John Duffy of 3C Interactive says he asks job candidates to describe what their first months on the job would be like, partly to “learn what their expectations are, and where they think we’re at.”
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BP, the British oil company, said Thursday that it would pay $4.5 billion in fines and other payments to the government and plead guilty to 14 criminal charges in connection with the giant oil spill in the Gulf of Mexico two years ago.
The explosion on the Deepwater Horizon drilling rig in the Gulf of Mexico that was connected to a well owned by BP killed 11 workers and spilled millions of barrels of oil.
The payments include $4 billion related to the criminal charges and $525 million to securities regulators, the company said in a statement. As part of the settlement, BP agreed to plead guilty to 11 felony counts of misconduct or neglect related to the deaths of 11 people in the Deepwater Horizon accident in April 2010, which released millions of barrels of oil into the gulf over the course of the next few months.
The Justice Department also filed criminal charges against three BP employees on Thursday.
The government charged the top BP officers aboard the drilling rig, Robert Kaluza and Donald Vidrine, with manslaughter in connection with each of the men who died, alleging that they were negligent in supervising tests before the well blowout and explosion that destroyed the rig.
Prosecutors also charged BP’s former vice president for exploration in the Gulf of Mexico, David Rainey, with obstruction of Congress and making false statements about the rate at which oil was spilling from the well.
“All of us at BP deeply regret the tragic loss of life caused by the Deepwater Horizon accident as well as the impact of the spill on the Gulf coast region,” Robert Dudley, BP’s chief executive, said in a statement. “From the outset, we stepped up by responding to the spill, paying legitimate claims and funding restoration efforts in the Gulf. We apologize for our role in the accident, and as today’s resolution with the U.S. government further reflects, we have accepted responsibility for our actions.”
While the settlement dispels one dark cloud that has hovered over BP since the spill, others remain. BP is still subject to other claims, including billions of dollars in federal civil claims and claims for damages to natural resources.
In particular, BP noted that the settlement does not resolve what is potentially the largest penalty related to the spill: fines under the Clean Water Act. The potential fine for the spill under the act is $1,100 to $4,300 a barrel spilled. That means the fine could be as much as $21 billion.
In addition to the 11 felonies related to the men killed in the accident, the company agreed to plead guilty to one misdemeanor violation of the Clean Water Act and one misdemeanor violation of the Migratory Bird Treaty Act.
BP also acknowledged that it had provided inaccurate information to the public early on about the rate at which oil was gushing from the well.
The company agreed to plead guilty to one felony count of obstruction of Congress over its statements on that issue. It also agreed to pay a civil penalty of $525 million to the Securities and Exchange Commission, spread over three years, to resolve the agency’s claims that the company made misleading filings to investors about the flow rate.
As part of its resolution of criminal claims with the Department of Justice, BP will pay about $4 billion, spread over five years. That amount includes $1.256 billion in criminal fines, $2.394 billion to the National Fish & Wildlife Foundation and $350 million to the National Academy of Sciences.
The criminal fine is one of the largest ever levied by the United States against a corporation, roughly equal to the $1.3 billion fine paid by Pfizer in 2009 for illegally marketing an arthritis drug. BP has repeatedly said it would like to reach a settlement with all claimants if the terms were reasonable. The unresolved issue of the claims has been weighing on BP’s share price.
On Thursday, BP’s American shares were trading at about $40 at midday, roughly unchanged on the day and down about 34 percent since the accident.
“It’s one less thing to be negative on BP about and a minor step in the right direction toward the rehabilitation of BP,” Iain Armstrong, an equity analyst at the investment manager Brewin Dolphin, in London, said. But he added that there were still concerns about remaining claims and that “lawyers might yet have their day at court.”
As part of Thursday’s agreements, BP said it was increasing its reserve for all costs and claims related to the spill to about $42 billion.
Because of the number of questions, his answers are being split into several parts. The first two, today and Friday, focus on diagnostic issues, including new tests, the role played by genetics and inheritance, causes and policy issues.
Next Wednesday Dr. Doraiswamy will address treatment, patient care and new clinical trials. (Some questions published here have been edited, and not all questions could be answered.)
The doctor’s answers are meant for educational purposes and are not meant to be a substitute for advice from your own doctor. Readers should contact their physician before making health care decisions.
……………………………………
Q. Why can I remember everything about a person except his or her name? — Horick, Texas
A. This is known as the “cook-Cook problem.” It is a result of how our brains are wired to enable predictions of future needs based on relevance and strength of associations. Common words with strong functional associations (for example, a cook who will prepare food) are easier to retrieve than proper names (Mr. Cook). Surveys show that more than 80 percent of normal older people report trouble with names. In reality, most of these individuals could probably recall several hundred names, but it’s the one they forget that causes panic. This helps explain why traditional American Indian names like Sitting Bull, which bring up a vivid image, are probably easier to recall.
