Digital billboard company issues $100-million threat against L.A.

An outdoor advertising company fighting to preserve dozens of digital billboards across Los Angeles warned this week that it would seek "substantially" more than $100 million from City Hall if it is ordered to remove any electronic signs targeted in a recent court ruling.

In an 11-page letter sent Friday, Clear Channel Outdoor told Mayor Antonio Villaraigosa, City Atty. Carmen Trutanich and Council President Herb Wesson that its digital signs are "valuable assets that the city cannot attempt to take away without paying just compensation."

The letter comes two months after a three-judge panel struck down a 2006 legal settlement approved by the City Council allowing Clear Channel and CBS Outdoor to convert 840 existing billboards to digital formats. The company installed 79 digital signs before the settlement was blocked.

The 2nd District Court of Appeal ordered a lower court to invalidate all digital conversions permitted under the agreement. But Sara Lee Keller, Clear Channel's lawyer, warned that if the council instructs the company to turn off the signs, "it would be exposed to liability to Clear Channel for the fair market value of such signs, which substantially exceeds $100 million."

"While litigating these claims would be costly and time-consuming for all … we believe it is important to be clear about the consequences," wrote Keller, who contends that other factors make all of the company's signs legal.

The letter drew a sharp response from Summit Media, a competing sign company that successfully sued to block the 2006 agreement. Phil Recht, the company's attorney, said Clear Channel has "no regard for the rule of law."

"Clear Channel is trying to bully the city into submission so that they can continue to make hundreds of millions of dollars in illegal profits from these digital billboards two courts ruled to be illegal," he said.

Clear Channel sent its letter one day before neighborhood activists and outdoor-advertising lobbyists — including the company and its representatives — took part in a working group to discuss possible digital sign legislation. One proposal up for discussion would allow new digital billboards to be installed in exchange for removing a greater number of static billboards.

Summit promised to work with neighborhoods on digital sign issues, saying the technology diminishes quality of life. In recent years, it has described the original 2006 agreement as a "sweetheart deal" that gave CBS and Clear Channel hundreds of millions of dollars in revenue.

Since the ruling, Clear Channel has been waging a publicity campaign in favor of digital billboards, putting together an advocacy group to argue on its behalf and touting support for its signs from such groups as AIDS Project Los Angeles, Art Share L.A. and the Los Angeles Area Chamber of Commerce. Those groups, among others, have asked the state Supreme Court to take another look at the ruling that invalidated the 2006 digital sign pact, according to Clear Channel's letter.

Clear Channel and a handful of other billboard companies also have been contributing tens of thousands of dollars in recent weeks to Proposition A, which is on the March 5 ballot and would raise the sales tax rate to 9.5% from 9%. That measure, if passed, is expected to generate more than $200 million annually for the city budget.

Meanwhile, Lamar Advertising, which has proposed its own plan for converting signs to digital formats, has been spending $5,000 per candidate on outdoor advertising promoting the City Council campaigns of Councilman Joe Buscaino and Assemblymen Bob Blumenfield (D-Woodland Hills), Felipe Fuentes (D-Sylmar) and Gil Cedillo (D-Los Angeles) as well as the city controller campaign of Councilman Dennis Zine.

Friday's letter from Clear Channel was accompanied by a legal claim, a document submitted before the filing of a lawsuit. Clear Channel spokesman Jim Cullinan said his company sent it because it must provide 90 days' notice before filing an action in court.

"This letter gives notice, but we hope it doesn't come to litigation," he said.

david.zahniser@latimes.com

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At War Blog: A Modern Medal Is Met with Modern Protest

It is only fitting that the announcement of a medal created for the digital age spawned its own Internet memes. As soon as Defense Secretary Leon E. Panetta announced the creation of the new Distinguished Warfare medal — immediately dubbed the Drone Medal — images such as the one below began appearing on blog after blog; in tweet after retweet.

