Another Look at a Drink Ingredient, Brominated Vegetable Oil

James Edward Bates for The New York Times

Sarah Kavanagh, 15, of Hattiesburg, Miss., started an online petition asking PepsiCo to change Gatorade’s formula.

Sarah Kavanagh and her little brother were looking forward to the bottles of Gatorade they had put in the refrigerator after playing outdoors one hot, humid afternoon last month in Hattiesburg, Miss.

But before she took a sip, Sarah, a dedicated vegetarian, did what she often does and checked the label to make sure no animal products were in the drink. One ingredient, brominated vegetable oil, caught her eye.

“I knew it probably wasn’t from an animal because it had vegetable in the name, but I still wanted to know what it was, so I Googled it,” Ms. Kavanagh said. “A page popped up with a long list of possible side effects, including neurological disorders and altered thyroid hormones. I didn’t expect that.”

She threw the product away and started a petition on Change.org, a nonprofit Web site, that has almost 200,000 signatures. Ms. Kavanagh, 15, hopes her campaign will persuade PepsiCo, Gatorade’s maker, to consider changing the drink’s formulation.

Jeff Dahncke, a spokesman for PepsiCo, noted that brominated vegetable oil had been deemed safe for consumption by federal regulators. “As standard practice, we constantly evaluate our formulas and ingredients to ensure they comply with federal regulations and meet the high quality standards our consumers and athletes expect — from functionality to great taste,” he said in an e-mail.

In fact, about 10 percent of drinks sold in the United States contain brominated vegetable oil, including Mountain Dew, also made by PepsiCo; Powerade, Fanta Orange and Fresca from Coca-Cola; and Squirt and Sunkist Peach Soda, made by the Dr Pepper Snapple Group.

The ingredient is added often to citrus drinks to help keep the fruit flavoring evenly distributed; without it, the flavoring would separate.

Use of the substance in the United States has been debated for more than three decades, so Ms. Kavanagh’s campaign most likely is quixotic. But the European Union has long banned the substance from foods, requiring use of other ingredients. Japan recently moved to do the same.

“B.V.O. is banned other places in the world, so these companies already have a replacement for it,” Ms. Kavanagh said. “I don’t see why they don’t just make the switch.” To that, companies say the switch would be too costly.

The renewed debate, which has brought attention to the arcane world of additive regulation, comes as consumers show increasing interest in food ingredients and have new tools to learn about them. Walmart’s app, for instance, allows access to lists of ingredients in foods in its stores.

Brominated vegetable oil contains bromine, the element found in brominated flame retardants, used in things like upholstered furniture and children’s products. Research has found brominate flame retardants building up in the body and breast milk, and animal and some human studies have linked them to neurological impairment, reduced fertility, changes in thyroid hormones and puberty at an earlier age.

Limited studies of the effects of brominated vegetable oil in animals and in humans found buildups of bromine in fatty tissues. Rats that ingested large quantities of the substance in their diets developed heart lesions.

Its use in foods dates to the 1930s, well before Congress amended the Food, Drug and Cosmetic Act to add regulation of new food additives to the responsibilities of the Food and Drug Administration. But Congress exempted two groups of additives, those already sanctioned by the F.D.A. or the Department of Agriculture, or those experts deemed “generally recognized as safe.”

The second exemption created what Tom Neltner, director of the Pew Charitable Trusts’ food additives project, a three-year investigation into how food additives are regulated, calls “the loophole that swallowed the law.” A company can create a new additive, publish safety data about it on its Web site and pay a law firm or consulting firm to vet it to establish it as “generally recognized as safe” — without ever notifying the F.D.A., Mr. Neltner said.

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State of the Art: Google Maps App for iPhone Goes in the Right Direction - Review

It was one of the biggest tech headlines of the year: in September, Apple dropped its contract with Google, which had always supplied the data for the iPhone’s Maps app. For various strategic reasons, Apple preferred to write a new app, based on a new database of the world that Apple intended to assemble itself.

As everybody knows by now, Apple got lost along the way. It was like a 22-car pileup. Timothy Cook, Apple’s chief executive, made a quick turn, publicly apologizing, firing the executive responsible and vowing to fix Maps. For a company that prides itself on flawless execution, it was quite a detour.

