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Bold Idea: The ‘Spotify for Textbooks’

The cost of a college education is significantly higher than it was in years past. Tuition for many universities and colleges has grown at a steady pace, and student loans debt is a recognized issue. But adding to these costs are the rising prices of textbooks. A single textbook can easily cost between $200 and $300, and this can limit educational access for some students. In fact, a significant percentage leave school because of the added expenses of necessary course materials. Understanding this, it’s not surprising that several new businesses are trying to provide digital textbooks to students. And some of the boldest now offer online textbook subscription services similar to those of Spotify for streamed music.

While several companies provide digital textbooks and other materials, one of the most successful is Perlego. This London-based startup boasts hundreds of thousands of textbooks and is looking to change the way students and institutions interact. In addition to its online textbook subscription service, Perlego hopes to be a one-stop platform for students, publishers, and educators. In essence, the company’s vision extends well beyond reducing textbook costs and improving student educational access. It dreams of being a central source for digital learning offering education without boundaries.  (Dig into Bold Business’ exploration of the age of education without boundaries in this story!)

“The market for educational content has lagged other types of content, which have successfully digitized and offered new models of consumption to users. We believe that adoption of an online subscription model in this category is inevitable.” – Elizabeth Brillman, VC partner at Raine Ventures

A Snapshot of Perlego

Perlego was founded in 2017 after its two founders graduated from college. Appreciating the high costs of course textbooks, they believed there was a better way. Without question, their business thrived during the pandemic as online college programs changed. But more importantly, students immediately saw the benefit of their online textbook subscription service. Given than many books are purchased with limited overall use, streaming textbooks and other materials simply makes sense. This is what made Perlego the most popular and largest digital textbook resource today.

By all accounts, the company looks to be thriving. It currently has over 400,000 subscribers to its platform. It also has over 850,000 titles in its library of digital textbooks and other materials. At the same time, Perlego works with several major textbook published including names like Cengage, Routledge, and Elsevier. In total, there are over 5,000 educational publishers with books on Perlego’s online textbook subscription service. But there’s more. The company also partners with more than 6,000 educational institutions in 172 different countries. These collaborations has been a big reason why Perlego has seen a 450% growth rate in 2021 alone.

“A big issue for publishers is that they price textbooks high in part to offset piracy. A model like ours not only prevents piracy, but it reduces the need for second-hand books.” – Gauthier Van Malderen, Cofounder of Perlego

A Win-Win for Textbook Publishers

Developing such a large number of digital textbooks in its online textbook subscription service wasn’t easy. Initially, textbook publishers were reluctant to partner with Perlego. But it soon became clear that Perlego offered several advantages that addressed publisher concerns. One of the most notable ones involves piracy of textbooks. Because costs of these materials have been so high, bootleg sites attempt to illegally sell pdf’s and texts to students. In 2021 alone, more than 2 million searches for piracy offerings by students were intercepted by Perlego. Because Perlego is able to make textbook costs reasonable, the incentive for illegal textbook copies have become less.

A student reading a digital textbook
Digital textbooks via subscription service? That sounds like a BOLD idea!

At the same time, Perlego is attractive to textbook publishers for other reasons. Publishers must also battle second-hand sales of textbooks among students also. Given that academic texts are highly specialized and written by professors and experts, development costs are substantial. Likewise, unlike other books, textbooks have much more limited printing volumes. All of this forces publishers to raise their prices for textbooks, making second-hand sales at lower prices very attractive. But digital textbooks accessed via Perlego are even cheaper than these offerings. This also made the company’s online textbook subscription service appealing to major publishers.

“Perlego is changing the equation for university students, helping them access course resources, while also enabling publishers to move online and harness new revenue opportunities.” – Paul Verwilt, COO at Mediahuis

Perlego’s Vision for the Future

Perlego’s online textbook subscription service has been a success by itself. Students can pay $18 a month to receive unlimited access to the company’s library of digital textbooks. This has been enough to stimulate major growth and to earn the company an additional $50 million in Series B funding. But the company’s founders, this is just the beginning. The dynamic platform they hope to provide is one that invites greater functionality to the entire educational system. This includes expanding offerings beyond digital textbooks to other academic materials. And it also involves developing a more interconnected network among academic institutions.

