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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White House, Republicans dig in ahead of budget talks

Speaker of the House John Boehner tells Scott Pelley in a "CBS Evening News" interview that a budget deal is now out of his hands.

WASHINGTON—

Positions hardened on Wednesday between President Barack Obama and Republican congressional leaders over the budget crisis even as they arranged to hold last-ditch talks to prevent harsh automatic spending cuts beginning this week.

Looking resigned to the $85-billion in "sequestration" cuts starting on Friday, government agencies began reducing costs and spelling out to employees how furloughs will work.

Expectations were low that a White House meeting on Friday between Obama and congressional leaders, including Republican foes, would produce any deal to avoid the cuts.

Public services across the country - from air traffic control to food safety inspections and education - might be disrupted if the cuts go ahead.

Put into law in 2011 as part of an earlier fiscal crisis, sequestration is unloved by both parties because of the economic pain it will cause, but the politicians cannot agree how to stop it.

A deal in Congress on less drastic spending cuts, perhaps with tax increases too, is needed by Friday to halt the sequestration reductions which are split between social programs cherished by Democrats and defense spending championed by Republicans.

Obama stuck by his demand that Republicans accept tax increases in the form of eliminating tax loopholes enjoyed mostly by the wealthy as part of a balanced approach to avoiding sequestration.

"There is no alternative in the president's mind to balance," White House spokesman Jay Carney told reporters.

Obama wants to end tax breaks for oil and gas companies and the lower "carried interest" tax rate enjoyed by hedge funds.

But Republicans who reluctantly agreed to raise income tax rates on the rich to avert the "fiscal cliff" crisis in December are in no mood for that.

"One thing Americans simply will not accept is another tax increase to replace spending reductions we already agreed to," said Senate Republican leader Mitch McConnell.

In one of the first concrete effects of the cuts, the administration took the unusual step of freeing several hundred detained illegal immigrants because of the cost of holding them.

Republicans described that move by Immigration and Customs Enforcement as a political stunt aimed at scaring them into agreeing to end the sequestration on Obama's terms.

Carney denied the White House had ordered the release.

Friday's White House meeting will include McConnell and the other key congressional leaders: Senate Democratic leader Harry Reid, House of Representatives Democratic leader Nancy Pelosi, and House Speaker John Boehner, the top U.S. Republican.

'BELATED FARCE'?

But the chances of success were not high.

One congressional Republican aide criticized the White House for calling the meeting for the day the cuts were coming into effect. "Either someone needs to buy the White House a calendar, or this is just a - belated - farce. They ought to at least pretend to try."

Unlike during other fiscal fights in Congress, the stock market is taking the sequestration impasse calmly.

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Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative. M.R.I. helped pay for previous vaccination campaigns in the country and the GAVI Alliance is helping to finance the upcoming one.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

This article has been revised to reflect the following correction:

Correction: February 27, 2013

An earlier version of this article misstated the source of the vaccine and some financing for the campaign. The vaccine and financing is being provided by the GAVI Alliance, not the Measles and Rubella Initiative.

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Author tells businesses to be like Mike

CAPTIONS

MJ in 1982
Michael Jordan in his college days with teammates Matt Doherty (44) and Sam Perkins and coach Dean Smith. (AP photo by Robert Willett /October 14, 1982)

By Samantha Bomkamp




Tribune reporter

10:11 a.m. CST, February 27, 2013

An author of a new book has some sage advice for business leaders: Be more like Michael Jordan.

Bruce Piasecki, who penned "Doing More with Teams: The New Way to Winning," says Michael Jordan's long and storied career "is a shining example of how the best teams operate."

Jordan shouldn't be emulated just because of the Bulls star's individual success, the author says, but by the way he showed leadership and helped create a seemingly unstoppable team, meshing with different personalities such as the quiet Scottie Pippen and outrageous Dennis Rodman to create a basketball dynasty.

Those team dynamics are similar in the business world, the author says. And businesses are most successful when they are led by the right leaders and are composed of a mix of people with varying talents, he argues.

Jordan also is held up as an example in other tenets of good business teamwork the author describes.

-- Ego and individual goals have no place on teams.

"When we pin all our hopes on a single individual and ignore the context in which he or she operates, we will be disappointed," he says.

--  Failure is part of winning.