Rumors swirled that Google would create an iPhone app of its own, one that would use its seven-year-old, far more polished database of the world.

That was true. Today, Google Maps for the iPhone has arrived. It’s free, fast and fantastic.

Now, there are two parts to a great maps app. There’s the app itself — how it looks, how it works, what the features are. In this regard, few people complain about Apple’s Maps app; it’s beautiful, and its navigation mode for drivers is clear, uncluttered and distraction-free.

But then there’s the hard part: the underlying data. Apple and Google have each constructed staggeringly complex databases of the world and its roads.

The recipe for both companies includes map data from TomTom, satellite photography from a different source, real-time traffic data from others, restaurant and store listings from still more sources, and so on. In the end, Apple says that it incorporated data from at least 24 different sources.

Those sources always include errors, if only because the world constantly changes. Worse, those sources sometimes disagree with one another. It takes years to fix the problems and mesh these data sources together.

So the first great thing about Google’s new Maps is the underlying data. Hundreds of Google employees have spent years hand-editing the maps, fixing the thousands of errors that people report every day. (In the new app, you report a mistake just by shaking the phone.) And since 2006, Google’s Street View vehicles have trawled 3,000 cities, photographing and confirming the cartographical accuracy of five million miles of roads.

You can sense the new app’s polish and intelligence the minute you enter your first address; it’s infinitely more understanding. When I type “200 W 79, NYC,” Google Maps drops a pin right where it belongs: on the Upper West Side of Manhattan.

Apple’s Maps app, on the other hand, acts positively drunk. It asks me to clarify: “Did you mean 200 Durham Road, Madison, CT? Or 200 Madison Road, Durham, CT?”

Um, what?

And then there’s the navigation. Lots of iPhone owners report that they’ve had no problem with Apple’s driving instructions, and that’s great. But I’ve been idiotically misdirected a few times — and the trouble is, you never know in advance. You wind up with a deep mistrust of the app that’s hard to shake. Google’s directions weren’t great in the app’s early days either, and they’re still not always perfect. But after years of polishing and corrections, they’re right a lot more often.

The must-have features are all here: spoken driving directions, color-coded real-time traffic conditions, vector-based maps (smooth at any size). But the new app also offers some incredibly powerful, useful features that Apple’s app lacks.

Street View, of course, lets you see a photograph of a place, and even “walk” down the street in any direction. Great for checking out a neighborhood before you go, scoping out the parking situation or playing “you are there” when you read a news article.

Along with driving directions, Google Maps gives equal emphasis to walking directions and public transportation options.

This feature is brilliantly done. Google Maps displays a clean, step-by-step timeline of your entire public transportation adventure. If you ask for a route from Westport, Conn., to the Empire State Building, the timeline says: “4:27 pm, Board New Haven train toward Grand Central Terminal.” Then it shows you the names of the actual train stops you’ll pass. Then, “5:47 pm, Grand Central. Get off and walk 2 min.” Then, “5:57 pm, 33rd St: Board the #6 Lexington Avenue Local towards Brooklyn Bridge.” And so on.

Even if public transportation were all it did, Google Maps would be one of the best apps ever. (Apple kicks you over to other companies’ apps for this information.)

E-mail: pogue@nytimes.com

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Top 2012 searches include Whitney, PSY, Sandy

LOS ANGELES (AP) — The world’s attention wavered between the tragic and the silly in 2012, and along the way, Web surfers searched in huge numbers to find out about a royal princess, the latest iPad, and a record-breaking skydiver.

Whitney Houston was the “top trending” search of the year, according to Google Inc.’s year-end “zeitgeist” report. Google‘s 12th annual roundup is “an in-depth look at the spirit of the times as seen through the billions of searches on Google over the past year,” the company said in a blog post Wednesday.

People around the globe searched en masse for news about Houston‘s accidental drowning in a bathtub just before she was to perform at a pre-Grammy Awards party in February.

Google defines topics as “trending” when they garner a high amount of traffic over a sustained period of time.

Korean rapper PSY’s “Gangnam Style” music video trotted into second spot, a testament to his self-deprecating giddy-up dance move. The video is approaching a billion views on YouTube.

Superstorm Sandy, the damaging storm that knocked out power and flooded parts of the East Coast in the midst of a U.S. presidential campaign, was third.

