Many States Say Cuts Would Burden Fragile Recovery

States are increasingly alarmed that they could become collateral damage in Washington’s latest fiscal battle, fearing that the impasse could saddle them with across-the-board spending cuts that threaten to slow their fragile recoveries or thrust them back into recession.

Some states, like Maryland and Virginia, are vulnerable because their economies are heavily dependent on federal workers, federal contracts and military spending, which will face steep reductions if Congress allows the automatic cuts, known as sequestration, to begin next Friday. Others, including Illinois and South Dakota, are at risk because of their reliance on the types of federal grants that are scheduled to be cut. And many states simply fear that a heavy dose of federal austerity could weaken their economies, costing them jobs and much-needed tax revenue.

So as state officials begin to draw up their budgets for next year, some say that the biggest risk they see is not the weak housing market or the troubled European economy but the federal government. While the threat of big federal cuts to states has become something of a semiannual occurrence in recent years, state officials said in interviews that they fear that this time the federal government might not be crying wolf — and their hopes are dimming that a deal will be struck in Washington in time to avert the cuts.

The impact would be widespread as the cuts ripple across the nation over the next year.

Texas expects to see its education aid slashed hundreds of millions of dollars, which could force local school districts to fire teachers, if the cuts are not averted. Michigan officials say they are in no position to replace the lost federal dollars with state dollars, but worry about cuts to federal programs like the one that helps people heat their homes. Maryland is bracing not only for a blow to its economy, which depends on federal workers and contractors and the many private businesses that support them, but also for cuts in federal aid for schools, Head Start programs, a nutrition program for pregnant women, mothers and children, and job training programs, among others.

Gov. Bob McDonnell of Virginia, a Republican, warned in a letter to President Obama on Monday that the automatic spending cuts would have a “potentially devastating impact” and could force Virginia and other states into a recession, noting that the planned cuts to military spending would be especially damaging to areas like Hampton Roads that have a big Navy presence. And he noted that the whole idea of the proposed cuts was that they were supposed to be so unpalatable that they would force officials in Washington to come up with a compromise.

“As we all know, the defense, and other, cuts in the sequester were designed to be a hammer, not a real policy,” Mr. McDonnell wrote. “Unfortunately, inaction by you and Congress now leaves states and localities to adjust to the looming threat of this haphazard idea.”

The looming cuts come just as many states feel they are turning the corner after the prolonged slump caused by the recession. Gov. Martin O’Malley of Maryland, a Democrat, said he was moving to increase the state’s cash reserves and rainy day funds as a hedge against federal cuts.

“I’d rather be spending those dollars on things that improve our business climate, that accelerate our recovery, that get more people back to work, or on needed infrastructure — transportation, roads, bridges and the like,” he said, adding that Maryland has eliminated 5,600 positions in recent years and that its government was smaller, on a per capita basis, than it had been in four decades. “But I can’t do that. I can’t responsibly do that as long as I have this hara-kiri Congress threatening to drive a long knife through our recovery.”

Federal spending on salaries, wages and procurement makes up close to 20 percent of the economies of Maryland and Virginia, according to an analysis by the Pew Center on the States.

But states are in a delicate position. While they fear the impact of the automatic cuts, they also fear that any deal to avert them might be even worse for their bottom lines. That is because many of the planned cuts would go to military spending and not just domestic programs, and some of the most important federal programs for states, including Medicaid and federal highway funds, would be exempt from the cuts.

States will see a reduction of $5.8 billion this year in the federal grant programs subject to the automatic cuts, according to an analysis by Federal Funds Information for States, a group created by the National Governors Association and the National Conference of State Legislatures that tracks the impact of federal actions on states. California, New York and Texas stand to lose the most money from the automatic cuts, and Puerto Rico, which is already facing serious fiscal distress, is threatened with the loss of more than $126 million in federal grant money, the analysis found.

Even with the automatic cuts, the analysis found, states are still expected to get more federal aid over all this year than they did last year, because of growth in some of the biggest programs that are exempt from the cuts, including Medicaid.

But the cuts still pose a real risk to states, officials said. State budget officials from around the country held a conference call last week to discuss the threatened cuts. “In almost every case the folks at the state level, the budget offices, are pretty much telling the agencies and departments that they’re not going to backfill — they’re not going to make up for the budget cuts,” said Scott D. Pattison, the executive director of the National Association of State Budget Officers, which arranged the call. “They don’t have enough state funds to make up for federal cuts.”

The cuts would not hit all states equally, the Pew Center on the States found. While the federal grants subject to the cuts make up more than 10 percent of South Dakota’s revenue, it found, they make up less than 5 percent of Delaware’s revenue.

Many state officials find themselves frustrated year after year by the uncertainty of what they can expect from Washington, which provides states with roughly a third of their revenues. There were threats of cuts when Congress balked at raising the debt limit in 2011, when a so-called super-committee tried and failed to reach a budget deal, and late last year when the nation faced the “fiscal cliff.”

John E. Nixon, the director of Michigan’s budget office, said that all the uncertainty made the state’s planning more difficult. “If it’s going to happen,” he said, “at some point we need to rip off the Band-Aid.”

Fernanda Santos contributed reporting.

Read More..

Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

Read More..

Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

Read More..

In a Slight Shift, North Korea Widens Internet Access, but Just for Visitors

HONG KONG — North Korea will finally allow Internet searches on mobile devices. But if you’re a North Korean, you’re out of luck — only foreigners will get this privilege.

Cracking the door open slightly to wider Internet use, the government will allow a company called Koryolink to give foreigners access to 3G mobile Internet service by next Friday, according to The Associated Press, which has a bureau in the North.

The North Korean police state is famously cloistered, a means for the government to keep news of the world from its impoverished people. Only the most elite North Koreans have been allowed access to the Internet, and even they are watched. And although many North Koreans are allowed to have cellphones, sanctioned phones cannot call outside the country.

Foreigners were only recently allowed to use cellphones in the country. Previously, most had to surrender their phones with customs agents.

But it is unlikely that the small opening will compromise the North’s tight control of its people; the relatively few foreigners who travel to North Korea — a group that includes tourists and occasional journalists — are assigned government minders.

The decision, announced Friday, to allow foreigners Internet access comes a month after Google’s chairman, Eric E. Schmidt, visited Pyongyang, the North’s capital. While there he prodded officials on allowing Internet access, noting how easy it would be to set up through the expanding 3G network of Koryolink, a joint venture of North Korean and Egyptian telecommunications corporations. Presumably, Mr. Schmidt’s appeal was directed at giving North Koreans such capability.

“As the world becomes increasingly connected, their decision to be virtually isolated is very much going to affect their physical world, their economic growth and so forth,” Mr. Schmidt told reporters following his visit. “We made that alternative very, very clear.”

North Koreans will get some benefit from the 3G service, as they will be allowed to text and make video calls, The Associated Press said. They can also view newspaper reports — but the news service mentioned only one source: Rodong Sinmun, the North’s main Communist Party newspaper.

Read More..

U.N. Rejects Claim for Direct Compensation to Victims of Cholera Epidemic in Haiti

There will be no direct financial compensation from the United Nations for the more than 8,000 Haitians who died and the 646,000 sickened by cholera since the disease struck the earthquake-ravaged country in October 2010, Secretary General Ban Ki-moon told the Haitian president this week.

More than 15 months after the United Nations received a legal claim seeking to hold peacekeeping troops responsible for setting off the epidemic, its lawyers declared the claim “not receivable,” citing diplomatic immunity.

At the same time, Partners in Health, the leading nongovernmental health care provider in Haiti, has stepped forward to urge the United Nations to invest more seriously in Mr. Ban’s own largely unfunded anticholera initiative to make amends.

