Genetically modified foods: Who has to tell?

Consumers who believe they have a right to know whether their food contains genetically modified ingredients are pressing lawmakers, regulators and voters to require labels on altered foods. But even if they succeed, experts say there's no guarantee that labels identifying genetically engineered foods would ever appear on packages.

"People are usually surprised to learn that there is no legal right to know," said Michael Rodemeyer, an expert on biotechnology policy at the University of Virginia in Charlottesville.

A variety of rules and regulations control the words that appear on food packages. Such rules must be balanced against companies' constitutionally protected right of commercial speech, experts said.

"It's an unsettled area in the law," said Hank Greely, director of the Stanford Center for Law and the Biosciences in Palo Alto. "If I were a betting man, I think the odds are good that the Supreme Court would ... strike down a GMO labeling requirement."

Consumers do have the right to know some things about foods, and it's the job of the Food and Drug Administration to enforce the various rules. Labels must carry an accurate name for the food, as well as its weight and manufacturer, a list of ingredients and, since 1990, that panel of calories and breakdown of basic nutrients that some people pore over and others blithely ignore.

And labels cannot be false or misleading. Consumers have a right to know that a product contains the nutrients they'd reasonably expect to find in a food with that name: An orange lacking vitamin C (should anyone desire to create such a thing) would have to be labeled as such.

They also have the right to know when a food contains something new that makes it materially different, such as an allergen or unexpected nutrient. Soybean varieties that are genetically engineered to contain high amounts of the monounsaturated fat oleic acid must bear labels that make that property clear, said FDA spokesperson Morgan Liscinsky.

But there is no requirement that food producers use those labels to say how they raised those oleic acid levels, according to the FDA. They could have done it through conventional breeding or by irradiating plant tissue to create mutations or by fusing cells together in a dish — or with genetic engineering.

When Flavr Savr tomatoes became the first genetically modified plants sold in supermarkets in 1994, they had stickers that informed shoppers that they were "made from genetically engineered seeds." Calgene Inc., the company that produced the tomatoes, even provided brochures and a toll-free number that consumers could call to learn more about the product, said Belinda Martineau, a geneticist at UC Davis who worked at Calgene in the 1990s.

But those labels were there only because Calgene decided to put them there. The FDA had scrutinized the process by which the company engineered the DNA in the tomatoes and decided that the technology itself didn't amount to a material change. Regulators concluded that Flavr Savr had the appearance, nutrients, flavor and texture of a tomato (although not, as it turned out, an especially tasty one).

"It was still a tomato," said Fred Degnan, a food lawyer with the firm King & Spalding in Washington, D.C., who has worked on biotechnology and labeling issues at the FDA. "They couldn't require it to be labeled in a way that implied it was different from a regular tomato."

Courts have ruled that forcing companies to label GM products violates their 1st Amendment right of free speech. In a 1996 case, a federal appeals court blocked a Vermont law that required dairy producers to label milk from cows that had been treated with a growth hormone made by genetically engineered bacteria. The hormone helped cows produce more milk, but the milk itself was the same as milk from untreated cows, the FDA determined. Because the law required labels to contain information that wasn't "material" to the product, it was unconstitutional, the 2nd Circuit Court of Appeals ruled in a 2-1 decision.

Labels can be required only if they alert consumers to a change that affects a food's composition or nutrition, its physical properties (such as shelf life), or the qualities that influence the sensory experience of smelling, tasting and eating it, the FDA says.

It is not a definition that sits well with all.

Andrew Kimbrell, executive director of the Washington-based advocacy group Center for Food Safety, said that approach reflects "19th century science." His group has petitioned the FDA to update its rules so that any product created via genetic engineering would be considered altered enough to require a label.

Such a change would also give companies more leeway to label their products as free of genetically modified ingredients: Today they can do so only if the label doesn't imply that there's something wrong with GM foods or that GMO-free foods are superior (although many companies skirt the rules).

