A delicate new balancing act in senior healthcare

When Claire Gordon arrived at Cedars-Sinai Medical Center, nurses knew she needed extra attention.

She was 96, had heart disease and a history of falls. Now she had pneumonia and the flu. A team of Cedars specialists converged on her case to ensure that a bad situation did not turn worse and that she didn't end up with a lengthy, costly hospital stay.

Frail seniors like Gordon account for a disproportionate share of healthcare expenditures because they are frequently hospitalized and often land in intensive care units or are readmitted soon after being released. Now the federal health reform law is driving sweeping changes in how hospitals treat a rapidly growing number of elderly patients.

The U.S. population is aging quickly: People older than 65 are expected to make up nearly 20% of it by 2030. Linda P. Fried, dean of the Columbia University Mailman School of Public Health, said now is the time to train professionals and test efforts to improve care and lower healthcare costs for elderly patients.

"It's incredibly important that we prepare for being in a society where there are a lot of older people," she said. "We have to do this type of experiment right now."

At Cedars-Sinai, where more than half the patients in the medical and surgical wards are 65 or older, one such effort is dubbed the "frailty project." Within 24 hours, nurses assess elderly patients for their risk of complications such as falls, bed sores and delirium. Then a nurse, social worker, pharmacist and physician assess the most vulnerable patients and make an action plan to help them.

The Cedars project stands out nationally because medical professionals are working together to identify high-risk patients at the front end of their hospitalizations to prevent problems at the back end, said Herb Schultz, regional director of the U.S. Department of Health and Human Services.

"For seniors, it is better care, it is high-quality care and it is peace of mind," he said.

The effort and others like it also have the potential to reduce healthcare costs by cutting preventable medical errors and readmissions, Schultz said. The federal law penalizes hospitals for both.

Gordon, an articulate woman with brightly painted fingernails and a sense of humor, arrived at Cedars-Sinai by ambulance on a Monday.

Soon, nurse Jacquelyn Maxton was at her bedside asking a series of questions to check for problems with sleep, diet and confusion. The answers led to Gordon's designation as a frail patient. The next day, the project team huddled down the hall and addressed her risks one by one. Medical staff would treat the flu and pneumonia while at the same time addressing underlying health issues that could extend Gordon's stay and slow her recovery, both in the hospital and after going home.

To reduce the chance of falls, nurses placed a yellow band on her wrist that read "fall risk" and ensured that she didn't get up on her own. To prevent bed sores, they got her up and moving as often as possible. To cut down on confusion, they reminded Gordon frequently where she was and made sure she got uninterrupted sleep. Medical staff also stopped a few unnecessary medications that Gordon had been prescribed before her admission, including a heavy narcotic and a sleeping pill.

"It is really a holistic approach to the patient, not just to the disease that they are in here for," said Glenn D. Braunstein, the hospital's vice president for clinical innovation.

Previously, nurse Ivy Dimalanta said, she and her colleagues provided similar care but on a much more random basis. Under the project, the care has become standardized.

The healthcare system has not been well designed to address the needs of seniors who may have had a lifetime of health problems, said Mary Naylor, gerontology professor at the University of Pennsylvania School of Nursing. As a result, patients sometimes fall through the cracks and return to hospitals again and again.

"That is not good for them and that is not good for society to be using resources in that way," Naylor said.

Using data from related projects, Cedars began a pilot program in 2011 and expanded it last summer. The research is continuing but early results suggest that the interventions are leading to fewer seniors being admitted to the intensive care unit and to shorter hospital stays, said Jeff Borenstein, researcher and lead clinician on the frailty project. "It definitely seems to be going in the right direction," he said.

The hospital is now working with Naylor and the University of Pennsylvania to design a program to help the patients once they go home.

"People who are frail are very vulnerable when they leave the hospital," said Harriet Udin Aronow, a researcher at Cedars. "We want to promote them being safe at home and continuing to recover."

In Gordon's case, she lives alone with the help of her children and a caregiver. The hospital didn't want her experiencing complications that would lengthen the stay, but they also didn't want to discharge her before she was ready. Under the health reform law, hospitals face penalties if patients come back too soon after being released.

Patients and their families often are unaware of the additional attention. Sitting in a chair in front of a vase of pink flowers, Gordon said she knew she would have to do her part to get out of the hospital quickly. "You have to move," she said. "I know you get bed sores if you stay in bed."

Gordon said she was comfortable at the hospital but she wanted to go back to her house as quickly as she could. "There's no place like home," she said.

Two days later, that's where she was.

anna.gorman@latimes.com

Read More..

In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

Read More..

John E. Karlin, 1918-2013: John E. Karlin, Who Led the Way to All-Digit Dialing, Dies at 94

Courtesy of Alcatel-Lucent USA

John E. Karlin, a researcher at Bell Labs, studied ways to make the telephone easier to use.

A generation ago, when the poetry of PEnnsylvania and BUtterfield was about to give way to telephone numbers in unpoetic strings, a critical question arose: Would people be able to remember all seven digits long enough to dial them?

And when, not long afterward, the dial gave way to push buttons, new questions arose: round buttons, or square? How big should they be? Most crucially, how should they be arrayed? In a circle? A rectangle? An arc?

For decades after World War II, these questions were studied by a group of social scientists and engineers in New Jersey led by one man, a Bell Labs industrial psychologist named John E. Karlin.

By all accounts a modest man despite his variegated accomplishments (he had a doctorate in mathematical psychology, was trained in electrical engineering and had been a professional violinist), Mr. Karlin, who died on Jan. 28, at 94, was virtually unknown to the general public.

But his research, along with that of his subordinates, quietly yet emphatically defined the experience of using the telephone in the mid-20th century and afterward, from ushering in all-digit dialing to casting the shape of the keypad on touch-tone phones. And that keypad, in turn, would inform the design of a spate of other everyday objects.

It is not so much that Mr. Karlin trained midcentury Americans how to use the telephone. It is, rather, that by studying the psychological capabilities and limitations of ordinary people, he trained the telephone, then a rapidly proliferating but still fairly novel technology, to assume optimal form for use by midcentury Americans.

“He was the one who introduced the notion that behavioral sciences could answer some questions about telephone design,” Ed Israelski, an engineer who worked under Mr. Karlin at Bell Labs in the 1970s, said in a telephone interview on Wednesday.

In 2013, the 50th anniversary of the introduction of the touch-tone phone, the answers to those questions remain palpable at the press of a button. The rectangular design of the keypad, the shape of its buttons and the position of the numbers — with “1-2-3” on the top row instead of the bottom, as on a calculator — all sprang from empirical research conducted or overseen by Mr. Karlin.

The legacy of that research now extends far beyond the telephone: the keypad design Mr. Karlin shepherded into being has become the international standard on objects as diverse as A.T.M.’s, gas pumps, door locks, vending machines and medical equipment.

Mr. Karlin, associated from 1945 until his retirement in 1977 with Bell Labs, headquartered in Murray Hill, N.J., was widely considered the father of human-factors engineering in American industry.

A branch of industrial psychology that combines experimentation, engineering and product design, human-factors engineering is concerned with easing the awkward, often ill-considered marriage between man and machine. In seeking to design and improve technology based on what its users are mentally capable of, the discipline is the cognitive counterpart of ergonomics.

