Stricken cruise ship reported awash in raw sewage nears port

MOBILE, Alabama—

Reeking of rotting food and sewage from overflowing toilets, a crippled cruise ship carrying more than 4,200 people was limping into Mobile, Alabama, on Thursday as passengers awaited the end of a vacation voyage some described as hellish.

The Carnival Triumph was being towed into port by tugboats as the drama played out live on U.S. cable news stations, creating another public relations nightmare for cruise giant Carnival Corp. Last year, its Costa Concordia luxury ship grounded off the coast of Italy, with 32 people killed.

Passengers described an overpowering stench on board the ship four days after an engine room fire knocked out power and plumbing across most of the 893-foot vessel and left it adrift in the Gulf of Mexico.

After the mishap, toilets overflowed, soaking many cabins and interior passages in raw sewage.

"Let's just say that I had a pair of shoes that I will not be bringing home with me," Julie Morgan told CNN.

"It is revolting," Morgan added, referring to the smell aboard the ship. "It's a mixture of sewage and rotting food."

But Terry Thornton, a senior Carnival Cruise Lines vice president, told reporters in Mobile that additional provisions were laid in on Wednesday and the ship was now "in excellent shape."

Passenger Donna Gutzman said those aboard the ship were treated to steak and lobster for lunch on Thursday afternoon.

"Our basic needs are being met. For the most part, they are making us happy," Gutzman told CNN.

The ship was expected to arrive in port around midnight CST (1.00 a.m. ET on Friday), Carnival said. A senior Carnival official said it could take up to five hours to remove all the passengers from the ship, which has only one functioning elevator.

Carnival Corp spokesman Vance Gulliksen said a tow line on one of four tugboats helping the Triumph get into port snapped on Thursday. But the tug was later reattached to the vessel.

Operated by Carnival Cruise Lines, the flagship brand of Carnival Corp, the ship left Galveston, Texas, a week ago carrying 3,143 passengers and 1,086 crew. It was supposed to return there on Monday.

A Coast Guard cutter has been escorting the Triumph on its long voyage into port since Monday, and a Coast Guard helicopter ferried about 3,000 pounds of equipment including a generator to the stricken ship late on Wednesday.

Earlier in the week, some passengers reported on the poor conditions on the Triumph when they contacted relatives and media before their cell phone batteries died. They said people were getting sick and passengers had been told to use plastic "biohazard" bags as makeshift toilets.

'VERY CHALLENGING CIRCUMSTANCES'

Carnival Cruise Lines Chief Executive Gerry Cahill said in a statement late on Wednesday that the company had decided to add further payment of $500 a person to help compensate passengers for "very challenging circumstances" aboard the ship.

"We are very sorry for what our guests have had to endure," Cahill said.

Mary Poret, who spoke to her 12-year-old daughter aboard the Triumph on Monday, rejected Cahill's apology in comments to CNN on Thursday, as she waited anxiously in Mobile with a friend for the Triumph's arrival.

"Seeing urine and feces sloshing in the halls, sleeping on the floor, nothing to eat, people fighting over food, $500? What's the emotional cost? You can't put money on that," Poret said.

Carnival Corp Chairman and CEO Micky Arison faced criticism in January 2012 for failing to travel to Italy and take personal charge of the Costa Concordia crisis after the luxury cruise shop operated by Carnival's Costa Cruises brand grounded on rocks off the Tuscan island of Giglio. The tragedy unleashed numerous lawsuits against his company.

The cruise ship mogul has taken a low-key approach to the Triumph situation as well, even as it grabbed a growing share of the U.S. media spotlight. His only known public appearance since Sunday was courtside on Tuesday at a game played by his Miami Heat championship professional basketball team.

"I think they really are trying to do the right thing, but I don't think they have been able to communicate it effectively," said Marcia Horowitz, an executive who handles crisis management at Rubenstein Associates, a New York-based public relations firm.