"We need to know we have an agency using 21st century regulations to deal with 21st century technology," Kimbrell said.

The FDA's stance on labeling genetically modified foods differs starkly from that of European regulators, who require foods with genetically engineered ingredients to bear labels. Most scientists believe that the FDA's approach is rational — but perhaps it's too rational if the goal is to encourage public acceptance of the technology, said Jennifer Kuzma, a science policy expert at the Humphrey School of Public Affairs at the University of Minnesota.

"This is something that people want to see on labels," Kuzma said. "My view is that consumers deserve a choice when it comes to something that is important to them, even though there may not be a scientific basis for doing it."

Rodemeyer, the expert on biotechnology policy, says he thinks food producers made a tactical mistake by deciding not to label their genetically modified products voluntarily.

"When you don't label, you're always raising suspicion you're trying to hide something," he said.

Since most processed foods contain oil, sugar, syrups, emulsifiers, flour, cornmeal and protein that are derived from GM crops, virtually every product sold in the last 15 years would have carried a label. By now, those labels would have lost all meaning, Rodemeyer said: "If they would have all held their noses and jumped together, this wouldn't be an issue."

science@latimes.com

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Adele, 'Les Miserables' cast sing on Oscar stage

LOS ANGELES (AP) — It was an extra starry, musical day at the Dolby Theatre.

Adele took the stage first Friday, followed by the cast of "Les Miserables," singing together of the first time.

Oscar nominees Hugh Jackman and Anne Hathaway, along with co-stars Russell Crowe, Amanda Seyfried, Helena Bonham-Carter, Sasha Baron-Cohen, Eddie Redmayne, Aaron Tveit and Samantha Barks rehearsed their performances on the Oscar stage. They were backed by members of the musical's stage productions from London and Broadway.

"Les Miserables" director Tom Hooper sat in the front row of the theater as his cast sang.

Moments earlier, Adele dazzled the tiny audience of show workers with her performance of the James Bond theme "Skyfall."

"I need a lot more reverb on me," she said after her first run. "You might need to get a new reverb machine."

The 24-year-old multiple Grammy winner arrived wearing a black tunic, black leggings and flats, with no makeup and her hair in a ponytail.

"I'm going to have very high heels on the night, guys," she announced from the microphone, sipping tea between verses.

"Do you need the dresses?" she asked, and a team of stylists brought out the gowns Adele is considering for her Oscar performance.

The dress producers favored? "It's very heavy — I mean I struggle to stand in it," Adele said. "Come and feel how heavy it is, so you don't think I'm a wimp!"

She performed her Oscar-nominated song five times before leaving the theater. "It's been good, yeah?" she asked producer Neil Meron, who nodded in approval.

Just after Adele wrapped, the star-studded "Les Miserables" cast took the stage. Hathaway chatted with Bonham-Carter as Jackman sang a capella. Then Hathaway checked her microphone with a quick verse.

"Ooh, that was flat," she said.

The entire cast assembled for a final run-through when Jackman spontaneously began singing "My Bonny Lies over the Ocean."

"My bonny lies over my daddy," the ensemble responded, breaking into laughter.

Other stars rehearsing Friday included Jennifer Hudson, who is set to perform a song from "Dreamgirls" at Sunday's ceremony.

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AP Entertainment Writer Sandy Cohen is on Twitter: www.twitter.com/APSandy .

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Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

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2013 Mustang GT: Does retro have a future?

A decade ago, as Ford engineers prepared the next-generation Mustang, they stared down an inescapable truth: The best Mustangs were built in the 1960s.

So they set out to build a brand-new 1968 Mustang fastback, wrapping modern technology in retro sheet metal. That strategy carried its own risks, like asking the Rolling Stones to rerecord "Exile on Main Street."

It's clear now that it worked brilliantly, setting off an unlikely second coming of the muscle car era. In a familiar stampede, Chevrolet and Dodge — which scrambled in the '60s to make their own "pony cars" — followed Ford's lead again with refried versions of the original Camaro and Challenger.

