The New Old Age Blog: Grief Over New Depression Diagnosis

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

Traditionally, depression has been underdiagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” We don’t find depression in old age normal any longer.

But critics of the D.S.M. 5 now argue that depression may become overdiagnosed, because this version removes the so-called “bereavement exclusion.” That was a paragraph that cautioned against diagnosing depression in someone for at least two months after loss of a loved one, unless that patient had severe symptoms like suicidal thoughts.

Without that exception, you could be diagnosed with this disorder if you are feeling empty, listless or distracted, a month after your parent or spouse dies.

“D.S.M. 5 is medicalizing the expected and probably necessary process of mourning that people go through,” said Allen Francis, a professor emeritus at Duke who chaired the D.S.M. IV task force and has denounced several of the changes in the new edition. “Most people get better with time and natural healing and resilience.”

If they are diagnosed with major depression before that can happen, he fears, they will be given antidepressants they may not need. “It gives the drug companies the right to peddle pills for grief,” he said.

An advisory committee to the Association for Death Education and Counseling also argued that bereaved people “will receive antidepressant medication because it is cheaper and ‘easier’ to medicate than to be involved therapeutically,” and noted that antidepressants, like all medications, have side effects.

“I can’t help but see this as a broad overreach by the APA,” Eric Widera, a geriatrician at the University of California, San Francisco, wrote on the GeriPal blog. “Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.”

But Dr. Kupfer said the panel worried that with the exclusion, too many cases of depression could be overlooked and go untreated. “If these things go on and get worse over time and begin to impair someone’s day to day function, we don’t want to use the excuse, ‘It’s bereavement — they’ll get over it,’” he said.

The new entry for major depressive disorder will include a note — the wording isn’t final — pointing out that while grief may be “understandable or appropriate” after a loss, professionals should also consider the possibility of a major depressive episode. Making that distinction, Dr. Kupfer said, will require “good solid clinical judgment.”

Initial field trials testing the reliability of D.S.M. 5 diagnoses, recently published in The American Journal of Psychiatry, don’t bolster confidence, however. An editorial remarked that “the end results are mixed, with both positive and disappointing findings.” Major depressive disorder, for instance, showed “questionable reliability.”

In an upcoming post, I’ll talk more about how patients might respond to the D.S.M. 5, and to a new diagnosis that might also affect a lot of older people — mild neurocognitive disorder.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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DealBook: Commerzbank to Cut Up to 6,000 Jobs

LONDON – Commerzbank, the second-largest lender in Germany, is planning to cut up to 6,000 jobs in a bid to increase earnings, joining other European banks that have announced restructuring plans in recent months.

The bank said on Thursday that it expected to eliminate 4,000 to 6,000 jobs by 2016, or 7 to 10 percent of its work force.

The layoffs will affect Commerzbank’s global operations, particularly a retail division that had expanded rapidly in recent years, according to a person with direct knowledge of the matter who spoke on condition of anonymity because he was not authorized to speak publicly.

In the wake of tougher capital requirements, sluggish economic growth and growing concerns about risky trading activity, several European banks have announced efforts to reduce their work forces, shed unwanted assets and increase capital reserves.

In October, the Swiss financial giant UBS said it would eliminate 10,000 jobs in its investment bank in a move to reduce exposure to risky trading activity and to focus on its wealth management division.

Barclays, which is to formally announce its own restructuring plan on Feb. 12, also started consulting with staff members in its investment banking unit this week over potential layoffs.

The expected job cuts at Barclays could result in up to a 10 percent reduction, or around 2,000 jobs, in the division, according to two people with direct knowledge of the matter who spoke on condition of anonymity because they were not authorized to speak publicly. On Thursday, Barclays started to reduce the size of its investment banking staff in Asia by 15 percent, or 70 jobs, according to one of the people.

On Jan. 17, the firm’s new chief executive, Antony P. Jenkins, told staff members they should leave the bank if they did not want to help rebuild its reputation. Barclays agreed last year to a $450 million settlement with American and British authorities over the manipulation of the London interbank offered rate, or Libor, a crucial benchmark rate.

