Man Indicted in New Hampshire in Hepatitis Infections

A traveling medical technician who is believed to have infected at least 39 people with hepatitis C through his use of stolen hospital drugs and syringes was indicted late Wednesday in New Hampshire on 14 new charges.

The technician, David Kwiatkowski, known as the “serial infector,” was arrested in July and charged with tampering with a consumer product and illegally obtaining drugs, primarily fentanyl, a powerful anesthetic that is about 80 times more potent than morphine.

After a lengthy investigation that ranged over several states, he was indicted Wednesday by a federal grand jury in Concord, N.H., and charged with seven counts of tampering with a consumer product and seven counts of illegally obtaining drugs.

If convicted on the pending charges, Mr. Kwiatkowski, 33, faces up to 10 years in prison for each count of tampering with a consumer product and up to four years in prison for each count of obtaining controlled substances by fraud. Each offense is also punishable by a fine of $250,000.

Mr. Kwiatkowski had pleaded not guilty to the original charges and remains in federal custody in New Hampshire.

In announcing the indictment, John P. Kacavas, the United States attorney in New Hampshire, said that Mr. Kwiatkowski “used the stolen syringes to inject himself, causing them to become tainted with his infected blood, before filling them with saline and then replacing them for use in the medical procedure.”

He continued, “Consequently, instead of receiving the prescribed dose of fentanyl, patients instead received saline tainted by Kwiatkowski’s infected blood.”

The problem was discovered after several patients in the cardiac catheterization lab at Exeter Hospital, where Mr. Kwiatkowski worked, tested positive for a specific strain of hepatitis C, a chronic disease that can lead to cancer and is a major reason for liver transplants. Mr. Kwiatkowski tested positive for the same strain, leading to the testing of thousands of patients in New Hampshire this summer.

The outbreak was one of the largest in recent history. The investigation has been complicated because Mr. Kwiatkowski worked at 18 hospitals in seven other states (Arizona, Georgia, Kansas, Maryland, Michigan, New York and Pennsylvania) over the last decade. He was fired from at least two hospitals but was hired subsequently by four others.

Since Mr. Kwiatkowski’s arrest, thousands of patients in the other states have been tested for hepatitis C. More than 30 patients in New Hampshire, about a half-dozen in Kansas and one in Maryland have tested positive for the same strain.

A report in August by the federal Centers for Medicare and Medicaid Services said that syringes at Exeter Hospital were left unattended on medication carts by nurses in the cardiac catheterization lab.

Hospital officials have said that they received reports of concerns about Mr. Kwiatkowski but not that he was diverting drugs. A statement on the hospital’s Web site said: “We understand that this has been a difficult time for our patients and the community. Our focus remains on all of our patients and while this situation has shaken the community, we will continue to do everything we can to restore the community’s confidence by providing excellent care to the hundreds of patients who receive care within our health system each day.”

Read More..

Windows 8 hasn't lifted U.S. tablet or PC sales, NPD says

Microsoft Corp.'s new Windows 8 has not given a boost to U.S. sales of PCs and tablet computers, according to the NPD Group.

Since the highly anticipated operating system was launched Oct. 26, Windows device sales have fallen 21% compared with the same period last year, the market research firm said.

Notebook sales, which have been weak throughout most of 2012, were down 24%, and desktop sales dropped 9%.

Through Nov. 17, Windows 8 had captured just 58% of Windows computing-device unit sales. That compared with 83% for Windows 7 in the four weeks after that operating system's debut, NPD said.

Windows 8 tablet sales have "been almost nonexistent," with unit sales representing less than 1% of all Windows 8 device sales to date, NPD said Thursday.

"After just four weeks on the market, it's still [too] early to place blame on Windows 8 for the ongoing weakness in the PC market," said Stephen Baker, vice president of industry analysis at NPD. "We still have the whole holiday selling season ahead of us, but clearly Windows 8 did not prove to be the impetus for a sales turnaround some had hoped for."

Baker went on to say that a sluggish back-to-school shopping season left a lot of inventory unsold, which hurt initial sales for Windows 8 devices.

Average selling prices of Windows computing devices have jumped significantly compared with last year, NPD said. Last year, overall prices were $433; this year's average selling price during the last four weeks was $477.

"The strong performance of Windows 8 notebooks with touch screens, where Windows 8 truly shines, offers some reason for optimism," Baker said. "These products accounted for 6% of Windows 8 notebook sales at an average price of $867, helping to reestablish a premium segment to the Windows consumer notebook market."

