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CrossFit Offers an Exercise in Corporate Teamwork, Too

Written By Unknown on Minggu, 31 Maret 2013 | 13.57

Kevin Moloney for The New York Times

Employees of Datalogix in Colorado take part in its CrossFit exercise program.

AT 12:30 p.m. on a Tuesday, the chief executive of Datalogix was spider-crawling across a conference room floor. All around him, account managers and data analysts were thrusting 20-pound medicine balls overhead, while their Spandex-clad co-workers sprinted up and down the lobby's carpeted staircase.

A panting, red-faced software developer rested against a railing as a colleague rushed past. "Push it, Karin!" she cried in encouragement. Minutes later, having regained her strength, the developer was back in the conference room, completing her fourth set of jumping squats while a muscle-bound trainer studied her form.

Since the summer of 2010, Datalogix, a Big Data company in Westminster, Colo., has offered these classes, called CrossFit, twice a week for its employees. CrossFit gained early popularity among law enforcement officers and military personnel, but lately, both large and small businesses — judging that fitness programs can bolster employee morale, improve productivity and reduce health insurance premiums — have taken an interest. This fast-growing fitness trend combines weight lifting, gymnastics and endurance training and has attracted more than 10 million practitioners around the world, according to the company, about 60 percent of them women.

"My enthusiasm for CrossFit knows no bounds," said Eric Roza, 45, Datalogix's supremely fit and upbeat chief executive. In fact, his enthusiasm led him to open with his wife a 10,000-square-foot gym in downtown Boulder, Colo., called CrossFit Sanitas, where he generally works out at 5:30 a.m., five days a week, though he will occasionally join his employees, too.

Mr. Roza used to run 100-mile ultramarathons, but he took up CrossFit after an injury in 2008. "I got hooked instantly," he said after the conference-room workout, his army-green T-shirt damp with sweat. "It was like crack or heroin." So when some Datalogix employees organized their own weight-loss competition three years ago, to see who could lose the most pounds, Mr. Roza began offering CrossFit classes in-house. He hired Pat Burke, the owner of another local CrossFit gym — or "box," as it's often called because of its spare, no-frills design — to teach the classes.

Mr. Burke, a former Marine, brings in barbells, gymnastics rings and medicine balls, depending on the day's workout. To vary the routine, he might show up with tractor tires, which Datalogix staff members flip and pound with sledgehammers in the parking lot as their less gung-ho colleagues stare from the windows. Mr. Roza estimates that 50 of the 200 employees at Datalogix's headquarters have taken part in the CrossFit classes. The participants, who sign a waiver of liability for injury, have shed around 300 pounds collectively — or at least that is the figure that Mr. Roza derived from informal employee interviews.

There are other, less quantifiable benefits. Karin Eisenmenger, 46, Datalogix's director of order management and the woman running up the stairs past her panting colleague, says the classes unite people from different departments who might otherwise never meet. "If you can sweat and groan and moan with your co-workers," she said, "you'll have no problem working with them in a meeting."

Ben Nelson, 31, an information technology analyst who says he lost 60 pounds after he started CrossFit in 2010, said a lunch hour spent doing squat thrusts and swinging kettlebells enabled him to work longer and with greater focus. "I used to work for the Dish Network," he said, "and the workouts there were running up and down the stairs on the way to company meetings."

CROSSFIT is one of many perks at Datalogix, where a range of other options — like self-defense classes and courses in the Java programming language — are available free and in-house. The company's fitness initiatives, called DLX Fit, cost the company around $25,000 a year, Mr. Roza said. A majority of that goes toward CrossFit.

"I've been calling CrossFit the new golf," Mr. Roza said. "You wouldn't believe how often it comes up in business meetings."

CrossFit was started in 2000 in Santa Cruz, Calif., by Greg Glassman, a former gymnastics coach. Over the next decade, it grew from a single gym to a global workout craze. (There are now 42 CrossFit boxes in South Africa alone.) In 2010, a partnership with Reebok further raised CrossFit's profile. Reebok has built 15 gyms inside or near its offices around the world, and plans to open 11 more. In most cases, Reebok employees receive their membership at a discount.


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National Briefing | South: Louisiana: Health Secretary Resigns Amid Investigations

Louisiana's health secretary, Bruce Greenstein, is resigning amid state and federal inquiries into the awarding of a Medicaid contract to a company where Mr. Greenstein once worked. Gov. Bobby Jindal's administration last week canceled the nearly $200 million state contract with CNSI, which is based in Maryland, after details leaked about a federal grand jury subpoena involving the contract award. The governor's office announced the resignation on Friday but said Mr. Jindal, a Republican, did not seek it. When the Medicaid contract was awarded two years ago, Mr. Greenstein denied any involvement in the selection of the company, but he acknowledged that a change he promoted in the bid solicitation made CNSI eligible for the contract. Mr. Greenstein gave no explanation for quitting in his resignation letter to the governor.


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World Briefing | Asia: Pakistan: Security Concerns Prevent Polio Vaccinations, Health Agency Says

About 240,000 children have missed vaccinations against polio because of security concerns in Pakistan's tribal regions bordering Afghanistan, a top official with the World Health Organization said Friday. The official, Dr. Nima Saeed Abid, the acting W.H.O. chief in Pakistan, said health workers had not been able to immunize children in the North and South Waziristan regions — Taliban strongholds — since July 2012. Pakistan is one of the few remaining countries, along with Afghanistan and Nigeria, where polio is rampant. As many as 58 cases were reported in Pakistan in 2012, down from 198 in 2011. Dr. Abid said that 15 health workers had been killed in the anti-polio campaign in Pakistan since July 2012. Pakistani militant groups oppose the vaccinations and accuse the workers of spying for the United States.


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As OSHA Emphasizes Safety, Long-Term Health Risks Fester

TAYLORSVILLE, N.C. — Sheri Farley walks with a limp. The only job she could hold would be one where she does not have to stand or sit longer than 20 minutes, otherwise pain screams down her spine and up her legs.

"Damaged goods," Ms. Farley describes herself, recalling how she recently overheard a child whispering to her mother about whether the "crippled lady" was a meth addict.

For about five years, Ms. Farley, 45, stood alongside about a dozen other workers, spray gun in hand, gluing together foam cushions for chairs and couches sold under brand names like Broyhill, Ralph Lauren and Thomasville. Fumes from the glue formed a yellowish fog inside the plant, and Ms. Farley's doctors say that breathing them in eventually ate away at her nerve endings, resulting in what she and her co-workers call "dead foot."

A chemical she handled — known as n-propyl bromide, or nPB — is also used by tens of thousands of workers in auto body shops, dry cleaners and high-tech electronics manufacturing plants across the nation. Medical researchers, government officials and even chemical companies that once manufactured nPB have warned for over a decade that it causes neurological damage and infertility when inhaled at low levels over long periods, but its use has grown 15-fold in the past six years.

Such hazards demonstrate the difficulty, despite decades of effort, of ensuring that Americans can breathe clean air on the job. Even as worker after worker fell ill, records from the Occupational Safety and Health Administration show that managers at Royale Comfort Seating, where Ms. Farley was employed, repeatedly exposed gluers to nPB levels that exceeded levels federal officials considered safe, failed to provide respirators and turned off fans meant to vent fumes.

But the story of the rise of nPB and the decline of Ms. Farley's health is much more than the tale of one company, or another chapter in the national debate over the need for more, or fewer, government regulations. Instead, it is a parable about the law of unintended consequences.

It shows how an Environmental Protection Agency program meant to prevent the use of harmful chemicals fostered the proliferation of one, and how a hard-fought victory by OSHA in controlling one source of deadly fumes led workers to be exposed to something worse — a phenomenon familiar enough to be lamented in government parlance as "regrettable substitution."

It demonstrates how businesses at once both suffer from and exploit the fitful and disjointed way that the government tries to protect workers, and why occupational illnesses have proved so hard to prevent.

And it highlights a startling fact: OSHA, the watchdog agency that many Americans love to hate and industry often faults as overzealous, has largely ignored long-term threats. Partly out of pragmatism, the agency created by President Richard M. Nixon to give greater attention to health issues has largely done the opposite.

OSHA devotes most of its budget and attention to responding to here-and-now dangers rather than preventing the silent, slow killers that, in the end, take far more lives. Over the past four decades, the agency has written new standards with exposure limits for 16 of the most deadly workplace hazards, including lead, asbestos and arsenic. But for the tens of thousands of other dangerous substances American workers handle each day, employers are largely left to decide what exposure level is safe.

By contrast, OSHA has two dozen pages of regulations just on ladders and stairs.

"I'm the first to admit this is broken," said David Michaels, the OSHA director, referring to the agency's record on dealing with workplace health threats. "Meanwhile, tens of thousands of people end up on the gurney."

Royale Comfort Seating disputes that Ms. Farley's health problems and those of some other workers were linked to their jobs. Company officials also say that while they have sought to safeguard their workers, they have also feared losing jobs to foreign competitors, as many of their industry counterparts in North Carolina have.

Royale has not switched away from the nPB glues, managers said, because alternatives did not work well, were sometimes more dangerous and were almost always more expensive.

"We, as a company, are also in a tight spot," said William Lee Isenhour, Royale's director of personnel and safety.