In an Op-Ed article posted Friday night on the Web site of The New York Times, Dr. Louise C. Ivers, the group’s senior health and policy adviser, says the United Nations has “a moral, if not legal, obligation to help solve a crisis it inadvertently helped start.” Evidence, she said, finds the United Nations “largely, though not wholly” culpable for the outbreak of cholera.

To date, Mr. Ban has not acknowledged the reigning scientific theory about the origin of Haiti’s cholera epidemic — that peacekeepers from Nepal imported the cholera and, through a faulty sanitation system at their base, infected a tributary of the country’s largest river.

Dr. Ivers, however, while noting the “causality” of epidemic disease is complex, says that no other reasonable hypothesis for Haiti’s cholera has been put forth.

What makes her comments especially striking is that her organization’s co-founder and chief strategist, Dr. Paul Farmer, served as the United Nations’ deputy special envoy for Haiti for the past three years and was appointed by Mr. Ban in December to lead the very anticholera initiative that she found lacking.

Dr. Farmer declined to comment, but a spokeswoman for Partners in Health said Dr. Ivers’s statements represented the group’s concerns about the 10-year, $2.2 billion anticholera initiative that he was supposed to advise.

The ambitious initiative is intended to upgrade Haiti’s abysmal water and sanitation infrastructure while increasing cholera prevention and treatment efforts, including the expansion of a small cholera vaccination campaign that Partners in Health and a Haitian health care group, Gheskio, undertook last year.

Donors have pledged $215 million. The United Nations said it would contribute $23.5 million — 1 percent of the initiative’s cost, Dr. Ivers said.

In contrast, she said, this year’s budget for the United Nations peacekeeping mission, $648 million, “could more than fund the entire cholera elimination initiative for two years.”

Expressing his “deep sorrow and solidarity with the many Haitian families who lost loved ones in this terrible epidemic,” Nigel Fisher, the new head of the peacekeeping mission, nonetheless said that the United Nations had “mobilized resolutely to combat the disease.” It spent some $118 million on cholera before the initiative was announced, officials have said.

Mr. Ban, through his spokesman, also expressed “his profound sympathy” while announcing on Thursday that the legal claim had been rejected.

Mario Joseph, lead lawyer for the cholera victims, said, “While these sympathies are welcome, they will not stop cholera’s killing or ensure that survivors can go on living after losing breadwinners to cholera.”

The demand, filed in an internal United Nations claims unit, had sought $100,000 for each bereaved family and $50,000 for each cholera survivor.

Mr. Joseph described the United Nations’ terse rejection of a claim filed over a year ago as “disgraceful,” and he and his American colleagues at the Institute for Justice and Democracy in Haiti said they would file a lawsuit in Haiti or abroad.

Though the death rate from cholera has declined significantly since the epidemic initially devastated Haiti, the disease is still coursing through the country. National statistics show a spike of reported cases in December 2012 over that same month in 2011 — 11,220 compared with 8,205.

“The U.N. will not pay,” said a headline Friday on the Web site of Haiti’s Le Nouvelliste newspaper.

“It’s not surprising,” a reader responded.

This article has been revised to reflect the following correction:

Correction: February 23, 2013

An earlier version of this article misrendered a quotation from an Op-Ed article by Dr. Louise C. Ivers. The quotation should have read “largely, though not wholly,” not “largely, if not wholly.”

Read More..

Room for Debate: Should Companies Tell Us When They Get Hacked?

A National Priority and a Business Priority

Lauren Gelman, BlurryEdge Strategies

Like pollution, an insecure infrastructure is bad for everyone. Disclosing security breaches reintroduces the public's collective interest.

Disclosure Plays Into Hackers’ Hands

Alexander Tabb, partner, research and consulting firm

By requiring companies to disclose security breaches, we would be requiring them to telegraph their weaknesses to the world.

Investors Need to Know

Jacob Olcott, Good Harbor Security Risk Management

It’s not that the events aren’t happening. It’s that you're not being told about them -- despite the S.E.C.'s instructions.

We Need Better Notification Laws

Lee Tien, Electronic Frontier Foundation

Existing laws focus mainly on whether a breach exposed information, not why it happened. Yet the reason can be critical.

More Disclosure Is Not Always Better

Baruch Fischhoff, decision sciences, Carnegie Mellon

People may exaggerate the risk of hacking if they suddenly start hearing about a lot of it. Or they may get used to frequent reports and underestimate the risks.

Improve Digital Hygiene

Joseph Lorenzo Hall, Center for Democracy and Technology

As a nation we devote few resources to creating a common social understanding of how to keep people and computer systems safe.

Read More..

Well: Depression May Stifle Shingles Vaccine Response

Depression may lower the effectiveness of the shingles vaccine, a new study found.

The research showed that adults with untreated depression who received the vaccine mounted a relatively weak immune response. But those who were taking antidepressants showed a normal response to the vaccine, even when symptoms of depression persist.

Shingles, an acute and painful rash, strikes a million Americans each year, mostly older adults. Health officials recommend that those over 60 get vaccinated against the condition, which is caused by reactivation of the same virus that causes chickenpox, varicella-zoster.

In the new study, published in the journal Clinical Infectious Diseases, researchers followed a group of 92 older men and women for two years. Forty of the subjects had a major depressive disorder; they were matched with 52 control subjects of similar age. The researchers measured their immune responses to the shingles vaccine and a placebo shot.

Compared with the control patients, those with depression were poorly protected by the vaccine. But the patients who were being treated for their depression showed a boost in immunity — what the researchers called a “normalization” of the immune response. It is unclear why that was the case.

The authors of the study speculated that treatment of older people with depression might increase the effectiveness of the flu shot and other vaccines as well.

Read More..

Well: Depression May Stifle Shingles Vaccine Response

Depression may lower the effectiveness of the shingles vaccine, a new study found.

The research showed that adults with untreated depression who received the vaccine mounted a relatively weak immune response. But those who were taking antidepressants showed a normal response to the vaccine, even when symptoms of depression persist.

Shingles, an acute and painful rash, strikes a million Americans each year, mostly older adults. Health officials recommend that those over 60 get vaccinated against the condition, which is caused by reactivation of the same virus that causes chickenpox, varicella-zoster.

In the new study, published in the journal Clinical Infectious Diseases, researchers followed a group of 92 older men and women for two years. Forty of the subjects had a major depressive disorder; they were matched with 52 control subjects of similar age. The researchers measured their immune responses to the shingles vaccine and a placebo shot.

Compared with the control patients, those with depression were poorly protected by the vaccine. But the patients who were being treated for their depression showed a boost in immunity — what the researchers called a “normalization” of the immune response. It is unclear why that was the case.

The authors of the study speculated that treatment of older people with depression might increase the effectiveness of the flu shot and other vaccines as well.

Read More..

Room for Debate: Should Companies Tell Us When They Get Hacked?

A National Priority and a Business Priority

Lauren Gelman, BlurryEdge Strategies

Like pollution, an insecure infrastructure is bad for everyone. Disclosing security breaches reintroduces the public's collective interest.

Disclosure Plays Into Hackers’ Hands

Alexander Tabb, partner, research and consulting firm

By requiring companies to disclose security breaches, we would be requiring them to telegraph their weaknesses to the world.

Investors Need to Know

Jacob Olcott, Good Harbor Security Risk Management

It’s not that the events aren’t happening. It’s that you're not being told about them -- despite the S.E.C.'s instructions.

We Need Better Notification Laws

Lee Tien, Electronic Frontier Foundation

Existing laws focus mainly on whether a breach exposed information, not why it happened. Yet the reason can be critical.

More Disclosure Is Not Always Better

Baruch Fischhoff, decision sciences, Carnegie Mellon

People may exaggerate the risk of hacking if they suddenly start hearing about a lot of it. Or they may get used to frequent reports and underestimate the risks.