“Human-factors studies are different from market research and other kinds of studies in that we observe people’s behavior and record it, systematically and without bias,” Mr. Israelski said. “The hallmark of human-factors studies is they involve the actual observation of people doing things.”

Among the issues Mr. Karlin examined as the head of Bell Labs’ Human Factors Engineering department — the first department of its kind at an American company — were the optimal length for a phone cord (a study that involved gentle, successful sabotage) and the means by which rotary calls could be made efficiently after the numbers were moved from inside the finger holes, where they had nestled companionably for years, to the rim outside the dial.

John Elias Karlin was born in Johannesburg on Feb. 28, 1918, and reared nearby in Germiston, where his parents owned a grocery store and tearoom.

He earned a bachelor’s degree in philosophy, psychology and music, and a master’s degree in psychology, both from the University of Cape Town. Throughout his studies he was a violinist in the Cape Town Symphony Orchestra and the Cape Town String Quartet.

Moving to the United States, Mr. Karlin earned a Ph.D. from the University of Chicago in 1942. Afterward, he became a research associate at Harvard; he also studied electrical engineering there and at the Massachusetts Institute of Technology.

At Harvard, Mr. Karlin did research for the United States military on problems in psychoacoustics that were vital to the war effort — studying the ways, for instance, in which a bomber’s engine noise might distract its crew from their duties.

Read More..

Big Bear locked down amid manhunt

The bustling winter resort of Big Bear took on the appearance of a ghost town Thursday as surveillance aircraft buzzed overhead and police in tactical gear and carrying rifles patrolled mountain roads in convoys of SUVs, while others stood guard along major intersections.

Even before authorities had confirmed that the torched pickup truck discovered on a quiet forest road belonged to suspected gunman Christopher Dorner, 33, officials had ordered an emergency lockdown of local businesses, homes and the town's popular ski resorts. Parents were told to pick up their children from school, as rolling yellow buses might pose a target to an unpredictable fugitive on the run.

By nightfall, many residents had barricaded their doors as they prepared for a long, anxious evening.

PHOTOS: A tense manhunt amid tragic deaths

"We're all just stressed," said Andrea Burtons as she stocked up on provisions at a convenience store. "I have to go pick up my brother and get him home where we're safe."

Police ordered the lockdown about 9:30 a.m. as authorities throughout Southern California launched an immense manhunt for the former lawman, who is accused of killing three people as part of a long-standing grudge against the LAPD. Dorner is believed to have penned a long, angry manifesto on Facebook saying that he was unfairly fired from the force and was now seeking vengeance.

Forest lands surrounding Big Bear Lake are cross-hatched with fire roads and trails leading in all directions, and the snow-capped mountains can provide both cover and extreme challenges to a fugitive on foot. It was unclear whether Dorner was prepared for such rugged terrain.

Footprints were found leading from Dorner's burned pickup truck into the snow off Forest Road 2N10 and Club View Drive in Big Bear Lake.

San Bernardino County Sheriff John McMahon said that although authorities had deployed 125 officers for tracking and door-to-door searches, officers had to be mindful that the suspect may have set a trap.

"Certainly. There's always that concern and we're extremely careful and we're worried about this individual," McMahon said. "We're taking every precaution we can."

PHOTOS: A fugitive's life on Facebook

Big Bear has roughly 400 homes, but authorities guessed that only 40% are occupied year-round.

The search will probably play out with the backdrop of a winter storm that is expected to hit the area after midnight.

Up to 6 inches of snow could blanket local mountains, the National Weather Service said.

Gusts up to 50 mph could hit the region, said National Weather Service meteorologist Mark Moede, creating a wind-chill factor of 15 to 20 degrees.

Extra patrols were brought in to check vehicles coming and going from Big Bear, McMahon said, but no vehicles had been reported stolen.

"He could be anywhere at this point," McMahon said. When asked if the burned truck was a possible diversion, McMahon replied: "Anything's possible."

Dorner had no known connection to the area, authorities said.

Craig and Christine Winnegar, of Murrieta, found themselves caught up in the lockdown by accident. Craig brought his wife to Big Bear as a surprise to celebrate their 28th wedding anniversary. Their prearranged dinner was canceled when restaurant owners closed their doors out of fear.

"It's definitely scary," Christine Winnegar said.

Read More..

Well: Old Age and Motorcycles Are a Dangerous Mix

If you’re over 40 and planning to hop on a motorcycle, take care. Compared with younger riders, the odds of being seriously injured are high.

That is the message of a new study, published this week in the journal Injury Prevention, which found that older bikers are three times as likely to be severely injured in a crash as younger riders.

The percentage of older bikers on the road is quickly rising, and their involvement in accidents is a growing concern. Nationwide, from 1990 to 2003, the percentage of motorcyclists over age 50 soared from roughly 1 in 10 to about 1 in 4. At the same time, the average age of riders involved in motorcycle crashes has also been climbing. Injury rates among those 65 and older jumped 145 percent from 2000 to 2006 alone.

Because of the increase in motorcycle ridership among older Americans, the researchers, led by Tracy Jackson, a graduate student in the epidemiology department at Brown University, wanted a closer look at their injury patterns. So she and her colleagues combed through a federal database of motorcycle crashes that were serious enough to require emergency medical care. That yielded about 1.5 million incidents involving motorcyclists 20 or older from 2001 to 2008.

The researchers then split them into groups: those in their 20s and 30s, another group between 40 and 59, and those 60 and older.

Over all, the study showed that injury rates for all three groups were on the rise. But the rise was steepest for the oldest riders. Compared with the youngest motorcyclists, those who were 60 and older were two and a half times as likely to end up with serious injuries, and three times as likely to be admitted to a hospital. The riders who were middle age were twice as likely as their younger counterparts to be hospitalized.

For older riders, the consequences of a collision were also especially alarming. Older and middle-aged bikers were more likely to sustain fractures and dislocations, and they had a far greater chance of ending up with injuries to internal organs, including brain damage.

The researchers speculated that it was very likely that a number of factors played a role in older riders’ higher injury rates. For one, declines in vision and reaction time may make older riders more prone to mistakes that end up in collisions. Another theory is that older riders tend to ride bigger bikes, “which may be more likely to roll or turn over,” Ms. Jackson said.

Then there is the greater fragility that comes with age. Older riders may be involved in the same types of accidents as younger riders, Ms. Jackson said, but in some cases, a collision that a 20-year-old would walk away from might send a 65-year-old to the hospital.

“Your bones become more brittle, and you lose muscle mass as you get older,” she said. “It could just be a matter of aging and the body being less durable.”

Read More..

European Leaders Struggle to Bridge Budget Gaps

BRUSSELS — European Union leaders on Friday morning edged closer to agreeing a budget worth nearly €1 trillion, or $1.3 trillion, to support farming, transportation and other infrastructure, as well as big research projects for the 27-nation bloc.

But after 15 hours of talks, the leaders were still seeking unanimity while also attempting to satisfy the wide array of national interests demanding attention.

The budget is negotiated every seven years and involves furious horse-trading as leaders focus on getting the best deal for their own countries’ citizens, rather than emphasizing pan-European considerations.

The marathon session was the second attempt to reach a deal on the funding package, which should run from 2014 to 2020, after the first attempt collapsed in November.

Another failure to strike a deal on a sum of money that represents only about 1 percent of the Union’s Gross Domestic Product would be a severe embarrassment for the leaders, who already have spent years bickering over how to save the euro.

