SAfrica: judge in Pistorius case suffers loss

JOHANNESBURG (AP) — Last week, the judge who granted bail to Oscar Pistorius was in the international spotlight, presiding over dramatic hearings in a courtroom as the Olympic athlete sat in the dock charged with murdering his girlfriend. This week, the judge is in private mourning.

Desmond Nair, chief magistrate of the Pretoria Magistrate's Court, confirmed Tuesday that he is related to a woman suspected of killing her two children and committing suicide on the weekend.

The revelation was the latest twist in the saga of Pistorius and prominent figures linked to the case against the double-amputee athlete, who faces a charge of premeditated murder in the Feb. 14 shooting death of Reeva Steenkamp, a 29-year-old model who appeared in a television reality show.

The bodies of a woman and her two sons were found Sunday evening at their Johannesburg home by her ex-husband, police Warrant Officer Balan Muthan said. Authorities suspect the woman administered a substance that killed her children, and took her own life by ingesting it as well.

"I can confirm the deceased is my first cousin," Nair told The Associated Press in a telephone interview.

The woman's brother, Vishal Maharaj, identified her as Anusha Maharaj. Police said Maharaj was her family name before she married. South African media identified her as Anusha Mooljee.

Muthan said police suspect "she took her own life by ingesting a substance that killed her," and that she "most probably" gave the same substance to her children. Autopsies were conducted Monday and toxicologists were analyzing the substance believed to have killed the three family members.

Suicide notes were found and a murder investigation was underway, Muthan said. He said copies of the notes were admitted as evidence in the probe and declined to comment on the contents.

Eyewitness News, a South African media outlet, said the boys who died were 12 and 17 years old and cited neighbor Claire Osment as saying she rushed outside after hearing screams coming from the townhouse where they lived.

"We asked what happened. The dad just said, 'She has killed my boys.' He was just crying," Eyewitness News quoted her as saying. "He couldn't believe it, he couldn't believe that his sons are gone."

Nair, 44, has presided over a number of high-profile cases, including the 2008 conviction on fraud charges of Sydney Maree, a South African who took American citizenship and became a track star in the United States; a 2011 plea agreement in which rugby player Bees Roux received a five-year suspended prison sentence for the beating death of a policeman; and inquiries into alleged misconduct by magistrates around South Africa.

On Friday, Nair delivered a lengthy discourse on why he was granting bail to Pistorius, including an assertion that prosecutors had not argued persuasively that the Paralympian was a flight risk. Nair criticized shortcomings in the state's investigation, but he also said aspects of Pistorius' account of what happened were not convincing.

Pistorius says he killed Steenkamp accidentally, opening fire after mistaking her for an intruder in his home. Prosecutors alleged he intentionally shot her after the couple had an argument.

Last week, the chief investigator in the case against Pistorius, Hilton Botha, was removed from the inquiry after it was revealed that attempted murder charges against him had been reinstated in early February. The charges relate to a 2011 incident in which Botha and two other police officers allegedly fired on a minibus.

In another surprise, a lawyer for the Pistorius family said Sunday that Oscar's brother, Carl, faces a charge of unlawful, negligent killing for a 2008 road death. That charge had also been dropped and later reinstated.

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The ConsUmer: Questions About a Robotic Surgery

Ever since it was approved by the Food and Drug Administration in 2005, robotic surgery for hysterectomy has been heavily advertised. Surgeons promise that using the da Vinci robotic device will bring better results and an easier recovery, and many hospitals claim that patients will experience less pain and fewer complications, getting back on their feet faster.

The company that makes da Vinci robotic surgery equipment promoted it last May at free health workshops organized by the federal Office on Womens’ Health. On Sunday, the Liberty Science Museum in Jersey City will host its first “Let’s Operate Day,” offering guests “hands-on” practice peering into video monitors and using da Vinci’s robot arms to pick up and manipulate small objects.

The cost of the new technology is rarely mentioned. But last week, a new study that evaluated outcomes in more than a quarter of a million American women raised questions about the manufacturer’s claims. The paper, published in The Journal of the American Medical Association, compared outcomes in 264,758 women who had either laparoscopic or robotically assisted hysterectomy at 441 hospitals between 2007 and 2010. Both methods are minimally invasive and involve smaller incisions than open abdominal surgery.

The researchers found no overall difference in complication rates between the two groups, and no difference in the rates of blood transfusion, even though one of the claims regarding robotic surgery is that it causes less blood loss.

But the researchers did find a big difference in cost. Robotically assisted surgery for hysterectomy costs on average about one-third more than laparoscopic surgery.

“It’s important to separate the marketing from the data,” said Dr. Jason D. Wright, the study’s lead author, an assistant professor of obstetrics and gynecology at Columbia University Medical Center. “For the surgeon, there is a greater degree of movement and control of the instruments and the visualization is better.

“But the ultimate question is, does this change outcomes for patients? This study suggests that there really is not a lot of difference as far as quantifiable outcomes.”

