After a billion, what next for Facebook?

MENLO PARK — In just eight years, Facebook signed up more than half the world's Internet population.

Now it's going after the rest.

Facebook wants to reach every single person on the Internet whether they are logging on from a laptop in Santa Monica, an iPhone in Tokyo or a low-tech phone with a tiny screen in Nairobi.

It's parachuting into market after market to take on homegrown social networks by currying favor with the locals and venturing where many people have spotty — if any — access to the Internet.

In Japan, it lets users list their blood types, which the Japanese believe — like astrological signs in the Western world — give insight into personality and temperament. In Africa, Facebook markets a stripped-down, text-only version of its service that works on low-tech mobile phones.

International growth is crucial to maintain its dominance as the world's largest social network. The company's scorching pace of growth has cooled especially in the United States. Facebook must coax users to sign up — and make sure it remains popular with the users it already has — or risk being knocked from its lofty perch.

"We're not a company that is just trying to add more people," said Chris Cox, Facebook's vice president of product. "What we are trying to do is build a service that everyone in the world can use."

But overseas growth that once seemed to come so easily is slower now. Facebook has already saturated most major markets around the globe. Eight out of 10 Facebook users are outside of the U.S.

"I don't think that Facebook has a chance of attracting another billion users," Wedbush Securities analyst Michael Pachter said.

Inside Facebook's Menlo Park, Calif., headquarters is a small army out to prove naysayers wrong. Above their desks they have hung flags from around the world that represent their nationalities. They obsessively scan screens that track user growth around the world.

They cheered and popped open champagne in September when the number of active Facebook users crossed 1 billion. But the moment of jubilation quickly passed as they redoubled their efforts to spread Facebook around the globe.

Naomi Gleit is the soft-spoken, headstrong 29-year-old product manager in charge of growth at Facebook. She says Facebook's future is on mobile devices, the medium by which most people will experience the Web in coming years. Facebook now works on more than 2,500 different phones, helping it gain a foothold in emerging markets. And it is forging relationships with mobile phone operators around the world.

Gleit's 150-member team has boots on the ground in far-flung places armed with low-tech phones and cheap data plans. Even team members here carry Nokia phones alongside their iPhones to update their status or check their News Feed.

"We originally built a product for ourselves," Gleit said. "This is different. Now we need to understand the experience of users who are not like us."

Analysts say Facebook already has established an impressive track record of uprooting entrenched competitors. In Britain, it displaced the dominant social network Bebo, forcing AOL to sell it at a huge loss. In Germany, Facebook overtook the homegrown StudiVZ. Facebook even broke Google social network Orkut's stranglehold on Brazil and India.

In 2009, it launched a clever tool to help Facebook users find their Orkut friends on Facebook and instantly send them friend requests. Two years later it swiped Google's top executive in Latin America, Alexandre Hohagen. Facebook sprinted ahead of Orkut one year ago, and now has 61 million active users in Latin America's largest country.

Facebook is treating India as a test lab for how it can spread in other emerging markets such as Indonesia. Facebook, which has offices in Hyderabad, India, has grown from 8 million users in 2010 to 65 million users today. It is aggressively targeting India's youth. A few hundred young Indian programmers recently jammed a Facebook hackathon at a Bangalore convention center to chug chai and brainstorm new apps that would appeal to their friends.

But Facebook has its eyes on a much bigger prize beyond the country's 100 million Internet users: the 900 million-plus Indians on mobile phones. Some analysts predict India will have more Facebook users than any other country including the United States by 2015.

The company also faces significant challenges in India. It must make the service captivating on low-tech mobile phones with unreliable Internet connections and it must gingerly navigate demands from the Indian government to remove objectionable content without alienating users.

Facebook is making some of its biggest moves in Russia, South Korea and Japan, the only major markets where it operates but has penetration of less than 50%, according to research firm ComScore.

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Microsoft updates Android Xbox SmartGlass app for 7-inch tablets

While Nintendo (NTDOY) has chosen to create second-screen experiences with the new Wii U GamePad, Microsoft’s (MSFT) strategy for the Xbox 360 involves bringing your own devices (BYOD) with the Xbox SmartGlass app for Android, iOS, Windows Phone 8 and Windows 8. One of the more frustrating things initially about the Xbox SmartGlass app was that it wasn’t natively compatible with 7-inch Android tablets such as Google’s (GOOG) excellent Nexus 7, but Microsoft’s gone ahead and updated the app to take advantage of 7-inch Android tablets while squashing a batch of bugs at the same time. While still in its infancy, Xbox SmartGlass is a glimpse at the future of smartphones and tablet and how they connect to the TV. 

Last month, we said: “SmartGlass isn’t just a fancy touchscreen remote control app for the Xbox 360 — it’s much more than that. With the app, users can start a movie on any mobile device and resume on the Xbox 360 (and vice versa), monitor real-time sports stats, bios and highlights on a secondary display, navigate the newly added Internet Explorer with multitouch gestures such as pinch-to-zoom and enhance gameplay with new gameplay options.”

The new Xbox SmartGlass is available for free in Google Play Store here.

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Katzenberg, Spielberg attend Governors Awards

LOS ANGELES (AP) — Stars such as Steven Spielberg and George Lucas are arriving at the Hollywood and Highland Center in Los Angeles to pay homage to four industry heavyweights.

The film academy's fourth annual Governors Awards are being presented Saturday to honorary Oscar winners Jeffrey Katzenberg, stuntman Hal Needham, documentarian D.A. Pennebaker and American Film Institute founding director George Stevens Jr.

The four men will accept their Oscar statuettes during the Academy of Motion Picture Arts and Sciences' private dinner program in the Ray Dolby Ballroom. Portions of the untelevised event may be included in the Feb. 24 Academy Awards telecast.

Other guests expected at Saturday's ceremony include Quentin Tarantino, Bradley Cooper, Kristen Stewart, Bryan Cranston and Oscar host Seth MacFarlane.

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Adderall, a Drug of Increased Focus for N.F.L. Players

The first time Anthony Becht heard about Adderall, he was in the Tampa Bay locker room in 2006. A teammate who had a prescription for the drug shook his pill bottle at Becht.

“ ‘You’ve got to get some of these,’ ” Becht recalled the player saying. “I was like, ‘What the heck is that?’ He definitely needed it. He said it just locks you in, hones you in. He said, ‘When I have to take them, my focus is just raised up to another level.’ ”

Becht said he did not give Adderall another thought until 2009, when he was playing in Arizona and his fellow tight end Ben Patrick was suspended for testing positive for amphetamines. The drug he took, Patrick said, was Adderall. Becht asked Patrick why he took it, and Patrick told Becht, and reporters, that he had needed to stay awake for a long drive.

Those two conversations gave Becht, now a free agent, an early glimpse at a problem that is confounding the N.F.L. this season. Players are taking Adderall, a medication widely prescribed to treat attention deficit hyperactivity disorder, whether they need it or not, and are failing drug tests because of it. And that is almost certainly contributing to a most-troubling result: a record-setting year for N.F.L. drug suspensions.

According to N.F.L. figures, 21 suspensions were announced this calendar year because of failed tests for performance-enhancing drugs, including amphetamines like Adderall. That is a 75 percent increase over the 12 suspensions announced in 2011 and, with a month to go in 2012, it is the most in a year since suspensions for performance-enhancing drugs began in 1989.

At least seven of the players suspended this year have been linked in news media reports to Adderall or have publicly blamed the drug, which acts as a strong stimulant in those without A.D.H.D. The most recent examples were Tampa Bay cornerback Eric Wright and New England defensive lineman Jermaine Cunningham last week.

The N.F.L. is forbidden under the terms of the drug-testing agreement with the players union from announcing what substance players have tested positive for — the urine test does not distinguish among types of amphetamines — and there is some suspicion that at least a few players may claim they took Adderall instead of admitting to steroid use, which carries a far greater stigma. But Adolpho Birch, who oversees drug testing as the N.F.L.’s senior vice president for law and labor, said last week that failed tests for amphetamines were up this year, although he did not provide any specifics. The increase in Adderall use probably accounts for a large part of the overall increase in failed tests.

“If nothing else it probably reflects an uptick in the use of amphetamine and amphetamine-related substances throughout society,” Birch said. “It’s not a secret that it’s a societal trend, and I think we’re starting to see some of the effects of that trend throughout our league.”

Amphetamines have long been used by athletes to provide a boost — think of the stories of “greenies” in baseball clubhouses decades ago. That Adderall use and abuse has made its way to the N.F.L. surprises few, because A.D.H.D. diagnoses and the use of medication to control it have sharply increased in recent years.