The European Commission, the bloc’s policymaking arm, had sought an increase in the overall budget of around 5 percent to more than €1 trillion.

Herman Van Rompuy, the president of the European Council, which represents E.U. leaders, pruned that sum to about €973 billion at the previous summit in November.

On Friday morning, Mr. Van Rompuy presented further revisions lowering the overall sum to about €960 billion but holding down the amount of cash governments pay up-front to around €908 billion.

That formula was designed, in part, to satisfy countries like Britain and the Netherlands that pay more into the budget than they receive, while also accommodating the demands of countries like France and Italy that want to maintain generous payments for agriculture and infrastructure.

Some of the deepest cuts would be made to pan-European projects to improve transport, energy, and digital services that are overseen by the commission. About €1 billion in cuts would be made to the part of the budget used to employ 55,000 people, including 6,000 translators, most of them in Brussels, who run the Union’s day-to-day affairs.

Expert national advisors were reviewing the proposals on Friday morning, and leaders were expected to reconvene for further talks.

Leaders also were wrestling over demands by some countries to renew a system of rebates that raises the costs for other countries.

One of the complications in the current round of negotiations has been the call for budgetary rigor from leaders like David Cameron, the British prime minister, who says the Union should tighten its belt at a time when many European governments have been compelled to impose stringent budget cuts.

Mr. Cameron, in particular, has earned the enmity of some European leaders by demanding a renegotiation of Britain’s treaty with the Union and promised a referendum on his nation’s membership in 2017.

Reflecting growing irritation with Britain among a number of European leaders, Martin Schulz, the president of the European Parliament, told a news conference late on Thursday night that leaders should not go out of their way to appease Mr. Cameron.

Because Britain could be outside the bloc by later this decade, there was little need to make concessions to Mr. Cameron that potentially jeopardized “the security of our financial planning,” Mr. Schulz suggested.

Mr. Van Rompuy, the president of the European Council, had intended to start the session during the mid-afternoon on Thursday to force leaders to make their complaints clear in a roundtable session rather than being allowed to break into small groups.

But his plan was derailed, and the first roundtable session was delayed until late in the evening, as leaders formed the kind of pre-summit huddles that he seemingly wanted to avoid.

President François Hollande of France was an hour late to a meeting during the afternoon with Mr. Cameron, Angela Merkel, the German chancellor, and Mr. Van Rompuy.

Mr. Hollande’s lateness was a sign of French displeasure with British demands that included strict limits on agriculture spending cherished by French farmers, according to an E.U. diplomat, who spoke on condition of anonymity because of the sensitivity of the talks.

Even if leaders eventually agree to a deal, it faces still more hurdles before it becomes law at the European Parliament, which has the power to veto the budget.

Some of the most influential figures in Parliament have already signaled that they are prepared to reject a budget that foresees spending less on Europe in the years ahead.

Guy Verhofstadt, the head of the alliance of liberals in the Parliament, called on Thursday for a full-revision clause to be inserted into the budget, so that it could be increased after three years if economic conditions improved.

Mr. Schulz, the president of the Parliament, said on Thursday that he would not approve a budget that ended up widening the overall gap between the amount of cash paid up-front by governments and the somewhat higher amounts known as commitments, which make up the overall budget.

Read More..

L.A. Unified misspent millions marked for school lunches

At least eight California school districts have misappropriated millions of dollars in funding intended to pay for meals for low-income students — the biggest culprit being the Los Angeles Unified School District, according to a state Senate watchdog group.

The California Department of Education has ordered districts to repay more than $170 million in misused funds to their student meal programs, the California Senate Office of Oversight and Outcomes said in a report issued Wednesday. L.A. Unified has been forced to pay back more than $158 million in misappropriations and unrelated charges that the district made over six years ending in 2011.

State officials suspect the alleged misuse of funds could be more widespread across California school districts.

In most cases, school systems attempted to use cafeteria funds to pay for personnel, utilities and other expenses. Other school districts named in the report are Oxnard, San Diego, Santa Ana, San Francisco, Baldwin Park, Centinela Valley and Compton.

Oxnard was forced to repay $5.6 million. San Diego and Santa Ana are challenging the findings of the department, which has ordered them to pay $4.5 million and $2.7 million, respectively.

L.A. Unified redirected funding for years –- ignoring reports from administrators and its own inspector general –- before an employee alerted state authorities, the survey said. Among other expenses, the district diverted funding to pay for sprinklers and salaries of employees at a district television station.

L.A. Unified said in a statement that administrators have been working with the state to ensure compliance and said the district "looks forward to success with state education officials in this work to find a more rational approach to accounting and compliance guidelines for all schools statewide."

Federal regulations require districts to keep the student meal funding in an account to be used only for the improvement of food service. Most districts keep federal, state and other cafeteria revenues in that same account and all funds must comply with federal regulations, the report said.

The report, however, found that the system to monitor the spending of those funds is overloaded and that the regulations governing spending are too complex. School districts, as a result, have repeatedly disregarded the rules and subsequently contested violations as arguable interpretations of the law, the report said.

Oversight of these funds is carried out by 60 state examiners who monitor nearly 3,000 districts. Examiners — who are nutritionists — have not completed all inspections required by law since 2001 and "rarely take more than a cursory look at the books," the report said.

The diversion of funds often contributes to conditions that discourage eligible students from seeking free or reduced-priced meals. To maximize funds, districts have used cost-saving methods of serving processed rather than fresh foods, shortening lunch periods and cutting back on cafeteria maintenance and staff — all of which hinder student participation, the report said.

"They are literally taking food out of the mouths of kids," Richard Zeiger, chief deputy superintendent of public instruction, said in a statement.

From the 2004-2005 school year to 2010-2011, the number of L.A. Unified students eligible for reduced-price or free lunches fell below statewide averages. During those years, the district — the state's largest — averaged a participation rate of between 51% and 60% among eligible students. School districts statewide averaged between 71% and 74% participation.

Students who are eligible for reduced-priced or free lunches are from low-income and poverty-level families.

L.A. Unified has become a leader in providing more healthful meals, offering foods with less sodium and fat, and including more fresh fruit and vegetables. The district serves 650,000 meals a day.

The state has allowed L.A. Unified to use money from its general fund that was already going toward covering a deficit in its food services budget to "write off" the debt, the report said. The district has used those funds to pay off about $120 million so far.

The state Education Department said it has begun training employees on how to flag accounting issues and is in the process of hiring additional monitoring staff.

stephen.ceasar@latimes.com

Read More..

Selena Gomez works the front row at Neo show

NEW YORK (AP) — Selena Gomez sat front and center at the fashion show to preview the first collection in her collaboration with Adidas‘ streetwear Neo label.

But the runway at Wednesday evening’s show was a next-gen catwalk: Teenager bloggers were charged with styling the outfits instead of industry professionals.

Gomez thanked them as she stood on stage at the end of the show. She was flanked by models in denim shorts, Bermudas, slouchy sweats and T-shirts that read “Pirate Love.” There were a few graffiti prints sprinkled in, and some varsity jackets.

The clothes, mostly in sunny yellow, bright pink and navy, were more surf than sport, which is Adidas’ normal niche.

The show was very briefly interrupted by a protester trying to hand out leaflets about sweatshops.

