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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Ricky Martin finds new home on small screen

NEW YORK (AP) — Ricky Martin is saying goodbye to Broadway's "Evita." But don't cry for him.

The Latin superstar has a slew of new projects in the works, including two television series and a children's book.

"It's about growing," said Martin in an interview Friday. "It's a moment in my life where I just need to absorb and be surrounded by amazing actors and musicians and grow as an entertainer. I think this is going to be an amazing year for that."

Martin takes his final bow in the Andrew Lloyd Webber revival on Jan. 26. Then he heads down under to join the second season of the Australian edition of "The Voice." But the Grammy winner says not to expect any biting, Simon Cowellesque critiques.

"I don't believe in tough love. I believe in love, and I believe in being nurturing to new talented men and women," he said at an M.A.C. Viva Glam event for Saturday's World AIDS Day. Martin partnered with the cosmetics brand to raise awareness and funding for HIV/AIDS programs worldwide.

The "Livin' la Vida Loca" singer is developing a new series for NBC, expected in 2013. He's producing, writing and will star in the currently untitled dramedy, where he hopes to tackle social issues with humor.

He's also writing his second book and admitted he didn't have to look far for inspiration.

"I think it's time to write about things that I've been through with my kids that I'm sure many daddys out there will understand," said the father of 4-year-old twins Matteo and Valentino.

The family-friendly story about self-esteem is slated for release next summer.

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AP writer Sigal Ratner-Arias contributed to this story.

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Follow Nicole Evatt on Twitter at http://twitter.com/NicoleEvatt

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Opinion: A Health Insurance Detective Story

I’VE had a long career as a business journalist, beginning at Forbes and including eight years as the editor of Money, a personal finance magazine. But I’ve never faced a more confounding reporting challenge than the one I’m engaged in now: What will I pay next year for the pill that controls my blood cancer?

After making more than 70 phone calls to 16 organizations over the past few weeks, I’m still not totally sure what I will owe for my Revlimid, a derivative of thalidomide that is keeping my multiple myeloma in check. The drug is extremely expensive — about $11,000 retail for a four-week supply, $132,000 a year, $524 a pill. Time Warner, my former employer, has covered me for years under its Supplementary Medicare Program, a plan for retirees that included a special Writers Guild benefit capping my out-of-pocket prescription costs at $1,000 a year. That out-of-pocket limit is scheduled to expire on Jan. 1. So what will my Revlimid cost me next year?

The answers I got ranged from $20 a month to $17,000 a year. One of the first people I phoned said that no matter what I heard, I wouldn’t know the cost until I filed a claim in January. Seventy phone calls later, that may still be the most reliable thing anyone has told me.

Like around 47 million other Medicare beneficiaries, I have until this Friday, Dec. 7, when open enrollment ends, to choose my 2013 Medicare coverage, either through traditional Medicare or a private insurer, as well as my drug coverage — or I will risk all sorts of complications and potential late penalties.

But if a seasoned personal-finance journalist can’t get a straight answer to a simple question, what chance do most people have of picking the right health insurance option?

A study published in the journal Health Affairs in October estimated that a mere 5.2 percent of Medicare Part D beneficiaries chose the cheapest coverage that met their needs. All in all, consumers appear to be wasting roughly $11 billion a year on their Part D coverage, partly, I think, because they don’t get reliable answers to straightforward questions.

Here’s a snapshot of my surreal experience:

NOV. 7 A packet from Time Warner informs me that the company’s new 2013 Retiree Health Care Plan has “no out-of-pocket limit on your expenses.” But Erin, the person who answers at the company’s Benefits Service Center, tells me that the new plan will have “no practical effect” on me. What about the $1,000-a-year cap on drug costs? Is that really being eliminated? “Yes,” she says, “there’s no limit on out-of-pocket expenses in 2013.” I tell her I think that could have a major effect on me.

Next I talk to David at CVS/Caremark, Time Warner’s new drug insurance provider. He thinks my out-of-pocket cost for Revlimid next year will be $6,900. He says, “I know I’m scaring you.”

I call back Erin at Time Warner. She mentions something about $10,000 and says she’ll get an estimate for me in two business days.

NOV. 8 I phone Medicare. Jay says that if I switch to Medicare’s Part D prescription coverage, with a new provider, Revlimid’s cost will drive me into Medicare’s “catastrophic coverage.” I’d pay $2,819 the first month, and 5 percent of the cost of the drug thereafter — $563 a month or maybe $561. Anyway, roughly $9,000 for the year. Jay says AARP’s Part D plan may be a good option.

NOV. 9 Erin at Time Warner tells me that the company’s policy bundles United Healthcare medical coverage with CVS/Caremark’s drug coverage. I can’t accept the medical plan and cherry-pick prescription coverage elsewhere. It’s take it or leave it. Then she puts CVS’s Michele on the line to get me a Revlimid quote. Michele says Time Warner hasn’t transferred my insurance information. She can’t give me a quote without it. Erin says she will not call me with an update. I’ll have to call her.