Perlego foresees being able to offer students not just digital textbooks but also videos and a variety of pdf’s. By signing up for the company’s online textbook subscription services, these might also be accessed. Alternatively, the company might develop tiered pricing and include these in its premium services. At the same time, the cofounders believe educational institutions could utilize their platform for grading and assignments. Given that Perlego would have easy access to digital textbooks, this could streamline entire online college campuses. Without question, it will be interesting to see where Perlego goes next.

The Competitive Landscape for Perlego

It’s worth noting that Perlego has some sizable competition in the area of digital textbooks and online textbook subscription services. Chegg, Open Library, and Libre Texts are among the best-known companies in this industry. But despite being relatively new to the market, Perlego has amassed more digital textbooks and more subscribers than the others. This includes the U.S. student market as 40% percent of all Perlego users reside in America. This is why investors believe Perlego may be the Spotify of online textbook subscription services in the future. In any case, all of this is great news for college students worldwide. It’s a bold idea that’s certainly overdue.


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Bold Boomer Series: Leveraging Robotics for Elder Care

(Editor’s note: Welcome to the third installment of the Bold Boomer Series, which will delve into various topics affecting the “Baby Boomer” generation. Check out the first installment, which explored innovative solutions for healthcare expenses in retirement, here, and the second installment, on the semi-retired life, here!)

The aging of the population is placing increasing demands on elder care across the globe. There are currently over one billion individuals over 60 years of age in the world. This figure is expected to rise to more than 1.4 billion by 2030. In some countries, such demographics are even more impressive. For example, in Japan, roughly a third of the population is over 65 years. As a result, Japan has been proactive in its support for elder care robots. Since 2015, it has subsidized the development of robotic assistants for senior people. And now, it looks like other areas of the world are following suit.

In terms of elder care robots, these technologies do much more than provide senior companionship or remote access to care. Robotic assistants for senior people are performing an increasing number of activities today. These not only include direct care services but also help in combatting loneliness and isolation. (Dive deeper into the use of AI chatbots to stave off loneliness in this Bold story.) As a result, the industry as a whole is expected to grow by nearly 25% annually for the next several years. By 2026, the market for elder care robotics is expected to exceed $2.2 million in revenues. And with nursing shortages and constraints on healthcare expenditures, these innovations couldn’t come at a better time.

“Over the course of the pandemic, we’ve seen the devastating effect that loneliness can have on the older adult population. At the same time, we’ve seen ElliQ be incredibly helpful to our beta users and put a smile on their faces.” – Dor Skuler, CEO & Cofounder of Intuition Robotics

Advances in Elder Care Robots

For many years, robotic assistants for senior people were considered a novelty. As humorous companions, these devices weren’t necessarily taken very seriously. But this has changed significantly in the last decade. Elder care robots now provide an array of services designed to ease caregiver burden and enhance the care of older adults. Not only can they provide emotional support and companionship, but they are also being used to assist with personal care. They are also being utilized to enhance remote access to care providers while educating individuals about health and wellness activities. The scope of robot services these now provide are constantly expanding.

Advances in the use of elder care robots has been most noticeable recently within older care facilities and hospitals. With nursing and care assistant shortages, these technologies are trying to fill voids in care resources. Some offer exoskeletons that can assist with patient lifting. Others perform mundane tasks like cleaning and organizing within nursing homes and hospitals. While there remains significant room for improvement, caretakers and older adults alike are welcoming these devices. This is why most predict that robotic assistants for senior people will continue to increase in the number of services they can provide.

“It’s a force multiplier for care staff. It’s not to replace people, but it’s to augment how people care for people.” – Conor McGinn, Mechanical Engineer at Trinity College, Dublin

Robotics Offerings on the Market 

Roughly two decades ago, one of the first robotic assistants for senior people introduced was PARO. This baby robotic seal was used as an emotional support robot and companion for older adults in Japan. Studies subsequently demonstrated that interactions with PARO resulted in lower blood pressure among seniors. In essence, it appeared that PARO had similar effects as live pets in this regard. But elder care robots have come a long way since then. And today, there are several companies on the market exploring their potential in senior care.

