Diberdayakan oleh Blogger.

Popular Posts Today

Chinese Chicken Processors Are Cleared to Ship to U.S.

Written By Unknown on Sabtu, 31 Agustus 2013 | 13.58

The Department of Agriculture on Friday approved four Chinese poultry processors to begin shipping a limited amount of meat to the United States, a move that is likely to add to the debate over food imports.

Initially, the companies will be allowed to export only cooked poultry products from birds raised in the United States and Canada. But critics predicted that the government would eventually expand the rules, so that chickens and turkeys bred in China could end up in the American market.

"This is the first step towards allowing China to export its own domestic chickens to the U.S.," said Tony Corbo, the senior lobbyist for Food and Water Watch, an advocacy group that works to promote food safety.

The U.S.D.A.'s decision follows years of wrangling over the issue, and comes as Americans are increasingly focused on the origin of their food.

In recent years, imports have been the source of contamination, prompting broader worries about food safety. The Food and Drug Administration just released an analysis of imported spices, showing high levels of salmonella in coriander, oregano, sesame seeds and curry powder.

China does not have the best track record for food safety, and its chicken products in particular have raised questions. The country has had frequent outbreaks of deadly avian influenza, which it sometimes has been slow to report.

Recently, an F.D.A. investigation tied the deaths of more than 500 dogs and a handful of cats to chicken jerky treats that came from China. The treats, which were eventually recalled, additionally were blamed for sickening more than 2,500 animals.

The proposed sale of Smithfield Foods to Shuanghui International, a major Chinese food processor, has added to the industry scrutiny. In July, senators from both parties questioned Larry Pope, the chief executive of Smithfield, about the implications of his company's deal for food safety and United States employment.

Mr. Pope responded that the deal was intended to address the rising demand for meat in China and that American workers would be employed in that effort. "This means increased capacity for U.S. producers, more jobs in processing and more exports for the U.S. economy," Mr. Pope said. "At the same time, we will continue to supply our same high-quality, renowned products to U.S. consumers."

The poultry trade between the United States and China has been contentious for years. Under the Bush administration, the U.S.D.A. moved to allow imports of chicken from China, which has banned imports of American beef since 2003 over worries about mad cow disease.

In response, Congress blocked Chinese chicken exports. China retaliated by slapping huge tariffs on American chicken. The fight ended up at the World Trade Organization, which ruled that the tariffs were too high.

After that, the U.S.D.A. then audited Chinese processing plants, giving its approval for them to process raw birds from the United States and Canada.

Under the new rules, the Chinese facilities will verify that cooked products exported to the United States came from American or Canadian birds. So no U.S.D.A. inspector will be present in the plants.

And because the poultry will be processed, it will not require country-of-origin labeling. Nor will consumers eating chicken noodle soup from a can or chicken nuggets in a fast-food restaurant know if the chicken came from Chinese processing plants.

"We certainly don't look forward to any more imports, but we also realize free trade is a two-way street," said Tom Super, spokesman for the National Chicken Council, which represents big chicken processors in the United States. "We're hoping the Chinese will look a little more favorably on our chicken products and on other U.S. agricultural imports."


13.58 | 0 komentar | Read More

Well: Dress Up Your Salad With Grains

You can turn a simple salad into a hearty, texture-rich dish just by adding a few grains, writes Martha Rose Shulman in this week's Recipes for Health.

When a grain is not the main ingredient in a salad you appreciate it for its texture and for the nutty flavor it contributes to the dish. Authentic Middle Eastern tabouli, for example, is a parsley salad to which a small amount of fine bulgur adds a bit of substance. I made a tabouli of sorts this week with lots of parsley and a little bit of barley, and I made a kale salad with a little bit of quinoa added. Both of these I served as side dishes or starters.

I had a bit more bulgur, couscous and brown rice on hand so I used them for more substantial salads, one that combined bulgur and greens, another that mixed an assortment of different grades of brown rice and a little bit of farro with roasted red peppers, herbs and feta. I used the remains of a box of whole wheat couscous and a little bit of sorghum (you can also use Israeli couscous) to show off my tomato crop. They were all perfect dishes for hot summer days. Those that don't call for seasonal summer vegetables will also be great at any time of year.

Here are five ways to dress up your salad with grains.

Kale and Quinoa Salad With Plums and Herbs: The kale is the main ingredient here, with quinoa adding texture and bulk.


Brown Rice and Farro Salad With Roasted Pepper, Basil, Arugula and Feta: Roasted pepper and a vinaigrette dressing infuse a chewy, savory mix of rice and farro.


Parsley Salad With Barley, Dill and Hazelnuts: This lemony salad is enriched with a small amount of barley and toasted hazelnuts.


Raw and Cooked Tomato and Herb Salad With Couscous and Sorghum: In this salad, two types of couscous show off summer's tomato bounty.


Bulgur Salad With Greens, Barberries and Yogurt: Barberries are a tart dried fruit that add an interesting flavor to this salad.



13.58 | 0 komentar | Read More

The New Old Age Blog: In California, Renewed Debate Over Home Care

An important struggle over home health care is playing out in California, the nation's most populous state, including nearly five million residents age 65 and older.

Unions and organizations representing the elderly have joined together to push for legislation that would license agencies, certify workers and create a publicly accessible caregiver registry. Home care agencies are pushing back, saying they favor regulation but oppose the measures under consideration. The legislation, Assembly Bill 1217, has already passed the State Assembly and was passed out of the State Senate's appropriations committee on Friday. It will be up for a vote on the Senate floor next week.

An estimated 1,400 home care agencies and 120,000 paid caregivers would be affected by the proposed legislation, which is essentially an effort to bring consumer protections to an industry that has been likened to the Wild West. "It's just not right that I can check the license status of an air-conditioning repairman but I can't do so for someone coming into my home to care for a loved one," said Assemblywoman Bonnie Lowenthal, a Democrat and the bill's sponsor.

Currently, a business license is all that is required in California for organizations that offer home care, defined as nonmedical services for the elderly who need help using the bathroom, dressing, bathing and performing other basic tasks.

That leaves older adults and their families without the means to check whether agencies are adequately overseeing their caregiving staff. And elderly people who hire caregivers online or through referral agencies — which maintain lists of caregivers but do not employ them directly — have no easy, reliable way of checking these individuals' qualifications.

Although agency officials in California insist they follow reputable practices, a study published last year by researchers at Northwestern University found that few agencies perform comprehensive background checks on caregivers or provide reliable training or supervision.

Nationwide, 27 states require home care agencies to be licensed or certified, according to a 2011 report from the Private Duty Homecare Association. A lack of regulatory oversight puts consumers at risk of inadequate care, abuse or neglect, experts warn. Those risks were highlighted in an April 2011 study from the California Senate Office of Oversight and Outcomes highlighting the lack of screening for caregivers.

In one case described in the report, a home care agency placed Daisy Lee Joubert, a convicted felon, in the home of Ileen and Norman Jonas, where she stole an estimated $100,000 in retirement checks and jewelry. Apprehended, Ms. Joubert pleaded guilty to eight counts of embezzlement.

Under the proposed Home Care Services Consumer Protection Act of 2013, California home care agencies would have to obtain a state license by July 1, 2014, or face a fine of up to $900 a day. Agencies would be required to conduct background checks on caregivers, assess their performance annually and supervise their activities in a client's home every 90 days.

For their part, caregivers would be required to obtain certification after undergoing background checks, a test for tuberculosis and five hours of basic training. Their names and locations would appear on a Web site maintained by the state.

Home care agencies say they have no quibble with licensing and certification requirements. But the agencies think that ensuring the competency of workers should be voluntary and their responsibility, not the state's, said Dean Chalios, president of the California Association for Health Services at Home, an industry organization.

And home care agencies strongly oppose the creation of a caregiver registry, which would disclose the names of their workers to competitors and union organizers.

"What this is really all about is trying to unionize home care workers in California," said Kathy Janz, a nurse and executive director of Matched CareGivers, an agency that operates in San Mateo and Santa Clara Counties.

Imposing extra costs on agencies could backfire, making their services unaffordable for families and driving them to gray markets like Craigslist, where no consumer protections exist, warned Assemblywoman Mariko Yamada, a Democrat who earlier this year introduced an alternative bill.

And requiring home care workers to obtain certification could reduce the pool of workers and make it more difficult for the elderly to get services, Kevin Smith, director of operations for the Home Care Association of America, said in a written statement.

Laphonza Butler, president of United Long Term Care Workers, a branch of the Service Employees International Union in California, is a strong supporter of A.B. 1217 and skeptical of the home care industry's arguments. "If they accept responsibility for training workers and maintaining standards, I wonder why they haven't done it," she said.

Gary Passmore, vice president of the Congress of California Seniors, which also supports the legislation, said that "we need to make home care more of a profession," whether caregivers provide services through agencies or not. With agency costs in California averaging $30 to $35 an hour — versus $15 to $17 an hour for referral agencies and $8 to $12 for individual contractors — middle-class families should have the ability to hire workers who have been vetted by the state directly, he said.

The Direct Care Alliance and PHI (Paraprofessional Healthcare Institute) represent home care workers nationally. Officials at both organizations said in interviews that they supported certification programs and enhanced training for caregivers. The Direct Care Alliance offers a voluntary certification program, but only 807 caregivers have applied. PHI is working with several states to put in place a 77-hour model curriculum for personal care aides, said Steven Edelstein, the organization's national policy director.

