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

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Stars salute MusiCares honoree Bruce Springsteen

LOS ANGELES (AP) — Be it concert or charity auction, Bruce Springsteen can bring any event to a crescendo.

Springsteen briefly took over auctioneering duties before being honored as MusiCares person of the year Friday night, exhorting the crowd to bid on a signed Fender electric guitar by amping up the deal. The 63-year-old rock 'n' roll star moved the bid north from $60,000 by offering a series of sweeteners.

"That's right, a one-hour guitar lesson with me," Springsteen shouted. "And a ride in my Harley Davidson sidecar. So dig in, one-percenters."

That moved the needle past $150,000. He added eight concert tickets and backstage passes with a bonus tour conducted by Springsteen himself. That pushed it to $200,000, but he wasn't done.

"And a lasagna made by my mother!" he shouted as an in-house camera at the Los Angeles Convention Center cut to his 87-year-old mother Adele Ann Springsteen.

And with an extra $250,000 in the musicians charity's coffers, Springsteen sat down and spent most of the evening in the unusual role of spectator as a string of stars that included Elton John, Neil Young, Sting, Kenny Chesney, John Legend, Faith Hill and Tim McGraw, Patti Smith, Jackson Browne took the stage two nights before the Grammy Awards.

"Here's a little secret about Bruce Springsteen: He loves this," host Jon Stewart joked. "There's nothing he'd rather do than come to Los Angeles, put on a suit ... and then have people talking about him like he's dead."

Alabama Shakes kicked things off with "Adam Raised A Cain" and over the course of the evening there were several interesting takes on Springsteen's voluminous 40-year catalog of hits. Natalie Manes, Ben Harper and Charlie Musselwhite played a stripped down "Atlantic City." Mavis Staples and Zac Brown put a gospel spin on "My City of Ruins." John added a funky backbeat to "Streets of Philadelphia." Kenny Chesney offered an acoustic version of "One Step Up."

Jim James and Tom Morello burned through a scorching version of "The Ghost of Tom Joad" that brought the crowd out of their seats as Morello finished the song with a fiery guitar solo. And Mumford & Sons took it the opposite way, playing a quiet, acoustic version of "I'm On Fire" in the round that had the crowd leaning in.

Legend offered a somber piano version of "Dancing in the Dark" and Young shut down the pre-Springsteen portion of the evening with a "Born in the USA" that included two sign-language interpreters dressed as cheerleaders signing along to the lyrics.

"John Legend made me sound like Gershwin," Springsteen said. "I love that. Neil Young made me sound like the Sex Pistols. I love that. What an evening."

Springsteen spoke of the "miracle of music," the importance of musicians in human culture and making sure everyone is cared for. And he joked that he somehow ended up being honored by MusiCares, a charity that offers financial assistance to musicians in need run by The Recording Academy, after his manager called up Grammys producer Ken Ehrlich to seek a performance slot on the show in a "mercenary publicity move."

In the end, though, he was moved by the evening.

"It's kind of a freaky experience, the whole thing," Springsteen said. "This is the huge Italian wedding Patti (Scialfa) and I never had. It's a huge Bar Mitzvah. I owe each and every one of you. You made me feel like the person of the year. Now give me that damn guitar."

He asked the several thousand attendees to move toward the stage — "Come on, it's only rock 'n' roll" — and kicked off his five-song set with his Grammy nominated song "We Take Care Of Our Own." At the end of the night he brought everyone on stage for "Glory Days."

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Online:

http://grammy.com

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Follow AP Music Writer Chris Talbott: http://twitter.com/Chris_Talbott.

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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.

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Tesla's electric Model S is a truly competitive premium sedan

The Tesla Model S may be a silent car, but other automakers will no doubt hear it coming.

In its first crack at a premium sedan, the Silicon Valley electric-car maker has matched or beaten the likes of the Audi A7 or Mercedes-Benz CLS — products of a century of German engineering. Similarly packaged as a sleek four-door coupe, the Model S delivers the performance and polish implied by its $89,770 price.

All that's missing is the roar of internal combustion.

Ask the folks at Tesla Motors Inc. how they pulled this off and they'll say Tesla isn't a car company. It's a tech company, headquartered in a hive of innovation that helped lure the sharp minds who conceptualized the car from an outsider's perspective.

Founded in 2003, Tesla produced its first car in 2008, the two-seat Roadster. It sold about 2,400 of them before halting production last year.

The Model S represents Phase 2 of the Palo Alto company's outsized ambitions. Unlike the Roadster, which was built on the chassis of a Lotus sports car, Tesla built the Model S from scratch. It's a showpiece of the start-up's design prowess, targeting a demanding and well-heeled niche of customers.

The third and crucial phase — if the Model S can secure the company's survival a while longer — will be to create an affordable mass-market car. That's no small feat, given that the electric-car market, littered with past failures, accounts for just one-tenth of 1% of U.S. auto sales. (For all the accolades showered on Nissan's Leaf, the company has sold just 20,000 of the cars since 2010.)

The odds against Tesla will be easier to calculate soon, when the company details sales and earnings at a shareholder's meeting expected in late February. The most recent update came last fall, when Tesla cut its revenue forecast and scaled back 2012 Model S production plans from 5,000 to about half that number.

Just 253 of the sedans had been delivered at that point.

The lowered expectations raised concern that the company will need a new influx of cash this year. The cash that produced the Model S was gathered during the Roadster era. Tesla secured $465 million in U.S. Department of Energy loans and went public on the Nasdaq Stock Market. It also started collecting Model S deposits and sold minority stakes in the company to Toyota and Daimler, the parent of Mercedes-Benz.

Now it's up to the Model S to bring in more cash.

Nearly a week spent in the car's high-tech cockpit suggests that Tesla has a legitimate shot at making automotive history with truly competitive electric cars.

