Northeast blizzard: 5 dead, thousands without power

New York/Boston—

A record-breaking blizzard packing hurricane-force winds hammered the northeastern United States on Saturday, cutting power to 700,000 homes and businesses, shutting down travel and leaving at least five people dead.

The mammoth storm that stretched from the Great Lakes to the Atlantic dumped more than 3 feet of snow across the Northeast, the National Weather Service said.

Coastal blizzard and flood warnings were in effect, but Massachusetts and Connecticut lifted vehicle travel bans as the storm slowly moved eastward on Saturday afternoon.

Stratford, Connecticut, Mayor John Harkins said he had never seen such a heavy snowfall, with rates reaching 6 inches an hour.

"Even the plows are getting stuck," Harkins told local WTNH television.

The storm centered its fury on Connecticut, Rhode Island and Massachusetts, with the highest snowfall total, 38 inches, in Milford, Connecticut.

About 2,200 flights were canceled on Saturday, according to FlightAware, which tracks airline delays. Boston's Logan International Airport and Bradley International Airport in Windsor Locks, Connecticut, were shut down.

The storm dumped 29.3 inches of snow on Portland, Maine, breaking a 1979 record, the weather service said. Winds gusted to 83 miles per hour (134 km per hour) at Cuttyhunk, New York, and brought down trees across the region.

The storm contributed to three deaths in Connecticut, Governor Dannel Malloy told a news conference.

An 80-year-old woman was killed by a hit-and-run driver while clearing her driveway, and a 40-year-old man collapsed while shoveling snow. One man, 73, slipped outside his home and was found dead on Saturday, Malloy said.

A Boston fire official said an 11-year-old boy died from carbon monoxide poisoning. He was overcome by fumes as he sat in a running car to keep warm.

In Poughkeepsie, New York, a man in his 70s was struck and killed on a snowy roadway, local media reported.

A 30-year-old motorist in New Hampshire also died when his car went off the road, but the man's health might have been a factor in the accident, state authorities said.

Police in New York's Suffolk County, some using snowmobiles, rescued hundreds of motorists stuck overnight on the Long Island Expressway, said police spokesman Rich Glanzer.

Even as the big storm's force was slackening, the National Weather Service forecast a possible blizzard in the Great Plains.

Snow and, in some areas, blizzard conditions were expected across parts of Colorado, Nebraska, North Dakota, Minnesota, South Dakota and Wyoming through the weekend into Monday, it said.

POWER LINES DOWN

Utility companies reported about 700,000 customers without electricity across nine states as the wet, heavy snow brought down tree branches and power lines.

The Pilgrim Nuclear Power Plant in Plymouth, Massachusetts, lost power and shut down automatically late on Friday, but there was no threat to the public, the Nuclear Regulatory Commission said.

As the storm tapered off, streets in Cambridge, Massachusetts, were largely quiet except for snowblowers and shoveling. Kevin Tierney, 41, struggled with a snowblower to carve out a parking space in more than 2 feet of snow.

"I had this all planned out, and I don't know who said it, but everybody goes into a boxing match with a plan until they get punched in the mouth," said Tierney, an attorney.

Massachusetts, Rhode Island, Connecticut, New York and Maine declared states of emergency before the storm. The U.S. Postal Service suspended mail delivery in parts of those five states plus New Hampshire and Vermont.

Although New York was hit by a foot of snow, Fashion Week went on unfazed as crowds arrived to watch the morning's shows by Ruffian and LaCoste.

Andrea Daney, a digital marketing senior manager for LaCoste, said she was trying to be discreet as she changed from snow boots to high-heeled crushed blue velvet ankle boots.

"I'm calling it the shoe storm of the century," she said. "You have to make adjustments to your outfit."

The snow delighted New England's ski industry after a dry winter that has left green grass visible across much of the region.

Greg Kwasnick, a spokesman for Loon Mountain in Lincoln, New Hampshire, said business was slightly slower than normal on Saturday but likely would pick up in coming days as roads cleared.

"Snow is what it's all about," he said.

(Additional reporting by Scott Malone in Boston, Kevin Gray in Miami, Ellen Wulfhorst in New York, Ian Simpson in Washington, Jason McLure in Maine, Dan Burns in Connecticut, and Dan Lovering and Zach Howard in Massachusetts; Writing by Ian Simpson; Editing by Vicki Allen and Eric Beech)

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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Rosenthal: Chevrolet restores style to Impala name

Because a brand embedded in our subconsciousness can find a space in our garage, the Impala endures.

About 16 million Chevys named for an African antelope have hit the road since 1958. And even though the one you recently returned to the airport rental lot bore little resemblance the one whose "giddy-up" the Beach Boys sang of a half-century ago, General Motors is betting the bloodline still can claim hearts.

A revamped 10th-generation 2014 model is now on display at the just-opened 105th Chicago Auto Show as a prelude to its dealership debut in a few weeks, a bid to re-establish its good name.

"It's always been a great brand name," Russ Clark, director of Chevrolet marketing, said alongside one of the made-over Impalas on the Auto Show floor at McCormick Place. "In fact, when we did research on the name, we found Impala is one of the strongest in terms of consideration and favorable opinion of any name in the industry. A lot of that is heritage. A lot of it is the fact that people say, 'I know people who have had them, and everybody loved them.'"

The brand has been ubiquitous for decades, even if you don't remember the Beach Boys immortalizing the vintage growl of a "four-speed dual-quad Posi-Traction 409" or how Robert Blake's 1970s TV tough guy Baretta drove a rusted-out Impala from '66, the era when Chevrolet could move about 1 million Impala sedans and station wagons a year. My own first car was a four-door V-8 '72 Impala, a powerful and roomy hand-me-down whose weather-beaten body — like the brand's identity — clearly had seen better days by the late '70s and early '80s.

More recent Impalas have hardly been the stuff of song, and it's hard to imagine them inspiring nostalgia. They've been too dully utilitarian to be iconic.

Nonetheless, although sales have slowed, it has been the overall best-seller among big sedans. Three-quarters of those sales have been as fleet vehicles for corporate salespeople, government agencies and rental companies. That means the premium has been on space, reliability and keeping costs down rather than the kind of panache and extras that might foster pride of ownership.

The goal of this Impala overhaul in both four- and six-cylinder iterations — drafting on similar nameplate revivals for models such as Ford's Taurus, Dodge's Charger and Chrysler's 300 — is to flip that 75-25 ratio of fleet sales to retail on its head.