The layoffs at Commerzbank come after efforts by the bank’s chief executive, Martin Blessing, to sell some of the firm’s 160 billion euros ($213 billion) of noncore assets, including shipping and real estate investments. The bank is also trying to reduce its exposure to European sovereign debt because of continuing volatility in countries like Spain and Greece.

Commerzbank said it would start negotiations with employee unions in early February to decide on the final number of layoffs. The announcement comes a day after Mr. Blessing was spotted at a party on Wednesday night at the luxury Belvedere hotel in Davos, whose attendees also included Deutsche Bank’s co-chief executive Anshu Jain. The Commerzbank chief is attending the World Economic Forum in the Swiss town.

Commerzbank received an 18.2 billion euro bailout from the German government in 2008 after its mistimed acquisition of a rival German bank, Dresdner, for 5.5 billion euros at the height of the financial crisis. As part of the deal, the German government still owns a 24 percent stake in Commerzbank.

Shares in Commerzbank bank rose less than 1 percent in morning trading in Frankfurt on Thursday.

European banks have been struggling through a series of recent financial scandals, mounting demands to increase capital reserves and growing political pressure to increase lending to stimulate local economies.

The Continent’s major financial institutions will begin reporting earnings next week, and analysts will be waiting to see if they will follow UBS’s lead in announcing major changes in response to these pressures.

“We believe that UBS has kicked off the much-awaited industry restructuring, even if each bank takes a different path,” Citigroup banking analysts told investors in a research note.

Neil Gough reported from Hong Kong. Jack Ewing contributed reporting from Davos.

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Dodgers near TV rights deal with Time Warner Cable









The Los Angeles Dodgers have negotiated a long-term television deal that would pay the team $7 billion to $8 billion, a move that would help cover its recent spending spree and quiet critics who scoffed at the record $2.15-billion purchase price paid by the new owner, Guggenheim Partners.


The expected 20-year agreement with Time Warner Cable could be announced this week, according to people familiar with the matter. They asked that their names not be used because the deal has not yet closed.


The arrangement is bad news for rival News Corp's Fox Sports unit, whose channel Prime Ticket holds cable TV rights to the Dodgers through the upcoming season. Fox will pay $39 million this season — a fraction of what Time Warner Cable would pay under the new contract — and found the proposed price tag too high, people inside News Corp. said.





And the pact would probably mean bigger pay TV bills — even for those who don't watch Dodgers baseball, potentially leading to a backlash against the team and Time Warner Cable.


Under the terms of the proposed contract, Guggenheim would own a Dodgers-dedicated television channel that would start carrying games in 2014, said the people with knowledge of the pact. Time Warner Cable would manage much of the channel's operations and handle distribution to other pay TV companies, including DirecTV and Cox Cable.


The Dodgers' move to control their own channel is driven in part by a desire to pocket as much money as possible while still abiding by Major League Baseball's revenue-sharing agreement — which requires that 34% of each team's locally generated revenue, most of it from TV rights and ticket sales, be contributed to a pool for other teams.


Mark Walter, the Dodgers' controlling owner, was believed to be sharing details of the tentative deal Tuesday with Major League Baseball officials. Walter has negotiated extensively with the league over how much of the television money must be shared with the other 29 Major League teams.


The Dodgers' revenue-sharing bill could range from $1 billion to $2.7 billion, based on the structure of the deal.


The new channel would also give the Dodgers the opportunity to expand team-related programming throughout the day, as the Los Angeles Lakers do on their Time Warner Cable channel.


"If you look at what the Lakers are doing, they're communicating with their client base," Dodgers owner and Guggenheim Partners President Todd Boehly told The Times last fall. "It's fantastic. It becomes self-fulfilling. If you start interacting with the team in all-new ways, you're going to love the team even more."


Boehly was not available for comment.


The addition of a new Dodgers network would bring the number of local sports channels in Los Angeles to six, the most in any major city in the United States. Besides Time Warner Cable's SportsNet and Deportes, and Fox's Prime Ticket and Fox Sports West, the Pac-12 Conference also has its own channel here. Fox Sports West carries Los Angeles Kings and Los Angeles Angels games.


"That's too many channels," said Marc Ganis, a sports industry consultant in Chicago. "I can't imagine that is sustainable on a long-term basis."


