Global Update: Meningitis Vaccine Gets Longer Window Without Refrigeration





In what may prove to be a major advance for Africa’s “meningitis belt,” regulatory authorities have decided that a new meningitis vaccine could be stored without refrigeration for up to four days.




The announcement was made last week at a conference in Atlanta of the American Society of Tropical Medicine and Hygiene. While a few days may seem trivial, the hardest part of protecting poor countries is often keeping a vaccine cold while moving it from electrified cities to villages with no power. In antipolio drives, for example, the freezers, generators and fuel needed to make ice for the shoulder bags of vaccinators can cost more than the vaccine.


The new vaccine, MenAfriVac, made in India for 50 cents a dose, was introduced in 2010. In bad years, epidemics during the hot harmattan winds have killed as many as 25,000 Africans and disabled 50,000 more. In Chad this year, vaccination drove down cases to near zero in districts where it was used, while others nearby had serious outbreaks.


Experts decided that the vaccine is safe for four days as long as it stays below 104 degrees.


While temperatures get higher than that in Africa, said Dr. Godwin Enwere, medical director for the Meningitis Vaccine Project, teams normally get the vaccine out of coolers at dawn, drive to villages and finish before the day heats up. Other experts said it should be kept in the shade and monitored with colored paper “dots” that darken after hours in the heat.


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DealBook: Ex-Trader Charged in $276 Million Insider Scheme

Federal prosecutors brought what they called “the most lucrative insider trading scheme ever charged,” filing a criminal case on Tuesday against a former trader at a unit of the hedge fund SAC Capital.

Mathew Martoma, a former trader at CR Intrinsic, a division of SAC Capital, was charged with making about $276 million in combined profits and avoided losses by obtaining confidential information about a drug trial for an Alzheimer’s drug developed by the pharmaceutical companies Elan and Wyeth.

The case is the latest to put the billionaire investor Steven A. Cohen and his hedge fund, SAC Capital, in the spotlight over insider trading crimes committed by former employees.

Mr. Martoma received the information from Sidney Gilman, a neurology professor at the University of Michigan, a leading expert in Alzheimer’s disease. Mr. Gilman is cooperating with the government and has entered into a nonprosecution agreement with the United States attorney’s office in Manhattan.

Mr. Gilman connected with Mr. Martoma through an expert network firm based in New York. Expert networks became popular on Wall Street in the last decade, linking Wall Street money managers to specialists in various industries to help give them an edge on their investments. Expert networks have been a focus of the government’s widespread crackdown on insider trading at hedge funds.

His consulting work at the expert network firm earned Mr. Gilman more than $100,000, according to a parallel civil complaint against Mr. Martoma and Mr. Gilman filed by the Securities and Exchange Commission on Monday.

According to the complaint, between 2006 and 2008, Mr. Martoma consulted with Mr. Gilman on dozens of occasions about the preliminary results of the drug trial and accumulated a roughly $700 million position in the stocks of Wyeth and Elan. Mr. Gilman was chairman of the safety committee overseeing the drug trial.

In June 2008, the complaint says, Mr. Martoma received secret information about negative data relating to the drug trials. After receiving that information, Mr. Martoma caused SAC Capital to sell its entire inventory of roughly 10.5 million shares in Elan and about 7 million shares of Wyeth before the public release of the data.

The day after the study was announced, Elan stock lost about 42 percent of its value and Wyeth dropped about 12 percent. The inside information allowed SAC Capital to make about $276 million in illegal gains.

Mr. Martoma left SAC Capital in 2010, according to a spokesman at the hedge fund. A lawyer for Mr. Martoma could not be reached immediately for comment.

In a statement, Preet Bharara, the United States attorney, said: “The charges unsealed today describe cheating coming and going – specifically, insider trading first on the long side, and then on the short side, on a scale that has no historical precedent. As alleged, by cultivating and corrupting a doctor with access to secret drug data, Mathew Martoma and his hedge fund benefited from what might be the most lucrative inside tip of all time.”

Mr. Martoma is the latest person to have worked at SAC to be ensnared in an insider trading investigation. Jon Horvath, a former technology industry analyst at SAC, pleaded guilty in September to participating in a conspiracy that illegally traded in the shares of Dell computer. His boss, the former portfolio manager Michael Steinberg, has been named as an unindicted co-conspirator but has not been charged in the case. Mr. Steinberg’s lawyer, Barry Berke, declined to comment.

Last year, two former SAC portfolio managers – Donald Longueuil and Noah Freeman – admitted to trading on illegal tips about publicly traded technology companies. Mr. Longueuil is serving a two-and-a-half-year term at a federal prison in Otisville, N.Y.; Mr. Freeman, who is cooperating with prosecutors, has yet to be sentenced.

