYC, Brooklyn, Washington DC, Philadelphia, Boston, Chicago, Austin, Seattle and Los Angeles.
A collection of over 300,000 items from several stores such as Whole Foods, Safeway or Costco enabling customers to place orders from their favourite store or to mix items from different stores into one order.
Crowdsourced Marketplace model with users being connected to personal shoppers who shop for ordered items and deliver them to the customers.

Value Proposition:
Tie-ups with existing supermarkets
Willing part time workers and their cars
Vast inventory
Extremely quick delivery
No warehouses
No shiny delivery trucks

Instacart’s 3 Customer Segments Explained:

Users:

They have an app from where they can order groceries by choosing one or more stores.
They can even order from a desktop or laptop using a web based interface.
Users pay online for their order and can tip their shopper in advance during check out.
Option to shop from any of the available stores in their area. An order can even be placed by combining items from different stores.
Users can schedule orders for a specific day and time.

Shoppers:
Shoppers receive orders on their smartphones.
Shoppers are stationed near the stores in order to save time.
They pick up the ordered items manually and deliver it to the customer.
Apart from the per hour pay, shoppers often get a tip from customers.

Stores:
Instacart has tie-ups with major superstores in various cities.
These stores have been able to increase their revenue through online sales via Instacart.
Instacart Business Model Canvas [Image: changes done] The 4 step model about How Instacart Works:
A customer places his order for groceries and pays online to instacart.
A personal shopper receives the order and starts collecting items as mentioned in the order.
Shopper pays the bill through Instacart’s prepaid debit card which is accepted at the store.
The shopper then goes to deliver the groceries to the customer as per the address mentioned in the order.
Any tip paid in cash at the time of delivery directly goes to the shopper and the tip paid to shopper during checkout gets accumulated in his Instacart account and is paid at the end of the week along with the salary.

Instacart revenue model – How it makes money?
Delivery Fee
Every order processed by Instacart which is above the value of $35 attracts a standard delivery fee of $3.99 for a scheduled or 2 hour delivery and $5.99 for a 1 hour delivery.

Orders under $35 value are charged at $7.99 for a scheduled or 2 hour delivery and $9.99 for a 1 hour delivery.

Membership Fee (Instacart Express)
Instacart offers an annual membership by the name ‘Instacart Express’ priced at $99. Users having this membership can get free delivery of groceries for full 1 year with few terms and conditions.
Mark up prices (15%+ more)
Some stores selling their products on Instacart offer the same prices as their in-store prices but few stores listed on Instacart have a mark-up of 15%+more from their in-store prices. The revenue from these mark-up prices goes to Instacart which helps them pay the shoppers.

How Instacart finds customers?

Word of Mouth Advertising
Internet Marketing
Free first delivery
Various offers

The process of Recruiting Shoppers:
Application are invited from individuals who want to earn money by shopping in their free time.
Applications are processed by the recruitment team and a face to face, one on one interview is scheduled.
Proper training is provided to selected individuals before they are ready to shop and deliver groceries.

Key Problems and Solutions:

Shopper Retention : As all shoppers work part time, it is difficult to retain them for a long time. To enhance the earnings of shoppers, Instacart added an option to pay tip to a shopper in the check-out section of the website.
Reduce Delivery time : Delivering groceries within 2 hours was a challenge for Instacart. To reduce the delivery time, Instacart places its shoppers outside the stores where it has tie-ups. Whenever a shopper receives an order, he is already at the store saving him 50% of the time.
Shopper Shortage : As Instacart shoppers work as freelancers with flexible schedules, it is difficult to manage the freelancers fleet and assign instant tasks to them. To deal with this problem, Instacart introduced a “busy pricing” policy by which it adds few dollars as delivery charges to a customer’s bill depending on how busy its shoppers are. A part of this additional price is also paid to the shoppers so that they can work as quick as they can.
Customer Trust : Customers lost their trust in Instacart when they came to know that the company is putting up its own pricing for products. These prices are marked up from the in-store prices. Instacart soon admitted to the marked up prices. However, few uses might have stopped using Instacart due to this, but majority are ready to pay the mark-up prices in order to get groceries at their door step.
Wrong item Delivery possibilities : Sometimes a shopper picks up the wrong item and delivers it. To handle all such issues, Instacart has a dedicated support team which can be reached over the phone or through email. Refund is processed if the personal shopper misses an item in the order list.
Out of stock items : Sometimes, Items in the shopping list go out of stock. In such cases, shoppers replace the non-available items with similar items that are available, which might not be wanted by the customer. To deal with this problem, Instacart allowed customers to add notes and they also added a “often out of stock” button on such items for the reference of customers.

The Future:

Grocery delivery business has a great future as more people want the most easy and convenient way to buy grocery items. Promising delivery within 2 hours, instacart has become a powerful solution in the US and with $275 million funding, it is ready to take on other cities in the USA as well as expand outside the country. Forbes has ranked Instacart at the Number 1 spot in the list of America’s most promising company.

