With record highs in sight, stocks face roadblocks

NEW YORK (Reuters) - If Wall Street needs to climb a wall of worry, it will have plenty of opportunity next week.

Major U.S. stock indexes will make another attempt at reaching all-time records, but the fitful pace that has dominated trading is likely to continue. Next Friday's unemployment report and the hefty spending cuts that look like they about to take effect will be at the forefront.

The importance of whether equities can reach and sustain those highs is more than Wall Street's usual fixation on numbers with psychological significance. Breaking through to uncharted territory is seen as a test of investors' faith in the rally.

"It's very significant," said Bucky Hellwig, senior vice president at BB&T Wealth Management in Birmingham, Alabama.

"The thinking is, there's just not enough there for an extended bull run," he said. "If we do break through (record highs), then maybe the charts and price action are telling us there's something better ahead."

Flare-ups in the euro zone's sovereign debt crisis and next Friday's report on the U.S. labor market could jostle the market, though U.S. job indicators have generally been trending in a positive direction.

Small- and mid-cap stocks hit lifetime highs in February. Now the Dow Jones industrial average <.dji> and the S&P 500 <.spx> are racing each other to the top. The Dow, made up of 30 stocks, is about 75 points - less than 1 percent - away from its record close of 14,164.53, which it hit on October 9, 2007. The broader S&P is still 3 percent away from its closing high of 1,565.15, also reached on October 9, 2007.

The advantage may be in the Dow's court. So far in 2013, it has gained 7.5 percent, beating the S&P 500 by about 1 percent.

THE RALLY AND THE REALITY CHECK

The Dow's relative strength owes much to its unique make-up and calculation, as well as to investors' recent preference for buying value stocks likely to generate steady reliable gains, rather than growth stocks.

But the more defensive stance illustrates how stock buyers are getting concerned about this year's rally. While investors don't want to miss out on gains, they're picking up companies that are less likely to decline as much as high-flying names - if a market correction comes.

The Russell Value Index <.rav> is up 7.6 percent for the year so far, outpacing the Russell Growth Index's <.rag> 5.7 percent rise. Within the realm of the S&P 500, the consumer staples sector led the market in February, gaining 3.1 percent.

There is some concern that growth-oriented names are being eclipsed by defensive bets, said Ryan Detrick, senior technical strategist at Schaeffer's Investment Research in Cincinnati.

"This isn't a be-all and end-all sell signal by any means, but we would feel much more comfortable if some of the more aggressive areas, like technology and small caps, would start to gain some leadership here," Detrick said.

Signs that investors are becoming concerned about the rally's pace is evident in the options market, where the ratio of put activity to call activity has recently shifted in favor of puts, which represent expectations for a stock to fall.

"We are seeing some put hedging in the financials, building up for the past month," said Henry Schwartz, president of options analytics firm Trade Alert in New York.

The put-to-call ratio representing an aggregate of about 562 financial stocks is 1:1, when normally, calls should be outnumbering puts.

Investors have no shortage of reasons to crave the relative safety of blue chips and defensive stocks. Although markets have mostly looked past uncertainty over Washington's plans to cut the deficit, fiscal policy negotiations still pose a risk to equities.

The $85 billion in spending cuts set to begin on Friday is expected to slow economic growth this year if policymakers do not reach a new deal. Markets so far have held firm despite the wrangling in Washington, but tangible economic effects could pinch stock prices going forward.

The International Monetary Fund warned that full implementation of the cuts would probably take at least 0.5 percentage point off U.S. growth this year.

EASY MONEY AND TEPID HIRING

Investors will also take in a round of economic data at a time when concerns are percolating that the market is being pushed up less by fundamentals and more by loose monetary policy around the world.

The main economic event will be Friday's non-farm payrolls report for February. The U.S. economy is expected to have added 160,000 jobs last month, only a tad higher than in January, in a sign the labor market is healing at a slow pace. The U.S. unemployment rate is forecast to hold steady at 7.9 percent.

While lackluster data has been a catalyst in the past for stock market gains as investors bet it would ensure continued stimulus from the Federal Reserve, that sentiment may be wearing thin.

Markets stumbled last week following worries that the Fed might wind down its quantitative easing program sooner than expected.

"It shows the underpinning of the market is being driven at this point by monetary policy," Hellwig said.

With investors questioning what is behind the rally, it will make a run to record highs even more significant, Hellwig added.

