Hip implants a bit more likely to fail in women

CHICAGO (AP) — Hip replacements are slightly more likely to fail in women than in men, according to one of the largest studies of its kind in U.S. patients. The risk of the implants failing is low, but women were 29 percent more likely than men to need a repeat surgery within the first three years.

The message for women considering hip replacement surgery remains unclear. It's not known which models of hip implants perform best in women, even though women make up the majority of the more than 400,000 Americans who have full or partial hip replacements each year to ease the pain and loss of mobility caused by arthritis or injuries.

"This is the first step in what has to be a much longer-term research strategy to figure out why women have worse experiences," said Diana Zuckerman, president of the nonprofit National Research Center for Women & Families. "Research in this area could save billions of dollars" and prevent patients from experiencing the pain and inconvenience of surgeries to fix hip implants that go wrong.

Researchers looked at more than 35,000 surgeries at 46 hospitals in the Kaiser Permanente health system. The research, published Monday in JAMA Internal Medicine, was funded by the U.S. Food and Drug Administration.

After an average of three years, 2.3 percent of the women and 1.9 percent of the men had undergone revision surgery to fix a problem with the original hip replacement. Problems included instability, infection, broken bones and loosening.

"There is an increased risk of failure in women compared to men," said lead author Maria Inacio, an epidemiologist at Southern California Permanente Medical Group in San Diego. "This is still a very small number of failures."

Women tend to have smaller joints and bones than men, and so they tend to need smaller artificial hips. Devices with smaller femoral heads — the ball-shaped part of the ball-and-socket joint in an artificial hip — are more likely to dislocate and require a surgical repair.

That explained some, but not all, of the difference between women and men in the study. It's not clear what else may have contributed to the gap. Co-author Dr. Monti Khatod, an orthopedic surgeon in Los Angeles, speculated that one factor may be a greater loss of bone density in women.

The failure of metal-on-metal hips was almost twice as high for women than in men. The once-popular models were promoted by manufacturers as being more durable than standard plastic or ceramic joints, but several high-profile recalls have led to a decrease in their use in recent years.

"Don't be fooled by hype about a new hip product," said Zuckerman, who wrote an accompanying commentary in the medical journal. "I would not choose the latest, greatest hip implant if I were a woman patient. ... At least if it's been for sale for a few years, there's more evidence for how well it's working."

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Online:

Journal: http://www.jamainternalmed.com

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Garcetti and Greuel trade shots in mayoral candidates debate

Los Angeles City Councilman Eric Garcetti disparaged rival Wendy Greuel's record as city controller and mocked her campaign platform Monday night in a feisty debate that highlighted the intensifying clash between the top two contenders in the race for mayor.

Greuel defended her record and agenda, but declined to take direct shots at Garcetti. Instead, she accused the entire City Council of failing to act on her findings of waste, fraud and abuse at City Hall.

"They can attack me," she said. "They can attack my numbers. They can attack my auditors. But the one thing they haven't done is attack the problem."

Garcetti's aggressive posture in the Cal State L.A. debate reflects the increasing pressure he faces as Greuel reaps the benefits of more than $1 million in advertising by independent committees funded by public employee unions and other supporters.

It also overshadowed efforts by three other candidates — Councilwoman Jan Perry, entertainment lawyer Kevin James and former tech executive Emanuel Pleitez — to decisively break from the pack during the 90-minute debate, televised live on KABC-TV Channel 7. Voters go to the polls in two weeks.

Garcetti began his assault by challenging as "simply not true" Greuel's frequent statements that she identified $160 million in squandered city money.

"It rests on an accounting maneuver and on unrealistic projections," he said, citing a Times review of audits by Greuel's office.

"What is real," he added, "is real pension reform like we've done the last few years, real cuts and consolidations — the tough choices — not just identifying potential savings, but actually enacting them."

Greuel told viewers that two former controllers, Laura Chick and Rick Tuttle, were supporting her.

"They told me that City Hall would try and kill the messenger, and that's what they're trying to do," she said. "And apparently my opponents don't feel there is any waste. I know there is and I'm going to do something about it."