Photos: Mustangs through the years

The 2013 Mustang GT we tested recently, a drag-strip beast that could smoke most anything from the '60s, may be among the last of the retro breed. With the Mustang's 50th anniversary approaching next year, the engineers in Dearborn, Mich., are again feverishly designing the next-generation Mustang. They face an even tougher challenge: How do you take a car into the future after you've taken it a half-century into the past?

However wonderful the next Mustang may be, it will be a shame to see this one pass into history, whence it came. The successful remake of the 1967-68 car represents a kind of redemption for dumb decisions Ford made when it abandoned the early Mustangs in the first place, leading to a series of putrid pony cars throughout the 1970s. (Note to Ford: DO NOT bring back the Mustang II.)

A week in the old-school cockpit of the latest GT confirms that its ride, handling and shifting are an upgrade over both ancient and recent Mustangs, which have always been a bit crude — endearingly so.

Ford has also pulled off a subtle but substantial evolution of its retro design. A mid-cycle refresh in 2010 added a sharpened belt line and a rear end pinched in on both sides. For 2013, Ford added a more prominent front grille and other tweaks. The updates somehow made the car look simultaneously less dated and more like the old car.

But only one option really matters on this car: the 302-cubic-inch, 5.0-liter V-8, a direct descendant of the first 302 small-block introduced in the 1968 Mustang, now with a ludicrous 420 horsepower and 390 pound-feet of torque. The first retro Mustang GT, a 2005 model, was impressive enough with 300 horses. Piling on 120 more is like deep-frying bacon in pork fat.

With the optional six-speed manual, it's difficult to launch the GT without roasting enough rubber to set off neighborhood smoke alarms. Shifts into second gear provoke another loud bark from the rear tires. Pushing the 7,000-rpm redline in higher gears requires acres of open highway.

The car's least-expected quality is a near-optimal trade-off between aggressive handling and a comfortable ride, both of which came in handy on the twisty, pockmarked Pasadena Freeway.

The GT has its issues. All Mustangs do. Their point has never been perfection, but rather the proper ratio of performance to price. The car can be a handful to drive in town, and feels a tad too big and heavy. Its center console is awkwardly angled up toward the back seat, making manual shifting an elbow-bumping affair.

Proper flogging of the GT also exposes a drawback to the whole '60s motif. The retro thing extends to the tall, skinny numbers on the circular analog speedometer. They're cool but hard to read, especially in the split second you have to look down, past your white knuckles, as the horizon starts to blur.

The GT dispenses with zero to 60 mph in 4.3 seconds on its way to 12.7-second quarter mile, according to Motor Trend. If you want something just a hair faster, plunk down $190,000 on an Aston Martin DB9.

Our loaded test car came to $40,255, a bit high for the quintessential affordable fast car. But GTs start at $31,545, and the V-6 base model — with a more-than-respectable 305 horsepower — brings the price down to $22,995.

All this sets a high bar for the next-generation Mustang. If Ford has learned anything from history, it will take care to avoid repeating what happened after the 1960s, a textbook case of messing with success. The first Mustang, a 1965 model unveiled on April 17, 1964, at the New York World's Fair, lasted just two model years — even though Ford sold more than a million of the cars. Feeling competitive pressure from Chevy and Dodge, the automaker rushed out two more generations before 1970. They were larger, faster cars, but respectful of the original.

Then Ford drove the Mustang into a ditch. The stretched and bloated 1971 Mustang, stripped of its trademark side-panel scoops, was a misguided attempt to turn the pony car into a luxury coupe. By 1973, as new emissions standards and an oil crisis took hold, horsepower had plummeted to a measly 150 for the strongest available V-8, according to a history of the Mustang by auto information company Edmunds.com.

That mere mistake was compounded by the crime against transportation known as the Mustang II, sold from the 1974 to 1978 model years. The mini-Mustang, which shared a chassis and engines with the lowly Pinto, today ranks second on Edmunds.com's list of 100 all-time worst cars.