The medal, Mr. Panetta explained, is intended to provide “recognition for the extraordinary achievements that directly impact on combat operations, but that do not involve acts of valor or physical risk that combat entails,” such as those piloting Predator or Reaper drones from a remote trailer. The medal has sparked much Photoshopped humor and heated online debate, much of it focusing on the Pentagon’s decision to rank it above the Purple Heart and the Bronze Star, both given to troops in combat.

As the Distinguished Warfare medal heads toward production, more than 13,000 people have signed an online petition demanding that the status of the medal be revised.

“Bronze Stars are commonly awarded with a Valor device in recognition of a soldier’s service in the heat of combat while on the ground in the theater of operation,” the petition states. “Under no circumstance should a medal that is designed to honor a pilot, that is controlling a drone via remote control, thousands of miles away from the theater of operation, rank above a medal that involves a soldier being in the line of fire on the ground.”

This was a sentiment echoed by many on Twitter:

Drone Medal is appropriate…but not ABOVE Bronze Star & Purple Heart! http://t.co/jcfcBT5BF6

— Doug Brower (@Mushbrower) 22 Feb 13

Higher Medal for drone operators? US soldiers fighting on ground demoralized http://t.co/S6QjWd8JvP

— Unity Media News (@unitymedianews1) 22 Feb 13

Similar commentary could be found in opinion pieces on news sites, such as The Business Insider, which called it “The Most Ridiculous Thing The Pentagon Could Do” and in longer anecdotes of protest on the comments section of the United States Air Force announcement:

2/21/2013 12:28:33 AM ET
I don’t like this at all my father was in ground combat from 1944 to 1945 in France Germany and Czechoslovakia his highest medal was the bronze star I have a copy of the award hanging in my living room I can’t even imagine what he went through. Now some guy sitting in an air conditioned building in Nevada is going to get a medal rated higher than the bronze star and the purple heart. I don’t care how many terrorists he killed or how many hours he sat in front of that screen how motivated he is or how well he does his job it is inconcievable to me that he or she can possibly earn a medal rated this high. Giving them a medal is ok but lets not degrade the honor of others who have risked their lives and in some cases actually been wounded in combat serving our country.
–Michael Sharkey, Trier Germany

According to the Defense Department, there is no controversy about the medal among military leaders. Each branch is in the process of drawing up their own specific guidelines and within two for four months, the first Distinguished Warfare Medals will be awarded.

“This is not a medal that will be awarded with the frequency of these other ones,”  Lt. Cmdr. Nate Christensen, a Defense Department spokesman, told At War, when asked why the medal should be above the Bronze Star.

Although there were some forms of recognition for drone operators and cyber operators before, none recognized truly exceptional acts of service, he said.

“This medal is visionary because it fills a void that existed before,” he said.

Although few people other than Pentagon officials came to the defense of the medal, some did circulate a piece by Maj. David Blair in the Air and Space Power Journal outlining the case for medals for drone operators.

For instance, consider a scenario in which Predator crews track a critical high­ value target to a safe house where he is then kinetically struck by a dynami­cally retasked F­16. In this case, both platforms’ crews perform their du­ties with excellence and professionalism. Perhaps that excellence merits decorations, or perhaps “doing your job” shouldn’t merit decoration. Ei­ther way, giving the F­16 pilot an award for heroism while excluding the Predator crews from consideration for the same sends a very clear message about what the institution believes is worth recognizing. This message ripples back into commissioning sources and light ­training pipelines, perpetuating perceptions and relative performance discrepan­cies through selection bias.

Published in July 2012, months before the announcement of the news medal, Major Blair’s piece did not address the flip-side: What happens when a member of the Predator crew receives a medal deemed more prestigious than the one awarded to the the F-16 pilot?

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Courtney Lopez: Gia Thinks Our Dog Is Having a Baby

Mom & Babies
Celebrity Baby Blog

02/22/2013 at 01:00 PM ET

Denise Truscello/Wireimage

Mario Lopez is a man of his word.

Following a December wedding, the EXTRA host declared he and wife Courtney would get to work expanding their family immediately — and he wasn’t kidding.

In January, the couple discovered they were indeed expecting.

“Mario and I are so excited to add to our family! I found out a month ago and surprised Mario with the good news at breakfast,” Courtney tells PEOPLE.