Last year, Gov. Jerry Brown of California vetoed home care legislation similar to A.B. 1217, citing the potential impact on small businesses. But now the state is in better fiscal shape, and it is not clear whether he would veto the bill again if it makes its way through the Assembly.

"Certainly, a goal we'll continue working toward is to make sure all agencies meet basic standards for providing home care," Ms. Yamada said.


13.58 | 0 komentar | Read More

Taylor Farms, Big Food Supplier, Grapples With Frequent Recalls

Nicole Bengiveno/The New York Times

A Taylor Farms vegetable processing plant in Yuma, Ariz., where shredded cabbage and carrots are mixed with lettuce.

Taylor Farms, the large vegetable producer whose salad mix is being investigated in connection with an outbreak of illness involving hundreds of people in 22 states, has had an unusual number of voluntary recalls for potentially tainted products in the last three years.

The recent investigation of greens used at Olive Garden, Red Lobster and possibly other restaurant chains follows three recalls by Taylor Farm this year. The company initiated three others in 2012 and three in 2011, according to the Food and Drug Administration.

Bruce Taylor, chief executive of Taylor Farms, attributed the number of recalls to the sheer size of his company — it sells as much salad as its next three largest competitors combined. "Just if you do the sheer math, our recalls relative to our size are fewer than anybody else," Mr. Taylor said.

Only the most recent was prompted by an outbreak of illnesses, he added. Since June of this year, more than 600 cases of cyclosporiasis, an intestinal disease caused by Cyclospora cayetanensis, a parasite that is transmitted through feces, have been reported. Although not all reported cases were tied to Taylor Farms produce, this is the largest outbreak of cyclosporiasis since 1997.

Food safety experts said the number was somewhat higher than they would expect, even given Taylor's size. "While produce companies have by far the most recalls among food companies in general, I'd say one every 12 to 18 months is more the standard," said Gene Grabowski, a consultant who assists companies in dealing with the public and the media over food recalls.

Taylor competitors Dole and Fresh Express, a unit of Chiquita Brands, each had four recalls in 2012 and one in 2011. Neither company has conducted a recall so far this year, according to F.D.A. records.

Bill Marler, a lawyer who specializes in food safety litigation, also said that even for a company of its size, the rate of recalls by Taylor seemed a bit high. "That's quite a number of recalls over that time period," Mr. Marler said.

But several of those recalls could have been prompted by random inspections by state health agencies under a federal program that is now defunct, he said.

Taylor and other large produce companies had successfully lobbied to get rid of it, arguing that by the time the program identified a pathogen, the tainted product had already long since been consumed, making it hard to recall.

Shelly Burgess, a spokeswoman for the F.D.A., which is responsible for the safety of fruits and vegetables, among other foods, said there was no specific number of recalls that would require greater scrutiny by the agency.

"In assessing whether a firm should be subject to increased F.D.A. scrutiny, the agency takes many risk factors into account beyond the number of recalls the firm has initiated," Ms. Burgess wrote in an e-mail.

Mr. Taylor said many of the recalls were prompted by the company's own food safety regimen. For example, preliminary company tests drove the decision to issue a 39-state recall of organic baby spinach that was potentially contaminated with E. coli, he said.

"We have a protocol where we do an initial test and get an initial positive or negative and then follow that with a confirmation test that gives a positive or negative," he said. "I violated that protocol, though, out of an abundance of caution, acting to recall the product before we got the final result."

Mr. Taylor said the final testing found no contamination, turning the company's recall into a withdrawal of any remaining products from the market. "It was a fire drill we didn't need to do," he said.

And two of Taylor's recalls this year — almost 700 cases of its BBQ Flavored Ranch Salad with Chicken and a Black Forest ham and Swiss cheese sandwich sold under the Wawa stores' name — involved undeclared allergens like peanuts, not pathogens. "We make 700 items with over 2,000 components," Mr. Taylor said. "If an employee picks up the wrong item, we have a recall."

This week, Taylor Farms resumed operations at its Mexican processing facilities, which were the source of the greens tainted with Cyclospora, after an inspection by the Food and Drug Administration found conditions met known safety protocols.

The Centers for Disease Control, which is working with the F.D.A. on the matter, said this week that while investigations in Nebraska and Iowa had linked the outbreaks there to products from Taylor Farms of Mexico, preliminary analysis of more recent cases in Texas suggested the greens involved did not come from there.

"Although the investigation of cases in 2013 is ongoing, available evidence suggests that not all of the cases of cyclosporiasis in the various states are directly related to each other," the C.D.C. said.

Mr. Marler said he had not yet filed a lawsuit in the case for that reason. "Something else is going on, and I think it's probably environmental," he said.

Mr. Taylor wondered whether flooding earlier this summer in the areas where the problem surfaced provided the conditions for bacterial infections. He said notices posted in Nebraska, Iowa and Texas had warned residents in flooded regions to boil their water. "It's pure speculation on my part," he said, "Iowa and Nebraska represent somewhere around 4 percent of the salad sold from our plant in Mexico in any given week."

This article has been revised to reflect the following correction:

Correction: August 31, 2013

An article on Friday about recalls involving products from Taylor Farms, a big national food supplier, misstated the recent action involving the company's salad mix. The company's produce is being investigated in connection with an outbreak of cyclosporiasis; the mix was not recalled, as any that might have been a source of the illness had most likely already been consumed or was no longer in the food system. The article also misstated the nature of Cyclospora cayetanensis. It is a parasite, not a strain of bacteria.


13.58 | 0 komentar | Read More

What We Eat: Building a Better Mass-Market Tomato

Written By Unknown on Jumat, 30 Agustus 2013 | 13.57

David Manning for The New York Times

Heirloom tomatoes grow in a greenhouse at the University of Florida. 

GAINESVILLE, Fla. — Science is trying to build a better supermarket tomato.

At a laboratory here at the University of Florida's Institute for Plant Innovation, researchers chop tomatoes from nearby greenhouses and plop them into glass tubes to extract flavor compounds — the essence of tomato, so to speak. These flavor compounds are identified and quantified by machine. People taste and rate the hybrid tomatoes grown in the university's fields.

"I'm 98 percent confident we can make a tomato that tastes substantially better," said Harry J. Klee, a professor of horticultural sciences. He hopes that the fruits of his labor will be available to commercial growers within four or five years and in supermarkets a couple of years after that. He thinks he can make seeds for better tomatoes available to home gardeners even sooner, within a year or two.

The insipid-tomato problem is well known both to salad lovers and scientists. For example, a gene mutation that tomato breeders love because it turns the fruit a luscious red also happens to make it blander. Refrigeration, transportation and other factors also take their toll. Over the decades, the average tomato has become not only less tasty but less nutritious.

Enter Dr. Klee, who helped found the Institute for Plant Innovation a decade ago and has been in a quest for a more flavorful and nutritious mass-market tomato ever since.

It is easy to find a better tasting and more nutritious tomato. Go to a farmer's market or grow one in the backyard. It is also easy to breed a plant that produces something tastier than a supermarket tomato — cross a sweet heirloom with the supermarket variety. In the greenhouse, Dr. Klee pulls one such hybrid tomato off a vine, and it does taste sweeter. But a hybrid also loses some of the qualities highly valued by commercial growers — it is not as fecund, not as resistant to disease, not as easily grown, not as pretty.

As growers are paid by the pound, a better-tasting but less productive tomato holds little economic appeal, and thus was the supermarket tomato doomed to blandness.

Dr. Klee's goal is to tweak the tomato DNA — through traditional breeding, not genetic engineering — to add desired flavors while not compromising the traits needed for it to thrive commercially. "I figure that with approximately five key genes we could very significantly improve flavor," he said. He said three genes that control the production of key flavor compounds have already been located. The next step is to identify versions of the genes that lead the tomato plant to produce more of them.

The chemistry of tomato flavor has three primary components: sugars, acids and what are known as volatile chemicals — the flavor compounds that waft into the air carrying the fruit's aroma. There are more than 400 volatiles in a tomato, and Dr. Klee and his collaborators set out to first determine which ones are the most important in making a tasty tomato.

This involved grinding up a lot of tomatoes, looking at what was in them, and asking a lot of people to taste them (unpulverized), gathering comments like "a bland firm watermelon," "soft and sloppy," and "Sweet! Finally a sample with some sweetness."

From there, Dr. Klee and his collaborators, who include Linda Bartoshuk, director of human research at the university's Center for Smell and Taste, used statistics to correlate people's preferences with the presence, or absence, of particular flavor compounds, to devise a chemical recipe for the ideal tomato.

The supermarket tomato — even when grown with care and picked ripe — did not excel. "The best it will do is middle-of-the-pack," Dr. Klee said.

Cherry Roma tomatoes were at the top of the charts, followed by heirloom varieties like Matina, Ailsa Craig and Bloody Butcher. Other heirlooms like Marmande and Oaxacan Pink ranked at the bottom, below the supermarket tomatoes, though perhaps these particular types just do not grow well in Florida.

The taste analysis produced several surprises. Some compounds, abundant in many tomato varieties and thus thought to be major contributors to flavor, turned out to be irrelevant, while others, in scant quantities, had major influences. With the new knowledge, "you can't help but get a better tomato," Dr. Bartoshuk said.

This article has been revised to reflect the following correction:

Correction: August 28, 2013

An article on Tuesday about the quest for a tastier supermarket tomato misstated part of the name of one variety of heirloom tomato. It is Ailsa Craig (not Alisa).