SAC CAPITAL UNDER A MICROSCOPE The firm has been under a cloud since a former employee, Richard Choo-Beng Lee, pleaded guilty in 2009 to insider trading and began helping the government in its investigation. The crimes he confessed to were committed after he left SAC, but he agreed to provide information about his five years at the firm, which ended in 2004.
NAMESTHE CASES
Jonathan HollanderThe former analyst paid more than $220,000 to settle civil charges brought by the Securities and Exchange Commission accusing him of trading in his personal account on confidential information about the 2006 takeover of the Albertsons grocery store chain.
Jon Horvath and Michael SteinbergMr. Horvath, right, a former technology industry analyst, pleaded guilty in September to participating in a conspiracy that illegally traded in the shares of Dell computer. His boss, the former portfolio manager Mr. Steinberg, has been named as an unindicted co-conspirator but has not been charged in the case. Federal prosecutors contend they were part of a seven-person conspiracy — a “circle of friends” — that earned about $62 million in illegal gains trading on secret tips from executives at publicly traded technology companies.
Donald Longueuil and Noah FreemanThe two former portfolio managers admitted in 2011 to trading on illegal tips about publicly traded technology companies. Mr. Longueuil, right, was swept up in a crackdown on so-called expert networks. He is one of roughly a dozen implicated in the case. Mr. Longueuil is serving a two-and-a-half-year jail term at a federal prison in Otisville, N.Y.; Mr. Freeman, who is cooperating with prosecutors, has yet to be sentenced.
Mathew MartomaThe former trader at CR Intrinsic, a unit of the hedge fund, was charged with making about $276 million in combined profits and avoided losses by obtaining confidential information about a drug trial for an Alzheimer’s drug developed by the pharmaceutical companies Elan and Wyeth.
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Hamas Strengthens as Palestinian Authority Weakens





RAMALLAH, West Bank — In the daily demonstrations here of solidarity with Gaza, a mix of sympathy and anguish, there is something else: growing identification with the Islamist fighters of Hamas and derision for the Palestinian Authority, which Washington considers the only partner for peace with Israel.




“Strike a blow on Tel Aviv!” proclaim the lyrics of a new hit song blasting from shops and speakers at Monday’s demonstration, in a reference to Hamas rockets that made it nearly to Israel’s economic and cultural capital. “Don’t let the Zionists sleep! We don’t want a truce or a solution! Oh Palestinians, you can be proud!”


Pop songs everywhere are filled with bravado and aggression. But this one reflects a widespread sentiment that does not augur well for President Mahmoud Abbas and his Palestinian Authority, which is rapidly losing credibility, even relevance. The Gaza truce talks in Cairo, involving Egypt, Turkey and Qatar, offer a telling tableau. The Palestinian leader seen there is not Mr. Abbas, but Khaled Meshal, the leader of the militant group Hamas, who seeks to speak for all Palestinians as his ideological brothers in the Muslim Brotherhood rise to power around the region.


Israel is also threatening Mr. Abbas, even hinting that it may give up on him, as he prepares to go to the United Nations General Assembly on Nov. 29 to try to upgrade the Palestinian status to that of a nonmember state. The Israelis consider this step an act of aggression, and even some Palestinians say it is somewhat beside the point at this stage.


“His people are being killed in Gaza, and he is sitting on his comfortable chair in Ramallah,” lamented Firas Katash, 20, a student who took part in the Ramallah demonstration.


For the United States, as for other countries hoping to promote a two-state solution to this century-old conflict, a more radicalized West Bank with a discredited Palestinian Authority would mean greater insecurity for Israel and increased opportunity for anti-Western forces to take root in a region where Islamism is on the rise.


Since Hamas, which won parliamentary elections in 2006, threw the Fatah-controlled authority out of Gaza a year later, Mr. Abbas has not set foot there. Yet he will be asking the world to recognize the two increasingly distinct entities as a unified state.


Manar Wadi, who works in an office in Ramallah, put the issue this way: “What is happening in Gaza makes the Palestinian Authority left behind and isolated. Now we see the other face of Hamas, and its popularity is rising. It makes us feel that the Palestinian Authority doesn’t offer a path to the future.”


In Cairo on Monday, Mr. Meshal seemed defiant and confident in his new role, daring the Israelis to invade Gaza as a sixth day of Israeli aerial assaults brought the death toll there to more than 100 people, many of them militants of Hamas and its affiliates. Rockets launched from Gaza hit southern Israel, causing some damage and panic, but no casualties, leaving the death toll there at three.


“Whoever started the war must end it,” he said at a news conference. “If Israel wants a cease-fire brokered through Egypt, then that is possible. Escalation is also possible.”


Officials in the authority have been holding leadership meetings, staying in close touch with the talks in Cairo and issuing statements of solidarity. They have also sent a small medical delegation to Gaza and argue that there is a new opportunity to forge unity between the two feuding movements. But they are acutely aware of their problem.


“The most dangerous thing is the fact that what we could not do in negotiations, Hamas did with one rocket,” one official said, speaking on the condition of anonymity. “The people had such excitement seeing the occupiers run in panic. It’s a very dangerous message.”


Mr. Abbas, whose popularity has been on the decline as the Palestinian Authority faces economic difficulty and growing Israeli settlements, also ran into trouble not long before the Gaza fighting began when he seemed to give up on the Palestinian demand of a right of return to what is now Israel.


