Investors on Wall St. React Nervously

Henny Ray Abrams/Associated Press

A trader on the floor of the New York Stock Exchange on Wednesday. A day after the election, the outlook of continued divided government in Washington and little prospect for compromise unnerved traders.

A one-two punch of worries about the post-election picture in the United States and economic weakness in Europe sent stocks reeling Wednesday, with major indices falling more than 2 percent. Some industry sectors, like finance and managed care, fell substantially more than that over fears they would be hurt by tougher regulations and other adverse policies in President Obama’s second term.

The Standard & Poor’s 500-stock index recorded its worst performance since June, falling 33.86 to 1,394.53, while the Dow Jones industrial average fell 312.95 to 12,932.73. It was the Dow’s first close below the psychologically important 13,000 level since August.

Shares also came under pressure after Barclays sharply reduced its year-end target for the S.&P. 500 to 1,325 from 1,395 — 5 percent below where the broad-based index closed Wednesday.

“Within the equity market in the near term, we believe there will be nowhere to hide,” said Barry Knapp, chief United States equity strategist at Barclays. “In the near term, we generally suggest cutting risk.”

Many market strategists expect that the market will remain volatile between now and mid-January. If Congress and the president cannot come up with a plan to cut the deficit, hundreds of billions in Bush-era tax cuts are set to expire at the beginning of 2013 while automatic spending cuts will sharply cut the defense budget and other programs.

Known as the fiscal cliff, this simultaneous combination of sweeping reductions in government spending and tax increases could push the economy into recession in 2013, economists fear.

In the wake of President Obama’s re-election, companies in some sectors, like hospitals and technology, will see a short-term pop, said Tobias Levkovich, chief United States equity strategist with Citi. Other areas, like financial services as well as coal and mining, are likely to be hurt, Mr. Levkovich said.

Indeed, coal companies were among the worst hit Wednesday. The coal industry is particularly sensitive to new environmental regulations, while Mr. Obama has pushed in the past for more investments in renewables and alternative energy sources that could reduce coal demand in the long-term.

Shares of Alpha Natural Resources, a coal giant, were down 12.2 percent to $8.45, while Arch Coal was off 12.5 percent to $7.58.

But HCA Holdings, a hospital operator, jumped 9.4 percent, to $33.85 a share. As a result of Mr. Obama’s victory, Goldman Sachs said it upgraded its rating on HCA to buy from neutral, and raised its price target to $39 from $31. It also raised price targets for Tenet Healthcare and Community Health Systems, although both are still rated neutral.

Goldman downgraded shares of Humana, a leading managed care company, to sell, and its shares fell 7.9 percent to $70.16. Goldman warned that Humana and other managed care providers could be hurt as health care reform moves forward, especially new rules for health insurers that become effective in 2014.

Shares of Wall Street firms and big banks were also hard hit. While Mitt Romney favored substantially altering the Dodd-Frank financial regulations passed in the summer of 2010 and easing many regulations, President Obama has supported stricter rules for the financial services industry. In addition, one of the industry’s fiercest critics, Elizabeth Warren, was elected to the Senate from Massachusetts, unseating her Republican opponent, Scott Brown.

Bank of America fell 7.1 percent to $9.23 while Goldman Sachs dropped 6.6 percent to $117.98 and JPMorgan Chase sank 5.6 percent to $40.48.

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Greece to Vote on $23 Billion in New Cuts

Angelos Tzortzinis for The New York Times

Greeks began two days of nationwide strikes on Tuesday to protest the new austerity measures, which include further cuts to pensions, civil service salaries and social benefits.

ATHENS — Destabilized by scandals yet held together by a lack of alternatives, the Greek government prepared to push a raft of politically toxic new austerity measures through Parliament on Wednesday, a move aimed at securing international financing and ensuring that the debt-wracked nation will remain in the euro zone.

But some members of Prime Minister Antonis Samaras’s fragile three-party coalition government were expected to break ranks and vote against the measures, reviving questions about how long the coalition can hold together.