Entertainment News Headlines – Yahoo! News

Title Post: Selena Gomez works the front row at Neo show
Url Post: http://www.news.fluser.com/selena-gomez-works-the-front-row-at-neo-show/
Link To Post : Selena Gomez works the front row at Neo show
Rating:
100%

based on 99998 ratings.
5 user reviews.
Author: Fluser SeoLink
Thanks for visiting the blog, If any criticism and suggestions please leave a comment

Read More..

Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His blue eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

---

Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Read More..

Profound Weight of Layoffs Seen in Survey

Layoffs have touched nearly every American household in some fashion over the last few years, according to new survey data to be released Thursday by the John J. Heldrich Center for Workforce Development at Rutgers University.

Joe Raedle/Getty Images

Lissette Marquez, center, and Amiel Ali looked for jobs last week in Miami with the help of a South Florida Workforce customer service representative, Nelson Munoz, left.

While about 8 percent of Americans are unemployed, nearly a quarter of Americans say they were laid off at some point during the recession or afterward, according to the survey. More broadly, nearly eight in 10 say they know someone in their circle of family and friends who has lost a job.

“This to me is why the recession was so all-consuming and is likely to influence the American psyche,” said Cliff Zukin, a public policy and political science professor at Rutgers and co-author of the report. “Almost everyone, four out of five, were directly or one step removed from unemployment and all that goes with it financially, socially, psychologically.”

The survey presented a bleak view of the economic future.

A majority of Americans say they think it will be at least six years before the economy is made whole again, if ever. Three in 10 said the economy would never fully recover from the Great Recession.

“Despite significant improvements in the nation’s labor market, American workers’ concerns about unemployment, the job market, job security and the future of the economy have not changed much since we conducted a similar survey in August 2010,” the report said.

Just a third of Americans surveyed in this poll, conducted from Jan. 9-16, said they thought the economy would be better next year, the same share that said so two years earlier.

Of those laid off in recent years, nearly a quarter said they still had not found a job. Re-employment rates for older workers have been particularly bad, with nearly two-thirds of unemployed people 55 and older saying they actively sought a job for more than a year before finding one or had still not found work.

Not surprisingly, those who are unemployed are especially downbeat about many economic issues in addition to their own finances. Of those who were jobless and looking for work, 31 percent said their jobless benefits had run out and 58 percent said they were concerned their benefits would run out before they found work.

Of those who have found work, nearly half say their current job is a step down from the one they lost, and a slim majority say they earn less than they did in their previous job. A quarter of those re-employed said they thought that the hit to their standard of living would be permanent.

The reliance on one’s personal network and savings rather than the social safety net showed up frequently in the survey data.

More people reported borrowing money from friends and family than reported using food stamps. A third cut back on doctors’ visits or medical treatment. A quarter of the unemployed said they had enrolled in retraining programs of some kind; half of them reported paying for the education on their own or through family assistance. Twenty-three percent received some type of government financing for their training programs.

Unemployed workers were more likely than employed workers to say that the government is primarily responsible for helping the jobless. But even then, a majority of the unemployed thought that workers and employers were more responsible for getting people back to work than the government was.

Americans over all were also somewhat less critical of bankers this time than they were two years earlier. About one in three (35 percent) respondents attributed high unemployment levels to the actions of Wall Street, compared with 45 percent in 2010.

Americans were most likely to attribute high unemployment to cheap foreign labor. Four in 10 also said they believed illegal immigrants were taking Americans’ job opportunities — which does not bode well for political support for an amnesty program now being discussed in Washington.

Most people surveyed lost at least some of their savings. Asked about their financial health, six in 10 Americans said their finances would not improve in the next few years; just 16 percent said their family finances were already back to prerecession levels or suffered no loss in the first place.

More educated, better-off people were substantially more likely to report being as financially secure as they were before the recession began.

Responses are based on an online survey conducted by GfK using a nationally representative sample of 1,090 adults. The margin of sampling error is plus or minus three percentage points.

Read More..

D.A. alleges Chris Brown failed to complete community service

Los Angeles County prosecutors on Tuesday accused singer Chris Brown of failing to complete his court-ordered community service for his 2009 assault conviction and questioned whether the documents submitted as proof of his service were fraudulent.

A motion filed by the district attorney's office said that Brown claimed he completed four hours of trash pickup between 10 a.m. and 6 p.m. on one day when he was actually on a private plane to Cancun that he boarded at 4 p.m.

On another day that the entertainer said he was picking up trash in a Richmond, Va., alley, news photographers were snapping him 100 miles away in Washington, D.C., where he hosted a charity event that raised funds for the developmentally disabled, prosecutors contended.

Deputy Dist. Atty. Mary A. Murray outlined a series of inconsistencies with a report prepared by Richmond police about the number of hours Brown had served. She said a district attorney's investigation into Brown's community service claims found "significant discrepancies indicating at best sloppy documentation and at worst fraudulent reporting," and she asked a judge to order Brown to carry out his court-ordered labor in Los Angeles County instead of Virginia, where he lives.

Brown's attorney, Mark Geragos, disputed the allegations, accusing prosecutors of making "scurrilous, libelous and defamatory statements" against the R&B star. Geragos also disagreed with suggestions in supporting documents filed by the district attorney's office alleging that the defense attorney coached Virginia authorities in their conversations with Los Angeles County investigators.

"The motion is a disgrace, and the D.A. should be embarrassed, and I plan on asking for sanctions against the D.A.," Geragos said. "I also encourage the Richmond Police Department to take legal action against the L.A. district attorney."

Brown is on five years' probation after pleading guilty to a felony count of assault in connection with a 2009 attack on then-girlfriend Rihanna. As part of his probation, he was required to perform 180 days of community labor in Virginia.

The district attorney did not ask a judge to find Brown in violation of his probation. A judge will decide later whether Brown must serve additional community service time in Los Angeles County. If he does not fulfill his obligation to the court, he could be sent to jail.

The allegations by prosecutors add to the continuing problems that Brown is facing just days before Sunday's Grammy Awards; his album "Fortune" is one of the nominees.

The Los Angeles County district attorney's office said that Brown was the subject of a sheriff's investigation into a Jan. 27 fight at a West Hollywood recording studio where singer Frank Ocean was punched repeatedly by Brown and his friends. After the beating, Brown said, "We can bust on you too," the district attorney's motion alleged, noting that "bust" was slang for "shoot." Ocean declined to press charges, and sheriff's officials said they plan to close the case.

Last year in Miami, prosecutors said, Brown snatched a cellphone that a fan had used to take a photo of him and his then-girlfriend, telling the fan, "You're not going to put these pictures on a website," before driving off with the phone. The incident underscored the star's "anger-management problems" and at least amounted to petty theft, prosecutors said. Florida prosecutors declined to file charges against Brown.

Murray also cited a March 2011 incident at the "Good Morning America" studio in New York, where Brown became enraged when asked about his assault on Rihanna. Brown threw a chair through a window, an act that prosecutors said was "another demonstration of the defendant's anger-control issues and violent temper resulting in a violation of the law."

Brown, prosecutors said, has also violated his probation by smoking marijuana and failing to obtain permits to allow him to travel while on probation.

The latest allegations by the district attorney's office also focus attention on the Richmond Police Department, tasked with supervising the singer's community service requirements. In an August 2009 letter to the Los Angeles County court, Richmond Police Chief Bryan Norwood confirmed his department would oversee Brown's probation, saying the singer would be assigned "manual labor tasks, such as graffiti removal, trash pick up, washing cars, cleaning, maintaining grounds, etc."