"There's smart people that are in the bull camp and the bear camp and the muddle-through camp," Hellwig said. "The fact that you can statistically, using historical evidence, make a case for going higher, lower, or staying the same makes this number very important this time around."

(Wall St Week Ahead runs every Friday. Comments or questions on this column can be emailed to: leah.schnurr(at)thomsonreuters.com)

(Reporting by Leah Schnurr; Additional reporting by Doris Frankel in Chicago; Editing by Jan Paschal)

Read More..

India Ink: How Will India Pay for the Perks in the New Budget?

Characteristic of a party headed for the polls, the Congress party’s budget Thursday morning had a lengthy list of handouts from increased spending on healthcare, education, rural and tribal welfare to a tax benefit for first-time home buyers and women’s development funds. Yet with all the additional spending adding up to a staggering 2.3 trillion rupees (about $42 billion), the minister projects that the country’s closely-watched fiscal deficit will be reined to 4.8 percent in 2013-14.

While appearing fiscally balanced, the question is how exactly does P. Chidambaram, the finance minister, plan to pay for it all?

Sure, he proposed tax increases on the rich, increased corporation tax and pared-down subsidies, but these sums add up to a paltry 450 billion rupees (about $8 billion) in contrast with his requirements of 2.3 trillion rupees in the coming year. Instead, he expects to make up the difference from non-tax sources, including the sale of telecommunication spectrum. This, he calculates, will add 1.7 trillion rupees (about $31 billion) to government coffers, which balances the budget. But in the current economic environment the minister’s expectations of non-tax revenues seem optimistic and difficult to achieve.

The government expects 408 billion rupees (about $7 billion) from sales of telecom spectrum while sales of shares from public-sector companies are expected to add 400 billion rupees to its coffers. These contribute just under half to the required total, but the investment climate is tough and these figures seem hopeful.

Take for the instance, the lackluster sale of telecom spectrum just last week. After cancelling licenses following a corruption investigation into the sector, the government had hoped to raise 582 billion rupees (about $10 billion) from sales of telecoms spectrum sales in the budget last year. These have been revised downward markedly this year; it now expects to get only 194 billion rupees (about $3.5 billion) this year, a third of the figure it originally expected to receive. Today, the marketplace for such sales is tougher, which is likely to put a dent in government’s plans to raise money.

Moreover, the government’s projected growth figures, released on Tuesday in the economic survey, show overly optimistic revenues ahead. A growth of 6.1-6.7 per cent is more than a full percentage point over this year’s growth, thereby buttressing the numbers of tax and non-tax revenues, making fiscal consolidation elusive.

Whether growth can really pick up depends on a rise in the rate of savings and investment. The middle classes might benefit from a lower inflation rate, but in a difficult financial environment disposable incomes will remain strained until investment picks up. As for investments, the budget has not instilled a sense of confidence in many investors, yet it has not rocked their faith either. The markets seem to have grudgingly accepted the pre-election profligacy, but the environment may not improve considerably in the coming few months. Mr. Chidambaram’s optimistic growth numbers have only given analysts a pause for thought, but not caused a much-feared downgrade of the country’s credit rating.

India has made improvements in the fiscal deficit this year, Standard & Poor’s said in a note to investors issued Thursday, which said ratings will remain unchanged. Still, the note said, “there is little progress in structural reforms to reduce the vulnerability of the government’s fiscal position.”

India remains vulnerable to spikes in oil and commodity prices, the rating agency said, and although the budget contains measures aimed at encouraging infrastructure projects, the effectiveness of attracting “much-needed investment is uncertain at this stage.”

Still, the finance minister has managed to pull a feat of balancing the books while pleasing rural vote banks and financial sector pundits in his last budget before the elections early next year. Like his predecessor, he managed to dodge the important questions of retrospective taxation and further financial sector reforms. The Congress Party rested its hope of economic salvation and electoral gains of the kind he delivered before 2009 and led to the election victory. So far, it seems he might have succeeded on the first, on the second it remains to be seen.

The author is a Research Associate at the Indian Council for Research on International Economic Relations. The views expressed are her own, not the organization’s.

Read More..

American Idol Reveals Its Top 20

By Steve Helling

02/28/2013 at 11:20 PM EST

From left: Randy Jackson, Mariah Carey, Ryan Seacrest, Nicki Minaj, Keith Urban

Michael Becker/FOX

American Idol has been on the air for 12 seasons. From the early days of Kelly Clarkson, the judges continually hounded the contestants on song choice. Simon Cowell (remember him?) would criticize contestants for being "cabaret," "old-fashioned" and, worst of all, "boring." Some of this season's contestants have been watching Idol since they were in elementary school, which makes it all the more inexplicable that they still choose to sing songs like Peggy Lee's "Fever," which is 57 years old.

