Surgeon infected patients during heart procedure, Cedars-Sinai admits

A heart surgeon at Cedars-Sinai Medical Center unwittingly infected five patients during valve replacement surgeries earlier this year, causing four of the patients to need a second operation.

The infections occurred after tiny tears in the latex surgical gloves routinely worn by the doctor allowed bacteria from a skin inflammation on his hand to pass into the patients' hearts, according to the hospital. The patients survived the second operation and are still recovering, hospital officials said.

The outbreak led to investigations by the hospital and both the L.A. County and California departments of public health. The federal Centers for Disease Control and Prevention was also consulted.

Hospital officials called it a "very unusual occurrence" probably caused by an unfortunate confluence of events: the nature of the surgery, the microscopic rips in the gloves and the surgeon's skin condition. Valve replacement requires the surgeon to use thick sutures and tie more than 100 knots, which can cause extra stress on the gloves, they said.

Nevertheless, the hospital's goal is to have zero infections, said Harry Sax, vice chairman of the hospital's department of surgery. "Any hospital-acquired infection is unacceptable," he said.

The infections raise questions about what health conditions should prevent a surgeon from operating and how to get the best protection from surgical gloves. Surgeons with open sores or known infections aren't supposed to operate, but there is no national standard on what to do if they have skin inflammation, said Rekha Murthy, medical director of the hospital's epidemiology department. She added that there were also no national standards on types of gloves used, whether to wear double gloves or how many times surgeons should change those gloves during a procedure.

Healthcare-acquired infections are very common throughout the United States. Each year, infections cause 99,000 deaths in the country, including about 12,000 in California. Hospitals in the state are required to report certain infections to the California Department of Public Health. That reporting makes the public more aware of the quality of care provided at local hospitals and is an important tool for reducing infections, said Debby Rogers, deputy director of the department's Center for Health Care Quality.

Cedars-Sinai has low rates for hospital-acquired infections compared with the state and national average but has not performed as well on other surgical quality measures recently, according to the Leapfrog Group, an employer-backed nonprofit focused on healthcare quality. The organization gave the hospital a C rating last month on its national report card, down from an A in June, though it was not related to the infection outbreak.

"Clearly this hospital is making attempts to reduce infections, but they have more work to do," said Leah Binder, Leapfrog's chief executive.

Cedars-Sinai Medical Center conducts about 360 valve replacement surgeries each year and said infections occur in fewer than 1% of its cases — lower than the national average.

The hospital learned about the problem in June after three patients who had undergone valve replacement surgery showed signs of infection. Doctors diagnosed the patients with an infection called endocarditis. Concerned there might be a connection among the cases, epidemiologists analyzed the bacteria, staphylococcus epidermidis, and determined that it was an identical strain and therefore must have come from a single source. "It led to the question of gee, I wonder where it came from?" Murthy said.

Epidemiologists homed in on the surgeon with the skin inflammation. The bacteria matched, and then they made a surprising discovery: microscopic tears in the gloves typically worn by surgeons after performing valve replacement surgery. The surgeon, whose name was not released, was not allowed to operate again until he healed. He is still a member of the medical staff but no longer performs surgeries at the hospital.

The hospital soon found the same infection in two more patients. Officials also reached out to 67 patients who had heart valve replacements with the same surgeon but didn't find any other cases. One of the five infected patients was treated with antibiotics, and the other four had new valve replacement surgeries. Sax said the hospital apologized to the patients and has continued to monitor their health. The hospital has also covered the cost of their care, including follow-up treatment and all the related surgeries.

All surgeons doing valve replacements are now required to change gloves more frequently, officials said. Some surgeons are wearing double gloves during the operations, Sax said.

Following the outbreak, Cedars-Sinai did the proper follow-up to ensure the safety of their patients, said Dawn Terashita, a medical epidemiologist with L.A. County, who was notified in September. What occurred at Cedars-Sinai was an unintentional consequence of the surgery, she said.

"There is no way to keep a room entirely sterile and all the people in it sterile," she said. "You will always have risk of infection."

anna.gorman@latimes.com

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15 Agonizing Automotive Atrocities

Yugo.