Many Palestinians believe that Israel launched its latest operation in Gaza to block the Palestinian Authority’s United Nations plans by embarrassing it. Israeli officials say that is ridiculous: the operation’s purpose is to stop the growing number of rockets being fired at their communities, and Israelis interrupted their deliberations over the United Nations bid to wage the military campaign.


But Israel says anything that does not involve direct negotiations is a waste of time. The government of Prime Minister Benjamin Netanyahu has repeatedly threatened to take severe retaliatory steps against the Palestinian Authority, including cutting off badly needed tax receipts to Palestinian coffers, should Mr. Abbas go ahead at the United Nations.


In a speech here on Sunday night at a Palestinian leadership meeting, Mr. Abbas repeated his determination to go to New York and ask for a change in status to that of nonmember state. He has chosen the symbolically significant date of Nov. 29, when the General Assembly voted in 1947 to divide this land into two states, one Jewish and the other Palestinian Arab.


The United States has asked Mr. Abbas not to do so but instead to resume direct negotiations with Israel, which have essentially been frozen since 2008.


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Wranglers say 'Hobbit' animals died on unsafe farm

WELLINGTON, New Zealand (AP) — Animal wranglers involved in the making of "The Hobbit" movie trilogy say the production company is responsible for the deaths of up to 27 animals, largely because they were kept at a farm filled with bluffs, sinkholes and other "death traps."

The American Humane Association, which is overseeing animal welfare on the films, says no animals were harmed during the actual filming. But it also says the wranglers' complaints highlight shortcomings in its oversight system, which monitors film sets but not the facilities where the animals are housed and trained.

A spokesman for trilogy director Peter Jackson on Monday acknowledged that horses, goats, chickens and one sheep died at the farm near Wellington where about 150 animals were housed for the movies, but he said some of the deaths were from natural causes.

The spokesman, Matt Dravitzki, agreed that the deaths of two horses were avoidable, and said the production company moved quickly to improve conditions after they died.

"The Hobbit: An Unexpected Journey," the first movie in the planned $500 million trilogy, is scheduled to launch with a red-carpet premiere Nov. 28 in Wellington and will open at theaters in the U.S. and around the world in December.

The animal rights group People for the Ethical Treatment of Animals (PETA) says it's planning protests at the premieres in New Zealand, the U.S. and the U.K.

Kathy Guillermo, a senior vice president at PETA, said whistleblowers on The Hobbit contacted the organization after it had taken an active role in exposing problems on other movie sets. The organization sent a letter to Jackson last week outlining its concerns.

"We want to send a clear message to Hollywood that they need to be very careful when using animals and take all the precautions that need to be taken," Guillermo said.

The Associated Press spoke to four wranglers who said the farm near Wellington was unsuitable for horses because it was peppered with bluffs, sinkholes and broken-down fencing. They said they repeatedly raised concerns about the farm with their superiors and the production company, owned by Warner Bros., but it continued to be used. They say they want their story aired publicly now to prevent similar deaths in the future.

One wrangler said that over time he buried three horses, as well as about six goats, six sheep and a dozen chickens. The wranglers say two more horses suffered severe injuries but survived.

Wrangler Chris Langridge said he was hired as a horse trainer in November 2010, overseeing 50 or so horses, but immediately became concerned that the farm was full of "death traps." He said he tried to fill in some of the sinkholes, made by underground streams, and even brought in his own fences to keep the horses away from the most dangerous areas. Ultimately, he said, it was an impossible task.

He said horses run at speeds of up to 30 mph and need to be housed on flat land: "It's just a no-brainer."

The first horse to die, he said, was a miniature named Rainbow.

"When I arrived at work in the morning, the pony was still alive but his back was broken. He'd come off a bank at speed and crash-landed," Langridge said. "He was in a bad state."

Rainbow, who had been slated for use as a hobbit horse, was euthanized. A week later, a horse named Doofus got caught in some fencing and sliced open its leg. That horse survived, but Langridge said he'd had enough.

He and his wife, Lynn, who was also working as a wrangler, said they quit in February 2011. The following month, they wrote an email to Brigitte Yorke, the Hobbit trilogy's unit production manager, outlining their concerns.

Chris Langridge said he responded to Yorke's request for more information but never received a reply after that.

Wrangler Johnny Smythe said that soon after Langridge left, a horse named Claire was found dead, its head submerged in a stream after it fell over a bluff. After that, he said, the horses were put in stables, where a third horse died.

Smythe said no autopsy was performed on the horse, which was named Zeppelin. Veterinary records say the horse died of natural causes, from a burst blood vessel, but Smythe said the horse was bloated and its intestines were full of a yellow liquid; he believes it died of digestive problems caused by new feed.

Smythe said the six goats and six sheep he buried died after falling into sinkholes, contracting worms or getting new feed after the grass was eaten. He said the chickens were often left out of their enclosure and that a dozen were mauled to death by dogs on two separate occasions.

Smythe said he was fired in October 2011 after arguing with his boss about the treatment of the animals.

A fourth wrangler, who didn't want to be named because she feared it could jeopardize her future employment in the industry, said another horse, Molly, got caught in a fence and ripped her leg open, suffering permanent injuries.

