Rescuers end effort to find body of man presumed dead in sinkhole

SEFFNER, Florida -- Florida rescue workers have ended their efforts to recover the body of a man who disappeared into a sinkhole that swallowed his bedroom while he slept in a suburban Tampa home, and the house will be demolished, a public safety official said on Saturday.

Jeff Bush, 36, who is presumed dead, was asleep when the other five members of the household who were getting ready for bed on Thursday night heard a loud crash and Jeff screaming.

Authorities have not detected any signs of life after lowering listening devices and cameras into the hole.

"Our data has come back, and there is absolutely no way we can do any kind of recovery without endangering lives of workers," said Hillsborough County Fire Rescue spokeswoman Jessica Dam.

The sinkhole also has compromised the house next door, officials said Saturday.

Officials planned to let family members, accompanied by firefighters, into the threatened  home for about 20 minutes to gather some  belongings, Hillsborough County Fire Rescue spokesman Ronnie Rivera told reporters Saturday.

She said demolition of the home would begin early on Sunday.

Bush's body hadn’t been removed by Saturday afternoon and the ground near the home was still "very, very unsafe," Rivera said at a televised press conference Saturday.

"At this time we did some testing and we determined that the house right next to the house that’s actually damaged is also compromised by the sinkhole," Rivera said.

Jeff's brother, 35-year-old Jeremy Bush, jumped into the hole and furiously kept digging to find his brother.

"I really don't think they are going to be able to find him," Jeremy said on Saturday. He "will be there forever."

A small memorial of balloons and flowers for his brother had formed near the house on Saturday morning.

"I thank the Lord for not taking my daughter and the rest of my family," he said.

Jeremy himself had to be rescued from the sinkhole by the first responder to the emergency call, Douglas Duvall of the Hillsborough County Sheriff's Office. When Duvall entered Jeff Bush's bedroom, all he saw was a widening chasm but no sign of Jeff.

"The hole took the entire bedroom," said Duvall. "You could see the bed frame, the dresser, everything was sinking," he said.

Norman Wicker, 48, the father of Jeremy's fiancée who also lived in the house, ran to get a flashlight and shovel.

"It sounded like a car ran into the back of the house," Wicker said.

"There is a very large, very fluid mass underneath this house rendering the entire house and the entire lot dangerous and unsafe," Bill Bracken, the head of an engineering company assisting fire and rescue officials, told the news conference late on Friday.

"We are still trying to determine the extent and nature of what's down there so we can best determine how to approach it and how to extricate," Bracken said.

After suspending the search overnight, it resumed at daylight on Saturday, with engineering consultants trying to determine the extent of the collapse so that a perimeter boundary can be established for setting up heavy equipment for future excavation.

Several nearby homes were evacuated in case the 30-foot wide sinkhole got larger but officials said Friday it only appeared to be getting deeper. Soil samples showed that the sinkhole has compromised the ground underneath a home next door, engineers said Saturday.

The residents of that house were allowed 20 minutes in their home on Saturday to gather belongings. Firefighters and residents formed an assembly line to move items out of the house into SUVs and trucks.

Rescue officials said that in addition to soil samples, they were focusing on engineering analysis, ground penetration radar and other techniques to determine the extent of the ongoing collapse. Listening devices were being used to detect any evidence of life although Bush was presumed dead.

The Bush brothers worked together as landscapers, according to Leland Wicker, 48, one of the other residents of the house.

The risk of sinkholes is common in Florida due to the state's porous geological bedrock, according to the Florida Department of Environmental Protection. As rainwater filters down into the ground, it dissolves the rock, causing erosion that can lead to underground caverns, which cause sinkholes when they collapse.

Reuters

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England Develops a Voracious Appetite for a New Diet

LONDON — Visitors to England right now, be warned. The big topic on people’s minds — from cabdrivers to corporate executives — is not Kate Middleton’s increasingly visible baby bump (though the craze does involve the size of one’s waistline), but rather a best-selling diet book that has sent the British into a fasting frenzy.