The majority of patients in both groups left the hospital in less than two days, though patients who had robotic surgery were slightly more likely to go home that early: 80 percent went home in less than two days, compared with 75 percent of those who had laparoscopic surgery.

But the cost of robotic surgeries was significantly higher, with a median cost to the hospital of $8,868, compared with $6,679 for laparoscopic hysterectomy. The study did not look at the difference in patients’ bills, but according to Newchoicehealth.com, the average patient price for a laparoscopic hysterectomy ranges from $7,700 in Dallas to $11,600 in Los Angeles.

With laparoscopic surgery — sometimes called keyhole surgery — narrow instruments and a small video camera are inserted through tiny incisions; the surgeon sees the image on a monitor and can cut and sew tissue with the instruments. With robotically assisted surgery, the surgeon sits at a console with a 3-dimensional view of the surgical site, and computer technology translates his or her hand movements into precise, scaled movements of the instruments.

Even without offering clear advantages the proportion of hysterectomies performed robotically has increased rapidly, up to nearly 10 percent of hysterectomies in 2010 from less than 1 percent in 2007, Dr. Wright said. Minimally invasive surgeries for hysterectomies are increasing across the board, he found, even at hospitals not performing robotic surgery.

Dr. Myriam J. Curet, chief medical adviser to Intuitive Surgical, which makes the da Vinci systems, did not dispute the study’s findings, but said the important message was that more women were able to receive minimally invasive surgeries because more options were available.

“That’s good for patients and for the health care system,” Dr. Curet said. Women who are not candidates for laparoscopic surgery might still be candidates for robotically-assisted surgery, she added.

Right now, however, it is not clear how to identify which women would benefit from robotic surgery and which would do well with a less expensive method.

The growing use of robotic surgery in hospitals will continue to drive up health costs, said Joel S. Weissman, of Brigham and Women’s Hospital and a co-author of an editorial published with the study.

“Once you have that robot, the tendency is to use it for all kinds of things, for which it may or may not have great value,” Dr. Weissman said. Studies like this one, he said, demonstrate the waste of health care dollars on “something that costs a lot more and doesn’t offer any added benefit over current treatment options.”

Each year approximately 600,000 American women have hysterectomies, according to the Centers for Disease Control and Prevention. By age 60, one in three American women has had her uterus removed, often along with her ovaries and cervix.

Critics who say far too many hysterectomies are done in the United States worry that all the attention to surgical method distracts from the question of whether patients should be having the surgery at all.

Most hysterectomies are prescribed for conditions that are not life-threatening, and advocates worry that women are not fully informed of the long-term harms, which may include a loss of sexual responsiveness, depression and chronic constipation, and higher risk for osteoporosis and heart disease, said Nora W. Coffey, the founder of the nonprofit Hysterectomy Educational Resources and Services Foundation.

“That’s the conversation we should be having,” Ms. Coffey said.

---

Nora W. Coffey and other experts emphasize that women considering a hysterectomy should discuss all options with their doctors.

¶Ask what the alternatives are and whether watchful waiting is an option. Remember that it is irreversible, regardless of how the surgery is done.

¶Learn about the nonreproductive functions of the uterus, ovaries and cervix, and the potential long-term consequences associated with their removal, as well as the function of the ovaries and cervix.

¶If you proceed, discuss the advantages and disadvantages of different surgical methods with your doctor. Interview several surgeons and inquire about the cost and how much insurance will cover. Your co-pay may vary depending on the surgical method.

¶Tell your surgeon if you do not want your ovaries and cervix removed.

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British Government Seeks to Limit Disclosure in Litvinenko Case

The British government sought on Tuesday to limit the information it is ready disclose at a planned inquest into the death of Alexander V. Litvinenko, a former officer in the K.G.B. who died of radiation poisoning in London more than six years ago, and the coroner hearing the case said it may now be postponed.

“Due to the complexity of the investigation which necessarily precedes the hearings” Sir Robert Owen, the coroner said, the planned May 1 start date for the hearings could represent “a timetable to which it may not be possible to adhere.”

The inquest would be the first — and likely the only — public forum at which witnesses would testify under oath about the killing, which strained Britain’s relationship with the Kremlin and kindled memories of the cold war.

The prospect of a postponement brought charges from Ben Emmerson, a lawyer representing Mr. Litvinenko’s widow, Marina Litvinenko, that the British government was trying to gag the inquiry in order to protect lucrative trade deals with Russia.

Referring to Prime Minister David Cameron, Mr. Emmerson said on Tuesday that “the British government, like the Russian government, is conspiring to get this inquest closed down in exchange for substantial trade interests which we know Mr. Cameron is pursuing."

He added: "One has to ask what is going on at the highest level of Her Majesty’s Government, particularly when the highest levels are building bridges with the Kremlin."

The British government, he said, had “no right to say to an independent judiciary, ’you may not investigate these issues’. That happens in Russia, for sure.”