Improve Digital Hygiene

Joseph Lorenzo Hall, Center for Democracy and Technology

As a nation we devote few resources to creating a common social understanding of how to keep people and computer systems safe.

Read More..

India Ink: Image of the Day: Feb. 22

Read More..

DealBook: Carlyle's Profit Fell in 4th Quarter as Growth Slowed

11:18 a.m. | Updated Most of the publicly traded private equity giants proudly reported glowing fourth-quarter earnings.

The Carlyle Group isn’t one of them.

The alternative investment giant disclosed on Thursday a 28 percent drop in fourth-quarter profit from the same time a year ago, as the growth of its portfolio companies slowed. That sent the company’s stock down more than 8 percent by midmorning, to $33.70.

Carlyle reported fourth-quarter profit of $182 million, expressed as economic net income, compared with $254 million in the year-earlier period. That amounts to 47 cents per unit. Analysts on average had expected about 66 cents per unit, according to a survey by Capital IQ.

And Carlyle’s distributable earnings, a measure the firm prefers because it tracks actual payouts to its limited partners, fell 24 percent, to $188 million. Using generally accepted accounting principles, Carlyle earned $12 million in net income.

The results fall short of those of rivals like the Blackstone Group and Kohlberg Kravis Roberts have reported. Private equity firms in general have gained from improvements in the markets, which have lifted the valuations of their portfolios and bolstered their core business of buying and selling companies.

Carlyle attributed the decline in economic net income to a smaller appreciation in the value of its portfolio. It reported a 4 percent gain for the quarter, compared with a 7 percent increase in the period a year earlier.

The decision to delay reaping carried interest from its latest mainstay fund, Carlyle Partners V, weighed on distributable earnings. The company opted to hold off, given the relative freshness of the fund and the influx of new investments like the buyouts of the TCW Group and Getty Images.

Carlyle highlighted its strong fund-raising and gains from selling investments. The firm raised $4.6 billion in new money for the quarter and $14 billion for the year, compared with a total of $6.6 billion raised in all of 2011. It generated $6.8 billion in realized proceeds for the quarter and $18.7 billion for the year, compared with $17.6 billion in 2011.

“We had another excellent year,” David M. Rubenstein, one of Carlyle’s co-chief executives, said in a statement. “Our performance over the past two years was marked by steady, continuous progress across our business.”

Read More..

Well: Getting Patients to Think About Costs

A colleague and I recently got into a heated discussion over health care spending. It wasn’t that he disagreed with me about the need to rein in costs; but he said he was frustrated every time he tried to do so.

Earlier that week, for example, he had tried to avoid ordering a costly M.R.I. scan for a patient who had been suffering from headaches. After a thorough examination, my colleague was convinced the headaches were the result of stress.

But the patient was not.

“She wouldn’t leave until she got that M.R.I.,” my colleague said. Even after he had explained his conclusions several times, proposed a return visit in a month to reassess the situation and ran so far overtime that his office nurse knocked on the door to make sure nothing had gone awry, the patient continued to insist on getting the expensive study.

When my colleague finally evoked cost – telling the woman that while an M.R.I. might ferret out rare causes, it didn’t make sense to spend the enormous fee on something of such marginal benefit – the woman became belligerent. “She yelled that this was her head we were talking about,” he recalled. “And expensive tests like this were the reason she had health insurance.”

Face flushed, he paused to take a deep breath. “Yeah, I may be all for controlling costs,” he finally said. “But are our patients?”

According to a new study in the journal Health Affairs, his concern about patients may not be far off the mark.

A growing number of initiatives aimed at controlling spiraling health care costs have been championed in recent years, aiming to replace the current model in which doctors are reimbursed for every office visit, test or procedure performed. These programs range from pay-for-performance, where doctors can earn more money by meeting predetermined quality “goals” like controlling patients’ blood sugar or high blood pressure, to accountable care organizations, where clinicians and hospitals in partnership are paid a lump sum to cover all care.

Their uninspired monikers aside, all of these plans share one defining feature: doctors are to be the key agents of change. Whether linked with quality measures, bundled payments or satisfaction scores, it is the doctors’ behavior and choice of treatments that result in savings, goes the thinking.

But as the new study reveals, doctors need to take into account more than just symptoms and diseases when deciding what to prescribe and offer. They must also consider their patients’ opinions and willingness to be cost conscious when it comes to their own care.

The researchers conducted more than 20 patient focus groups and asked the participants to imagine themselves with various symptoms and a choice of diagnostic and treatment options that varied only slightly in effectiveness but significantly in cost. They were asked, for example, to choose between an M.R.I. or a CT scan for a severe long-standing headache, with the M.R.I. being much more expensive but also more likely to catch some extremely rare problems.

When it came to their own treatment, “patients for the most part did not want cost to play any role in decision-making,” said Dr. Susan Dorr Goold, one of the study authors and a professor of internal medicine and health management and policy at the University of Michigan in Ann Arbor. Most did not want their doctors to take expenditures into account, and many made it clear that they would ask for the significantly more expensive medications, procedures or diagnostic studies, even if those options were only slightly better than the cheaper alternatives. “That puts doctors, whose primary responsibility is to their individual patients, in a very difficult position.”

A majority of the participants refused to consider the expenses borne by insurers or by society as a whole when making their choices. Some doubted that one individual’s efforts would have any real overall impact and so gave up considering cost-savings altogether. Others said they would go out of their way to choose the more expensive options, viewing such decisions as acts of defiance and a kind of well-deserved “payback” after years of paying insurance premiums.

Underlying all of these comments was the belief that cost was synonymous with quality. Even when the focus group leaders reminded participants that the differences between proposed options were nearly negligible, participants continued to choose the more expensive options as if it were beyond question that they must be more efficacious or foolproof.

The study’s findings are disheartening. But Dr. Goold and her co-investigators believe that public beliefs and attitudes about cost and quality can be changed. They cite the dramatic transformation in attitudes about end-of-life care as an example of how initiatives to improve understanding can lead people to make higher quality and more cost-effective decisions, like choosing hospices over hospitals.

“We need to begin to talk about these issues in a way that doesn’t turn it into a discussion pitting money against life, and we need to find ways of getting people to think about not spending money on things that offer marginal benefit” Dr. Goold said. “Because it’s going to be tough otherwise trying to implement any cost-saving measures, if patients don’t accept them.”

Read More..

Well: Getting Patients to Think About Costs

A colleague and I recently got into a heated discussion over health care spending. It wasn’t that he disagreed with me about the need to rein in costs; but he said he was frustrated every time he tried to do so.

Earlier that week, for example, he had tried to avoid ordering a costly M.R.I. scan for a patient who had been suffering from headaches. After a thorough examination, my colleague was convinced the headaches were the result of stress.

But the patient was not.

“She wouldn’t leave until she got that M.R.I.,” my colleague said. Even after he had explained his conclusions several times, proposed a return visit in a month to reassess the situation and ran so far overtime that his office nurse knocked on the door to make sure nothing had gone awry, the patient continued to insist on getting the expensive study.

When my colleague finally evoked cost – telling the woman that while an M.R.I. might ferret out rare causes, it didn’t make sense to spend the enormous fee on something of such marginal benefit – the woman became belligerent. “She yelled that this was her head we were talking about,” he recalled. “And expensive tests like this were the reason she had health insurance.”

Face flushed, he paused to take a deep breath. “Yeah, I may be all for controlling costs,” he finally said. “But are our patients?”

According to a new study in the journal Health Affairs, his concern about patients may not be far off the mark.

