Americans answer D.C.’s siren song of employment, strong economy

WASHINGTON (Reuters) – Thirteen years ago the band The Magnetic Fields crooned that the U.S. capital city is “the greatest place to be,” in the indie love song “Washington, D.C.”

Recently, a growing number of Americans are singing along as they move to the District in search of jobs, economic opportunity and cultural attractions.

In a study on migration provided exclusively to Reuters that is set to be released next month, United Van Lines found the District of Columbia tops all 50 states for the number of people moving in during 2012.

The city has held that spot for five years running, with 64 percent of the household moves in Washington coming from outside the city in 2012.

United Van Lines is the largest moving company in the country for households.

Oregon ranked second, followed by Nevada, North Carolina and South Carolina. Washington is a city that does not belong to a state, but is subject to loose control from the federal government.

“Washington, D.C., is unique because over the last five years its unemployment rate was not hit as hard by the Great Recession,” said Michael Stoll, chair and professor of public policy at the University of California at Los Angeles about the study. “But I think the other thing is that the city has remade itself from the one we knew 10 to 15 years ago.”

Washington has shed its reputation as the crime capital of the country, and it has developed a high technology corridor and other businesses that are both stable and hiring, said Stoll.

Also, many members of the Baby Boom generation are moving in as they retire, taking advantage of the free museums, monuments and cultural events the city has to offer, he said.

The rising popularity could yield a result also unthinkable less than two decades ago.

“D.C. will not just be a place of tourism. It will be a major economic engine, which many of us haven’t thought of it as being before,” Stoll said.

A U.S. Census report released on Thursday also showed the city is gaining new residents. Washington’s population increased 2.15 percent between July 2011 and July 2012, a rise second only to North Dakota.

The District’s population increase of 5.1 percent from 2010 to 2012 was the biggest in the country, the Census found. It had had 632,323 residents as of July 1.

The city has a large international community, largely due to the presence of foreign embassies and organizations such as the World Bank. The Census found people from other countries made up 32 percent of the net migration from 2011 to 2012.

According to a Labor Department report released on Friday, the District’s unemployment rate fell in November to 8.1 percent from 10.1 percent the year before. Local political leaders point to a development boom and one of the highest median incomes in the country – $ 63,124 – as other draws to the city.

On a national level, Stoll said, the migration patterns show Americans are seeking economic opportunity in places where new manufacturing and technology enterprises are building up. The patterns reveal a swelling group of aging people who are retiring and looking for affordable and comfortable places to live, as well.

He added that many people who wanted to move to California, but were put off by the state’s economic woes, turned their moving vans north to Oregon.

New Jersey topped states for outward moves, in 2012, the United Van Lines study showed, largely due to a shrinking factory sector. It was followed by Illinois, West Virginia, Michigan and New York.

Washington’s popularity surge recently created a paradox in the city’s economic success story. Last month, the Brookings Institution concluded three U.S. metropolitan areas are in economic recovery, but did not include Washington because its population burst drove down its gross domestic product on a per capita basis.

(Reporting By Lisa Lambert; Editing by Leslie Adler)

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Genetic Gamble : Drugs Aim to Make Several Types of Cancer Self-Destruct

C.J. Gunther for The New York Times

Dr. Donald Bergstrom is a cancer specialist at Sanofi, one of three companies working on a drug to restore a tendency of damaged cells to self-destruct.

For the first time ever, three pharmaceutical companies are poised to test whether new drugs can work against a wide range of cancers independently of where they originated — breast, prostate, liver, lung. The drugs go after an aberration involving a cancer gene fundamental to tumor growth. Many scientists see this as the beginning of a new genetic age in cancer research.

Great uncertainties remain, but such drugs could mean new treatments for rare, neglected cancers, as well as common ones. Merck, Roche and Sanofi are racing to develop their own versions of a drug they hope will restore a mechanism that normally makes badly damaged cells self-destruct and could potentially be used against half of all cancers.

No pharmaceutical company has ever conducted a major clinical trial of a drug in patients who have many different kinds of cancer, researchers and federal regulators say. “This is a taste of the future in cancer drug development,” said Dr. Otis Webb Brawley, the chief medical and scientific officer of the American Cancer Society. “I expect the organ from which the cancer came from will be less important in the future and the molecular target more important,” he added.

And this has major implications for cancer philanthropy, experts say. Advocacy groups should shift from fund-raising for particular cancers to pushing for research aimed at many kinds of cancer at once, Dr. Brawley said. John Walter, the chief executive officer of the Leukemia and Lymphoma Society, concurred, saying that by pooling forces “our strength can be leveraged.”