On the streets, austerity-weary Greeks kicked off two days of nationwide strikes on Tuesday to protest the new measures, which will total $23 billion over the next four years.

The measures, which are expected to pass by a razor-thin margin in Parliament, are required to unlock $40 billion in rescue financing that the country needs to meet expenses. The European Union’s commissioner for economic and monetary affairs, Olli Rehn, said in Brussels on Monday that lenders were on track to release the aid.

But with so many volatile elements in play, including a series of interlocking scandals in Greece that are gaining momentum, analysts said that it was unclear if the Samaras government could survive under the pressure. “All systems are in critical condition, even the smallest thing can destabilize the system or the government,” said Paschos Mandravelis, a columnist for the daily newspaper Kathimerini.

Even as they jockey over a new round of austerity, leaders are under fire for failing to crack down on high-level tax evasion, after they were handed a list two years ago of more than 2,000 Greeks said to have Swiss bank accounts.

Called the Lagarde list, after Christine Lagarde, the International Monetary Fund chief who provided the information, it was published last week by the investigative magazine HotDoc, prompting the arrest and rapid acquittal of the publication’s editor. The entire affair has done substantial damage to the already weakened Socialist party, the second largest in Mr. Samaras’s coalition. Two Socialist finance ministers — Evangelos Venizelos, the current Socialist leader, and George Papaconstantinou, his predecessor — are under fire for failing to act on the list.

Most analysts said that they believed the government would hold up for now. But two other rival parties are gaining ground in opinion polls. If the country were to hold new elections today, the leftist Syriza party — which has risen rapidly from virtual obscurity on a platform of repudiating Greece’s bailout but staying in the euro — would place first, followed by Mr. Samaras’s New Democracy Party, the polls suggest.

Since claiming power in June, Mr. Samaras has labored to restore Greece’s credibility with its European partners, particularly with Chancellor Angela Merkel of Germany, who has insisted that Greece remain a part of the euro zone.

“It’s clear that this government is making all the right noises,” said Mujtaba Rahman, Europe analyst at the Eurasia Group. “They’re much more credible, and creditors are happy with the progress they have made.” Nevertheless, he added, even when the next wave of financial aid arrives, “Greece is not at all out of the woods.”

The new austerity measures, which include further cuts to pensions, civil service salaries and social benefits, are expected to reduce gross domestic product by 9 percent, dealing a new blow to an economy entering its sixth year of recession and likely adding to an unemployment rate already exceeding 25 percent. A total of $17 billion in cuts and tax increases will be put into effect in the next two years. But because the Greek economy is shrinking even faster than expected, an additional $4.5 billion in austerity measures will be required between 2015 and 2016 to meet the country’s fiscal targets.

As matters stand, Greece is still staggering under a mountain of debt, which is expected to rise to 189 percent of gross domestic product in 2013, from 175.6 percent now, as interest piles up on all the loans Greece must repay. The deficit next year is expected to swell as well, to 5.2 percent of G.D.P. from a forecast of 4.2 percent.

Other euro zone governments have discussed forgiving some or part of the nearly $68 billion in loans they made to Greece, a step that many economists regard as inevitable if Greece is ever to emerge from its fiscal straitjacket. But it is considered politically unpalatable, especially in Germany, where Mrs. Merkel faces an election next year.

Niki Kitsantonis contributed reporting.

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Exclusive - Amazon to win EU e-book pricing tussle with Apple

BRUSSELS (Reuters) - European Union regulators are to end an antitrust probe into e-book prices by accepting an offer by Apple and four publishers to ease price restrictions on Amazon, two sources said on Tuesday.

That decision would hand online retailer Amazon a victory in its attempt to sell e-books cheaper than rivals in the fast-growing market publishers hope will boost revenue and increase customer numbers.

"Faced with years of court battles and uncertainty I can understand why some of these guys decided to fold their cards and take the whipping," said Mark Coker, founder of Smashwords, an ebook publisher and distributor that works with Apple.