If Tesla is a technology company, the evidence starts with the car's innovative infotainment system. The 17-inch touch screen controls nearly everything — including navigation, stereo, climate control and driving settings. As clear and touch-sensitive as an Apple iPad, the huge screen can easily accommodate multiple functions at once.

You can view the Google Maps-based navigation on one half of the screen while fiddling with radio controls on the other. Or swap the two. Or close one of them and bring up a new function — say, the phone or the Internet browser. Or just expand one function to cover the whole screen.

Contrast that to a car company making technology: Ford has produced its Sync system about as long as Tesla has made cars, and yet Sync remains eons behind in sophistication and ease of use.

But the most impressive technology resides in the guts of the Model S. The car overflows with torque, that delicious byproduct of electric propulsion. Despite a portly curb weight — a comparable Audi A7 weighs about 400 pounds less — the S clears zero to 60 mph in a mere 5.6 seconds.

Our test car, rated at 362 horsepower and 325 pound-feet of torque, uses an 85-kilowatt-hour battery to power the rear wheels through an electric motor. The battery comes in the premium version of the Model S — the only one currently produced, with a base price of $81,820, including delivery, before any state or federal tax incentives. Additional options on our test car included the tech package, an upgraded sound system and air suspension.

Tesla has promised two less expensive versions of the car with smaller batteries, meaning decreased power and range.

Power in the premium Model S comes from roughly 1,000 pounds of lithium-ion cells — all integrated into the car's floor pan, an innovative setup giving the Model S a low center of gravity and a stiff chassis. The underside of the battery pack forms the underside of the car.

In eager driving, the S doesn't feel exactly light, but it carries its weight well, with no excessive body roll in turns. Drivers can use the touch screen to select one of three different steering modes, although the most aggressive 'sport' setting proved a little too firm in most driving situations.

The brakes on the Model S are plenty strong, and fortunately are not the regenerative variety you'll find on most gas-electric hybrids, which have a mushy, grabby feel.

Mash the go-pedal, and the Tesla plants you in your seat and rushes forward with eerily little feedback, save for the faint whir of the motor behind you. The addicting experience is not unlike being flung out of a giant sling-shot.

The trouble is that repeated demonstrations of the car's prodigious power utterly destroy its range. Tesla says this model will go 300 miles on a single charge. The EPA puts that number at 265 miles. Over four days of testing the car, we managed only about 160 miles in heavy-footed driving.

All Model S's will charge through a 120V or 240V outlet. Tesla says the former needs roughly 46 hours to recharge fully, while the latter needs eight to 10 hours. Buyers can reduce these times by adding a second on-board charger for $1,500 and buying a high-power wall connector for $1,200.

Tesla is also installing 100 of what it calls supercharging stations in the U.S. and Canada by year's end, including six already operating in California. They're free for Tesla owners, who can add half a charge in about half an hour.

There will be a lot more of those owners soon, the company says. Tesla has more than 13,000 fully refundable deposits and expects to deliver 20,000 of the cars this year. The only other morsel of intel on the company's finances came from Tesla Chief Executive Elon Musk, of PayPal fame, who cryptically tweeted in early December that the company was "narrowly cash-flow positive last week."

Established automakers should be paying attention, but they shouldn't be surprised. In a blog post dated August 2006, Musk laid out his three-step vision for Tesla. Step 1: Build a sports car. Then use that money to build an affordable car. Then, finally, use that money to build an even more affordable car.

Steps 1 and 2 are done, with mixed results. The Model S is hardly affordable, nor does it guarantee safe passage to Step 3. But strip away the financial drama, and all that's left is the best electric car ever made.

david.undercoffler@latimes.com

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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.

FULL COVERAGE: Sweeping manhunt for rampaging ex-cop

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.

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Uggs? Ugh. NY Fashion Week battles the elements

NEW YORK (AP) — Mother Nature is clearly not a fashionista.

An impending blizzard forced Michael Kors to arrive at New York Fashion Week's Project Runway show on Friday in — gasp — Uggs.

"I came in looking like Pam Anderson," he joked backstage, where the offending boots had been traded for tasteful black leather.

Marc Jacobs postponed his Monday night show until Thursday, citing delivery problems, but for the most part Fashion Week went on with the show. IMG Fashion said organizers remained in contact with city officials including the Mayor's office about potential weather problems, but that they had planned for an extra layer of tenting for the venue and more heat at Lincoln Center along with crews to help with snow and ice.

Zac Posen said he would present his collection as usual on Sunday but he worried that out-of-town editors and retailers might not be able to make it. Other designers were considering plan B — perhaps an internet stream — in case crowds are snowed out.

Still, plenty of fashion fans wouldn't let a little snow get in the way. Baltimore college student Carmen Green arrived in a red cocktail dress and black high-heel booties.

"In this outfit, the blizzard did not deter me," she said. She did allow that she had only had to cross the street from her hotel and would change into combat boots for the train ride home.

The celebrity stylist Phillip Bloch even offered a blizzard pro tip.

"You either come in warm and comfortable clothes and boots or you come in neon — or sequins would be a good one — so they see you in the drift," he said.

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The New Old Age: The Executor's Assistant

I’m serving as executor for my father’s estate, a role few of us are prepared for until we’re playing it, so I was grateful when the mail brought “The American Bar Association Guide to Wills and Estates” — the fourth edition of a handbook the A.B.A. began publishing in 1995.

This is a legal universe, I’m learning, in which every step — even with a small, simple estate that owes no taxes and includes no real estate or trusts — turns out to be at least 30 percent more complicated than expected.

If my dad had been wealthy or owned a business, or if we faced a challenge to his will, I would have turned the whole matter over to an estate lawyer by now. But even then, it would be helpful to know what the lawyer was talking about. The A.B.A. guide would help.

Written with surprising clarity (hey, they’re lawyers), it maps out all kinds of questions and decisions to consider and explains the many ways to leave property to one’s heirs. Updated from the third edition in 2009, the guide not only talks taxes and trusts, but also offers counsel for same-sex couples and unconventional families.