There, we got it out of the way. When you read the headline, of course an image of a tiny Cold War-era hatchback popped into your head. We bet you also shuddered at the thought of a Pontiac Aztek.

We love to poke fun at failure, and no failure made a punchline better than the Yugo. We found that out while talking with Jason Vuic, author of The Yugo: The Rise and Fall of the Worst Car in History. Vuic was aware that the Yugo fell far short of being a good car, but what truly amazed him was how many people who had never driven a Yugo knew just how bad it was. In failure, it became a wild viral marketing success.

Not all cars rose to level of infamy embodied by the Yugo. To paraphrase Shakespeare, some cars were born awful while others had awfulness thrust upon them. Some automotive atrocities were the result of automakers trying something new and falling far short of the mark, while other cars failed from a lack of effort. Still others were perfectly adequate cars but came to represent a regrettable moment in time.

Here we display all three kinds of auto-trocities, highlighting famous failures and digging deep to dredge up detritus better off forgotten. Yes, we know there are many, many more automotive atrocities and this list only scratches the surface of the heap. You’ll have a chance to list your favorite heaps tomorrow, so stay tuned.

Above: Peel Trident 1965-1966

Famous from appearances on Top Gear and Monster Garage, the Peel Trident was a “shopping car” built on the Isle of Man. Along with the bubblelicious BMW Isetta and the fiberglass Reliant Robin, the Trident was ridiculed for its small size and three wheels.

Photo: Casaflamingo/Flickr

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Rolling Stones hit NY for 50th anniversary gig

NEW YORK (AP) — “Time Waits for No One,” the Rolling Stones sang in 1974, but lately it’s seemed like that grizzled quartet does indeed have some sort of exemption from the ravages of time.

At an average age of 68-plus years, the British rockers are clearly in fighting form, sounding tight, focused and truly ready for the spotlight at a rapturously received pair of London concerts last month.

On Saturday, Mick Jagger, Keith Richards, Ronnie Wood and Charlie Watts hit New York for the first of three U.S. shows on their “50 and Counting” mini-tour, marking a mind-boggling half-century since the band first began playing its unique brand of blues-tinged rock.

And the three shows — Saturday’s at the new Barclays Center in Brooklyn, then two in Newark, N.J., on Dec. 13 and 15 — aren’t the only big dates on the agenda. Next week the Stones join a veritable who’s who of British rock royalty and U.S. superstars at the blockbuster 12-12-12 Sandy benefit concert at Madison Square Garden. Also scheduled to perform: Paul McCartney, the Who, Eric Clapton, Bruce Springsteen & The E Street Band, Alicia Keys, Kanye West, Eddie Vedder, Billy Joel, Roger Waters and Chris Martin.

The Stones‘ three U.S. shows promise to have their own special guests, too. Mary J. Blige will be at the Brooklyn gig, as well as guitarist Gary Clark Jr., the band has announced. (Blige performed a searing “Gimme Shelter” with frontman Jagger in London.) Rumors are swirling of huge names at the Dec. 15 show, which also will be on pay-per-view.

In a flurry of anniversary activity, the band also released a hits compilation last month with two new songs, “Doom and Gloom” and “One More Shot,” and HBO premiered a new documentary on their formative years, “Crossfire Hurricane.”

The Stones formed in London in 1962 to play Chicago blues, led at the time by the late Brian Jones and pianist Ian Stewart, along with Jagger and Richards, who’d met on a train platform a year earlier. Bassist Bill Wyman and drummer Charlie Watts were quick additions.

Wyman, who left the band in 1992, was a guest at the London shows last month, as was Mick Taylor, the celebrated former Stones guitarist who left in 1974 — to be replaced by Wood, the newest Stone and the youngster at 65.

The inevitable questions have been swirling about the next step for the Stones: another huge global tour, on the scale of their last one, “A Bigger Bang,” which earned more than $ 550 million between 2005 and 2007? Something a bit smaller? Or is this mini-tour, in the words of their new song, really “One Last Shot”?