At the heart of this search for new cancer drugs are patients like Joe Bellino, who was a post office clerk until his cancer made him too sick to work. Seven years ago, he went into the hospital for hernia surgery, only to learn he had liposarcoma, a rare cancer of fat cells. A large tumor was wrapped around a cord that connects the testicle to the abdomen. “I was shocked,” he said in an interview this summer.

Companies have long ignored liposarcoma, seeing no market for drugs to treat a cancer that strikes so few. But it is ideal for testing Sanofi’s drug because the tumors nearly always have the exact genetic problem the drug was meant to attack — a fusion of two large proteins. If the drug works, it should bring these raging cancers to a halt. Then Sanofi would test the drug on a broad range of cancers with a similar genetic alteration. But if the drug fails against liposarcoma, Sanofi will reluctantly admit defeat.

“For us, this is a go/no-go situation,” said Laurent Debussche, a Sanofi scientist who leads the company’s research on the drug.

The genetic alteration the drug targets has tantalized researchers for decades. Normal healthy cells have a mechanism that tells them to die if their DNA is too badly damaged to repair. Cancer cells have grotesquely damaged DNA, so ordinarily they would self-destruct. A protein known as p53 that Dr. Gary Gilliland of Merck calls the cell’s angel of death normally sets things in motion. But cancer cells disable p53, either directly, with a mutation, or indirectly, by attaching the p53 protein to another cellular protein that blocks it. The dream of cancer researchers has long been to reanimate p53 in cancer cells so they will die on their own.

The p53 story began in earnest about 20 years ago. Excitement ran so high that, in 1993, Science magazine anointed it Molecule of the Year and put it on the cover. An editorial held out the possibility of “a cure of a terrible killer in the not too distant future.”

Companies began chasing a drug to restore p53 in cells where it was disabled by mutations. But while scientists know how to block genes, they have not figured out how to add or restore them. Researchers tried gene therapy, adding good copies of the p53 gene to cancer cells. That did not work.

Then, instead of going after mutated p53 genes, they went after half of cancers that used the alternative route to disable p53, blocking it by attaching it to a protein known as MDM2. When the two proteins stick together, the p53 protein no longer functions. Maybe, researchers thought, they could find a molecule to wedge itself between the two proteins and pry them apart.

The problem was that both proteins are huge and cling tightly to each other. Drug molecules are typically tiny. How could they find one that could separate these two bruisers, like a referee at a boxing match?

In 1996, researchers at Roche noticed a small pocket between the behemoths where a tiny molecule might slip in and pry them apart. It took six years, but Roche found such a molecule and named it Nutlin because the lab was in Nutley, N.J.

But Nutlins did not work as drugs because they were not absorbed into the body.

Roche, Merck and Sanofi persevered, testing thousands of molecules.

At Sanofi, the stubborn scientist leading the way, Dr. Debussche, maintained an obsession with p53 for two decades. Finally, in 2009, his team, together with Shaomeng Wang at the University of Michigan and a biotech company, Ascenta Therapeutics, found a promising compound.

The company tested the drug by pumping it each day into the stomachs of mice with sarcoma.

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Amazon Book Reviews Deleted in a Purge Aimed at Manipulation

Giving raves to family members is no longer acceptable. Neither is writers’ reviewing other writers. But showering five stars on a book you admittedly have not read is fine.

After several well-publicized cases involving writers buying or manipulating their reviews, Amazon is cracking down. Writers say thousands of reviews have been deleted from the shopping site in recent months.

Amazon has not said how many reviews it has killed, nor has it offered any public explanation. So its sweeping but hazy purge has generated an uproar about what it means to review in an era when everyone is an author and everyone is a reviewer.

Is a review merely a gesture of enthusiasm or should it be held to a higher standard? Should writers be allowed to pass judgment on peers the way they have always done offline or are they competitors whose reviews should be banned? Does a groundswell of raves for a new book mean anything if the author is soliciting the comments?

In a debate percolating on blogs and on Amazon itself, quite a few writers take a permissive view on these issues.

The mystery novelist J. A. Konrath, for example, does not see anything wrong with an author indulging in chicanery. “Customer buys book because of fake review = zero harm,” he wrote on his blog.

Some readers differ. An ad hoc group of purists has formed on Amazon to track its most prominent reviewer, Harriet Klausner, who has over 25,000 reviews. They do not see how she can read so much so fast or why her reviews are overwhelmingly — and, they say, misleadingly — exaltations.