If you want to permit your second husband to live in the family home until he dies, but then guarantee that the house reverts to the children of your first marriage, the guide tells you how a “life estate” works. It explains what is taxable and what isn’t, and discusses how to choose executors and trustees. It lists lots of resources and concludes with an estate-planning checklist.

In general, the A.B.A. intends its guide for the person trying to put his or her affairs in order, more than for family members trying to figure out how to proceed after someone has died. But many of us will play both these parts at some point (and if you are already an executor, or have been, please tell us how that has gone, and mention your state). We’ll need this information.

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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U.S. growth in fourth quarter likely stronger on export gains

The U.S. trade deficit narrowed sharply in December because exports rose while oil imports plummeted. The smaller trade gap means the economy almost surely grew in the October-December quarter — an improvement from the government's estimate last week that it shrank in the final months of 2012.

The trade deficit fell nearly 21 percent in December from November to $38.6 billion, the Commerce Department said Friday. That's the smallest in nearly three years.

Exports rose 2.1 percent to $186.4 billion. Exports of oil and other petroleum products rose to the highest level on record. Overseas shipments of agriculture goods and aircraft also increased.

Imports shrank 2.7 percent to $224.9 billion. Oil imports plunged to 223 billion barrels, the fewest since February 1997.

"All this is encouraging and … it now looks like exports will continue to strengthen as the year goes on," said Paul Ashworth, an economist at Capital Economics. A survey of U.S. manufacturers, released last week, showed that export orders grew in January for the second straight month.

A narrower trade gap boosts growth because it means U.S. companies earned more from overseas sales while consumers and businesses spent less on foreign products.

Fewer exports were one of the reasons the government's first estimate of economic growth in the October-December quarter showed a contraction at an annual rate of 0.1 percent. The December trade deficit figures were not available when the government reported its estimate last week.

Jim O'Sullivan, chief U.S. economist at High Frequency Economics, estimates the improved trade picture will add 0.7 percentage point to economic growth in the October-December quarter. That would show growth at an annual rate of 0.6 percent.

The government will issue its second estimate for fourth-quarter growth on Feb. 28. Sluggish restocking by companies and deep cuts in defense spending are expected to keep growth at the end of last year weak.

The trade deficit also narrowed for all of last year, shrinking 3.5 percent to $540.4 billion.

Many economists believe that trade will give the economy a small lift in 2013. That forecast is based on an assumption that the European debt crisis will stabilize, helping boost U.S. exports to that region, and economic growth in Asia will continue to rebound.

The politically sensitive trade deficit with China rose to $315.1 billion last year, the largest on record with any country. That could add to pressure on the Obama administration and Congress to take a harder line on China's trade practices. Some U.S. manufacturers contend that China keeps the value of its currency artificially low to make its exports to the U.S. cheaper.

"The record trade deficit with China will not disappear on its own," said Scott Paul, president of the Alliance for American Manufacturing. "Congress and the Administration must take on currency manipulation … as well as China's persistent cheating on its trade obligations."

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Manhunt underway for ex-LAPD officer suspected of shooting 3 cops

A manhunt involving multiple law enforcement agencies was underway early Thursday after three police officers were shot -- one fatally -- in Riverside County. Authorities believe that the suspect is a former Los Angeles police officer already wanted in connection with two Orange County slayings.

The suspect, Christopher Jordan Dorner, 33, wrote an online manifesto threatening to harm police officials and their families, authorities said, and he is considered "armed and extremely dangerous."

The California Highway Patrol issued a "blue alert" for nine Southern California counties. Officials said Dorner is believed to be driving a 2005 blue or gray Nissan Titan, with California license plate 8D83987 or 7X09131. Police said they believe he may be switching between the two license plates. Dorner is described as a black male, 33 years old, 6 feet tall, weighing 270 pounds with black hair and brown eyes. His last known address is in La Palma.

Members of the public were warned to stay away from him if they spot him, and to call 911 immediately.

The first shooting occurred about 1:30 a.m. in Corona, where two Los Angeles Police Department officers were on "protection detail" for someone mentioned in the suspect's manifesto, officials said. One officer suffered a grazing head wound during a shootout and Dorner fled the scene, police said.

A short time later, two Riverside officers were involved in a shooting with a suspect at the corner of Magnolia Avenue and Arlington Avenue in Riverside, according to Riverside Police Officer Bryan Galbreath.

Sources told The Times that the officers were in a patrol unit and ambushed by the suspect.

One police officer was killed, the other seriously wounded, Galbreath said.

He said said there were no other officers who witnessed the shooting, and that it's only a possibility that Dorner was involved.

Irvine police on Wednesday night named Dorner as the suspect in the double slaying in the parking lot of an upscale Irvine apartment complex Sunday. Law enforcement sources said police have placed security at the homes of LAPD officials named in the manifesto and believe that Dorner has numerous weapons.

In the online postings on his Facebook page, Dorner specifically named the father of Monica Quan, the Cal State Fullerton assistant basketball coach who was found dead Sunday, along with her fiance, Keith Lawrence.

Randy Quan, a retired LAPD captain, was involved in the review process that ultimately led to Dorner’s dismissal.

A former U.S. Navy reservist, Dorner was fired in 2009 for allegedly making false statements about his training officer.

Dorner said in his online postings that being a police officer had been his life’s ambition since he served in the Police Explorers program. Now that had been taken away from him, he said, and he suffered from severe depression and was filled with rage over the people who forced him from his job.

Dorner complained that Randy Quan and others did not fairly represent him at the review hearing.

“Your lack of ethics and conspiring to wrong a just individual are over. Suppressing the truth will leave to deadly consequences for you and your family. There will be an element of surprise where you work, live, eat, and sleep,” he wrote, referring to Quan and several others.

“I never had the opportunity to have a family of my own, I'm terminating yours,” he added.

