The New Old Age Blog: Home Health Care Help by the Hour

Here is a bright idea that ought to spread: You call your home care agency and say you will need your mother’s aide for the normal two hours on Monday and Wednesday, but for just half an hour (to drive her to a doctor’s office) on Tuesday, then 90 minutes on Thursday. And the agency says, “Sure.”

It sounds logical to hire someone to help — with bathing, dressing, errands, meal preparation, medication reminders – for only as many hours as an older adult needs assistance. But it is actually unusual for companies to offer such flexibility.

The majority of agencies require a four-hour minimum. Having to spend $80  — the national average cost for home care is $21 an hour — if you only need $40 worth of help is a big barrier for families trying to keep their elderly relatives living at home longer. A few agencies allow you to hire for fewer than four hours, but at higher rates.

But Mission Healthcare in San Diego, Calif., a three-year-old agency that began with Medicare-certified skilled home nursing and hospice care, expanded to general home care this summer and decided that clients should be able to specify how much help they want – in 15-minute increments — and will pay for.

“We’ll come for as long as they need us to,” said Mark Kimsey, one of Mission’s four directors. “In one hour, a well-trained caregiver can get the client bathed and dressed, prepare three meals and have them organized for the day.” (I have to think that is a speedy caregiver with a not-too-frail client, but still … )

Can Mission, which charges $19 to $20 an hour, actually make money this way? Though overall the agency serves 1,100 clients, its fledgling home care business is still small: 30 aides caring for just 60 clients. The aides can get benefits if they work enough hours, a bonus for them and for consumers (better employees, lower turnover), but an additional cost for the company.

The directors say they are profitable already, and that the approach will succeed because more people will like the flexibility and potential savings, and sign up. It is also true, let’s acknowledge, that a person who can get by with an hour or two a day for now may well need more help eventually, a boost for Mission’s bottom line.

Competitors are no doubt watching to see if this works. I’m curious, too, to see if the policy catches on. “Consumers can change the marketplace if they want to,” Mr. Kimsey said. It would be nice to think that is true.

Would you use this kind of hourly service, if it were available?

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

Read More..

The New Old Age Blog: Home Health Care Help by the Hour

Here is a bright idea that ought to spread: You call your home care agency and say you will need your mother’s aide for the normal two hours on Monday and Wednesday, but for just half an hour (to drive her to a doctor’s office) on Tuesday, then 90 minutes on Thursday. And the agency says, “Sure.”

It sounds logical to hire someone to help — with bathing, dressing, errands, meal preparation, medication reminders – for only as many hours as an older adult needs assistance. But it is actually unusual for companies to offer such flexibility.

The majority of agencies require a four-hour minimum. Having to spend $80  — the national average cost for home care is $21 an hour — if you only need $40 worth of help is a big barrier for families trying to keep their elderly relatives living at home longer. A few agencies allow you to hire for fewer than four hours, but at higher rates.

But Mission Healthcare in San Diego, Calif., a three-year-old agency that began with Medicare-certified skilled home nursing and hospice care, expanded to general home care this summer and decided that clients should be able to specify how much help they want – in 15-minute increments — and will pay for.

“We’ll come for as long as they need us to,” said Mark Kimsey, one of Mission’s four directors. “In one hour, a well-trained caregiver can get the client bathed and dressed, prepare three meals and have them organized for the day.” (I have to think that is a speedy caregiver with a not-too-frail client, but still … )

Can Mission, which charges $19 to $20 an hour, actually make money this way? Though overall the agency serves 1,100 clients, its fledgling home care business is still small: 30 aides caring for just 60 clients. The aides can get benefits if they work enough hours, a bonus for them and for consumers (better employees, lower turnover), but an additional cost for the company.

The directors say they are profitable already, and that the approach will succeed because more people will like the flexibility and potential savings, and sign up. It is also true, let’s acknowledge, that a person who can get by with an hour or two a day for now may well need more help eventually, a boost for Mission’s bottom line.

Competitors are no doubt watching to see if this works. I’m curious, too, to see if the policy catches on. “Consumers can change the marketplace if they want to,” Mr. Kimsey said. It would be nice to think that is true.

Would you use this kind of hourly service, if it were available?

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

Read More..

The Shrewd Shopper Carries a Smartphone

Tim Gruber for The New York Times

From left, Tara Niebeling, Sarah Schmidt, Bridget Jewell and Erin Vande Steeg are members of the social media team at the Mall of America in Bloomington, Minn.

Retailers are trying to lure shoppers away from the Internet, where they have increasingly been shopping to avoid Black Friday madness, and back to the stores. The bait is technological tools that will make shopping on the busiest day of the year a little more sane — and give shoppers an edge over their competition.

Those with smartphones in hand will get better planning tools, prices and parking spots. Walmart has a map that shows shoppers exactly where the top Black Friday specials can be found. A Mall of America Twitter feed gives advice on traffic and gifts, and the Macy’s app sends special deals for every five minutes a shopper stays in a store.

