Surgeon infected patients during heart procedure, Cedars-Sinai admits

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

anna.gorman@latimes.com

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Rolling Stones hit NY for 50th anniversary gig

NEW YORK (AP) — "Time Waits for No One," the Rolling Stones sang in 1974, but lately it's seemed like that grizzled quartet does indeed have some sort of exemption from the ravages of time.

At an average age of 68-plus years, the British rockers are clearly in fighting form, sounding tight, focused and truly ready for the spotlight at a rapturously received pair of London concerts last month.

On Saturday, Mick Jagger, Keith Richards, Ronnie Wood and Charlie Watts hit New York for the first of three U.S. shows on their "50 and Counting" mini-tour, marking a mind-boggling half-century since the band first began playing its unique brand of blues-tinged rock.

And the three shows — Saturday's at the new Barclays Center in Brooklyn, then two in Newark, N.J., on Dec. 13 and 15 — aren't the only big dates on the agenda. Next week the Stones join a veritable who's who of British rock royalty and U.S. superstars at the blockbuster 12-12-12 Sandy benefit concert at Madison Square Garden. Also scheduled to perform: Paul McCartney, the Who, Eric Clapton, Bruce Springsteen & The E Street Band, Alicia Keys, Kanye West, Eddie Vedder, Billy Joel, Roger Waters and Chris Martin.

The Stones' three U.S. shows promise to have their own special guests, too. Mary J. Blige will be at the Brooklyn gig, as well as guitarist Gary Clark Jr., the band has announced. (Blige performed a searing "Gimme Shelter" with frontman Jagger in London.) Rumors are swirling of huge names at the Dec. 15 show, which also will be on pay-per-view.

In a flurry of anniversary activity, the band also released a hits compilation last month with two new songs, "Doom and Gloom" and "One More Shot," and HBO premiered a new documentary on their formative years, "Crossfire Hurricane."

The Stones formed in London in 1962 to play Chicago blues, led at the time by the late Brian Jones and pianist Ian Stewart, along with Jagger and Richards, who'd met on a train platform a year earlier. Bassist Bill Wyman and drummer Charlie Watts were quick additions.

Wyman, who left the band in 1992, was a guest at the London shows last month, as was Mick Taylor, the celebrated former Stones guitarist who left in 1974 — to be replaced by Wood, the newest Stone and the youngster at 65.

The inevitable questions have been swirling about the next step for the Stones: another huge global tour, on the scale of their last one, "A Bigger Bang," which earned more than $550 million between 2005 and 2007? Something a bit smaller? Or is this mini-tour, in the words of their new song, really "One Last Shot"?

The Stones won't say. But in an interview last month, they made clear they felt the 50th anniversary was something to be marked.

"I thought it would be kind of churlish not to do something," Jagger told The Associated Press. "Otherwise, the BBC would have done a rather dull film about the Rolling Stones."

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Associated Press writer David Bauder contributed to this report.

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Auto execs share insights on the industry and what's next

It's hard to get America's most senior auto executives together in the same building to address the same topics, but we managed to do it with Mark Reuss, president of General Motors Co.'s North American operations, and Mark Fields, the newly appointed chief operating officer of Ford Motor Co.

They came to town for the Los Angeles Auto Show, which ends Sunday. Even then, they weren't in the same room — so we just asked them identical questions, in separate interviews, to create this virtual debate.

Both executives address key issues facing the industry, including the future of in-dash technology, fuel economy, electric cars and the prospects for the industry at large. They don't always agree.

Do vehicle embedded features such as MyFord Touch or Cadillac Cue make sense when smartphones can do many of the same tasks with fewer glitches? Why not use architecture that allows people to use phone apps for vehicle infotainment?

Reuss: There is no way that the auto industry in the long haul should be carrying all that technology in a car. Phones will move faster in technology than anything we can put into a car. Embedding those functions in a car and then trying to guess where phones are going is not a solution. We will experiment with technology in Cadillac, but that's not where the mainline brands will be going.

Fields: It is very clear that for younger consumers, staying connected in their lives is hugely important whether they are in their bedrooms, walking outside or in their cars. That's why we started Sync and MyFord Touch.

In the future, you might end up seeing a hybrid of embedded technology and smartphone connectivity. There are certain things that we want to ensure, such as safety and integration into the rest of the vehicle. There could be some issues with just plugging in a smartphone and allowing it to do a lot of vehicle functions. We're already engaging in those discussions, thinking like a technology company.

The U.S. auto industry has been one of the better-performing segments of the U.S. economy recently but is still well below the 16 million to 17 million vehicles it once sold regularly. Can it shift to a higher gear?

Fields: We expect the market to continue to improve based on two factors. One is the age of the car park out there. [Registration data show the average age of vehicles on the road today is 10 to 11 years.] Cars are old and trucks are old. Look at that, combined with the fuel economy consumers can get from new cars right now, and there are some good reasons to buy. And then there is the gradual improvement of the economy.

This is a great business … but when you look out on the horizon in North America, do I think we will go back to the days of 18 million units anytime soon? No. But when you look at the components that set demand, I think it is very encouraging. The opportunities and growth in front of us are pretty substantial.

Reuss: It can happen based on population growth and the car-park age. But sales are throttled by the variance in consumer confidence and in jobs.

The industry is in a place it has never been in before. It has a break-even point of just 11 [million] to 12 million units. [Automakers are expected to sell about 14.5 million vehicles in the U.S. this year.] That's providing profits to invest in good cars, even if we haven't seen that quick sales growth.