“Everyone in this group will tell you that we’ve all been duped into buying books based on her reviews,” said Margie Brown, a retired city clerk from Arizona.

Once a populist gimmick, the reviews are vital to making sure a new product is not lost in the digital wilderness. Amazon has refined the reviewing process over the years, giving customers the opportunity to rate reviews and comment on them. It is layer after layer of possible criticism.

“A not-insubstantial chunk of their infrastructure is based on their reviews — and all of that depends on having reviews customers can trust,” said Edward W. Robertson, a science fiction novelist who has watched the debate closely.

Nowhere are reviews more crucial than with books, an industry in which Amazon captures nearly a third of every dollar spent. It values reviews more than other online booksellers like Apple or Barnes & Noble, featuring them prominently and using them to help decide which books to acquire for its own imprints by its relatively new publishing arm.

So writers have naturally been vying to get more, and better, notices. Several mystery writers, including R. J. Ellory, Stephen Leather and John Locke, have recently confessed to various forms of manipulation under the general category of “sock puppets,” or online identities used to deceive. That resulted in a widely circulated petition by a loose coalition of writers under the banner, “No Sock Puppets Here Please,” asking people to “vote for book reviews you can trust.”

In explaining its purge of reviews, Amazon has told some writers that “we do not allow reviews on behalf of a person or company with a financial interest in the product or a directly competing product. This includes authors.” But writers say that rule is not applied consistently.

In some cases, the ax fell on those with a direct relationship with the author.

“My sister’s and best friend’s reviews were removed from my books,” the author M. E. Franco said in a blog comment. “They happen to be two of my biggest fans.” Another writer, Valerie X. Armstrong, said her son’s five-star review of her book, “The Survival of the Fattest,” was removed. He immediately tried to put it back “and it wouldn’t take,” she wrote.

In other cases, though, the relationship was more tenuous. Michelle Gagnon lost three reviews on her young adult novel “Don’t Turn Around.” She said she did not know two of the reviewers, while the third was a longtime fan of her work. “How does Amazon know we know each other?” she said. “That’s where I started to get creeped out.”

Mr. Robertson suggested that Amazon applied a broad brush. “I believe they caught a lot of shady reviews, but a lot of innocent ones were erased, too,” he said. He figures the deleted reviews number in the thousands, or perhaps even 10,000.

The explosion of reviews for “The 4-Hour Chef” by Timothy Ferriss shows how the system has evolved from something spontaneous to a means of marketing and promotion. On Nov. 20, publication day, dozens of highly favorable reviews immediately sprouted. Other reviewers quickly criticized Mr. Ferriss, accusing him of buying supporters.

He laughed off those suggestions. “Not only would I never do that — it’s unethical — I simply don’t have to,” he wrote in an e-mail, saying he had sent several hundred review copies to fans and potential fans. “Does that stack the deck? Perhaps, but why send the book to someone who would hate it? That doesn’t help anyone: not the reader, nor the writer.”

As a demonstration of social media’s grip on reviewing, Mr. Ferriss used Twitter and Facebook to ask for a review. “Rallying my readers,” he called it. Within an hour, 61 had complied.

A few of his early reviews were written by people who admitted they had not read the book but were giving it five stars anyway because, well, they knew it would be terrific. “I am looking forward to reading this,” wrote a user posting under the name mhpics.

A spokesman for Amazon, which published “The 4-Hour Chef,” offered this sole comment for this article: “We do not require people to have experienced the product in order to review.”

The dispute over reviews is playing out in the discontent over Mrs. Klausner, an Amazon Hall of Fame reviewer for the last 11 years and undoubtedly one of the most prolific reviewers in literary history.

Mrs. Klausner published review No. 28,366, for “A Red Sun Also Rises” by Mark Hodder. Almost immediately, it had nine critical comments. The first accused it of being “riddled with errors in grammar, spelling and punctuation.” The rest were no more kind. The Harriet Klausner Appreciation Society had struck again.

Mrs. Klausner, a 60-year-old retired librarian who lives in Atlanta, has published an average of seven reviews a day for more than a decade. “To watch her in action is unbelievable,” said her husband, Stanley. “You see the pages turning.”

Mrs. Klausner, who says ailments keep her home and insomnia keeps her up, scoffs at her critics. “You ever read a Harlequin romance?” she said. “You can finish it in one hour. I’ve always been a speed reader.” She has a message for her naysayers: “Get a life. Read a book.”