But district attorney's investigators concluded that Richmond police rarely checked on Brown's progress, even though the chief wrote to the court in November 2011 vouching for Brown's completing more than 100 days of labor. Overtime records show that Richmond police officers provided Brown security at a concert performance, Murray wrote.

Richmond police declined to comment, citing the ongoing court case.

In addition, prosecutors said they could not find evidence that Brown completed more than 500 hours of community labor at Tappahannock Children's Center, where his mother had once served as director and where he spent time as a child. The center is an hour's drive from Richmond and rarely visited by police, according to Murray's motion.

Part of the singer's labor reportedly included waxing floors at the center. But a longtime janitor at the facility told investigators that he had maintained all of the floors for eight years and was unaware of anyone else doing so.

The janitor told a district attorney's investigator that he had been contacted by the center's current administrator "to warn him" about questions from L.A. County officials, the report said. The administrator "tried to tell [the janitor] how to handle our questions," the investigator wrote, to which the janitor said "he wasn't going to lie to anyone about anything."

andrew.blankstein@latimes.com

jack.leonard@latimes.com

Times staff writer Kate Mather contributed to this report.

Read More..

Singer Gloria Estefan, husband, plan Broadway show of their lives

NEW YORK (Reuters) – Cuban-American singer Gloria Estefan and her music entrepreneur husband, Emilio, are developing a new Broadway show based on their lives, the show’s producer said on Tuesday.

The couple is working with the Nederlander Organization on the show that will trace their lives from leaving Cuba to international stardom.

“The Estefans’ journey of success, led by raw talent and passion, is captivating as it drove them from relative obscurity to global sensations,” Jimmy Nederlander, the organization’s president, said in a statement announcing the deal.

Estefan, one of the most successful Latin crossover stars, fled Cuba with her family as a toddler. She met her husband in Miami and became the lead singer of his band, which was renamed the Miami Sound Machine. The couple married in 1978.

She has sold more than 100 million albums worldwide, won seven Grammy Awards and produced a list of hits including “Conga,” “The Rhythm is Going to Get You,” and “1,2,3.”

Emilio, a music, television and film director, was instrument in his wife’s career, and helped to develop stars such as Shakira, Ricky Martin and Jennifer Lopez.

“Sharing our life story through music will give us a new opportunity to honor our roots and, hopefully, to be able to inspire generations to come,” the couple said in a statement.

The Nederlander Organization said no creative team has been announced yet.

(Reporting by Noreen O’Donnell; Editing by Patricia Reaney and Eric Walsh)

Music News Headlines – Yahoo! News

Title Post: Singer Gloria Estefan, husband, plan Broadway show of their lives
Url Post: http://www.news.fluser.com/singer-gloria-estefan-husband-plan-broadway-show-of-their-lives/
Link To Post : Singer Gloria Estefan, husband, plan Broadway show of their lives
Rating:
100%

based on 99998 ratings.
5 user reviews.
Author: Fluser SeoLink
Thanks for visiting the blog, If any criticism and suggestions please leave a comment

Read More..

Ipswich Journal: Paul Mason Is One-Third the Man He Used to Be

Paul Nixon Photography

Paul Mason in 2012, two years after gastric bypass surgery stripped him of the unofficial title of “the world’s fattest man.”

IPSWICH, England — Who knows what the worst moment was for Paul Mason — there were so many awful milestones, as he grew fatter and fatter — but a good bet might be when he became too vast to leave his room. To get him to the hospital for a hernia operation, the local fire department had to knock down a wall and extricate him with a forklift.

That was nearly a decade ago, when Mr. Mason weighed about 980 pounds, and the spectacle made him the object of fascinated horror, a freak-show exhibit. The British news media, which likes a superlative, appointed him “the world’s fattest man.”

Now the narrative has shifted to one of redemption and second chances. Since a gastric bypass operation in 2010, Mr. Mason, 52 years old and 6-foot-4, has lost nearly two-thirds of his body weight, putting him at about 336 pounds — still obese, but within the realm of plausibility. He is talking about starting a jewelry business.

“My meals are a lot different now than they used to be,” Mr. Mason said during a recent interview in his one-story apartment in a cheerful public housing complex here. For one thing, he no longer eats around the clock. “Food is a necessity, but now I don’t let it control my life anymore,” he said.

But the road to a new life is uphill and paved with sharp objects. When he answered the door, Mr. Mason did not walk; he glided in an electric wheelchair.

And though Mr. Mason looks perfectly normal from the chest up, horrible vestiges of his past stick to him, literally, in the form of a huge mass of loose skin choking him like a straitjacket. Folds and folds of it encircle his torso and sit on his lap, like an unwanted package someone has set there; more folds encase his legs. All told, he reckons, the excess weighs more than 100 pounds.

As he waits to see if anyone will agree to perform the complex operation to remove the skin, Mr. Mason has plenty of time to ponder how he got to where he is. He was born in Ipswich and had a childhood marked by two things, he says: the verbal and physical abuse of his father, a military policeman turned security guard; and three years of sexual abuse, starting when he was 6, by a relative in her 20s who lived in the house and shared his bed. He told no one until decades later.

After he left school, Mr. Mason took a job as a postal worker and became engaged to a woman more than 20 years older than him. “I thought it would be for life, but she just turned around one day and said, ‘No, I don’t want to see you anymore — goodbye,’ ” he said.

His father died, and he returned home to care for his arthritic mother, who was in a wheelchair. “I still had all these things going around in my head from my childhood,” he said. “Food replaced the love I didn’t get from my parents.” When he left the Royal Mail in 1986, he said, he weighed 364 pounds.

Then things spun out of control. Mr. Mason tried to eat himself into oblivion. He spent every available penny of his and his mother’s social security checks on food. He stopped paying the mortgage. The bank repossessed their house, and the council found them a smaller place to live. All the while, he ate the way a locust eats — indiscriminately, voraciously, ingesting perhaps 20,000 calories a day. First he could no longer manage the stairs; then he could no longer get out of his room. He stayed in bed, on and off, for most of the last decade.

Social service workers did everything for him, including changing his incontinence pads. A network of local convenience stores and fast-food restaurants kept the food coming nonstop — burgers, french fries, fish and chips, even about $22 worth of chocolate bars a day.

“They didn’t deliver bags of crisps,” he said of potato chips. “They delivered cartons.”

His life became a cycle: eat, doze, eat, eat, eat. “You didn’t sleep a normal sleep,” he said. “You’d be awake most of the night eating and snacking. You totally forgot about everything else. You lose all your dignity, all your self-respect. It all goes, and all you focus on is getting your next fix.”

He added, “It was quite a lonely time, really.”

He got infections a lot and was transported to the hospital — first in a laundry van, then on the back of a truck and finally on the forklift. For 18 months after a hernia operation in 2003, he lived in the hospital and in an old people’s home — where he was not allowed to leave his room — while the local government found him a house that could accommodate all the special equipment he needed.

This article has been revised to reflect the following correction:

Correction: February 6, 2013

The headline on an earlier version of this article misstated Paul Mason’s current weight relative to what he weighed nearly a decade ago. He is now about one-third, not two-thirds, the weight he was then.

Read More..

DealBook: Liberty Global Reaches Deal for Virgin Media

8:07 p.m. | Updated

LONDON – Liberty Global, the international cable company owned by the American billionaire John C. Malone, agreed on Tuesday to buy the British cable company Virgin Media for about $16 billion.