The online postings indicated that Quan served as Dorner’s representative in the review hearing. Of Quan, Dorner wrote: “He doesn't work for you, your interest, or your name. He works for the department, period. His job is to protect the department from civil lawsuits being filed and their best interest which is the almighty dollar. His loyalty is to the department, not his client.”

In the document, he threatens violence against other police officers: “The violence of action will be high. ... I will bring unconventional and asymmetrical warfare to those in LAPD uniform whether on or off duty.”

In his postings, Dorner seemed to allude to the Irvine slaying.

“I know most of you who personally know me are in disbelief to hear from media reports that I am suspected of committing such horrendous murders and have taken drastic and shocking actions in the last couple of days,” he wrote.

“Unfortunately,” he added, “this is a necessary evil that I do not enjoy but must partake and complete for substantial change to occur within the LAPD and reclaim my name.”

Quan, 28, and Lawrence, 27, had recently become engaged and moved into the condominium complex near Concordia University, where they had played basketball and received their degrees, authorities said. Lawrence worked as a campus officer at USC.

Dorner’s LAPD case began when he lodged a complaint against his field training officer, Sgt. Teresa Evans. He accused her of kicking a suspect named Christopher Gettler. An LAPD Board of Rights found that the complaint was false and terminated his employment for making false statements. He appealed the action.

He testified that he graduated from the Police Academy in February 2006 and left for a 13-month military deployment in November 2006.

“This is my last resort,” he wrote online. “The LAPD has suppressed the truth and it has now led to deadly consequences.”

Dorner said it was the LAPD’s fault that he lost his law enforcement and Navy careers, as well as his relationships with family and close friends. Dorner wrote that he began his law enforcement career in February 2005 and that it ended in January 2009. His Navy career began in April 2002 and ended this month.

“I lost everything,” he said, “because the LAPD took my name and knew I was innocent.”

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Morrissey rules as The Governor in 'Walking Dead'

NEW YORK (AP) — "Brother against brother," says The Governor fiercely. "Winner goes free. Fight to the death."

Is this any way to run a town?

AMC's zombie drama "The Walking Dead" ended the first half of this season with a wrenching faceoff: roughneck brothers Merle and Daryl were pitted in a bloody test of loyalty to The Governor as he rallied his flock — the residents of Woodbury, Ga. — to goad them on.

That was last December.

Things haven't settled down as the hit horror serial returns for another eight episodes Sunday at 9 p.m. EST. The death match continues. The Governor, played by David Morrissey, is increasingly oppressive, even deranged.

"With Woodbury, he has built a sanctuary, a place of safety where humanity can start again," says Morrissey. "But the negative side of power is like a wobbly tooth for him. He just can't stop sticking his tongue in there. There's something gloriously painful about it, and he likes that."

He seems to be losing his marbles as he sees threats both within and beyond the town walls. This has placed on his enemies list not only the zombies — with their ploddingly persistent appetite for human flesh — but also mortals, who are far less predictable. These include the ragtag refugees led by Sheriff Rick Grimes hiding out in an abandoned prison nearby.

"You can adapt to the zombie threat, and that's part of what Woodbury is about," says Morrissey. "But the new problem that has emerged in Season 3 is human beings. What you have now is two communities of humans in conflict. That's much more complicated."

In other words: What's scarier than the undead? The living!

In the past, The Governor exhibited a softer side. His most touching moments showed his desperate attempts to stay connected with Penny, his undead little girl. Removing her from the cell in his apartment where he kept her chained, he lovingly combed her wiry zombie hair in one memorable scene, while she snarled and snapped ferociously.

Strange as it was, the scene made perfect sense to Morrissey.

"You have a sick child and you're trying to do normal things that just aren't normal anymore," he says. "There's great certainty and comfort in the past, and he was trying to re-create that."

But in December's finale, Penny was stabbed by Michonne, an intruder out to kill The Governor.

"He loses the one thing he lives for," says Morrissey, adding with a bit of understatement, "Now he's full of anger."

The 48-year-old actor gravitates toward complex, off-kilter roles. He is celebrated for the 2003 British miniseries "State of Play," where he played an upright Member of Parliament who may have been involved in a string of killings. The same year, "The Deal" was a British TV film that starred Morrissey as MP (and future prime minister) Gordon Brown.

A few years earlier, he played a jazz musician with underworld connections in the British series "Finney." In the 2000 film "Some Voices," he was the long-suffering brother of schizophrenic Daniel Craig.

Morrissey approached the role of The Governor with his typical concern that the character display many facets and steadily develop.

"I wanted to be sure he didn't just become a cartoon buddy," Morrissey says.

Meanwhile, he began mastering the obligatory Southern accent.

Describing his happy, working-class childhood in Liverpool, England — "it was a tough environment, but tough in the right way" — Morrissey speaks in the singsongy lilt reminiscent of the Liverpudlian lads who formed the world's greatest rock band (and might pronounce "band" something like "bah-yind.")

He says he worked with the same accent coach assigned to series star Andrew Lincoln (who plays Rick Grimes), a fellow Brit. And he trained hard. "My children got very bored with me reading them bedtime stories in a Georgia accent," he says with a laugh.

The Woodbury scenes were shot in the town of Senoia, Ga., 40 miles south of Atlanta. Months of filming took Morrissey away from his family — sons 17 and 8 years old, and a daughter, 15, as well as his wife, novelist Esther Freud (who happens to be the great-granddaughter of Sigmund Freud).

"The people who live there are great," says Morrissey, "because we do disrupt their lives." Shooting for the season wrapped in November, "and I had a lovely time there."

But will The Governor be back to rule over the ultimate gated community? Not surprisingly, Morrissey is cagey when replying to that question: "Contractually, I'm there for five years. But that's not to say that I don't die at the end of this season, Or whenever."

Whether or not he's back on "The Walking Dead," Morrissey means to keep taking risks with his roles.

"I want to go into a job feeling a bit of frisson, thinking things MAY not work," he explains before offering "Blackpool" as a prime example.

