Surgeon infected patients during heart procedure, Cedars-Sinai admits

A heart surgeon at Cedars-Sinai Medical Center unwittingly infected five patients during valve replacement surgeries earlier this year, causing four of the patients to need a second operation.

The infections occurred after tiny tears in the latex surgical gloves routinely worn by the doctor allowed bacteria from a skin inflammation on his hand to pass into the patients' hearts, according to the hospital. The patients survived the second operation and are still recovering, hospital officials said.

The outbreak led to investigations by the hospital and both the L.A. County and California departments of public health. The federal Centers for Disease Control and Prevention was also consulted.

Hospital officials called it a "very unusual occurrence" probably caused by an unfortunate confluence of events: the nature of the surgery, the microscopic rips in the gloves and the surgeon's skin condition. Valve replacement requires the surgeon to use thick sutures and tie more than 100 knots, which can cause extra stress on the gloves, they said.

Nevertheless, the hospital's goal is to have zero infections, said Harry Sax, vice chairman of the hospital's department of surgery. "Any hospital-acquired infection is unacceptable," he said.

The infections raise questions about what health conditions should prevent a surgeon from operating and how to get the best protection from surgical gloves. Surgeons with open sores or known infections aren't supposed to operate, but there is no national standard on what to do if they have skin inflammation, said Rekha Murthy, medical director of the hospital's epidemiology department. She added that there were also no national standards on types of gloves used, whether to wear double gloves or how many times surgeons should change those gloves during a procedure.

Healthcare-acquired infections are very common throughout the United States. Each year, infections cause 99,000 deaths in the country, including about 12,000 in California. Hospitals in the state are required to report certain infections to the California Department of Public Health. That reporting makes the public more aware of the quality of care provided at local hospitals and is an important tool for reducing infections, said Debby Rogers, deputy director of the department's Center for Health Care Quality.

Cedars-Sinai has low rates for hospital-acquired infections compared with the state and national average but has not performed as well on other surgical quality measures recently, according to the Leapfrog Group, an employer-backed nonprofit focused on healthcare quality. The organization gave the hospital a C rating last month on its national report card, down from an A in June, though it was not related to the infection outbreak.

"Clearly this hospital is making attempts to reduce infections, but they have more work to do," said Leah Binder, Leapfrog's chief executive.

Cedars-Sinai Medical Center conducts about 360 valve replacement surgeries each year and said infections occur in fewer than 1% of its cases — lower than the national average.

The hospital learned about the problem in June after three patients who had undergone valve replacement surgery showed signs of infection. Doctors diagnosed the patients with an infection called endocarditis. Concerned there might be a connection among the cases, epidemiologists analyzed the bacteria, staphylococcus epidermidis, and determined that it was an identical strain and therefore must have come from a single source. "It led to the question of gee, I wonder where it came from?" Murthy said.

Epidemiologists homed in on the surgeon with the skin inflammation. The bacteria matched, and then they made a surprising discovery: microscopic tears in the gloves typically worn by surgeons after performing valve replacement surgery. The surgeon, whose name was not released, was not allowed to operate again until he healed. He is still a member of the medical staff but no longer performs surgeries at the hospital.

The hospital soon found the same infection in two more patients. Officials also reached out to 67 patients who had heart valve replacements with the same surgeon but didn't find any other cases. One of the five infected patients was treated with antibiotics, and the other four had new valve replacement surgeries. Sax said the hospital apologized to the patients and has continued to monitor their health. The hospital has also covered the cost of their care, including follow-up treatment and all the related surgeries.

All surgeons doing valve replacements are now required to change gloves more frequently, officials said. Some surgeons are wearing double gloves during the operations, Sax said.

Following the outbreak, Cedars-Sinai did the proper follow-up to ensure the safety of their patients, said Dawn Terashita, a medical epidemiologist with L.A. County, who was notified in September. What occurred at Cedars-Sinai was an unintentional consequence of the surgery, she said.

"There is no way to keep a room entirely sterile and all the people in it sterile," she said. "You will always have risk of infection."

anna.gorman@latimes.com

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New Crowdfunding Site Seeks to Protect Backers of Industrial Design

Entrepreneur Jamie Siminoff wants to build more credibility into crowdfunding — so he’s launching a new platform that takes responsibility for ensuring the viability of new projects.

The crowdfunding process, pioneered by sites like Kickstarter, has had its share of huge successes, as well as failures. The problem, says Siminoff, is that when a venture fails, the funders are left holding the bag. That’s all well and good if you were investing in an artist’s crazy project. It’s much more of a problem if you thought you were pre-ordering a nearly finished gadget.

The biggest culprit for these kinds of issues are physical products. Witness the anger unleashed when Kickstarter darling Pebble announced a further delay alongside underwhelming color choices.

This kind of issue is why Kickstarter recently made some changes, undertaking a combination of education and rule revision. They reminded consumers that Kickstarter is not a store while requiring that all projects disclose risks and challenges, as well as forbidding renderings and concept videos in hardware products.

Siminoff’s answer is Christie Street, a crowdfunding site devoted exclusively to physical products. The promise of Christie Street is that it will vet the projects that it launches carefully, and provide guarantees of progress along the way. The idea is that these protections will make consumers feel safer about the products they’re backing. “We built something that we felt we needed,” he says.

Christie Street, named for the New Jersey road where Edison’s workshop was located, will require that all funders go through an auditing process before they are allowed to go live. Siminoff says that the idea will be to check for basic viability, a kind of sanity test.

“You look at the chips they say they want to use, the size of components that will need to fit in, and so on,” he says, “You check that things conform to what’s available on the market.” From there, they also perform third-party audits of the places where the product will be manufactured, and look at things like production cost and likely shipping time, to ensure that all of this seems realistic.

It’s an all-or-nothing audit. Either the new project meets Christie Street’s approval or it doesn’t. “Our feeling is that the customer that’s buying doesn’t have the sophistication to make the right decision [about whether a design's production targets are reliable],” says Siminoff, “The only way is create a place where you can trust to buy.”

Even after the initial approval, Christie Street stays involved in the project. Successfully funded projects get their money in stages, with Christie Street holding the rest in escrow. Inventors get one-third of the money on funding, one-third of the money once they have a production-ready prototype, and the final one-third when they have a golden prototype, which means they are ready for full manufacturing.

If at any time along the way the project fails, Christie Street will can the project and refund the remaining money to investors.

What constitutes failure? Siminoff ticks off four conditions.

First, the inventor could for whatever reason announce that they couldn’t finish.

Second, if the project ends up more than six months late. “This forces people to be more careful with their delivery dates,” says Siminoff.

Third, if the product falls short of what was promised. “If the pre-production sample is more than 15 percent worse than what was promised, we will not allowed you to manufacture the product,” says Siminoff. (For example, if you promised me 512GB and only delivered 256.)

Last, says Siminoff there are other nuances that they’ll have to work out as the site develops. For example, if a product ends up requiring significant redesign, then Christie Street might end up withholding funds. “Design is a tougher one to quantify,” he says, “but it’s important that the design overall fits what was promised to the customer.”

For the extra cautious, Christie Street goes even further than the refund of remaining money. For 10 percent of their pledge value, backers can insure their entire pledge. If the project goes wrong they’ll get all of it back. Combine that with a pledge from inventors that the product will retail for at least 10 percent more than the pledge amount, and you can either take a 10 percent discount for some additional risk or pay full retail, with a money-back guarantee.

In effect, Christie Street is navigating a space between crowfunding sites like Kickstarter and Indiegogo, which expect backers to handle a lot of their own due diligence while allowing the inventors to be entrepreneurs, and crowdsourcing design sites like Quirky, which handles all of the business elements in-house.

Christie Street is an effort at drawing the lines of trust in a new way, one tied directly to the realities of post-industrial product design. Rather than a blanket ban on renderings and early designs, or a Wild West ‘anything goes’ approach, they instead seeks to tame the parts where production can go really wrong, in the devilish details of prototyping and manufacturing. It leaves questions of whether or not the thing is cool to the wisdom of the crowds, while taking on the question of whether or not the thing is possible.