“The Fast Diet,” published in mid-January in Britain, could do the same in the United States if Americans eat it up. The United States edition arrived last week.

The book has held the No. 1 slot on Amazon’s British site nearly every day since its publication in January, according to Rebecca Nicolson, a founder of Short Books, the independent publishing company behind the sensation. “It is selling,” she said, “like hot cakes,” which coincidentally are something one can actually eat on this revolutionary diet.

With an alluring cover line that reads, “Lose Weight, Stay Healthy, Live Longer,” the premise of this latest weight-loss regimen — or “slimming” as the British call “dieting” — is intermittent fasting, or what has become known here as the 5:2 diet: five days of eating and drinking whatever you want, dispersed with two days of fasting.

A typical fasting day consists of two meals of roughly 250 to 300 calories each, depending on the person’s sex (500 calories for women, 600 for men). Think two eggs and a slice of ham for breakfast, and a plate of steamed fish and vegetables for dinner.

It is not much sustenance, but the secret to weight loss, according to the book, is that even after just a few hours of fasting, the body begins to turn off the fat-storing mechanisms and turn on the fat-burning systems.

“I’ve always been into self-experimentation,” said Dr. Michael Mosley, one of the book’s two authors and a well-known medical journalist on the BBC who is often called the Sanjay Gupta of Britain.

He researched the science of the diet and its health benefits by putting himself through intermittent fasting and filming it for a BBC documentary last August called “Eat, Fast and Live Longer.” (The broadcast gained high ratings, three million viewers, despite running during the London Olympics. PBS plans to air it in April.)

“This started because I was not feeling well last year,” Dr. Mosley said recently over a cup of tea and half a cookie (it was not one of his fasting days). “It turns out I was suffering from high blood sugar, high cholesterol and had a kind of visceral fat inside my gut.”

Though hardly obese at the time, at 5 feet 11 inches and 187 pounds, Dr. Mosley, 55, had a body mass index and body fat percentage that were a few points higher than the recommended amount for men. “Given that my father had died at age 73 of complications from diabetes, and I was now looking prediabetic, I knew something had to change,” he added.

The result was a documentary, almost the opposite of “Super Size Me,” in which Dr. Mosley not only fasted, but also interviewed scientific researchers, mostly in the United States, about the positive results of various forms of intermittent fasting, tested primarily on rats but in some cases human volunteers. The prominent benefits, he discovered, were weight loss, a lower risk of cancer and heart disease, and increased energy.

“The body goes into a repair-and-recover mode when it no longer has the work of storing the food being consumed,” he said.

Though Dr. Mosley quickly gave up on the most extreme forms of fasting (he ate little more than one cup of low-calorie soup every 24 hours for four consecutive days in his first trial), he finally settled on the 5:2 ratio as a more sustainable, less painful option that could realistically be followed without annihilating his social life or work.

“Our earliest antecedents,” Dr. Mosley argued, “lived a feast-or-famine existence, gorging themselves after a big hunt and then not eating until they scored the next one.” Similarly, he explained, temporary fasting is a ritual of religions like Islam and Judaism — as demonstrated by Ramadan and Yom Kippur. “We shouldn’t have a fear of hunger if it is just temporary,” he said.

What Dr. Mosley found most astounding, however, were his personal results. Not only did he lose 20 pounds (he currently weighs 168 pounds) in nine weeks, but his glucose and cholesterol levels went down, as did his body fat. “What’s more, I have a whole new level of energy,” he said.

The documentary became an instant hit, which in turn led Mimi Spencer, a food and fashion writer, to propose that they collaborate on a book. “I could see this was not a faddish diet but one that was sustainable with long-term health results, beyond the obvious weight-loss benefit,” said Ms. Spencer, 45, who has lost 20 pounds on the diet within four months and lowered her B.M.I. by 2 points.