The next biggest trending searches globally were a pair of threes: the iPad 3 tablet from Apple Inc. and Diablo 3, a popular video game.

Rounding out the Top 10 were Kate Middleton, who made news with scandalous photos and a royal pregnancy; the 2012 Olympics in London; Amanda Todd, a Canadian teen who was found dead of an apparent suicide in October after being bullied online; Michael Clarke Duncan, the “Green Mile” actor who died of a heart attack in September at age 54; and “BBB12,” the 12th edition of “Big Brother Brasil,” a reality show featuring scantily clad men and women living together.

Some trending people, according to Google, were:

— Felix Baumgartner, an Austrian skydiver who became the first to break the sound barrier without a vehicle with a 24-mile plummet from Earth’s stratosphere;

— Jeremy Lin, the undrafted NBA star who exploded off the New York Knicks bench and sparked a wave of “Linsanity”;

— Morgan Freeman, the actor whose untimely death turned out not to be true.

The Internet also continued its rise as a popular tool for spreading addictive ideas and phrases known as “memes.” Remember LOL? If you don’t know what it means by now, someone may “Laugh Out Loud” at you.

This year, Facebook said its top memes included “TBH (To Be Honest),” ”YOLO (You Only Live Once),” ”SMH (Shake My Head).” Thanks to an endlessly fascinating U.S. presidential campaign, “Big Bird” made the list after Republican candidate Mitt Romney said he might consider cutting some funds for public broadcasting.

Yahoo said its own top-searched memes for the year included “Kony 2012,” a reference to the short film and campaign against Ugandan militia leader Joseph Kony; “stingray photobomb” for an unusual vacation snapshot that went viral; and “binders full of women,” another nod to Romney for his awkward description of his search for women cabinet members as Massachusetts’ governor.

And people were happy to pass on popular Twitter posts by retweeting them. According to Twitter, the year’s most popular retweets were President Barack Obama‘s “Four more years,” and Justin Bieber’s farewell to six-year-old fan Avalanna Routh, who died of a rare form of brain cancer: “RIP Avalanna. i love you”.

Gadgets News Headlines – Yahoo! News

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Congress examines science behind HGH test for NFL

WASHINGTON (AP) — A congressional committee has opened a hearing to examine the science behind a human growth hormone test the NFL wants to start using on its players.

Nearly two full seasons have passed since the league and the players' union signed a labor deal that set the stage for HGH testing.

The NFL Players Association won't concede the validity of a test that's used by Olympic sports and Major League Baseball, and the sides haven't been able to agree on a scientist to help resolve that impasse.

Among the witnesses before the House Oversight and Government Reform Committee on Wednesday is Pro Football Hall of Fame member Dick Butkus. In his prepared statement, Butkus writes: "Now, let's get on with it. The HGH testing process is proven to be reliable."

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WebMD to cut 14 percent of workforce to reduce expenses

(Reuters) – Health information website WebMD Health Corp said it will cut around 250 jobs, or 14 percent of its workforce, to reduce costs.

The company, which had about 1700 employees according to Thomson Reuters data, said it would take a charge of about $ 6 million to $ 8 million in the fourth quarter, primarily on severance and other restructuring-related costs.

WebMD, which is a popular and long-trusted destination for checking health and disease related information, has lost its sheen for investors in recent times as it struggled to convert its growing user base into a steady revenue stream.

The company named a former Pfizer Inc executive Cavan Redmond as CEO earlier this year, entrusting the industry veteran with the task of reviving the website’s flagging business.

Its previous CEO, Wayne Gattinella, resigned after the company took itself off the auction block in January.

WebMD also said on Tuesday that it plans to streamline its operations and focus resources on increasing user engagement, customer satisfaction and innovation, and expects these efforts to reduce annualized operating expenses by about $ 45 million.

While most of the job cuts will be effective at the end of the year, other cost saving actions will be implemented in the first quarter of 2013, the company said in a statement.

The company reported a third-quarter loss in November, compared with a profit in the year-ago quarter, and said revenue fell 13 percent.

WebMD’s shares, which have lost nearly 40 percent of their value over the past six months, were down about 2 percent in premarket trade. They closed at $ 13.85 on Monday on the Nasdaq.