The show began with the 10 contestants rising from the floor, Hunger Games-style. Five of them will continue, while five of them met their end. Find out who made it through to the next round …
Spoiler Alert! The final picks for the Top 20 follow:

Cortez Shaw: His ballad arrangement of David Guetta's "Titanium" was excellent – and it was a nice change to hear a song that was current and relevant. "Your range surprised me today," judge Randy Jackson said. "When you hit those big notes, I was shocked."

Burnell Taylor: He's lost 40 lbs. since auditioning, and singing John Legend's "This Time," he brought down the house – despite oddly exaggerated hand movements. "I would pay to hear you sing," said Nicki Minaj, sharing the best compliment of the night. Mariah Carey was also pleased, simply saying, "This was fantastic."

Lazaro Arbos: After delivering an emotional performance of Keith Urban's "Tonight I Want to Cry," the 21-year-old singer from Naples, Fla., was unanimously sent through to the next round. The Cuban-born Arbos has arguably the season's most poignant backstory, with a severe stutter that vanishes when he sings. Minaj remains a big fan, telling him: "You feel it. You stay in it. Don't change nothing."

Nick Boddington: The New York City bartender performed "Say Something Now" by James Morrison and did a passable – if unremarkable – job. "I kept waiting for the feeling of being connected to you as a person," said Urban. Carey agreed, saying, "I needed to feel you more connected to the song."

Vincent Powell: Singing Lenny Williams's "'Cause I Love You," he effortlessly broke into a falsetto that elicited cheers from the audience. After calling him a "sexy old-fashioned" singer, Minaj added, "I could envision a whole bunch of 50-year-olds throwing their panties at you." Powell, who works his day job as a church worship leader, laughed nervously.

And yes, it was guys' night, but finalist Zoanette Johnson made a cameo when she stood up and cheered Powell's performance, prompting host Ryan Seacrest to run over with a microphone. (For a brief moment, It felt like a '90s-era episode of Ricki Lake, which is actually a very good thing.) "Get it, Papa Smurf," Johnson screamed. "You go get it."

Leave it to Zoanette to steal the show on guy's night.

Tonight's finalists will join Charlie Askew, Curtis Finch Jr., Paul Jolley, Elijah Liu and Devin Velez – and 10 female finalists – to sing for America's votes next week.

Who are you rooting for?

Read More..

WHO: Slight cancer risk after Japan nuke accident

LONDON (AP) — Two years after Japan's nuclear plant disaster, an international team of experts said Thursday that residents of areas hit by the highest doses of radiation face an increased cancer risk so small it probably won't be detectable.

In fact, experts calculated that increase at about 1 extra percentage point added to a Japanese infant's lifetime cancer risk.

"The additional risk is quite small and will probably be hidden by the noise of other (cancer) risks like people's lifestyle choices and statistical fluctuations," said Richard Wakeford of the University of Manchester, one of the authors of the report. "It's more important not to start smoking than having been in Fukushima."

The report was issued by the World Health Organization, which asked scientists to study the health effects of the disaster in Fukushima, a rural farming region.

On March 11, 2011, an earthquake and tsunami knocked out the Fukushima plant's power and cooling systems, causing meltdowns in three reactors and spewing radiation into the surrounding air, soil and water. The most exposed populations were directly under the plumes of radiation in the most affected communities in Fukushima, which is about 150 miles (240 kilometers) north of Tokyo.

In the report, the highest increases in risk are for people exposed as babies to radiation in the most heavily affected areas. Normally in Japan, the lifetime risk of developing cancer of an organ is about 41 percent for men and 29 percent for women. The new report said that for infants in the most heavily exposed areas, the radiation from Fukushima would add about 1 percentage point to those numbers.

Experts had been particularly worried about a spike in thyroid cancer, since radioactive iodine released in nuclear accidents is absorbed by the thyroid, especially in children. After the Chernobyl disaster, about 6,000 children exposed to radiation later developed thyroid cancer because many drank contaminated milk after the accident.

In Japan, dairy radiation levels were closely monitored, but children are not big milk drinkers there.