The result is a 200-page paperback: the first half written by Dr. Mosley outlining the scientific findings of intermittent fasting; the second by Ms. Spencer, with encouraging text on how to get through the first days of fasting, from keeping busy so you don’t hear your rumbling belly, to waiting 15 minutes for your meal or snack.

She also provides fasting recipes with tantalizing photos like feta niçoise salad and Mexican pizza, and a calorie counter at the back. (Who knew a quarter of a cup of balsamic vinegar dressing added up to a whopping 209 calories?)

In London, the diet has taken off with the help of well-known British celebrity chefs and food writers like Hugh Fearnley-Whittingstall, who raved about it in The Guardian after his sixth day of fasting, having already lost eight pounds. (“I feel lean and sharper,” he wrote, “and find the whole thing rather exhilarating.”)

The diet is also particularly popular among men, according to Dr. Mosley, who has heard from many of his converts via e-mail and Twitter, where he has around 24,000 followers. “They find it easy to work into their schedules because dieting for a day here and there doesn’t feel torturous,” he said, adding that couples also particularly like doing it together.

But not everyone is singing the diet’s praises. The National Health System, Britain’s publicly funded medical establishment, put out a statement on its Web site shortly after the book came out: “Despite its increasing popularity, there is a great deal of uncertainty about I.F. (intermittent fasting) with significant gaps in the evidence.”

The health agency also listed some side effects, including bad breath, anxiety, dehydration and irritability. Yet people in London do not seem too concerned. A slew of fasting diet books have come out in recent weeks, notably the “The 5:2 Diet Book” and “The Feast and Fast Diet.”

There is also a crop of new cookbooks featuring fasting-friendly recipes. Let’s just say, the British are hungry for them.

This article has been revised to reflect the following correction:

Correction: March 2, 2013

An earlier version of this article misstated part of the name of the national healthcare organization in Britain. It is the National Health Service, not the National Health System. The article also misidentified the Balsamic product that has 209 calories per cup. It is Balsamic vinegar dressing, not Balsamic vinegar.

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Incomes see largest drop in 20 years

U.S. consumer spending rose in January as Americans spent more on services, with savings providing a cushion after income recorded its biggest drop in 20 years.

Income tumbled 3.6 percent, the largest drop since January 1993. Part of the decline was payback for a 2.6 percent surge in December as businesses, anxious about higher taxes, rushed to pay dividends and bonuses before the new year.

A portion of the drop in January also reflected the tax hikes. The income at the disposal of households after inflation and taxes plunged a 4.0 percent in January after advancing 2.7 percent in December.

The Commerce Department said on Friday consumer spending increased 0.2 percent in January after a revised 0.1 percent rise the prior month. Spending had previously been estimated to have increased 0.2 percent in December.

January's increase was in line with economists' expectations. Spending accounts for about 70 percent of U.S. economic activity and when adjusted for inflation, it gained 0.1 percent after a similar increase in December.

Though spending rose in January, it was supported by a rise in services, probably related to utilities consumption. Spending on goods fell, suggesting some hit from the expiration at the end of 2012 of a 2 percent payroll tax cut. Tax rates for wealthy Americans also increased.

The impact is expected to be larger in February's spending data and possibly extend through the first half of the year as households adjust to smaller paychecks, which are also being strained by rising gasoline prices.

Economists expect consumer spending in the first three months of this year to slow down sharply from the fourth quarter's 2.1 percent annual pace.

With income dropping sharply and spending rising, the saving rate - the percentage of disposable income households are socking away - fell to 2.4 percent, the lowest level since November 2007. The rate had jumped to 6.4 percent in December.

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New budget crisis begins after Washington fiscal talks fail

The U.S. government stumbled headlong on Friday toward wide-ranging spending cuts that threaten to hinder the economic recovery, after President Barack Obama and congressional leaders failed to find an alternative budget plan.