According to Dr. Lenard Adler, who runs the adult A.D.H.D. program at New York University Langone Medical Center, 4.4 percent of adults in the general population have the disorder, of which an estimated two-thirds are men. Birch said the number of exemptions the N.F.L. has granted for players who need treatment for A.D.H.D. is “almost certainly fewer” than 4.4 percent of those in the league.

The rates of those with the disorder fall as people get older; it is far more prevalent in children and adolescents. A report from the Centers for Disease Control and Prevention, using input from parents, found that as of 2007, about 9.5 percent or 5.4 million children from ages 4 to 17 had A.D.H.D. at some point. That was an increase of 22 percent from 2003. Boys (13.2 percent) were more likely to have the disorder than girls (5.6 percent).

Of children who currently have A.D.H.D., 66.3 percent are receiving medication, with boys 2.8 times more likely to receive medication. Those 11 to 17 years old are more likely to receive medication than younger children.

But Adderall, categorized by the Drug Enforcement Administration as a Schedule II controlled substance because it is particularly addictive, is also used by college students and even some high school students to provide extra energy and concentration for studying or as a party drug to ward off fatigue.

Dr. Leah Lagos, a New York sports psychologist who has worked with college and professional athletes, said she had seen patients who have used Adderall. She said she believed the rise in its use by professional athletes mimicked the use by college students. Just a few years ago, she said, it was estimated that 1 in 10 college students was abusing stimulants like Adderall and Ritalin. That estimate, Lagos said, has almost doubled.

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After a billion, what next for Facebook?

MENLO PARK — In just eight years, Facebook signed up more than half the world's Internet population.

Now it's going after the rest.

Facebook wants to reach every single person on the Internet whether they are logging on from a laptop in Santa Monica, an iPhone in Tokyo or a low-tech phone with a tiny screen in Nairobi.

It's parachuting into market after market to take on homegrown social networks by currying favor with the locals and venturing where many people have spotty — if any — access to the Internet.

In Japan, it lets users list their blood types, which the Japanese believe — like astrological signs in the Western world — give insight into personality and temperament. In Africa, Facebook markets a stripped-down, text-only version of its service that works on low-tech mobile phones.

International growth is crucial to maintain its dominance as the world's largest social network. The company's scorching pace of growth has cooled especially in the United States. Facebook must coax users to sign up — and make sure it remains popular with the users it already has — or risk being knocked from its lofty perch.

"We're not a company that is just trying to add more people," said Chris Cox, Facebook's vice president of product. "What we are trying to do is build a service that everyone in the world can use."

But overseas growth that once seemed to come so easily is slower now. Facebook has already saturated most major markets around the globe. Eight out of 10 Facebook users are outside of the U.S.

"I don't think that Facebook has a chance of attracting another billion users," Wedbush Securities analyst Michael Pachter said.

Inside Facebook's Menlo Park, Calif., headquarters is a small army out to prove naysayers wrong. Above their desks they have hung flags from around the world that represent their nationalities. They obsessively scan screens that track user growth around the world.

They cheered and popped open champagne in September when the number of active Facebook users crossed 1 billion. But the moment of jubilation quickly passed as they redoubled their efforts to spread Facebook around the globe.

Naomi Gleit is the soft-spoken, headstrong 29-year-old product manager in charge of growth at Facebook. She says Facebook's future is on mobile devices, the medium by which most people will experience the Web in coming years. Facebook now works on more than 2,500 different phones, helping it gain a foothold in emerging markets. And it is forging relationships with mobile phone operators around the world.

Gleit's 150-member team has boots on the ground in far-flung places armed with low-tech phones and cheap data plans. Even team members here carry Nokia phones alongside their iPhones to update their status or check their News Feed.

"We originally built a product for ourselves," Gleit said. "This is different. Now we need to understand the experience of users who are not like us."

Analysts say Facebook already has established an impressive track record of uprooting entrenched competitors. In Britain, it displaced the dominant social network Bebo, forcing AOL to sell it at a huge loss. In Germany, Facebook overtook the homegrown StudiVZ. Facebook even broke Google social network Orkut's stranglehold on Brazil and India.

In 2009, it launched a clever tool to help Facebook users find their Orkut friends on Facebook and instantly send them friend requests. Two years later it swiped Google's top executive in Latin America, Alexandre Hohagen. Facebook sprinted ahead of Orkut one year ago, and now has 61 million active users in Latin America's largest country.

Facebook is treating India as a test lab for how it can spread in other emerging markets such as Indonesia. Facebook, which has offices in Hyderabad, India, has grown from 8 million users in 2010 to 65 million users today. It is aggressively targeting India's youth. A few hundred young Indian programmers recently jammed a Facebook hackathon at a Bangalore convention center to chug chai and brainstorm new apps that would appeal to their friends.

But Facebook has its eyes on a much bigger prize beyond the country's 100 million Internet users: the 900 million-plus Indians on mobile phones. Some analysts predict India will have more Facebook users than any other country including the United States by 2015.

The company also faces significant challenges in India. It must make the service captivating on low-tech mobile phones with unreliable Internet connections and it must gingerly navigate demands from the Indian government to remove objectionable content without alienating users.

Facebook is making some of its biggest moves in Russia, South Korea and Japan, the only major markets where it operates but has penetration of less than 50%, according to research firm ComScore.

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South L.A. frustrated by delays in building new King hospital

Earlier this year, Joane Austin rushed her elderly mother to the emergency room for fear she was having a heart attack.

Austin normally would have made the short trip to Martin Luther King Jr./Drew Medical Center, the landmark hospital in South Los Angeles. But King/Drew has been closed for five years, so Austin drove several miles to the emergency room at Centinela Hospital Medical Center in Inglewood.

"I prayed all the lights would stay green," she said. "It was scary."

Once they arrived, doctors determined that Austin's mother needed emergency surgery to remove scar tissue around her intestines.

For years, King/Drew provided emergency, trauma and inpatient care to residents from throughout South Los Angeles. After a series of medical errors resulted in patient deaths, Los Angeles County closed it in 2007. County officials promised the community a better, safer new medical center in a few years.

But the opening has been repeatedly delayed, and the community is still waiting. Originally, officials hoped to have the new facility ready by 2010. Then it was pushed to 2012. Now, officials say they plan to have construction completed next year and the hospital opening its doors in 2014.

Without a nearby hospital, patients have had to travel to such places as Bellflower, Inglewood and Long Beach for emergency room and inpatient care.

Several local hospitals — California Hospital Medical Center, L.A. County/USC Medical Center and Harbor-UCLA Medical Center — received an influx of former King patients after the closure. The closest hospital, St. Francis Medical Center in Lynwood, reported an increase of 20% to 30% in emergency room visits since King/Drew closed, though other factors also may have contributed to the rise.

Getting to other hospitals has presented a challenge for many in the low-income neighborhood, said William Hobson, president and chief executive of the Watts Healthcare Corp. "Just the fact that it is a long way away may discourage them from going," he said.

The closure of King/Drew, which was born out of the Watts riots and opened in 1972, created a healthcare gap in a community where rates of chronic disease are high and vast swaths of the population lack insurance, said David Carlisle, president of the adjacent Charles R. Drew University of Medicine and Science. South Los Angeles has a shortage of doctors, inpatient beds and outpatient services, according to both experts and research.

Despite King/Drew's many medical lapses, which earned it the nickname "Killer King," many in the community remained fiercely loyal to the hospital and the services it provided.

Studies examining the impact of King/Drew's closure found that it led to delays in care for elderly blacks and Latinos and a dramatic increase in patient admissions at other trauma centers. Physicians throughout the county also reported more overcrowding in other emergency rooms and said they saw sicker patients who didn't know where to go or couldn't afford transportation elsewhere.

"It is fearful to think about how many lives may have been saved had this thing been opened by now," said Lark Galloway-Gilliam, executive director of the advocacy group Community Health Councils. "It shouldn't take five years to build a facility."

Patrick Wooten, 49, went to St. Francis when he had a dislocated kneecap a few years ago. Wooten, who is uninsured, said he received good care at the private hospital but then got a $3,200 bill. Wooten said he is frustrated that the new King hospital still hasn't opened and won't until 2014. "What you do until then, God only knows," he said. "Hopefully we can wait it out."

Last year, Sandira Gonzalez, 29, took her 5-year-old son to the Martin Luther King urgent care center when he had a fever. But when the center closed for the night, her son had to be taken by ambulance to Harbor-UCLA near Torrance, where he was treated for an infection.

Community members and advocates said they are disappointed by the long wait, caused by a combination of bureaucratic delays and the complexity of the project. But when it does open, they said, they are hopeful that it will be a better, and safer, hospital.

The county is building the hospital and will help support it financially but will not be responsible for day-to-day operations. Instead, an independent, nonprofit organization will run the facility, to be known as Martin Luther King Jr. Community Hospital, and the University of California will help staff it and ensure the quality of patient care. Construction is progressing, but the grand opening may still be nearly two years away.