So now you know how Instacart works. This amazing technology can be used to create a similar business model in the on-demand segment. If you are dreaming to make the next big thing in this world, then this is the time to take action.

Upload : Amazon series

Rolling Stone Review by Alan Sepinwall



Early in Amazon Prime Video’s new sci-fi comedy Upload, a character explains that her grandmother is in heaven. “Which one?” she’s asked.

The question makes sense within the context of the near future depicted in Upload, where tech companies can — for the right price — digitize human consciousness and grant customers a virtual afterlife of their choosing. There are computerized heavens modeled on the hills of Tuscany, the casinos of Las Vegas, the African veldt, and more, including Lake View — “the only digital afterlife modeled on the grand Victorian hotels of the United States and Canada” — where our hero, young coder Nathan (Robbie Amell) finds himself after dying in a self-driving car accident. .

But the question applies just as easily to the context in which Upload arrives. We are in the middle of Peak TV Afterlife, with lots of shows — many of them from people who used to work on Parks and Recreation with Upload creator Greg Daniels — set partially or entirely in versions of heaven where things aren’t working quite as they should. We only just said goodbye to The Good Place, and, even more recently, the finale to Devs discussed the idea of the recently deceased being given a new digital life. Amazon already dabbled in afterlife ennui with the short-lived Maya Rudolph/Fred Armisen vehicle Forever, and the first season of TBS’ Miracle Workers reimagined heaven as a corporate factory run by an incompetent CEO named God. The HBO miniseries Years and Years had one of its leads attempt to upload themselves to the Web before they died. And several Black Mirror episodes — including arguably the two most famous ones, “San Junipero” and “USS Callister” — involve characters gaining immortality through digital consciousness transfer..

Daniels is among the most gifted and influential comedy minds of the last 25 years of television, responsible for everything from classic Simpsons episodes like “Bart Sells His Soul” and “Homer Badman” to excellent shows he created or co-created, such as King of the Hill, the American Office, and Parks and Rec. But Upload has been in development for what seems like an epoch, going back to the HBO regime of Michael Lombardo (who hasn’t worked there since the Obama administration). So, through no real fault of his own, he can’t help but seem way behind the curve this time.

The show’s satiric portrait of a world in which the afterlife is just an app with pop-up ads and different subscription tiers plays like a longer, gentler Black Mirror story. Nathan’s dawning realization that his wealthy girlfriend Ingrid (Allegra Edwards) — who can video chat with him and even visit him in Lake View using virtual reality equipment — is a vapid monster with whom he will soon be doomed to spend eternity recalls the questions Forever asked about what happens when “’til death do us part” gets an unlimited extension. The bumbling artificial intelligence (Owen Daniels) that staffs Lake View is basically a creepier, much less helpful version of Janet from The Good Place. Nathan quickly grows frustrated to find this grinning A.I. around every corner; the sense of familiarity that Upload unwittingly evokes is just as omnipresent.

Upload has some sharp points to make about income inequality. Nathan can’t afford Lake View himself, and winds up prisoner to the whims of his sponsor Ingrid, while our frequent glimpses of the world he left behind suggest the have-nots have less than ever. (The One Percent can not only get into these digital heavens, but are the only people left who can afford real food, as opposed to the kind made in a 3D printer.) Its commentary about all the ways we’ve allowed corporations’ long tentacles to wrap themselves around our lives (or afterlives) is reminiscent of half of Black Mirror (get ready to be reminded of the one about the perils of being able to rate humans on a five-star scale), but that doesn’t make it any less pertinent to our own increasingly dysfunctional world.

Still, the déjà vu of it all makes the humor play softer than may have been intended. Where Upload is most successful is in depicting a star-crossed romance between Nathan and Nora (Andy Allo), the optimistic customer service rep for the company that runs Lake View. He’s technically involved with Ingrid, and Nora is forbidden from even befriending the “guests,” let alone dating one, yet their attraction is clear from the start. Their attempts to overcome the metaphysical distance between them is one of the few aspects of the show that feels completely current, and not borrowed from another recent series(*).

(*) Even smaller details inadvertently conjure thoughts of other shows. While Nathan is exploring the perks of Lake View, there’s a scene scored to Walter Murphy’s disco classic “A Fifth of Beethoven,” which is the theme song for FX on Hulu’s Mrs. America.

The chemistry between Amell and Allo is strong enough to push aside some sense of of overfamiliarity, and to cover for aspects of the show that don’t quite click. (An investigation into whether Nathan was murdered never really gets up to speed, and Ingrid is so cartoonishly awful that she throws the tone of everything else out of balance.) Once you get past the exposition-laden 45-minute premiere episode, the rest of it is a quick and mostly likable binge. And there are periodic moments of inspiration, be they comic (even in heaven, you can ask to speak to a manager) or something more divine.

