A delicate new balancing act in senior healthcare

When Claire Gordon arrived at Cedars-Sinai Medical Center, nurses knew she needed extra attention.

She was 96, had heart disease and a history of falls. Now she had pneumonia and the flu. A team of Cedars specialists converged on her case to ensure that a bad situation did not turn worse and that she didn't end up with a lengthy, costly hospital stay.

Frail seniors like Gordon account for a disproportionate share of healthcare expenditures because they are frequently hospitalized and often land in intensive care units or are readmitted soon after being released. Now the federal health reform law is driving sweeping changes in how hospitals treat a rapidly growing number of elderly patients.

The U.S. population is aging quickly: People older than 65 are expected to make up nearly 20% of it by 2030. Linda P. Fried, dean of the Columbia University Mailman School of Public Health, said now is the time to train professionals and test efforts to improve care and lower healthcare costs for elderly patients.

"It's incredibly important that we prepare for being in a society where there are a lot of older people," she said. "We have to do this type of experiment right now."

At Cedars-Sinai, where more than half the patients in the medical and surgical wards are 65 or older, one such effort is dubbed the "frailty project." Within 24 hours, nurses assess elderly patients for their risk of complications such as falls, bed sores and delirium. Then a nurse, social worker, pharmacist and physician assess the most vulnerable patients and make an action plan to help them.

The Cedars project stands out nationally because medical professionals are working together to identify high-risk patients at the front end of their hospitalizations to prevent problems at the back end, said Herb Schultz, regional director of the U.S. Department of Health and Human Services.

"For seniors, it is better care, it is high-quality care and it is peace of mind," he said.

The effort and others like it also have the potential to reduce healthcare costs by cutting preventable medical errors and readmissions, Schultz said. The federal law penalizes hospitals for both.

Gordon, an articulate woman with brightly painted fingernails and a sense of humor, arrived at Cedars-Sinai by ambulance on a Monday.

Soon, nurse Jacquelyn Maxton was at her bedside asking a series of questions to check for problems with sleep, diet and confusion. The answers led to Gordon's designation as a frail patient. The next day, the project team huddled down the hall and addressed her risks one by one. Medical staff would treat the flu and pneumonia while at the same time addressing underlying health issues that could extend Gordon's stay and slow her recovery, both in the hospital and after going home.

To reduce the chance of falls, nurses placed a yellow band on her wrist that read "fall risk" and ensured that she didn't get up on her own. To prevent bed sores, they got her up and moving as often as possible. To cut down on confusion, they reminded Gordon frequently where she was and made sure she got uninterrupted sleep. Medical staff also stopped a few unnecessary medications that Gordon had been prescribed before her admission, including a heavy narcotic and a sleeping pill.

"It is really a holistic approach to the patient, not just to the disease that they are in here for," said Glenn D. Braunstein, the hospital's vice president for clinical innovation.

Previously, nurse Ivy Dimalanta said, she and her colleagues provided similar care but on a much more random basis. Under the project, the care has become standardized.

The healthcare system has not been well designed to address the needs of seniors who may have had a lifetime of health problems, said Mary Naylor, gerontology professor at the University of Pennsylvania School of Nursing. As a result, patients sometimes fall through the cracks and return to hospitals again and again.

"That is not good for them and that is not good for society to be using resources in that way," Naylor said.

Using data from related projects, Cedars began a pilot program in 2011 and expanded it last summer. The research is continuing but early results suggest that the interventions are leading to fewer seniors being admitted to the intensive care unit and to shorter hospital stays, said Jeff Borenstein, researcher and lead clinician on the frailty project. "It definitely seems to be going in the right direction," he said.

The hospital is now working with Naylor and the University of Pennsylvania to design a program to help the patients once they go home.

"People who are frail are very vulnerable when they leave the hospital," said Harriet Udin Aronow, a researcher at Cedars. "We want to promote them being safe at home and continuing to recover."

In Gordon's case, she lives alone with the help of her children and a caregiver. The hospital didn't want her experiencing complications that would lengthen the stay, but they also didn't want to discharge her before she was ready. Under the health reform law, hospitals face penalties if patients come back too soon after being released.

Patients and their families often are unaware of the additional attention. Sitting in a chair in front of a vase of pink flowers, Gordon said she knew she would have to do her part to get out of the hospital quickly. "You have to move," she said. "I know you get bed sores if you stay in bed."

Gordon said she was comfortable at the hospital but she wanted to go back to her house as quickly as she could. "There's no place like home," she said.

Two days later, that's where she was.

anna.gorman@latimes.com

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DC Comics Turns the Occupy Movement Into a Superhero Title

Eighteen months after the phrase first entered the collective public consciousness, the plight of the 99 percent is coming to mainstream superhero comics — via a new series from the second biggest publisher in the American comic industry, which just happens to be a subsidiary of a multi-national corporation that makes around $12 billion a year. Irony, anybody?

In May, DC Comics will launch two new series taking place in their mainstream superhero universe that offer different insights into the class struggle in a world filled with superheroes, alien races and inexplicable events. The Green Team, written by Tiny Titans and Superman Family Adventures creators Art Baltazar and Franco, with art by Ig Guara, revives an obscure 1975 concept about teenage rich kids who try to make the world a better place with their outrageous wealth. In an interview promoting the series, Franco promised that it would address questions like “Can money make you happy?” and “If you had unlimited wealth, could you use that to make the lives of people better?”

Obviously, this is one of the more fanciful series DC will be publishing.

But while DC is promoting The Green Team series as the adventures of the “1%,” its companion title, The Movement, is teased as a chance for us to “Meet the 99%… They were the super-powered disenfranchised — now they’re the voice of the people!”

“It’s a book about power,” explained The Movement writer Gail Simone. “Who owns it, who uses it, who suffers from its abuse. As we increasingly move to an age where information is currency, you get these situations where a single viral video can cost a previously unassailable corporation billions, or can upset the power balance of entire governments. And because the sources of that information are so dispersed and nameless, it’s nearly impossible to shut it all down.”

“The thing I find fascinating and a little bit worrisome is, what happens when a hacktivist group whose politics you find completely repulsive has this same kind of power and influence,” she elaborated in an interview at Big Shiny Robot. “What if a racist or homophobic group rises up and organizes in the same manner?”

While the concept is ambitious, the idea that a comic capable of living up to the book’s populist inspiration could come from DC Entertainment still strikes some as unlikely. Matt Pizzolo, the editor of the Occupy Comics anthology, told Wired that “though DC Comics did help launch Alan Moore and David Lloyd’s seminal anarchist epic V For Vendetta over two decades ago, it’s unlikely they would do so today. Between dismantling Vertigo and frankensteining Watchmen, the past year has demonstrated DC isn’t a safe place for bold creators who want to tell the kinds of stories that would inspire things like Occupy, rather than just cash in on them.”

Still, Simone says that the use of the iconography and language of a real-world populist movement is deliberate, promising that the book will reflect today’s decentralized political world and offer ”a slice of rarity that we’re unlikely to see in most superhero books.”

This wouldn’t the first time that DC has attempted to offer pre-packaged populist rebellion, of course; in addition to the aforementioned publication of the anti-establishment V For Vendetta, the company’s Vertigo imprint also published Grant Morrison’s The Invisibles, a series centering around an international organization struggling against forces of authority and repression that included anti-corporate themes.

Only time will tell whether The Movement will live up to the subversive examples of these earlier books, or just end up a well-intentioned piece of topical super heroics that trades on, and commodifies, a real political movement.

The Movement #1 will be available in both print and digital formats on May 1, while The Green Team #1 will be released on May 22.