"It will be a significantly different kind of institution, with the right kind of accountability," said Robert K. Ross, president and chief executive of the California Endowment. "Now we just need the institution to open up on budget and on time."

Los Angeles County Supervisor Mark Ridley-Thomas said it takes time to create a state-of-the-art hospital — and a whole medical complex — that could become a model for others around the nation. "A lot of eyes are on this," he said. "We want to do this well and we want to do it right.... Nothing else is acceptable."

The nonprofit's board recognizes how critical the facility is to the area, said board President Manny Abascal. "Every day this hospital is not open, people are suffering," he said. At the same time, he added, the board is committed to ensuring that the new hospital is a high-quality institution. "If you open it … and there are some of the same problems you had before, then it's going to be devastating," he said.

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Glen Campbell considering more live shows in 2013

NASHVILLE, Tenn. (AP) — Glen Campbell may be wrapping up a goodbye tour but that doesn't mean he's done with the stage.

Campbell is considering scheduling more shows next year after playing more than 120 dates in 2012.

The 76-year-old singer has Alzheimer's disease and has begun to lose his memory. He put out his final studio album, "Ghost on the Canvas," in 2011 and embarked on the tour with family members and close friends serving in his band and staffing the tour.

Campbell's longtime manager Stan Schneider said in a phone interview from Napa, Calif., where the tour wrapped for the year Friday night, that recent West Coast shows have been some of the singer's strongest. Campbell will break for the holidays and if he still feels strong he'll begin scheduling more shows.

___

Online:

http://glencampbellmusic.com

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Cut Medicare and Social Security? What's the rush?

The question that normally comes to mind when someone claims to know the future is why he's out hustling rubes for pennies with his purported clairvoyance, instead of using it to make a fortune and retiring to the South Seas.

Of course, the answer is that nobody ever does know the future. And that leads to the question of why so much of the "fiscal cliff" debate in Washington is based on supposedly perfect knowledge of conditions that are 20, or even 70, years away.

We're talking about projections of the cost of "entitlements" — a noxious way of referring to Medicare and Social Security, excellent programs that most workers have paid for during their careers and that have kept millions of Americans healthy and out of poverty.

The customary talking point by the anti-deficit lobby is that the rising cost of these programs will eat us alive. That future, the argument continues, is coming at us like an onrushing train, so to avoid having to cut benefits when it arrives, we best cut benefits now.

The element of haste is a crucial element in this debate. That's because as real estate brokers and late-night TV hucksters know, pressure to Act Now! is what leads their marks to overlook that the basic premise is bogus.

Consider the prevailing assumptions about the future of Social Security and Medicare. One is that Social Security's trust fund will run dry in 2033, at which point the money coming in from payroll taxes will be enough to cover only about 75% of currently scheduled benefits. Will this happen? It might, but it might not:

The program's trustees, who are the source of the projection, don't bet the farm on it. They also project that under certain conditions of economic and employment growth — all of them perfectly plausible — it might never run dry. You don't hear much about that projection because it doesn't fit into the narrative that Social Security is "going broke."

Healthcare costs, with Medicare and Mediaid as big components, have been projected to rise to as much as 40% of gross domestic product by 2082 if not restrained. That's a fearsome prospect, but it's based on a long-outdated forecast by the Congressional Budget Office, which doesn't use the same methodology anymore. It was highly implausible, if not impossible, in the first place.

That CBO projection, like others employed by the anti-"entitlement" lobby to push for gutting the program, relied on projecting past experience into the future without adjusting for changes in behavior or policy.

This is a common fallacy well understood by pollsters. They know that if you ask people what the future will look like, they'll describe something that looks like today, except more so. If street crime is in the news, for example, they'll posit a future in which every community looks like Deadwood.

Investment experts try to moderate this tendency by reminding clients that trees don't grow to the stratosphere. To put it another way, just because your son is 4 feet tall at age 6 doesn't mean he'll be 12 feet tall at age 18. And just because the average American born today will live to the age of 78 doesn't mean that a baby born in 2032 will live to 100.

These questionable forecasts result in the nauseating spectacle of corporate CEOs such as Lloyd Blankfein of Goldman Sachs lecturing Americans that the retirement benefits and elder healthcare coverage they've paid for during their working lives are things we "can't afford."

Blankfein didn't worry about what the country could afford when Goldman pocketed $12.9 billion in taxpayer funds to cover its losses in the collapse of insurance giant AIG. But there he was on CBS on Nov. 19, saying, "You...have to do something to lower people's expectations — the entitlements and what people think that they're going to get, because they're not going to get it."

Blankfein proceeded to lecture his interviewer that Social Security "wasn't devised to be a system that supported you for a 30-year retirement after a 25-year career." This is fair enough, one supposes, though it's a mystery where Blankfein gets the idea that the average retiree today has spent only 25 years in the workplace, rather than 45, and lives to the age of 95. Does Goldman Sachs do all its math this way?

The Social Security projection is probably the most misused and misunderstood statistic in the fiscal-cliff debate. The trustees warn every year that its forecast is "inherently uncertain." They warn that it's a melange of projections of at least 17 factors, including fertility and mortality rates, economic growth, unemployment, wages and life expectancy, many of which are interrelated.

No one — no business, no government agency — makes plans today based on a vision of the world 20 years from now. IBM doesn't do it. Google doesn't do it. The Department of Defense doesn't do it. You and I don't do it. Not even life insurance companies, which might be said to live in the future, do it.

The reason smart people and companies don't make bets on the distant future is precisely because it's unknowable. Try the following thought experiment: Instead of looking ahead 20 years, look back 20 years, and try to list all the events that have had immense, material effects on today's economy, but were unimaginable in 1992.

Here's my list: 9/11. The Afghan war. The Iraq war. The housing bubble. The crash of 2000. The crash of 2008. The crash of Lehman Bros. The iPod. The iPhone. The iPad. The founding of Google. Hurricane Andrew, Hurricane Katrina, Superstorm Sandy. Obamacare.

What are the chances that another such list will make the U.S. economy in 2033 look utterly different from what we imagine in 2012? I'd say 100%.

Forecasting healthcare costs may be even more of a mug's game. In a 2008 paper, economists Glenn Follette and Louise Sheiner of the Federal Reserve observed that the CBO unwisely projected healthcare costs into the future by assuming that the trends of the past simply would continue.

But the trends of the past had included an unprecedented expansion of public and private insurance coverage, which cut average out-of-pocket spending from 51% of total healthcare outlays in 1960 to 13% in 2005. That created an explosion in demand.

Could the trend continue? Plainly not. The Fed economists also noted that any trend pointing toward healthcare consuming 40% of GDP would have such destructive effect on the rest of the economy that personal behavior or political action would change it before reaching that point. The CBO now acknowledges that.

Healthcare reform has made such projections even more uncertain today, in part because the reform act includes numerous cost-limiting initiatives, the success of which can only be guessed at. That's an argument against taking such radical steps as raising the Medicare eligibility age, as some fiscal-cliff pundits advocate.

Leaving aside that doing so would drive up costsfor employers, states and Medicare participants themselves by more than it would save the federal government (the Kaiser Family Foundation crunched the numbers), it's far too early to know if it's even necessary.

One might argue that the uncertainty of economic forecasts means there's no point in economic planning at all. But there are good reasons for looking ahead, just not good reasons for thinking your vision of the future is 20/20.

And there's a big difference between making a congressional budget and making fundamental changes in programs as complex as Social Security and Medicare. The life span of a congressional budget is two years, max, because no Congress can bind its successors. But changes in Social Security and Medicare are forever. So when you hear that we have to do it now, stat! or we're doomed, take it for the snake oil that it is.

Michael Hiltzik's column appears Sundays and Wednesdays. Reach him at mhiltzik@latimes.com, read past columns at latimes.com/hiltzik, check out facebook.com/hiltzik and follow @latimeshiltzik on Twitter.

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Away from Egypt's protests, the worries mount

CAIRO — Amid thimbles, pins and strands of silver thread, the tailor twitched his pencil-perfect mustache in disgust and said the country where he learned to sew and raised six children was edging into darkness.

"I'm worried," said Sayed Abdelwahab, leaning on a worn counter in a shop where he has mended suits for decades. "I have employees with three and four kids. I'm responsible for them. My customers are mostly foreigners, but they're leaving the country. My business is down 50%. Did you see what happened to the stock market?"

"It's Morsi," said his friend Awad Abdelhafez, a porter, referring to Egyptian President Mohamed Morsi. "He's taken all the power.... Who's responsible for those dying in this violence?"

Such was the talk Thursday on a shaded street in a Cairo neighborhood far from the protest banners in Tahrir Square and the political intrigue over a new constitution. After nearly two years marked by endless clashes and skies tinged with tear gas, the true Egypt is slipping deeper into its worries.