"Most of all, you really need a face for Carnival," she added. "You can do all the right things. But unless you communicate it effectively, it will not see the light of day."

Carnival Corp shares closed down $0.11 at $37.35 in trading on Thursday on the New York Stock Exchange. The shares closed down 4 percent at $37.46 on Wednesday after the company said voyage disruptions and repair costs related to Carnival Triumph could shave up to 10 cents a share off its second-half earnings.

The Triumph is a Bahamian-flagged vessel and the Bahamas Maritime Authority will be the primary agency investigating the cause of its engine room fire.

For all the passengers' grievances, they will likely find it difficult to sue the cruise operator for any damages, legal sources said. Over the years, the cruise industry has put in place a legal structure that ring-fences operators from big-money lawsuits.

Rules for seeking redress are spelled out in complex, multi-page ticket contracts that have been the subject of decades of court battles. Victims are often required to proceed with any litigation in remote jurisdictions.

(Writing and additional reporting by Tom Brown; Editing by Peter Cooney)

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Doctor and Patient: Afraid to Speak Up to Medical Power

The slender, weather-beaten, elderly Polish immigrant had been diagnosed with lung cancer nearly a year earlier and was receiving chemotherapy as part of a clinical trial. I was a surgical consultant, called in to help control the fluid that kept accumulating in his lungs.

During one visit, he motioned for me to come closer. His voice was hoarse from a tumor that spread, and the constant hissing from his humidified oxygen mask meant I had to press my face nearly against his to understand his words.

“This is getting harder, doctor,” he rasped. “I’m not sure I’m up to anymore chemo.”

I was not the only doctor that he confided to. But what I quickly learned was that none of us was eager to broach the topic of stopping treatment with his primary cancer doctor.

That doctor was a rising superstar in the world of oncology, a brilliant physician-researcher who had helped discover treatments for other cancers and who had been recruited to lead our hospital’s then lackluster cancer center. Within a few months of the doctor’s arrival, the once sleepy department began offering a dazzling array of experimental drugs. Calls came in from outside doctors eager to send their patients in for treatment, and every patient who was seen was promptly enrolled in one of more than a dozen well-documented treatment protocols.

But now, no doctors felt comfortable suggesting anything but the most cutting-edge, aggressive treatments.

Even the No. 2 doctor in the cancer center, Robin to the chief’s cancer-battling Batman, was momentarily taken aback when I suggested we reconsider the patient’s chemotherapy plan. “I don’t want to tell him,” he said, eyes widening. He reeled off his chief’s vast accomplishments. “I mean, who am I to tell him what to do?”

We stood for a moment in silence before he pointed his index finger at me. “You tell him,” he said with a smile. “You tell him to consider stopping treatment.”

Memories of this conversation came flooding back last week when I read an essay on the problems posed by hierarchies within the medical profession.

For several decades, medical educators and sociologists have documented the existence of hierarchies and an intense awareness of rank among doctors. The bulk of studies have focused on medical education, a process often likened to military and religious training, with elder patriarchs imposing the hair shirt of shame on acolytes unable to incorporate a profession’s accepted values and behaviors. Aspiring doctors quickly learn whose opinions, experiences and voices count, and it is rarely their own. Ask a group of interns who’ve been on the wards for but a week, and they will quickly raise their hands up to the level of their heads to indicate their teachers’ status and importance, then lower them toward their feet to demonstrate their own.

It turns out that this keen awareness of ranking is not limited to students and interns. Other research has shown that fully trained physicians are acutely aware of a tacit professional hierarchy based on specialties, like primary care versus neurosurgery, or even on diseases different specialists might treat, like hemorrhoids and constipation versus heart attacks and certain cancers.

But while such professional preoccupation with privilege can make for interesting sociological fodder, the real issue, warns the author of a courageous essay published recently in The New England Journal of Medicine, is that such an overly developed sense of hierarchy comes at an unacceptable price: good patient care.