"It makes perfectly good sense on General Motors' part to finally put some style back in the Impala," auto industry analyst Art Spinella, president of CNW Research, explained. "If you have a great brand name, to almost toss it off, treat it as an orphan and send it off to the fleet sales department with bland styling and cheap interiors, that's a disgrace. What they've done is kind of salvage themselves with this.

"It's finally dawned on General Motors that you can sell a consumer car to fleets, but you can't sell a fleet car to consumers. You always keep fleet cars (looking) relatively obscure and you keep the price way down, and that's what General Motors had been doing for years to keep the (Impala sales) volume up. Now they're taking another look. I don't think they've necessarily gone far enough, but it's a step in the right direction."

To wander through the vast Auto Show, which runs through Feb. 18, is to be reminded of how deeply many of us connect to vehicles, starting as children playing with toy trucks and cars. There's a teenage rite of passage when car keys and a license expand the world. Certain makes and models mesh with what played on their radios, the places traveled in them, the stage of life they marked.

That emotional bond doesn't form so easily with a mere box with wheels.

"What was it that made us fall in love with cars in the first place?" Henrik Fisker, executive chairman and co-founder of high-end hybrid carmaker Fisker Automotive, asked the crowd at Thursday's Economic Club of Chicago luncheon. "It struck me that most of us, when we really start to get our heart pumping about cars, it's usually not the cars of today. It's usually the cars of the '50s and '60s."

Road salt, slush and rain were my old '72 Impala's kryptonite. In time, its front bench seat reclined like a La-Z-Boy whenever I hit the gas because the floor beneath had rusted through. Whatever my affection for the vehicle, I could see the road we were on — literally and figuratively — both looking ahead and glancing down.

Thirty years after I traded it in for a sporty red Pontiac with seats that reclined only how and when I wanted, I would not have expected my old flame to generate much heat.

Carmakers, like most marketers, know that even when a brand is disconnected from what it once represented, it still can resonate. The new Impala is neither the muscular car of old nor the generic conveyance of late. Yet Impala means something to would-be buyers, and good or bad, it gives them something to measure this latest version against.

"They have equity in the name and you never get rid of a brand that has a good reputation," Spinella said. "Some people will buy it because it's an Impala. Some people won't. But they'll look at it because it's an Impala and they remember the Impala. It's easier to reintroduce a name than to introduce a name nobody knows."

I can still remember driving around with my friends with no particular place to go, a song on the radio about a horse with no name. If there was a tune about a nameless car, I don't recall it.

philrosenthal@tribune.com

Twitter @phil_rosenthal

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Blizzard slams Northeast

A blizzard slammed into the northeastern United States on Friday, snarling traffic, disrupting thousands of flights and prompting five governors to declare states of emergency in the face of a fearsome snowstorm.

The storm caused a massive traffic pile-up in southern Maine. Organizers of the U.S. sledding championship in that state postponed a race scheduled for Saturday, fearing too much snow for the competition.

The blizzard left about 10,000 along the East Coast without power. Almost 3,500 flights were canceled and officials in Massachusetts and Connecticut closed roads.

Forecasters warned about 2 feet of snow would blanket most of the Boston area with some spots getting as much as 30 inches. The city's record snowfall, 27.6 inches, came in 2003.

"We're seeing heavier snow overspread the region from south to north," said Lance Franck, a meteorologist with the National Weather Service in Taunton, Massachusetts, outside Boston. "As the snow picks up in intensity, we're expecting it to fall at a rate of upwards of two to three inches per hour."

Early Friday evening, officials warned that the storm was just ramping up to full strength, and that heavy snow and high winds would continue through midday on Saturday. The governors of Massachusetts, Rhode Island, Connecticut, New York and Maine declared states of emergency and issued bans on driving by early Friday afternoon.

Authorities ordered nonessential government workers to stay home, urged private employers to do the same, told people to prepare for power outages and encouraged them to check on elderly or disabled neighbors.

People appeared to take the warnings seriously. Traffic on streets and public transportation services was significantly lighter than usual on Friday.

"This is a very large and powerful storm, however we are encouraged by the numbers of people who stayed home today," Boston Mayor Thomas Menino told reporters.

Even so, the storm caused a few accidents, including a 19-vehicle pile-up outside Portland, Maine, that sent one person to the hospital.

Winds were blowing at 35 to 40 miles per hour by Friday afternoon and forecasters expected gusts up to 60 miles per hour as the evening wore on.

Almost 3,500 flights were canceled on Friday, with more than 1,200 planned cancellations for Saturday, according to the website FlightAware.com.

The storm also posed a risk of flooding at high tide to areas still recovering from superstorm Sandy last fall.

"Many of the same communities that were inundated by Hurricane Sandy's tidal surge just about 100 days ago are likely to see some moderate coastal flooding this evening," said New York Mayor Michael Bloomberg.

About one foot of snow was forecast to land on New York City.

Brick Township in New Jersey had crews out building up sand dunes and berms ahead of a forecast storm surge, said Mayor Stephen Acropolis.

Travel became more difficult as the day progressed. Massachusetts started closing its public transportation system at 3:30 p.m. and ordered most drivers off roads by 4 p.m. Connecticut also closed its roads.

The Amtrak railroad suspended service between New York, Boston and points north on Friday afternoon.

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Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

Friday Feb. 8 4:13 p.m. | Updated Thanks for all your responses. You can read about the winner at “Think Like a Doctor: A Confused and Terrified Patient Solved.”

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Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Correction: The patient’s eyes were brown, not blue.

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S&C relay at center of Super Bowl outage

An electrical relay device supplied by Rogers Park's S&C Electric Co. was found to be at the center of the Super Bowl power outage in New Orleans, the company said Friday.

S&C Electric Co. said the outage, which lasted for more than 30 minutes at Sunday's game, happened when the demand for Superdome power exceeding a "trip setting" for its electrical relay.

But the device didn't malfunction, S&C said. Instead, it said it found in testing that system operators didn't account for the amount of power needed at the Superdome. S&C doesn't control the power settings on its equipment.

S&C wouldn't go into more details, but the power provider for Sunday's game was Entergy New Orleans, a unit of Entergy Corp.

In a statement, Entergy said the relay device had functioned properly at other high-profile sporting events, including the Sugar Bowl.

The relay was designed to prevent an outage if a cable connection to the stadium failed.