The Stones won’t say. But in an interview last month, they made clear they felt the 50th anniversary was something to be marked.

“I thought it would be kind of churlish not to do something,” Jagger told The Associated Press. “Otherwise, the BBC would have done a rather dull film about the Rolling Stones.”

__

Associated Press writer David Bauder contributed to this report.

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Supreme Court to rule on California's Prop. 8 ban on gay marriage

The Supreme Court announced Friday it will rule for the first time on same-sex marriage by deciding the constitutionality of California’s Proposition 8, the voter initiative that limited marriage to a man and a woman.

The justices also said they would decide whether legally married gay couples have a right to equal benefits under federal law.

The California case raises the broad question of whether gays and lesbians have an equal right to marry.

FULL COVERAGE: The battle over gay marriage 

If the justices had turned down the appeal from the defenders of Prop. 8, it would have allowed gay marriages to resume in California, but without setting a national precedent.

Now, the high court has agreed to decide whether a state’s ban on same-sex marriages violates the U.S. Constitution. The court’s intervention came just one month after voters in three states — Maine, Maryland and Washington — approved gay marriages. This brought the total to nine states having legalized same-sex marriages. 

But the justices also left themselves a way out. They said they would consider whether the defenders of Prop. 8 had legal standing to bring their appeal.

The justices made the announcement after meeting behind closed doors. They did not say which justices voted to hear the appeals.

Last year, the U.S. 9^th Circuit Court of Appeals struck down Prop. 8, but it did so on a narrow basis. Judge Stephen Reinhardt reasoned that the voter initiative was unconstitutional because it took away from gays and lesbians a right to marry that they had won before the state Supreme Court.

The justices now will have at least three options before them: They could reverse the 9^th Circuit and uphold Prop. 8, thereby making it clear that the definition of marriage will be left to the discretion of each state and its voters.

They could rule broadly that denying gays and lesbians the fundamental right to marry violates the Constitution’s guarantee of equal protection of the laws. Such a decision would open the door to gay marriages nationwide.

Or as a third option, they could follow the approach set by the 9^th Circuit and strike down Prop. 8 in a way that limits the ruling to California only.

In the other gay-marriage cases, the court will decide the constitutionality of part of the Defense of Marriage Act  that denies federal benefits to legally married couples. Judges in New England, New York and California have ruled this provision unconstitutional.

The justices are expected to hear arguments in the two sets of gay marriage cases in March and issue decisions by late June.

FULL COVERAGE: The battle over gay marriage 

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david.savage@latimes.com

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Apple's U.S.-Made Macs Are a Drop in the Bucket — But Could Herald a Job Flood

Apple spent nearly $10 billion this past year on the tools and equipment needed to make its products. In that light, Apple CEO Tim Cook’s promise this week to invest more than $100 million to move production for one of its Mac lines to the U.S. next year sounds paltry.

But even such a small sum could signal something much bigger for the U.S. economy: namely, that moving manufacturing jobs back from China to the U.S. is starting to make financial sense.

For more than a dozen years, Apple has relied on a “designed in the U.S., made in China” strategy. That’s chiefly because the cost of labor in China is so much cheaper. This simple reality has shifted the globe’s economic center of gravity over the past decade. China has become the world’s manufacturing hub.

But that influx of wealth into China hasn’t only meant more money for factory owners and CEOs. Hal Sirkin, a senior partner with The Boston Consulting Group, has spent the past two years examining the phenomenon of “insourcing” — the return of jobs to the U.S. from overseas. When China joined the World Trade Organization in 2001, Sirkin says, the average Chinese worker made 58 cents per hour — a cost that had companies around the world banging on the doors of Chinese factories. Every year since, however, Sirkin says wages in China have risen an average of 15 to 20 percent annually.

“Once labor stops becoming cheap, all of a sudden the equation turns,” he says.