Dr. Ranjana Srivastava, a medical oncologist at the Monash Medical Centre in Melbourne, Australia, recalls a patient she helped to care for who died after an operation. Before the surgery, Dr. Srivastava had been hesitant to voice her concerns, assuming that the patient’s surgeon must be “unequivocally right, unassailable, or simply not worth antagonizing.” When she confesses her earlier uncertainty to the surgeon after the patient’s death, Dr. Srivastava learns that the surgeon had been just as loath to question her expertise and had assumed that her silence before the surgery meant she agreed with his plan to operate.

“Each of us was trying our best to help a patient, but we were also respecting the boundaries and hierarchy imposed by our professional culture,” Dr. Srivastava said. “The tragedy was that the patient died, when speaking up would have made all the difference.”

Compounding the problem is an increasing sense of self-doubt among many doctors. With rapid advances in treatment, there is often no single correct “answer” for a patient’s problem, and doctors, struggling to stay up-to-date in their own particular specialty niches, are more tentative about making suggestions that cross over to other doctors’ “turf.” Even as some clinicians attempt to compensate by organizing multidisciplinary meetings, inviting doctors from all specialties to discuss a patient’s therapeutic options, “there will inevitably be a hierarchy at those meetings of who is speaking,” Dr. Srivastava noted. “And it won’t always be the ones who know the most about the patient who will be taking the lead.”

It is the potentially disastrous repercussions for patients that make this overly developed awareness of rank and boundaries a critical issue in medicine. Recent efforts to raise safety standards and improve patient care have shown that teams are a critical ingredient for success. But simply organizing multidisciplinary lineups of clinicians isn’t enough. What is required are teams that recognize the importance of all voices and encourage active and open debate.

Since their patient’s death, Dr. Srivastava and the surgeon have worked together to discuss patient cases, articulate questions and describe their own uncertainties to each other and in patients’ notes. “We have tried to remain cognizant of the fact that we are susceptible to thinking about hierarchy,” Dr. Srivastava said. “We have tried to remember that sometimes, despite our best intentions, we do not speak up for our patients because we are fearful of the consequences.”

That was certainly true for my lung cancer patient. Like all the other doctors involved in his care, I hesitated to talk to the chief medical oncologist. I questioned my own credentials, my lack of expertise in this particular area of oncology and even my own clinical judgment. When the patient appeared to fare better, requiring less oxygen and joking and laughing more than I had ever seen in the past, I took his improvement to be yet another sign that my attempt to talk about holding back chemotherapy was surely some surgical folly.

But a couple of days later, the humidified oxygen mask came back on. And not long after that, the patient again asked for me to come close.

This time he said: “I’m tired. I want to stop the chemo.”

Just before he died, a little over a week later, he was off all treatment except for what might make him comfortable. He thanked me and the other doctors for our care, but really, we should have thanked him and apologized. Because he had pushed us out of our comfortable, well-delineated professional zones. He had prodded us to talk to one another. And he showed us how to work as a team in order to do, at last, what we should have done weeks earlier.

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Buffet, 3G to buy Heinz for $23B

Warren Buffett's Berkshire Hathaway and private equity firm 3G Capital will buy ketchup and baby food maker H.J. Heinz Co for $23.2 billion in cash, a deal that combines 3G's ambitions in the food industry with Buffett's hunt for growth.

Including debt assumption, Heinz valued the transaction, which it called the largest in its industry's history, at $28 billion. Berkshire and 3G will pay $72.50 per share, a 19 percent premium to the stock's previous all-time high. Heinz shares actually rose slightly above the offer price, although Buffett cautioned he had no intention of raising his bid.

Analysts said the deal could be the first step in a broader wave of mergers for the food and beverage industry.

"Maybe for the consumer staples group in general this may start some talk about consolidation. Even corporate entities are flush with cash, interest rates are low, it would seemingly make sense," Edward Jones analyst Jack Russo said.