"S&C continues to work with all those involved to get the system back online, and our customers can continue to rely on the quality and performance of our products," Spokesman Michael Edmonds said in a statement.

S&C equipment is commonly used where high reliability is critical, he said, including data centers for United Parcel Service Inc., drug manufacturing centers and hospitals. The company also works with other stadiums throughout the U.S. and Canada.

Entergy said in a statement that the Superdome relay has been removed and replacement equipment is being examined.

That statement came before a special meeting of the New Orleans City Council's Utility Committee Friday morning to discuss the root cause of the outage.

Immediately after the game, Entergy indicated its equipment was functional and the problem must have come from the Superdome, but later said it was launching an investigation to determine the source of the problem.

"While some further analysis remains, we believe we have identified and remedied the cause of the power outage and regret the interruption that occurred during what was a showcase event for the city and state," Entergy New Orleans President and CEO Charles Rice said.

sbomkamp@tribune.com | Twitter: @SamWillTravel

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Snow to hit evening commute

A winter storm warning has been issued for Lake and McHenry counties, with heavy wet snow falling at the rate of one to two inches an hour in some northern suburbs.

Some areas, such as Gurneee, had 5 inches by 4 p.m. Those areas are expected to get 6 to 8 inches of snow by the time the storm moves out overnight, according to National Weather Service meteorologist Bill Nelson..

“Parts of Cook and DuPage counties will see around 2 to 5 inches,” Nelson said. Areas farther south will see only an inch or two.

As of 4:30 p.m. the Chicago put out 199 of its snow and salt trucks and expected to patrol main streets throughout the evening rush.

The Illinois Tollway also has mobilized its full fleet of 182 snowplows during rush hour and throughout the evening across the 286-mile system, according to a release.

By 4 p.m., Gurnee had 5 inches, Beach Park 4.6 inches, Wadsworth 4.5 inches, Kenosha 4.3 inches, Spring Grove 4 inches, Beach Park 3.1 inches, Antioch 2.8 inches and Bull Valley 2.1 inches.

North and northwest suburbs were seeing numerous accidents, from Barrington to Antioch, according to Traffic.com.

In McHenry County, police were warning motorists to avoid U.S. Route 31 between Crystal Lake and McHenry because the road was "impassable" where it crosses over a hill.

State police said expressways were largely clear but the weather service warned of a slow evening commute.

"The threat for a period of heavy snow could result in reduced visibilities under a mile at times and rapid accumulation on area roads during the evening commute," the weather service warned.

Photos: Chicago winter 2012-13

Still, the storm was nothing like the one barreling toward New England with forecasts of up to two feet of snow. A blizzard warning has been issued for New York City, Connecticut and the Boston area.

Forecasters warned the snow would begin lightly on Friday morning but ramp up to blizzard conditions by afternoon, leading Boston Mayor Thomas Menino to order the city's schools closed Friday. He asked businesses to consider allowing staff to stay home.

"We are hardy New Englanders, let me tell you, and used to these types of storms. But I also want to remind everyone to use common sense and stay off the streets of our city. Basically, stay home," Menino told reporters. "Stay put after noontime tomorrow."

The National Weather Service said Boston could get one to two feet of snow on Friday and Saturday, which would be its first major snow fall in about two years. Light snow is expected to begin falling around 7 a.m. EST on Friday, with heavier snow and winds gusting as high as 60 to 75 miles per hour as the day progresses.

"It's the afternoon rush-hour time frame into the evening and overnight when the height of the storm will be," said Kim Buttrick, a meteorologist at the National Weather Service in Taunton, Massachusetts. "That's when we expect the storm to begin in earnest."

The heaviest snow was expected around Boston, the region's most populous city, with cities from Hartford, Connecticut to Portland, Maine, expected to see at least a foot.

If more than 18.2 inches of snow fall in Boston, the storm will rank among the 10 biggest snowfalls on record in the city. The heaviest snowfall ever recorded in Boston was a 27.6 inch dump that accompanied the blizzard of February 17-18, 2003.

The storm's timing brought back memories of the blizzard of 1978, Boston's second-heaviest recorded snow fall, which roared in on an afternoon, dropping 27.1 inches of snow, trapping commuters on roadways and leaving dozens dead across the region, largely as a result of downed electrical lines.

Peter Judge, a spokesman for the Massachusetts Emergency Management Agency, said one of the state's biggest worry is power outages.

"It being winter, folks losing their power means they're also losing their heat, and if you lose heat during the middle of the storm, you're not going to be able to go out to get to a shelter," he said, adding that the agency would begin 24-hour operations at its emergency compound at noon (1700 GMT) on Friday and would be in close contact with local utilities.

Unlike the 1978 blizzard, which had been forecast to drop far less snow than it actually did, he said he hoped several days of news coverage about this storm would prompt people to stay off the roads.

"People have been warned, they have been told what the issues are," Judge said. "We don't expect people to be surprised."

Reuters contributed to this report.

chicagobreaking@tribune.com

Twitter: @chicagobreaking

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Well: The 'Monday Morning' Medical Screaming Match

I did not think I would ever see another “morbidity and mortality” conference in which senior doctors publicly attacked their younger colleagues for making medical errors. These types of heated meetings were commonplace when I was a medical student but have largely been abandoned.

Yet here they were again on “Monday Mornings,” a new medical drama on the TNT network, based on a novel by Dr. Sanjay Gupta, CNN’s chief medical correspondent and one of the executive producers of the show. Such screaming matches may make for good television, but it is useful to review why new strategies have emerged for dealing with medical mistakes.

So-called M&M conferences emerged in the early 20th century as a way for physicians to review cases that had either surprising outcomes or had somehow gone wrong. Although the format varied among institutions and departments, surgery M&Ms were especially known for their confrontations, as more experienced surgeons often browbeat younger doctors into admitting their errors and promising to never make them again.

Such conferences were generally closed door — that is, attended only by physicians. Errors were a private matter not to be shared with other hospital staff, let alone patients and families.

But in the late 1970s, a sociology graduate student named Charles L. Bosk gained access to the surgery department at the University of Chicago. His resultant 1979 book, “Forgive and Remember,” was one of the earliest public discussions of how the medical profession addressed its mistakes.

Dr. Bosk developed a helpful terminology. Technical and judgment errors by surgeons could be forgiven, but only if they were remembered and subsequently prevented by those who committed them. Normative errors, which called into question the moral character of the culprit, were unacceptable and potentially jeopardized careers.