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Mary J. Blige honored by Vibe at pre-Grammy party

LOS ANGELES (AP) — Babyface called her an icon; Diddy said she was like a sister; and Anita Baker credited her for helping secure her latest Grammy nomination.

There was no shortage of superlatives bestowed on Mary J. Blige on Friday night as Vibe magazine celebrated the Queen of Hip-Hop Soul’s career, which has now spanned for more than two decades.

“She’s a musical soulmate, she’s my sister, she’s one of my best friends in the world,” said Diddy, who has worked with Blige since the beginning of her career. “Mary is our queen. … There is no one to come after her.”

Blige was feted during Vibe’s first Impact Awards, which coincided with the magazine’s 20th anniversary. The event included guests like MC Lyte, Jermaine Dupri and Queen Latifah. Blige appeared to wipe away tears at moments as she was lauded by one guest after another.

Babyface, who wrote one of Blige’s biggest hits, “Not Gon’ Cry,” recalled being a little intimidated by the idea of working with Blige, whom he saw as a tough New Yorker.

“Mary walked in and she was so sweet … and so respectful and totally melted me right there,” he said.

Diddy recalled how Blige worked with him after he got fired from one of his first high-profile jobs in the industry and when no else one would, and also said she was one of his best friends.

One of the more emotional tributes came from Baker, who was a childhood idol of Blige’s. Baker thanked Blige for seeking her out for collaborations and helping a new generation discover her music.

“That kind of generosity is non-existent in our business,” said Baker, who is nominated for a Grammy at Sunday’s awards. “This Grammy nomination that I have is in great part because you spoke my name into the 21st century.”

Latifah noted the personal transformation of Blige, who overcame substance abuse and other obstacles to become one of music’s leading role models.

“For me when I look back at you and the journey you’ve taken, I find you to be extremely inspirational and aspirational, especially to young women,” Latifah said.

When Blige got up to accept her honor, she thanked everyone for embracing her throughout her career, even during her very public missteps. She also thanked people for accepting her imperfections. She recounted a story about being sent to charm school early in her career by handlers who thought she needed to smooth over her rough edges. But Blige was not a good student.

“I just walked out and I never went back,” Blige said. “I’m glad I didn’t go back because I don’t think that I would have had an impact on anyone’s life had I lived someone else’s life.”

Blige recently starred as Betty Shabazz, the widow of Malcolm X, in the Lifetime movie “Betty & Coretta” co-starring Angela Bassett.

___

Online:

http://www.maryjblige.com

___

Follow Nekesa Mumbi Moody on Twitter at http://www.twitter.com/nekesamumbi

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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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Strategies: At Dell, a Gamble on a Legacy

IN 1984 — the year Mark Zuckerberg, the Facebook creator, was born — Michael S. Dell started a tech company in his dorm room, dropped out of college and changed the world.

By making personal computers that were powerful, reliable and inexpensive, and by selling directly to buyers who customized their PC features, Mr. Dell revolutionized his industry.

“The original PC industry was long on people with great technical ideas but short on people who were able to turn those ideas into opportunities — into products that people really wanted,” said Timothy Bresnahan, a Stanford economist. Along with Steve Jobs and Bill Gates, as well as Scott Cook of Intuit, Mr. Dell was one of those few great innovators, he said. “These people are very rare.”

Mr. Dell’s early achievements were formidable, but unless his latest effort to turn around his company is successful, the Dell legacy today is very much in doubt. Last week, along with Silver Lake Partners, a private equity firm, he made a $24.4 billion buyout offer for his company — an apparent bet that, without the scrutiny of public shareholders, he can get Dell back on track.

Dell, the company, has been losing ground for years as the industry it once dominated has undergone upheavals that its founder failed to foresee. “The very nature of technology is that it changes a lot,” said Toni Sacconaghi, an analyst at Sanford C. Bernstein. “And Michael has conceded publicly that he has missed some big changes — he failed to foresee smartphones or tablets — and both of these shifts have been highly detrimental to the PC world.”

He has lagged in a crucial area of corporate strategy as well, said Shaw Wu, an analyst at Sterne Agee in San Francisco. While Mr. Dell has always been attuned to the needs of corporate clients, he is 20 years behind I.B.M. in embracing a strategic shift to enterprise software and services, Mr. Wu said: “That’s a higher-margin business that Dell would like to go after, but I.B.M. and others have got tremendous leads. It will be very difficult for him to catch up.”

If Dell shareholders accept an offer price of $13.65 a share, Mr. Dell, who is contributing his stake of more than 14 percent in the company plus hundreds of millions more, would end up with more than 50 percent of the new company’s equity, Mr. Sacconaghi estimated. Mr. Dell, who declined to comment for this article, would control the company without being subject to the day-to-day pressures of the stock market, which has pummeled Dell shares because its earnings have weakened.

While Dell reports that 50 percent of its revenue is directly related to PCs, Mr. Wu says the figure is 70 to 80 percent when indirect revenue, like that for computer monitors, printers and services, is included. “The company has made big investments in other areas, but it’s still mainly a PC company,” he said.

That’s a big problem for several reasons. Once considered the low-cost provider in the field, Dell now faces lean Asian competitors like Lenovo, Asus and Acer that make PCs more cheaply and accept lower profit margins. Yet these companies, particularly Lenovo, have also garnered praise for making excellent computers, not merely well-priced ones. At the same time, Dell’s vaunted reputation for quality and service has waned.

Lenovo, which makes the ThinkPad line of notebook computers formerly sold by I.B.M., “has been picking up corporate customers from Dell,” Mr. Wu said.

THEN there is a deeper issue: the entire PC industry is stagnant at best. Worldwide PC shipments declined 4.9 percent in the fourth quarter, versus the year-earlier period, according to Gartner, a market research firm. Consumer preferences are shifting. With the ubiquity of smartphones and tablets — segments where Dell is absent or very weak — consumers aren’t replacing PCs as often.

“We don’t expect people to abandon PCs, but they won’t rely on them as much in the future,” said Mikako Kitagawa, a Gartner analyst. Dell’s share of this no-growth market has been shrinking, to 10.2 percent worldwide in the fourth quarter of 2012, from 12.2 percent the previous year, Gartner said.

Facing such headwinds, Mr. Sacconaghi said, Dell hopes to “hold PC profits flat or, worst case, down 5 percent a year, while they grow the rest of the business to more than offset that.” But the market is skeptical. Dell’s shares fell 30 percent in the 12 months before Jan. 14, when reports of an imminent buyout appeared.

The leveraged buyout will layer $15 billion of new debt on the company. Microsoft, with which Dell has had close ties, is providing $2 billion. Because interest rates are extraordinarily low, servicing all that debt should be manageable, assuming that Dell maintains its current cash flow, Mr. Sacconaghi said.

It’s not clear how much the debt load will constrain Dell’s investments in research and development. Josh Lerner, a Harvard Business School professor, said a study for which he was a co-author found that after leveraged buyouts, most companies maintained their ability to innovate, largely by focusing research in “their core competencies.”

In other words, he said, “Dell might be able to prosper after a buyout; it would depend on how Michael Dell manages the company.”

Is the price being offered for the company fair? It’s often unwise to bet against company insiders, especially founders like Mr. Dell, who may be presumed to know their companies’ value better than outside investors.

Consider John W. Kluge, who took Metromedia private in 1984 in a $1.1 billion leveraged buyout. Mr. Kluge, Metromedia’s founder, promptly liquidated it, selling television stations (to Rupert Murdoch) and sundry assets like the Harlem Globetrotters and the Ice Capades. In the end, Mr. Kluge tripled his take — to the chagrin of many former shareholders.

Mr. Kluge, who died in 2010, wasn’t interested in preserving his company or revolutionizing an industry, however. He merely wanted to make money. “When we buy an asset, we look at it as a return on the investment,” he said in 1980.