NPD said its research excluded sales of the Surface with Windows RT tablet, which also launched Oct. 26. Microsoft has not specified how many it has sold.

On Thursday, Microsoft announced the pricing for a premium version of that tablet.

Surface with Windows 8 Pro, which will be available in January, will cost $899 for a 64GB version and $999 for a 128GB version, the Redmond, Wash., company said.

The premium tablet looks much like the Surface with Windows RT model currently on the market. Both include dark titanium VaporMG casings, dual 2x2 MIMO antennas and kickstands.

But the Surface Pro has Intel Corp.'s next-generation Core i5 processor, which should give the tablet a graphics boost for its 10.6-inch display that runs at a full-HD resolution. The Surface Pro also includes a full-size USB 3.0 port and a Surface pen with Palm Block technology. It will run current Windows 7 desktop applications.

"It's a full PC AND a tablet," Panos Panay, general manager of Microsoft Surface, said in a blog post.

The device weighs less than 2 pounds and is less than 14 millimeters thick.

andrea.chang@latimes.com

Read More..

British judge urges new press regulator due to hacking scandal

LONDON – In a highly anticipated and lengthy report, a senior judge Thursday recommended that a new, independent regulatory authority be set up to monitor Britain’s raucous press and to crack down on media abuses such as phone hacking and other unethical newsgathering practices.

Justice Brian Leveson said such a regulator was necessary because the press had at times “wreaked havoc in the lives of innocent people” through its intrusions on privacy and relentless pursuit of scoops.

The new regulatory body should be backed by law, but it should not include any politicians, in order to avoid government control of the press, nor any editors, in order to maintain full independence, Leveson said.

The regulator would replace a previous press complaints commission that is widely recognized in Britain to have been a failure, particularly with regard to the phone-hacking scandal. Evidence has emerged that hundreds of high-profile figures may have had their cellphones tapped by the now-defunct News of the World tabloid.

The scandal gave rise to a months-long, government-commissioned investigation into media culture and ethics by Leveson, who heard testimony from more than 300 witnesses.

The recommendations in his 2,000-page report are likely to please some hacking victims and satisfy demands of some lawmakers who say that Britain’s media, in particular its sensation-seeking and gossip-hungry tabloids, have been allowed to run amok.

But the news organizations themselves have expressed alarm over any form of regulation that has its roots in law and that, they fear, could be the first step toward government censorship. Although they recognize the need for oversight, many news outlets have pushed for a better system of self-regulation with no legal underpinning.

Leveson was eager to emphasize his respect for a free press and denied that his recommendations represented any threat to it.

“The press operating freely and in the public interest is one of the true safeguards of our democracy. As a result, it holds a privileged and powerful place in our society,” he told reporters. “But this power and influence carries with it responsibilities to the public interest in whose name it exercises these privileges. Unfortunately, as the evidence has shown beyond doubt, on too many occasions those responsibilities … have simply been ignored.”

The report has been eagerly awaited for months. As its release date neared, politicians and high-profile individuals dug in on either side, calling for laws to regulate the media or warning against them as an unacceptable infringement on a free press.

“As parliamentarians, we believe in free speech and are opposed to the imposition of any form of statutory control,” said a letter signed by 86 lawmakers. “The solution is not new laws but a profound restructuring of the self-regulatory system.”

A recent poll, however, found a majority of Britons in favor of some kind of regulation of the media backed by the force of the law.

The witnesses who appeared before Leveson included some of Britain’s best-known public figures, such as Prime Minister David Cameron. Actor Hugh Grant and "Harry Potter" author J.K. Rowling denounced media invasions of their privacy. Media baron Rupert Murdoch and other newspaper proprietors spoke about newsgathering practices.

The inquiry was launched last year after the hacking scandal exploded in the public consciousness with the revelation that the News of the World had tapped the voicemail messages of a missing 13-year-old girl, whose body was later found dumped in the woods by her killer.

Like a fast-spreading fire, the scandal quickly engulfed key pillars of British public life, putting the heat not just on tabloid newspapers but also the politicians who cozied up to them and the police who offered scoops in hopes of flattering coverage. Within days, the head of Scotland Yard resigned, as did one of Murdoch’s closest confidants, and the 168-year-old News of the World was shut down.