This article has been revised to reflect the following correction:

Correction: August 30, 2013

An article on Tuesday about building a better mass-market tomato misstated the amount of money it would take to get regulatory approval to sell a genetically engineered tomato. It would cost an estimated $15 million, not $1.5 million.


13.57 | 0 komentar | Read More

N.F.L. Agrees to Settle Concussion Suit for $765 Million

The National Football League has agreed to pay $765 million to settle a lawsuit brought by more than 4,500 players and their families, largely closing the legal front in the league's battle against accusations that it concealed what it knew about the dangers of repeated hits to the head.

The settlement, announced Thursday, will be seen as a victory for the league, which has nearly $10 billion in annual revenue and faced the possibility of billions of dollars in liability payments and a discovery phase that could have proved damaging if the case had moved forward.

The league has changed its rules to make the game safer and modified its medical protocols for concussions as mounting scientific evidence in recent years linked head trauma sustained on the field to long-term cognitive damage. Among the terms of the agreement is that the settlement is not to be regarded as an admission of guilt by the league.

"The settlement seems low considering the number of claimants and the severity of their conditions, but it also shows the uphill climb in proving the league was responsible for the players' injuries," said Michael LeRoy, who teaches labor law at the University of Illinois at Urbana-Champaign. "The league is keenly sensitive to its public image. It changes the conversation and really lets the air out of the publicity balloon."

The case was widely considered a possible reckoning for the N.F.L., which has been criticized in recent years after dozens of former players were found to have chronic traumatic encephalopathy, or C.T.E., a degenerative brain disease similar to Alzheimer's disease. It is believed to be caused only by repeated head trauma. While the settlement closes a legal case for the league, brain trauma among current and former players may continue to vex a sport that embraces violent collisions.

"Settlement on concussions not gonna make up for early death, forgetting kids name and rest of stuff that come w/ brain trauma," the former N.F.L. player Aaron Curry, who was not part of the suit, said on Twitter.

Lawyers for the plaintiffs were eager to reach a settlement because many of their clients have debilitating neurological problems that need attention. Without a deal, a legal remedy might have taken years, with no guarantee that the courts would rule in favor of the players.

"The big picture was we got immediate care to the retired players, and I think we accomplished that," Christopher Seeger, a lawyer for the plaintiffs, said.

A court-appointed mediator helped the two sides reach the settlement; it now needs approval from Judge Anita B. Brody of United States District Court in Philadelphia.

The money would be used for medical exams, concussion-related compensation and a program of medical research for retired players and their families. The money, which may not be distributed for many months, will be available to all retired players with neurological problems, not just the plaintiffs. The N.F.L. also agreed to pay legal fees for the plaintiffs' lawyers, a sum that could reach tens of millions of dollars.

The pool of beneficiaries could be smaller or larger than the number of plaintiffs in the case, depending on how many retired players with neurological problems come forward. The settlement does not cover current players.

"Rather than litigate literally thousands of complex individual claims over many years, the parties have reached an agreement that, if approved, will provide relief and support where it is needed at a time when it is most needed," Layn Phillips, the mediator, said in a statement.

The settlement will include $675 million for players or the families of players who sustained cognitive injury. As much as $75 million will be set aside for baseline medical exams. A $10 million research fund will be established. Assuming Judge Brody signs off, the deal could take about 180 days for the players to start receiving compensation, Mr. Seeger said.


13.57 | 0 komentar | Read More

Taylor Farms, Big Food Supplier, Grapples With Frequent Recalls

Nicole Bengiveno/The New York Times

A Taylor Farms vegetable processing plant in Yuma, Ariz., where shredded cabbage and carrots are mixed with lettuce.

Taylor Farms, the large vegetable producer whose salad mix has been linked to hundreds of sickened people in 22 states, has had an unusual number of voluntary recalls for potentially tainted products in the last three years.

The recent recall of greens used at Olive Garden, Red Lobster and possibly other restaurant chains is Taylor Farm's fourth this year. The company initiated three others in 2012 and three in 2011, according to the Food and Drug Administration.

Bruce Taylor, chief executive of Taylor Farms, attributed the number of recalls to the sheer size of his company — it sells as much salad as its next three largest competitors combined. "Just if you do the sheer math, our recalls relative to our size are fewer than anybody else," Mr. Taylor said.

Only the most recent was prompted by an outbreak of illnesses, he added. Since June of this year, more than 600 cases of cyclosporiasis, an intestinal disease caused by Cyclospora cayetanensis, a bacteria that is transmitted through feces, have been reported. Although not all reported cases were tied to Taylor Farms produce, this is the largest outbreak of cyclosporiasis since 1997.

Food safety experts said the number was somewhat higher than they would expect, even given Taylor's size. "While produce companies have by far the most recalls among food companies in general, I'd say one every 12 to 18 months is more the standard," said Gene Grabowski, a consultant who assists companies in dealing with the public and the media over food recalls.

Taylor competitors Dole and Fresh Express, a unit of Chiquita Brands, each had four recalls in 2012 and one in 2011. Neither company has conducted a recall so far this year, according to F.D.A. records.

Bill Marler, a lawyer who specializes in food safety litigation, also said that even for a company of its size, the rate of recalls by Taylor seemed a bit high. "That's quite a number of recalls over that time period," Mr. Marler said.

But several of those recalls could have been prompted by random inspections by state health agencies under a federal program that is now defunct, he said.

Taylor and other large produce companies had successfully lobbied to get rid of it, arguing that by the time the program identified a pathogen, the tainted product had already long since been consumed, making it hard to recall.

Shelly Burgess, a spokeswoman for the F.D.A., which is responsible for the safety of fruits and vegetables, among other foods, said there was no specific number of recalls that would require greater scrutiny by the agency.

"In assessing whether a firm should be subject to increased F.D.A. scrutiny, the agency takes many risk factors into account beyond the number of recalls the firm has initiated," Ms. Burgess wrote in an e-mail.

Mr. Taylor said many of the recalls were prompted by the company's own food safety regimen. For example, preliminary company tests drove the decision to issue a 39-state recall of organic baby spinach that was potentially contaminated with E. coli, he said.

"We have a protocol where we do an initial test and get an initial positive or negative and then follow that with a confirmation test that gives a positive or negative," he said. "I violated that protocol, though, out of an abundance of caution, acting to recall the product before we got the final result."

Mr. Taylor said the final testing found no contamination, turning the company's recall into a withdrawal of any remaining products from the market. "It was a fire drill we didn't need to do," he said.

And two of Taylor's recalls this year — almost 700 cases of its BBQ Flavored Ranch Salad with Chicken and a Black Forest ham and Swiss cheese sandwich sold under the Wawa stores' name — involved undeclared allergens like peanuts, not pathogens. "We make 700 items with over 2,000 components," Mr. Taylor said. "If an employee picks up the wrong item, we have a recall."

This week, Taylor Farms resumed operations at its Mexican processing facilities, which were the source of the greens tainted with Cyclospora, after an inspection by the Food and Drug Administration found conditions met known safety protocols.

The Centers for Disease Control, which is working with the F.D.A. on the matter, said this week that while investigations in Nebraska and Iowa had linked the outbreaks there to products from Taylor Farms of Mexico, preliminary analysis of more recent cases in Texas suggested the greens involved did not come from there.

"Although the investigation of cases in 2013 is ongoing, available evidence suggests that not all of the cases of cyclosporiasis in the various states are directly related to each other," the C.D.C. said.

Mr. Marler said he had not yet filed a lawsuit in the case for that reason. "Something else is going on, and I think it's probably environmental," he said.

Mr. Taylor wondered whether flooding earlier this summer in the areas where the problem surfaced provided the conditions for bacterial infections. He said notices posted in Nebraska, Iowa and Texas had warned residents in flooded regions to boil their water. "It's pure speculation on my part," he said, "Iowa and Nebraska represent somewhere around 4 percent of the salad sold from our plant in Mexico in any given week."


13.57 | 0 komentar | Read More

Advertising: E-Cigarette Makers’ Ads Echo Tobacco’s Heyday

Electronic cigarettes may be a creation of the early 21st century, but critics of the devices say manufacturers are increasingly borrowing marketing tactics that are more reminiscent of the heady days of tobacco in the mid-1900s.

With American smokers buying e-cigarettes at a record pace — annual sales are expected to reach $1.7 billion by year's end — e-cigarette makers are opening their wallets wide, spending growing sums on television commercials with celebrities, catchy slogans and sports sponsorships. Those tactics can no longer be used to sell tobacco cigarettes, but are readily available to the industry because it is not covered by the laws or regulations that affect the tobacco cigarette industry. The e-cigarette industry is also spending lavishly on marketing methods that are also still available to their tobacco brethren, including promotions, events, sample giveaways and print ads.

The Blu eCigs brand — which recently added the actress Jenny McCarthy to its roster of star endorsers, joining the actor Stephen Dorff — spent $12.4 million on ads in major media for the first quarter of this year compared with $992,000 in the same period a year ago, according to the Kantar Media unit of WPP. And ad spending in a category that Kantar Media calls smoking materials and accessories, which includes products like pipes and lighters in addition to e-cigarettes, has skyrocketed: from $2.7 million in 2010 to $7.2 million in 2011 to $20.8 million last year.

In the first quarter of 2013, Kantar Media reported, category ad spending soared again, reaching $15.7 million, compared with $2 million in the same period a year ago. In fact, that $15.7 million total exceeded the spending for ads in major media for tobacco cigarettes, at $13.9 million, according to Kantar Media.