Among the show’s running gags is that every corporation we know in 2020 has combined with at least one other, so that Nora and her colleagues are asked to encourage Lake View guests to try a new Nokia Taco Bell dish, while the scientists of Oscar Meyer Intel are hard at work trying to prove that the recently deceased can be downloaded back into clones of their old bodies. This itself is not a new joke — the final season of Parks and Rec, set in what was then the near future, did the same thing — but it seems fitting for a series that feels like an amalgamation of so many pre-existing ideas. Spend too much time in the afterlife — whichever version you prefer — and even the miraculous can get old.

Why China has zero new covid 19 cases and the rest of the world doesnt

April 27, 2020

In this weekly round-up, Richard Lehman looks at a personal selection of articles of relevance to clinicians dealing with covid-19
The Kung Fu of Covid

One third of a year has passed since the start of the covid-19 pandemic, but there is little sense of shared global wisdom. The Chinese sage Kǒng Qiū (551-479 BCE) would be saddened. Among the many sayings attributed to him are: “All people are the same; only their habits differ.” China, with the largest population in the world, is the only one which has come close to eliminating covid-19 within its borders (with the possible exceptions of New Zealand and Iceland, as we go to press). Among 1.4 billion people, daily deaths are zero. Why then isn’t the rest of the world rushing to adopt the habits of China? Another maxim of Confucius/Kung Fu is “Learn avidly. Question repeatedly. Analyze carefully. Then put what you have learned into practice intelligently.”

Dialogue concerning the two world systems

“The man who asks a question is a fool for a minute, the man who does not ask is a fool for life.”

Galileo wrote a dialogue to show you could not believe contrary things at once: either the sun revolved around the earth, or the earth revolved around the sun. Unfortunately the Pope was office-bound to believe the first, and Galileo’s book made him look a fool. Mistake. The pope remained a fool for life, and Galileo remained under house arrest for life. Now, with covid-19, any containment policy either revolves around the value of individual life, or it revolves around the economy. It cannot do both at the same time. China exemplifies the first, and Britain exemplifies the second. On 12 March our chief medical officer, chief scientific officer, and our prime minister Boris Johnson declared in favour of “herd immunity”, and nothing that has happened since shows serious intent to prevent the cull which that implies. Britain has already lost ten times more people per head of population than China during the whole of its epidemic. If we had started by valuing the individual, this would not have happened. And our economy would be less ruined too. Maybe there is time to mend our ways in the second wave.

Controlled Avalanche

“Do not impose on others what you yourself do not desire.”
So let’s say you have embraced the idea of herd immunity, without waiting for a vaccine. That means allowing the infection to spread through the population. It will kill those it is going to kill, but in a “controlled avalanche” that will be spread out to allow some to return to normal economic activity and health provision. That sounds like a good British compromise, though in fact the following model comes from Israel. “Individuals whose probability of developing serious health conditions is low (i.e. 20-49 years old with no comorbidities) will be offered the option to be voluntarily exposed to the virus under controlled supervision, and will then be issued ‘immunity certificates’ if they are confirmed to have developed SARS-CoV-2 antibodies.” I can see that having some appeal, especially to altruistic health professionals who have already voluntarily exposed themselves to covid-19 risk through lack of protective equipment. What I can’t understand is how the modellers come to the conclusion that this “reduces the overall mortality by 43%, reduces the maximum number of people in need for ICUs by 62%, and decreases the time required for release of 50% of the low-risk population by more than 2 months.” How can any controlled infection strategy reduce the virulence and case-fatality rate of the infection itself?

Face value

“If you make a mistake and do not correct it, this is called a mistake.”

When you put on a mask in public, you lose a lot of face. You also stop a lot of droplets. But this is at the cost of adopting a habit that many people in English-speaking countries seem to find repellent. I think they lose more face by insisting on randomised controlled trial evidence than they ever would by just putting on a mask. No RCT is ever going to be as good for detecting harms as a natural experiment involving 2 billion people. No cluster randomised trial of sufficient scale is going to be able to adjust for confounders any better than an observational comparison. Every population observation we have favours masking. Then triangulate this with some simple, common sense physical experiments, such as this: “We found that most home fabrics substantially block droplets, even as a single layer. With two layers, blocking performance can reach that of surgical mask without significantly compromising breathability. Overall, our study suggests that most double-layered cloth face coverings may help reduce droplet transmission of respiratory infections.” I do wish that some EBM-loving friends would admit that some ideas that have face validity are in fact valid until proven otherwise. On faces, even.

Ventilator Mortality

“To know what you know and what you do not know, that is true knowledge.”
A month ago the question on everyone’s mind was how many very sick covid-19 patients would have to be turned away from ventilators. For some of us older people, there was also the question of whether it was worth going on to a ventilator at all. In fact it seems that very few ventilator rationing decisions have had to be made in the UK, and thanks to the brilliant work of ICNARC we know that the mortality of ventilated patients in the UK is 67%. This is based on a much larger sample than from any other country. A more pertinent question may be: which patients really need ventilation and which might do better with a non-invasive strategy? Since continuous positive airways pressure was first proposed as an alternative, surprisingly little seems to have appeared about it in the clinical literature. Meanwhile, high flow nasal cannulas are making an appearance. I hope someone sorts all this out before I arrive on an ICU.