"Leaders must instill in teams a tolerance of losing," he said. "We must convey that failure is a part of life and thus a part of business."

Jordan, who helped the Chicago Bulls win six NBA championships, famously said "I've failed over and over and over again in my life, and that is why I succeed."

The book is set to be released next month but is available for pre-order on Amazon.com.

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Winter storm: Lake, McHenry could see 10 inches of snow

Chicago's midday full weather forecast. (WGN - Chicago)

A winter storm warning for up 6 to 10 inches of snow was issued for Lake and McHenry Counties, and a winter weather advisory for other Chicago-area counties has been extended into Wednesday as a strong storm made travel hazardous and grounding hundreds of flights.

The National Weather Service expected the heaviest snow to fall this afternoon, but some heavy snow is expected to fall into the early evening, with accumulations of up to 10 inches in north suburbs by daybreak, according to the winter storm warning for Lake and McHenry counties. An advisory issued late this afternoon for Cook, DuPage, Kane and other northern Illinois counties called for up to 7 inches by late evening. Winds gusting at 35 to 40 mph will reduce visibility and glaze roads, the weather service warned in the advisory.

"Snowfall rates in excess of an inch per hour could occur at times, along with wind whipped snow resulting in temporary white out conditions with near zero visibility at times in open areas," according to the advisory. "This will likely be a heavy wet snow sometimes referred to as heart attack snow."

By a little before 5:30 p.m., the weather service was reporting these snowfall accumulations: 6.4 inches in Northbrook; 5.2 inches in Streamwrood; and 4.5 inches in Winnetka.

Earlier, about 4:30 p.m., the weather service had reported these snowfall accumulations: 5.5 inches in northwest suburban Bull Valley, 5 inches in north suburban Lake Bluff, 4.9 inches in northwest suburban Elk Grove Village, 4 inches in northwest suburban South Elgin and Schaumburg, 3.3 inches in west suburban Winfield, 1.8 inches in north suburban Morton Grove, and 1.5 inches at Midway International Airport and southwest suburban Romeoville.

About 600 flights have been canceled at O'Hare International Airport and about 170 at Midway, according to FlightStats, which gathers data from airports and airlines. There were about 734 flights delayed at O'Hare and 118 at Midway.

On the roads, spinouts have been reported on interstates 90, 94 and 55, according to the Illinois State Police.

The Illinois State Police Chicago District has instituted its emergency snow plan. In an accident where there are no injuries and the cars are driveable, the drivers should exchange information at a safe place and file accident reports with the state police within 10 days.

Chicago's Streets and Sanitation Department has deployed its entire fleet of 284 plows. Drivers will plow the main roads, such as Lake Shore Drive, through the evening rush hour. As the snow begins to taper off, the plows will clear residential roads, said department spokeswoman Anne Sheahan.

Extra plows are being deployed to the 2ndCongressional District to help residents get to their polling places for today's primary election, Sheahan said.

Road conditions were treacherous throughout the southwest suburbs, especially along Interstates 55 and 80 in Will County, police and fire officials said.

Several vehicles have slipped into ditches along I-55 near Plainfield, especially near U.S. Route 30, said Jon Stratton, a deputy chief with the Plainfield Fire Protection District.  "On I-55, there are vehicles everywhere in the ditch," Stratton said. "Visibility is going down and roads are getting all snow covered, so it's going to be an interesting day."

The most serious accident in the area so far today occurred when an SUV slid under a semi's trailer on the Route 30 overpass over I-55, Stratton said.

Firefighters extricated the woman who was driving the SUV, and she was taken by ambulance to Provena Saint Joseph Medical Center in Joliet, Stratton said. The woman was conscious and stable when removed from the SUV, he said.

A school bus carrying about 35 elementary students collided with a plow truck in Plainfield around 4 p.m., but no injuries were reported, officials said.

In fact, the students from Plainfield's Central Elementary School seemed to be more excited by the firefighters and police officers who responded than startled by the crash, said Stratton.

"They were all happy to see us, waving out the windows," he said.

The crash occurred near the intersection of Mill Street and Plainfield Naperville Road, Stratton said. The bus suffered minor damage to its front-end but appeared to be drivable, Stratton said. The plow truck, a pickup, was operated by a private company or contractor, he said.

A school official came to the scene after the collision to help check on the students, Stratton said.

