Hockey Coaches Defy Doctors on Concussions, Study Finds

Despite several years of intensive research, coverage and discussion about the dangers of concussions, the idea of playing through head injuries is so deeply rooted in hockey culture that two university teams kept concussed players on the ice even though they were taking part in a major concussion study.

The study, which will be published Friday in a series of articles in the journal Neurosurgical Focus, was conducted during the 2011-12 hockey season by researchers from the University of Western Ontario, the University of Montreal, Harvard and other institutions.

“This culture is entrenched at all levels of hockey, from peewee to university,” said Dr. Paul S. Echlin, a concussion specialist and researcher in Burlington, Ontario, and the lead author of the study. “Concussion is a significant public health issue that requires a generational shift. As with smoking or seat belts, it doesn’t just happen overnight — it takes a massive effort and collective movement.”

The study is believed to be among the most comprehensive analyses of concussions in hockey, which has a rate of head trauma approaching that of football. Researchers followed two Canadian university teams — a men’s team and a women’s team — and scanned every player’s brain before and after the season. Players who sustained head injuries also received scans at three intervals after the injuries, with researchers using advanced magnetic resonance imaging techniques.

The teams were not named in the study, in which an independent specialist physician was present at each game and was empowered to pull any player off the ice for examination if a potential concussion was observed.

The men’s team, with 25 players and an average age of 22, played a 28-game regular season and a 3-game postseason. The women’s team, with 20 players and an average age of 20, played 24 regular-season games and no playoff games. Over the course of the season, there were five observed or self-reported concussions on the men’s team and six on the women’s team.

Researchers noted several instances of coaches, trainers and players avoiding examinations, ignoring medical advice or otherwise obstructing the study, even though the players had signed consent forms to participate and university ethics officials had given institutional consent.

“Unless something is broken, I want them out playing,” one coach said, according to the study.

In one incident, a neurologist observing the men’s team pulled a defenseman during the first period of a game after the player took two hits and was skating slowly. During the intermission the player reported dizziness and was advised to sit out, but the coach suggested he play the second period and “skate it off.” The defenseman stumbled through the rest of the game.

“At the end of the third period, I spoke with the player and the trainer and said that he should not play until he was formally evaluated and underwent the formal return-to-play protocol,” the neurologist said, as reported in the study. “I was dismayed to see that he played the next evening.”

After the team returned from its trip, the neurologist questioned the trainer about overruling his advice and placing the defenseman at risk.

“The trainer responded that he and the player did not understand the decision and that most of the team did not trust the neurologist,” according to the study. “He requested that the physician no longer be used to cover any more games.”

In another episode, a physician observer assessed a minor concussion in a female player and recommended that she miss the next night’s game. Even though the coach’s own playing career had ended because of concussions, she overrode the medical advice and inserted the player the next evening.

According to the report, the coach refused to speak to another physician observer on the second evening. The trainer was reluctant to press the issue with the coach because, the trainer said, the coach did not want the study to interfere with the team.

Read More..

Stocks flat; consumer spending falls

Stocks are little changed in early trading as lawmakers seek to thrash out a budget agreement. The government reported that consumer spending fell in October.

The Dow Jones industrial average rose 24 points to 13,045 as of 10:25 a.m. Eastern. The Standard and Poor's 500 was up 0.9 points to 1,417. The Nasdaq composite was down two points to 3,010.

Stocks are slightly higher for the week. The Dow is up 0.3 percent, the S&P 500 index 0.6 percent. The market has fluctuated between gains and losses in recent days as news and comments filtered out from the budget negotiations in Washington.

Investors have been closely following the talks between the White House and Congress over the “fiscal cliff,” which refers to sharp government spending cuts and tax increases scheduled to start Jan. 1. Economists say that those measures, if implemented, would push the U.S. economy back into a recession.

“Right now the market is just going to be held hostage as to what happens in the next five hours, versus what's going to happen in the next five years,” said Dan Veru, chief investment officer at Palisade Capital Management, in Fort Lee, New Jersey.

Americans cut back on spending last month and saw no growth in their income, reflecting disruption from Superstorm Sandy that could hold back economic growth in the final months of the year.