That's a great place to be…. You could really be happy driving 98% of the stuff that is on display here.

What's the deal with electric vehicles? They garnered a lot of attention when automakers started selling them again two years ago, but sales are poor.

Reuss: The range has to grow and the cost of the battery and the car has to come down. The quickest way for the cost to come down is to build a platform-specific electric vehicle. Otherwise, you will always have a battery that is heavier than what you want and have less range than you want.

Our Spark EV will work, because it is already small and lightweight and close to what you want to do in a platform-specific vehicle.... We will sell a few thousand, and we are doing it in California, where there already is interest and some infrastructure for electric vehicles.

I don't think you will see bigger people-carrier EVs. It's just a harder sell. Who wants to be stranded with your family [because the battery drained down] and pay a lot of money to do it?

Fields: The simple answer is that we don't know what percentage of the marketplace battery-electric vehicles will occupy next year or even five years from now. Our strategy is to align our manufacturing so that wherever it goes, we will be able to flex.

Demand for full-electric vehicles depends on a lot of factors, including getting the cost down lower, and the price of fuel and the infrastructure to be able to support mass EVs with charging stations, etc.

It is so dynamic right now. At gas at $3.40 a gallon, will sales of EVs bump up appreciably? If gas is $5 a gallon, you would get another answer. Whatever the continuum, we will be able to meet the demand.

What single feature or attribute of a vehicle is the consumer most focused on right now?

Fields: I think fuel economy is now embedded in people's minds, no matter what the price of oil is. In the 1970s to get fuel economy you had to get really small, inconvenient vehicles, but now you don't have to compromise on size or performance.

Reuss: It is reliability and durability. You can do the styling right, the technology right and price right. But if you don't have the durability and reliability, you won't get retention. People won't buy your car again. No one wants to be accused of buying something stupid. Fuel economy would be the next reason to buy.

jerry.hirsch@latimes.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

paul.richter@latimes.com

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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American Airlines pilots approve new contract

Pilots at American Airlines have approved a new labor contract, which could clear the way for American to consider a merger with US Airways.

The pilots union announced Friday that 74% of its members voted to ratify the contract. Pilots rejected a similar offer in August, but union leaders lobbied hard for passage the second time around.

Under the contract, pilots will get pay raises and own 13.5% of American Airlines parent AMR Corp. after it emerges from bankruptcy protection.

Union officials and analysts say the vote gives AMR creditors certainty about the company's labor costs, making it easier for them to weigh which gives them more money — American on its own, or a bigger entity through a merger with US Airways.

"This contract represents a bridge to a merger with US Airways," said union spokesman Dennis Tajer. He said the vote "should not in any way be viewed as support for the American stand-alone plan or for this current management team."

American also hailed the vote as a key step in its turnaround after years of heavy losses.

The pilots' vote "gives us the certainty we need for American to successfully restructure," said Denise Lynn, American's senior vice president of people, in a statement. She added that "the modernization of our company is well underway, and we remain focused on emerging as a competitive, world-class airline."

AMR and American filed for bankruptcy protection in November 2011. With the pilots deal in hand, the company could exit Chapter 11 early next year, a faster reorganization than those in the last decade at United Airlines and Delta Air Lines.

Friday's vote filled in the last unknown piece in AMR's labor-cost puzzle. The company's creditors "very much wanted a contract because they want some visibility on what the cost structure will be," said Ray Neidl, an airline analyst for Maxim Group.

US Airways has proposed a merger that would give AMR creditors 70% of the combined company, which would be run by US Airways Group Inc. CEO Doug Parker, according to a person familiar with the discussions who spoke on condition of anonymity because the talks are private.

There have been reports that AMR might seek up to 80% for its creditors, which could be unacceptable to US Airways shareholders, the person said. Last month, a committee of bondholders told the pilots union that it would support an independent American only if AMR had a new board that would pick managers to run the airline.

The airlines have exchanged confidential financial information and talked about a potential merger for several weeks, although a deal is not certain.

American has about 7,500 active pilots plus a few hundred others on furlough. The union said the vote to ratify the contract was 5,490 to 1,951.

The six-year contract will raise pilots' pay by 4% on signing and 2% per year after that, with an adjustment in the third year to bring pay in line with that of other big airlines. The union will get 13.5% of the stock in the new AMR when it emerges from bankruptcy, which analysts estimate would amount to at least $100,000 per pilot.

In exchange, pilots will fly more hours and American will get more flexibility to outsource flying to other airlines.

American, which has already frozen pension plans and made other changes in benefits and work rules, is trying to use the bankruptcy process to cut annual labor costs by 17%, or about $1 billion.

In recent months flight attendants and ground workers have ratified separate contracts that reduced benefits and outsourced thousands of jobs. American expects to cut about 10,000 jobs, with 3,000 layoffs and the rest coming from early retirements and attrition.

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U.S. spy agencies to detail cyber attacks from abroad

WASHINGTON — The U.S. intelligence community is nearing completion of its first detailed review of cyber spying against American targets from abroad, including an attempt to calculate U.S. financial losses from hacker attacks based in China, officials said.

The National Intelligence Estimate, the first involving cyber espionage, also will seek to determine how large a role the Chinese government plays in directing or coordinating digital attacks aimed at stealing U.S. intellectual property, according to officials who spoke on the condition of anonymity to discuss a classified undertaking.

