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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James Cameron Relives Voyage to Ocean’s Deepest Spot

SAN FRANCISCO — The first thing James Cameron saw 7 miles below the sea was man-made: tracks from a remotely operated vehicle.

“When I got to the bottom, I saw skid marks from the ROV,” Cameron said yesterday (Dec. 4) here at the annual meeting of the American Geophysical Union, referring to a 2009 survey by the Monterey Bay Aquarium Research Institute. Scientific results of the film director’s expedition to the Mariana Trench were presented at the meeting this week, and Cameron and the researchers described the highlights to a packed crowd.

Cameron reported a new, corrected depth for his landing — 35,803 feet (10,912 meters) — which beats by five feet (1.5 m) the record set by U.S. Navy Lt. Don Walsh and Jacques Piccard in 1960 at the same spot. However, “because the error [calculating the depth] on Don’s dive is much greater, we’re just going to have to call it a tie,” Cameron said.

Deepsea Challenger

Cameron’s Deepsea Challenger expedition made dives to the New Britain Trench and the Mariana Trench in the southwestern Pacific Ocean between Jan. 31 and April 3, with one manned dive by Cameron to the Mariana’s Challenger Deep, the deepest spot in any ocean.

Unusual, never-before-seen species were snared and brought back to the surface. A bizarre microbial mat community was discovered living on altered rocks in the Sirena Deep, another deep pool 6.77 miles (10.9 kilometers) below the surface.

Changes in temperature and salinity starting at 26,200 feet (8 km) deep hint at an unknown current coming into the Challenger Deep, said Doug Bartlett, a microbiology professor at the Scripps Institution of Oceanography at UC San Diego.

The filmmaker journeyed inside a high-tech lime-green machine — a steel sphere encased in foam — dubbed the Deepsea Challenger. The expedition traveled with two unmanned seafloor “landers” — large contraptions hoisted over the side of a ship and dropped to the seafloor. Once on the bottom, bait attached to the lander lured seafloor creatures to the craft, and a suite of instruments took samples, photographs and data. [Images: James Cameron's Historic Deep-Sea Dive]

The two contraptions working together proved to be a very good system, Cameron said. “We could rendezvous on the bottom and see the results of that bait running for six to eight hours, and that’s how Doug could find a new species of giant arthropod,” Cameron said.

Challenging journey

The March 26 dive proved to be a physical and mental challenge for Cameron. “I did yoga for six months so I could contort myself into the sphere,” he said.

As he sank through the water, Cameron said he “burned though my whole checklist,” designed to distract him during the long hours of the dive. “I still had 3,000 meters left to go with pretty much nothing left to do but sit quietly and think about the pressure building up around the hull,” he said.

The sub touched down gently, and Cameron immediately took a sample of the seafloor, as planned. This was a good contingency, because the sub’s hydraulic fluid line then burst, leaving him unable to collect more samples.

To his surprise, the sub’s voice communications worked perfectly. “We actually expected they wouldn’t, and I would have to default to texting,” he said. “Texting while driving is not a good thing, especially if you’re using two hands to operate seven joysticks and you’re 7 miles down.”

Cameron first drove the sub about 200 meters, finding the seafloor elevation stayed the same. In fact, Challenger Deep turned out to be remarkably flat, and the sub was easy to drive. “The vehicle was quite nimble, the sub’s yaw rate was very good,” he said. (Yaw describes the left-to-right rotation of a craft.)

A quick return

After about three hours, some of the submersible’s batteries had low charge readings, the steering was problematic, and it was time to return to the surface. The mission should have lasted five to six hours. “I hate this. I hated having to go back,” Cameron recalled thinking.