This is obviously a lot more intervention between middleman and inventor than you’d see on a site like Indigegogo or Kickstarter. Siminoff says that they can still take the same 5 percent cut as their competitors because physical products tend to be involved higher dollar-value projects from the start. “If all goes well, we’ll be doing 10 to 15 live projects a months a year from now,” he says, “We think we can be profitable in the product world.”

“We’re not trying to make it where inventors are just be a name on a product,” says Siminoff, “We still want them to be entrepreneur and build this thing. We just want to make sure that they don’t fail in a way that hurts the customer.”

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New Whitney Houston book recalls singer’s musical magic

LOS ANGELES (Reuters) – A new book on Whitney Houston by her early producer seeks to tell the story of the rise to stardom of the pop diva who died nine months ago.

Emmy and Grammy-winning producer Narada Michael Walden, who produced many of Houston‘s early hits, like “How Will I Know” and “I Wanna Dance With Somebody,” appeared at the Grammy Museum in Los Angeles on Wednesday to discuss the book and perform some of the songs he collaborated on.

“Her death was so shocking and sudden that I wanted to create something to keep alive the beautiful aspects of her life. The media was lashing out on the addiction and ignoring her musical genius,” Walden told Reuters.

Since she drowned in a bathtub on February 11 after taking cocaine, Houston‘s music and life have generated a TV tribute with Jennifer Hudson, Usher and others, a greatest hits CD, a coffee table book of photos and a TV reality show starring family members.

Walden’s book “Whitney Houston: The Voice, the Music, the Inspiration,” co-written with Richard Buskin, describes how Walden first met the singer when she was 13 and accompanied her mother to the studio. Walden was working on a record with her mom, soul and gospel singer Cissy Houston.

Walden said he all but forgot the young pretty girl until he got a call from Arista records in 1984, while working on an Aretha Franklin record, and was told to “make the time” to work on Houston‘s debut album.

Walden said Janet Jackson‘s management turned down the chance to record “How Will I Know” and that he rewrote it to make it catchier for Houston, who with her five-octave vocal range, recorded the 1985 No.1 song in only one take.

“The first take was the keeper. Instead of laboring on it for the better part of a day or even longer, we were done in a matter of minutes,” he said, noting Houston always worked fast.

Walden, who also produced for Ray Charles, Stevie Wonder and Barbra Streisand, collaborated with Houston on “So Emotional,” “One Moment in Time” and “I’m Every Woman” from the film, “The Bodyguard.”

Walden and Houston went in different directions by the late 1990s, but he would see her at the annual pre-Grammy party hosted by her long-time mentor, record industry mogul Clive Davis.

At the 2011 Davis party, Houston sat with her daughter, Bobbi Kristina – then 17 – who exclaimed she wanted to sing and work with Walden. “But Whitney gave me a look that said ‘Slow down. I’ve been down that road….and I’m not sure I want to curse her with that’,” he said.

Walden said he would now welcome the opportunity to work with Houston‘s daughter, who has become a fixture of gossip blogs and tabloids.

“If she wants to, I’d love to produce her and keep alive the professional image of her mother and focus on the positive,” he said.

(Reporting By Susan Zeidler, editing by Jill Serjeant and Andrew Hay)

Music News Headlines – Yahoo! News

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Doping at U.S. Tracks Affects Europe’s Taste for Horse Meat

PARIS — For decades, American horses, many of them retired or damaged racehorses, have been shipped to Canada and Mexico, where it is legal to slaughter horses, and then processed and sold for consumption in Europe and beyond.

Christinne Muschi for The New York Times

A slaughterhouse in Saint-André-Avellin, Quebec, where meat is processed for sale in Europe.

Lately, however, European food safety officials have notified Mexican and Canadian slaughterhouses of a growing concern: The meat of American racehorses may be too toxic to eat safely because the horses have been injected repeatedly with drugs.

Despite the fact that racehorses make up only a fraction of the trade in horse meat, the European officials have indicated that they may nonetheless require lifetime medication records for slaughter-bound horses from Canada and Mexico, and perhaps require them to be held on feedlots or some other holding area for six months before they are slaughtered.

In October, Stephan Giguere, the general manager of a major slaughterhouse in Quebec, said he turned away truckloads of horses coming from the United States because his clients were worried about potential drug issues. Mr. Giguere said he told his buyers to stay away from horses coming from American racetracks.

“We don’t want them,” he said. “It’s too risky.”

The action is just the latest indication of the troubled state of American racing and its problems with the doping of horses. Some prominent trainers have been disciplined for using legal and illegal drugs, and horses loaded with painkillers have been breaking down in arresting numbers. Congress has called for reform, and state regulators have begun imposing stricter rules.

But for pure emotional effect, the alarm raised in the international horse-meat marketplace packs a distinctive punch.

Some 138,000 horses were sent to Canada or Mexico in 2010 alone to be turned into meat for Europe and other parts of the world, according to a Government Accountability Office report. Organizations concerned about the welfare of retired racehorses have estimated that anywhere from 10 to 15 percent of the population sent for slaughter may have performed on racetracks in the United States.

“Racehorses are walking pharmacies,” said Dr. Nicholas Dodman, a veterinarian on the faculty of Tufts University and a co-author of a 2010 article that sought to raise concerns about the health risks posed by American racehorses. He said it was reckless to want any of the drugs routinely administered to horses “in your food chain.”

Horses being shipped to Mexico and Canada are by law required to have been free of certain drugs for six months before being slaughtered, and those involved in their shipping must have affidavits proving that. But European Commission officials say the affidavits are easily falsified. As a result, American racehorses often show up in Canada within weeks — sometimes days — of their leaving the racetrack and their steady diets of drugs.

In October, the European Commission’s Directorate General for Health and Consumers found serious problems while auditing the operations of equine slaughter facilities in Mexico, where 80 percent of the horses arrive from the United States. The commission’s report said Mexican officials were not allowed to question the “authenticity or reliability of the sworn statements” about the ostensibly drug-free horses, and thus had no way of verifying whether the horses were tainted by drugs.

“The systems in place for identification, the food-chain information and in particular the affidavits concerning the nontreatment for six months with certain medical substances, both for the horses imported from the U.S. as well as for the Mexican horses, are insufficient to guarantee that standards equivalent to those provided for by E.U. legislation are applied,” the report said.

The authorities in the United States and Canada acknowledge that oversight of the slaughter business is lax. On July 9, the United States Food and Drug Administration sent a warning letter to an Ohio feedlot operator who sells horses for slaughter. The operator, Ronald Andio, was reprimanded for selling a drug-tainted thoroughbred horse to a Canadian slaughterhouse.

The Canadian Food Inspection Agency had tested the carcass of the horse the previous August and found the anti-inflammatory drug phenylbutazone in the muscle and kidney tissues. It also discovered clenbuterol, a widely abused medication for breathing problems that can build muscle by mimicking anabolic steroids.

Because horses are not a traditional food source in the United States, the Food and Drug Administration does not require human food safety information as it considers what drugs can be used legally on horses. Patricia El-Hinnawy, a spokeswoman for the agency, said agency-approved drugs intended for use in horses carried the warning “Do not use in horses intended for human consumption.”

She also said the case against Mr. Andio remained open.

“On the warning letter, the case remains open and no further information can be provided at this time,” Ms. El-Hinnawy said.

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U.S. now hindered by distance it kept on Syria conflict

WASHINGTON — With the Syrian civil war apparently near a turning point, Obama administration officials are finding their ability to influence the fast-moving events and growing violence hampered by their reluctance to become too deeply involved during the first 21 months of the conflict.

As the opposition has scored major gains against the regime of President Bashar Assad in recent days, U.S. officials have stepped up diplomatic efforts and begun weighing whether to start providing arms or other military assistance to the rebels.