Although Dr. Bosk’s book was more observational than proscriptive, his depiction of M&M conferences was disturbing. I remember attending a urology M&M as a medical student in which several senior physicians berated a very well-meaning and competent intern for a perceived mistake. The intern seemed to take it very well, but my fellow students and I were shaken by the event, asking how such hostility could be conducive to learning.

There were lots of angry accusations in the surgical M&Ms in the pilot episode of “Monday Mornings.” In one case, a senior doctor excoriated a colleague who had given Tylenol to a woman with hip pain who turned out to have cancer. “You allowed metastatic cancer to run amok for four months!” he screamed.

If this was what Dr. Bosk would have called a judgment error, the next case raised moral issues. A neurosurgeon had operated on a boy’s brain tumor without doing a complete family history, which would have revealed a disorder of blood clotting. The boy bled to death on the operating table. “The boy died,” announced the head surgeon, “because of a doctor’s arrogance.”

In one respect, it is good to see that the doctors in charge were so concerned. But as the study of medical errors expanded in the 1990s, researchers found that the likelihood of being blamed led physicians to conceal their errors. Meanwhile, although doctors who attended such conferences might indeed not make the exact same mistakes that had been discussed, it was far from clear that M&Ms were the best way to address the larger problem of medical errors, which, according to a 1999 study, killed close to 100,000 Americans annually.

Eventually, experts recommended a “systems approach” to medical errors, similar to what had been developed by the airline industry. The idea was to look at the root causes of errors and to devise systems to prevent them. Was there a way, for example, to ensure that the woman with the hip problem would return to medical care when the Tylenol did not help? Or could operations not be allowed to occur until a complete family history was in the chart? Increasingly, hospitals have put in systems, such as preoperative checklists and computer warnings, that successfully prevent medical errors.

Another key component of the systems approach is to reduce the emphasis on blame. Even the best doctors make mistakes. Impugning them publicly — or even privately — can make them clam up. But if errors are seen as resulting from inadequate systems, physicians and other health professionals should be more willing to speak up.

Of course, the systems approach is not perfect. Studies continue to show that physicians conceal their mistakes. And elaborate systems for preventing errors can at times interfere with getting things done in the hospital.

Finally, it is important not to entirely remove the issue of responsibility. Sad to say, there still are physicians who are careless and others who are arrogant. Even if today’s M&M conferences rarely involve screaming, supervising physicians need to let such colleagues know that these types of behaviors are unacceptable.

---

Barron H. Lerner, M.D., professor of medicine at New York University Langone Medical Center, is the author, most recently, of “One for the Road: Drunk Driving Since 1900.”

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EveryBlock shuts down

Hyper local news and social media site EveryBlock.com has shut down, the company said Thursday.

"Though EveryBlock has been able to build an engaged community over the years, we're faced with the decision to wrap things up," a item on the EveryBlock.com blog said.

The posting said Everyblock faced increasing challenges to build a profitable business. It had 10 employees, including President Brian Addison.

The company was founded in 2007 by Naperville native Adrian Holovaty and acquired by MSNBC.com in 2009. NBC News acquired MSNBC.com last year.

NBC News Chief Digital Officer Vivian Schiller said EveryBlock's financial losses "were considerable," although she declined to offer specific financial results.

"Hyper local is a very tough business. This isn't about anything being a failure, but more about our need to stay focused on the strengths of NBC News' digital portfolio," she added in an email.

Schiller said the company looked for various options for EveryBlock, such as a sale, but none of the options ended up being viable.

"EveryBlock was among the more innovative and ambitious journalism projects at a time when journalism desperately needed innovation and ambition. RIP," Holovaty wrote Thursday in a blog post on his site Holovaty.com.

Holovaty wrote that he believes EveryBlock, founded with the help of a $1.1 million grant from the John S. and James L. Knight Foundation, was a successful attempt to push innovation in newspapers and journalism.

"It was a great site, beautifully designed and lovingly crafted. It made a difference for people, particularly in Chicago," he wrote.

Holovaty left the site in August to pursue other interests.

Hyper local sites in general have surged in popularity in recent years, but with the success came an explosion of competitors, making generating revenue extremely difficult. In 2007, about 1 in 8 Americans lived in a town with a local blog, according to data from Placeblogger.com, which indexes local weblogs. Today, more than half do.

Still, limited revenue streams make for a shaky future.

"Most of these companies have the structural integrity of a wet cardboard box," said Lisa Williams, Placeblogger's founder and CEO.

Williams said the sudden shutdown of EveryBlock and others like highlights the boom-and-bust cycles in technology businesses, but also underscores the impatience of the big companies who acquire them.

"Whenever someone invests in you there's always a ticking clock attached to money," she said. "It's a very high-turn business. You have to either get big or get out."

In the Chicago area, hyper local news has proved itself to be a competitive and challenging niche, with both local and out-of-town organizations trying to gain traction.

The Chicago News Cooperative, which had a publishing deal with the New York Times, closed down in 2012 after a little more than two years. AOL's Patch has had a rough time, with one investor estimating last year that the national collection of hyperlocal sites, including dozens in Illinois, lost $147 million in 2011.

Tribune Co.  partnered last year with Journatic, a Chicago-based company, to provide hyperlocal content for the Chicago Tribune's TribLocal.  Tribune Co. then suspended Journatic over ethical lapses, and after a lengthy investigation resumed limited use of Journatic with added safeguards.

The Chicago Tribune also at one time hosted a search box on its web site that directed readers to EveryBlock data.

sbomkamp@tribune.com | Twitter: @SamWillTravel

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Cops: Salon bandit was paying for cocaine habit

Jason Logsdon, 41, of Evanston has been charge with 11 counts of armed robbery.

The man accused of holding up hair salons in Chicago and the suburbs used a BB gun, picked places where there would be no male workers, and told police the robberies paid for his crack cocaine habit, authorities say.

Jason Logsdon, 41, also used his girlfriend's car during at least one of the robberies, which finally led to his arrest this week, police said. He was tracked down in Skokie after someone at his last robbery on the North Side of Chicago provided a partial license plate number, authorities said.

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Police said they recovered the BB gun along with a red coat that the Evanston man wore during the robberies.

Logsdon is accused of robbing a hair salon in Broadview, five in Chicago, one in Morton Grove, two in Niles and two in Skokie. The DuPage County state’s attorney’s office is pursuing additional charges against Logsdon for two robberies in Lombard, one in Glen Ellyn and one in Bensenville, officials said.

