Rate of Childhood Obesity Falls in Several Cities

Jessica Kourkounis for The New York Times

At William H. Ziegler Elementary in Northeast Philadelphia, students are getting acquainted with vegetables and healthy snacks.

PHILADELPHIA — After decades of rising childhood obesity rates, several American cities are reporting their first declines.

The trend has emerged in big cities like New York and Los Angeles, as well as smaller places like Anchorage, Alaska, and Kearney, Neb. The state of Mississippi has also registered a drop, but only among white students.

“It’s been nothing but bad news for 30 years, so the fact that we have any good news is a big story,” said Dr. Thomas Farley, the health commissioner in New York City, which reported a 5.5 percent decline in the number of obese schoolchildren from 2007 to 2011.

The drops are small, just 5 percent here in Philadelphia and 3 percent in Los Angeles. But experts say they are significant because they offer the first indication that the obesity epidemic, one of the nation’s most intractable health problems, may actually be reversing course.

The first dips — noted in a September report by the Robert Wood Johnson Foundation — were so surprising that some researchers did not believe them.

Deanna M. Hoelscher, a researcher at the University of Texas, who in 2010 recorded one of the earliest declines — among mostly poor Hispanic fourth graders in the El Paso area — did a double-take. “We reran the numbers a couple of times,” she said. “I kept saying, ‘Will you please check that again for me?’ ”

Researchers say they are not sure what is behind the declines. They may be an early sign of a national shift that is visible only in cities that routinely measure the height and weight of schoolchildren. The decline in Los Angeles, for instance, was for fifth, seventh and ninth graders — the grades that are measured each year — between 2005 and 2010. Nor is it clear whether the drops have more to do with fewer obese children entering school or currently enrolled children losing weight. But researchers note that declines occurred in cities that have had obesity reduction policies in place for a number of years.

Though obesity is now part of the national conversation, with aggressive advertising campaigns in major cities and a push by Michelle Obama, many scientists doubt that anti-obesity programs actually work. Individual efforts like one-time exercise programs have rarely produced results. Researchers say that it will take a broad set of policies applied systematically to effectively reverse the trend, a conclusion underscored by an Institute of Medicine report released in May.

Philadelphia has undertaken a broad assault on childhood obesity for years. Sugary drinks like sweetened iced tea, fruit punch and sports drinks started to disappear from school vending machines in 2004. A year later, new snack guidelines set calorie and fat limits, which reduced the size of snack foods like potato chips to single servings. By 2009, deep fryers were gone from cafeterias and whole milk had been replaced by one percent and skim.

Change has been slow. Schools made money on sugary drinks, and some set up rogue drink machines that had to be hunted down. Deep fat fryers, favored by school administrators who did not want to lose popular items like French fries, were unplugged only after Wayne T. Grasela, the head of food services for the school district, stopped buying oil to fill them.

But the message seems to be getting through, even if acting on it is daunting. Josh Monserrat, an eighth grader at John Welsh Elementary, uses words like “carbs,” and “portion size.” He is part of a student group that promotes healthy eating. He has even dressed as an orange to try to get other children to eat better. Still, he struggles with his own weight. He is 5-foot-3 but weighed nearly 200 pounds at his last doctor’s visit.

“I was thinking, ‘Wow, I’m obese for my age,’ ” said Josh, who is 13. “I set a goal for myself to lose 50 pounds.”

Nationally, about 17 percent of children under 20 are obese, or about 12.5 million people, according to the Centers for Disease Control and Prevention, which defines childhood obesity as a body mass index at or above the 95th percentile for children of the same age and sex. That rate, which has tripled since 1980, has leveled off in recent years but has remained at historical highs, and public health experts warn that it could bring long-term health risks.

Obese children are more likely to be obese as adults, creating a higher risk of heart disease and stroke. The American Cancer Society says that being overweight or obese is the culprit in one of seven cancer deaths. Diabetes in children is up by a fifth since 2000, according to federal data.

“I’m deeply worried about it,” said Francis S. Collins, the director of the National Institutes of Health, who added that obesity is “almost certain to result in a serious downturn in longevity based on the risks people are taking on.”

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Luke Bryan cleans up at ACAs with 9 awards

Luke Bryan didn’t want the American Country Awards to end.

He cleaned up during the fan-voted show, earning nine awards, including artist and album of the year. His smash hit “I Don’t Want This Night To End” was named single and music video of the year.

Miranda Lambert took home the second most guitar trophies with three. Jason Aldean was named touring artist of the year. Carrie Underwood won female artist of the year, and a tearful Lauren Alaina won new artist of the year.

Bryan, Aldean, Keith Urban, Lady Antebellum and Trace Adkins with Lynyrd Skynrd were among the high-energy performances.

The third annual ACAs were held at Mandalay Bay in Las Vegas Monday night.

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Online: http://www.theACAs.com

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Follow http://www.twitter.com/AP_Country for the latest country music news from The Associated Press.

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DealBook: Delta Takes 49% Stake in Virgin Atlantic for $360 Million

There are few more lucrative airline routes than the one between the financial powerhouses of New York and London. On Tuesday, Delta Air Lines signaled that it was going after that business-heavy market, agreeing to buy a 49 percent stake in Virgin Atlantic from Singapore Airlines for $360 million.

The deal will provide Delta with more access to Heathrow Airport, one of the world’s busiest hubs, where takeoff and landing rights are limited because of high demand and tight capacity. New York, where all major airlines are battling to attract high-paying passengers, is the top international destination from Heathrow.