But the proud parents aren’t the only ones gearing up for a new addition. Big sister Gia Francesca, 2, already has babies on the brain.

“Gia kind of understands that there is a baby in my belly,” Courtney notes. “She also told me our dog Julio has a baby in his belly — so who knows!”

Despite a bumpy start — “I had a rough couple of weeks when I first found out,” she shares — the mom-to-be is feeling better and already sporting quite the blossoming belly. “I am showing so much faster this time around,” she says.

And with warmer weather on the way, Courtney will be swathing her bump in floor-length frocks — but plans on foregoing a few fashion ensembles from her past.

“I love being pregnant in the summer! I live in maxi dresses,” she says. “Looking back at my first pregnancy, there are certain things that I wore and I have no idea why. I looked horrible and I won’t do that again!”

Originally from Pittsburgh, the expectant mama is thrilled to have settled down with her growing family on the West Coast. Her only wish? That her children will one day enjoy a winter wonderland.

“I don’t miss the East Coast at all — especially the humidity,” she explains. “The one thing I do want my children to experience from an early age is snow. There is nothing like being a kid playing in the snow.”

– Anya Leon

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FDA approves new targeted breast cancer drug

WASHINGTON (AP) — The Food and Drug Administration has approved a first-of-a-kind breast cancer medication that targets tumor cells while sparing healthy ones.

The drug Kadcyla from Roche combines the established drug Herceptin with a powerful chemotherapy drug and a third chemical linking the medicines together. The chemical keeps the cocktail intact until it binds to a cancer cell, delivering a potent dose of anti-tumor poison.

Cancer researchers say the drug is an important step forward because it delivers more medication while reducing the unpleasant side effects of chemotherapy.

"This antibody goes seeking out the tumor cells, gets internalized and then explodes them from within. So it's very kind and gentle on the patients — there's no hair loss, no nausea, no vomiting," said Dr. Melody Cobleigh of Rush University Medical Center. "It's a revolutionary way of treating cancer."

Cobleigh helped conduct the key studies of the drug at the Chicago facility.

The FDA approved the new treatment for about 20 percent of breast cancer patients with a form of the disease that is typically more aggressive and less responsive to hormone therapy. These patients have tumors that overproduce a protein known as HER-2. Breast cancer is the second most deadly form of cancer in U.S. women, and is expected to kill more than 39,000 Americans this year, according to the National Cancer Institute.

The approval will help Roche's Genentech unit build on the blockbuster success of Herceptin, which has long dominated the breast cancer marketplace. The drug had sales of roughly $6 billion last year.

Genentech said Friday that Kadcyla will cost $9,800 per month, compared to $4,500 per month for regular Herceptin. The company estimates a full course of Kadcyla, about nine months of medicine, will cost $94,000.

FDA scientists said they approved the drug based on company studies showing Kadcyla delayed the progression of breast cancer by several months. Researchers reported last year that patients treated with the drug lived 9.6 months before death or the spread of their disease, compared with a little more than six months for patients treated with two other standard drugs, Tykerb and Xeloda.

Overall, patients taking Kadcyla lived about 2.6 years, compared with 2 years for patients taking the other drugs.

FDA specifically approved the drug for patients with advanced breast cancer who have already been treated with Herceptin and taxane, a widely used chemotherapy drug. Doctors are not required to follow FDA prescribing guidelines, and cancer researchers say the drug could have great potential in patients with earlier forms of breast cancer

Kadcyla will carry a boxed warning, the most severe type, alerting doctors and patients that the drug can cause liver toxicity, heart problems and potentially death. The drug can also cause severe birth defects and should not be used by pregnant women.

Kadcyla was developed by South San Francisco-based Genentech using drug-binding technology licensed from Waltham, Mass.-based ImmunoGen. The company developed the chemical that keeps the drug cocktail together and is scheduled to receive a $10.5 million payment from Genentech on the FDA decision. The company will also receive additional royalties on the drug's sales.

Shares of ImmunoGen Inc. rose 2 cents to $14.32 in afternoon trading. The stock has ttraded in a 52-wek range of $10.85 to $18.10.