The Pentagon requested the estimate more than a year ago, and it sparked a broad review of evidence and analysis from the 17 U.S. intelligence agencies. The document has been submitted to the National Intelligence Council, which coordinates such efforts, but it was unclear whether the council had reached or approved final conclusions. The study is expected to be given to policymakers early next year.

U.S. intelligence agencies monitor daily digital assaults from hackers based in China who seek to steal intellectual property from American and other Western companies, current and former intelligence officials said. Intelligence analysts disagree over the extent to which the intrusions are organized by Chinese authorities, but the CIA and National Security Agency have traced cyber attacks and thefts to Chinese military and intelligence agencies.

"We know much more about who is doing this than we did even two years ago," one official involved in the effort said. "We have traced attacks back to a desk in a [People's Liberation Army] office building."

Some analysts believe the Chinese government has a broad policy of encouraging theft of intellectual property through cyber attacks, but that it leaves the details to intelligence services, state-owned companies and freelancers. As a result, at least some of the attacks appear poorly orchestrated.

U.S. officials have raised concerns about cyber espionage with Chinese officials. Beijing has denied any involvement.

Obama administration officials have publicly warned in recent months about threats to national security from cyber attacks, but they have tiptoed around the issue of who is to blame. "It's no secret that Russia and China have advanced cyber capabilities," Defense Secretary Leon E. Panetta said in a speech on Oct. 11 in New York.

Russia engages in cyber espionage against government targets, as does China, the United States, Israel, France and other nations. But Russia does not systematically steal corporate secrets from U.S. companies to aid its own national companies, U.S. intelligence officials say.

Last week, the congressionally sponsored U.S.-China Economic and Security Review Commission alleged that China has "an elaborate strategy for obtaining America's advanced technology by subterfuge, either stealing it outright or by requiring U.S. companies to turn over technology to Chinese business partners as a condition for investment and market access in China."

Part of that strategy relies on computer attacks, the commission said.

"In 2012, Chinese state-sponsored actors continued to exploit U.S. government, military, industrial and nongovernmental computer systems," the report said. "The volume of exploitation attempts yielded enough successful breaches to make China the most threatening actor in cyberspace."

Losses from the theft of U.S. intellectual property through cyber attacks and theft are difficult to quantify but are believed to be in the billions of dollars a year.

In one recent case, Brian Milburn, who runs Solid Oak Software Inc. in Santa Barbara, sued the Chinese government and nine companies for $2.2 billion in January 2010 in federal court in Santa Ana, alleging that his Cybersitter child-monitoring software had been pirated and illegally sold to 57 million users in China. The lawsuit was settled for an undisclosed amount in April, though the Chinese government did not participate in the settlement.

As the lawsuit unfolded, Milburn was targeted for harassment by Chinese hackers thought to have been tracked by U.S. intelligence, according to his Los Angeles lawyer, Gregory Fayer. He said the hackers blocked orders on the Cybersitter website, costing Milburn tens of thousands of dollars in lost sales.

"The guys they put on us were the virtual Chinese A-Team of hackers," Milburn said in a phone interview Thursday. "They were the most patient people I've ever seen. They basically used the same techniques against me that they would use for cyber espionage."

ken.dilanian@latimes.com

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Zynga moves to enter US gambling market

NEW YORK (AP) — Online games company Zynga said it has asked Nevada gambling regulators for a decision that could pave the way for it to enter the U.S. gambling market.

This follows Zynga’s October disclosure that it has signed a deal to offer online poker and casino games, played with real money, in the U.K. It plans to launch those games in the first half of 2013.

Zynga Inc. said in an email late Wednesday that it is seeking an “application for a preliminary finding of suitability” from the Nevada Gaming Control Board. This, the company says, is part of its plan to enter regulated “real-money gaming,” that is, gambling markets.

Zynga has not said what it plans to do with a gaming license. But the company, whose games are played primarily on Facebook, has faltered in recent months and is looking for additional revenue sources beyond online games such as “FarmVille 2″ and “Words With Friends.”

The San Francisco-based company says the process with Nevada regulators should take 12 to 18 months. If Zynga passes the first regulatory hurdle, it can then apply for a gaming license in the state. That, the company said, takes two to three months.

Zynga’s stock rose 17 cents, or 7.1 percent, to close Thursday at $ 2.49. The company went public about a year ago, when its stock priced at $ 10 per share.

Gaming News Headlines – Yahoo! News

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Actor Stephen Baldwin charged in NY tax case

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

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

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

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

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

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

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

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

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

His brothers Alec, William and Daniel are also actors.

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

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

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

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Extended Use of Breast Cancer Drug Suggested

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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HUD secretary defends efforts to stabilize FHA finances

WASHINGTON — A top Obama administration official said a key government agency that has helped stabilize the housing market might be able to stay afloat next year, but he couldn't guarantee it wouldn't need a taxpayer bailout.

He warned lawmakers, however, not to make the situation worse by messing too much with how it does business.

In a Senate hearing Thursday, Housing and Urban Development Secretary Shaun Donovan cautioned lawmakers worried about the increasingly precarious finances of the Federal Housing Administration that making hasty changes to its operations could endanger the strengthening housing turnaround.

The FHA insures more than $1 trillion worth of mortgages and has backed about 14% of new loans made this year. It played a crucial role in keeping the housing market afloat after the subprime mortgage bubble burst, and now it is paying the price for bad loans it backed from 2007 to 2009.

Quiz: How much do you know about mortgages?