Retitled "Viva Blackpool" for its U.S. telecast in 2005, this was a quirky British miniseries in which he costarred with David Tennant, whose credits include The Doctor in "Dr. Who." Morrissey played the thuggish owner of an arcade in the seaside town of Blackpool, England, who becomes swallowed up in a murder probe.

What truly set apart the series was the penchant of its characters for bursting into a song-and-dance number at the drop of a hat. Think Tony Soprano channeling Elvis. Clearly, THIS was risky for all concerned!

"I remember halfway through the shoot they showed us a bit of the dailies," says Morrissey, laughing at the memory. "Then me and David Tennant walked away and got in the lift and the doors closed. And we went, 'We're NEVER gonna work again!'"

As it happened, "Blackpool" charmed viewers and won awards. And its stars did work again.

___

Online:

http://www.amctv.com

___

Frazier Moore is a national television columnist for The Associated Press. He can be reached at fmoore(at)ap.org and at http://www.twitter.com/tvfrazier

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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 brown 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.

Correction: The patient’s eyes were brown, not blue.

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White House, defense industry officials meet to discuss cuts

By W.J. Hennigan

February 7, 2013, 7:56 a.m.

With automatic federal spending cuts set to hit the defense industry on March 1, senior White House officials met with chief executives from contractors to discuss the potential impact.

White House spokesman Jay Carney made the disclosure Wednesday after President Obama urged Congress to find other ways to postpone the $85 billion in cuts.

Under a law approved last year, federal funds of all kinds would be held back, or "sequestered," until there is budget agreement, at which time the funds may be reinstated. The buzzword used by contractors for the cutbacks is "sequestration."

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"The focus of their conversation was the potential devastating impact of the sequester going into effect," Carney said.

PHOTOS: A new breed of drones

The meeting with Obama's top economic advisors included executives from Northrop Grumman Corp., BAE Systems, Pratt & Whitney and ship-maker Huntington Ingalls Industries Inc.

Budget cuts unrelated to the sequester have already stung the Southland.

In November, Northrop, maker of the B-2 bomber and Global Hawk spy drone, revealed plans to eliminate about 200 positions in Woodland Hills and Salt Lake City. In September, the company confirmed that it has accepted buyouts from about 590 employees in its aerospace division. Most of them were at sprawling complexes in Redondo Beach, El Segundo and Palmdale.

That same month, Boeing Co. said it was trimming its executive workforce 30% from 2010 levels. It also revealed plans to sell office buildings in Seal Beach and demolish one in Huntington Beach. It has already sold property in Anaheim.

And there is a trickle-down effect: Northrop, for example, has about 20,000 small businesses that supply parts to its hardware.

In a worst-case scenario, the Aerospace Industries Assn., an Arlington, Va., trade group, estimated that 1 million jobs of all kinds would be lost nationwide, including 126,000 in California.

“It’s a reminder that what happens here and the decisions made, or the failure to act, all of this has an effect on people around the country; it’s not just a parlor game here in Washington,” Carney said.  “These are real-world decisions that significantly affect our economy and the American people.”

ALSO:

City in Virginia passes anti-drone resolution

Boeing sues Russian, Ukrainian partners for $355 million

British troops use mini-drones to find targets on the battlefield

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Postal Service to cut Saturday mail to trim costs

Apparently trying an end-run around an unaccommodating Congress, the financially struggling U.S. Postal Service says it will stop delivering mail on Saturdays but continue to disburse packages six days a week.

In an announcement scheduled for later Wednesday, the service is expected to say the Saturday mail cutback would begin in August and could save $2 billion annually.

The move accentuates one of the agency's strong points — package delivery has increased by 14 percent since 2010, officials say, while the delivery of letters and other mail has declined with the increasing use of email and other Internet services.

Under the new plan, mail would be delivered to homes and businesses only from Monday through Friday, but would still be delivered to post office boxes on Saturdays. Post offices now open on Saturdays would remain open on Saturdays.

Over the past several years, the Postal Service has advocated shifting to a five-day delivery schedule for mail and packages — and it repeatedly but unsuccessfully appealed to Congress to approve the move. Though an independent agency, the service gets no tax dollars for its day-to-day operations but is subject to congressional control.

It was not immediately clear how the service could eliminate Saturday mail without congressional approval.

But the agency clearly thinks it has a majority of the American public on its side regarding the change.

Material prepared for the Wednesday press conference by Patrick R. Donahoe, postmaster general and CEO, says Postal Service market research and other research has indicated that nearly 7 in 10 Americans support the switch to five-day delivery as a way for the Postal Service to reduce costs.

"The Postal Service is advancing an important new approach to delivery that reflects the strong growth of our package business and responds to the financial realities resulting from America's changing mailing habits," Donahoe said in a statement prepared for the announcement. "We developed this approach by working with our customers to understand their delivery needs and by identifying creative ways to generate significant cost savings."

But the president of the National Association of Letter Carriers, Fredric Rolando, said the end of Saturday mail delivery is "a disastrous idea that would have a profoundly negative effect on the Postal Service and on millions of customers," particularly businesses, rural communities, the elderly, the disabled and others who depend on Saturday delivery for commerce and communication.

He said the maneuver by Donahoe to make the change "flouts the will of Congress, as expressed annually over the past 30 years in legislation that mandates six-day delivery."

There was no immediate comment from lawmakers.

But others agreed the Postal Service had little choice but to try.

"If the Congress of the United States refuses to take action to save the U.S. Postal Service, then the Postal Service will have to take action on its own," said corporate communications expert James S. O'Rourke, professor of management at the University of Notre Dame.

He said other action will be needed as well, such as shuttering smaller rural post offices and restructuring employee health care and pension costs.

"It's unclear whether the USPS has the legislative authority to take such actions on its own, but the alternative is the status quo until it is completely cash starved," O'Rourke said in a statement.

The Postal Service is making the announcement Wednesday, more than six months before the switch, to give residential and business customers time to plan and adjust, the statement said.