Natural History
“No matter how busy you make think you are you must find time for reading, or surrender yourself to self-chosen ignorance.”

I may have been reading the wrong journals, but so far I’ve found little about the varied natural histories of the illness called covid-19. For sure, there have been plenty of symptom lists and time-course diagrams and so forth, but nothing that’s helped me understand the transition from what I’ve called benign covid into malignant covid. Now a very comprehensive review of the world literature has appeared in medRxiv.

This divides covid-19 into three stages: “the time of infection (Stage I), sometimes progressing to pulmonary involvement (Stage II, with or without hypoxemia) and less frequently to systemic inflammation (Stage III).” The hard-working authors go on to attempt to map therapy on to each stage. That is certainly the central challenge, though it seems hardly addressable in the present state of ignorance.

PM Question Time

“The essence of knowledge is, having it, to use it.”

Now let’s look at the few who die. Remember that modern medicine was not built on numbers but on observation: living patients reviewed on a daily basis, and then examined post mortem should they get unlucky. Autopsy just means seeing for yourself. I am baffled that medicine today should employ so many statisticians and so few gross pathologists. A new article tells us about the lung findings in 38 patients from Northern Italy. Terminal covid-19 is a systemic disease, but I guess it’s better to know about the lungs than about nothing. They are a mess, of course. “The features of the exudative and proliferative phases of Diffuse Alveolar Disease (DAD) were found: capillary congestion, necrosis of pneumocytes, hyaline membrane, interstitial oedema, pneumocyte hyperplasia and reactive atypia, platelet-fibrin thrombi.” There is lots about those thrombi in small arterial vessels, confirming that coagulopathy often dominates the end-stage of covid-19. In 4 patients, there were multiple small lung abscesses caused by bacterial infection.

Silver lining

“Success depends upon previous preparation, and without such preparation there is sure to be failure.” Two and a half millennia later, this Confucian saying reappeared on the lips of Louis Pasteur (1822-95) as “Fortune favours the prepared mind”. Pasteur’s experiments with yeast and cotton wool had prepared his mind to discover that infectious diseases were transmitted by filterable micro-organisms. Before long, other people discovered that certain infectious diseases, like smallpox, were spread by organisms that seemed to be invisible and pass through filters. Subsequently, with better filters and stronger microscopes, these viruses appeared in their full glory. The image of a blob covered in a mass of collar studs that you see everywhere is a triumph of cumulative science. Forget post-modernism. This represents knowledge that is certain and will never go away. Soon it will lead us to an effective vaccine. There is no reason to doubt that: the only question is when and which of the 115+ candidate vaccines it will be. And then it will all seem so straightforward. “Anyone can find the switch after the lights are on.”

No, Confucius did not really say that. There is no record that he invented the electric light in 500 BCE. Yet you can find it in a list of his sayings on Google.
Richard Lehman is professor of the Shared Understanding of Medicine at the University of Birmingham.

The Assistant - subtle movie of the year

The fact that it was directed by a documentary filmmaker like Kitty Green sets the tone for the movie. Just imagine a movie about predatory behavior at workplaces and they dont show the predator or the victims POV but rather the entire mundane life of an omnipresent employee of the firm It explores the tolerance of the public to the nefarious behavior of the wealthy and powerful and how it translates in to the decadence of society.I like how the movie literally walk-through the entire day of the assistant detailing the grind of chores and adhoc requests/tirades thrown at her. There is minimal dialogue in this movie and the director seems to prefer to let silence and facial expressions detail the mood and feelings of the protagonist. This demands an intricate performance fro the artist which Julia garner executed for this role. The minimal use of BGM and devoid of any flashy editing leads to a real life atmosphere throughout the movie.There is no explanation for the

How ARR scored Bombay

National interest - trust the data

Aubade by Philip Larkin

Aubade

By PHILIP LARKIN

I work all day, and get half-drunk at night.
Waking at four to soundless dark, I stare.
In time the curtain-edges will grow light.
Till then I see what’s really always there:
Unresting death, a whole day nearer now,
Making all thought impossible but how
And where and when I shall myself die.
Arid interrogation: yet the dread
Of dying, and being dead,
Flashes afresh to hold and horrify.

The mind blanks at the glare. Not in remorse
—The good not done, the love not given, time
Torn off unused—nor wretchedly because
An only life can take so long to climb
Clear of its wrong beginnings, and may never;
But at the total emptiness for ever,
The sure extinction that we travel to
And shall be lost in always. Not to be here,
Not to be anywhere,
And soon; nothing more terrible, nothing more true.