The deal gives Liberty Global access to Europe’s largest cable market, and pits Mr. Malone against Rupert Murdoch, his longtime rival and biggest shareholder in Britain’s largest pay-TV provider British Sky Broadcasting.

Under the terms of the deal, Liberty Global said it had offered a package of cash and stock that it valued at $47.87 for each share in Virgin Media, a 24 percent premium over Virgin Media’s closing price on Monday.

The takeover ranks as one of the 10 largest cable deals of all time, according to figures from the data provider Thomson Reuters.

“Virgin Media will add significant scale and a first-class management team in Europe’s largest and most dynamic media and communications market,” Mike Fries, Liberty Global’s president and chief executive, said in a statement.

“After the deal, roughly 80 percent of Liberty Global’s revenue will come from just five attractive and strong countries — the U.K., Germany, Belgium, Switzerland and the Netherlands.”

News of the talks, confirmed earlier in the day in a statement by Virgin Media, came amid heightened merger and acquisition activity in the European television business. As European broadcasters suffer from stagnant or falling advertising revenue, American media conglomerates, looking to expand their international presence, are playing a significant role.

Mr. Malone and Mr. Murdoch have gone head-to-head before. From 2004 to 2006, they fought for control of DirecTV, the American satellite television provider.

The clash ended with Mr. Malone yielding a stake that he had built up in News Corporation. But the Liberty Group, which has operations in 13 countries, completed its purchase of a controlling stake in DirecTV from News Corporation in a cash-and-equity deal worth roughly $11 billion.

In recent years, Liberty Global has been expanding its presence in Europe and has operations from Ireland to Romania, though it failed last month in its bid to acquire the Telenet Group of Belgium for $2.7 billion. Liberty Global owns a 58 percent stake in Telenet.

Since early 2010, Liberty has bought two German rivals to build its operations in Europe’s largest economy.

In response, News Corporation has been expanding its global cable business, including the $2.1 billion acquisition of Consolidated Media, the Australian pay-television company, late last year.

Since the beginning of the financial crisis, Virgin Media, whose commercials feature the Olympic sprinting star Usain Bolt, has announced job cuts and invested in its broadband structure to reduce costs and increase its market share in Britain’s competitive cable market.

The company’s market capitalization stands at more than $10 billion. Including debt, its enterprise value is around $19.4 billion, according Thomson Reuters. Shares of Virgin Media, which are primarily traded on the Nasdaq, were up nearly 18 percent to $45.61 on the news of the Liberty talks.

Virgin’s shares have jumped almost 90 percent in the last 12 months, as more consumers sign up for so-called bundled services, including Internet and cellphone contracts. Virgin Media will announce its earnings on Wednesday.

Analysts warned that it would be difficult for Liberty Global to make additional savings between its current European operations and those of Virgin Media because Liberty does not have a business in Britain.

They said Liberty waited to make its move until Virgin made several upgrades to its network and restructured its debt. While Virgin has been gaining market share, it has 4.9 million customers, or roughly half the number of subscribers as its larger rival, BSkyB, according to filings by the companies.

The British billionaire Richard Branson, whose Virgin brand is used for a variety of products and services, including airlines and banks, owns less than 3 percent of Virgin Media.

News of the talks also came amid heightened merger and acquisition activity in the European television business. In December, Discovery Communications agreed to pay $1.7 billion for the Scandinavian operations of a large German commercial television company.

According to news reports this week, the majority owners of the German company are considering a sale. American media companies, including Time Warner, have been mentioned as potential buyers.

Analysts say the flurry of activity is driven by a desire among pay-television companies and broadcasters to diversify revenue sources that are coming under increased pressure. So broadcasters are setting up pay-television channels, and cable and satellite companies are looking to new content delivery platforms, like the Internet.

While commercial broadcasters remain powerful in Germany, Britain is the most lucrative pay-television market in Europe, according to Screen Digest, a research firm.

The deal for Virgin Media is expected to close during the second quarter of this year.

LionTree Advisors, Credit Suisse and the law firms Shearman & Sterling and Ropes & Gray advised Liberty Global, while Goldman Sachs, JPMorgan Chase and the law firms Fried Frank and Milbank advised Virgin Media.

Mark Scott reported from London, and Eric Pfanner from Paris.

---

This post has been revised to reflect the following correction:

Correction: February 5, 2013

Because of an editing error, an earlier version of this article misstated the first name of the leader of News Corporation. He is Rupert Murdoch, not Richard.

Read More..

GOP lawmakers want probe of Cal Fire over off-budget account

State Republican legislators want federal prosecutors to investigate the California Department of Forestry and Fire Protection for putting $3.6 million from legal settlements into an off-budget account.

"This subterfuge money has been spent on a wide array of questionable expenditures that has nothing to do with reimbursing the state for firefighting costs," the legislators wrote in a Friday letter to Gov. Jerry Brown, asking him to request an investigation by the U.S. attorney.

The letter follows a story in The Times that found that from 2005 to 2012, Cal Fire, as the department is commonly known, placed funds with the California District Attorneys Assn. to use for training and equipment. Cal Fire regulations say the money is supposed to be sent to the state general fund.

The legislators said the state attorney general had authorized sending the money to the California District Attorneys Assn. Brown served as attorney general from 2007 to 2011.

Lynda Gledhill, a spokeswoman for the current attorney general, denied that claim.

"The California Department of Justice did not endorse placement of settlement money into an account outside of the budget process," Gledhill said. "Atty. Gen. [Kamala] Harris has directed her office to examine the state's settlement practices to ensure all settlements are not only lawful, but fully transparent to the public."

The state Department of Finance has begun an audit of the fund, which is expected to take about two months, spokesman H.D. Palmer said.

In addition, a joint Assembly and state Senate committee announced last week that it will conduct a hearing to determine the extent California agencies are using off-budget accounts to hold money outside the state system.

The GOP letter was signed by 25 members of the Senate and Assembly. They also are using the issue to call for an end to a law the Legislature passed last year requiring rural homeowners who rely on state firefighters to pay $150 a year for fire prevention services.

"It is clear that the state has not been judicious in its use of taxpayer dollars," the lawmakers' letter said. "The state must stop these outrageous duplicitous tactics."

Senate Republican leader Robert Huff of Diamond Bar and Assembly GOP leader Connie Conway of Tulare sent a letter last week asking the attorney general to refer the matter to the U.S. attorney. A spokeswoman for the U.S. attorney in Sacramento said no information about the fund had been brought to her office.

Janet Upton, a Cal Fire spokeswoman, said the agency would welcome an investigation.

"We stand by the intent of this fund and have many examples of good things it's done that benefit the taxpayers of this state," she said.

Cal Fire's own audit, released in 2009, raised questions about whether the fund was allowed. But many of the critical comments were dropped from the audit's final version.

The scrutiny follows similar revelations that the state Department of Parks and Recreation hid $20 million as budget cuts were forcing the closure of parks. Although the Department of Finance looked for other secret funds, it did not find Cal Fire's account with the prosecutors' association.

jeff.gottlieb@latimes.com

Read More..

NJ Gov. Christie, Letterman laugh about fat jokes

TRENTON, N.J. (AP) — New Jersey Gov. Chris Christie and David Letterman have shared some laughs about the many fat jokes the comedian has made about the lawmaker’s ample girth.