Logsdon, wearing a blue long-sleeved shirt and jeans, kept his head lowered during a hearing where Judge Marcia Orr ordered him held without bond. "I am considering the number of crimes in the short time in which they were committed," she said.

His public defender described Logsdon as a student at Le Cordon Bleu College of Culinary Arts in Chicago. He was expecting to graduate in February, according to his lawyer. A spokesman at the school said he could not confirm or deny that information.

Logsdon is unemployed but has worked as a chef before, his lawyer said. He has lived in Evanston four years. He was arrested in 2003 for a DUI in Missouri, but otherwise has a clean record, lawyers said.

Logsdon was arrested after a salon in the Wicker Park neighborhood was hit. A man stole about $250 in cash from the Great Clips salon in the 1200 block of a well-trafficked North Ashland Avenue around 10:45 a.m. Monday, police said.

The man brandished a handgun before presenting a dark bag to three salon workers, which one of them filled with money, Chicago Police News Affairs Officer Daniel O'Brien said. Wearing a red and gray jacket, blue jeans and a hat and scarf, the man walked north on Ashland and hopped in a gray colored sedan, which left driving southbound, police said.

No one was injured, police said.

A witness from that robbery provided a license plate number that was one digit off, according to Brian Baker, Skokie’s commander in charge of the investigative division.

Chicago police ran variations on the number until they found a vehicle with a similar make and model as reported by the witness. The woman who owned the car had “no knowledge that these (robberies) were occurring,” Baker said.

chicagobreaking@tribune.com

Twitter: @ChicagoBreaking

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Kiefer Sutherland named Hasty Pudding Man of the Year

LOS ANGELES (TheWrap.com) – Kiefer Sutherland has gained his share of accolades throughout his acting career, but none quite like this.

The “24″ star has been named 2013′s Man of the Year by Harvard University‘s Hasty Pudding Theatricals student society, succeeding “The Muppets” actor Jason Segel, who received the honors last year.

Sutherland will be feted with a roast on Friday at Harvard’s Farkas Hall, where he will receive his ceremonial Pudding Pot. If Hasty Pudding tradition is any indication, Sutherland will also dress at least partially in women’s clothes at some point during the event. Which is presumably a rare event for the actor.

“Inception” actress Marion Cotillard, who was named 2013′s Woman of the Year by the theatrical society, was honored at a January 13 ceremony, during which she led a parade through the streets of Cambridge, Mass.

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Personal Health: Effective Addiction Treatment

Countless people addicted to drugs, alcohol or both have managed to get clean and stay clean with the help of organizations like Alcoholics Anonymous or the thousands of residential and outpatient clinics devoted to treating addiction.

But if you have failed one or more times to achieve lasting sobriety after rehab, perhaps after spending tens of thousands of dollars, you’re not alone. And chances are, it’s not your fault.

Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free. Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse.

According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives. People typically do more research when shopping for a new car than when seeking treatment for addiction.

A groundbreaking report published last year by the National Center on Addiction and Substance Abuse at Columbia University concluded that “the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.” The report added, “Only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works.”

The Columbia report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors suggested that such insufficient care could be considered “a form of medical malpractice.”

The failings of many treatment programs — and the comprehensive therapies that have been scientifically validated but remain vastly underused — are described in an eye-opening new book, “Inside Rehab,” by Anne M. Fletcher, a science writer whose previous books include the highly acclaimed “Sober for Good.”

“There are exceptions, but of the many thousands of treatment programs out there, most use exactly the same kind of treatment you would have received in 1950, not modern scientific approaches,” A. Thomas McLellan, co-founder of the Treatment Research Institute in Philadelphia, told Ms. Fletcher.

Ms. Fletcher’s book, replete with the experiences of treated addicts, offers myriad suggestions to help patients find addiction treatments with the highest probability of success.

Often, Ms. Fletcher found, low-cost, publicly funded clinics have better-qualified therapists and better outcomes than the high-end residential centers typically used by celebrities like Britney Spears and Lindsay Lohan. Indeed, their revolving-door experiences with treatment helped prompt Ms. Fletcher’s exhaustive exploration in the first place.

In an interview, Ms. Fletcher said she wanted to inform consumers “about science-based practices that should form the basis of addiction treatment” and explode some of the myths surrounding it.

One such myth is the belief that most addicts need to go to a rehab center.

“The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually,” she wrote.

Contrary to the 30-day stint typical of inpatient rehab, “people with serious substance abuse disorders commonly require care for months or even years,” she wrote. “The short-term fix mentality partially explains why so many people go back to their old habits.”

Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism, said in an interview, “You don’t treat a chronic illness for four weeks and then send the patient to a support group. People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it.”

Dr. Willenbring now practices in St. Paul, where he is creating a clinic called Alltyr “to serve as a model to demonstrate what comprehensive 21st century treatment should look like.”

“While some people are helped by one intensive round of treatment, the majority of addicts continue to need services,” Dr. Willenbring said. He cited the case of a 43-year-old woman “who has been in and out of rehab 42 times” because she never got the full range of medical and support services she needed.

Dr. Willenbring is especially distressed about patients who are treated for opioid addiction, then relapse in part because they are not given maintenance therapy with the drug Suboxone.

“We have some pretty good drugs to help people with addiction problems, but doctors don’t know how to use them,” he said. “The 12-step community doesn’t want to use relapse-prevention medication because they view it as a crutch.”

Before committing to a treatment program, Ms. Fletcher urges prospective clients or their families to do their homework. The first step, she said, is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with the program you are considering.

Check on the credentials of the program’s personnel, who should have “at least a master’s degree,” Ms. Fletcher said. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine.

Does the facility’s approach to treatment fit with your beliefs and values? If a 12-step program like A.A. is not right for you, don’t choose it just because it’s the best known approach.

Meet with the therapist who will treat you and ask what your treatment plan will be. “It should be more than movies, lectures or three-hour classes three times a week,” Ms. Fletcher said. “You should be treated by a licensed addiction counselor who will see you one-on-one. Treatment should be individualized. One size does not fit all.”

Find out if you will receive therapy for any underlying condition, like depression, or a social problem that could sabotage recovery. The National Institute on Drug Abuse states in its Principles of Drug Addiction Treatment, “To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems.”

Look for programs using research-validated techniques, like cognitive behavioral therapy, which helps addicts recognize what prompts them to use drugs or alcohol, and learn to redirect their thoughts and reactions away from the abused substance.

Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, “Get Your Loved One Sober,” with co-author Brenda L. Wolfe. It helps addicts adopt a lifestyle more rewarding than one filled with drugs and alcohol.

This is the first of two articles on addiction treatment.

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Chicago sees surge in foreclosure auctions

More than 35,000 homes and small multifamily buildings in the Chicago area completed the foreclosure process last year, the highest number since the housing crisis began, and the vast majority of them became bank-owned.

An increase in foreclosure auctions was expected since lenders shelved many foreclosure cases while state and federal authorities investigated allegations of faulty foreclosure processes. Still, the heightened level of auctions — 35,244 in 2012, compared with 20,281 in 2011 — along with an increase in initial foreclosure filings, shows the local housing market has a long road to recovery, according to the Woodstock Institute.

"There's going to be pain in the housing market in the short term," said Katie Buitrago, senior policy and communications associate at Woodstock. "There's still high levels of filings. Five years into it, there is still work to be done to help people save their homes."

The Chicago-based public policy and research group is expected to release its report on 2012 foreclosure activity Wednesday.

The year-end numbers show that, with few exceptions, all Chicago neighborhoods and suburban communities saw high double-digit percentage gains in auctions last year. Across the six-county area, 91.3 percent of the foreclosed properties were repossessed by lenders. At the same time, notices of initial default sent to homeowners, the first step in the foreclosure process, increased by 2.9 percent last year, to 66,783.

Real estate agents have worried for more than two years about a glut of foreclosed properties — a shadow inventory — that banks would list for sale en masse and cause home values to plunge. That largely has not happened, but the vast number of distressed properties in the market has kept a lid on local home values.

On Tuesday, for instance, Fannie Mae and Freddie Mac's websites listed 2,415 Cook County homes for sale that the two agencies had repossessed.

Chicago-area home prices, including distressed sales, fell 2.3 percent in December from a year ago, housing analytics firm CoreLogic said Tuesday. Illinois was one of only four states to see home-price depreciation.

The increase in auctions "is a mixed blessing," Buitrago said. "We've been having a lot of trouble in the region with vacant properties that have been languishing for years. The longer they're vacant, the more likely they are to be a destabilizing force in their communities."

Woodstock found that within the city of Chicago, there were 20 communities where more than 1 in 10 owner-occupied one- to four-unit residential buildings and condos went through foreclosure from 2008 to 2012. Five of those neighborhoods are included in the city's 18-month-old Micro-Market Recovery Program, a coordinated effort to stabilize neighborhoods and property values hit hard by foreclosures and vacant buildings.

Also designed to benefit hard-hit areas are the recent establishment of a Cook County Land Bank and legislation waiting for Gov. Pat Quinn's signature that will fast-track the foreclosure process for vacant, abandoned homes while providing financial resources to foreclosure prevention efforts.

mepodmolik@tribune.com

Twitter @mepodmolik

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Fast-moving snow band hitting area, may slow evening commute

CAPTIONS

Rock salt
Rock salt does its job at Sheridan Road Granville Avenue as snow falls in the Edgewater neighborhood on Chicago's North Side. (Phil Velasquez, Chicago Tribune /February 4, 2013)

Staff report

5:06 p.m. CST, February 5, 2013

A fast-moving storm dumped as much as 1-1/2 inches of snow on parts of the Chicago area this afternoon, but had largely moved on before 5 p.m., according to the National Weather Service.

The weather service had predicted snowfalls of an inch or two, falling as quickly as an inch or more an hour. In McHenry County, a weather spotter reported 1-1/2 inches falling between noon and 2:45 p.m., according to the weather service. But many parts of the Chicago area reported less than half an incho of snow.

This morning, State Police responded to a high number of spinouts, including several in the inbound express lanes of the Dan Ryan Expressway 43rd Street around 5:30 a.m.  Officials closed the express lanes so a transportation crew could spread salt.

This afternoon's snow led to some accidents, but no great rash of them.

Temperatures today are expected to hover in the 30s. Snow or rain is expected to return Thursday morning.

chicagobreaking@tribune.com

Twitter: @ChicagoBreaking

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Focus buys Jeremy Renner as Award-winning journalist Gary Webb

NEW YORK (TheWrap.com) – Focus Features has acquired the worldwide rights to “Kill the Messenger,” an upcoming film starring Jeremy Renner as prize-winning journalist Gary Webb, according to a Focus spokeswoman.

Focus will distribute the film domestically and sell it internationally, initiating the deal making at the European Film Market in Berlin later this week.

Michael Cuesta will direct the film from a script by Peter Landesman. Cuesta has made a quartet of films and directed several episodes of successful TV series “Six Feet Under,” “Dexter” and “Homeland.”

Webb’s life took a turn for the worse after what should have been a major professional breakthrough. He wrote a series for the San Jose Mercury News exposing how the CIA permitted Nicaragua’s Contra rebels to smuggle cocaine into the United States. The contras then used the profits to fund a war against the leftist Nicaraguan government. Webb also drew a link between the influx of cocaine and the rise of crack cocaine, a drug that devastated many American cities in the 1980s.

Webb was on the staff of the Mercury News when it won the Pulitzer Prize for General News Reporting for its 1989 coverage of the Bay Area earthquake. However, his 1996 “Dark Alliance” series about the CIA and the Contras generated significant controversy, prompting the Mercury News to back away from it and alienating Webb from the journalistic community.

Webb shot himself to death in 2004.

Renner will both play Webb and produce with Don Handfield and Scott Stuber. The film was once set-up at Universal, making the acquisition by the studio’s specialty label something of a homecoming for the project.

Deadline first reported Focus’ involvement.

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Well: Warning Too Late for Some Babies

Six weeks after Jack Mahoney was born prematurely on Feb. 3, 2011, the neonatal staff at WakeMed Hospital in Raleigh, N.C., noticed that his heart rate slowed slightly when he ate. They figured he was having difficulty feeding, and they added a thickener to help.

When Jack was discharged, his parents were given the thickener, SimplyThick, to mix into his formula. Two weeks later, Jack was back in the hospital, with a swollen belly and in inconsolable pain. By then, most of his small intestine had stopped working. He died soon after, at 66 days old.

A month later, the Food and Drug Administration issued a caution that SimplyThick should not be fed to premature infants because it may cause necrotizing enterocolitis, or NEC, a life-threatening condition that damages intestinal tissue.