The WHO report estimated that women exposed as infants to the most radiation after the Fukushima accident would have a 70 percent higher chance of getting thyroid cancer in their lifetimes. But thyroid cancer is extremely rare and one of the most treatable cancers when caught early. A woman's normal lifetime risk of developing it is about 0.75 percent. That number would rise by 0.5 under the calculated increase for women who got the highest radiation doses as infants.

Wakeford said the increase may be so small it will probably not be observable.

For people beyond the most directly affected areas of Fukushima, Wakeford said the projected cancer risk from the radiation dropped dramatically. "The risks to everyone else were just infinitesimal."

David Brenner of Columbia University in New York, an expert on radiation-induced cancers, said that although the risk to individuals is tiny outside the most contaminated areas, some cancers might still result, at least in theory. But they'd be too rare to be detectable in overall cancer rates, he said.

Brenner said the numerical risk estimates in the WHO report were not surprising. He also said they should be considered imprecise because of the difficulty in determining risk from low doses of radiation. He was not connected with the WHO report.

Some experts said it was surprising that any increase in cancer was even predicted.

"On the basis of the radiation doses people have received, there is no reason to think there would be an increase in cancer in the next 50 years," said Wade Allison, an emeritus professor of physics at Oxford University, who also had no role in developing the new report. "The very small increase in cancers means that it's even less than the risk of crossing the road," he said.

WHO acknowledged in its report that it relied on some assumptions that may have resulted in an overestimate of the radiation dose in the general population.

Gerry Thomas, a professor of molecular pathology at Imperial College London, accused the United Nations health agency of hyping the cancer risk.

"It's understandable that WHO wants to err on the side of caution, but telling the Japanese about a barely significant personal risk may not be helpful," she said.

Thomas said the WHO report used inflated estimates of radiation doses and didn't properly take into account Japan's quick evacuation of people from Fukushima.

"This will fuel fears in Japan that could be more dangerous than the physical effects of radiation," she said, noting that people living under stress have higher rates of heart problems, suicide and mental illness.

In Japan, Norio Kanno, the chief of Iitate village, in one of the regions hardest hit by the disaster, harshly criticized the WHO report on Japanese public television channel NHK, describing it as "totally hypothetical."

Many people who remain in Fukushima still fear long-term health risks from the radiation, and some refuse to let their children play outside or eat locally grown food.

Some restrictions have been lifted on a 12-mile (20-kilometer) zone around the nuclear plant. But large sections of land in the area remain off-limits. Many residents aren't expected to be able to return to their homes for years.

Kanno accused the report's authors of exaggerating the cancer risk and stoking fear among residents.

"I'm enraged," he said.

___

Mari Yamaguchi in Tokyo and AP Science Writer Malcolm Ritter in New York contributed to this report.

__

Online:

WHO report: http://bit.ly/YDCXcb

Read More..

Benedict XVI Begins Final Day as Pope

VATICAN CITY — A day after blessing the faithful for the last time as pope, Benedict XVI prepared on Thursday to meet the cardinals who will elect his successor. After a nearly eight-year papacy that he said was filled with “light and joy” but also darker moments, Benedict will later leave the Vatican by helicopter for the papal summer residence where his retirement will formally take effect at 8 p.m. local time.

Benedict, the first pope to step down willingly for six centuries, was expected to greet the cardinals individually, but not offer any public remarks.

In an emotional and unusually personal message on Wednesday, his final public audience in St. Peter’s Square, Benedict said that sometimes he felt that “the waters were agitated and the winds were blowing against” the church, and other days when “the Lord seemed to be sleeping.”

Benedict shocked the world on Feb. 11 when he announced that, feeling his age and diminishing strength, he would retire, a dramatic step that sent the members of the Vatican hierarchy into a tailspin. He reassured the faithful on Sunday that he was not “abandoning” the church, but would continue to serve, even in retirement.

Starting Thursday night, Benedict will be called “pope emeritus” and will don a white cassock and brown shoes from Mexico, replacing the red slippers that he and other popes have traditionally worn, the red symbolizing the blood of the martyrs.

The conclave to elect the next pope, which is expected to start by mid-March, will begin amid a swirl of scandal. On Monday, Cardinal Keith O’Brien, Britain’s senior Roman Catholic cleric said that he would not participate in the conclave, after having been accused of “inappropriate acts” with several priests, charges that he denies. Other cardinals have also come under fire in sex abuse scandals, but only Cardinal O’Brien has recused himself.