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Councilman's preferred successor holds edge in Westside district

When Los Angeles City Councilman Bill Rosendahl decided in October to retire and focus on battling cancer, he anointed Mike Bonin, his longtime chief of staff, as his preferred successor.

The March 5 primary election now seems Bonin's to lose.

Of four candidates seeking to represent Council District 11 — which includes Brentwood, Mar Vista, Venice and Westchester — Bonin has raised the most money ($380,000, including matching funds, more than four times the amount amassed by his nearest rival). The self-avowed "progressive activist" has also received hundreds of endorsements from politicians, business and labor leaders, environmental groups and residents.

"He's smart, he's a doer, and he's solution-oriented," said Austin Beutner, a conservative businessman and former mayoral hopeful who recently held a meet-and-greet event for Bonin in Pacific Palisades. "He's not an ideologue."

Bonin's three opponents — Frederick Sutton, 28, a part-time bartender and community activist; Tina Hess, 52, a prosecutor with the city attorney's office; and Odysseus Bostick, 36, a Westchester teacher and parent — all acknowledge the financial leader's sizable edge. But they say they're fed up with pothole-riddled streets, homeless encampments and out-of-control municipal expenditures. Bonin, they say, represents a politics-as-usual bureaucracy that has turned the City Council into what Sutton calls "a merry-go-round of lifetime politicians."

Having received $87,000 in donations and matching funds, Sutton sees his immediate goal as keeping Bonin from getting the simple majority of votes needed to seal victory in March. "Once you get into a runoff," Sutton said, "suddenly everything changes."

On the stump, Bonin, who will turn 46 next month, sounds savvy and confident. He has unveiled plans to make Los Angeles more employer-friendly (extend the Internet tax exemption for Silicon Beach companies, support tax credits and reduce red tape for film operations) and to improve residents' access to City Hall through regular community meetings and technology ("Hikes with Mike" and "Mayberry meets the iPhone")

After receiving his bachelor's degree in U.S. history at Harvard University, Bonin worked as a newspaper reporter before entering politics. The Massachusetts native moved to the Los Angeles area in the early 1990s. He lives in Mar Vista with his partner, Sean Arian, a consultant.

A Gold's Gym regular who eats mostly raw foods, Bonin sports five tattoos, including a recycling symbol on his left shoulder that serves partly "as a symbol of getting sober and taking a life that had been trash and making it productive again." After long overdoing it on drugs and alcohol, Bonin said, he has been sober for 18 years.

The diverse Westside sector he seeks to represent is rife with vocal activists and hot-button issues: congestion, transit construction, an imbalance between jobs and housing, transients and the modernization of Los Angeles International Airport. Like Rosendahl, Bonin opposes separating the northern runways but is all for updating the airport.

Bonin said his 17 years in public service have prepared him.

He first worked in city government as legislative deputy, district director and deputy chief of staff for former Councilwoman Ruth Galanter. He then became deputy chief of staff and district director for Rep. Jane Harman, who represented many 11th district neighborhoods before retiring from Congress. He has been Rosendahl's chief deputy since 2005.

Elected in 2005 and 2009, Rosendahl, 67, was favored to win a third and final term before being diagnosed with advanced cancer last summer.

Bonin said he has been inspired by his boss' spirit and resilience after months of grueling cancer treatments. "He's got the level of energy back that most of the staff finds exhausting to be around," Bonin told a group of elderly residents one recent afternoon.

Marcia Hanscom, a wetlands activist, said she endorsed Bonin after hearing his ideas for bringing government closer to the people and promoting nature in the city.

"He's got good values and instincts, and he also knows the inner workings of City Hall and its bureaucracy," she said in an email. "If he does as he says — getting and staying close to the constituents — he will not be so captured by City Hall as some think he is."

martha.groves@latimes.com

Times researcher Maloy Moore contributed to this report.