The ragged semblance of democracy that emerged from the 2011 uprising against Hosni Mubarak is dominated by Morsi and his Muslim Brotherhood. The opposition can fill the streets with demonstrators and slogans but so far lacks the momentum to unseat Islamists in the fight for the nation's character.

But on this street, where butcher knives flash quick and women sell dusty oranges stacked in pyramids, such thoughts seem strange abstractions. But then, so does the recent revelation by Morsi to Time magazine that he found the movie "Planet of the Apes" to be politically instructive. Heads shake in weary unison.

"I'm so worried and depressed I can't follow things anymore," said Dina Mohamed, a call center operator. "Morsi's been ruling us for four months but he's mixing the wrong ingredients. I'm scared we're facing a hunger revolution. The poor will rise up for bread, not politics or culture, but for their own lives."

This in a nation where the average annual income is reported to be about $4,000. More than 40% of the population lives on $2 a day. The revolution has not improved these statistics, and to many Egyptians, that is its central failing. All the promises that have echoed from mosques, political rallies and television studios have drifted past them like smoke.

The deeper worry is about prolonged civil strife between Islamists and secularists over how deeply Islam will be embedded in public life. This is the fierce debate that the country knew for generations had to come. But now that it has suddenly arrived, the sides have hardened to the point where even Mubarak loyalists have joined their onetime foes, the leftists, to take on Morsi and other Islamists.

"I respect Morsi very much," said Mahmoud Hashem, stepping out from behind the counter of a juice shop. He wears a beard and, as is customary for conservative Muslims, does not look an unveiled woman in the eye. "We elected him. He needs to make decisions as a president, and whether they're right or wrong we have to stand by him. We chose him for four years. He must be given a chance."

But then, step into the tailor's shop, a box of a place with mannequins in the window wearing half-finished jackets, pins in shoulders, strips of fabric whirling on the floor. Abdelwahab has been here since 1966. He started in the trade even before that, when he was 13, after his parents died and he quit school "because I had to look after myself."

That was a few years after Gamal Abdel Nasser, a charismatic army officer, led the 1952 revolution that won Egypt its independence, eventually leading to President Anwar Sadat's peace treaty with Israel, the rise of Mubarak and, Abdelwahab scoffed, the era of Morsi.

"It was good under Nasser and Sadat," he said. "It was good under Mubarak for the first 20 years, but the last 10, when he gave his son more power and started privatization, things started going bad."

Now?

"Worst time of all," he said. "The country is falling apart. We're going to hell."

Abdelhafez, the porter, nodded.

A man sewing upstairs, yelled down, "Half of us are slaves!"

"The people in Tahrir Square will never be slaves," said Abdelwahab. "They are fighting."

The men talked, voices rising and falling in an afternoon cool with the coming winter. Would the military step in again like it did immediately after Mubarak's fall? Would the stock market rebound? Would those killing the protesters be prosecuted? Why is it that every time U.S. Secretary of State Hillary Rodham Clinton visits Cairo, as she did last week to help seal a cease-fire between Israel and Hamas, something bad happens shortly after? (The porter's eyebrows danced at the question.) Why isn't the Muslim Brotherhood open to different views, different ways of seeing things?

So many discussions. But there was work to do, even if many of Abdelwahab's clients had left the country and there were only a few bags of ruffled shirts needing a needle and thread, a steam and a pressing.

This weekend, the Brotherhood has promised a huge rally in Cairo to support Morsi and pressure the protesters in Tahrir.

The porter and the tailor glanced at each other.

"We are entering a dangerous weekend," said Abdelhafez, who left his friend's shop and crossed the street, passing a man yelling into his cellphone. "The Islamists want to pass this constitution!" the man said. "They want to make this country their own!"

jeffrey.fleishman@latimes.com

Special correspondent Reem Abdellatif contributed to this report.

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Adkins explains Confederate flag earpiece

NEW YORK (AP) — Trace Adkins wore an earpiece decorated like the Confederate flag when he performed for the Rockefeller Center Christmas Tree Lighting but says he meant no offense by it.

Adkins appeared with the earpiece on a nationally televised special for the lighting on Wednesday. Some regard the flag as a racist symbol and criticized Adkins in Twitter postings.

But in a statement released Thursday, the Louisiana native called himself a proud American who objects to any oppression and says the flag represents his Southern heritage.

He noted he's a descendant of Confederate soldiers and says he did not intend offense by wearing it.

Adkins — on a USO tour in Japan — also called for the preservation of America's battlefields and an "honest conversation about the country's history."

___

Online:

http://www.traceadkins.com

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Medicare Is Faulted in Electronic Medical Records Conversion

The conversion to electronic medical records — a critical piece of the Obama administration’s plan for health care reform — is “vulnerable” to fraud and abuse because of the failure of Medicare officials to develop appropriate safeguards, according to a sharply critical report to be issued Thursday by federal investigators.

Mike Spencer/Wilmington Star-News, via Associated Press

Celeste Stephens, a nurse, leads a session on electronic records at New Hanover Regional Medical Center in Wilmington, N.C.

Centers for Medicare and Medicaid Services

Marilyn Tavenner, acting administrator for Medicare.

The use of electronic medical records has been central to the aim of overhauling health care in America. Advocates contend that electronic records systems will improve patient care and lower costs through better coordination of medical services, and the Obama administration is spending billions of dollars to encourage doctors and hospitals to switch to electronic records to track patient care.

But the report says Medicare, which is charged with managing the incentive program that encourages the adoption of electronic records, has failed to put in place adequate safeguards to ensure that information being provided by hospitals and doctors about their electronic records systems is accurate. To qualify for the incentive payments, doctors and hospitals must demonstrate that the systems lead to better patient care, meeting a so-called meaningful use standard by, for example, checking for harmful drug interactions.

Medicare “faces obstacles” in overseeing the electronic records incentive program “that leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements,” the investigators concluded. The report was prepared by the Office of Inspector General for the Department of Health and Human Services, which oversees Medicare.

The investigators contrasted the looser management of the incentive program with the agency’s pledge to more closely monitor Medicare payments of medical claims. Medicare officials have indicated that the agency intends to move away from a “pay and chase” model, in which it tried to get back any money it has paid in error, to one in which it focuses on trying to avoid making unjustified payments in the first place.

Late Wednesday, a Medicare spokesman said in a statement: “Protecting taxpayer dollars is our top priority and we have implemented aggressive procedures to hold providers accountable. Making a false claim is a serious offense with serious consequences and we believe the overwhelming majority of doctors and hospitals take seriously their responsibility to honestly report their performance.”

The government’s investment in electronic records was authorized under the broader stimulus package passed in 2009. Medicare expects to spend nearly $7 billion over five years as a way of inducing doctors and hospitals to adopt and use electronic records. So far, the report said, the agency has paid 74, 317 health professionals and 1,333 hospitals. By attesting that they meet the criteria established under the program, a doctor can receive as much as $44,000 for adopting electronic records, while a hospital could be paid as much as $2 million in the first year of its adoption. The inspector general’s report follows earlier concerns among regulators and others over whether doctors and hospitals are using electronic records inappropriately to charge more for services, as reported by The New York Times last September, and is likely to fuel the debate over the government’s efforts to promote electronic records. Critics say the push for electronic records may be resulting in higher Medicare spending with little in the way of improvement in patients’ health. Thursday’s report did not address patient care.

Even those within the industry say the speed with which systems are being developed and adopted by hospitals and doctors has led to a lack of clarity over how the records should be used and concerns about their overall accuracy.

“We’ve gone from the horse and buggy to the Model T, and we don’t know the rules of the road. Now we’ve had a big car pileup,” said Lynne Thomas Gordon, the chief executive of the American Health Information Management Association, a trade group in Chicago. The association, which contends more study is needed to determine whether hospitals and doctors actually are abusing electronic records to increase their payments, says it supports more clarity.

Although there is little disagreement over the potential benefits of electronic records in reducing duplicative tests and avoiding medical errors, critics increasingly argue that the federal government has not devoted enough time or resources to making certain the money it is investing is being well spent.

House Republicans echoed these concerns in early October in a letter to Kathleen Sebelius, secretary of health and human services. Citing the Times article, they called for suspending the incentive program until concerns about standardization had been resolved. “The top House policy makers on health care are concerned that H.H.S. is squandering taxpayer dollars by asking little of providers in return for incentive payments,” said a statement issued at the same time by the Republicans, who are likely to seize on the latest inspector general report as further evidence of lax oversight. Republicans have said they will continue to monitor the program.