My oncologist’s assistant steers me to Celgene, Revlimid’s manufacturer. Jennifer in “patient support” says premium assistance grants can cut the cost of Revlimid to $20 or $30 a month. She says, “You’re going to be O.K.” If my income is low enough to qualify for assistance.

NOV. 12 I try CVS again. Christine says my insurance records still have not been transferred, but she thinks my Revlimid might cost $17,000 a year.

Adriana at Medicare warns me that AARP and other Part D providers will require “prior authorization” to cover my Revlimid, so it’s probably best to stick with Time Warner no matter what the cost.

But Brooke at AARP insists that I don’t need prior authorization for my Revlimid, and so does her supervisor Brian — until he spots a footnote. Then he assures me that it will be easy to get prior authorization. All I need is a doctor’s note. My out-of-pocket cost for 2013: roughly $7,000.

NOV. 13 Linda at CVS says her company still doesn’t have my file, but from what she can see about Time Warner’s insurance plans my cost will be $60 a month — $720 for the year.

CVS assigns my case to Rebecca. She says she’s “sure all will be fine.” Well, “pretty sure.” She’s excited. She’s been with the company only a few months. This will be her first quote.

NOV. 14 Giddens at Time Warner puts in an “emergency update request” to get my files transferred to CVS.

Frank Lalli is an editorial consultant on retirement issues and a former senior executive editor at Time Warner’s Time Inc.

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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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Student scores may be used in LAUSD teacher ratings

After months of tense negotiations, leaders of the Los Angeles Unified School District and its teachers union have tentatively agreed to use student test scores to evaluate instructors for the first time, officials announced Friday.

Under the breakthrough agreement, the nation's second-largest school district would join Chicago and a growing number of other cities in using test scores as one measure of how much teachers help their students progress academically in a year.

Alarm over low student performance, especially in impoverished and minority communities, has prompted the Obama administration and others to press school districts nationwide to craft better ways to identify struggling teachers for improvement.

The Los Angeles pact proposes to do that using a unique mix of individual and schoolwide testing data — including state standardized test scores, high school exit exams and district assessments, along with rates of attendance, graduation and suspensions.

But the tentative agreement leaves unanswered the most controversial question: how much to count student test scores in measuring teacher effectiveness. The school district and the union agreed only that the test scores would not be "sole, primary or controlling factors" in a teacher's final evaluation.

"It is crystal clear that what we're doing is historic and very positive," said L.A. Supt. John Deasy, who has fought to use student test scores in teacher performance reviews since taking the district's helm nearly two years ago. "This will help develop the skills of the teaching profession and hold us accountable for student achievement."

Members of United Teachers Los Angeles, however, still need to ratify the agreement. Many teachers have long opposed using test scores in their evaluations, saying test scores are unreliable measures of teacher ability.

The union characterized the agreement as a "limited" response to a Dec. 4 court-ordered deadline to show that test scores are being used in evaluations and said negotiations were continuing for future academic years. The deadline was imposed by Los Angeles County Superior Court Judge James C. Chalfant, who ruled this year that state law requires L.A. Unified to use test scores in teacher performance reviews.

In a statement, the teachers union also emphasized that the agreement rejected the use of the district's method of measuring student academic progress for individual instructors. That measure, called Academic Growth Over Time, uses a mathematical formula to estimate how much a teacher helps students' performance, based on state test scores and controlling for such outside factors as income and race. Under the agreement, however, schoolwide scores using this method, also known as a value-added system, will be used.

For individual teachers, the agreement proposes to use raw state standardized test score data. Warren Fletcher, teachers union president, said that data give teachers more useful information about student performance on specific skills.

Critics of using test scores in teacher reviews praised Los Angeles' proposed new system, saying it uses a wide array of data to determine a teacher's effect on student learning.

Deasy said he will be developing guidelines for administrators on how to use the mix of data in teacher reviews and has said in the past that test scores should not count for more than 25% of the final rating.

"This is a complex agreement and possibly the most sophisticated evaluation agreement that I have seen," said Diane Ravitch, an educational historian and vocal critic of the use of test scores in teacher evaluations. "It assures that test scores will not be overused, will not be assigned an arbitrary and inappropriate weight, will not be the sole or primary determinant of a teacher's evaluation."

Teacher Brent Smiley at Lawrence Middle School in Chatsworth said: "I will vote yes. I have no doubt that my union leaders negotiated the best they could, given the adverse set of circumstances they faced."

Labor-relations expert Charles Kerchner called the agreement "a shotgun wedding," but added, "I think it's unabashed good news."

He said it's notable that value-added measures and test scores have been accepted in some form by the teachers union.

"UTLA has moved beyond a strategy of just saying no to a strategy of trying to craft a useful agreement," said Kerchner, a professor at Claremont Graduate University.

The district is currently developing a new evaluation system that uses Academic Growth Over Time — along with a more rigorous classroom observation process, student and parent feedback and a teacher's contributions to the school community. The new observations were tested last year on a voluntary basis with about 450 teachers and 320 administrators; this year, every principal and one volunteer teacher at each of the district's 1,200 schools are expected to be trained.