For Mr. Dell, whose name is on the door, other factors may be in play. “Another chapter is still to be written,” Mr. Bresnahan said. Money will be part of it. So will the Dell legacy.

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Big Bear locked down amid manhunt

The bustling winter resort of Big Bear took on the appearance of a ghost town Thursday as surveillance aircraft buzzed overhead and police in tactical gear and carrying rifles patrolled mountain roads in convoys of SUVs, while others stood guard along major intersections.

Even before authorities had confirmed that the torched pickup truck discovered on a quiet forest road belonged to suspected gunman Christopher Dorner, 33, officials had ordered an emergency lockdown of local businesses, homes and the town's popular ski resorts. Parents were told to pick up their children from school, as rolling yellow buses might pose a target to an unpredictable fugitive on the run.

By nightfall, many residents had barricaded their doors as they prepared for a long, anxious evening.

PHOTOS: A tense manhunt amid tragic deaths

"We're all just stressed," said Andrea Burtons as she stocked up on provisions at a convenience store. "I have to go pick up my brother and get him home where we're safe."

Police ordered the lockdown about 9:30 a.m. as authorities throughout Southern California launched an immense manhunt for the former lawman, who is accused of killing three people as part of a long-standing grudge against the LAPD. Dorner is believed to have penned a long, angry manifesto on Facebook saying that he was unfairly fired from the force and was now seeking vengeance.

Forest lands surrounding Big Bear Lake are cross-hatched with fire roads and trails leading in all directions, and the snow-capped mountains can provide both cover and extreme challenges to a fugitive on foot. It was unclear whether Dorner was prepared for such rugged terrain.

Footprints were found leading from Dorner's burned pickup truck into the snow off Forest Road 2N10 and Club View Drive in Big Bear Lake.

San Bernardino County Sheriff John McMahon said that although authorities had deployed 125 officers for tracking and door-to-door searches, officers had to be mindful that the suspect may have set a trap.

"Certainly. There's always that concern and we're extremely careful and we're worried about this individual," McMahon said. "We're taking every precaution we can."

PHOTOS: A fugitive's life on Facebook

Big Bear has roughly 400 homes, but authorities guessed that only 40% are occupied year-round.

The search will probably play out with the backdrop of a winter storm that is expected to hit the area after midnight.

Up to 6 inches of snow could blanket local mountains, the National Weather Service said.

FULL COVERAGE: Sweeping manhunt for rampaging ex-cop

Gusts up to 50 mph could hit the region, said National Weather Service meteorologist Mark Moede, creating a wind-chill factor of 15 to 20 degrees.

Extra patrols were brought in to check vehicles coming and going from Big Bear, McMahon said, but no vehicles had been reported stolen.

"He could be anywhere at this point," McMahon said. When asked if the burned truck was a possible diversion, McMahon replied: "Anything's possible."

Dorner had no known connection to the area, authorities said.

Craig and Christine Winnegar, of Murrieta, found themselves caught up in the lockdown by accident. Craig brought his wife to Big Bear as a surprise to celebrate their 28th wedding anniversary. Their prearranged dinner was canceled when restaurant owners closed their doors out of fear.

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Building of the Week: Bank of Georgia

Each week, Wired Design brings you a photo of one of our favorite buildings, showcasing boundary-pushing architecture and design involved in the unique structures that make the world's cityscapes interesting. Check back Fridays for the continuing series, and feel free to make recommendations in the comments, by Twitter, or by e-mail.

The Soviets were not known for comfortable or ornamental architecture, and the Bank of Georgia headquarters is neither of those. But despite being a series of massive, stacked concrete blocks (or perhaps, because of that), it is an interesting adaptation of its period's stark, square style.

Built in 1975 as the Soviet Ministry of Roads and sold to the bank in 2007, the Tetris-like structure is actually 18 stories high and 44,000 square feet. Like many examples of constructivist architecture, its blocky, three-dimensional form is almost a variation on an industrial bunker, but re-imagined to allow a forest to grow underneath. Giorgi Chakhava was in the envious position of being both minister of highway construction and architect, and with Zurab Jalaghania, he was able to both follow and expand beyond typical Soviet brutalism.

Photo: Matt Bateman/Flickr

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The New Old Age: The Executor's Assistant

I’m serving as executor for my father’s estate, a role few of us are prepared for until we’re playing it, so I was grateful when the mail brought “The American Bar Association Guide to Wills and Estates” — the fourth edition of a handbook the A.B.A. began publishing in 1995.

This is a legal universe, I’m learning, in which every step — even with a small, simple estate that owes no taxes and includes no real estate or trusts — turns out to be at least 30 percent more complicated than expected.

If my dad had been wealthy or owned a business, or if we faced a challenge to his will, I would have turned the whole matter over to an estate lawyer by now. But even then, it would be helpful to know what the lawyer was talking about. The A.B.A. guide would help.

Written with surprising clarity (hey, they’re lawyers), it maps out all kinds of questions and decisions to consider and explains the many ways to leave property to one’s heirs. Updated from the third edition in 2009, the guide not only talks taxes and trusts, but also offers counsel for same-sex couples and unconventional families.

If you want to permit your second husband to live in the family home until he dies, but then guarantee that the house reverts to the children of your first marriage, the guide tells you how a “life estate” works. It explains what is taxable and what isn’t, and discusses how to choose executors and trustees. It lists lots of resources and concludes with an estate-planning checklist.

In general, the A.B.A. intends its guide for the person trying to put his or her affairs in order, more than for family members trying to figure out how to proceed after someone has died. But many of us will play both these parts at some point (and if you are already an executor, or have been, please tell us how that has gone, and mention your state). We’ll need this information.

Editor’s Note: More information about “The American Bar Association Guide to Wills and Estates” can be found here.

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

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Japanese Still Seeking Link in 787 Battery Incidents

Japan’s investigation of a battery that was smoking on a Boeing 787 flight there last month has not yet determined if the incident started in the same way as a fire on another 787 in Boston, a Japanese official said Friday.

Akinobu Yokoyama, a spokesman for Japan’s Transport Safety Board, said it was still not clear whether a short-circuit or other malfunction occurred within one or more of the eight cells in the new lithium-ion battery.

His comments in an interview came a day after Deborah Hersman, the chairwoman of the National Transportation Safety Board, said that the problems on the Boston jet seemed to have originated in the battery. She said one of the cells had a short-circuit that created a “thermal runaway” as it cascaded through the rest of the cells, heating the battery to 500 degrees.

Given that the problems on the innovative jets occurred just nine days apart, it is crucial for investigators to determine whether they started in a similar manner. If the incidents seem to parallel one another, it could be easier for Boeing and its regulators to find a fix than if they are dealing with two different problems.

The Japanese investigation started later than the American one. Mr. Yokoyama said it was “not appropriate to talk yet about whether proximity of the cells within the battery is a structural problem or a cause of the battery malfunctions.”

“By looking at the battery, it is obvious there was a thermal runway,” he said. “But we have yet to determine with any certainty why that happened.”

Ms. Hersman said Thursday that American investigators still did not know what caused the short-circuit in the cell of the Boston battery. She also said that in certifying the lithium-ion batteries in 2007, the Federal Aviation Administration accepted test results from Boeing that seriously underestimated the risk of smoke or fire.

The 787 is the first commercial plane to use large lithium-ion batteries for major flight functions. The batteries are more volatile than conventional nickel-cadmium batteries, but they weigh less and create more power, contributing to a 20 percent gain in fuel economy over older planes.

All 50 of the 787s that have been delivered so far have been grounded since mid-January.