Chronic ailments caused by toxic workplace air — black lung, stonecutter's disease, asbestosis, grinder's rot, pneumoconiosis — incapacitate more than 200,000 workers in the United States annually. More than 40,000 Americans die prematurely each year from exposure to toxic substances at work — 10 times as many as those who die from the refinery explosions, mine collapses and other accidents that grab most of the news media attention.

Occupational illnesses and injuries like Ms. Farley's cost the American economy roughly $250 billion per year because of medical expenses and lost productivity, according to government data analyzed by J. Paul Leigh, an economist at the University of California, Davis, more than the cost of diabetes or chronic obstructive pulmonary disease. Roughly 40 percent of medical expenses from workplace hazards, or about $27 billion a year, is paid by public programs like Medicare and Medicaid.

And yet the full price of this epidemic is measured not just in hospital bills and wages lost, but also in the ways, large and small, that life has changed for Ms. Farley and other sickened workers. Glue fumes robbed her of dignity and the joy of small comforts. Her favorite high heels stay in her closet because her feet no longer cooperate. She barks at her 8-year-old daughter, Allie, for hopping around their double-wide trailer because the floor's vibrations cause intense stinging.

"I did the work," Ms. Farley said about her years putting together furniture for America's households. "This doesn't seem a fair price to pay."

Foam Country

Two industries converge in North Carolina along the nine-mile stretch of Interstate 40 between Hickory and Claremont. Foam meets furniture here. Cushions find seats.

For nearly a century, towns in these western foothills have been famous for their fine home furnishings, producing roughly half the chairs and tables sold nationwide at the industry's peak in the 1980s. Every year, several million pounds of a flexible polyurethane foam known as slabstock arrives. It becomes the spongy filling in most of the mattresses, chairs and couches produced in the United States.

Delivered as huge yellow or pink loaves, often about four feet high and the length of a tractor-trailer, the slabstock is cut into pieces and glued into shapes by rows of workers standing in booths. They sometimes attach upholstery or add a top layer of polyester fiber to give the cushions a softer feel.

North Carolina has been especially affected by globalization and federal regulations. Shifting cultural mores and rising cigarette taxes have cleared hundreds of tobacco farms. Foreign competition has closed most of the textile mills. More than half of the furniture jobs once based here are now gone, according to federal labor data.

Still, about a thousand people spread across several dozen plants in the state work in this locally vital industry. For Ms. Farley, the job at Royale making cushions represented something rare: a chance for someone with little more than a high school diploma and an ability to stand on her feet all day to make more than $9 an hour.

Day 1 at the job brought ominous advice. Don't dally, co-workers counseled her; managers keep track of your cushions per hour. Bring a hair dryer; it helps in warming brittle hands in winter when the plant gets frigid. Stock up on aspirin and tissues: the first to survive the headaches from the glue's gasoline-like fumes; the second because the fumes clear the sinuses.

Asked about the conditions, Royale officials said their three plants, two here in Taylorsville and one about 15 miles away in Conover, were no worse than others in the business.

But no one denied it was dirty, bone-tiring work. During 10-hour shifts, the gluers held spray guns attached to hoses that ran to a humming compressor and 55-gallon drums filled with the glue. Once sprayed, the glue coated everything — the lights, fans, floors and electrical outlets — and hung over the workers' cubicles like a shroud.

"It puts the fog in your head," Ms. Farley said. By the end of a shift, the glue left some workers so dizzy that they walked as if they were drunk. At times, they did not remember driving home.

A Chemical's Use Grows

Cushion-making companies had every reason to like nPB glues. First marketed in the late 1990s, they were inexpensive, strong, fast-drying and, best of all, unregulated.

"It's so safe you can eat it," glue salesmen in North Carolina told customers, according to federal researchers. Plant operators joked, "At worst, it's a cheap high," an official from an industry trade association recalled. Water-based glues, though safer, dried slower. And retooling a plant to use them could cost anywhere from several thousand dollars to more than $1 million, in some cases doubling a company's gluing costs.

Finding a glue that complied with federal rules was a continuing struggle. In the early 1980s, many companies used glue with a chemical called 1,1,1-trichloroethane, or TCA. But the United States and other countries then banned it because it damages the ozone layer, and businesses switched to methylene chloride.

Nicknamed by cushion makers "methyl ethyl bad stuff," it killed more than 30 workers a year and sickened thousands more across all industries. OSHA tightened safety limits on the chemical, so companies sought a new option. Before long, roughly a third of the cushion-making industry had switched to nPB-based glues.

For the most part, American employers are left on their own to find substitutes when federal agencies impose new rules on chemicals. But when the government forces the phasing out of one hazardous chemical, it is often replaced by another equally or more dangerous one.

From the start, government officials worried about the safety of nPB, which is also sometimes called 1-bromopropane or 1-BP.

In 1999, Adam Finkel, OSHA's top health officer who had led the agency's drive to phase out methylene chloride, wrote a letter warning that nPB was being used as a replacement at levels 10 to 200 times what chemical companies said was safe. Something needed to be done, he said, before the number of people exposed to the new chemical "grows from the hundreds to the tens of thousands or more."

Some companies pulled back. Protonique SA, a Swiss circuit-board maker, banned it for its workers, who used a form of the chemical that was less toxic than that inhaled by Royale workers. "There is a weight of evidence that should sound warning bells to any thinking person," the company said in 1999. By 2003, Atofina and Great Lakes, two large chemical companies, had decided they would no longer sell nPB.

In the six years after Mr. Finkel wrote his warning letter, federal authorities learned that more than 140 cushion workers nationwide, mostly from plants in Utah, Mississippi and North Carolina, including Royale, had been exposed to dangerous levels of the chemical, many of them sickened and unable to walk.

Cushion makers in the 30,000-employee foam industry were among the most vulnerable of all workers using nPB because they breathed it in aerosol doses. Those employed in other businesses mostly used it in other forms, which pose lower risks, according to scientists, who are finding mounting evidence that nPB is also a carcinogen.

Pinpointing the cause of a worker's ailment is an inexact science because it is so difficult to rule out the role played by personal habits, toxins in the environment or other factors. But for nearly two decades, most chemical safety scientists have concluded that nPB can cause severe nerve damage when inhaled even at low levels.

Ms. Farley sued Royale for workers' compensation payments. Her case, along with several other lawsuits related to glue fumes brought by other workers, has been settled.

When news of exposure problems at Royale reached officials at Mid South Adhesives, the maker of the glue that Royale used, they sent an inspector who found that Royale's Conover plant showed levels at least 10 times what Mid South deemed safe. Mid South officials wrote to Royale to say they could "not stress enough" the need to provide better protections or to stop using their glue.

Royale officials, though, responded that even though they had added fans, had trained workers handling toxic chemicals and planned to put in a new ventilation system, problems persisted.

"We tried to use a water-base adhesive, which did not work for us," a Royale official wrote, adding that the company saw no alternative but to stick with nPB glue.

Other companies were also reluctant to switch from nPB glues. Officials of the Franklin Corporation, a cushion plant in Houston, Miss., explained in court documents that safety was important but that nPB glues were attractive because they dried so fast that the cushions could be produced in a third of the time.

"There are people lined up out there for jobs," said John Lyles, a vice president at Franklin, according to testimony by a plant manager in a successful lawsuit in Mississippi brought by four cushion workers who suffered severe nerve damage from the glue. "If they start dropping like flies, or something in that order, we can replace them today."

Businesses found nPB appealing partly because the E.P.A. had given it an endorsement of sorts by adding it to a list of chemicals that do not harm the ozone layer. But an unintended effect of that action was to allow sellers of the chemical to market it as federally approved, "nonhazardous," green and worker-friendly.

As the chemical's popularity grew, E.P.A. officials worried about its use in spray glues, especially in cushion-making factories where the agency had determined that even with "state of the art" ventilation, "nPB-based adhesives cannot be reliably used in a manner that protects human health."

Environmental officials figured that OSHA, pressured by the Bush administration and Republican lawmakers to be more business-friendly, would not be capable of policing the growing threat. "OSHA is tough," E.P.A. officials said, according to notes from a November 2006 meeting on concerns about nPB. "But their budget is small, and they are not going to crack down on small businesses."

OSHA has never set a standard establishing safety limits on workers' exposure to nPB. The E.P.A. recommended such a limit and considered banning the nPB glues, but it has yet to finalize the plan. It determined that most cushion companies using the glue had fewer than 100 employees, which meant they were less able to absorb the cost of another regulation.

"There just wasn't the political will," an E.P.A. official who was part of the decision-making said on the condition of anonymity.

Improvised Remedies

A single tattered page from a 2005 workers' compensation log summed up the emerging situation at Royale. Beneath a column headed "Injury or Illness" stretched a dozen rows, each reading "Alleged Neurological Injury" — one for each worker in the Conover plant sickened in the first three months of the year. Each missed more than 40 days of work because of the glue fumes, which were especially intense after the company moved the work stations closer together.

Thousands of additional pages of court and government documents, as well as interviews with more than two dozen current and former employees — some speaking on the condition of anonymity — present a fuller view of the conditions in the plant and how things got that way.