(Reporting by Esha Dey in Bangalore; Editing by Roshni Menon)

Internet News Headlines – Yahoo! News

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NHL, union to return to bargaining

TORONTO (AP) — The NHL and its players' union will return to bargaining Wednesday at an undisclosed location in an effort to save the hockey season.

The Canadian Press on Tuesday reported the resumption of talks, citing unidentified people on both sides of the dispute.

Tuesday marks the 87th day of the lockout. Wednesday's session will be the first meeting since the sides criticized each other after talks broke off last week.

Until then, they appeared to be making progress during three days in New York in which they exchanged proposals. Union executive director Donald Fehr maintains there are agreements on almost all the important issues.

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Mind: A Compromise on Defining and Diagnosing Mental Disorders

They plotted a revolution, fell to debating among themselves, and in the end overturned very little except their own expectations.

But the effort itself was a valuable guide for anyone who has received a psychiatric diagnosis, or anyone who might get one.

This month, the American Psychiatric Association announced that its board of trustees had approved the fifth edition of the association’s influential diagnostic manual — the so-called bible of mental disorders — ending more than five years of sometimes acrimonious, and often very public, controversy.

The committee of doctors appointed by the psychiatric association had attempted to execute a paradigm shift, changing how mental disorders are conceived and posting its proposals online for the public to comment. And comment it did: Patient advocacy groups sounded off, objecting to proposed changes in the definitions of depression and Asperger syndrome, among other diagnoses. Outside academic researchers did, too. A few committee members quit in protest.

The final text, which won’t be fully available until publication this spring, has already gotten predictably mixed reviews. “Given the challenges in a field where objective lines are hard to draw, they did a solid job,” said Dr. Michael First, a psychiatrist at Columbia who edited a previous version of the manual and was a consultant on this one.

Others disagreed. “This is the saddest moment in my 45-year career of practicing, studying and teaching psychiatry,” wrote Dr. Allen Frances, the chairman of a previous committee who has been one of the most vocal critics, in a blog post about the new manual, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM5.

Yet many experts inside and outside the process said the final document was not radically different from the previous version, and its lessons more mundane than the rhetoric implied. The status quo is hard to budge, for one. And when changes do happen, they are not necessarily the ones that were intended.

The new manual does extend the reach of psychiatry in some areas, as many critics feared it might. Hoarding is now a mental disorder (previously it was considered a symptom of obsessive-compulsive behavior). “Premenstrual dysphoric disorder,” a severe form of premenstrual syndrome, is also new (it was previously in the appendix).

And binge-eating disorder (also formerly in the appendix), a kind of severe, highly distressing gluttony, is now a full-blown diagnosis. This one by itself could tag millions of people considered healthy, if often overindulgent, with a psychiatric label, some experts said.

But the deeper story is one of compromise. It is most evident in how the committee handled three of the thorniest diagnoses in psychiatry: autism, depression and pediatric bipolar disorder.

The group working on depression declared early on that it wanted to eliminate the so-called bereavement exclusion, which stated that grieving the loss of a loved one should not be considered a clinical disorder, though it shares many of the same outward signs. Grief has always been a normal reaction to death, not a kind of depression.

Advocacy and support groups, such as those representing people who have lost a child, objected furiously to the idea that the bereaved might be given a diagnosis of depression.

“This was just astonishing, that they would eliminate the exclusion, and a distortion of the research on the subject,” said Jerome Wakefield, a professor of social work and psychiatry at New York University, who did not work on the manual.

In the end the committee cut a deal. It eliminated the grief exclusion but added a note in the text, reminding doctors that any significant loss — of a job, a relationship, a home — could cause depressive symptoms and should be carefully investigated.

“It’s like they took it all back,” Dr. Wakefield said. “I don’t like the way it was done — in a footnote — but it’s there.”

The debate over autism was even more furious, and it resulted in a similar rapprochement.

From the outset, the committee intended to tighten the definition of autism and simplify it, eliminating related labels like Asperger syndrome and “pervasive developmental disorder not otherwise specified,” or PDD-NOS. The rate of diagnosis of such conditions has exploded over the past decade, in part due to the vagueness of the definitions, and the committee wanted to draw clearer boundaries.

It proposed a single “autism spectrum disorder” category, with stricter requirements.