"It's certainly another win for Amazon," he added. "I have not seen the terms of the final settlement, but my initial reaction is that it places restrictions on what publishers can do, slowing them down just when they need to be more nimble."

A spokesman at the EU Commission said its investigation was not yet finished. Amazon and Apple declined to comment.

In September, Apple and the publishers offered to let retailers set prices or discounts for a period of two years, and also to suspend "most-favored nation" contracts for five years.

Such clauses bar Simon & Schuster, News Corp. unit HarperCollins, Lagardere SCA's Hachette Livre and Verlagsgruppe Georg von Holtzbrinck, the owner of German company Macmillan, from making deals with rival retailers to sell e-books more cheaply than Apple.

The agreements, which critics say prevent Amazon and other retailers from undercutting Apple's charges, sparked an investigation by the European Commission in December last year.

Pearson Plc's Penguin group, which is also under investigation, did not take part in the offer.

The EU antitrust authority, which in September asked for feedback from rivals and consumers about the proposal, has not asked for more concessions, said one of sources.

"The Commission is likely to accept the offer and announce its decision next month," the source said on Tuesday.

Antoine Colombani, spokesman for competition policy at the European Commission, said: "We have launched a market test in September and our investigation is still ongoing."

Amazon declined to comment, while Apple did not respond to an email seeking comment.

Companies found guilty of breaching EU rules could be fined up to 10 percent of their global sales, which in Apple's case could reach $15.6 billion, based on its 2012 fiscal year.

AGGREGATE PRICING

UBS analysts estimate that e-books account for about 30 percent of the U.S. book market and 20 percent of sales in Britain but are minuscule elsewhere. When Amazon launched its Kindle e-reader, it charged $9.99 per book.

Apple's agency model let publishers set prices in return for a 30 percent cut to the maker of iPhone and iPad.

The U.S. Department of Justice is investigating e-book prices. HarperCollins, Simon & Schuster and Hachette have settled, but Apple, Pengin Group and Macmillan have not.

The DOJ settlement required that retailers must at least break even selling all ebooks from a publisher's available list, according to Coker and Joe Wikert, general manager and publisher at O'Reilly Media Inc.

It was not clear if EU regulators will include a similar requirement, which would prohibit Amazon from pricing all ebooks at a loss, said Wikert, a former publishing executive.

In the United States, Amazon will likely price popular titles at a loss and try to make up the difference on a publisher's other ebooks, he said.

Coker said any such rule could be dangerous in Europe, which still has distinct markets.

"It could allow a single retailer to charge full price in a large market like the U.K., and then sell below cost or for free in multiple smaller markets as a strategy to kill regional ebook retailing upstarts before they take root," Coker said.

FROWNING ON ONLINE TRADE CURBS

Antitrust regulators tend to frown on restrictions on online trade and the case is a good example, said Mark Tricker, a partner at Brussels-based law firm Norton Rose.

"This case shows the online world continues to be a major focus for the Commission," he said.

"These markets change very quickly and if you don't stamp down on potential infringements of competition rules, you can have significant consequences."

(Additional reporting by Alistair Barr in San Francisco; Editing by Rex Merrifield, David Goodman and David Gregorio)

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Brees, Robinson lead Saints past Eagles 28-13

NEW ORLEANS (AP) — Two teams with the same record. Two teams heading in strikingly different directions.

Drew Brees and the New Orleans Saints appear to be on the rise again.

Michael Vick and the Philadelphia Eagles are down, and nearly out.

Brees threw two touchdown passes, extending his NFL record streak to 51 games in a row, while Vick was sacked seven times and took an awful beating as the Saints romped to a 28-13 victory over the Eagles on Monday night.

Not that Philadelphia didn't have its chances. But four first-and-goals resulted in two measly field goals, a tipped pass led to Patrick Robinson's 99-yard interception return for a New Orleans touchdown, and the Eagles messed up a trick play when they had the home team totally fooled, costing them a score.