"The American public understands the financial challenges of the Postal Service and supports these steps as a responsible and reasonable approach to improving our financial situation," Donahoe said. "The Postal Service has a responsibility to take the steps necessary to return to long-term financial stability and ensure the continued affordability of the U.S. Mail."

He said the change would mean a combination of employee reassignment and attrition and is expected to achieve cost savings of approximately $2 billion annually when fully implemented.

The agency in November reported an annual loss of a record $15.9 billion for the last budget year and forecast more red ink in 2013, capping a tumultuous year in which it was forced to default on billions in retiree health benefit prepayments to avert bankruptcy.

The financial losses for the fiscal year ending Sept. 30 were more than triple the $5.1 billion loss in the previous year. Having reached its borrowing limit, the mail agency is operating with little cash on hand.

The agency's biggest problem — and the majority of the red ink in 2012 — was not due to reduced mail flow but rather to mounting mandatory costs for future retiree health benefits, which made up $11.1 billion of the losses. Without that and other related labor expenses, the mail agency sustained an operating loss of $2.4 billion, lower than the previous year.

The health payments are a requirement imposed by Congress in 2006 that the post office set aside $55 billion in an account to cover future medical costs for retirees. The idea was to put $5.5 billion a year into the account for 10 years. That's $5.5 billion the post office doesn't have.

No other government agency is required to make such a payment for future medical benefits. Postal authorities wanted Congress to address the issue last year, but lawmakers finished their session without getting it done. So officials are moving ahead to accelerate their own plan for cost-cutting.

The Postal Service is in the midst of a major restructuring throughout its retail, delivery and mail processing operations. Since 2006, it has cut annual costs by about $15 billion, reduced the size of its career workforce by 193,000 or by 28 percent, and has consolidated more than 200 mail processing locations, officials say.

They say that while the change in the delivery schedule announced Wednesday is one of the actions needed to restore the financial health of the service, they still urgently need lawmakers to act. Officials say they continue to press for legislation that will give them greater flexibility to control costs and make new revenues.

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AP NewsBreak: Timothy Geithner planning book

NEW YORK (AP) — Former Treasury Secretary Timothy Geithner will write a book focusing on his response to the financial crisis, The Associated Press has learned.

Geithner, 51, will be represented by Washington-based attorney Robert Barnett, who confirmed Wednesday that Geithner would be meeting with publishers, but otherwise declined comment. Barnett has negotiated deals for President Barack Obama, former Secretary of State Hillary Rodham Clinton and many others. Clinton said recently that she hoped to write a book.

Few treasury secretaries have attracted as much attention as Geithner, who has been praised for helping to prevent a second Great Depression, but criticized for being too sympathetic to Wall Street.

Geithner, who stepped down Jan. 25, was the last remaining original economic adviser to Obama. In an Associated Press interview given shortly before he left office, he defended such controversial actions as bailing out large banks, saying, "It is very hard to convince people or make credible to people the risks that we were living with at that time. That we could have had a much deeper collapse of not just the U.S. economy but the global economy."

Geithner has not started writing the book and no timetable has been set for a deal, but an official with knowledge of his plans says the goal is for publication in 2014. The official asked not to be identified, saying that no formal announcement would be made until an agreement is reached with a publisher.

Also Wednesday, the Council on Foreign Relations announced that Geithner will become a distinguished fellow with the organization. Geithner had previously been a senior fellow with the council in 2001 after he stepped down as Treasury undersecretary for international affairs in the administration of President Bill Clinton.

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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 like 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 frequently got infections 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 of the weight he was then, not two-thirds.

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Ex-Treasury Secretary Geithner's new job: fellow at N.Y. think tank

WASHINGTON -- It didn't take long for former Treasury Secretary Timothy F. Geithner to land a new job, and it's not on Wall Street -- though it's in the same area code.

The Council on Foreign Relations, a nonpartisan think tank based in New York, said Wednesday that Geithner would become its newest senior fellow later this month. He stepped down as Treasury secretary on Jan. 25.

President Obama has nominated White House Chief of Staff Jacob J. Lew to replace him.

Geithner has followed this route before. He was a senior fellow at the Council on Foreign Relations in 2001 after his first stint at the Treasury Department and before he started a job at the International Monetary Fund. After the IMF, Geithner served as president of the Federal Reserve Bank of New York from 2003 until he became Treasury secretary in 2009.

"Both at Treasury and at the New York Federal Reserve, Tim was a tireless, creative, and responsible custodian of the public trust," said Richard N. Haass, president of the Council of Foreign Relations.

"His coming to CFR only strengthens our capacity to produce thoughtful analysis of issues at the intersection of economic, political, and strategic developments," Haas said.

Because of Geithner's long history dealing with the financial industry and his role in the banking bailouts, some speculated he might take a job on Wall Street.

Geithner bristled when people assumed he had worked for the industry, which he had not, and he recently told New York magazine it was "extremely unlikely" he would take a position on Wall Street. He also dismissed another rumored landing spot -- as a successor to Federal Reserve Chairman Ben S. Bernanke, whose term ends in early 2014.

Geithner said the bailouts were about saving the economy, not the big banks.

“If you want to protect the economy from a failing financial system, you have to get the system functionally working, and that requires you to do things that look like you are helping the people who helped cause the crisis,” Geithner said in the interview. “People describe this as the rescue of the financial system. That’s not really right; it was the rescue of the economy from the failing financial system.”

ALSO:

Jacob J. Lew, White House chief of staff, to get Treasury nod

Geithner's stature and influence at the White House increase

As he departs, Geithner says 'not a chance' he'll be next Fed chair

 

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Friends, investigators seek answers in killing of O.C. couple

They met in college, two highly regarded basketball players who seemed to have the same winning touch on the court and off.

After blazing through high school and college with her outside shot, Monica Quan became the assistant women's basketball coach at Cal State Fullerton. Keith Lawrence, whose highlight shots are still there on his college website, became a campus officer at USC.