But severely tightening the agency's standards for insuring mortgages, typically made to first-time, lower income home buyers, could damp the recovery and lead to more foreclosures that would further reduce the size of the fund the FHA uses to cover its losses.

"We are seeing a recovery, but it is still fragile," Donovan told the Senate Banking Committee. "We don't want to hurt the market, and in turn the FHA fund, by going too far and stopping that recovery."

Still, some senators were critical of the way FHA operates and the steps taken over the last four years by HUD, which oversees the agency, to stabilize its finances. They want to move more quickly to address possible changes at the agency.

"It is time for serious reform of the FHA before it needs a taxpayer bailout, if it isn't too late already," said Sen. Richard Shelby (R-Ala.).

The FHA insures mortgages with as little as 3.5% down and has backed loans for people who went through foreclosures as recently as three years earlier. In its annual actuarial report to Congress, the agency said that its reserves to cover losses dropped into negative territory for the fiscal year that ended Sept. 30.

Under law, the FHA's net worth must not drop below 2% of the outstanding balances of the loans it guarantees. But hit by foreclosures and lower house prices, the agency's so-called reserve ratio has been dropping since 2006 and ended the 2012 fiscal year at negative 1.44%.

The agency, which is funded by mortgage insurance premiums it charges to homeowners, had $30.3 billion in cash reserves as of Sept. 30 to cover $46.6 billion in projected losses in coming years.

The shortfall could force it to tap the U.S. Treasury, as it is legally allowed to do, for the first time in its 78-year history.

Democrats and Republicans said they were concerned about that possibility. But while Republicans pushed for quicker action by the administration to shore up the agency, Democrats echoed Donovan in warning against acting precipitously.

"There is a clear case to be made in my mind that, but for FHA in the midst of this housing crisis, we would have a far greater crisis on our hands," said Sen. Robert Menendez (D-N.J.). "And so reconciling the fiduciary responsibilities here to the taxpayers as well as to the [FHA] mission to the people of America is incredibly important."

Donovan said the FHA has been raising the insurance premiums it charges to homeowners and plans another increase, by an average of about $13 a month, for new loans it backs. The agency also plans to sell at least 40,000 delinquent loans a year and streamline short sales to reduce losses from foreclosures.

The changes "have significantly decreased" the chances of a bailout, Donovan said. But pressed by Sen. David Vitter (R-La.), Donovan would not predict the likelihood the FHA would need to draw taxpayer money.

A determination would not be made until the end of the 2013 fiscal year, Donovan said.

But given the continued problems at the FHA, some Republicans weren't satisfied with the slow pace of changes.

Sen. Bob Corker (R-Tenn.) said he did not understand why the FHA was backing loans for so-called rebound buyers, borrowers who recently went through foreclosure.

Donovan said the agency was considering revising its standards for such buyers. But he stressed that some were responsible borrowers who simply lost their jobs during the Great Recession.

"We believe if somebody can show they are back at work and are a responsible borrower again, that's somebody we should work with," he said.

Donovan said Congress could help the FHA by enacting some changes that the agency is unable to make on its own.

He noted that lawmakers last year reduced loan limits for seized housing finance giants Fannie Mae and Freddie Mac to $625,500 but kept the FHA limit at $729,750. The move increased the FHA's exposure to large, potentially bad loans. Lowering the FHA limit would help the agency's finances, Donovan said.

jim.puzzanghera@latimes.com

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Jazz legend Dave Brubeck dies at 91

Dave Brubeck's pioneering style in pieces such as "Take Five" caught listeners' ears with exotic, challenging rhythms.

In the strait-laced Eisenhower 1950s, Dave Brubeck seemed, on one hand, deeply conventional. He didn't drink, smoke or take drugs. He favored expressions like "baloney!" and "you bet" over ruder alternatives. He had a prodigious work ethic that had been ground into him by his cowboy father on the family's California cattle ranch.

But rebellion was in Brubeck's soul. Schooled in piano by his musically gifted mother, he became a jazz man — outwardly square but quintessentially cool — whose genius at marrying spontaneity and unorthodox rhythms with classical forms became an enduring legacy.

Brubeck, the pianist and composer who pushed the boundaries of jazz for six decades and became one of the genre's most popular artists, died Wednesday, a day before his 92nd birthday.

The jazz maestro, who had a history of heart trouble, became unresponsive on his way to a medical appointment, said his longtime manager and producer Russell Gloyd. Brubeck's son, who was in the car with him, rushed him to a hospital in Norwalk, Conn., where he was pronounced dead.

Jazz guitarist Kenny Burrell called Brubeck "a true musical giant. He helped to keep jazz at a truly high level and he was very consistent in both his performance and composition."

He was best known for his work with his classic Dave Brubeck Quartet, which included longtime musical partner Paul Desmond on alto saxophone, Eugene Wright on bass and Joe Morello on drums. Brubeck's innovative ideas generated an enthusiastic response from a new audience of young listeners — as well as the players most directly connected with his music.

"When Dave is playing his best, it's a profoundly moving thing to experience, emotionally and intellectually," Desmond said in 1952 in the jazz publication Down Beat. "It's completely free, live improvisation ... the vigor and force of simple jazz, the harmonic complexities of Bartok and Milhaud, the form [and much of the dignity] of Bach and, at times, the lyrical romanticism of Rachmaninoff."

In the late 1950s, the group began exploring unusual rhythmic meters. By the end of the decade, the album "Time Out" had reached No. 2 on the pop music album charts, and a single off the album — with "Take Five" on one side and "Blue Rondo a la Turk" on the other — became the first jazz recording to sell more than a million copies.