The teachers union has filed an unfair labor charge against the district, arguing that the system is being unilaterally imposed without required negotiations.

Some teachers who have participated in the new observation process say it offers more specific guidance on how they can improve. Other educators — teachers and administrators alike — complain that it is too time-consuming.

The tentative agreement, acknowledging the extra time the new evaluations would take, would extend the time between evaluations from two to as long as five years for teachers with 10 or more years of experience.

Bill Lucia of EdVoice, the Sacramento-based educational advocacy group that brought the lawsuit, said he was "cautiously optimistic."

But he expressed dismay that the union did not reach agreement a few weeks earlier, which he said would have given L.A. Unified a shot at a $40-million federal grant. The district applied for the Race to the Top grant without the required teacher union support and was eliminated from the competition this week.

Negotiations over the tentative pact, however, nearly fell apart. Earlier this week, the union pulled away from the deal on the table, L.A. Unified officials said. And the district discussed holding a Monday emergency school-board meeting to craft a formal response to the court order in anticipation that no deal would be reached. The options included adopting an evaluation system without the union's consent.

Some members of the Board of Education, who also will need to approve the pact, praised the agreement for taking student growth and achievement into account but gauging this growth through multiple measures. Steve Zimmer said that, just as important, this milestone was achieved through negotiation.

School board President Monica Garcia praised the tentative deal as "absolutely, by all accounts, better than what we have today."

teresa.watanabe@latimes.com

howard.blume@latimes.com

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Zynga shares slide after privileged status with Facebook ends

(Reuters) – Shares of gaming company Zynga Inc fell as much as 10 percent, a day after the “Farmville” creator reached an agreement with Facebook Inc that reduces its dependence on the social networking giant.

The companies reported in regulatory filings on Thursday that they have reached an agreement to amend a 2010 deal that was widely seen as giving Zynga privileged status on the world’s No.1 social network.

Zynga gets a freer hand to operate a standalone gaming website, but gives up its ability to promote its site on Facebook and to draw from the thriving social network of about 1 billion users.

“Although Zynga investors have reacted negatively to Thursday’s announcements so far, we view them as a long-term positive for both companies,” Wedbush Securities analyst Michael Pachter said in a note to clients.

“Zynga now has an advantage to offer more payment options which could result in additional subscribers who are not Facebook users,” he said, maintaining his “outperform” rating and price target of $ 4 on the stock.

Both internet companies have been trying to reduce their interdependence, with Zynga starting up its own Zynga.com platform, and Facebook wooing other games developers.

In recent quarters, fees from Zynga contributed 15 percent of Facebook’s revenue, while Zynga relies on Facebook for roughly 80 percent of its revenue.

Francisco-based Zynga’s shares were down 7 percent at $ 2.44 in morning trading on the New York Stock Exchange on Friday.

Facebook shares were down more than 1 percent at $ 26.98.

(Reporting By Aurindom Mukherjee in Bangalore; Editing by Don Sebastian)

Tech News Headlines – Yahoo! News

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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.

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Online:

http://glencampbellmusic.com

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First marine wilderness in continental U.S. is designated

The federal government cleared the way Thursday for waters off the Northern California coast to become the first marine wilderness in the continental United States, ending a contentious political battle that pitted a powerful U.S. senator against the National Park Service.

Interior Secretary Ken Salazar settled the dispute by refusing to extend a permit for a commercial oyster farm operating in Point Reyes National Seashore. Congress designated the area as potential wilderness in 1976 but put that on hold until the farm's 40-year federal permit ended.

As the expiration date approached, the farm became the center of a costly and acrimonious fight that dragged on more than four years, spawned federal investigations and cost taxpayers millions of dollars to underwrite scores of scientific reviews.

"I believe it is the right decision for Point Reyes National Seashore and for future generations who will enjoy this treasured landscape," Salazar said Thursday. The area includes Drakes Estero, an environmentally rich tidal region where explorer Sir Francis Drake is believed to have made landfall more than 400 years ago.

Salazar's decision drew a sharp response from Sen. Dianne Feinstein, who had championed the Drakes Bay Oyster Co. in its fight with the government. Feinstein said in a statement that she was "extremely disappointed" with Salazar's decision.

She had argued that the National Park Service contorted scientific studies to make the case that oyster harvesting operations caused environmental harm to Drakes Estero, a dramatic coastal sweep of five bays in Marin County north of San Francisco.

"The National Park Service's review process has been flawed from the beginning with false and misleading science," her statement said. "The secretary's decision effectively puts this historic California oyster farm out of business. As a result, the farm will be forced to cease operations and 30 Californians will lose their jobs."

Feinstein had attached a rider to an appropriations bill giving Salazar the unusual prerogative to extend the farm's permit. The company was seeking a 10-year extension of its lease.

Salazar said he gave the matter serious consideration, including taking into account legal advice and park policies. He directed the park service to develop a jobs-training plan for the oyster company's employees and to work with the local community to assist them in finding employment.