“This has all the hallmarks of a situation which is shaping up to be a stain on British justice,” the lawyer said.

Sir Robert, the coroner, said he would rule on Wednesday on the government’s application for a so-called Public Interest Immunity Certificate, usually issued on the grounds of national security, which would prevent the inquest from hearing information on topics without explaining what those issues were.

British analysts say they believe Britain is keen to avoid disclosing any information that might link Mr. Litvinenko to the British security services.

Last December, Mr. Emmerson, the lawyer, told a preparatory hearing that that Mr. Litvinenko was a “registered and paid agent and employee of MI6,” as the British Secret Intelligence Service is known. Mr. Litvinenko also worked for the Spanish intelligence service, Mr. Emmerson said, and both the British and Spanish spy agencies made payments into a joint account with his wife. The lawyer added that the inquest should consider whether MI6 failed in its duty to protect the onetime KGB officer against a “real and immediate risk to life.”

Mr. Litvinenko, who fled Russia in 2000 and styled himself a whistle-blower and foe of the Kremlin, died in November 2006, aged 43, weeks after he secured British citizenship. He had ingested polonium 210 — a rare radioactive isotope — at the Pine Bar of the Millennium Hotel in London’ central Grosvenor Square.

Britain’s Crown Prosecution Service is seeking the extradition from Russia of Andrei K. Lugovoi, another former K.G.B. officer, to face trial on murder charges. Mr. Lugovoi denies the accusation and Russia says its Constitution forbids it from sending its citizens to other countries to face trial.

The coroner has said in previous hearings that he will examine what was known about threats to Mr. Litvinenko and would also seek to determine whether the Russian state bore responsibility. In a deathbed statement, Mr. Litvinenko directly blamed President Vladimir V. Putin, who dismissed the accusation. Mr. Emmerson, the lawyer, complained on Tuesday that the preparations for the inquest were becoming “bogged down” by “the government’s attempt to keep a lid on the truth.”

“It is the government’s secret files that are delaying this inquest.”

British media outlets including the BBC and The Guardian newspaper are opposing the government’s effort to restrict evidence. The Guardian said that “the public and media are faced with a situation where a public inquest into a death may have large amounts of highly relevant evidence excluded from consideration by the inquest. Such a prospect is deeply troubling.”

But the Foreign Office said the authorities had made their application in line with their “duty to protect national security” and the coroner would rule according to “the overall public interest.”

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Iran Enters Nuclear Talks in a Defiant Mood

TEHRAN — When Iran’s nuclear negotiating team sits down with its Western counterparts in Almaty, Kazakhstan, on Tuesday, it will offer no new plans or suggestions, people familiar with the views of the Iranian leadership say. More likely, they say, the Iranian negotiators will sit with arms crossed, demanding a Western change of heart.

Iran’s leaders believe that the effects of Western sanctions have been manageable, and Iran continues to make progress on what it says is a peaceful nuclear energy program. And Iran’s leaders see that North Korea, which openly admits that it wants nuclear weapons, has performed three nuclear tests without suffering any real penalties.

As a result, Iran’s leaders feel that they, not the West, hold the upper hand in negotiations. “The West has no option but stopping to threaten Iran and reduce sanctions,” said Kazem Anbarloui, the editor in chief of the state newspaper Resalat, who was appointed by Iran’s supreme leader, Ayatollah Ali Khamenei. “But it seems they just want to talk for the sake of talks.”

Further signaling that they expect a grand gesture, Iranian officials last week turned down a Western proposal to gradually lift sanctions on trading in gold in return for the closing of a mountain bunker enrichment facility called Fordo. They said the site, which is under an inspection regime by the United Nations nuclear watchdog, would never be shut down, because it afforded protection against attacks, particularly from Israel.

“Such a proposal would only help the Zionist regime to threaten our facilities,” an influential lawmaker, Ala’edin Borujerdi, told reporters. “They would never dare to attack us, but why would we tempt them?”

In recent days, dozens of Iranian politicians have made defiant statements, urging the United States and other nations to accept Iranian nuclear “realities,” which means unconditional acceptance of Iran’s nuclear energy program.

“If they want constructive negotiations, it’s better this time they come with a new strategy and credible proposals,” the top nuclear negotiator, Saeed Jalili, told reporters before his departure to Kazakhstan.

As a sign of their resistance to Western pressures, Iranian officials on Saturday announced the mass installment of higher-yielding enrichment centrifuges, said they had discovered new uranium mines, and designated new sites for future nuclear projects.

“You should raise the level of your tolerance,” Fereydoun Abbasi-Davani, the head of the Atomic Energy Organization of Iran, said on Saturday. “Try to find ways for cooperation with a country that is moving towards technological progress.”

On Sunday, Iranian lawmakers signed a petition urging their negotiating team to defend national interests in Almaty. “The West must learn that Iran’s nuclear train, which moves on the rails of peaceful goals, will never stop,” the petition read, according to the semiofficial Fars news agency.