"It is beyond troubling that e-cigarettes are using the exact same marketing tactics we saw the tobacco industry use in the '50s, '60s and '70s, which made it so effective for tobacco products to reach youth," said Matthew L. Myers, president of an organization in Washington, the Campaign for Tobacco-Free Kids, that has fought for decades against aiming cigarette ads at minors.

"The real threat," he added, "is whether, with this marketing, e-cigarette makers will undo 40 years of efforts to deglamorize smoking."

Makers of e-cigarettes counter that their marketing efforts are legal and intended to reach adults — particularly, they say, adults who smoke tobacco cigarettes.

"Our company is being built on branding," said Elliot B. Maisel, chairman and chief executive at the Fin Branding Group in Atlanta, which last month began running television commercials for its Fin e-cigarette to accompany other initiatives like print and online ads. The company plans to spend more than $8 million this year to take advantage of "the opportunity to build a great American iconic brand," he added.

Joana Martins, vice president for marketing at Fin Branding, described the Fin ads as aimed at "adult smokers, 25 to 44, who are tired of being ostracized" and would be receptive to a pitch that "it's O.K. to smoke again." That is reflected in the campaign theme, "Rewrite the rules."

There is another reason that e-cigarette makers are appropriating the marketing playbook of tobacco cigarettes beyond the proven effectiveness of tactics like advertising on television and sponsoring racecars: giant tobacco companies like Lorillard and Reynolds American, which sell traditional smokes like Newport and Camel, are entering the e-cigarette category alongside smaller, entrepreneurial outfits like Fin Branding. Big Tobacco's arrival is coming through acquisitions (e.g., Lorillard bought Blu eCigs last year) and start-ups (e.g., Reynolds American is introducing an e-cigarette named Vuse).

A selling point in a campaign for Vuse that began this week in Colorado is that it is "designed by tobacco experts" to deliver "a perfect puff every time," said Stephanie Cordisco, president of the R. J. Reynolds Vapor Company division of Reynolds American in Winston-Salem, N.C.

(In "A perfect puff every time," you might hear an alliterative echo of classic tobacco cigarette slogans like "Not a cough in a carload," "A treat instead of a treatment" or "Light up a Lucky").

"I spent a lot of my career working with Camel," Ms. Cordisco said, "under the marketing restrictions" that affect how tobacco cigarettes are sold.

"Obviously, I'm very excited," she added, to be able to use media like television and radio to promote Vuse. "It's a major consumer win, because consumers have access to information."

Matt Coapman, vice president for marketing at Blu eCigs in Charlotte, N.C., said: "Our target audience is adult smokers. Where we can reach those adult smokers, we're going to try our best to get in front of them."

"As the category increases in sales, so will the marketing dollars follow," he added.

Lorillard intends to spend $30 million on marketing this year for Blu eCigs, Mr. Coapman said, including a renewal of the endorsement agreement with Mr. Dorff for "another year, at least." Celebrities who endorsed tobacco cigarettes back in the day included, in addition to film and television stars, athletes, singers, doctors and even cartoon characters like the Flintstones.

A point made by the e-cigarette industry and its supporters is that electronic smokes offer an alternative to tobacco cigarettes that may be less harmful.

"Whether e-cigarette products, responsibly marketed and properly regulated, could help people quit smoking and reduce tobacco use is a fair question," Mr. Myers said.

"But what we see in the marketplace is something entirely different," he added. "The people who are making them are behaving more like the tobacco industry than like people who care about public health."


13.57 | 0 komentar | Read More

World Briefing | Asia: China: Police Search for Woman Accused of Gouging Out Boy’s Eyes

Written By Unknown on Kamis, 29 Agustus 2013 | 13.58

The police in northern China began a search Wednesday for a woman accused of gouging out the eyes of a 6-year-old boy. The authorities in the city of Linfen in Shanxi Province offered a $16,000 reward for the woman's capture. The police did not say if they had identified a suspect, and the boy said only that the woman spoke with an accent from outside the area. State media said the boy was recovering in a hospital, but had lost his sight permanently after the ordeal Saturday. A police officer who only gave his surname, Liu, said that the boy's eyeballs were found at the scene, and that the corneas had not been removed. State media previously had raised the possibility that the boy's corneas were taken for sale because of a donor shortage. The Beijing Times quoted the parents of the boy, whose family name is Guo according to the police, as saying that their son told them he was walking along a path when he was grabbed.


13.58 | 0 komentar | Read More

Well: A Guide for Swimmers Breaking Boundaries

Written By Unknown on Senin, 26 Agustus 2013 | 13.57

Lynne Cox has spent more than four decades swimming past the known limits of human capacity. Driven by an explorer's voracious desire to do what has never been done, and frankly obsessive about mental and physical preparation, she has completed scores of pioneering swims, most famously the frigid Bering Strait in just a suit, cap and goggles.

Now she has channeled her vast expertise on the dangers, joys and logistics of open water swimming into a new book aimed at the exploding ranks of triathletes and other swimmers who are escaping the safe confines of pools.

The book, "Open Water Swimming Manual: An Expert's Survival Guide for Triathletes and Open Water Swimmers" (Vintage, $15.95), brings together research and advice from a range of experts, including marine biologists, meteorologists, hypothermia scientists, emergency medical teams and even the famously secretive Navy SEALs. She weaves in details and cautionary advice relating to her own swims and those of others, like Steve Irwin, the Australian environmentalist television star, who died while swimming at the Great Barrier Reef when a stingray stung his chest. ("Applying acid, such as orange juice, urine, or vinegar, does not have any effect on the sting.") A boy's plunge into a freshwater lake in Finland results in an ear infection, which it turns out was caused by algae growing in his ears. ("Earplugs might have helped.")

The publication could hardly be better timed. A steep rise in the popularity of triathlons has been swelling the ranks of open water events. Some 1,100 people dashed into the surf off Los Angeles in early August for the two-mile Dwight Crum Pier-to-Pier Swim, up from 586 in 2000. In New York, more than 200 swam around Governors Island and some 70 people circumnavigated Manhattan in relays this summer.

But Ms. Cox, 56, knows something many of them may not grasp. Venturing into wild water is a high-risk endeavor. The exertion can be intense. The environment – a confluence of wind, waves, sun, creatures and self — is unpredictable. Swimmers can inhale too much water, lose too much body heat, overheat, underhydrate, become disoriented. Exiting an ocean swim through surf can subject the swimmer to a maddening swirl of currents and bone-breaking beatings from crashing waves. These situations, she relates firmly, can be life-threatening.

This summer, a 34-year-old British woman, Susan Taylor, died after collapsing near the end of the 21-mile crossing from England to France. In 2010, a 26-year-old Pennsylvania man, Fran Crippen, died near the finish of a 10-kilometer swim in the warm waters off the United Arab Emirates.

So Ms. Cox, the product of an artist mother and a father who was a Marine, tempers vision and enthusiasm with methodical, unstinting effort.

"I could think that I could do it, and that's a great way to help prepare," she said at a recent lunchtime talk at Google's New York headquarters. "But if I don't physically train to do it, then mentally I'm not prepared to do it, and physically and mentally I can't do it."

So she includes training advice for beginner, intermediate and advanced swimmers, starting with "shorter" swims of one to three miles and beefing up the miles and intensity for those aiming at the Catalina channel or the Strait of Magellan.

What makes for a trusty crew for distance events? One crucial factor: there must be one person in charge at all times, though the role can be serially occupied. If a swimmer is in jeopardy, whether from the perilous water conditions, physical exhaustion or threatening critters, there must be no arguing among the crew over what to do.

Almost 30 pages are devoted to marine organisms to look out for, including what to do if a swimmer is afflicted by jellyfish, stingrays or tiny irritants that cause so-called seabather's eruption.

Sharks get their own chapter. Good advice: Be careful what you wear. If swimming near seals or sea lions, don't wear a black suit, or a predator might mistake you for dinner. Jewelry or metallic swimsuits can attract sharks, too.

The book also includes the Navy SEALs' five-page Risk Assessment Worksheet, which rates the likelihood and effects of 14 hazards, among them "swimmer-induced pulmonary edema" (seldom, critical) and even "ambulance stuck in sand" (seldom, catastrophic). Part of the point is real safety, and part is clearing the mind, she said. "If you think about the energy you use being anxious," she said, "just think about how much faster you could be in your race!"

You don't have to know Ms. Cox long to discover that she relishes  her time in the water, and even the moments of danger. In the opening chapter of the manual, a paean to outdoor immersion, she writes of "water song," the music of breath, body, wind and waves.

And she offers a benediction, elegant in its simplicity, to readers who take up the challenge to leave water within walls and head out into the unknown.

"For many of you, the open water will become a haven, a favorite place to visit, and many of you will discover that no matter where you are in the world, it will always be a place where you feel at home."


Andrea Kannapell, an editor on the foreign desk of The New York Times, is a longtime open-water swimmer.


This post has been revised to reflect the following correction:

Correction: August 25, 2013

An earlier version of this article misidentified the United Arab Emirates.


13.57 | 0 komentar | Read More

How to Charge $546 for Six Liters of Saltwater

It is one of the most common components of emergency medicine: an intravenous bag of sterile saltwater.

Luckily for anyone who has ever needed an IV bag to replenish lost fluids or to receive medication, it is also one of the least expensive. The average manufacturer's price, according to government data, has fluctuated in recent years from 44 cents to $1.