Sports channels aren't cheap. Time Warner Cable already charges other cable and satellite operators close to $4 a month a subscriber for SportsNet. The Dodgers and Time Warner Cable are expected to seek as much as $5 for their new channel, which is double what Fox charges for Prime Ticket, according to industry consulting firm SNL Kagan.


Those price hikes are generally passed on to consumers, who may resent the increase.


"Why do I have to pay for the Dodgers when I am not a Dodgers fan?" said Laura Burnes, a mother of two who lives in Orange County. "I don't want to see my cable costs go up any more."


The cost for sports has skyrocketed over the last decade. That's partly because the content is seen as "DVR proof." It is watched live by viewers, which makes it more valuable to advertisers and networks than sitcoms and dramas, which are often recorded and viewed later by people who skip ads.


But non-sports fans and pay TV companies are increasingly frustrated at having to pick up the tab for big sports deals. There have been calls to sell sports channels "a la carte," or separately from other programming.


The Dodger agreement with Time Warner Cable may be a tipping point.


"That is the solution everyone should be looking at seriously," said Derek Chang, a former senior executive at satellite broadcaster DirecTV. Such a move, he added, may be the only way to lower the cost of TV sports. "Ultimately the market for fees would then reset."


The Dodger deal marks the second time in less than two years that Time Warner Cable has outbid Fox Sports for a Los Angeles franchise. In 2011, the company agreed to pay $3.6 billion for a 20-year accord with the Lakers, which had been on Fox Sports West.


Time Warner Cable used the Lakers to create SportsNet and Deportes, a Spanish-language sports channel.


The two media titans have also done battle on other turf.


Last year, Fox acquired an ownership stake in Yes, the New York sports channel that is home to the Yankees. In 2011, Fox outbid Time Warner Cable for rights to the San Diego Padres.


Losing the Dodgers will hurt Fox's Prime Ticket, but the company still has rights to the Los Angeles Clippers and Anaheim Ducks. A Fox executive said there are no plans to consolidate Prime Ticket and Fox Sports West, which besides the Angels also has rights to the Stanley Cup champion Kings.


Distributors will press for a reduction in the fee for Prime Ticket without the Dodgers, but it's not a sure thing they'll get it, Ganis said. When New York's MSG channel lost rights to the Yankees, the subscription fee did not decrease.


joe.flint@latimes.com


bill.shaikin@latimes.com


Times staff writer Meg James contributed to this report.





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Falling Photos Force Us to Face Our Fundamental Fears



Kerry Skarbakka wants to capture the feeling you get when you’re about to eat it — wrecking your bike, tripping down the stairs, falling off a ladder — and you know it. The ground comes flying up and for a split second you’re resigned to letting events take their course. To do that, he voluntarily throws himself off of things and takes a photo in midair.


He sets up these falling photos by scoping a location he likes and then figuring out what he needs to stay safe during the plunge. If he can get away without using ropes, great, but if he needs to, Skarbakka will wear a harness underneath his clothing and tie off to an anchor. He tries to keep the falls shorter than seven feet. His girlfriend usually snaps the photos, but he says he’s also occasionally resorted to asking random people on the street to push the button.


“I ask [people], ‘Can you press the shutter when I look most compromised?’ which often gets a weird reaction,” says Skarbakka, an assistant professor of digital media and photographic studies at Prescott College in Arizona.


When Skarbakka frames the shot, he likes to try and hide the rope from view. If the rope somehow makes it into the frame, he’ll Photoshop it out in post production. He then makes enormous prints of the photos — almost life size — which helps transport the viewer to the scene of the “accident.”


Predictably, there have been some mishaps during the picture-taking process. The worst injury he’s sustained is a broken rib, but he says there’s been innumerable bumps and bruises. Sometimes the location is so intense he won’t even try to fall. In the railroad bridge photo, for example, he leaned over the edge (while tied to one of the railroad tracks) just far enough to be at what looked like a point of no return. But he never actually jumped off.