Put in place during a bout of deficit-reduction fever in 2011, the automatic cuts can only be halted by agreement between Congress and the White House

"This is not going to be an apocalypse,” Obama told reporters at the White House  Friday. "It's just dumb. And it's going to hurt. It's going to hurt individual people, and it's going to hurt the economy overall."

A deal proved elusive in talks at the White House on Friday as expected, meaning that government agencies will now begin to hack a total of $85 billion from their budgets between Saturday and October 1. Financial markets in New York shrugged off the stalemate in Washington.

Democrats predict the cuts, known as "sequestration," could soon cause air traffic delays, furloughs for hundreds of thousands of federal employees and disruption to education.

While the International Monetary Fund warned that the belt tightening could slow U.S. economic growth by at least 0.5 of a percentage point this year, that is not a huge drag on an economy that is picking up steam.

Obama was resigned to government budgets shrinking.

"Even with these cuts in place, folks all across this country will work hard to make sure that we keep the recovery going, but Washington sure isn't making it easy," he said after meeting Republican and Democratic congressional leaders.

At the heart of Washington's persistent fiscal crises is disagreement over how to slash the budget deficit and the $16 trillion national debt, bloated over the years by wars in Iraq and Afghanistan and government stimulus for the ailing economy.

Obama wants to close the fiscal gap with spending cuts and tax hikes, but Republicans don't want to concede again on taxes after doing so in negotiations over the "fiscal cliff" at the New Year.

"The discussion about revenue, in my view, is over. It's about taking on the spending problem," House of Representatives Speaker John Boehner said on leaving the meeting.

The billions of dollars in cuts that go into effect on Saturday will probably be phased in over the coming weeks and months. Agencies from the Pentagon to the Department of Education have begun making plans to notify employees who will have to take unpaid days off.

Administration officials say the cutbacks in staffing will affect everything from air-traffic control to border security, preventive health screenings and prosecution of criminal cases. The automatic cuts were harsh by design, meant to force Republicans and Democrats into a bigger budget deal that reduces deficit spending.

No matter how Obama and Congress resolve the 2013 battle, this round of automatic spending cuts is only one of a decade's worth of annual cuts totaling $1.2 trillion mandated by the sequestration law.

Given the current absence of a deal, Obama is required to issue an order to federal agencies by midnight to reduce their budgets. The White House budget office must send a report to Congress detailing the spending cuts.

The Justice Department has already sent notices of furloughs that will begin April 21 at the earliest to some 115,000 workers, including at the Federal Bureau of Investigation.

Unlike previous fiscal dramas, the sequestration fight is not rattling Wall Street.

U.S. stocks rose moderately on Friday, with the Dow Industrials closing up 35 points, as data showed manufacturing expanded at its fastest pace in 20 months in February. Despite being up more than 7 percent this year, and near a record high, the discord in Washington has not prompted traders to cash in gains.

"Most of us believe that sequestration is not something that will make us fall off the cliff, since the cuts will be worked in relatively slowly," said Bill Stone, chief investment strategist at PNC Wealth Management in Philadelphia.

Poll shows GOP beraing blame

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Well: A Rainbow of Root Vegetables

This week’s Recipes for Health is as much a treat for the eyes as the palate. Colorful root vegetables from bright orange carrots and red scallions to purple and yellow potatoes and pale green leeks will add color and flavor to your table.

Since root vegetables and tubers keep well and can be cooked up into something delicious even after they have begun to go limp in the refrigerator, this week’s Recipes for Health should be useful. Root vegetables, tubers (potatoes and sweet potatoes, which are called yams by most vendors – I mean the ones with dark orange flesh), winter squash and cabbages are the only local vegetables available during the winter months in colder regions, so these recipes will be timely for many readers.