That has also stopped Boeing from delivering more of the planes. Two European carriers, Thomson Airways and Norwegian Air Shuttle, said Friday that Boeing had notified them that the deliveries they had expected soon would be delayed until the problems with the batteries could be resolved.

Boeing’s rival, Airbus, plans to use smaller — and it says safer — lithium-ion batteries in its next-generation A350 jets, which will compete with the 787. Airbus reiterated Friday that it was watching to see how the investigations of the Boeing battery turned out.

“There is nothing that prevents us from going back to a classical battery on the A350, which we’ve been studying in parallel to the lithium battery from the beginning,” said Justin Dubon, an Airbus spokesman in Toulouse.

Hiroko Tabuchi reported from Tokyo. Nicola Clark contributed reporting from Paris.

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Fugitive cop stayed in San Diego this week; military bases on alert

Military bases in the San Diego area have been warned to be on the lookout for a fugitive former LAPD officer suspected of shooting three police officers early Thursday morning -- one of them fatally -- and killing an Irvine couple on Sunday.

Christoper Jordan Dorner, 33, is a former Navy reserve lieutenant with multiple weapons at his disposal, including an assault rifle, officials said. He is considered armed and extremely dangerous and alerts have been issued in California and Nevada.

Guards at military bases have been alerted that Dorner may have military identification and military-issue clothing. He has a military sticker on his vehicle windshield and was station in San Diego at times during his Navy career.

Dorner is believed to be connected to an attempted boat theft at the Southwestern Yacht Club in Point Loma, where he allegedly held an 81-year-old boat owner at gunpoint, tied him up and tried to steal the boat to flee to Mexico.

When that attempt was thwarted by mechanical difficulties, he apparently drove north to Corona.

Sometime after 1:30 a.m., Dorner is suspected of shooting an Los Angeles Police Department officer in Corona, then heading to Riverside where authorities say he "ambushed" two Riverside officers. Both officers were shot, one fatally. Police said he was seen wearing military fatigues.

Dorner is also wanted in connection with the slaying Sunday in Irvine of the daughter of a retired LAPD captain and her fiance.

Authorities confirmed Thursday morning that Dorner had stayed at a hotel on a local military base several days ago.

Dorner was able to check in at the motel on the San Diego Naval base but it was not clear how he gained access to the secured area, police told reporters.

"We have confirmation that he stayed here several days ago," Lt. Joseph Ramos said at a news conference.

He said Dorner had not been seen in the area on Thursday despite reports that he was still at the motel.

[Updated at 11:55 a.m.: Navy officials confirmed that Dorner checked into the base on Feb. 5, using military identification. He did not check out.]

Law enforcement authorities said they were concerned about Dorner's military background and weapons training.

Dorner received awards for his expertise with a rifle and pistol, according to military records obtained by The Times. He received an Iraq Campaign Medal and served in a mobile inshore undersea warfare unit.

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Valve's Newell: How PCs Will Take Over the Living Room

LAS VEGAS — At the DICE Summit on Thursday, Valve CEO Gabe Newell laid out his vision for how the PC, as a gaming platform, can move into the living room.

“Traditionally, people say nobody wants a PC in the living room,” Newell said. But he sees that changing soon, and pointed to a “good/better/best” scenario in which different users will have different solutions for playing PC games on their television.

“Good,” he said, is “home streaming” — devices like Nvidia’s Shield that stream games from your PC to a mobile screen. “Think of it as, your PC now has an extra monitor and an extra set of inputs,” Newell said. “The price point is going to be much, much lower than what we’ve traditionally seen in living-room devices.”

Streaming setups like this, he said, “do require [game creators] to do some work to ensure the customer experience is seamless.”

“Better” is a “PC in a console form factor at a console price point,” or what has become colloquially known as a Steam box. “Nowadays, making small quiet cool PCs is a well-solved problem by multiple vendors,” Newell said.

“We’re developing console form factor PCs, and working with partners on that as well,” he said, devices that have “all the characteristics of a great console device while taking advantage of the price performance of a PC.”

“Best,” Newell said, is “pretty straightforward.” If you want a $4,000 living room PC with all the bells and whistles, he said, there are plenty of vendors who will provide that.

Newell stressed the need for free and open platforms like Linux. “Our company wouldn’t exist if it weren’t for the openness of the PC. Steam wouldn’t exist if not for the openness of the Internet,” Newell said, noting that he sees Linux as a “get out of jail free pass for our industry, if we need it.”

He also restated his previous assertion that Apple is “more threatening to the PC in the living room than anything that would be happening on the console side,” noting that the company has a “natural progression into the living room.”

Newell said he sees PCs in the living room as a way of ending “disruptive console transitions.”

“You don’t have to say, oh my god, how are we going to get that application running on our dedicated hardware in the living room?” he said.

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Kraftwerk mixes art with music in sell-out shows

LONDON (Reuters) – German electronic music pioneers Kraftwerk have always aimed to combine music and art so performing at London’s Tate Modern was the ideal venue for them after three years of planning.

Kraftwerk took over the 800-capacity Turbine Hall at the art gallery on Wednesday to play the first of eight consecutive shows, each focused on a different album, starting with “Autobahn” from 1974 and ending with “Tour de France” from 2003.

The sight of four middle-aged men in skintight neon suits standing almost motionless on stage behind a line of consoles backed by 3D images may look bizarre to the uninitiated but to the group’s devoted following it all seems to make sense.

When tickets went on sale in December, priced at 60 pounds ($ 95) each, the demand crashed the gallery’s website.

Two similar eight night runs at New York’s Museum of Modern Art and in Kraftwerk’s home town of Duesseldorf were also sold out with massive demand to see the group hailed by some as one of the most influential in pop history.

Catherine Wood, curator of contemporary art and performance at the Tate Modern, said it made sense for Kraftwerk to perform in an art gallery, and particularly at the Tate Modern which was once a power station – the English translation of Kraftwerk.

“They have a history of engaging with visual art, with minimal form, and perform in a way that is completely at odds with the usual idea of the rock star by putting the robot in the foreground,” Wood told Reuters.

“It takes away the aura of the artist and they have played with that in a very knowing way.”

In fact only one of the original members of Kraftwerk remains in the group — Ralf Hutter — and no details were available on the other three musicians in the line-up.

INFLUENCE ON POP

Kraftwerk rarely does interviews and a request for one this week was unsuccessful. In 2009, Hutter sent a robot in his place for an interview on a British television show.

The group dates back to 1970 when Hutter and Florian Schneider began the Kraftwerk project at their Kling Klang Studio in Duesseldorf, experimenting with electronic music and creating images of the future and the digital age.

Their international breakthrough came in 1974 with “Autobahn” and they went on to build a strong following for using robotic and technical innovations in performances as well as computerized compositions.

They are credited for being the godfathers of synthpop, hip-hop and all range of electronic offshoots and cited as an inspiration for groups like Joy Division, Orchestral Manoeuvres in the Dark, and Human League.

In the past two decades Kraftwerk has produced little new material which some critics put down to the fact that synthesizers and electronics are now fully integrated into mainstream pop and dance music.

The restrospective performances at the Tate Modern, titled “The Catalogue 1 2 3 4 5 6 7 8″, were their first London dates since 2004 and the crowd, handed 3D glasses on entry, was dominated by middle-aged men on Wednesday.

The show started with robotic figures in suits towering out of the screen over the audience as the group performed “The Robots” before a Volkswagen Beetle sped up and down a motorway to their hit song “Autobahn”.

Lunar landscapes, the galaxy, musical notes all rose and emerged from the screen during the two-hour show that started and ended precisely on time and included “The Model” from 1981, their most successful UK single.

Fans and critics described the show as “mesmerising”, “spectacular” and “unique”, even after 40 years.