This is a special way of being afraid
No trick dispels. Religion used to try,
That vast moth-eaten musical brocade
Created to pretend we never die,
And specious stuff that says No rational being
Can fear a thing it will not feel, not seeing
That this is what we fear—no sight, no sound,
No touch or taste or smell, nothing to think with, Nothing to love or link with,
The anaesthetic from which none come round.

And so it stays just on the edge of vision,
A small unfocused blur, a standing chill
That slows each impulse down to indecision.
Most things may never happen: this one will,
And realisation of it rages out
In furnace-fear when we are caught without
People or drink. Courage is no good:
It means not scaring others. Being brave
Lets no one off the grave.
Death is no different whined at than withstood.

Slowly light strengthens, and the room takes shape
. It stands plain as a wardrobe, what we know,
Have always known, know that we can’t escape,
Yet can’t accept. One side will have to go.
Meanwhile telephones crouch, getting ready to ring
In locked-up offices, and all the uncaring
Intricate rented world begins to rouse.
The sky is white as clay, with no sun.
Work has to be done.
Postmen like doctors go from house to house.

Why "The office" is not relatable to reality

By Julia Alexander - The Verge

The scenes that make The Office special aren’t overly zany but are extremely relatable, like Dwight Schrute making an obnoxious sales call at his desk, while Jim and Pam roll their eyes at their colleague’s behavior. It happens almost every episode: two people, the stand-ins for the audience, acknowledging just how annoying the workplace is.

 The Office is a show about the random, boring bits of everyday work life and the comedy that ensues from being surrounded by the same people on a daily basis. Employees sit at their desks, jokes are made, and snacks are munched on. Fifteen years later, it’s still one of the most enduring sitcoms because The Office is an extraordinarily ordinary depiction of modern working life in America — well, it was.

 How jobs look has shifted radically over the last decade. The coronavirus pandemic simply sped up the circumstances for many industries. The gig economy is one of the biggest notable transitions. Uber, Lyft, Fiverr, Amazon Flex, and Airbnb didn’t exist 15 years ago when The Office premiered. Now, there are more than 55 million gig economy workers in the United States, according to Forbes. That’s more than 55 million people who don’t go into an office every day and share a kitchen with co-workers. Their idea of day-to-day work is already different from what The Office presented.

 Before the pandemic forced us inside, The Office was relatable. How does a workplace comedy operate without a workplace? Today, it feels like a piece of popular culture from eras past. Social distancing measures mean more people are working from home. Gags have shifted from pranking your deskmate to creating weird glitch art on Zoom using random anime backgrounds; hijinks in the shared kitchen turned into creating new Slack emoji to deliver a joke faster

. Even those who aren’t in gig economy jobs are facing a time when physical offices aren’t necessary for most companies. Instant communication tools like Slack make talking with co-workers possible from anywhere, remote work is easy to do with an assortment of productivity services. Michael Scott’s outbursts in The Office don’t transition well to Slack, where the equivalent is a message typed out in all-caps. That’s not as funny. Videoconferencing has also never been easier. Services like Zoom allow remote workers to talk face-to-face, all from the safety and comfort of their own homes.

 In 2019, Zoom saw heights of 10 million daily users — by March 2020, Zoom was hitting “more than 200 million daily meeting was
 both free and paid,” CEO Eric S. Yuan wrote in a blog post. “We did not design the product with the foresight that, in a matter of weeks, every person in the world would suddenly be working, studying, and socializing from home,” Yuan wrote.

 Companies have transitioned quickly from operating in physical spaces to moving everything online. Zoom is hitting record-breaking numbers, as is Microsoft Teams, a group chat and collaboration tool from Microsoft that rivals Slack. Slack is no different. CEO Stewart Butterfield shared numbers in a lengthy tweet thread, noting that on Tuesday, March 10th, Slack’s concurrent users passed 10 million. That number jumped to 10.5 million just six days later, reaching 12.5 million on March 25th. “We have an incredible business that has been growing very quickly and that will continue to do so for many, many years to come,” Butterfield told Slack employees, as seen in screenshots he tweeted. “We provide a platform that is going to become even more useful to the world in the years to come.” This pandemic will forever change parts of our lives, much like the 1918 influenza did more than 100 years ago. A big part of that will be the physicality of work. “The age of the office as we know it is probably over, and the bell can’t be unrung,” Matt Burr, CEO at Nomadic Learning, wrote in The Wall Street Journal recently.


 More employees, once ready to commute into an office every day, will use tools like Slack and Zoom to work from home more often, according to Burr. Companies will see less of a reason to have physical space and will use remote advantages to build teams in different cities. Work has changed, and television will follow. Pop culture has always reflected our lives at a certain moment in time. Similar to how we revisit The Dick Van Dyke Show or Growing Pains to scratch the nostalgic itch for times when families were corny and homely or marathoning shows like Friends and How I Met Your Mother to reminisce about a time when people actually hung out, The Office yearns for simpler times. Actress Angela Kinsey (who played Angela Martin on the show) described the series as inexplicably comforting. That comfort comes from the normalcy of a work routine — something I’ve come to miss in the weeks I’ve been at home.