Written by Desmond, "Take Five" became a universally recognized jazz classic despite the offbeat 5/4 meter.

The group's popularity began to climb in the mid-1950s when a series of live college recordings — "Jazz Goes to College," "Jazz Goes to Junior College" and "Jazz Goes to Oberlin" — was released. Brubeck appeared on the cover of Time magazine in 1954, only the second such honor for a jazz artist. (Louis Armstrong was first.)

The New Yorker described the quartet as "the world's best-paid, most widely traveled, most highly publicized, and most popular small group now playing improvised syncopated music."

But Brubeck's fascination with groundbreaking elements not generally included in the jazz styles of the '50s also made his music a target of widespread disparagement from jazz critics, who often referred to a "heavy-handed, bombastic approach" to piano improvising. The words directly contradicted another critical view, which identified the music of Brubeck and Desmond as another example of the "effete, laid-back, West Coast cool jazz" style."

Most of the criticism failed to recognize the complex range of elements — from stride piano to a Bach canon — that could course through a single piece. Brubeck often cited the positive response his music received from legendary jazz figures including Duke Ellington, Miles Davis and Charles Mingus, among others.

David Warren Brubeck was born Dec. 6, 1920, in Concord, northeast of Oakland. His father, Howard "Pete" Brubeck, was a cattle rancher, his mother, Elizabeth Ivey Brubeck, a pianist and music teacher. When he was 11, the family moved to a 45,000-acre ranch near Ione, in the Sierra foothills.

His older brothers Howard and Henry became classical musicians, but Dave preferred ranching and improvising pop songs on the piano. As a teenager, he played at dances on weekends.

Brubeck started out studying veterinary medicine at what is now the University of the Pacific in Stockton but switched to music at the suggestion of his science advisor. He managed to earn a bachelor's degree without learning to properly read music.

He was drafted into the Army after graduation in 1942, marrying his college sweetheart, Iola Marie Whitlock, just before he was sent to France in 1944.

His wife, who frequently wrote lyrics for his projects, survives him along with his daughter Catherine, his sons Darius, Chris, Dan and Matthew, 10 grandchildren and four great-grandchildren. Another son, Michael, died several years ago.

Discharged from the military in 1946, Brubeck went to Mills College in Oakland, studying with French composer Darius Milhaud and forming the Brubeck Octet, a musically adventurous group with an imaginative and avant-garde repertoire. Brubeck's trio, which he led from 1949 to 1951, provided a different, more intimate forum for his far-reaching ideas. The group, which included bassist Ron Crotty and drummer/vibist Cal Tjader, played standards and Brubeck's originals.

In 1951, Brubeck added Desmond to his trio. It was the beginning of a journey into national visibility that established Brubeck and Desmond as significant jazz figures. The quartet, which remained together until 1967 and was briefly reunited in 1976, a year before Desmond died, became the most important vehicle for Brubeck's playing and innovative musical ideas.

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Michael Strahan makes his Broadway debut in 'Elf'

NEW YORK (AP) — Michael Strahan has tackled something few football stars have attempted — Broadway.

The gap-toothed co-host of "Live with Kelly and Michael" made three short appearances at Wednesday's matinee of "Elf" and said he has new respect for Broadway performers.

"I was surprised at how nervous you get and the adrenaline and that feedback from the audience — it really was an amazing thing," the former football player said after the show. "To see these performers who do it every day — eight or nine times a week — is really amazing. I take my hat off to them."

Fans can see a behind-the-scenes recap on Thursday's TV show.

The musical is adapted from the Will Ferrell film from 2003 about Buddy, a human raised in the North Pole who travels to New York in search of his parents.

Strahan thought making his Broadway debut would be fun and represented a new experience for a guy who holds the single season sack record. He found himself more nervous than he has been for high-stakes football games or live TV.

"It's a little nerve-wracking because so many people depend on you, you want to get your line across and you have to play to the crowd. It's a lot more intricate with everyone hitting their marks. You don't want to be the guy that messes everyone up," he said.

Strahan, 41, played both a police officer and a Salvation Army Santa in the first act and later came on as himself in a scene with the real Santa in the second act. As he waited in the wings of the Al Hirschfeld Theatre, he saw the toll the musical takes on its dancers.

"Some of these performers are breathing as if they just went into a football game and played a 12-play drive," he joked. "I was tired walking up and down from my dressing room."

Strahan rehearsed for an hour in the morning with stage managers and associate director Casey Hushion. At 1 p.m., some in the cast came in early to work with him, including Jordan Gelber, who plays Buddy, and Beth Leavel, who plays Buddy's stepmother.

The audience was quiet when Strahan first appeared as an officer with another cop after Buddy gets kicked out of Macy's. But the seven-time Pro-Bowler and Super Bowl winner flashed his trademark smile and they went wild. More applause greeted him after he played a Salvation Army Santa as he and Buddy wrestled over the kettle bells.

In the second act, he waited to ask Santa for a present. Santa asked him his name, the newly minted actor said "Michael Strahan" and he then asked for a red Schwinn bicycle with a bell shaped like Miss Piggy. The crowd cheered when Strahan identified himself and he got another wide round of applause at the curtain call, where the cast gave him flowers.

Strahan was named in September as Kelly Ripa's permanent co-host aboard the morning show "Live with Kelly and Michael." A former defensive star who spent 15 years in the NFL, he is also a host of "Fox NFL Sunday."