More than 99.9 percent of Mrs. Klausner’s reviews are four or five stars. “If I can make it past the first 50 pages, that means I like it, and so I review it,” she said. But even Stanley said, “She’s soft, I won’t deny that.”

The campaign against Mrs. Klausner has pushed down her reviewer ratings, which in theory makes her less influential. But when everything is subject to review, the battle is never-ending.

Ragan Buckley, an aspiring novelist active in the campaign against Mrs. Klausner under the name “Sneaky Burrito,” is a little weary. “There are so many fake reviews that I’m often better off just walking into a physical store and picking an item off the shelf at random,” she said.

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Flawed data stall California's 911 upgrades

A three-year effort by California to improve 911 emergency service has been stymied by flawed data and aging computers at local fire departments and rescue agencies across the state, a Times investigation has found.

Since 2009, the state Emergency Medical Services Authority has been seeking to centralize reports on millions of emergency medical responses, a project that officials see as critical to improving life-saving practices.

State officials hoped to capture information from the moment dispatchers answer a call until the victim is transferred to a hospital. The program would for the first time give public officials, medical researchers and regulators the ability to compare response times and patient treatment across local jurisdictions.

But the project has floundered because many fire departments and ambulance operations have been unable to provide usable information.

One problem is that fire departments report basic information inconsistently, including how long it takes them to reach victims. Some begin counting the second a 911 call is answered. Others, including the Los Angeles Fire Department, start the clock when rescue crews are alerted at fire stations.

Moreover, nearly half of the state's 32 regional emergency medical agencies have failed to contribute reports to the system, officials said. And many of those who do file reports use paper records.

The shortcomings, officials and experts said, underscore how fire agencies lag behind police departments and the private sector in using technology to better manage and evaluate their performance.

"There's been a lot of benign neglect in the fire service as far as collecting data," said Robert Upson, a Connecticut fire marshal who has analyzed data for a nationwide group that sets performance standards for fire departments.

"There's so much sloppiness in recording data. It's just built into the system."

Similar troubles have fueled a months-long controversy over faulty response time data at the Los Angeles Fire Department. In March, top commanders admitted that the department had repeatedly published reports overstating how fast rescuers reached victims in need of help. The flawed reports have been blamed on the use of unqualified firefighters to analyze data and outdated computer systems.

In an effort to improve such data, California officials launched their program to collect rich, comparable details on medical emergencies statewide. Incident reports were to be gathered by regional regulatory agencies and forwarded to the state.

But three years and about $1.6 million later, the voluntary project is plagued by lack of participation, money problems and inconsistent information. The root of the problem is that some agencies rely on outmoded, "home-brewed" computer systems, said Tom McGinnis, the state official overseeing the project.

"We can't compare apples to apples. We compare apples to oranges and peaches," McGinnis said.

The state isn't forcing cash-strapped local agencies to participate because doing so would require many to replace computer systems, McGinnis said. "Really what it comes down to is money," he said.

Some experts say the state program won't be able to deliver on its promise until reporting standards are clarified and participation is mandatory.

"It should become a requirement tomorrow," said Bruce Wagner, the top administrator for the emergency medical services agency in Sacramento County.

His agency is among those that have not provided data to the state. That's because fire departments and ambulance firms under his jurisdiction are hesitant to spend time and money gathering records if they are not required to do so, Wagner said.

"It's hard for us to tell them they are going to incur additional costs if it's not mandated," he told The Times.

Los Angeles County, where a third of the state's 911 medical rescues take place, is a year behind in processing performance information because 28 of the county's 31 fire departments submit paper reports, said Cathy Chidester, the local oversight agency's top executive. Voluminous pages of information must be individually scanned into electronic files or manually typed into a county computer system.

"It's like sweeping sand off the beach," Chidester said.

Of the county's three largest fire departments — Los Angeles city, Los Angeles County and Long Beach — only the LAFD collects medical records electronically.

The county Fire Department has not filed reports on more than 300,000 incidents over the last two years because budget cuts eliminated employees working on the records, officials said. Next year, the agency is launching a test program in which paramedics will use iPads to create electronic reports, Chief Deputy Mike Metro said.

The state data project, known as CEMSIS, short for California Emergency Medical Services Information System, has also struggled for funding. It began as a $240,000-a-year demonstration project using federal grants and philanthropic donations. But no permanent funding has been secured.

Where possible, officials are attempting to use the partial records they have compiled for research. But thus far, they haven't been able to answer fundamental questions, including how different agencies' 911 response times compare, McGinnis said.