At the same time, a former top nuclear negotiator, Ali Larijani, who is currently the head of the Iranian Parliament, stressed that reports by the United Nations watchdog, the International Atomic Energy Agency, had no effect on the “will and determination of the Iranian nation.”

Iranian officials do not deny that the sanctions have had an impact — Iran’s oil sales have fallen by more than half because of sanctions, and the national currency lost over 40 percent of its value in 2012, amid the international isolation of its central bank. But they say they are confident that the country can withstand any hardships the West imposes.

“The U.S. government is imposing all its power to impose pressure on us; they tell other countries not to trade with us,” President Mahmoud Ahmadinejad said on Saturday. “We will pass this situation.”

Ayatollah Khamenei gave much the same message in two addresses this month. “If the Iranian people had wanted to surrender to the Americans, they would not have carried out a revolution,” he said in a meeting at his private home, which was broadcast by the Iranian news media. “The people, particularly the underprivileged classes, truly feel the hardships. But they do not separate themselves from the Islamic Republic, because they know that the Islamic Republic and the dear Islam are the powerful hands which can solve the problems.”

In elevators, in private taxis and at family parties in the Iranian capital, many hope that the talks in Almaty will bring an end to the decade-long nuclear standoff. But few expect much. “Both the U.S. and our leaders will never give in,” said one judge who did not want his name mentioned because of the nature of his work. “There can only be one winner and one loser; no compromise.”

Ramtin Rastin contributed reporting.

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Johnson back on top with 2nd Daytona 500 victory

DAYTONA BEACH, Fla. (AP) — Jimmie Johnson went two years without a title and suddenly became an afterthought at the Daytona 500.

All the attention went to Danica Patrick and a handful of other drivers.

Not that it mattered Sunday, because look who pulled into Victory Lane.

Five-time is back. Not that he ever went away.

Johnson won his second Daytona 500 on Sunday, a year after he completed just one lap in the race and three months after falling short in his bid for a sixth Sprint Cup title. That so-called drought had made him something of a no-name during Speedweeks.

"In my mind, I didn't feel like I was under the radar," he said. "I felt like we were working hard to put the best product on the track. I guess I was quiet in the overall spectrum of things from the media side. I think people in the garage, people knew we were sitting on a lot of speed and had a very good race car."

But in winning the biggest race of the year, the No. 48 team wasn't sending a message to the competitors.

"I don't think we went anywhere; anybody in the garage area, they're wise to all that," Johnson said.

Johnson's win came on the same day that Patrick, who became the first woman in history to start a Sprint Cup race from the pole, again made history as the first woman to lead laps in the Daytona 500.

She ran inside the top 10 almost the entire race, kept pace with the field and never panicked on the track.

Her only mistakes were on pit road, where she got beat on the race back to the track, and on the final lap, when she was running third but got snookered by the veterans and faded to eighth. That's going to stick with Patrick for some time.

"I would imagine pretty much anyone would be kicking themselves about what they coulda, shoulda have done to give themselves an opportunity to win," she said. "I think that's what I was feeling today, was uncertainty as to how I was going to accomplish that."

There were several multicar crashes, but no one was hurt and none of them approached the magnitude of the wreck that injured more than two dozen fans in the grandstand at the end of the second-tier Nationwide Series race on the same track a day earlier. Daytona International Speedway workers were up until 2 a.m repairing the fence that was damaged in the accident, and track officials offered Sunday morning to move any fans who felt uneasy sitting close to the track.

Several drivers said the accident and concern for the fans stuck with them overnight and into Sunday morning, and Johnson was quick to send his thoughts from Victory Lane.

"I just want to give a big shout-out to all the fans, and I also want to send my thoughts and prayers out to everybody that was injured in the grandstands," Johnson said.

Dale Earnhardt Jr., whose father was killed in this race 12 years ago, was involved in Saturday's accident but refocused and finished second to Johnson, his Hendrick Motorsports teammate.

"Me personally, I was just really waiting to get the news on how everybody was, how all the fans were overnight, just hoping that things were going to improve," Earnhardt said, adding that he "wasn't really ready to proceed until you had some confirmation that things were looking more positive."

The race itself, the debut for NASCAR's new Gen-6 car, was quite similar to all the other Cup races during Speedweeks in that the cars seemed to line up in a single-file parade along the top groove of the track. It made the 55th running of the Daytona 500 relatively uneventful.

When the race was on the line, Johnson took off.

The driver known as "Five-time" raced past defending NASCAR champion Brad Keselowski on the final restart and pulled out to a sizeable lead that nobody challenged over the final six laps.

Johnson and Keselowski went down to the wire last season in their race for the Sprint Cup title, with Johnson faltering in the final two races as Keselowski won his first Cup championship.

Although it was a bit of an upset that stuck with Johnson into the offseason, it gave him no extra motivation when he found himself racing with Keselowski late Sunday for the Daytona 500.