Yet there is nothing either cheap or simple about its ultimate cost, as I learned when I tried to trace the commercial path of IV bags from the factory to the veins of more than 100 patients struck by a May 2012 outbreak of food poisoning in upstate New York.

Some of the patients' bills would later include markups of 100 to 200 times the manufacturer's price, not counting separate charges for "IV administration." And on other bills, a bundled charge for "IV therapy" was almost 1,000 times the official cost of the solution.

It is no secret that medical care in the United States is overpriced. But as the tale of the humble IV bag shows all too clearly, it is secrecy that helps keep prices high: hidden in the underbrush of transactions among multiple buyers and sellers, and in the hieroglyphics of hospital bills.

At every step from manufacturer to patient, there are confidential deals among the major players, including drug companies, purchasing organizations and distributors, and insurers. These deals so obscure prices and profits that even participants cannot say what the simplest component of care actually costs, let alone what it should cost.

And that leaves taxpayers and patients alike with an inflated bottom line and little or no way to challenge it.

A PRICE IN FLUX

In the food-poisoning case, some of the stricken were affluent, and others barely made ends meet. Some had private insurance; some were covered by government programs like Medicare and Medicaid; and some were uninsured.

In the end, those factors strongly (and sometimes perversely) affected overall charges for treatment, including how much patients were expected to pay out of pocket. But at the beginning, there was the cost of an IV bag of normal saline, one of more than a billion units used in the United States each year.

"People are shocked when they hear that a bag of saline solution costs far less than their cup of coffee in the morning," said Deborah Spak, a spokeswoman for Baxter International, one of three global pharmaceutical companies that make nearly all the IV solutions used in the United States.

It was a rare unguarded comment. Ms. Spak — like a spokesman for Hospira, another giant in the field — later insisted that all information about saline solution prices was private.

In fact, manufacturers are required to report such prices annually to the federal government, which bases Medicare payments on the average national price plus 6 percent. The limit for one liter of normal saline (a little more than a quart) went to $1.07 this year from 46 cents in 2010, an increase manufacturers linked to the cost of raw materials, fuel and transportation. That would seem to make it the rare medical item that is cheaper in the United States than in France, where the price at a typical hospital in Paris last year was 3.62 euros, or $4.73. One-liter IV bags normally contain nine grams of salt, less than two teaspoons. Much of it comes from a major Morton Salt operation in Rittman, Ohio, which uses a subterranean salt deposit formed millions of years ago. The water is local to places like Round Lake, Ill., or Rocky Mount, N.C., where Baxter and Hospira, respectively, run their biggest automated production plants under sterility standards set by the Food and Drug Administration.

But even before the finished product is sold by the case or the truckload, the real cost of a bag of normal saline, like the true cost of medical supplies from gauze to heart implants, disappears into an opaque realm of byzantine contracts, confidential rebates and fees that would be considered illegal kickbacks in many other industries.

IV bags can function like cheap milk and eggs in a high-priced grocery store, or like the one-cent cellphone locked into an expensive service contract. They serve as loss leaders in exclusive contracts with "preferred manufacturers" that bundle together expensive drugs and basics, or throw in "free" medical equipment with costly consequences.

Few hospitals negotiate these deals themselves. Instead, they rely on two formidable sets of middlemen: a few giant group-purchasing organizations that negotiate high-volume contracts, and a few giant distributors that buy and store medical supplies and deliver them to client hospitals.

Proponents of this system say it saves hospitals billions in economies of scale. Critics say the middlemen not only take their cut, but they have a strong interest in keeping most prices high and competition minimal.


13.57 | 0 komentar | Read More

DealBook: Amgen Said to Be Near Deal to Buy Onyx for $10.5 Billion

Updated, Aug. 25, 7:38 p.m. | Amgen announced on Sunday that it has agreed to buy Onyx for $125 a share.

Updated, 5:15 p.m. | Amgen is close to a deal to buy Onyx Pharmaceuticals Inc., a maker drugs to fight cancer, for about $10.5 billion, people briefed on the matter said on Saturday.

A deal — in which Amgen would pay about $125 a share — could be announced as soon as Monday, though these people cautioned that talks are continuing and could still fall apart.

If a transaction is completed, it would be the latest of many in the health care industry, especially as drug makers look to add to their offerings. One attractive set of products is new cancer drugs, which can fetch high prices.

Amgen is the world's largest biotechnology company by sales, with $17.3 billion in revenue last year. But its top-selling products are older and many are selling more slowly, or even declining.

Some of the company's drugs are also facing competition in Europe from near-generic copies, known as biosimilars, and that competition is expected to come to the United States in the next few years. Teva is expected to introduce a near-copy of Amgen's Neupogen, a drug that helps prevent infections in patients undergoing chemotherapy, late this year.

A deal for Onyx would be the first big takeover struck by Robert A. Bradway, who became Amgen's chief executive in May of last year. Analysts expected Mr. Bradway, who spent most of his career as an investment banker at Morgan Stanley, to drive a tough bargain.

Amgen began its quest for Onyx in June, when it made an unsolicited bid valued at $120 a share, about 38 percent above the stock price at the time.

But Onyx rebuffed the approach and hired the investment bank Centerview Partners to seek bids for the company. A number of drug makers expressed interest, including Pfizer and Novartis, but analysts considered Amgen the most likely buyer.

Onyx's main attraction is its cancer drugs, two of which won approval last year. Its crown jewel is Kyprolis, a drug for multiple myeloma that was approved in July and that Onyx fully owns.

Several analysts expect annual sales of Kyprolis to reach $2 billion within several years, providing tremendous impetus to Onyx's growth. The company reported $362.2 million in revenue in 2012, mostly from proceeds of drugs it shares with Bayer.

But Kyprolis's $61 million in sales during the second quarter were slightly below some analysts' expectations, raising concerns about competition. Onyx also disclosed that the drug had failed to improve survival in an interim analysis of results from a clinical trial being conducted to win approval in Europe. While that does not mean the drug does not work, the company must now wait for final data from the testing, which is expected in the first half of next year.

A brief hiccup in the discussions occurred recently when Amgen demanded to see more clinical trial data on Kyprolis, people briefed on the discussions have said. Amgen sought to lower its bid from the $130 a share it had floated because of that dispute.

Onyx and its advisers, however, have come to the conclusion that at $125 a share, Amgen's bid is significantly more than its original proposal  and outweighs the uncertainty of a drawn-out sales process, one of the people briefed on the matter said.

At $125 a share, Amgen would be paying about 13 times the amount analysts expect Onyx to have in sales over the next 12 months, one of the highest multiples in the biopharmaceutical industry.

Mark Schoenebaum, a biotechnology and pharmaceutical analyst at the ISI Group, has said that many of Amgen's largest shareholders are value investors who are interested in having the company return money to shareholders through dividends and share buybacks instead of making big acquisitions.

"I think they are under a lot of pressure to not overpay,'' he told clients  this week.


13.57 | 0 komentar | Read More

Well: Keeping Food-Borne Illnesses at Bay

Each year, one in six Americans becomes sick from eating contaminated food. But while outbreaks of food-borne illness linked to processing plants or imported products capture the public's attention and raise fears about the safety of the food supply, as many as 70 percent of food poisoning cases originate in the kitchen.

People, not products, are the main cause of food-borne illnesses, and they can be avoided by following certain basic principles of food safety.

Unfortunately, some of the best advice, like using disposable paper towels in place of reusable cloths and sponges, butts headfirst against modern efforts to be "green." Other measures, like discarding leftovers after two days, are antithetical to the "waste not, want not" philosophy I was raised on. (Just before writing this paragraph, I reheated and ate a plate of delicious well-cooked leftovers that I had prepared for a dinner party six days earlier and promptly refrigerated.)

Still, there are many noncontentious steps that can be taken to minimize the risk that anyone will be sickened by the food you buy and prepare.

SHOPPING Seek stores that are clean, well-organized and appear to have high product turnover: you can tell partly by checking the expiration and sell-by dates on the goods. Reject expired products and those in damaged or leaking packages. Don't buy more perishables than you can use.

Pick up dry products first, then those that should be kept cold or frozen. In warm weather, or if there will be delays getting home, bring a cooler with ice or a freezer pack to keep items cold. Put all raw meats, poultry and fish in separate plastic bags before placing them in the shopping cart. At checkout, have them bagged separately from the dry foods and produce.

STORAGE Separate raw meats, poultry and fish from other foods in the refrigerator, placing them on the lowest shelf, in a bin or on a tray to prevent dripping. Freeze meats that will not be cooked within two or three days. Use eggs within three to five weeks of purchase. In the pantry, place newly bought products behind older ones, which should be used first.

Place thermometers in the refrigerator and freezer, if they are not built in. Make sure the temperatures are at or below 40 degrees in the refrigerator and 2 degrees in the freezer. Defrost all uncooked foods in the refrigerator, the microwave or in a bowl of ice water.

PREPARATION
Start by washing your hands with soap and warm water. Pin long hair back or cover it; remove rings and bracelets, and put on a clean apron.

If you should sneeze, have to blow your nose or use the bathroom while working with food, wash your hands again. Half of people harbor the infectious Staphylococcus bacteria in their nasal passages. Also wash if you pet the dog or hand-feed it while preparing food.

Wash all produce, including melons, lemons and limes and fruits that will be peeled, before picking up a knife. If the fruit's surface contains infectious organisms, they can spread to its flesh when the fruit is cut.