Ideally, McGinnis said, regulators could use the database to compare "the entire spectrum" of emergency medical care in California. "I want everybody to participate and see what we're doing statewide," he said.

Detailed data could improve understanding of what works best in the field. For example, researchers could examine how often rescuers are able to restore heartbeats after arriving on the scene, a key step in increasing cardiac-arrest survival rates, said Dr. Marc Eckstein, the medical director for the Los Angeles Fire Department.

"You have to really drill down to make sure we are talking about the right things," he said.

Slipping response times at the LAFD were only documented when outside experts, the city controller and The Times dug into the department's data. A series of Times reports found breakdowns and delays in processing 911 calls, dispatching units and summoning the nearest medical rescuers from neighboring jurisdictions.

Los Angeles Fire Commissioner Alan Skobin, who is overseeing a task force charged with overhauling the LAFD's data management, said programs such as California's fledgling 911 records system could help his agency compare its performance to other departments and improve service.

"There's a benefit to looking outside," Skobin said. "That's something the LAFD has to do."

Full coverage: Life on the line, 911 breakdowns at LAFD

Map: How fast is LAFD where you live?

Download: Open-source maps of California's emergency medical agencies

ben.welsh@latimes.com

robert.lopez@latimes.com

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TSX ends flat as RIM buckles, gold miners bounce

TORONTO (Reuters) – Canada‘s main stock index ended little changed on Friday as gold miners gained on safe-haven buying amid U.S. budget uncertainty, while BlackBerry maker Research In Motion Ltd plunged more than 20 percent.

The index’s materials sector, which includes miners, rose 0.4 percent. Even though the price of gold was near its lowest level in four months, the gold-mining sub-sector added 0.9 percent as investors fretted over stalled U.S. budget talks that could throw Canada’s largest trading partner back into recession.

“As our tiptoes are over the (U.S.) fiscal cliff and we’re looking over the abyss, the markets are upset obviously, and this is sort of putting a damper on the stocks,” said John Ing, president of Maison Placements Canada.

“But we’ve had a mixed reaction in Canada, mainly because the resources have been much better, like gold for example, which is hedging into the uncertainty (around the budget talks),” he said, noting gold miners had been under pressure for the last two weeks.

Miner Barrick Gold Corp edged up 0.2 percent to C$ 33.29. Centerra Gold Inc jumped more than 3 percent to C$ 9.10.

Gold miners are playing catch-up after underperforming throughout the year and could rise further in 2013, said Gavin Graham, president at Graham Investment Strategy.

Shares of RIM dropped 22.2 percent to C$ 10.86 on fears that a new fee structure for its high-margin services segment could put pressure on the business that has set the company apart from its competitors.

The Toronto Stock Exchange‘s S&P/TSX composite index <.gsptse> fell 3.01 points, or 0.02 percent, to end at 12,385.70. It gained 0.7 percent for the week.</.gsptse>

Efforts to avoid the looming U.S. “fiscal cliff” were thrown into disarray on Friday with finger-pointing lawmakers fleeing Washington for Christmas vacations even as the year-end deadline for action edged ever closer.

Graham said that until a deal is reached in the U.S. budget talks, investors will avoid economically sensitive Canadian stocks and those most closely tied to the U.S. economy: auto parts manufacturers, forestry companies and resource stocks generally.

“The resource sectors in Canada, which is half of the index, is going to be adversely affected, correctly or not,” he said.

“Chinese demand is likely to pick up somewhat now with the new leadership there but people will be focused on the U.S. given that it is still by far the most important export market for Canada.”

($ 1=$ 0.99 Canadian)

(Additional reporting by Claire Sibonney, Julie Gordon and Jeffrey Hodgson; Editing by Peter Galloway)

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Ashton Kutcher files for divorce from Demi Moore

LOS ANGELES (AP) — Ashton Kutcher filed court papers Friday to end his seven-year marriage to actress Demi Moore.

The actor’s divorce petition cites irreconcilable differences and does not list a date that the couple separated. Moore announced last year that she was ending her marriage to the actor 15 years her junior, but she never filed a petition.

Kutcher’s filing does not indicate that the couple has a prenuptial agreement. The filing states Kutcher signed the document Friday, hours before it was filed in Los Angeles Superior Court.

Kutcher and Moore married in September 2005 and until recently kept their relationship very public, communicating with each other and fans on the social networking site Twitter. After their breakup, Moore changed her name on the site from (at)mrskutcher to (at)justdemi.

Kutcher currently stars on CBS’ “Two and a Half Men.”