By 2005, Efrain Robles Avila was using a walker because he could no longer stand on his own, according to medical records. Victor Gonzales, a father of three, needed help putting on his clothes because he had lost control of his hands. Laura Garcia, who had worked for Royale for less than a year, complained of a cold numbness running from her waist to her toes. "It was like your legs didn't receive the signal when you had to walk," she said in court documents.

The numbness was dangerous. One worker recounted meeting a neighbor who asked why she was wearing a single red shoe. Only then did the worker realize her foot was bleeding profusely from a two-inch gash.

Inside the plant, workers improvised. Some stood on scrap pieces of foam to cushion their feet and ease the stinging sensation creeping up their legs. One, Sonia Richards, arrived with her own respirator, but a manager told her to put it away, saying it was spooking other workers. In whispers, new employees were warned to visit the bathroom whenever the fog grew thick.

"If you don't clear your head," a worker recalled being told, "it will clear you."

Royale is among the industry's most dangerous businesses, according to OSHA data. Federal officials found that it had exposed workers to dangerous levels of nPB at least a dozen times, more often than any other company. Since 2002, nearly three dozen Royale workers have been found to be breathing dangerous levels of glue fumes, federal records show.

Current and former employees say the number of workers sickened is most likely double that, since OSHA visited only periodically and turnover was high.

Some buyers of Royale cushions said they knew generally of the dangers of nPB, but expected their suppliers to take all required precautions. Lisa Hanly, vice president of Furniture Brands, which handles Broyhill and other well-known furniture, said, "Our goal is to produce high-quality product, which meets all legal and safety requirements, at an affordable price." She said the company's inspections focused on suppliers overseas, where regulations are weaker than in the United States. Other companies that buy from Royale declined to comment.

Royale workers became regular visitors at local health clinics, including the Clinic for People Without Health Insurance, then run by Dr. Ben Wofford.

Looking like "upright cadavers," Dr. Wofford said, cushion workers arrived unable to stand on their own, supported under their arms by family members. They had showered and changed out of their work clothes, he said, but their breath still carried an odor he remembered from his boyhood days putting together model airplanes.

He had watched for years as his patients' suffering worsened with the bottoming out of the state's tobacco, textile and furniture industries. When people are out of work, he explained in an interview in his office above the pharmacy in Newton, N.C., a diabetic ulcer that would normally cost a toe takes a leg. Their nonfatal hernia bleeds them to death.

"You kill jobs," Dr. Wofford said, "you kill patients."

Reluctantly, he wrote a letter in 2005 alerting OSHA about problems at Royale. One worker was in especially bad shape, he wrote: "Indeed he may die as a result of his exposure."

But Dr. Wofford also urged OSHA not to overreact. "I would hate to see this plant's multiple shortcomings result in its being shut down," he wrote, warning of jobs that could be lost. "Many are my patients and are already in dire straits economically."

Referring to one woman who was the sole support for herself and three children, he wrote, "She too is unlikely to find work if the effects of the neurotoxin are irreversible, as my neurological consultant thinks they may be."

Over the years, officials with Royale, which employs about 100 workers and had around $7.5 million in sales in 2011, have repeatedly said they have done all they can to make their three plants safe. They frequently took steps to improve the air in their plants, but their actions were also sometimes counterproductive — after improving ventilation, they failed to change filters, for example, or covered vents with plastic in the winter to keep out cold air, according to OSHA documents.

In a recent interview, Mr. Isenhour, Royale's safety director, said the company never meant to harm anyone and initially did not realize the hazards of nPB. Royale has continued using nPB glues, he added, because alternatives are ineffective or risky.

Glues that use acetone, for example, are popular but highly flammable, he said. Converting the Royale plant to meet federal rules on fire safety would entail replacing the glue-spraying booths with metal walls, installing sprinklers and explosion-proof lighting and retraining workers, at a cost of tens of thousands of dollars, he added.

In 2005, when seven workers became seriously ill at one plant, Mr. Isenhour said, Royale had to lay off 40 people, close the facility and spend $50,000 to move operations to another site and upgrade the ventilation there. OSHA found high levels of fumes in subsequent years because no one informed the company that fans and filters needed cleaning for ventilation to work properly, he said.

If the company switched to a more expensive glue, he said, he would have to raise the price of each cushion, and the furniture makers Royale supplies would contract with Chinese competitors instead.

"We are trying to keep jobs in America," he said. "But that's expensive."

Both government officials and employers weigh the costs and benefits of protective measures. Many studies show that investing in workplace safety saves money in the long run, but economists say that does not prove true in every case. This, of course, raises the most difficult calculus of all: comparing the worth of a dangerous job versus no job at all. How should companies and regulators put a dollar value on workers' quality of life — indeed, on their very lives?

To date, Royale has paid nearly a half-million dollars — in court settlements, required upgrades and less than $20,000 in OSHA fines related to glue fumes. Those costs — and the harm to workers — accumulated in slow motion. Cushion making is a boom-bust business, subject to the swings of big orders from furniture companies. Royale and others in the industry frequently use transient, nonunion and illegal immigrant laborers, according to workers and court documents, who are less likely to report hazards and document symptoms.

As fast as workers were getting sick, managers found replacements.

"Folks was limping in and getting worse," said Dewaun Teague, a former Royale manager. "Then they would be let go, and we would hire more."

Mr. Teague said Royale was a good company to work for in many ways. The owner, Clyde Goble, looked you in the eye when he shook your hand and remembered your children's birthdays, Mr. Teague said, adding, "This was family."

Complain. Inspect. Repeat.

After receiving an anonymous complaint about glue fumes, Beverly Stone, an OSHA inspector, visited a Royale foam cushion plant in Taylorsville in May 2011. She toured the facility, tested the air and then filed a lengthy report.

"Ventilation did not appear to be working properly," it said, adding that at least 16 workers were breathing dangerous levels of glue fumes.

Worrisome enough on their own, Ms. Stone's findings were even more alarming because they were so similar to what OSHA documented in 1996, 2000, 2002 and 2005.

Again and again, Royale workers got sick and contacted OSHA. Inspectors came and went. Little changed.

Company officials were told to ventilate to the outside. They bought pedestal fans instead, and when OSHA inspectors returned, they found the fans turned off or malfunctioning. OSHA demanded respirators that would have cost the company $18. Managers instead handed out 90-cent dust masks — the type inspectors had told them were useless in blocking vapors.

The agency advised the company to stop using nPB-based glues. And yet, each time inspectors showed up, they found more workers exposed to the chemical and at levels higher than what the glue companies were saying was safe.

Back and forth it went, as workers fell victim not just to toxic air but also to a federal agency's inability to enforce its requirements.

While agency inspectors consistently showed up within a day of receiving worker complaints, records show, they often did with one hand what they undid with the other. Sometimes they failed to levy fines because they did not believe they had the authority. Other times they undermined their own leverage by slashing the size of penalties in hopes of promoting cooperation from the company.

After each visit, the agency suggested abatements but never did follow-up air tests and appeared again only when sick workers complained.

For its part, the company shuffled workers among its three plants in the frustrated hope that one of the sites might have better air flow. But the constant movement of these workers from plant to plant also made repeat problems look to regulators like isolated cases.

In early 2011, when Royale officials realized that they could not fix the ventilation at the Taylorsville plant where Ms. Farley worked, they moved her and a half-dozen other workers to the other Taylorsville site. Ms. Farley's symptoms grew worse there; the ventilation problems had been identified by OSHA in 2002 but never corrected.

If inspections are supposed to force companies to rectify problems and avoid future ones, that 2002 inspection was a failure. "Not able to require the employer to implement engineering controls," the OSHA official wrote at the time, adding that the agency could not levy fines or mandate respirators because there was no federal safety standard involving nPB.

That was a legal judgment call, one that many workplace safety experts say illustrates OSHA's unwillingness to exert its full authority. Though the agency has the legal means to force companies to protect workers better from certain chemicals even when there is no specific exposure level established by the agency as safe, OSHA rarely invokes this power for fear of sapping limited resources if the matter ends up in court.

"We do the best we can," said Kevin Beauregard, an assistant deputy OSHA commissioner in North Carolina, which is among 25 states deputized by the federal government to oversee worker safety programs. He said that before his office could act in such instances, it must first prove that workers were exposed to a substance whose hazards were recognized in the industry and that the exposure was avoidable.

OSHA also rates health hazards as a lower priority than safety threats. In 1996, for instance, inspectors discovered that a machine part hit a Royale worker in the groin. The agency threatened to fine the company a total of $120,000, adding $5,000 to the fine for each day that the company failed to repair the machine. But when nPB levels remained high during five visits between 2002 and 2011, the agency never increased the penalties. The proposed total for all of Royale's health-related fines was $20,800, an amount the agency later lowered.

Partly, the emphasis on safety enforcement is a numbers game. OSHA's performance is often measured by lawmakers, advocacy groups and the news media based on how many inspections it does in a year; an inspector can do five times as many safety inspections in the time it typically takes to do one focused on health, where the issues may be less clear-cut. And the agency tends to face less public pressure about health enforcement, because the harm done by these sorts of hazards typically does not show up for years.

Furthermore, while the number of inspectors has grown under the Obama administration, OSHA still has just 2,400 responsible for overseeing roughly eight million work sites — roughly one inspector per 60,000 workers, a ratio that has not changed since 1970. The federal budget for protecting workers is less than half of that set aside for protecting fish and wildlife.