Q. My question is not medical per se: Do you believe that people diagnosed with Alzheimer’s disease (or other dementias) should be told about their diagnosis? My mom, who had Alzheimer’s, died in 2008, and this was a very contentious issue separating me and my oldest sister who, alas, had health-care power of attorney. I emphatically believe people have to know that they have dementia. I am curious to know if you have an opinion on this. — Carol, Chicago
A. I believe they should be told since they have a right to know and make plans as well as a right to grieve. There are some situations where it may be appropriate to withhold information, such as when the exact diagnosis is uncertain or when obvious harm (such as suicide) may result. Surveys indicate that most family members would withhold the diagnosis from a loved one, but when asked if they themselves would like to know if they had the illness, most said "yes." This issue is likely to become more contentious as it becomes possible to predict disease more precisely using genetics and brain scans.
Q. “Can you tell me, wait, I forget ...” What are initial signs of Alzheimer’s?
If I place an object (i.e. cellphone, keys) in a different spot than usual, it seems to have disappeared. I’ve been leaving house key outdoors in the lock; forget names of folks I’ve met a few times (once reminded, I recall); almost totally forget titles of movies/books - when reminded, I recall..??.age-first of baby boomers, mother is 100+, has Alzheimers.
What are the initial signs of dementia? Memory loss? hysical affectations? Language dysfunction? I am nearing 65, in good health, but often can’t think of a specific word while speaking or briefly forget how to spell a word while typing.
— Wally Wallace, Ames, Iowa; Technic Alley, Toronto; Maureen64, Calif.; Motmista, Pensacola, Fla.; Canadian Content Only, Toronto; Lulu858; Marie Marley, Kan.; Unknown; Susa Bruce, Brooklyn.
A. The “tip of the tongue” (also called “Teflon brain”) phenomenon becomes more common as we age, perhaps due to chemical changes in the brain’s wiring. This commonly affects recall of names and words, and sometimes where you placed objects. Often, turning your mind to something else will make the information pop up. If what you forgot comes back to you a few hours or days later or comes back readily with a cue, it’s probably benign. Sometimes there is a “feeling of knowing,” but other times your mind can go totally blank — for example, where you parked your car at an airport. “Relax, and call me in the morning” is what memory doctors sometimes call this problem.
If you don’t pay close attention to something because your life is hectic, you’re multitasking, feeling anxiety or it has little emotional relevance, the thought will not register as well in your memory. It’s helpful to stick to a routine (e.g. park your car in the same spot daily) or write things down (e.g. a memo to yourself on your phone about where you left your keys).
If cues don’t help or if memory is forever lost or if things are starting to affect your daily activities frequently, then a medical evaluation is in order. Trouble remembering new information is the classic early problem in Alzheimer’s. In some people early changes can also include mild depression or apathy, and trouble with words, repeating oneself and confusion. Some of the things that suggest a serious memory problem are:
1) Memory getting worse over time, and cues don’t help with recall.
2) Memory problems are affecting your work and functioning, and friends or family members are getting concerned.
3) You have trouble learning new information or doing tasks you know well.
4) Forgetting entire experiences rather than parts of an experience
5) Making up stories to cover up the memory gaps.
Bottom line: if you are concerned, don’t hesitate to get your memory checked.
Q. What is the average risk of someone getting Alzheimer’s? If a sibling has it but parents don’t, what is the risk? What about if a parent or aunt has the disease?
My father, his mother and most of his siblings had Alzheimer’s. My mother’s immediate family had no incidence. She is 86 and pretty sharp. What are the chances I will get it?
My father had Alzheimer’s and my oldest sister has also been diagnosed with the disease. What are the chances of having it since we are obviously genetically predisposed? My memory has always been poor and is definitely getting worse. I’m 65.
— Christine R, Roseland, N.J.; Mitchell McG, Manhattan; Penguinwoman, Toronto; Tosia, New York; Ms. Skeptical, Alexandria, Va.
Because of the number of questions, his answers are being split into several parts. The first two, today and Friday, focus on diagnostic issues, including new tests, the role played by genetics and inheritance, causes and policy issues.
Next Wednesday Dr. Doraiswamy will address treatment, patient care and new clinical trials. (Some questions published here have been edited, and not all questions could be answered.)
The doctor’s answers are meant for educational purposes and are not meant to be a substitute for advice from your own doctor. Readers should contact their physician before making health care decisions.
……………………………………
Q. Why can I remember everything about a person except his or her name? — Horick, Texas
A. This is known as the “cook-Cook problem.” It is a result of how our brains are wired to enable predictions of future needs based on relevance and strength of associations. Common words with strong functional associations (for example, a cook who will prepare food) are easier to retrieve than proper names (Mr. Cook). Surveys show that more than 80 percent of normal older people report trouble with names. In reality, most of these individuals could probably recall several hundred names, but it’s the one they forget that causes panic. This helps explain why traditional American Indian names like Sitting Bull, which bring up a vivid image, are probably easier to recall.