Messages sent to Kutcher’s and Moore’s publicists were not immediately returned Friday.

Moore, 50, and Kutcher, 34, created the DNA Foundation, also known as the Demi and Ashton Foundation, in 2010 to combat the organized sexual exploitation of girls around the globe. They later lent their support to the United Nations’ efforts to fight human trafficking, a scourge the international organization estimates affects about 2.5 million people worldwide.

Moore was previously married to actor Bruce Willis for 13 years. They had three daughters together — Rumer, Scout and Tallulah Belle — before divorcing in 2000. Willis later married model-actress Emma Heming in an intimate 2009 ceremony at his home in Parrot Cay in the Turks and Caicos Islands that attended by their children, as well as Moore and Kutcher.

Kutcher has been dating former “That ’70s Show” co-star Mila Kunis.

The divorce filing was first reported Friday by People magazine.

___

Anthony McCartney can be reached at http://twitter.com/mccartneyAP.

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About New York: One Boy’s Death Moves State to Action to Prevent Others

Prompted by the death of a 12-year-old Queens boy in April, New York health officials are poised to make their state the first in the nation to require that hospitals aggressively look for sepsis in patients so treatment can begin sooner. Under the regulations, which are now being drafted, the hospitals will also have to publicly report the results of their efforts.

The action by New York has elated sepsis researchers and experts, including members of a national panel who this month formally recommended that the federal government adopt standards similar to what the state is planning.

Though little known, sepsis, an abnormal and self-destructive immune response to infection or illness, is a leading cause of death in hospitals. It often progresses to severely low blood pressure, shock and organ failure.

Over the last decade, a global consortium of doctors, researchers, hospitals and advocates has developed guidelines on early identification and treatment of sepsis that it says have led to significant drops in mortality rates. But first hints of the problem, like a high pulse rate and fever, often are hard for clinicians to tell apart from routine miseries that go along with the flu or cold.

“First and foremost, they need to suspect sepsis,” Dr. Mitchell M. Levy, a professor at Brown University School of Medicine and a lead author of a paper on the latest sepsis treatment guidelines to be published simultaneously next month in the United States in a journal, Critical Care Medicine, and in Europe in Intensive Care Medicine.

“It’s the most common killer in intensive care units,” Dr. Levy said. “It kills more people than breast cancer, lung cancer and stroke combined.”

If started early enough, the treatment, which includes antibiotics and fluids, can help people escape from the drastic vortex of sepsis, according to findings by researchers working with the Surviving Sepsis Campaign, the global consortium. The tactics led to a reduction of “relative risk mortality by 40 percent,” Dr. Levy said.

Although studies of 30,000 patients show that the guidelines save lives, “the problem is that many hospitals are not adhering to them,” said Dr. Clifford S. Deutschman, director of the sepsis research program at the Perelman School of Medicine at the University of Pennsylvania and the president of the Society of Critical Care Medicine.

About 300 hospitals participate in the study, and the consortium has a goal of having 10,000. “The case is irrefutable: if you take these sepsis measures, and you build a program to help clinicians and hospitals suspect sepsis and identify it early, that will mean more people will survive,” Dr. Levy said.

At a symposium in October, the New York health commissioner, Dr. Nirav R. Shah, said that he would require state hospitals to adopt best practices for early identification and treatment of sepsis. Gov. Andrew M. Cuomo intends to make it a major initiative in 2013, said Josh Vlasto, a spokesman for the governor. “The state is taking unprecedented measures to prevent and effectively treat sepsis in health care facilities across the state and is looking at a wide range of additional measures to better protect patients,” Mr. Vlasto said.

In April, Rory Staunton, a sixth grader from Queens, died of severe septic shock after he became infected, apparently through a cut he suffered while playing basketball. The severity of his illness was not recognized when he was treated in the emergency room at NYU Langone Medical Center. He was sent home with a diagnosis of an ordinary bellyache. Hours later, alarming laboratory results became available that suggested he was critically ill, but neither he nor his family was contacted. For an About New York column in The New York Times, Rory’s parents, Ciaran and Orlaith Staunton, publicly discussed their son’s final days. Their revelations prompted doctors and hospitals across the country to seek new approaches to heading off medical errors.

In addition, Commissioner Shah in New York convened a symposium on sepsis, which included presentations from medical experts and Rory’s parents.

At the end of the meeting, Dr. Shah said that he had listened to all the statistics on the prevalence of the illness, and that one had stuck in his memory: “Twenty-five percent,” he said — the portion of the Staunton family lost to sepsis.

