A Breakthrough Against Leukemia Using Altered T-Cells

PHILIPSBURG, Pa. — Emma Whitehead has been bounding around the house lately, practicing somersaults and rugby-style tumbles that make her parents wince.

It is hard to believe, but last spring Emma, then 6, was near death from leukemia. She had relapsed twice after chemotherapy, and doctors had run out of options.

Desperate to save her, her parents sought an experimental treatment at the Children’s Hospital of Philadelphia, one that had never before been tried in a child, or in anyone with the type of leukemia Emma had. The experiment, in April, used a disabled form of the AIDS virus to reprogram Emma’s immune system genetically to kill cancer cells.

The treatment very nearly killed her. But she emerged from it cancer-free, and seven months later is still in complete remission. She is the first child and one of the first humans ever in whom new techniques have achieved a long-sought goal — giving a patient’s own immune system the lasting ability to fight cancer.

Emma had been ill with acute lymphoblastic leukemia since 2010, when she was 5, her parents, Kari and Tom, said. She is their only child.

She is among just a dozen patients with advanced leukemia to have received the experimental treatment, which was developed at the University of Pennsylvania. Similar approaches are also being tried at other centers, including the National Cancer Institute and Memorial Sloan-Kettering Cancer Center in New York.

“Our goal is to have a cure, but we can’t say that word,” said Dr. Carl June, who leads the research team at the University of Pennsylvania. He hopes the new treatment will eventually replace bone-marrow transplantation, an even more arduous, risky and expensive procedure that is now the last hope when other treatments fail in leukemia and related diseases.

Three adults with chronic leukemia treated at the University of Pennsylvania have also had complete remissions, with no signs of disease; two of them have been well for more than two years, said Dr. David Porter. Four adults improved but did not have full remissions, and one was treated too recently to evaluate. A child improved and then relapsed. In two adults, the treatment did not work at all. The Pennsylvania researchers are presenting their results on Sunday and Monday in Atlanta at a meeting of the American Society of Hematology.

Despite the mixed results, cancer experts not involved with the research say it has tremendous promise, because even in this early phase of testing it has worked in seemingly hopeless cases.

“I think this is a major breakthrough,” said Dr. Ivan Borrello, a cancer expert and associate professor of medicine at the Johns Hopkins University School of Medicine.

Dr. John Wagner, director of pediatric blood and marrow transplantation at the University of Minnesota, called the Pennsylvania results “phenomenal,” and said they were “what we’ve all been working and hoping for but not seeing to this extent.”

A major drug company, Novartis, is betting on the Penn team, and has committed $20 million to building a research center on the Penn campus to bring the treatment to market.

Hervé Hoppenot, president of Novartis Oncology, called the research “fantastic” and said it had the potential — if the early results hold up — to revolutionize the treatment of leukemia and related blood cancers. Researchers say the same approach, reprogramming the patient’s immune system, may also be used eventually against tumors like breast and prostate cancer.

To perform the treatment, doctors remove millions of the patient’s T-cells — a type of white blood cell — and insert new genes that enable the T-cells to kill cancer cells. The new genes program the T-cells to attack B-cells, a normal part of the immune system that turns malignant in leukemia.

The altered T-cells — called chimeric antigen receptor cells — are then dripped back into the patient’s veins, and if all goes well they multiply like crazy and start destroying the cancer.

The T-cells home in on a protein called CD-19 that is found on the surface of most B-cells, whether they are healthy or malignant.

A sign that the treatment is working is that the patient becomes terribly ill, with raging fevers and chills — a reaction that oncologists call “shake and bake,” Dr. June said. Its medical name is cytokine-release syndrome, or cytokine storm, referring to the natural chemicals that pour out of cells in the immune system as they are being activated, causing fevers and other symptoms. The storm can also flood the lungs and cause perilous drops in blood pressure — effects that nearly killed Emma.

Steroids sometimes ease the reaction, but did not help Emma. Her temperature hit 105. She wound up on a ventilator, unconscious and swollen almost beyond recognition, surrounded by friends and family who had come to say goodbye.

But at the eleventh hour, a battery of blood tests gave the researchers a clue as to what might help save Emma: Her level of one of the cytokines, interleukin-6 or IL-6, had shot up a thousandfold. Doctors had never seen such a spike before and thought it might be what was making her so sick. Dr. June knew that a drug could lower IL-6 — his daughter takes it, for rheumatoid arthritis. It had never been used for a crisis like Emma’s, but there was little to lose. Her oncologist, Dr. Stephan A. Grupp, ordered the drug. The response, he said, was “amazing.”

Within hours, Emma began to stabilize. She woke up a week later, on May 2, the day she turned 7; the intensive-care staff sang “Happy Birthday.”

Since then, the research team has used the same drug, tocilizumab, in several other patients.

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Jenni Rivera aboard plane missing in Mexico

CAPTIONS

Jenni Rivera performs at the Latin Billboard Awards
Jenni Rivera performs during the Latin Billboard Awards in Coral Gables, Fla. Authorities in Mexico say the wreckage of a small plane believed to be carrying Rivera has been found and there are no apparent survivors. (Lynne Sladky / Associated Press /April 26, 2012)

By Meg James

December 9, 2012, 1:05 p.m.

A small plane carrying Mexican American singer Jenni Rivera is missing and believed to have crashed in northern Mexico early Sunday.

The Associated Press reported the plane, a Learjet, left Monterrey about 3:30 a.m. after a concert by Rivera. The pilot lost contact with air traffic contollers about 10 minutes after its departure. It was scheduled to arrive in Toluca, near Mexico City, about an hour later.

An NBCUniversal spokeswoman confirmed that Rivera was aboard the plane. Seven people, including the pilots and crew, were believed to be on the plane.

PHOTOS: Jenni Rivera missing

The Long Beach native's career has been soaring. The 43-year-old singer is best known for her interpretations of regional Mexican music, norteno and banda. She also is one of NBCUniversal's brightest bilingual television stars.

Her reality show on the Telemundo cable channel, mun2, "I Love Jenni," has been one of the channel's highest rated shows. The program is in its second year.

ABC television network was reportedly considering casting Rivera as a star of a prime-time sitcom in development about a strong-willed single Latina mother.

The AP said that a search for the plane was launched early Sunday.

[Updated 3:37 p.m.: Mexican transportation officials have reported the wreckage of the plane believed to be carrying Rivera has been located and no one appears to have survived the crash.

Read more: Jenni Rivera, Mexican American music star, feared dead in plane crash]

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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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