Garcetti's offensive left James, a former federal prosecutor, in the unfamiliar role of watching another candidate play attack dog.

Nonetheless, he said large raises for city employees — approved by Garcetti, Perry and Greuel when she was on the City Council — show that three longtime officials were "too cozy with the union leaders that have run City Hall."

"We'll talk about cozy later, Mr. James," Perry responded. She too portrayed herself as independent.

"I'm not the favorite of the political power-brokers or insiders because I've never been willing to cut backroom deals or make promises to special interests," said Perry, whose campaign mailers have accused Greuel of selling out to the union representing DWP workers in return for support.

Pleitez struck similar notes, saying he was "tired of the same politicians saying what they're doing, yet the results — there's nothing to show for them."

"Let's take our city in a new direction," said Pleitez.

But it was Garcetti's attacks that stood out.

Alluding to $700,000 spent by the city utility employees' union to benefit Greuel, Garcetti asked, "Do you want a DWP union to buy this election by spending a million dollars on Ms. Greuel's campaign? Or do you want a mayor who is independent enough to make the right decisions and to preserve our democracy?"

Taking aim at her plan to hire more than 2,000 new police officers and 700 new firefighters and paramedics by 2020, Garcetti cited Supervisor Zev Yaroslavsky's criticism of the plan as unrealistic, given the city's budget troubles.

Greuel defended her plan and attacked the council for cutting the Fire Department's budget after the recession hit. She also noted her endorsements by public safety unions.

"The police officers and the firefighters had a choice," she said. "They chose me."

michael.finnegan@latimes.com

david.zahniser@latimes.com

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Oscar Pistorius Charge Upgraded to Premeditated Murder

Breaking News

By Stephen M. Silverman

02/19/2013 at 07:20 AM EST

Oscar Pistorius

Antonie de Ras/Reuters/Landov

Charges against Oscar Pistorius have been upgraded to premeditated murder, after the judge in Pretoria, South Africa, said during Tuesday's bail hearing that he could not rule out the possibility that the "Blade Runner" track star planned the shooting death of girlfriend Reeva Steenkamp, reports CNN.

Magistrate Desmond Nair said he would consider downgrading the charge at a later date. Wearing a blue shirt and gray suit, and sometimes clenching his jaw, Pistorius also openly wept in the packed courtroom as prosecutors provided details of their accusations.

Prosecutors said Pistorius, 26, opened fire on Steenkamp, 29, four times through a locked bathroom door of his home in a gated community last Thursday after attaching his prosthetic legs and walking more than 20 feet from a bedroom.

Prosecutor Gerrie Nel said Steenkamp, a model who only recently had made her debut in a reality TV show, had been in a room less than 20 square feet when the shots were fired, reports The New York Times.

"She could not go anywhere," said Nel. "It must have been horrific."

A lawyer for Pistorius, Barry Roux, said the defense would "submit that this is not a murder," citing a lack of evidence or motive.

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IHT Rendezvous: Holding Obama's Feet to the Climate-Change Fire

At first glance, it was hard to tell whether they had come to bury Obama or to praise him.

Thousands of activists from hundreds of environmental, social justice and community groups marched on Washington yesterday in the biggest climate rally ever held in the U.S. capital. Activists both called on President Obama to make good on his climate change policy promises and protested the Keystone XL pipeline project.

“For 25 years our government has basically ignored the climate crisis: now people in large numbers are finally demanding they get to work,” Bill McKibben, head of 350.org, one of the environmental groups organizing the event, told the crowd.

The “Forward on Climate” rally comes less than a week after President Obama urged American leaders to “act before it is too late,” on climate change during his State of the Union address.

The demonstration’s timing — early in the administration’s second term — was important. While many say Mr. Obama achieved important green goals in his first term (Rendezvous wrote about tougher fuel efficiency standards for cars), critics say he did not achieve enough in the fight to address climate change. Many blame an uncooperative Congress and the always-looming re-election campaign. (The words “climate change” were not uttered during any of the three presidential debates between Mr. Obama and Mitt Romney.