“The crazy mad rush to camp out and the crazy mad rush to hit the doorbusters have really made people think, ‘I’m just going to stay home on Black Friday,’ ” said Carey Rossi, editor in chief of ConsumerSearch.com, a review site. “This is going to invite some people back and say, ‘You know what? It doesn’t have to be that crazy.’ ”

Part of the retailers’ strategy is to slap back at online stores like Amazon.com, which last year used apps to pick off shoppers as they browsed in physical stores. But the stores are also recognizing that shopping on the Friday after Thanksgiving need not require an overnight wait in line, a helmet and elbow pads. A smartphone gives shoppers enough of an edge.

“This takes away that frantic Black Friday anxiety,” said Lawrence Fong, co-founder of BuyVia, an app that sends people price alerts and promotions. “While there’s a sport to it, life’s a little too short.”

Denise Fouts, 45, who works repairing fire and water damage in Chandler, Ariz., was already using apps, including Shopkick, Target’s app and one called Black Friday, before Thanksgiving to prepare for Black Friday. “There still are going to be the crowds, but at least I already know ahead of time what I’m going specifically for,” Ms. Fouts said.

Last week, Macy’s released an update to its app with about 300 Black Friday specials and their location. In the Herald Square store, for instance, the $49.99 cashmere sweater specials will be in the Broadway side of the fifth-floor women’s department.

“With the speed that people are shopping with on Black Friday, they need to be really efficient about how they’re spending their time,” said Jennifer Kasper, group vice president for digital media at Macy’s.

When shoppers keep the app open, Macy’s will start sending special deals to the phone every five minutes. The deals are not advertised elsewhere.

Walmart has had an app for several years, but recently introduced an in-store mode, which shows things like the current circular or food tastings when a shopper is near a certain location. Twelve percent of Walmart’s mobile revenue now comes from when a person is inside a store.

For Black Friday, the app will have a map of each store, with the precise location of the top sale items — so planners can determine the best way to run. “The blitz items are not where you think they would be, because for traffic reasons, maybe the hot game console is in the lawn and garden center,” said Gibu Thomas, senior vice president for mobile and digital for Walmart Global eCommerce.

Target is also testing a way-finding feature on its app at stores that include some in Seattle, Chicago and Los Angeles. If a shopper types in an item, the app will give its location.

Other app makers are betting that shoppers want apps that pull in information from many stores.

RedLaser, an eBay app, lets shoppers use their phones to compare prices and recently started using location data to give shoppers personalized promotions when they walk into stores, including items not on store shelves at Best Buy, for instance. RetailMeNot, which offers e-commerce coupons, now has offline coupons that will pop up on users’ cellphones when they step near 500 malls on Black Friday.

“Consumers are not going to download 40 different apps for 40 different stores,” said Cyriac Roeding, co-founder of Shopkick, a location-based app that gives shoppers points, redeemable for perks, when they walk into stores or scan certain items.

For Black Friday, Shopkick is publishing what it calls a little black book with the top doorbusters. Shoppers will earn extra points and rewards for shopping on Black Friday.

Read More..

Military Analysis: For Israel, Gaza Conflict Is Test for an Iran Confrontation

Menahem Kahana/Agence France-Presse — Getty Images

An Israeli missile is launched from a battery. Officials said their antimissile system shot down 88 percent of all assigned targets.

WASHINGTON — The conflict that ended, for now, in a cease-fire between Hamas and Israel seemed like the latest episode in a periodic showdown. But there was a second, strategic agenda unfolding, according to American and Israeli officials: The exchange was something of a practice run for any future armed confrontation with Iran, featuring improved rockets that can reach Jerusalem and new antimissile systems to counter them.

It is Iran, of course, that most preoccupies Prime Minister Benjamin Netanyahu and President Obama. While disagreeing on tactics, both have made it clear that time is short, probably measured in months, to resolve the standoff over Iran’s nuclear program.

And one key to their war-gaming has been cutting off Iran’s ability to slip next-generation missiles into the Gaza Strip or Lebanon, where they could be launched by Iran’s surrogates, Hamas, Hezbollah and Islamic Jihad, during any crisis over sanctions or an Israeli strike on Iran’s nuclear facilities.

Michael B. Oren, the Israeli ambassador to the United States and a military historian, likened the insertion of Iranian missiles into Gaza to the Cuban missile crisis.

“In the Cuban missile crisis, the U.S. was not confronting Cuba, but rather the Soviet Union,” Mr. Oren said Wednesday, as the cease-fire was declared. “In Operation Pillar of Defense,” the name the Israel Defense Force gave the Gaza operation, “Israel was not confronting Gaza, but Iran.”

It is an imprecise analogy. What the Soviet Union was slipping into Cuba 50 years ago was a nuclear arsenal. In Gaza, the rockets and parts that came from Iran were conventional, and, as the Israelis learned, still have significant accuracy problems. But from one point of view, Israel was using the Gaza battle to learn the capabilities of Hamas and Islamic Jihad — the group that has the closest ties to Iran — as well as to disrupt those links.