Companies like General Mills and Campbell Soup - itself long seen as a potential Heinz merge partner - rose on the news.

BUFFETT HUNTING GROWTH

The surprise purchase satisfies, at least in part, Buffett's hunt for growth through acquisition. He was frustrated in 2012 by the collapse of at least two deals in excess of $20 billion and said he might have to do a $30 billion deal this year to help fuel Berkshire's growth engine. In this case, Berkshire is putting up about $12 billion to $13 billion cash, Buffett told CNBC, leaving it ample room for another major transaction.

Berkshire Hathaway already has a variety of food assets, including the Dairy Queen ice cream chain, chocolatier See's Candies and the food distributor McLane. Buffett, famed for a love of cheeseburgers, joked he was well acquainted with Heinz's products already and that this was "my kind of deal."

It does represent an unusual teaming of Berkshire with private equity, though; historically, Buffett's purchases have been outright his own. He and 3G founder Jorge Paulo Lemann have known each other for years, and Buffett said Lemann approached him with the Heinz idea in December. One Berkshire investor said he had mixed feelings about the deal because of the limited growth prospects domestically.

"We're a little hesitant on the staple companies because they don't have any leverage in the United States," said Bill Smead, chief investment officer of Smead Capital Management in Seattle. But at the same time, he said, Buffett was likely willing to accept a bond-like steady return even if it was not necessarily a "home run."

3G EXPANDS

For 3G, a little-known firm with Brazilian roots, the purchase is something of a natural complement to its investment in fast-food chain Burger King, which it acquired in late 2010 and in which it still holds a major stake. Lemann, a globe-trotting financier with Swiss roots, made his money in banking and gained notoriety for helping to pull together the deals that ultimately formed the beer brewing giant AB InBev.

3G's Alex Behring runs the fund out of New York. He appeared at a Pittsburgh news conference on Thursday with Heinz management to discuss the deal - and to reassure anxious local crowds that the company will remain based there and will continue to support local philanthropy.

But at the same time, Behring said it was too soon to talk about cost cuts at the company. Unlike Berkshire, which is a hands-off operator, 3G is known for aggressively controlling costs at its operations.

PITTSBURGH ROOTS Also to be determined is whether CEO Bill Johnson would stay on. Only the fifth chairman in the company's history, Johnson is widely credited with Heinz's recent strong growth.

"I am way too young to retire," he told the news conference, adding that discussions had not yet started with 3G over the details of Heinz's future management.

The company, known for its iconic ketchup bottles, Heinz 57 sauces as well as other brands including Ore-Ida frozen potatoes, has increased net sales for the last eight fiscal years in a row.

Heinz said the transaction would be financed with cash from Berkshire and 3G, debt rollover and debt financing from J.P. Morgan and Wells Fargo. Buffett told CNBC that Berkshire and 3G would be equal equity partners.

Heinz shares soared 19.9 percent, or $12.06, to $72.54 on the New York Stock Exchange. A week ago the stock hit a long-term high of $61 a share - near records it set in 1998 - having risen almost 5 percent this year and nearly 12 percent since the beginning of 2012.

The deal is also a potential boon for new U.S. Secretary of State John Kerry, whose wife Teresa is the widow of H.J. Heinz Co heir John Heinz.

Kerry's most recent financial disclosures from his time in the U.S. Senate show a position in Heinz shares of more than $1 million, although the precise size is unclear.

Centerview Partners and BofA Merrill Lynch were financial advisers to Heinz, with Davis Polk & Wardwell LLP the legal adviser. Moelis & Company was financial adviser to the transaction committee of Heinz's board and Wachtell, Lipton, Rosen & Katz served as its legal adviser. Lazard served as lead financial adviser. J.P. Morgan and Wells Fargo also served as financial advisers to the investment consortium. Kirkland & Ellis LLP was legal adviser to 3G Capital, and Munger, Tolles & Olson LLP was legal adviser to Berkshire Hathaway.