 Less than 20 years ago, people worked in offices. Now, many of us work from home. Ben Silverman and Paul Lieberstein, co-producers on The Office, are developing a new workplace comedy, but this one won’t include characters like Dwight and Jim throwing pencils at each other over their computers. Instead, the show is about a “wunderkind boss who, in an effort to ensure his staff’s connectedness and productivity, asks them all to virtually interact and work face-to-face all day,” according to Deadline. We’ve walked toward this change in work culture for years, but now it’s here for millions of people. The pandemic didn’t suddenly flip a switch; it proved that people can — and will — work without an office.

Last year, the US Bureau of Labor Statistics reported that 26 million Americans, or approximately 16 percent of the total workforce, work from home. Imagine if half of The Office’s cast suddenly stopped showing up because they could conduct calls at home and check in with co-workers online. Between 2005 and 2015, employees who telecommuted rose by 115 percent, the bureau reported. Those years also happen to represent The Office’s run. As The Office went off the air, so did the idea that day-to-day work would look the same as it did in 2005. More than 55 million people are gig workers who don’t have offices to go to, more people are set to work from home than ever, and an entire generation of employees may not experience that type of work setting — one considered universal less than 20 years ago. That’s the future pop culture will incorporate. There’s something poetic about The Office’s co-producers being some of the first to try. “Start with the office comedy, lose the office and you’re just left with comedy,” co-producer Lieberstein told Deadline. “The math works.”


 In themeantime, many of us are at home, so lonely that we are wistfully streaming old episodes of The Office, longing for the Dwight Schrutes in our lives, wishing they could do something annoying enough that we could turn to another colleague for just a moment and roll our eyes.

Westworld : season 4 wicked games

One of the best violin pieces...

Ramin djawadi is a legend in television music. Always able to capture the moment in the episode

People in the trees

Then there was the matter of the jungle profligacy which I began to resent as if it were an overdressed woman parading her entire cache of sparkly jewels before me. I felt that the jungle was constantly showing off to itself - every rock, every tree, every surface that would stay still was trimmed, bedecked , baroque with greenery there was fistulas of bushes wrapped with creeping vines and spotted with moss ....... It was an exhausting performance that never ended and for what? To prove the imperturbability of nature , I suppose it's unknowability it's fundamental lack of interest in humanity. Or at least that's what it seemed like at the time a mockery. It was absurd. I knew to wake each day and resent the jungle and my own insignificance in it . But I couldn't help it. I began to think that I might be going a little ,- well not crazy I suppose but that I might be losing touch as they say now. And then I felt childish and amazed ............

An excerpt in The people in the Trees by Hanya Yanagihara

Building a Fire - By Maxine scates

Staring at the flames of the woodstove fire
guarded by its glass door, I’m trying to remember
what I’m good at—surprised when it occurs to me
I’m good at making this fire out of kindling
I’ve split, plus one piece of fir and two of oak, cut
from the large branches of the neighbor’s oak
that fell across the road two years ago
on a winter evening. We were driving home
when we saw the flashlights telling us to slow,
the road impassable. It was then I lost my glasses
climbing over a downed tree, and when we
reached our house I called my neighbor,
not yet home from work, to tell him his tree
had fallen and, at first, he thought it had fallen
on his house, as if he already saw our oak glancing
off his roof a year later during the ice storm,
when it seemed every oak in the neighborhood
fell at the same moment. By then, our neighbor


had enough wood and so we cut our old oak
and hauled it up the road. All our ricks
are overflowing now, filled with oak
and four fir trees that died over four summers
due to drought or sunburn, the man who cut
them down said, the consequence, no doubt,
of the woods in front of us being clear-cut to build
a house free of the hazards of trees. Today,


I had jury duty and the D.A. asked me if I thought
economic hardship could impact a relationship
and I said yes, I certainly did. And when the defense
attorney asked about domestic violence, I said
I’d grown up with it, it being the shout and stumble,
the raw confusion of the shove and slap . . .
though it was all I said, and then I said I’d listened
to the charges and the judge’s emphasis on the phrase
“beyond a reasonable doubt” and thought I could
be fair, perhaps because, like my fire contained
in its iron box, for a moment I believed in the clarity
of language, its unblurred definition. I should


have known what I’d said was enough
for the defense attorney to want me gone from
that grim room where the jurors’ chairs did not face
the defendant, accused of harming two people
who shared his name, and the bailiff’s shoes
were scuffed and the judge seemed to be looking
at his computer screen most of the time. And when
I picked up my belongings to go, even as the judge
was thanking me, I hurried, feeling as if I’d done
something wrong, to the door, where I realized
I didn’t know how I’d gotten there because
the bailiff had led us, so for a while I walked down
hallways where each door opened to a courtroom
where people’s lives were changing one way
or the other. Then I came home and built this fire,


and my brother called to tell me my mother
had done just fine with the physical therapist until
she started to shake because her muscles tire. They
both live where there is no need to build a fire on
a cold night though the hills around them
are rimmed by the glow of fire pushed by warm
winds in this dark December. I doubt they think
of those long-ago nights in our small house,
nights grown distant enough that even I thought
I could judge the facts as if they were discrete—
and free of unending consequence