"As far as racing with Brad out there, you really lose sight of who is in what car," Johnson said. "It's just somebody between you and the trophy. It could have been anybody."

Once Johnson cleared Keselowski on the last restart he had a breakaway lead with Greg Biffle and Patrick behind him. But as the field closed in on the checkered flag, Earnhardt finally made his move, just too late and too far behind to get close enough to the lead.

Earnhardt wound up second for the third time in the last four years. But with all the crashes the Hendrick cars have endured in restrictor-plate races — teammate Kasey Kahne was in the first accident Sunday — team owner Rick Hendrick was just fine with the finish.

"We have a hard time finishing these races. Boy, to run 1-2, man, what a day," Hendrick said. Jeff Gordon, who was a contender early, faded late to 20th.

And Johnson considered himself lucky to be the one holding the trophy at the end.

"Man, it's like playing the lottery; everybody's got a ticket," he said. "I've struck out a lot at these tracks, left with torn-up race cars. Today we had a clean day."

Mark Martin was third in a Michael Waltrip Racing Toyota. Keselowski, who overcame two accidents earlier in the race, wound up fourth in Penske Racing's new Ford. Ryan Newman was fifth in a Chevy for Stewart-Haas Racing and was followed by Roush-Fenway Racing's Greg Biffle, who was second on the last lap but was shuffled back with Patrick to finish sixth.

Regan Smith was seventh for Phoenix Racing, while Patrick, Michael McDowell and JJ Yeley rounded out the top 10.

Patrick was clearly disappointed with her finish. When the race was on the line, she was schooled by Earnhardt, who made his last move and blocked any chance she had.

Still, Patrick became the first woman in history to lead laps in the 500 when she passed Michael Waltrip on a restart on Lap 90. She stayed on the point for two laps, then was shuffled back to third. She ended up leading five laps, another groundbreaking moment for Patrick, who as a rookie in 2005 became the first woman to lead the Indianapolis 500 and now is the 13th driver to lead laps in both the Daytona 500 and the Indy 500.

"Dale did a nice job and showed what happens when you plan it out, you drop back and get that momentum. You are able to go to the front," Patrick said. "I think he taught me something. I'm sure I'll watch the race and there will be other scenarios I see that can teach me, too."

Earnhardt was impressed, nonetheless.

"She's going to make a lot of history all year long. It's going to be a lot of fun to watch her progress," he said. "Every time I've seen her in a pretty hectic situation, she always really remained calm. She's got a great level head. She's a racer. She knows what's coming. She's smart about her decisions. She knew what to do today as far as track position and not taking risks. I enjoy racing with her."

Johnson, one of three heavyweight drivers who took their young daughters to meet Patrick — "the girl in the bright green car" — after she won the pole in qualifications, tipped his cap, too.

"I didn't think about it being Danica in the car," Johnson said. "It was just another car on the track that was fast. That's a credit to her and the job she's doing."

The field was weakened by an early nine-car accident that knocked out race favorite Kevin Harvick and sentimental favorite Tony Stewart.

Harvick had won two support races coming into the 500 to cement himself as the driver to beat, but the accident sent him home with a 42nd place finish.

Stewart, meanwhile, dropped to 0-for-15 in one of the few races the three-time NASCAR champion has never won.

"If I didn't tell you I was heartbroken and disappointed, I'd be lying to you," Stewart said.

That accident also took former winner Jamie McMurray, his Chip Ganassi Racing teammate Juan Pablo Montoya, and Kasey Kahne out of contention.

The next accident — involving nine cars — came 105 laps later and brought a thankful end to Speedweeks for Carl Edwards. He was caught in his fifth accident since testing last month, and this wreck collected six other Ford drivers.

The field suddenly had six Toyota drivers at the front as Joe Gibbs Racing and Michael Waltrip Racing drivers took control of the race. But JGR's day blew up — literally — when the team was running 1-2-3 with Matt Kenseth, Denny Hamlin and Kyle Busch setting the pace.

Kenseth, who led a race-high 86 laps, went to pit road first with an engine problem, and Busch was right behind him with a blown engine. Busch was already in street clothes watching as Hamlin led the field.

"It's a little devastating when you are running 1-2-3 like that," Busch said.

Hamlin's shot disappeared when he found himself in the wrong lane on the final restart. He tried to hook up with Keselowski to get them back to Johnson, but blamed former teammate Joey Logano for ruining the momentum of the bottom lane.

Hamlin offered a backhanded apology to Keselowski on Twitter, posting that he couldn't get close enough because "your genius teammate was too busy messing up the inside line 1 move at a time."

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Mediterranean Diet Can Cut Heart Disease, Study Finds

About 30 percent of heart attacks, strokes and deaths from heart disease can be prevented in people at high risk if they switch to a Mediterranean diet rich in olive oil, nuts, beans, fish, fruits and vegetables, and even drink wine with meals, a large and rigorous new study found.