Although some suggest that poultry and meats not be rinsed lest they contaminate the sink, I find that hard to avoid. Instead, I rinse them, then clean the sink with a bleach spray. And I do use clean paper towels to dry raw food.

Work on well-washed cutting boards, using separate ones for produce and raw animal products. I use plastic boards that can be cleaned with a bleach spray or in the dishwasher, but wood is fine as long as all implements and boards are washed immediately after each chore. Never reuse an unwashed knife, plate or board on cooked food that was in contact with raw food without washing it first. Cross-contamination from raw to cooked food is a common cause of food-borne illness.

If making dishes a day or more ahead, cover them well, chill them quickly, and keep them cold until it is time to reheat or serve.

COOKING You can't always tell if a food is contaminated by its appearance: foods containing harmful organisms can look, smell and taste O.K. A goal of cooking is to destroy most infectious organisms.

It's best to use a food thermometer and to heed recommended final temperatures when preparing meats, poultry, fish and seafood, and eggs. Whole cuts of beef, veal and lamb should be cooked to an internal temperature of 145 degrees, followed by a three-minute rest off the heat; pork and fresh ham should reach 145 degrees, followed by a three-minute rest (heat precooked ham to 140 degrees).

Ground meats should reach 160 degrees; poultry (whole or ground), 165 degrees and fish, 145 degrees (or until it is opaque and separates easily with a fork). Shrimp, lobster and crab should be cooked until the flesh is pearly and opaque. Clams, mussels and oysters should be cooked until the shells open, and scallops until the flesh is milky white or opaque and firm. Cook eggs until the yolk and white are firm, and cook egg dishes to 160 degrees.

If a recipe calls for raw or partly cooked eggs in a dish that will not be cooked (like eggnog, mayonnaise or Caesar salad dressing), use only pasteurized eggs, which are available in most large markets.

If you taste a dish while cooking, use a clean spoon each time.

If serving foods buffet-style over a period of hours, use hot plates or cold trays. Leftovers should be refrigerated as soon as possible. Reheat leftover meats and other animal products to 165 degrees.

CLEANING You don't have to become a clean freak; some exposure to infectious organisms is necessary for a healthy immune system. But do take steps to reduce the risk of food-borne illness.

Kitchen sponges and dishcloths are notorious for harboring and breeding germs. Wash them often in the dishwasher or in the sink with hot, soapy water, or clean them with a bleach solution. Never wipe the floor with sponges used on countertops and food preparation equipment.Consider investing in a large package of microfiber cloths. Use separate cloths for the floor, counters and to dry utensils. Put soiled cloths in the laundry.

When hand-washing dishes and pots, use very hot water and put them on a rack to air-dry. Damp dish towels can harbor bacteria.

Thoroughly clean the refrigerator, stovetop and countertops often. I use a bleach solution on most surfaces, especially those that come in contact with foods.


This is the second of two columns on kitchen safety. You can read the first one here.
13.57 | 0 komentar | Read More

Well: A Guide for Swimmers Breaking Boundaries

Written By Unknown on Minggu, 25 Agustus 2013 | 13.57

Lynne Cox has spent more than four decades swimming past the known limits of human capacity. Driven by an explorer's voracious desire to do what has never been done, and frankly obsessive about mental and physical preparation, she has completed scores of pioneering swims, most famously the frigid Bering Strait in just a suit, cap and goggles.

Now she has channeled her vast expertise on the dangers, joys and logistics of open water swimming into a new book aimed at the exploding ranks of triathletes and other swimmers who are escaping the safe confines of pools.

The book, "Open Water Swimming Manual: An Expert's Survival Guide for Triathletes and Open Water Swimmers" (Vintage, $15.95), brings together research and advice from a range of experts, including marine biologists, meteorologists, hypothermia scientists, emergency medical teams and even the famously secretive Navy SEALs. She weaves in details and cautionary advice relating to her own swims and those of others, like Steve Irwin, the Australian environmentalist television star, who died while swimming at the Great Barrier Reef when a stingray stung his chest. ("Applying acid, such as orange juice, urine, or vinegar, does not have any effect on the sting.") A boy's plunge into a freshwater lake in Finland results in an ear infection, which it turns out was caused by algae growing in his ears. ("Earplugs might have helped.")

The publication could hardly be better timed. A steep rise in the popularity of triathlons has been swelling the ranks of open water events. Some 1,100 people dashed into the surf off Los Angeles in early August for the two-mile Dwight Crum Pier-to-Pier Swim, up from 586 in 2000. In New York, more than 200 swam around Governors Island and some 70 people circumnavigated Manhattan in relays this summer.

But Ms. Cox, 56, knows something many of them may not grasp. Venturing into wild water is a high-risk endeavor. The exertion can be intense. The environment – a confluence of wind, waves, sun, creatures and self — is unpredictable. Swimmers can inhale too much water, lose too much body heat, overheat, underhydrate, become disoriented. Exiting an ocean swim through surf can subject the swimmer to a maddening swirl of currents and bone-breaking beatings from crashing waves. These situations, she relates firmly, can be life-threatening.

This summer, a 34-year-old British woman, Susan Taylor, died after collapsing near the end of the 21-mile crossing from England to France. In 2010, a 26-year-old Pennsylvania man, Fran Crippen, died near the finish of a 10-kilometer swim in the warm waters off the United Arab Republic.

So Ms. Cox, the product of an artist mother and a father who was a Marine, tempers vision and enthusiasm with methodical, unstinting effort.

"I could think that I could do it, and that's a great way to help prepare," she said at a recent lunchtime talk at Google's New York headquarters. "But if I don't physically train to do it, then mentally I'm not prepared to do it, and physically and mentally I can't do it."

So she includes training advice for beginner, intermediate and advanced swimmers, starting with "shorter" swims of one to three miles and beefing up the miles and intensity for those aiming at the Catalina channel or the Strait of Magellan.

What makes for a trusty crew for distance events? One crucial factor: there must be one person in charge at all times, though the role can be serially occupied. If a swimmer is in jeopardy, whether from the perilous water conditions, physical exhaustion or threatening critters, there must be no arguing among the crew over what to do.

Almost 30 pages are devoted to marine organisms to look out for, including what to do if a swimmer is afflicted by jellyfish, stingrays or tiny irritants that cause so-called seabather's eruption.

Sharks get their own chapter. Good advice: Be careful what you wear. If swimming near seals or sea lions, don't wear a black suit, or a predator might mistake you for dinner. Jewelry or metallic swimsuits can attract sharks, too.

The book also includes the Navy SEALs' five-page Risk Assessment Worksheet, which rates the likelihood and effects of 14 hazards, among them "swimmer-induced pulmonary edema" (seldom, critical) and even "ambulance stuck in sand" (seldom, catastrophic). Part of the point is real safety, and part is clearing the mind, she said. "If you think about the energy you use being anxious," she said, "just think about how much faster you could be in your race!"

You don't have to know Ms. Cox long to discover that she relishes  her time in the water, and even the moments of danger. In the opening chapter of the manual, a paean to outdoor immersion, she writes of "water song," the music of breath, body, wind and waves.

And she offers a benediction, elegant in its simplicity, to readers who take up the challenge to leave water within walls and head out into the unknown.

"For many of you, the open water will become a haven, a favorite place to visit, and many of you will discover that no matter where you are in the world, it will always be a place where you feel at home."


Andrea Kannapell, an editor on the foreign desk of The New York Times, is a longtime open-water swimmer.


13.57 | 0 komentar | Read More

Economic View: Public Policies, Made to Fit People

I HAVE written here before about the potential gains to government from involving social and behavioral scientists in designing public policies. My enthusiasm comes in part from my experiences as an academic adviser to the Behavioral Insights Team created in Britain by Prime Minister David Cameron.

Thus I was pleased to hear reports that the White House is building a similar initiative here in the United States. Maya Shankar, a cognitive scientist and senior policy adviser at the White House Office of Science and Technology Policy, is coordinating this cross-agency group, called the Social and Behavioral Science Team; it is part of a larger effort to use evidence and innovation to promote government performance and efficiency. I am among a number of academics who have shared ideas with the administration about how research findings in social and behavioral science can improve policy.

It makes sense for social scientists to become more involved in policy, because many of society's most challenging problems are, in essence, behavioral. Using social scientists' findings to create plausible interventions, then testing their efficacy with randomized controlled trials, can improve — and sometimes save — people's lives, all while reducing the need for more government spending to fix problems later.

Here are three examples of social science issues that have attracted the team's attention:

THE 30-MILLION-WORD GAP One of society's thorniest problems is that children from poor families start school lagging badly behind their more affluent classmates in readiness. By the age of 3, children from affluent families have vocabularies that are roughly double those of children from poor families, according to research published in 1995.

The research found that one of many reasons that poor children often have difficulty learning to read is that they suffer at home from what might be called a "word deficiency." The caregivers of these children simply don't speak or read to them as often as those in better-off families. The study estimated that by age 3, a poor child would have heard 30 million fewer words than a child growing up in a family of higher socioeconomic status.

Until recently, this word gap has been hard to address. One promising new approach is being tested by Dr. Dana Suskind, a professor of surgery and pediatrics at the University of Chicago. Parents or caregivers who want to improve their children's language skills can be coached to improve their interactions with them. (For example, interactive exchanges are better than soliloquies.)