Dravitzki, the spokesman for Peter Jackson, said the production company reacted swiftly after the first two horses died, spending hundreds of thousands of dollars upgrading housing and stable facilities in early 2011.

"We do know those deaths were avoidable and we took steps to make sure it didn't happen again," he said.

Dravitzki said Zeppelin died of a burst blood vessel and that he knew only of three goats, one sheep and about eight chickens that had died aside from that. He said two of the goats died in a cold snap but the third, like the sheep, was old and had likely died of natural causes. He said the chicken maulings were the result of careless staff oversight.

The American Humane Association said in its report on "An Unexpected Journey" that it investigated the farm at the production company's request. Dravitzki said the company contacted the AHA after Smythe alleged mistreatment of animals.

Mark Stubis, an association spokesman, said it investigated the farm in August 2011, months after the first deaths.

"We made safety recommendations to the animals' living areas. The production company followed our recommendations and upgraded fence and farm housing, among other things," the group said.

Dravitzki said the company had already made many of the recommended changes by the time the AHA made them.

Stubis said the association acknowledges that what happens off-set remains a blind spot in its oversight.

"We would love to be able to monitor the training of animals and the housing of animals," Stubis said. "It's something we are looking into. We want to make sure the animals are treated well all the time."

Dravitzki questioned the timing of the allegations with the premiere so close but said the producers are investigating all the claims "and are attempting to speak with all parties involved to establish the truth."

He said the company no longer leases the farm and has no animals left on the property. He said he didn't know if animals will be needed for future filming in the trilogy, but added that Jackson himself adopted three of the pigs used.

Hollywood has made animal welfare a stated priority for years.

In March, HBO canceled the horse racing series "Luck" after three thoroughbred horses died during production. The network said it canceled the show because it could not guarantee against future accidents.

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Really?: The Claim: Eye Problems Can Cause Headaches in Children

Really?

Anahad O’Connor tackles health myths.

THE FACTS When a child complains of frequent headaches, many pediatricians order an eye exam. “In some pediatric ophthalmology practices, it’s a daily occurrence,” said Dr. Zachary Roth, a resident in ophthalmology at Albany Medical Center in New York.

Often, a child may experience headaches while reading or doing schoolwork, leading parents to think the child needs glasses. But are eye problems really a cause of childhood headaches?

In a recent study, Dr. Roth and his colleagues examined 158 children under age 18 who were referred to ophthalmologists for frequent headaches. Then, they evaluated the children’s medical records and looked at the results of earlier vision exams.

Ultimately, the researchers could not find any significant link between headaches and diagnoses of vision problems. In three-quarters of the subjects, the headaches went away over time, both in those who received new glasses and those who did not.

The study, which was presented at a recent American Academy of Ophthalmology conference, was not designed to look for causes of the headaches. But there were “quite a few” children with family histories of migraine, Dr. Roth said. Sinus problems and stress headaches also appeared to be common issues, he added.

“I think the take-away message is that it’s very unlikely for headaches to be caused by an eye problem,” he said. “The experience of all the ophthalmologists we talked to is that it almost never seems to be related to the eyes, so it’s probably more fruitful to investigate other causes.”

THE BOTTOM LINE Vision problems are often blamed for childhood headaches, but in reality, the two are rarely related.

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Solar Power as Solution for Storm-Darkened Homes





When Hurricane Sandy wiped out the power in areas like coastal Long Island and the Jersey Shore, what should have been beacons of hope — hundreds of solar panels glinting from residential rooftops — became symbols of frustration.







Robert Stolarik for The New York Times

R. David Gibbs of the nonprofit group Solar One directed volunteers in an installation at the Rockaway Beach Surf Club.









A blog about energy and the environment.









Despite the popular perception that installing solar panels takes a home “off the grid,” most of those systems are actually part of it, sending excess power to the utility grid during the day and pulling electricity back to run the house at night. So when the storm took down power lines and substations across the Northeast, safety systems cut the power in solar homes just like everywhere else.


“Here’s a $70,000 system sitting idle,” said Ed Antonio, who lives in the Rockaways in Queens and has watched his 42 panels as well as those on several other houses in the area go unused since the power went out Oct. 29. “That’s a lot of power sitting. Just sitting.”


Yet there are ways to tap solar energy when the grid goes down, whether by adding batteries to a home system or using the kinds of independent solar generators that have been cropping up in areas hard-hit by the storm.


In the Rockaways, where nearly 14,000 customers still had no power as of Monday morning, volunteers set up a makeshift solar charging station between a car roof and a shopping cart. A multipanel, battery-tied system is helping fuel a relief center’s operations.


In the storm’s wake, solar companies have been donating equipment across New York and other stricken areas to function as emergency power systems now and backups in the longer term. It is important, executives say, to create smaller, more decentralized ways of generating and storing electricity to help ease strain on the grid in times of high demand or failure.


“The grid won’t evolve into something more distributed and fault-tolerant overnight — it’s still dependent upon a centralized system,” said Ben Tarbell, vice president for products at SolarCity, a leading installer that has donated generators after Hurricanes Katrina and Sandy and is developing a battery backup system for its customers. “But the components are starting to come together.”