---

Catherine Saint Louis speaks about using SimplyThick in premature infants.

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Experts do not know how the product may be linked to the condition, but Jack is not the only child to die after receiving SimplyThick. An F.D.A. investigation of 84 cases, published in The Journal of Pediatrics in 2012, found a “distinct illness pattern” in 22 instances that suggested a possible link between SimplyThick and NEC. Seven deaths were cited; 14 infants required surgery.

Last September, after more adverse events were reported, the F.D.A. warned that the thickener should not be given to any infants. But the fact that SimplyThick was widely used at all in neonatal intensive care units has spawned a spate of lawsuits and raised questions about regulatory oversight of food additives for infants.

SimplyThick is made from xanthan gum, a widely-used food additive on the F.D.A.’s list of substances “generally recognized as safe.” SimplyThick is classified as a food and the F.D.A. did not assess it for safety.

John Holahan, president of SimplyThick, which is based in St. Louis, acknowledged that the company marketed the product to speech language pathologists who in turn recommended it to infants. The patent touted its effectiveness in breast milk.

However, Mr. Holahan said, “There was no need to conduct studies, as the use of thickeners overall was already well established. In addition, the safety of xanthan gum was already well established.”

Since 2001, SimplyThick has been widely used by adults with swallowing difficulties. A liquid thickened to about the consistency of honey allows the drinker more time to close his airway and prevent aspiration.

Doctors in newborn intensive care units often ask non-physician colleagues like speech pathologists to determine whether an infant has a swallowing problem. And those auxiliary feeding specialists often recommended SimplyThick for neonates with swallowing troubles or acid reflux.

The thickener became popular because it was easy to mix, could be used with breast milk, and maintained its consistency, unlike alternatives like rice cereal.

“It was word of mouth, then neonatologists got used to using it. It became adopted,” said Dr. Steven Abrams, a neonatologist at Texas Children’s Hospital in Houston. “At any given time, several babies in our nursery — and in any neonatal unit — would be on it.”

But in early 2011, Dr. Benson Silverman, the director of the F.D.A.’s infant formula section, was alerted to an online forum where doctors had reported 15 cases of NEC among infants given SimplyThick. The agency issued its first warning about its use in babies that May. “We can only do something with the information we are provided with,” he said. “If information is not provided, how would we know?”

Most infants who took SimplyThick did not fall ill, and NEC is not uncommon in premature infants. But most who develop NEC do so while still in the hospital. Some premature infants given SimplyThick developed NEC later than usual, a few after they went home, a pattern the F.D.A. found unusually worrisome.

Even now it is not known how the thickener might have contributed to the infant deaths. One possibility is that xanthan gum itself is not suitable for the fragile digestive systems of newborns. The intestines of premature babies are “much more likely to have bacterial overgrowth” than adults’, said Dr. Jeffrey Pietz, the chief of newborn medicine at Children’s Hospital Central California in Madera.

“You try not to put anything in a baby’s intestine that’s not natural.” If you do, he added, “you’ve got to have a good reason.”

A second possibility is that batches of the thickener were contaminated with harmful bacteria. In late May 2011, the F.D.A. inspected the plants that make SimplyThick and found violations at one in Stone Mountain, Ga., including a failure to “thermally process” the product to destroy bacteria of a “public health significance.”

The company, Thermo Pac, voluntarily withdrew certain batches. But it appears some children may have ingested potentially contaminated batches.

The parents of Jaden Santos, a preemie who died of NEC while on SimplyThick, still have unused packets of recalled lots, according to their lawyer, Joe Taraska.

The authors of the F.D.A. report theorized that the infants’ intestinal membranes could have been damaged by bacteria breaking down the xanthan gum into too many toxic byproducts.

Dr. Qing Yang, a neonatologist at Wake Forest University, is a co-author of a case series in the Journal of Perinatology about three premature infants who took SimplyThick, developed NEC and were treated. The paper speculates that NEC was “most likely caused by the stimulation of the immature gut by xanthan gum.”

Dr. Yang said she only belatedly realized “there’s a lack of data” on xanthan gum’s use in preemies. “The lesson I learned is not to be totally dependent on the speech pathologist.”

Julie Mueller’s daughter Addison was born full-term and given SimplyThick after a swallow test showed she was at risk of choking. It was recommended by a speech pathologist at the hospital.

Less than a month later, Addison was dead with multiple holes in her small intestine. “It was a nightmare,” said Ms. Mueller, who has filed a lawsuit against SimplyThick. “I was astounded how a hospital and manufacturer was gearing this toward newborns when they never had to prove it would be safe for them. Basically we just did a research trial for the manufacturer.”

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Deficit hits 5-year low, but cuts drag economy

WASHINGTON -- The federal deficit will drop to less than $1 trillion for the first time in five years, but massive spending cuts that have improved the budget outlook are also slowing the economy, according to a report released Tuesday by the Congressional Budget office.

The nonpartisan arbiter of federal budgets said the combination of new tax revenue from the "fiscal cliff" deal as well as looming cuts that kick in March 1 will push the deficit down to $845 billion for fiscal 2013. Deficits have topped $1 trillion in recent years.

The projections will fuel the coming budget debates, which started Tuesday as President Obama was calling on Congress to steer around the coming budget cuts.

The budget office said the cuts will contribute to an economy that lags in 2013. The unemployment rate likely will remain above 7.5% through the year. It predicted that the gross domestic product will be well below its potential, growing by just 1.4%, more than half a percentage point slower than would happen if the spending cuts were averted.

At the same time, the nation's debt load is expected to fluctuate but ultimately rise to record levels this decade, largely because of increased spending on healthcare and the federal safety net for older Americans with the aging of the baby boom population.

Additionally, the outlook shows how difficult it will be for House Republicans to accomplish their goal of balancing the budget in 10 years with potentially deep austerity measures.

Even though revenue is rising and spending is decreasing, the overall budget outlook remains stark. By the end of the decade, public debt is set to rise to 77% of GDP, a decade of highs on par with debt levels in World War II.

"The projected path of the federal budget remains a significant concern," the CBO wrote.

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Lisa.mascaro@latimes.com

Twitter: @LisaMascaroinDC

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Alabama hostage standoff ends with gunman dead, boy safe

MIDLAND CITY, Ala. -- A man who killed a school bus driver and then held a 5-year-old boy hostage in an underground bunker in rural Alabama for nearly a week was killed on Monday and the child was plucked to safety without injury, law enforcement officials said.