Stratton also said road conditions have gradually improved in the Plainfield area as the afternoon has gone on. Most primary roads are in good shape, he said, but many secondary roads are still snow-covered.

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Advanced Breast Cancer May Be Rising Among Young Women, Study Finds

The incidence of advanced breast cancer among younger women, ages 25 to 39, may have increased slightly over the last three decades, according to a study released Tuesday.

But more research is needed to verify the finding, which was based on an analysis of statistics, the study’s authors said. They do not know what may have caused the apparent increase.

Some outside experts questioned whether the increase was real, and expressed concerns that the report would frighten women needlessly.

The study, published in The Journal of the American Medical Association, found that advanced cases climbed to 2.9 per 100,000 younger women in 2009, from 1.53 per 100,000 women in 1976 — an increase of 1.37 cases per 100,000 women in 34 years. The totals were about 250 such cases per year in the mid-1970s, and more than 800 per year in 2009.

Though small, the increase was statistically significant, and the researchers said it was worrisome because it involved cancer that had already spread to organs like the liver or lungs by the time it was diagnosed, which greatly diminishes the odds of survival.

For now, the only advice the researchers can offer to young women is to see a doctor quickly if they notice lumps, pain or other changes in the breast, and not to assume that they cannot have breast cancer because they are young and healthy, or have no family history of the disease.

“Breast cancer can and does occur in younger women,” said Dr. Rebecca H. Johnson, the first author of the study and medical director of the adolescent and young adult oncology program at Seattle Children’s Hospital.

But Dr. Johnson noted that there is no evidence that screening helps younger women who have an average risk for the disease and no symptoms. “We’re certainly not advocating that young women get mammography at an earlier age than is generally specified,” she said.

Expert groups differ about when screening should begin; some say at age 40, others 50.

Breast cancer is not common in younger women; only 1.8 percent of all cases are diagnosed in women from 20 to 34, and 10 percent in women from 35 to 44. However, when it does occur, the disease tends to be more deadly in younger women than in older ones. Researchers are not sure why.

The researchers analyzed data from SEER, a program run by the National Cancer Institute to collect cancer statistics on 28 percent of the population of the United States. The study also used data from the past when SEER was smaller.

The study is based on information from 936,497 women who had breast cancer from 1976 to 2009. Of those, 53,502 were 25 to 39 years old, including 3,438 who had advanced breast cancer, also called metastatic or distant disease.

Younger women were the only ones in whom metastatic disease seemed to have increased, the researchers found.

Dr. Archie Bleyer, a clinical research professor in radiation medicine at the Knight Cancer Institute at the Oregon Health and Science University in Portland who helped write the study, said scientists needed to verify the increase in advanced breast cancer in young women in the United States and find out whether it is occurring in other developed Western countries. “This is the first report of this kind,” he said, adding that researchers had already asked colleagues in Canada to analyze data there.

“We need this to be sure ourselves about this potentially concerning, almost alarming trend,” Dr. Bleyer said. “Then and only then are we really worried about what is the cause, because we’ve got to be sure it’s real.”

Dr. Johnson said her own experience led her to look into the statistics on the disease in young women. She had breast cancer when she was 27; she is now 44. Over the years, friends and colleagues often referred young women with the disease to her for advice.

“It just struck me how many of those people there were,” she said.

Dr. Donald A. Berry, an expert on breast cancer data and a professor of biostatistics at the University of Texas’ M. D. Anderson Cancer Center in Houston, said he was dubious about the finding, even though it was statistically significant, because the size of the apparent increase was so small — 1.37 cases per 100,000 women, over the course of 30 years.

More screening and more precise tests to identify the stage of cancer at the time of diagnosis might account for the increase, he said.

“Not many women aged 25 to 39 get screened, but some do, but it only takes a few to account for a notable increase from one in 100,000,” Dr. Berry said.

Dr. Silvia C. Formenti, a breast cancer expert and the chairwoman of radiation oncology at New York University Langone Medical Center, questioned the study in part because although it found an increased incidence of advanced disease, it did not find the accompanying increase in deaths that would be expected.

A spokeswoman for an advocacy group for young women with breast cancer, Young Survival Coalition, said the organization also wondered whether improved diagnostic and staging tests might explain all or part of the increase.

“We’re looking at this data with caution,” said the spokeswoman, Michelle Esser. “We don’t want to invite panic or alarm.”