On Monday, Benedict met with three cardinals he had asked to conduct an investigation into the “VatiLeaks” scandal in which hundreds of confidential documents were leaked to the press and published in a tell-all book last May, the worst security breach in the church’s modern history. The three cardinals compiled a hefty dossier on the scandal, which Benedict has entrusted only to his successor, not to the cardinals entering the conclave, the Vatican spokesman said earlier this week.

On Thursday, Panorama, a weekly magazine, reported that the Vatican secretary of state, Cardinal Tarcisio Bertone, had been conducting his own investigation into the leaks scandal, including requesting wiretaps on the phones of some members of the Vatican hierarchy.

A shy theologian who appeared to have little interest in the internal politics of the Vatican, Benedict has said that he is retiring “freely, and for the good of the church,” entrusting it to a successor who has more strength than he. But shadows linger. The next pope will inherit a hierarchy buffeted by crises of governance as well as power struggles over the Vatican Bank, which has struggled to conform to international transparency norms.

Many faithful have welcomed Benedict’s gesture as a sign of humility and humanity, a rational decision taken by a man who no longer feels up to the job.

As he stood near St. Peter’s Square on Wednesday after attending the pope’s last public audience, Vincenzo Petrucci, 26, said he had come to express “not so much solidarity, but more like closeness” to the pope. “At first we felt astonished, shocked and disoriented,” he said. “But then we saw what a weighty decision it must have been. He seemed almost lonely.”

Many in the Vatican hierarchy, known as the Roman Curia, are still reeling from the news. Many are bereaved and others seem almost angry. “We are terribly, terribly, terribly shocked,” one senior Vatican official said, speaking on condition of anonymity.

There is also hushed concern about what it will mean to have two popes residing in the Vatican. On Thursday evening, Benedict will initially reside in Castel Gandolfo, a hilltop town outside Rome where popes have summered for centuries.

He is expected to stay there for several months before returning to the Vatican, where he will live in a convent with a fountain and gardens that look out with a perfect view of the dome of St. Peter’s Basilica.

Read More..

American Idol Reveals Its Top 10 Women

TV Watch

American Idol

02/27/2013 at 10:45 PM EST

From left: Randy Jackson, Mariah Carey, Ryan Seacrest, Nicki Minaj, Keith Urban

Michael Becker/FOX

American Idol's's list of the top 10 women is complete!

After the first week of sudden-death rounds, the judges gave their stamp of approval to five more female singers Wednesday night. And they sent five others home.

Keep reading to find out who's in and who's out on Idol ...

Here are the five contestants who are moving on in the competition:

1. Zoanette Johnson: The Tulsa resident, 20, was the first to be put through by the judges, who showered her with praise for singing a spirited version of "Circle of Life" from The Lion King. Keith Urban declared her "queen of the jungle." Nicki Minaj told Zoanette, "You make me so emotional ... You're the person we're going to remember tonight."

2. Aubrey Cleland: After singing a slowed-down version of Beyoncé's "Sweet Dreams," Mariah Carey told Cleland, 19, "You're limitless." Nicki and Randy Jackson pointed out her commercial appeal. "Lookin' like a current artist, soundin' like one, feelin' like one," said Nicki of the performance.

3. Candice Glover: Taking on Aretha Franklin's "(You Make Me Feel Like) A Natural Woman" paid off for the singer, 23, who earned a standing ovation from Keith. Randy said she was "one of my favorite singers in the whole competition."

4. Breanna Steer: "You're extremely marketable and gorgeous and talented," Mariah told the singer, 18, after she sang a dramatic version of Jazmine Sullivan's "Bust Your Windows" that had Randy wanting to sign her up for a recording contract. "You got the whole package," he said. "You brought so much drama."

5. Janelle Arthur: She beat out the other country singer in the competition, Rachel Hale, for the final spot in the women's top 10 after singing Lady Antebellum's "Just a Kiss." Though Randy called Arthur, 23, his "favorite country singer in this competition," the other judges questioned her song choice. "[The song] doesn't give you a chance to really soar," Keith said. "The melody kept pulling you back."

These five will join the five female finalists announced last week – Kree Harrison, Amber Holcomb, Adriana Latonio, Angela Miller and Tenna Torres – as well as the five men – Charlie Askew, Curtis Finch Jr., Paul Jolley, Elijah Liu and Devin Velez. Ten more guys will sing Thursday (8 p.m. ET) and five will move on to round out season 12's top 20.