The Commerce Department reported that consumer spending dropped 0.2 percent in October. That's down from an increase of 0.8 percent in September and the weakest showing since May.

Among stocks making big moves:

—Yum Brands, which runs KFC, Pizza Hut and Taco Bell, fell $6.85 to $67.57. The fast-food operator reported disappointing sales and earnings forecasts. An analyst recommended that investors sell the stock.

—Zynga fell 20 cents to $2.42 after the online gaming company said late Thursday that it was loosening its ties with Facebook.

Read More..

British judge urges new press regulator due to hacking scandal

LONDON – In a highly anticipated and lengthy report, a senior judge Thursday recommended that a new, independent regulatory authority be set up to monitor Britain’s raucous press and to crack down on media abuses such as phone hacking and other unethical newsgathering practices.

Justice Brian Leveson said such a regulator was necessary because the press had at times “wreaked havoc in the lives of innocent people” through its intrusions on privacy and relentless pursuit of scoops.

The new regulatory body should be backed by law, but it should not include any politicians, in order to avoid government control of the press, nor any editors, in order to maintain full independence, Leveson said.

The regulator would replace a previous press complaints commission that is widely recognized in Britain to have been a failure, particularly with regard to the phone-hacking scandal. Evidence has emerged that hundreds of high-profile figures may have had their cellphones tapped by the now-defunct News of the World tabloid.

The scandal gave rise to a months-long, government-commissioned investigation into media culture and ethics by Leveson, who heard testimony from more than 300 witnesses.

The recommendations in his 2,000-page report are likely to please some hacking victims and satisfy demands of some lawmakers who say that Britain’s media, in particular its sensation-seeking and gossip-hungry tabloids, have been allowed to run amok.

But the news organizations themselves have expressed alarm over any form of regulation that has its roots in law and that, they fear, could be the first step toward government censorship. Although they recognize the need for oversight, many news outlets have pushed for a better system of self-regulation with no legal underpinning.

Leveson was eager to emphasize his respect for a free press and denied that his recommendations represented any threat to it.

“The press operating freely and in the public interest is one of the true safeguards of our democracy. As a result, it holds a privileged and powerful place in our society,” he told reporters. “But this power and influence carries with it responsibilities to the public interest in whose name it exercises these privileges. Unfortunately, as the evidence has shown beyond doubt, on too many occasions those responsibilities … have simply been ignored.”

The report has been eagerly awaited for months. As its release date neared, politicians and high-profile individuals dug in on either side, calling for laws to regulate the media or warning against them as an unacceptable infringement on a free press.

“As parliamentarians, we believe in free speech and are opposed to the imposition of any form of statutory control,” said a letter signed by 86 lawmakers. “The solution is not new laws but a profound restructuring of the self-regulatory system.”

A recent poll, however, found a majority of Britons in favor of some kind of regulation of the media backed by the force of the law.

The witnesses who appeared before Leveson included some of Britain’s best-known public figures, such as Prime Minister David Cameron. Actor Hugh Grant and "Harry Potter" author J.K. Rowling denounced media invasions of their privacy. Media baron Rupert Murdoch and other newspaper proprietors spoke about newsgathering practices.

The inquiry was launched last year after the hacking scandal exploded in the public consciousness with the revelation that the News of the World had tapped the voicemail messages of a missing 13-year-old girl, whose body was later found dumped in the woods by her killer.

Like a fast-spreading fire, the scandal quickly engulfed key pillars of British public life, putting the heat not just on tabloid newspapers but also the politicians who cozied up to them and the police who offered scoops in hopes of flattering coverage. Within days, the head of Scotland Yard resigned, as did one of Murdoch’s closest confidants, and the 168-year-old News of the World was shut down.

Three separate police investigations – into phone hacking, computer hacking and bribery of public officials – were spawned by the affair. Dozens of people, most of them journalists at Murdoch-owned publications, have been arrested.

Only a few hours before Leveson’s report was released, the former head of Murdoch’s newspapers in Britain and a onetime senior aide to Cameron appeared in court on charges of paying public officials for information.

ALSO:

Three managers arrested after deadly Bangladesh factory fire

Outgoing Mexican President Felipe Calderon heading to Harvard

Google opposes German push for search engines to pay newspapers

Read More..