"As coaches and as players, we obviously have to do a better job," embattled coach Andy Reid said of the Eagles (3-5), who are mired in a four-game losing streak. "That starts with me."

The Saints (3-5) revolve around Brees, of course, and he played much better than he did the previous week in a 34-14 loss to Denver. But his performance was more efficient than spectacular, as New Orleans seemed intent on proving it's not just a one-man team.

The NFL's worst-ranked running game relied on a trio of backs — Chris Ivory, Mark Ingram and Pierre Thomas — and finished with 140 yards, nearly double its season average. Ivory had a 22-yard touchdown run.

The defense came up with two huge turnovers near its own end zone. There was Robinson's interception and return, which matched Darren Sharper's franchise record. Then, with just over 3 minutes left and the Eagles down to their last gasp, Brent Celek caught a pass at the New Orleans 8 but fumbled it away.

The Saints recovered, and the Superdome celebration was on.

"There are defining moments throughout a season," Brees said. "Big plays, big wins, that kind of bring you together and let you see a vision of what you can be, what you can accomplish. Here we are the midway point. It's gone by fast.

"This," he added, "is the type of momentum we want going into the second half of the season."

Another dismal performance by the Eagles is sure to keep the heat on Vick and Reid.

Vick threw a 77-yard touchdown pass to DeSean Jackson in the third quarter, but that was about the only highlight for the visiting team. The elusive quarterback matched his career high for sacks; he also went down seven times when playing for the Atlanta Falcons against the New York Giants on Oct. 15, 2006.

"It's very frustrating," Vick said. "These are games that we have the opportunity to win, or get back in the game. At this point, everything has to be dead on. You can't miss, and you almost have to be perfect on every drive."

Philadelphia was far from perfect, but sure had plenty of chances. The Eagles outgained New Orleans and finished with 447 yards — the eighth straight team to put up more than 400 on the Saints.

But the offensive line just couldn't keep Vick upright, a problem that got worse after right tackle Todd Herremans went down in the first half with a strained ankle tendon. He didn't return.

"These are correctable mistakes," Reid said, repeating a familiar theme. "With some of those sacks you can look at coverage, and with some of them you can look at play calling, but we have to do better. The bottom line is we have to block the guys and do a better job."

Rubbing salt in the wound, Philadelphia squandered a chance to get back in the game with a unique trick play on a kickoff return. Riley Cooper laid flat in the end zone, unseen by the Saints, then popped up to take a cross-field lateral from Brandon Boykin.

Cooper streaked down the sideline for an apparent touchdown. Only one problem — Boykin's lateral was actually an illegal forward pass by about a yard, and the officials caught it. Cooper stood with his hands on his hips, in disbelief, when he saw the yellow flag.

Brees kept his record touchdown streak going, hooking up with Marques Colston on a 1-yard scoring pass and Jimmy Graham from 6 yards out.

The Saints quarterback finished 21 of 27 for 239 yards, a big improvement on his 22-of-42 showing against the Broncos.

Meanwhile, a Saints defense that had endured much ridicule kept the heat on Vick, and the brutal pounding made it tough for No. 7 to establish any rhythm. He finished 22 of 41 for 272 yards and really couldn't be blamed for Robinson's interception, which went off the hands of Celek, the first major miscue on a tough night for the tight end.

Cameron Jordan had three sacks, matching his total for the season, while Will Smith took down Vick twice — also matching his sack total through the first seven games.

Reid moved quickly to snuff out any talk about replacing Vick, which has become a weekly ritual.

"Michael Vick will be the quarterback," the Eagles coach said.

The Saints raced to a 21-3 halftime lead, putting the Eagles in a big hole for the second straight game. Over the last two weeks, they have been outscored 45-10 in the first and second quarters.

New Orleans was on the verge of blowing it open when it took the second-half kickoff and drove deep into Philadelphia territory. But the Eagles defense came up with a big turnover, as Brandon Graham stripped the ball from Brees and fell on it at the Eagles 17. Two plays later, Vick found Jackson wide open down the right side on a deep throw, and he took it the rest of the way for a touchdown.