Some outside researchers raised concerns. In January one of them, Dr. Fred Volkmar of the Yale School of Medicine, who had quit the committee in protest, presented research suggesting that 45 percent or more of people who currently had an autism or related diagnosis would not have one under the proposed revision.

Autism groups reacted immediately, fearing that the change in the diagnosis would deny services to children and families who need them.

The committee countered with its own study, suggesting that the new definition would exclude about 10 percent of people currently with a diagnosis. And again, the experts took a half step back.

The new, streamlined definition was approved, but with language that took into account a person’s diagnostic history. “It’s explicit that anyone who’s had an Asperger’s or autism or PDD-NOS diagnosis before is now included,” said Catherine Lord, a committee member who worked on the new definition and who is director of the Center for Autism and the Developing Brain in New York. “Essentially everyone gets in.”

Pediatric bipolar disorder posed a different challenge.

In the 1990s and 2000s, psychiatrists began giving aggressive, explosive children a diagnosis of bipolar disorder in increasing numbers. The trend appalled many patient advocates and doctors.

Bipolar disorder, which is characterized by episodes of depression and mania, had previously been an adult problem; now the diagnosis is given to children as young as 2 — along with powerful psychiatric drugs and tranquilizers that also cause rapid weight gain. The committee wanted to stop the trend in its tracks, said experts who were involved.

Most of the children treated for bipolar disorder did not have it, recent research found. The committee settled on an alternative label: “disruptive mood dysregulation disorder,” or D.M.D.D., which describes extreme hostility and outbursts beyond normal tantrums.

“They essentially wanted to have some place for these kids, and D.M.D.D. was all they had in their kit,” said Dr. Gabrielle Carlson, a child psychiatrist at Stony Brook University Medical Center, who provided some outside consultation. “These are mostly kids who have A.D.H.D. or what we would call oppositional defiant disorder, but with this explosive feature. They need help; you can’t wait forever. The question was what to call it, without pretending we know enough to saddle them with a lifelong diagnosis” like bipolar disorder.

D.M.D.D. has its own problems, as many experts were quick to point out. It could be a symptom of an underlying condition, as Dr. Carlson argues. It could “medicalize” frequent temper tantrums. It’s brand new, and no one knows how it will play out in practice.

But it is now in the book — because it was the best solution available, experts inside and outside of the revision process said.

From beginning to end, many experts said, the process of defining psychiatric diagnoses is very much like finding the right one for an individual: it’s a process of negotiation, in many cases.

“That’s one of the take-aways from all this, and I think it’s a good one,” Dr. Carlson said. “A diagnosis is a hypothesis. It’s a start, and you have to start somewhere. But that’s all it is.”

One of the committee’s most ambitious proposals was perhaps the least noticed: a commitment to update the book continually, when there’s good reason to, rather than once every decade or so in a giant heave. That was approved without much fanfare.

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Moroccans Fear That Flickers of Democracy Are Fading

TANGIER, Morocco — Until recently, politics in Morocco involved red carpets and speeches in high Arabic that the average citizen could not understand. But on a campaign swing this fall through a working-class area of this port city, Prime Minister Abdelilah Benkirane stood on a makeshift podium in a muddy vacant lot.

He spoke without notes, kissed babies passed forward by the crowd and promised, as he has done all along, to fight corruption and return the government to the people.

“We will get stronger with the help of God and accomplish what we wanted,” he told the crowd, which roared its approval.

But more and more Moroccans are questioning his ability to do that, wondering whether Morocco’s version of the Arab Spring brought anything more than cosmetic changes to this impoverished country, which has been one of America’s most stable and staunch allies in a region marked by turmoil.

A year ago, it seemed Moroccans were giddy with the sense that they had found a gentle, negotiated answer to the popular uprisings in the streets. The country’s king, Mohammed VI, 49, defused angry protesters by volunteering to share his power. Within months, Morocco had a new Constitution.

Mr. Benkirane’s moderate Islamist party, the Justice and Development Party, won a plurality in parliamentary elections in November. Western governments heaped praise on the election process, satisfied that this strategically important country, just 12 miles south of Spain and atop a changing and uncertain continent, was settling in to a new more democratic order. (This week Secretary of State Hillary Rodham Clinton is scheduled to visit Morocco for a meeting of the Friends of Syria.)