She said it was important to note that the findings applied only to women who had metastatic disease at the time of diagnosis, and did not imply that women who already had early-stage cancer faced an increased risk of advanced disease.

Dr. J. Leonard Lichtenfeld
, deputy chief medical officer of the American Cancer Society, said he and an epidemiologist for the society thought the increase was real.

“We want to make sure this is not oversold or that people suddenly get very frightened that we have a huge problem,” Dr. Lichtenfeld said. “We don’t. But we are concerned that over time, we might have a more serious problem than we have today.”

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JPMorgan to eliminate 4,000 jobs in 2013

JPMorgan Chase & Co. plans to cut 3,000 to 4,000 jobs in its consumer bank in 2013, representing about 1.5 percent of the company's overall workforce, as the bank tries to improve the profitability of its branches.

The cuts will come mainly through attrition, spokeswoman Kristin Lemkau said. The bank's branches have 63,500 employees, representing about a quarter of JPMorgan Chase's total employees.

JPMorgan is one of the few big U.S. banks that is still adding branches to its network, but to boost profit it plans to scale back the tellers it has on hand for routine transactions and to add some salespeople for products and services like wealth management that can boost revenue.

The net effect will be to reduce staff per branch by 20 percent through 2015, the company's head of consumer banking, Ryan McInerney, said in a presentation to investors.

In JPMorgan Chase's mortgage business, the company reiterated its previously announced plans to shed 13,000 to 15,000 jobs by 2014.

JPMorgan Chase had 5,614 branches at the end of 2012, and plans to increase its network by about 100 branches a year, it said. Chase's U.S. branch network is second to Wells Fargo & Co's in size.

The bank is hoping to focus on selling more to wealthy depositors. Its average consumer checking account has a balance of $4,276, and about half of all affluent U.S. households are within two miles a Chase branch or automated teller machine, the bank said.

JPMorgan Chase overall earned $21.9 billion last year, excluding accounting charges linked to changes in the value of its debt. The bank said it has the potential to earn about $27.5 billion, thanks in part to efficiency gains. It aims to cut overall expenses by $1 billion in 2013.

For overall staffing levels, JPMorgan Chase had 258,965 employees globally at the end of 2012. Its headcount rose following the financial crisis, to 262,882 in the second quarter of 2012 from 219,569 in the first quarter of 2009. Since last year's second quarter, staffing levels have drifted lower.

JPMorgan Chase shares were down 1.3 percent at $47.08 on Tuesday morning on the New York Stock Exchange.
 

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Woman freed after conviction in son's death tossed

Nicole Harris, who has been locked up since the 2005 death of her son, walked out of an Illinois prison today after an appeals court threw out her murder conviction.

Harris emerged from Dwight Correctional Center in front of a gathering of news crews after being reunited with her other son.

"I'm just overwhelmed and I'm thankful that's it's going to be over and I just want to be home with my son," Harris told the assembled media.

"I'm just ready to get on with my life and hold my son."

The Chicago woman was 23 when a jury found her guilty of killing her 4-year-old son Jaquari in their Northwest Side apartment following her confession to authorities. But Harris has long maintained that her confession was false and the result of threats and manipulation by police.

She said today that she was able to make it through the past seven years knowing that "I'm innocent and the truth will come out."

"It was like at some point I just knew this isn't it, that this was not my final destination."

In a 90-page ruling last October that vacated her conviction, the 7th Circuit U.S. Court of Appeals said there were "many reasons" to question her confession.

The appeal judges also ruled that Diante, then 5, should have been allowed to testify.

Now 14, Diante was the first person to meet Harris when she was released into an outer room of the prison at about 11:30 a.m. today.  Diante walked in bearing a balloon that read, "It's your Day" and a teddy bear. Harris threw her arms around him, wept softly and kissed him.

When asked later what it was like to see her son at that time, she said, "There are no words."

At exactly noon, a prison official told Harris she was "free to go." She clutched hands with a close friend and walked out of the prison. She had been told to get her things together around 8:30 a.m. this morning, she told the media, and said that, at that time, "I was beyond anxious."

Jaquari had been found dead with an elastic bedsheet cord wrapped around his neck. Diante had told authorities that he was alone with Jaquari when he saw him wrap the cord around his neck while playing.