Q. My question is not medical per se: Do you believe that people diagnosed with Alzheimer’s disease (or other dementias) should be told about their diagnosis? My mom, who had Alzheimer’s, died in 2008, and this was a very contentious issue separating me and my oldest sister who, alas, had health-care power of attorney. I emphatically believe people have to know that they have dementia. I am curious to know if you have an opinion on this. — Carol, Chicago
A. I believe they should be told since they have a right to know and make plans as well as a right to grieve. There are some situations where it may be appropriate to withhold information, such as when the exact diagnosis is uncertain or when obvious harm (such as suicide) may result. Surveys indicate that most family members would withhold the diagnosis from a loved one, but when asked if they themselves would like to know if they had the illness, most said "yes." This issue is likely to become more contentious as it becomes possible to predict disease more precisely using genetics and brain scans.
Q. “Can you tell me, wait, I forget ...” What are initial signs of Alzheimer’s?
If I place an object (i.e. cellphone, keys) in a different spot than usual, it seems to have disappeared. I’ve been leaving house key outdoors in the lock; forget names of folks I’ve met a few times (once reminded, I recall); almost totally forget titles of movies/books - when reminded, I recall..??.age-first of baby boomers, mother is 100+, has Alzheimers.
What are the initial signs of dementia? Memory loss? hysical affectations? Language dysfunction? I am nearing 65, in good health, but often can’t think of a specific word while speaking or briefly forget how to spell a word while typing.
— Wally Wallace, Ames, Iowa; Technic Alley, Toronto; Maureen64, Calif.; Motmista, Pensacola, Fla.; Canadian Content Only, Toronto; Lulu858; Marie Marley, Kan.; Unknown; Susa Bruce, Brooklyn.
A. The “tip of the tongue” (also called “Teflon brain”) phenomenon becomes more common as we age, perhaps due to chemical changes in the brain’s wiring. This commonly affects recall of names and words, and sometimes where you placed objects. Often, turning your mind to something else will make the information pop up. If what you forgot comes back to you a few hours or days later or comes back readily with a cue, it’s probably benign. Sometimes there is a “feeling of knowing,” but other times your mind can go totally blank — for example, where you parked your car at an airport. “Relax, and call me in the morning” is what memory doctors sometimes call this problem.
If you don’t pay close attention to something because your life is hectic, you’re multitasking, feeling anxiety or it has little emotional relevance, the thought will not register as well in your memory. It’s helpful to stick to a routine (e.g. park your car in the same spot daily) or write things down (e.g. a memo to yourself on your phone about where you left your keys).
If cues don’t help or if memory is forever lost or if things are starting to affect your daily activities frequently, then a medical evaluation is in order. Trouble remembering new information is the classic early problem in Alzheimer’s. In some people early changes can also include mild depression or apathy, and trouble with words, repeating oneself and confusion. Some of the things that suggest a serious memory problem are:
1) Memory getting worse over time, and cues don’t help with recall.
2) Memory problems are affecting your work and functioning, and friends or family members are getting concerned.
3) You have trouble learning new information or doing tasks you know well.
4) Forgetting entire experiences rather than parts of an experience
5) Making up stories to cover up the memory gaps.
Bottom line: if you are concerned, don’t hesitate to get your memory checked.
Q. What is the average risk of someone getting Alzheimer’s? If a sibling has it but parents don’t, what is the risk? What about if a parent or aunt has the disease?
My father, his mother and most of his siblings had Alzheimer’s. My mother’s immediate family had no incidence. She is 86 and pretty sharp. What are the chances I will get it?
My father had Alzheimer’s and my oldest sister has also been diagnosed with the disease. What are the chances of having it since we are obviously genetically predisposed? My memory has always been poor and is definitely getting worse. I’m 65.
— Christine R, Roseland, N.J.; Mitchell McG, Manhattan; Penguinwoman, Toronto; Tosia, New York; Ms. Skeptical, Alexandria, Va.
Tablets are changing computing, there’s no doubt. I realized this when I saw my 2-year-old son pick up an iPad and master its basic controls, including discovering a child’s app, in about half an hour. The iPad led the way into this brave new world more or less alone at first. It has taken until now for the sheer pressure of innovation inside Apple’s rivals to lead to some great Android-based tablets finally making a mark.
The Need for Speed Most Wanted app for Android.
The Autumn Tree Live Wallpaper app lets you select different trees and watch their leaves descend.
A "tiled" news item display on News360.
If you’re a new owner of one of these, you’ll be happy to know that there’s many an app that will simultaneously thrill you, inform you and welcome you into the world of tablet computing.
For a great news experience, the free app News360 has to be one of the better news-aggregating ones I’ve seen on any platform. When you first open the app, you are presented with a long list of topics that it can aggregate for your convenience into different categories, from arts through science to zombies.
The app uses this profile to grab news from the Web and present it to you within its elegant interface. This is dominated by picture-based “tiles” for each news article the app collects. Each tile tells you the appropriate category, where the news item came from and when. Tapping on one of these tiles takes you to a new page that contains a screen grab of the original online source, alongside the text the app has collected from the article.