The trip to the top was mercifully short at 73 minutes. The submersible covered nearly 7 miles in a little over an hour — slow in a car, but like riding a missile for a human in a metal ball. Cameron said the surface trip is when he noticed the aches and pains from the cramped sub. “That’s when your butt is really sore, and when you notice how much it hurts.” [Infographic: James Cameron's Mariana Trench Dive]

The sub now sits in a barn in Santa Barbara, waiting for Cameron or another group with enough money to send it back to the deep ocean. He declined to say how much it cost to build and mount the expedition.

“I would love for the sub to dive again,” he said. “I personally feel that we just barely got started before we had to turn back and there’s just so much out there.”

“And if not, at the very least, the technical innovations can be incorporated into other vehicle platforms,” Cameron added. “As far as I’m concerned, it’s an open source situation.”

Reach Becky Oskin at [email protected]. Follow her on Twitter @beckyoskin. Follow OurAmazingPlanet on Twitter @OAPlanet. We’re also on Facebook and Google+.

Copyright 2012 OurAmazingPlanet, a TechMediaNetwork company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Linux/Open Source News Headlines – Yahoo! News

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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."

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Associated Press writer David Bauder contributed to this report.

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New Taxes to Take Effect to Fund Health Care Law

WASHINGTON — For more than a year, politicians have been fighting over whether to raise taxes on high-income people. They rarely mention that affluent Americans will soon be hit with new taxes adopted as part of the 2010 health care law.

The new levies, which take effect in January, include an increase in the payroll tax on wages and a tax on investment income, including interest, dividends and capital gains. The Obama administration proposed rules to enforce both last week.

Affluent people are much more likely than low-income people to have health insurance, and now they will, in effect, help pay for coverage for many lower-income families. Among the most affluent fifth of households, those affected will see tax increases averaging $6,000 next year, economists estimate.

To help finance Medicare, employees and employers each now pay a hospital insurance tax equal to 1.45 percent on all wages. Starting in January, the health care law will require workers to pay an additional tax equal to 0.9 percent of any wages over $200,000 for single taxpayers and $250,000 for married couples filing jointly.

The new taxes on wages and investment income are expected to raise $318 billion over 10 years, or about half of all the new revenue collected under the health care law.

Ruth M. Wimer, a tax lawyer at McDermott Will & Emery, said the taxes came with “a shockingly inequitable marriage penalty.” If a single man and a single woman each earn $200,000, she said, neither would owe any additional Medicare payroll tax. But, she said, if they are married, they would owe $1,350. The extra tax is 0.9 percent of their earnings over the $250,000 threshold.

Since the creation of Social Security in the 1930s, payroll taxes have been levied on the wages of each worker as an individual. The new Medicare payroll is different. It will be imposed on the combined earnings of a married couple.

Employers are required to withhold Social Security and Medicare payroll taxes from wages paid to employees. But employers do not necessarily know how much a worker’s spouse earns and may not withhold enough to cover a couple’s Medicare tax liability. Indeed, the new rules say employers may disregard a spouse’s earnings in calculating how much to withhold.

Workers may thus owe more than the amounts withheld by their employers and may have to make up the difference when they file tax returns in April 2014. If they expect to owe additional tax, the government says, they should make estimated tax payments, starting in April 2013, or ask their employers to increase the amount withheld from each paycheck.

In the Affordable Care Act, the new tax on investment income is called an “unearned income Medicare contribution.” However, the law does not provide for the money to be deposited in a specific trust fund. It is added to the government’s general tax revenues and can be used for education, law enforcement, farm subsidies or other purposes.

Donald B. Marron Jr., the director of the Tax Policy Center, a joint venture of the Urban Institute and the Brookings Institution, said the burden of this tax would be borne by the most affluent taxpayers, with about 85 percent of the revenue coming from 1 percent of taxpayers. By contrast, the biggest potential beneficiaries of the law include people with modest incomes who will receive Medicaid coverage or federal subsidies to buy private insurance.

Wealthy people and their tax advisers are already looking for ways to minimize the impact of the investment tax — for example, by selling stocks and bonds this year to avoid the higher tax rates in 2013.