Did the judges make the right decisions? Sound off in the comments below.

Read More..

Medicare paid $5.1B for poor nursing home care

SAN FRANCISCO (AP) — Medicare paid billions in taxpayer dollars to nursing homes nationwide that were not meeting basic requirements to look after their residents, government investigators have found.

The report, released Thursday by the Department of Health and Human Services' inspector general, said Medicare paid about $5.1 billion for patients to stay in skilled nursing facilities that failed to meet federal quality of care rules in 2009, in some cases resulting in dangerous and neglectful conditions.

One out of every three times patients wound up in nursing homes that year, they landed in facilities that failed to follow basic care requirements laid out by the federal agency that administers Medicare, investigators estimated.

By law, nursing homes need to write up care plans specially tailored for each resident, so doctors, nurses, therapists and all other caregivers are on the same page about how to help residents reach the highest possible levels of physical, mental and psychological well-being.

Not only are residents often going without the crucial help they need, but the government could be spending taxpayer money on facilities that could endanger people's health, the report concluded. The findings come as concerns about health care quality and cost are garnering heightened attention as the Obama administration implements the nation's sweeping health care overhaul.

"These findings raise concerns about what Medicare is paying for," the report said.

Investigators estimate that in one out of five stays, patients' health problems weren't addressed in the care plans, falling far short of government directives. For example, one home made no plans to monitor a patient's use of two anti-psychotic drugs and one depression medication, even though the drugs could have serious side effects.

In other cases, residents got therapy they didn't need, which the report said was in the nursing homes' financial interest because they would be reimbursed at a higher rate by Medicare.

In one example, a patient kept getting physical and occupational therapy even though the care plan said all the health goals had been met, the report said.

The Office of Inspector General's report was based on medical records from 190 patient visits to nursing homes in 42 states that lasted at least three weeks, which investigators said gave them a statistically valid sample of Medicare beneficiaries' experiences in skilled nursing facilities.

That sample represents about 1.1 million patient visits to nursing homes nationwide in 2009, the most recent year for which data was available, according to the review.

Overall, the review raises questions about whether the system is allowing homes to get paid for poor quality services that may be harming residents, investigators said, and recommended that the Centers for Medicare & Medicaid Services tie payments to homes' abilities to meet basic care requirements. The report also recommended that the agency strengthen its regulations and ramp up its oversight. The review did not name individual homes, nor did it estimate the number of patients who had been mistreated, but instead looked at the overall number of stays in which problems arose.

In response, the agency agreed that it should consider tying Medicare reimbursements to homes' provision of good care. CMS also said in written comments that it is reviewing its own regulations to improve enforcement at the homes.

"Medicare has made significant changes to the way we pay providers thanks to the health care law, to reward better quality care," Medicare spokesman Brian Cook said in a statement to AP. "We are taking steps to make sure these facilities have the resources to improve the quality of their care, and make sure Medicare is paying for the quality of care that beneficiaries are entitled to."

CMS hires state-level agencies to survey the homes and make sure they are complying with federal law, and can require correction plans, deny payment or end a contract with a home if major deficiencies come to light. The agency also said it would follow up on potential enforcement at the homes featured in the report.

Greg Crist, a Washington-based spokeswoman for the American Health Care Association, which represents the largest share of skilled nursing facilities nationwide, said overall nursing home operators are well regulated and follow federal guidelines but added that he could not fully comment on the report's conclusions without having had the chance to read it.

"Our members begin every treatment with the individual's personal health needs at the forefront. This is a hands-on process, involving doctors and even family members in an effort to enhance the health outcome of the patient," Crist said.

Virginia Fichera, who has relatives in two nursing homes in New York, said she would welcome a greater push for accountability at skilled nursing facilities.

"Once you're in a nursing home, if things don't go right, you're really a prisoner," said Fichera, a retired professor in Sterling, NY. "As a concerned relative, you just want to know the care is good, and if there are problems, why they are happening and when they'll be fixed."

Once residents are ready to go back home or transfer to another facility, federal law also requires that the homes write special plans to make sure patients are safely discharged.

Investigators found the homes didn't always do what was needed to ensure a smooth transition.

In nearly one-third of cases, facilities also did not provide enough information when the patient moved to another setting, the report found.

___

On the Web:

The OIG report: http://1.usa.gov/VaztQm

The Medicare nursing home database: http://www.medicare.gov/NursingHomeCompare/search.aspx?bhcp=1&AspxAutoDetectCookieSupport=1

___

Follow Garance Burke on Twitter at —http://twitter.com/garanceburke.