Mr. Michaels, whose tenure leading OSHA since December 2009 has been characterized by more aggressive enforcement than that of his most recent predecessors, cites a deeper problem: the small amount that OSHA can levy in fines. The maximum penalty for a violation that causes a "substantial probability of death — or serious physical harm" is $7,000. The highest fine for a willful and repeated violation is $70,000.

This, Mr. Michaels said, pales in comparison with fines of up to $130,000 that the Department of Agriculture can levy if a dairy company refuses to pay fees that help the federal government advertise milk products, or the $325,000 that the Federal Communications Commission can fine a TV or radio station for indecent content.

"If the cost of compliance to our rules outweighs the penalties for breaking them, companies just take a 'catch me if you can' approach to worker safety and health," he said. And serious violations of the rules should not be misdemeanors, he said, but felonies, much like insider trading, tax crimes and antitrust violations.

But Jeff Ruch, the director of Public Employees for Environmental Responsibility, a public health advocacy organization, said that, on average, OSHA now conducts health inspections and collects air samples less than half as often as it did under the Reagan administration.

"You can't hit someone with a fine," Mr. Ruch said, "if you aren't on site looking to find the violations."

Hard Calculus

As her truck crawled down a bumpy dirt road, Ms. Farley said she needed to go slowly because she could not afford to replace her duct-taped bumper if it fell off. Between money from breeding her four Rottweilers, food stamp assistance and the occasional help from her ex-husband or the local food bank, her finances leave little room for error.

She stopped in a field dotted with narrow white trailers to pick up Cosondra Little, another former Royale worker, who limped as she approached. Ms. Little lives with her 24-year-old daughter, SoSonia, who is unemployed. What fresh tomatoes, collard greens and other vegetables the two eat come mostly from scavenging on nearby fields when farmers allow it. This has been the case, Ms. Little said, ever since she lost her job at the cushion plant in May 2003.

"My feet started to throw a fit," she said. First went her health insurance, then money for SoSonia's college tuition, then their savings, and finally the car.

"You try getting a job around here without a car," Ms. Little said, riding along a wooded stretch of Highway 16 just south of Taylorsville.

Soon the two women arrived at Martha Cardenas's house, where they were joined by two others, one a former cushion maker, the other a current one. They had gathered to explain that Royale is not unique.

After small talk about Ms. Cardenas's empanadas, the women stacked their medical records on the table. Different plants, different doctors, same glue. Broken lives reduced to physicians' scribbles. "Staggered gait," "numb hands and feet," "spinal pain."

Usually the same medical advice, too: find a different job; stop working with the glue. It "has been clearly documented as a cause of" nerve damage, Ms. Little's doctor wrote to her boss about nPB.

But other jobs are hard to come by. And that is why everyone has wanted to keep Royale in business. "Now none of us are working," Ms. Farley said. In Dr. Wofford's hesitant whistle-blower letter to OSHA, in a $50,000 loan that county officials gave to Royale, in OSHA's formula for lowering fines, there were vexing calculations seeking to strike the right balance between protecting jobs and safeguarding those holding them.

In Ms. Cardenas's house, the women were doing some math of their own. One tried to tally how many hours she had spent in the unemployment office. Another added up her credit card debt and counted her doctors' visits. But mostly the women listed the subtler costs of their injuries, like the pounds gained from immobility or the addiction concerns with pain pills.

As the women stood up to leave, several grabbed the wall for balance. Ms. Farley added a parting thought.

"And all the while everyone thinks you're just faking," she said. The women agree that this is the worst part.


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Dental Patients in Oklahoma Warned of Disease Risk

Written By Unknown on Sabtu, 30 Maret 2013 | 13.57

The unsanitary practices of a dentist in Tulsa, Okla., may have exposed thousands of patients to H.I.V. and hepatitis, forcing him to close his offices while health officials investigate and test about 7,000 people who had visited him since 2007.

Officials with the Oklahoma Department of Health began sending letters Friday to those patients, urging them to have their blood tested for H.I.V., hepatitis B and hepatitis C. The dentist, Dr. W. Scott Harrington, has offices in Tulsa and Owasso, a northern Tulsa suburb, and investigators said they found numerous health and safety violations at the Tulsa office, including nonsterilized and rusty instruments.

So far, only one patient has been confirmed as having been infected — with hepatitis C — after being treated by Dr. Harrington. While officials stressed how important it was for patients to be tested, they cautioned that it was premature to characterize the situation as a widespread public health crisis. They said the transmission of H.I.V., hepatitis B and hepatitis C in a setting like a dentist's office was unusual.

"This is certainly going to be very alarming for those patients of this dental practice, but we're trying to assure folks that this is not an outbreak investigation," said Leslea Bennett-Webb, the spokeswoman for the Health Department. "We know based on scientific investigations in the past that acquiring these kinds of infectious diseases in a dental practice is very rare."

Health officials have records for Dr. Harrington's patients only since 2007, so they do not know how many others had visited him before then and might have been exposed to the viruses. They also do not know how long the improper practices were in place, and so were recommending that anyone who had ever been treated by Dr. Harrington be tested.

Dr. Harrington, 64, has been a state-licensed dentist since 1974 and an oral surgeon since 1977. He told investigators that he had treated a large number of patients known to be infectious disease carriers.

He has voluntarily closed his two offices and surrendered his dental license for 30 days. He faces the possibility of having his license revoked, after a hearing on April 19 at the state Board of Dentistry in Oklahoma City.

Dr. Harrington and his lawyer did not respond to requests for comment.

In a 17-count complaint filed Thursday by the dentistry board, Dr. Harrington was accused of being "a menace to the public health" by using unsafe and unsanitary practices. The complaint accused him of using drug vials for more than one patient and keeping expired vials; failing to keep suitable records of dangerous drugs; leaving his drug cabinet unlocked and unsupervised; and allowing dental assistants to sedate patients though they were not licensed to do so.

Dr. Harrington told officials during one inspection that his staff handled all sterilization and drug procedures, telling investigators, according to the complaint: "They take care of that. I don't."

Inspectors this month also found two separate sets of instruments at the Tulsa office, each cleaned by a different method — one for those patients known to have infectious diseases and one for those not believed to have such diseases, the complaint stated. The proper approach, officials said, is for all instruments to be handled as if they contained viruses.

"This is unprecedented for us," said Susan Rogers, the executive director of the state Board of Dentistry and a member of the team that examined Dr. Harrington's office. "When I say he wasn't following infection control guidelines, that's an understatement. I will tell you that I was stunned. I'm used to seeing drug cabinets in disarray. I'm not used to seeing rusty instruments."

A spokeswoman for the federal Centers for Disease Control and Prevention said the agency was assisting Oklahoma authorities with the investigation.

The Tulsa Health Department said it would offer free testing at a local clinic starting on Saturday.

Emma G. Fitzsimmons contributed reporting.


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Hospitals Question Fairness of New Medicare Rules

J. Emilio Flores for The New York Times

Tiffany Phan, left, a care manager at U.C.L.A. hospital, spoke to Marjorie Crear about medications and doctors' appointments.

It is no longer enough for hospitals to make patients healthy enough to leave. Now, as part of the Obama administration's health care overhaul, they are spending millions of dollars to keep those patients from coming back, often acting like personal assistants to help them manage their post-hospital lives.

While federal statistics show the effort is beginning to reduce costly and unnecessary readmissions, a growing chorus of critics is asking whether the government policy, which penalizes hospitals that have high readmission rates, is unfair. They are also questioning whether hospitals should be responsible for managing the personal lives of patients once they are released — or whether they should focus on other ways to improve care.

"It's consumed a lot of resources," said Dr. J. Michael Henderson, who focuses on quality and patient safety for the Cleveland Clinic, which attributes its relatively high readmission rate to the fact that it successfully treats a high number of severely ill patients.

Under the new federal regulations, hospitals face hefty penalties for readmitting patients they have already treated, on the theory that many readmissions result from poor follow-up care.

It makes for cheaper and better care in the long run, the thinking goes, to help patients stay healthy than to be forced to readmit them for another costly hospital stay.

So hospitals call patients within 48 hours of discharge to find out how they are feeling. They arrange patients' follow-up appointments with doctors even before a patient leaves. And they have redoubled their efforts to make sure patients understand what medicines to take at home.

But hospitals have also taken on responsibilities far outside the medical realm: they are helping patients arrange transportation for follow-up doctor visits, get safe housing or even find a hot meal, all in an effort to keep them healthy.

"There's a huge opportunity to reduce the cost of medical care by addressing these other things, the social aspects," said Dr. Samuel Skootsky, chief medical officer of the U.C.L.A. Faculty Practice Group and Medical Group.

Medicare, which monitors hospitals' compliance with the new rules, says nearly two-thirds of hospitals receiving traditional Medicare payments are expected to pay penalties totaling about $300 million in 2013 because too many of their patients were readmitted within 30 days of discharge. Last month, the agency reported that readmissions had dropped to 17.8 percent by late last year from about 19 percent in 2011.

But increasingly, health policy experts and hospital executives say the penalties, which went into effect in October, unfairly target hospitals that treat the sickest patients or the patients facing the greatest socioeconomic challenges. They say a hospital's readmission rate is not a clear measure of the quality of care it provides, noting that hospitals with higher mortality rates may also have fewer returning patients.

