U.S. Judges Offer Addicts a Way to Avoid Prison

Todd Heisler/The New York Times

Emily Leitch of Brooklyn, with her son, Nazir, 4, was arrested for importing cocaine but went to “drug court” to avoid prison.

Federal judges around the country are teaming up with prosecutors to create special treatment programs for drug-addicted defendants who would otherwise face significant prison time, an effort intended to sidestep drug laws widely seen as inflexible and overly punitive.

The Justice Department has tentatively embraced the new approach, allowing United States attorneys to reduce or even dismiss charges in some drug cases.

The effort follows decades of success for “drug courts” at the state level, which legal experts have long cited as a less expensive and more effective alternative to prison for dealing with many low-level repeat offenders.

But it is striking that the model is spreading at the federal level, where judges have increasingly pushed back against rules that restrict their ability to make their own determination of appropriate sentences.

So far, federal judges have instituted programs in California, Connecticut, Illinois, New Hampshire, New York, South Carolina, Virginia and Washington. About 400 defendants have been involved nationwide.

In Federal District Court in Brooklyn on Thursday, Judge John Gleeson issued an opinion praising the new approach as a way to address swelling prison costs and disproportionate sentences for drug trafficking.

“Presentence programs like ours and those in other districts mean that a growing number of courts are no longer reflexively sentencing federal defendants who do not belong in prison to the costly prison terms recommended by the sentencing guidelines,” Judge Gleeson wrote.

The opinion came a year after Judge Gleeson, with the federal agency known as Pretrial Services, started a program that made achieving sobriety an incentive for drug-addicted defendants to avoid prison. The program had its first graduate this year: Emily Leitch, a Brooklyn woman with a long history of substance abuse who was arrested entering the country at Kennedy International Airport with over 13 kilograms of cocaine, about 30 pounds, in her luggage.

“I want to thank the federal government for giving me a chance,” Ms. Leitch said. “I always wanted to stand up as a sober person.”

The new approach is being prompted in part by the Obama administration, which previously supported legislation that scaled back sentences for crimes involving crack cocaine. The Justice Department has supported additional changes to the federal sentencing guidelines to permit the use of drug or mental health treatment as an alternative to incarceration for certain low-level offenders and changed its own policies to make those options more available.

“We recognize that imprisonment alone is not a complete strategy for reducing crime,” James M. Cole, the deputy attorney general, said in a statement. “Drug courts, re-entry courts and other related programs along with enforcement are all part of the solution.”

For nearly 30 years, the United States Sentencing Commission has established guidelines for sentencing, a role it was given in 1984 after studies found that federal judges were giving defendants widely varying sentences for similar crimes. The commission’s recommendations are approved by Congress, causing judges to bristle at what they consider interference with their judicial independence.

“When you impose a sentence that you believe is unjust, it is a very difficult thing to do,” Stefan R. Underhill, a federal judge in Connecticut, said in an interview. “It feels wrong.”

The development of drug courts may meet resistance from some Republicans in Congress.

“It is important that courts give deference to Congressional authority over sentencing,” Representative F. James Sensenbrenner Jr., Republican of Wisconsin, a member and former chairman of the Judiciary Committee, said in a statement. He said sentencing should not depend “on what judge happens to decide the case or what judicial circuit the defendant happens to be in.”

At the state level, pretrial drug courts have benefited from bipartisan support, with liberals supporting the programs as more focused on rehabilitation, and conservatives supporting them as a way to cut spending.

Under the model being used in state and federal courts, defendants must accept responsibility for their crimes and agree to receive drug treatment and other social services and attend regular meetings with judges who monitor their progress. In return for successful participation, they receive a reduced sentence or no jail time at all. If they fail, they are sent to prison.

The drug court option is not available to those facing more serious charges, like people accused of being high-level dealers or traffickers, or accused of a violent crime. (These programs differ from re-entry drug courts, which federal judges have long used to help offenders integrate into society after prison.)

In interviews, the federal judges who run the other programs pointed to a mix of reasons for their involvement.

Read More..

Brazil is trying to restart its economic growth spurt

SAO PAULO, Brazil — The Brazilian government is hoping to get South America's largest economy kicking again.

It has yanked down interest rates to record lows and kept the value of the real, the Brazilian currency, in check. The government has even doled out tax cuts in attempts to boost growth.

But so far, there's not much evidence those strategies are working — and key economic data released Friday probably won't change things.

The government reported the economy grew less than 1% for 2012, which was slightly below what economists expected. That expansion in gross domestic product was well below the 4.5% the country had been recently averaging, presenting a challenge for a government that needs growth to continue its social progress.

"We're suffering from a hangover from growing too fast, and the slowdown in 2011 and 2012 has been worse than we expected," said Caio Megale, an economist at the Brazilian bank Itau Unibanco. "We're waiting to get back on track in 2013 and 2014, but still, because of structural limitations we think that for the time being we'll grow slower than we did from 2005 to 2010."