Singapore bought its stake in 2000 for £600.3 million ($966 million), but it has been dissatisfied with the returns, analysts said. While Delta had considered buying Singapore’s stake two years, the carriers could not agree on a price.

On Tuesday, Delta and Virgin Atlantic said they would apply for antitrust immunity from American and European competition authorities in order to coordinate fares and flight schedules, as well as offer seats on each other’s planes. Virgin Group, headed by the British billionaire Richard Branson, has said it does not plan to sell its 51 percent controlling majority in Virgin Atlantic.

Delta has a strong partnership with Air France-KLM that serves many European destinations, but it is not a strong contender in the London market. Delta has nine daily flights to Heathrow from New York, Boston and Atlanta. But it has no direct flights from other top markets like San Francisco, Chicago, Washington, D.C., Miami or Los Angeles, requiring passengers to connect through its other hubs.

Heathrow is operating at full capacity, and the British government has rejected expansion plans to build a third runway. As a result, landing and takeoff rights, known as slots, are limited, making them rare and prized commodities for the airlines.

Getting more slots, however, is no simple matter even for an airline like Delta, which has global ambitions. Delta has just 0.3 percent of the Heathrow slots, according to the Airport Coordination Limited, which is responsible for slot allocations at airports in Britain.

British Airways dominates Heathrow, with 53 percent of the slots, followed by Lufthansa of Germany, with 5.6 percent, and Virgin with 3.3 percent. American and United each have 2.3 percent.

British Airways’ hold on the airport actually increased in the last year after it completed the acquisition of British Midland International from Lufthansa. The acquisition was challenged by Virgin Atlantic, which claimed it would distort competition and simply reinforce the dominance of British Airways. The deal, however, was cleared by the European Commission in March under certain conditions, including that 14 of the 56 daily slot pairs British Airways received from British Midland be released to other carriers.

Still, Delta’s move is a challenge to American Airlines and British Airways, which are partners in the Oneworld global alliance. The two carriers dominate the New York to London market with 15 daily flights and a shuttlelike schedule of departures every 20 or 30 minutes in the peak evening hours. British Airways and American received antitrust immunity two years ago allowing them to coordinate their schedules and fares.

Delta’s challenge in New York comes at a weak time for American Airlines, which has been in bankruptcy for over a year and which counts New York as one of its five major hubs. Delta is spending $1.2 billion in New York to build a new
terminal at Kennedy Airport to replace its outdated facilities there. It has also expanded its presence at La Guardia Airport, which serves mostly domestic locations, with a deal to exchange landing right with US Airways.

United Airlines, for its part, holds a dominant position at Newark Liberty International Airport since merging with Continental Airlines in 2010.

Virgin was founded by Mr. Branson in 1984 with flights to New York. From the start, it embraced an image of fun travel and cheaper fares. It now has 38 airplanes in its fleet and flies to more than two dozen destinations. But the airline, which is not aligned with any of the three global groups – ­Star Alliance, Sky Team and Oneworld Alliance – has struggled in recent years because of high fuel prices.

The announcement in New York came a day after Virgin disclosed its plans to start domestic flights within the United Kingdom in the spring, with service to Edinburgh and Aberdeen in Scotland. Thanks to slots at Heathrow that British Airways gave up, Virgin will add 24 domestic flights a day.

The Virgin Group also own 25 percent of Virgin America, a low-cost domestic carrier that is independent of its international namesake. American law forbids foreigners from owning more than 25 percent of a domestic
airline. The European Union has a similar requirement barring non-European carriers from holding a majority stake in a European Union airline.

Air France-KLM is also considering buying part of Mr. Branson’s stake in Virgin Atlantic, according to reports in the British media. Such a deal, if it happened, would further strengthen Delta, which is a partner with Air France within the Sky Team alliance.

With the deal, Delta is wading into an old and often feisty rivalry opposing Virgin and British Airways.

Willie Walsh, who runs the parent company of British Airways, the International Airlines Group, said recently that Delta was really more interested in Virgin’s slots at Heathrow than in preserving the airline or its brand.

“I can’t see Delta wanting to operate the Virgin brand because if they do, what does that say about the Delta brand?” Mr. Walsh told Britain’s Telegraph newspaper in an interview. “Delta believes they are the No. 1 airline in the world, so what they would want to do is acquire the slots at Heathrow to enable them to have a strong presence at Heathrow.”

The comments drew a quick response from Mr. Branson, doubled with a characteristic challenge.

“Rumors have been spread in the press that I am planning to give up control of Virgin Atlantic and, according to Willie Walsh (who runs BA) that our brand will soon disappear,” Mr. Branson said on Monday in a statement titled “Sorry BA ­we’re not going anywhere.” “This is wishful thinking and totally misguided. Will BA never learn?”

Mr. Branson then offered to give employees of British Airways £1 million if Virgin Atlantic disappeared within the next five years. If it was still in business then, he challenged Mr. Walsh to pay the same amount to Virgin’s employees.

“Let’s see how much they believe this,” he said. “Let them put their money where their mouth is.”

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Latin music star Jenni Rivera believed dead in plane crash

Fans of Mexican-American singing star Jenni Rivera held a vigil Sunday night in Lynwood

MEXICO CITY — Mexican American singer Jenni Rivera, the "diva de la banda" whose commanding voice burst through the limits of regional Latin music and made her a cross-border sensation and the queen of a business empire, was believed to have died Sunday when the small jet carrying her and members of her entourage crashed in mountainous terrain.