The Mustang didn't fully recover until 1985, when Ford finally dropped a respectable version of its 5.0-liter V-8 into the long-running sixth-generation pony car. Horsepower topped 200 for the first time since 1971, and the "five-point-oh" models proved quite popular. (Today's GT gives a nod to this era with a small "5.0" badge just behind the front-wheel hub.)

The history no doubt weighs heavily on Mustang engineers now holed up in top-secret design sessions, walking the line between traditional and innovation. Whatever emerges will be the product of much pride and many arguments, says Jim Owens, a marketing manager for the Shelby line of ultra-performance Mustangs.

"There's a billboard on the plant that builds Mustangs. It says, 'We love taking our work home with us,'" Owens said, describing the factory in Flat Rock, Mich. "We will argue over a single pound of tire pressure and what it means at the apex of Turn 11 at Laguna Seca."

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Gunfire and deadly crash rattle the Las Vegas Strip

LAS VEGAS — A spectacular predawn crash on the Strip — triggered when bullets fired from a black Range Rover peppered a Maserati — hit this resort city right between the eyes. In the end, three people were dead and a major intersection under lockdown during a three-state manhunt for the shooters, leaving even casino veterans used to the extraordinary scratching their heads.

The mayhem was sparked, witnesses told police, by a quarrel early Thursday at a hotel valet stand.

The two vehicles left the Aria resort hotel and were heading north on Las Vegas Boulevard at 4:20 a.m., an hour when the casino marquees shine brightly but the gambling thoroughfare is largely empty. At Harmon Avenue, occupants inside the Range Rover opened fire on the Maserati, police said.

The silver-gray sports car, which was struck several times, sped into the intersection at Flamingo Road, ramming a Yellow cab. The taxi exploded, killing the driver and a passenger. Four other vehicles in the intersection were also involved in the crash and explosion, but officers offered no details.

"Omg Omg Omg that car just blew up!" one witness tweeted shortly after the crash, posting a photo of the wreckage. "God Bless their Souls! Omg!"

The driver of the Maserati died later at a hospital, police said. A passenger in the vehicle received minor injuries and was being interviewed by investigators. At least three others were also injured.

Police in Nevada, California, Arizona and Utah were on alert for the distinctive black Range Rover SUV, described as having dark-tinted windows, black rims and out-of-state paper dealer plates.

"We are going to pursue these individuals and prosecute them," Clark County Sheriff Doug Gillespie said at an afternoon news conference. "This act was totally unacceptable. It's not just tragic but unnecessary — the level of violence we see here in Las Vegas and across America."

Authorities had not publicly identified the dead. But a Las Vegas television station late Thursday identified the taxi driver as Michael Boldon, 62, who the station said had recently moved here from Michigan to care for his 93-year-old mother.

The victim's son, who drives a limousine, told Fox News 5 that he last talked with his father after 3 a.m., and later called his cellphone shortly after the crash to warn him to avoid the Strip. But there was no answer.

The station also identified the driver of the Maserati as Ken Cherry, a rap artist from Oakland who also is known as "Kenny Clutch." The station quoted family members identifying Cherry as the driver. An Internet video of a Cherry song called "Stay Schemin" shows two men in a vehicle on the Strip.

Police had more questions than answers.

"It began with a dispute at a nearby hotel and spilled onto the streets," said Capt. Chris Jones of the Las Vegas Police Robbery and Homicide Division.

The morning's events threw the Strip into disarray all day. The gambling boulevard's busiest and best-known intersection was cordoned off by yellow police tape until nightfall, keeping traffic and curious pedestrians away from the carnage. Even skywalks were blocked off.

While slot machines beeped and card games continued inside casinos around the accident scene — including the Bellagio, Caesars Palace and Paris Las Vegas — hotel bell captains were fielding questions from tourists who had awakened to news of the crash and the Strip shutdown. The alleys and side streets between nearby hotels were clogged with pedestrians who inched along on narrow sidewalks, past delivery doors, many making their own paths between the landscaped bushes and palm trees.