He follows in the footsteps of Joe Namath, a quarterback nicknamed "Broadway Joe" who made an appearance on Broadway in 1983 as a replacement in a revival of "The Caine Mutiny Court-Martial."

Strahan would not rule out a return to the stage. "I will take it off my bucket list, but if the opportunity came across again, I might just take it up and do it again," he said. "I had a great time."

___

Online:

http://www.elfmusical.com

http://dadt.com/live

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Extended Use of Breast Cancer Drug Suggested

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Northridge shooting probe yields more arrests, sources say

Los Angeles Police Department detectives have made additional arrests in connection with a quadruple homicide in Northridge, sources familiar with the investigation said.

The sources would not immediately identify the suspects nor would they detail what offenses they were arrested for. One of the arrests took place in Las Vegas overnight; it was not clear where the others occurred.

Sources familiar with the investigation said the killings appeared to stem from a dispute over personal property, although they would not say what kind of items were involved.

Los Angeles City Councilman Mitchell Englander said one of the suspects was believed to have lived in the illegal boardinghouse where the shootings occurred. Englander stressed that the information came from people briefed on the case but outside the LAPD.

A news conference is planned for later Tuesday, when the LAPD is expected to reveal more information about the case.

Officers responded to the home in the 17400 block of Devonshire Street about 4:25 a.m. Sunday after a 911 caller reported yelling and shots fired, police said. Authorities found four people -- two men and two women -- shot dead outside.

No weapon was recovered at the home, prompting police to rule out a murder-suicide. Three of the victims -- a man and two women -- were shot on the walkway on the left side of the home, a source familiar with the case told The Times on Monday. They were all wearing hooded sweat shirts and were about two feet apart from one another. All three had at least one bullet wound to the head.

One victim was crumpled on her knees, the source said, her face buried in the palms of her hands, "almost like she was praying." The other two victims on the walkway were face down.

The fourth victim -- a man -- was farther away and appeared as if he was trying to run to the backyard when he was shot. He had at least one gunshot wound, according to the source.

"It looked like a quick kill," said the source, who spoke on the condition of anonymity because the case is ongoing.

The names of the victims have not been released. Police said the women were in their mid-20s; one man was in his mid-30s and the other man in his late 40s.

Authorities said the home was an illegal boardinghouse, with up to 17 people living in conditions that Englander described as "deplorable." The home had so much debris and so many partitions that one room could be accessed only through a window, he said.

A trail of extension cords led investigators to the backyard, where several makeshift living quarters had been assembled.

The owner of the home, Yag Kapil, said he rented out rooms but denied he was running a boardinghouse. Kapil, 78, who lives at the home, said he is bedridden and was sleeping at the time of the shootings. He said he didn't hear anything and didn't know the victims.

The slayings stunned the quiet Northridge street, which residents said was the kind where neighbors knew one another and walked to the grocery store or synagogue nearby.

"It's usually sleepy-time America," said Richard Rutherford, 58, who was awakened by the gunfire. The violent-crime rate for Northridge falls in the middle of all Los Angeles neighborhoods, but homicide is rare in the community, according to LAPD data analyzed in The Times' Crime L.A. database. In the previous six months, Northridge had one homicide out of the 89 violent crimes reported.

Since 2007 and before Sunday's quadruple homicide, Northridge had 11 homicides, 10 of them south of Nordhoff Street. The location of Sunday's slayings is on the border with Granada Hills, which typically has a much lower violent-crime rate than Northridge.

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32% of Young People Use Social Media in the Bathroom

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Huston's "Infrared" wins Bad Sex fiction prize

LONDON (AP) — It's the prize no author wants to win.

Award-winning novelist Nancy Huston won Britain's Bad Sex in Fiction award Tuesday for her novel "Infrared," whose tale of a photographer who takes pictures of her lovers during sex proved too revealing for the judges.

The choice was announced by "Downton Abbey" actress Samantha Bond during a ceremony at the Naval & Military Club in London.

Judges of the tongue-in-cheek prize — which is run by the Literary Review magazine — said they were struck by a description of "flesh, that archaic kingdom that brings forth tears and terrors, nightmares, babies and bedazzlements," and by a long passage that builds to a climax of "undulating space."

Huston, who lives in Paris, was not on hand to collect her prize. In a statement read by her publicist, the 59-year-old author said she hoped her victory would "incite thousands of British women to take close-up photos of their lovers' bodies in all states of array and disarray."

The Canada-born Huston, who writes in both French and English, is the author of more than a dozen novels, including "Plainsong" and "Fault Lines." She has previously won France's Prix Goncourt prize and was a finalist for Britain's Orange Prize for fiction by women.

She is only the third woman to win the annual Bad Sex prize, founded in 1993 to name and shame authors of "crude, tasteless and ... redundant passages of sexual description in contemporary novels."

Some critics, however, have praised the sexual passages in "Infrared." Shirley Whiteside in the Independent on Sunday newspaper said there were "none of the lazy cliches of pornography or the purple prose of modern romantic fiction" — though she conceded the book's sex scenes were "more perfunctory than erotic."

Huston beat finalists including previous winner Tom Wolfe — for his passage in "Back to Blood" describing "his big generative jockey" — and Booker Prize-nominated Nicola Barker, whose novel "The Yips" compares a woman to "a plump Bakewell pudding."