A robot hairdresser about to mess up some poor woman's hair
They may not be as entertaining as R2-D2 and C3PO, but elder care robots might help an aging population.

For example, Diligent Robotics was founded in 2017 and created Moxi, one of the more well-known robotic assistants for senior people. Moxi is a rolling, one-armed robot with LED eyes that is being used within hospitals to perform a variety of tasks. These include things like delivering medication, fetching supplies and equipment, and handling patient linens. Using an app-based system, hospital staff can request services from Moxi to reduce care burdens within a facility. Another company also founded in 2017 was Hello Robot based in Martinez, California. This company is pursuing the development of elder care robots that assist with senior tasks at home. Its robot Stretch can assist with vacuuming, playing with the dog, and collecting clothes from the dryer.

Intuition Robotics recently made headlines as well with its line of elder care robots. Its premier release is named ElliQ, which utilizes psychology, behavioral science, and advanced cognitive AI. ElliQ is used within older adults’ homes as well, and it promotes engagement, connectedness, and activity. Users of the device average about 20 minutes of interaction time daily, which boosted exercise, reduced stress, and improved sleep. Intuition Robotics offers these robotic assistants for senior people for a $250 enrollment fee and $30 monthly subscription. This type of services looks to be the likely way of the future.

“Older adult populations are often limited by barriers to care, which not only leads to feelings of isolation, but can also negatively affect long-term health outcomes. Our work will allow seniors to stay connected to their community — whether that be a doctor’s appointment or a church group.” – Caitlin Donovan, Global Head of Uber Health

A Continued Work in Progress

While advances in robotic assistants for senior people are noteworthy, that doesn’t mean obstacles don’t remain. The use of robots in warehouse manufacturing allows a more predictive setting for design. In comparison, elder care robots much traverse people’s homes and care facilities that are often more unpredictable. Likewise, these robots also have a much higher rate of human interactions and unexpected encounters. This naturally poses serious challenges for those designing robotic assistants for senior people, especially from a safety perspective. But based on the work to date, tremendous progress is being made. As sensors and AI technologies advance, it’s probable that the market for elder care robots will continue to expand. And leveraging these technologies will become increasingly important as older populations grow and care staff volumes shrink.


Believe it or not, “Baby Boomer” goals are Bold Goals, too. Read more in this recent Notes From Ed!

Healing Hearts with an Innovative Bionic Pacemaker

There are over 26 million people suffering with heart failure in the world. Caring for these individuals consumes about two percent of all national healthcare budgets. Even worse, the 50-percent mortality rate for these patients is roughly five years. This highlights the need for better preventative and care strategies. Available medications certainly help improve symptoms, but they do little if anything for reversing underlying problems. And many of these individuals have associated heart rhythm disturbances that can be life-threatening. These are often managed with a pacemaker of the heart. But traditional pacemakers fail to improve heart function otherwise. This is an area that scientists and clinicians would like to better address.

Recent studies out of New Zealand now suggest, however, that new approaches to heart failure may be around the corner. Researchers have been investigating a bionic that not only corrects irregular heart rhythms but actually improves heart failure. While these studies have only been performed in animals thus far, human trials will begin soon. If the results are the same, then this innovative pacemaker of the heart could be a game-changer. It has the potential to save billions of dollars globally in heart failure management. And it could significantly improve quality of life and longevity for patients with heart conditions. Plus, researchers even envision their device being utilized for non-cardiac illnesses in the future.