RIM jumps 10 percent in Toronto trade after Goldman upgrade

Read More..

AP Newsbreak: New Suzanne Collins book in 2013

NEW YORK (AP) — "The Hunger Games" novelist Suzanne Collins has a new book coming out next year.

The multimillion-selling children's author has completed an autobiographical picture story scheduled for Sept. 10, 2013, Scholastic Inc. announced Thursday. The 40-page book will be called "Year of the Jungle," based on the time in Vietnam served by Collins' father, a career Air Force officer.

"Year of the Jungle" is her first book since 2010's "Mockingjay," the last of "The Hunger Games" trilogy that made Collins an international sensation. More than 50 million copies of the "Hunger Games" books are in print and the first of four planned movies has grossed more than $600 million worldwide since being released out in March.

Collins' next project will be intended for ages 4 and up, a younger audience than those who have read, and re-read, her dystopian stories about young people forced to hunt and kill each other. But "Year of the Jungle" will continue, in a gentler way, the author's exploration of war. James Proimos, an old friend from her days as a television writer who helped persuade Collins to become a children's author, illustrated the book.

"For several years I had this little wicker basket next to my writing chair with the postcards my dad had sent me from Vietnam and photos of that year. But I could never quite find a way into the story. It has elements that can be scary for the audience and it would be easy for the art to reinforce those. It could be really beautiful art but still be off-putting to a kid, which would defeat the point of doing the book," Collins, 50, said in a statement released by Scholastic.

"Then one day I was having lunch with Jim and telling him about the idea and he said, 'That sounds fantastic.' I looked at him and I had this flash of the story through his eyes, with his art. It was like being handed a key to a locked door. So, I just blurted out, 'Do you want to do it?' Fortunately he said 'Yes.'"

"How could I refuse?" Proimos said in a statement. "The idea she laid out over burritos and ice tea during our lunch was brilliant and not quite like any picture book I had ever come across. The writing is moving and personal. What Suzanne does so well here is convey complicated emotions through the eyes of a child."

According to Scholastic, "Year of the Jungle" will tell of a little girl named Suzy and her fears after her father leaves for war. She wonders when he'll come back and "feels more and more distant" as he misses family gatherings. He does return, but he has changed and his daughter must learn that "he still loves her just the same."

Collins has said before that she wanted to write a book about her father. In a 2010 interview with The Associated Press, she explained that her father was a trained historian who made a point of discussing war with his family.

"I believe he felt a great responsibility and urgency about educating his children about war," she said. "He would take us frequently to places like battlefields and war monuments. It would start back with whatever had precipitated the war and moved up through the battlefield you were standing in and through that and after that. It was a very comprehensive tour guide experience. So throughout our lives we basically heard about war."

Scholastic also announced Thursday that "Catching Fire," the second "Hunger Games" book and originally released in 2009, is coming out in June as a paperback. The paperback edition usually comes within a year of the hardcover, but "Catching Fire" had been selling so well that Scholastic waited. "Mockingjay" has yet to be released as a paperback.

Next summer, Collins' five-volume "The Underland Chronicles," published before "The Hunger Games," will be reissued with new covers.

"'The Underland Chronicles,' with its fantasy world and 11-year old protagonist, Gregor, was designed for middle readers," Collins said in a statement. "The 'Hunger Games' trilogy features a teen narrator, Katniss Everdeen, and a stark dystopian backdrop for the YA (young adult) audience. 'Year of the Jungle' attempts to reach the picture book readers by delving into my own experience as a first grader with a father deployed in Vietnam."

___

Online:

http://www.suzannecollinsbooks.com/

Read More..

Mortgage rates level off near record low, Freddie Mac says

Freddie Mac's corporate offices in McLean, Va. (Pablo Martinez Monsivais / Associated Press / July 13, 2008)

By E. Scott Reckard

November 29, 2012, 7:51 a.m.

Mortgage interest rates edged up a hair from their record lows this week, with lenders offering the 30-year fixed loan at an average of 3.32%, Freddie Mac said in its latest survey.