The pleasure of News360 is that you can either satisfy your curiosity by tapping on a link to read the original article or decide you have learned enough and navigate on. You can also mark the article as interesting, save it for reading offline — perhaps on a commute — or share it on a social network. These controls are also accessible from the initial “tiles” screen, where you flip over an article’s tile to see the controls. The flip is accompanied by a very pleasing animation. It’s just a little graphical touch, but small details like this make an app great fun.
Part of the fun of having a new tablet is showing off its graphical prowess. Games are a great way to do this. I’ve had immense fun with Edge Extended (about $3 on Google Play). In this game, you play a multicolored cube that you roll around a blocky terrain to collect targets. You swipe your finger on the screen to make the cube flop onto its faces to move. There are all the classic elements of collecting points, avoiding pitfalls, activating switches and so on. But despite its graphical simplicity, the app is swift-paced and very satisfying; it even gave me that sensation of falling from a height in some of its trickier parts.
If you really want to impress people with your tablet’s screen, then you’ll probably get a kick out of a game like Need for Speed Most Wanted ($7 on Google play). It’s a racing game that uses motion to control steering and simple tap controls to brake, slide the car in a drift or turn on a nitrous turbo boost. True to the “Most Wanted” title, you race on regular roads, not racetracks, and can get in trouble with the police. This app has all the typical racing fun, along with the ability to earn points that unlock better cars and so on. But the standout feature is the attractiveness of the graphics, and the image rendering even includes reflections of passing buildings in puddles. It’s really eye-popping, and it even works on a diminutive tablet like the Nexus 7.
If racing’s not your thing, you may like SoulCraft THD instead. In this hack-and-slash role-playing game, you control your character from above as it fights its way through a fantasy landscape of dungeons and cities. As on a standard computer action game, you can earn spells and improve your character’s powers.
The game is “freemium” so it’s free to download and play, but you have to make in-game purchases with real money to advance quickly. The graphics are slick, but don’t expect the kind of detailed rendering you would see on a gaming PC.
If you want to make your pals who own iPads jealous, turn on an animated background. This shows off the computing power of your tablet and Android’s skills, too.
Right now my tablet is rocking the seasonal Autumn Tree Live Wallpaper, which is $1. You can control all sorts of aspects of the app, including what type of trees wave their autumnal leaves in the wind, and it’s delightful. It’s also something that a stock iPad absolutely can’t do.
Have fun, but here’s a big reminder for you: Not all Android tablets will play nicely with all tablet apps, and some features depend on installing the latest edition of the operating system.
Quick Calls
Fresh and free on Android and iOS is a highly unusual “experimental” game, Curiosity. It’s a cube with faces made of millions of smaller cubes. Players all around the world hack away at these by tapping on their devices. A single prize is hidden inside an unknown number of layers. It’s weirdly fun to play ... One of the earliest and slickest apps for Windows 8/RT devices is the official Wikipedia app (free), which shows the online encyclopedia in its most elegant, graphical format yet.
KIRYAT MALACHI, Israel — Israel and Hamas widened their increasingly deadly conflict over Gaza on Thursday, as a militant rocket killed three civilians in an apartment block in this small southern town. The deaths were likely to lead Israel to intensify its military offensive on Gaza, now in its second day of airstrikes.
In Gaza, the Palestinian death toll rose to 11 as Israel struck what the military described as medium- and long-range rocket and infrastructure sites and rocket-launching squads. The military said it had dispersed leaflets over Gaza warning residents to stay away from Hamas operatives and facilities, suggesting that more was to come.
The regional perils of the situation sharpened, meanwhile, as President Mohamed Morsi of Egypt warned on Thursday that his country stood by the Palestinians against what he termed Israeli aggression, echoing similar condemnation on Wednesday.
“The Egyptian people, the Egyptian leadership, the Egyptian government, and all of Egypt is standing with all its resources to stop this assault, to prevent the killing and the bloodshed of Palestinians,” Mr. Morsi said in nationally televised remarks before a crisis meeting of senior ministers. He also instructed his prime minister to lead a delegation to Gaza on Friday and said he had contacted President Obama to discuss strategies to “stop these acts and doings and the bloodshed and aggression.”
In language that reflected the upheaval in the political dynamics of the Middle East since the overthrow of Hosni Mubarak last year, Mr. Morsi said: “Israelis must realize that we don’t accept this aggression and it could only lead to instability in the region and has a major negative impact on stability and security in the region.”
The thrust of Mr. Morsi’s words seemed confined to diplomatic maneuvers, including calls to the United Nations secretary general, Ban Ki-moon, the head of the Arab League and President Obama.
The 120-nation Nonalignmed Movement, the biggest bloc at the United Nations, added its condemnation of the Gaza airstrikes in a statement released by Iran, the group’s rotating president and one of Israel’s most ardent foes. “Israel, the occupying power, is, once more, escalating its military campaign against the Palestinian people, particularly in the Gaza Strip,” the group’s coordinating bureau said in the statement. The group made no mention of the Palestinian rocket fire but condemned what it called “this act of aggression by the Israelis and their resort to force against the defenseless people” and demanded “decisive action by the U.N. Security Council.”