“As a work of art, part of an abstract history lesson set to music, ghostly echoes of the 20th century, it is mesmerising,” Paul Morley wrote in The Telegraph.

(Reporting by Belinda Goldsmith, editing by Paul Casciato)

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Well: Expressing the Inexpressible

When Kyle Potvin learned she had breast cancer at the age of 41, she tracked the details of her illness and treatment in a journal. But when it came to grappling with issues of mortality, fear and hope, she found that her best outlet was poetry.

How I feared chemo, afraid
It would change me.
It did.
Something dissolved inside me.
Tears began a slow drip;
I cried at the news story
Of a lost boy found in the woods …
At the surprising beauty
Of a bright leaf falling
Like the last strand of hair from my head

Ms. Potvin, now 47 and living in Derry, N.H., recently published “Sound Travels on Water” (Finishing Line Press), a collection of poems about her experience with cancer. And she has organized the Prickly Pear Poetry Project, a series of workshops for cancer patients.

“The creative process can be really healing,” Ms. Potvin said in an interview. “Loss, mortality and even hopefulness were on my mind, and I found that through writing poetry I was able to express some of those concepts in a way that helped me process what I was thinking.”

In April, the National Association for Poetry Therapy, whose members include both medical doctors and therapists, is to hold a conference in Chicago with sessions on using poetry to manage pain and to help adolescents cope with bullying. And this spring, Tasora Books will publish “The Cancer Poetry Project 2,” an anthology of poems written by patients and their loved ones.

Dr. Rafael Campo, an associate professor of medicine at Harvard, says he uses poetry in his practice, offering therapy groups and including poems with the medical forms and educational materials he gives his patients.

“It’s always striking to me how they want to talk about the poems the next time we meet and not the other stuff I give them,” he said. “It’s such a visceral mode of expression. When our bodies betray us in such a profound way, it can be all the more powerful for patients to really use the rhythms of poetry to make sense of what is happening in their bodies.”

On return visits, Dr. Campo’s patients often begin by discussing a poem he gave them — for example, “At the Cancer Clinic,” by Ted Kooser, from his collection “Delights & Shadows” (Copper Canyon Press, 2004), about a nurse holding the door for a slow-moving patient.

How patient she is in the crisp white sails
of her clothes. The sick woman
peers from under her funny knit cap
to watch each foot swing scuffing forward
and take its turn under her weight.
There is no restlessness or impatience
or anger anywhere in sight. Grace
fills the clean mold of this moment
and all the shuffling magazines grow still.

In Ms. Potvin’s case, poems related to her illness were often spurred by mundane moments, like seeing a neighbor out for a nightly walk. Here is “Tumor”:

My neighbor walks
For miles each night.
A mantra drives her, I imagine
As my boys’ chant did
The summer of my own illness:
“Push, Mommy, push.”
Urging me to wind my sore feet
Winch-like on a rented bike
To inch us home.
I couldn’t stop;
Couldn’t leave us
Miles from the end.

Karin Miller, 48, of Minneapolis, turned to poetry 15 years ago when her husband developed testicular cancer at the same time she was pregnant with their first child.

Her husband has since recovered, and Ms. Miller has reviewed thousands of poems by cancer patients and their loved ones to create the “Cancer Poetry Project” anthologies. One poem is “Hymn to a Lost Breast,” by Bonnie Maurer.

Oh let it fly
let it fling
let it flip like a pancake in the air
let it sing: what is the song
of one breast flapping?

Another is “Barn Wish” by Kim Knedler Hewett.

I sit where you can’t see me
Listening to the rustle of papers and pills in the other room,
Wondering if you can hear them.
Let’s go back to the barn, I whisper.
Let’s turn on the TV and watch the Bengals lose.
Let’s eat Bill’s Doughnuts and drink Pepsi.
Anything but this.

Ms. Miller has asked many of her poets to explain why they find poetry healing. “They say it’s the thing that lets them get to the core of how they are feeling,” she said. “It’s the simplicity of poetry, the bare bones of it, that helps them deal with their fears.”

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Have you written a poem about cancer? Please share them with us in the comments section below.

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Media Decoder Blog: Led by Celebrity Titles, Magazine Newsstand Sales Slide

2:11 p.m. | Updated As the magazine industry continues to suffer from declining circulation, celebrity gossip magazines and young women’s titles have taken some of the biggest hits.

According to data released by the Alliance for Audited Media on Thursday morning, overall paid and verified circulation of magazines declined slightly by 0.3 percent in the second half of 2012. But newsstand sales – which are often viewed as the best barometer of how well a magazine is doing – dropped by 8.2 percent.

These figures were far worse for celebrity magazines, which largely suffered double-digit declines. People’s newsstand sales dropped by 12.2 percent while US Weekly experienced a 14.6 percent decline. In Touch Weekly declined by 14.8 percent and Life & Style Weekly suffered a 19.1 percent drop on newsstands.

Some young women’s magazines like Cosmopolitan and Glamour, which often attract an overlapping audience as celebrity magazines, also suffered major hits. Cosmopolitan had an 18.5 percent decline in newsstand sales while Glamour’s newsstand sales declined by 14.5 percent.

John Harrington, an industry consultant, said that both categories are suffering because young women can access a lot of similar content online.

“They’re fighting all the social media and information that’s just available in so many places,” said Mr. Harrington about the kinds of pressures these magazines are under. “Some of the same factors are that their audience are people who are digitally adept and tend to go to social media.”
While all magazines reported a rise in digital subscribers and the number of average digital magazine copies more than doubled from the year before, these numbers still make up less than 2.4 percent of the entire magazine industry’s average circulation.

Industry experts said that magazines also suffered from what was and was not happening in the world. Steven Cohn, editor of the Media Industry Newsletter, said that celebrity weeklies didn’t benefit from the boom that comes from celebrity weddings, births or deaths in recent months. He expects that business prospects may improve for these titles in the second half of the year after Prince William and Kate Middleton have their first child.

“In the second half of 2012, there was no royal wedding. There was no tragedy like the death of Michael Jackson,” said Mr. Cohen. “They should get a bump by the royal birth.”

Mr. Cohen added that Hurricane Sandy also may have hurt newsstand sales. He noted that even during an election year, Time Inc. experienced a decline in newsstand sales. Newsstand sales for the magazine declined to 58,776 in the second half of 2012 from 76,555 from the same time in 2011.

“I think Sandy is a factor,” said Mr. Cohen. “It certainly hurt newsstand in New York and New Jersey, which is the biggest market in the country.”

While Family Circle and Woman’s Day both noted rises in their newsstand sales, Mr. Harrington said that both magazines had cut back their frequency of publication to 12 times a year from 15 times a year. Both magazines also are relatively inexpensive.

“That helped their average newsstand sales and they’re still relatively lower priced items,” said Mr. Harrington.

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Postal Service seeks to end Saturday mail delivery

Postal Service to Cut Saturday Mail

By Michael Muskal

February 6, 2013, 8:34 a.m.

The U.S. Postal Service, struggling under a financial load and facing tough competition, will stop delivering mail on Saturdays beginning this summer, officials announced.

The announcement, which had been expected, is seen as an attempt to force Congress to deal with the Postal Service's increasing financial woes. Congress has tried to reorganize the agency, but efforts have been derailed because of politics.

Material prepared for a Wednesday news conference by Postmaster General Patrick R. Donahoe says that Postal Service market research and other research has indicated that nearly 7 in 10 Americans support the switch to five-day delivery as a way for the agency to reduce costs.

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"The Postal Service is advancing an important new approach to delivery that reflects the strong growth of our package business and responds to the financial realities resulting from America's changing mailing habits," Donahoe said. "We developed this approach by working with our customers to understand their delivery needs and by identifying creative ways to generate significant cost savings."