The secretaries of the interior and energy — portfolios where green leadership is seen as important — are being replaced. The head of the Environmental Protection Agency, Lisa Jackson, announced her resignation late last year.

Despite the President’s recent emphatic address to the nation, critics point out that his speech was short on details. And for many of the organizers of yesterday’s rally, the fact that the President did not mention the controversial Keystone XL pipeline — a pipeline that is to bring crude oil from Canada to Texas refineries — was a warning sign.

At the rally on the National Mall, activists from the ‘Backbone Campaign’ carried a 70-foot model of a spine, with an anti-Keystone XL pipeline message painted on the side, imploring the President to stand strong against the project.

As my colleagues John M. Broder, Clifford Krauss and Ian Austen reported, the Keystone XL pipeline issue is particularly thorny for Mr. Obama because the project is so detested by environmentalists, but supported by so many other players, including the government of Canada, one of the United States’ most important trading partners.

On Thursday, the House of Representatives passed an energy bill that would allow Congress, rather than the White House, to issue a permit for the Keystone XL pipeline. The President had put plans for the pipeline on hold temporarily.

On the same day in the Senate, several senators co-sponsored legislation for a carbon tax program that would finance clean-energy projects, in a move largely seen as symbolic because of the legislation’s scant chance of passing either house of Congress.

Partially due to recent extreme weather events, the issue of climate change is once more at the forefront of American politics. A survey carried out by the League of Conservation voters found that 65 percent of American voters were in favor of “the President taking significant steps to address climate change now.”

“Twenty years from now on President’s Day, people will want to know what the President did in the face of rising sea levels, record droughts and furious storms brought on by climate disruption,” said Michael Brune, head of the Sierra Club, an environmental organization that helped organized Sunday’s rally.

A man dressed as the grim reaper held a sign that read: “the only steady job on a dying planet will be mine.”

While no official attendance numbers were recorded, participating organizations estimated that more than 35,000 people attended. On its Facebook page, 350.org claimed that 50,000 protesters took part in the event.

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Study: Better TV might improve kids' behavior

SEATTLE (AP) — Teaching parents to switch channels from violent shows to educational TV can improve preschoolers' behavior, even without getting them to watch less, a study found.

The results were modest and faded over time, but may hold promise for finding ways to help young children avoid aggressive, violent behavior, the study authors and other doctors said.

"It's not just about turning off the television. It's about changing the channel. What children watch is as important as how much they watch," said lead author Dr. Dimitri Christakis, a pediatrician and researcher at Seattle Children's Research Institute.

The research was to be published online Monday by the journal Pediatrics.

The study involved 565 Seattle parents, who periodically filled out TV-watching diaries and questionnaires measuring their child's behavior.

Half were coached for six months on getting their 3-to-5-year-old kids to watch shows like "Sesame Street" and "Dora the Explorer" rather than more violent programs like "Power Rangers." The results were compared with kids whose parents who got advice on healthy eating instead.

At six months, children in both groups showed improved behavior, but there was a little bit more improvement in the group that was coached on their TV watching.

By one year, there was no meaningful difference between the two groups overall. Low-income boys appeared to get the most short-term benefit.

"That's important because they are at the greatest risk, both for being perpetrators of aggression in real life, but also being victims of aggression," Christakis said.

The study has some flaws. The parents weren't told the purpose of the study, but the authors concede they probably figured it out and that might have affected the results.

Before the study, the children averaged about 1½ hours of TV, video and computer game watching a day, with violent content making up about a quarter of that time. By the end of the study, that increased by up to 10 minutes. Those in the TV coaching group increased their time with positive shows; the healthy eating group watched more violent TV.

Nancy Jensen, who took part with her now 6-year-old daughter, said the study was a wake-up call.

"I didn't realize how much Elizabeth was watching and how much she was watching on her own," she said.

Jensen said her daughter's behavior improved after making changes, and she continues to control what Elizabeth and her 2-year-old brother, Joe, watch. She also decided to replace most of Elizabeth's TV time with games, art and outdoor fun.

During a recent visit to their Seattle home, the children seemed more interested in playing with blocks and running around outside than watching TV.