Rookie Travaris Cadet, filling in on returns for the injured Darren Sproles, fumbled the ensuing kickoff and Philadelphia recovered again. Vick broke off a 14-yard run to the 8, but yet another sack stifled the drive.

The Eagles settled for Alex Henery's second field goal from 37 yards.

It was that kind of night for the Eagles.

NOTES: Graham led the Saints with a season-high eight catches for 72 yards. ... Jackson finished with 100 yards receiving on just three catches. ... Philadelphia's LeSean McCoy had 19 carries for 119 yards, but only 18 yards came after halftime. ... New Orleans gave up a season low in points. The previous best was a 31-24 victory over San Diego. ... The Saints lost two players to injuries. OT Zach Strief (groin) went down in the third quarter, and DE Junior Galette (ankle) was hurt in the first. Neither returned.

___

Follow Paul Newberry on Twitter at www.twitter.com/pnewberry1963

___

Online: http://pro32.ap.org/poll and http://twitter.com/AP_NFL

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Global Update: Polio Eradication Efforts in Pakistan Focus on Pashtuns

Michael Kamber for The New York Times

Polio will never be eradicated in Pakistan until a way is found to persuade poor Pashtuns to embrace the vaccine, according to a study released by the World Health Organization.

A survey of 1,017 parents of young children found that 41 percent had never heard of polio and 11 percent refused to vaccinate their children against it. The survey was done in Karachi, Pakistan’s largest city and the only big city in the world where polio persists; it was published in the agency’s November bulletin.

Parents from poor families “cited lack of permission from family elders,” said Dr. Anita Zaidi, who teaches pediatrics at the Aga Khan University in Karachi. Some rich parents also disdained the vaccine, saying it was “harmful or unnecessary,” she added.

Pashtuns account for 75 percent of Pakistan’s polio cases even though they are only 15 percent of the population. Wealthy children are safer because the virus travels in sewage, and their neighborhoods may have covered sewers and be less flood-prone.

Pashtuns are the largest ethnic group in next-door Afghanistan, where polio has also never been wiped out. Most Taliban fighters are Pashtun, and some Taliban threatened to kill vaccinators earlier this year. Two W.H.O. vaccinators were shot in Karachi in July.

Rumors persist that the vaccine is a plot to sterilize Muslims. But the eradication drive is recruiting Pashtuns as vaccinators and asking prominent religious leaders from various sects to make videos endorsing the vaccine.

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Changing of the Guard: Facing Protests, China’s Business Investment May Be Cooling

SHIFANG, China — Local leaders were all smiles this summer at a groundbreaking ceremony for a vast copper smelting project that seemed like the answer to the chronic unemployment that has plagued this city in northern Sichuan ever since a devastating earthquake in 2008.

Reuters

A protest against plans to expand a petrochemical plant in Ningbo, China, last month. More investment projects are running into opposition from a growing Chinese middle class concerned about environmental damage.

Articles in this series are examining the implications for China and the rest of the world of the coming changes in the leadership of the Chinese Communist Party.

But within days, the tree-lined plaza at the heart of the city was packed with thousands of youths, protesting that the $1.6 billion factory would pose a pollution hazard. After two nights of street battles pitting youths against the riot police, city leaders canceled the smelter.

“The environment is more important” than new investments or jobs, said a young woman sitting on a recent afternoon at the cafe across the street from the plaza, now empty except for a clutch of retirees gathered under the clock tower.

China’s economic boom over the last three decades has depended overwhelmingly on a build-at-all-costs investment strategy in which pollution concerns, the preservation of neighborhoods and other such questions have been swept aside. But that approach is starting to backfire, posing one of the biggest challenges for the new generation of Chinese policy makers who will take over at the Communist Party Congress, which starts on Thursday.

New investment projects used to be seen as the best way to keep the Chinese public happy with jobs and rising incomes, assuring social stability — a paramount goal of the Communist Party — while frequently enriching local politicians as well.