The findings, published on the New England Journal of Medicine’s Web site on Monday, were based on the first major clinical trial to measure the diet’s effect on heart risks. The magnitude of the diet’s benefits startled experts. The study ended early, after almost five years, because the results were so clear it was considered unethical to continue.

The diet helped those following it even though they did not lose weight and most of them were already taking statins, or blood pressure or diabetes drugs to lower their heart disease risk.

“Really impressive,” said Rachel Johnson, a professor of nutrition at the University of Vermont and a spokeswoman for the American Heart Association. “And the really important thing — the coolest thing — is that they used very meaningful end points. They did not look at risk factors like cholesterol of hypertension or weight. They looked at heart attacks and strokes and death. At the end of the day, that is what really matters.”

Until now, evidence that the Mediterranean diet reduced the risk of heart disease was weak, based mostly on studies showing that people from Mediterranean countries seemed to have lower rates of heart disease — a pattern that could have been attributed to factors other than diet.

And some experts had been skeptical that the effect of diet could be detected, if it existed at all, because so many people are already taking powerful drugs to reduce heart disease risk, while other experts hesitated to recommend the diet to people who already had weight problems, since oils and nuts have a lot of calories.

Heart disease experts said the study was a triumph because it showed that a diet is powerful in reducing heart disease risk, and it did so using the most rigorous methods. Scientists randomly assigned 7,447 people in Spain who were overweight, were smokers, had diabetes or other risk factors for heart disease to follow the Mediterranean diet or a low-fat one.

Low-fat diets have not been shown in any rigorous way to be helpful, and they are also very hard for patients to maintain — a reality born out in the new study, said Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic Foundation.

“Now along comes this group and does a gigantic study in Spain that says you can eat a nicely balanced diet with fruits and vegetables and olive oil and lower heart disease by 30 percent,” he said. “And you can actually enjoy life.”

The study, by Dr. Ramon Estruch, a professor of medicine at the University of Barcelona, and his colleagues, was long in the planning. The investigators traveled the world, seeking advice on how best to answer the question of whether a diet alone could make a big difference in heart disease risk. They visited the Harvard School of Public Health several times to consult Dr. Frank M. Sacks, a professor of cardiovascular disease prevention there.

In the end, they decided to randomly assign subjects at high risk of heart disease to three groups. One would be given a low-fat diet and counseled on how to follow it. The other two groups would be counseled to follow a Mediterranean diet. At first the Mediterranean dieters got more intense support. They met regularly with dietitians while the low-fat group just got an initial visit to train them in how to adhere to the diet followed by a leaflet each year on the diet. Then the researchers decided to add more intensive counseling for them, too, but they still had difficulty staying with the diet.

One group assigned to a Mediterranean diet was given extra virgin olive oil each week and was instructed to use at least 4 tablespoons a day. The other group got a combination of walnuts, almonds and hazelnuts and was instructed to eat about an ounce of them each day. An ounce of walnuts, for example, is about a quarter cup — a generous handful. The mainstays of the diet consisted of at least 3 servings a day of fruits and at least two servings of vegetables. Participants were to eat fish at least three times a week and legumes, which include beans, peas and lentils, at least three times a week. They were to eat white meat instead of red, and, for those accustomed to drinking, to have at least 7 glasses of wine a week with meals.

They were encouraged to avoid commercially made cookies, cakes and pastries and to limit their consumption of dairy products and processed meats.

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Many Cruise Ship Lack Backup Power Systems, Vexing Regulators

Denis Poroy/Associated Press

The Carnival Splendor cruise ship was towed into San Diego Bay in 2010, after a fire destroyed its electrical systems.

It is becoming a familiar tale: When the cruise ship was towed into port, the endless hours for passengers of sleeping on deck and going without electricity or toilets were finally over.

“It was really hell,” said Bernice Spreckman, who is 77 and lives in Yonkers, N.Y. “I used my life jacket, which was flashing with a little light on it, to find a bathroom it was so dark.”

Ms. Spreckman was not among the 4,200 people aboard the Carnival Triumph who this month endured five days of sewage-soaked carpets and ketchup sandwiches. Her trial at sea came in 2010, on another ship run by Carnival Cruises, called the Splendor, which carried 4,500 passengers.

On both ships, fires broke out below decks, destroying the electrical systems and leaving them helpless. A preliminary Coast Guard inquiry into the Splendor found glaring deficiencies in its firefighting operations, including manuals that called for crew members to “pull” valves that were designed to turn.

But more than two years after the episode, the final report about what happened on the Splendor has yet to appear, a reflection of what critics say is a pattern of international regulatory roulette that governs cruise ship safety.

While the Splendor was based in the United States, the ship was legally registered in Panama, meaning the Panamanian Maritime Authority had the right to lead the investigation. But after the 2010 fire, Panamanian regulators chose to have the Coast Guard take over the inquiry. Then, officials in both countries apparently spent months trading drafts of their reports.