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Chicago Public Schools narrows its closing list to 129

Chicago Public Schools has narrowed the number of schools it will consider for closing to 129.

The preliminary list will be culled further before a final list is released by March 31.

Schools will be removed from the list as the district continues to gather information from parents, teachers and community groups during a new round of hearings that begin Wednesday night.

The district in December said 330 schools are underutilized, the chief consideration for closing, so the list released Wednesday offers a far better picture of what schools are still on the block.

Most of the targeted schools are on the South, West and Southwest Sides, many in impoverished neighborhoods that saw significant population loss over the last decade.

CPS last month removed high schools and high performing schools from consideratio. On Wednesday, the district told schools with student populations over 600 or utilization rates of at least 70 percent that they also were safe.

“We are going to take these 129 and continue to sift through these schools,” said CPS schools chief Barbara Byrd-Bennett.

Over the next month, CPS will look at schools on the preliminary list in an effort to determine what led to the declines in enrollment, and whether the schools have academic plans in place to drive improvement.

Safety issues connected with moving students to different neighborhoods will also be considered. CPS is working with the Chicago Police Department and using its own data to determine if closing specific schools could jeopardize the safety of students.

CPS says it needs to close a significant number of under-utilized schools to “right-size” the district and address a $1 billion deficit expected next year.

District officials say closings this year will be based primarily on under-enrollment but have begun looking at academic performance as they whittle down their list.

The district has been holding school closing meetings across the city since December. The initial round of meetings were overseen by the Commission on School Utilization, whose recommendations included removing high schools and the best performing schools.

Most of the additional criteria announced Wednesday came out of suggestions made by the commission and gathered during community meetings the district began holding in late January. Byrd-Bennett had asked for more time to study the commission’s recommendations and define parameters like which improving schools should be taken off the list.

Schools in the middle tier of performance, or Level 2, that have seen increased enrollment over the last three years will be removed from consideration. There are 33 Level 2 schools still on the preliminary list.

District officials have also decided to no longer target Level 3 or the worst-performing schools that have shown gains on state assessment tests while serving 300 or more students. Schools that were designated by CPS to take in students from school closings over the past three years or were forced to share their building with another school this year have also been taken off the chopping block.
 
In addition, CPS added a few parameters: Schools separated from another neighborhood school by more than a mile, and schools that are surrounded by neighborhood schools that are at capacity or overcrowded, are no longer targeted for a shut down.

Tribune reporter John Chase contributed to this story.

nahmed@tribune.com

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Phys Ed: Getting the Right Dose of Exercise

Phys Ed

Gretchen Reynolds on the science of fitness.

Fitness Tracker

Marathon, half-marathon, 10k and 5K training plans to get you race ready.

A common concern about exercise is that if you don’t do it almost every day, you won’t achieve much health benefit. But a commendable new study suggests otherwise, showing that a fairly leisurely approach to scheduling workouts may actually be more beneficial than working out almost daily.

For the new study, published this month in Exercise & Science in Sports & Medicine, researchers at the University of Alabama at Birmingham gathered 72 older, sedentary women and randomly assigned them to one of three exercise groups.

One group began lifting weights once a week and performing an endurance-style workout, like jogging or bike riding, on another day.

Another group lifted weights twice a week and jogged or rode an exercise bike twice a week.

The final group, as you may have guessed, completed three weight-lifting and three endurance sessions, or six weekly workouts.

The exercise, which was supervised by researchers, was easy at first and meant to elicit changes in both muscles and endurance. Over the course of four months, the intensity and duration gradually increased, until the women were jogging moderately for 40 minutes and lifting weights for about the same amount of time.

The researchers were hoping to find out which number of weekly workouts would be, Goldilocks-like, just right for increasing the women’s fitness and overall weekly energy expenditure.