A growing number of initiatives aimed at controlling spiraling health care costs have been championed in recent years, aiming to replace the current model in which doctors are reimbursed for every office visit, test or procedure performed. These programs range from pay-for-performance, where doctors can earn more money by meeting predetermined quality “goals” like controlling patients’ blood sugar or high blood pressure, to accountable care organizations, where clinicians and hospitals in partnership are paid a lump sum to cover all care.

Their uninspired monikers aside, all of these plans share one defining feature: doctors are to be the key agents of change. Whether linked with quality measures, bundled payments or satisfaction scores, it is the doctors’ behavior and choice of treatments that result in savings, goes the thinking.

But as the new study reveals, doctors need to take into account more than just symptoms and diseases when deciding what to prescribe and offer. They must also consider their patients’ opinions and willingness to be cost conscious when it comes to their own care.

The researchers conducted more than 20 patient focus groups and asked the participants to imagine themselves with various symptoms and a choice of diagnostic and treatment options that varied only slightly in effectiveness but significantly in cost. They were asked, for example, to choose between an M.R.I. or a CT scan for a severe long-standing headache, with the M.R.I. being much more expensive but also more likely to catch some extremely rare problems.

When it came to their own treatment, “patients for the most part did not want cost to play any role in decision-making,” said Dr. Susan Dorr Goold, one of the study authors and a professor of internal medicine and health management and policy at the University of Michigan in Ann Arbor. Most did not want their doctors to take expenditures into account, and many made it clear that they would ask for the significantly more expensive medications, procedures or diagnostic studies, even if those options were only slightly better than the cheaper alternatives. “That puts doctors, whose primary responsibility is to their individual patients, in a very difficult position.”

A majority of the participants refused to consider the expenses borne by insurers or by society as a whole when making their choices. Some doubted that one individual’s efforts would have any real overall impact and so gave up considering cost-savings altogether. Others said they would go out of their way to choose the more expensive options, viewing such decisions as acts of defiance and a kind of well-deserved “payback” after years of paying insurance premiums.

Underlying all of these comments was the belief that cost was synonymous with quality. Even when the focus group leaders reminded participants that the differences between proposed options were nearly negligible, participants continued to choose the more expensive options as if it were beyond question that they must be more efficacious or foolproof.

The study’s findings are disheartening. But Dr. Goold and her co-investigators believe that public beliefs and attitudes about cost and quality can be changed. They cite the dramatic transformation in attitudes about end-of-life care as an example of how initiatives to improve understanding can lead people to make higher quality and more cost-effective decisions, like choosing hospices over hospitals.

“We need to begin to talk about these issues in a way that doesn’t turn it into a discussion pitting money against life, and we need to find ways of getting people to think about not spending money on things that offer marginal benefit” Dr. Goold said. “Because it’s going to be tough otherwise trying to implement any cost-saving measures, if patients don’t accept them.”

Read More..

Gadgetwise Blog: Tip of the Week: Search the Text on a Web Page

Search engines help find the Web pages you are looking for, but when it comes down to locating your keywords on the actual page, your browser can help. Most browser programs use the Control-F (Command-F on the Mac) to open a search box for finding certain words within the page itself, and most highlight the instances of the word (and number of time it appears). Google Chrome also displays yellow markers vertically along the scroll bar on the right side of the page so you can quickly see all the places the word or phrase appears.

Back and forward buttons in the search box let you click through the page for each occurrence of the word. Depending on the browser, you may be able to fine-tune your search results within the page. Internet Explorer includes an Options button that can match the whole word only or just the typographical case; Firefox can also match the word’s case, making it easier to locate proper nouns and names within a page.

Read More..

India Ink: Image of the Day: Feb. 21

Read More..

DealBook: Office Depot and OfficeMax Announce Plans to Merge, After Erroneous Release

11:12 a.m. | Updated

Office Depot and OfficeMax announced plans to merge on Wednesday, just hours after an erroneous news release about the deal surfaced briefly.

Under the terms of the deal, Office Depot said it would issue 2.69 new shares of common stock for each share of OfficeMax. At that level, the transaction would value OfficeMax at $13.50, or roughly $1.19 billion, a premium of more than 25 percent to the company’s closing price last week.

The deal has been anticipated, as the companies face an increasingly difficult competitive environment. Both companies, which are burdened with big real estate footprints, have struggled against lower-priced rivals like Amazon.com and Costco. By uniting, the two companies should be able to reduce costs and better negotiate prices.

“In the past decade, with the growth of the Internet, our industry has changed dramatically,” Neil R. Austrian, chairman and chief executive of Office Depot, said in a statement. “Combining our two companies will enhance our ability to serve customers around the world, offer new opportunities for our employees, make us a more attractive partner to our vendors and increase stockholder value.”

While the deal has been years in the making, it was initially announced prematurely. A news release announcing the merger of the companies was posted on Office Depot’s Web site early on Wednesday morning, but it quickly disappeared.

Several news organizations reported the terms disclosed in the errant news release for Office Depot’s earnings. The details were buried on page four of the release, under the header “Other Matters.”

As the details filtered through the market, shares of the companies jumped. In premarket trading, Office Depot’s stock rose more than 7 percent, while OfficeMax shares were up more than 8 percent.

In a call with analysts, Mr. Austrian said that Office Depot’s webcast provider “inadvertently” published his company’s fourth-quarter earnings “well ahead of schedule.”

The episode is reminiscent of other times that companies’ earnings releases were published prematurely. Last fall, Google‘s third-quarter earnings were published three hours early, which the technology giant blamed on a mistake by R.R. Donnelley & Sons, the company’s printer.

Representatives for Office Depot and OfficeMax were not immediately available for comment on the erroneous release.

Strategically, the deal makes sense, as the companies face a changing competitive environment.

Combined, the companies reported about $4.4 billion in revenue for their third quarter of 2012; in comparison, Staples disclosed $6.4 billion in revenue for the same period.

Office Depot has also been under pressure from an activist hedge fund, Starboard Value, which sent a letter to the retailer’s board last fall. In it, Starboard called for more cost cuts and a greater focus on higher-margin businesses like copy and print services. With a 14.8 percent stake, Starboard is the company’s biggest investor.

In announcing the deal, the two companies emphasized their new financial heft.

With the merger, the retailers expect to generate $400 million to $600 million in annual cost savings. The combined entity would also have $1 billion in cash, providing additional firepower to invest in the business.

“We are excited to bring together two companies intent on accelerating innovation for our customers and better differentiating us for success in a dynamic and highly competitive global industry,” Ravi K. Saligram, chief executive of OfficeMax, said in a statement. “We are confident that there will be exciting new opportunities for employees as part of a truly global business.”

Each company will have an equal number of directors on the board of the combined retailer. Before the deal closes, OfficeMax will pay a special dividend of $1.50 a share to its shareholders.

OfficeMax was advised by JPMorgan Chase and the law firms Skadden, Arps, Slate, Meagher & Flom and Dechert. Office Depot was counseled by Simpson Thacher & Bartlett, while its board was advised by the Peter J. Solomon Company, Morgan Stanley and Kirkland & Ellis. Perella Weinberg Partners provided financial advice to the board’s transaction committee.

Read More..

Ask an Expert: Questions About Hearing Loss? A Help Desk

This week’s Ask the Expert features Neil J. DiSarno, who will answer questions about hearing loss. Dr. DiSarno is the chief staff officer for audiology at the American Speech-Language-Hearing Association. From 1998 to 2012 he was chairman of the department of communication sciences and disorders at Missouri State University. Following are the types of questions that Dr. DiSarno is prepared to answer.

Neil J. DiSarno of the American Speech-Language-Hearing Association.

¶My wife has told me she believes I’m not hearing as well as I used to. What sort of specialist should I see and what can I expect?

¶I’ve been told that I should consider using hearing aids. If I decide to, how much better am I likely to hear?