In her letter in response, which has not been made public, Ms. Sebelius dismissed the idea of suspending the incentive program, arguing that it “would be profoundly unfair to the hospitals and eligible professionals that have invested billions of dollars and devoted countless hours of work to purchase and install systems and educate staff.” She said Medicare was trying to determine whether electronic records had been used in any fraudulent billing but she insisted that the current efforts to certify the systems and address the concerns raised by the Republicans and others were adequate.

This article has been revised to reflect the following correction:

Correction: November 30, 2012

An article on Thursday about a federal report critical of Medicare’s performance in assuring accuracy as doctors and hospitals switch to electronic medical records misstated, in some copies, the timing of a statement from a Medicare spokesman in response to the report. The statement was released late Wednesday, not late Thursday.

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Electricity rates to rise for Southern California Edison customers

SACRAMENTO — Almost 5 million Southern California Edison Co. customers in hundreds of cities and communities across the southern, central and coastal parts of the state will be hit with higher electric bills early next year and bigger hikes in each of the following two years.

The decision, which Edison says will add an average of $7 a month to residential bills for the first year, covers Edison's costs to provide service, which amounts to about half a ratepayer's bill. Other costs for buying fuel and contracting for power deliveries fluctuate and are passed directly to consumers.

The California Public Utilities Commission unanimously approved new rates, retroactive to the beginning of this year, on Thursday as part of an every-three-years process of reviewing finances at the heavily regulated utility.

The 5% increase for 2012 — providing the Rosemead company with $5.7 billion in revenue — is less than the 16.6% the company had sought. Rates, however, are estimated to rise an additional 6.3% for 2013 and 5.9% in 2014 under the PUC order.

"This decision ensures that SCE is able to invest in smart energy systems, renewables and safety and reliability, while its ratepayers are protected," PUC Commissioner Timothy Alan Simon said.

Edison provides electricity to 13 million people, including most of Los Angeles and Orange counties as well as much of Central California and the Inland Empire. Not included are residents of Los Angeles who get their power from the municipally owned Department of Water and Power.

Edison, the decision notes, has faced "two significant challenges to operations" in the last year: a December 2011 wind storm that damaged the grid, and the extended shutdown of two nuclear power reactors at the San Onofre Nuclear Generating Station in San Diego County.

Edison in a statement called the commission's action "constructive" because the decision helps it finance needed upgrades in its system.

Consumer groups said they were pleased that commissioners granted Edison, a unit of Edison International, less than what the company sought from the PUC.

"We definitely got a substantial amount shaved off, but it's still more than we think Edison really needs," said Mindy Spatt, a spokeswoman for the Utility Reform Network, which advocates for ratepayers at the state's three big investor-owned electric companies.

Business groups also complained that the jump in Edison's already steep electric rates could make it harder for them to keep operating profitably.

"California manufacturers already pay 50% higher electricity rates than the national average," said Gino Di Caro, a spokesman for the California Manufacturers & Technology Assn. "Obviously, energy costs are one of the primary budgetary items for any manufacturing operation, and this is all the more reason for California to find ways to offset these costs."

marc.lifsher@latimes.com

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Powerball's $580-million-plus jackpot inspires wishes, dreamers

Don't bother telling Wednesday night's Powerball winners -- if there are any -- that a lottery is just a tax on those who flunked math. With a winning ticket in hand, or even just the dream of one, who cares if the odds against them exceeded 175 million to 1? 

Last-minute ticket-buying pushed the jackpot to nearly $580 million, which is how much a single winner would get if he or she took the money in annual payments over 30 years.  

The winning numbers: 5-16-22-23-29, and the Powerball:  06

Officials couldn't say immediately after the 8 p.m. drawing whether there were any winning tickets. But beforehand, officials had said there was a 75% chance that someone would win Wednesday night. 

No one had won since Oct. 6, causing the jackpot to roll over 16 times. It  grows at least $10 million every time no one wins, lottery officials said. 

To play Powerball, one must pick five unique numbers from 1 through 59, and a Powerball number from 1 through 35. The odds of winning are 1 in 175,223,510. 

Powerball tickets aren't sold in California, but some feverish residents reportedly drove or flew to one of 42 participating states  to buy a chance at a fortune. The District of Columbia and the U.S. Virgin Islands also participate. 

Maybe the next time the jackpot soars, out-of-state travel won't be necessary. On Thursday, the California State Lottery Commission is expected to adopt regulations to join the Powerball lottery. If so, California retailers could start selling the $2 tickets in April.

[Updated, 9:53 p.m., Nov. 28: An earlier version of this post said the jackpot would exceed $550 million.  Late Wednesday, the Associated Press reported, Powerball officials said it would be nearly $580 million.]

 ALSO:

Zig Ziglar dies at 86; motivational speaker inspired millions

Nanny, in hospital, pleads not guilty to murder of 2 children

Texas moves to seize polygamist Warren Jeffs' ranch compound 

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Samsung takes aim at Japanese rivals with Android camera

SEOUL (Reuters) – South Korean consumer electronics giant Samsung Electronics Co is taking aim at its Japanese rivals with an Android-powered digital camera that allows users to swiftly and wirelessly upload pictures to social networking sites.

The Galaxy camera lets users connect to a mobile network or Wi-Fi to share photographs and video without having to hook up the camera to a computer.

While it’s not the first to the market, Samsung‘s financial and marketing clout suggest it could be the biggest threat to Japanese domination of a digital camera industry which research firm Lucintel sees growing to $ 46 billion by 2017 and where big brands include Canon Inc, Sony Corp, Panasonic Corp, Nikon Corp and Olympus Corp.

“Samsung has a tough row to hoe against the likes of Canon and Nikon in the camera brand equity landscape,” said Liz Cutting, senior imaging analyst at research firm NPD Group. “Yet as a brand known more in the connected electronic device arena, Samsung has a unique opportunity to transfer strength from adjacent categories into the dedicated camera world.”

The Korean group, battling for mobile gadget supremacy against Apple Inc, is already a global market leader in televisions, smartphones and memory chips.

Samsung last year brought its camera and digital imaging business – one of its smallest – under the supervision of JK Shin, who heads a mobile business that generated 70 percent of Samsung’s $ 7.4 billion third-quarter profit.

“Our camera business is quickly evolving … and I think it will be able to set a new landmark for Samsung,” Shin said on Thursday at a launch event in Seoul. “The product will open a new chapter in communications – visual communications,” he said, noting good reviews for the Samsung Galaxy camera which went on sale in Europe and the United States earlier this month.

AIMING AT ‘PRO-SUMERS’

The Galaxy camera, which sells in the United States for $ 499.99 through AT&T with various monthly data plans, features a 4.8-inch LCD touchscreen and a 21x optical zoom lens. Users can send photos instantly to other mobile devices via a 4G network, access the Internet, email and social network sites, edit photos and play games.

The easy-to-use camera, and the quality of the pictures, is aimed at mid-market ‘pro-sumers’ – not quite professional photographers but those who don’t mind paying a premium for user options not yet available on a smartphone – such as an optical, rather than digital, zoom, better flash, and image stabilization.

The appeal of high picture quality cameras with wireless connection has grown as social media services such as Facebook Inc drive a boom in rapid shoot-and-share photos.

“At a price point higher than some entry-level interchangeable-lens cameras, the Galaxy camera should appeal to a consumer willing to pay an initial and ongoing premium for 24/7 creative interactivity,” said Cutting.

Traditional digital camera makers are responding.

Canon, considered a leader in profitability in corporate Japan with its aggressive cost cutting, saw its compact camera sales eroded in the most recent quarter by smartphones, and has just introduced its first mirrorless camera to tap into a growing market for small, interchangeable-lens cameras that rival Nikon entered last year.

Nikon has also recently introduced an Android-embedded Wi-Fi only camera.

($ 1 = 1086.4000 Korean won)

(This story fixes typing error in paragraph 9)

(Additional reporting by Dhanya Skariachan in NEW YORK; Editing by Ian Geoghegan)

Wireless News Headlines – Yahoo! News

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'That 70s Show' star arrested in North Carolina

STATESVILLE, N.C. (AP) — "That '70s Show" star Lisa Robin Kelly is free on bond after being arrested for assault.

Police in the Charlotte, N.C., suburb of Mooresville arrested the 42-year-old Kelly and 61-year-old husband Robert Joseph Gilliam after responding to a disturbance at their home Monday. Both are free on bond.

Gilliam is charged with misdemeanor assault on a female. Kelly is charged with misdemeanor assault. They were taken to the Iredell County Detention Center and released on $500 bond apiece. They have a court date of Jan. 25. It's not known if either has an attorney.

Kelly portrayed Laurie Forman, sister of Topher Grace's lead character Eric, on the FOX series, which ended in 2006. She also appeared on the TV shows "Murphy Brown" and "Married . . . With Children."