Generally, home systems like Mr. Antonio’s are engineered to feed electricity from the roof array through an inverter and into the home’s electrical panel, sending the excess to the broader electric grid. But during a failure, the inverter automatically shuts down the system to guarantee that no electricity is flowing into equipment that workers will be trying to fix. The shutdown also ensures that the system’s current will sync with the grid when power is restored and guards against damaging the lines.


Certain systems allow solar panels to run a household directly during prolonged power failures, generally combined with battery storage to keep the power functioning around the clock. Those require installing a separate electrical panel and a more complicated inverter that would switch the flow of electricity entirely over to the house, perhaps to a few critical circuits to run, say, the refrigerator, some lights, television and minimal heat.


“You size the battery system to go with that, and then the system will work just on those dedicated circuits,” said Tony Clifford, chief executive of Standard Solar, an installer based in Maryland.


The cost of adding battery storage to an existing system can range from $500 to $30,000, depending on how large the solar array is and how much the customer wants to be able to run.


Although demand for battery backup is not yet widespread, interest tends to go up after storms, said David Panico, senior vice president of the industrial power group at SunWize, a solar supplier that provided a low-cost mobile system to the Rockaway Beach Surf Club, a hub of that area’s relief effort.


But a drawback is that residents have to figure out where to put the batteries — a particular quandary for those with homes vulnerable to flooding.


So some are looking at electric vehicles as potential backup energy sources instead. In some cases, a car could fuel a house for days on a single charge.


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Gaza Violence Is Unabating as Other Nations Push for Truce





GAZA CITY — Israeli forces killed at least 11 people, including several children, in a single airstrike that destroyed a home here on Sunday, as Israel pressed its bombardment of the Gaza Strip for a fifth day, deploying warplanes and naval vessels to pummel the coastal enclave.




The airstrike, which the Israeli military said was meant to kill a Palestinian militant involved in the recent rocket attacks, was the deadliest operation to date and would no doubt weigh on negotiations for a possible cease-fire. Among the dead were five women and four small children, The Associated Press reported, citing a Palestinian health official.


Two media offices were also hit on Sunday, and Prime Minister Benjamin Netanyahu of Israel warned of a “significant” expansion in the onslaught, which has already killed over 50 people, many of them civilians.


Speaking on Sunday from Bangkok, President Obama condemned missile attacks by Palestinian fighters in Gaza and defended Israel’s right to protect itself.


“There’s no country on earth that would tolerate missiles raining down on its citizens from outside its borders,” Mr. Obama said in his first public comments since the violence broke out. “We are fully supportive of Israel’s right to defend itself.”


The president also said that efforts were under way to address Israel’s security concerns and end the violence. “We’re going to have to see what kind of progress we can make in the next 24, 36, 48 hours,” Mr. Obama said.


Even as the diplomacy intensified on Sunday, the attacks continued in Gaza and Israel.


Mr. Netanyahu made his warning as militants in Gaza aimed at least one rocket at Tel Aviv, a day after Israeli forces broadened the attack beyond military targets, bombing centers of government infrastructure in Gaza, including the four-story headquarters of the Hamas prime minister.


“We are exacting a heavy price from Hamas and the terrorist organizations, and the Israel Defense Forces are prepared for a significant expansion of the operation,” Mr. Netanyahu told his cabinet at its routine Sunday meeting, referring directly to the of thousands of reservists who have been called up and the massing of armor on the Gaza border that many analysts have interpreted as preparations for a possible invasion.


“I appreciate the rapid and impressive mobilization of the reservists who have come from all over the country and turned out for the mission at hand,” Mr. Netanyahu said. “Reservist and conscript soldiers are ready for any order they might receive.”


His remarks were reported shortly after a battery of Israel’s Iron Dome defense shield, hastily deployed near Tel Aviv on Saturday in response to the threat of longer-range rockets, intercepted at least one aimed at the city on Sunday, Israeli officials said. It was the latest of several salvos that have illustrated Hamas’s ability to extend the reach of its rocket attacks.


Since Wednesday, when the escalation of the conflict began, Iron Dome has knocked 245 rockets out of the sky, the military said Saturday, while 500 have struck Israel.


The American-financed system is designed to intercept only rockets streaking toward towns and cities and to ignore those likely to strike open ground. But on Sunday a rocket fired from Gaza plowed through the roof of an apartment building in the southern Israeli city of Ashkelon. There were no immediate reports of casualties there.


In Gaza City, the crash of explosions pierced the quiet several times throughout the early morning.


Before the latest deadly strike involving civilians on Sunday, Hamas health officials had said the Palestinian death toll had risen to 53. One of the latest victims was a 52-year-old woman whose house in the eastern part of Gaza City was bombed around lunchtime.


A few hours earlier, a Hamas militant was killed and seven people were wounded in an attack on the Beach Refugee Camp, where Ismail Haniya, the Hamas prime minister, has a home. Those killed on Sunday included three children ages 1 through 5, the health officials said.