Read More..

Iran and Six Nations Agree to Two More Rounds of Nuclear Talks

Pool photo by

The European Union foreign policy chief, Catherine Ashton, and Iran’s chief negotiator, Saeed Jalili, at the start of the talks.

ALMATY, Kazakhstan — Talks between Iran and six world powers over its nuclear program ended on Wednesday with an agreement to convene technical experts in Istanbul on March 18 and return to Almaty for full negotiations among the delegations on April 5 and 6, a senior Western diplomat said.

Iran’s chief negotiator, Saeed Jalili, said that modest progress had been achieved. The participants “had come back with more realistic proposals that come a little closer to Iran’s position,” he said. “Their proposals seem more realistic and positive.” He added that there have been “some changes in their viewpoint.”

The two days of talks here had been convened to to get a clear response from Tehran to an offer of step-by-step sanctions relief in return for confidence-building measures from Iran, Western diplomats said.

They cautioned that there was little substantive progress other than Iran’s willingness to study the proposals delivered here and added that the technical meeting in Istanbul is to explain the proposals in detail before returning to Almaty to hear Iran’s response. Senior Western diplomats have said that this week’s meeting would be a low-level success if it produced a specific agreement to meet again soon so that there would be an element of momentum to the negotiations. The talks have been intermittent since beginning in October 2009, with the last meeting eight months ago in Moscow.

The six powers want Iran, as a first step, to stop enriching uranium to 20 percent and to export its stockpile of that more highly enriched uranium, which can be more quickly turned into bomb-grade material. The six also want Iran to shut down its Fordo enrichment facility, built deep into a mountain, which Iran has steadily refused to do. In return, the six — the five permanent members of the Security Council, plus Germany — have offered Iran further sanctions relief, reportedly including permission to resume its gold and precious metals trade as well as some international banking activity and petroleum trade.

The ultimate goal of talks with Iran is to get the country to comply with Security Council resolutions demanding that it stop enrichment altogether until it can satisfy the International Atomic Energy Agency that it has no weapons program and no hidden enrichment sites. In return, all sanctions — which have so far cost Iran 8 percent of its gross domestic product, sharply increased inflation and collapsed the value of the Iranian currency, the rial — would be lifted.

No one expected that kind of breakthrough in this round, especially with Iranian presidential elections coming in June and any major concession likely to be perceived as weakness. But the hope was for an incremental movement toward Iranian compliance in return for a modest lifting of sanctions.

The six nations talking with Iran have remained united and share an impatience over what they perceive to be its delaying tactics. The Russian envoy, Deputy Foreign Minister Sergei Ryabkov, who has been most opposed to increasing sanctions, said Tuesday that time was running out for the talks. He told the Interfax news agency that easing sanctions would be possible only if Iran could assure the world that its nuclear program was for exclusively peaceful purposes.

“There is no certainty that the Iranian nuclear program lacks a military dimension, although there is also no evidence that there is a military dimension,” he said.

He said Moscow hoped the talks would now move into a phase of “bargaining,” rather than just offering proposals. “There needs to be a political will to move into that phase,” Mr. Ryabkov said. “We call on all participants not to lose any more time.”

Tuesday’s talks began at 1:30 p.m. with a plenary session that lasted about 2 hours, 30 minutes, largely taken up with the six laying out their latest modified proposal to the Iranians. The European Union’s foreign policy chief, Catherine Ashton, is the chairwoman and speaks for the six. There was also discussion of the proposal by the Iranians and some questions asked, the diplomats said.

There were a few brief bilateral meetings with the Iranian delegation by the Russians, British and Germans, diplomats said, but not with the French or the Americans. The one and only bilateral meeting between the Americans and the Iranians in the course of the talks was in October 2009 in Geneva, although the chief American negotiator now, Wendy R. Sherman, the under secretary for political affairs in the State Department, has repeatedly said that she is open to another such meeting.

Read More..

Bobby Brown Sentenced to 55 Days in Jail in Drunk Driving Case

02/26/2013 at 09:30 PM EST

Bobby Brown has been sentenced to 55 days in jail and four years probation in his most recent drunk driving arrest.

Brown, 44, was pulled over in Studio City, Calif., on Oct. 24 for driving erratically and was arrested when the officer detected "a strong scent of alcohol." He was charged with DUI and driving on a suspended license.