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Phys Ed: Keeping Your Eye on the Ball

Recently, researchers in England set out to determine whether weekend golfers could improve their game through one of two approaches. Some were coached on individual swing technique, while others were instructed to gaze fixedly at the ball before putting. The researchers hoped to learn not only whether looking at the ball affects performance, but also whether where we look changes how we think and feel while in action.

Phys Ed

Gretchen Reynolds on the science of fitness.

Back in elementary school gym class, virtually all of us were taught to keep our eyes on the ball during sports. But a growing body of research suggests that, as adults, most of us have forgotten how to do this. When scientists in recent years have attached sophisticated, miniature gaze-tracking devices to the heads of golfers, soccer players, basketball free throw shooters, tennis players and even competitive sharpshooters, they have found that a majority are not actually looking where they believe they are looking or for as long as they think.

It has been less clear, though, whether a slightly wandering gaze really matters that much to those of us who are decidedly recreational athletes.

Which is in part why the British researchers had half of their group of 40 duffers practice putting technique, while the other half received instruction in a gaze-focusing technique known as “Quiet Eye” training.

Quiet Eye training, as the name suggests, is an attempt to get people to stop flicking their focus around so much. But “Quiet Eye training is not just about looking at the ball,” says Mark Wilson, who led the study, published in Psychophysiology, and is a senior lecturer in human movement science at the University of Exeter in England. “It is about looking at the ball for long enough to process aiming information.” It involves reminding players to first briefly sight toward the exact spot where they wish to send the ball, and then settle their eyes onto the ball and hold them there.

This tight focus on the ball, Dr. Wilson says, blunts distracting mental chatter and allows the brain “to process the aiming information you just gathered” and direct the body in the proper motions to get the ball where you wish it to go.

A quiet, focused eye, in other words, seems to encourage a quiet, focused mind, which then makes for more accurate putting.

And in fact, after Dr. Wilson had his golfing volunteers practice for hours on either specific aspects of stroke technique or on focusing their gaze and not worrying about technique, those who had worked on their gaze were more accurate than those who had fine-tuned their technique. Those trained to focus also had lower heart rates and less muscle twitchiness, indicating less performance anxiety.

Similar results have been reported among soccer penalty kickers, who, like golfers, need to precisely place a ball but have the added distraction of a peripatetic, obstructive goalie. Many players tend to glance at the goalie as they prepare to shoot. Their eyes are not quiet, and their aim is affected.

But in a study published last year in the journal Cognitive Processing, collegiate players who were instructed to look briefly toward one of the upper, far corners of the goal and then immediately back to the ball, ignoring the goalie, significantly improved their shooting accuracy and reduced by 50 percent the number of times the goalie blocked their try, compared to teammates who didn’t quiet their gaze.

It did not seem to matter, says Greg Wood, also of the University of Exeter, who led the study, that kickers were glancing briefly toward where they planned to shoot, potentially telegraphing their intentions to the goalie. “An accurate shot kicked with typical speed will reach the goal in approximately 400 milliseconds, leaving the goalie with insufficient processing and response time,” he says. Players needn’t disguise intent if their aim is true.

Of course, merely keeping your eye on the ball won’t induce it to roll or rise to the desired location if you employ miserable technique. No amount of laser-eyed focus will get one of my putts to land. But what is interesting about Quiet Eye-style training, Dr. Wilson says, is that it can allow recreational and novice athletes with rudimentary skills to progress rapidly.

Specifically, Dr. Wilson says, after having extensively studied just how the best golfers look, he now teaches novice golfers at his lab to “keep their gaze on the back of the ball, which is the contact point for the putter, for a brief period before starting the putting action” — long enough to, for instance, “say ‘back of the cup’ to themselves,” he says. The golfers are told to hold that position throughout the putting stroke and, he says, “importantly, after contact for a split second. I often ask golfers to rate the quality of their contact on the ball from 1 to 10, before they look up to see where the ball went.”

Inexperienced putters who followed these instructions improved much more rapidly, he says, than those who merely practiced putts repeatedly.

“It seems so obvious,” Dr. Wilson says. “It is almost too simple. People assume that they are doing all of this already. ‘You mean I should look at the ball?’ Duh!”

But, he concludes, “the fact is that many people do not look at the right place at the right time.”

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Union walkout cripples ports of Los Angeles and Long Beach

A small union of maritime clerks managed to shut down most of the nation's busiest seaport complex Wednesday, raising concerns about harm to the fragile economy.

Although late November is a relatively slow time for cargo movement at the ports of Los Angeles and Long Beach, a prolonged closure could prove costly for retailers and manufacturers who rely on the ports to get their goods as well as truckers and other businesses that depend on the docks for work.

"You are stranding goods at ports that handle 40% of the nation's import trade," said Jock O'Connell, an international trade economist who works as an advisor to Beacon Economics.

"The danger here is that this could call into question the reliability of the San Pedro Harbor ports," O'Connell said. "The Wal-Marts and the Home Depots may be forced to think twice about relying on these ports as their primary gateway."

Showing an influence that extended far beyond its numbers, the 800-member International Longshore and Warehouse Union Local 63's Office Clerical Unit established picket lines at seven of the eight terminals at the Port of Los Angeles, which is the largest container port in the U.S.

The union, whose members handle most of the paperwork for ships entering and leaving the ports, also struck three of the six terminals at the neighboring Port of Long Beach, which ranks second only to Los Angeles in the amount of container cargo it moves.

The union's picket lines had at least the tacit approval of the larger, 50,000-member ILWU of dockworkers, clerks and other workers who handle all of the cargo on the west coasts of the U.S. and Canada and in Hawaii.

About 10,000 of those dockworkers are employed at the Los Angeles and Long Beach ports, and they refused to cross the lightly manned picket lines. That left the normally bustling harbor eerily quiet for a Wednesday afternoon.

On Tuesday, with the walkout confined to the APM Terminals at the Port of Los Angeles, an arbitrator ruled that the picket lines were invalid because the union was not bargaining in good faith. The arbitrator ordered union members to return to work Tuesday night, but they refused. Union members have been working without a contract since June 30, 2010.

At the entrance to Long Beach's Total Terminals International, six members of the clerical workers union held signs that said, "On Strike ... For hours, wages & working conditions." Workers on that picket line and six others said they were under strict orders not to talk to the news media.

Officially, the union fell back on a statement released Tuesday evening and had no further comment Wednesday.

In that statement, logistics clerk Trinie Thompson said the workers were "drawing the line against corporate greed and outsourcing that's destroying the good-paying jobs that support working families in our community." The union's primary concern is that its jobs could be transferred to nonunion labor in countries with lower wages.

But the 14 employers involved in the contract negotiations — some of the largest ocean shipping lines and terminal operators in the world — said they hadn't outsourced any jobs. The management group said it had offered "absolute job security" and generous wage and pension increases.

The employers have accused the union of engaging in the practice of "feather bedding," requiring employers to call in temporary employees and hire new permanent employees even when there is no work to perform.

On Wednesday, the management group said the union's conduct "shows an irresponsible willingness to jeopardize port operations and thousands of jobs in the Los Angeles area." If a strike drags on, "the negative effects on jobs and the economy will be felt nationwide," the employers said.

The dispute was raising concerns far beyond the harbor area.

"A work stoppage at America's two busiest ports just as the holiday shopping season begins is a recipe for disaster," said Sandy Kennedy, president of the Retail Industry Leaders Assn., a trade group. "If the strike isn't resolved quickly, the effects on retailers, their customers and the economy will be enormous."

A 10-day lockout in 2002 at all West Coast ports left ships piling up offshore, unable to unload cargo. The cost of the dispute was estimated as high as $15 billion.

California Sens. Barbara Boxer and Dianne Feinstein issued a statement urging a quick resolution of the dispute "so we can protect the economy of the Los Angeles region, the West Coast and our nation, which will be adversely affected by the closures at these ports."

Rep. Janice Hahn (D-San Pedro) said she was backing the port workers.

"I stand in solidarity with the hard-working clerical workers, most of whom are women, of the ILWU Local 63's Office Clerical Unit, who are striking today to prevent their jobs from being sent overseas," Hahn said in a statement. "These workers have been bargaining in good faith for over two years, and I urge a fair resolution that keeps these good-paying jobs" at the ports of Los Angeles and Long Beach.

ron.white@latimes.com

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Regents OK raise for new UC Berkeley chief

Despite strong opposition from Gov. Jerry Brown, the UC Board of Regents on Tuesday gave the incoming chancellor of UC Berkeley a $50,000 — or 11.4% — pay raise over the current campus head. The extra money will come from private donations, not state funds, the regents said.

Nicholas B. Dirks will be paid $486,000, which officials said is $14,000 less than his current salary as a high-ranking administrator at Columbia University.