He says most of the reaction to the work has been positive but occasionally misunderstood. In 2005 he worked with the Museum of Contemporary Art Chicago on a performance piece where he was photographed as a special effects team dropped him off the museum’s roof dozens of times. A member of the media covering the event made a visual connection between the art and the people jumping out of the World Trade Center during 9/11 and quickly initiated a wave of backlash against Skarbakka, who says a comparison was never his intention.


“People got really mad,” he says.


At the moment Skarbakka says he’s trying to cull all the work together into a book and is actively looking for a publisher. In the future he’ll be incorporating the desert into his work — which is new to him because he recently moved to Arizona. He says he’s curious to know how we might change as a society if we were a little more resolved to the fact that a bit of chaos is inevitable.


“If we can give up that control, worry a little less about that existential anxiety, what would that do for us?” he says.


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“Cyborg Foundation” wins $100K Focus Forward prize






LOS ANGELES (TheWrap.com) – Spanish director Rafel Duran Torrent has won the $ 100,000 cash prize in the Focus Forward Filmmaker Competition at the Sundance Film Festival. The awards, the most lucrative ever given to short documentaries, went to five different shorts, with the top one being Duran Torrent’s “Cyborg Foundation.”


The director will also be invited to a Sundance Institute ShortsLab program of his choice this year.






Runners-up were Jared P. Scott and Kelly Nyks for “The Artificial Leaf,” Paul Lazarus for “Slingshot,” Kim Munsamy for “Bones Don’t Lie and Don’t Forget” and Callum Cooper for “Mine Kafon.”


The program was launched at last year’s Sundance by Morgan Spurlock and Karol Martesko-Fenster. Focus Forward was run by Spurlock’s and Martesko-Fenster’s company, cinelan, and sponsored by GE.


The top films were chosen by a jury consisting of Sundance senior programmer Caroline Libresco, actress Daryl Hannah and directors Barbara Kopple, Jose Padilha, Joe Berlinger, Floyd Webb and Peter Wintonick.


The winning films and the 15 other finalists can be viewed on the Focus Forward website.


Movies News Headlines – Yahoo! News





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The New Old Age Blog: Study Links Cognitive Deficits, Hearing Loss

There’s another reason to be concerned about hearing loss — one of the most common health conditions in older adults and one of the most widely undertreated. A new study by researchers at Johns Hopkins Medicine suggests that elderly people with compromised hearing are at risk of developing cognitive deficits — problems with memory and thinking — sooner than those whose hearing is intact.

The study in JAMA Internal Medicine was led by Dr. Frank Lin, a hearing specialist and epidemiologist who over the past several years has documented the extent of hearing problems in older people and their association with falls and the onset of dementia.

The physician’s work is bringing fresh, and some would say much-needed, attention to the link between hearing difficulties and seniors’ health.

In his new report, Dr. Lin looked at 1,984 older adults who participated over many years in the Health ABC Study, a long-term study of older adults conducted in Pittsburgh and Memphis. Participants’ mean age was 77; none had evidence of cognitive impairment when the period covered by this research began. In 2001 and 2002, they received hearing tests and cognitive tests; cognitive tests alone were repeated three, five and six years later.

The tests included the Modified Mini-Mental State exam, which is administered through an interview and yields an overall picture of cognitive status, and the Digit Symbol Substitution Test, a paper-only exercise that asks people to match symbols and numbers, which can reveal deficits in someone’s working memory and executive functioning.

Dr. Lin found that annual rates of cognitive decline were 41 percent greater in older adults with hearing problems than in those without, based on results from the Modified Mini-Mental State Exam. A five-point decline on that test is considered a “clinically significant” indicator of a change in cognition.

Using this information, Dr. Lin found that elderly people with hearing problems experienced a five-point decline on the exam in 7.7 years, compared with 10.9 years for those with normal hearing.

Results from the Digit Symbol Substitution Test showed the same downward trend, though not quite as steep: older people with hearing loss recorded a yearly rate of cognitive decline 32 percent greater on it than those with intact hearing. In both cases, the results showed an association only, with no proof of causality.

Still, given the fact that nearly two-thirds of adults age 70 and older have hearing problems, it is an important finding.

For caregivers and older adults, the bottom line is “pay attention to hearing loss,” said Kathleen Pichora-Fuller, a professor of psychology at the University of Toronto who was not involved in the study.