"Dead patients can't be readmitted," Dr. Henderson said.

"We're using a proxy because it's a convenient proxy — it's just not a very accurate proxy," said Dr. Karen E. Joynt, a health policy expert and co-author of an article critical of the penalties in The New England Journal of Medicine this month. Large academic medical centers and so-called safety-net hospitals are bearing the brunt of the new policy, and the authors warn that the penalties could make it even harder for hospitals struggling to care for those patients with the highest needs. The current policy, the article says, "has the potential to exacerbate disparities in care and create disincentives to providing care for patients who are particularly ill or who have complex health needs."

The penalties, which apply to rates of readmission after hospitalization for heart attacks, pneumonia and heart failure, are now calculated at 1 percent of hospital payments but will increase to 3 percent by 2015. Medicare also expects to expand the targeted readmissions to include more kinds of hospitalizations, like those for chronic lung disease.

Some hospitals say they have little choice but to incur the penalties, simply because they have other demands. At Boston Medical Center, which serves a high number of low-income patients, efforts to reduce readmissions, including making follow-up appointments and writing out a simple plan of what to do after leaving the hospital, have been successful for Medicaid patients.

But the medical center chose not to immediately expand the program to all patients, including the Medicare patients who would count toward future penalties.

"We make those trade-offs," said Dr. Stanley Hochberg, the center's chief quality officer. Medicare's focus on readmissions "doesn't necessarily align with our social priorities and medical priorities," he said. Medicare officials say they have listened to hospitals' concerns but defend the policy as heading in the right direction. "It's a very traumatic event to go back to the hospital," said Jonathan Blum, a senior Medicare official. "I'm personally comfortable with some imprecision to our measures."

"The ultimate goal is to have these numbers come down," he said.

Because so many hospital readmissions are tied to social or economic factors, hospitals have a hard time predicting which patients are likely to return, said Dr. Jan Berger, the chief medical officer for Silverlink Communications, a consulting firm. When Marjorie Crear, 66, left Ronald Reagan U.C.L.A. Medical Center after a stroke, she struggled to keep track of her medications and to remember her doctor appointments. Tiffany Phan, a newly hired care manager, helped with those tasks and has also been trying to find public housing with a shower instead of a hard-to-navigate bathtub.

Making it even harder for hospitals is the number of consultants and companies springing up to offer solutions with little hard evidence about which steps are the most effective. "We don't really know very clearly how to prevent more readmissions," said Austin Frakt, a health economist at Boston University.

In some cases, such prevention may take a combination of efforts that differ from hospital to hospital, said Dr. Risa Lavizzo-Mourey, chief executive of the Robert Wood Johnson Foundation, which has been financing pilot programs aimed at reducing readmissions. "One of the key factors we keep emphasizing is that there isn't a single magic bullet to fix everything," she said.

And complicating the issue even further is the possibility of doing harm. In 2011, for example, the Department of Veterans Affairs halted a program in which patients with chronic lung disease were supposed to learn to take better care of themselves when 28 patients in the program died, in contrast to 10 deaths in the group receiving typical care.

"It was just an incredible thing," said Dr. Dennis E. Niewoehner, a researcher from the University of Minnesota who said the findings were "a warning signal" for others thinking about embarking on similar programs. The higher death rate may have been purely chance, he said, but the researchers, who published their findings last year, do not know.


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National Briefing | South: Louisiana: Health Secretary Resigns Amid Investigations

Louisiana's health secretary, Bruce Greenstein, is resigning amid state and federal inquiries into the awarding of a Medicaid contract to a company where Mr. Greenstein once worked. Gov. Bobby Jindal's administration last week canceled the nearly $200 million state contract with CNSI, which is based in Maryland, after details leaked about a federal grand jury subpoena involving the contract award. The governor's office announced the resignation on Friday but said Mr. Jindal, a Republican, did not seek it. When the Medicaid contract was awarded two years ago, Mr. Greenstein denied any involvement in the selection of the company, but he acknowledged that a change he promoted in the bid solicitation made CNSI eligible for the contract. Mr. Greenstein gave no explanation for quitting in his resignation letter to the governor.


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World Briefing | Asia: Pakistan: Security Concerns Prevent Polio Vaccinations, Health Agency Says

About 240,000 children have missed vaccinations against polio because of security concerns in Pakistan's tribal regions bordering Afghanistan, a top official with the World Health Organization said Friday. The official, Dr. Nima Saeed Abid, the acting W.H.O. chief in Pakistan, said health workers had not been able to immunize children in the North and South Waziristan regions — Taliban strongholds — since July 2012. Pakistan is one of the few remaining countries, along with Afghanistan and Nigeria, where polio is rampant. As many as 58 cases were reported in Pakistan in 2012, down from 198 in 2011. Dr. Abid said that 15 health workers had been killed in the anti-polio campaign in Pakistan since July 2012. Pakistani militant groups oppose the vaccinations and accuse the workers of spying for the United States.


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Doctor and Assistant Charged in $10 Million Oxycodone Operation

Written By Unknown on Jumat, 29 Maret 2013 | 13.57

Dr. Hector Castro had a secret.

For a certain price, according to the authorities, he would write prescriptions for oxycodone, a powerful painkiller, even if the "patient" never stepped foot in his office at the Itzamna Medical Center in the Gramercy neighborhood in Lower Manhattan. On an average day, he would write 11 fraudulent prescriptions and charge $125 per prescription, the authorities said on Thursday.

Dr. Castro's office assistant, Patricia Valera, also had a secret.

Unbeknown to the doctor, she was handing out sham prescriptions too, selling each prescription for $500.

"She was doing her boss one better," Bridget G. Brennan, chief of New York City's Special Narcotics Prosecutor's Office, said at a news conference. "Smart businesswoman I guess."

On Thursday, both had their secrets revealed when the authorities announced their arrests for illegally selling painkillers as part of a $10 million operation that involved dozens of people throughout the Northeast.

A total of 49 people were arrested in New York, New Jersey and Pennsylvania on Thursday after a 15-month investigation involving both federal and local authorities.

Lawyers for Dr. Castro and Ms. Valera did not return phone messages seeking comment.

The investigation began in December 2011, after a young man overdosed on oxycodone and was found dead in his home in Woodbridge, N.J.

A detective found a bottle of oxycodone at the home that had been prescribed by Dr. Castro one day before the man died.

The authorities said Dr. Castro's name was familiar to pharmacists in New Jersey.

From September 2011 to last month, officials said, pharmacies in the state dispensed about half a million oxycodone pills based on more than 4,500 prescriptions issued out of his office.

In August 2012, after spending months conducting surveillance and interviews, an undercover officer successfully infiltrated a New Jersey drug trafficking organization and began making visits to Dr. Castro's Gramercy office on behalf of the drug organization, the authorities said.

Dr. Castro asked the undercover agent for an M.R.I. exam, ostensibly to justify the need for painkiller, but did not question the fact that the male undercover agent provided him with a female's imaging.

The doctor accepted a cash payment for the prescription in the office, the authorities said. While officials said Dr. Castro had flooded New Jersey with thousands of fake prescriptions, he was charged only with illegally selling 39 prescriptions, including 28 sold to the undercover officer since it would not be feasible to investigate every prescription.

Dr. Castro was arrested on Tuesday morning at his home at 540 West 52nd Street, where the authorities seized $20,000 in cash.

Shortly after the authorities started an investigation into Dr. Castro, they received information that prescriptions from his office were also flooding a rural area in Pennsylvania in the Poconos.

"The demand for oxycodone became so pronounced in this area that normal patients cannot get their prescriptions filled," Ms. Brennan said in an interview.

It quickly became clear, according to the authorities, that it was not Dr. Castro selling the prescriptions in Pennsylvania, but rather the office manager, Ms. Valera — who was also known by her nickname, Kardashian.

She was selling prescriptions to two competing drug rings and charging a premium of $500, which included delivery from her husband, Hector Rodriguez, who was also arrested this week.

The street value of oxycodone, according to the authorities, is $20 to $30 per pill.

An average prescription yields 120 pills and is worth about $2,400 on the street.

Ms. Valera and her husband were arrested at their Bronx home on Tuesday morning and agents seized a loaded handgun, about $8,000 cash and blank prescription sheets belonging to Dr. Castro and his brother, who is also a doctor.

His brother, who helped found the Gramercy Park clinic, is not accused of any wrongdoing.

Randy Leonard contributed reporting.


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Most Children’s Meals at Large Chains Are Unhealthy, Study Finds

A new study of the nutritional quality of meals for children on the menus of the nation's largest chain restaurants has found that 91 percent do not even meet the standards set by the National Restaurant Association's Kids LiveWell program.

An even larger percentage — 97 percent of restaurant children's meals — failed to meet stricter standards developed by a panel of nutrition and health experts for the Center for Science in the Public Interest, the nonprofit research and advocacy group that commissioned the study.

"These were pretty dismal results," said Margo G. Wootan, its director of nutrition policy.

The center did a similar study in 2008, which found that 99 percent of restaurant meals offered for children did not meet the standards. Ms. Wootan said she had expected a more significant improvement, particularly since many restaurant chains have been promoting their healthier options for youngsters.