The company will have 90 days to remove its racks and other property from park land and waters. When that occurs, the 2,500-acre Drakes Estero will be managed as wilderness, with prohibitions on motorized access to the waterway but allowances for snorkeling, kayaking and other recreation.

The new wilderness will become only the second marine protected area in the national park system and the first in the Lower 48 states. The only current marine wilderness is 46,000 acres in Alaska's Glacier Bay National Park and Preserve.

Environmental groups applauded the decision, which they lobbied for.

"We are ecstatic that this ecological treasure will be forever protected as marine wilderness," said Amy Trainer, executive director of the Environmental Action Committee of West Marin.

The heart of the debate is an agreement that Kevin Lunny and his family inherited when they took over a failing oyster operation in the park in 2004. That lease with the park service stipulated that the business would cease operations in 2012.

Kevin Lunny has from the beginning sought to stay on the property and continue harvesting oysters. His farm has an extensive record of violating state and federal agreements and permits. The California Coastal Commission has fined the farm for various violations, issued two cease and desist orders and repeatedly requested that the Lunnys acquire a coastal development permit.

The state agency initiated another enforcement action against the farm earlier this month.

Lunny could not be reached for comment.

The farm's mariculture operation has found support among west Marin County's advocates for sustainable agriculture, who agreed with Lunny that federal and state agencies were unfairly hounding his operation.

His travails have caused alarm among the historic cattle and dairy ranches that operate within the national seashore in a designated pastoral zone. Park officials have repeatedly said they have no intention of curtailing ranching operations, and Salazar echoed that, adding that he wished to extend the terms of the ranch leases from 10 to 20 years.

The Lunny family also has a cattle operation in the park.

julie.cart@latimes.com

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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."

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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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Witness says victim of deputies' shooting did not pose threat

An 18-year-old woman who witnessed an officer-involved shooting of a Culver City man has told investigators that the victim was standing with his hands on his head when deputies shot and killed him.

Her account contradicts Los Angeles County deputies' statement that they fired only after Jose de la Trinidad, an unarmed 36-year-old father of two, seemed to reach for his waistband.

The witness told The Times she watched the Nov. 10 shooting — and the events that led up to it — from her bedroom window. She has been interviewed twice by sheriff's investigators, telling them that De la Trinidad complied with the deputies' orders to stop running and raised his hands to surrender. She contends that two deputies opened fire seconds later, seemingly without provocation.

"I know what I saw," said Estefani, who asked that her last name not be used out of fear of being harassed by media outlets. "His hands were on his head when they started shooting."

The Los Angeles County Sheriff's Department maintains that the deputies opened fire only after De la Trinidad appeared to reach for his waist, where he could have been concealing a weapon. Authorities did not comment on Estefani's account other than to say it would be included in the final report on the shooting.

Estefani, who lives directly across the street from where the shooting occurred, said that just after 10:20 p.m. Nov. 10, the sound of a car screeching to a stop jerked her attention away from music she was downloading at her small desk.

She turned to the bedroom window and pulled back her dark green curtains.

Then, she said, she saw an unarmed man, a handful of sheriff's deputies and, suddenly, the shooting that remains vivid in her mind.

Two sheriff's deputies had attempted to pull over De la Trinidad and his brother for speeding as they were leaving a family quinceañera. De la Trinidad's brother was driving the car and fled for a few blocks before the car came to a sudden stop in the 1900 block of East 122nd Street in Willowbrook, a residential neighborhood tucked just off the 105 Freeway.

According to the deputies' account, De la Trinidad jumped out of the passenger seat.

His brother, 39-year-old Francisco de la Trinidad, took off again in the car. One of the four deputies on the scene gave chase in his cruiser, leaving Jose de la Trinidad on the sidewalk and three deputies standing in the street with their weapons drawn.

The deputies said Jose de la Trinidad then appeared to reach for his waistband, prompting two of them to fire multiple shots into the unarmed man. He died at the scene.

Unknown to the deputies at the time, Estefani sat perched in her bedroom window, directly overlooking the shooting.

Estefani said De la Trinidad did jump out of the car after it came to a sudden stop. After he ran toward the deputies a few feet, they ordered him to stop and turn around — which he did immediately, she said.

Seconds later, the deputies opened fire, she said.

Estefani said that, frozen in shock, she did not count the number of shots fired by the deputies.

"As soon as I saw him hit the floor, I couldn't look up any longer," Estefani said. "Then I ran downstairs and started to cry."

She was still crying half an hour later when two sheriff's deputies canvassing the area for witnesses came to her door, Estefani said.

The deputies, she said, repeatedly asked her which direction De la Trinidad was facing, which she perceived as an attempt to get her to change her story.

"I told them, 'You're just trying to confuse me,' and then they stopped," she said.