But these days, many here are questioning whether the king and his entourage really gave up anything at all. Telquel, perhaps the country’s most influential magazine, ran a cover story this fall saying that the palace had gradually taken back its concessions: the king’s shadow cabinet was interfering at will and was even sending its own emissaries to the United States and Brussels when Moroccan interests needed tending to. Mr. Benkirane, the magazine pointed out, had publicly admitted that the king’s advisers sometimes met with government officials without consulting him.

Some also point to a quiet clamping down on political activists. In October, the United Nations said there was evidence of a recent spike in reports of torture in Morocco. About 70 protesters associated with the pro-democracy February 20 Movement are still in prison. In May, a popular rapper was sentenced to a year in jail for a song about police corruption. And six political activists testified at a hearing in September that they had been physically — and sexually — abused after being arrested for protesting in July.

In other countries rocked by Arab Spring uprisings, tensions today are being felt largely over the role of Islam in government. These issues have come up in Morocco, too. But here, the larger tensions appear to be over the power of the old guard. Many Moroccans will not criticize the king, instead focusing on the network of power and privilege that surrounds him and the corruption that they believe sucks any hope of prosperity from this country.

The problems Morocco faces are enormous. The country has invested heavily in infrastructure: superhighways are everywhere and there are plans for a high-speed train, too. But 40 percent of the population cannot read or write. Forbes has estimated the king’s fortune to be more than $2 billion. But the average income here is low, roughly half of what it was in Tunisia, where the Arab Spring first took off.

Mr. Benkirane took office showing a flare for the dramatic. He quickly slashed ministerial salaries and perquisites, and he refused to move to the prime minister’s mansion. He also took on Morocco’s notorious cronyism. To widespread amazement, his government published the names of those who had been given lucrative bus licenses. Since then, however, his efforts have foundered.

Some critics say the prime minister has been outmaneuvered at every turn. Once last spring, Mr. Benkirane seemed to lash out at the king and his entourage, suggesting that protesters could easily return to the streets. But soon after, he said the remarks had been misunderstood.

Aida Alami contributed reporting.

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RG3 hurts knee, but Skins beat Ravens 31-28 in OT

LANDOVER, Md. (AP) — This, of course, is the sort of thing everyone associated with — and rooting for — the Washington Redskins worries about: Robert Griffin III limping to the sideline after a knee-spraining hit.

With the Redskins driving while trailing the Baltimore Ravens late in the fourth quarter of a game Washington would wind up winning 31-28 in overtime Sunday, Griffin was slow to rise after being tackled at the end of a 13-yard scramble.

"I screamed. Like a man, of course," Griffin said with a laugh, before acknowledging: "It hurt really bad."

He left for one play, then returned for four more. But by then, the No. 2 overall pick in this year's NFL draft was hopping on his left leg, keeping all weight off his injured right one. Eventually, Griffin knelt on the turf, unable to continue.

"I knew I needed to get out at that point," said last year's Heisman Trophy winner, who had an MRI exam later Sunday that didn't show significant ligament damage. "I couldn't move. At some point, you have to do what's right for the team. And if I'm playing the rest of that game, I probably would have hurt myself even more."

Said Redskins coach Mike Shanahan: "I could see that he was hurting the second time he came out. You could see his face."

So whatever euphoria the Redskins (7-6) and their fans might have been feeling following a fourth consecutive victory was mixed with concern about the sight of the man they call RG3 hobbling around on the sideline with a thick, black brace on his right knee as Kai Forbath kicked a 34-yard field goal to end the game.

"We're happy that we won, obviously," left tackle Trent Williams said. "But that is concerning, knowing he went down. Everyone wants to know how he's doing."

About three hours after the game, an answer arrived: Team spokesman Tony Wyllie said the MRI showed that while Griffin sprained his knee, "everything is clear" in terms of a major knee injury. Wyllie specifically ruled out a season-ending ACL tear, such as the one Griffin had on the same knee while playing in college at Baylor in 2009.

Still, because a sprained knee, by definition, means at least one of the several ligaments is damaged in some way, it's not clear what Griffin's status for next week at the Cleveland Browns will be.

"Everybody's praying for me. I feel pretty good right now about the whole situation," said Griffin, who left a game earlier this season because of a concussion.