Most people seek medical attention for hearing difficulties 10 to 20 years after they first notice a problem, she said, because “there’s a stigma about hearing loss and people really don’t want to wear a hearing aid.” That means years of struggling with the consequences of impairment, without interventions that can make a difference.

One consequence that may help explain Dr. Lin’s findings is social isolation. When people have a hard time distinguishing what someone is saying to them, as is common in older age, they often stop accepting invitations to dinners or parties, attending concerts or classes, or going to family events. Over time, this social withdrawal can become a self-fulfilling prophecy, leading to the loss of meaningful relationships and activities that keep older people feeling engaged with others.

A substantial body of research by cognitive scientists has established that seniors’ cognitive health depends on exercising both body and brain and remaining socially engaged, and “now we have this intersection of hearing research and cognitive research lining up and showing us that hearing health is part of cognitive health,” said Dr. Pichora-Fuller, who originally trained as an audiologist.

Family physicians and internists, too, often dismiss older patients’ complaints about hearing, and should pay close attention to Dr. Lin’s research, she said.

“I hope this study will be a wake-up call to clinicians that auditory tests need to be part of the battery of tests they employ to look at an older person’s health,” agreed Patricia Tun, an adjunct associate professor of psychology at Brandeis University.

Although the tests are effective and cause no known harm, a panel of experts recently failed to recommend them for older adults because of a lack of supporting evidence, as I wrote last August.

Another potential explanation for Dr. Lin’s new finding lies in a concept known as “cognitive load” that Dr. Tun has explored through her research. Basically, this assumes that “we only have a certain amount of cognitive resources, and if we spend a lot of those resources of processing sensory input coming in — in this case, sound — it’s going to be processed more slowly and understand and remembered less well,” she explained.

In other words, when your brain has to work hard to hear and identify meaningful speech from a jumble of sounds, “you’ll have less mental energy for higher cognitive processing,” Dr. Tun said.

Even seniors who hear sounds relatively well often report that words sound garbled or mumbled, she noted, indicating a deterioration in hearing mechanisms that process complex speech.

Also, as yet unidentified biological or neurological pathways may affect both speech and cognition. Or hearing loss may exacerbate frailty and other medical conditions that older people oftentimes have in ways that are as yet poorly understood, Dr. Lin’s paper notes.

A limitation to his study is its reliance, in part, on the Modified Mini-Mental State exam, which asks older adults to respond to questions posed by an interviewer, according to Barbara Weinstein, a professor and head of the audiology program at CUNY’s Graduate Center.

Her research has shown that hearing-compromised seniors may not understand questions and answer incorrectly, confounding results. Another limitation arises from the failure to test participants’ hearing over time, as happened with cognitive tests, making associations more difficult to tease out.

Dr. Lin hopes to address this through another research project that would follow older adults over time and test whether interventions such as hearing aides help prevent the onset or slow the progression of cognitive decline. In the meantime, older people and caregivers should arrange for hearing tests if they have concerns, and consider getting a hearing aid if problems are confirmed.

Getting sound to the brain is the “first and most important step” in preventing sensory deprivation that can contribute to cognitive dysfunction, said Kelly Tremblay, a professor of speech and hearing science at the University of Washington.

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McDonald's December Sales Help Fourth-Quarter Profit







(Reuters) - McDonald's Corp reported an unexpected rise in sales in December at established U.S. restaurants, helping to lift its fourth-quarter profit above analysts estimates.




The world's largest restaurant chain on Wednesday said sales at U.S. eateries open at least 13 months rose 0.9 percent in December, compared with an average estimate compiled by Consensus Metrix calling for a 1.78 percent drop in the month.


A push by the company to have more of its restaurants open on Christmas and a shift of the limited-time offering of its popular McRib sandwich to December, both helped boost U.S. sales during the month.


But analysts said the early part of 2013 will be tough for the chain as it runs short of quick fixes for boosting U.S. sales that have been hurt by stiffer competition for customers who are pinching pennies in a weak economic recovery.


Net income at the world's biggest restaurant chain rose to $1.40 billion, or $1.38 per share, from $1.38 billion, or $1.33 per share, a year earlier.