¶I’ve noticed that my 2-year-old granddaughter’s speech is not developing properly. Neither her mother or the pediatrician seem to be concerned, but I suspect there is a problem. What do you suggest?

¶I use hearing aids, but still have great difficulty hearing conversation in restaurants and in large group settings. Is this common and is there something more that I can do to improve my ability to function in those settings?

Please leave your questions in the comments section. Answers will be posted on Wednesday, Feb. 27. (Unfortunately, not all questions may be answered.)

Booming: Living Through the Middle Ages offers news and commentary about baby boomers, anchored by Michael Winerip. You can connect with Michael Winerip on Facebook here. You can follow Booming via RSS here or visit nytimes.com/booming and reach us by e-mail at booming@nytimes.com.

Read More..

Ask an Expert: Questions About Hearing Loss? A Help Desk

This week’s Ask the Expert features Neil J. DiSarno, who will answer questions about hearing loss. Dr. DiSarno is the chief staff officer for audiology at the American Speech-Language-Hearing Association. From 1998 to 2012 he was chairman of the department of communication sciences and disorders at Missouri State University. Following are the types of questions that Dr. DiSarno is prepared to answer.

Neil J. DiSarno of the American Speech-Language-Hearing Association.

¶My wife has told me she believes I’m not hearing as well as I used to. What sort of specialist should I see and what can I expect?

¶I’ve been told that I should consider using hearing aids. If I decide to, how much better am I likely to hear?

¶I’ve noticed that my 2-year-old granddaughter’s speech is not developing properly. Neither her mother or the pediatrician seem to be concerned, but I suspect there is a problem. What do you suggest?

¶I use hearing aids, but still have great difficulty hearing conversation in restaurants and in large group settings. Is this common and is there something more that I can do to improve my ability to function in those settings?

Please leave your questions in the comments section. Answers will be posted on Wednesday, Feb. 27. (Unfortunately, not all questions may be answered.)

Booming: Living Through the Middle Ages offers news and commentary about baby boomers, anchored by Michael Winerip. You can connect with Michael Winerip on Facebook here. You can follow Booming via RSS here or visit nytimes.com/booming and reach us by e-mail at booming@nytimes.com.

Read More..

DealBook: Court Gives Investor an Edge in a Lawsuit Against Apple

7:47 p.m. | Updated

In the battle between Apple and the hedge fund manager David Einhorn, score a point for the billionaire who is taking up the mantle of shareholder advocate.

A federal judge said on Tuesday that he was leaning toward Mr. Einhorn’s contention that Apple had violated securities regulations by bundling several shareholder proposals into one matter.

A lawsuit by Mr. Einhorn’s Greenlight Capital, filed this month in Federal District Court in Manhattan, argues that Apple improperly grouped a vote to eliminate the company’s ability to issue preferred stock at will with other initiatives that Mr. Einhorn supports.

While the judge overseeing the case, Richard J. Sullivan, did not immediately grant Mr. Einhorn’s request for a halt to the vote, he said that the facts of the case favored the investor’s interpretation.

“I think success on the merits lies with Greenlight,” Judge Sullivan said at the end of a nearly two-hour hearing. Earlier in the hearing, he implied that he believed Securities and Exchange Commission rules prohibited the bundling of disparate shareholder initiatives.

Spokesmen for Greenlight and Apple declined to comment after the hearing.

Though a small point in the skirmish between Apple and Mr. Einhorn, the judge’s comments may provide some ballast to the hedge fund manager’s call to other investors. Mr. Einhorn’s bigger goal is to persuade Apple to return some of its $137 billion cash trove to shareholders.

He has asked Apple to issue preferred shares, which would pay out billions of dollars in dividends over time. His lawsuit revolves around the technology giant’s proposal to eliminate “blank check” preferred shares that the company can issue without a shareholder vote. He argues that the company improperly bundled the plan with two other corporate governance changes that he supports.

Apple has said that it will consider Mr. Einhorn’s request, but that it has no plans to amend the shareholder proposal.

Judge Sullivan is expected to decide within days whether to grant a preliminary injunction, given the Feb. 27 cutoff for voting on Apple’s shareholder proposals.

A lawyer for Mr. Einhorn, Mitchell P. Hurley of the firm Akin Gump, argued during Tuesday’s hearing that his client would suffer “irreparable harm” if the vote were allowed to proceed, because he would be forced to vote against two matters he would ordinarily support.

During questioning, however, Judge Sullivan expressed skepticism about the need to take immediate action.

A lawyer for Apple, George Riley of O’Melveny & Myers, said in court that if shareholders approved the disputed initiative, the company would wait for the judge to rule before adopting the new measures in its corporate charter.

Judge Sullivan also questioned why Mr. Einhorn had waited so long to act. He filed suit on Feb. 6, over a month after Apple first disclosed its shareholder proxy.

A version of this article appeared in print on 02/20/2013, on page B2 of the NewYork edition with the headline: Court Gives Investor an Edge In a Lawsuit Against Apple.

Read More..

IHT Rendezvous: True or False? The Tussle Over Ping Fu's Memoir

Did Ping Fu, a prominent Chinese-American businesswoman and author of a recent memoir, “Bend, not Break,” make up her horrible experiences during the 1966-76 Cultural Revolution in order to gain United States citizenship? Did they help her become an American by claiming political asylum?

That’s what her critics, many of them fellow Chinese-Americans, say. It’s an accusation that can stick. As a recent New York Times investigation showed, claiming persecution has spawned an immigration industry involving lawyers prepping clients to make false asylum claims.

As I write in my Letter from China this week, Ms. Fu is being accused of making up a lot of things in her memoir. She’s also a successful entrepreneur: the U.S. government honored Ms. Fu, the founder of the software company Geomagic (in the process of being sold to 3D Systems), with a “2012 Outstanding American by Choice” award.

Ms. Fu is on the board of the White House’s National Advisory Council on Innovation and Entrepreneurship, and is a member of the National Council on Women in Technology, according to the Web site of the U.S. Citizenship and Immigration Services.

Ms. Fu, who says in her memoir she was “quietly deported” to the U.S. in 1984 for writing about female infanticide while still a college student, denies the accusations. But until now she hadn’t explained in public how she became an American.

In an interview with the International Herald Tribune, she said, apparently for the first time, the reason she kept quiet was she was trying to protect her first husband, an American, whom she does not mention in her memoir. The marriage took place while she was living in California, she said.

“I had a first marriage and that’s how I got my green card,” she said by telephone. She married on Sept. 1, 1986 and divorced three years later. Until now she had kept silent because of a “smear” campaign against her online, mostly by fellow Chinese who accuse her of lying, which extended to real-life harassment, she said: “They smear my name, they try to get my daughter’s name on the Internet, they sent people to Shanghai to surround my family and to Nanjing to harass my neighbors.” She said the accusers, who are “angry” for reasons she doesn’t really understand, contacted U.S. immigration authorities to challenge her award and her citizenship, as well as shareholders of 3D Systems to warn them she was a “liar,” and not to buy Geomagic. Her second husband, Herbert Edelsbrunner, whom she has since divorced, received many “hate e-mails,” she said. “I just don’t want to hurt innocent people.”

If a first, unpublicized marriage might lay to rest one contentious issue, there are others. Some were the result of exaggeration or unclear communication with her ghostwriter, MeiMei Fox of Los Angeles, she said.

In the interview, she volunteered an example of an error: a widely criticized account of the ‘‘period police,’’ the authorities who checked a woman’s menstrual cycle to ensure she wasn’t pregnant in the early days of the one-child policy. To stop women substituting others’ sanitary pads for inspection, they were sometimes required to use their own finger to show blood. Through a misunderstanding with Ms. Fox, Ms. Fu said this was portrayed as the use of other people’s fingers — an invasion of the woman’s body.