In his conversation with Mr. Obama, Mr. Morsi said, he “clarified Egypt’s role and Egypt’s position; our care for the relations with the United States of America and the world; and at the same time our complete rejection of this assault and our rejection of these actions, of the bloodshed, and of the siege on Palestinians and their suffering.”
Mr. Obama had agreed to speak with Israeli leaders, Mr. Morsi said.
The Thursday’ deaths in Kiryat Malachi were the first casualties on the Israeli side since Israel launched its assault on Gaza, the most ferocious in four years, in response to persistent Palestinian rocket fire.
Southern Israel has been struck by more than 750 rockets fired from Gaza this year that have hit homes and caused injuries. On Thursday, a rocket smashed into the top floor of an apartment building in Kiryat Malachi, about 15 miles north of Gaza. Two men and one woman were killed, according to witnesses at the scene. A baby was among the injured and several Israelis were hospitalized with shrapnel wounds after rockets hit other southern cities and towns, they said.The apartment house was close to a field in a blue-collar neighborhood and the rocket tore open top-floor apartments, leaving twisted metal window frames and bloodstains.
Nava Chayoun, 40, who lives on the second floor, said her husband, Yitzhak, ran up the stairs immediately after the rocket struck and saw the body of a woman on the floor. He rescued two children from the same apartment and afterward, she said, she and her family “read psalms.”
Gretchen Ertl for The New York Times
Jim Koch, who started brewing Samuel Adams Boston Lager at his house in 1984, and Carlene O'Garro, who runs a cake business, participate in a program in which big businesses help small ones.
Carlene O’Garro’s cake business was barely a month old when she arrived at the Samuel Adams brewery in South Boston recently to meet with business counselors, but she brought with her an agenda that hinted at outsize ambitions.
Ms. O’Garro bakes nondairy cheesecakes that she was selling at a handful of grocery stores, including two Whole Foods outlets, in the Boston area. She hoped to learn how to expand the business and distribute the cakes nationally. “I know Jim is all over the place,” she said, “and I want to be like that.”
Jim is Jim Koch, the founder of the Boston Beer Company and one of 36 advisers who spent an evening last August “speed coaching” fledgling food, beverage and hospitality businesses. In 20-minute sessions, some 95 bakers, brewers and restaurant owners peppered the coaches — Boston Beer employees and consultants who included lawyers, accountants and small-business counselors — with questions about both basic day-to-day issues and more strategic concerns.
Speed coaching is one element of “Brewing the American Dream,” a program Boston Beer established with a microlender, Accion, to help small businesses. Mr. Koch, who started brewing Samuel Adams Boston Lager at his house in 1984, remains central to these efforts even as he presides over a company with a market capitalization of $1.4 billion and annual revenue of more than $500 million. He said he had not forgotten his early days, when he struggled to find capital, get his beer into distribution networks and expand.
In six sessions that August evening, Mr. Koch spoke with perhaps a dozen entrepreneurs and then stayed another hour to visit with six or eight more. This year, Boston Beer and Accion are staging 12 speed-coaching events in 11 cities, and Mr. Koch expects to attend about half of them.
Big businesses reaching out to help smaller businesses has come into vogue since the recession. In 2009, Goldman Sachs introduced its 10,000 Small Businesses campaign. Starbucks raises money from customer donations to finance small-business loans. American Express encourages consumers to shop locally on “Small Business Saturday” after Thanksgiving. The New York Stock Exchange links small vendors with large corporations and finances loans through Accion. And several corporations have run contests — Wal-Mart, Chase Bank and Staples have furnished winning small companies with opportunities for retail distribution, capital and office equipment.
It is the latest example of what is known in corporate circles as cause marketing — hitching a brand to a social issue. “How you improve the American economy and create jobs is on everybody’s minds these days,” said David Hessekiel, founder and president of Cause Marketing Forum. “Companies know that it’s on the minds of their consumers, and they want to be seen as part of the solution, not as the enemy.”
That has been a particular concern for chains like Wal-Mart and Starbucks, given their longstanding reputations for forcing local competitors to close. Helping small businesses, Mr. Hessekiel said, “helps them deal with an old issue.”
The Boston Beer program actually predates the recent economic crisis. The seeds of the idea, Mr. Koch said, came to him in 2007 as he walked to his car after he and his employees had volunteered to paint a nearby community center. “I should have felt really good, and I didn’t — I felt a little depressed,” he said. “What I realized is, I’d just taken about $10,000 worth of management time and talent, and turned it into about $1,000 worth of painting. And it was pretty bad painting, too.”