Analysts on average forecast $1.33 a share, according to Thomson Reuters I/B/E/S.


Total sales rose 1.5 percent to $4.59 billion.


McDonald's fourth-quarter global sales at restaurants open at least 13 months rose 0.1 percent. Analysts on average had forecast a 0.3 percent decline, according to Consensus Metrix.


(Reporting By Lisa Baertlein in Los Angeles and Brad Dorfman in Chicago; Editing by Maureen Bavdek)


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County official calls car leasing contract procedure 'embarrassing'









Auditors reviewing a $1.75-million car leasing contract given to a company with a politically connected lobbying firm found that Los Angeles County officials had failed to create a "truly competitive" process, but that there was no evidence of improper influence.


Investigators with the county auditor-controller's office reviewed the Enterprise Rent-a-Car contract at the request of Supervisor Michael D. Antonovich. A report by KCET-TV had raised questions about the way the business was awarded.


Enterprise was given a sole-source, five-year deal in March to provide 60 leased  vehicles to the county's Community Development Commission and to maintain the agency's existing fleet. Commission staff projected that outsourcing the fleet services would save about $300,000 a year.





The Nov. 28 report on KCET's "SoCal Connected" focused on the lobbying firm Englander Knabe & Allen and questioned whether its clients — including Enterprise — got an unfair advantage because partner Matt Knabe is the son of county Supervisor Don Knabe, who voted along with all the other supervisors to award the contract.


Both Knabes have said that their relationship has never posed a conflict, and a spokesman for the Englander firm has said Matt Knabe never lobbies his father directly.


The auditor-controller found no evidence of attempts to influence the rental car award. Matt Knabe told investigators that no one from his firm had lobbied on the contract, and the commission's executive director said he was "100% confident" the supervisor's son did not influence the process.


"The report shows that Matt acted professionally and used no undue influence in his dealings with the county," said Englander partner Eric Rose.


But the review did find that county staff did an "inadequate" job of trying to find other potential bidders.


Asked by KCET what vendors had been contacted and given a chance to compete for the business, a county analyst created a list to make it appear the department had reached out to 50 companies. In fact, only 16 firms had been contacted, auditors found. Enterprise was the only company that responded to the email request, and staff made no follow-up attempt to contact the other firms.


According to the auditor's report, the count of 50 vendors was originally used as a "place holder" in a template document and never corrected. By the time the contract was awarded, the contract analyst "felt he could not correct the number without embarrassment."


Investigators also found that the agency violated its own policy by not advertising the contract on the commission's or the county's websites, and that the contract should have gone through a full bidding process.


In addition, several vendors that contract officials emailed to invite interest had no "realistic potential" to provide a leased fleet to the county in the first place, the review concluded.


Investigators wrote that they couldn't determine whether the commission could have gotten a better deal but said "the potential for greater savings from a more competitive process appears to be plausible."


County auditor-controller Wendy Watanabe called the situation "embarrassing" but chalked up the issues to incompetence rather than intentional steering.


"I think they got lazy, they took a shortcut, and they didn't think it was that big of a deal," she said.


Watanabe said the investigation had focused on the Enterprise contract, so she could not say whether there was a broader issue with the agency's contracting process.


Commission representatives could not be reached Monday. The commission was slated to respond to the report's findings within 30 days.


abby.sewell@latimes.com





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Fitness Trackers Are Long on Hype, Short on Credibility



We are awash in personal data trackers. There are wristbands, headbands, watches, smart scales, helmets and even forks to help us track our weight, heart rate, blood pressure and glucose level while logging how far we walk and how many calories we burn. All this information is supposed to give us behavior-morphing insights into our personal health habits.


Trouble is, no one can say for sure that any of it makes us healthier. Oh sure, these gadgets might get us psyched up to exercise, and they might encourage us to take the stairs instead of the elevator, but there has not yet been any scientific exploration of whether fitness gadgets, like the Fitbit Flex or Withings Smart Activity Monitor, actually work like they should.


“The durability of the effect is still in question,” said Dr. Eric Topol, the director of the Scripps Translational Science Institute. “We don’t have randomized [clinical] trials showing improved outcomes or durability in influencing behavior.”