Previous recipients of the dubious honor, usually accepted with good grace, include Sebastian Faulks, the late Norman Mailer and the late John Updike, who was awarded a Bad Sex lifetime achievement award in 2008.

___

Online: http://www.literaryreview.co.uk

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Stocks close lower as budget talks continue

Stocks are closed slightly lower on Wall Street as budget talks continue in Washington.

The Dow Jones industrial average fell 14 points to close at 12,952 Tuesday. It traded in a narrow range of just 82 points.

The Standard and Poor's 500 index lost two points to 1,407. The Nasdaq composite was down five and a half points at 2,997.

Investors are waiting on developments from Washington in the budget talks, which are aimed at avoiding a series of sharp government spending cuts and tax increases that begin to kick in Jan. 1.

Big Lots soared after the discount retailer raised its forecast for full-year profits.

Falling stocks narrowly outnumbered rising ones on the New York Stock Exchange. Volume was light at 3.2 billion shares.

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Two Mexican nationals charged in killing of U.S. Coast Guardsman

Federal prosecutors charged two Mexican nationals in connection with killing U.S. Coast Guardsmen Terrell Horne III after they allegedly rammed his vessel with a drug-smuggling panga boat.

The two men, boat captain Jose Mejia-Leyva and Manuel Beltra-Higuera, are expected to appear in court Monday afternoon to face charges that they killed a federal officer.

Horne, 34, of Redondo Beach, was killed Sunday after suspected smugglers in a panga rammed his vessel off the Ventura County coast. He died of severe head trauma, officials said.

The Redondo Beach resident was second in command of the Halibut, an 87-foot patrol cutter based in Marina del Rey. Authorities said they could not recall a Coast Guard chief petty officer being killed in such a manner off the coast of California.

Early Sunday morning, the Halibut was dispatched to investigate a boat operating near Santa Cruz Island, the largest of California's eight Channel Islands. The island is roughly 25 miles southwest of Oxnard.

The boat, first detected by a patrol plane, had come under suspicion because it was operating in the middle of the night without lights and was a "panga"-style vessel, an open-hulled boat that has become "the choice of smugglers operating off the coast of California," said Coast Guard spokesman Adam Eggers.

The Coast Guard cutter contains a smaller boat, a rigid-hull inflatable used routinely for search-and-rescue operations and missions that require a nimble approach. When Horne and his team approached in the inflatable, the suspect boat gunned its engine, maneuvered directly toward the Coast Guard inflatable, rammed it and fled.

The impact knocked Horne and another guardsman into the water. Both were quickly plucked from the sea. Horne had suffered a traumatic head injury. While receiving medical care, he was raced to shore aboard the Halibut. Paramedics met the Halibut at the pier in Port Hueneme and declared Horne dead at 2:21 a.m.

The second crew member knocked into the water suffered minor injuries and was treated and released from a hospital later Sunday. He was not identified.

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Four Things Google’s Nexus 4 Has in Common with the iPhone 4

Besides being each company’s flagship smartphone (and having the number 4 in their names), Google‘s new Nexus 4 and the 2010 iPhone 4 have a fair bit in common with each other.

This could be a good thing, if you remember just how popular the iPhone 4 was. Unfortunately, in this case it’s more of a bad thing, and hearkens back to “Antennagate” and the iPhone 4′s other problems. Do any of these features remind you of anything?

​A glass back

With the iPhone 5, Apple finally moved from a crack- and scratch-prone glass backplate to a solid, aluminum unibody construction. Google doesn’t seem to have gotten the memo that the former may have been a bad idea, however, and the Nexus 4 has a sparkly glass back surface.

While sparkly things obviously have their fans, the Nexus 4′s chassis also seems to lean towards the brittle side. Joshua Topolsky, who reviewed the Nexus 4 for The Verge, managed to crack the glass when he accidentally knocked his phone off the table. Meanwhile, Droid-Life’s Kellex found that setting the phone on a stone countertop caused its glass back to fracture in two.

​No 4G

Even Topolsky’s glowing review of the Nexus 4 said “It feels slow,” and “There’s simply no way to ignore this deficit.” That’s because, like the iPhone 4, the Nexus 4 lacks a 4G radio (even though it has the chip to support one if it had it).

The iPhone 4, however, was released in 2010, when 4G was still a new thing and the Android “superphones” which supported it had enormous screens and horrible battery life. Today, even the iPhone has 4G. Possibly because of bad blood between Google and the wireless carriers, which appear to resent Google’s selling phones unsubsidized and sans “customizations,” the Nexus 4 does not.

​Selling out fast

Every one of Apple’s iPhone models has sold out faster, and more dramatically, than the one before. Google’s Android devices, in contrast, haven’t tended to do so … although the new Nexus smartphones and tablets are starting to have this problem.

How bad is it? After Google finally got a new wave of Nexus 4s up for sale, they sold out in about a half-hour. Google claims that it hasn’t actually sold out, but even if you spotted the Nexus 4 on Google Play, chances are you ran into technical glitches which kept it out of your shopping cart. Tipster “Syko Pompos” told the Android Police blog how to get around this and place your order, but expect to wait months to receive it.

​Public relations nightmares

It hasn’t quite reached Antennagate levels yet, perhaps partly because the Nexus brand isn’t as well-known as the iPhone (the iPhone 4′s antenna problems were actually shared by many smartphones). But most of the press coverage of the Nexus 4 lately has been about how you can’t get one. Or else, how if you want one you’ll have to either buy it on contract or pay a lot more to get it unsubsidized from T-Mobile.