Indeed, the first strike in the eight-day conflict between Hamas and Israel arguably took place nearly a month before the fighting began — in Khartoum, the capital of Sudan, as another mysterious explosion in the shadow war with Iran.

A factory said to be producing light arms blew up in spectacular fashion on Oct. 22, and within two days the Sudanese charged that it had been hit by four Israeli warplanes that easily penetrated the country’s airspace. Israelis will not talk about it. But Israeli and American officials maintain that Sudan has long been a prime transit point for smuggling Iranian Fajr rockets, the kind that Hamas launched against Tel Aviv and Jerusalem over recent days.

The missile defense campaign that ensued over Israeli territory is being described as the most intense yet in real combat anywhere — and as having the potential to change warfare in the same way that novel applications of air power in the Spanish Civil War shaped combat in the skies ever since.

Of course, a conflict with Iran, if a last-ditch effort to restart negotiations fails, would look different than what has just occurred. Just weeks before the outbreak in Gaza, the United States and European and Persian Gulf Arab allies were practicing at sea, working on clearing mines that might be dropped in shipping lanes in the Strait of Hormuz.

But in the Israeli and American contingency planning, Israel would face three tiers of threat in a conflict with Iran: the short-range missiles that have been lobbed in this campaign, medium-range rockets fielded by Hezbollah in Lebanon and long-range missiles from Iran.

The last of those three could include the Shahab-3, the missile Israeli and American intelligence believe could someday be fitted with a nuclear weapon if Iran ever succeeded in developing one and — the harder task — shrinking it to fit a warhead.

A United States Army air defense officer said that the American and Israeli militaries were “absolutely learning a lot” from this campaign that may contribute to a more effective “integration of all those tiered systems into a layered approach.”

The goal, and the challenge, is to link short-, medium- and long-range missile defense radar systems and interceptors against the different types of threats that may emerge in the next conflict.

Even so, a historic battle of missile versus missile defense has played out in the skies over Israel, with Israeli officials saying their Iron Dome system shot down 350 incoming rockets — 88 percent of all targets assigned to the missile defense interceptors. Israeli officials declined to specify the number of interceptors on hand to reload their missile-defense batteries.

Before the conflict began, Hamas was estimated to have amassed an arsenal of 10,000 to 12,000 rockets. Israeli officials say their pre-emptive strikes on Hamas rocket depots severely reduced the arsenal of missiles, both those provided by Iran and some built in Gaza on a Syrian design.

Read More..

Tool Kit: Online Shopping Tips for the Holidays

Some people may be looking forward to leaving Thanksgiving dinner before the pie is served to join the Black Friday rush, which will begin during dinnertime Thursday, earlier than ever, at stores like Sears, Walmart and Lord & Taylor.

But for those who prefer to stay for the pie course, avoid the lines and freezing temperatures and shop from the comfort of their homes, there are just as many deals to be found online this year, especially for smart shoppers.

Last year, online shoppers spent $816 million on Black Friday, an increase of 26 percent from the year before, and an additional $2.3 billion over Thanksgiving weekend and Cyber Monday, according to comScore. It expects online spending to rise this year.

Online, there is no commute, no parking and no crowds — and shopping can be done in bed or at the Thanksgiving dinner table. Still, you cannot try clothes on, you have to wait for your purchase to arrive and there is always the nagging feeling that a better price is just one more click away.

To find your way around those problems, here are some tips from online shopping pros, retailers and shopping bloggers.

BARGAINS START EARLY “Cyber Monday is passé,” said Fiona Dias, chief strategy officer for ShopRunner.com, a network of e-commerce sites. “With online sales beginning as early as the Wednesday night before Thanksgiving, consumers who hold out for the best deal may find that what they are looking for has already sold out.”

Amazon.com, for example, started its Black Friday deals on Monday, but they end Saturday. SHOP ON TUESDAYS One of the secrets of online shopping is that prices change by the second. To maximize your chances of getting the best price year-round, shop on Tuesday, a variety of e-commerce experts say. For whatever reason, Tuesday is when most e-commerce sites, including Shopbop, Etsy and RetailMeNot, post discounts and new items.

No matter the day, online retailers often start sales in the wee hours, so shop early.

As for the time of year, women’s clothes, shoes and accessories are discounted most in January, February, August and September, according to Shop It To Me, an online shopping search site. For consumer electronics like laptops, shop in midsummer and late September, before and after the back-to-school rush, according to Decide.com, a price comparison site.

NEVER PAY FULL PRICE Online holiday shoppers should use 40 percent off as a benchmark for a good deal, said Marjorie Cader, a Shop It To Me spokeswoman, based on discount data the site has collected. Expect discounts that are about 5 percent better from online-only retailers than from those that also operate brick and mortar stores, she said.

Comparison shopping sites like TheFind or ShopStyle can locate the best prices; Google or coupon sites like RetailMeNot can also help find a discount.

Google, Amazon and even flash sale sites like Gilt.com do not always have the lowest prices. You might check small shopping blogs dedicated to your favorite brands, like Grechen’s Closet for contemporary women’s clothes or J. Crew Aficionada.