Rivera, a native of Long Beach, was 43. Mexico's ministry of transportation did not confirm her death outright, but it said that she had been aboard the plane and that no one had survived the crash. Six others, including two pilots, also were on board.

"Everything suggests, with the evidence that's been found, that it was the airplane that the singer Jenni Rivera was traveling in," said Gerardo Ruiz Esparza, Mexico's secretary of communications and transportation. Of the crash site, Ruiz said: "Everything is destroyed. Nothing is recognizable."

Word of the accident ricocheted around the entertainment industry, with performer after performer expressing shock and grief. Fans gathered outside Rivera's four-acre estate in Encino.

"She was the Diana Ross of Mexican music," said Gustavo Lopez, an executive vice president at Universal Music Latin Entertainment, an umbrella group that includes Rivera's label. Lopez called Rivera "larger than life" and said that based on ticket sales, she was by far the top-grossing female artist in Mexico.

"Remember her with your heart the way she was," her father, Don Pedro Rivera, told reporters in Spanish on Sunday evening. "She never looked back. She was a beautiful person with the whole world."

Rivera had performed a concert in Monterrey, Mexico, on Saturday night — her standard fare of knee-buckling power ballads, pop-infused interpretations of traditional banda music and dizzying rhinestone costume changes.

At a news conference after the show, Rivera appeared happy and tranquil, pausing at one point to take a call on her cellphone that turned out to be a wrong number. She fielded questions about struggles in her personal life, including her recent separation from husband Esteban Loaiza, a professional baseball player.

"I can't focus on the negative," she said in Spanish. "Because that will defeat you. That will destroy you.... The number of times I have fallen down is the number of times I have gotten up."

Hours later, shortly after 3 a.m., Rivera is believed to have boarded a Learjet 25, which took off under clear skies. The jet headed south, toward Toluca, west of Mexico City; there, Rivera had been scheduled to tape the television show "La Voz" — Mexico's version of "The Voice" — on which she was a judge.

The plane, built in 1969 and registered to a Las Vegas talent management firm, reached 11,000 feet. But 10 minutes and 62 miles into the flight, air traffic controllers lost contact with its pilots, according to Mexican authorities. The jet crashed outside Iturbide, a remote city that straddles one of the few roads bisecting Mexico's Sierra de Arteaga national park.

Wreckage was scattered across several football fields' worth of terrain. An investigation into the cause of the crash was underway, and attempts to identify the remains of the victims had begun.

Rivera, a mother of five and grandmother of two, was believed to have been traveling with her publicist Arturo Rivera, who was not related to her, as well as with her lawyer, hairstylist and makeup artist; reports of their names were not consistent. Their identities were not confirmed by authorities. The pilots were identified as Miguel Perez and Alejandro Torres.

In the world of regional Latin music — norteño, cumbia and ranchera are among the popular niches — Rivera was practically royalty.

Her father was a noted singer of the Mexican storytelling ballads known as corridos. In the 1980s he launched the record label Cintas Acuario. It began as a swap-meet booth and grew into an influential and taste-making independent outfit, fueling the careers of artists such as the late Chalino Sanchez. Jenni Rivera's four brothers were associated with the music industry; her brother Lupillo, in particular, is a huge star in his own right.

Born on July 2, 1969, Rivera initially showed little inclination to join the family business. She worked for a time in real estate. But after a pregnancy and a divorce, she went to work for her father's record label and found her voice, literally and figuratively.

She released her first studio album in 2003, when she was 34.

Her path had not been easy, but rather than running from it, she wrote it into her music — domestic violence; struggles with weight; raising her children alone, or "sin capitan," without a captain. She was known for marathon live shows that left audiences exhilarated and exhausted; by the fifth hour of one recent performance, she was drinking straight from a tequila bottle and launching into a cover of "I Will Survive."

In a witty and sometimes baffling stew of Spanish and English, she sang about her three husbands, about drug traffickers, in tribute to her father, in tribute to her gynecologist.

She became, in a most unlikely way, a feminist hero among Latin women in Mexico and the United States and a powerful player in a genre of music dominated by men and machismo. Regional Mexican music styles had long been seen as limiting to artists, but Rivera shrugged off the labels and brought traditional-laced music — some of which sounded perilously close to polka — to a massive pop audience.

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U.S. Spies See Superhumans, Instant Cities by 2030

3-D printed organs. Brain chips providing superhuman abilities. Megacities, built from scratch. The U.S. intelligence community is taking a look at the world of 2030. And it is very, very sci-fi.

Every four or five years, the futurists at the National Intelligence Council take a stab at forecasting what the globe will be like two decades hence; the idea is to give some long-term, strategic guidance to the folks shaping America’s security and economic policies. (Full disclosure: I was once brought in as a consultant to evaluate one of the NIC’s interim reports.) On Monday, the Council released its newest findings, Global Trends 2030. Many of the prognostications are rather unsurprising: rising tides, a bigger data cloud, an aging population, and, of course, more drones. But tucked into the predictable predictions are some rather eye-opening assertions. Especially in the medical realm.

We’ve seen experimental prosthetics in recent years that are connected to the human neurological system. The Council says the link between man and machine is about to get way more cyborg-like. “As replacement limb technology advances, people may choose to enhance their physical selves as they do with cosmetic surgery today. Future retinal eye implants could enable night vision, and neuro-enhancements could provide superior memory recall or speed of thought,” the Council writes. “Brain-machine interfaces could provide ‘superhuman’ abilities, enhancing strength and speed, as well as providing functions not previously available.”