Roasting is a good place to begin with most root vegetables. They sweeten as they caramelize in a hot oven. I roasted baby carrots and thick red scallions (they may have been baby onions; I didn’t get the information from the farmer, I just bought them because they were lush and pretty) together and seasoned them with fresh thyme leaves, then sprinkled them with chopped toasted hazelnuts. I also roasted a medley of potatoes, including sweet potatoes, after tossing them with olive oil and sage, and got a wonderful range of colors, textures and tastes ranging from sweet to savory.

Sweet winter vegetables also pair well with spicy seasonings. I like to combine sweet potatoes and chipotle peppers, and this time in a hearty lentil stew that we enjoyed all week.

Here are five colorful and delicious dishes made with root vegetables.

Spicy Lentil and Sweet Potato Stew With Chipotles: The combination of sweet potatoes and spicy chipotles with savory lentils is a winner.

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Roasted Carrots and Scallions With Thyme and Hazelnuts: Toasted hazelnuts add a crunchy texture and nutty finish to this dish.

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Carrot Wraps: A vegetarian sandwich that satisfies like a full meal.

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Rainbow Potato Roast: A multicolored mix that can be vegan, or not.

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Leek Quiche: A lighter version of a Flemish classic.

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Incomes see largest drop in 20 years

U.S. consumer spending rose in January as Americans spent more on services, with savings providing a cushion after income recorded its biggest drop in 20 years.

Income tumbled 3.6 percent, the largest drop since January 1993. Part of the decline was payback for a 2.6 percent surge in December as businesses, anxious about higher taxes, rushed to pay dividends and bonuses before the new year.

A portion of the drop in January also reflected the tax hikes. The income at the disposal of households after inflation and taxes plunged a 4.0 percent in January after advancing 2.7 percent in December.

The Commerce Department said on Friday consumer spending increased 0.2 percent in January after a revised 0.1 percent rise the prior month. Spending had previously been estimated to have increased 0.2 percent in December.

January's increase was in line with economists' expectations. Spending accounts for about 70 percent of U.S. economic activity and when adjusted for inflation, it gained 0.1 percent after a similar increase in December.

Though spending rose in January, it was supported by a rise in services, probably related to utilities consumption. Spending on goods fell, suggesting some hit from the expiration at the end of 2012 of a 2 percent payroll tax cut. Tax rates for wealthy Americans also increased.

The impact is expected to be larger in February's spending data and possibly extend through the first half of the year as households adjust to smaller paychecks, which are also being strained by rising gasoline prices.

Economists expect consumer spending in the first three months of this year to slow down sharply from the fourth quarter's 2.1 percent annual pace.

With income dropping sharply and spending rising, the saving rate - the percentage of disposable income households are socking away - fell to 2.4 percent, the lowest level since November 2007. The rate had jumped to 6.4 percent in December.

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Groupon founder Andrew Mason fired; shares jump

Groupon on Thursday ousted its CEO, company co-founder Andrew Mason, replacing him with two current directors amid increasing heat about the deal site's disappointing financial performance.

In a letter to employees, Mason said he was fired, with a playful and self-deprecating addition: "If you're wondering why ... you haven't been paying attention."

"From controversial metrics in our (initial public offering) to two quarters of missing our own expectations and a stock price that's hovering around one quarter of our listing price, the events of the last year and a half speak for themselves," Mason continued. "As CEO, I am accountable."

As far back as November, Groupon and Mason were forced to respond publicly to a report that he would lose his job. Reports surfaced at the time that Groupon's board was considering replacing Mason with a more experienced CEO to lead the Chicago-based daily deal company's turnaround.  

The board said it's searching for a permanent replacement. For now, Executive Chairman Eric Lefkofsky -- an original investor -- and Vice Chairman Ted Leonsis will share the task.

The company said its earnings expectations for the first quarter and full year outlined on Wednesday remain unchanged.

Investors appear to applaud Mason's departure, driving shares up in after-hours trading after a brutal regular session in which the stock lost a quarter of its value. Shares had plummeted in continuing fallout from a weaker than expected earnings report and forecast on Wednesday. The stock jumped 8 percent after hours on the news and was at $4.70, up nearly 4 percent, at 5:26 p.m.