The new 3.8 percent tax applies to the net investment income of certain high-income taxpayers, those with modified adjusted gross incomes above $200,000 for single taxpayers and $250,000 for couples filing jointly.

David J. Kautter, the director of the Kogod Tax Center at American University, offered this example. In 2013, John earns $160,000, and his wife, Jane, earns $200,000. They have some investments, earn $5,000 in dividends and sell some long-held stock for a gain of $40,000, so their investment income is $45,000. They owe 3.8 percent of that amount, or $1,710, in the new investment tax. And they owe $990 in additional payroll tax.

The new tax on unearned income would come on top of other tax increases that might occur automatically next year if President Obama and Congress cannot reach an agreement in talks on the federal deficit and debt. If Congress does nothing, the tax rate on long-term capital gains, now 15 percent, will rise to 20 percent in January. Dividends will be treated as ordinary income and taxed at a maximum rate of 39.6 percent, up from the current 15 percent rate for most dividends.

Under another provision of the health care law, consumers may find it more difficult to obtain a tax break for medical expenses.

Taxpayers now can take an itemized deduction for unreimbursed medical expenses, to the extent that they exceed 7.5 percent of adjusted gross income. The health care law will increase the threshold for most taxpayers to 10 percent next year. The increase is delayed to 2017 for people 65 and older.

In addition, workers face a new $2,500 limit on the amount they can contribute to flexible spending accounts used to pay medical expenses. Such accounts can benefit workers by allowing them to pay out-of-pocket expenses with pretax money.

Taken together, this provision and the change in the medical expense deduction are expected to raise more than $40 billion of revenue over 10 years.

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Auto execs share insights on the industry and what's next

It's hard to get America's most senior auto executives together in the same building to address the same topics, but we managed to do it with Mark Reuss, president of General Motors Co.'s North American operations, and Mark Fields, the newly appointed chief operating officer of Ford Motor Co.

They came to town for the Los Angeles Auto Show, which ends Sunday. Even then, they weren't in the same room — so we just asked them identical questions, in separate interviews, to create this virtual debate.

Both executives address key issues facing the industry, including the future of in-dash technology, fuel economy, electric cars and the prospects for the industry at large. They don't always agree.

Do vehicle embedded features such as MyFord Touch or Cadillac Cue make sense when smartphones can do many of the same tasks with fewer glitches? Why not use architecture that allows people to use phone apps for vehicle infotainment?

Reuss: There is no way that the auto industry in the long haul should be carrying all that technology in a car. Phones will move faster in technology than anything we can put into a car. Embedding those functions in a car and then trying to guess where phones are going is not a solution. We will experiment with technology in Cadillac, but that's not where the mainline brands will be going.

Fields: It is very clear that for younger consumers, staying connected in their lives is hugely important whether they are in their bedrooms, walking outside or in their cars. That's why we started Sync and MyFord Touch.

In the future, you might end up seeing a hybrid of embedded technology and smartphone connectivity. There are certain things that we want to ensure, such as safety and integration into the rest of the vehicle. There could be some issues with just plugging in a smartphone and allowing it to do a lot of vehicle functions. We're already engaging in those discussions, thinking like a technology company.

The U.S. auto industry has been one of the better-performing segments of the U.S. economy recently but is still well below the 16 million to 17 million vehicles it once sold regularly. Can it shift to a higher gear?

Fields: We expect the market to continue to improve based on two factors. One is the age of the car park out there. [Registration data show the average age of vehicles on the road today is 10 to 11 years.] Cars are old and trucks are old. Look at that, combined with the fuel economy consumers can get from new cars right now, and there are some good reasons to buy. And then there is the gradual improvement of the economy.

This is a great business … but when you look out on the horizon in North America, do I think we will go back to the days of 18 million units anytime soon? No. But when you look at the components that set demand, I think it is very encouraging. The opportunities and growth in front of us are pretty substantial.