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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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Well: Weight Loss Surgery May Not Combat Diabetes Long-Term

Weight loss surgery, which in recent years has been seen as an increasingly attractive option for treating Type 2 diabetes, may not be as effective against the disease as it was initially thought to be, according to a new report. The study found that many obese Type 2 diabetics who undergo gastric bypass surgery do not experience a remission of their disease, and of those that do, about a third redevelop diabetes within five years of their operation.

The findings contrast with the growing perception that surgery is essentially a cure for Type II diabetes. Earlier this year, two widely publicized studies reported that surgery worked better than drugs, diet and exercise in causing a remission of Type 2 diabetes in overweight people whose blood sugar was out of control, leading some experts to call for greater use of surgery in treating the disease. But the studies were small and relatively short, lasting under two years.

The latest study, published in the journal Obesity Surgery, tracked thousands of diabetics who had gastric bypass surgery for more than a decade. It found that many people whose diabetes at first went away were likely to have it return. While weight regain is a common problem among those who undergo bariatric surgery, regaining lost weight did not appear to be the cause of diabetes relapse. Instead, the study found that people whose diabetes was most severe or in its later stages when they had surgery were more likely to have a relapse, regardless of whether they regained weight.

“Some people are under the impression that you have surgery and you’re cured,” said Dr. Vivian Fonseca, the president for medicine and science for the American Diabetes Association, who was not involved in the study. “There have been a lot of claims about how wonderful surgery is for diabetes, and I think this offers a more realistic picture.”

The findings suggest that weight loss surgery may be most effective for treating diabetes in those whose disease is not very advanced. “What we’re learning is that not all diabetic patients do as well as others,” said Dr. David E. Arterburn, the lead author of the study and an associate investigator at the Group Health Research Institute in Seattle. “Those who are early in diabetes seem to do the best, which makes a case for potentially earlier intervention.”

One of the strengths of the new study was that it involved thousands of patients enrolled in three large health plans in California and Minnesota, allowing detailed tracking over many years. All told, 4,434 adult diabetics were followed between 1995 and 2008. All were obese, and all underwent Roux-en-Y operations, the most popular type of gastric bypass procedure.

After surgery, about 68 percent of patients experienced a complete remission of their diabetes. But within five years, 35 percent of those patients had it return. Taken together, that means that most of the subjects in the study, about 56 percent — a figure that includes those whose disease never remitted — had no long-lasting remission of diabetes after surgery.

The researchers found that three factors were particularly good predictors of who was likely to have a relapse of diabetes. If patients, before surgery, had a relatively long duration of diabetes, had poor control of their blood sugar, or were taking insulin, then they were least likely to benefit from gastric bypass. A patient’s weight, either before or after surgery, was not correlated with their likelihood of remission or relapse.

In Type 2 diabetes, the beta cells that produce insulin in the pancreas tend to wear out as the disease progresses, which may explain why some people benefit less from surgery. “If someone is too far advanced in their diabetes, where their pancreas is frankly toward the latter stages of being able to produce insulin, then even after losing a bunch of weight their body may not be able to produce enough insulin to control their blood sugar,” Dr. Arterburn said.

Nonetheless, he said it might be the case that obese diabetics, even those whose disease is advanced, can still benefit from gastric surgery, at least as far as their quality of life and their risk factors for heart disease and other complications are concerned.

“It’s not a surefire cure for everyone,” he said. “But almost universally, patients lose weight after weight loss surgery, and that in and of itself may have so many health benefits.”

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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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Most L.A. County youths held for prostitution come from foster care

A majority of juveniles arrested on prostitution charges in Los Angeles County come from the county's foster care system, and, in some cases, pimps use underage sex workers to recruit fellow group home residents, county officials said.

Until now, foster youth caught in the sex trade have largely been the responsibility of the county Probation Department.

The Los Angeles County Board of Supervisors voted Tuesday to launch a multiagency task force to address the ongoing issue of sex trafficking involving youth in the foster care system. The move was spurred in part by this month's passage of an anti-sex-trafficking ballot measure, which county officials said will shift much of the responsibility for juvenile prostitutes from the criminal justice system to the foster care system.

Of the 174 juveniles arrested on prostitution-related charges in Los Angeles County in 2010, 59% were in the foster care system, according to Probation Department statistics. The department has launched initiatives to address the issue of sex trafficking, including running prevention workshops in juvenile halls.

But underage sex workers may no longer fall under the Probation Department's jurisdiction.

Proposition 35, which imposes tougher penalties on pimps, also includes language that decriminalizes prostitution for minors caught up in the trade — although there is debate about the effects of that change. But officials fear that greater numbers of young people involved in prostitution will become the responsibility of the county Department of Children and Family Services. Department director Philip Browning said his agency is "really unprepared at this point" to handle such an influx.

Browning and others said the department is not empowered to keep children in group homes and other placements against their will, and can't prevent them from running away. Emilio I. Mendoza, a children services' program manager, said many young sex workers fear they will be punished by their pimps if they don't leave foster homes when they have an opportunity do so.

"These kids see themselves as having no way out unless they're in a secure setting," he said.

Probation camps and juvenile halls provide that security. But advocates say the criminal justice system is not the proper setting for young victims of abuse and coercion.