But at a moment when the future of the strategically key nation may be up for grabs, Washington's power is limited by its weak ties to rebel field commanders who will have a major say in what comes next if Assad is toppled, say diplomats, opposition officials and regional experts.

"We don't have a presence on the ground and we haven't given assistance in any measure to these people," said James Jeffrey, a veteran U.S. diplomat who retired last summer after a final posting as U.S. ambassador to Iraq. "This is going to have an impact on our influence ... and it didn't have to be this way."

Though the administration has provided diplomatic pressure, humanitarian relief and nonlethal aid, it has been unwilling to supply arms or to use U.S. military force to set up a no-fly zone, as it did in the Libyan civil war last year. Officials fear that weapons would end up in the hands of extremists, and they want to limit U.S. military involvement at a time when Americans are war-weary and world powers and Arab states are divided on the conflict.

But it has become clear that, as they plan their approach to the next stage of the war, U.S. officials will have to try to overcome the unhappiness of rebel commanders who don't understand America's unwillingness to provide the military help it gave Libyan rebels last year.

The stakes are high. If the regime falls — by no means a certainty — the United States and its allies will want to move quickly to try to steer Syria toward a moderate, multiethnic government and away from a sectarian bloodbath. U.S. officials and allies are now busy formulating plans to help Syrians form a new government.

The number of extremist fighters in groups such as the Al Qaeda-linked Al Nusra Front has been rising, and if those groups take control of a new government, the geopolitical landscape of the region could change overnight in dangerous ways. Obama, who has been criticized by conservatives for failing to do more in Syria, could face accusations that his policy of limited engagement "lost" Syria.

The issue came up in the presidential campaign, with Republican challenger Mitt Romney saying he would supply arms to the Syrian opposition and Obama advocating a more cautious approach.

"We can't simply suggest that giving heavy weapons to the Syrians is a simple proposition that would lead us to be safer over the long term," the president said in the final debate of the campaign.

The rebel commanders' frustration with the United States has been apparent in recent weeks, in demonstrations that in some cases have shown up on YouTube.

One video shows a Nov. 30 demonstration in the village of Binish in which rebel fighters brandish their weapons and declare that they are fighting to create an Islamist Syria that would not be led by a Western-backed coalition of opposition groups, the newly formed National Coalition of Syrian Revolutionary and Opposition Forces.

"We will not leave the revolution to the coalition that is a game in the hand of America and serves the American project," one of the fighters says in Arabic. "Oh, Obama, listen and listen!"

Though his views may be more radical than those of most opposition fighters, there is widespread unhappiness that America has not done more.

"Syrians have been looking for U.S. leadership, but unfortunately the United States has chosen not to get involved and people here have gotten more and more upset," said Khalid Saleh, an executive board member of the Syrian National Council opposition bloc and a representative to the new coalition. He said he believes the United States could still take a lead role, but he has not seen signs that the administration wants to do so.

He noted that whereas France and Britain have recognized the new coalition as the legitimate government-in-waiting in Syria, the United States has been reluctant to do the same — a sign, in his view, that Washington still wants others to lead the way. U.S. officials are expected to formally recognize the group Wednesday at an international meeting on Syria in Marrakech, Morocco.

Dan Layman, an official with the Syrian Support Group, a Washington-based organization that sends nonlethal supplies to the opposition, said he understands the U.S. reluctance to send arms that could end up in the hands of extremists. But he said some Syrian commanders have complained that they have felt compelled to affiliate themselves with militant groups because those groups have access to weapons that are not being supplied by the West.

"We're concerned that some of these commanders may be moving to the wrong side of the street out of necessity," said Layman, whose group is licensed by the U.S. government and funded mostly by Syrian Americans.

U.S. officials have limited their ties to the rebels since the beginning of the conflict, when they urged demonstrators not to turn to arms.

Though they are in regular contact with military councils — provincial bodies that try to coordinate the patchwork of militias — relationships are not strong with individual groups, said Andrew Tabler, a leading Syria expert at the Washington Institute for Near East Policy. The United States could have built a valuable relationship, for example, with Al Farouq brigade, a nationalist but mainline group, he said.

Though the new coalition has been praised in the West for its inclusiveness and leadership, diplomats acknowledge that it's not clear whether the umbrella group would be strong enough to issue orders to the militias that could hold the most power in a post-Assad Syria.

One unsettling possibility is that Syria could be filled with militias that retain their weapons, as in postrevolutionary Libya, but without goodwill toward the United States or loyalty to a transitional government.

"You could have dozens of militias, battle-tested and brimming with weapons, that don't necessarily consider the authorities in Damascus to be sovereign," said David Schenker, a Pentagon official in the George W. Bush administration who is now with the Washington Institute for Near East Policy.

paul.richter@latimes.com

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Feds Charge Anonymous Spokesperson for Sharing Hacked Stratfor Credit Cards

A Dallas grand jury has brought charges against Anonymous spokesman Barrett Brown stemming from the 2011 hack of intelligence vendor Stratfor Global Intelligence.

Brown isn’t charged with committing the hack; just with possessing and transmitting credit card numbers that were stolen in the incident.

He has been in prison since he was arrested in dramatic and public fashion three months ago after posting a threatening video to YouTube. Brown was talking with acquaintances during a Sept. 12 TinyChat session when the feds burst in and took him away. The chat session was later posted to the internet.

The Anonymous spokesman was charged the next day with threatening a federal officer.

This time the charges are are related to a different incident: the 2011 Stratfor hack where credit card numbers and internal e-mail messages were stolen.

According to the grand jury indictment, dated Tuesday, Brown posted a link to a zipped version of the documents stolen in the Stratfor hack on Christmas day 2011 — that counts as trafficking in “stolen authentication features,” the indictment claims. He’s also charged with possessing stolen credit card numbers, Card Verification Values, and other information related to those credit card numbers.

Brown, 31, has been in custody since his Sept. 12 arrest, the U.S. Department of Justice said Friday in a press release announcing the 12-count indictment. He could face a maximum of 15 years in prison if convicted on the most serious of these charges.

The self-proclaimed Anonymous spokesman said he was expecting to face fraud charges after his apartment was raided back in March. He mentioned them in a long, rambling video posted to YouTube the day on the same day he was arrested in September. “I bring in no money. I have $25,000 I brought in the last year from this fucking book deal. that’s it.” he said. “A fucking fraud charge for a fucking writer activist who has no fucking money.”

Later in the video, Brown railed against FBI Agent Robert Smith, saying that he was going to “ruin” Smith’s life “and look into his fucking kids.” The Anonymous activist said he was angry that feds were contemplating obstruction of justice charges against his mother.

The indictment is below.

Gov.uscourts.txnd.226354.1.0

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Viral rapper PSY apologizes for anti-US protests

South Korean rapper and Internet sensation PSY is apologizing to Americans for participating in anti-U.S. protests several years ago.

Park Jae-sang, who performs as PSY, issued a statement Friday after reports surfaced that he had participated in concerts protesting the U.S. military presence in South Korea during the early stages of the Iraq war.

At a 2004 concert, the “Gangnam Style” rapper performs a song with lyrics about killing “Yankees” who have been torturing Iraqi captives and their families “slowly and painfully.” In another protest, he smashed a model of a U.S. tank on stage.

“While I’m grateful for the freedom to express one’s self, I’ve learned there are limits to what language is appropriate and I’m deeply sorry for how these lyrics could be interpreted,” he wrote in the statement. “I will forever be sorry for any pain I have caused by those words.”

The 34-year-old rapper says the protests were part of a “deeply emotional” reaction to the war and the death of two Korean school girls, who were killed when a U.S. military vehicle hit them as they walked alongside the road. He noted antiwar sentiment was high around the world at the time.

PSY attended college in the U.S. and says he understands the sacrifices U.S. military members have made to protect South Korea and other nations. He has recently performed in front of servicemen and women.