But from Shifang in the west to the port of Ningbo in the east, where a week of sometimes violent protests forced the suspension on Oct. 28 of plans to expand a chemical plant, more projects are running into public hostility.

In many cases, they are running into opposition not just from farmers who do not want their houses and fields confiscated, but also from a growing middle class fearful that new factories will lead to more environmental damage.

In response to this and other worries about the economy, a number of influential officials and business leaders in China have stepped up their calls for changes aimed at increasing the efficiency of investment and simultaneously shifting the country toward a greater reliance on consumption.

But China’s leaders, including the outgoing prime minister, Wen Jiabao, have been talking about such a transformation for years with little sign of success, as state-controlled banks continue to lend huge sums to politically powerful state-owned enterprises and local governments.

Frenzied construction of roads, bridges, tunnels and rail lines over the last decade has left China with world-class infrastructure. But it has also produced deeply indebted local governments that are struggling to finance more projects.

At the same time, vast unused capacity in practically every industrial sector has crippled profitability and left manufacturing companies straining to repay their borrowings, a problem that has been partly masked by banks in the habit of simply rolling over loans rather than recognizing losses.

“All Chinese industries are like that — can you dig out which area of Chinese industry is not in overcapacity?” said Li Junfeng, a longtime director general for energy at China’s top economic planning agency.

Investment reached 46 percent of China’s economic output last year. By comparison, Japan’s investment rate peaked at 36 percent, which it reached in the early 1970s; South Korea topped out at 39 percent in the late 1980s.

Growth in Japan and South Korea started to slow and eventually tumbled after investment peaked. The big question now is when China will run into the same limits, and how rapidly change will take place, said Diana Choyleva, an economist at Lombard Street Research in Hong Kong. “The potential for a big crisis is always there,” she said.

Even experts who strongly favor fundamental policy changes, like moving to a more market-oriented system for allocating bank loans and setting interest rates, doubt that China’s leaders are preparing to move quickly. Conversations at senior levels of the Communist Party appear to have focused so far on reducing the state’s role in the day-to-day management of many state-owned enterprises rather than selling them or breaking them up.

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Syrian Rebels Claim to Kill Dozens of Soldiers

SANA, via Associated Press

An image released by Syria’s official news agency showed Damascus residents gathering at the scene of a blast on Monday.

BEIRUT, Lebanon — Some of the worst violence in months racked Syria on Monday with residents of southern Damascus fleeing heavy shelling, several smaller towns shattered by air attacks and at least two car bombs erupting.

The Local Coordinating Committees, a collection of activist organizations across Syria, said the daily toll reached at least 159, including 72 killed in Idlib, and 47 in Damascus and its suburbs.

People in Damascus, the capital, said the fighting was the fiercest they could remember since July, with thousands of people fled as a Palestinian faction that supports the Assad government skirmished with government opponents in three southern neighborhoods.

“It’s a real war,” said an activist reached in southern Damascus via Skype, who used only one name, Eman, for her own safety. “Explosions, bombing and gunfire, and of course the helicopters, which have become part of the sky in Damascus now, like birds,” she said.

The fighting, escalating over three days, ignited the quarters of Yarmouk and Tadamon, both heavily Palestinian, as well as Hajjar al-Aswad, a long-embattled center of resistance to the government.

Syria took in large numbers of Palestinians who fled their homes at the founding of Israel, and they and their descendants number about 450,000 now. Many have sided with those leading the uprising, but the Popular Front for the Liberation of Palestine-General Command, a faction with a prominent role in the neighborhoods, still supports the government. Much of the fighting involved Popular Front units, backed by government artillery. Artillery rounds fired from the military airfield in Mezze slammed into the area repeatedly, activists said.

Yarmouk, founded as a Palestinian refugee camp in 1957, gradually became a residential district barely distinguishable from the rest of greater Damascus. A Facebook page focused on camp news published a statement from the Popular Front group saying it had thwarted an infiltration of the area by government opponents.