And if the machines can’t be embedded into the person, the person may embed himself in the robot. “Augmented reality systems can provide enhanced experiences of real-world situations. Combined with advances in robotics, avatars could provide feedback in the form of sensors providing touch and smell as well as aural and visual information to the operator,” the report adds. There’s no word about whether you’ll have to paint yourself blue to enjoy the benefits of this tech.

The Council’s futurists are less definitive about 3-D printing and other direct digital manufacturing processes. On one hand, they say that any changes brought about by these new ways of making things could be “relatively slow.” On the other, they rip a page out of Wired, comparing the emerging era of digital manufacturing to the “early days of personal computers and the internet.” Today, the machines may only be able to make simple objects. Tomorrow, that won’t be the case. And that shift will change not only manufacturing and electronics — but people, as well.

“By 2030, manufacturers may be able to combine some electrical components (such as electrical circuits, antennae, batteries, and memory) with structural components in one build, but integration with printed electronics manufacturing equipment will be necessary,” the Council writes. “Though printing of arteries or simple organs may be possible by 2030, bioprinting of complex organs will require significant technological breakthroughs.”

But not all of these biological developments will be good things, the Council notes. “Advances in synthetic biology also have the potential to be a double-edged sword and become a source of lethal weaponry accessible to do-it-yourself biologists or biohackers,” according to the report. Biology is becoming more and more like the open source software community, with “open-access repository of standardized and interchangeable building block or ‘biobrick’ biological parts that researchers can use” — for good or for bad.  ”This will be particularly true as technology becomes more accessible on a global basis and, as a result, makes it harder to track, regulate, or mitigate bioterror if not ‘bioerror.’”

Some of the Council’s predictions may give a few of Washington’s more sensitive politicians a rash. Although the Council does allow for the possibility of a “decisive re-assertion of U.S. power,” the futurists seem pretty well convinced that America is, relatively speaking, on the decline and that China is on the ascent. In fact, the Council believes nation-states in general are losing their oomph, in favor of “megacities [that will] flourish and take the lead in confronting global challenges.” And we’re not necessarily talking New York or Beijing here; some of these megacities could be somehow “built from scratch.”

Unlike some Congressmen, the Council takes climate change as a given. Unlike many in the environmental movement, the futurists believe that the discovery of cheap ways to harvest natural gas are going to relegate renewables to bit-player status in the energy game.

But most of the findings are apolitical bets on which tech will leap out the furthest over the next 17 years. People can check back in 2030 to see if the intelligence agencies are right — that is, if you still call the biomodded cyborgs roaming the planet people.

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Singer feared dead in Mexican plane crash

MONTERREY, Mexico (AP) — Mexico’s music world mourned Jenni Rivera, the U.S.-born singer presumed killed in a plane crash whose soulful voice and openness about her personal troubles had made her a Mexican-American superstar.

Authorities have not confirmed her death, but Rivera’s relatives in the U.S. say they have few doubts that she was on the Learjet 25 that disintegrated on impact Sunday in rugged territory in Nuevo Leon state in northern Mexico.

“My son Lupillo told me that effectively it was Jenni’s plane that crashed and that everyone on board died,” her father, Pedro Rivera told dozens of reporters gathered in front of his Los Angeles-area home. “I believe my daughter’s body is unrecognizable.”

He said that his son would fly to Monterrey early Monday to identify her presumed remains

Messages of condolence poured in from fellow musicians and celebrities.

Mexican songstress and actress Lucero wrote on her Twitter account: “What terrible news! Rest in peace … My deepest condolences for her family and friends.” Rivera’s colleague on the Mexican show “The Voice of Mexico,” pop star Paulina Rubio, said on her Twitter account: “My friend! Why? There is no consolation. God, please help me!”

Born in Long Beach, California, Rivera was at the peak of her career as perhaps the most successful female singer in grupero, a male-dominated regional style influenced by the norteno, cumbia and ranchero styles.

A 43-year-old mother of five children and grandmother of two, the woman known as the “Diva de la Banda” was known for her frank talk about her struggles to give a good life to her children despite a series of setbacks.

She was recently divorced from her third husband, was once detained at a Mexico City airport with tens of thousands of dollars in cash, and she publicly apologized after her brother assaulted a drunken fan who verbally attacked her in 2011.

Her openness about her personal troubles endeared her to millions in the U.S. and Mexico.

“I am the same as the public, as my fans,” she told The Associated Press in an interview last March.

Rivera sold 15 million records, and recently won two Billboard Mexican Music Awards: Female Artist of the Year and Banda Album of the Year for “Joyas prestadas: Banda.” She was nominated for Latin Grammys in 2002, 2008 and 2011.

Transportation and Communications Minister Gerardo Ruiz Esparza said “everything points toward” the wreckage belonging to the plane carrying Rivera and six other people to Toluca, outside Mexico City, from Monterrey, where the singer had just given a concert.

“There is nothing recognizable, neither material nor human” in the wreckage found in the state of Nuevo Leon, Ruiz Esparza said. The impact was so powerful that the remains of the plane “are scattered over an area of 250 to 300 meters. It is almost unrecognizable.”

A mangled California driver’s license with Rivera’s name and picture was found in the crash site debris.

No cause was given for the plane’s crash, but its wreckage was found near the town of Iturbide in Mexico’s Sierra Madre Oriental, where the terrain is very rough.