Brazilians are living better than ever, enjoying record-low unemployment and still-rising wages. But more social gains depend on how — and whether — the country rebounds, economists say.

In Latin America, countries such as Mexico and Colombia are sucking in some of the investment that used to come to Brazil when it was still an investors' darling. After overtaking the UK as the world's sixth-largest economy last year, Brazil slid back into seventh place, ahead of France.

Investors have been startled by stubborn inflation, low productivity and onerous taxes that have reappeared as the country attempts to get back on track. Stocks have slid, and the Brazilian government hasn't done much to make it easy for foreign investors.

"Investing in Brazil is less of a no-brainer now," Megale said. "You have to know what stock or asset you're investing in. It's not just that you bring your money in and automatically make more money, like it was before."

For much of the 21st century so far, two factors propelled the previously long-suffering Brazilian economy forward.

First, Asian demand for commodities such as iron ore and soy pushed up prices, and money poured into Brazil. From 2000 to 2011, Brazilian exports to China increased more than fortyfold.

Second, governments put the country's previously crisis-ridden financial system on track, enabling Brazilians to go on a credit-fueled spending spree, often for basic (and Asian-made) consumer items such as refrigerators, cars and washing machines.

The resulting boom, combined with moderate social programs put in place by the government of Luiz Inacio "Lula" da Silva, has lifted almost 40 million Brazilians out of poverty and reduced the often shocking inequality among the country's residents. Investors got some nice returns, and Brazil emerged on the world stage — winning the rights to host the 2014 World Cup and 2016 Olympics in Rio de Janeiro.

But a recent slowdown in China, not to mention the European economic crisis, has taken its toll. Banks say Brazilian consumers are reaching the limit of debt they can take on.

After the economy averaged 4% to 5% GDP growth per year in 2005-10, growth dropped to 2.7% in 2011, and in 2012 it is expected to have been less than 1%.

"We think the growth from 2005 to 2010 was an exceptional period, owing to factors that won't be repeated," said Tony Volpon, an economist with Nomura in New York. He expects Brazil to grow 3.5% this year. "The government is waiting for the measures taken in 2012 to sooner or later cause growth, but those measures may have simply failed."

From 2011 to 2012, Brazil's central bank brought interest rates down to 7.25% from as high as 12.5% — around where they had long hovered as some of the highest in the world. The government also granted ad hoc tax breaks to stimulate industry and continued intervening in the foreign exchange markets.

The much-feared threat of inflation has also reared its head again. Inflation may be approaching the official upper limit of 6.5%.

That's still much lower than problematic levels in neighboring Argentina, but Brazil is especially averse to price rises after going through years of hyperinflation. Some parts of the market want the central bank to change course and raise rates again.

"Growth will stay slow unless there are structural changes, and that really means reform. There is some low-hanging fruit for easy changes, such as with the tax code, which is very silly in places," Volpon said. "But unlike in Mexico, there is no political consensus here for reform at the moment."

This may be because in the streets of Brazil, normal people are feeling great, and the government is confident. While investors have taken a hit, high wages and low unemployment have gone hand in hand with approval ratings for President Dilma Rousseff as high as 78%. With most people happy, there is little incentive to make changes.

But all will not stay rosy if growth doesn't return, Volpon and Megale said.

Many Brazilian industries are in dire need of skilled laborers, having already snapped up everyone available. Economists believe a scarcity of productive workers is one of a few obstacles to getting the country back on track, along with huge infrastructure bottlenecks long in need of investment.

"If we can't get investment up to 25% of our GDP, we'll never be able to grow at the rates we had going recently," said Paulo Sandroni, professor of economics at the Fundacao Getulio Vargas, an elite business school. Poor infrastructure could also be a headache during the World Cup and Olympics.

The worst-hit part of the economy, however, has been industrial production, undercut by competition from China, high costs, and an overvalued real.

"So far a consumer boom has counteracted drops in manufacturing output," Sandroni said. "But the weakening of the dollar really hurt us."

After the real climbed against the dollar, making Brazilian exports less competitive, Brazil Finance Minister Guido Mantega in 2010 blamed loose monetary policy in the United States, then put in place a shifting regime of capital controls that made it harder to invest in the country.

The real eventually came down, but as with low interest rates and the fiscal stimulus, the expected benefits have not yet materialized.

business@latimes.com

Read More..

Bell jurors ordered to begin anew after panelist is dismissed

After nearly five days of deliberations, jurors in the Bell corruption trial were ordered Thursday to begin anew after a member of the panel was dismissed for misconduct and replaced by an alternate.

The original juror, a white-haired woman identified only as Juror No. 3, told Los Angeles County Superior Court Judge Kathleen Kennedy she had gone onto a legal website to look up jury instructions and then asked her daughter to help find a definition for the word "coercion."

Although all but one defense attorney requested that the woman stay, Kennedy said the juror needed to be removed. "She has spoken about the deliberations with her daughter, she has conducted research on the Internet, and I've repeatedly, repeatedly throughout this trial — probably hundreds of times — cautioned the jury not to do that," the judge said.