Three separate police investigations – into phone hacking, computer hacking and bribery of public officials – were spawned by the affair. Dozens of people, most of them journalists at Murdoch-owned publications, have been arrested.

Only a few hours before Leveson’s report was released, the former head of Murdoch’s newspapers in Britain and a onetime senior aide to Cameron appeared in court on charges of paying public officials for information.

ALSO:

Three managers arrested after deadly Bangladesh factory fire

Outgoing Mexican President Felipe Calderon heading to Harvard

Google opposes German push for search engines to pay newspapers

Read More..

Lindsay Lohan arrested on assault charge in NYC

NEW YORK (AP) — Actress Lindsay Lohan was arrested Thursday after police said she hit a woman during an argument at a New York City nightclub.

The "Mean Girls" and "Freaky Friday" star was arrested at 4 a.m. and charged with third-degree assault.

She left a police precinct nearly four hours later with a black jacket pulled over her head. She was wearing leggings, a green mini skirt and high-heels, and drove off in a black SUV with a driver and another man who was seen going in and out of the precinct.

She allegedly got into the spat with another woman at Club Avenue, in Manhattan's Chelsea section. She struck the woman in face with her hand, police said. The woman did not require medical attention.

Lohan's publicist did not immediately return a call for comment.

The arrest is Lohan's latest brush with law enforcement in New York City.

She was involved in a NYPD investigation in September after alleging a man had assaulted her in a New York hotel, but charges against the man were later dropped.

Also in September, the actress was accused of clipping a man with her car outside another Manhattan nightclub, but prosecutors chose not to move ahead with charges.

In October, police were called to her childhood home on Long Island after a report of fight between her and her mother. An investigation revealed "no criminality."

The actress was also involved in a car accident in California this summer that sent her and an assistant to a hospital, but didn't result in serious injuries for anyone. The accident remains under investigation.

In May, she was cleared of allegations that she struck a Hollywood nightclub manager with her car.

Lohan remains on informal probation for taking a necklace from a jewelry store without permission last year. That means she doesn't have to check in with a judge or probation officer but could face a jail term if arrested again.

Her latest film, "Liz & Dick," in which she portrays screen icon Elizabeth Taylor, premiered on Lifetime on Sunday.

Lohan also recently filmed "The Canyons," an indie film written by "Less Than Zero" and "American Psycho" author Bret Easton Ellis.

Read More..

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.

Read More..

Stocks open higher as budget talks move ahead

Stocks are rising in early trading on Wall Street as optimism builds that a budget deal will be reached in Washington.

Later Thursday Treasury Secretary Timothy Geithner will meet with Senate Republican Leader Mitch McConnell and Senate Democratic Leader Harry Reid to push the negotiations forward.

The Dow Jones industrial average was up 50 points at 13,034 shortly after the opening bell.

The Standard & Poor's 500 index was up seven points at 1,416 and the Nasdaq composite rose 20 points to 3,012.

The Commerce Department raised its estimate for U.S. economic growth to an annual rate of 2.7 percent in the July-through-September period.

That's much better than the 2 percent rate estimated a month ago and more than twice the 1.3 percent rate logged in the April-June quarter.

Read More..

27 indicted in Mexican Mafia drug case in Ventura County

From a prison cell outside California, an inmate known as "Evil" was making himself known on Ventura County's streets.

Martin Madrigal, 39, was squeezing drug profits from street gangs for the prison-based Mexican Mafia, according to a grand jury indictment released Tuesday. He was so feared that rival gangs cooperated on extortion schemes, drug deals and violent crimes, according to law enforcement officials.

The 35-count indictment portrays Madrigal as a powerful figure representing an efficient and merciless organization that law enforcement officials believe has been operating for decades, largely from behind bars, calling shots among street gangs. He was one of 27 people named in the indictment, 24 of whom have been arrested. Officials declined to disclose where or why Madrigal is serving time.

The forced cooperation among rival gangs alleged in the indictment may be a sign that Mexican drug cartels are attempting to extend their authority over California drug trafficking, according to Ventura County Assistant Sheriff Gary Pentis.

Madrigal operated as a kind of regional manager, with a Ventura County gang member named Edwin "Sporty" Mora enforcing his decisions on the street with a written hit list from Madrigal and "permission to conduct extortion on behalf of the Mexican Mafia," according to the indictment. In one of the document's counts, Mora is said to have indicated that a gang member named Little Rudy "was going to kick in money by Wednesday and if he can't make that happen, Mora wanted the fool in the dirt."