The Postal Service contends that it has the authority to cut back service, though some in Congress insist that lawmakers have the final word. In any case, the announcement is expected to move the issue to a front burner.

According to postal officials, the end of Saturday delivery would begin on Aug. 1. The service said it will continue to deliver packages on Saturdays.

Ending Saturday service is estimated to save the agency about $2 billion a year. Officials said it lost about $16 billion in fiscal 2012, which ended Sept. 30 -- about three times the loss it had a year ago.

The proposal comes as the agency has closed post offices and changed procedures to try to stem its hemorrhaging of billions of dollars in recent years. More people have been turning to alternatives to traditional mail service, including electronic tools such as email and outside competitors such as Fed Ex, both of which have seriously cut into the Postal Service's erstwhile monopoly.

Congress in recent years has prohibited the Postal Service from dropping Saturday mail delivery, but the initial response to Wednesday's announcement was more accepting of what might be inevitable.

"This common-sense reform would save the Postal Service more than $2 billion annually," two top Republicans, Rep. Darrell Issa of California and Sen. Tom Coburn of Oklahoma, said in a statement.

"In his recent inaugural address, President Obama spoke about the need to find real solutions to our nation’s problems. Supporting the U.S. Postal Service's plan to move forward with 5-day mail delivery is one such solution worthy of bipartisan support," they said.

Rep. Elijah E. Cummings of Maryland, the top Democrat on the House Oversight and Government Reform Committee chaired by Issa, agreed that action was needed, but questioned whether the Postal Service could act alone.

"The Postal Service's declining mail volume poses a significant challenge, and the enactment of comprehensive postal reform legislation must be an urgent priority for the current Congress," Cummings said in a statement. “However, the issue of service delivery frequency should be addressed in that legislation rather than through arbitrary action by the Postal Service.”

Recent national polls show that a majority of respondents support ending Saturday mail delivery, and Obama has proposed halting such service as part of his budget-cutting proposals. Though the Postal Service is a quasi-governmental, self-funding entity, its worker compensation and retirement plans are tied to the federal budget.

Lawmakers have tried unsuccessfully for years to overhaul the Postal Service, but efforts have fallen victim to different needs in different areas. Representatives of rural areas tend to argue that traditional mail delivery is needed, a position backed by magazine publishers and other heavy users of the Postal Service.

The president of the National Assn. of Letter Carriers, Fredric Rolando, said in a statement that the end of Saturday mail delivery is "a disastrous idea that would have a profoundly negative effect on the Postal Service and on millions of customers,” particularly businesses, rural communities, the elderly, the disabled and others who depend on Saturday delivery for commerce and communication.

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Times staff writers Richard Simon and Jim Puzzanghera contributed to this report.

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<cite>Portal</cite>, the Movie: Valve, J.J. Abrams Team Up for Future Games, Films

LAS VEGAS — Valve, the game developer behind Half-Life and Portal, and J.J. Abrams’ production studio Bad Robot will work together to produce games and movies, the heads of the two studios said at the DICE Summit on Wednesday.

“There’s an idea we have for a game that we’d like to work with Valve on,” said Abrams while sharing the stage with Valve head Gabe Newell.

“We’re going to figure out if we can make a Portal movie or Half-Life movie together,” Newell said.

The surprise announcement came at the close of a brief joint keynote by Abrams and Newell, titled “Storytelling Across Platforms: Who Benefits Most, the Audience or the Player?” The opening presentation at the game industry’s annual high-level business summit featured two creative minds at the top of their respective mediums of choice: Lost creator Abrams was recently tapped to direct Star Wars: Episode VII, and Newell’s company Valve is redefining how games are made and sold with its Steam service, which it intends to push into the living room this year with an entry into the hardware market.

Abrams and Newell made the surprise, succinct announcement at the end of their keynote speech, which took the form of a carefully rehearsed discussion between the two creatives about the strengths and weaknesses of games and movies as storytelling mediums.

“Players are often asked to imprint themselves or relate to insanely mute empty vessels,” Abrams said, playing a clip from Valve’s Half-Life that showed its mute protagonist Gordon Freeman.

Newell pointed out that it can be frustrating for a viewer to not have agency while watching a movie, pointing to Abrams’ film Cloverfield as an example — why, he said, doesn’t the character just drop the camera and run away from the danger? The “self-paced” nature of games, he said, can create a more optimal experience.

“Movies let you experience moments that you might not think are the point, but really are everything,” Abrams said, pointing to the early introduction of compressed air canisters in the opening scenes of the movie Jaws, which initially seem unimportant but prove consequential to the film’s ending. Newell pointed out that the “take your child to work” scene in Portal 2 accomplished the same thing, setting up important plot points in a way that made them initially seem like humorous throwaways.

This seems to have been exactly what Abrams and Newell were doing with their DICE Summit keynote: Setting up the audience with what seemed to be a lighthearted, friendly discussion about games and movies, then surprising them with the revelation that they weren’t just going to chat about it at a conference but actively working together to create movies and games that learn from one another.

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The New Old Age Blog: For Women, Reduced Access to Long-Term Care Insurance

“This was a very, very good business for a short time, with people buying long-term care insurance like it was candy in a candy store,’’ said Michael Perry, a vice president at the Opus Advisory Group, a strategic financial planning firm in Purchase, N.Y.

No more. Mr. Perry has sold only one long-term care policy in the last six months and is “backing off from marketing’’ them as he watches this corner of the insurance business contract, raise premiums, tighten eligibility requirements and reduce key benefits. Long-term care insurance is a comparatively new product, launched in the late ’80s, and only now, as claims begin to pour in, have the actual costs to insurers become apparent.

Companies like MetLife, Prudential Financial, Allianz and Berkshire Financial (a subsidiary of Guardian) have stopped selling new policies and are hiking premiums for the ones already in place — up 37 percent, by one estimate, in 2011. Insurers are increasing elimination periods — the period during which a beneficiary must cover his or her own costs — and reducing inflation protection to 3 percent from 5 percent, once customary. They are requiring home visits instead of phone interviews from new applicants, as well as blood tests and a thorough examination of their medical records.

But the change that has generated the most public attention is so-called gender-distinct pricing, a new strategy that will raise rates for single women by as much as 40 percent beginning in April. Genworth Financial, the nation’s largest long-term care insurance provider with more than a million policy holders, is the first to win approval by state insurance commissions to raise rates for single women purchasing new policies. Women, most of them single by the time they reach advanced age, cost the company $2 of every $3 in benefits paid so far, according to Steve Zabel, Genworth’s senior vice president for long-term care insurance.

The company also will introduce what Mr. Zabel called “enhanced underwriting,” or more stringent qualifying standards, including blood testing to check for nicotine, drugs and markers of cardiovascular disease for all new applicants, regardless of gender or marital status.

Now permitted in all states except Montana and Colorado, gender-distinct pricing will not affect Genworth’s current policyholders, only new applicants. But all other carriers are likely to follow, according to Jesse Slome, executive director of the American Association for Long-Term Insurance, a trade group in Westlake Village, Calif. With the entire industry headed toward higher rates, Mr. Slome recently warned women that “the window is closing” and that now is the time to grab a policy while the price is still manageable.

Women have always paid less than men for life insurance. But because they live longer, women are the disproportionate beneficiaries of long-term care insurance, which paid out $6.6 billion in benefits in 2011. Mr. Slome expects that number to top $7 billion in 2012.

The reasons are well known:

* On average, women outlive men by five years. Among those born in 1960, the average man will live to age 67 and the average woman to age 73. And women who reach age 65 can expect to live an average of 20 more years.