“Spend 20 minutes and ensure you are getting the best deal out there,” said John Faith, senior vice president of mobile at WhaleShark Media, which operates coupon sites, including RetailMeNot.

BE A HAGGLER This is the year haggling at the cash register could become acceptable, as offline retailers try to keep shoppers offline. If you find a better price online — by using an application like RedLaser or searching Amazon — ask whether the cashier will match it. Big retailers like Target have already said they will.

WAIT TILL THE LAST MINUTE Procrastinators might benefit during the holidays. Electronics sold online are least expensive in the week before Christmas, according to Decide, especially TVs, laptops and cameras.

And while Dec. 17 is the last day that most online retailers will offer free shipping in time for Christmas, Walmart, the luxury clothing seller Net-a-Porter and others will deliver the same day. In San Francisco and New York, eBay now offers same-day delivery from hundreds of stores, including Macy’s, Target and Toys “R” Us.

NEVER PAY FOR SHIPPING... Nine of ten retailers will offer free shipping on certain purchases this holiday season, and a third will offer free shipping on all purchases, according to the National Retail Federation.

Some, though, require that you enter a promotional code, so it’s wise to take a minute to look around the Web site or search a coupon site to find it.

Stores including Walmart, Toys “R” Us and Nordstrom allow you to shop online and pick up your order locally.

...OR FOR RETURNS Sites like Zappos.com and Piperlime send prepaid shipping labels, but beware.

“When it comes to returns, read the fine print,” said Brian Hoyt, a spokesman for WhaleShark Media. Some merchants include a prepaid return label but subtract the price from your refund, and others charge a restocking fee as high as 30 percent for consumer electronics.

Many companies, including Gap and J. Crew, also let you return an online purchase to a local store. And until Dec. 31, PayPal will cover the return shipping cost if the merchant does not, as long as you pay with PayPal and make the return within 30 days.

SEARCH WISELY Try searching synonyms, like “coat” instead of “jacket.” On sites like eBay, try leaving out words — if you are looking for an Yves Saint Laurent handbag on eBay, search for “Saint Laurent” or “Laurent bag.”

“If you search for ‘Yves Saint Laurent,’ you’ll be fighting over pieces with a bigger group of people,” said Sophia Amoruso, founder and chief executive of the e-commerce retailer Nasty Gal, who suggested purposefully misspelling brand names as well. “Think of what an uninformed person might list a really great designer piece as, and you can get an amazing gem for an incredible price.”

EBay Fashion also lets shoppers search by taking a cellphone picture of a fabric to find similar designs.

GET INSPIRED Search for “black sequin dress,” and you’ll get 128 results on Zappos.com, 2,618 on Amazon.com and a truly overwhelming 18 million on Google.

One solution: Trust online curators to suggest items. Etsy creates lists of recommended items. On Pinterest, you can peruse items culled by others. Other sites to search for inspiration: Polvyore, Fancy, Svpply, Lookbook.nu and We Heart It.

TRY IT ON, VIRTUALLY You can visit sites that show real people wearing the clothes you’re interested in buying, like Go Try It On, Fashism and Rent the Runway and sites that show video, including Asos, MyHabit and Joyus. Or, as long as a site offers free shipping and returns, order two sizes and return one.

SHOP INTERNATIONALLY “Don’t let international shopping scare you off,” said Caroline Nolan, the writer of Pregnant Fashionista, a maternity shopping blog.

Many international e-commerce sites, like Asos, ship free to the United States. And because the seasons are different, winter clothes in Australia, for instance, go on sale just as Americans are starting to shop for winter, she said. FarFetch has items from small boutiques worldwide and 1stDibs is good at finding rare items like an antique from Paris. On eBay, you might have luck finding items made by a European designer by switching to eBay’s site for a particular country.

MAKE SITES WORK FOR YOU On Shop It To Me, you can enter your favorite designers and sizes and the site will send you personalized e-mails with promotions and sales. Many sites allow shoppers to place a symbol like a heart on best-liked items or save them to a wish list. On a site like Pinterest, shoppers can build a list.

“You always think you’ll remember where you saw something or what brand it was, but really you never do,” said Noria Morales, style director at SugarInc, a network of fashion and lifestyle blogs.

Even better, sites like Shopbop and Polyvore send alerts when items you have saved go on sale or are running low. EBay sends alerts when new items are listed for a search you have saved.

BE DILIGENT No one has time to read 50 e-mails a day from retailers. But for your favorite e-commerce sites, it is worth signing up for e-mails, as well as tracking them on Facebook and Twitter, where they often post exclusive deals. Many online shoppers have more luck hunting for items than trusting services to send alerts, said Grechen Reiter, owner of Grechen Media, a network of shopping blogs.

“It is the thrill of the hunt that gets us going, after all,” she said.

Read More..

Recipes for Health: Apple Pear Strudel — Recipes for Health

Andrew Scrivani for The New York Times

This strudel is made with phyllo dough. When I tested it the first time, I found that I had enough filling for two strudels. Rather than cut the amount of filling, I increased the number of strudels to 2, as this is a dessert you can assemble and keep, unbaked, in the freezer.