Brown, who is a regent, described Dirks as an excellent choice but said he would not vote for the salary given the austerities that the state and the 10-campus UC system still face. The university must look for more efficient ways to teach and operate and "the leaders have to demonstrate that they are also sacrificing," Brown said.

The $50,000 increase, even though it won't come from public coffers, "does not fit within the spirit of servant leadership that I think will be required over the next few years," the governor said.

Brown also cited voters' recent approval of his Proposition 30 tax increase, which spared UC from deep budget cuts. During the campaign for the measure, the governor said, he promised voters that he would "use their funds judiciously and with prudence."

Brown, who rarely attended regents meetings before the election, has since become a dramatic presence and voice against UC status quo. Since last summer, he has criticized raises for Cal State executives and suggested that all public colleges promote less expensive insiders instead of shopping for high-priced "hired guns" from across the country.

Besides noting that Dirks will take a pay cut from being Columbia's executive vice president and dean of its arts and sciences faculty, UC leaders said his UC Berkeley salary will be much lower than that of leaders at many other prestigious public and private universities.

"I try to get the very best person I can in this job to navigate the university through some very complicated times," UC system President Mark G. Yudof said.

Yudof said he and Brown do not see "exactly eye to eye" on Dirks' pay, but Yudof said he and the governor agree on nearly all other issues, including efforts to keep tuition from rising.

The regents first debated the issue privately Tuesday in a telephone conference call linking those in Oakland, Sacramento and Los Angeles. After the call went public, three regents voted against the pay increase — Brown, Lt. Gov. Gavin Newsom and Charlene Zettel — and 11 others voted for it. All 14 voted to appoint Dirks.

State Sen. Leland Yee (D-San Francisco), a frequent UC critic, issued a statement suggesting that Dirks follow the example of Timothy P. White, who recently asked for a 10% pay cut from the salary paid his Cal State predecessor. Yee said he would reintroduce legislation to limit executive pay raises in public higher education.

When he starts at the 36,000-student UC Berkeley on June 1, Dirks will receive free campus housing, along with $121,700 in relocation fees paid out in installments over four years and other benefits.

An anthropologist and historian who is an expert on India and its British colonial era, he will succeed Robert J. Birgeneau, who has been Berkeley chancellor for eight years. Dirks' wife, Columbia history professor Janaki Bakhle, is expected to receive a faculty job at UC Berkeley, but officials said her hiring and any possible salary must be reviewed by faculty panels.

After his confirmation, Dirks, who is the son of a former UC Santa Cruz administrator, said he was grateful to lead "one of the greatest universities in the world" and said he would work to boost student financial aid and encourage interdisciplinary research and studies.

He thanked Brown and California voters for passing Proposition 30, which raises the state sales tax a quarter-cent over four years and the income tax on high earners over seven years. Dirks, 61, promised that he would carefully "steward the tax dollars that are being paid by the citizens of this great state."

The regents unanimously approved an annual $245,600 salary and housing for Jane Close Conoley, who will become acting chancellor at UC Riverside next month until a permanent one is hired. That salary is below the $325,000 pay of the current Riverside campus chief, White, who is leaving to become chancellor of the Cal State system. Conoley is now dean of UC Santa Barbara's Gervitz Graduate School of Education.

larry.gordon@latimes.com

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'Dancing With the Stars: All Stars' champ crowned

LOS ANGELES (AP) — She was dissed on "The Bachelor" and came in third place during her first stint on "Dancing With the Stars," but Melissa Rycroft is now a winner.

The reality TV star and her professional dance partner, Tony Dovolani, were named the champions Tuesday on ABC's "Dancing With the Stars: All Stars."

The pair beat out fellow finalists (and former champs) actress Kelly Monaco and Olympian Shawn Johnson to claim the sparkly mirror-ball trophy.

Fellow contestants on the show's first "all-star" season hoisted the new winners into the air as confetti rained down inside the "Dancing With the Stars" ballroom.

On the eve of the final competition, Rycroft said she felt confident and excited.

"I want to feel like a champion," she said.

Tuesday's two-hour season finale featured performances by the three finalists and each of the returning cast members: actors Pamela Anderson, Sabrina Bryan, Kirstie Alley and Gilles Marini; singers Joey Fatone and Drew Lachey; race car driver Helio Castroneves; reality TV star Bristol Palin; Olympic skater Apolo Anton Ohno; and football star Emmitt Smith.

Six of those contestants — Johnson, Monaco, Lachey, Ohno, Smith and Castroneves — were previous "Dancing" winners.

Rycroft and Dovolani came into the final contest with a pair of perfect scores. Those points were combined with viewer votes and a last set of judges' scores for an "instant dance" for which they had less than an hour to prepare.

Rycroft was a contestant on "The Bachelor" in 2009 and first appeared on "Dancing With the Stars" that same year. The 29-year-old also starred in a reality series earlier this year, "Melissa & Tye," about her marriage to Tye Strickland and their move to Hollywood so she could pursue an entertainment career.

___

Online:

http://beta.abc.go.com/shows/dancing-with-the-stars/index

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Personal Health: Aiding the Doctor Who Feels Cancer's Toll

The woman was terminally ill with advanced cancer, and the oncologist who had been treating her for three years thought the next step might be to deliver chemotherapy directly to her brain. It was a risky treatment that he knew would not, could not, help her.

When Dr. Diane E. Meier asked what he thought the futile therapy would accomplish, the oncologist replied, “I don’t want Judy to think I’m abandoning her.”

In a recent interview, Dr. Meier said, “Most physicians have no other strategies, no other arrows in their quiver beyond administering tests and treatments.”

“To avoid feeling that they’ve abandoned their patients, doctors throw procedures at them,” she said.

Dr. Meier, a renowned expert on palliative care at Mount Sinai Medical Center in New York, was the keynote speaker this month at the Buddhist Contemplative Care Symposium, organized by the New York Zen Center for Contemplative Care and the Garrison Institute. She described contemplative care as “the discipline of being present, of listening before acting.”

“Counter to how the American medical system is structured, which pays for what gets done,” she said, “its approach is, ‘Don’t just do something, stand there.’ ”

But the idea is not to do just that. Rather, she said, the goal is to “restore the patient to the center of the enterprise.”

Under the Affordable Care Act, she said, unnecessary procedures may decline as more doctors are reimbursed for doing what is best for their patients over time, not just for administering tests and treatments. But more could be done if physicians were able to step away from the misperception that everything that can be done should be done.

Dr. Meier’s question prompted Judy’s oncologist to realize that what his patient needed most at the end of her life was not more chemotherapy, but for him to sit down with her, to promise to do his best to keep her comfortable and to be there for the rest of her days.

Occupational Distress

Patients and families may not realize it, but doctors who care for people with incurable illness, and especially the terminally ill, often suffer with their patients. Unable to cope with their own feelings of frustration, failure and helplessness, doctors may react with anger, abruptness and avoidance.

Visits may be reduced to a quick review of the medical chart, and phone calls may not be returned. Even though their doctors are still there, incurably ill patients may feel neglected and depressed, which can exacerbate illness and pain and even hasten death. Dr. Michael K. Kearney, a palliative care physician at Santa Barbara Cottage Hospital, told the Contemplative Care conference that doctors, especially those who care for terminally ill patients, are subject to two serious forms of occupational stress: burnout and compassion fatigue.

He described burnout as “the end stage of stresses between the individual and the work environment” that can result in emotional and physical exhaustion, a sense of detachment and a feeling of never being able to achieve one’s professional goals.

He likened compassion fatigue to “secondary post-traumatic stress disorder, or vicarious traumatization — trauma suffered when someone close to you is suffering.”

A doctor with compassion fatigue may avoid thoughts and feelings associated with a patient’s misery, become irritable and easily angered, and face physical and emotional distress when reminded of work with the dying. Compassion fatigue can lead to burnout.

In one study of 18 oncologists, published in 2008 in The Journal of Palliative Medicine, those who saw their role as both biomedical and psychosocial found end-of-life care very satisfying. But those “who described a primarily biomedical role reported a more distant relationship with the patient, a sense of failure at not being able to alter the course of the disease and an absence of collegial support,” the authors noted.

Healing the Healer

For doctors at risk of becoming overwhelmed by the stresses of their jobs, Dr. Kearney recommends adopting the time-honored Buddhist practice of “mindfulness meditation,” which involves cultivating mental techniques for stress reduction that are native to all of us but practiced by too few. He likened meditation to “learning to breathe underwater, or finding sources of renewal within work itself.”

To achieve it, a person sits quietly, paying attention to one’s breathing and whenever a distracting thought intrudes, turning one’s attention back to the sensation of breathing. This can help calm the mind and prepare it for a clearer perspective.

Dr. Kearney said this practice could help doctors “really pay attention and be tuned into their patients and what the patients are experiencing.”

“Patients, in turn,” he said, “experience a doctor who’s not just focused on a medical agenda but who really listens to them.”