Even casino industry workers were thrown into turmoil. Hotel maids and dealers who finished their midnight shifts after dawn were left without bus service home. "I'm stranded," said Tiruselam Kefyalew, 25, a maid. "What a day to leave my cellphone at home."

Limousine drivers who normally prowl the city's gambling core improvised detours. Some said the police blockade would cost them $500 or more in lost business and tips.

"Most people understand, but you have your complainers," said Jim DeSanto, a limo driver who waited for fares outside Bally's casino. "Those people will complain, even when everything is perfect."

Well after noon, guests peered out nearby hotel windows and others leaned into the street to glimpse the crime scene.

"Hey, honey, it must have happened right here," one man told his wife as they left Caesars around noon. The tourist, who would only say that he had arrived from Tampa, Fla., the previous evening, had looked out his hotel window at 4:30 to see a vehicle in flames.

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Oscar animators ready to be taken seriously

BEVERLY HILLS, Calif. (AP) — In the animated feature film category at this year's Oscars, there's a film set in medieval Scotland, another that features old-school video game characters, one that relies heavily on dry British humor, while the other two take inspiration from the supernatural.

It's not exactly kid stuff — and that's how the directors like it.

"I think this year with these films — and so many more — the envelope for animation is being pushed," said "Brave" director Mark Andrews at an Academy Awards event Thursday night honoring the animated feature film nominees. "We keep seeing more risky, deep films that we wouldn't have seen 10 years ago coming out. I wanna be one of those guys pushing it more and more and more because it's not only an awesome medium, but there's so many more stories that we can tell."

The Scotland-set "Brave," a darker fable from Pixar about a rebellious red-headed princess named Merida, will face off against four other animated films at Sunday's 85th annual Academy Awards. The category was first introduced at the 2002 ceremony, with "Shrek" winning the inaugural trophy.

Despite the less lighthearted tone of this year's animated nominees, none cracked the best picture category for a spot alongside the likes of "Argo," ''Lincoln" and "Zero Dark Thirty." (Only three animated films have ever been nominated for best picture at the Oscars: "Beauty and the Beast," ''Up" and "Toy Story 3.")

"Edward Scissorhands" and "The Nightmare Before Christmas" mastermind Tim Burton could take home his first-ever Oscar at the Dolby Theatre ceremony for "Frankenweenie," his black-and-white stop-motion film based on his 1984 live-action short film of the same name.

"Frankenweenie" is among three of the five Oscar nominated films this year that employ stop-motion, the intricate and time consuming animation method that use miniature sculptures and sets. Despite a strong stop-motion presence at this year's Oscars, Burton cited finances, not the omnipresence of computer animation, as the reason that more stop-motion films aren't produced.

"In the case of 'Frankenweenie,' it's not like it was a studio wish-list to-do: 'Let's make black-and-white stop-motion animation,'" said Burton. "You hope it can survive. We all love it."

The other stop-motion nominees are the English seafaring comedy "Pirates! Band of Misfits" from director Peter Lord and the undead tale "ParaNorman" from directors Sam Fell and Chris Butler.

"Wreck-It Ralph" director Rich Moore told the crowd at the motion picture academy's Beverly Hills headquarters that he never envisioned the video game adventure from Disney as a musical, but "Book of Mormon" co-writer Robert Lopez and his wife Kristen Anderson-Lopez did create an original song for the film.

"It didn't work, so it's not in the movie," said Moore. "That's our process. We try lots of stuff. We throw it against the wall, and the stuff that sticks stays in the movie. It's a very organic process making films like this."

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Follow AP Entertainment Writer Derrik J. Lang on Twitter at http://www.twitter.com/derrikjlang.