Another researcher who was not involved in this study but also focuses his work on kids and television commended Christakis for taking a look at the influence of positive TV programs, instead of focusing on the impact of violent TV.

"I think it's fabulous that people are looking on the positive side. Because no one's going to stop watching TV, we have to have viable alternatives for kids," said Dr. Michael Rich, director of the Center on Media and Child Health at Children's Hospital Boston.

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Online:

Pediatrics: http://www.pediatrics.org

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Contact AP Writer Donna Blankinship through Twitter (at)dgblankinship

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Major donor to GOP helping L.A. mayoral candidate Kevin James

Dallas billionaire Harold Simmons and Los Angeles mayoral candidate Kevin James crossed paths just once.

It was an intimate cocktail fundraiser for James in the tony Montecito enclave near Santa Barbara, where Simmons owns a weekend retreat and counts Oprah Winfrey among his neighbors. Simmons, one of the top donors to Republican "super PACs" in 2012, turned to the candidate and asked, "What on Earth can you do to save L.A.?"

James, recounting the exchange, said he launched into his political pitch, railing against the city's flirtation with bankruptcy and the power of its labor unions. "I remember him telling me he was impressed," James said.

Later, when James made formal remarks to the group, which included a few of Simmons' fellow Texans, the industrial magnate stood up and announced that he would give. By mid-January, Simmons had given $600,000 to an independent group backing James, making him the largest single contributor to any political committee affiliated with the L.A. mayor's race — a sphere most often dominated by labor unions.

His contributions made it possible for a super PAC known as Better Way LA, created by GOP ad man Fred Davis, to buy half a million dollars of TV ad time last week promoting James, the only Republican in the race.

But that political help could come at a price in a city as liberal and Democratic as Los Angeles, where James needs to win over moderates, as well as conservatives, to reach a two-way runoff in May. In recent years, Simmons has funded some of the most controversial conservative groups in presidential politics, and last year he called President Obama "the most dangerous American alive."

Simmons' interest in city politics and a long shot like James remains something of a mystery. A corporate investor whose net worth was valued at $7.1 billion by Forbes last September, Simmons declined to be interviewed. He votes in Texas and has not contributed to any other Los Angeles city candidates in recent years, according to election records.

By the standards of his past political giving, Simmons' support for the pro-James super PAC has been small.

In last year's presidential race, Simmons, his wife, his companies and their employees gave $31 million to a network of super PACs that proliferated after the Supreme Court's 2010 Citizens United ruling, which loosened the reins on political spending by corporations and labor unions, according to the Center for Responsive Politics.

"This is one of a handful of mega-donors in U.S. politics who has given extraordinary sums of money over many, many years," said Sheila Krumholz, the center's executive director who has monitored Simmons' political giving for two decades. "He's a savvy donor, somebody who is very familiar with how this game is played at the highest levels and on down."

James, an openly gay Republican, said he knew of no specific business that Simmons has before the city. And Simmons did not mention any particular Los Angeles issue, he said.

James suggested that Simmons, 81, may be interested in elevating a moderate Republican voice statewide. Simmons has contributed to another California moderate, former Gov. Arnold Schwarzenegger, and told the Wall Street Journal last year that he was "probably pro-choice."

"For donors who are looking for the Republican Party to be able to plant a flag again in California," James said, "I'm the kind of Republican that's a bigger-tent Republican."

In that rare interview he granted the Wall Street Journal last year, Simmons said he wanted to make the U.S. tax and regulatory structure more friendly to business by electing Republicans at all levels of government. He said he hoped like-minded individuals would make political donations to help counter spending by labor unions.

In 2004, Simmons donated $3 million to Swift Boat Veterans for Truth, a group that ran ads accusing then-Democratic presidential candidate John Kerry of exaggerating his record in the Vietnam War. And during President Obama's first run, Simmons was the sole funder of the American Issues Project, which ran TV ads tying Obama to a founder of the Weather Underground, which planned a series of bombings to protest the Vietnam War.

In his interview with the Journal, Simmons described Obama as "a socialist" who "would eliminate free enterprise in this country."