Worker productivity adds another variable that could make the math behind insourcing even more attractive to U.S. companies. Sirkin says American workers are about three times as productive as their Chinese counterparts, even as the Great Recession has kept U.S. wages stagnant. At 58 cents an hour, 10 Chinese workers were still cheaper than a single more productive worker in the U.S. But by 2015, if current trends continue, Sirkin says the wage gap will shrink enough that lower productivity combined with transportation costs will make Chinese workers the more expensive option for making goods to be sold in the U.S.

All that said, a mere $100 million from Apple doesn’t register as a huge vote of confidence in insourcing, nor does the part of its business it’s bringing back home. The Mac lineup is no longer Apple’s main source of revenue, nor is it a growing sector. In its most recent quarter, the company sold just under 5 million Macs, a 1 percent increase from the previous year. In comparison, the company sold 14 million iPads, up 26 percent from the prior year, and just under 27 million iPhones, a whopping 58 percent jump from the same quarter one year ago.

“This is going to impact a very small percentage of the business,” says Tom Dinges, a senior supply chain analyst at IHS.

Dinges says Cook is under a lot of pressure to create more U.S. jobs in the U.S. when so many of its products are sold here, though the company itself says it’s responsible for nearly 600,000 American jobs directly and indirectly. Add the bad publicity Apple has faced following revelations of employee suicides, poor working conditions and low wages at Foxconn factories in China and $100 million starts to seem like a small price for Apple to pay to polish its tarnished corporate image.

But no company gets to be as big as Apple without keeping a sharp eye on global economic trends. Apple has built up an incredibly efficient supply chain overseas, and we won’t be seeing iPhone or iPad factories springing up stateside anytime soon. But even a small move back to the U.S. gives Apple better footing to make further strides if insourcing starts to look like a clearer path to more profits.

And it’s not the only PC maker headed in that direction. Lenovo, the world’s second largest PC maker, has committed to building a manufacturing facility in Whitsett, North Carolina, close to its U.S. headquarters — though this isn’t exactly insourcing, since Lenovo is itself a Chinese company. Google made it’s Nexus Q, albeit a failed device, in the U.S. And server companies like SeaMicro have also opted to manufacture close to home.

In the end, every company will make its own calculations, and the answer won’t always come out the same, says Michael Marks, former CEO of contract manufacturer Flextronics Inc. and a founding partner at Riverwood Capital, a private equity firm. Asia has built up a huge infrastructure over decades supplying the components to make consumer electronics, which makes makes any attempt to manufacture gadgets in the U.S. again a complicated proposition.

At the same time, he says “the balance of power in cost has changed.” Nobody will be making circuit boards or displays in U.S., Marks predicts. But he says bringing all the components together and assembling them for just-in-time delivery to stores and customers could help PC makers stay competitive in the domestic market compared to having a fully assembled machine sit on a boat for a month en route from China.

Even then, insourcing still might not be an unequivocal cause for celebration. If more assembly-line jobs do return to the U.S., Marks says they won’t be like the fabled post-World War II middle-class manufacturing jobs in automaking and aerospace. “A hamburger flipper makes more money at McDonald’s than an assembly line worker would make,” he says. Such factories also won’t be massive 5,000-employee behemoths, he says, since the U.S. — even with its current unempoloyment rate — doesn’t have the labor pool to staff them. Instead, he says the country will see smaller shops more in the range of 100 employees each.

Still, he says insourcing is real. And it will change the job landscape.

“A whole bunch of hundreds turns into thousands,” Marks says. “It’s definitely a useful trend for America.”

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UK’s Kate and William “saddened” by nurse’s death

LONDON (Reuters) – Britain’s Prince William and his wife Kate said on Friday they were “deeply saddened” by the death of a nurse who fell victim to a prank call from an Australian radio station seeking details of the duchess’s condition while she was in hospital for morning sickness.

The King Edward VII hospital earlier confirmed the death of the nurse, Jacinda Saldanha.

“Their Royal Highnesses were looked after so wonderfully well at all times by everybody at King Edward VII Hospital, and their thoughts and prayers are with Jacintha Saldanha‘s family, friends and colleagues at this very sad time,” said a statement from William’s office.