Now police in Irvine are scrambling for an explanation — and friends are looking for a way to express their shock — after Quan and Lawrence were found shot to death in their parked car on the top floor of a parking structure in an upscale, high-security condominium complex near UC Irvine.

The two had just announced their engagement and had recently moved into a condominium complex near Concordia University, where they played basketball and had gone on to earn their degrees.

Late Sunday, after a passerby noticed two people in the parked car, police said they found Lawrence slumped in the driver's side of his white Kia. Quan was next to him, also dead. The couple were shot multiple times, and authorities said they have tentatively ruled out the possibility of it being a murder-suicide or motivated by robbery. Nothing in the car, police said, seemed to be disturbed.

The couple's friends and family said they were shaken by the violent deaths of two people who seemed to have so much to offer.

Quan was a 2002 graduate of Walnut High School in the San Gabriel Valley, where she set school records for the most three-pointers in a season and a game. She played at Long Beach State and at Concordia, where she graduated in 2007. She went on to earn a master's degree before becoming the assistant coach at Fullerton.

Quan's father was the first Chinese American captain in the LAPD, and went on to become police chief at Cal Poly Pomona.

Quan was known for pulling students aside to offer encouragement, said Megan Richardson, a former player. Marcia Foster, the head basketball coach at Cal State Fullerton, described her assistant as a special person — "bright, passionate and empowering," she said.

Quan shared a love of basketball with her fiancee, Lawrence, whom she met at Concordia.

He too had been a standout basketball player, starting at Moorpark High, where he played point guard and shooting guard, said Tim Bednar, who coached Lawrence.

Bednar said that Lawrence, who came from a family of athletes, was talented, yet quiet and humble. After Lawrence graduated in 2003, he continued to participate in summer youth camps

When he returned for the camps, Bednar said, he was known as the "best basketball player that ever came through" the school.

"He was awesome with the kids," Bednar said. "They all wanted to be around Keith Lawrence."

Bednar heard from Lawrence when he needed a recommendation to become a police officer after graduating from the Ventura County Sheriff's Academy. In August, he was hired by USC's public safety department.

John Thomas, the executive director and chief of the department, said that Lawrence was an "honorable, compassionate and professional" member of the community.

"We are a better department and the USC campus community is a safer place as a result of his service," Thomas said in a statement.

On Monday night, Quan's friends gathered outside Walnut High School. One clutched a heart-shaped balloon, another carried a collage of her basketball playing days. Still another held a basketball.

Lawrence's friends and family put up a Facebook page. "RIP Keith Lawrence, you will be missed," it said simply. Within hours, 840 had left comments or indicated they "liked" it. Concordia put up a link to Lawrence's game-winning shot that carried the school into a post-season tournament.

Michelle Thibeault, 27, said in a Facebook message that she had known Quan for more than a decade. The two were on the same athletic teams and went to junior high and high school together. "Monica was loved by everyone," she said.

During a somber gathering at the Cal State Fullerton gymnasium Monday, Foster read a brief statement from Quan's brother Ryan.

"We just shared a moment of incredible joy on her recent engagement," he wrote, and then added: "A bright light was just put out."

nicole.santacruz@latimes.com

kate.mather@latimes.com

lauren.williams@latimes.com

Times staff writer John Canalis contributed to this report.

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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.

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Well: Gluten-Free for the Gluten Sensitive

Eat no wheat.

That is the core, draconian commandment of a gluten-free diet, a prohibition that excises wide swaths of American cuisine — cupcakes, pizza, bread and macaroni and cheese, to name a few things.

For the approximately one-in-a-hundred Americans who have a serious condition called celiac disease, that is an indisputably wise medical directive.

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One woman’s story of going gluten-free.

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Now medical experts largely agree that there is a condition related to gluten other than celiac. In 2011 a panel of celiac experts convened in Oslo and settled on a medical term for this malady: non-celiac gluten sensitivity.

What they still do not know: how many people have gluten sensitivity, what its long-term effects are, or even how to reliably identify it. Indeed, they do not really know what the illness is.

The definition is less a diagnosis than a description — someone who does not have celiac, but whose health improves on a gluten-free diet and worsens again if gluten is eaten. It could even be more than one illness.

“We have absolutely no clue at this point,” said Dr. Stefano Guandalini, medical director of the University of Chicago’s Celiac Disease Center.

Kristen Golden Testa could be one of the gluten-sensitive. Although she does not have celiac, she adopted a gluten-free diet last year. She says she has lost weight and her allergies have gone away. “It’s just so marked,” said Ms. Golden Testa, who is health program director in California for the Children’s Partnership, a national nonprofit advocacy group.

She did not consult a doctor before making the change, and she also does not know whether avoiding gluten has helped at all. “This is my speculation,” she said. She also gave up sugar at the same time and made an effort to eat more vegetables and nuts.

Many advocates of gluten-free diets warn that non-celiac gluten sensitivity is a wide, unseen epidemic undermining the health of millions of people. They believe that avoiding gluten — a composite of starch and proteins found in certain grassy grains like wheat, barley and rye — gives them added energy and alleviates chronic ills. Oats, while gluten-free, are also avoided, because they are often contaminated with gluten-containing grains.

Others see the popularity of gluten-free foods as just the latest fad, destined to fade like the Atkins diet and avoidance of carbohydrates a decade ago.

Indeed, Americans are buying billions of dollars of food labeled gluten-free each year. And celebrities like Miley Cyrus, the actress and singer, have urged fans to give up gluten. “The change in your skin, physical and mental health is amazing!” she posted on Twitter in April.

For celiac experts, the anti-gluten zeal is a dramatic turnaround; not many years ago, they were struggling to raise awareness among doctors that bread and pasta can make some people very sick. Now they are voicing caution, tamping down the wilder claims about gluten-free diets.

“It is not a healthier diet for those who don’t need it,” Dr. Guandalini said. These people “are following a fad, essentially.” He added, “And that’s my biased opinion.”