Mr. Koch retooled his company’s philanthropy to take advantage of its resources, particularly its employees’ expertise. The company has committed $1.4 million to finance loans, which are handled by Accion. The loans are small, typically $5,000 to $7,000, with terms of 18 months to two years and interest rates that vary regionally. (In New England, the rate is around 13 percent, typical for microloans.) Perhaps as important as the money is the tutoring by Mr. Koch and his employees. Most microloan programs provide borrowers with rudimentary counseling, but Boston Beer is unusually “high touch,” said Shaolee Sen, vice president for strategy and development at the Accion U.S. Network.
Ms. O’Garro was one of the program’s original clients — she has had two loans, totaling $4,000 — and though she’s repaid that debt and though the muffin business it helped finance has been dormant since 2010, she continues to derive benefits from the program with her cheesecake business, Delectable Desires. She learned how to price her cakes from an employee in Boston Beer’s finance department, Mike Cramer, who went to Whole Foods and scoped out the competition. “He actually made a spreadsheet for me of how much the high-end and low-end desserts cost,” she said.
Another borrower, Sandy Russo of Lulu’s Sweet Shoppe in Boston, said that when she had questions, she sometimes called Mr. Koch’s executive assistant. Last summer, when Lulu’s opened a second location, Boston Beer’s lawyers reviewed the lease and its public relations staff wrote the news release.
Of course, it’s one thing to provide that kind of support to a handful of companies. The question facing Accion and Boston Beer is whether the program can remain as intensive as it expands nationally. “We’re really struggling with that right now,” Ms. Sen said. “The portfolio has been so small up until this point that they really are passionate about their clients.”
ST. LOUIS — Addressing long-held concerns about whether organ donors have adequate protections, the country’s transplant regulators acted late Monday to require that hospitals thoroughly inform living kidney donors of the risks they face, fully evaluate their medical and psychological suitability, and then track their health for two years after donation.
Enactment of the policies by the United Network for Organ Sharing, which manages the transplant system under a federal contract, followed six years of halting development and debate.
Meeting at a St. Louis hotel, the group’s board voted to establish uniform minimum standards for a field long regarded as a medical and ethical Wild West. The organ network, whose initial purpose was to oversee donation from people who had just died, has struggled at times to keep pace with rapid developments in donations from the living.
“There is no question that this is a major development in living donor protection,” said Dr. Christie P. Thomas, a nephrologist at the University of Iowa and the chairman of the network’s living donor committee.
Yet some donor advocates complained that the measures did not go far enough, and argued that the organ network, in its mission to encourage transplants, has a conflict of interest when it comes to safeguarding donors.
Three years ago, the network issued some of the same policies as voluntary guidelines, only to have the Department of Health and Human Services insist they be made mandatory.
Although long-term data on the subject is scarce, few living kidney donors are thought to suffer lasting physical or psychological effects. Kidney donations, known as nephrectomies, are typically done laparoscopically these days through a series of small incisions. The typical patient may spend only a few nights in a hospital and feel largely recovered after several months.
Kidneys are by far the most transplanted organs, and there have been nearly as many living donors as deceased ones over the last decade. What data is available suggests that those with one kidney typically live as long as those with two, and that the risk of a donor dying during the procedure is roughly 3 in 10,000.
But kidney transplants, like all surgery, can sometimes end in catastrophe.
In May at Montefiore Medical Center in the Bronx, a 41-year-old mother of three died when her aorta was accidentally cut during surgery to donate a kidney to her brother. In other recent isolated cases, patients have received donor kidneys infected with undetected H.I.V. or hepatitis C.
Less clear are any longer-term effects on donors. Research conducted by the United Network for Organ Sharing shows that of roughly 70,000 people who donated kidneys between late 1999 and early 2011, 27 died within two years of medical causes that may — or may not — have been related to donation. For a small number of donors, their remaining kidney failed, and they required dialysis or a transplant.
The number of living donors — 5,770 in 2011 — has dropped 10 percent over the last two years, possibly because the struggling economy has made it difficult for prospective donors to take time off from work to recuperate. With the national kidney waiting list now stretching past 94,000 people, and thousands on the list dying each year, transplant officials have said they must improve confidence in the system so more people will donate.
The average age of donors has been rising, posing additional medical risks. And new ethical questions have been raised by the emergence of paired kidney exchanges and transplant chains started by good Samaritans who give an organ to a stranger.
Brad Kornfeld, who donated a kidney to his father in 2004, told the board that it had been impossible to find good information about what to expect, leaving him to search for answers on unreliable Internet chat rooms. He said he had almost backed out.
“If information is power,” said Mr. Kornfeld, a Coloradan who serves on the living donor committee, “the lack of information is crippling.”
Under the policies approved this week, the organ network will require hospitals to collect medical data, including laboratory test results, on most living donors to study lasting effects. Results must be reported at six months, one year and two years.
Similar regulations have been in place since 2000, but they did not require blood and urine testing, and hospitals were allowed to report donors who could not be found as simply lost.
That happened often. In recent years, hospitals have submitted basic clinical information — like whether donors were alive or dead — for only 65 percent of donors and lab data for fewer than 40 percent, according to the organ network. Although the network holds the authority, no hospital has ever been seriously sanctioned for noncompliance.