“And I hope they and all Americans can accept my apology,” he wrote. “While it’s important that we express our opinions, I deeply regret the inflammatory and inappropriate language I used to do so. In my music, I try to give people a release, a reason to smile. I have learned that thru music, our universal language we can all come together as a culture of humanity and I hope that you will accept my apology.”

His participation in the protests was no secret in South Korea, where the U.S. has had a large military presence since the Korean War, but was not generally known in America until recent news reports.

PSY did not write “Dear American,” a song by The N.E.X.T., but he does perform it. The song exhorts the listener to kill the Yankees who are torturing Iraqi captives, their superiors who ordered the torture and their families. At one point he raps: “Kill their daughters, mothers, daughters-in-law, and fathers/Kill them all slowly and painfully.”

PSY launched to international acclaim based on the viral nature of his “Gangnam Style” video. It became YouTube’s most watched video, making him a millionaire who freely crossed cultural boundaries around the world. Much of that success has happened in the U.S., where the rapper has managed to weave himself into pop culture.

He recently appeared on the American Music Awards, dancing alongside MC Hammer in a melding of memorable dance moves that book-end the last two decades. And the Internet is awash with copycat versions of the song. Even former Republican Sen. Alan Simpson, the 81-year-old co-chairman of President Barack Obama‘s deficit commission, got in on the fun, recently using the song in a video to urge young Americans to avoid credit card debt.

It remains to be seen how PSY’s American fans will react. Obama, the father of two pop music fans, wasn’t letting the news change his plans, though.

Earlier Friday, the White House confirmed Obama and his family will attend a Dec. 21 charity concert where PSY is among the performers. A spokesman says it’s customary for the president to attend the “Christmas in Washington” concert, which will be broadcast on TNT. The White House has no role in choosing performers for the event, which benefits the National Children’s Medical Center.

Entertainment News Headlines – Yahoo! News

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The New Old Age Blog: A Son Lost, a Mother Found

My friend Yvonne was already at the front door when I woke, so at first I didn’t realize that my mother was missing.

It was less than a week after my son Spencer died. Since that day, a constant stream of friends had been coming and going, bringing casseroles and soup, love, support and chatter. Mom hated it.

My 94-year-old mother, who has vascular dementia, has been living in my home in upstate New York for the past few years. Like many with dementia, mom is courteous but, underneath, irascible. Pride defines her, especially pride in her Phi Beta Kappa intellect. She hates to be confronted with how she has become, as she calls it, “stupid.”

The parade of strangers confused her. She had to be polite, field solicitous questions, endure mundane comments. She could not remember what was going on or why people were there. It must have been stressful and annoying.

That night, like every night since the state troopers brought the news, I woke hourly, tumbling in panic. As if it were not too late to save my son. Mom knew something was wrong, but she could not remember what. As I overslept that morning, she must have decided enough was enough. She was going home.

In a cold sky, the sun blazed over tall pines. As I opened the door, the dogs raced out to greet Yvonne and her two housecleaners. Yvonne often brags about her cleaning duo. They were her gift to me. They were going to clean my house before the funeral reception, which was scheduled for later that week. This was a very big gift because, like my mother before me, I am a very bad housekeeper.

Mom’s door was shut. I cautioned the housecleaners to avoid her room as I showed them around. Yvonne went to the kitchen to listen to the 37 unheard messages on my answering machine; the housecleaners went out to their van to get their instruments of dirt removal.

I ducked into Mom’s room to warn her about the upcoming noise. The bed was unmade; the floor was littered with crumpled tissues; the room was empty.

Normally, I would have freaked out right then. I knew Mom was not in the house, because I had just shown the whole house to the cleaners. Although Mom doesn’t wander like some dementia patients, she does on occasion run away. But I could not muster a shred of anxiety.

“Yvonne,” I called, “did you see my mother outside?”

Yvonne popped her head into the living room, eyebrows raised.“Outside? No!” She was alarmed. “Is she missing?”

“Yeah,” I said wearily, “I’ll look.” I stepped out onto the front porch, tightening the belt of my bathrobe and turning up the collar. Maybe she had walked off into the woods. The dogs danced around my legs, wanting breakfast.

I had no space left in my body to care. Either we would find her, or we would not. Either she was alive, or she was not. My child was gone. How could I care about anything ever again?

Then I saw my car was missing. My mouth fell open and my eyeballs rolled up to the right, gazing blindly at the abandoned bird’s nest on top of the porch light: What had I done with the keys?

Mom likes to run away in the car when she is angry. She used to do it a lot when my father was still alive — every time they fought. Since Mom took off in my car almost a year ago, after we had had a fight, I’d kept the keys hidden. Except for this week; this week, I had forgotten.

I was reverting to old habits. I had left the doors unlocked and the keys in the cupholder next to the driver’s seat. Exactly like Mom used to do.

“Uh-oh,” I said aloud. Mom was still capable of driving, even though she did not know where she was going. I just really, really hoped that she didn’t hurt anybody on the road. I pulled out my cellphone, about to call the police.

“Celia!” Yvonne shouted from the kitchen. She hurried up behind me, excited. “They found your mother. There are two messages on your machine.”

At that very moment, Mom was holed up at the College Diner in New Paltz, a 20-minute drive over the mountain, through the fields, left over the Wallkill River and away down Main Street.

Yvonne called the diner. They promised to keep the car keys until someone arrived. By that time, Yvonne had to go to work. She drove my friend Elizabeth to the diner, and Elizabeth drove Mom home in my car.

Half an hour later, they walked in the front door. Mom’s cheeks were rouged by the chill air and her eyes sparkled, her white hair riffing with static electricity. “Hello, hello,” she sang out. “Here we are.” She was wearing the flannel nightgown and robe I had dressed her in the night before. It was covered by her oversized purple parka, and her bare feet were shoved into sneakers.

I started laughing as soon as I saw her. I couldn’t help it. Elizabeth and Mom started laughing too. “You had a big adventure,” I said, hugging them both. “How are you?”

“I’m just marvelous,” said my mother. Mom always feels great after doing something rakish. We settled her on the sofa with her feet on the ottoman. By the time I got her blanket tucked in around her shoulders, she had fallen asleep.

Elizabeth couldn’t stop laughing as she described the scene. “Your mother was holding court in this big booth. She was sitting there in her nightgown and her parka, talking to everybody, with this plate of toast and coffee and, like, three of the staff hovering around her.”

The waitress said Mom seemed “a little disoriented” when she got there. Mom said she was meeting a friend for breakfast, but since she was wearing a nightgown and didn’t know whom she was meeting or where she lived, the staff thought there might be a problem. They convinced Mom to let them look in the glove compartment of the car, where they found my name and number.

It was then that I realized I was laughing – something I’d thought I would never be able to do again. “Elizabeth, Elizabeth, I’m laughing,” I said.

“Ha, ha, ha,” laughed Elizabeth, holding her belly.

“Ha, ha, ha,” I laughed, rolling on the floor.

And she who gave me life, who had suffered the death of my child and the extinction of her own intellect, snoozed on: oblivious, jubilant, still herself, still mine.

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Off the Charts: European Banks Thriving as Investor Fears Ease

THE European bank crisis was one of the major worries of 2012. There were forecasts that the euro zone would break up, that various countries would default on their debts and that undercapitalized banks would fail because national governments could not afford to keep them alive.

The bank crisis is not yet resolved, but it “appears to have been put on the back burner of investor concerns,” Jeffrey Yale Rubin and Kevin Pleines of Birinyi Associates said in a research bulletin sent to clients this week.

The accompanying charts show what has happened to the share prices of an index of euro zone bank stocks, and to each of the 28 members in the index, since June 30. In early July, the index kept falling, but by late in the month it turned around. Anyone who bought all the banks at the end of June is up by about 25 percent. Anyone with the good fortune to buy at the exact bottom has a profit of about half the money invested.