“When the terrorists failed to enter, they fired mortars killing a large number of martyrs and wounding a lot of people,” the statement said.

Civilians have been fleeing in droves. Small artillery hit a minibus carrying people trying to escape from Yarmouk, killing five of them. Each side blamed the other for that strike.

Displaced families have started camping in back gardens or schoolyards, Eman said.

A car bomb exploded in Mezze 86, a Damascus neighborhood on the slopes below the official palace that houses the offices of President Bashar al-Assad. The area is heavily populated by families linked to the security forces, which Mr. Assad’s Alawite minority dominates. Pictures posted on Facebook showed a large black column of smoke rising from the area.

The Free Syrian Army claimed responsibility for that attack, saying in a statement that it targeted military officers and members of the armed militias who fight for the government.

The bomb, a booby-trapped car, exploded in Bride Square, killing at least 11 people and wounding more than 30, some of them critically, said the Syrian Observatory for Human Rights, which tracks the conflict from abroad.

The official news agency, SANA, also put the death toll at 11 killed but said at least 56 were injured. The explosion ignited other cars and caused widespread destruction, it said.

Accounts differed more sharply on another car bombing, outside a government-owned Rural Development Center near Hama. The rebels and activists reported that dozens of soldiers were killed; the government said just two civilians had died.

The Syrian Observatory, which tracks the conflict from abroad, said that Jabhet Al-Nusra — known as a jihadist organization — and other rebel groups in the region collaborated to explode a car bomb at a government checkpoint in a village near Hama, killing at least 50 soldiers. If true, that would make it one of the single deadliest attacks against the government since the uprising started in March 2011.

The accounts from the observatory and rebel groups stated that the military had taken over the development center to house military units. Checkpoints in rural areas often serve as rudimentary bases for the government, with large numbers of men and equipment.

Hania Mourtada contributed reporting from Beirut; Hala Droubi from Dubai, United Arab Emirates; and Rick Gladstone from New York.

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Apple sells 3 million iPads over first weekend

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Doctor: Colts coach Pagano's leukemia in remission

INDIANAPOLIS (AP) — The doctor of Indianapolis Colts coach Chuck Pagano says his leukemia is in remission.

Dr. Larry Cripe told The Associated Press on Monday that Pagano's white blood cell count was normal and his bone marrow showed no indication of the disease.

Earlier Monday, interim coach Bruce Arians said the Colts (5-3) hoped to have Pagano back on the sideline for their regular-season finale Dec. 30. Pagano spoke to his players before and after Sunday's 23-20 victory over Miami.

Pagano was diagnosed with leukemia Sept. 26 and remained hospitalized until Oct. 21 as doctors treated him with chemotherapy. He has been resting at home since then.

Sunday marked the first time he was allowed to return to Lucas Oil Stadium.

Pagano will go through a second round of chemotherapy soon because some cancerous cells may remain in his body.

___

Online: http://pro32.ap.org/poll and http://twitter.com/AP_NFL

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The New Old Age Blog: Old, Frail and in Harm's Way

“Check on your elderly neighbors,” the weather forecasters say when a storm is bearing down, advice that’s always struck me as necessary but not sufficient. Community matters, and if what your neighbor needs is a grocery run, some hot soup or a reminder to keep drinking water during a heat wave, you can make an important difference.

But if what your neighbor needs is thrice-weekly dialysis but your town has lost power for a week, if she’s already prone to falls and now she’s in darkness, if she refuses an evacuation order, you may have reached the limits of neighborliness. Our country tends to privatize elder care, but there’s a public responsibility as well, as Hurricane Sandy demonstrated once more.

I spoke Friday with Laura Radensky, the harried community liaison of Jewish Home Lifecare, who had sent cars to downtown Manhattan so that staff members could deliver food, water, flashlights, batteries and – as temperatures dropped – blankets.