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The New Old Age Blog: For Traumatized Caregivers, Therapy Helps

I recently wrote about caregivers who experienced symptoms of traumatic-like stress, and readers responded with heart-rending stories. Many described being haunted by distress long after a relative died.

Especially painful, readers said, was witnessing a loved one’s suffering and feeling helpless to do anything about it.

The therapists I spoke with said they often encountered symptoms among caregivers similar to those shown by people with post-traumatic stress — intrusive thoughts, disabling anxiety, hyper-vigilance, avoidance behaviors and more — even though research documenting this reaction is scarce. Improvement with treatment is possible, they say, although a sense of loss may never disappear completely.

I asked these professionals for stories about patients to illustrate the therapeutic process. Read them below and you’ll notice common themes. Recovery depends on unearthing the source of psychological distress and facing it directly rather than pushing it away. Learning new ways of thinking can change the tenor of caregiving, in real time or in retrospect, and help someone recover a sense of emotional balance.

Barry Jacobs, a clinical psychologist and author of “The Emotional Survival Guide for Caregivers” (Guilford Press, 2006), was careful to distinguish normal grief associated with caregiving from a traumatic-style response.

“Nightmares, lingering bereavement or the mild re-experiencing of events that doesn’t send a person into a panic every time is normal” and often resolves with time, he said.

Contrast that with one of his patients, a Greek-American woman who assisted her elderly parents daily until her father, a retired firefighter, went to the hospital for what doctors thought would be a minor procedure and died there of a heart attack in the middle of the night.

Every night afterward, at exactly 3 a.m., this patient awoke in a panic from a dream in which a phone was ringing. Unable to go back to sleep for hours, she agonized about her father dying alone at that hour.

The guilt was so overwhelming, the woman couldn’t bear to see her mother, talk with her sisters or concentrate at work or at home. Sleep deprived and troubled by anxiety, she went to see her doctor, who works in the same clinic as Dr. Jacobs and referred her to therapy.

The first thing Dr. Jacobs did was to “identify what happened to this patient as traumatic, and tell her acute anxiety was an understandable response.” Then he asked her to “grieve her father’s death” by reaching out to her siblings and her mother and openly expressing her sadness.

Dr. Jacobs also suggested that this patient set aside a time every day to think about her father — not just the end of his life, but also all the things she had loved about him and the good times they’d had together as a family.

Don’t expect your night time awakenings to go away immediately, the psychologist told his patient. Instead, plan for how you’re going to respond when these occur.

Seven months later, the patient reported her panic at a “3 or 4” level instead of a “10” (the highest possible number), Dr. Jacobs said.

“She’ll say, ‘oh, there’s the nightmare again,’ and she can now go back to sleep fairly quickly,” he continued. “Research about anxiety tells us that the more we face what we fear, the quicker we are to extinguish our fear response and the better able we are to tolerate it.”

Sara Qualls, a professor of psychology at the University of Colorado in Colorado Springs, said it’s natural for caregivers to be disgusted by some of what they have to do — toileting a loved one, for instance — and to be profoundly conflicted when they try to reconcile this feeling with a feeling of devotion. In some circumstances, traumatic-like responses can result.

Her work entails naming the emotion the caregiver is experiencing, letting the person know it’s normal, and trying to identify the trigger.

For instance, an older man may come in saying he’s failed his wife with dementia by not doing enough for her. Addressing this man’s guilt, Dr. Qualls may find that he can’t stand being exposed to urine or feces but has to help his wife go to the bathroom. Instead of facing his true feelings, he’s beating up on himself psychologically — a diversion.

Once a conflict of this kind is identified, Dr. Qualls said she can help a person deal with the trigger by using relaxation exercises and problem-solving techniques, or by arranging for someone else to do a task that he or she simply can’t tolerate.

Asked for an example, Dr. Qualls described a woman who traveled to another state to see her mother, only to find her in a profound disheveled, chaotic state. Her mother said that she didn’t want help, and her brother responded with disbelief. Soon, the woman’s blood pressure rose, and she began having nightmares.