He said he would issue new regulations requiring hospitals to use best practices in identifying and treating sepsis, actions that, he said, he was taking “in honor of Rory Staunton.”

The governor’s spokesman, Mr. Vlasto, said that “the Staunton family’s advocacy has been essential to creating a strong public will for action.”

Dr. Levy said New York’s actions were “bold, pioneering and grounded in good scientific evidence,” adding, “The commissioner has taken the first step even before the federal government.”

Dr. Deutschman said that initiatives like those in New York were needed to overcome resistance among doctors. “You’re talking about a profession that has always prided itself on its autonomy,” he said. “They don’t like to be told that they’re wrong about something.”

The availability of proven therapies should move treatment of sepsis into a new era, experts say, comparing it to how heart attacks were handled not long ago. People arriving in emergency rooms with chest pains were basically put to bed because not much could be done for them, said Dr. Kevin J. Tracey, the president of the Feinstein Institute for Medical Research at North Shore-Long Island Jewish Health System. Dr. Tracey, a neurosurgeon, has made major discoveries about the relationship between the nervous system and the runaway immune responses of sepsis.

If physicians and nurses were trained to watch for sepsis, as they now routinely do for heart attacks, many of its most dire problems could be headed off before they got out of control, he said. The Stauntons have awakened doctors and nurses to the possibility of danger camouflaged as a stomach bug.

“We are with sepsis where we were with heart attack in the early 1980s,” Dr. Tracey said.

“If you don’t think of it as a possibility, this story can happen again and again. This case could change the world.”

E-mail: dwyer@nytimes.com

Twitter: @jimdwyernyt

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As Shoppers Hop From Tablet to PC to Phone, Retailers Try to Adapt

Ryan O’Neil, a Connecticut government employee, was in the market to buy a digital weather station this month. His wife researched options on their iPad, but even though she found the lowest-price option there, Mr. O’Neil made the purchase on his laptop.

“I do use the iPad to browse sites,” Mr. O’Neil said, but when it comes time to close the deal, he finds it easier to do on a computer.

Many online retailers had visions of holiday shoppers lounging beneath the Christmas tree with their mobile devices in hand, making purchases. The size of the average order on tablets, particularly iPads, tends to be bigger than on PCs. So retailers poured money and marketing into mobile Web sites and apps with rich images and, they thought, easy checkout.

But while visits to e-commerce sites and apps on tablets and phones have nearly doubled since last year, consumers like Mr. O’Neil are more frequently using multiple devices to shop. In many cases, they are more comfortable making the final purchase on a computer, with its bigger screen and keyboard. So retailers are trying to figure out how to appeal to a shopper who may use a cellphone to research products, a tablet to browse the options and a computer to buy.

“I’ve been yelling at customers for two years, saying, ‘Mobile, mobile, mobile,’ ” said Jason Spero, director of mobile sales and strategy at Google. “But the funny thing is, now we’re going to say: ‘Don’t put mobile in a silo. It’s also about the desktop.’ ”

The challenges are daunting, though. It is technically difficult to track consumers as they hop from phone to computer to tablet and back again. This means customers who, say, fill shopping carts on their tablets have to do all the work again on their PCs or other devices. The biggest obstacle, retailers say, is that the tools used to track shoppers on computers — cookies, or bundles of data stored in Web browsers — don’t transfer across devices.

Instead, retailers are figuring out how to sync the experience in other ways, like prompting shoppers to log in on each device. And being able to track people across devices gives retailers more insight into how they shop.

The retailers’ efforts are backed by research. While one-quarter of the visits to e-commerce sites occur on mobile devices, only around 15 percent of purchases do, according to data from I.B.M. According to Google, 85 percent of online shoppers start searching on one device — most often a mobile phone — and make a purchase on another.

At eBags, customers are shopping on their tablets in the evening and returning on their work computers the next day. But eBags has not yet synced the shoppers across devices, so customers must build their shopping carts from scratch if they switch devices.

“That is a blind spot with a lot of sites,” said Peter Cobb, co-founder of eBags. “It is a requirement moving forward.”

At eBay, one-third of the purchases involve mobile devices at some point, even if the final purchase is made on a computer.

At eBay, once shoppers log in on a device, they do not need to log in again. Their information, like shipping and credit card details and saved items, syncs across all their devices. If an eBay shopper is interested in a certain handbag, and saves that search on a computer, eBay will send alerts to her cellphone when a new handbag arrives or an auction is about to end.