The Learjet 25, number N345MC, took off from Monterrey at 3:30 a.m. local time and was reported missing about 10 minutes later. It was registered to Starwood Management of Las Vegas, Nevada, according to FAA records. It was built in 1969 and had a current registration through 2015.

Also believed aboard the plane were her publicist, Arturo Rivera, her lawyer, makeup artist and the flight crew.

Though drug trafficking was the theme of some of her songs, she was not considered a singer of “narco corridos,” or ballads glorifying drug lords like other groups, such as Los Tigres del Norte. She was better known for singing about her troubles in love and disdain for men.

Her parents were Mexicans who had migrated to the United States. Two of her five brothers, Lupillo and Juan Rivera, are also well-known singers of grupero music.

She studied business administration and formally debuted on the music scene in 1995 with the release of her album “Chacalosa”. Due to its success, she recorded two more independent albums, “We Are Rivera” and “Farewell to Selena,” a tribute album to slain singer Selena that helped expand her following.

At the end of the 1990s, Rivera was signed by Sony Music and released two more albums. But widespread success came for her when she joined Fonovisa and released her 2005 album titled “Partier, Rebellious and Daring.”

Besides being a singer, she is also a businesswoman and actress, appearing in the indie film Filly Brown, which was shown at the Sundance Film Festival, as the incarcerated mother of Filly Brown.

She was filming the third season of “I love Jenni,” which followed her as she shared special moments with her children and as she toured through Mexico and the United States. She also has the reality shows: “Jenni Rivera Presents: Chiquis and Raq-C” and her daughter’s “Chiquis ‘n Control.”

In 2009, she was detained at the Mexico City airport when she declared $ 20,000 in cash but was really carrying $ 52,167. She was taken into custody. She said it was an innocent mistake and authorities gave her the benefit of the doubt and released her.

In 2011, her brother Juan assaulted a drunken fan at a popular fair in Guanajuato. In the face of heavy criticism among her fans and on social networks, Rivera publicly apologized for the incident during a concert in Mexico City, telling her fans: “Thank you for accepting me as I am, with my virtues and defects.”

On Saturday night, Rivera had given a concert before thousands of fans in Monterrey. After the concert she gave a press conference during which she spoke of her emotional state following her recent divorce from former Major League Baseball pitcher Esteban Loaiza, who played for teams including the New York Yankees and Los Angeles Dodgers.

“I can’t get caught up in the negative because that destroys you. Perhaps trying to move away from my problems and focus on the positive is the best I can do. I am a woman like any other and ugly things happen to me like any other woman,” she said Saturday night. “The number of times I have fallen down is the number of times I have gotten up.”

Rivera had announced in October that she was divorcing Loaiza after two years of marriage.

There have been several high-profile crashes involving Learjets, known as swift, longer-distance passenger aircraft popular with corporate executives, entertainers and government officials.

A Learjet carrying pro-golfer Payne Stewart and five others crashed in northeastern South Dakota in 1999. Investigators said the plane lost cabin pressure and all on board died after losing consciousness for lack of oxygen. The aircraft flew for several hours on autopilot before running out of fuel and crashing in a corn field.

Former Blink 182 drummer Travis Barker was severely injured in a 2008 Learjet crash in South Carolina that killed four people.

That same year, a Learjet slammed into rush-hour traffic in a posh Mexico City neighborhood, killing Mexico’s No. 2 government official, Interior Secretary Juan Camilo Mourino, and eight others on the plane, plus five people on the ground.

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Associated Press Writer Galia Garcia-Palafox and Olga R. Rodriguez contributed to this report from Mexico City.

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The New Old Age Blog: Training Needed for Home Care Is Lacking

“H” from Chicago, I heard you when you joined a lively discussion over hospice at home here a couple of weeks ago and asked, “where can family members get the training to do all the nursing tasks?”

In the comments section, many readers wrote in to say that caring for relatives at the end of their lives was a duty and a privilege. Others said they were unprepared for the physical and emotional burdens of doing so.

Your question stood out because of its practical character. Do caregivers have to figure out how to handle all these complicated medical issues on their own? Or is some help out there?

For an answer, I called two of the authors of “Home Alone: Family Caregivers Providing Complex Chronic Care,” put out by the United Hospital Fund and the AARP Public Policy Institute. That study recently made headlines by reporting that 46 percent of the nation’s 42 million caregivers handle medical and nursing tasks such as giving injections, caring for wounds or administering I.V.s.

Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, sighed when I reached her, and said “this is a huge gap,” referring to a notable absence of available training in demanding caregiving tasks.

To the extent training exists through local agencies on aging, disease-specific organizations or social service groups, it deals mostly with so-called “activities of daily living” — helping someone bath, dress, eat, or use the bathroom — not the demands of nursing-style care, Ms. Reinhard observed.

Really, this kind of training should be the responsibility of health care providers, but doctors and nurses often give only cursory, unsatisfactory explanations of complex tasks that fall to caregivers, said Carole Levine, director of the Families and Health Care Project of the United Hospital Fund.

That leaves the burden on caregivers to be assertive and ask for help, these experts agreed. If someone is hospitalized and ready to return home, they suggest asking a nurse or another provider “show me what you are doing so I can learn how to do it,” and then asking “now, watch me do it and tell me if I am doing it wrong or right.”

Don’t give up after the first time if you feel awkward or uncomfortable. Ask to do the task again, and ask again for feedback.