"They should not be treated as the criminal. They are a victim. The pimps should be treated as the criminal and given long prison sentences," said county Supervisor Michael D. Antonovich, who proposed the task force. Antonovich said during Tuesday's meeting that the trafficking issue came to the county board's attention early this year, when they learned that young girls were serving as prostitutes around Staples Center after Lakers games.

The task force includes county children's services, probation and mental health workers as well as law enforcement officials. It will examine the scope of the foster youth prostitution problem and report back with recommendations in six months.

But Lois Lee, founder of a Los Angeles-based, 24-bed shelter for child sex workers called Children of the Night, said she is skeptical of the claim that kids in the foster system are particularly vulnerable to sex trafficking. The majority of the shelter's clients were under the legal guardianship of their parents when they arrived, according to the organization's 2011 annual report.

"They're kids that [the Department of Children and Family Services] left behind in the first place," Lee said.

abby.sewell@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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Amid Hurricane Sandy, a Race to Get a Liver Transplant

It was the best possible news, at the worst possible time.

The phone call from the hospital brought the message that Dolores and Vin Dreeland had long hoped for, ever since their daughter Natalia, 4, had been put on the waiting list for a liver transplant. The time had come.

They bundled her into the car for the 50-mile trip from their home in Long Valley, N.J., to NewYork-Presbyterian Morgan Stanley Children’s Hospital in Manhattan. But it soon seemed that this chance to save Natalia’s life might be just out of reach.

The date was Sunday, Oct. 28, and Hurricane Sandy, the worst storm to hit the East Coast in decades, was bearing down on New York. Airports and bridges would soon close, but the donated organ was in Nevada, five hours away. The time window in which a plane carrying the liver would be able to land in the region was rapidly closing.

In a hospital room, Natalia watched cartoons. Her parents watched the clock, and the weather. “Our anxiety was through the roof,” Mrs. Dreeland said. “It just made your stomach into knots.”

The Dreelands, who are in their 60s, became Natalia’s foster parents in 2008 when she was 7 months old, and adopted her just before she turned 2. They have another adopted daughter, Dorothy Jane, who is 17.

Natalia is a “smart little cookie” who loves school and dressing up Alice, her favorite doll, her mother said. At age 3, Natalia used the word “discombobulated” correctly, Mr. Dreeland said.

Natalia’s health problems date back several years. Her gallbladder was taken out in 2010, and about half her liver was removed in 2011. The underlying problem was a rare disease, Langerhans cell histiocytosis. It causes a tremendous overgrowth of a type of cell in the immune system and can damage organs. Drugs can sometimes keep it in check, but they did not work for Natalia.

In her case, the disease struck the bile ducts, which led to progressive liver damage. “She would have eventually gone into liver failure,” said Dr. Nadia Ovchinsky, a pediatric liver transplant specialist at NewYork-Presbyterian. “And she demonstrated some signs of early liver failure.”

The only hope was a transplant.

Dr. Tomoaki Kato, Natalia’s surgeon, knew that the liver in Nevada was a perfect match for Natalia in the two criteria that matter most: blood type and size. The deceased donor was 2 years old, and though Natalia is nearly 5, she is small for her age. Scar tissue from her previous operations would have made it very difficult to fit a larger organ into her abdomen.

Though Dr. Kato had considered transplanting part of an adult liver into Natalia, a complete organ from a child would be far better for her. But healthy organs from small children do not often become available, Dr. Kato said. This was a rare opportunity, and he was determined to seize it.

But as the day wore on, the odds for Natalia grew slimmer. The operation in Nevada to remove the liver was delayed several times.

At many hospitals, surgery to remove donor organs is done at the end of the day, after all regularly scheduled operations. The Nevada hospital had a busy surgical schedule that day, made worse by a trauma case that took priority.

At the hospital in New York, Tod Brown, an organ procurement coordinator, had alerted a charter air carrier that a flight from Nevada might be needed. That company in turn contacted West Coast carriers to pick up the donated liver and fly it to New York.

Initially, two carriers agreed, but then backed out. Several other charter companies also declined.

Mr. Brown told Dr. Kato that they might have to decline the organ. Dr. Kato, soft-spoken but relentless, said, “Find somebody who can fly.”

Dr. Kato used to work in Miami, where pilots found ways to bypass hurricanes to deliver organs. Even during Hurricane Katrina, his hospital performed transplants.

“I asked the transplant coordinators to just keep pushing,” he said.

Mr. Brown said, “Dr. Kato knew he was going to get that organ, one way or another.”

As the trajectory of the storm became clearer, one of the West Coast charter companies agreed to attempt the flight. The plan was to land at the airport in Teterboro, N.J. The backup was Newark airport, and the second backup was Albany, from where an ambulance would finish the trip.

The timing was critical: organs deteriorate outside the body, and ideally a liver should be transplanted within 12 hours of being removed.