"It's one thing if they had gone from 99 percent unhealthy to 50-50," she said. "But to go from 1 percent of kids' meals being healthy to 3 percent over four years — it's as if the restaurant industry hasn't heard there is an obesity epidemic in this country."

The center singled out Subway as the only restaurant that did not offer sugared drinks with its children's meals, instead suggesting water or low-fat milk. All eight of the sandwich chain's Fresh Fit for Kids meal combinations met the nutritional criteria.

At the other extreme were meals like grilled cheese on sourdough bread accompanied by fries and 2 percent chocolate milk at Applebee's. The meal contained 1,210 calories, almost half of which came from fat, or almost three times the amount of calories as the center's criteria for 4- to 8-year-olds allowed.

In a statement, DineEquity, the parent company of Applebee's, said its children's menu offered other choices that were "significantly" lower in calories, fat and sodium, like a grilled chicken sandwich with a side of steamed broccoli and apple or grape juice, which contains 355 calories.

"We know Applebee's best serves our guests by providing a wide selection of dishes, and we'll continue to do so by expanding the number of options for kids by the end of this year," the company said.

Applebee's is one of 120 restaurant chains that participate in the National Restaurant Association's Kids LiveWell program, which requires that at least one children's meal have two servings of fruits or vegetables, whole grains and a low-fat dairy product and be under 600 calories. There are 342 meal options that meet the criteria among the first 19 chains that signed onto the program, the association says.

Anita Jones-Mueller, a registered dietitian and founder of the Web site Healthy Dining Finder, which works with the association to design and monitor the program, said many of the restaurant companies that support the site were working hard to improve the nutritional quality of the meals they offered children.


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Deal Reached on Paid Sick Leave in New York City

Suzanne DeChillo/The New York Times

A hearing on paid sick leave last week. The agreement reached on Thursday night is subject to a vote by the City Council after action on the issue had been blocked for three years.

New York City is poised to mandate that thousands of companies provide paid time off for sick employees, bolstering a national movement that has been resisted by wary business leaders.

A legislative compromise reached on Thursday night represents a raw display of political muscle by a coalition of labor unions and liberal activists who overcame fierce objections from New York's business-minded mayor, Michael R. Bloomberg, and his allies in the corporate world.

The deal required a high-profile concession from a leading candidate to succeed Mr. Bloomberg, Christine C. Quinn, the City Council speaker, who had single-handedly blocked action on the sick-leave issue for three years, arguing that it would inflict damage on the city's fragile economy.

The legislation would eventually force companies with at least 15 employees to give full-time workers five compensated days off a year when they are ill, a requirement that advocates said would allow much of the city's labor force to stay home from work without fear of losing a day's wage — or worse, a job. The advocates said the legislation would provide paid sick leave for one million New Yorkers who do not currently have such benefits.

But to the disappointment of those who pushed for a more sweeping version of the legislation, New York City's mandate would not take effect until spring 2014, and for the first 18 months, it would apply only to businesses with 20 or more employees, according to people involved in the negotiations.

The measure is subject to a vote by the City Council. Mr. Bloomberg is expected to veto the measure, but there is enough support on the Council to override his veto.

New York's measure would be less stringent than similar requirements in Portland, Ore., San Francisco, Seattle and Washington, which cover either all companies or those with five or more workers.  

In a provision designed to placate the city's corporate leaders, the sick-leave requirement would not be implemented next year should the city's economy significantly erode, as measured by a financial index kept by the Federal Reserve Bank of New York.

Still, advocates argued that its passage would represent a significant symbolic victory because of New York's vast size and its role at times as a bellwether for public policy around the country.

"It's not perfect," said Sherry Leiwant, co-president of A Better Balance, an advocacy group involved in the negotiations. "But it's very important to get this done in New York."

New York's relative slowness to tackle the issue of mandatory sick-leave benefits has become a source of embarrassment for the city's liberal leaders, who directed their frustration at Ms. Quinn, a Democrat and longtime ally of Mr. Bloomberg who has aggressively courted the business community in her run for mayor.

Until a few weeks ago, Ms. Quinn had firmly resisted calls for mandated paid sick-leave legislation, using her power as speaker to block fellow lawmakers from voting on a bill proposed by Councilwoman Gale A. Brewer, of the Upper West Side, despite the bill's widespread support.  

But Ms. Quinn and her aides became unsettled by the steady drumbeat of news conferences calling on her to permit a vote, and emotional appeals from unions, elected officials, and activists including the feminist Gloria Steinem.

The outcry, which coincided with the official declaration of Ms. Quinn's mayoral campaign, quickly took center stage in the mayor's race, spilling out into contentious candidate forums and turning into an emblem of Ms. Quinn's complicated relationship with left-leaning Democrats.

In one particularly potent tactic, advocates persuaded the usually timid members of the Council to try to circumvent Ms. Quinn and force a vote on a version of the bill that was unacceptable to her, a maneuver never tried during her tenure as speaker.

Soon after it became clear that she might face a revolt in the City Council, Ms. Quinn sought to end the controversy — and cast off a political liability — by jump-starting negotiations, working with a local building service workers' union with whom she has a close relationship.

The two sides started far apart: Ms. Quinn proposed a rule that would apply to companies with 50 or more workers; advocates wanted a threshold of five.

Under the deal, companies exempt from the requirement because of their low number of employees would have to offer workers five days of unpaid sick leave annually.

Whether the sick leave is paid or unpaid, companies will be legally forbidden from firing workers for taking such time off.

Ms. Quinn, who insisted on the strong exemptions for smaller companies, said the compromise bill struck a balance between the needs of workers and their employers.

"We have a good, strong and sensible piece of legislation that recognizes the needs of everyday New Yorkers and the realities that our struggling small businesses face," Ms. Quinn said in a statement.

As the marathon talks drew to a close on Thursday night, advocates said that, compromises aside, they believed New York had given new momentum to a broader social cause.

"This is a sweet victory," said Bill Lipton, state director of the Working Families Party, which has overseen the advocates' day-to-day effort to win passage of the measure. "It provides economic security for New Yorkers, and a shot in the arm for the paid sick days movement across the country."


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Well: Is the Secret to Olive Oil in Its Scent?

Why is olive oil, the crown jewel of the Mediterranean diet, so good for your health?

Nutritionists point to its abundance of antioxidants and oleic acid, a monounsaturated fat that protects the heart. But new research suggests that some of the benefits of olive oil might be contained in its aroma.

The research found that compared to other oils and fats, extra virgin olive oil was more likely to increase a person's feelings of satiety after a meal. But another phase of the study showed that just imparting the scent of olive oil to food – by adding an aromatic extract – reduced the amount of calories people in the study consumed and improved their blood sugar response.

Smell and taste, it is well known, are two senses that are strongly tied together. Previous research has shown that manipulating the aroma of certain foods can influence the amount of them that people choose to eat. Intensifying the smell and flavor of a dessert, for example, can prompt people to take smaller bites.

The goal of the new study was to take a closer look at the factors that make some foods more filling than others.

Many products in supermarkets nowadays attract consumers with labels saying "low-fat," but eating low-fat foods can cause people to compensate by overeating later on, said Dr. Malte Rubach, a nutritional scientist who helped carry out the research with colleagues at the German Research Center for Food Chemistry, a government-financed institute based outside of Munich that published the report.

"We wanted to see whether there was a way to reduce the fat content of food without losing its taste or aroma," Dr. Rubach said.

The researchers, who received no funding from producers of olive oil, began the study by comparing the effects of four different fats on feelings of satiety: lard, butter, olive oil and canola oil. Canola oil has less monounsaturated fat than olive oil, but less saturated fat as well, and is often recommended along with olive oil as a healthy alternative to other cooking oils.

The researchers recruited 120 people and randomly split them into five groups. The participants were told simply to eat 500 grams of yogurt every day for three months. In four of the groups, the yogurt was enriched with one of the four fats. The fifth group, which served as the control, ate plain, zero-fat yogurt.

The subjects were followed closely and regularly given blood tests. They were not told specifically what was in their daily yogurt, though for ethical reasons they were informed that it might be enriched with animal or plant-derived fats, Dr. Rubach said.

After eating their yogurt, the olive oil group showed the greatest increases in blood levels of serotonin, a hormone associated with satiety. They also reduced their normal caloric intake most days to compensate for the extra daily yogurt, which prevented them from gaining weight, a pattern that was also seen in the butter and control groups. The canola and lard groups, however, did gain weight during the study period. Instead of cutting back on other calories, they added the yogurt to what they were already eating on a regular basis.

"You could see that those who felt really satiated reduced their total energy intake," Dr. Rubach said, "whereas the others didn't reduce their energy intake and they gained some weight."

The researchers were particularly surprised to see that weight and body fat increased in the group that was fed canola oil, despite its similar health properties to olive oil. So they designed the next phase of the study to see whether there was something other than the nutrients in the two oils that accounted for their different impacts.

This time, subjects were split into two groups that were given zero-fat yogurt. In one of the groups, the yogurt was mixed with an aroma extract that imparted the scent of olive oil without adding any fat.

Those who ate the plain yogurt showed a drop in serotonin levels and reported less satiation after eating it. They also did not cut back on other calories to compensate; instead, their intake increased an average of 176 calories a day.