“Currently, all pacemakers pace the heart metronomically, which means a very steady, even pace. But when you record heart rate in a healthy individual, you see it is constantly on the move.” – Professor Julian Paton, Director, Manaaki Manawa, the Centre for Heart Research at the University of Auckland, New Zealand

Heart Failure and Traditional Pacemakers

In terms of heart failure, there can be different causes. Some who suffer heart attacks will have residual heart muscle damage that can lead to heart failure. This is why innovative heart disease prevention techniques are being pursued. (Read more about nanoparticles as a biomedical therapy in this Bold story.) Others may have leaky heart valves that may cause this as well. In both cases, changes in the muscle can lead to cardiac arrythmias. Because the electrical rhythm generators exist partially within the heart muscle, this is not an uncommon occurrence. And the standard of care is to manage these patients with medications and/or a pacemaker of the heart. But a traditional pacemaker of the heart operates like a metronome…a steady, rhythmic beat. But scientists have long known this is not how the heart’s rhythm typically behaves.

With normal heart function, the heart’s rhythm varies with each breath we take. When we inhale, our heart rate increases slightly. When we exhale, the opposite occurs. However, patients with heart failure lose this natural variability in their heart rhythm. As a result of heart muscle injury, the normal association of the heart’s rhythm with breathing is significantly diminished. Researchers are now learning how important these rhythmic variations are based on recent studies. And while a traditional pacemaker of the heart does little to change this, a bionic pacemaker can.

“…[T]his study shows introducing a natural variation in the heartbeat improves the heart’s ability to pump blood through the body. The other big news is that we get a 20 percent improvement in cardiac output, which is effectively the ability of the heart to pump blood through the body.” –  Dr. Rohit Ramchandra, Researcher, Department of Cardio-physiology, University of Auckland, New Zealand

The Promise of a Bionic Pacemaker

For the last five years, researchers in New Zealand have been working on a bionic pacemaker. The University of Auckland has been working with Ceryx Medical, a startup biotechnology company based on Wales. The bionic pacemaker device they have developed goes by the name of Cysoni, and several animal trials have now been conducted. In these trials, heart failure animals wearing the bionic pacemaker demonstrated significant improvements in overall heart function. Once the heart rhythm was better coupled with breathing patterns, the heart began to pump much more efficiently. In fact, some of the animals showed a 20 percent improvement in pumping abilities. Considering a traditional pacemaker of the heart shows only minor benefits in pumping function, these findings are substantial.

A medical professional doing something to some dude
Heart failure vs. bionic pacemaker–who wins? People do!

At a more cellular level, researchers found more profound evidence that their bionic pacemaker induces heart failure improvement. Heart muscle cells require T-tubules in the muscle to allow for a strong muscular contraction. This leads to better pumping abilities of the heart. Unlike a regular pacemaker of the heart, the bionic pacemaker improved T-tubule function. Plus, other pathologic changes of heart muscle cells, like unhealthy enlargement, was reversed. As a result, the animals with these devices showed significant improvements in exercise performance. This combination of cellular repair and improved function are reasons why scientists are so enthusiastic about the Cysoni device.

“We typically see improvements in heart function with current pacemakers, but this bionic pacemaker has far exceeded our expectations. This discovery may revolutionize how heart failure patients are paced in the future.” – Dr. Martin Stiles, Cardiologist, Waikato Hospital, New Zealand

Human Trials to Follow

Ceryx Medical and University of Auckland researchers are planning to move forward with human trials in the near future. After performing rigorous testing on their bionic pacemaker for the last half-decade, they believe they’re ready for this next step. If successful, Ceryx Medical stands to reap their benefits of their efforts. Owning the patent for their unique biotechnology, they would be the first-to-market with this new approach. Likewise, researchers involved in the latest studies also see this as being revolutionary in terms of heart failure patient care. They foresee this as a disruptive technology that could make the typical pacemaker of the heart obsolete.

While human research and subsequent approval for a bionic pacemaker is likely a few years away, its potential is significant. This primarily applies to heart failure management, but researchers suggest these variability pacemakers could improve other health conditions. For instance, some with cognitive impairment might see improved memory and concentration using such devices. Other types of organ failure patients may also benefit from enhanced cardiac pumping efficiency. These are areas that will require further investigation. But for now, many see the bionic pacemaker as the future of heart failure management.


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