Mason, a 32-year-old Northwestern University graduate, has come under fire for a series of missteps including controversy during its IPO and not finding a quick enough solution for its financial struggles.

Arvind Bhatia, a senior research analyst at Sterne Agee who recently upgraded Groupon to a "buy" with a $9 price target, said he expected Mason to have a few more quarters to prove himself, but the plummeting stock price likely forced the board to make a move.

"I think the reaction to the stock pushed them over the edge," Bhatia said. "It was basically saying that the market is not giving Andrew a vote of confidence, and I think the board took that message seriously."

Groupon, which was founded in 2008, was once a red-hot company that sparked a number of deal site competitors by marketing discounts on local services such as spas and restaurants to millions of online subscribers.

It turned down a nearly $6 billion buyout offer by Google in 2010 that at the time was thought to undervalue the company. A year later, it ended its first day as a public company worth $16 billion.

But it has lost about three-quarters of its value since it went public. On Thursday, its market capitalization was less than $3 billion, according to Capital IQ.

The scrutiny of Groupon was tremendous, given the "high-flying" nature of the company and the culture created and fostered by Mason, observers said.

That culture turned from a lovable quirk to a major liability as the company ran into controversy over its poorly received Super Bowl ads two years ago and a series of missteps before its IPO. Then, within months of its public debut, it disclosed an accounting flaw that forced it to restate financial results.

The larger question surrounding Groupon -- the long-term viability of its basic business model -- remains. The company has been expanding offerings beyond its core daily deals, where growth has slumped.

On Wednesday, the company posted a fourth-quarter net loss of $81.1 million, or 12 cents a share, missing Wall Street's expectations for a profit. Revenue for the quarter was up 30 percent, in line with analysts' views.

Groupon also warned Wednesday that its turnaround would take time, suggesting it will likely cut employees and overall expenses.

Tribune reporter Robert Channick contributed.

GRPN data by YCharts

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Cellar victim Kampusch raped, starved in film of ordeal

VIENNA (Reuters) – A new film based on the story of Austrian kidnap victim Natascha Kampusch shows her being repeatedly raped by the captor who beat and starved her during the eight-and-a-half years that he kept her in a cellar beneath his house.

Kampusch was snatched on her way to school at the age of 10 by Wolfgang Priklopil and held in a windowless cell under his garage near Vienna until she escaped in 2006, causing a sensation in Austria and abroad. Priklopil committed suicide.

Kampusch had always refused to respond to claims that she had had sex with Priklopil, but in a German television interview on her 25th birthday last week said she had decided to reveal the truth because it had leaked out from police files.

The film, “3,096 Days” – based on Kampusch’s autobiography of the same name – soberly portrays her captivity in a windowless cellar less than 6 square metres (65 square feet) in area, often deprived of food for days at a time.

The emaciated Kampusch – who weighed just 38 kg (84 pounds) at one point in 2004 – keeps a diary written on toilet paper concealed in a box.

One entry reads: “At least 60 blows in the face. Ten to 15 nausea-inducing fist blows to the head. One strike with the fist with full weight to my right ear.”

The movie shows occasional moments that approach tenderness, such as when Priklopil presents her with a cake for her 18th birthday or buys her a dress as a gift – but then immediately goes on to chide her for not knowing how to waltz with him.

GREY AREAS

Antonia Campbell-Hughes, who plays the teenaged Kampusch, said she had tried to portray “the strength of someone’s soul, the ability of people to survive… but also the grey areas within a relationship that people don’t necessarily understand.”

The British actress said she had not met Kampusch during the making of the film or since. “It was a very isolated time, it was a bubble of time, and I wanted to keep that very focused,” she told journalists as she arrived for the Vienna premiere.

Kampusch herself attended the premiere, looking composed as she posed for pictures but declining to give interviews.