Christie has termed his plumpness “fair game” for comedians. And during his first appearance on “Late Show with David Letterman” on Monday, the outspoken Republican and potential 2016 presidential contender read two of Letterman‘s jokes that he said were “some of my personal favorites.”

The governor also drew loud laughs when he pulled out a doughnut and started eating it while Letterman asked him if he was bothered by the digs that have been made about his weight. Christie said he wasn’t, noting that he laughs at the jokes if he finds them funny.

“Late Show” airs on CBS at 11:35 p.m. Eastern time.

Entertainment News Headlines – Yahoo! News

Title Post: NJ Gov. Christie, Letterman laugh about fat jokes
Url Post: http://www.news.fluser.com/nj-gov-christie-letterman-laugh-about-fat-jokes/
Link To Post : NJ Gov. Christie, Letterman laugh about fat jokes
Rating:
100%

based on 99998 ratings.
5 user reviews.
Author: Fluser SeoLink
Thanks for visiting the blog, If any criticism and suggestions please leave a comment

Read More..

Well: Expressing the Inexpressible

When Kyle Potvin learned she had breast cancer at the age of 41, she tracked the details of her illness and treatment in a journal. But when it came to grappling with issues of mortality, fear and hope, she found that her best outlet was poetry.

How I feared chemo, afraid
It would change me.
It did.
Something dissolved inside me.
Tears began a slow drip;
I cried at the news story
Of a lost boy found in the woods …
At the surprising beauty
Of a bright leaf falling
Like the last strand of hair from my head

Ms. Potvin, now 47 and living in Derry, N.H., recently published “Sound Travels on Water” (Finishing Line Press), a collection of poems about her experience with cancer. And she has organized the Prickly Pear Poetry Project, a series of workshops for cancer patients.

“The creative process can be really healing,” Ms. Potvin said in an interview. “Loss, mortality and even hopefulness were on my mind, and I found that through writing poetry I was able to express some of those concepts in a way that helped me process what I was thinking.”

In April, the National Association for Poetry Therapy, whose members include both medical doctors and therapists, is to hold a conference in Chicago with sessions on using poetry to manage pain and to help adolescents cope with bullying. And this spring, Tasora Books will publish “The Cancer Poetry Project 2,” an anthology of poems written by patients and their loved ones.

Dr. Rafael Campo, an associate professor of medicine at Harvard, says he uses poetry in his practice, offering therapy groups and including poems with the medical forms and educational materials he gives his patients.

“It’s always striking to me how they want to talk about the poems the next time we meet and not the other stuff I give them,” he said. “It’s such a visceral mode of expression. When our bodies betray us in such a profound way, it can be all the more powerful for patients to really use the rhythms of poetry to make sense of what is happening in their bodies.”

On return visits, Dr. Campo’s patients often begin by discussing a poem he gave them — for example, “At the Cancer Clinic,” by Ted Kooser, from his collection “Delights & Shadows” (Copper Canyon Press, 2004), about a nurse holding the door for a slow-moving patient.

How patient she is in the crisp white sails
of her clothes. The sick woman
peers from under her funny knit cap
to watch each foot swing scuffing forward
and take its turn under her weight.
There is no restlessness or impatience
or anger anywhere in sight. Grace
fills the clean mold of this moment
and all the shuffling magazines grow still.

In Ms. Potvin’s case, poems related to her illness were often spurred by mundane moments, like seeing a neighbor out for a nightly walk. Here is “Tumor”:

My neighbor walks
For miles each night.
A mantra drives her, I imagine
As my boys’ chant did
The summer of my own illness:
“Push, Mommy, push.”
Urging me to wind my sore feet
Winch-like on a rented bike
To inch us home.
I couldn’t stop;
Couldn’t leave us
Miles from the end.

Karin Miller, 48, of Minneapolis, turned to poetry 15 years ago when her husband developed testicular cancer at the same time she was pregnant with their first child.

Her husband has since recovered, and Ms. Miller has reviewed thousands of poems by cancer patients and their loved ones to create the “Cancer Poetry Project” anthologies. One poem is “Hymn to a Lost Breast,” by Bonnie Maurer.

Oh let it fly
let it fling
let it flip like a pancake in the air
let it sing: what is the song
of one breast flapping?

Another is “Barn Wish” by Kim Knedler Hewett.

I sit where you can’t see me
Listening to the rustle of papers and pills in the other room,
Wondering if you can hear them.
Let’s go back to the barn, I whisper.
Let’s turn on the TV and watch the Bengals lose.
Let’s eat Bill’s Doughnuts and drink Pepsi.
Anything but this.

Ms. Miller has asked many of her poets to explain why they find poetry healing. “They say it’s the thing that lets them get to the core of how they are feeling,” she said. “It’s the simplicity of poetry, the bare bones of it, that helps them deal with their fears.”

---

Have you written a poem about cancer? Please share them with us in the comments section below.

Read More..

DealBook: Dell Nears a Buyout Deal of More Than $23 Billion

Dell Inc. neared an agreement on Monday to sell itself to a group led by its founder and the investment firm Silver Lake for more than $23 billion, people briefed on the matter said, in what would be the biggest buyout since the financial crisis.

If completed, a takeover would be the most ambitious attempt yet by Michael S. Dell to revive the company that bears his name. Such is the size of the potential deal that Mr. Dell has called upon Microsoft, one of his most important business partners, to shore up the proposal with additional financial muscle. The question will now turn to whether taking the personal computer maker private will accomplish what years of previous turnaround efforts have not.

The final details were being negotiated on Monday evening, and a deal could be announced as soon as Tuesday. Still, last-minute obstacles could cause the talks to collapse, the people briefed on the matter cautioned.

The consortium is expected to pay $13.50 to $13.75 a share, these people said. Mr. Dell is expected to contribute his nearly 16 percent stake to the deal, worth about $3.8 billion under the current set of terms. He is also expected to contribute hundreds of millions of dollars in fresh capital from his own fortune.

Silver Lake, known as one of the biggest investors in technology companies, would most likely contribute roughly $1 billion, these people added. Microsoft is expected to put in about $2 billion, though that would probably come in the form of preferred shares or debt.

Dell is also expected to bring home some of the cash that it holds in offshore accounts to help with the financing.

A spokesman for Dell declined to comment.

For decades, Dell benefited from its status as a pioneer in the market for personal computers. Founded in 1984 in a dormitory room at the University of Texas, the company grew into one of the biggest computer makers in the world, built on the simple premise that customers would flock to customize their machines.

By the late 1990s, its fast-rising stock created a company worth $100 billion and minted a class of “Dellionaires” whose holdings made for big fortunes, at least on paper. Mr. Dell amassed an estimated $16 billion and formed a quietly powerful investment firm to manage those riches.

But growing competition has sapped Dell’s strength. Rivals like Lenovo and Samsung have made the PC-making business less profitable. Last month, the market research firm Gartner reported that Dell sold 37.6 million PCs worldwide in 2012, a 12.3 percent drop from the previous year’s shipments. Perhaps more significant is the emergence of the smartphone and the tablet, two classes of devices that have eaten away at sales of traditional computers.

Mr. Dell has sought to move the company into the more lucrative and stable business of providing corporations with software services, spending billions of dollars on acquisitions to lead that transformation. The aim is to refashion Dell into something more like I.B.M. or Oracle. Even so, manufacturing PCs still makes up half of the company’s business.