The removal came after jurors notified the judge that they were deadlocked and that continued deliberations seemed fruitless.

It was unclear how to interpret the day's events, whether the dismissed juror had been a lone holdout or an indication of a fractured jury.

The juror started to tell the judge which way she was leaning in the case, saying she had gone online "looking to see at what point can I get the harassment to stop.... How long do I have to stay in there and deliberate with them when I have made my decision that I didn't think there was —"

Kennedy cut her off before she could finish.

The woman clasped her hands over her mouth and said, "I'm sorry."

Two defense attorneys thought she was leaning toward acquittal and wanted her to stay. "I would have preferred the deadlock to a guilty verdict," said Alex Kessel, the attorney for George Mirabal, one of six former council members charged with misappropriation of public funds.

The council members are charged with inflating their salaries in what prosecutors contend was a far-reaching web of corruption in which fat paychecks were placed ahead of the needs of the city's largely immigrant, working-poor constituents.

When attorneys and defendants were summoned to the courtroom Thursday morning, they were initially told that the jury appeared to be deadlocked.

"Your honor, we have reached a point where as a jury we have fundamental disagreements and cannot reach a unanimous verdict in this case," read a note signed by two jurors, including the foreman, that was given to Kennedy.

A note from another juror alerted the judge that Juror No. 3 had consulted an outside attorney. That did not appear to be the case, but her other actions were revealed under questioning from the judge.

The same juror made a tearful request Monday to be removed from the panel because she felt others were picking on her. Kennedy told the woman that although discussions can get heated, it was important to continue deliberating.

On Thursday, however, the juror again broke into tears and said she had spoken with her daughter about "the abuse I have suffered." She said her daughter told her, "Mom, they're trying to find the weak link."

The woman said she had turned to the Internet to better understand the rules about jury deliberations and came across the word "coercion." After her daughter helped her look up the word's definition, she wrote it down on a piece of paper and brought it with her to court. When the judge asked to see the paper she went into the jury room to retrieve it.

The woman later left the courtroom in tears.

With an alternate in place, Kennedy told the panel to act as if the earlier deliberations had not taken place. The alternate had sat in the jury box during the four-week trial but did not take part in deliberations.

Former council members Luis Artiga, Victor Bello, George Cole, Oscar Hernandez, Teresa Jacobo and Mirabal are accused of drawing annual salaries of as much as $100,000 a year by serving on boards that did little work and seldom met, part of a scandal that drew national attention to the small city in 2010.

Prosecutors said that Bell's charter follows state law regarding council members' compensation. In a city the size of Bell, council members should be paid no more than $8,076 a year.

The trial began in late January, and the case went to the jury last Friday.

As the jury resumed deliberations in downtown Los Angeles, the verdict was clearly in on the streets of Bell.

One resident unfurled old protest banners and signs from the days when the pay scandal was first exposed and then called former members of an activist group that had led the charge for reform in the city.

"We're holding our breaths and waiting," Denise Rodarte, a member of the grassroots group Bell Assn. to Stop the Abuse, said in regard to a verdict.

"It's cut and dry: Local elected officials were supposed to make a certain amount of money, and they made a lot more."

corina.knoll@latimes.com

jeff.gottlieb@latimes.com

Times staff writer Ruben Vives contributed to this report.

Read More..

Lindsay Lohan driving case returns to LA court

LOS ANGELES (AP) — Lindsay Lohan's attorney returns to court Friday for a hearing in the actress's latest criminal case, as discussions continue about a possible plea deal before trial.

The 26-year-old isn't required to attend the hearing.

The hearing is intended to take care of any issues before a March 18 trial on misdemeanor charges that Lohan lied to police about a June car crash and was driving recklessly.

Attorney Mark Heller also plans to meet with prosecutors Friday to try to negotiate a plea deal. He wants to delay the case so Lohan can pursue psychotherapy and perform community service.

Lohan was on probation at the time of the accident and she faces jail time if a judge determines she violated her sentence in a 2011 theft case.

Read More..

The New Old Age Blog: Why Can’t I Live With People Like Me?

“Aging in place” is the mantra of long-term care. Whether looking at reams of survey data, talking to friends or wishing on a star, who among us wouldn’t rather spend the final years — golden or less so — at home, surrounded by our cherished possessions, in our own bed, no cranky old coot as a roommate, no institutional smells or sounds, no lukewarm meals on a schedule of someone else’s making?

That works best, experts tell us, in dense cities, where we can hail a cab at curbside, call the superintendent when something breaks and have our food delivered from Fresh Direct or countless takeout restaurants. We’d have neighbors in the apartment above us, below us, just on the other side of the wall. Hearing their toilets flush and their children ride tricycles on uncarpeted floors is a small inconvenience compared to the security of knowing they are so close by in an emergency.