Toss a coin to your Witcher

Witcher Season 1 review : IGN

In its first, short season, Netflix’s The Witcher has a lot of work to do. A whole new world must be introduced, with all its many races, kingdoms, and the laws - both political and metaphysical - that govern it, not to mention a cast of characters with strange names and unfamiliar positions in society. But Netflix’s fantasy darling rises to this challenge, and by the end of its eight-episode run has transformed Polish author Andrzej Sapkowski’s books into a fascinating cinematic world of fearsome monsters, corrupt kings, and scheming mages. But the journey to that end point is messy, convoluted, and littered with poor performances, dialogue, and direction. It makes for a show that is equal parts entertaining and exasperating, and falling a little short of its massive potential.

The Witcher is headlined by a dedicated performance from the perfectly cast Henry Cavill, taking on the role of Geralt of Rivia; a grizzled man mutated to the point of being superhuman. Shunned by society, he makes his way through life by slaughtering monsters for anyone who will pay the coin, be they prince or pauper. The season’s first episode introduces him as a character with a starkly black-and-white view of the world; there is good and evil, and no sense of anything in between. He harbours, almost Batman-like, an unbreakable rule: he never kills humans.

Cavill clearly relishes the role; he’s often shared his adoration of the books and the CD Projekt Red video games, and that shines through. His look and demeanor for the show is essentially a high-end cosplay of Geralt from the games. His gravelly vocal performance captures the character’s decades-long weariness, which, when combined with mostly curt, short lines of dialogue helps convey a man who often has little interest in the debauched kings or squabbling people who hire him. But while those traits make him true to the source material, a lack of genuine plot development for Geralt means there's a little depth or nuance; a couple of episodes challenge his values, but by the finale it feels as if the White Wolf is no more interesting than he is in the premiere.

Geralt is the driving force behind most of the show’s action sequences, which feature some of the best sword fight choreography seen on television. Their direction fully embraces that this is a fantasy show, rejecting any need for historical accuracy or realistic strength. One particular battle, set within the decadent halls of a palace, utilises camera work that follows the combatants’ blades in swinging motions, which calls to mind the slick, stylized fights of superhero films.

While always entertaining, the quality of each individual fight does vary depending on Geralt’s opposition. Choreography is at its very best when he’s clashing with humans, as it allows for tense and loud sword parries. Against monsters the results are less explosive; creatures rendered in CGI have less weight and often look a little cheap, and so make for less believable encounters. Netflix's The Witcher: Cast vs. Video Game Characters Monster designs are always fantastic, though, even if their construction doesn’t make for the best action. Part of the appeal is their root in Polish and Slavic folklore; chances are you’ve not seen anything like them in any Western European or American fantasy show before. Episode 1 opens on a fight with a kikimora, and while the CGI budget sadly doesn’t allow for it to be a Game of Thrones-style delight, the crustacean-like horror of its numerous bony limbs still has a sense of grim fun. The best creatures are those with enough human properties to allow a prosthetic-covered human to still convey a sense of emotion, though; a goat-headed Sylvan or a knight with an hedgehog-like face and spines for hair are among the show’s best-realised beasts.

Geralt may be The Witcher’s protagonist by virtue of him being the titular character, but he is just one of a trio of core characters. And while Cavill provides the best embodiment of the three, it’s Anya Chalotra’s Yennefer that actually proves the show’s most compelling character. Acting as an origin story, this season chronicles Yennefer’s rise from deformed farm-hand to embittered sorceress. It’s a dark, harrowing tale dealing with abuse, betrayal, and anger, which delivers consistent growth and enjoyable turns with each successive episode.

Chalotra deserves recognition for her portrayal of Yennefer in her earliest scenes, in which a mouth-piece and hunchback prosthesis is used to bring her deformities to life. Despite all the visual elements, her performance focuses on Yennefer’s sadness and anger, which significantly humanises what could have been an uncomfortably one-note story. Unfortunately that subtlety is lost as Yennefer becomes stronger in the narrative. Chalotra’s on-screen confidence doesn’t match that of Yennefer’s growth, leaving her feeling unconvincing in later episodes.

Completing the trio is Freya Allan’s Ciri, princess of the Kingdom of Cintra. Her destiny is entwined with Geralt’s, and much of her story follows her journey to meet with the Witcher whom she has never previously met. From the first episode Ciri is emphasised as an important piece of the show’s puzzle - she’s of particular interest to the Nilfgaardian Empire, this world's evil stampeding force - and her fate is the subject of the show’s overarching narrative. It’s frustrating, then, that so little time is spent with her; one episode entirely ignores her for all but its final few minutes. This neglect makes Ciri feel little more than a macguffin for Geralt to find, rather than a compelling character in her own right.