Early Monday, as the storm whirled offshore, the plane landed at Teterboro. Soon a nurse rushed to tell the Dreelands that she had just seen an ambulance with lights and sirens screech up to the hospital. Someone had jumped out carrying a container.

At about 5 a.m., the couple kissed Natalia and saw her wheeled off to the operating room.

Three weeks later, she is back home, on the mend. The complicated regimen of drugs that transplant patients need is tough on a child, but she is getting through it, her father said.

Recently, Mr. Dreeland said, he found himself weeping uncontrollably during a church service for the family of the child who had died. “Their child gave my child life,” he said.

Though only time will tell, because the histiocytosis appeared limited to Natalia’s bile ducts and had not affected other organs, her doctors say there is a good chance that the transplant has cured her.

This article has been revised to reflect the following correction:

Correction: November 28, 2012

Because of an editing error, a picture caption with an article on Tuesday about a girl who received a liver transplant during Hurricane Sandy misspelled the surname of the girl’s family. As the article correctly noted, it is Dreeland, not Vreeland.

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Judge orders tobacco companies to say they lied about smoking risk

WASHINGTON — A federal judge ordered tobacco companies to publish corrective statements that say they lied about the dangers of smoking and that disclose smoking's health effects, including the death on average of 1,200 people a day.

U.S. District Judge Gladys Kessler previously had said she wanted the industry to pay for corrective statements in various types of advertisements. But Tuesday's ruling was the first time she had specified what the statements will say.

Each corrective ad is to be prefaced by a statement that a federal court has concluded that the defendant tobacco companies "deliberately deceived the American public about the health effects of smoking." Among the required statements are that smoking kills more people than murder, AIDS, suicide, drugs, car crashes and alcohol combined, and that "secondhand smoke kills over 3,000 Americans a year."

The corrective statements are part of a case the government brought in 1999 under the Racketeer Influenced and Corrupt Organizations Act. Kessler ruled in that case in 2006 that the nation's largest cigarette makers concealed the dangers of smoking for decades, and said she wanted the industry to pay for "corrective statements" in various types of ads, both broadcast and print. The Justice Department proposed corrective statements, which Kessler used as the basis for some of the ones she ordered Tuesday.

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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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Letters: Cycle of Birth and Death (1 Letter)

To the Editor:

Re “Amid Cosmic Fatigue, Scarcely a Star Is Born” (Out There, Nov. 20): Though one may bemoan the rapidly declining birthrate of stars, the inescapable fact is that everything ends. People live for about 80 years, but any one of us could die tomorrow. As for our species, a cosmic impact causing mass extinctions like that of the dinosaurs occurs every 100 million years or so, although we may extinguish ourselves long before that through war or by destroying our environment.

Our planet will be incinerated in about 5 billion years when our Sun, in its own death throes, becomes a red giant. And our Milky Way galaxy will collide and merge with Andromeda in 3 to 4 billion years. Even the universe itself will end in either fire or ice, depending on whether its expansion continues forever, causing a “big rip,” or is reversed, resulting in a “big crunch.”

Happy holidays!

Stephen A. Silver

San Francisco

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Cyber Monday shoppers look for online deals, many while at work

Retail reporter Shan Li and consumer columnist David Lazarus talk with Trae Bodge, senior editor at Retailmenot.com Insider about Cyber Monday.

Consumers hopped online for some more Internet shopping on Cyber Monday after last week's post-Thanksgiving Black Friday frenzy came to a close.

Many started early this year: Online spending on Black Friday topped $1 billion for the first time as some shoppers turned to their computers instead of braving the crowds in person.

Cyber Monday is "the Super Bowl of online shopping," said Jonathan Johnson, president of bargain site Overstock.com.

As of late afternoon, the site's traffic was up compared with last year's Cyber Monday, he said, but it was too early to predict how the entire day's sales would shake out. In the last few years, he said, Cyber Monday shoppers with high-speed Web access have started browsing Overstock at home after a day at the office.

"It used to be during the work hours that people shopped the most," Johnson said. "Now, it's a big hump in the middle of the day during work hours, then slows down during the commute home, and the biggest hump is at night."

This Cyber Monday, up to 129 million consumers were expected to hit Web merchants to take advantage of discounts, promotions and free shipping, according to the National Retail Federation.

Some of them, just returning to work after Thanksgiving, indulged right at their desks.

"People at work already take care of personal business like online banking. During the holidays they shop and buy gifts," said Andrew Lipsman, vice president of industry analysis at research firm ComScore Inc. "People can also shop without family members looking over their shoulder and kids snooping around to see what they're getting."

Nancy Lu, 28, of Los Angeles' Koreatown planned to surreptitiously browse the websites of favorite stores such as Macy's and J. Crew in the hopes of scoring some bargains for herself and her family. The personal assistant said she was hoping to get holiday shopping done early this year.

"I'm usually the person at the malls two days before Christmas trying to find something for everyone," she said. "If I find really good deals on Monday then I can relax later on."

For the last two years, Cyber Monday has been the year's biggest online spending day, Lipsman said. That's up from 12th place in 2006. Last year, Cyber Monday sales totaled $1.3 billion, and ComScore predicted they could reach $1.5 billion this year.