Filling for 2 strudels:

1/2 pound mixed dried fruit, like raisins, currants, chopped dried figs, chopped dried apricots, dried cranberries

1 1/2 pounds apples (3 large) (I recommend Braeburns), peeled, cored and cut in 1/2-inch dice

1 tablespoon fresh lemon juice

2 tablespoons unsalted butter for cooking the apples

1/4 cup (50 grams) brown sugar

1 teaspoon vanilla

1 teaspoon cinnamon

1/2 teaspoon freshly grated nutmeg

1/4 cup (30 grams) chopped or slivered almonds

3/4 pound (1 large or 2 small) ripe but firm pears, peeled, cored and cut in 1/2-inch dice

For each strudel:

8 sheets phyllo dough

7/8 cup (100 grams) almond powder, divided

1 1/2 ounces butter, melted, for brushing the phyllo

1. Preheat the oven to 375 degrees. Line 2 sheet pans with parchment.

2. Place the dried fruit in a bowl and pour on hot or boiling water to cover. Let sit 5 minutes, and drain. Toss the apples with the lemon juice.

3. Heat a large, heavy frying pan over high heat and add 2 tablespoons butter. Wait until it becomes light brown and carefully add the apples and the sugar. Do not add the apples until the pan and the butter are hot enough, or they won’t sear properly and retain their juice. But be careful when you add them so that the hot butter doesn’t splatter. When the apples are brown on one side, add the vanilla, cinnamon, nutmeg and almonds, flip the apples and continue to sauté until golden brown, about 5 to 7 minutes. Stir in the pears and dried fruit, then scrape out onto one of the lined sheet pans and allow to cool completely. Divide into two equal portions (easiest to do this if you weigh it).

4. Place 8 sheets of phyllo dough on your work surface. Cover with a dish towel and place another, damp dish towel on top of the first towel. Place a sheet of parchment on your work surface horizontally, with the long edge close to you. Lay a sheet of phyllo dough on the parchment. Brush lightly with butter and top with the next sheet. Continue to layer all eight sheets, brushing each one with butter before topping with the next one.

5. Brush the top sheet of phyllo dough with butter. Sprinkle on half of the almond powder (50 grams). With the other half, create a line 3 inches from the base of the dough, leaving a 2 1/2-inch margin on the sides. Top this line with one portion of the fruit mixture. Fold the bottom edge of the phyllo up over the filling, then fold the ends over and roll up like a burrito. Using the parchment paper to help you, lift the strudel and place it on the other parchment-lined baking sheet. Brush with butter and make 3 or 4 slits on the diagonal along the length of the strudel. Repeat with the other sheets of phyllo to make a second strudel. If you are freezing one of them, double-wrap tightly in plastic.

6. Place the strudel in the oven and bake 20 minutes. Remove from the oven, brush again with butter, rotate the pan and return to the oven. Continue to bake for another 20 to 25 minutes, or until golden brown. Remove from the heat and allow to cool for at least 15 minutes. Serve warm or room temperature.

Yield: 2 strudels, each serving 8

Advance preparation: The fruit filling will keep for a couple of days in the refrigerator. The strudel can be baked a few hours before serving it. Recrisp in a medium oven for 10 minutes. It can also be frozen before baking, double-wrapped in plastic. Transfer directly from the freezer to the oven and add 10 minutes to the baking time.

Nutritional information per serving: 259 calories; 13 grams fat; 4 grams saturated fat; 3 grams polyunsaturated fat; 5 grams monounsaturated fat; 15 milligrams cholesterol; 34 grams carbohydrates; 4 grams dietary fiber; 91 milligrams sodium; 4 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

Read More..

Documents Show F.D.A.’s Failures in Meningitis Outbreak

Newly released documents add vivid detail to the emerging portrait of the Food and Drug Administration’s ineffective and halting efforts to regulate a Massachusetts company implicated in a national meningitis outbreak that has sickened nearly 500 people and killed 34.

In the documents, released on Tuesday in response to a Freedom of Information Act request, the agency would threaten to bring the full force of its authority down on the company, only to back away, citing lack of jurisdiction.

The company, the New England Compounding Center, at times cooperated with F.D.A. inspectors and promised to improve its procedures, and at other times challenged the agency’s legal authority to regulate it, refused to provide records and continued to ship a drug in defiance of the agency’s concerns.

Some of the documents were summarized last week by Congressional committees that held hearings on the meningitis outbreak. Republicans and Democrats criticized the F.D.A. for failing to act on information about unsafe practices at the company as far back as March 2002.

By law, compounding pharmacies are regulated primarily by the states, but the pharmacies have grown over the years into major suppliers of some of the country’s biggest hospitals. The F.D.A. is asking Congress for stronger, clearer authority to police them, but Republicans have said the agency already has enough power.