Dozens of weapons, including an AK47, were confiscated during a series of arrests starting in May and ending earlier this month.

The Ventura County probe, dubbed Operation Wicked Hand, started with two shootings in Moorpark in April and a heroin bust about the same time.

"We soon came to realize the incidents weren't happenstance," Ventura County Sheriff Geoff Dean said.

Sheriff's officials said investigators thwarted several crimes, including two planned killings and a drugstore robbery.

Officials would not reveal details of how the investigation was conducted. The indictment, returned Nov. 14, makes it clear authorities had access to text messages and phone calls that gang members made among themselves.

More than 70 officers from the Sheriff's Department participated in the investigation, as well as officers from the Oxnard Police Department and other agencies.

"This case has dealt a crushing blow to organized crime in Ventura County," Pentis said. "We have incapacitated the organization from the top through its geographic managers."

Bail for those arrested, including two juveniles, ranges from $1 million to $5 million. Dist. Atty. Greg Totten said a number of suspects are facing multiple charges, and three are facing possible life sentences under the state's three-strikes law.

Totten said his office submitted the case to a criminal grand jury rather than opting for a preliminary hearing because of its complexity and the ongoing investigation's need for secrecy.

The indictment names more individuals than any other in Ventura County's history, he said.

steve.chawkins@latimes.com

Read More..

U.S. for-profit colleges spend big on marketing while slashing other costs

(Reuters) – Google‘s biggest advertiser is neither a bank nor a retailer.

It’s the for-profit University of Phoenix, which has recently been spending nearly $ 400,000 a day on ads, more than any financial firm or retailer, the traditional big spenders on online advertising, according to search analytics firm SpyFu.

That kind of spending may seem surprising coming from a college, but marketing has become vital for the university and its for-profit rivals as enrollments plummet and they fight back against a host of criticisms, including low job-placement rates.

Colleges such as University of Phoenix, the industry leader owned by Apollo Group Inc, will not only have to boost enrollments to reverse their fortunes, analysts say. They will also need to consider cutting tuition fees as well as continue to slash costs and take market share from rivals.

“I have witnessed several versions of this cycle but none as extreme as this,” said Trace Urdan, an analyst with Wells Fargo Securities, who has been covering the U.S. for-profit education industry for about 15 years.

“We are going to see more pointed efforts at marketing and more price competition in an effort to try to capture more market share both from each other as well as from traditional schools,” Urdan said.

Operators of other for-profit colleges, whose ranks include the Washington Post Co’s Kaplan business, DeVry Inc and ITT Educational Services Inc, are also boosting their spending on marketing and are among the 25 biggest advertisers on Google.

But no one is spending like the University of Phoenix, which doubled its spending on Google ads to about $ 380,000 per day on average between October 12 and November 12, compared with $ 170,000 a day in the previous month, according to SpyFu.

Increased marketing alone will not be enough to fatten fast-shrinking profit margins and increase enrollments, however. Lower tuition fees and increased specialization of the type of programs offered, along with further streamlining of operations, will also be necessary, analysts say.

Industry bellwether University of Phoenix, which offers courses at about 230 campuses as well as online, announced plans last month to shut about half its locations and cut 800 jobs in order to save about $ 300 million a year by 2014.

New enrollments in the Apollo system are down nearly 50 percent in the past two years. As of August 31, enrollment totaled about 328,000.

Career Education Corp, which owns American InterContinental University and the Le Cordon Bleu colleges, and Lincoln Educational Services Corp have also announced closures.

LOW-COST MODEL

The $ 25 billion industry, which typically serves adults looking for a career change or a program to enhance job skills, is reeling after government investigations revealed fraud related to financial aid, worryingly high student debt loads and low rates of graduation and job placement.

“Many for-profit colleges make decisions that prioritize their bottom line, even when those decisions limit their students’ opportunities for academic success,” a U.S. Senate report said earlier this year.

Tuition fees, and therefore profits, is one area under pressure as potential students need to be convinced to take out loans in an uncertain job market.

Apollo, whose stock has lost about 65 percent of its value this year, implemented a tuition freeze earlier this year and promised students it will not increase prices through the course of their programs.

Apollo is also looking at different cost models, with a view to serving segments of the population that it cannot serve with current University of Phoenix tuition prices.

“We have certainly seen a lot more competition at the lower end of the price scale, and that’s something we are focusing on,” Apollo spokesman Mark Brennar said, while declining to offer specifics.