The other result of Ciri’s limited screen time is a sense of tardiness in the season’s pacing. Episode 1 acts as a strong introduction to Geralt and Ciri, setting up the stakes involved and why it’s vital that the two characters meet. But Ciri’s continued relegation to the back seat of the show means that half the season goes by before any even limited development is made upon the problems set out in the premiere.

This is made worse by a confused approach to the show’s overall construction. Showrunner Lauren Schmidt Hissrich has opted to adapt short stories from Andrzej Sapkowski’s The Last Wish and The Sword of Destiny collections and thread them together with longer-running plotlines, and the season constantly feels like a war between these brief and extended formats. The short story adaptations, always featuring Geralt, make for a series of fun monster-of-the-week style episodes akin to The X-Files or Supernatural. Their one-and-done nature means Geralt is always in the thick of it, with the show constantly exploring fun new ground, but the lack of connective tissue between each adventure limits his development, and means he’s almost always divorced from the larger plotlines. Ciri’s story is serialised in nature, but feels hamstrung while it waits for Geralt to catch up - which he never does because he’s still got short stories to episodically experience. Only Yennefer’s storyline feels as if it truly works, almost certainly because much of her story is original material written for the show that neatly weaves her adapted sequences into a larger framework.

Furthermore, each character’s adventures are distinctly different in tone. Geralt’s stories often involve humour and have an almost Dungeons & Dragons podcast vibe, while Yennefer’s story is incredibly dour and tragic. It could be argued that this variety of perspectives demonstrates the world’s plethora of experiences, but it mainly serves to undermine any sense of cohesive tone and iron-forged identity. Is this a fun romp that’s designed to chronicle tabletop RPG-like antics, or a dark look at the perils of power? If it’s the latter, frequent soap opera-esque dialogue and ham-fisted handling of the show’s most interesting morality issues derail any genuine sense of seriousness. The Witcher is an oddly camp show, mixing traditional fantasy dialogue with jarringly modern turns of phrase (largely a crime committed by Jaskier, Geralt’s increasingly irritating bard companion). And by not consistently playing the world straight, the show can occasionally feel as if it lacks conviction in its own setting.

Making things feel further disjointed is the fact that all three main characters exist in different time periods, with their stories told at different speeds. For one character, this season takes place over a matter of days. For another, it’s three decades. The core trio being separated by space and time is something that the show makes very little effort to communicate outside of a few off-hand lines of dialogue. I believe this comes from a good place - showrunner Hissrich is on record saying that she trusts the audience to be smart - but unfortunately the indicators simply aren’t strong enough. While the timelines do finally combine and produce a satisfying merging of the stories, the payoff does not justify the obtuse journey, especially as it has no real narrative payoff such as that seen in HBO’s Westworld.

These problems prevent The Witcher from achieving its potential, but they don’t derail the experience entirely. On an episode-by-episode basis the stories are often engaging and provide some solid thrills. As an anthology of standalone quests the show is actually pretty successful, if not played as straight as the stories deserve. And special note should be paid to composers Sonya Belousova and Giona Ostinelli, who provide an exceptional score for the series that builds atmosphere and provides The Witcher with a genuinely unique signature.

But viewing the season as a whole reveals an admirably adventurous experiment gone awry, where the fundamentals of cinematic storytelling are discarded in a misguided attempt to surprise viewers with multiple time periods, and the storytelling is muddled between episodic and serialised plotlines. That it all comes together at the end of the season is satisfying mostly because it's a relief that The Witcher makes it there largely intact. Essentially, it’s less than the sum of its parts.

Verdict The Witcher’s first season is unconventional and messy. It’s failed by its convoluted structure, which ultimately restricts character growth, and prevents the show from having any true sense of depth. This makes for an unsatisfying big picture, but thankfully there are plenty of things to enjoy in its individual components. Henry Cavill has found his perfect match in Geralt of Rivia, and his appreciation of the role helps elevate all of the White Wolf’s storylines above their imperfections. Anya Chalotra’s Yennefer doesn’t get the depth of character exploration that her character deserves, but does demonstrate the show’s ability to weave a complex, consequential journey. And, weak CGI aside, the show is filled with beasts - both human and monstrous - that give the show a unique, Slavic flavour.

This eight-part season is effectively a prologue for the show’s main story, which has only just begun in the finale’s last scene. And while that does mean that these hours do feel somewhat inconsequential and exposition-heavy, they do establish a fascinating world worth exploring. Indeed, as the credits roll you’ll almost certainly reach for a copy of The Last Wish or boot up the games to continue that adventure. But if you do, you’ll likely discover that Netflix’s The Witcher has a bit of work to put in before it hits the high quality bar set by the story’s other mediums.