One official in Panama said the authority had completed its review of the Splendor report in October 2012. But a Coast Guard spokeswoman, Lisa Novak, said it still had not “finalized” the report. In the case of the Carnival Triumph, the regulatory scene will shift to the Bahamas, where that ship was registered.

In a recent letter to Coast Guard officials, Senator Jay Rockefeller, Democrat of West Virginia, said that cruise ships seemed to have two separate lives. Only during days near port are they closely monitored.

“Once they are beyond three nautical miles from shore, the world is theirs,” said the letter from Senator Rockefeller, who has headed recent inquiries into cruise ship safety.

Cruise industry officials point out that seaborne vacations are extremely safe and that some 20 million people go on cruises annually, with few problems. The most glaring exception to that record occurred last year when a vessel operated by a subsidiary of Carnival, the Costa Concordia, ran aground off the coast of Italy, resulting in 32 deaths.

In the Triumph’s case, the Coast Guard has said that the ship’s safety equipment failed to contain the blaze. And both the Triumph and the Splendor returned from their aborted voyages without serious injuries to passengers or crew.

But those successes also underscore what most travelers do not realize when they book cruises: nearly all ships lack backup systems to help them return to port should power fail because to install them would have cost operators more money.

The results are repeated episodes involving dead ships, with all the discomforts and potential dangers such situations can bring. In another case, in late 2012, the Costa Allegra cruise ship, a sister ship of the Concordia, lost power after a fire in the generator room and it had to be towed under guard from its location in the Indian Ocean.

In many ways, passengers aboard boats like the Triumph and Splendor were lucky because their ships were disabled in calm weather, when instead they could have been knocked out during storms, or when they were far out at sea or in pirate-infested waters, experts said.

“Anything that knocks a ship dead in the water is serious,” said Mark Gaouette, a safety expert and former Navy officer.

This article has been revised to reflect the following correction:

Correction: February 25, 2013

A caption with an earlier version of this article misstated the number of passengers on the Carnival Splendor when it was disabled at sea. There were 4,500 aboard, not 14,500.

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IHT Rendezvous: As Oscars Fever Builds, Some Chinese Ask: ‘What About Our Films?’

BEIJING — As Oscar fever grows around the world with the 85th Academy Awards set to begin in Los Angeles just hours from now, excitement is building in China, even though it has no films in competition. There is also a sense of frustration here about why China’s movies aren’t nominated for the world’s biggest awards?

China sees itself as advancing in many ways, growing richer and more powerful, so its inability to come up with serious Oscars contenders rankles.

The most popular answer to the question, held by ordinary Chinese and film experts alike, is: “Too few good films. That’s the real reason in recent years Chinese films have moved further and further away from the Oscars dream,” wrote The International Herald Leader newspaper, in a story carried on the country’s popular Tencent entertainment site.

An article by The Economic Daily, carried on People’s Daily Web site, gave another interpretation: “The Oscars have never been a communal forum, the films taken seriously have only the responsibility to portray the North American world view and the lives they’re willing to see.”

As I’ve explored elsewhere, strict censorship hobbles the Chinese film industry. Directors are increasingly voicing their frustration in public, yet there’s little they can do against the directives of the state. One result of this hamstringing of talent is it’s virtually impossible to make probing films about contemporary society, which has many social tensions the government doesn’t want openly explored. Instead, filmmakers retreat to the safety of historical themes, with tales of warring dynasties commonplace.

Also, strict import rules governing overseas movies mean few may be shown here. As a person with the handle LA-YIN wrote on Sina Weibo, the microblog: “With the exception of Ang Lee’s ‘Life of Pi,’ none of the nominated films has screened in China.”

Much attention is being focused on a prediction of winners in an annual list drawn up by the actress Zhang Ziyi. Ms. Zhang starred in “Crouching Tiger, Hidden Dragon,” a hit in 2000 by the Taiwanese director Ang Lee. She is also the first Chinese star from the People’s Republic of China to be listed on the jury for the Oscars, in 2005, Xinhua, the state news agency, reported.

Many netizens are pointing out that Ms. Zhang’s list runs at an estimated 90 percent accuracy rate. So what’s she tapping?

Best Director? Mr. Lee and Steven Spielberg (“Lincoln”) are in tight competition, she writes. “Emotionally, I’m drawn to Ang Lee. Intellectually I’m drawn to Spielberg. These are the two films I’ve liked most this year.”

Best Film? “Lincoln. Whether you like the movie or not, it gives off glamor and radiance. I salute Spielberg’s youthfulness,” she wrote.

China is 16 hours ahead of Los Angeles, so watching will be tricky for people headed into a normal working day on Monday. As –Mostro- wrote on a microblog site, “It’s the Oscars today!!!!!!! But it’ll only be on tomorrow, Beijing time ….I can’t watch it,” followed by four yellow, grimacing emoticons.