Urban planners, mindful that most Americans live in sprawling, car-reliant suburbs, are designing more elder-friendly, walkable communities, far from “real” cities. Houses and apartments are built around village greens, with pockets of commerce instead of distant strip malls. Some have community centers for congregate meals and activities; others share gardens, where people can get their hands in the warm spring dirt long after they can push a lawn mower.

All of this is a step in the right direction, despite the Potemkin-village look of so many of them. But it doesn’t take into account those who are too infirm to stay at home, even in cities or more manageable suburban environments. Some are alone, others with a loving spouse who by comparison is “well” but may not be for long, given the rigors of care-taking. It doesn’t take into account people who can’t afford a home health aide, who don’t qualify for a visiting nurse, who have no adult children to help them or whose children live far away.

But by now, aging in place, unrealistic for some, scary or unsafe for others and potentially very isolating, has become so entrenched as the right way to live out one’s life that not being able to pull it off seems a failure, yet another defeat at a time when defeats are all too plentiful. Are we making people feel guilty if they can’t stay at home, or don’t want to? Are we discouraging an array of other solutions by investing so much, program-wise and emotionally, in this sine qua non?

Regular readers of The New Old Age know that I am single, childless and terrified of falling off a ladder while replacing a light bulb, breaking a hip and lying on the floor, unattended, until my dog wails so loudly a neighbor comes by to complain. A MedicAlert pendant is not something that appeals to me at 65, but even if I give in to that, say at 75, I’m not sure my life will be richer for digging my heels in and insisting home is where I should be.

So I spend a lot of time thinking about the alternatives. I know enough to distinguish between naturally-occurring-retirement communities, or NORCs (some of which work better than others); age-restricted housing complexes (with no services); assisted living (which works fine when you don’t really need it and not so fine when you do); and continuing care retirement communities (which require big upfront payments and extensive due diligence to be sure the place doesn’t go belly up after you get there).

What I find so unappealing about all these choices is that each means growing old among people with whom I share no history. In these congregate settings, for the most part, people are guaranteed only two things in common: age and infirmity. Which brings us to what is known in the trade as “affinity” or “niche” communities,” long studied by Andrew J. Carle at the College of Health and Human Services at George Mason University in Fairfax, Va.

Mr. Carle, who trains future administrators of senior housing complexes, was a media darling a few years back, before the recession, with the first baby boomers approaching 65 and niche communities that included services for the elderly — not merely warm-weather developments adjacent to golf courses — expected to explode. In newspaper interviews as recently as 2011, Mr. Carle said there were “about 100 of them in existence or on the drawing board,” not counting the large number of military old-age communities.

Mr. Carle still believes that better economic times, when they come, will reinvigorate this sector of senior housing, after the failure of some in the planning stages and others in operation. In an e-mail exchange, Mr. Carle said there were now about 70 in operation, with perhaps 50 of those that he has defined as University Based Retirement Communities, adjacent to campuses and popular with alumni, as well as non-alumni, who enjoy proximity to the intellectual and athletic activities. Among the most popular are those near Dartmouth, Oberlin, the University of Alabama, Penn State, Notre Dame, Stanford and Cornell.

At the height of the “affinity” boom, L.G.B.T.-assisted living communities and nursing homes were all the rage, seen as a solution to the shoddy treatment that those of different sexual orientations in the pre-Stonewall generation experienced in generic facilities. A few failed, most never got built and, by all accounts, the only one to survive is the pricy Rainbow Vision community in Sante Fe, N.M.

A handful of nudist elder communities, and ones for old hippies, also fell by the wayside, perhaps too free-spirited for the task. According to Mr. Carle, despite the odds, at least one group of RV enthusiasts has added an assisted-living component to what began as collections of transient elderly, looking only for a parking spot and necessary water and power hook-ups for their trailers. Native Americans have made a go of an assisted-living community in Montana, and Asians have done the same in Northern California.

But professional affinity communities, which I find most appealing, are few and far between.

The storied Motion Picture & Television Country House and Hospital, a sliding-scale institution in the San Fernando Valley since 1940, survived near-closure in 2009 as a result of litigation, activism by the Screen Actors Guild and the local chapter of the Teamsters, and news media pressure. Among film legends who died there — along with cameramen, back-lot security guards and extras — were Mary Astor, Joel McCrea, Yvonne De Carlo and Stepin Fetchit.

New York State’s volunteer firefighters are all welcome to a refurbished facility in the Catskill region that offers far more in the way of care and activities, including a state-of-the-art gym, than when I visited there five years ago. At that time, the residents amused themselves by activating the fire alarm to summon the local hook and ladder company, which didn’t mind a bit.

Then there is Nalcrest, the retirement home for unionized letter carriers. Even as post offices nationwide are preparing to eliminate Saturday service, and snail mail becomes an artifact, the National Association of Letter Carriers holds monthly fees around the $500 mark, is located in central Florida so its members no longer have to brave rain and sleet to complete their appointed rounds, and bans dogs, the bane of their existence.