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Neighbors Kill Neighbors in Kenya as Election Tensions Stir Age-Old Grievances

MALINDI, Kenya — In a room by the stairs, Shukrani Malingi, a Pokomo farmer, writhed on a metal cot, the skin on his back burned off. Down the hall, at a safe distance, Rahema Hageyo, an Orma girl, stared blankly out of a window, a long scar above her thimble-like neck. She was nearly decapitated by a machete chop — and she is only 9 months old.

Jonathan Kalan for The New York Times

Orma men were patrolling their village in the Tana River Delta, fearful of Pokomo attacks. Kenya’s disastrous 2007 vote set off clashes that killed 1,000 people.

Ever since vicious ethnic clashes erupted between the Pokomo and Orma several months ago in a swampy, desolate part of Kenya, the Tawfiq Hospital has instituted a strict policy for the victims who are trundled in: Pokomos on one side, Ormas on the other. The longstanding rivalry, which both sides say has been inflamed by a governor’s race, has become so explosive that the two groups remain segregated even while receiving lifesaving care. When patients leave their rooms to use the restroom, they shuffle guardedly past one another in their bloodstained smocks, sometimes pushing creaky IV stands, not uttering a word.

“There are three reasons for this war,” said Elisha Bwora, a Pokomo elder. “Tribe, land and politics.”

Every five years or so, this stable and typically peaceful country, an oasis of development in a very poor and turbulent region, suffers a frightening transformation in which age-old grievances get stirred up, ethnically based militias are mobilized and neighbors start killing neighbors. The reason is elections, and another huge one — one of the most important in this country’s history and definitely the most complicated — is barreling this way.

In less than two weeks, Kenyans will line up by the millions to pick their leaders for the first time since a disastrous vote in 2007, which set off clashes that killed more than 1,000 people. The country has spent years agonizing over the wounds and has taken some steps to repair itself, most notably passing a new constitution. But justice has been elusive, politics remain ethnically tinged and leaders charged with crimes against humanity have a real chance of winning.

People here tend to vote in ethnic blocs, and during election time Kenyan politicians have a history of stoking these divisions and sometimes even financing murder sprees, according to court documents. This time around, the vitriolic speeches seem more restrained, but in some areas where violence erupted after the last vote the underlying message of us versus them is still abundantly clear.

Now, the country is asking a simple but urgent question: Will history repeat itself?

“This election brings out the worst in us,” read a column last week in The Daily Nation, Kenya’s biggest newspaper. “All the tribal prejudice, all ancient grudges and feuds, all real and imagined slights, all dislikes and hatreds, everything is out walking the streets like hordes of thirsty undeads looking for innocents to devour.”

As the election draws nearer, more alarm bells are ringing. Seven civilians were ambushed and killed in northeastern Kenya on Thursday in what was widely perceived to be a politically motivated attack. The day before, Kenya’s chief justice said that a notorious criminal group had threatened him with “dire consequences” if he ruled against a leading presidential contender. Farmers in the Rift Valley say that cattle rustling is increasing, and they accuse politicians of instigating the raids to stir up intercommunal strife.

Because Kenya is such a bellwether country on the continent, what happens here in the next few weeks may determine whether the years of tenuous power-sharing and political reconciliation — a model used after violently contested elections in Zimbabwe as well — have ultimately paid off.

“The rest of Africa wants to know whether it’s possible to learn from past elections and ensure violence doesn’t flare again,” said Phil Clark, a lecturer at the School of Oriental and African Studies in London. “With five years’ warning, is it possible to address the causes of conflict and transfer power peacefully?”

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Cressida 'Cress' Bonas: 5 Things About Prince Harry's New Squeeze

By Simon Perry

02/21/2013 at 07:50 PM EST

Prince Harry and Cressida Bonas

Bauer-Griffin; Splash News Online

It's love on the slopes for Prince Harry – who has been spending some of his downtime since returning from Afghanistan rekindling his relationship with society gal Cressida Bonas.

With breathy excitement, tabloids have splashed pictures of the couple embracing in Verbier, where they have been vacationing this week. As a friend tells London's Evening Standard, "It's early days, but they are having fun together and enjoying spending time together.”