The bank stocks have outperformed other European stocks and they have outperformed American bank stocks, although the shares of most American banks also have risen.

The reasons for the relaxation of investor fears are simple enough. There is a growing confidence that euro zone institutions will succeed in their support efforts. Finance ministers are still arguing about the details of a single regulator for banks throughout the zone, but the European Central Bank’s promise to lend money to banks that need it is widely accepted, and investors believe that Germany will put up whatever money is needed to keep the euro zone from breaking up.

Troubled governments like Italy and Spain are still paying much more than Germany to borrow, but their rates have fallen. Costs have declined even in Portugal, which is in the weakest position of countries other than Greece. The French banks led the way up in late 2012, but even the price of Banco Espirito, a Portuguese bank, has soared by about half since midyear. There are still major concerns about troubled Spanish banks, and two of those join an Italian institution in being the only stock market losers over the period. But the National Bank of Greece managed a small gain.

None of this means that those banks have served long-term shareholders well. Only one of them, a Finnish institution, has a share price higher than it did at the end of 2007, before the financial crisis.

But, for now at least, investors seem to have growing confidence that the banks will survive. Given the fears of a few months ago, that is reason for celebration.

Floyd Norris comments on finance and the economy at nytimes.com/economix.

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An actor despairs in Tinseltown

Seth Burnham sat in a dim corner of Kaldi Coffee & Tea, clutching a mug as he tried to conjure some confidence.

Being here in L.A., I'm giving it everything, he thought.

But after three years of living in Los Angeles, he hadn't had a single role he could be proud of. In a cable TV comedy, he played Percy the Carjacker, a dimwit blown to shreds by an air hose. For an independent film, he had been the best friend of a beautiful woman — a role the script called Small Gay Man.

Hollywood is one big lottery. You have to play it if you want a career in movies or TV....You have to be here. You have to believe.

Sometimes that was tough. Take STARmeter, the entertainment insider's website that measures the popularity of Hollywood actors.

"I was No. 80,000," Burnham said, "for a while."

Frustrated and fatigued, he would retire to this worn, cave-like cafe in Atwater Village.

He had found his surrogate Los Angeles family here, a group of a dozen or so who eased his loneliness and shared his Hollywood ambition: Amy, the animator who had worked on "South Park," Nicholas, whose latest film was well received at the Sundance Film Festival, and Amad, a rising African American actor who worried about being typecast in criminal roles.

They stayed for hours, talking, typing, hunched hard over laptops, nursing lattes. They were actors, writers and directors; stragglers, success stories and hard-luck cases like Burnham.

Many days, he sat in a torn leather chair reading through newspapers and memorizing scripts. He seemed swallowed in the furniture — brown-haired, bearded, not much more than 5 feet tall, with worry lines marching from the corners of his eyes.

Time was against him. Asked his age back in February, Burnham paused. "Mid 30s-ish, early 40s-ish," he said.

Outside of the cafe, he had few Los Angeles friends. His wife, a medical student, moved to St. Louis last year for a residency, but he stayed here. They decided that if she was going to devote herself fully to her dream, then he would too.

But how much more rejection could he handle? And was the unrelenting struggle worth more to him than his marriage?

::

Since his college days in the early 1990s, the acting quest had taken Burnham to several cities. He lived in San Francisco and London, where he trained at a drama school in the classical English style and started a theater company. He lived in Portland, Ore., and Seattle, where he got good reviews for his role in a modern adaptation of Chekhov's "The Seagull."

Everywhere he put down roots he found a place like Kaldi. "The anti-Starbucks," he said. "Just my style."

In Los Angeles, he developed a cafe routine. Each morning, he awoke in his cramped apartment, fed kibbles to his cats, threw on his sneakers and walked across Glendale Boulevard.

He drank two iced coffees a day, no more. He couldn't afford more, not when he didn't have a job — he had to be free for auditions. He relied on credit cards and his wife's salary to pay his bills.

Burnham didn't want fame; he wanted to simply be a journeyman, a working actor, appreciated for his skill, making roughly the same yearly salary as a union electrician.

He sat in the cafe for entire mornings and sometimes entire days. "Wrestling demons," he said.

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How Trusting in Vice Led to John McAfee's Downfall



By now, you are aware of John McAfee. If there’s one thing that the sexagenarian millionaire antivirus founder seems to love more than teenage girls, it’s publicity. And he is extremely adroit at getting it. His misadventures in Central America have eaten the media whole. Even now, in the hospital where he was taken after suffering chest pain, he is surrounded by a crush of media.

He’s a natural story, as I learned firsthand earlier this year. Charming and good-looking, he peppers his speech in Virginia-accented “sirs.” It’s disarming, like some patrician version of neuro-linguistic programming. Combined with his wild stories, it means reporters love to talk to him.

And of course, he is a media magnet for other reasons too, all related to his bizarre lifestyle. His relocation to Belize. His fights with that nation’s government. His coterie of young women. The armed gang members he associates with. The allegations of drug use. The McAfee story, with its drugs and guns and prostitutes and allegations of police corruption, seemed tailor-made for Vice, a publication that revels in all of those subjects on a regular basis. It is as if some hipster god reached down and extended a smelly, fickle finger of fate to Vice editor-in-chief Rocco Castoro, muttering “here’s a cool story, bro.”

Naturally, Vice scuttled down to Belize, and traveled with McAfee as he fled the country, penning a blog post titled “We Are With John McAfee Right Now, Suckers.”

Vice is just the most recent media crew McAfee has latched onto. And if the past is prologue, it won’t go well. The chummy relationship McAfee tends to enjoy with his contacts in the media almost always goes south. He’s previously attached his media ambitions on Jeff Wise, only to then smear him, and then subsequently apologize. Wired’s own Joshua Davis also enjoyed his attentions, and when McAfee first went on the lam, he gave Davis exclusive interviews. This lasted until Davis wrote stories McAfee didn’t like, at which point the old man in the jungle claimed it had all been a ruse and quit talking to Davis.

So now he’s with Vice. In a blog post he later deleted, he claimed they would tell his real story. That Vice would show once and for all whether or not he is a drug-crazed madman. Instead, he’s in a hospital in Guatemala after having been detained by police, and facing likely deportation.

Oddly, Vice directly contributed to McAfee’s capture by revealing his location in the metadata of a photo it published. This was deeply stupid. People have been pointing out the dangers of inadvertently leaving GPS tags in cellphone pictures for years and years. Vice is the same publication that regularly drops in on revolutions and all manner of criminals. They should have known better.

Then, it followed up this egregiously stupid action with a far worse one. Vice photographer Robert King apparently lied on his Facebook page and Twitter in order to protect McAfee. Like McAfee, he claimed that the geodata in the photo had been manipulated to conceal their true location.

This explanation, of course, made no damn sense at all. If McAfee and King were trying to conceal their location by spreading disinformation, why immediately admit to it?

Shortly thereafter, McAfee copped to lying, and admitted to being in Guatemala. King deleted his tweet and Facebook status update. McAfee blamed the disclosure on a Vice “technician,” but regardless of whether it was a technician who screwed up, or King, or Castoro, or some intern, the photo that revealed his whereabouts in Guatemala appeared in Vice. And that photo, effectively, forced McAfee out of hiding.

But the coverup, as always, is worse than the crime. In claiming the geodata had been manipulated when it had not, Vice was no longer just documenting. Now it was actively aiding a fugitive wanted for questioning in the murder investigation of his neighbor Gregory Faull, who was shot dead at his own home.

McAfee had claimed that his plan was to leave the country temporarily, to get his traveling companion and lover Sam out, and then to return to Belize to fight from the inside without turning himself in. But once his location was blown, he had to get a brand-new plan. He would seek asylum in Guatemala. He hired a lawyer, Telésforo Guerra, formerly the attorney general of Guatemala. Vice crowed that McAfee had “just hired the best lawyer in the country.” Take that, suckers.