Ms. Fox “wrote it wrong,’’ she said. ‘‘I corrected it three times but it didn’t get corrected.’’ Women used their own finger to show blood, she said, but the mistake went into print anyway.

In general, Ms. Fox may have ‘‘just made some searches on the Internet that maybe weren’t correct,’’ Ms. Fu said.

Chiefly the errors involved use of the words ‘‘all, never, any,’’ that generalized unacceptably, Ms. Fu said. And, ‘‘She doesn’t know China’s geography,’’ she said.

At the beginning of her memoir, Ms. Fu writes of being kidnapped by a Vietnamese-American on arrival in the U.S. state of New Mexico and locked in his apartment to care for his very young children, whose mother had left, in a bizarre incident. A spokeswoman at the Albuquerque Police Department’s Records Office, where the alleged kidnapping took place, said she could not locate such an incident in their records. Asked about it, Ms. Fu repeated that she did not press charges as, fresh from China, she was terrified of all police, “So I don’t know how they keep records, if there is no criminal charges or record.”

And in an e-mail to me, she admitted she made mistakes about a magazine she said she helped edit, called Wugou, or “No Hook,” produced in 1979 by students at her college, then called the Jiangsu Teacher’s College (later it changed its name to Suzhou University, she said.) It was not that magazine but another one, This Generation, that was taken to a meeting in Beijing of student magazine writers from around the country, she wrote in the e-mail. “A good case that shows everyone’s memory can be wrong,” she wrote.

But bigger questions about the scale of the online vitriol from parts of the Chinese and Chinese-American community remain. “I really haven’t known China for 20-something years, and it didn’t occur to me that what I wrote would generate so much anger,” she said. In the last years, “as China got stronger, nationalistic views got stronger,” she said, making a “civil conversation” about disagreements apparently harder.

Additional reporting by Cindy Hao in Seattle.

Read More..

Media Decoder Blog: NBC News Hires David Axelrod as Political Analyst

NBC News announced Tuesday that it had hired David Axelrod, the chief political strategist for both of Barack Obama’s presidential elections, as a full-time political analyst for the news organization.

He will appear on news programs for NBC’s broadcast network and for its cable news channel MSNBC. That channel has positioned itself aggressively as the liberal counterpart to the conservative-leaning Fox News Channel.

Mr. Axelrod’s hiring at MSNBC emulates Fox’s hiring of Karl Rove, who filled the similar political post for George W. Bush.

The path from political adviser to expert commentator on television has been well trod. George Stephanopoulos, who advised President Clinton , joined ABC News as a journalist. He is, of course, now the anchor of “Good Morning, America” for ABC.  And MSNBC already employs Steve Schmidt, the senior strategist for the losing campaign of Senator John McCain.

Mr. Axelrod most recently was named political director at the Institute of Politics as the University of Chicago, his alma mater, and a Distinguished Fellow at the Harris School of Public Policy.

He began his career as a journalist, working for the Chicago Tribune. He began in politics in 1984 and founded a media and consulting firm, Axelrod and Associates.

Read More..

Well: Susan Love's Illness Gives New Focus to Her Cause

During a talk last spring in San Francisco, Dr. Susan Love, the well-known breast cancer book author and patient advocate, chided the research establishment for ignoring the needs of people with cancer. “The only difference between a researcher and a patient is a diagnosis,” she told the crowd. “We’re all patients.”

It was an eerily prescient lecture. Less than two months later, Dr. Love was given a diagnosis of acute myelogenous leukemia. She had no obvious symptoms and learned of her disease only after a checkup and routine blood work.

“Little did I know I was talking about myself,” she said in an interview. “It was really out of the blue. I was feeling fine. I ran five miles the day before.”

Dr. Love, a surgeon, is best known as the author of the top-selling “Dr. Susan Love’s Breast Book” (Da Capo Press, 2010) now in its fifth edition. She is also president of the Dr. Susan Love Research Foundation, which focuses on breast cancer prevention and research into eradicating the disease. But after decades of tireless advocacy on behalf of women with breast cancer, Dr. Love found herself in an unfamiliar role with an unfamiliar disease.

“There is a sense of shock when it happens to you,” she said. “In some ways I would have been less shocked if I got breast cancer because it’s so common, but getting leukemia was a world I didn’t know. Even when you’re a physician, when you get shocking news like this you sort of forget everything you know and are scared the same as everybody else.”

Because Dr. Love’s disease was caught early, she had a little time to seek second opinions and choose her medical team. She chose City of Hope in Duarte, Calif., because of its extensive experience in bone marrow transplants. At 65, Dr. Love was startled to learn she was considered among the “elderly” patients for this type of leukemia.

She was admitted to the hospital and underwent chemotherapy. Because her blood counts did not rebound after the treatment, her stay lasted a grueling seven weeks.

She went home for just two weeks, and then returned to the hospital for a bone-marrow transplant, with marrow donated by her younger sister, Elizabeth Love De Garcia, 53, who lives in Mexico City.

Although the transplant itself was uneventful, the next four weeks were an ordeal. Dr. Love developed pain and neuropathy from the chemotherapy drugs. Dr. Love’s wife, Dr. Helen Cooksey; daughter, Katie Love-Cooksey, 24; and siblings offered round-the-clock support. Ms. Love-Cooksey slept in the hospital every night. “I wasn’t very articulate during that time, but I always had my family there,” Dr. Love said. “They were great advocates for me.”

The transplant “is quite an amazing thing,” Dr. Love said. Her blood type changed from O positive to B positive, the same type as her sister. She also has inherited her sister’s immune system, and a lifelong allergy to nickel has disappeared. “I can wear cheap jewelry now,” she said. She returned to work last month.

Dr. Love has been told her disease is in remission, though her immune system remains compromised and she is more susceptible to infection. So she avoids crowds, air travel and other potential sources of cold and flu viruses.

While Dr. Love has always been a strong advocate for women undergoing cancer treatment, she says her disease and treatment has strengthened her understanding of what women with breast cancer and other types of cancer go through during treatments.

“There are little things like having numb toes or having less stamina to building muscles back up after a month of bed rest,” she said. “There is significant collateral damage from the treatment that is underestimated by the medical profession. There’s a sense of ‘You’re lucky to be alive, so why are you complaining?’ ”

Dr. Love says her experience has emboldened her in her quest to focus on the causes of disease rather than new drugs to treat it.

“I think I’m more impatient now and in more of a hurry,” she said. “I’ve been reminded that you don’t know how long you have. There are women being diagnosed every day. We don’t have the luxury to sit around and come up with a new marketing scheme. We have to get rid of this disease, and there is no reason we can’t do it.”

People who remain skeptical about the ability to eradicate breast cancer should look to the history of cervical cancer, she said. Decades ago, a woman with an abnormal Pap smear would be advised to undergo hysterectomy. Now a vaccine exists that can protect women from the infection that causes most cervical cancers.

“We need to focus more on the cause of breast cancer,” she said. “I’m still very impressed with the fact that cancer of the cervix went from being a disease that robbed women of their fertility, if not their lives, to having a vaccine to prevent it.”

Dr. Love, who wrote a book called “Live a Little!,” said illness has also made her grateful that she didn’t put off her “bucket list” and that she has traveled the world and focused on work she finds challenging and satisfying.

“It just reminds you that none of us are going to get out of here alive, and we don’t know how much time we have,” she said. “I say this to my daughter, whether it’s changing the world or having a good time, that we should do what we want to do. I drink the expensive wine now.”

Read More..

Well: Susan Love's Illness Gives New Focus to Her Cause

During a talk last spring in San Francisco, Dr. Susan Love, the well-known breast cancer book author and patient advocate, chided the research establishment for ignoring the needs of people with cancer. “The only difference between a researcher and a patient is a diagnosis,” she told the crowd. “We’re all patients.”