Here's five more things to know about her:

1. Knows How to Move
Just like Harry's last longstanding girlfriend, Chelsy Davy, she went to Leeds University, where she got a 2:1 (just under a first-place ranking) in dance.

2. Sister's Royal Connection
The daughter of an "It Girl" of the '60s, Lady Mary-Gaye Curzon, Bonas has a half-sister, Isabella Anstruther Gough-Calthorpe – who was once linked to Harry's brother, Prince William.

3. Family Name Games
Her other siblings have deliciously aristocratic and colorful names: Pandora Cooper-Key, Georgiana and Jacobi Anstruther-Gough-Calthorpe. And they have wonderfully eccentric nicknames, to boot: Cressida is "Small" or "Smally"; Isabella is "Bellie"; Jacobi is "Cozy"; and Pandora is "Baba," it's been reported.

4. Oh, Yes, She Matters
With her well-connected family, and links to the most eligible bachelor in the world, she was recently ranked by the society glossy magazine Tatler as 27th among those people who "really matter."

5. Funky Style
She is said to like music festivals, hippy-style clothes, favors sneakers over heels and is now taking a dance class in Greenwich, southeast London.

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APNewsBreak: Govs to hear Oregon health care plan

SALEM, Ore. (AP) — Oregon Gov. John Kitzhaber will brief other state leaders this weekend on his plan to lower Medicaid costs, touting an overhaul that President Barack Obama highlighted in his State of the Union address for its potential to lower the deficit even as health care expenses climb.

The Oregon Democrat leaves for Washington, D.C., on Friday to pitch his plan that changes the way doctors and hospitals are paid and improves health care coordination for low income residents so that treatable medical problems don't grow in severity or expense.

Kitzhaber says his goal is to win over a handful of other governors from each party.

"I think the politics have been dialed down a couple of notches, and now people are willing to sit down and talk about how we can solve the problem" of rising health care costs, Kitzhaber told The Associated Press in a recent interview.

Kitzhaber introduced the plan in 2011 in the face of a severe state budget deficit, and he's been talking for two years about expanding the initiative beyond his state. Now, it seems he's found people ready to listen.

Hospital executives from Alabama visited Oregon last month to learn about the effort. And the U.S. Department of Health and Human Services announced Thursday that it's giving Oregon a $45 million grant to help spread the changes beyond the Medicaid population and share information with other states, making it one of only six states to earn a State Innovation Model grant.

Kitzhaber will address his counterparts at a meeting of the National Governors Association. His talk isn't scheduled on the official agenda, but a spokeswoman confirmed that Kitzhaber is expected to present.

"The governors love what they call stealing from one another — taking the good ideas and the successes of their colleagues and trying to figure out how to apply that in their home state," said Matt Salo, director of the National Association of Medicaid Directors.

There's been "huge interest" among other states in Oregon's health overhaul, Salo said, not because the concepts are brand new, but because the state managed to avoid pitfalls that often block health system changes.

Kitzhaber persuaded state lawmakers to redesign the system of delivering and paying for health care under Medicaid, creating incentives for providers to coordinate patient care and prevent avoidable emergency room visits. He has long complained that the current financial incentives encourage volume over quality, driving costs up without making people healthier.

Obama, in his State of the Union address this month, suggested that changes such as Oregon's could be part of a long-term strategy to lower the federal debt by reigning in the growing cost of federally funded health care.

"We'll bring down costs by changing the way our government pays for Medicare, because our medical bills shouldn't be based on the number of tests ordered or days spent in the hospital — they should be based on the quality of care that our seniors receive," Obama said.

The Obama administration has invested in the program, putting up $1.9 billion to keep Oregon's Medicaid program afloat over the next five years while providers make the transition to new business models and incorporate new staff and technology.

In exchange, though, the state has agreed to lower per-capita health care cost inflation by 2 percentage points without affecting quality.

The Medicaid system is unique in each state, and Kitzhaber isn't suggesting that other states should adopt Oregon's specific approach, said Mike Bonetto, Kitzhaber's health care policy adviser. Rather, he wants governors to buy into the broad concept that the delivery system and payment models need to change.