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The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain

Matt Rainwaters for Texas Monthly

The Sherman grave of Andre Thomas’s victims.

SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org

Matt Rainwaters for Texas Monthly

Laura Boren

He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.

He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.

In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.

Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.

“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.

From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.

bgrissom@texastribune.org

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Major Banks Aid in Payday Loans Banned by States

Major banks have quickly become behind-the-scenes allies of Internet-based payday lenders that offer short-term loans with interest rates sometimes exceeding 500 percent.

With 15 states banning payday loans, a growing number of the lenders have set up online operations in more hospitable states or far-flung locales like Belize, Malta and the West Indies to more easily evade statewide caps on interest rates.

While the banks, which include giants like JPMorgan Chase, Bank of America and Wells Fargo, do not make the loans, they are a critical link for the lenders, enabling the lenders to withdraw payments automatically from borrowers’ bank accounts, even in states where the loans are banned entirely. In some cases, the banks allow lenders to tap checking accounts even after the customers have begged them to stop the withdrawals.

“Without the assistance of the banks in processing and sending electronic funds, these lenders simply couldn’t operate,” said Josh Zinner, co-director of the Neighborhood Economic Development Advocacy Project, which works with community groups in New York.

The banking industry says it is simply serving customers who have authorized the lenders to withdraw money from their accounts. “The industry is not in a position to monitor customer accounts to see where their payments are going,” said Virginia O’Neill, senior counsel with the American Bankers Association.

But state and federal officials are taking aim at the banks’ role at a time when authorities are increasing their efforts to clamp down on payday lending and its practice of providing quick money to borrowers who need cash.

The Federal Deposit Insurance Corporation and the Consumer Financial Protection Bureau are examining banks’ roles in the online loans, according to several people with direct knowledge of the matter. Benjamin M. Lawsky, who heads New York State’s Department of Financial Services, is investigating how banks enable the online lenders to skirt New York law and make loans to residents of the state, where interest rates are capped at 25 percent.

For the banks, it can be a lucrative partnership. At first blush, processing automatic withdrawals hardly seems like a source of profit. But many customers are already on shaky financial footing. The withdrawals often set off a cascade of fees from problems like overdrafts. Roughly 27 percent of payday loan borrowers say that the loans caused them to overdraw their accounts, according to a report released this month by the Pew Charitable Trusts. That fee income is coveted, given that financial regulations limiting fees on debit and credit cards have cost banks billions of dollars.

Some state and federal authorities say the banks’ role in enabling the lenders has frustrated government efforts to shield people from predatory loans — an issue that gained urgency after reckless mortgage lending helped precipitate the 2008 financial crisis.

Lawmakers, led by Senator Jeff Merkley, Democrat of Oregon, introduced a bill in July aimed at reining in the lenders, in part, by forcing them to abide by the laws of the state where the borrower lives, rather than where the lender is. The legislation, pending in Congress, would also allow borrowers to cancel automatic withdrawals more easily. “Technology has taken a lot of these scams online, and it’s time to crack down,” Mr. Merkley said in a statement when the bill was introduced.

While the loans are simple to obtain — some online lenders promise approval in minutes with no credit check — they are tough to get rid of. Customers who want to repay their loan in full typically must contact the online lender at least three days before the next withdrawal. Otherwise, the lender automatically renews the loans at least monthly and withdraws only the interest owed. Under federal law, customers are allowed to stop authorized withdrawals from their account. Still, some borrowers say their banks do not heed requests to stop the loans.

Ivy Brodsky, 37, thought she had figured out a way to stop six payday lenders from taking money from her account when she visited her Chase branch in Brighton Beach in Brooklyn in March to close it. But Chase kept the account open and between April and May, the six Internet lenders tried to withdraw money from Ms. Brodsky’s account 55 times, according to bank records reviewed by The New York Times. Chase charged her $1,523 in fees — a combination of 44 insufficient fund fees, extended overdraft fees and service fees.

For Subrina Baptiste, 33, an educational assistant in Brooklyn, the overdraft fees levied by Chase cannibalized her child support income. She said she applied for a $400 loan from Loanshoponline.com and a $700 loan from Advancemetoday.com in 2011. The loans, with annual interest rates of 730 percent and 584 percent respectively, skirt New York law.

Ms. Baptiste said she asked Chase to revoke the automatic withdrawals in October 2011, but was told that she had to ask the lenders instead. In one month, her bank records show, the lenders tried to take money from her account at least six times. Chase charged her $812 in fees and deducted over $600 from her child-support payments to cover them.

“I don’t understand why my own bank just wouldn’t listen to me,” Ms. Baptiste said, adding that Chase ultimately closed her account last January, three months after she asked.

A spokeswoman for Bank of America said the bank always honored requests to stop automatic withdrawals. Wells Fargo declined to comment. Kristin Lemkau, a spokeswoman for Chase, said: “We are working with the customers to resolve these cases.” Online lenders say they work to abide by state laws.

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