Borrowers would have paid an average of 0.8% of the loan amount in upfront lender fees and discount points to obtain the rate, Freddie Mac said. That was up from an average 0.7% in lender charges for a 3.31% 30-year loan in last week's survey, the latest in a long series of record lows set this year.

The 15-year fixed mortgage, popular with refinancers seeking to pay off their loans faster, was being offered this week at an average 2.64% and 0.6% in lender fees, up from 2.63% and 0.6% in fees a week earlier.

Start rates for adjustable loans also were little changed, although few people would opt for a variable rate at this peculiar point in time. The start rate for a hybrid loan that becomes variable after five years fixed was 2.72% -- higher than that of the 15-year fixed mortgage.

Quiz: How much do you know about mortgages?

Concerns about the so-called fiscal cliff have depressed interest rates as demand increased for ultra-safe Treasury securities and insured mortgage bonds from Freddie Mac and other government-backed issuers, Freddie Mac economist Frank Nothaft noted.

The yield, or effective interest rate, declines on bonds when demand rises. 

Freddie Mac asks mortgage lenders around the country each Monday through Wednesday about popular combinations of rates and points they are offering to low-risk borrowers. The survey doesn't include third-party charges often paid by borrowers, such as for title insurance and appraisals.

Mortgage pros say solid borrowers often can find somewhat lower rates than those in the survey by shopping around.

ALSO:

GDP revised higher

New home sales dipped in October

Striking union expands walkout at LA, Long Beach ports

Read More..

Poll says 6 in 10 Americans back tax hike on income over $250,000

WASHINGTON -- Six in 10 Americans support a tax increase on annual income of more than $250,000, according to a nationwide poll released Wednesday.

Such a hike is the centerpiece of President Obama's efforts to avoid the large automatic tax increases and spending cuts, collectively known as the fiscal cliff, that are coming at the start of next year.

The Washington Post/ABC News poll showed 73% of Democrats and 63% of independents back raising taxes on incomes over $250,000, while just 39% of Republicans support it. 

The poll results show the divide in Washington between Democrats and Republicans over reaching a major deficit-reduction package that would avoid the fiscal cliff. But the findings could boost Obama as he takes his case to the public.

House Speaker John Boehner (R-Ohio) has said he's open to raising additional tax revenue from the wealthy to help close the deficit, but wants to do it by eliminating deductions in the tax code.

Quiz: How much do you know about the fiscal cliff?

The Post/ABC poll showed that approach has less support than Obama's, with 44% supporting a reduction in deductions that people can claim on their federal taxes and 49% opposed.

Democratic and independent support for that idea is about the same as the national figure, but only 39% of Republicans back the approach, the poll said.

One area of agreement among Democrats, Republicans and independents is opposition to raising the age for Medicare coverage to 67 years old from 65, with 67% of respondents opposing it.

Sen. Bob Corker (R-Tenn.) has proposed a gradual increase in the eligibility age for Medicare and Social Security as part of a deficit-reduction plan.

ALSO:

Much talk, little action on 'fiscal cliff' as Congress returns

Local leaders tally possible "fiscal cliff" losses in California

Obama returns to campaign trail to promote middle-class tax cuts

Follow Jim Puzzanghera on Twitter and Google+.

Read More..

In elf ears and wizard hats, 'Hobbit' fans rejoice

WELLINGTON, New Zealand (AP) — Wearing elf ears and wizard hats, sitting atop their dad's shoulders or peering from balconies, tens of thousands of New Zealanders watched their favorite "Hobbit" actors walk the red carpet Wednesday at the film trilogy's hometown premiere.

An Air New Zealand plane freshly painted with "Hobbit" characters flew low over Wellington's Embassy Theatre, eliciting roars of approval from the crowd.

Sam Rashidmardani, 12, said he came to see Gollum actor Andy Serkis walk the red carpet — and he wasn't disappointed.

"It was amazing," Rashidmardani said of the evening, adding his Gollum impression: "My precious."

British actor Martin Freeman, who brings comedic timing to the lead role of Bilbo Baggins, said he thought director Peter Jackson had done a fantastic job on "The Hobbit: An Unexpected Journey."

"He's done it again," Freeman said in an interview on the red carpet. "If it's possible, it's probably even better than 'The Lord of the Rings.' I think he's surpassed it."