Prosecutors, who argued that Diante also said he was asleep when Jaquari died, accused Harris of strangling Jaquari with the cord because she was angry he would not stop crying.

Harris' release, which the state argued against, is not the end of legal battle. The state has appealed the October ruling, asking the U.S. Supreme Court to review the case. In addition, Cook County prosecutors could still move to retry her. A representative from the state's attorney's office said no decision on a retrial has been made.

For now, Harris said, "I just want to enjoy life."

"I'm just glad to be free. I'm just glad to be free."

deldeib@tribune.com

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Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative, which will provide the vaccine and help pay for the campaign.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

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Horsemeat found in IKEA meatballs

PRAGUE/STOCKHOLM (Reuters) - Sweden's Ikea stopped nearly all sales of meatballs at its furniture store cafeterias across Europe after tests in the Czech Republic on Monday showed some contained horsemeat.

The world's No. 1 furniture retailer, known also for the signature restaurants at its huge out-of-town stores, said it was pulling all meatballs produced by its main supplier in Sweden after the tests showed horsemeat in its beef and pork meatballs.

A European scandal erupted last month when tests in Ireland revealed some beef products contained horsemeat, triggering recalls of ready-made meals in several countries and damaging confidence in Europe's vast and complex food industry.

Meatballs, a famous Swedish dish often served with mashed potatoes, gravy and lingonberry jam, have become a trademark for IKEA, which sells them hot from the in-store cafeterias and packaged off the shelf.

The vast majority of Ikea's meatballs are made by Sweden's Familjen Dafgard, which said on its website that it was investigating the situation and would receive further test results in coming days.

The withdrawals did not affect meatballs in Norway, Russia, nor some in Switzerland or Poland, which were made by other suppliers, said Ikea spokeswoman Ylva Magnusson at the company's headquarters in Helsingborg, southern Sweden.

"We are now getting to the bottom of this and making extra tests, but we have decided to stop the meatball sales for a few days, so that no one needs to worry, until we have the results," Magnusson said.

IKEA stores in the United States, Canada, Australia and Japan were unaffected as they too have other suppliers.

Besides the Czech Republic, the batch containing horsemeat had also been on sale in Britain, Portugal, Netherlands, Belgium, Slovakia, Hungary, France, Italy, Spain, Greece, Cyprus and Ireland.

Magnusson said the test results would determine the percentage of horsemeat in the specific batch of meatballs. There was no indication that any other batch had been affected.

Earlier this month, food manufacturer Findus was forced to recall thousands of packages of frozen beef lasagnes in Sweden after discovering they contained 60 to 100 percent horsemeat.

On the sidelines of a meeting in Brussels, Sweden's rural affairs minister Eskil Erlandsson called the test results awful.

"Consumers should know that what is labelled on the package should also be inside the package and nothing else," he told Reuters, adding that it may damage IKEA's reputation.

"All fraud has an impact on the reputation of a company, especially when you talk about meat or other foodstuffs."

However, he did not see a need for the European Union to enforce mandatory origin labels for processed meat.

In Italy, consumer rights group Codacons called for checks on all meat products sold by IKEA in the country.

"We are ready to launch legal action and seek compensation not only against the companies who are responsible but also those whose duty it was to protect citizens," Codacons President Carlo Rienzi said in a statement.

The Czech State Veterinary Administration had reported its findings to the EU's Rapid Alert System for Food and Feed, it said in a statement.

The inspectors took samples for DNA tests in IKEA's unit in the city of Brno from a product labelled as "beef and pork meatballs", it said.

(Additional reporting by Mia Shanley in Stockholm, Maria Pia Quaglia in Milan and Charlie Dunmore in Brussels; Writing by Anna Ringstrom; Editing by Tom Pfeiffer)

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Oscars 2013 live: Rolling out the red carpet

LOS ANGELES -- The Oscars rolled out the red carpet on Sunday for the movie industry's biggest night, with Iran hostage drama "Argo" and presidential drama "Lincoln" in a tight race for Best Picture.

With several contests too close to call, a slate of big box office hits to celebrate and an unpredictable first-time host in Seth MacFarlane, movie fans could be in for surprises when the curtain rises on the 85th annual Academy Awards.

Before the festivities begin, nominees including Jennifer Lawrence, Hugh Jackman, Sally Field, Jessica Chastain, British singer Adele and "Argo" producer George Clooney, along with performers Barbra Streisand and Jennifer Hudson will parade along the 500-ft long (152 meter) red carpet before dozens of photographers and camera crews.