Nonetheless, Dr. Guandalini agrees that some people who do not have celiac receive a genuine health boost from a gluten-free diet. He just cannot say how many.

As with most nutrition controversies, most everyone agrees on the underlying facts. Wheat entered the human diet only about 10,000 years ago, with the advent of agriculture.

“For the previous 250,000 years, man had evolved without having this very strange protein in his gut,” Dr. Guandalini said. “And as a result, this is a really strange, different protein which the human intestine cannot fully digest. Many people did not adapt to these great environmental changes, so some adverse effects related to gluten ingestion developed around that time.”

The primary proteins in wheat gluten are glutenin and gliadin, and gliadin contains repeating patterns of amino acids that the human digestive system cannot break down. (Gluten is the only substance that contains these proteins.) People with celiac have one or two genetic mutations that somehow, when pieces of gliadin course through the gut, cause the immune system to attack the walls of the intestine in a case of mistaken identity. That, in turn, causes fingerlike structures called villi that absorb nutrients on the inside of the intestines to atrophy, and the intestines can become leaky, wreaking havoc. Symptoms, which vary widely among people with the disease, can include vomiting, chronic diarrhea or constipation and diminished growth rates in children.

The vast majority of people who have celiac do not know it. And not everyone who has the genetic mutations develops celiac.

What worries doctors is that the problem seems to be growing. After testing blood samples from a century ago, researchers discovered that the rate of celiac appears to be increasing. Why is another mystery. Some blame the wheat, as some varieties now grown contain higher levels of gluten, because gluten helps provide the springy inside and crusty outside desirable in bread. (Blame the artisanal bakers.)

There are also people who are allergic to wheat (not necessarily gluten), but until recently, most experts had thought that celiac and wheat allergy were the only problems caused by eating the grain.

For 99 out of 100 people who don’t have celiac — and those who don’t have a wheat allergy — the undigested gliadin fragments usually pass harmlessly through the gut, and the possible benefits of a gluten-free diet are nebulous, perhaps nonexistent for most. But not all.

Anecdotally, people like Ms. Golden Testa say that gluten-free diets have improved their health. Some people with diseases like irritable bowel syndrome and arthritis also report alleviation of their symptoms, and others are grasping at gluten as a source of a host of other conditions, though there is no scientific evidence to back most of the claims. Experts have been skeptical. It does not make obvious sense, for example, that someone would lose weight on a gluten-free diet. In fact, the opposite often happens for celiac patients as their malfunctioning intestines recover.

They also worried that people could end up eating less healthfully. A gluten-free muffin generally contains less fiber than a wheat-based one and still offers the same nutritional dangers — fat and sugar. Gluten-free foods are also less likely to be fortified with vitamins.

But those views have changed. Crucial in the evolving understanding of gluten were the findings, published in 2011, in The American Journal of Gastroenterology, of an experiment in Australia. In the double-blind study, people who suffered from irritable bowel syndrome, did not have celiac and were on a gluten-free diet were given bread and muffins to eat for up to six weeks. Some of them were given gluten-free baked goods; the others got muffins and bread with gluten. Thirty-four patients completed the study. Those who ate gluten reported they felt significantly worse.

That influenced many experts to acknowledge that the disease was not just in the heads of patients. “It’s not just a placebo effect,” said Dr. Marios Hadjivassiliou, a neurologist and celiac expert at the University of Sheffield in England.

Even though there was now convincing evidence that gluten sensitivity exists, that has not helped to establish what causes gluten sensitivity. The researchers of the Australian experiment noted, “No clues to the mechanism were elucidated.”

What is known is that gluten sensitivity does not correlate with the genetic mutations of celiac, so it appears to be something distinct from celiac.

How widespread gluten sensitivity may be is another point of controversy.

Dr. Thomas O’Bryan, a chiropractor turned anti-gluten crusader, said that when he tested his patients, 30 percent of them had antibodies targeting gliadin fragments in their blood. “If a person has a choice between eating wheat or not eating wheat,” he said, “then for most people, avoiding wheat would be ideal.”

Dr. O’Bryan has given himself a diagnosis of gluten sensitivity. “I had these blood sugar abnormalities and didn’t have a handle where they were coming from,” he said. He said a blood test showed gliadin antibodies, and he started avoiding gluten. “It took me a number of years to get completely gluten-free,” he said. “I’d still have a piece of pie once in a while. And I’d notice afterwards that I didn’t feel as good the next day or for two days. Subtle, nothing major, but I’d notice that.”

But Suzy Badaracco, president of Culinary Tides, Inc., a consulting firm, said fewer people these days were citing the benefits of gluten-free diets. She said a recent survey of people who bought gluten-free foods found that 35 percent said they thought gluten-free products were generally healthier, down from 46 percent in 2010. She predicted that the use of gluten-free products would decline.

Dr. Guandalini said finding out whether you are gluten sensitive is not as simple as Dr. O’Bryan’s antibody tests, because the tests only indicate the presence of the fragments in the blood, which can occur for a variety of reasons and do not necessarily indicate a chronic illness. For diagnosing gluten sensitivity, “There is no testing of the blood that can be helpful,” he said.

He also doubts that the occurrence of gluten sensitivity is nearly as high as Dr. O’Bryan asserts. “No more than 1 percent,” Dr. Guandalini said, although he agreed that at present all numbers were speculative.

He said his research group was working to identify biological tests that could determine gluten sensitivity. Some of the results are promising, he said, but they are too preliminary to discuss. Celiac experts urge people to not do what Ms. Golden Testa did — self-diagnose. Should they actually have celiac, tests to diagnose it become unreliable if one is not eating gluten. They also recommend visiting a doctor before starting on a gluten-free diet.

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This post has been revised to reflect the following correction:

Correction: February 4, 2013

An earlier version of this article misspelled the surname of Thomas O'Bryan. It is O'Bryan, not O'Brien.

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