In Israel, 3 civilians have died and 63 have been injured. Four soldiers were wounded on Saturday.


The onslaught continued despite talks in Cairo that President Mohamed Morsi of Egypt said Saturday night could soon result in a cease-fire. Mr. Netanyahu said he would consider a comprehensive cease-fire if the launchings from Gaza stopped.


The attack on Mr. Haniya’s office, one of several on government installations, came a day after he hosted his Egyptian counterpart in the same building, a sign of Hamas’s new legitimacy in a radically redrawn Arab world.


Jodi Rudoren and Fares Akram reported from Gaza City. Reporting was contributed by Isabel Kershner, Carol Sutherland and Iritz Pazner Garshowitz from Jerusalem; Tyler Hicks from Gaza, Peter Baker from Bangkok, Alan Cowell from London, Michael Schwirtz from New York and David D. Kirkpatrick and Mayy El Sheikh from Cairo.



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Singing stars arrive for American Music Awards

Pink on a song with Lauryn Hill? The pop star hopes so.

Pink said on the red carpet of the American Music Awards that she'd like to collaborate with the acclaimed singer-rapper.

Cyndi Lauper said her musical playlist includes Pink, Nicki Minaj and Carly Rae Jepsen's "Call Me Maybe." Boy band The Wanted is excited to see "Gangnam Style" star PSY and Colbie Caillat wants to watch No Doubt rock the stage.

The stars walking the red carpet before the AMAs were ready to take their seats as fans. Arrivals included Taylor Swift, 50 Cent, Gloria Estefan, Ludacris, Kelly Rowland, Lady Antebellum, J. Cole, Luke Bryan, the Backstreet Boys and Linkin Park.

"What makes the American Music Awards special is the fans choose the winning artists," said Chester Bennington of Linkin Park, who is nominated for favorite artist alternative rock and will perform at the show.

Carrie Underwood arrived in a magenta dress and Kerry Washington was in a banana Stella McCartney number Sunday. Heidi Klum and Ginnifer Goodwin were also on the scene.

Along with Rihanna, Minaj is the top nominee at Sunday's American Music Awards, but the rapper-singer isn't concerned with her four nominations.

"I don't do music for awards," the 29-year-old said in an interview. "It's so crazy because people always have to remind me that I'm nominated for an award when I go to award shows."

"I know they're going to come. I'm sitting here looking at my awards right now," she continued with a laugh. "I never stress it. I think of myself as 'I'll have a career long enough to get all those different awards.'"

In the pop/rock category, Minaj is up for favorite female artist and album for "Pink Friday: Roman Reloaded." She's also nominated for favorite artist and album in the hip-hop/rap category, two awards she won last year.

Minaj isn't up for the night's top award, though. Rihanna, Maroon 5, Drake, Katy Perry and Justin Bieber will battle it out for artist of the year.

But the American Music Awards are all about performances, and Sunday's show will be no exception. Taylor Swift and Carrie Underwood will perform. Justin Bieber will share the stage with Minaj. Ludacris and Chris Brown will perform with Swizz Beatz. And Stevie Wonder is set to provide the soundtrack for a tribute to the late Dick Clark.

"I'm really going there to perform 'Freedom,'" Minaj said of her new single. "I'm very, very proud of the record and I'm happy that people are going to get to hear it. I'm performing a hip-hop song on the AMAs, and I think . that's just a big look for hip-hop."

Rae Jepsen, Kelly Clarkson and Usher are also among those set to sing during the three-hour program, which is to be broadcast live on ABC.

Other multiple nominees include Usher, Bieber, Drake, Maroon 5 and One Direction, who have three nods each. Perry, Underwood, Brown, Clarkson, Pitbull, fun., Gotye, J. Cole and Luke Bryan are all double nominees.

American Music Awards nominees were selected based on sales and airplay, and fans chose the winners by voting online.

The 40th anniversary show will also include the tribute to Clark, its creator.

"Dick changed the face of music back in the late '50s," producer Larry Klein said. "Dick is the one who made rock 'n' roll acceptable to come into people's homes... We're paying tribute to Dick because of the legacy that he's left everybody and also the creativity of what he did on this show."

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AP Entertainment Writer Sandy Cohen contributed to this report from Los Angeles. Follow (at)APSandy's American Music Award updates at www.twitter.com/APEntertainment.

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Online:

http://beta.abc.go.com/shows/american-music-awards

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News Analysis: Steroids and Back Pain: An Uneasy Match


RANDALL KINNAIRD’S legal clients had steroids injected into their backs last summer for a wide range of reasons. Of the 25, one got three shots in a two-month period when pain never totally disappeared. Another got one as a preventive measure because she was going on a trip to Europe and was worried that cobblestones would aggravate an old injury.


Now the 25 — or their survivors — have engaged Mr. Kinnaird, one of Nashville’s leading lawyers, to sue the New England Compounding Center. Three have died, one is paralyzed, several more are still hospitalized and all suffer blinding headaches — victims of the meningitis that resulted from vials of steroid medicine contaminated by fungus.