Vice documented how this attorney, also Sam’s uncle, was able to hook McAfee up with a tailor. He promised McAfee he could make the tailor actually sew faster. McAfee promised publicity in return. Vice rolled cameras.

And then, like that, it was over. King again took to social media to report the arrest, claiming McAfee had been taken into custody by “Guatemalan Federalizes.” Vice posted footage of McAfee being taken into police custody by Guatemala’s National Civil Police and Interpol.

Today, Guatemala’s president denied McAfee asylum. Guatemala is kicking McAfee out of the country, back to Belize. Afterwards, his lawyer claimed McAfee had two heart attacks. ABC reports he has been hospitalized. It’s hard not to wonder if this, too, is part of the plan. If there is a plan.

Though his offer of a $25,000 reward for information about the real killers strikes obvious O.J. Simpson chords, there’s so far no public evidence — aside from his flight — that he anything to do with the murder.

He may have shot his neighbor in the head. He may have ordered one of the gangsters in his employ to do so. He may have had a “will no one rid me of this troublesome priest” moment that caused one of his hangers-on to take it upon himself or herself to kill Faul. He and his entourage may have had nothing to do with it whatsoever. He may be completely innocent.

Nobody knows.

McAfee is clearly sleazy, likely crazy, and possibly even a murderer. But he also would be a free man right now were it not for Vice’s screw up.

As Alan Rules pointed out on Twitter, Vice could come out of this looking good either way. If McAfee turns out to be innocent, it is there to document it and even attempted to help him win his freedom. If he’s guilty, they helped bring him to justice, and have an action-packed documentary to boot. And if he dies? Well. The camera is ready.

Vice promises more footage. That it will continue to pick over John McAfee until he is free or dead or imprisoned, all of which now seem equally likely. And ultimately it offers an implicit promise that it can play by a different set of rules, one that allows it to burn sources and lie to readers. Maybe this is the media partner McAfee has truly wanted all along. Cool story, bro.

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Actor Stephen Baldwin charged in NY tax case

WHITE PLAINS, N.Y. (AP) — Actor Stephen Baldwin was charged Thursday with failing to pay New York state taxes for three years, amassing a $ 350,000 debt.

Rockland County District Attorney Thomas Zugibe said Baldwin, of Upper Grandview, skipped his taxes in 2008, 2009 and 2010.

The youngest of the four acting Baldwin brothers pleaded not guilty at an arraignment and was freed without bail. His lawyer, Russell Yankwitt, said Baldwin should not have been charged.

“Mr. Baldwin did not commit any crimes, and he’s working with the district attorney‘s office and the New York State Tax Department to resolve any differences,” Yankwitt said.

The district attorney said Baldwin could face up to four years in prison if convicted. The actor is due back in court on Feb. 5.

Zugibe said Baldwin owes more than $ 350,000 in tax and penalties.

“We cannot afford to allow wealthy residents to break the law by cheating on their taxes,” the district attorney said. “The defendant’s repetitive failure to file returns and pay taxes over a period of several years contributes to the sweeping cutbacks and closures in local government and in our schools.”

Thomas Mattox, the state tax commissioner, said, “It is rare and unfortunate for a personal income tax case to require such strong enforcement measures.”

Baldwin, 46, starred in 1995′s “The Usual Suspects” and appeared in 1989′s “Born on the Fourth of July.” He is scheduled to appear in March on NBC’s “The Celebrity Apprentice.”

His brothers Alec, William and Daniel are also actors.

A bankruptcy filing in 2009 said Stephen Baldwin owed $ 1.2 million on two mortgages, $ 1 million in taxes and $ 70,000 on credit cards.

In October, Baldwin pleaded guilty in Manhattan to unlicensed driving and was ordered to pay a $ 75 fine. Earlier this year, he lost a $ 17 million civil case in New Orleans after claiming that actor Kevin Costner and a business partner duped him in a deal related to the cleanup of the 2010 Gulf of Mexico oil spill. The actors and others had formed a company that marketed devices that separate oil from water.

Baldwin co-hosts a radio show with conservative talk figure Kevin McCullough.

Entertainment News Headlines – Yahoo! News

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Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs might be taken for a longer duration as well.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them are in premenopausal women with estrogen receptor-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing 10 years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

“They don’t feel well on them, but it’s their safety net,” said Dr. Garber, who added that the news would be welcomed by many patients who would like to stay on the drug. “I have patients who agonize about this, people who are coming to the end of their tamoxifen.”

Emily Behrend, who is a few months from finishing her five years on tamoxifen, said she would definitely consider another five years. “If it can keep the cancer away, I’m all for it,” said Ms. Behrend, 39, a single mother in Tomball, Tex. She is taking the antidepressant Effexor to help control the night sweats and hot flashes caused by tamoxifen.

Cost is not considered a huge barrier to taking tamoxifen longer because the drug can be obtained for less than $200 a year.

The results, while answering one question, raise many new ones, including whether even more than 10 years of treatment would be better still.

Perhaps the most important question is what the results mean for postmenopausal women. Even many women who are premenopausal at the time of diagnosis will pass through menopause by the time they finish their first five years of tamoxifen, or will have been pushed into menopause by chemotherapy.

Postmenopausal patients tend to take aromatase inhibitors like anastrozole or letrozole, which are more effective than tamoxifen at preventing breast cancer recurrence, though they do not work for premenopausal women.

Mr. Peto said he thought the results of the Atlas study would “apply to endocrine therapy in general,” meaning that 10 years of an aromatase inhibitor would be better than five years. Other doctors were not so sure.

The Atlas study was paid for by various organizations including the United States Army, the British government and AstraZeneca, which makes the brand-name version of tamoxifen.

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Apple Will Bring Jobs Making PCS Back to the U.S.

Apple plans to join a small but growing number of companies that are bringing some manufacturing jobs back to the United States, drawn by the growing economic and political advantages of producing in their home market.

Kevork Djansezian/Getty Images

Timothy D. Cook, Apple's chief executive, introduced new products in October, including a thinner iMac.

On Thursday, Apple’s chief executive, Timothy D. Cook, who built its efficient Asian manufacturing network, said the company would invest $100 million in producing some of its Mac computers in the United States, beyond the assembly work it already does in the United States. He provided little detail about how the money would be spent or what kinds of workers might benefit.

Apple, which long manufactured parts in the United States but stopped about a decade ago, has been under pressure to create more jobs here given its market power. It sold 237 million iPods, iPads, Macs and other devices in the year ended in September.

“I don’t think we have a responsibility to create a certain kind of job,” Mr. Cook told Bloomberg Businessweek. “But I think we do have a responsibility to create jobs.”

Some analysts are hopeful that the move by a big, innovative company like Apple could inspire a broader renaissance in American manufacturing, but a number of experts remain skeptical.

“I find it hard to see how the supply chains that drive manufacturing are going to move back here,” said Andre Sharon, a professor at Boston University and director of the Fraunhofer Center for Manufacturing Innovation. “So much of the know-how has been lost to Asia, and there’s no compelling reason for it to return. It’s great when a company says they want to create American jobs — but it only really helps the country if those are jobs that belong here, if it starts a chain reaction or is part of a bigger economic shift.”

Over the last few years, companies across various industries, including electronics, automotive and medical devices, have announced that they are “reshoring” jobs after decades of shipping them abroad. Lower energy costs in America, rising wages in developing countries like China and Brazil, quality control issues and the desire to keep the supply chain close to the gigantic American consumer base have all factored into these decisions.

“Companies were going abroad in pursuit of cost reduction, and it turns out there were a lot of unintended costs,” said Diane Swonk, chief economist at Mesirow Financial. “America has been looking a lot more competitive lately.”

Even so, the impact on the American job market has been modest so far. Much of the work brought back has been high-value-added, automated production that requires few actual workers, which is part of the reason America’s higher wages are not scaring off companies.