No videos or written manuals, can substitute for this one-on-one, hands-on instruction. If you don’t get it to your satisfaction before a loved-one is ready to go home, don’t sign the form that says you have been given instructions on what to do, Ms. Reinhard advised. The hospital is legally obligated to ensure that discharges are safe, and this operates in your favor.

The same goes for the pharmacy: don’t sign that sheet that the pharmacist hands you indicating that you have been adequately informed about the medications you are purchasing. If you are concerned about the number of prescriptions, what they are for, their possible side effects and whether all are necessary, ask the pharmacist to sit down with you and go over all this information. Again, don’t leave until you are satisfied.

Often, caregiving tasks will change as someone with a chronic condition like Parkinson’s disease or heart failure becomes more frail. Should this happen, consider calling a home care agency and asking for a nurse to come out and teach you how to administer oxygen or help transfer someone safely from a bed to a wheelchair, Ms. Reinhard said.

You may want to videotape the session so you can view it several times; most of us don’t pick these skills up right away and need repeat practice, Ms. Levine said.

Be as specific in your request for help as possible. Rather than complaining that you are overwhelmed, say something along the lines of, “I want to make sure I know how to clean this wound and prevent an infection” or “I need to know what texture the food should be so I can feed mom without having her choke,” Ms. Levine suggested.

Her organization has prepared comprehensive materials for caregivers called “Next Step in Care.” While the focus isn’t on nursing-style caregiving tasks, three might be useful: a self-assessment tool for family caregivers, a medication management guide, and a guide to hospice and palliative care.

Other helpful materials are few and far between. Ms. Levine’s staff identified a $24.95 American Red Cross training manual for family caregivers that has a DVD explaining the mechanics of transfers and a few other complicated tasks. Also, some videos are available for free at www.mmlearn.org, a Web site that says its mission is to provide caregivers with online training and education.

Asked about model programs, Ms. Reinhard said she knew of only one: the Schmieding Home Caregiver Training Program in Arkansas, operated by the Donald W. Reynolds Institute on Aging of the University of Arkansas for Medical Sciences. The Schmieding program trains family caregivers as well as professional caregivers who work in people’s homes or nursing homes.

On the family side, it offers eight hours of instruction in “physical needs” associated with caregiving — managing incontinence, skin care, turning someone regularly in bed, using adaptive equipment, transfers from a bed to a wheelchair, helping patients remain mobile, and more. Classes are offered at five sites and four more are planned in the next several years, said Robin McAtee, associate director of the Reynolds Institute on Aging. If people, churches or senior centers want the instruction, which is free, Schmieding nurses will take the program to them. One-on-one instruction for tasks is also available on request.

A separate eight-hour program is available for caregivers dealing with dementia, who have additional concerns.

At a Web site called Elder Stay at Home, Schmieding sells a package of materials (three DVDs and a booklet, for $99) summarizing the content of its family caregiver training program. Separately, it has begun selling its curriculum for paid caregivers, and programs in California, Hawaii and Texas are among the first buyers. The University of Arkansas for Medical Sciences also has received a $3.7 million innovation grant from the government to expand the caregiver training program more broadly and develop online training materials.

Ms. Reinhard said AARP would like to see Schmieding-style programs rolled out across the country and begin to offer structured, reliable support to caregivers now providing nursing-style care in homes with little or no assistance.

What else am I missing here? Do you know of resources or other organizations providing intensive caregiver training along the lines of what I’ve been discussing? Where would you suggest people turn for this kind of help?

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Fed Likely to Sustain Bond-Buying Program to Stimulate Growth

WASHINGTON — The Federal Reserve is widely expected to announce on Wednesday that it will continue buying Treasury securities to stimulate growth in the new year.

The Fed’s public declaration in September that it would buy bonds until the outlook for the labor market “improved substantially” has cleared away much of the uncertainty and controversy that usually precedes such announcements.

The economic recovery remains lackluster and millions are looking for work. But while some analysts question the central bank’s ability to improve the situation, few doubt that the Fed, under its chairman, Ben S. Bernanke, is determined to keep trying.

Indeed, while Fed officials continue to warn that a failure to avert scheduled tax increases and spending cuts next year would overwhelm their efforts and plunge the economy back into recession, they have also said that even if Congress and the White House negotiate a compromise, the Fed’s efforts would continue.

“I am not prepared to say we are remotely close to substantial improvement on the employment front,” Dennis P. Lockhart, president of the Federal Reserve Bank of Atlanta, said in a recent speech. “I expect that continued aggressive use of balance sheet monetary tools will be appropriate and justified by economic conditions for some time, even if fiscal cliff issues are properly addressed.”

The remarks were particularly significant because Mr. Lockhart is among the moderate members of the Federal Open Market Committee whose support Mr. Bernanke invested months in winning before starting the new policy.

With the direction of policy clearly set, debate has turned to the details. The Fed, whose policy-making committee is meeting on Tuesday and Wednesday, still must determine what to buy and how much to spend, and officials continue to debate the best way to describe when the agency is likely to stop buying.

In making those decisions, the Fed must balance its conviction that buying bonds reduces borrowing costs for businesses and consumers against concerns the purchases might disrupt financial markets or inhibit its control of inflation.

Analysts say the immediate answer is likely to be more of the same. The Fed currently buys $40 billion of mortgage-backed securities and $45 billion of Treasury securities a month. Officials highlighted that $85 billion figure in September, and have indicated since that it remained their rough target.