On the plus side (for the Nexus), this problem is only partly caused by the Google Play store’s technical errors. The biggest reason it’s taking so long to get out to people is, like with the iPhone 4, simply how popular it is.

Jared Spurbeck is an open-source software enthusiast, who uses an Android phone and an Ubuntu laptop PC. He has been writing about technology and electronics since 2008.

Linux/Open Source News Headlines – Yahoo! News

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Additional copies of 'Lincoln' headed to theaters

LOS ANGELES (AP) — "Lincoln" is marching to more movie theaters.

Disney, which distributed the DreamWorks film, is making additional prints of director Steven Spielberg's historical saga starring Daniel Day-Lewis to meet an unexpected demand that has left some moviegoers in Alaska out in the cold.

"To say that we're encouraged by the results to date or that they've exceeded our expectations is an understatement," said Dave Hollis, head of distribution at the Walt Disney Co. "We're in the midst of making additional prints to accommodate demand and will have them available to our partners in exhibition by mid-December for what we hope will be a great run through the holiday and awards corridor."

The film, which opened in wide release Nov. 9 and has earned $83.6 million in North America so far, has been unavailable at some smaller venues, such as the Gross Alaska theaters in Juneau.

But the extra prints are coming a little too late to fit the movie into the five-screen Glacier Cinemas theater during the holiday season, said Kenny Solomon-Gross, general manager of the Gross Alaska, which runs two theaters in Juneau and one in Ketchikan, Alaska.

"When we had the room for 'Lincoln,' Disney didn't have a copy for us," Solomon-Gross said Monday.

His film lineup is pretty booked through the end of the year, and he probably can't screen "Lincoln" until after the first of the new year. Yes, the excitement over the film will have dimmed, but then the Academy Awards season will be stirring up, he said. That should kick up the buzz.

In the meantime, Solomon-Gross plans to head to Las Vegas this week and catch the film there.

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Follow AP Entertainment Writer Derrik J. Lang on Twitter at http://www.twitter.com/derrikjlang . Associated Press writer Rachel D'Oro in Anchorage, Alaska, contributed to this report.

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Online:

http://www.thelincolnmovie.com

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Global Update: GlaxoSmithKline Tops Access to Medicines Index

Sang Tan/Associated Press

GlaxoSmithKline hung on to its perennial top spot in the new Access to Medicines Index released last week, but its competitors are closing in.

Every two years, the index ranks the world’s top 20 pharmaceutical companies based on how readily they get medicines they hold patents on to the world’s poor, how much research they do on tropical diseases, how ethically they conduct clinical trials in poor countries, and similar issues.

Johnson & Johnson shot up to second place, while AstraZeneca fell to 16th from 7th. AstraZeneca has had major management shake-ups. It did not do less, but the industry is improving so rapidly that others outscored it, the report said.

The index was greeted with skepticism by some drugmakers when it was introduced in 2008. But now 19 of the 20 companies have a board member or subcommittee tracking how well they do at what the index measures, said David Sampson, the chief author.

The one exception was a Japanese company. As before, Japanese drugmakers ranked at or near the index’s bottom, and European companies clustered near the top. Generic companies — most of them Indian — that export to poor countries are ranked separately.

Johnson & Johnson moved up because it created an access team, disclosed more and bought Crucell, a vaccine company.

The foundation that creates the index now has enough money to continue for five more years, said its founder, Wim Leereveld, a former pharmaceutical executive.

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Chinese units of 5 big U.S. audit firms charged

WASHINGTON — Federal regulators have charged the Chinese affiliates of five of the biggest U.S. accounting firms with impeding the government's investigation of Chinese companies by refusing to turn over documents.

The Securities and Exchange Commission said Monday it has started proceedings against the Chinese affiliates of all so-called Big Four accounting firms — Deloitte, Ernst & Young, KPMG and PricewaterhouseCoopers — and a fifth major firm, BDO.

Hundreds of Chinese companies trade on U.S. stock exchanges. The SEC has been investigating many of them for possible accounting fraud. The agency says the accounting firms, which audit Chinese companies, have refused to cooperate in investigations of nine companies and to provide documents.

The Chinese affiliates of the firms, which are subject to Chinese law, say they cannot hand over the documents because the Chinese government won't allow them to do so, and could penalize them if they do. The Chinese government maintains that providing the documents to U.S. regulators would violate Chinese sovereignty and its secrecy laws.

In statements Monday, some of the Chinese affiliates said they hoped the issue could be resolved in negotiations between Chinese and U.S. authorities.

Ernst & Young Hua Ming said "We hope that an agreement can be reached between U.S. and Chinese regulators that will enable our compliance with all applicable laws and regulations."

"While it is unfortunate that the two countries have not yet been able to find common ground on these issues, we remain hopeful that a diplomatic agreement can be reached," Deloitte Touche Tohmatsu said in its statement.

And PwC China said that it "has cooperated with the SEC at every opportunity" but that it will, and must, comply with Chinese law.

Representatives for the affiliates of KPMG and BDO could not immediately be reached for comment.

SEC Enforcement Director Robert Khuzami said the agency needs to have access to the documents in order to verify the accuracy of the firms' audits and protect investors from accounting fraud. "Firms that conduct audits knowing they cannot comply with laws requiring access to these work papers face serious sanctions," he said in a statement.

The SEC's case against the firms' affiliates will go before an administrative law judge at the agency. If the judge rules in favor of the SEC, the judge will determine what sanctions the affiliates could face.

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