The group eating the olive-oil flavored yogurt, meanwhile, reduced their calories from other foods and showed better responses when given glucose tolerance tests, which measure blood sugar control. Abrupt swings in blood sugar are part of what drives hunger and satiation.

The researchers attributed the impact of the olive oil scent to two aroma compounds that are particularly abundant in Italian olive oils, including hexanal, which is said to resemble the scent of freshly cut grass.

Dr. Rubach said that because the study was small, it would not be a good idea to draw any general recommendations from it. But the findings do suggest that consumers should be aware that the physiological impact of a meal is not limited to what they can see on the plate.

"This is the first time where we've really looked at the effects that things other than fatty acids, protein and carbohydrates have on satiety," he said. "Everything that completes our impression of a meal can have an impact."


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Tennessee Governor Balks at Medicaid Expansion

Written By Unknown on Kamis, 28 Maret 2013 | 13.57

Gov. Bill Haslam of Tennessee said Wednesday that he would not expand Medicaid in his state as called for in the federal health care overhaul, joining 18 other Republican governors who have rejected expansion for now.

Governor Haslam said he wanted instead to use federal Medicaid money to buy private insurance for as many as 175,000 low-income residents of his state. But he said that plan was being held up because the Obama administration had put too many conditions on the money.

With his health care law, President Obama wanted to make Medicaid, the federal-state health program for poor people, available to many more Americans, covering those earning up to 138 percent of the federal poverty level (currently up to $15,856 a year for an individual). But when the Supreme Court upheld the law last year, it ruled that states could opt out of the Medicaid expansion.

For states that opt in, the federal government will pay the full cost of expansion from 2014 to 2016, with its share gradually decreasing to 90 percent in 2020. So far, about two dozen governors, most of them Democrats, have said they want to expand Medicaid.

Tennessee is not the first state to latch on to the idea of using the federal expansion money to buy private insurance for a portion of its low-income population. Arkansas and Ohio are seeking permission from the Obama administration to do so, and some lawmakers in other states, including Florida, Louisiana, Pennsylvania and Texas, have also expressed interest.

Under this option, a state would use the federal Medicaid expansion funds to pay premiums for commercial insurance that will be sold through new marketplaces known as insurance exchanges. But Governor Haslam said he had not received assurances from the Obama administration that he could do things the way he wanted. For example, he said, he wants beneficiaries to pay a portion of their health care costs if they can afford to. And he does not want the expansion population to have better benefits than others who get insurance through the exchange.

"Until we get those assurances," Governor Haslam said in a speech to state legislators, "I cannot recommend to you that we move forward on this plan."

Erin Shields Britt, a spokeswoman for the federal Department of Health and Human Services, said, "We welcome continued conversations with Tennessee about developing a state-based solution that meets both the state's unique needs and the requirements of the Medicaid program while providing much-needed coverage to thousands of Tennesseans."

Robert Pear contributed reporting from Washington.


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National Briefing | Health: Study Shows Bacteria Moves From Animals to Humans

A new study used genetic sequencing to establish that a strain of antibiotic-resistant bacteria has been transmitted from farm animals to people, a connection that the food industry has long disputed. Representative Louise M. Slaughter, Democrat of New York, said the study by researchers in Britain and Denmark, which drew on data from two small farms in Denmark, "ends any debate" about whether giving antibiotics to livestock is a risk to humans. Scientists had shown a connection between animals and people before, but never in as much detail, said Keeve Nachman, a scientist at the Johns Hopkins Center for a Livable Future.


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National Briefing | Health: Link Is Found Between Stressfull Events and Stillbirths

Pregnant women who have stressful experiences in the year before giving birth are more likely to deliver stillborn babies, a new study reports. The study, by the National Institutes of Health, asked 2,000 women in five states about specific events, like losing a job, moving or losing a close friend or relative. Stillbirth risk increased with each event. Non-Hispanic black women were most affected. Experiences most correlated with stillbirth included being in a fight, going to jail and hearing a partner express opposition to the pregnancy.


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Well: Living With Cancer: The Scar Project

In the documentary "Baring it All," a young woman declares, "The scar represents everything I've been through. I'm proud of what I've been through." The film focuses on the fashion photographer David Jay, who created a pictorial series about breast cancer called "The Scar Project."

The photos from "The Scar Project" strike me as raw and beautiful. Not beautiful like the post-mastectomy pose of the artist Matuschka, whose "Beauty Out of Damage" photo became iconic after appearing on the cover of The New York Times Magazine in 1993. By comparison, David Jay's portraits contain images of women whose bared breasts look crumpled, concave, synthetic, reconstructed without or with reconfigured nipples, stitched horizontally or vertically or at an acute angle, lumpy, lopsided, wounded, or hacked off.

Bravery resides there, beauty elsewhere, in these shots of topless women in their 20s and 30s — in a wary smile, a cocked hat and suspenders, the branching veins of an inner arm, a mystic tattoo on a lower back, resolute hands on hips, smudged make-up smeared by a tear, an abundantly pregnant belly. Often beauty radiates from the eyes of the subject whose proud gaze conveys a steadfast determination to confront a grotesque turn of events with fortitude.

The ones that grip me stare at the photographer — at me — defiant. They want to live. I want them to live. Like Barbara Ehrenreich, David Jay seeks to unsettle a "public anesthetized by pink ribbons and fluffy teddy bears."

Cancer and its treatments challenge our perceptions of beauty. Without hair and breasts, some of the photographed young women had trouble feeling pretty and feminine. Some felt more beautiful and womanly because they realized their strength. All volunteered to participate in the project to help others confronting a cancer diagnosis and to raise awareness about the number of young adults dealing with the disease.

A scar on one woman, "Michaela," travels from her bellybutton down toward taut black briefs. She has dealt with mastectomies and reconstruction as well as the sort of gynecological cancer that afflicts me. At the end of the volume, she writes about her fate: "never being able to bear more children," "never being sexually aroused," "forever loosing the feeling in my breasts," and "always wondering if one or both cancers will reappear."

The last plate in David Jay's book is a black rectangle dedicated to "Jennifer," as is the entire volume. Jennifer Buffaloe had wanted to participate in the project, but grew too weak from metastases in her liver. She died in 2009 at the age of 27.

Because of the documentary and the book, I force myself to look at my body. There are lumps, bumps, thickened lines, deep indents, purplish bruises and permanent protrusions in unglamorous places. If I cannot bring myself to go into specifics here, I certainly would never have the nerve to bare myself before a camera. This fact underscores for me the valor of the young women in "The Scar Project."

The youthfulness of David Jay's subjects wrenches me. Unlike them, I had a good span of my adult life — more than 60 years — before treatment. Their bodies stopped being their own too soon. Did their selves also stop being their own too soon? Cancer scars are physical mutilations of and on the body; but, more than that, cancer scars the psyche, the soul, the spirit. The "me" before cancer is not the "me" after cancer. Nor can these identities always be sutured.

A number of people regretfully recall the "me" before cancer as ungrateful for an intact body, taking for granted organs that functioned normally, arrogant about the boons of health, ignorant of the preciousness of life. But I remember the "me" before cancer nostalgically. My earlier self could teach and connect with family, friends and students spontaneously and lavishly. At times I visualize the diagnosis as a gun aimed at a flying bird — pitched down from the sky in an instant to lie fluttering on the ground (or, to be more literal, the blue couch).

From my perspective, the young women in "The Scar Project" were gunned down while just trying their wings. With courage, the wounded survivors bear invisible scar tissue beneath the physical scars of cancer: the haunting lost person each might have become, had it not been for the disease. They live, but not the lives they would have led.


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Bloomberg Seeks an End to Cheap Cigarettes

Written By Unknown on Rabu, 27 Maret 2013 | 13.57

Victor J. Blue for The New York Times

Cigarettes are displayed at the Great Land Deli in the Bushwick neighborhood of Brooklyn. A new bill would establish a minimum price for cigarettes and cigarillos, or little cigars.

Mayor Michael R. Bloomberg opened a new front in his antismoking campaign last week when he proposed new legislation that would require stores to keep tobacco products out of sight, making New York the first city in the nation to do so.

Its companion bill, however, has the potential to be just as groundbreaking, experts on tobacco control said. Along with strengthening the penalties on retailers that evade tobacco taxes, the second bill establishes a minimum price for cigarettes and cigarillos, or little cigars, of $10.50 a pack, the first time such a strategy has been used to combat smoking. The bill also prohibits retailers from redeeming coupons or offering other discounts, like two-for-one deals.

"This is kind of a landmark set of proposals here," said Kurt Ribisl, a professor of public health at the University of North Carolina, Chapel Hill, whose research on tobacco control influenced Mr. Bloomberg's proposal. "For someone like me, who's spent 18 years studying point-of-sale issues, this is kind of big."

Dr. Ribisl studies what happens at the retail counter, where a customer at a typical convenience store sees a colorful array of signs, packaging and "shelf talkers" — the small tags that flutter from shelves — promoting two-for-one, dollar-off and other types of deals. According to a Federal Trade Commission report issued last year, the tobacco industry spent $6.5 billion on discounts in 2010, and Dr. Ribisl said they are one of the major ways cigarette makers encourage price-conscious customers like teenagers and low-income smokers to buy.