Some previous studies had suggested that working out only once or twice a week produced few gains in fitness, while exercising vigorously almost every day sometimes led people to become less physically active, over all, than those formally exercising less. Researchers theorized that the more grueling workout schedule caused the central nervous system to respond as if people were overdoing things, sending out physiological signals that, in an unconscious internal reaction, prompted them to feel tired or lethargic and stop moving so much.

To determine if either of these possibilities held true among their volunteers, the researchers in the current study tracked the women’s blood levels of cytokines, a substance related to stress that is thought to be one of the signals the nervous system uses to determine if someone is overdoing things physically. They also measured the women’s changing aerobic capacities, muscle strength, body fat, moods and, using sophisticated calorimetry techniques, energy expenditure over the course of each week.

By the end of the four-month experiment, all of the women had gained endurance and strength and shed body fat, although weight loss was not the point of the study. The scientists had not asked the women to change their eating habits.

There were, remarkably, almost no differences in fitness gains among the groups. The women working out twice a week had become as powerful and aerobically fit as those who had worked out six times a week. There were no discernible differences in cytokine levels among the groups, either.

However, the women exercising four times per week were now expending far more energy, over all, than the women in either of the other two groups. They were burning about 225 additional calories each day, beyond what they expended while exercising, compared to their calorie burning at the start of the experiment.

The twice-a-week exercisers also were using more energy each day than they had been at first, burning almost 100 calories more daily, in addition to the calories used during workouts.

But the women who had been assigned to exercise six times per week were now expending considerably less daily energy than they had been at the experiment’s start, the equivalent of almost 200 fewer calories each day, even though they were exercising so assiduously.

“We think that the women in the twice-a-week and four-times-a-week groups felt more energized and physically capable” after several months of training than they had at the start of the study, says Gary Hunter, a U.A.B. professor who led the experiment. Based on conversations with the women, he says he thinks they began opting for stairs over escalators and walking for pleasure.

The women working out six times a week, though, reacted very differently. “They complained to us that working out six times a week took too much time,” Dr. Hunter says. They did not report feeling fatigued or physically droopy. Their bodies were not producing excessive levels of cytokines, sending invisible messages to the body to slow down.

Rather, they felt pressed for time and reacted, it seems, by making choices like driving instead of walking and impatiently avoiding the stairs.

Despite the cautionary note, those who insist on working out six times per week need not feel discouraged. As long as you consciously monitor your activity level, the findings suggest, you won’t necessarily and unconsciously wind up moving less over all.

But the more fundamental finding of this study, Dr. Hunter says, is that “less may be more,” a message that most likely resonates with far more of us. The women exercising four times a week “had the greatest overall increase in energy expenditure,” he says. But those working out only twice a week “weren’t far behind.”

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Feds OK insurance exchange partnership

Health and Human Services Secretary Kathleen Sebelius on Wednesday said her department conditionally approved Illinois’ plan to operate a health insurance exchange in a partnership with the federal government, a widely expected move that makes the state the third to receive the official go ahead. 

Sebelius plans to make the announcement Wednesday afternoon at a West Side clinic alongside Gov. Pat Quinn, Sebelius said the approval will allow the state and the federal government to continue work on readying the online marketplace for Oct. 1, when uninsured Illinoisans can begin signing up for health insurance offered under the 2010 health care overhaul law.

Under the partnership model, Illinois will maintain its responsibility for regulating the insurance market, a function that will allow the state to tailor the types of private health insurance plans offered through the exchange. Illinois also will be in charge of customer assistance, which will allow it to conduct outreach efforts and aid people in signing up.

The federal government is responsible for building and operating the exchange.

Illinois becomes the third state to have its partnership plan approved, following Delaware and Arkansas. A handful of other states, including Iowa, Michigan, West Virginia and New Hampshire, also are interested in the partnership model. Other states have opted to set up and run their own exchanges, while a majority refused to participate, relying on the federal government to do so.