Reuss: It can happen based on population growth and the car-park age. But sales are throttled by the variance in consumer confidence and in jobs.

The industry is in a place it has never been in before. It has a break-even point of just 11 [million] to 12 million units. [Automakers are expected to sell about 14.5 million vehicles in the U.S. this year.] That's providing profits to invest in good cars, even if we haven't seen that quick sales growth.

That's a great place to be…. You could really be happy driving 98% of the stuff that is on display here.

What's the deal with electric vehicles? They garnered a lot of attention when automakers started selling them again two years ago, but sales are poor.

Reuss: The range has to grow and the cost of the battery and the car has to come down. The quickest way for the cost to come down is to build a platform-specific electric vehicle. Otherwise, you will always have a battery that is heavier than what you want and have less range than you want.

Our Spark EV will work, because it is already small and lightweight and close to what you want to do in a platform-specific vehicle.... We will sell a few thousand, and we are doing it in California, where there already is interest and some infrastructure for electric vehicles.

I don't think you will see bigger people-carrier EVs. It's just a harder sell. Who wants to be stranded with your family [because the battery drained down] and pay a lot of money to do it?

Fields: The simple answer is that we don't know what percentage of the marketplace battery-electric vehicles will occupy next year or even five years from now. Our strategy is to align our manufacturing so that wherever it goes, we will be able to flex.

Demand for full-electric vehicles depends on a lot of factors, including getting the cost down lower, and the price of fuel and the infrastructure to be able to support mass EVs with charging stations, etc.

It is so dynamic right now. At gas at $3.40 a gallon, will sales of EVs bump up appreciably? If gas is $5 a gallon, you would get another answer. Whatever the continuum, we will be able to meet the demand.

What single feature or attribute of a vehicle is the consumer most focused on right now?

Fields: I think fuel economy is now embedded in people's minds, no matter what the price of oil is. In the 1970s to get fuel economy you had to get really small, inconvenient vehicles, but now you don't have to compromise on size or performance.

Reuss: It is reliability and durability. You can do the styling right, the technology right and price right. But if you don't have the durability and reliability, you won't get retention. People won't buy your car again. No one wants to be accused of buying something stupid. Fuel economy would be the next reason to buy.

jerry.hirsch@latimes.com

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

Justices will rule for the first time on same-sex marriage by deciding the constitutionality of Prop. 8.

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 

Follow Politics Now on Twitter and Facebook

david.savage@latimes.com

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The Era of Twitter Without Instagram Has Now Begun

We know everyone is a little bummed about all those filtered photos disappearing from your Twitter streams this weekend, but let’s not get all worked up about it: They are disappearing, and there is no scandal.

RELATED: Why You Can’t See Instagram Photos on Twitter Anymore

TechCrunch’s  Drew Olanoff got a little too excited on Friday and thought a single in-stream photo meant that Instagram was allowing its Twitter cards back on Twitter and thought the two services were planning a sudden reunion. You may have seen some, too, but a Facebook spokesperson assured users these Instagram photos on Twitter were the last holdouts in the switchover. ”What you are seeing now may be some sort of regression depending on the mobile client, but we’re checking in with the engineers,” read Facebook’s statement, via Talking Points Memo’s Carl Franzen.

RELATED: How to Get Over the Twitter-Instagram War on Photos

Which means the end of this particular social-media marriage is upon us. Despite the immediate user backlash, Instagram CEO Kevin Systrom has made it pretty clear that the photo-sharing app doesn’t plan on making nice with Twitter. In case you hadn’t accepted the reality of Silicon Valley competition the first time around, this photo-friendly weekend might be the time to check out our handy three-step guide to getting over it. 

Social Media News Headlines – Yahoo! News

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The New Old Age Blog: A Son Lost, a Mother Found

My friend Yvonne was already at the front door when I woke, so at first I didn’t realize that my mother was missing.