Wells Fargo’s Urdan said it is likely that Apollo wants to compete in the low-cost end of the market by building a second brand, which it would likely do by acquiring another college rather than starting from scratch.

As colleges lower their revenue base by cutting tuition fees even as they spend more on marketing, lower margins could become the norm, analysts say. That has spooked investors already worried about sliding enrollments.

The S&P 1500 Education Services index has lost three-quarters of its value since April 2010, including a 50 percent decline in 2012.

Some for-profit colleges already differentiate themselves in the crowded higher-education market by offering programs in a particular field or by targeting students of a particular background, and that trend could accelerate.

American Public Education, for example, is known for enrolling those who work in the military and public services, while Universal Technical Institute offers programs related to the automotive industry.

For-profit colleges play up their links to employers to attract students who may otherwise opt for traditional or community colleges, said Rob Lytle, head of the education practice at advisory firm Parthenon Group.

“They are about getting people workforce employability skills, and I think they are going to be focusing tighter on that,” said Lytle.

(Reporting by A. Ananthalakshmi in Bangalore; Editing by Ted Kerr)

Internet News Headlines – Yahoo! News

Read More..

In elf ears and wizard hats, 'Hobbit' fans rejoice

WELLINGTON, New Zealand (AP) — Wearing elf ears and wizard hats, sitting atop their dad's shoulders or peering from balconies, tens of thousands of New Zealanders watched their favorite "Hobbit" actors walk the red carpet Wednesday at the film trilogy's hometown premiere.

An Air New Zealand plane freshly painted with "Hobbit" characters flew low over Wellington's Embassy Theatre, eliciting roars of approval from the crowd.

Sam Rashidmardani, 12, said he came to see Gollum actor Andy Serkis walk the red carpet — and he wasn't disappointed.

"It was amazing," Rashidmardani said of the evening, adding his Gollum impression: "My precious."

British actor Martin Freeman, who brings comedic timing to the lead role of Bilbo Baggins, said he thought director Peter Jackson had done a fantastic job on "The Hobbit: An Unexpected Journey."

"He's done it again," Freeman said in an interview on the red carpet. "If it's possible, it's probably even better than 'The Lord of the Rings.' I think he's surpassed it."

While it is unusual for a city so far from Hollywood to host the premiere of a hoped-for blockbuster, Jackson's filming of his lauded 'LOTR' trilogy and now "The Hobbit" in New Zealand has helped create a film industry here. The film will open in theaters around the world next month.

One of the talking points of the film is the choice by Jackson to shoot it using 48 frames per second instead of the traditional 24 in hopes of improving the picture quality.

Some say the images come out too clear and look so realistic that they take away from the magic of the film medium. Jackson likens it to advancing from vinyl records to CDs.

"I really think 48 frames is pretty terrific and I'm looking forward to seeing the reaction," Jackson said on the red carpet. "It's been talked about for so long, but finally the film is being released and people can decide for themselves."

Jackson said it was strange working on the project so intimately for two years and then having it suddenly taken away as the world got to see the movie.

"It spins your head a little bit," he said.

Aidan Turner, who plays the dwarf Kili in the movie, said his character is reckless and thinks he's charming.

"I don't get to play real people it seems, I only get to play supernatural ones," he said. "So playing a dwarf didn't seem that weird, actually.

Perhaps the most well-known celebrities to walk the carpet were Cate Blanchett and Elijah Wood, who reprise their roles in the LOTR in the "Hobbit."

"Mostly I came here to see everyone. I like them all," said fan Aysu Shahin, 16, adding that Wood was her favorite. She said she wanted to see the movie "as soon as possible. I'm excited for it."

At a news conference earlier in the day, Jackson said many younger people are happy to watch movies on their iPads.

"We just have to make the cinema-going experience more magical and more spectacular to get people coming back to the movies again," he said.

Jackson said only about 1,000 of the 25,000 theaters that will show the film worldwide are equipped to show 48 frames, so most people will see it in the more traditional format. The movie has also been shot in 3D.

A handful of animal rights protesters held signs at the premiere.

The protest by the group People for the Ethical Treatment of Animals comes after several animal wranglers said three horses and up to two dozen other animals had died during the making of the movies because they were housed at an unsafe farm.

Jackson's spokesman earlier acknowledged two horses had died preventable deaths at the farms but said the production company worked quickly to improve stables and other facilities and that claims of mistreatment were unfounded.