American manufacturing has been growing in the last two years, but the sector still has two million fewer jobs than it had when the recession began in December 2007. Worldwide manufacturing appears to be growing much faster, even for many of the American-owned companies that are expanding at home. General Electric, for example, has hired American workers to build water heaters, refrigerators, dishwashers and high-efficiency topload washers, but continues to add more jobs overseas as well.

Apple has not announced plans to move the complex, faster-growing portions of its product lines. Macs now represent a relatively small portion of Apple’s business, accounting for less than 20 percent of its nearly $36 billion in revenue in its most recent quarter. The company’s iPad and iPhone products, which amount to nearly 70 percent of its sales, will continue to be made in low-cost centers of manufacturing like China, mostly on contract with outside companies like Foxconn.

Mr. Cook’s statements suggested Apple was planning to build more of the Mac’s components domestically, but with partners. He told Bloomberg Businessweek that the plan “doesn’t mean that Apple will do it ourselves, but we’ll be working with people, and we’ll be investing our money.”

Whether Apple’s newly announced plan might help create other higher-paying jobs along the supply line depends on the nature of the manufacturing.

Other computer manufacturing has been trickling back to the United States after largely shifting overseas in the 1990s.

Charles Duhigg and Quentin Hardy contributed reporting.

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Obama resolute in showdown with GOP over 'fiscal cliff'

WASHINGTON — President Obama brushed off the latest Republican gambit to gain leverage in averting the so-called fiscal cliff, bluntly telling business chief executives in a speech Wednesday, "I'm not going to play that game."

That flash of swagger reflects growing White House confidence about its position in the year-end showdown over scheduled spending cuts and tax increases. With less than a month to act and the wind of an electoral victory at their back, White House officials think they are boxing in Republicans.

The White House credits its strategy crafted from painful lessons of past go-rounds with the Republican-led House. Rather than engaging intensely with the GOP leadership in high-profile meetings, Obama has sought to isolate Republicans and pump up the pressure from all sides. He has picked a red line and is sticking to it. And now he's waiting.

"The only time these guys have ever moved on something is when they have felt the outside pressure," said an Obama advisor who requested anonymity to discuss strategy.

Both sides say they are working to defuse the scheme of tax increases and budget cuts they enacted to force themselves to reach a larger deficit reduction deal. Experts say that if nothing is done, the double blow could send the economy back into recession.

For now, though, the president has reason to be resolute, even as Republicans call on him to counter their latest offer.

Treasury Secretary Timothy F. Geithner underscored that position Wednesday in an interview on CNBC. The administration is "absolutely" ready to go over the "fiscal cliff" if Republicans refuse to raise tax rates on the wealthy, he said.

"There's no prospect in an agreement that doesn't involve those rates going up on the top 2% of the wealthiest Americans," he said.

Public polling shows a majority of Americans not only support the president's push to allow tax rates to rise on top earners but are prepared to hold the GOP responsible if negotiations fail. A new poll from the Washington Post and Pew Research Center found that 53% of Americans said Republicans should be blamed if there is no deal, compared with 27% who would blame the president.

Obama's stance has bred discord and frustration among Republicans on Capitol Hill who find themselves in the politically awkward position of threatening a tax increase for all to preserve lower taxes for the wealthy. Tension bubbled up this week as Republicans floated a new strategy that would involve reviving a threat to let the U.S. default on its debt payments.

Under that scenario, Republicans would agree to raise taxes on the wealthiest 2% of taxpayers, as the president has demanded, but would defer talks about a larger deficit reduction package until the new year, when Obama would need their votes to avoid a federal default on the debt. Republicans could then demand concessions on the federal budget in return for voting to raise the nation's debt limit.

"The debt ceiling is hanging out there, and the debt ceiling is the next point of leverage," said Rep. Steve King, a conservative Republican from Iowa. "The president does not fear the fiscal cliff. He's concerned about who's going to get the blame. But he doesn't fear the cliff."

A spokesman for House Speaker John A. Boehner (R-Ohio) also suggested that Republicans would try to extract spending cuts in return for a debt limit increase. "We agree there is no reason for drama surrounding a debt limit increase. All that is required is the president getting serious about spending cuts," said Boehner spokesman Brendan Buck.

In his CNBC interview, Geithner said the administration would insist that any agreement include an increase in the debt ceiling.

Obama and Boehner spoke on the phone Wednesday. Neither side disclosed details of the call.

Obama's strategy involves risks. His repeated attempts to bludgeon Republicans on taxes while offering no new concessions has engendered little goodwill, and he will need some Republican votes soon.

And his declaration that he won't play chicken with the vote to raise the debt ceiling? Though that is the tough talk that some Democrats have craved, it has little practical meaning. Unless Republicans agree to his request to largely cede authority to raise the limit, he will need Congress to do it.

For Obama, the lesson on how to gain and use leverage began with the summer of 2011, when a marathon of high-level bargaining sessions with Republicans failed to produce a grand bargain on the federal budget.

After that, Obama set out to negotiate on the campaign trail, announcing his terms publicly as he rallied people behind them.

The Obama team added social media campaigns and testimonials from middle-class Americans, and managed to pass an extension of the payroll tax break in February. That's when aides came to believe the president could shift the dynamic in talks with Capitol Hill.

Early signs are that the formula may be working again. The latest Twitter campaign has elicited more than 100,000 emails from people explaining how the middle-class tax increase would affect them.

And Obama's outreach to interested parties is showing progress. Business leaders are worrying openly about the uncertainty around the fiscal cliff and debt ceiling.

At the Business Roundtable on Wednesday, Boeing's chief executive introduced Obama by suggesting that business leaders could "serve a useful purpose in the dialogue."

To be sure, there's grousing about Obama's negotiating posture. Sen. Mitch McConnell (R-Ky.), the chamber's Republican leader, has complained that Obama is campaigning rather than working out the issues with his negotiating partners.

But the strategy is worth the aggravation, administration officials think. The president isn't avoiding private negotiations, but doesn't plan to start them until there is some movement.

"Once Republicans acknowledge that rates are going up for top earners," White House Press Secretary Jay Carney said, "we believe that an agreement is very achievable."

christi.parsons@latimes.com

kathleen.hennessey@latimes.com

Melanie Mason, Michael A. Memoli and Lisa Mascaro in the Washington bureau contributed to this report.

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Google Now Delivers Travel Forecasts, Boarding Passes Before You Search

Google’s Search App has received a travel-focused update just in time for the holidays. Wednesday’s update adds new capabilities to Google Now, the app’s feature set designed to deliver frequently searched-for information before you even think to search for it.

Previously, opening the Google Search App on any Android phone running Jelly Bean (versions 4.1 and newer), would pull up a Google Now card detailing the weather where you’re standing along with traffic routes to your home and office, sports scores, and package tracking info, among other things. The update adds into the mix new information centered around weather, plane flights and finding things to do in the new locale you’re visiting.

In the updated app, Google Now will still bubble up a card with local weather, but it will now also provide a card detailing the forecast for your upcoming destination about a day before you travel so you can pack and plan correctly. This can serve as a raincoat reminder for those headed to Seattle, or an alert for shorts if you’re vacationing in Melbourne, Australia.

If you’re flying for the holidays, the Search app will pull up a Google Now card with your boarding pass — if you’re flying United Airlines. Additional airlines will be added in coming weeks and months, said in Baris Gultekin, a Google Now product director. This feature, like all Google Now cards, requires a user’s permission to pull flight details from your Gmail account. If permission is granted, the app will serve up cards with restaurant and hotel reservations, translation help, and currency conversions too.

“Our goal is to figure out what the one thing you need right now is, and deliver that to you,” Gultekin told Wired. “A lot of our users need assistance the most when they’re traveling.”

With that in mind, Google Now also will provide suggestions on places to check out once you’ve reached your destination. The Search app already regularly offers recommendations on nearby restaurants and photo-worthy spots, but now it will list events taking place nearby and local websites that may be useful in figuring out what to do.