Records show that the agency was sometimes slow in pursuing its own inspection findings. In one case involving the labeling and marketing of drugs, the agency issued a warning letter to New England Compounding 684 days after an inspection, a delay that the company’s chief pharmacist complained was so long that some of the letter’s assertions no longer applied to its operations.

The agency said in a statement Wednesday that it “was not the timeline we strive for,” but that much of the delay was because of “our limited, unclear and contested authority in this area.” Because of litigation, it said, there was “significant internal discussion about how to regulate compounders.”

The agency first inspected the company in April 2002 after reports that two patients had become dizzy and short of breath after being injected with a steroid made by the company.

 On the first day of the inspection, Barry Cadden, the chief pharmacist, was cooperative, but the next day, the agency inspectors wrote, Mr. Cadden “had a complete change in attitude & basically would not provide any additional information either by responding to questions or providing records,” adding that he challenged their legal authority to be at his pharmacy at all.

The F.D.A. was back at New England Compounding in October 2002 because of possible contamination of another of its products, methylprednisolone acetate, the same drug involved in the current meningitis outbreak.

 While the F.D.A. had the right to seize an adulterated steroid, officials at the time said that action alone would not resolve the company’s poor compounding practices. In a meeting with Massachusetts regulators, F.D.A. officials left authority in the hands of the state, which “would be in a better position to gain compliance or take regulatory action,” according to a memo by an F.D.A. official summarizing the meeting.

 David Elder, compliance branch director for the F.D.A.’s New England District, warned at the meeting that there was the “potential for serious public health consequences if N.E.C.C.’s compounding practices, in particular those relating to sterile products, are not improved.”

 The company fought back hard, repeatedly questioning the F.D.A.’s jurisdiction. In a September 2004 inspection over concerns that the company was dispensing trypan blue, a dye used for some eye surgeries that had not been approved by the F.D.A., Mr. Cadden told the agency inspector that he had none in stock.

But in the clean room, the inspector noticed a drawer labeled “Trypan Blue,” which contained 189 vials of the medicine.

A few days later, Mr. Cadden was defiant. He told the agency that he was continuing to dispense trypan blue and that there was nothing in the law saying a compounder could not dispense unapproved products.

 The conversation turned testy. “Don’t answer any more questions!” Mr. Cadden told another pharmacy executive, according to the F.D.A.’s report.

Mr. Cadden rejected many of the assertions in the warning letter that finally came in December 2006. The next correspondence from the agency did not come until almost two years later, in October 2008, saying that the agency still had “serious concerns” about the company’s practices, and that failing to correct them could result in seizure of products and an injunction against the company and its principals.

It is not known whether any corrective actions were taken. The agency did not conduct another inspection until the recent meningitis outbreak.

Denise Grady contributed reporting.

Read More..

When Phones Come Out Long Before the Turkey

ATLANTA — Caleb J. Spivak will be busier with his phone than his fork this Thanksgiving.

Mr. Spivak, 23, is spending the holiday with his boyfriend’s family in Kennesaw, Ga. His mother will be in Virginia with his grandmother. His sister will be in Ohio, his father and brother in Florida. And his friends will be all over the country.

So he’ll post photographs of dinner to show his tight inner circle on Facebook, send out more general Thanksgiving cheer to his 11,000 Twitter followers and post images of the prettiest dishes to Instagram.

To stay close to his mother, he will use the videoconferencing feature on his phone to talk to her as he sits down to eat.

Multiply Mr. Spivak’s social media activity by that of the millions of others who will be using the platforms to record their Thanksgivings, and this year’s holiday could be the most documented in history.

“This year, more than ever before, we will see how we get along as a national family,” said Lee Rainie, director of the Pew Research Center’s Internet and American Life Project in Washington. All of the strengths and weaknesses of the American family will be on full display, he said.

Not long ago, pulling out a phone to send a photograph of Thanksgiving dinner or a text about the proceedings was considered rude, a violation of the “eat it, don’t tweet it” rule.

But almost 40 percent of the 234 million Americans over the age of 13 with a mobile phone now use a social network, according to the analyst group comScore, and the numbers are growing fast. Instagram, the darling of people who love to share pictures of what they’re eating, has more than doubled its members to more than 100 million in less than a year, according to Facebook, the company that bought Instagram this spring. Facebook says Thanksgiving is one of its busiest days of the year.

At Twitter, as the holiday approached, the words “turkey,” “Thanksgiving” and “thankful” have been appearing in those 140-word posts more and more each year. In 2011, use of “thankful” alone was up 263 percent on the network from 2010, and more than a thousandfold from a non-holiday, the company said.

“People are sharing on such a scale for common experiences like Thanksgiving,” said Mor Naaman, a professor at Rutgers University and the founder of Mahaya, a social media start-up. “The potential is just mind-blowing.”

Mr. Naaman, along with others who research humanities, social sciences and media trends, says the development of such a vast pool of documentation has staggering possibilities for understanding American culture — at least once they figure out how to harness and make sense of it.

“There is a lot of information that will be available and ready to mine like never before,” he said. “When do the family arguments start? How many people watch the football games? How much do people drink?”