The company’s stock had fallen 59 percent in the 10 years ended Jan. 11, the last business day before word of the buyout talks emerged. That has actually made Dell more tempting as a takeover target for its founder and Silver Lake, which see it as undervalued.

A Dell deal would be a watershed moment for the leveraged buyout industry: It would be the largest takeover since the Blackstone Group paid $26 billion for Hilton Hotels in the summer of 2007. No leveraged buyout since the financial crisis has surpassed the $7.2 billion that Kohlberg Kravis Roberts and others paid for the Samson Investment Company, an oil and gas driller, in the fall of 2011.

Private equity executives have hungered for the chance to strike a deal worth more than $10 billion, an accomplishment believed difficult because of the sheer size of financing required. Dell would take on more than $15 billion in debt, an enormous amount arranged by no fewer than four banks.

But the debt markets have been soaring over the last two years, as the cost of junk bonds has stayed low. Persistent low interest rates have prompted debt buyers to seek investments that carry higher yields

Dell was unusually well-placed to make a deal with private equity. The company carries $4.9 billion in long-term debt, which some analysts have regarded as a manageable amount. And its management has signaled a willingness to bring back at least some of the company’s cash hoard held overseas, despite potentially ringing up a hefty tax bill.

It is unclear whether the company’s biggest investors will accept a deal at the levels that the buyer consortium is advocating. Shares of Dell fell 2.6 percent, to $13.27, on Monday after reports of the proposed price range emerged.

Biggest Private Equity-Backed Leveraged Buyouts

DEAL, IN BILLIONS	TARGET	BUYER	ANNOUNCED
Source: Thomson Reuters *At time of deal, including assumption of debt, not adjusted for inflation.
$44.3	TXU	Morgan Stanley, Citigroup, Lehman Brothers Holdings, Kohlberg Kravis Roberts, Texas Pacific Group and Goldman Sachs	February 2007
37.7	Equity Office Properties Trust	Blackstone Group	November 2006
32.1	HCA	Bain Capital, Kohlberg Kravis Roberts and Merrill Lynch Global Private	July 2006
30.2	RJR Nabisco	Kohlberg Kravis Roberts	October 1988
30.1	BAA	Grupo Ferrovial SA, Caisse de Depot et Placement and GIC Special Invest	March 2006
27.6	Harrah’s Entertainment	Texas Pacific Group and Apollo Management	October 2006
27.4	Kinder Morgan	GS Capital Partners, The Carlyle Group and Riverstone Holdings	May 2006
27.2	Alltel	TPG Capital and GS Capital Partners	May 2007
27.0	First Data	Kohlberg Kravis Roberts	April 2007
26.7	Hilton Hotels	Blackstone Group	July 2007

Read More..

Slaying casts light on Hollywood's transgender prostitutes

The last that Cassidy Vickers' street friends saw of him was about 10 p.m. on Nov. 17, 2011, outside the Donut Time shop on Santa Monica Boulevard in Hollywood.

He was waving and saying he'd be back in a bit.

A transgender prostitute whose legal name was Nathan, Cassidy had come down from the San Francisco Bay Area to work the Hollywood streets.

That night, on Lexington Avenue, 10 blocks from the doughnut shop, Vickers was shot to death by a man on a bike.

Vickers' death was part of a series of crimes by a man police are now calling the Western Bandit for his armed robberies late at night in the vicinity of Western Avenue from Hollywood to South Los Angeles. Detectives believe he has recently resurfaced, committing six more street robberies from June to October, and then two more last month.

"This is a huge concern for us, and for the safety of the public," said Lt. John Radtke of the Los Angeles Police Department. Radtke, supervisor of West Bureau homicide detectives, said a "signature aspect" of the crimes, which he declined to specify, has led investigators to believe the same man has appeared three times to commit crimes.

His victims, Radtke said, range from transgender prostitutes to people coming home from work late at night. Besides Vickers, two other victims have been transgender women, neither of whom was hurt. Detectives don't believe he's specifically targeting transgender prostitutes.

"My feeling is he's out there robbing and desperate to get his money and he takes whoever he encounters," Radtke said.

Still, the case of the Western Bandit casts light on the world of transgender streetwalkers, which has changed radically in recent years, leaving only the most vulnerable on the street at night — people like Nathan "Cassidy" Vickers.

Vickers grew up in a tidy, four-bedroom house in East Palo Alto, a working-class black and Latino town south of San Francisco.

In the years after high school, he came out as a gay man, said his mother, Mitzy Thompson, though "he had some of the 'hood in him," dressing in baggy pants, with braided hair and two fake gold front teeth.

His friends remember a funny, talkative and loyal gay man attempting to find his way in a tough town like East Palo Alto.

He left, eventually living in Las Vegas and, briefly, New York. He then returned to the Bay Area, where he worked for years cleaning rooms in hotels.

Sometime in 2010 he began going to Oakland parties in drag and from there, desperate for cash, working as a prostitute.

Cross-dressing, for Vickers, "was 90% economic; 10% because he liked the attention," said Nelee Webb, a friend and former roommate. Unemployment "took his self-esteem. He felt 'This is my last resort.' "

By early 2011, Vickers was traveling the Hollywood-Bay Area circuit that has for years been followed by many transgender prostitutes.

He remained Nathan in East Palo Alto, but became Cassidy while working Hollywood's transgender prostitute strip: Santa Monica Boulevard.

According to a report by the city attorney's office, Cassidy Vickers was arrested for soliciting prostitution, a month before he died, on nearby Lexington Avenue, which is where many transgender prostitutes hang out.

Several blocks of Lexington, just north of Santa Monica Boulevard and lined with small bungalows and crowded apartments, have been a strip for male hookers dressed as women for at least two decades. The scene reached its zenith in the mid-1990s. But it has declined in the era of Internet sites that match johns with prostitutes.

"It's a street of no return," said Elena Pupo, a Venezuelan transgender woman and advocate for the community.

Vickers had no home, no cosmetic surgery. He was, said a friend who asked not to be identified, a handsome man, "but wasn't really an attractive looking female."

He was the kind of vulnerable night denizen that the Western Bandit appears to target. Working late at night, he slept in bushes on a street between Donut Time and Lexington, or in a booth at the X-Spot adult bookstore in the strip mall behind the doughnut shop, Amber said.

The last time Amber saw Vickers, he seemed happier and more exuberant — the kind of outgoing person that Bay Area friends describe. "She felt good about herself that day," Amber said.

An hour later, Amber said, police cars descended on the Donut Time strip mall. Officers circulated a picture of Vickers asking the streetwalkers who heshe was.

More than a hundred people attended Vickers' funeral in East Palo Alto. Thompson didn't know many of them. She was startled to see a few were men with women's breasts and clothes.

Nevertheless, Thompson dressed her son's body in a man's suit — burgundy, his favorite color. His face, bewhiskered for years, was clean-shaven — the way he kept it as a woman when he died. Thompson said she learned of her son's cross-dressing only after his death, from a Facebook video he'd posted.

For police, Vickers' story is one they've seen all too often.

"It's the age-old Hollywood story," said Brett Goodkin, the Los Angeles police homicide detective called to Lexington that night. "People come to Hollywood … so they can be somebody else. In Nathan's case, he could be himself in Hollywood. That was his Hollywood dream. It ended like so many others."

sam.quinones@latimes.com

Read More..