About 150 of the agency’s 1,200 home-care clients faced potential crises, she estimated. “They’re all chronically ill and need skilled nursing, and they’re on Medicaid, so they’re low-income,” Ms. Radensky said. They’d been trapped in high-rise buildings without water, heat or working elevators, she said, and “in a lot of instances, we’re the only ones making contact.”

A 91-year-old who had refused her family’s entreaties to leave but who hadn’t answered her phone in days turned out to be fine when someone trekked up 12 floors to see her.

But Ms. Radensky worried that there were thousands of other frail old people in Lower Manhattan who were not enrolled with any service agency. Who was checking on them? Did anyone even know if they were in need?

Disasters take a particularly high toll on the elderly, research has shown. “Adults 65 and older are consistently the least prepared of any subgroup of the population,” said Lisa Brown, a psychologist at the University of South Florida who convenes a Gerontological Society of America working group on disasters and older adults. “They’re most likely to have increased levels of mortality and morbidity.”

People over 60 represented 15 percent of New Orleans’s population, for example, but 70 percent of those who died in Hurricane Katrina in 2005. Almost half of those killed by last year’s tornado in Joplin, Mo., were older adults.

New York City now fits this grim pattern: The census says 17.2 percent of residents are over 60, but of the 40 people whose deaths the medical examiner’s office attributed to Hurricane Sandy at last count, 37.5 percent were older than 60. They ranged in age from 62 to 91; most had drowned.

“What makes you at risk isn’t that you’re 75,” said Jennifer Campbell, former director of the Hurricane Fund for the Elderly, which distributed aid in the Gulf Coast region after Hurricane Katrina. “It’s that you have arthritis that makes it difficult to walk more than a block.”

We know what adds to the risks: multiple chronic diseases, the need for many prescription drugs, impaired mobility and cognition, “problems that make it hard to get out of danger quickly,” Dr. Campbell said. A third of older adults live alone and may not have anyone to help in emergencies. Evacuation brings its own hazards.

Alerts and communications helpful for a younger, healthier population – telling people to head for an evacuation center half a mile away or to consult a Web site, for instance — may be of little use.

In New York, moreover, a quite functional 80-year-old able to care for herself, to go out, to shop, could have been suddenly rendered disabled if a blackout left her stranded on an upper floor.

Since Hurricane Katrina — when, Dr. Campbell notes, “being old, being frail and being unconnected turned into a terminal condition” — state and local agencies have made considerable progress in disaster preparedness for the elderly.

Margaret Moore, coordinator of a report in March by the Centers for Disease Control and Prevention on identifying and protecting vulnerable older adults in disasters, singled out the Gulf Coast states (“They really learned their lesson,” she said) as well as Hawaii and Florida as leaders.

Miami-Dade County, for instance, provides applications in English, Spanish, Creole, Braille and large print for those who may need emergency transportation during disasters. About 2,500 people, most elderly, have signed up, said the coordinator, Roberto Cepeda. Even there, despite outreach campaigns, Mr. Cepeda thinks at least twice that many should be on the registry.

New York City hastily mounted its own senior preparedness effort last week. The numbers are staggering: City workers brought extra food to the nearly 17,000 elderly clients who get meals delivered, placed 11,000 calls and visited 1,500 people before the storm, then called and visited again afterward.

Still, said Commissioner Lilliam Barrios-Paoli of the Department for the Aging, her people had prepared for a one- to two-day crisis. “We were successful in meeting the needs of seniors we know, who receive services, who go to our senior centers,” she said. “I have to rethink, how do I work with the seniors who don’t come to me?” When power failures drag on, “we need to know where people are.”

For five days, Ruth Weissblatt endured the storm and its dark aftermath in her Manhattan apartment with a loyal home care aide who on Sunday took the last No. 3 train out of Brooklyn to join her.

Mrs. Weissblatt, 98 and ailing, had sufficient food, water and flashlights only because her 67-year-old nephew came by each day, lugging supplies up nine flights. “I can’t imagine how anyone my age could survive without that kind of help,” she said.

Might other elders in her 15-story building need assistance? Mrs. Weissblatt didn’t know.

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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