New technologies, like the digital language processor developed by the LENA Research Foundation, whose work focuses on language problems in young children, can aid in this effort by letting parents receive feedback on the frequency and nature of their verbal interactions with their children. (Think of it as a box score for those interactions.) Providence, R.I., has won a $5 million grant from the Bloomberg Philanthropies for a Providence Talks program to use these kinds of techniques to improve school readiness for low-income children.

In this domain, the team's role is multifaceted. There is no silver bullet for closing the word gap, but by encouraging more trials nationwide, providing evaluation expertise and distributing results, we can help give poor children their best chance to succeed.

DOMESTIC VIOLENCE The team will primarily lend support and expertise to federal agency initiatives. One example concerns the effort to reduce domestic violence, a problem for which there is no quick fix. But a good place to start is to ensure that each component of a victim's support system works as well as it can. One such component is the National Domestic Violence Hotline, which victims can call for advice and support. Like other call-in centers, it can become busy and put callers on hold. Many victims hang up before they've had a chance to speak with a counselor.

In this case, the Administration for Children and Families is building an alliance of call centers to collaborate on experimental trials to see how best to keep callers on the line long enough to get assistance. Avoiding long periods of silence with callers, and offering an estimate of the waiting time, can help achieve that goal. So can composing the initial message in a way that maximizes the chances that a caller won't hang up.

HEALTH COMPLIANCE One reason for high health care costs is that patients fail to follow their treatment regimen.

A good way to approach this problem is via a behavioral assessment, identifying obstacles to that compliance. As Sendhil Mullainathan, a Harvard economist, discussed in this space recently, one such obstacle is the co-payment, the patient's share of a treatment's cost. He sensibly suggests that for some highly effective treatments, there should be no co-payment at all. That's a good place to start.

A thorough assessment could also uncover other factors that reduce patients' adherence to best medical practices. If forgetting to take a medicine is the problem, a variety of interventions can help — from changing the medication's design (a once-a-day dose is easier to remember than one taken three times a day) to using technology that reminds patients to take their pills.

Similarly, offering phone or text reminders of medical appointments can reduce no-shows and ensure that lab tests are done on time. Information technology makes these mental crutches easy to use, and is the focus of the team's collaboration with the National Coordinator for Health Information Technology.

All of these examples show that the role of behavioral science in policy isn't for the government to tell people how to think or act. It is to help them achieve their own goals. Parents want their children to excel, callers to a victims' hot line want help, and sick people want to get well. Offering aids is like providing an alarm clock: it may help people get to an appointment on time, but no one is forcing them to use it.

Richard H. Thaler is a professor of economics and behavioral science at the Booth School of Business at the University of Chicago. He has informally advised the Obama administration.


13.57 | 0 komentar | Read More

For a Chef, 41 Years in the Kitchen Takes Its Toll

Monica Almeida/The New York Times

For Mark Peel, 58, the crazy hours and physical strain of life as a professional chef have meant wrist, shoulder and back pain, a bone spur and hernia operations. But he is aiming to age gracefully, with a less strenuous schedule.

STARTING as a dishwasher at the age of 17, the chef Mark Peel worked his way up at some of the great California restaurants: Ma Maison, Michael's, Chez Panisse, Spago, Chinois and, finally, for more than two decades, Campanile, his own place in Los Angeles.

Those 41 years in the kitchen have brought him considerable fame: Campanile won the James Beard award as outstanding restaurant in the United States in 2001. They have also brought him carpal tunnel syndrome in both wrists and thoracic outlet syndrome in his shoulders, resulting from repetitive stirring, fine knife movements and heavy lifting. He has a bone spur on one foot and a cyst between toes of the other from constantly standing. He has had three hernia operations and lives with a chronically sore back.

Being a professional chef, like being an elite athlete, tends to be a young person's game. When he started out, Mr. Peel thought nothing of shifting a 125-pound stockpot full of hot, sloshing liquid from one burner to the next without calling for help, his arms stretched away from his body, muscles tight to control the motion. It was a recipe for trouble down the line.

The 16-hour days he once put in at Spago — seven days a week for seven weeks in a row — are no longer an option for Mr. Peel, who is now 58. He straightens a sore shoulder at the memory of those days. He can still work like that, he says — "just not as often, and not as long." Today, he says, he can survive perhaps three days of crazy hours, as long as Day 4 includes sleeping in, to recover.

In September, Mr. Peel will open a new Campanile at Los Angeles International Airport. He closed the 190-seat original last fall after 23 years, 16 of them alongside the chef Nancy Silverton, then his wife, and seven more years on his own. His career track record going into the new project is excellent; his body, the worse for wear.

The new, smaller Campanile will open at the American Airlines terminal, in a licensing agreement with Host International. Mr. Peel will "train, taste, advise, direct and organize," while younger chefs execute the dishes he creates. "At some point, the mind is willing but the body rebels," Mr. Peel says. "Most chefs over 50 are no longer cooking daily."

Mr. Peel came of age during an explosion of interest in dining out, and his workload expanded to keep pace. Many in the next generation of young chefs have seen the physical toll on their elders, and they are planning accordingly.

"There's an arc," says the chef Jonah Miller, 26, whose awareness of his "shelf life as an active cook" informed his decision to open his own restaurant sooner rather than later. That establishment, Huertas, a Northern Spanish restaurant, will open this winter in Brooklyn. It is a nod in equal parts to Mr. Miller's youthful ambition — he first volunteered in a kitchen when he was 13 — and the "need to plan for the time when I'm not physically able to work the line, which for most cooks comes in their late 30s."

"It's a pretty hard-and-fast rule," he says, that chefs eventually step away from the action; he aspires to the natural progression from cook to chef to "purely a coach and a mentor."

Mitchell Davis, executive vice president of the James Beard Foundation, agrees that cooks can age quickly. "Every time I find myself eating in an exciting restaurant, the chef is 28 years old," he says.

A chef's early years are arduous, devoted to working the line — cooking some portion of what lands on the plate, shift after shift. In cities like New York and Los Angeles, where high rents and demanding diners require a chef to "maximize every minute of the day," according to Mr. Davis, it is even harder.

"Cooking on the line is a sport," says Mr. Miller, who played basketball and baseball in high school. "It's regimented and it's continuous. You're always pushing, just like an athlete: the highest quality you can manage in a specific time frame, doing it again and again."

Chefs are more likely to sustain injuries than the average American worker, according to the Bureau of Labor Statistics. Sprains, strains and tears are the most common complaints, followed by cuts, lacerations and punctures; burns; and fractures, says Martin Kohli, chief regional economist for the bureau. Musculoskeletal injuries like Mr. Peel's carpal tunnel syndrome are also common.

When asked to name chefs who have persevered in the kitchen past their youth despite the physical toll, Mr. Peel, Mr. Miller and Mr. Davis all hesitate for a long moment. Mr. Davis comes up with the New York-based Daniel Boulud and David Bouley, who have reputations for being active in the kitchen longer than their peers. But each example is served with a side order of disclaimer; they are the exceptions who prove the rule.


13.57 | 0 komentar | Read More

DealBook: Amgen Said to Be Near Deal to Buy Onyx for $10.5 Billion

Updated, 5:15 p.m. | Amgen is close to a deal to buy Onyx Pharmaceuticals Inc., a maker drugs to fight cancer, for about $10.5 billion, people briefed on the matter said on Saturday.

A deal — in which Amgen would pay about $125 a share — could be announced as soon as Monday, though these people cautioned that talks are continuing and could still fall apart.

If a transaction is completed, it would be the latest of many in the health care industry, especially as drug makers look to add to their offerings. One attractive set of products is new cancer drugs, which can fetch high prices.

Amgen is the world's largest biotechnology company by sales, with $17.3 billion in revenue last year. But its top-selling products are older and many are selling more slowly, or even declining.

Some of the company's drugs are also facing competition in Europe from near-generic copies, known as biosimilars, and that competition is expected to come to the United States in the next few years. Teva is expected to introduce a near-copy of Amgen's Neupogen, a drug that helps prevent infections in patients undergoing chemotherapy, late this year.

A deal for Onyx would be the first big takeover struck by Robert A. Bradway, who became Amgen's chief executive in May of last year. Analysts expected Mr. Bradway, who spent most of his career as an investment banker at Morgan Stanley, to drive a tough bargain.

Amgen began its quest for Onyx in June, when it made an unsolicited bid valued at $120 a share, about 38 percent above the stock price at the time.

But Onyx rebuffed the approach and hired the investment bank Centerview Partners to seek bids for the company. A number of drug makers expressed interest, including Pfizer and Novartis, but analysts considered Amgen the most likely buyer.

Onyx's main attraction is its cancer drugs, two of which won approval last year. Its crown jewel is Kyprolis, a drug for multiple myeloma that was approved in July and that Onyx fully owns.

Several analysts expect annual sales of Kyprolis to reach $2 billion within several years, providing tremendous impetus to Onyx's growth. The company reported $362.2 million in revenue in 2012, mostly from proceeds of drugs it shares with Bayer.

But Kyprolis's $61 million in sales during the second quarter were slightly below some analysts' expectations, raising concerns about competition. Onyx also disclosed that the drug had failed to improve survival in an interim analysis of results from a clinical trial being conducted to win approval in Europe. While that does not mean the drug does not work, the company must now wait for final data from the testing, which is expected in the first half of next year.

A brief hiccup in the discussions occurred recently when Amgen demanded to see more clinical trial data on Kyprolis, people briefed on the discussions have said. Amgen sought to lower its bid from the $130 a share it had floated because of that dispute.