In an interview with Germany’s Bild Zeitung last week, she said: “Yes, I did recognize myself, although the reality was even worse. But one can’t really show that in the cinema, since it wasn’t supposed to be a horror film.”

The movie, made at the Constantin Film studios in Bavaria, Germany, also stars Amy Pidgeon as the 10-year-old Kampusch and Danish actor Thure Lindhardt as Priklopil.

“I focused mainly on playing the human being because… we have to remember it was a human being. Monsters do not exist, they’re only in cartoons,” Lindhart said.

“It became clear to me that it’s a story about survival, and it’s a story about surviving eight years of hell. If that story can be told then I can also play the bad guy.”

The director was German-American Sherry Hormann, who made her English-language debut with the 2009 move “Desert Flower”, an adaptation of the autobiography of Somali-born model and anti-female circumcision activist Waris Dirie.

“I’m a mother and I wonder at the strength of this child, and it was important for me to tell this story from a different perspective, to tell how this child using her own strength could survive this atrocious martyrdom,” Hormann said.

The Kampusch case was followed two years later by that of Josef Fritzl, an Austrian who held his daughter captive in a cellar for 24 years and fathered seven children with her.

The crimes prompted soul-searching about the Austrian psyche, and questions as to how the authorities and neighbors could have let such crimes go undetected for so long.

The film goes on general release on Thursday.

(Reporting by Georgina Prodhan, Editing by Paul Casciato)

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Doctor and Patient: Why Failing Med Students Don’t Get Failing Grades

Tall and dark-haired, the third-year medical student always seemed to be the first to arrive at the hospital and the last to leave, her white coat perpetually weighed down by the books and notes she jammed into the pockets. She appeared totally absorbed by her work, even exhausted at times, and said little to anyone around her.

Except when she got frustrated.

I first noticed her when I overheard her quarreling with a nurse. A few months later I heard her accuse another student of sabotaging her work. And then one morning, I saw her storm off the wards after a senior doctor corrected a presentation she had just given. “The patient never told me that!” she cried. The nurses and I stood agape as we watched her stamp her foot and walk away.

“Why don’t you just fail her?” one of the nurses asked the doctor.

“I can’t,” she sighed, explaining that the student did extremely well on all her tests and worked harder than almost anyone in her class. “The problem,” she said, “is that we have no multiple choice exams when it comes to things like clinical intuition, communication skills and bedside manner.”

Medical educators have long understood that good doctoring, like ducks, elephants and obscenity, is easy to recognize but difficult to quantify. And nowhere is the need to catalog those qualities more explicit, and charged, than in the third year of medical school, when students leave the lecture halls and begin to work with patients and other clinicians in specialty-based courses referred to as “clerkships.” In these clerkships, students are evaluated by senior doctors and ranked on their nascent doctoring skills, with the highest-ranking students going on to the most competitive training programs and jobs.

A student’s performance at this early stage, the traditional thinking went, would be predictive of how good a doctor she or he would eventually become.

But in the mid-1990s, a group of researchers decided to examine grading criteria and asked directors of internal medicine clerkship courses across the country how accurate and consistent they believed their grading to be. Nearly half of the course directors believed that some form of grade inflation existed, even within their own courses. Many said they had increasing difficulty distinguishing students who could not achieve a “minimum standard,” whatever that might be. And over 40 percent admitted they had passed students who should have failed their course.

The study inspired a series of reforms aimed at improving how medical educators evaluated students at this critical juncture in their education. Some schools began instituting nifty mnemonics like RIME, or Reporter-Interpreter-Manager-Educator, for assessing progressive levels of student performance; others began to call regular meetings to discuss grades; still others compiled detailed evaluation forms that left little to the subjective imagination.

Now a new study published last month in the journal Teaching and Learning in Medicine looks at the effects of these many efforts on the grading process. And while the good news is that the rate of grade inflation in medical schools is slower than in colleges and universities, the not-so-good news is that little has changed. A majority of clerkship directors still believe that grade inflation is an issue even within their own courses; and over a third believe that students have passed their course who probably should have failed.