He was also arrested for driving under the influence in March of 2012.

Brown pled no contest to the charges on Tuesday, reports TMZ. He was also ordered to complete an 18-month alcohol treatment program.

The singer, who married Alicia Etheredge in Hawaii in June of 2012, must report to jail by March 20.

Read More..

Advanced breast cancer edges up in younger women

CHICAGO (AP) — Advanced breast cancer has increased slightly among young women, a 34-year analysis suggests. The disease is still uncommon among women younger than 40, and the small change has experts scratching their heads about possible reasons.

The results are potentially worrisome because young women's tumors tend to be more aggressive than older women's, and they're much less likely to get routine screening for the disease.

Still, that doesn't explain why there'd be an increase in advanced cases and the researchers and other experts say more work is needed to find answers.

It's likely that the increase has more than one cause, said Dr. Rebecca Johnson, the study's lead author and medical director of a teen and young adult cancer program at Seattle Children's Hospital.

"The change might be due to some sort of modifiable risk factor, like a lifestyle change" or exposure to some sort of cancer-linked substance, she said.

Johnson said the results translate to about 250 advanced cases diagnosed in women younger than 40 in the mid-1970s versus more than 800 in 2009. During those years, the number of women nationwide in that age range went from about 22 million to closer to 30 million — an increase that explains part of the study trend "but definitely not all of it," Johnson said.

Other experts said women delaying pregnancy might be a factor, partly because getting pregnant at an older age might cause an already growing tumor to spread more quickly in response to pregnancy hormones.

Obesity and having at least a drink or two daily have both been linked with breast cancer but research is inconclusive on other possible risk factors, including tobacco and chemicals in the environment. Whether any of these explains the slight increase in advanced disease in young women is unknown.

There was no increase in cancer at other stages in young women. There also was no increase in advanced disease among women older than 40.

Overall U.S. breast cancer rates have mostly fallen in more recent years, although there are signs they may have plateaued.

Some 17 years ago, Johnson was diagnosed with early-stage breast cancer at age 27, and that influenced her career choice to focus on the disease in younger women.

"Young women and their doctors need to understand that it can happen in young women," and get checked if symptoms appear, said Johnson, now 44. "People shouldn't just watch and wait."

The authors reviewed a U.S. government database of cancer cases from 1976 to 2009. They found that among women aged 25 to 39, breast cancer that has spread to distant parts of the body — advanced disease — increased from between 1 and 2 cases per 100,000 women to about 3 cases per 100,000 during that time span.

The study was published Tuesday in the Journal of the American Medical Association.

About one in 8 women will develop breast cancer in their lifetime, but only 1 in 173 will develop it by age 40. Risks increase with age and certain gene variations can raise the odds.

Routine screening with mammograms is recommended for older women but not those younger than 40.

Dr. Len Lichtenfeld, the American Cancer Society's deputy chief medical officer, said the results support anecdotal reports but that there's no reason to start screening all younger women since breast cancer is still so uncommon for them.

He said the study "is solid and interesting and certainly does raise questions as to why this is being observed." One of the most likely reasons is probably related to changes in childbearing practices, he said, adding that the trend "is clearly something to be followed."

Dr. Ann Partridge, chair of the federal Centers for Disease Control and Prevention's advisory committee on breast cancer in young women, agreed but said it's also possible that doctors look harder for advanced disease in younger women than in older patients. More research is needed to make sure the phenomenon is real, said Partridge, director of a program for young women with breast cancer at the Harvard-affiliated Dana-Farber Cancer Institute.

The study shouldn't cause alarm, she said. Still, Partridge said young women should be familiar with their breasts and see the doctor if they notice any lumps or other changes.

Software engineer Stephanie Carson discovered a large breast tumor that had already spread to her lungs; that diagnosis in 2003 was a huge shock.

"I was so clueless," she said. "I was just 29 and that was the last thing on my mind."

Carson, who lives near St. Louis, had a mastectomy, chemotherapy, radiation and other treatments and she frequently has to try new drugs to keep the cancer at bay.

Because most breast cancer is diagnosed in early stages, there's a misconception that women are treated, and then get on with their lives, Carson said. She and her husband had to abandon hopes of having children, and she's on medical leave from her job.

"It changed the complete course of my life," she said. "But it's still a good life."

____

Online:

JAMA: http://jama.ama-assn.org

CDC: http://www.cdc.gov/cancer/breast/index.htm

Read More..