With Griffin done for the day, and Baltimore — now 9-4 after its first consecutive losses since early in the 2009 season — leading 28-20, fellow rookie QB Kirk Cousins stepped in. Cousins, a fourth-round pick who only played in one other game this season, threw an 11-yard touchdown pass to Pierre Garcon with 29 seconds remaining in regulation, then ran a quarterback draw for the tying 2-point conversion.

"He's ice. Like they used to say about Larry Bird, he got ice water in his veins. That's the best thing you can say about Kirk," receiver Joshua Morgan said.

Griffin heard the call for Cousin's draw through his headphones while getting treatment on the sideline.

"It was awesome," said Griffin, who was 15 for 26 for 246 yards and a touchdown pass, along with 34 yards on seven carries, adding to his single-season record for rushing by a rookie quarterback.

Ravens safety Ed Reed said his defense was ready for that 2-point play, actually, but "we didn't execute."

The Ravens got the ball first in overtime but went three-and-out. Yet another Redskins rookie, Richard Crawford, returned the punt 64 yards to set up Forbath, who is now 14 for 14 to start his NFL career; each got a game ball from Shanahan.

While Washington remained one game behind the New York Giants (8-5) in the race for the NFC East title, the Ravens wasted a chance to clinch the AFC North — and even missed out on an opportunity to assure themselves of a playoff berth.

Joe Flacco completed 16 of 21 passes for 182 yards and three first-half TD passes that built a 21-14 lead. But Baltimore's first four drives of the second ended with Flacco's fumble, his interception deep in Washington's territory, and two three-and-outs.

"As a leader on this team I like to finish teams out," said Ray Rice, who finished with 121 yards on 20 carries but picked up a left hip pointer. "I don't want to be known as, 'Yeah, we get them close in the fourth quarter, and the Ravens are going to give it away.' That's never been us. That's not going to be us."

Rice's 7-yard touchdown run with 4:47 to play in the fourth quarter put the Ravens up by eight points, before Griffin started the trying drive — and Cousins finished it.

Forbath's winning kick prompted a wild on-field celebration by many Redskins. Not Griffin, though. He gingerly walked toward the locker room, a brace on his knee, and flashed a thumb's up to raucous spectators in the stands.

Later, around the Redskins announced the results of his good-news MRI, Griffin tweeted: "Your positive vibes and prayers worked people!!!!"

NOTES: Cousins completed both passes he threw. ... Ravens RG Marshal Yanda sprained his right ankle and was wearing a black walking boot on that foot in the locker room. Other injuries for Baltimore: LB Jameel McClain had a neck injury, but X-rays were negative. ... Washington's 186 yards were the most by any NFL team in the first quarter this season and the most by the franchise in that quarter since 1997. ... The Redskins hadn't won four games in a row since 2008.

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Connect with Howard Fendrich on Twitter at http://twitter.com/HowardFendrich

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

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The New Old Age Blog: Training Needed for Home Care Is Lacking

“H” from Chicago, I heard you when you joined a lively discussion over hospice at home here a couple of weeks ago and asked, “where can family members get the training to do all the nursing tasks?”

In the comments section, many readers wrote in to say that caring for relatives at the end of their lives was a duty and a privilege. Others said they were unprepared for the physical and emotional burdens of doing so.

Your question stood out because of its practical character. Do caregivers have to figure out how to handle all these complicated medical issues on their own? Or is some help out there?

For an answer, I called two of the authors of “Home Alone: Family Caregivers Providing Complex Chronic Care,” put out by the United Hospital Fund and the AARP Public Policy Institute. That study recently made headlines by reporting that 46 percent of the nation’s 42 million caregivers handle medical and nursing tasks such as giving injections, caring for wounds or administering I.V.s.

Susan Reinhard, senior vice president and director of the AARP Public Policy Institute, sighed when I reached her, and said “this is a huge gap,” referring to a notable absence of available training in demanding caregiving tasks.

To the extent training exists through local agencies on aging, disease-specific organizations or social service groups, it deals mostly with so-called “activities of daily living” — helping someone bath, dress, eat, or use the bathroom — not the demands of nursing-style care, Ms. Reinhard observed.