That's not a new theory. But Oregon has shown that under the right circumstances massive changes to deeply entrenched business models can gain wide support.

What Oregon can't yet show is proof the idea is working — that it's lowering costs without squeezing on the quality or availability of care. The state is just finishing compiling baseline data that will be used as a basis of comparison.

One factor driving the Obama administration's interest in Oregon's success is the president's health care overhaul. Under the Affordable Care Act, millions more Americans will join the Medicaid rolls after Jan. 1, and the health care system will have to be able to absorb the influx of patients in a logistically and financially sustainable way.

The federal government will pay 100 percent of the costs for those additional patients in the first three years before scaling back to 90 percent in 2020 and beyond.

"There are a lot of governors who are facing the same challenges we're facing in Oregon," Kitzhaber said. "They recognize that the cost of health care is something they're going to have to get their arms around."

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Persistent strain of TB claims victims on L.A.'s skid row

Public health officials have launched a new, coordinated attack to contain a persistent outbreak of tuberculosis on downtown Los Angeles' skid row, including a search for more than 4,500 people who may have been exposed to the disease.

The Centers for Disease Control and Prevention has dispatched scientists to Los Angeles to help local health officials determine why the disease is spreading and how to stop it.

Officials say 11 have died since 2007. Sixty of the 78 cases were among homeless people who live on and around skid row.

Scientists have recently linked the outbreak to a tuberculosis strain that is unique to Los Angeles, with a few isolated cases outside the area.

"This is the largest outbreak in a decade," said Jonathan Fielding, director of the Los Angeles County Department of Public Health. "We are really putting all of our resources into this."

Health workers have identified about 4,650 people who were probably exposed and are trying to track them down for testing and treatment. Local and federal officials are particularly concerned because the cases are linked to one relatively small geographic area and one vulnerable population. But officials are concerned that the outbreak could spread beyond skid row if action isn't taken.

Homeless people are especially at risk of getting TB and of being undiagnosed because they have poor hygiene and nutrition, limited access to healthcare and ongoing contact with infected people. Transmission of the airborne disease is also common because the homeless live in overcrowded areas and are constantly moving among hospitals, shelters and the streets. Many homeless people also have substance abuse or mental health issues that can impede treatment.

"They go from place to place and the likelihood of passing it along is much greater," said Paul Gregerson, chief medical officer of the JWCH Institute, which runs a homeless healthcare program on skid row. "It makes everybody more susceptible."

Tuberculosis is easily transmitted by inhaling droplets from infected patients when they sneeze, cough or laugh. When left untreated, TB can be deadly. The skid row strain can be treated with all anti-TB medications. Treatment lasts six to nine months.

The public health department issued an alert several weeks ago to doctors at emergency rooms, clinics and urgent care centers informing them about the investigation within the homeless community.

Most of the patients are men and about 20% are also HIV-positive, according to the alert, which was obtained by The Times. Six of the eight patients who also had HIV have died.

The increase of TB among the homeless population is occurring even as the county is seeing a decline in overall cases, officials said. There are probably additional cases among the homeless population that have not yet been confirmed.

The health department also issued new guidelines for shelters earlier this year on how to effectively screen and identify patients at risk of tuberculosis. The guidelines urge shelters to appoint a TB liaison and to create a "cough alert" log for tracking patients with persistent coughs.

The county also recommended that shelters determine if incoming clients have been screened and refer those who haven't been to health providers.

The county suggests that all employees and volunteers also be screened for TB because they are also at risk.

As part of the ongoing investigation, the public health department asked shelters last week for information about everybody who has used their services. In the Feb. 12 letter, Los Angeles County TB Control Program acting Director Peter Kerndt said that the information "is necessary to investigate the increase in TB cases so that appropriate steps can be taken to prevent and control the spread."

Officials at local shelters said they are committed to working with public health officials.

"We're trying to understand the urgency of what the CDC and L.A. County Health is doing," Midnight Mission spokeswoman Mai Lee said.

"It does raise questions and concerns."

At the Union Rescue Mission's health clinic, officials said they are taking a much more proactive approach to TB screening — going to the patients rather than waiting for them to come to the clinic.