It was an eerily prescient lecture. Less than two months later, Dr. Love was given a diagnosis of acute myelogenous leukemia. She had no obvious symptoms and learned of her disease only after a checkup and routine blood work.

“Little did I know I was talking about myself,” she said in an interview. “It was really out of the blue. I was feeling fine. I ran five miles the day before.”

Dr. Love, a surgeon, is best known as the author of the top-selling “Dr. Susan Love’s Breast Book” (Da Capo Press, 2010) now in its fifth edition. She is also president of the Dr. Susan Love Research Foundation, which focuses on breast cancer prevention and research into eradicating the disease. But after decades of tireless advocacy on behalf of women with breast cancer, Dr. Love found herself in an unfamiliar role with an unfamiliar disease.

“There is a sense of shock when it happens to you,” she said. “In some ways I would have been less shocked if I got breast cancer because it’s so common, but getting leukemia was a world I didn’t know. Even when you’re a physician, when you get shocking news like this you sort of forget everything you know and are scared the same as everybody else.”

Because Dr. Love’s disease was caught early, she had a little time to seek second opinions and choose her medical team. She chose City of Hope in Duarte, Calif., because of its extensive experience in bone marrow transplants. At 65, Dr. Love was startled to learn she was considered among the “elderly” patients for this type of leukemia.

She was admitted to the hospital and underwent chemotherapy. Because her blood counts did not rebound after the treatment, her stay lasted a grueling seven weeks.

She went home for just two weeks, and then returned to the hospital for a bone-marrow transplant, with marrow donated by her younger sister, Elizabeth Love De Garcia, 53, who lives in Mexico City.

Although the transplant itself was uneventful, the next four weeks were an ordeal. Dr. Love developed pain and neuropathy from the chemotherapy drugs. Dr. Love’s wife, Dr. Helen Cooksey; daughter, Katie Love-Cooksey, 24; and siblings offered round-the-clock support. Ms. Love-Cooksey slept in the hospital every night. “I wasn’t very articulate during that time, but I always had my family there,” Dr. Love said. “They were great advocates for me.”

The transplant “is quite an amazing thing,” Dr. Love said. Her blood type changed from O positive to B positive, the same type as her sister. She also has inherited her sister’s immune system, and a lifelong allergy to nickel has disappeared. “I can wear cheap jewelry now,” she said. She returned to work last month.

Dr. Love has been told her disease is in remission, though her immune system remains compromised and she is more susceptible to infection. So she avoids crowds, air travel and other potential sources of cold and flu viruses.

While Dr. Love has always been a strong advocate for women undergoing cancer treatment, she says her disease and treatment has strengthened her understanding of what women with breast cancer and other types of cancer go through during treatments.

“There are little things like having numb toes or having less stamina to building muscles back up after a month of bed rest,” she said. “There is significant collateral damage from the treatment that is underestimated by the medical profession. There’s a sense of ‘You’re lucky to be alive, so why are you complaining?’ ”

Dr. Love says her experience has emboldened her in her quest to focus on the causes of disease rather than new drugs to treat it.

“I think I’m more impatient now and in more of a hurry,” she said. “I’ve been reminded that you don’t know how long you have. There are women being diagnosed every day. We don’t have the luxury to sit around and come up with a new marketing scheme. We have to get rid of this disease, and there is no reason we can’t do it.”

People who remain skeptical about the ability to eradicate breast cancer should look to the history of cervical cancer, she said. Decades ago, a woman with an abnormal Pap smear would be advised to undergo hysterectomy. Now a vaccine exists that can protect women from the infection that causes most cervical cancers.

“We need to focus more on the cause of breast cancer,” she said. “I’m still very impressed with the fact that cancer of the cervix went from being a disease that robbed women of their fertility, if not their lives, to having a vaccine to prevent it.”

Dr. Love, who wrote a book called “Live a Little!,” said illness has also made her grateful that she didn’t put off her “bucket list” and that she has traveled the world and focused on work she finds challenging and satisfying.

“It just reminds you that none of us are going to get out of here alive, and we don’t know how much time we have,” she said. “I say this to my daughter, whether it’s changing the world or having a good time, that we should do what we want to do. I drink the expensive wine now.”

Read More..

Bits Blog: Tech Predictions for 2013: It's All About Mobile

If there is one theme that will be the topic of digital business this year, it is mobile.

ComScore, which tracks Web and mobile usage, published a report about what happened in 2012, and what to expect in 2013.

It shows that the effects of a movement toward mobile are everywhere, from shopping to media to search. According to the report, “2013 could spell a very rocky economic transition,” and businesses will have to scramble to stay ahead of consumers’ changing behavior.

Here are a few interesting tidbits from the 48-page report.

The mobile transition is happening astonishingly quickly. Last year, smartphone penetration crossed 50 percent for the first time, led by Android phones. People spend 63 percent of their time online on desktop computers and 37 percent on mobile devices, including smartphones and tablets, according to comScore.

Just as they compete on computers, Facebook and Google are dominant and at each other’s throats on phones.

Google’s map app for the iPhone, which had been the most used mobile app, lost its No. 1 spot to Facebook after Apple kicked Google’s maps off the iPhone in October. Now, Facebook reaches 76 percent of the smartphone market and accounts for 23 percent of total time spent using apps each month. The next five most used apps are Google’s, which account for 10 percent of time on apps.

As mobile continues to take share from desktop, some industries have been particularly affected, and they are seeing significant declines in desktop use of their products as a result. They are newspapers, search engines, maps, weather, comparison shopping, directories and instant messenger services.

The most visited Web sites are not so surprising: Google, Yahoo, Microsoft, Facebook and Amazon. Facebook continues to take up most of our time online.

But there were a few surprises from younger, smaller Web companies. Tumblr was No. 8 on the list of sites, ordered by time spent on them. And several Web sites were breakout hits last year, as measured by growth and visitor numbers: Spotify (music), Dropbox (online storage), Etsy (shopping), BuzzFeed (news), JustFab (shopping), SoundCloud (music) and BusinessInsider (news).

Search, one of the biggest and most reliable Web industries, is at a crossroads, comScore said. Even though the search market continues to be extraordinarily profitable, there is a desire for it to evolve and offer new services to users.

Here is some evidence: Searches on traditional search engines, dominated by Google, declined 3 percent last year, and the number of searches per searcher declined 7 percent. Yet searches on specialty sites, known as vertical search engines, like Amazon.com or Whitepages.com, climbed 8 percent.

Social search, based on what users’ friends like, has put Facebook and Google on a “collision course,” comScore said, particularly in searches for local businesses like restaurants.

In social networking, the visual Web, as comScore calls it, has transformed the landscape. Pinterest, Tumblr and Instagram, all of which emphasize images, each gained more than 10 million visitors last year.

Last year was also pivotal for online video, comScore said, as viewers increasingly seek the ability to watch video when and where they want. Watching TV shows online helped last year break viewing records, especially during the Olympics.

In the United States, 75 million people a day watch online video and stream 40 billion videos a month, and viewing is driven by YouTube.

There has also been a turning point for video ads. They cost more than typical ads, and have always lagged behind viewership. But in 2012, 23 percent of videos were accompanied by an ad, up from 14 percent the year before. More TV ad dollars are coming to online video, comScore concluded.

Though e-commerce spending grew 13 percent last year, it was a disappointing holiday season online, largely because of economic pressures. Purchasing on mobile phones is beginning to make a dent in e-commerce, comScore said, with mobile shopping accounting for 11 percent of e-commerce in the fourth quarter of 2012, up from 3 percent in the period two years earlier.

Read More..