Really, this kind of training should be the responsibility of health care providers, but doctors and nurses often give only cursory, unsatisfactory explanations of complex tasks that fall to caregivers, said Carol Levine, director of the Families and Health Care Project of the United Hospital Fund.

That leaves the burden on caregivers to be assertive and ask for help, these experts agreed. If someone is hospitalized and ready to return home, they suggest asking a nurse or another provider “show me what you are doing so I can learn how to do it,” and then asking “now, watch me do it and tell me if I am doing it wrong or right.”

Don’t give up after the first time if you feel awkward or uncomfortable. Ask to do the task again, and ask again for feedback.

No videos or written manuals, can substitute for this one-on-one, hands-on instruction. If you don’t get it to your satisfaction before a loved-one is ready to go home, don’t sign the form that says you have been given instructions on what to do, Ms. Reinhard advised. The hospital is legally obligated to ensure that discharges are safe, and this operates in your favor.

The same goes for the pharmacy: don’t sign that sheet that the pharmacist hands you indicating that you have been adequately informed about the medications you are purchasing. If you are concerned about the number of prescriptions, what they are for, their possible side effects and whether all are necessary, ask the pharmacist to sit down with you and go over all this information. Again, don’t leave until you are satisfied.

Often, caregiving tasks will change as someone with a chronic condition like Parkinson’s disease or heart failure becomes more frail. Should this happen, consider calling a home care agency and asking for a nurse to come out and teach you how to administer oxygen or help transfer someone safely from a bed to a wheelchair, Ms. Reinhard said.

You may want to videotape the session so you can view it several times; most of us don’t pick these skills up right away and need repeat practice, Ms. Levine said.

Be as specific in your request for help as possible. Rather than complaining that you are overwhelmed, say something along the lines of, “I want to make sure I know how to clean this wound and prevent an infection” or “I need to know what texture the food should be so I can feed mom without having her choke,” Ms. Levine suggested.

Her organization has prepared comprehensive materials for caregivers called “Next Step in Care.” While the focus isn’t on nursing-style caregiving tasks, three might be useful: a self-assessment tool for family caregivers, a medication management guide, and a guide to hospice and palliative care.

Other helpful materials are few and far between. Ms. Levine’s staff identified a $24.95 American Red Cross training manual for family caregivers that has a DVD explaining the mechanics of transfers and a few other complicated tasks. Also, some videos are available for free at www.mmlearn.org, a Web site that says its mission is to provide caregivers with online training and education.

Asked about model programs, Ms. Reinhard said she knew of only one: the Schmieding Home Caregiver Training Program in Arkansas, operated by the Donald W. Reynolds Institute on Aging of the University of Arkansas for Medical Sciences. The Schmieding program trains family caregivers as well as professional caregivers who work in people’s homes or nursing homes.

On the family side, it offers eight hours of instruction in “physical needs” associated with caregiving — managing incontinence, skin care, turning someone regularly in bed, using adaptive equipment, transfers from a bed to a wheelchair, helping patients remain mobile, and more. Classes are offered at five sites and four more are planned in the next several years, said Robin McAtee, associate director of the Reynolds Institute on Aging. If people, churches or senior centers want the instruction, which is free, Schmieding nurses will take the program to them. One-on-one instruction for tasks is also available on request.

A separate eight-hour program is available for caregivers dealing with dementia, who have additional concerns.

At a Web site called Elder Stay at Home, Schmieding sells a package of materials (three DVDs and a booklet, for $99) summarizing the content of its family caregiver training program. Separately, it has begun selling its curriculum for paid caregivers, and programs in California, Hawaii and Texas are among the first buyers. The University of Arkansas for Medical Sciences also has received a $3.7 million innovation grant from the government to expand the caregiver training program more broadly and develop online training materials.

Ms. Reinhard said AARP would like to see Schmieding-style programs rolled out across the country and begin to offer structured, reliable support to caregivers now providing nursing-style care in homes with little or no assistance.

What else am I missing here? Do you know of resources or other organizations providing intensive caregiver training along the lines of what I’ve been discussing? Where would you suggest people turn for this kind of help?

Editor’s Note:

Correction: An earlier version of this post contained an incorrect spelling of the first name of the director of the Families and Health Care Project of the United Hospital Fund. She is Carol Levine, not Carole Levine.

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