“Grades don’t have a lot of meaning,” said Dr. Sara B. Fazio, lead author of the paper and an associate professor of medicine at Harvard Medical School who leads the internal medicine clerkship at the Beth Israel Deaconess Medical Center in Boston. “‘Satisfactory’ is like the kiss of death.”

About a quarter of the course directors surveyed believed that grade inflation occurred because senior doctors were loath to deal with students who could become angry, upset or even turn litigious over grades. Some confessed to feeling pressure to help students get into more selective internships and training programs.

But for many of these educators, the real issue was not flunking the flagrantly unprofessional student, but rather evaluating and helping the student who only needed a little extra help in transitioning from classroom problem sets to real world patients. Most faculty received little or no training or support in evaluating students, few came from institutions that had remediation programs to which they could direct students, and all worked under grading systems that were subjective and not standardized.

Despite the disheartening findings, Dr. Fazio and her co-investigators believe that several continuing initiatives may address the evaluation issues. For example, residency training programs across the country will soon be assessing all doctors-in-training with a national standards list, a series of defined skills, or “competencies,” in areas like interpersonal communication, professional behavior and specialty-specific procedures. Over the next few years, medical schools will likely be adopting a similar system for medical students, creating a national standard for all institutions.

“There have to be unified, transparent and objective criteria,” Dr. Fazio said. “Everyone should know what it means when we talk about educating and training ‘good doctors.’”

“We will all be patients one day,” she added. “We have to think about what kind of doctors we want to have now and in the future.”

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Economic expansion weakest since 2011

The U.S. economy barely grew in the fourth quarter although a slightly better performance in exports and fewer imports led the government to scratch an earlier estimate that showed an economic contraction.

Gross domestic product expanded at a 0.1 percent annual rate, the Commerce Department said on Thursday, missing the 0.5 percent gain forecast by analysts in a Reuters poll.

The growth rate was the slowest since the first quarter of 2011 and far from what is needed to fuel a faster drop in the unemployment rate.

However, much of the weakness came from a slowdown in inventory accumulation and a sharp drop in military spending. These factors are expected to reverse in the first quarter.

Consumer spending was more robust by comparison, although it only expanded at a 2.1 percent annual rate.

Because household spending powers about 70 percent of national output, this still-lackluster pace of growth suggests underlying momentum in the economy was quite modest as it entered the first quarter, when significant fiscal tightening began.

Initially, the government had estimated the economy shrank at a 0.1 percent annual rate in the last three months of 2012. That had shocked economists.

Thursday's report showed the reasons for the decline were mostly as initially estimated. Inventories subtracted 1.55 percentage points from the GDP growth rate during the period, a little more of a drag than initially estimated. Defense spending plunged 22 percent, shaving 1.28 points off growth as in the previous estimate.

There were some relatively bright spots, however. Imports fell 4.5 percent during the period, which added to the overall growth rate because it was a larger drop than in the third quarter. Buying goods from foreigners bleeds money from the economy, subtracting from economic growth.

Also helping reverse the initial view of an economic contraction, exports did not fall as much during the period as the government had thought when it released its advance GDP estimate in January. Exports have been hampered by a recession in Europe, a cooling Chinese economy and storm-related port disruptions.

Excluding the volatile inventories component, GDP rose at a revised 1.7 percent rate, in line with expectations. These final sales of goods and services had been previously estimated to have increased at a 1.1 percent pace.

Business spending was revised to show more growth during the period than initially thought, adding about a percentage point to the growth rate.

Growth in home building was revised slightly higher to show a 17.5 percent annual rate. Residential construction is one of the brighter spots in the economy and is benefiting from the Federal Reserve's ultra easy monetary policy stance, which has driven mortgage rates to record lows. (Reporting by Jason Lange; Editing by Andrea Ricci)
 

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