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sexta-feira, 5 de outubro de 2012

4 dead from rare meningitis; more cases expected

MIKE STOBBENASHVILLE, Tennessee -- Health officials are expecting to find more cases of a rare and deadly form of meningitis that has sickened more than two dozen people in five states. Four have died.

All received steroid injections, mostly for back pain, a fairly typical treatment.

The type of meningitis involved is not contagious like the more common forms. This type is caused by a fungus often found in leaf mold and which health officials suspect may have been in the steroid.

Eighteen of the cases are in Tennessee, where a Nashville clinic received the largest shipment of the steroid. The drug was made by a specialty pharmacy in Massachusetts that issued a recall last week. Investigators, though, say they are still trying to confirm the source of the infection.

Three cases have been reported in Virginia, two in Maryland, two in Florida and one in North Carolina. Two of the deaths were in Tennessee, and Virginia and Maryland had one each, said officials at the Centers for Disease Control and Prevention.

More new cases are almost certain to appear in the coming days, said Tennessee Department of Health Commissioner John Dreyzehner. Five new cases were confirmed over the past 24 hours, he said Wednesday, calling the situation a "rapidly evolving outbreak."

But federal health officials weren't clear about whether new infections are occurring. They are looking for - and increasingly finding - illnesses that occurred in the past two or three months.

Meningitis is caused by the inflammation of meninges, which are protective membranes covering the brain and spinal cord. Symptoms include severe and worsening headache, nausea, dizziness and fever. Some of the patients also experienced slurred speech, and difficulty walking and urinating, Tennessee health officials said.

"Some are doing well and improving. Some are very ill - very, very seriously ill and may die," Tennessee health official Dr. David Reagan said of the state's patients.

The incubation period is estimated at anywhere from two to 28 days, so some people may not have fallen ill yet, Tennessee health officials said. At three clinics in Tennessee, officials are contacting the more than 900 people who received the steroid in the past three months.

Investigators also have been looking into the antiseptic and anesthetic used during the injections. Neither has been ruled out. However, the primary suspicion is on the steroid medication. Steroid shots are common for back pain, often given together with an anesthetic.

The Food and Drug Administration identified the maker of the steroid as New England Compounding Center, a specialty pharmacy in Framingham, Mass. Last week, the company issued a recall of three lots of the steroid - methylprednisolone acetate. In a statement, the company said it had voluntarily suspended operations and was working with regulators to identify the source of the infection.

Compounding pharmacies mix ingredients for customized medicines that generally aren't commercially available. They are regulated by states.

The outbreak was discovered about two weeks ago when Vanderbilt University's Dr. April Pettit was treating a patient who was not doing well for reasons doctors did not understand.

When the lab found the fungus in the patient's spinal fluid, Pettit began asking questions and learned the patient recently had steroid injections in his spine, according to Dr. William Schaffner, who chairs Vanderbilt's Department of Preventive Medicine.

"When it became clear that the infection-control practices at the clinic were up to par, the steroid medication became implicated," Schaffner said.

Federal officials did not release condition reports or details on all the patients in the five states. Fungal meningitis is treated with high-dose antifungal medications, usually given intravenously in a hospital.

Seventeen of the Tennessee cases were treated at the Saint Thomas Outpatient Neurosurgery Center in Nashville. It had 2,000 vials of the suspect lots, the largest number. That clinic voluntarily closed last month to deal with the investigation.

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terça-feira, 10 de janeiro de 2012

Earlier than expected, Daley out as chief of staff

By BEN FELLERWASHINGTON -- In a jolt to the White House, President Barack Obama announced Monday that chief of staff William Daley was quitting and heading home, capping a short and rocky tenure that had been expected to last until Election Day. Obama budget chief Jack Lew, a figure long familiar with Washington's ways, will take over one of the most consuming jobs in America.

Daley's run as Obama's chief manager and gatekeeper lasted only a year. It was filled with consequential moments for the White House, like the killing of al-Qaida terrorist leader Osama bin Laden, but also stumbles with Congress and grumbles that Daley was not the right choice to coordinate an intense operation of ideas, offices and egos.

Obama said he reluctantly accepted the news and at first refused to accept Daley's post-holidays resignation letter last week.

Daley did not waver, expressing to his boss a desire to get back to his family in Chicago, where Daleys have dominated city politics for decades. But he offered no explanation on Monday about what accelerated his decision; he had committed to Obama that he would stay on through the election.

It apparently became clear that the fit was no longer working for either side. Senior adviser Pete Rouse had already taken on more of the day-to-day management.