The desire to share a common experience will bring out Sarah Han’s phone with regularity as she and her boyfriend prepare dinner for her extended family in their new house in Oakland, Calif.

Her mother used to take pictures constantly, many of which ended up in a photo album. Sending images of her meal to her followers through Instagram isn’t any different, she says, except that no one has to paste photographs into a book.

And instant photo-sharing creates something a traditional collection of snapshots cannot.

“It is kind of cool when you are on Instagram, and you see a common thread throughout an event,” said Ms. Han, 34, who works as a producer for The Bold Italic, an online magazine in San Francisco.

She cited a double rainbow that recently arced across the city’s skyline.

“Literally within five minutes, everyone’s photos were of a double rainbow,” she said. “The same thing will happen this Thanksgiving. You’ll see everyone’s table setting and turkey and see how everyone does it differently.”

Of course, not everyone is thrilled that Thanksgiving is becoming something to document constantly and share obsessively. The argument is as old as the mobile phone: by trying to stay connected, we end up being less connected.

“The problem is when the cellphones come out, people will take a picture, but then they’ll check Facebook and check e-mail, and it becomes an obsession that distracts everyone,” said Dr. Gwenn Schurgin O’Keeffe, a pediatrician who writes often about the effects of technology on family life.

Once, people took a photograph and had the patience to get it developed, reliving the moment well after it was over.

“So document the moment, and then worry about passing it around later,” she said. “You don’t need these instant updates of, ‘Oh, look, Grandma’s eating cranberries.’ ”

Sharing that shot of your partner trying to carve the turkey means an instant connection for families celebrating apart.

Most of Rebecca Palsha’s family doesn’t live in Anchorage, where she is a television reporter. She will use social media to keep them close as she and her husband, another journalist, prepare dinner for 10 this year.

Still, she realizes there comes a point where the moment might be better simply experienced.

“At some point, you have to put your phone away,” she said. “You have to realize when it’s time to talk to people here instead of people who aren’t with you.”

Mr. Spivak, a social media manager for Atlantic Station, a planned urban community in Atlanta, disagrees.

“It’s not that you’re missing out on real life,” he said. “Maybe now this is what’s becoming real life.”

Robbie Brown contributed reporting.

Read More..

Egypt Leader and Obama Forge Link in Gaza Deal

Lefteris Pitarakis/Associated Press

Israelis in the town of Sderot watched a Palestinian missile on Wednesday, before a cease-fire.

WASHINGTON — President Obama skipped dessert at a long summit meeting dinner in Cambodia on Monday to rush back to his hotel suite. It was after 11:30 p.m., and his mind was on rockets in Gaza rather than Asian diplomacy. He picked up the telephone to call the Egyptian leader who is the new wild card in his Middle East calculations.

Over the course of the next 25 minutes, he and President Mohamed Morsi of Egypt hashed through ways to end the latest eruption of violence, a conversation that would lead Mr. Obama to send Secretary of State Hillary Rodham Clinton to the region. As he and Mr. Morsi talked, Mr. Obama felt they were making a connection. Three hours later, at 2:30 in the morning, they talked again.

The cease-fire brokered between Israel and Hamas on Wednesday was the official unveiling of this unlikely new geopolitical partnership, one with bracing potential if not a fair measure of risk for both men. After a rocky start to their relationship, Mr. Obama has decided to invest heavily in the leader whose election caused concern because of his ties to the Muslim Brotherhood, seeing in him an intermediary who might help make progress in the Middle East beyond the current crisis in Gaza.

The White House phone log tells part of the tale. Mr. Obama talked with Mr. Morsi three times within 24 hours and six times over the course of several days, an unusual amount of one-on-one time for a president. Mr. Obama told aides he was impressed with the Egyptian leader’s pragmatic confidence. He sensed an engineer’s precision with surprisingly little ideology. Most important, Mr. Obama told aides that he considered Mr. Morsi a straight shooter who delivered on what he promised and did not promise what he could not deliver.

“The thing that appealed to the president was how practical the conversations were — here’s the state of play, here are the issues we’re concerned about,” said a senior administration official who spoke on the condition of anonymity to discuss private conversations. “This was somebody focused on solving problems.”

The Egyptian side was also positive about the collaboration. Essam el-Haddad, the foreign policy adviser to the Egyptian president, described a singular partnership developing between Mr. Morsi, who is the most important international ally for Hamas, and Mr. Obama, who plays essentially the same role for Israel.

“Yes, they were carrying the point of view of the Israeli side but they were understanding also the other side, the Palestinian side,” Mr. Haddad said in Cairo as the cease-fire was being finalized on Wednesday. “We felt there was a high level of sincerity in trying to find a solution. The sincerity and understanding was very helpful.”

The fledgling partnership forged in the fires of the past week may be ephemeral, a unique moment of cooperation born out of necessity and driven by national interests that happened to coincide rather than any deeper meeting of the minds. Some longtime students of the Middle East cautioned against overestimating its meaning, recalling that Mr. Morsi’s Muslim Brotherhood constitutes a philosophical brother of Hamas even if it has renounced violence itself and become the governing party in Cairo.