(Reporting by Tim Castle; editing by Stephen Addison)

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18 arrested in federal crackdown on gang that operated near USC

Federal authorities on Thursday announced a sweeping racketeering indictment against a Mexican Mafia-controlled gang that operated in an L.A. neighborhood just north of USC and was allegedly involved in at least one slaying, drug sales, extortion and robberies.

Eighteen members of the Harpys gang, also known as the Harpys-Dead End gang, were arrested Thursday morning on charges in three federal indictments resulting from “Operation Roman Empire.”

Those arrested include Vianna Roman, 37, daughter of a Mexican Mafia member, Danny Roman, who allegedly controlled the gang while serving a life sentence at Pelican Bay State Prison.

A total of 29 defendants were named in the racketeering indictment, eight of whom were already in state custody. Among them is Miguel Delgado, 18, accused of committing armed robbery against three USC students.

Federal prosecutors alleged that Vianna Roman and her husband, Aaron Soto, 40, traveled to and from Pelican Bay passing along orders from Danny Roman and collecting taxes to be funneled to him through profits the gang made through dealing in methamphetamine, cocaine, crack cocaine and heroin and through extorting businesses, including swap-meet vendors, via threats of violence.

Members of the gang are suspected in the slaying of one gang member who owed a debt, as well as plotting to kill a witness slated to testify against a gang member in a state court case, according to the indictment.

The gang has previously been targeted by the Los Angeles city attorney’s office in injunctions alleging the gang’s members were engaged in shakedowns, robberies, vandalism and murder. A judge issued a court order in 1998 that barred 30 of the gang’s members from associating with one another in the area.

At the time, one business owner said the Harpys asked for $150 to $180 a month for protection from the gang.

The gang controlled an area southwest of downtown that spanned from Normandie Avenue to Figueroa Street and Washington Boulevard to Jefferson Boulevard. Over the course of the operation, authorities seized 8½ pounds of methamphetamine, approximately one-half pound of heroin, approximately one pound of cocaine, 23 pounds of marijuana and 22 guns, according to a press release from the U.S. attorney's office.

If convicted of the racketeering charges, all but one of the defendants face a maximum sentence of life in prison, prosecutors said.

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T-Mobile Finally Gets the Apple iPhone

Apple’s iPhone is finally coming to T-Mobile USA.

T-Mobile’s parent company, Germany’s Deutsche Telekom, announced Thursday that its U.S. subsidiary has struck an agreement with Apple to sell iProducts in 2013. In a statement issued online, Deutsche Telekom stopped short of specifically naming the iPhone or iPad. But during an investors conference in Germany on Thursday, T-Mobile USA CEO John Legere hoisted an iPhone and said the carrier will sell the wildly popular handset, according to the Los Angeles Times.

The move means the iPhone will be available through each of the top four U.S. carriers, which also include AT&T, Verizon and Sprint. Apple also sells the iPhone through a few smaller, regional carriers such as C-Spire. The move definitely helps T-Mobile.

“If we do see Apple products being sold through T-Mobile, I do think that would be a nice boost for their portfolio in 2013,” said Hughes de la Vergne, a smartphone analyst with the Gartner research firm. “Right now, T-Mobile is the only national carrier that doesn’t sell any Apple products. And with Android truly dominating their portfolio, it’s limited consumer choice over there.”

The pact between Apple and T-Mobile also will bring the iPhone up to retail par with Samsung’s Galaxy S III and Galaxy Note II smartphones, which were previously the only handsets offered by each of the big four carriers.

Samsung is Apple’s biggest rival in smartphone sales and the Galaxy lineup is the Korean company’s answer to the iPhone. The competition between the two companies is one of the major reasons they’re waging a patent war in courtrooms, each trying to get the other’s phones and tablets removed from store shelves.

“I don’t think you can say that Samsung selling their phones across all four carriers is the one thing that pushed Apple to work out a deal with T-Mobile,” De la Vergne said. “But the expansion of the iPhone across major carriers and smaller carriers like C-Spire and Cricket and Virgin over the last couple years; when you’re competing with Android for developer mindshare and Samsung has its devices sold in so many places, the competition between Apple and Android and Samsung is certainly an aspect of all this.”