“It’s time we put some teeth into our policy,” said Jill McMaster, a board member from Tennessee.
By 2015, transplant programs will have to report thorough clinical information on at least 80 percent of donors and lab results on at least 70 percent. The requirements phase in at lower levels for the next two years.
Dr. Stuart M. Flechner of the Cleveland Clinic, the chairman of a coalition of medical societies that made recommendations to the organ network, said 9 of 10 hospitals would currently not meet the new requirement.
Donna Luebke, a kidney donor from Ohio who once served on the organ network’s board, said the new standards would matter only if enforcement were more rigorous. She noted that the organization was dominated by transplant doctors: “UNOS is nothing but the foxes watching the henhouse,” she said.
Another of the new regulations prescribes in detail the medical and psychological screenings that hospitals must conduct for potential donors. It requires automatic exclusion if the potential donor has diabetes, uncontrolled hypertension or H.I.V., among other conditions.
The new policies also require that hospitals appoint an independent advocate to counsel and represent donors, and that donors receive detailed information in advance about medical, psychological and financial risks.
ST. LOUIS — Addressing long-held concerns about whether organ donors have adequate protections, the country’s transplant regulators acted late Monday to require that hospitals thoroughly inform living kidney donors of the risks they face, fully evaluate their medical and psychological suitability, and then track their health for two years after donation.
Enactment of the policies by the United Network for Organ Sharing, which manages the transplant system under a federal contract, followed six years of halting development and debate.
Meeting at a St. Louis hotel, the group’s board voted to establish uniform minimum standards for a field long regarded as a medical and ethical Wild West. The organ network, whose initial purpose was to oversee donation from people who had just died, has struggled at times to keep pace with rapid developments in donations from the living.
“There is no question that this is a major development in living donor protection,” said Dr. Christie P. Thomas, a nephrologist at the University of Iowa and the chairman of the network’s living donor committee.
Yet some donor advocates complained that the measures did not go far enough, and argued that the organ network, in its mission to encourage transplants, has a conflict of interest when it comes to safeguarding donors.
Three years ago, the network issued some of the same policies as voluntary guidelines, only to have the Department of Health and Human Services insist they be made mandatory.
Although long-term data on the subject is scarce, few living kidney donors are thought to suffer lasting physical or psychological effects. Kidney donations, known as nephrectomies, are typically done laparoscopically these days through a series of small incisions. The typical patient may spend only a few nights in a hospital and feel largely recovered after several months.
Kidneys are by far the most transplanted organs, and there have been nearly as many living donors as deceased ones over the last decade. What data is available suggests that those with one kidney typically live as long as those with two, and that the risk of a donor dying during the procedure is roughly 3 in 10,000.
But kidney transplants, like all surgery, can sometimes end in catastrophe.
In May at Montefiore Medical Center in the Bronx, a 41-year-old mother of three died when her aorta was accidentally cut during surgery to donate a kidney to her brother. In other recent isolated cases, patients have received donor kidneys infected with undetected H.I.V. or hepatitis C.
Less clear are any longer-term effects on donors. Research conducted by the United Network for Organ Sharing shows that of roughly 70,000 people who donated kidneys between late 1999 and early 2011, 27 died within two years of medical causes that may — or may not — have been related to donation. For a small number of donors, their remaining kidney failed, and they required dialysis or a transplant.
The number of living donors — 5,770 in 2011 — has dropped 10 percent over the last two years, possibly because the struggling economy has made it difficult for prospective donors to take time off from work to recuperate. With the national kidney waiting list now stretching past 94,000 people, and thousands on the list dying each year, transplant officials have said they must improve confidence in the system so more people will donate.
The average age of donors has been rising, posing additional medical risks. And new ethical questions have been raised by the emergence of paired kidney exchanges and transplant chains started by good Samaritans who give an organ to a stranger.
Brad Kornfeld, who donated a kidney to his father in 2004, told the board that it had been impossible to find good information about what to expect, leaving him to search for answers on unreliable Internet chat rooms. He said he had almost backed out.
“If information is power,” said Mr. Kornfeld, a Coloradan who serves on the living donor committee, “the lack of information is crippling.”
Under the policies approved this week, the organ network will require hospitals to collect medical data, including laboratory test results, on most living donors to study lasting effects. Results must be reported at six months, one year and two years.
Similar regulations have been in place since 2000, but they did not require blood and urine testing, and hospitals were allowed to report donors who could not be found as simply lost.
That happened often. In recent years, hospitals have submitted basic clinical information — like whether donors were alive or dead — for only 65 percent of donors and lab data for fewer than 40 percent, according to the organ network. Although the network holds the authority, no hospital has ever been seriously sanctioned for noncompliance.
“It’s time we put some teeth into our policy,” said Jill McMaster, a board member from Tennessee.
By 2015, transplant programs will have to report thorough clinical information on at least 80 percent of donors and lab results on at least 70 percent. The requirements phase in at lower levels for the next two years.