New York's price-regulation bill would, in effect, close off the remaining means of access to cheap cigarettes and little cigars, which make it easier for teenagers to experiment with smoking, and progress to smoking regularly, said Brett Loomis, a researcher at RTI International, a nonprofit institute that offers research and technical services to governments and businesses.

City and state taxes already add $5.85 to the cost of every pack, the highest cigarette taxes in the country. About half of all states, including New York, also require wholesalers and retailers to mark the price of cigarettes up by a certain percentage. The laws were generally intended to protect business in small stores by preventing large chains from selling cigarettes below cost, as so-called loss leaders, which draw in customers.

Mr. Bloomberg's proposal, which will be taken up by the City Council, goes beyond those laws by specifying a minimum price. The health department said $10.50 was the median price of the lowest-priced packs in more than 300 city stores. That, and the prohibition on coupons or discounts, will "thwart the tobacco companies' ability to prey on low-income and minority smokers," Dr. Ribisl said.

David Sutton, a spokesman for Altria, parent company of Philip Morris USA, said the city should focus on eradicating the illegal cigarette trade, rather than further restricting retailers, who are already required to perform age checks on customers.

"Piling on additional regulations designed to get at youth access when the sales compliance rate at licensed retailers is very, very high already — we just don't think that's the right approach," Mr. Sutton said.

As for the ban on discounts, Mr. Bloomberg, who is accustomed to setting an example for other municipalities in public-health initiatives, from smoking bans to calorie counts, may have looked to Providence, R.I., which passed an ordinance forbidding retailers from honoring coupons and discounts last January.

Tobacco companies sued, but the federal district judge ruled for Providence, which defended its right to regulate sales and prices within the city. Though the tobacco companies have appealed, the ban went into effect on Jan. 3. Mr. Bloomberg's tobacco-control bills are also almost certain to be challenged in court.

"We felt that these coupons and multipack discounts were a loophole," said Providence's mayor, Angel Taveras, "and we felt it was important to close this loophole, especially because it was a matter of life and death. We anticipated getting sued, but it was worth the fight."

As for Mr. Bloomberg's announcement, Mr. Taveras said he wished his crusading counterpart all the best.

"I'm not sure that he needs any advice from me," he said.


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Op-Ed Contributor: The Talmud and Other Diet Books

HARDLY a week goes by without yet another study documenting the increasing prevalence of obesity in America. Most of us take seriously the fact that close to 70 percent of American adults are now either overweight or obese, and most are willing to consider various ways to mitigate the problem.

Yet the solutions frequently trumpeted, like taxing sugary beverages, are top-down and invariably meet with strong resistance. In fact, Mississippi recently passed a bill essentially barring federal restrictions on what its people may eat or drink. Most Americans don't want to be told what to consume. They want their fill.

Perhaps a different approach can be considered, one that begins from within. Instead of fixating on indulgence and excess, as do so many top-down and outside-in efforts, we should focus on what it means for each individual to be sated.

Satiety, the feeling of being satisfied, is inherently idiosyncratic: everyone has her or his own sensation of being full. What sates my hunger will be different from what sates yours. Nevertheless, what sates our hunger will be less than what you might imagine.

Long before cooking shows and diet fads, many ancient civilizations understood this balance. The Greeks, for example, worried that excessive consumption would disrupt the four humors constituting the human body. They, like the ancient Buddhist and Confucian traditions, encouraged moderation as the golden mean. Judaism, Christianity and Islam added to those arguments theological overtones: eating too little could be as spiritually damning as eating too much.

The prophet Isaiah, for example, inveighed against the Israelites for vainly fasting when so much injustice surrounded them. Such fasting, and particularly fasting only for self-affliction, was sinful, rabbis of the Talmud said. But the Talmud also counseled "removing your hand from a meal that pleases you."

Christianity, especially through the teachings of Pope Gregory I and Thomas Aquinas, identifies gluttony as a mortal sin. More than just excessive desire for food, gluttony involves eating irregularly (snacking), being preoccupied with eating, consuming costly (sumptuous or unhealthy) foodstuffs and being fastidious about food. And the Koran insists that improper and wasteful eating incurs God's wrath. Eat well and live well, Islam teaches.

Of course, every civilization and religious tradition has its exceptions. Many Jewish households are celebrating lavish Passover Seders this week, and many Christian ones will have Easter feasts on Sunday. Celebrations like these are highly regulated, however. Not every day or every meal is meant to be a feast or a fast, and the one who feasts or fasts too much sins. It is far better, these traditions hold, for people to eat only the amount that satisfies them.

Among these old arguments is the novel idea of eating less than what fills one's belly. The Talmud teaches that people should eat enough to fill a third of their stomachs, drink enough to fill another third, and leave a third empty. (A hadith in the Islamic tradition also teaches this.) Rashi, a medieval French rabbi, interpreted the Talmud to mean that the final empty third is necessary so that the body can metabolize emotions. If one ate until one's belly was completely full, there'd be no room left to manage one's emotions and one would burst asunder.

However absurd this may seem to us today, it made physiological sense in the premodern world as the emotions were considered physical things that, like food and drink, were metabolized by the body. A body stuffed with food and drink is full only of biology; it leaves no room for biography, for what makes us human.

The medieval physician and legal scholar Maimonides similarly instructed people to eat and drink less than what filled their bellies (he thought the stomach should be three-quarters full). Moreover, they should eat slowly. Modern science corroborates Maimonides: it takes about 20 minutes for the brain to receive messages from the stomach that it has had enough. Satiety can be achieved with less food than one might think, and it requires more time to reach it.

Of course, one need not be a theist to experience satiety. One needs only a belly. Perhaps these old ideas could inspire new ways of addressing the complex weight problem in America. They could help us reduce the amount of food we put on our plates, which would lower the tonnage of otherwise good food discarded every day. And they could mitigate the costly and debilitating diseases associated with our current eating practices.

This approach is personalized: everyone is empowered to be in control of his own satiety. It is adaptable, changing as a person ages and ails. And although it is not exactly nonhierarchical if you believe it's God's will, at least it is not imposed by any human government. Finally, it is sustainable, as it promotes a culture that views limitless consumption with suspicion. Capitalism may abhor contentedness, but our bodies need us to heed it.

We have to realize that enough is enough. We should stop asking ourselves, "Am I full?" and start asking, "Am I satisfied?"


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New York State Budget Drops Plan to Allow For-Profit Investment in Hospitals

A proposal to allow for-profit investment in two hospitals in New York State has been dropped from the budget, an unexpected setback to a push to open health care systems to private investors for the first time.

One of the leading proponents of the change, Stephen Berger, an investment banker who has long advised the state on health care, said the State Assembly leadership had balked at allowing the two demonstration projects, one planned for Brooklyn and the other upstate, which were included in Gov. Andrew M. Cuomo's proposed budget.

"It doesn't mean we're not going to find a way to work around it," he added in an interview on Tuesday, saying he was very disappointed. "But this will make it much harder."

On the other side of the debate, Jill Furillo, executive director of the New York State Nurses Association, hailed the elimination of the pilot projects from the final version of the budget, calling it a victory for the nurses' union and patients. Busloads of nurses went to Albany to tell lawmakers why they wanted New York to remain the rare state that prevents large companies and their stockholders from owning hospitals.

"For-profit health care does not work," she said. "People in the Assembly listened to us, and so did Gov. Andrew Cuomo."

Mr. Berger scoffed at that idea and said the governor's office pushed hard for the measure, dropping it only when the chairman of the Assembly's Health Committee, Richard N. Gottfried, a Democrat from Manhattan, would not budge.

Assemblyman Gottfried did not respond to a request for comment on Tuesday; a staff member said he was traveling from Albany to New York for Passover.

Richard Azzopardi, a spokesman for the governor, said, "We continue to have an interest in exploring this and any other option that will promote access to capital for the improvement of health care facilities."

The two major hospital associations in the state were internally divided on the legislation, Mr. Berger added, but did not oppose it, a change from past battles.

Mr. Berger was chairman in 2011 of a state-appointed committee on reorganizing the failing system of health care in Brooklyn. That committee recommended changes in law that could open hospitals and physicians' practices to investment by large private companies. With many hospitals that serve poor patients in Brooklyn facing bankruptcy or closing, Mr. Berger says the need for private capital is urgent.

Mr. Gottfried's counterpart in the State Senate, Kemp Hannon, Republican from Nassau County, had proposed expanding the pilot to 10 hospitals, from 2. He then agreed to cut it back to five, leaving the executive budget's two-hospital pilot as a likely compromise. Instead, Mr. Berger said, "Dick Gottfried killed it. He dug in his heels. I don't know why."

The measure dropped from the final version of the state budget would have authorized the establishment of "no more than two business corporations formed under the business corporation law, one of which shall be the operator of a hospital or hospitals in Kings County and one shall be elsewhere in the state." The corporations would have been allowed to affiliate with at least one academic medical institution.

Advocates for public health have argued that for-profit operations would mainly benefit stockholders and investors by cherry-picking patients and procedures, sending the poorest and uninsured patients to other overwhelmed hospitals, and shredding a frayed safety net.

"We thank all of them for listening to front-line caregivers," Anne Bové, a registered nurse at Bellevue Hospital and one of the elected leaders of the New York State Nurses Association, said in a statement. "Nurses, caregivers and patients should be the ones making decisions about patient care — not hedge funds and private equity investors."


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