So why not aged journalists? We surely have war stories to embroider as we rock on the porch. Perhaps a mimeograph machine to produce an old-fashioned, dead-tree newspaper, which some of us will miss once it has given way to Web sites like this one. Pneumatic tubes, one colleague suggested, to whisk our belongings upstairs when we can no longer carry them. Other colleagues wondered about welcoming both editors and reporters. How can these two groups, which some consider natural adversaries, complain about each others’ tin ears or missed deadlines if we’re not segregated?

I disagree. The joy of this profession is its collaboration. We did the impossible day after day when young. We belong together when old.

---

Read More..

Airports big and small may feel effects of federal budget feud

Get ready for longer lines at Los Angeles International Airport, slower delivery of packages and the possible shutdown of small Southern California airport control towers if a resolution isn't reached on federal budget cuts.

The good news is that the biggest effects probably will not take hold until April, giving President Obama and congressional leaders time to hammer out a deal to resolve the budget feud.

But if no agreement is reached, the Federal Aviation Administration will be forced to cut its budget about $600 million. That could force the FAA to close more than 100 air traffic control towers across the country, primarily at smaller regional airports, including in Santa Monica, Victorville and Oxnard.

The night shift for air traffic controllers could also be eliminated at about 70 larger airports, including LA/Ontario International.

The federal agency has also put out the option of furloughing FAA employees for one or two days per two-week pay period, beginning in mid-April.

At Los Angeles International Airport, officials say it is too early to gauge how much of an effect the budget cuts would have on the average air traveler.

But Transportation Security Administration head John Pistole said lines at security gates at major airports across the country could grow longer during the peak spring and summer travel seasons if he is forced to cut overtime pay, which would reduce the number of screening officers.

"The longer it goes, the greater the potential impact," he said of the budget battle.

The National Air Traffic Controllers Assn. expects the cuts to lead to fewer flights and increased delays of as long as 90 minutes during peak hours.

"Safety will remain the top priority, but in order to maintain the appropriate level of safety with fewer controllers, fewer planes will be allowed in the sky, as well as in and out of airports," the group said in a statement.

The FAA has announced plans to shut down towers at airports with fewer than 150,000 landings and takeoffs a year. Santa Monica Airport, which is on the FAA closure list, operates about 105,000 landings and takeoffs a year. Van Nuys Airport, which is not on the list, has more than 250,000 landings and takeoffs.

Still, the effect on smaller airports on the FAA cut list may not be severe because pilots can land and depart without the help of an air traffic controller by keeping track of each other through radio communications.

Joe Justice, who operates Justice Aviation, a company that offers flying lessons at Santa Monica Airport, said he doesn't expect his business to face major changes if the tower is closed.

"We would continue to give flying lessons," he said. "There would be no reason not to. We would depart here and practice at a place where there is an open tower."

Private jet charter companies said they may even get more business if sequestration increases delays on commercial airlines, forcing passengers to charter a jet.

"People who are sitting on the fence about wanting to hire a private jet may spend the extra money so they won't be caught in a situation where they have no idea how long their delays will be," said Ben Schusterman, founder of Los Angeles-based ElJet.

The closure of overnight shifts at the control tower in Ontario could eliminate 12 passenger flights, or 9% of operations, but a bigger effect would be the loss of 73 cargo flights, or 36% of all cargo operations.

Cargo operators at Ontario said they were still unsure of the effect of budget cuts on their businesses.

"UPS is closely monitoring the sequestration proceedings," United Parcel Service Inc. spokesman Mike Mangeot said. "And while we are in communications with the FAA regarding the effects of the possible cuts, it is premature to speculate at this time."

hugo.martin@latimes.com

Read More..

DNA science points to better treatment for acne

Ancient Egyptians were vexed by it, using sulfur to dry it out. Shakespeare wrote of its "bubukles, and whelks, and knobs, and flames o' fire."

Today, acne plagues us still. Doctors can cure some cancers and transplant vital organs like hearts, but they still have trouble getting rid of the pimples and splotches that plague 85% of us at some time in our lives — usually, when we're teenagers and particularly sensitive about they way we look.

But new research hints that there's hope for zapping zits in the future, thanks to advances in genetic research.

Using state-of-the-art DNA sequencing techniques to evaluate the bacteria lurking in the pores of 101 study volunteers' noses, scientists discovered a particular strain of Propionibacterium acnes bacteria that may be able to defend against other versions of P. acnes that pack a bigger breakout-causing punch.

As best as dermatologists can tell, zits occur when bacteria that reside in human skin, including P. acnes, feed on oils in the pores and prompt an immune response that results in red, sometimes pus-filled bumps. But the study subjects who had the newly discovered bacterial strain weren't suffering from whiteheads or blackheads, according to a report published Thursday in the Journal of Investigative Dermatology.

Someday, the realization that "not all P. acnes are created equal" might help dermatologists devise treatments that more precisely target bad strains while allowing beneficial ones to thrive, said Dr. Noah Craft, a dermatologist at the Los Angeles Biomedical Research Institute who conducted the study with colleagues from UCLA and Washington University in St. Louis.