It was less than a week after my son Spencer died. Since that day, a constant stream of friends had been coming and going, bringing casseroles and soup, love, support and chatter. Mom hated it.

My 94-year-old mother, who has vascular dementia, has been living in my home in upstate New York for the past few years. Like many with dementia, mom is courteous but, underneath, irascible. Pride defines her, especially pride in her Phi Beta Kappa intellect. She hates to be confronted with how she has become, as she calls it, “stupid.”

The parade of strangers confused her. She had to be polite, field solicitous questions, endure mundane comments. She could not remember what was going on or why people were there. It must have been stressful and annoying.

That night, like every night since the state troopers brought the news, I woke hourly, tumbling in panic. As if it were not too late to save my son. Mom knew something was wrong, but she could not remember what. As I overslept that morning, she must have decided enough was enough. She was going home.

In a cold sky, the sun blazed over tall pines. As I opened the door, the dogs raced out to greet Yvonne and her two housecleaners. Yvonne often brags about her cleaning duo. They were her gift to me. They were going to clean my house before the funeral reception, which was scheduled for later that week. This was a very big gift because, like my mother before me, I am a very bad housekeeper.

Mom’s door was shut. I cautioned the housecleaners to avoid her room as I showed them around. Yvonne went to the kitchen to listen to the 37 unheard messages on my answering machine; the housecleaners went out to their van to get their instruments of dirt removal.

I ducked into Mom’s room to warn her about the upcoming noise. The bed was unmade; the floor was littered with crumpled tissues; the room was empty.

Normally, I would have freaked out right then. I knew Mom was not in the house, because I had just shown the whole house to the cleaners. Although Mom doesn’t wander like some dementia patients, she does on occasion run away. But I could not muster a shred of anxiety.

“Yvonne,” I called, “did you see my mother outside?”

Yvonne popped her head into the living room, eyebrows raised.“Outside? No!” She was alarmed. “Is she missing?”

“Yeah,” I said wearily, “I’ll look.” I stepped out onto the front porch, tightening the belt of my bathrobe and turning up the collar. Maybe she had walked off into the woods. The dogs danced around my legs, wanting breakfast.

I had no space left in my body to care. Either we would find her, or we would not. Either she was alive, or she was not. My child was gone. How could I care about anything ever again?

Then I saw my car was missing. My mouth fell open and my eyeballs rolled up to the right, gazing blindly at the abandoned bird’s nest on top of the porch light: What had I done with the keys?

Mom likes to run away in the car when she is angry. She used to do it a lot when my father was still alive — every time they fought. Since Mom took off in my car almost a year ago, after we had had a fight, I’d kept the keys hidden. Except for this week; this week, I had forgotten.

I was reverting to old habits. I had left the doors unlocked and the keys in the cupholder next to the driver’s seat. Exactly like Mom used to do.

“Uh-oh,” I said aloud. Mom was still capable of driving, even though she did not know where she was going. I just really, really hoped that she didn’t hurt anybody on the road. I pulled out my cellphone, about to call the police.

“Celia!” Yvonne shouted from the kitchen. She hurried up behind me, excited. “They found your mother. There are two messages on your machine.”

At that very moment, Mom was holed up at the College Diner in New Paltz, a 20-minute drive over the mountain, through the fields, left over the Wallkill River and away down Main Street.

Yvonne called the diner. They promised to keep the car keys until someone arrived. By that time, Yvonne had to go to work. She drove my friend Elizabeth to the diner, and Elizabeth drove Mom home in my car.

Half an hour later, they walked in the front door. Mom’s cheeks were rouged by the chill air and her eyes sparkled, her white hair riffing with static electricity. “Hello, hello,” she sang out. “Here we are.” She was wearing the flannel nightgown and robe I had dressed her in the night before. It was covered by her oversized purple parka, and her bare feet were shoved into sneakers.

I started laughing as soon as I saw her. I couldn’t help it. Elizabeth and Mom started laughing too. “You had a big adventure,” I said, hugging them both. “How are you?”