At times, Simmons' political contributions have tracked closely with his business interests — a network of companies that include hazardous waste disposal and metal component manufacturers.

He was a generous backer of Texas Gov. Rick Perry at a time when one of those companies, Waste Control Specialists, needed the governor's backing to build a low-level radioactive waste disposal site, the nation's first such new facility in three decades.

After a fierce lobbying campaign, Perry signed a law opening the way for the proposal. Perry appointees later approved the license for the $500-million site in West Texas despite concerns of some state environmental experts about potential harm to aquifers near the site. Simmons' spokesman has said that Simmons' connections to Perry did not work to his company's advantage and in fact increased the state's scrutiny of the deal.

Krumholz said Simmons' companies span so many fields that it has been difficult to trace possible ties between his business interests and his giving even at the federal level.

"He's kind of like the AT&T of individual donors," said Krumholz, noting that the telecommunications giant has interests in defense contracting and other industries. "He might have reason to be involved at various levels of government and in specific races because his investments are so diverse."

maeve.reston@latimes.com

Molly Hennessy-Fiske contributed to this report.

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Photo Fun at the Oscar Nominees Luncheon

Jessica Chastain, Hugh Jackman, Denzel Washington and more pull their best poses at PEOPLE's exclusive photo shoot

Credit: Larry Busacca/Getty for People.com

Updated: Tuesday Feb 05, 2013 | 01:30 PM EST
By: Alison Schwartz

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IHT Rendezvous: In Singapore's Immigration Debate, Sign of Asia's Slipping Middle Class?

BEIJING — Immigration is a hot-button issue nearly everywhere in the world, though the contours of the debate vary from place to place. In the United States, sweeping changes to the law may offer legal residency for millions of people who have entered the country illegally, my colleague Ashley Parker reports.

In Singapore, the debate looks somewhat different: The government plans to increase the population from just over five million to a possible high of nearly seven million by 2030, via regulated, legal immigration, and this is provoking opposition.

So much so that on Saturday, about 3,000 people turned out for what some commentators said was one of the biggest demonstrations in the nation’s history. (If the number seems small, it reflects the tight political control exerted over Singapore life by the People’s Action Party, which has run the country for about half a century and discourages public protest.)

What are the contours of the debate in Singapore?

Concern over booming immigration, often focused on new arrivals from increasingly rich China, has been simmering in the nation, with many feeling that the immigrants do not play by the same rules, that their manners are poor and that they are pushing up prices. That feeling crystallized last year when a wealthy Chinese man driving a Ferrari at high speed killed three people (including himself) in a nighttime accident.

(Similar sentiments are found in Hong Kong, as my colleagues Bettina Wassener and Gerry Mullany wrote.)

Vividly illustrating the resentment, Singaporeans sometimes call the wealthy immigrants “rich Chinese locusts,” according to an article in the Economic Observer’s Worldcrunch.

So the Singapore government’s Population White Paper that passed in Parliament earlier this month, just before Chinese New Year, was bound to stir things up.

The government is presenting the rise in immigration as a target that is needed if Singapore, where immigrants already make up about 40 percent of the population, and which has the highest concentration of millionaires in the world, is to continue to flourish, reports said. Singaporeans just are not having enough children, said the prime minister, Lee Hsien Loong.

“In my view, in 2030, I think six million will not be enough to meet Singaporeans’ needs as our population ages because of this problem of the baby boomers and bulge of aging people,” Mr. Lee said in Parliament, adding that 6.9 million was not a target but a number to be used to help plan for infrastructure.

“Do we really need to increase our population by that much?” wrote a person called Chang Wei Meng in a letter to The Straits Times, according to Reuters. “What happened to achieving the Swiss standard of living?”

Gilbert Goh, a main organizer of the rally Saturday at Singapore’s Speaker’s Corner in a public park, said the protesters had a message: “They want to tell the government, please reconsider this policy. The turnout is a testimony that this policy is flawed and unpopular on the ground,” The Associated Press quoted Mr. Goh as saying.