Doctors might prescribe probiotic creams that deliver "good" P. acnes to the face the same way a daily serving of yogurt helps restore healthy bacteria in the digestive tract.

"There are healthy strains that we need on our skin," Craft said. "The idea that you'd use a nuclear bomb to kill everything — what we're currently doing with antibiotics and other treatments — just doesn't make sense."

The research is part of a broad effort backed by the National Institutes of Health to characterize the so-called human microbiome: the trillions of microbes that live in and on our bodies and evolve along with us, sometimes causing illness and often promoting good health.

Most of the microbiome attention so far has gone to studying species in the gut, said study leader Huiying Li, an assistant professor of molecular and medical pharmacology at UCLA's Geffen School of Medicine. But the NIH's Human Microbiome Project, which funds her research, also looks at microbial communities in the nasal passages, the mouth, the urogenital tract and the skin.

Li said she became interested in studying acne because the skin microbiome seemed particularly understudied.

The research team recruited 101 patients in their teens and 20s from dermatology clinics in Southern California. Among them, 49 had acne and 52 had "normal skin" and were not experiencing breakouts but had come to the clinics for other problems.

Doctors used adhesive pore strips to remove skin bacteria from patients' noses. The researchers then collected the waxy plugs — a combination of bacteria, oils, dead skin cells and other stuff — and used DNA to figure out which bacteria were present.

They found that the P. acnes species accounted for about 90% of the bacteria in pores, in both healthy patients and acne sufferers. Digging a little deeper into the DNA, they found that two particular strains appeared in about 20% of acne sufferers, while a third strain was found only in acne-free patients.

"Dogs are dogs, but a Chihuahua isn't a Great Dane," Craft said. "People with acne had pit bulls on their skin. Healthy people had poodles."

The team then sequenced the complete genomes — about 2.6 million base pairs apiece — of 66 of the P. acnes specimens to explore in more depth how the good and bad strains differed.

The two notable bad strains had genes, probably picked up from other bacteria or viruses, that are thought to change the shape of a microbe to make it more virulent. The researchers hypothesized that the foreign DNA, perhaps by sticking more effectively to human host tissues, may help trigger an inflammatory response in the skin: acne.

The good strain, on the other hand, contained an element known to work like an immune system in bacteria, Li said. Perhaps it allows this P. acne to fight off intruders and prevent pimples from forming.

Li said the researchers did not know why some people had the bad P. acnes strains and others did not, and whether genetics or environment played a bigger role.

Dr. Vincent Young, who conducts microbiome research at the University of Michigan Medical School but wasn't involved in the acne project, said advances in sequencing technology and analysis made the new study possible. In the past, he said, scientists wouldn't have tried to sequence dozens of genomes in a single species.

"They'd say, why waste the money?" he said. "Now you can do this in a couple of days."

Li and Craft — neither of whom suffered bad acne as teens — plan to keep up the work.

More research is needed to come up with super-targeted anti-microbial therapies, or to develop a probiotic cream for acne sufferers.

Craft continues collecting samples from patients' pores. He hopes to study whether twins share the same microbial profiles, how acne severity is reflected in bacteria populations, and how things change in a single patient over the course of a treatment regimen.

One of the study volunteers, 19-year-old UC Santa Cruz student Brandon Pritzker, said he would have loved to have treated his acne without affecting the rest of his body. When he took Accutane, he suffered back pain and mood shifts.

Now off the drug, Pritzker said he is at peace with his pimples. "I still have breakouts, but I figure I'm 19, that's the way it's going to be," he said.

But, he added, "it hindered my confidence at the time. Kids with clear skin are probably a little happier."

eryn.brown@latimes.com

Read More..

Steven Spielberg to head Cannes jury this year

PARIS (AP) — France's Cannes Film Festival says it has finally snagged Steven Spielberg to serve as president of the award jury.

Gilles Jacob, the festival's president, recounted how he had been trying to get the award-winning director to head the jury for years — but the American was always working. Finally, this year, Spielberg got in touch.

"When this year I was told 'E.T., phone home,' I understood and immediately replied: 'At last!'" Jacob said in a statement posted on the festival's website Thursday.

Spielberg, who was nominated but didn't win the directing Oscar for his biopic "Lincoln" this week, takes the reins from Italian Nanni Moretti. The 66th Cannes festival takes place in the glamorous French Mediterranean resort from May 15 to 26.

Spielberg's presence will likely give more of an American flavor this year to the Cannes festival, a mélange of intellectual international cinema and Hollywood glamour. Jury presidents in the festival's seven-decade history have included such figures as Tennessee Williams, Ingrid Bergman, Roman Polanski and Francis Ford Coppola.

Spielberg has had several films show at Cannes, and "E.T." had its world premiere there in 1982. His first film, "Sugarland Express," won best screenplay at Cannes in 1974.

"It is an honor and a privilege to preside over the jury of a festival that proves, again and again, that cinema is the language of the world," Spielberg was quoted as saying in a statement by the Cannes festival organizers. "The most prestigious of its kind, the festival has always established the motion picture as a cross cultural and generational medium."