Sebelius is in town through Thursday to meet with several large stakeholders, including union leaders, clergy and community groups, to raise awareness about the forthcoming exchanges, a spokesman said.

The exchanges are a crucial part of the government's plan to expand the number of Americans who have some form of health insurance.

Eventually, an estimated 20 million people will benefit from federal tax credits starting in 2014 that will help offset the cost of paying for insurance premiums. Even so, the government estimates that about 6 million Americans will not sign up and will start paying tax penalties in 2014.

In the first year, those penalties are relatively modest, starting at $95 for adults and $47.50 per child. But they’re expected to increase in future years, eventually totaling nearly $7 billion in 2016, an average fine of about $1,200 per person.

While states were given the option of setting up and running their own exchanges, only 18 chose to do so, with most of the rest opting to allow the federal government to operate them, at least in the beginning.

Julie Hamos, director of the state Department of Healthcare and Family Services, has said she hopes to get legislation passed this spring to authorize a purely state-run exchange that will be up and ready in time for open enrollment for 2015.

Meanwhile, consumers can expect a marketing blitz during the summer and into the fall touting the exchanges, which will serve individuals who are not eligible for Medicare or Medicaid and not offered health insurance through their employers.

pfrost@tribune.com | Twitter: @peterfrost

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Ex-cop shootout: 1 deputy killed, 1 wounded, sources say

Christopher Dorner was engaged in a shootout with federal authorities in the Big Bear area Tuesday, a law enforcement source told The Times.

Los Angeles Times

5:53 p.m. CST, February 12, 2013

One of the deputies involved in a gun battle Tuesday afternoon with fugitive former police officer Christopher Dorner has died of his wounds, law enforcement sources told The Times.

The San Bernardino County sheriff's deputy was airlifted to Loma Linda University Medical Center, where he was pronounced dead, according to the sources. 

Another deputy was also wounded in the shootout near a cabin where Dorner was believed to be holed up in the snow-covered mountains near Big Bear. His condition was not immediately known.

The afternoon gun battle in which hundreds of rounds were exchanged was part of a quickly changing situation that began after Dorner allegedly broke into a home, tied up a couple and held them hostage before fleeing with their white pickup truck, authorities said. 

Then Dorner was allegedly spotted by state Fish and Wildlife officers in the pickup truck, sources said. A vehicle-to-vehicle shootout ensued. The officer's vehicle was peppered with multiple rounds, according to authorities.

Dorner crashed his vehicle and took refuge in a nearby cabin, sources said. One deputy was hit as Dorner fired out of the cabin and a second deputy was injured when Dorner exited the back of the cabin, deployed a smoke bomb and opened fire again in an apparent attempt to flee. Dorner was driven back inside the cabin, the source said.

He remained inside the cabin Tuesday afternoon as officers swarmed the site.

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Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

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Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

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Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

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Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

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This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

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Chicago leads nation in gas-price spikes

Drivers in Chicago are seeing a painful rise in gas prices get even worse this month.

The average price of regular unleaded in the Chicago metro area on Tuesday is $3.93, according to AAA. That's up 12 cents from a week ago. A month ago, the average was $3.42. Statewide, the average is about $3.79, up 8 cents from last week and 46 cents last month.

Prices are rising at pumps across the country, too, but not as dramatically. The national average is $3.60, up about 7 cents from a week ago and 30 cents higher than this time last month.

It's not typical to see gas price spikes at this time of year. Demand is typically low and picks up in the spring before driving season. And in general, gas is cheaper to produce in the winter because refineries can use less expensive blends.

The main reason for the spike is the higher price of crude oil. The price of oil has gone from around $85 a barrel in December to around $97 now because of improving economic certainty as the country moved past the election and the fiscal cliff deadline, according to energy analyst Phil Flynn. It's also being driven by better-than-expected growth in China, the world's second largest economy.

Prices in the Chicago area are typically some the highest in the nation, but the cost of a local fill-up is accelerating at almost double the national rate.