“It would be odd for them to disappoint the expectations that they have created themselves,” Kris Dawsey of Goldman Sachs wrote in a note to clients predicting that the Fed would maintain both the dollar amount and the division. Other analysts have suggested the Fed might slightly decrease the total amount of purchases, to $80 billion, or increase the share of mortgage securities.

The Fed is unlikely to announce a new timetable this week, analysts said. The committee has said that it does not plan to raise interest rates before the middle of 2015, and that it will stop buying bonds before it starts raising rates.

Many officials on the 12-member committee — perhaps even the majority — would prefer to substitute economic objectives for guidance set by the calendar. The Fed’s ability to reduce borrowing costs derives in part from persuading investors that interest rates will remain low. Telling investors how the economic situation must change in order to warrant a change in policy could be more convincing, and therefore more potent, than simply publishing an estimated endpoint, these officials say.

But an account of the committee’s previous meeting, in late October, showed that officials remained divided about which economic objectives to use.

The most vocal proponent of focusing on economic goals, Charles L. Evans, president of the Federal Reserve Bank of Chicago, said last month that the Fed should declare its intent to keep short-term interest rates near zero until the unemployment rate fell below 6.5 percent, provided that the rate of inflation did not exceed 2.5 percent.

“I believe we have the ability to go even further in reassuring financial markets and the general public that policy will stay appropriately accommodative,” Mr. Evans said in advocating the change during a speech in Toronto.

Other officials have misgivings about placing such emphasis on any single economic indicator, or on the unemployment rate in particular.

The discussions are moving slowly, in part because it is not clear the changes being contemplated would have significant benefits. The targets the Fed is considering closely resemble its own past practice, meaning the new thresholds would tend to reinforce rather than shift expectations.

Lou Crandall, chief economist at the research firm Wrightson ICAP, noted in a recent analysis that the unemployment rate exceeded 7 percent in the mid-1980s and again in the early 1990s, and in both cases the Fed waited until the rate fell well into the 6 percent range before it began to raise interest rates.

The relative complacency of Fed officials also reflects their judgment that the mortgage-bond purchases announced in September are working. Average interest rates on 30-year mortgages are at the lowest levels on record, averaging 3.35 percent in November, according to Freddie Mac’s regular survey.

“This is solid evidence that our policy has been and continues to be effective — though it is certainly not all-powerful in current circumstances,” William C. Dudley, president of the Federal Reserve Bank of New York, said last week.

To continue the companion purchases of Treasury securities, the Fed will need to change its approach. It is now buying long-term securities with proceeds from the sale of short-term securities, but it is running out of inventory to sell.

The most likely alternative is to create money by crediting the accounts of banks that sell bonds to the Fed, the same method now being used to buy mortgage bonds and also to finance earlier rounds of the Fed’s so-called quantitative easing.

The Fed has repeatedly overestimated the health of the economy and the impact of its efforts. This time, officials have promised to maintain their efforts even as the economy shows signs of improvement. But they are once again sounding notes of cautious optimism about the coming year — if Washington does not interfere.

A budget deal reducing deficits in the long term, Mr. Bernanke said in November, “could help make the new year a very good one for the American economy.”

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Chavez to have more cancer surgery in Cuba

CARACAS, Venezuela—

Venezuelan President Hugo Chavez is heading back to Cuba on Sunday for more surgery for cancer, announcing on television that the illness has returned after two previous operations, chemotherapy and radiation treatment.

Chavez acknowledged the seriousness of his situation in an address Saturday night, saying for the first time that if he suffers complications Vice President Nicolas Maduro should take his place as Venezuela's leader and continue his socialist movement.

"There are risks. Who can deny it?" Chavez said, seated at the presidential palace beside Maduro and other aides.

"In any circumstance, we should guarantee the advance of the Bolivarian Revolution," Chavez said.

Outside medical experts said that based on Chavez's account of his condition, he is facing a very difficult fight against an aggressive type of cancer.

The president, who just returned from Cuba early Friday, said tests had found a return of "some malignant cells" in the same area where tumors were previously removed.

Chavez, who has yet to be sworn in for his new term after winning re-election on Oct. 7, said he would return to Havana on Sunday and would undergo the operation in the coming days.

Chavez's quick trip home appeared aimed at sending a clear directive to his inner circle that Maduro is his chosen successor. He called for his allies to pull together, saying: "Unity, unity, unity."

Chavez said his doctors had recommended he have the surgery right away, but that he had told them he wanted to return to Venezuela first.

"I want to go there. I need to go to Venezuela," Chavez recalled telling his doctors. "And what I came for was this," he said, seated below a portrait of independence hero Simon Bolivar, the inspiration of his Bolivarian Revolution movement.

Chavez named Maduro, his longtime foreign minister, as his choice for vice president three days after winning re-election. Maduro, a burly former bus driver, has shown unflagging loyalty and become a leading spokesman for Venezuela's socialist leader in recent years.

The vice president's expression was solemn as Chavez said that Maduro should become president if any complication were to prevent him from finishing his current term, which concludes in early January. Chavez said that if new elections are held, his movement's candidate should be Maduro.

"In that scenario, which under the constitution would require presidential elections to be held again, you all elect Nicolas Maduro as president," Chavez said. "I ask that of you from my heart."

Chavez held a small blue copy of the constitution in his hands and waved it. The Venezuelan constitution says that if a president-elect dies before taking office, a new election should be held within 30 days and that in the meantime the president of the National Assembly is to be in charge of the government.