Dr. Stuart M. Flechner of the Cleveland Clinic, the chairman of a coalition of medical societies that made recommendations to the organ network, said 9 of 10 hospitals would currently not meet the new requirement.
Donna Luebke, a kidney donor from Ohio who once served on the organ network’s board, said the new standards would matter only if enforcement were more rigorous. She noted that the organization was dominated by transplant doctors: “UNOS is nothing but the foxes watching the henhouse,” she said.
Another of the new regulations prescribes in detail the medical and psychological screenings that hospitals must conduct for potential donors. It requires automatic exclusion if the potential donor has diabetes, uncontrolled hypertension or H.I.V., among other conditions.
The new policies also require that hospitals appoint an independent advocate to counsel and represent donors, and that donors receive detailed information in advance about medical, psychological and financial risks.
Reuters
Palestinians extinguished a fire after an Israeli airstrike on a car carrying Ahmed al-Jabari, who ran Hamas's military wing, on Wednesday in Gaza City.
GAZA — Israel on Wednesday launched one of the most ferocious assaults on Gaza since its invasion four years ago, hitting at least 20 targets in aerial attacks that killed the top military commander of Hamas, drew strong condemnation from Egypt and escalated the risks of a new war in the Middle East.
The Israelis coupled the intensity of the airstrikes with warnings to all Hamas leaders in Gaza to stay out of sight or risk the same fate as the Hamas military commander, Ahmed al-Jabari, who was killed in a pinpoint airstrike as he was traveling by car down a Gaza street. “We recommend that no Hamas operatives, whether low level or senior leaders, show their faces above ground in the days ahead,” the Israel Defense Forces said in a Twitter message.
The ferocity of the airstrikes, in response to what Israel called repeated rocket attacks by Gaza-based Palestinian militants, provoked rage in Gaza, where Hamas said the airstrikes amounted to war and promised a harsh response. Civil-defense authorities in Israel raised alert levels and told residents to take precautions for rocket retaliation from Gaza.
The abrupt escalation in hostilities between Israel and Hamas, the militant organization regarded by Israel as a terrorist group sworn to Israel’s destruction, came amid rising tensions between Israel and all of its Arab neighbors. Israel has faced growing lawlessness on its border with the Sinai, including cross-border terror attacks. It recently fired twice into Syria, which is caught in a civil war, after munitions fell in the Israeli-occupied Golan Heights, and it has absorbed rocket fire from Gaza, which has damaged homes and frightened the population.
Israeli officials had promised a robust response to the rocket fire, but for the moment, at least, opted against a ground invasion and instead chose airstrikes and targeted killings.
The Israeli attacks especially threatened to further complicate Israel’s fragile relations with Egypt, where the Islamist-led government of President Mohamed Morsi, reversing a policy of ousted predecessor Hosni Mubarak, had established closer ties with Hamas and had been acting as a mediator to restore calm between Israel and Gaza-based militant groups.
In a sign of rising anti-Israel hostility in Egypt, Mr. Morsi’s Freedom and Justice Party, which was founded by the Muslim Brotherhood, issued a statement saying: “The wanton aggression against Gaza proves that Israel has yet to realize that Egypt has changed and that the Egyptian people who revolted against oppression/ injustice will not accept assaulting Gaza.”
A spokesman for Hamas, Fawzi Barhoum, said the Israelis had “committed a dangerous crime and broke all redlines,” and that “the Israeli occupation will regret and pay a high price.”
Military officials in Israel, which announced responsibility for the death of Mr. Jabari, later said in a statement that their forces had carried out additional airstrikes in Gaza targeting what they described as “a significant number of long-range rocket sites” owned by Hamas that had stored rockets capable of reaching 25 miles into Israel. The statement said the airstrikes had dealt a “significant blow to the terror organization’s underground rocket-launching capabilities.”
Yisrael Katz, a minister from Israel’s governing Likud Party, issued a statement saying that the operation had sent a message to the Hamas political leaders in Gaza “that the head of the snake must be smashed. Israel will continue to kill and target anyone who is involved in the rocket attacks.”Hamas and medical officials in Gaza said both Mr. Jabari and a companion were killed by the airstrike on his car in Gaza City. Israeli news media said the companion was Mr. Jabari’s son, but there was no immediate confirmation.
The Israel Defense Forces said in a statement that Mr. Jabari had been targeted because he “served in the upper echelon of the Hamas command and was directly responsible for executing terror attacks against the state of Israel in the past number of years.”
The statement said the purpose of the attack was to “severely impair the command and control chain of the Hamas leadership as well as its terrorist infrastructure.”
The statement did not specify how the Israelis knew Mr. Jabari was in the car but said the operation had been “implemented on the basis of concrete intelligence and using advanced capabilities.”
A video released by the Israeli Defense Forces and posted on YouTube showed an aerial view of the attack on what it identified as Mr. Jabari’s car on a Gaza street as it was targeted and instantly blown up in a pinpoint bombing. News photographs of the aftermath showed the car’s blackened hulk surrounded by a large crowd.
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