Onyx and its advisers, however, have come to the conclusion that at $125 a share, Amgen's bid is significantly more than its original proposal  and outweighs the uncertainty of a drawn-out sales process, one of the people briefed on the matter said.

At $125 a share, Amgen would be paying about 13 times the amount analysts expect Onyx to have in sales over the next 12 months, one of the highest multiples in the biopharmaceutical industry.

Mark Schoenebaum, a biotechnology and pharmaceutical analyst at the ISI Group, has said that many of Amgen's largest shareholders are value investors who are interested in having the company return money to shareholders through dividends and share buybacks instead of making big acquisitions.

"I think they are under a lot of pressure to not overpay,'' he told clients  this week.


13.57 | 0 komentar | Read More

Africa and Pakistan Face Polio Outbreaks, in Blow to Global Fight

Written By Unknown on Jumat, 23 Agustus 2013 | 13.57

The global effort to eradicate polio, a disease that has been on the brink of extinction for years, is facing serious setbacks on two continents. The virus is surging in Somalia and the Horn of Africa, which had been largely free of cases for several years. And a new outbreak has begun in a part of Pakistan that a warlord declared off limits to vaccinators 14 months ago.

The African outbreak began in May with just two cases of polio paralysis: one in Mogadishu, Somalia's capital, and another in the huge Dadaab refugee camp in Kenya, where thousands of Somalis have fled fighting between Islamic militants, clan militias, government troops and African peacekeepers.

Now there are 121 cases in the region; last year, there were only 223 in the world.

The new Pakistan outbreak is in North Waziristan, near the frontier with Afghanistan. It is in an area where a warlord banned polio vaccinations after it was disclosed that the C.I.A. had staged a hepatitis vaccination campaign in its hunt for Osama bin Laden. The warlord, Hafiz Gul Bahadur, banned all efforts until American drone strikes ended.

Although only three North Waziristan children have suffered polio paralysis since then, even one case shows that the virus is in the area and could spread.

The new outbreaks may delay a recently announced $5.5 billion plan to eradicate polio by 2018. Nonetheless, public health officials still believe that, with enough local political will and donor money, they can prevail by using techniques that have worked before.

To prevent the disease from reaching Mecca during next month's hajj, Saudi Arabia has tightened its rules. Pilgrims from any country with polio cases must be vaccinated at home and again on arrival. Last year, nearly 500,000 pilgrims were vaccinated on arrival, Dr. Ziad A. Memish, the Saudi deputy health minister, said recently.

The Pakistan outbreak is particularly frustrating because eradication had been going steadily forward despite the killings in December of nine vaccinators for which some blamed the Taliban.

Public health officials had counted themselves lucky that despite simultaneous vaccination bans in North and South Waziristan, no polio virus was known to be circulating in the 250,000 children in those areas. Vaccination posts were set up on nearby highways and on buses and trains. Urban hospitals packed the vaccine on ice for families willing to smuggle it back to neighbors. But it was not enough.

"The equation is simple," said Dr. Elias Durry, emergency coordinator for polio eradication in Pakistan for the World Health Organization. "Where you can immunize, the virus goes away. Where you can't, the virus gets in, and it will paralyze these poor kids."

Dr. Durry said he hoped that parents whose children were paralyzed would speak up at local decision-making councils, called shuras, that are common in tribal areas, and possibly put pressure on warlords to rescind the ban.

The Taliban warlord in South Waziristan, Maulvi Nazir, was killed by a drone strike in January.

Before the Waziristan outbreak, Pakistan had seen only 24 cases this year, about as many as it had at the same point in 2012. Most were around Karachi and Peshawar, where last year's killings of the vaccinators took place and where resistance to vaccines is highest.

The Somali outbreak is different. There is little opposition to the vaccine itself, said Dr. Bruce Aylward, the W.H.O. assistant director general for polio. In several Muslim countries, including Pakistan, the drive has been hurt by rumors that the vaccine sterilizes girls or contains the virus that causes AIDS or pork products.

But, he said, many cases are in areas south of Mogadishu where the Shabab, a militant group, operate. The group opposes mass campaigns because it believes the sight of thousands of vaccinators going house to house would undercut its claim to rule those areas.

"It's all about control," Dr. Aylward said.

Instead, the campaign negotiates with local chiefs and midlevel Shabab members to hold small drives.

Other tactics have changed, too: children of any age, and sometimes adults, get the drops, and drives are held twice a month instead of every three months.

Refugee camps face other obstacles. Large ones often have lawless areas on their fringes where vaccinators may fear to work because of predatory criminals.

"When this started, I said, 'Brace yourself for hundreds of cases,' " Dr. Aylward said, because he knew that few children born in the last five years had been immunized.

Still, he said he believed this outbreak could be beaten because it echoed the one that plagued the region from 2005 to 2007. It also began in Mogadishu, and it spread as far as Yemen and Eritrea and paralyzed about 700 children before multiple mass vaccination rounds snuffed it out. Kenya, Yemen and Ethiopia are already planning those with help from Geneva.

Somalia is so dangerous for health workers that Doctors Without Borders pulled out of the country this month after 22 years there. But polio officials hope their campaign will not be targeted, largely because it creates thousands of temporary paying jobs for "volunteer" vaccinators.

In Mogadishu in July, President Hassan Sheik Mohamud publicly took polio drops at an event encouraging parents to vaccinate.

Asha Ali, 38, a mother of four, changed her attitude. "I was thinking the vaccine might sicken our children," she said. "I realized later that it was good."

Hamdi Hashi, 26, said she accepted it "because I don't want this serious disease to cripple my children."

But Habow Madey, in a different Mogadishu neighborhood, said her husband had forbidden vaccination, believing it causes "a mysterious disease."

Mohammed Ibrahim contributed reporting from Mogadishu, Somalia.

This article has been revised to reflect the following correction:

Correction: August 22, 2013

An earlier version of this article misstated the number of polio cases in the world in 2012. It is 223, not 232.


13.57 | 0 komentar | Read More

Texas Tribune: Shortage of Doctors Tough to Fix

Texas lawmakers invested millions of additional dollars in the 2013 legislative session to address a looming physician shortage. Voters and university regents have rubber-stamped plans to open two new medical schools, in Austin and the Rio Grande Valley. But those moves have not placated the medical community, which remains concerned that Texas has no long-term solution to produce enough physicians, particularly in primary care, to support the surging population.

Michael Stravato for The Texas Tribune

Plastic surgery residents at a University of Texas Medical Branch hospital in Galveston.

The Texas Tribune

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

"Nobody wants to see this pendulum swing, where there's money for this biennium and no money the next biennium," said Dr. David Wright, chairman of the Texas Medical Association's education committee. "There has to be a better, more stabilized funding mechanism for all of this." (The Texas Medical Association is a corporate sponsor of the Texas Tribune.)

Texas taxpayers already spend $168,000 educating each of the state's medical students. IFor medical school graduates, the state will pay $32.8 million to finance nearly 6,500 medical residency positions in the 2014-15 biennium.

But beginning in 2014, there will be more graduating medical students in Texas than first-year residency slots available in the state, according to a 2012 report by the Texas Higher Education Coordinating Board.

"If they are forced to do their residency training outside of Texas because we don't have enough slots, they take that investment with them," said State Senator Jane Nelson, Republican of Flower Mound. Ms. Nelson filed legislation in the last session to offset that trend by devoting $16 million to expand residency opportunities for graduating medical students at Texas facilities.

The majority of that financing — $12.4 million — will be used to create new first-year residency positions in Texas or fill existing slots that are empty for financial reasons. Ms. Nelson's legislation also sets aside $1.9 million in planning grants to help hospitals that do not have accredited residency programs evaluate what it would take to establish them. There is another $2.1 million in incentives for medical schools to encourage students to go into primary care.

"The message is out to any residency program out there that if you want to grow, you can grow," said Stacey Silverman, interim assistant commissioner of the Higher Education Coordinating Board, which is charged with distributing the grants. "It's not a finish line by any standard, but it is an excellent first step, and it gets Texas on the road to solving the physician shortage."

The nation as a whole is facing a physician shortage. The Association of American Medical Colleges estimates that the United States will have a shortfall of 90,000 physicians within the next decade. The need will be particularly acute in Texas, which in 2010 had 165 physicians per 100,000 people, compared with the national average of 220.

The number of Texas primary care physicians — whose services prevent patients from developing more costly and harmful conditions — is particularly low. Texas does not have enough primary care doctors in 126 of its 254 counties, according to the United States Department of Health and Human Services, which sets a threshold of one for every 3,000 residents. The majority of those counties are rural.

The state's new grants will mostly benefit hospitals looking to start residency programs from scratch, said Dr. Thomas Blackwell, associate dean of graduate medical education at the University of Texas Medical Branch in Galveston. He said the financing was not enough to encourage most teaching hospitals, including his own, to expand their programs. (U.T.M.B. is a corporate sponsor of The Tribune.)

"It's not enough, because remember, it only pays for the first year," he said. "So who is going to pay for the other years?"

Residency programs last three to eight years, depending on the specialty. The state's first-year residency grants will provide up to $65,000 per trainee, covering each first-year resident's salary. But factoring in other costs, like supervisors' salaries and the expense of extra tests and procedures ordered by doctors-in-training, each position costs about $100,000 to $150,000 a year, Dr. Blackwell said.

baaronson@texastribune.org


13.57 | 0 komentar | Read More
techieblogger.com Techie Blogger Techie Blogger