Stepping in is the mild-mannered Lew, who began his career on Capitol Hill, where he spent nearly a decade as principal domestic policy adviser to the late House Speaker Tip O'Neill. Lew, 56, has worked for Obama as a deputy secretary of state before becoming budget director, the same position he held in the Clinton administration.

Daley had been brought in for his political savvy, business ties and experience as a commerce secretary. Yet as an outsider, he did not personally know Obama well, meaning he was forced to figure out the president and run his operation simultaneously. He did not seem to mesh as the one, more than anyone, charged with ensuring a smooth operation.

The president delivered the other side of the story, describing Daley as highly influential and effective.

White House officials said that to the degree Daley gets blame for any missteps, he also deserves credit for his work during a remarkably demanding year that ended on a high for Obama, with a political victory over House Republicans in getting a payroll tax cut extended.

"No one in my administration has had to make more important decisions more quickly than Bill. And that's why I think this decision was difficult for me," Obama said in a State Dining Room that was nearly empty except for the assembled media.

The mood was decidedly more low-key than other transitions involving the top staff job at the White House.

Obama now plows ahead in an election year with his third chief of staff - one of the most crucial positions in government and politics. Daley had replaced the colorful and involved-in-everything Rahm Emanuel, who left the job to run for Chicago mayor, a position he now holds. Rouse also served as interim chief of staff for a stretch.

Those following Washington politics had seen this day coming, especially since Rouse took on more of Daley's traditional role in November. Although Obama praised Daley at length for his help on major decisions in 2011, the West Wing had endured private struggles with coordination and communication, particularly with Congress.

Daley, 63, was not pushed out the door, said a Democratic strategist familiar with the decision The timing was driven by Daley's personal reflection, yet it also only would have gotten more awkward for the White House had he not left before Obama's tone-setting State of the Union, said the strategist, who spoke on condition of anonymity to discuss the personnel matter.

The State of the Union speech is Jan. 24, followed closely by the release of his White House budget proposal in early February.

The chief-of-staff transition is expected by the end of the month, with Lew staying on at the Office of Management and Budget until the budget plan is released. It is unclear who will lead the agency after that.

Lew and Daley stood with the president on Wednesday but did not speak. The White House said neither man was giving interviews.

Lew's private sector experience includes a stint as managing director and chief operating officer of Citigroup's global wealth management division.

Daley, meanwhile, will serve as a co-chair of Obama's Chicago-based re-election efforts, said a campaign official, who requested anonymity ahead of the official announcement.

Unlike Daley, Lew comes with deep connections to Congress, where Obama's relationship with lawmakers is a source of constant debate.

Coming after Emanuel, a former congressman and a leader of his caucus, Daley's relationship with congressional Democrats was hardly smooth.

Senate Majority Leader Harry Reid, D-Nev., who after being accustomed to speaking with Emanuel up to a dozen times a day, was in contact with Daley only rarely, according to a former senior Senate Democratic leadership aide who talked on condition of anonymity to speak about private relationships.

Reid sent out an upbeat statement on Lew ("a consummate professional with intimate knowledge of Congress) and Daley (for "handling crises few chiefs of staff have had to face.")

Daley also was blamed by congressional Democrats for an embarrassing incident last fall when Obama was forced to reschedule his plans to deliver a jobs speech to Congress after House Speaker John Boehner, R-Ohio, rejected the date Obama first proposed.

Matters hit a new low when Daley complained in an interview with Politico in October that both congressional Republicans and Democrats were making life difficult for the president. Reid objected strongly to Daley's mention of problems with Democrats, considering his efforts to advance Obama's agenda, the aide said.

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Associated Press writers Erica Werner and Julie Pace contributed to this report.

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sábado, 7 de janeiro de 2012

Americans expected to buy more cars in 2012

By TOM KRISHER and DEE-ANN DURBINDETROIT -- Strong sales in December capped off a great year for U.S. carmakers - especially Chrysler - and 2012 should be even better.

For their biggest Japanese rivals, a year of natural disasters and other struggles ended on a sour note, with U.S. sales falling and the outlook for this year just as challenging.

Chrysler Group, in the midst of a comeback after its 2009 trip through bankruptcy court, said Wednesday that sales surged 37 percent in December and 26 percent for all of 2011. Demand was particularly strong for the Jeep Grand Cherokee and the Chrysler 200. Chrysler catapulted itself ahead of Honda Motor Co. as the fourth-largest automaker by sales in the U.S.