In therapy, Dr. Qualls reassured the patient that her fear for her mother’s safety was reasonable and guided her toward practical solutions. Gradually, she was able to enlist her brother’s help and change her mother’s living situation, and her sense of isolation and helplessness dissipated.

“I think that a piece of the trauma reaction that is so devastating is the intense privacy of it,” Dr. Qualls said. “Our work helps people moderate their emotional reactivity through human contact, sharing and learning strategies to manage their responsiveness.”

Dolores Gallagher-Thompson, a professor of psychiatry at Stanford University School of Medicine in California, noted that stress can accumulate during caregiving and reach a tipping point where someone’s ability to cope is overwhelmed.

She tells of a vibrant, active woman in her 60s caring for an older husband who declined rapidly from dementia. “She’d get used to one set of losses, and then a new loss would occur,” Dr. Gallagher-Thompson said.

The tipping point came when the husband began running away from home and was picked up by the police several times. The woman dropped everything else and became vigilant, feeling as if she had to watch her husband day and night. Still, he would sneak away and became more and more difficult.

Both husband and wife had come from Jewish families caught up in the Holocaust during World War II, and the feeling of “complete and utter helplessness and hopelessness” that descended on this older woman was intolerable, Dr. Gallagher-Thompson said.

Therapy was targeted toward helping the patient articulate thoughts and feelings that weren’t immediately at the surface of her consciousness, like, for example, her terror at the prospect of abandonment. “I’d ask her ‘what are you afraid of? If you visualize your husband in a nursing home or assisted living, what do you see?’” Dr. Gallagher-Thompson said.

Then the conversation would turn to the choices the older woman had. Go and look at some long-term care places and see what you think, her psychologist suggested. You can decide how often you want to visit. “This isn’t an either-or — either you’re miserable 24/7 or you don’t love him,” she advised.

The older man went to assisted living, where he died not long afterward of pneumonia that wasn’t diagnosed right away. The wife fell into a depression, preoccupied with the thought that it was all her fault.

Another six months of therapy convinced her that she had done what she could for her husband. Today she works closely with her local Alzheimer’s Association chapter, “helping other caregivers learn how to deal with these kinds of issues in support groups,” Dr. Gallagher-Thompson said.

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Foreign tourists' spending in U.S. rises to new record

The U.S. continues to be a hot destination for big-spending tourists, setting a new record of $168.1 billion in foreign visitor spending in 2012.

The country last year welcomed 66 million foreign visitors, whose spending represents a 10% increase over 2011, said Rebecca Blank, deputy secretary of the U.S. Department of Commerce.

The greatest increase in visitors and spending came from countries with a burgeoning middle class, including China, Brazil and India.

Spending by foreign tourists has been on the rise for the last three years, with tourist hubs such as Los Angeles, Las Vegas, New York and San Francisco reaping much of the spending, Blank said.

"The coasts that are close to Asia and South America will see the notable effects," she said.

The federal government and the tourism industry have been paying special attention to foreign overseas tourists because they typically stay longer and spend more than visitors from Mexico or Canada.

Long-haul foreign visitors spend an average of $4,000 per visit, while visitors from Mexico and Canada — although they represent the greatest number of foreign tourists — spend less than $1,000 per visit, according to federal reports.

Visitor numbers from Europe — once the source of most of the U.S. tourism spending — have been dropping in recent years, as Europeans struggle with economic hardships. But the U.S. Department of Commerce predicts continued growth in tourists from Brazil (274% by 2016), China (135%) and India (50%).

To promote more foreign visitors, the Obama administration and leaders of the travel industry launched in 2011 a public-private partnership to promote the U.S. in foreign countries. The campaign, known as Brand USA, is funded by fees charged to visitors applying for visas and contributions from private firms.

The administration has also pushed the Department of State and the Department of Homeland Security to shorten the wait time for visa interviews and expanded a program to speed low-risk visitors through expedited security lines at major airports.