He said mindfulness meditation helps doctors become more self-aware, empathetic and patient-focused, and to make fewer medical errors. It enables doctors to notice what is going on within themselves and to consider rational options instead of just reacting.

“It’s like pressing an internal pause button,” Dr. Kearney said. “The doctor is able to recognize he’s being stressed, and it prevents him from invoking the survival defense mechanisms of fight (‘Let’s do another course of chemotherapy’), flight (‘There’s nothing more I can do for you — I’ll go get the chaplain’) and freeze (the doctor goes blank and does nothing).” Such reactions can be highly distressing to a dying patient.

When a patient asks for the impossible, like “Promise me I’m not going to die,” the mindful doctor is more likely to step back and say, “I can promise you I’ll do everything I can to help you. I’m going to continue to care for you and support you as best as I can. I’ll be back to see you later today and again tomorrow,” Dr. Kearney said.

Although Dr. Kearney does mindfulness meditation for 30 minutes every morning, he said as little as 8 to 10 minutes a day has been shown helpful to practicing physicians.

In addition, doctors can factor moments of meditation into the course of the workday — say, while washing their hands, having a snack or coffee or pausing before entering the next patient room to focus on breathing.

To deal with the emotional flood that can come after a traumatic event, he suggested taking a brief timeout or calling on a friend or colleague to go for a walk.

This is the second of two columns about communication and cancer. Read the first: “When Treating Cancer Is Not an Option”

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UCLA Medical Center gets failing grade on patient safety

A national report card on patient safety gave a failing grade to Ronald Reagan UCLA Medical Center, one of the country's most prestigious hospitals and one of only 25 nationwide to receive such low marks.

In a report issued Wednesday, the Leapfrog Group, an employer-backed nonprofit group focused on healthcare quality, gave a letter grade of F to UCLA Medical Center for performing poorly on several measures tied to preventing medical errors, patient infections and deaths.

Leapfrog withheld a failing grade for UCLA in June when it released its first-ever hospital safety scores to give low-performing hospitals time to show improvement.

Officials at UCLA disputed the failing grade and they said one patient death in 2010 unfairly lowered its grade from a C to an F under Leapfrog's methodology.

"UCLA is not an F hospital in quality and safety," said Tom Rosenthal, chief medical officer at Ronald Reagan UCLA Medical Center. "It is not a fair scoring system and it does a disservice to the public."

This debate over UCLA's score comes amid a proliferation of healthcare ratings by outside organizations trying to provide more information to consumers and employers. These scores are also taking on greater importance as some insurers and employers use them as one factor in determining whether a hospital or doctor should be included in a provider network.

Given those stakes, the California Hospital Assn. has called on Leapfrog and other rating organizations to offer more details on how their scores are tabulated and to focus on reliable measures that can assess patient care. Some highly regarded hospitals across the country, such as UCLA, fare well in one ranking and then poorly in the next.

Leapfrog gave an F to one other area hospital, Western Medical Center Anaheim. The hospital said it disagreed with Leapfrog's rating methods and added that it "continuously adds new systems to enhance our patient care."

Cedars-Sinai Medical Center received an A in Leapfrog's June report, but its grade dropped to a C on this latest review, which included more recent data from last year. Thirty Kaiser Permanente hospitals received an A and one got a B from Leapfrog.

Experts urge consumers to use these score cards as one tool in evaluating a hospital and to discuss any specific concerns with their doctor and other medical providers.

Leapfrog estimates that 180,000 Americans die annually from hospital accidents, errors and infections, and it says hospitals need to do more to protect patients from harm. Its hospital safety score is derived from 26 measures of publicly reported data.

Rosenthal said UCLA scores well on healthcare quality and patient outcomes on numerous measures tracked by the federal government and other rating organizations, suggesting that Leapfrog's methods are potentially flawed.

He said a liver transplant patient died during surgery in 2010 from an air embolism, one of several preventable medical errors that Leapfrog and other groups regularly track. Rosenthal said the patient's death was a regrettable mistake, but that error hasn't occurred since then.

Leah Binder, Leapfrog's president and chief executive, said her group's scoring methods are statistically valid and devised by a panel of leading experts in patient safety. She said UCLA scored poorly in several areas of patient care, such as foreign objects left in a patient during surgery and pressure ulcers.

"It isn't just one incident that gave them a score so far below the national average," Binder said. "We see it all the time that a hospital might have a stellar reputation, but behind the scenes they aren't safe for many of their patients."

On pressure ulcers, Rosenthal said, UCLA looked worse than its actual performance because of over-reporting in the hospital billing data that was reviewed by Leapfrog.

Overall, Leapfrog gave an A or B to 1,468 hospitals, or 56% of the 2,618 reviewed nationwide. The group issued a C to 1,004 hospitals, or 38%. At the bottom, 146 hospitals, or 6%, were labeled D or F.

Leapfrog reviewed 246 hospitals in California. The ratings are available online at http://www.hospitalsafetyscore.org.

chad.terhune@latimes.com

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Egypt president meets judges, fails to 'contain crisis'

CAIRO — President Mohamed Morsi suggested Monday that he would scale back broad powers he assumed last week but failed to appease Egypt's judiciary, which would still lack oversight of some institutions including the Islamist-led assembly drafting a new constitution.

Morsi and senior judges met for nearly five hours to discuss differences resulting from the president's declaration that his office was free from judicial review. Morsi told judges that the decree was meant to be temporary, and mainly aimed at shielding the long-troubled constitutional assembly from any judicial attempt to disband it.

Presidential spokesman Yasser Ali said after the meeting that Morsi's decree was not designed to "infringe" on the judiciary, suggesting not all of the president's actions would be immune from court review. The Supreme Judicial Council on Saturday condemned Morsi's expanded powers as an "unprecedented attack" on the courts. And Monday's talks did not seem to soften the sentiment of some council members.

"Our meeting with the president has failed to contain the crisis," Abdelrahman Bahloul, a member of the judicial council, told the newspaper Al Masry al Youm. "The statement issued by the presidency is frail and does not represent the members of the council."

The Judges Club, a separate legal organization, also was not satisfied that Morsi had scaled back enough of his authority. It called on its members to continue a partial strike in Alexandria and other cities. Ziad Akl, a political analyst, said Morsi's negotiations with the judges were a move to show the public he's not a dictator, "but, in reality, his declaration has not changed."

The talks in the presidential palace did not stop anti-Morsi demonstrations in Tahrir Square on Monday. But in a sign tensions may be easing, the Muslim Brotherhood, which Morsi helped lead until his inauguration in June, announced it was canceling a scheduled demonstration Tuesday to avoid bloodshed and possible clashes with Morsi opponents.

The consequences of the nation's restiveness played out as Morsi and the judges met Monday, with mourners turning out to bury two boys from opposite political sides who were killed in recent clashes: a 16-year-old antigovernment protester reportedly shot with a rubber bullet near Tahrir Square and a 15-year-old struck by a stone when a crowd attacked an office of the Brotherhood's Freedom and Justice Party in the Nile Delta.

"The presidency mourns two of the nation's finest young men," Morsi said in a statement.

But the images of two funerals made it clear that Morsi and the Brotherhood, although still Egypt's dominant political forces, miscalculated the depth of public anger that has bristled since last year's overthrow of longtime autocrat Hosni Mubarak and subsequent government setbacks, including judicial action disbanding the Islamist-led parliament.

Last month, Morsi, who for months has held wide executive and legislative powers, attempted to fire Prosecutor-General Abdel Meguid Mahmoud, only to retreat after a backlash from judges. His most recent decree to hold his office above judicial oversight struck many as another ill-conceived bid to consolidate his authority and advance an Islamist agenda.

Morsi contended that his intent was to prevent Mubarak-era judges from disrupting the country's political transition. Many Egyptians, including opposition figures, are suspicious of the courts, Mahmoud in particular. But Morsi's unilateral decree echoed the strongman tactics of his predecessor.

One of the president's biggest challenges is to protect the assembly drafting the constitution, which will open the way for new parliamentary elections. In June, the Supreme Constitutional Court, made up mostly of Mubarak-appointed judges, dissolved parliament. The court has since been deciding the fate of the Islamist-led assembly, which Morsi feared would also be disbanded.

Activists, liberals, women and non-Muslims have boycotted the assembly, saying that it is too focused on sharia, or Islamic law, which could limit civil rights. Protesters in Tahrir Square said they will continue their demonstrations until Morsi retracts more of his power.

Jaber Nassar, a legal expert quoted on state TV, said Morsi's meeting with the judges showed that he remains adamant on keeping broad authority. He called Morsi's announcement Monday "simply a political statement meant to curb protests against" his decree.

jeffrey.fleishman@latimes.com

Abdellatif is a special correspondent.

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