Yet amid the familiar rhetoric about immigrants, heard around the world – they don’t fit in, they’re rude, they’re different – might something more important be going on here?

In a blog post on Singapore News Alternative, Nicole Seah, a politician who has run for Parliament and comments on social issues, wrote: “Along with many other Singaporeans, I oppose the White Paper.”

Why? She is looking for “a society that lives in harmony, rather than tense and overcrowded conditions,” she writes.

“Not the Singapore Inc. that has been aggressively forced down our throats the past few years – a Singapore which is in danger of becoming a transient state where people from all over, come, make their fortunes, and leave.”

Not “a Singapore that has become a playground for the rich and the people who can afford it. A Singapore where the middle class is increasingly drowned out because they do not have the social clout or sufficient representatives in Parliament to voice their concerns.”

Ms. Seah’s statements raise an interesting question: Is this part of a phenomenon that the columnist Chrystia Freeland has written about so ably for this newspaper, the ascendancy of a wealthy, “plutocrat” class and the slipping status of the middle class?

As Ms. Freeland wrote last week: “The most important fact about the United States in this century is that middle-class incomes are stagnating. The financial crisis has revealed an equally stark structural problem in much of Europe.” Is it hitting Asia, too, and does Singapore’s protest speak, at least in part, to this? Hong Kong’s dissatisfaction too?

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UN warns risk of hepatitis E in S. Sudan grows

GENEVA (AP) — The United Nations says an outbreak of hepatitis E has killed 111 refugees in camps in South Sudan since July, and has become endemic in the region.

U.N. refugee agency spokesman Adrian Edwards says the influx of people to the camps from neighboring Sudan is believed to be one of the factors in the rapid spread of the contagious, life-threatening inflammatory viral disease of the liver.

Edwards said Friday that the camps have been hit by 6,017 cases of hepatitis E, which is spread through contaminated food and water.

He says the largest number of cases and suspected cases is in the Yusuf Batil camp in Upper Nile state, which houses 37,229 refugees fleeing fighting between rebels and the Sudanese government.

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Beyoncé's Life Is But a Dream: The Best Moments

TV Watch

By Aaron Parsley

02/16/2013 at 11:05 PM EST

I am ... still singing!

Beyoncé's HBO documentary, Life Is But a Dream, aired Saturday night and it was a 90-minute whirlwind of music, dance and emotion. And though the singer, 31, has been everywhere recently (the Inauguration, the Super Bowl halftime show, Oprah's Next Chapter), the film was full of new and exciting moments. Here are my favorites:

Baby Bey: A home movie of Beyoncé as a little girl playing with bees made my jaw drop. The scene seems to prove what her fans believe: that she was born to be a superstar known as Queen B. I also loved seeing her singing – and being a typical, giggling teenager – with her sister Solange and Kelly Rowland.

The Heartbreak: From her frank discussion of firing her father as a manager to hearing "the saddest song" she's ever written after having miscarriage, the film – which Beyoncé produced and directed herself – had raw, emotional moments.

Mrs. Carter: Life is like a dream for Beyoncé and husband Jay-Z, who surprisingly shared intimate moments together – giddy over her pregnancy, singing Coldplay's "Yellow" to each other, enjoying solitude on a boat in an undisclosed, exotic location. You could feel the love when she toasted him on his birthday.

Blue Ivy: How cute is she?! When Beyoncé and Jay's baby girl, who turned 1 in January, appeared on the screen at the premiere of Life Is But a Dream at New York's Ziegfeld Theater, the crowd gasped and then let out a collective "aww." And I jammed my fingers on the TV screen the first time I watched, trying to pinch those cheeks. Seeing Beyoncé at home with a baby on her hip was a powerful reminder that the fierce superstar is human afterall.

The Music: Of course! Seeing her sing "Listen" with a gorgeously altered ending in a car convinced me of one thing: Beyoncé is definitely not human! I also loved seeing everything that went into her epic Billboard Music Awards performance of "Run the World (Girls)." I just wish I could do that dance. And is it me or does "Resentment" get grittier and angrier every time she performs it?

Praise Beysus and long live the Queen B!

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