At last year's Cannes festival, Michael Haneke won the top prize with his stark film about love and death, "Amour."

Read More..

Well: Think Like a Doctor: The Man Who Wobbled

The Challenge: Can you solve the medical mystery of a man who suddenly becomes too dizzy to walk?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to try their hand at solving a medical mystery. Below you will find the story of a 56-year-old factory worker with dizziness and panic attacks. I have provided records from his two hospital visits that will give you all the information available to the doctor who finally made the diagnosis.

The first reader to offer the correct diagnosis gets a signed copy of my book, “Every Patient Tells a Story,” and the satisfaction of solving a case that stumped a roomful of specialists.

The Patient’s Story:

The middle-aged man clicked his way through the multiple reruns of late-late-night television. He should have been in bed hours ago, but lately he hadn’t been able to get to sleep. Suddenly his legs took on a life of their own. Stretched out halfway to the center of the room, they began to shake and twitch and jump around. The man watched helplessly as his legs disobeyed his mental orders to stop moving. He had no control over them. He felt nauseous, sweaty and out of breath, as if he had been running some kind of race. He called out to his wife. She hurried out of bed, took one look at him and called 911.

The Patient’s History:

By the time the man arrived at Huntsville Hospital, in Alabama, the twitching in his legs had subsided and his breathing had returned to normal. Still, he had been discharged from that same hospital for similar symptoms just two weeks earlier. They hadn’t figured out what was going on then, so they weren’t going to send him home now.

The patient considered himself pretty healthy, but the past year or so had been tough. In 2011, at the age of 54, he had had a mild stroke. He had no medical problems that put him at risk for stroke — no high blood pressure, no high cholesterol, no diabetes. A work-up at that time showed that he had a hole in his heart that allowed a tiny clot from somewhere in his body to travel to the brain and cause the stroke. He was discharged on a couple of blood thinners to keep his blood from making more clots. He hadn’t really felt completely well, though, ever since. His balance seemed a little off, and he was subject to these weird panic attacks, in which his heart would pound and he would feel short of breath whenever he got too stressed. Mostly he could manage them by just walking away and focusing on his breathing. Still, he never felt as if he was the kind of guy to panic.

And he had always been quick on his feet. The first half of his career he had been in the steel business — building huge metal trusses and supports. He and his team put together 60-plus tons of steel structures every day. For the past decade he had been machining car parts. After his stroke, work seemed to get a lot harder.

The Dizziness:

A few weeks ago, he stood up and wham — suddenly the whole world went off-kilter. He felt as if he was constantly about to fall over in a world that no longer lay down flat. His first thought was that he was having another stroke. He went straight to his doctor’s office. The doctor wasn’t sure what was going on and sent him to that same emergency room at Huntsville Hospital. After three days of testing and being evaluated by lots of specialists, his doctors still were not sure what was going on. He hadn’t had a heart attack; he hadn’t had a stroke. There was no sign of infection. All the tests they could think of were normal.

The only abnormal finding was that when he stood up, his blood pressure dropped. Why this happened wasn’t clear, but the doctors in the hospital gave him compression stockings and a pill — both could help keep his blood pressure in the normal range. Then they sent him home. He was also started on an antidepressant to help with the panic attacks he continued to have from time to time.

You can read the report from that hospital admission below.

You can also read the consultation and discharge notes from that hospital visit here.

He had been home for nearly two weeks and still he felt no better. He tried to go back to work after a week or so at home, but after driving for less than five miles, he felt he had to turn around. He wasn’t sure what was wrong; he just knew he didn’t feel right. Then his legs started jumping around, and he ended up back in the hospital.

The Doctor’s Exam:

It was nearly dawn by the time Dr. Jeremy Thompson, the first-year resident on duty that night, saw the patient. Awake but tired, the patient told his story one more time. He had been at home, watching TV, when his legs started jumping on their own and he started feeling short of breath. His wife sat at the bedside. She looked just as worried and exhausted as he did. She told the resident that when he spoke that night at home, his speech was slurred. And when the ambulance came, he could barely walk. He has never missed this much work, she told the young doctor. It’s not like him. Can’t you figure out what’s wrong?

The resident had already reviewed the records from the patient’s previous hospital admissions. He asked a few more questions: the patient had never smoked and rarely drank; his father died at age 80; his mother was still alive and well. The patient exam was normal, as were the studies done in the E.R.

The first E.R. doctor thought that his symptoms were a result of anxiety, culminating in a full-blown panic attack. The resident thought that was probably right. In any case he would discuss the case with the attending in a couple of hours during rounds on the new patients. Till then, he told the worried couple, they should just try to get a little sleep.