You wouldn’t know that walking through the South Hall of the Las Vegas Convention Center during CES, where more than 220 companies showed off their digital health gadgets. They all used pictures of youthful, happy, svelte people lacing up running shoes, eating salads and playing outdoors. Their booths were filled with attractive, fit gals and guys.



The message is clear: These devices will help improve your health and physique.


But so far there aren’t many studies or trials testing the effectiveness of activity trackers or health monitors at getting us to move more and eat better foods or whether digital sensors are any better than old-school approaches like Weight Watchers.


Many of these devices have been developed by startups or Kickstarter campaigns and simply don’t have the deep pockets necessary to finance expensive clinical trials, says Topol.


Some researchers, Topol included, are following the wave of health technology with studies testing how activity monitors and other digital health sensors influence outcomes for chronic illnesses like cardiac disease and diabetes.


Other scientists at the University of California, San Francisco; Mayo Clinic; Massachusetts General Hospital; and Aurora Health Care are conducting trials to determine how digital data trackers affect activity levels, obesity and dietary intake in various populations. Some of these trials are just now recruiting patients or recently finished collecting data.


Dr. Anne Thorndike, a researcher at Harvard Medical School, is wrapping up a study of Fitbit’s effect on activity levels among medical residents. She couldn’t share all her findings because she’s still submitting her study for publication, but said there was some fatigue over the course of her 12-week study, suggesting the motivating effect of information, badges and notifications might be short-lived. That’s to be expected. As with any new toy or gadget, the novelty wears off.


A 2007 study in the Journal of the American Medical Association found that using pedometers, activity monitors and step counters was associated with being more physically active and having a lower body mass index and blood pressure. But the authors note that “whether these changes are durable over the long term is undetermined.”


The key to prolonging people’s engagement with their trackers might be to harness the social networking features built into the devices. Some research has shown social networks can impact health outcomes for patients with migraine, obesity and ALS, but whether that will translate to sensor-based social networks remains to be seen.


At this point, the connection between sensor-collected data and a patient’s official (electronic) health record also is not well defined. There’s no simple interface to upload data collected by biometric sensors into medical health records short of printing out your data, scanning it and converting it into a PDF you can send to your doctor.


That might become more of an issue as personal data trackers mature from pedometers pimped out with great user interfaces into hardware that’s being added to mobile devices to gather data typically collected by physicians, like electrocardiograms, galvanic skin response and blood oxygenation and glucose levels, says Topol. And that democratization of health care is what he sees as the biggest benefit of these devices. He predicts 2013 will see more “medical wearables,” which will make studying conditions like sleep apnea more comfortable and less expensive for patients.


The next step is the commercialization of sensors floating around in our bloodstreams or implanted in our skin, teeth or brains.


As these medical sensors become more pervasive, companies also will have to be conscious of how they market their products. For example, the Masimo iSpO2 pulse oximeter is approved for consumers to measure their own blood oxygen levels and pulse rates using the similar technology used in hospitals. But because it’s not approved for medical use, doctors can’t use it or have their patients use products like this until they are approved by the Food and Drug Administration. AliveCor, which makes a portable electrocardiogram built into an iPhone case, faced similar issues until it was approved by the FDA in December.


“It’s like the wild, wild West,” said Dr. Atul Butte of the Stanford School of Medicine, who just started using a Fitbit and an Aria Scale. “For a drug company, there’s such a burden to show how [their product] works better. A gadget maker is … not required to show that data and that’s kind of unfair.”


“Probably, like most gadgets, these devices help those folks on the borderline, [those] ready to make behavioral changes and looking for something to tip them into healthy behaviors,” he added.


After a few days of using his own trackers, Butte admits he’s “already making changes like switching from lattes to more espressos.”


Will those changes last more than a few weeks? Only time will tell.


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Michelle Obama wears Wu to the balls again






WASHINGTON (AP) — Michelle Obama made it a fashion tradition Monday night, wearing a custom-made Jason Wu gown to the inauguration balls. The ruby-colored dress was a follow-up to the white gown Wu made for her four years ago when she was new to Washington, the pomp and circumstance, and the fashion press.