Flynn attributes this to a number of refinery issues in the region. Some scheduled maintenance at refineries -- where gasoline and other products are produced from oil -- occurred earlier than usual, which cut off some supply, affecting prices. Many close at this time of year to start the switchover to lower-emission summer blends of gasoline.

Besides a major overhaul of BP's Whiting refinery, the largest supplier of gasoline to Midwest markets, that's believed to be driving prices higher, a fire temporarily shut down a refinery in northwest Ohio.

AAA, which tracks daily gasoline prices around the country, predicts they will continue their rapid climb as local refinery issues continue into the beginning of peak driving season.

Flynn is more optimistic.

He believes that once the major Whiting refinery overhaul is complete later this year, gas prices will stabilize.

"I'm probably in the minority but I think we are starting to see some light at the end of the tunnel," he said.

sbomkamp@tribune.com | Twitter: @SamWillTravel

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Cardinal George praises pope's 'courage' in resigning

Cardinal Francis George said he was as surprised as everyone else when Pope Benedict XVI announced he was stepping down, saying he saw the pontiff briefly last week in Rome and “there was not the slightest indication in my mind.”

But George added during a news conference that Benedict "looks like a man who’s feeling the weight of his years.”

The cardinal, who will return to Rome to elect a new pope, said Benedict's public role was a particular burden.

"It the public role that the most effort for him and takes the most energy from him," George said, calling Benedict an introvert. "He gets tired in big crowds. . .The teaching, the decision-making [is] relatively easy in comparison to the public role."

Earlier, in a statement, George said Benedict "placed the will of God for the good of the church before every other consideration" when he decided to resign.

"He has taught with clarity and charity what God has revealed to the world in Christ, he has handed on the apostolic faith, he has loved all of God’s people with all his heart," George said in a statement. "He has now shown great courage in deciding, after prayer and soul-searching, to resign his office at the end of this month.
 
"With the gratitude of sons and daughters in our hearts, we ask the Lord to bless him and give him strength, as we begin to pray now for the one who will succeed him as Bishop of Rome, Successor of Peter and Vicar of Christ."

Joliet Bishop Daniel Conlon said the pope's decision "is consistent with the humble disposition that I have come to recognize in him, both in my brief personal encounters with him and in his deportment generally as earthly shepherd of the church.

"He recognized that he no longer had the physical gifts necessary to carry out an office that becomes increasingly demanding," Conlon said. "He has been a steady and calm presence in the face of tumult in the world.  He has persevered in Blessed John Paul II’s determination to confront the scandal of child abuse in the church."

Benedict shocked the world by saying he no longer had the mental and physical strength to cope with his ministry, in an announcement that left his aides "incredulous" and will make him the first pontiff to step down since the Middle Ages.

The German-born pope, 85, admired as a hero by conservative Roman Catholics and viewed with suspicion by liberals, told cardinals in Latin that his strength had deteriorated recently. He will step down on Feb. 28 and the Vatican expects a new Pope to be chosen by the end of March.

Vatican spokesman Father Federico Lombardi said the pope had not decided to resign because of "difficulties in the papacy" and the move had been a surprise, indicating that even his inner circle was unaware that he was about to quit.

A priest at St. Peter's Church in the Loop said the news is "surprising but not terrifying," saying it will allow the church to continue to renew itself.

“It’s a new beginning and a chance for new energy in the church,” said the Rev. Ed Shea. "This is good news.”

The selection of a new pope will offer the church the chance to continue its emergence into the “the modern light, the modern world,” Shea said. 

It will also provide a chance to choose a pope from Africa or South America, he said, to reflect the growth of the church on those continents.

“I was shocked, like everybody else,” Father Ed Shea said.  “It kind of surprised me that we didn’t know about it ahead of time.”

As worshipers left a morning mass at St. Peter’s this morning, several said the pope’s announcement had caught them completely by surprise.

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