While it is unusual for a city so far from Hollywood to host the premiere of a hoped-for blockbuster, Jackson's filming of his lauded 'LOTR' trilogy and now "The Hobbit" in New Zealand has helped create a film industry here. The film will open in theaters around the world next month.

One of the talking points of the film is the choice by Jackson to shoot it using 48 frames per second instead of the traditional 24 in hopes of improving the picture quality.

Some say the images come out too clear and look so realistic that they take away from the magic of the film medium. Jackson likens it to advancing from vinyl records to CDs.

"I really think 48 frames is pretty terrific and I'm looking forward to seeing the reaction," Jackson said on the red carpet. "It's been talked about for so long, but finally the film is being released and people can decide for themselves."

Jackson said it was strange working on the project so intimately for two years and then having it suddenly taken away as the world got to see the movie.

"It spins your head a little bit," he said.

Aidan Turner, who plays the dwarf Kili in the movie, said his character is reckless and thinks he's charming.

"I don't get to play real people it seems, I only get to play supernatural ones," he said. "So playing a dwarf didn't seem that weird, actually.

Perhaps the most well-known celebrities to walk the carpet were Cate Blanchett and Elijah Wood, who reprise their roles in the LOTR in the "Hobbit."

"Mostly I came here to see everyone. I like them all," said fan Aysu Shahin, 16, adding that Wood was her favorite. She said she wanted to see the movie "as soon as possible. I'm excited for it."

At a news conference earlier in the day, Jackson said many younger people are happy to watch movies on their iPads.

"We just have to make the cinema-going experience more magical and more spectacular to get people coming back to the movies again," he said.

Jackson said only about 1,000 of the 25,000 theaters that will show the film worldwide are equipped to show 48 frames, so most people will see it in the more traditional format. The movie has also been shot in 3D.

A handful of animal rights protesters held signs at the premiere.

The protest by the group People for the Ethical Treatment of Animals comes after several animal wranglers said three horses and up to two dozen other animals had died during the making of the movies because they were housed at an unsafe farm.

Jackson's spokesman earlier acknowledged two horses had died preventable deaths at the farms but said the production company worked quickly to improve stables and other facilities and that claims of mistreatment were unfounded.

"No mistreatment, no abuse. Absolutely none," Jackson said at the news conference.

Read More..

The New Old Age Blog: Doctor's Orders? Another Test

It is no longer news that Americans, and older Americans in particular, get more routine screening tests than they need, more than are useful. Prostate tests for men over 75, annual Pap smears for women over 65 and colonoscopies for anyone over 75 — all are overused, large-scale studies have shown.

Now it appears that many older patients are also subjected to too-frequent use of the other kind of testing, diagnostic tests.

The difference, in brief: Screening tests are performed on people who are asymptomatic, who aren’t complaining of a health problem, as a way to detect incipient disease. We have heard for years that it is best to “catch it early” — “it” frequently being cancer — and though that turns out to be only sometimes true, we and our doctors often ignore medical guidelines and ongoing campaigns to limit and target screening tests.

Diagnostic tests, on the other hand, are meant to help doctors evaluate some symptom or problem. “You’re trying to figure out what’s wrong,” explained Gilbert Welch, a veteran researcher at the Dartmouth Institute for Health Policy and Clinical Practice.

For these tests, medical groups and task forces offer many fewer guidelines on who should get them and how often — there is not much evidence to go on — but there is general agreement that they are not intended for routine surveillance.

But a study using a random 5 percent sample of Medicare beneficiaries — nearly 750,000 of them — suggests that often, that is what’s happening.

“It begins to look like some of these tests are being routinely repeated, and it’s worrisome,” said Dr. Welch, lead author of the study just published in The Archives of Internal Medicine. “Some physicians are just doing them every year.”

He is talking about tests like echocardiography, or a sonogram of the heart. More than a quarter of the sample (28.5 percent) underwent this test between 2004 and 2006, and more than half of those patients (55 percent) had a repeat echocardiogram within three years, most commonly within a year of the first.

Other common tests were frequently repeated as well. Of patients who underwent an imaging stress test, using a treadmill or stationery bike (or receiving a drug) to make the heart work harder, nearly 44 percent had a repeat test within three years. So did about half of those undergoing pulmonary function tests and chest tomography, a CAT scan of the chest.