"No mistreatment, no abuse. Absolutely none," Jackson said at the news conference.

Read More..

The New Old Age Blog: Doctor's Orders? Another Test

It is no longer news that Americans, and older Americans in particular, get more routine screening tests than they need, more than are useful. Prostate tests for men over 75, annual Pap smears for women over 65 and colonoscopies for anyone over 75 — all are overused, large-scale studies have shown.

Now it appears that many older patients are also subjected to too-frequent use of the other kind of testing, diagnostic tests.

The difference, in brief: Screening tests are performed on people who are asymptomatic, who aren’t complaining of a health problem, as a way to detect incipient disease. We have heard for years that it is best to “catch it early” — “it” frequently being cancer — and though that turns out to be only sometimes true, we and our doctors often ignore medical guidelines and ongoing campaigns to limit and target screening tests.

Diagnostic tests, on the other hand, are meant to help doctors evaluate some symptom or problem. “You’re trying to figure out what’s wrong,” explained Gilbert Welch, a veteran researcher at the Dartmouth Institute for Health Policy and Clinical Practice.

For these tests, medical groups and task forces offer many fewer guidelines on who should get them and how often — there is not much evidence to go on — but there is general agreement that they are not intended for routine surveillance.

But a study using a random 5 percent sample of Medicare beneficiaries — nearly 750,000 of them — suggests that often, that is what’s happening.

“It begins to look like some of these tests are being routinely repeated, and it’s worrisome,” said Dr. Welch, lead author of the study just published in The Archives of Internal Medicine. “Some physicians are just doing them every year.”

He is talking about tests like echocardiography, or a sonogram of the heart. More than a quarter of the sample (28.5 percent) underwent this test between 2004 and 2006, and more than half of those patients (55 percent) had a repeat echocardiogram within three years, most commonly within a year of the first.

Other common tests were frequently repeated as well. Of patients who underwent an imaging stress test, using a treadmill or stationery bike (or receiving a drug) to make the heart work harder, nearly 44 percent had a repeat test within three years. So did about half of those undergoing pulmonary function tests and chest tomography, a CAT scan of the chest.

Cytoscopy (a procedure in which a viewing tube is inserted into the bladder) was repeated for about 41 percent of the patients, and endoscopy (a swallowed tube enters the esophagus and stomach) for more than a third.

Is this too much testing? Without evidence of how much it harms or helps patients, it is hard to say — but the researchers were startled by the extent of repetition. “It’s inconceivable that it’s all important,” Dr. Welch said. “Unfortunately, it looks like it’s important for doctors.”

The evidence for that? The study revealed big geographic differences in diagnostic testing. Looking at the country’s 50 largest metropolitan areas, it found that nearly half the sample’s patients in Miami had an echocardiogram between 2004 and 2006, and two thirds of them had another echocardiogram within three years — the highest rate in the nation.

In fact, for the six tests the study included, five were performed and repeated most often in Florida cities: Miami, Jacksonville and Orlando. “They’re heavily populated by physicians and they have a long history of being at the top of the list” of areas that do a lot of medical procedures and hospitalizations, Dr. Welch said.

But in Portland, Ore., where “the physician culture is very different,” only 17.5 percent of patients had an echocardiogram. The places most prone to testing were also the places with high rates of repeat testing. Portland, San Francisco and Sacramento had the lowest rates.

We often don’t think of tests as having a downside, but they do. “This is the way whole cascades can start that are hard to stop,” Dr. Welch said. “The more we subject ourselves, the more likely some abnormality shows up that may require more testing, some of which has unwanted consequences.”

Properly used, of course, diagnostic tests can provide crucial information for sick people. “But used without a good indication, they can stir up a hornet’s nest,” he said. And of course they cost Medicare a bundle.

An accompanying commentary, sounding distinctly exasperated, pointed out that efforts to restrain overtesting and overtreatment have continued for decades. The commentary called it “discouraging to contemplate fresh evidence by Welch et al of our failure to curb waste of health care resources.”

It is hard for laypeople to know when tests make sense, but clearly we need to keep track of those we and our family members have. That way, if the cardiologist suggests another echocardiogram, we can at least ask a few pointed questions:

“My father just had one six months ago. Is it necessary to have another so soon? What information do you hope to gain that you didn’t have last time? Will the results change the way we manage his condition?”

Questions are always a good idea. Especially in Florida.

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

Read More..