“They might discover an item on a phone or tablet, do a saved-search push alert later on some other screen and eventually close on the Web site,” said Steve Yankovich, who runs eBay Mobile. “People are buying and shopping and consuming potentially every waking moment of the day.”

ModCloth, an e-commerce site for women’s clothes, said that while a quarter of its visits come from mobile devices, people are not yet buying there in the same proportion, though they are becoming more comfortable with checking out on those devices.

“She’s visiting us more on the phone, but she’s actually transacting somewhere else,” said Sarah Rose, vice president of product at ModCloth.

For example, a shopper will skim through new arrivals on her phone while on the bus and add items to her wish list, then visit that evening on her tablet to make a purchase, Ms. Rose said.

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Boehner rejects Democrats' push for immediate vote on gun bill

WASHINGTON -- House Speaker John A. Boehner rejected calls from Democrats to schedule a vote on new gun restrictions before the end of the year, saying he wants to wait for recommendations from a newly formed White House task force before committing to a legislative response to the mass shooting at a Connecticut school.

“When the vice president's recommendations come forward, we'll certainly take them into consideration,’’ Boehner (R-Ohio) said Thursday in his first public comments on calls for new gun legislation since the slaying of 20 students and six adults at Sandy Hook Elementary School. “But at this point I think our hearts and souls ought to be to think about those victims in this horrible tragedy.”

President Obama on Wednesday said he had asked Vice President Joe Biden to lead a task force to come up with initiatives to stem gun violence by the end of next month. House Democratic Leader Nancy Pelosi of San Francisco and fellow Democrats have pressed for an immediate vote on a long-stalled bill that would ban ammunition magazines containing more than 10 rounds.

Obama has outlined a slightly slower pace for action, urging Congress to hold a vote “in a timely manner” in the new year.

Both Obama and Democrats on Capitol Hill say they are trying to seize on what appears to be a burst of momentum behind gun legislation in the wake of the Newtown, Conn., tragedy. Similar efforts initiated after other high-profile shootings faltered after national attention veered elsewhere.

Biden held the first meeting of the task force Thursday, gathering several cabinet members and White House officials with a group of local law enforcement leaders. In remarks before the meeting, the vice president noted his work on the 1994 crime bill, which banned the sale of some assault weapons, and said he would again be working closely with police groups to craft proposals.

“What I think the public has learned about you is you have a much more holistic view of how to deal with violence on our streets and in our country that you’re ever given credit for,” Biden told the law enforcement officials. “I want to hear your views because, for anything to get done, we’re going to need your advocacy.”

richard.simon@latimes.com

Twitter: @richardsimon11

kathleen.hennessey@latimes.com

Twitter: @khennessey

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Video game shares down in wake of shooting

LOS ANGELES (AP) — Shares of video game makers and sellers fell Thursday in the aftermath of a mass shooting at a Connecticut elementary school, which has renewed debate about violent games and their potential influence on crime.

Shares of GameStop Corp., whose stores sell video games as well as systems like the Xbox and Wii, fell 5 percent in afternoon trading.

Investors are seen as being increasingly concerned that the government may impose tougher rules on the sales of games rated for “mature” and older audiences.

Investors may be worried that parents will also avoid buying first-person shooter games like “Call of Duty: Black Ops 2″ after the tragedy Friday morning at Sandy Hook Elementary, in which 20 children and six adults were shot and killed by 20-year-old Adam Lanza.

“Maybe there will be more stringent efforts to make sure youth are not playing games that they’re not old enough to play,” said Mike Hickey, an analyst with National Alliance Securities. “Maybe there will be a greater effort by parents in managing the content their kids are playing.”

Shares of companies involved in the video game industry, many of which had been dropping since the shooting, declined further Thursday.

— GameStop stock lost $ 1.37, or 5 percent, to $ 26.18. Shares have barely changed since last Thursday’s close, the day before the shooting, to Wednesday’s close.

— Shares of Activision Blizzard Inc., the publisher of “Call of Duty: Black Ops 2,” fell 9 cents to $ 10.70. The stock had already dropped 5.6 percent.

— Electronic Arts Inc. shares fell 41 cents, or 2.9 percent, to $ 13.99. Shares had dropped 5.6 percent.

— Take-Two Interactive Software Inc. shares slipped 29 cents, or 2.5 percent, to $ 11.69. The stock had dropped 8 percent.

The declines came as broader markets rose. The Dow Jones industrial average was up 0.3 percent at 13,295.

Gaming News Headlines – Yahoo! News

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