She now emerged in velvet and chiffon as a bona fide trendsetter.






“I can’t believe it. It’s crazy,” said Wu, reached at his Manhattan studio. “To have done it once was already the experience of my life. To have a second time is tremendous.”


President Barack Obama also struck a similar style chord to his first-term inaugural balls: He wore a white tie with his tuxedo.


The red halter dress was the only one Wu, who went from fashion insider to household name on this night in 2009, submitted for Mrs. Obama’s consideration. He collaborated with jeweler Kimberly McDonald on the jeweled neckline. “For this occasion, it had to be real diamonds,” Wu said.


He said he felt the dress showed how he has grown up as a designer — and how Mrs. Obama’s style has evolved to be even more confident.


The first family headed out to inaugural festivities earlier on Monday with Mrs. Obama leading a very coordinated fashion parade in a navy-silk, checkered-patterned coat and dress by Thom Browne that were inspired by a menswear necktie.


The outfit was specifically designed for Mrs. Obama, but Browne said he wasn’t 100 percent sure she was going to wear it until she came out with it on at Inauguration. “I am proud and humbled,” he said.


The rest of Mrs. Obama’s Inauguration Day outfit included a belt from J. Crew, necklace by Cathy Waterman and a cardigan by Reed Krakoff, whose ensemble she also wore to yesterday’s intimate, indoor swearing-in ceremony.


Obama wore a blue tie with his white shirt, dark suit and overcoat. Malia Obama had on a plum-colored J. Crew coat with the hemline of an electric-blue dress peeking out and a burgundy-colored scarf, and her younger sister Sasha had on a Kate Spade coat and dress in a similar purple shade.


“It is an honor that Sasha Obama chose to wear Kate Spade New York,” said the company’s creative director, Deborah Lloyd, in an email to the Associated Press. “She epitomizes the youthful optimism and colorful spirit of the brand. We are so proud to have been a part of this historic moment.”


Jenna Lyons, creative director of J. Crew, said it was “a huge point of pride for all of us” to be a part of the day — as the brand was back in 2009 when the girls wore outfits by CrewCuts, its children’s label.


“It’s amazing to see the evolution of the family. I love the way Michelle looks. She looks beautiful in something so clean and tailored. It’s such an elegant choice,” Lyons said, “and they all look so sophisticated! You can see how the girls have grown up in the four years, and they’re still so alive and vibrant, but more sophisticated.”


The vice president’s wife, Jill Biden, wore a gray coat and dress by American designer Lela Rose.


Mrs. Obama has worn Browne’s designs for other occasions, including a gray dress with black lace overlay to one of the presidential debates last fall, and she honored him last summer at the Smithsonian’s Cooper-Hewitt National Design Awards for his contribution to fashion.


Browne made his name in modern — very modern — menswear, but he launched womenswear in 2011. He was in Paris on Monday, just finishing previews for his next menswear collection. The idea to use the tie fabric came to him because he was indeed designing these men’s clothes at the same time, he explained.


“I wanted ‘tailored’ for her. For me, she stands for strength and confidence, and that’s what I wanted to design for her,” he said.


Simon Collins, dean of the school of fashion at Parsons The New School for Design in New York, said the Obamas dressed in their typical fashion: one that shows pride in their appearance.


“They are a stylish couple and their children look fabulous. Too many people get dressed in the dark,” he said. “They show it’s good to dress up, take pride in how you look. … It’s a wonderful example for America and the rest of the world.”


He also noted that the Obamas seem to understand that the fashion industry is a driving force in the U.S. economy and that its lobby is a powerful one. They don’t treat fashion frivolously, he observed.


The first lady “is so supportive of so many American designers,” Browne noted.


But Collins said he was a bit surprised the public doesn’t pay much attention to the president’s wardrobe. He joked that Obama should perhaps try one of Browne’s signature shrunken suits — the ones that show a man’s ankles.


At the end of the Inaugural festivities, Mrs. Obama’s outfit and accompanying accessories will go to the National Archives.


___


Samantha Critchell tweets fashion at (at)AP_Fashion, and can be reached on Twitter at (at)Sam_Critchell.


Entertainment News Headlines – Yahoo! News





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