The New England Compounding Center certainly seems deserving of its current status as the prime culprit in a tragic outbreak that has killed 32 and sickened 438. The bottles of supposedly sterile steroid medication it shipped were reportedly so tainted that white fuzz could be seen floating in some vials.


But, experts say, the now notorious Compounding Center has a nationwide network of unwitting enablers and accomplices: There are the doctors who overprescribe an invasive back-pain therapy that, in studies, has not proved useful for many of the patients who get it. And there are the patients, living in an increasingly medicalized society, who want a quick fix for life’s aches and pains.


The use of steroid injections to treat back pain has skyrocketed in the past 15 years — out of proportion to growth in the number of patients with back pain, or the aging of the population. The frequency of steroid injections dispensed to Medicare patients rose 121 percent from 1997 to 2006. Washington State found that the use of back injections grew 12.6 percent between 2006 and 2009, at a cost to the state of $56 million. Some people received more than 10 shots a year.


The increase in treatment has not led to less pain over all, researchers say, and is a huge expense at a time of runaway health costs. “There are lots of places doing lots of injections for conditions that haven’t been shown to benefit,” says Dr. Janna Friedly, a researcher at the University of Washington, who added, “Sadly, some of the patients who got meningitis were probably in that category — they did not have conditions where steroid injections were indicated.”


Studies are at best inconclusive about exactly which groups of back-pain patients are likely to benefit from steroid shots. Though some patients clearly get much-needed relief, health researchers are nearly unanimous that the treatment is vastly overused in the United States.


But Dr. Laxmaiah Manchikanti, head of the American Society of Interventional Pain Physicians, said the increasing number of spine injections was just part of “an exponential increase in all interventional techniques” and is a good thing, reflecting a better understanding of chronic pain and patients’ demands for improved pain relief.


Though doctors are still arguing, most academic researchers say there is no evidence that steroid injections are useful in easing straightforward chronic low back pain. Professional guidelines say such shots should generally not be used for back pain that is less than four to six weeks old, which studies show almost always gets better with noninvasive treatments. Although many Medicare patients get spinal injections to treat a condition called spinal stenosis, a narrowing of spaces between bones of the spine, Dr. Friedly said, shots are not used for that condition in many European countries.


Spinal injections, which can cost between $600 and $2,500, including the fees for treatment rooms, have been fostered and promoted by the rising number of pain clinics and pain specialists — mostly anesthesiologists and rehab doctors — who invest in extra training to learn procedures like spinal injections.


“There used to be only a small number of people who did this, but that’s gone way up, and reimbursement has gone up, too,” says Scott Forseen, a doctor who studies the treatment of back pain at the Georgia Health Sciences University. The number of spinal injections given in any geographical area correlates better with the number of local specialists trained in the procedure rather than the amount of back pain, Dr. Friedly says. There is an old saying in medicine: “When you go to Midas, you get a muffler.”


The shots — which may include a steroid and an anesthetic — are often dispensed at for-profit pain clinics owned by the physicians holding the needle. “There’s a lot of concern about perverse financial incentive,” Dr. Friedly added.


Mr. Kinnaird’s clients got their injections at the St. Thomas Outpatient Neurosurgery Clinic, a limited-liability corporation half owned by doctors, which occupied a floor of one of Nashville’s major hospitals. It gave 5,000 injections a year, or about 20 each business day, and epidural steroid injections are listed on its Web site as its “top procedure.”


Since guidelines for injections are being disputed among doctors’ groups, it is hard in most cases to say if a particular patient should or should not have been offered an injection, says Marc Lipton, a Michigan attorney who is representing more that 20 patients with fungal meningitis. Though he believes that steroid shots are overused, he says many of the patients he represents were treated appropriately, for example, receiving an injection for pain from a herniated disc in an attempt to stave off back surgery. He and other lawyers are, for now, targeting the Compounding Center in product liability lawsuits.


But, says Dr. Forseen: “You have to use injections selectively, and selectivity has gone way down. In some places, people get injections because they’ve walked in the door.”


Patients have proved eager consumers of the new medical offering, desirous of a quick cure rather than waiting the weeks or months for the normal healing process to occur.


Mr. Kinnaird, the lawyer, says: “If I hurt my back in the ’70s, my doctor would say, go to the beach, get a few beers, relax, you’ll be fine. Now if you hurt your back, you go to the doctor and right away there’s an M.R.I., and they need to fix something. Maybe you should take an injection.”


And steroid shots are not a cure-all, even for the conditions for which doctors agree an attempt is worthwhile: low back pain accompanied by signs of nerve injury like tingling or weakness in a leg. One-third of such patients will get better, one-third will show some improvement and some will show no improvement at all, Dr. Forseen said.


When Oregon’s Health Evidence Review Commission earlier this year explored narrowing reimbursement for injections to certain conditions, it got an earful of public comment from groups like the International Spine Intervention Society.


“Obviously they are not utilizing the literature correctly,” said Dr. Manchikanti, adding that attempts to limit the shots were motivated in part by an effort to control costs and by competition from other medical specialties.


Private insurers vary considerably in coverage for the procedure, though some will pay after two weeks of back pain.