* By age 75, 7 in 10 women are widowed, divorced or have never been married. Some 40 percent of them live alone, compared to 22 percent of men. Two-thirds of those past the age of 85 are women, as are 80 percent of centenarians.

* Women who live to age 65 experience on average two years of disability requiring assistance before death. Those who reach age 80 will require three years of assistance.

* In nursing homes, the most expensive form of long-term care, 7 in 10 residents are women. They represent 76 percent of the residents in assisted living facilities and two-thirds of the recipients of home care. Virtually none of this is paid for by Medicare, the government’s health plan for those 65-and-over. In nursing homes, Medicaid, a poverty program, kicks in for residents who run out of money.

“Woman live longer than men,” said Suzanna de Baca, a vice president of wealth strategies at Ameriprise Financial. “This may mean we experience a longer period of decline. Unfortunately, we are often less likely to have a partner around to help take care of us than our male counterparts.’’

Long-term care, Mr. Slome said, “is truly a women’s issue.”

While acknowledging the extra expense of caring for women, Mr. Slome said that in his view insurance carriers are being disingenuous in blaming the new policies on long-apparent gender differences. Rather he said, the culprit in the changing requirements is interest rates. “Blame the Federal Reserve,’’ he said.

Insurance carriers invest premiums and need to earn enough on that investment to pay benefits. When interest rates were higher, it was not all that difficult. Now the numbers don’t pencil out, and stockholders are fuming. But it is illegal to file for premium increases with the state insurance commissions based on changes in the financial market, Mr. Slome said.

This position does not endear Mr. Slome to his membership, at least one of whom disputes the claim. Asked if the new rate policies were related to interest rates, Mr. Zabel of Genworth, in an e-mail, replied with a succinct “no.”

Insurers say they were not able to judge the costs of care until the payouts began in earnest.

So what is a woman trying to prepare for old age supposed to do, especially after the elimination of the Class Act, a modest attempt to include long-term care in the Affordable Care Act?

Ms. da Baca suggests “careful and thorough budgeting,” “focusing on wellness,” and “proactive steps” to research suitable places to live when home is no longer an option. Ms. da Baca also advises women to make home modifications — incrementally, as one’s budget permits — to increase the chances that you’ll be able to stay there longer.

Mr. Perry, of the Opus Advisory Group, suggests an intriguing option: life insurance with a chronic care rider, which permits the policy-holder to spend money for such needs while alive, although doing so will reduce the tax-free death benefit. Still, not all buyers — or their survivors — are willing to sacrifice those benefits.

“The need is still there, no question about it,’’ Mr. Perry said. But long-term care insurance is likely to become much harder for everyone to find and afford, especially women.

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State of the Art: Microsoft’s Surface Pro Works Like a Tablet and a PC

For decades, Microsoft has subsisted on the milk of its two cash cows: Windows and Office. The company’s occasional ventures into hardware generally haven’t ended well: (*cough*) Zune, Kin Phone, Spot Watch (*cough*).

But the new Surface Pro tablet, which goes on sale Saturday, seemed to have more going for it than any Microsoft hardware since the Xbox.

Everybody knows what a tablet is, right? It’s a black touch-screen slab, like an iPad or an Android tablet. It doesn’t run real Windows or Mac software — it runs much simpler apps. It’s not a real computer.

But with the Surface Pro ($900 for the 64-gigabyte model, $1,000 for a 128-gig machine), Microsoft asks: Why not?

The Surface Pro looks like a tablet. It can work like a tablet. You can hold it in one hand and draw on it with the other. It even comes with a plastic stylus that works beautifully.

But inside, the Pro is a full-blown Windows PC, with the same Intel chip that powers many high-end laptops, and even two fans to keep it cool (they’re silent). As a result, the Pro can run any of the four million Windows programs, like iTunes, Photoshop, Quicken and, of course, Word, Excel and PowerPoint.

The Surface Pro is beautiful. It’s clad in matte-black metal, beveled at the edges like a Stealth helicopter. Its connectors immediately suggest its post-iPad capabilities, like a memory-card slot for expanded storage. The screen is bright and beautiful, with 1080p high-definition resolution (1,080 by 1,820) — but when you connect the tablet to a TV or desktop monitor, it can send out an even bigger, sharper picture (2,550 by 1,440). There’s one USB 3.0 jack in the tablet, and a second ingeniously built into the power cord, so you can charge your phone as you work. Or you can connect anything you’d connect to a PC: external drives, flash drives, keyboard, mouse, speakers, cameras and so on.

Are you getting it? This is a PC, not an iPad.

As though to hammer home that point, Microsoft has endowed the Surface Pro with two unusual extras that complete the transformation from tablet to PC in about two seconds.

First, this tablet has a kickstand. It’s a thin metal flap that disappears completely when closed, but holds the tablet at a nice angle when you’re working or watching a movie.

Second, you can buy Microsoft’s now-famous keyboard cover. There are two models, actually. One is about as thick as a shirt cardboard. You can type on it — slowly — but you’re tapping drawings of keys, not actual keys. It’s called the Touch Cover ($100 with Surface purchase).

The other keyboard, the Type Cover ($130) is thicker — a quarter-inch — but its keys really travel, and it has a trackpad. You can really type on this thing.

Either keyboard attaches to the tablet with a powerful magnetic click. For tablet use, you can flip either keyboard around to the back; it disables itself so you don’t type gibberish by accident.

And if you really want to go whole hog with the insta-PC idea, you should also spring for the matching Touch Wedge mouse. It’s a tiny $40 cordless wedge, not much bigger than the AA battery that powers it, with supercrisp buttons and a touch surface on top for scrolling.

Now, when I wrote a first-look post on my blog last month , I was surprised by the reader reactions. Over and over, they posted the same argument:

“For that money, I could buy a very nice lightweight laptop with a dedicated keyboard and much more storage. Why should I buy Surface Pro when I can have more for less?”

Why? Because the Surface Pro does things most laptops can’t do. Like it weighs two pounds, with touch screen. Or work in portrait orientation, like a clipboard. Or remain comfortable in one hand as you make medical rounds, take inventory or sketch a portrait. Or stay in a bag as it goes through airport security (the TSA says tablets are O.K. to stay in).

You also hear: “But haven’t there been full-blown PC tablets before?”

Yes, there are a couple. But without the kickstand and keyboard cover, they can’t change instantly into a desktop computer.

So it’s true: for this much money, you could buy a very nice laptop. You could also buy a five-day cruise, a Gucci handbag or 250 gallons of milk. They just happen to be different beasts.

All right then: the Surface Pro is fast, flexible and astonishingly compact for what it does; that much is unassailable. But in practice, there are some disappointments and confusions.

E-mail: pogue@nytimes.com

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Friends, investigators seek answers in killing of O.C. couple

A joint burial is being planned for an engaged Orange County couple found dead inside their car at their Irvine condo complex.

They met in college, two highly regarded basketball players who seemed to have the same winning touch on the court and off.

After blazing through high school and college with her outside shot, Monica Quan became the assistant women's basketball coach at Cal State Fullerton. Keith Lawrence, whose highlight shots are still there on his college website, became a campus officer at USC.

Now police in Irvine are scrambling for an explanation — and friends are looking for a way to express their shock — after Quan and Lawrence were found shot to death in their parked car on the top floor of a parking structure in an upscale, high-security condominium complex near UC Irvine.

The two had just announced their engagement and had recently moved into a condominium complex near Concordia University, where they played basketball and had gone on to earn their degrees.

Late Sunday, after a passerby noticed two people in the parked car, police said they found Lawrence slumped in the driver's side of his white Kia. Quan was next to him, also dead. The couple were shot multiple times, and authorities said they have tentatively ruled out the possibility of it being a murder-suicide or motivated by robbery. Nothing in the car, police said, seemed to be disturbed.