French Family of 7 Kidnapped in Cameroon

PARIS (AP) — A French family of seven — including four children — was kidnapped on Tuesday in northern Cameroon, and officials suggested that the Islamic extremist sect Boko Haram was behind it.

Details of the kidnapping were not immediately clear. However, President Francois Hollande, speaking during a visit to Greece, noted that France is engaged in a military campaign in Mali to rout out jihadists who had taken control of the north. Terrorists, he said, "are not just in Mali."

Hollande warned French citizens in the region to avoid putting themselves in dangerous situations.

A total of 15 French citizens are currently being held in western Africa — one other in Nigeria and seven thought to be in northern Mali.

A French official close to the embassy in Cameroon said the family was believed to have been taken from northern Cameroon to Nigeria, where on Monday a little-known extremist group called Ansaru claimed responsibility for a separate abduction of seven foreigners.

Boko Haram — which means "Western education is sacrilege" — has launched a guerrilla campaign of bombings and shootings across Nigeria's predominantly Muslim north. It is blamed for at least 792 killings last year alone, according to an AP count. It is known to have ties to al-Qaida in the Islamic Maghreb, or AQIM, an Algerian-based group that opened a front in Mali.

"If everything is confirmed, this signifies that the fight against terrorist groups is a necessity," Foreign Minister Laurent Fabius said in Paris. "There is a battle to be led by the international community against terrorist groups and narco-terrorists," a reference to the trafficking in drugs, cigarettes and other commodities that has flourished in northern Mali under the extremists.

The latest kidnappings have added to fears of instability and danger toward Westerners. Before Tuesday, there were eight French citizens being held in the region, including one who was taken in Nigeria.

An analysis published Monday by Stratfor, a U.S.-based private global intelligence firm, warned that there likely will be more attacks by Ansaru targeting Westerners and Western interests in Nigeria, as well as neighboring nations.

___

Lori Hinnant in Paris contributed to this report.

Read More..

Media Decoder Blog: Hong Kong Disneyland Turns a Profit

LOS ANGELES — Mickey Mouse is finally making money in Hong Kong.

The Walt Disney Company on Monday said that its seven-year-old theme park and resort complex in Hong Kong turned a profit for the first time — a modest $14 million, but a profit nonetheless — following an aggressive expansion costing several hundred million dollars.

To compare, the park lost about $31 million dollars during the previous fiscal period. As recently as 2008, the park was losing roughly $200 million a year. Disney owns 48 percent of Hong Kong Disneyland, with the balance controlled by the local government.

Disney said attendance at the park increased 13 percent last year, to 6.7 million people. Revenue was up 18 percent; occupancy at two themed hotels, which have a combined 1,000 rooms, stood at 92 percent.

Hong Kong Disneyland has been the smallest of Disney’s theme parks around the world, limiting interest in annual passes and repeat attendance. But a continuing expansion to increase the size of Hong Kong Disneyland by 25 percent appears to have had dramatic effects.

Already open are new rides themed to the “Toy Story” movies and an Old-West area called Grizzly Gulch; coming this spring is another area called Mystic Point, billed by Disney as “the site of mysterious forces and supernatural events in the heart of a dense, uncharted rain forest.”

One question for the future: To what degree, if any, will Disney’s mega-resort in Shanghai, now under construction and scheduled to open in 2015, take wind out of Hong Kong Disneyland’s sails?

Read More..

Well: Certain Television Fare Can Help Ease Aggression in Young Children, Study Finds

Experts have long known that children imitate many of the deeds — good and bad — that they see on television. But it has rarely been shown that changing a young child’s viewing habits at home can lead to improved behavior.

In a study published Monday in the journal Pediatrics, researchers reported the results of a program designed to limit the exposure of preschool children to violence-laden videos and television shows and increase their time with educational programming that encourages empathy. They found that the experiment reduced the children’s aggression toward others, compared with a group of children who were allowed to watch whatever they wanted.

“Here we have an experiment that proposes a potential solution,” said Dr. Thomas N. Robinson, a professor of pediatrics at Stanford, who was not involved in the study. “Giving this intervention — exposing kids to less adult television, less aggression on television and more prosocial television — will have an effect on behavior.”

While the research showed “a small to moderate effect” on the preschoolers’ behavior, he added, the broader public health impact could be “very meaningful.”

The new study was a randomized trial, rare in research on the effects of media on children. The researchers, at Seattle Children’s Research Institute and the University of Washington, divided 565 parents of children ages 3 to 5 into two groups. Both were told to track their children’s media consumption in a diary that the researchers assessed for violent, didactic and prosocial content, which they defined as showing empathy, helping others and resolving disputes without violence.

The control group was given advice only on better dietary habits for children. The second group of parents were sent program guides highlighting positive shows for young children. They also received newsletters encouraging parents to watch television with their children and ask questions during the shows about the best ways to deal with conflict. The parents also received monthly phone calls from the researchers, who helped them set television-watching goals for their preschoolers.

The researchers surveyed the parents at six months and again after a year about their children’s social behavior. After six months, parents in the group receiving advice about television-watching said their children were somewhat less aggressive with others, compared with those in the control group. The children who watched less violent shows also scored higher on measures of social competence, a difference that persisted after one year.

Low-income boys showed the most improvement, though the researchers could not say why. Total viewing time did not differ between the two groups.

“The take-home message for parents is it’s not just about turning off the TV; it’s about changing the channel,” said Dr. Dimitri A. Christakis, the lead author of the study and a professor of pediatrics at the University of Washington.

“We want our children to behave better,” Dr. Christakis said, “and changing their media diet is a good way to do that.”

Until she began participating in Dr. Christakis’s trial, Nancy Jensen, a writer in Seattle, had never heard of shows like Nickelodeon’s “Wonder Pets!,” featuring cooperative team players, and NBC’s “My Friend Rabbit,” with its themes of loyalty and friendship.

At the time, her daughter Elizabeth, then 3, liked“King of the Hill,”a cartoon comedy geared toward adults that features beer and gossip. In hindsight, she said, the show was “hilariously funny, but completely inappropriate for a 3-year-old.”

These days, she consults Common Sense Media, a nonprofit advocacy group in San Francisco, to make sure that the shows her daughter watches have some prosocial benefit. Elizabeth, now 6, was “not necessarily an aggressive kid,” Ms. Jensen said. Still, the girl’s teacher recently commended her as very considerate, and Ms. Jensen believes a better television diet is an important reason.

The new study has limitations, experts noted. Data on both the children’s television habits and their behavior was reported by their parents, who may not be objective. And the study focused only on media content in the home, although some preschool-aged children are exposed to programming elsewhere.

Children watch a mix of “prosocial but also antisocial media,” said Marie-Louise Mares, an associate professor of communications at the University of Wisconsin, Madison. “Merely being exposed to prosocial media doesn’t mean that kids take it that way.”

Even educational programming with messages of empathy can be misunderstood by preschoolers, with negative consequences. A study published online in November in The Journal of Applied Developmental Psychology found that preschoolers shown educational media were more likely to engage in certain forms of interpersonal aggression over time.

Preschoolers observe relationship conflict early in a television episode but do not always connect it to the moral lesson or resolution at the end, said Jamie M. Ostrov, the lead author of the November study and an associate professor of psychology at the University of Buffalo.

Preschoolers watch an estimated 4.1 hours of television and other screen time daily, according to a 2011 study. Dr. Ostrov advised parents to watch television with their young children and to speak up during the relationship conflicts that are depicted. Citing one example, Dr. Ostrov counseled parents to ask children, “What could we do differently here?” to make it clear that yelling at a sibling is not acceptable.

He also urged parents to stick with age-appropriate programming. A 3-year-old might misunderstand the sibling strife in the PBS show“Arthur,” he said, or stop paying attention before it is resolved.

Read More..