General Motors Co. and Ford Motor Co. ended the year with more modest double-digit percentage gains. Analysts say U.S. car and truck sales rose for the second year in a row as buyers' confidence in the economy picked up, their aging vehicles wore down and their ability to take out cheap loans improved.

U.S. auto sales rose 10 percent to 12.8 million in 2011. That's up 23 percent from 2009, when the U.S. auto industry and the financial system were in peril.

The best-selling vehicle in 2011 was the Ford F-Series pickup - the 30th straight year it's been at the top. That was followed by Chevrolet's Silverado pickup. Next were cars: the Toyota Camry and Nissan Altima sedans. Rounding out the top 10 were the Ford Escape small SUV, the Ford Fusion midsize sedan, the Ram pickup, Toyota's Corolla compact, the Honda Accord sedan and the new Chevy Cruze compact.

November and December were the strongest months of the year for U.S. auto sales, and analysts expect the momentum to continue into 2012. Improving employment numbers, low interest rates and building demand to replace older cars should all boost 2012 sales.

GM's December sales rose 5 percent, resulting in a 13 percent bump for the year, while Ford's December sales climbed 10 percent, closing out an 11 percent gain for 2011.

Nissan Motor Co., which recovered more quickly than its rivals from the March earthquake and tsunami in Japan, was the only major Japanese automaker to sell more cars in the U.S. in 2011. Its sales surged nearly 8 percent in December and 15 percent for the year.

Nissan's Leaf electric car also outsold GM's Chevrolet Volt in the cars' first full year on the market. Nissan sold 9,674 Leafs, beating the Volt by just over 2,000.

But for Honda and Toyota, 2011 was a disappointing sales year.

They couldn't get enough cars and trucks to U.S. dealers because of Japan's disasters and flooding in Thailand. Toyota said Wednesday that it doesn't expect its inventory to be at normal levels until March.

Both carmakers, whose sales fell 7 percent in 2011, were also hurt by aging offerings like the Toyota Corolla and poor reviews of the new Honda Civic.

While U.S. sales haven't returned to their pre-recession levels, American motorists are increasingly eager to buy, says Jesse Toprak, vice president of analysis for the car pricing site TrueCar.com.

Buyers snapped up more small cars like the Chevrolet Cruze, Hyundai Elantra and Ford Fiesta. And sales of trucks and SUVs picked up as well, a sign that small businesses are updating their aging fleets, something they were reluctant to do shortly after the Great Recession of 2007-2009.

"They're becoming more comfortable buying a car even though the dust hasn't totally settled," says Toprak.

GM and others predict that total U.S. auto sales will rise by another 1 million or so in 2012 to a range of 13.5 million to 14 million. That's still far below the peak of around 17 million in 2005, but consistent with a slow and steady economic recovery.

The unemployment rate is at a three-and-a-half-year low, and hiring is improving. That's helping consumers feel more confident about a big purchase like a car. Low interest rates - below 3 percent, in some cases - are also enticing buyers, says Don Johnson, GM's U.S. sales chief. And with the average age of a car in the U.S. pushing a record 11 years, there is growing demand to replace old vehicles.

Buyers are coming out even though car prices are relatively high. The average new vehicle cost $30,686 in December, up 5 percent from a year earlier, as automakers offered more pricy features like navigation systems and backup cameras but cut back on rebates and other deals. Incentive spending dropped 3 percent in December from a year earlier to an average of $2,562 per vehicle, according to TrueCar.com.

Many analysts had predicted a price war in 2011 as Toyota and Honda factories resumed normal production and they sought to win customers. But the big discounts never materialized, and GM's Johnson doesn't expect them in 2012, either.

But others think Toyota and Honda will use incentives to try to win back the market share they lost in 2011. Toyota ended the year with market share of 12.9 percent, down from 15 percent in 2010.

"I still expect Toyota and Honda to be a little more aggressive in the first half," says Paul Ballew, a former GM chief economist who now works for Nationwide Insurance.

Other automakers reporting Wednesday:
- Volkswagen AG says 2011 sales were up 26 percent on strong demand for the Jetta and Passat sedans. December sales were up 36 percent to 32,502, the company's best December in the U.S. since 1972.

- Hyundai Motor Co. says 2011 sales rose 20 percent on strong demand for the Sonata and Elantra sedans. December sales were up 13 percent.

- Kia Motors Corp. says 2011 sales rose 36 percent on sales of the new Optima, Soul and Sorento. December sales were up 43 percent.

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