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Iceland Weighs Exporting the Power Bubbling From Below

Ilvy Njiokiktjien for The New York Times

The Krafla plant is Iceland’s largest geothermal power station, a showcase of renewable energy.

KRAFLA, Iceland — Soon after work began here on a power plant to harness some of the vast reserves of energy stored at the earth’s crust, the ground moved and, along a six-mile-long fissure, began belching red-hot lava. The eruptions continued for nine years, prompting the construction of a stone and soil barrier to make sure that molten rock did not incinerate Iceland’s first geothermal power station.

While the menacing lava flow has long since stopped and Krafla is today a showcase of Iceland’s peerless mastery of renewable energy sources, another problem that has dogged its energy calculations for decades still remains: what to do with all the electricity that the country — which literally bubbles with steam, hot mud and the occasional cloud of volcanic ash — is capable of producing.

In a nation with only 320,000 people, the state-owned power company, Landsvirkjun, which operates the Krafla facility, sells just 17 percent of its electricity to households and local industry. The rest goes mostly to aluminum smelters owned by the American giant Alcoa and other foreign companies that have been lured to this remote North Atlantic nation by its abundant supply of cheap energy.

Now a huge and potentially far more lucrative market beckons — if only Iceland can find a way to transmit electricity across the more than 1,000 miles of frigid sea that separate it from the 500 million consumers of the European Union. “Prices are so low in Iceland that it is normal that we should want to sell to Europe and get a better price,” said Stein Agust Steinsson, the manager of the Krafla plant. “It is not good to put all our eggs in one basket.”

What Landsvirkjun charges aluminum smelters exactly is a secret, but in 2011 it received on average less than $30 per megawatt/hour — less than half the going rate in the European Union and barely a quarter of what, according to the Renewable Energies Federation, a Brussels-based research unit, is the average tariff, once tax breaks and subsidies are factored in, for “renewable” electricity in the European Union. Iceland would not easily get this top “renewable” rate, which is not a market price, but it still stands to earn far more from its electricity than it does now.

Eager to reach these better paying customers, the power company has conducted extensive research into the possibility of a massive extension cord — or a “submarine interconnector,” in the jargon of the trade — to plug Iceland into Europe’s electricity grid. Such a cable would probably go first to the northern tip of Scotland, which, about 700 miles away, is relatively close, and then all the way to continental Europe, nearly 1,200 miles away. That is more than three times longer than a link between Norway and the Netherlands, which is currently the world’s longest.

Laying an underwater cable from the North Atlantic would probably cost more than $2 billion, and the idea is not popular with those who worry about Iceland — a country that takes pride in living by its own means in harsh isolation — becoming an ice-covered version of Middle East nations addicted to easy money from energy exports.

Backers of the cable “are looking for easy money, but who is going to pay in the end?” said Lara Hanna Einarsdottir, an Icelandic blogger who has written extensively on the potential risks involved in geothermal energy. “We will all pay.”

Iceland, Ms. Einarsdottir said, should use its energy sources to “supply ourselves and coming generations” and not gamble with Iceland’s unique heritage by “building more and more plants so that we can provide electricity to towns in Scotland.”

The idea of somehow exporting electricity to Europe has been around for decades and has been “technically doable for some time,” said Hordur Arnarson, the power company’s chief executive, “but it was not seen as economically feasible until recently.” The change is largely because of a push by the European Union to reduce the use of oil and coal and promote green energy, a move that has put a premium on electricity generated by wind, water and geothermal sources. The union’s 27 member states agreed in 2009 to a mandatory target of deriving at least 20 percent of its energy from “renewable sources” by 2020.

A connection to Europe would not only allow Iceland to tap the export market but also to import electricity from Europe in the event of a crisis, a backup that would allow it to stop keeping large emergency reserves, as it does now.

“This is a very promising project,” Mr. Arnarson said. “We have a lot of electricity for the very few people who live here.” Compared with the rest of the world, he said, Iceland produces “more energy per capita by far, and it is very natural to consider connecting ourselves to other markets.”

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