“I’m just marvelous,” said my mother. Mom always feels great after doing something rakish. We settled her on the sofa with her feet on the ottoman. By the time I got her blanket tucked in around her shoulders, she had fallen asleep.

Elizabeth couldn’t stop laughing as she described the scene. “Your mother was holding court in this big booth. She was sitting there in her nightgown and her parka, talking to everybody, with this plate of toast and coffee and, like, three of the staff hovering around her.”

The waitress said Mom seemed “a little disoriented” when she got there. Mom said she was meeting a friend for breakfast, but since she was wearing a nightgown and didn’t know whom she was meeting or where she lived, the staff thought there might be a problem. They convinced Mom to let them look in the glove compartment of the car, where they found my name and number.

It was then that I realized I was laughing – something I’d thought I would never be able to do again. “Elizabeth, Elizabeth, I’m laughing,” I said.

“Ha, ha, ha,” laughed Elizabeth, holding her belly.

“Ha, ha, ha,” I laughed, rolling on the floor.

And she who gave me life, who had suffered the death of my child and the extinction of her own intellect, snoozed on: oblivious, jubilant, still herself, still mine.

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American Airlines pilots approve new contract

Pilots at American Airlines have approved a new labor contract, which could clear the way for American to consider a merger with US Airways.

The pilots union announced Friday that 74% of its members voted to ratify the contract. Pilots rejected a similar offer in August, but union leaders lobbied hard for passage the second time around.

Under the contract, pilots will get pay raises and own 13.5% of American Airlines parent AMR Corp. after it emerges from bankruptcy protection.

Union officials and analysts say the vote gives AMR creditors certainty about the company's labor costs, making it easier for them to weigh which gives them more money — American on its own, or a bigger entity through a merger with US Airways.

"This contract represents a bridge to a merger with US Airways," said union spokesman Dennis Tajer. He said the vote "should not in any way be viewed as support for the American stand-alone plan or for this current management team."

American also hailed the vote as a key step in its turnaround after years of heavy losses.

The pilots' vote "gives us the certainty we need for American to successfully restructure," said Denise Lynn, American's senior vice president of people, in a statement. She added that "the modernization of our company is well underway, and we remain focused on emerging as a competitive, world-class airline."

AMR and American filed for bankruptcy protection in November 2011. With the pilots deal in hand, the company could exit Chapter 11 early next year, a faster reorganization than those in the last decade at United Airlines and Delta Air Lines.

Friday's vote filled in the last unknown piece in AMR's labor-cost puzzle. The company's creditors "very much wanted a contract because they want some visibility on what the cost structure will be," said Ray Neidl, an airline analyst for Maxim Group.

US Airways has proposed a merger that would give AMR creditors 70% of the combined company, which would be run by US Airways Group Inc. CEO Doug Parker, according to a person familiar with the discussions who spoke on condition of anonymity because the talks are private.

There have been reports that AMR might seek up to 80% for its creditors, which could be unacceptable to US Airways shareholders, the person said. Last month, a committee of bondholders told the pilots union that it would support an independent American only if AMR had a new board that would pick managers to run the airline.

The airlines have exchanged confidential financial information and talked about a potential merger for several weeks, although a deal is not certain.

American has about 7,500 active pilots plus a few hundred others on furlough. The union said the vote to ratify the contract was 5,490 to 1,951.

The six-year contract will raise pilots' pay by 4% on signing and 2% per year after that, with an adjustment in the third year to bring pay in line with that of other big airlines. The union will get 13.5% of the stock in the new AMR when it emerges from bankruptcy, which analysts estimate would amount to at least $100,000 per pilot.

In exchange, pilots will fly more hours and American will get more flexibility to outsource flying to other airlines.

American, which has already frozen pension plans and made other changes in benefits and work rules, is trying to use the bankruptcy process to cut annual labor costs by 17%, or about $1 billion.