FBI agents entered the bunker to rescue the child after fearing that he was in “imminent danger,” said Steve Richardson, special agent in charge in Mobile.

Negotiations with the suspect, identified as 65-year-old Jimmy Lee Dykes, had deteriorated during the previous 24 hours, Richardson said during a televised news conference.

“Mr. Dykes was observed holding a gun,” the FBI agent said.

The rescue of the boy came on the seventh day of a standoff that drew national media coverage and gripped a rural corner of southeast Alabama with dread.

The drama began when Dykes, a retired trucker and veteran of the war in Vietnam, seized the kindergarten student last Tuesday after boarding a school bus and killing its driver with four shots from a 9 mm handgun, local sheriff's department officials said.

Dykes fled with the child, identified only as Ethan, to a homemade bunker on the man's property down a dirt road.

The child was being treated on Monday at a local hospital, but was physically unharmed, Richardson said. The boy is due to celebrate his birthday on Wednesday and, by all accounts, was taken by Dykes at random.

It was not immediately clear how Dykes died.

A local law enforcement source said a stun or flash grenade was detonated as part of the operation to free the boy, but further details were not immediately released.

The hostage-taking came amid heightened concerns about gun violence and school safety across the United States after the December shooting deaths of 20 children and six adults at a Connecticut elementary school.

Law enforcement officials had offered few insights about Dykes and their negotiations with him ahead of the rescue just after 3 p.m. local time.

Earlier on Monday, Dale County Sheriff Wally Olson said the gunman had a “very complex” story to tell.

“Based on our discussion with Mr. Dykes, he feels like he has a story that's important to him, although it's very complex. And we try to make a safe environment for all for that,” Olson said, without elaborating.

The sheriff's office previously had thanked Dykes for allowing them to deliver medication, coloring books and toys to the boy, who is said to suffer from Asperger's Syndrome and attention deficit-hyperactivity disorder.

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Live action: Twitter grabs Super Bowl spotlight

NEW YORK (AP) — Beyonce’s splashy show, a freak power outage, and —oh, yeah— a captivating game of football combined to generate a record 24.1 million posts on Twitter during Sunday night’s Super Bowl.

That’s up from 13.7 million last year — and that doesn’t even include chatter surrounding the ads.

Twitter said in a late Sunday blog post that about half of the more than 50 national TV spots that aired during the game included a “hashtag,” a word or phrase preceded by a number sign that’s used to organize subjects on the short messaging site. During last year’s game, only one in five ads included one. Brands ranging from Oreo to Tide and Budweiser, meanwhile, captured online buzz by linking the blackout to their brands in humorous tweets.

Super Bowl XLVII, like the London Summer Olympics and the U.S. presidential election, was yet another moment in which Twitter became the platform for millions of people to share quick reactions and participate in a massive, public conversation. Though it’s not as popular as Facebook Inc. or its buttoned-up cousin LinkedIn Corp., Twitter’s surging popularity during big events is a testament to its reach and utility. The question is whether these moments can translate into revenue for the 7-year-old company.

The company makes money by charging advertisers to promote individual tweets, accounts or trends designed to spark a conversation. Research firm eMarketer estimates that Twitter will book advertising revenue of $ 545.2 million this year, up 89 percent from 2012. Next year, worldwide ad revenue is expected to hit $ 807.5 million, a 48 percent increase from 2013.

Tweetable events such as the 34-minute Super Bowl power outage are ripe with marketing potential, provided that brands act quickly.

“It’s really clear right now that Twitter has a lock on real-time conversation on the Internet,” says eMarketer analyst Debra Aho Williamson.

To capitalize on this, Twitter has to show advertisers that it pays to promote their tweets — even though fans are likely to spread the catchiest slogans on their own, free of charge.

That’s what happened with a certain cream-filled cookie on Sunday.

It took Oreo’s marketers roughly 10 minutes after the power went out to tweet a picture of an Oreo cookie in the half-dark with the words: “You can still dunk in the dark.” As of Monday afternoon, the image had been shared on Twitter more than 15,000 times. Tide followed suit with the slogan “we can’t get your blackout. But we can get your stains out” with more limited success. The message was re-tweeted about 1,300 times. Calvin Klein, meanwhile, tweeted a video of a shirtless, chiseled male model doing crunches “since the lights are still out…”

Such “real-time marketing” is still in its infancy, but Williamson expects this to change, as more companies develop the ability to respond to events immediately.”

“To do what Oreo did actually takes a lot of pre-planning,” she says.

Laurie Guzzinati, spokeswoman for Oreo owner Mondelez says the power outage was a natural moment to engage consumers. The cookie’s TV ad had a planned social media component asking people to follow Oreo on Twitter and post photos on Instagram. The company had set up a “social media command center” that included people from Oreo’s brand team, the ad agency 360i and other partners whose job was to follow the Super Bowl and interact with fans on Facebook, Twitter and elsewhere.

Mondelez likely spent the going rate of as much as $ 4 million on its Super Bowl television spot. But Guzzinati says the company didn’t pay Twitter anything for the “dunk in the dark” picture. Still, Twitter says advertisers moved quickly following the outage.

Matt McGee, editor-in-chief of the blog Marketing Land, counted 26 Twitter mentions in the 52 national spots that aired during the game. Facebook, meanwhile, got only four shout-outs, while Google Plus walked away with zero (though Google Inc.’s YouTube scored one mention from Hyundai).

“When it comes to second-screen advertising, it’s Twitter’s world now and there’s no close second place,” McGee wrote in a blog post late Sunday night. “Last year, brands split their focus on Twitter and Facebook with eight mentions each. This year, brands recognize that Twitter is where they need to try to attract the online conversation around one of the world’s biggest events.”

David Berkowitz, vice president of emerging media at 360i, which worked on the Oreo campaign, says Twitter has done a good job tying itself into major television events.

“If you look at (Twitter’s) trending topics any day especially during prime time or major events, they’re heavily fueled by television,” he says. “So TV is responsible for Twitter’s growth in general.”

He thinks Twitter has done a better job than other social media sites like Tumblr and Pinterest in proving it’s the place to be when it comes to talking about big events online.

“A large part of it right now is just showing this is where the conversation is happening and building their brand around that,” he says. “Even with other very successful social media sites, no one is better at conversation than Twitter.”

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AP Retail Writer Mae Anderson contributed to this story.

Social Media News Headlines – Yahoo! News

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