But not all the updates have to do with travel. The refresh also adds birthday reminders for those you’re connected to on Google+. And Google’s stellar voice assistant, also built into the Search app, received some new tricks today as well. Now, by speaking to the Google Search app, a user can post a text update to Google+, ask what song is playing in the background and launch a barcode scanner to retrieve product info while out shopping.

The updates hit the Google Search app today for Android owners — sorry iOS users.

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Brazilian architect Oscar Niemeyer dies, aged 104

RIO DE JANEIRO (Reuters) – Oscar Niemeyer, a towering patriarch of modern architecture who shaped the look of modern Brazil and whose inventive, curved designs left their mark on cities worldwide, died late on Wednesday. He was 104.

Niemeyer had been battling kidney ailments and pneumonia for nearly a month in a Rio de Janeiro hospital. His death was confirmed by a hospital spokesperson.

Starting in the 1930s, Niemeyer’s career spanned nine decades. His distinctive glass and white-concrete buildings include such landmarks as the United Nations Secretariat in New York, the Communist Party headquarters in Paris and the Roman Catholic Cathedral in Brasilia.

He won the 1988 Pritzker Architecture Prize, considered the “Nobel Prize of Architecture” for the Brasilia cathedral. Its “Crown of Thorns” cupola fills the church with light and a sense of soaring grandeur despite the fact that most of the building is underground.

It was one of dozens of public structures he designed for Brazil’s made-to-order capital, a city that helped define “space-age” style.

After flying over Niemeyer’s pod-like Congress, futuristic presidential palace and modular ministries in 1961, Yuri Gagarin, the Russian cosmonaut and first man in space, said “the impression was like arriving on another planet.”

In his home city of Rio de Janeiro, Niemeyer’s many projects include the “Sambadrome” stadium for Carnival parades. Perched across the bay from Rio is the “flying saucer” he designed for the Niteroi Museum of Contemporary Art.

The collection of government buildings in Brasilia, though, remain his most monumental and enduring achievement. Built from scratch in a wild and nearly uninhabited part of Brazil’s remote central plateau in just four years, it opened in 1960.

While the airplane-shaped city was planned and laid out by Niemeyer’s friend Lucio Costa, Niemeyer designed nearly every important government building in the city.

BECAME NATIONAL ICON

An ardent communist who continued working from his Copacabana beach penthouse apartment in Rio until days before his death, Niemeyer became a national icon ranking alongside Bossa Nova pioneer Tom Jobim and soccer legend Pelé.

His architecture, though, regularly trumped his politics.

Georges Pompidou, a right-wing Gaullist former French president, said Niemeyer’s design for the Communist Party of France headquarters in Paris “was the only good thing those commies ever did,” according to Niemeyer’s memoirs.

Prada, the fashion company known for providing expensive bags and wallets, thought the Communist Party building in Paris so cool it rented it for a fashion show.

Even the 1964-1985 Brazilian military government that forced Niemeyer into exile in the 1960s eventually found his buildings congenial to their dreams of making Brazil “the country of the future.”

His work is celebrated for innovative use of light and space, experimentation with reinforced concrete for aesthetic value and his self-described “architectural invention” style that produced buildings resembling abstract sculpture.

Initially influenced by the angular modernism of French-Swiss architect Le Cobusier, who worked with Niemeyer and Costa on a visit to Brazil in the 1930s, his style evolved toward rounded buildings that he said were inspired by the curves of Rio’s sunbathing women as well as beaches and verdant hills.

“That is the architecture I do, looking for new, different forms. Surprise is key in all art,” Niemeyer told Reuters in an interview in 2006. “The artistic capability of reinforced concrete is so fantastic – that is the way to go.”

Responding to criticism that his work was impractical and overly artistic, Niemeyer dismissed the idea that buildings’ design should reflect their function as a “ridiculous and irritating” architectural dogma.

“Whatever you think of his buildings, Niemeyer has stamped on the world a Brazilian style of architecture,” Dennis Sharp, a British architect and author of The Illustrated Encyclopedia of Architects and Architecture, once said of Niemeyer.

LIFELONG COMMUNIST

Niemeyer’s legacy is heavily associated with his communist views. He was a close friend of Cuba’s revolutionary leader Fidel Castro and an enemy of Brazil’s 21-year military dictatorship.

“There are only two communists left in the world, Niemeyer and myself,” Castro once joked.

Niemeyer remained politically active after returning to Brazil, taking up the cause of a militant and sometimes violent movement of landless peasants. He said in 2010 that he was a great admirer of Luiz Inacio Lula da Silva, the former labor leader who was Brazil’s president from 2003 to 2010.

Niemeyer once built a house in a Rio slum for his former driver and gave apartments and offices as presents to others.

Despite his egalitarian views, Niemeyer had no illusions that his buildings were helping to improve social justice.

Far from the model city Niemeyer had envisioned, Brasilia today is in many ways the epitome of inequality. Planned for 500,000 people, the city is now home to more than 2.5 million and VIPs keep to themselves in fenced-in villas while the poor live in distant satellite towns.

“It seemed like a new era was coming, but Brazil is the same crap – a country of the very poor and the very rich,” he said in another Reuters interview in 2001.

In a 2010 interview in his office, he was quick to blame Costa for things many dislike about Brasilia, such as its rigid ordering into homogenous “hotel,” “government,” “residential” and even “mansion” and “media” districts that can make finding a newspaper or groceries a chore.

“I just did the buildings,” he said. “All that other stuff was Costa.”

Despite Niemeyer’s atheism, one of his first significant early works was a church built in homage to St. Francis, part of a complex of modern buildings in Belo Horizonte, Brazil.

That work won the confidence of the city’s mayor Juscelino Kubitschek. When he became president, he tapped Niemeyer to help realize the dream of opening up Brazil’s interior by moving the capital from coastal Rio to the empty plains of central Brazil.

Despite years of bohemian living, Niemeyer remained married for 76 years to Annita Baldo, his first wife. He married his second wife, long-time aide Vera Lucia Cabreira, in 2006 at the age of 99. She survives him, as do four grandchildren.

Niemeyer’s only daughter, an architect, designer and gallery owner, Anna Maria, died on June 6 at the age of 82.

(Additional reporting by Brian Ellsworth; Editing by Todd Benson and Kieran Murray)

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Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs might be taken for a longer duration as well.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them are in premenopausal women with estrogen receptor-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing 10 years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

“They don’t feel well on them, but it’s their safety net,” said Dr. Garber, who added that the news would be welcomed by many patients who would like to stay on the drug. “I have patients who agonize about this, people who are coming to the end of their tamoxifen.”

Emily Behrend, who is a few months from finishing her five years on tamoxifen, said she would definitely consider another five years. “If it can keep the cancer away, I’m all for it,” said Ms. Behrend, 39, a single mother in Tomball, Tex. She is taking the antidepressant Effexor to help control the night sweats and hot flashes caused by tamoxifen.

Cost is not considered a huge barrier to taking tamoxifen longer because the drug can be obtained for less than $200 a year.

The results, while answering one question, raise many new ones, including whether even more than 10 years of treatment would be better still.

Perhaps the most important question is what the results mean for postmenopausal women. Even many women who are premenopausal at the time of diagnosis will pass through menopause by the time they finish their first five years of tamoxifen, or will have been pushed into menopause by chemotherapy.

Postmenopausal patients tend to take aromatase inhibitors like anastrozole or letrozole, which are more effective than tamoxifen at preventing breast cancer recurrence, though they do not work for premenopausal women.

Mr. Peto said he thought the results of the Atlas study would “apply to endocrine therapy in general,” meaning that 10 years of an aromatase inhibitor would be better than five years. Other doctors were not so sure.

The Atlas study was paid for by various organizations including the United States Army, the British government and AstraZeneca, which makes the brand-name version of tamoxifen.

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