The deal also could help T-Mobile move from a lagging fourth-place carrier to a company vying for the third spot in the U.S., he said.

“T-Mobile has been in an uphill battle the last couple years,” De la Vergne said. “AT&T, Sprint, and Verizon, they’ve all got a nice lead when it comes to selling the iPhone and having deployed 4G LTE networks. T-Mobile will still need to overcome that, but if they can get an iPhone on store shelves and a have an LTE network up and running, they’ll be in a much better position to challenge Sprint for third place among U.S. carriers.

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mtvU honors Frank Ocean, wounded Pakistani teen

NEW YORK (AP) — The mtvU network is honoring a rap superstar who detailed his love for another man and a Pakistani girl shot for her education advocacy as its Man and Woman of the Year.

Frank Ocean, who earned six Grammy nominations Wednesday, published a letter online about his first love, a man, just as his “channel ORANGE” disc was being released. MtvU on Thursday called it “an incredibly brave move for an artist on the verge of superstardom.”

Fifteen-year-old Malala Yousufzai (mah-LAH’-lah YOO’-suf-ZAY’) blogged about her support of education for girls in Pakistan. For that, Taliban militants stormed her school bus and shot her in the head and neck, but she survived.

The mtvU network is geared toward college students and is seen on more than 750 campuses.

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Well: Running in Reverse

This column appears in the Dec. 9 issue of The New York Times Magazine.

Backward running, also known as reverse or retro running, is not as celebrated as barefoot running and will never be mistaken for the natural way to run. But a small body of science suggests that backward running enables people to avoid or recover from common injuries, burn extra calories, sharpen balance and, not least, mix up their daily routine.

The technique is simple enough. Most of us have done it, at least in a modified, abbreviated form, and probably recently, perhaps hopping back from a curb as a bus went by or pushing away from the oven with a roasting pan in both hands. But training with backward running is different. Biomechanically, it is forward motion’s doppelgänger. In a study published last year, biomechanics researchers at the University of Milan in Italy had a group of runners stride forward and backward at a steady pace along a track equipped with force sensors and cameras.

They found that, as expected, the runners struck the ground near the back of their feet when going forward and rolled onto the front of their feet for takeoff. When they went backward though, they landed near the front of their feet and took off from the heels. They tended to lean slightly forward even when running backward. As a result, their muscles fired differently. In forward running, the muscles and tendons were pulled taut during landing and responded by coiling, a process that creates elastic energy (think rubber bands) that is then released during toe-off. When running backward, muscles and tendons were coiled during landing and stretched at takeoff. The backward runners’ legs didn’t benefit from stored elastic energy. In fact, the researchers found, running backward required nearly 30 percent more energy than running forward at the same speed. But backward running also produced far less hard pounding.

What all of this means, says Giovanni Cavagna, a professor at the University of Milan who led the study, is that reverse running can potentially “improve forward running by allowing greater and safer training.”

It is a particularly attractive option for runners with bad knees. A 2012 study found that backward running causes far less impact to the front of the knees. It also burns more calories at a given pace. In a recent study, active female college students who replaced their exercise with jogging backward for 15 to 45 minutes three times a week for six weeks lost almost 2.5 percent of their body fat.

And it aids in balance training — backward slow walking is sometimes used as a therapy for people with Parkinson’s and is potentially useful for older people, whose balance has grown shaky.

But it has drawbacks, Cavagna says — chiefly that you can’t see where you’re going. “It should be done on a track,” he says, “or by a couple of runners, side by side,” one facing forward.

It should be implemented slowly too, because its unfamiliar motion can cause muscle fatigue. Intersperse a few minutes periodically during your regular routine, Cavagna says. Increase the time you spend backward as it feels comfortable.

The good news for serious runners is that backward does not necessarily mean slow. The best recorded backward five-kilometer race time is 19:31, faster than most of us can hit the finish line with our best foot forward.

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