MORE OSCARS: Red carpet pics | Live stream | Oscars trivia quiz

Inside Hollywood's Dolby Theatre, Academy Awards history could be re-written.

Daniel Day-Lewis as U.S. President Abraham Lincoln is considered an unstoppable force to become the first man to win three Best Actor Oscars.

Buzz is building over a possible late upset by France's Emmanuelle Riva, 86, in the Best Actress contest that would make the star of harrowing Austrian entry "Amour" the oldest person ever to win an acting Oscar.

"Lincoln" goes into Sunday's three-hour plus ceremony with a leading 12 nominations, including a directing nod for double Oscar winner Steven Spielberg.

But its front-runner Best Picture status has been dented by the six-week victory streak enjoyed at other Hollywood awards by Ben Affleck's "Argo."

"It's been an interesting year," said Matt Atchity, editor in chief of movie review website Rotten Tomatoes.

"I think 'Argo' probably has the best shot. It's certainly got the momentum. It has won so many top awards, and I think it's probably the movie to beat," Atchity told Reuters.

If "Argo" does prevail for the top prize, it will be the first movie to win Best Picture without its director even getting a nomination since "Driving Miss Daisy" in 1990.

ANNE HATHAWAY OSCAR BOUND

Musical "Les Miserables," comedy "Silver Linings Playbook," shipwreck tale "Life of Pi," Osama bin laden thriller "Zero Dark Thirty," slavery Western "Django Unchained," indie film "Beasts of the Southern Wild," and "Amour" round out the contenders for the best film of 2012.

In other categories, only Anne Hathaway is considered a sure bet to take home a golden statuette after starving herself and chopping off her long brown locks for her supporting turn as tragic heroine Fantine in "Les Miserables."

Awards pundits says Spielberg could lose out in the director's race to Taiwan's Ang Lee for his technical and imaginative feat in filming fantastical adventure "Life of Pi" with a cast of exotic animals.

And the supporting actor Oscar could go to any of the five nominees - Robert De Niro ("Silver Linings Playbook"), Alan Arkin ("Argo"), Christoph Waltz ("Django Unchained"), Tommy Lee Jones ("Lincoln") and Philip Seymour Hoffman ("The Master").

The Oscar winners are chosen in secret ballots by some 5,800 members of the Academy of Motion Picture Arts and Sciences and handed out before an audience of 3,300 guests and tens of millions more watching around the world on television.

After several years of nominating little-seen movies, this year's nine Best Picture contenders have pulled in more than $2 billion in tickets worldwide.

"We are so fortunate to inherit this great group of films that are also popular at the box office ... We just lucked out and had this fantastic year in film," Academy Awards telecast co-producer Neil Meron told Reuters.

Producers are promising a fast-paced show packed with music and big performances. But the man getting the early attention will be MacFarlane, the provocative comedian behind animated TV series "Family Guy" and an unknown quantity as Oscar host.

"We are not going to know what works until we put it out there and see what plays in front of an audience," co-producer Craig Zadan said.

"It's a live show and that is always unpredictable. Once the train has left the station, whatever happens, happens."

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Chris Egan, Tom Ellis cast in ABC’s sexy gothic soap pilot

LOS ANGELES (TheWrap.com) – “Poe” star Chris Egan and “Miranda” actor Tom Ellis are ready to get hot and soapy for ABC.

Egan and Ellis have been cast in the network’s drama pilot “Gothica,” billed as a “sexy gothic soap set in present day that weaves together a mythology that incorporates the legends of Dracula, Jekyll and Hyde, Frankenstein and Dorian Gray among others.”

Egan has been cast in the role of Dorian (presumably, Gray), while Ellis will play Victor (presumably, Frankenstein).

Matt Lopez (“The Sorcerer’s Apprentice,” “Escape to Witch Mountain”) is writing the pilot, which is being produced by ABC Studios and the Mark Gordon Company.

TV News Headlines – Yahoo! News

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The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain

Matt Rainwaters for Texas Monthly

The Sherman grave of Andre Thomas’s victims.

SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org

Matt Rainwaters for Texas Monthly

Laura Boren

He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.

He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.

In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.

Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.

“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.

From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.

bgrissom@texastribune.org

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