The couple's friends and family said they were shaken by the violent deaths of two people who seemed to have so much to offer.

Quan was a 2002 graduate of Walnut High School in the San Gabriel Valley, where she set school records for the most three-pointers in a season and a game. She played at Long Beach State and at Concordia, where she graduated in 2007. She went on to earn a master's degree before becoming the assistant coach at Fullerton.

Quan's father was the first Chinese American captain in the LAPD, and went on to become police chief at Cal Poly Pomona.

Quan was known for pulling students aside to offer encouragement, said Megan Richardson, a former player. Marcia Foster, the head basketball coach at Cal State Fullerton, described her assistant as a special person — "bright, passionate and empowering," she said.

Quan shared a love of basketball with her fiancee, Lawrence, whom she met at Concordia.

He too had been a standout basketball player, starting at Moorpark High, where he played point guard and shooting guard, said Tim Bednar, who coached Lawrence.

Bednar said that Lawrence, who came from a family of athletes, was talented, yet quiet and humble. After Lawrence graduated in 2003, he continued to participate in summer youth camps

When he returned for the camps, Bednar said, he was known as the "best basketball player that ever came through" the school.

"He was awesome with the kids," Bednar said. "They all wanted to be around Keith Lawrence."

Bednar heard from Lawrence when he needed a recommendation to become a police officer after graduating from the Ventura County Sheriff's Academy. In August, he was hired by USC's public safety department.

John Thomas, the executive director and chief of the department, said that Lawrence was an "honorable, compassionate and professional" member of the community.

"We are a better department and the USC campus community is a safer place as a result of his service," Thomas said in a statement.

On Monday night, Quan's friends gathered outside Walnut High School. One clutched a heart-shaped balloon, another carried a collage of her basketball playing days. Still another held a basketball.

Lawrence's friends and family put up a Facebook page. "RIP Keith Lawrence, you will be missed," it said simply. Within hours, 840 had left comments or indicated they "liked" it. Concordia put up a link to Lawrence's game-winning shot that carried the school into a post-season tournament.

Michelle Thibeault, 27, said in a Facebook message that she had known Quan for more than a decade. The two were on the same athletic teams and went to junior high and high school together. "Monica was loved by everyone," she said.

During a somber gathering at the Cal State Fullerton gymnasium Monday, Foster read a brief statement from Quan's brother Ryan.

"We just shared a moment of incredible joy on her recent engagement," he wrote, and then added: "A bright light was just put out."

nicole.santacruz@latimes.com

kate.mather@latimes.com

lauren.williams@latimes.com

Times staff writer John Canalis contributed to this report.

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How Facebook Is Transforming Science and Public Health

Facebook has encompassed many things in its nine-year run. From a subtler version of a dating site to a gaming platform and a messaging hub. We’ve seen Facebook and its billion-plus users play a part in influencing politics, the form advertising takes, and how retail happens. Now we’re starting to see Facebook begin to impact science and public health, and it could be Facebook’s biggest industry-changing opportunity yet.

The logic is a simple one: Everyone on Facebook, all 1 billion-plus people, will have an illness at some point in their lives. And, as Facebook’s social creatures are in the habit of doing, that mass of people will share their experience battling disease, ask questions of their friends, and field advice from outsiders. Through the bullhorn of Facebook, healthcare professionals can deliver information 24-7 about flu vaccines, the path of epidemics, and essential preventive care. The social network can influence how and when people respond to disease, and how we manage death and dying. “Facebook has this massive and powerful platform [that] can be deployed for health care,” says Dr. Eric Topol, director of the Scripps Translational Science Institute.

In his book about digital health care, Topol writes about the story of a mother who posted pictures of her sick child on Facebook. People in her network started commenting on those photos. Three, including a cousin who was a pediatric cardiologist, called to tell her her son might have Kawasaki’s disease, a rare genetic disorder. She called her doctor and told her she was on her way to the hospital because she had a “sense” her kid was really sick.

“What [else] was I going to say? Three of my Facebook friends think my kid has an extremely rare childhood auto-immune disorder which I just read about on Wikipedia, and since they all contacted me after I posted a photo of him on my wall, I’m going? It seemed … wrong!” Deborah Kogan wrote on Slate. Once she got to the hospital, she writes, she told the doctor about her Facebook-prompted visit. She claims the doc said, “You know what? I was just thinking it could be Kawasaki disease. Makes total sense. Bravo, Facebook.”

This is only one story, but it does highlight the potential power of the Facebook network effect.

Last May, for example, Facebook made registering as an organ donor an official “Life Event.” Theoretically, users always had the option to tell their friends they wanted someone else to benefit from their body after they died. But publicizing that information was likely not high on the list of things people thought of sharing when they logged in. Facebook changed that, at least for a time.

About 6,000 people in 22 states registered as organ donors on the first day after the announcement was made, up from an average of about 360. That spike in registrations may have trailed off because users were not continuously reminded of this option, but the social experiment showed the influence Facebook could have on public health, say experts studying the collision between digital tools and health care.

Facebookers can already add overcoming an illness, losing weight, breaking bones or having their braces removed to their Life Events under the category “health and wellness,” but those updates provide very limited information about health.

Physicians, Topol says, don’t even know what normal, minute-by-minute blood pressure should be. That’s a problem because millions of Americans suffer from high blood pressure. But what if researchers could reach even a fraction of Facebook users who have this condition and prompt them to participate in a research study that tracked their blood pressure, along with other metrics like activity levels and heart rate through digital sensors? What if at some point in the future, there was even an option to share genetic information on your Facebook profile? With its growing cross-section of users, Facebook “could really get us an enriched data set,” Topol says.

That assumes, of course, that the data will be reliable, that Facebook will work with scientists to do research as it currently does, and that people will be willing to share personal health information given concerns about how Facebook or third parties might use their data. If you post that you have insomnia for example, would sleep medication ads suddenly pop up?

Those kinds of questions, and the cautious nature of the health care industry, have tended to keep the flow of health related data on Facebook fairly unsophisticated. Until now, Facebook has mostly served as a platform to disseminate information on the cheap. “More hospitals are on Facebook than any other social platform,” said Lee Aase, director of the Mayo Clinic Center for Social Media. Organizations use it, Aase says, to raise awareness about local blood drives, mental health services, free vaccinations, STD/HIV testing, or prenatal care.

Physicians, who you might think would love to use Facebook as a natural hub to communicate with their patients, have mostly shied away from it and other social media platforms to interact with patients because of concerns over professionalism and legal liabilities due to patient confidentiality laws.

But there are signs that the healthcare crowd is warming up to Facebook, in particular research scientists are increasingly using Facebook as a tool. Currently, there have been roughly 400 academic papers published in the last four years that mention the social network, according to a search for the word ‘Facebook’ on PubMed, a public database of biomedical and life sciences research. That’s not many, but the number of such articles published each year seems to be growing. Some of these studies are trying to tease out whether Facebook could be a valid teaching tool for dentistry, histology and continuing education, which suggests the field might be getting more comfortable with the idea of using social media more widely.

In September, researchers from the University of California, San Diego, in collaboration with Facebook’s Data Science group, published a study of 61 million Facebook users in the journal Nature that suggested political messaging on Facebook influenced real-word voting of millions in the 2010 congressional elections. When users were told that their friends had voted, they were slightly more likely to vote themselves. Although the effect was small, “they translate into a significant numbers of votes” if extrapolated into a real-world scenario, according to an editorial published with the report. Imagine if the same could be shown for public health campaigns on Facebook? Scripps’ Topol asks.

“The leading digital doctors are really pushing the envelope on this,” says Topol. “But it’s just getting started.”

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