“I would caution the president from believing that President Morsi has in any way distanced himself from his ideological roots,” said Robert Satloff, executive director of the Washington Institute for Near East Policy. “But if the president takes away the lesson that we can affect Egypt’s behavior through the artful use of leverage, that’s a good lesson. You can shape his behavior. You can’t change his ideology.”

Other veterans of Middle East policy agreed with the skepticism yet saw the seeds of what might eventually lead to broader agreement.

“It really is something with the potential to establish a new basis for diplomacy in the region,” said Tamara Cofman Wittes, who was Mr. Obama’s deputy assistant secretary of state for the Middle East until earlier this year and now runs the Saban Center for Middle East Policy at the Brookings Institution. “It’s just potential, but it’s particularly impressive potential.”

The relationship between the two leaders has come a long way in just 10 weeks. Mr. Morsi’s election in June as the first Islamist president of Egypt set nerves in Washington on edge and raised questions about the future of Egypt’s three-decade-old peace treaty with Israel. Matters worsened in September when Egyptian radicals protesting an anti-Islam video stormed the United States Embassy in Cairo.

Peter Baker reported from Washington, and David D. Kirkpatrick from Cairo.

This article has been revised to reflect the following correction:

Correction: November 21, 2012

An earlier version of this article misstated the given name of the director of the Saban Center for Middle East Policy at the Brookings Institution. She is Tamara Cofman Wittes, not Teresa.

Read More..

Airlines’ On-Time Performance Rises

Rich Addicks for The New York Times

Delta Air Lines employees monitor ground traffic from a tower at Hartsfield-Jackson Atlanta International Airport.

ATLANTA — Next time you dawdle at the duty-free store or an airport bar, thinking you have a few more minutes until your flight is set to go, know this: the plane’s doors might have already closed.

Rich Addicks for The New York Times

A customer checking her bag. Delta installed bag check-in computers on boarding ramps.

There is a lot to complain about in air travel, particularly during the holiday season, with seats and overhead bins filled to capacity and the airlines charging fees for everything from a few inches of extra leg room to a bite to eat. But there is a nugget of good news. The number of flights leaving, and arriving, on time has improved significantly in recent years.

That is partly the result of the airlines flying fewer flights. But it is also because some airlines are focusing more on getting their planes out of the gate on schedule.

“There has been a lot of focus on improving performance across the industry,” said Peter McDonald, United’s chief operations officer. With carry-on space at a premium, he said passengers are also eager to board early. “There’s not a lot of hanging out at the bar until the last minute anymore.”

John Fechushak, Delta Air Lines’ director of operations in Atlanta, compared the daily task to “putting together a puzzle with different pieces every day.”

Here is a sampling of what Delta, for instance, looks at each day for each flight. How many minutes did it take for a plane to reach its gate after landing? Was the cabin door opened within three minutes? How soon were bags loaded in the hold? Did boarding start 35 minutes before takeoff? Were the cabin doors closed three minutes ahead of schedule?

So far this year, 83 percent of all flights took off within 15 minutes of schedule, the highest level since 2003, according to the Department of Transportation, which compiled figures through September. But that average belies a wide range of airline performances.

Hawaiian Airlines, helped by good weather for much of the year, topped the rankings, with 95 percent of flights leaving on time. At US Airways, 89 percent of departures were on time in that period, while Delta had 87 percent.

The biggest laggard this year has been United, which is struggling with its merger with Continental Airlines. The carrier has had three major computer problems this year, including two that crashed the airline’s passenger reservation system, stranding thousands of travelers and causing significant delays and cancellations. Its on-time departure rate, as a result, was 76 percent this year, the industry’s lowest.

American Airlines, which is going through bankruptcy proceedings and has been dealing with contentious labor relations, has also performed poorly. It delayed or canceled hundreds of flights in recent months after pilots called in sick or reported more mechanical problems. The airline also canceled scores of flight after seats were improperly bolted on some of its planes. As a result, nearly 40 percent of American’s flights were late in September.

Government statistics, however, do not provide the full picture: smaller carriers, like ExpressJet and SkyWest Airlines, which operate regional flights for Delta, United and US Airways, generally have lower on-time performance than their partners.

On-time statistics also vary widely by month, with the worst months in August and January, when summer storms, holiday travel or winter weather cause more disruptions. There are also single events that throw off the airlines: statistics, for instance, will be skewed for October by Hurricane Sandy, which shut down air travel through much of the East Coast and caused more than 19,000 flight cancellations.

Carriers have strong incentives to get planes out on time. Airlines now operate schedules that leave little wiggle room. Airplanes typically fly to several places every day, so any delayed flights, especially early in the day, can cascade through the system like falling dominoes and bedevil flight planners all day. Airlines often have to burn more fuel to try to make up for lost time, or make new arrangements for passengers who miss connections.

Airlines have long padded flight times to make up for congestion at airports or delays caused by air traffic controllers. Even so, passengers still expect their flight to take off and land at the time printed on their ticket.

Read More..