An Important Clue:

Dr. Robert Centor was definitely a morning person. His cheerful enthusiasm about teaching and taking care of patients made him a favorite among residents. At 7:30 that morning, he stood outside the patient’s door as Dr. Thompson relayed the somewhat frustrating case of the middle-aged man with worsening dizziness and panic attacks. Then they went into the room to meet the patient. He was a big guy, tall and muscular with the first signs of middle-aged thickening around his middle. His complexion had the look of someone who spent a lot of time outdoors. Dr. Centor introduced himself and pulled up a chair as the rest of the team watched. He asked the patient what brought him to the hospital.

“Every time I get up, I get dizzy,” the man replied. Sure, he had had some balance problems ever since his stroke, he explained, but this felt different – somehow worse. He could hardly walk, he told the doctor. He just felt too unstable.

“Can you get up and show us how you walk?” Dr. Centor asked.

“Don’t let me fall,” the patient responded. He carefully swung his legs over the side of the bed. The resident and intern stood on either side as he slowly rose. He stood with his feet far apart. When asked to close his eyes as he stood there, he wobbled and nearly fell over. When he took a few steps, his heel and toes hit the ground at the same time, making a strange slapping sound.

Seeing that, Dr. Centor knew where the problem lay and ordered a few tests to confirm his diagnosis.

You can see the review report and notes for the patient’s second hospital visit below.

Solving the Mystery:

What tests did Dr. Centor order? Do you know what is making this middle-aged man wobble? Enter your guesses below. I’ll post the answer tomorrow.

---

Rules and Regulations: Post your questions and diagnosis in the Comments section below. The correct answer will appear tomorrow on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

.

Read More..

Island Air is Ellison's latest buy

How do you follow the purchase of an island in Hawaii?

If you're Oracle Chief Executive Larry Ellison, you buy an airline so you can hop to and from your tropical paradise.

Ellison has been on a shopping spree lately, buying 98% of the island of Lanai in June from Los Angeles billionaire David Murdock and then, in November, buying a beachfront Malibu home from film and TV producer Jerry Bruckheimer.

Ellison's most risky acquisition may be Island Air, which he bought Wednesday through a holding company.

The exact purchase prices of Ellison's recent deals have not been disclosed, but local observers value the 141-square-mile island at more than $500 million and the three-bedroom, three-bath Malibu pad at more than $3.65 million. The details of the airline deal were not announced.

Island Air, a regional carrier serving airports on all major Hawaiian islands, has 245 employees and three turboprop planes, with 224 weekly flights between the islands of Oahu, Maui, Molokai, Lanai and Kauai.

Lanai, the sixth-largest Hawaiian island, was once a pineapple plantation and is still sparsely inhabited. It includes two resort hotels and two golf courses with clubhouses, according to Hawaii's Public Utilities Commission.

But Ellison did not buy the airline just to get to and from his island, airline officials say.

He hopes to expand the businesses to serve locals visiting relatives on the islands and to fly mainland and foreign tourists throughout the island state, airline officials said. The airline plans to retire two 1980s-era planes and expand to four or five new ATR 72 turboprops by the end of the year.

But Ellison should not get his hopes up about pocketing big profits, said Ray Neidl, an aviation analyst for Nexa Capital Partners in Washington, D.C.

"It's a high-risk situation with no significant margins, at least initially," he said of owning an airline.

And if Ellison hopes to expand the business, he should expect to get some resistance from the big carrier on the island, Hawaiian Airlines, Neidl added. "It really depends on what Hawaiian does."

Island Air began in 1980 as Princeville Airways, carrying passengers from Kauai to Honolulu. The history of the carrier has not always been blue skies and soft landings.

"In our 30-plus years, we had our ups and downs, pardon the pun," said Michael Rodyniuk, a senior consultant to the airline.

Like most airlines across the country, he said, Island Air struggled during the economic turmoil between 2008 and 2012 but expects to thrive with a surge in tourism that Hawaii has been enjoying in the past year or so.

The state welcomed a record 8 million visitors in 2012, surpassing the previous high of 7.6 million visitors in 2006.

"All major markets are up," Rodyniuk said.

The previous owner of the airline, California businessman Charles Willis IV, had been looking for a buyer for the airline and had put all 245 employees on notice that layoffs could begin as soon as March 11 if a buyer was not found, he said. "So Mr. Ellison saved 245 jobs," Rodyniuk said.

Forbes ranks Ellison as the third-richest American, with a net worth of $36 billion. He has cut big checks in the past on high-priced properties in Malibu, Lake Tahoe, Rancho Mirage and other locations.

But unlike real estate, air carriers are an investment that can give investors nightmares.

Virgin America, a California-based airline partly owned by millionaire Richard Branson, has been operating for more than five years without recording a profitable year.

California Pacific Airlines is the brainchild of Encinitas businessman Ted Vallas, who has already invested more than $6 million of his own money but has spent the last year trying to clear federal red tape so he can begin selling tickets.

And then there are the 11 other airlines — including American, Delta, United and US Airways — that have filed for bankruptcy since 2000.

"The profit margins on airlines, even though they are improving, are not that attractive," Neidl said.

hugo.martin@latimes.com

Read More..