Cytoscopy (a procedure in which a viewing tube is inserted into the bladder) was repeated for about 41 percent of the patients, and endoscopy (a swallowed tube enters the esophagus and stomach) for more than a third.

Is this too much testing? Without evidence of how much it harms or helps patients, it is hard to say — but the researchers were startled by the extent of repetition. “It’s inconceivable that it’s all important,” Dr. Welch said. “Unfortunately, it looks like it’s important for doctors.”

The evidence for that? The study revealed big geographic differences in diagnostic testing. Looking at the country’s 50 largest metropolitan areas, it found that nearly half the sample’s patients in Miami had an echocardiogram between 2004 and 2006, and two thirds of them had another echocardiogram within three years — the highest rate in the nation.

In fact, for the six tests the study included, five were performed and repeated most often in Florida cities: Miami, Jacksonville and Orlando. “They’re heavily populated by physicians and they have a long history of being at the top of the list” of areas that do a lot of medical procedures and hospitalizations, Dr. Welch said.

But in Portland, Ore., where “the physician culture is very different,” only 17.5 percent of patients had an echocardiogram. The places most prone to testing were also the places with high rates of repeat testing. Portland, San Francisco and Sacramento had the lowest rates.

We often don’t think of tests as having a downside, but they do. “This is the way whole cascades can start that are hard to stop,” Dr. Welch said. “The more we subject ourselves, the more likely some abnormality shows up that may require more testing, some of which has unwanted consequences.”

Properly used, of course, diagnostic tests can provide crucial information for sick people. “But used without a good indication, they can stir up a hornet’s nest,” he said. And of course they cost Medicare a bundle.

An accompanying commentary, sounding distinctly exasperated, pointed out that efforts to restrain overtesting and overtreatment have continued for decades. The commentary called it “discouraging to contemplate fresh evidence by Welch et al of our failure to curb waste of health care resources.”

It is hard for laypeople to know when tests make sense, but clearly we need to keep track of those we and our family members have. That way, if the cardiologist suggests another echocardiogram, we can at least ask a few pointed questions:

“My father just had one six months ago. Is it necessary to have another so soon? What information do you hope to gain that you didn’t have last time? Will the results change the way we manage his condition?”

Questions are always a good idea. Especially in Florida.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

Stocks decline as investors wait on 'cliff'

Stocks declined for a third day on Wall Street as investors waited for signs of progress on the “fiscal cliff.”

The Dow Jones industrial average fell 105 points to 12,772 just after 10 a.m. in New York. The Standard and Poor's 500 was down 13 points to 1,386. The Nasdaq Composite was off 29 points at 2,938.

Stocks declined Tuesday after Senate Majority Leader Harry Reid said he was frustrated by the lack of progress in budget talks. About $671 billion of tax increases and spending cuts will come into effect Jan. 1 if no deal is reached. Economists say the measures could eventually push the U.S. back into recession.

Concern that the U.S. will go over the “cliff” has weighed on stocks since the Nov. 6 elections returned a divided government to power with President Barack Obama returning to the White House and Republicans retaining control of the House.

In economic news Wednesday, U.S. sales of new homes dipped 0.3 percent in October though remain up 20.4 percent for the year, according to a government report. Stable home prices suggest the housing market is steadily recovering.

Investors will also look will also look to the Federal Reserve for indications about the strength of the economy. A Fed snapshot of business conditions around the nation, covering October through mid-November, will be published at 2 p.m.

The yield on the 10-year Treasury note fell 3 basis points to 1.61 percent.

Stocks making big moves:

— Chipmaker Analog Devices fell $1.03 to $39.09 after it said sales fell 3 percent in the third quarter due to weak economic conditions and global uncertainty.

— Costco, the wholesale club operator, gained $4.45 to $100.90 after the company said that it would pay a special dividend of $7 a share next month, in addition to the regular quarterly dividend it pays shareholders.

— Green Mountain Coffee Roasters surged $7.04 to $36.04 after the beleaguered coffee company reported fourth-quarter results and guidance that far exceeded the market's expectations.

Read More..