In recent months flight attendants and ground workers have ratified separate contracts that reduced benefits and outsourced thousands of jobs. American expects to cut about 10,000 jobs, with 3,000 layoffs and the rest coming from early retirements and attrition.

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L.A. County mass burial honors more than 1,600 unclaimed bodies

In a simple ceremony Wednesday, about two dozen people gathered over a single grave holding the ashes of more than 1,600 people whose bodies were never claimed by loved ones.

With dense fog enveloping the quiet hill above a busy Boyle Heights intersection and the smell of burning sage lingering in the morning air, county officials, soup kitchen volunteers, chaplains and mourners prayed over the ashes of 1,656 people.

Yvette Gonzales, 36, came with three friends to pay final respects to her mother, who was homeless when she died Oct. 2, 2009. She'd heard about the service on the news after waking Wednesday, and ran over hoping her mother had been finally buried.

The mass burial is a custom each December at the Los Angeles County Crematory and Cemetery.

Ashes at the county morgue — including the homeless and those whose families simply could not afford to bury or cremate them — are kept in storage for two to three years before being sent to the common grave, according to the coroner's office. Most who were buried this week died in 2009.

Gonzales, who was incarcerated when her mother died, learned of the death after she was released.

"Me and my brother, we're the only ones now," she said. "We tried to get her ashes, but we never got enough money." The Rev. Chris Ponnet, the County-USC Medical Center chaplain who has led the service the last five years, said it differs sharply from other burials: There are no personal histories to read, no names. And rarely is there a grieving family.

After a few words, Ponnet stepped aside for burial rites from multiple faiths, including readings from Islamic, Jewish, Hindu and Christian traditions recited in Korean, Spanish and English. In Native American tradition, a barefoot woman chanted and beat a canvas drum, turning in the four directions of the compass, briefly drowning out the hum of the buses and trains on the other side of the cemetery fence.

The service concluded with the 23rd Psalm. Mourners sang a hymn: "Blessed are your poor, for the kingdom shall be theirs."

Each year, a new mass grave is marked with a roughly 4-by-4-inch plaque inscribed simply with the year. County-USC has conducted the burials since 1896.

There currently are 5,369 people on the coroner's online unclaimed persons list.

"All of these folks represent the work that we do for the community: identify bodies, trying to reunite families," said Craig R. Harvey, chief coroner investigator. "It's sad that a lot of it comes down to the almighty dollar."

Sometimes, family members discover too late that a loved one was buried in the mass grave. A few small markers with individual names are scattered throughout the cemetery — each a personal memorial, each telling a story.

Near the marker for 1966, a small stone is dedicated to Jeffery, a 5-year-old "beloved brother and son." A toy pinwheel buried in the dirt near his stone squeaked and turned in the wind.

A man named Thomas, born March 14, 1947, was memorialized a foot away from the stone for the year 2000. A single, fading blue flower rested near the engraving, "Remembered with love."

As the ceremony came to a close, mourners scattered rose petals over the freshest grave, decorated with flower arrangements from county officials.

A few feet away, a man and woman in dark clothing embraced.

Selene Santiago and Dres Vasquez were attending the service for the first time. Though they knew none of the dead, they wanted to pay their respects. Santiago dapped her face with a tissue during the service.

Santiago, 34, of Alhambra grew up in Boyle Heights. As a teenager, she often walked through the cemetery, reading the gravestones. She never knew about the section dedicated to the county burials.

"I thought about the people and what it means to die alone," she said. "I wondered what was going through these people's minds and whether they even knew there would be a formal service."

Gonzales took another look at the humble grave where her mother was buried. She finally feels closure, she said. It has been more than three years since her mother's death, but every time Gonzales sees a green traffic light, she's reminded of her mother.

"They're green," she said, "her eyes were green."

hailey.branson@latimes.com

rosanna.xia@latimes.com

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