While he spoke, Chavez was flanked by both Maduro and National Assembly President Diosdado Cabello.

Chavez is scheduled to be sworn in for a new six-year term Jan. 10, and he called his relapse a "new battle."

This will be his third operation to remove cancerous tissue in about a year and a half.

The 58-year-old president first underwent surgery for an unspecified type of pelvic cancer in Cuba in June 2011, after an operation for a pelvic abscess earlier in the month found the cancer. He had another cancer surgery last February after a tumor appeared in the same area. He has also undergone chemotherapy and radiation treatments.

Chavez said tests immediately after his re-election win had shown no sign of cancer. But he said he had swelling and pain, which he thought was due to "the effort of the campaign and the radiation therapy treatment."

"It's a very sensitive area, so we started to pay a lot of attention to that," he said, adding that he had reduced his public appearances.

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New Crowdfunding Site Seeks to Protect Backers of Industrial Design

Entrepreneur Jamie Siminoff wants to build more credibility into crowdfunding — so he’s launching a new platform that takes responsibility for ensuring the viability of new projects.

The crowdfunding process, pioneered by sites like Kickstarter, has had its share of huge successes, as well as failures. The problem, says Siminoff, is that when a venture fails, the funders are left holding the bag. That’s all well and good if you were investing in an artist’s crazy project. It’s much more of a problem if you thought you were pre-ordering a nearly finished gadget.

The biggest culprit for these kinds of issues are physical products. Witness the anger unleashed when Kickstarter darling Pebble announced a further delay alongside underwhelming color choices.

This kind of issue is why Kickstarter recently made some changes, undertaking a combination of education and rule revision. They reminded consumers that Kickstarter is not a store while requiring that all projects disclose risks and challenges, as well as forbidding renderings and concept videos in hardware products.

Siminoff’s answer is Christie Street, a crowdfunding site devoted exclusively to physical products. The promise of Christie Street is that it will vet the projects that it launches carefully, and provide guarantees of progress along the way. The idea is that these protections will make consumers feel safer about the products they’re backing. “We built something that we felt we needed,” he says.

Christie Street, named for the New Jersey road where Edison’s workshop was located, will require that all funders go through an auditing process before they are allowed to go live. Siminoff says that the idea will be to check for basic viability, a kind of sanity test.

“You look at the chips they say they want to use, the size of components that will need to fit in, and so on,” he says, “You check that things conform to what’s available on the market.” From there, they also perform third-party audits of the places where the product will be manufactured, and look at things like production cost and likely shipping time, to ensure that all of this seems realistic.

It’s an all-or-nothing audit. Either the new project meets Christie Street’s approval or it doesn’t. “Our feeling is that the customer that’s buying doesn’t have the sophistication to make the right decision [about whether a design's production targets are reliable],” says Siminoff, “The only way is create a place where you can trust to buy.”

Even after the initial approval, Christie Street stays involved in the project. Successfully funded projects get their money in stages, with Christie Street holding the rest in escrow. Inventors get one-third of the money on funding, one-third of the money once they have a production-ready prototype, and the final one-third when they have a golden prototype, which means they are ready for full manufacturing.

If at any time along the way the project fails, Christie Street will can the project and refund the remaining money to investors.

What constitutes failure? Siminoff ticks off four conditions.

First, the inventor could for whatever reason announce that they couldn’t finish.

Second, if the project ends up more than six months late. “This forces people to be more careful with their delivery dates,” says Siminoff.

Third, if the product falls short of what was promised. “If the pre-production sample is more than 15 percent worse than what was promised, we will not allowed you to manufacture the product,” says Siminoff. (For example, if you promised me 512GB and only delivered 256.)

Last, says Siminoff there are other nuances that they’ll have to work out as the site develops. For example, if a product ends up requiring significant redesign, then Christie Street might end up withholding funds. “Design is a tougher one to quantify,” he says, “but it’s important that the design overall fits what was promised to the customer.”

For the extra cautious, Christie Street goes even further than the refund of remaining money. For 10 percent of their pledge value, backers can insure their entire pledge. If the project goes wrong they’ll get all of it back. Combine that with a pledge from inventors that the product will retail for at least 10 percent more than the pledge amount, and you can either take a 10 percent discount for some additional risk or pay full retail, with a money-back guarantee.

In effect, Christie Street is navigating a space between crowfunding sites like Kickstarter and Indiegogo, which expect backers to handle a lot of their own due diligence while allowing the inventors to be entrepreneurs, and crowdsourcing design sites like Quirky, which handles all of the business elements in-house.

Christie Street is an effort at drawing the lines of trust in a new way, one tied directly to the realities of post-industrial product design. Rather than a blanket ban on renderings and early designs, or a Wild West ‘anything goes’ approach, they instead seeks to tame the parts where production can go really wrong, in the devilish details of prototyping and manufacturing. It leaves questions of whether or not the thing is cool to the wisdom of the crowds, while taking on the question of whether or not the thing is possible.

This is obviously a lot more intervention between middleman and inventor than you’d see on a site like Indigegogo or Kickstarter. Siminoff says that they can still take the same 5 percent cut as their competitors because physical products tend to be involved higher dollar-value projects from the start. “If all goes well, we’ll be doing 10 to 15 live projects a months a year from now,” he says, “We think we can be profitable in the product world.”

“We’re not trying to make it where inventors are just be a name on a product,” says Siminoff, “We still want them to be entrepreneur and build this thing. We just want to make sure that they don’t fail in a way that hurts the customer.”

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