The number of international visitors rose to 62.3 million in 2011, up from 59.7 million in 2010, according to the Department of Commerce. President Obama has set a goal of welcoming 100 million foreign visitors by 2021.

"Our projection is that the travel and tourism industries are going to create over 1 million jobs in the next decade," Blank said.

hugo.martin@latimes.com

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Rapper Ja Rule set to leave NY prison in gun case

ALBANY, N.Y. (AP) — Platinum-selling rapper Ja Rule was set to leave an upstate prison on Thursday after serving most of his two-year sentence for illegal gun possession but head straight into federal custody in a tax case.

The rapper, who had been in protective custody at the Mid-State Correctional Facility because of his celebrity, has some time remaining on a 28-month sentence for tax evasion, correction officials said. His sentences were expected to run concurrently.

Ja Rule may have less than six months left and may be eligible for a halfway house, defense attorney Stacey Richman said. An order to pay $1.1 million in back taxes is one of the main reasons he wants to get back to work, she said.

"Many people are looking forward to experiencing his talent again," Richman said.

Ja Rule scored a Grammy Award nomination in 2002 for the best rap album with "Pain is Love." He also has appeared in movies, including "The Fast and the Furious" in 2001 and "Scary Movie 3" in 2003.

Ja Rule, who went to the prison in Marcy in June 2011, is getting out at his earliest release date, state correction spokeswoman Linda Foglia said. He had two misbehavior reports for unauthorized phone calls in February 2012 and had work assignments on lawn and grounds crews and participated in education programs, she said.

In the gun case, New York City police said they found a loaded .40-caliber semiautomatic gun in a rear door of Ja Rule's $250,000 luxury car after it was stopped for speeding, and he pleaded guilty in 2010.

He admitted in March 2011 in federal court that he failed to pay taxes on more than $3 million he earned between 2004 and 2006 while he lived in Saddle River, N.J.

"I in no way attempted to deceive the government or do anything illegal," he told the judge. "I was a young man who made a lot of money — I'm getting a little choked up — I didn't know how to deal with these finances, and I didn't have people to guide me, so I made mistakes."

Richman said the 36-year-old rapper, whose real name is Jeffrey Atkins, is looking forward to his daughter's graduation.

"He's a devoted father," she said.

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Rebates for California electricity ratepayers clear hurdle

SACRAMENTO — California electricity ratepayers could get rebates of as much as $1.6 billion from more than a dozen power wholesalers that allegedly manipulated the market during the energy crisis of 2000, the state Public Utilities Commission announced.

The commission in a statement released late Tuesday praised an "initial decision" issued Friday by a federal administrative law judge who ruled in favor of the state in a complaint filed with the Federal Energy Regulatory Commission.

The judge's ruling, which still must be endorsed by the full federal commission, found the power wholesalers guilty of overcharging California utilities and limiting electricity supplies in the summer of 2000. That resulted in high prices and rolling brownouts and blackouts throughout the state that drove one utility, Pacific Gas & Electric Co., into bankruptcy.

The alleged manipulators, the PUC said, citing the judge's ruling, included Powerex, a wholly owned subsidiary of Canadian firm BC Hydro; Shell Energy North America, a subsidiary of Shell Oil Co.; TransAlta Corp. of Alberta, Canada; and the Bonneville Power Administration, part of the U.S. Department of Energy.

A Bonneville spokesman said the government-owned power agency is "disappointed with the outcome" of the judge's initial ruling but needs more time to analyze the decision.

PUC President Michael Peevey called the initial ruling by the judge a vindication for complaints brought by California officials on behalf of electricity ratepayers.

"We've been relentless in our pursuit of economic justice for Californians who were grievously overcharged for electricity during and after the energy crisis of 2000-2001," Peevey said. "We look forward to the day when all of these cases can come to a close and consumers can see the benefit of refunds of the overcharges."

marc.lifsher@latimes.com

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