Back pain is, of course, a debilitating condition. And modern medicine has produced some miraculous cures. But from now on when doctors and patients are tempted to say “what’s the harm in trying an injection” to dispense with a nagging back — they will be more aware of just how big the risk can be.


A physician and a reporter for The New York Times.



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Machinima Using Game-Themed Videos to Lure Young Men





LOS ANGELES — Big Media’s hunt for young male viewers is not going so well.




News Corporation is holding a fire sale for IGN, its online network aimed at guys. Disney XD, a cable channel for boys, is growing in popularity — among girls. Comcast’s game-focused G4 channel is retooling its entire programming strategy.


Where are all the “lost boys,” as analysts sometimes call them? Increasingly, the answer involves Machinima.


Intensely focused on 18- to 34-year-old men, Machinima (pronounced ma-SHIN-i-ma) is a Web and mobile distribution network that delivers free game-oriented shows, trailers and news reports. The company, founded in 2000, generates more than 2.2 billion video views a month, according to comScore data. Machinima Prime, a YouTube channel that arrived in August and is dedicated to highly polished episodic series, ranked as the video hub’s No. 1 destination this month.


Despite their escalating reluctance to watch television or go to the movies, young men continue to flock to traditional outlets like Disney’s ESPN or Viacom’s Comedy Central.


And Machinima is certainly not the only online network where young men congregate; Break Media operates testosterone-heavy sites like ManMade.com and HolyTaco.com.


But Machinima has rapidly evolved into a must-visit site for young men by improving the quality of its programming. The company’s mission is not dissimilar to that of cable channels: gain a foothold with inexpensive content (in Machinima’s case it was user-generated videos) and then use that perch to attract higher-quality programs, as AMC did with “Mad Men.”


Ultimately, Machinima intends to produce its own long-form episodic series.


First, Machinima must prove that YouTube can indeed become the new television — that consumers will watch long videos and come back the next week for another episode. In many ways, Machinima just pulled that off with “Halo 4: Forward Unto Dawn,” a five-part live-action series.


“Forward Unto Dawn,” which cost Microsoft $10 million to make and was meant to promote the release of the game Halo 4 on Xbox, has been viewed about 27 million times; four related videos delivered 9.2 million additional views. Machinima also said it experienced very little viewer “fall off,” an industry term for people leaving after watching only a couple of minutes.


Fans understand that this kind of programming is really marketing masquerading as entertainment, said Allen DeBevoise, Machinima’s chief executive. But he contended that “high-quality content is better marketing than traditional advertising; if it’s the equivalent of what people would watch on their own anyway, fans really appreciate that.”


Halo 4 had $220 million in global sales in its first 24 hours in stores.


“If you’re a marketer and not paying serious attention to Machinima, you’re really behind the curve,” said Matt Britton, a founder of MRY, a youth-focused New York marketing firm. “College kids may not be bringing TVs to their dorm rooms anymore, but Machinima, because it has smartly built itself around YouTube, is right there on their laptops.”


NBCUniversal recently decided Machinima was the best way to bring one of its TV movies to consumers. “Battlestar Galactica: Blood and Chrome,” a prequel to the Syfy channel’s 2004 “Battlestar Galactica” series, was cut into 10 episodes and is rolling out on Machinima Prime. “Blood and Chrome” will then run on Syfy next year as a two-hour movie.


Warner Brothers is completing a programming deal with Machinima for a new series tied to its Mortal Kombat game franchise. “Mortal Kombat: Legacy,” a nine-part series, ran on Machinima last year, and at least one installment captured over 10 million views — on par with viewership for some fantasy programs on television.


Machinima, which is based in Los Angeles and makes money by selling advertising, got its start in 2000 as a Web site dedicated to a genre of digital filmmaking that uses video game graphics to create original animated movies.


In 2005, Mr. DeBevoise and his brother, Philip, bought the Web site and set about turning it into a global entertainment network. It has about 200 employees and secured a $35 million round of financing in May; the company declined to discuss revenue or profitability.


Mr. DeBevoise said about 50 percent of Machinima’s total traffic now came from overseas. The company — with backing from MK Capital, Redpoint Ventures and Google, which owns YouTube — also has a significant presence on mobile devices.


Machinima Prime is part of YouTube’s strategy, started a year ago, to lure television viewers and advertisers with higher-quality videos, even if aimed at niche interests.


YouTube invested about $100 million in the overall effort — Machinima received an undisclosed portion — and in recent weeks YouTube began evaluating which channels had done well enough to receive a second round of financing.


In addition to Machinima Prime, YouTube successes include AwesomenessTV, aimed at 12- to 17-year-olds, and Vice, which also courts young men. In an e-mail, Malik Ducard, YouTube’s director of content strategy, called Machinima “a great example of how a Web brand with a laserlike focus on serving a single audience can drive massive eyeballs.”


Mr. Ducard added that YouTube partners like Machinima, sometimes dismissed as niche players, were adding subscribers at a rate “four times faster” than they did just a couple of years ago.


“Niche may not be the right word because that may sound small,” he said. “Billions of views is not small.”


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