More consumers are using laptops, smartphones and tablet computers to do their shopping this holiday season.

On Black Friday, 57.3 million Americans visited an online retail site, up 18% from a year earlier, ComScore said. The National Retail Federation said that for the first time ever, more than half of shoppers over the long Thanksgiving weekend said they checked out stores online.

Cyber Monday, its name coined in 2005, quickly gained traction as shoppers took advantage of work computers with faster Internet connections, Lipsman said. Now, he said, at-work transactions account for about half the dollars spent at online retailers that day.

Nearly half of workers plan to do some of their shopping online while at the office this holiday season, according to a survey from CareerBuilder. More women than men said they had shopped at work in the past: 43% compared with 36%.

The retailer with the most-visited site on Black Friday was e-commerce giant Amazon.com Inc., followed by Wal-Mart Stores Inc., Best Buy Co., Target Corp. and Apple Inc., ComScore said. Amazon is the nation's largest online-only retailer.

Nearly all merchants with a Web presence are participating in the flurry of promotions and discounts surrounding Cyber Monday, said Trae Bodge, a shopping expert at deals site RetailMeNot.

She said some people admit to devoting three or more hours to shopping while at work.

That's good news for retailers, many of which will continue to roll out deals online this week.

shan.li@latimes.com

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Survey finds lots of unused vacation time

As an information technology supervisor at Pitzer College in Claremont, Dennis Crowley had so much work to do last year that he finished 2011 without using nearly five days of paid vacation.

"And to be frank, I was too busy to even realize I was losing time," he said.

Crowley's situation is not unusual. A survey by Harris Interactive Inc. found that by the end of 2012, Americans will leave an average of 9.2 days of vacation unused, up from the average of 6.2 days in 2011.

Nearly 90% of those questioned said they would take more leisure trips on their vacation if they had the time and money to do so, according to the survey of more than 2,000 U.S. adults that was commissioned by travel website Hotwire.

Hotwire has a selfish reason for pointing out the survey results: The travel website says vacationers can save lots of money by traveling between Thanksgiving and Christmas. During the holiday gap, hotel rates drop 33% in Boston, 28% in San Francisco and 26% in Seattle, compared with the peak summer travel season, according to the website.

Crowley has learned his lesson. He said he is keeping closer tabs on his vacation time this year. But instead of using his accrued vacation time to travel, he said is spending more time with his children.

Airline food getting more healthful

On the nation's airlines, the days of free lunch are long over. That also goes for breakfast, dinner and snacks. Once complimentary, most airline food now comes with a price tag.

But there is some good news about what you get to eat on commercial airlines: It is getting more healthful.

That's the assessment of Charles Platkin, a professor of nutrition at the City University of New York's Hunter College who has tested and ranked airline foods off and on since 2000. With few exceptions, Platkin said most airlines now offer at least one healthful meal alternative on their menu.

"It's actually moving in a good direction," he said. "It's been an ebb and flow, but the overall trend is positive."

Platkin gave the top ranking this year to Virgin America, noting that the airline based in California offers low-calorie options such as roasted pear and arugula salad, a "protein plate" with hummus and whole wheat pita bread, plus oatmeal for breakfast. He gave the airline 41/4 stars out of a maximum of five stars.

At the bottom of the list was Allegiant Air, with a rating of only one and a half stars. Platkin said the Las Vegas airline "made it clear that their foods were not healthy. It shows."

The airline's snacks include M&Ms, Oreo Brownies and Pringles chips.

Air Canada and Alaska Airlines came in second and third, respectively, in Platkin's ranking. The other big airlines — including United, American, Delta and US Airways — ranked in the middle of the list.

Platkin does not eat the food on every airline. "I don't have that kind of time," he said. "I have classes to teach."

Instead, he collects and reviews lists of food items, including the ingredients and calorie numbers, from the airlines.

TSA defends stopping traveler over watch

A traveler was stopped by federal security officers at the Oakland International Airport this month because of an unusual wristwatch he was wearing.

When word got out about the incident, critics of the Transportation Security Administration blasted the agency, saying it was another example of the TSA overreacting.

In hopes of stifling the uproar, the TSA released a photo of the watch last week. This is no ordinary timepiece. It includes a toggle switch, wires and what look like tiny fuses attached to the wristband.

A TSA explosives detection team determined that the watch was not an explosive device. Still, the Alameda County sheriff's deputies, who were called by the TSA to investigate, arrested the watch owner, Geoffrey McGann, a teacher and artist from Rancho Palos Verdes. He was jailed on suspicion of possession of components to make a destructive device, according to news reports.

The Alameda County district attorney's office declined last week to file charges against McGann.

McGann's attorney accused the TSA of being "hyper-vigilant."

The TSA responded in its blog last week, saying, "Terrorists take everyday items and attempt to manipulate them to make improvised explosive devices. Our officers are trained to look for anomalies such as this one."

hugo.martin@latimes.com

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