Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative. M.R.I. helped pay for previous vaccination campaigns in the country and the GAVI Alliance is helping financing the upcoming one.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

This article has been revised to reflect the following correction:

Correction: February 27, 2013

An earlier version of this article misstated the source of the financing for the upcoming vaccination campaign in Rwanda. It is being financed by the GAVI Alliance, not the Measles and Rubella Initiative.

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DealBook: Obama’s Nominee for S.E.C. Tries to Allay Skepticism

Mary Jo White’s path to the Securities and Exchange Commission has reached a crucial juncture: the Congressional charm campaign.

Lawmakers are scrutinizing Ms. White ahead of her Senate confirmation hearing, raising questions about the former prosecutor’s lack of regulatory experience and the challenge of policing Wall Street firms she recently defended in private practice. But Ms. White is seeking to quell concerns about potential conflicts of interest.

She recently scheduled meetings with Senate Banking Committee members, who must clear her nomination, and answered a 20-page boilerplate questionnaire detailing her qualifications, according to a copy provided to The New York Times. The document sheds new light on her list of Wall Street clients, including little-known work performed for HSBC’s former chief executive. It also describes her ties to New York Democratic causes and laurels she earned both as a defense lawyer and federal prosecutor.

The questionnaire, created by the banking committee, focused significant attention on her movement through the revolving door between government service and private practice, a concern that has loomed since President Obama nominated Ms. White in January.

“As a government official, I believe I have an established track record and the reputation of being tough, but fair,” she said in the document.

Ms. White also offered a previously undisclosed concession, vowing “as far as can be foreseen,” never to return to Debevoise & Plimpton, where she had built a lucrative legal practice. To avert potential conflicts stemming from her work on behalf of Wall Street giants, Ms. White had already agreed to recuse herself for one year from most matters that involve former clients.

While Ms. White’s nomination is expected to sail through the committee before receiving full Senate approval, four Congressional officials who spoke anonymously warned that some Democrats have lingering reservations.

The Democrats note that her husband, John W. White, is co-chairman of the corporate governance practice at Cravath, Swaine & Moore, where he represents many of the companies that the S.E.C. regulates. They also question whether Ms. White’s recusals, even if well-intentioned, could cripple her ability to run the agency.

In a meeting on Tuesday with Senator Sherrod Brown, Democrat of Ohio, Ms. White did little to alleviate the fears.

“Senator Brown respects Ms. White’s credentials and experience, but is concerned with Washington’s long-held bias toward Wall Street,” his spokeswoman, Meghan Dubyak, said in a statement. “He pushed Ms. White,” to explain “whether her previous employment or her spouse’s current employment could cause her to recuse herself from key business facing the S.E.C.” The agency has already fallen behind in writing dozens of new rules for Wall Street.

Ms. White’s supporters counter that, before the White House announced the appointment, the Office of Government Ethics vetted her disclosures. The nonpartisan officials concluded that, even with her recusals, Ms. White could effectively run the agency.

Her supporters also trumpet her long tenure as a tenacious prosecutor. During stints as a federal prosecutor in Brooklyn and as the first woman United States attorney in Manhattan, she helped oversee the prosecution of the crime figure John Gotti and directed the case against those responsible for the 1993 World Trade Center bombing. The cases won her praise from several lawmakers.

Ms. White still has time to win over remaining skeptics. Her confirmation hearing is not expected until the week of March 11, Congressional officials briefed on the matter said.

Until then, Ms. White is blitzing through the halls of Congress, a routine practice for nominees. She began her charm offensive at the top of the banking committee’s roster, visiting this month with the Democratic chairman, Senator Tim Johnson, of South Dakota. A Congressional official briefed on the matter said Ms. White performed well at the gathering, and no major issues arose.

In the next round of meetings, she will face off with a more liberal arm of the committee known to scrutinize nominees. After meeting Mr. Brown, Ms. White is scheduled to see Senator Jeff Merkley, Democrat of Oregon. She also will meet Elizabeth Warren, the Massachusetts Democrat who is an outspoken critic of Wall Street, Ms. Warren’s office confirmed on Tuesday.

Even if Ms. White fails to satisfy lawmakers’ concerns, the meetings are an important step in clearing the way for her appointment.

“Senators will have a chance to size Mary Jo up, and I believe will come away with a great sense of comfort that she’s a candidate of true quality,” said Harvey Pitt, who passed through the confirmation process in 2001 to lead the S.E.C.

He noted that additional disclosures could bolster her candidacy. “I do think she will need to provide a level of comfort to the committee that she is aware of the issue, has a definitive plan for navigating through the potential conflict issues, and will be completely open about when she has a potential recusal issue, and how she has handled it,” he said.

Ms. White, a political independent, assured lawmakers in her questionnaire that she was “completely independent of political or personal influences.” She did disclose, however, $13,000 in campaign donations to Democratic candidates. She also served on the campaign committee of a Democrat who had run for New York attorney general.

Her ties to Debevoise — and its clients — are more significant; she represented JPMorgan Chase, UBS and Michael Geoghegan, the former head of HSBC.

Ms. White, 65, said this month said that she would retire from Debevoise after taking over the S.E.C. and would forgo the firm’s typical retirement perks: office space and a free BlackBerry. She also will sever financial ties to the firm during her term at the S.E.C., taking an upfront lump-sum retirement payment rather than collecting a monthly installment of $42,500.

Her husband has also offered concessions. He agreed to convert his partnership at Cravath, Swaine & Moore from equity to nonequity status and promised not to “communicate directly” with the S.E.C. about rule-making. Ms. White will not participate in a matter with a direct effect on his compensation.

In line with a standard move for federal appointees, Ms. White further agreed to recuse herself for one year from voting on enforcement cases involving Debevoise clients. There are limitations to the policy, though, in case it is “in the public interest” and a “reasonable” person would not object.

Some lawmakers dismiss questions about her potential conflicts, but still question her mastery of regulatory minutiae. While Ms. White is a skilled litigator, she lacks experience in financial rule-writing, unlike a predecessor, Mary Schapiro, a lifelong regulator who ran the S.E.C. for nearly four years.

In her questionnaire, Ms. White highlighted her role as a director of the Nasdaq exchange and other experiences that she said gave her “a firm grounding” in securities laws.

She also, inadvertently, drew a connection to Ms. Schapiro. Like Ms. Schapiro, Ms. White is an animal lover, currently serving as a board member of the American Society for the Prevention of Cruelty to Animals.

She agreed to step down from the board once she is sworn in at the S.E.C.

A version of this article appeared in print on 02/27/2013, on page B1 of the NewYork edition with the headline: Nominee For S.E.C. Tries to Allay Skepticism.

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Benedict XVI to Keep His Name and Become Pope Emeritus

VATICAN CITY — Pope Benedict XVI will keep the name Benedict XVI and become the Roman pontiff emeritus or pope emeritus, the Vatican announced Tuesday, putting an end to days of speculation on how the pope will be addressed once he ceases to be the leader of the world’s 1.1 billion Roman Catholics on Thursday.

Benedict, the first pope to resign voluntarily in six centuries, will dress in a simple white cassock, forgoing the mozzetta, the elbow-length cape worn by some Catholic clergymen, the Vatican spokesman, the Rev. Federico Lombardi, told reporters at a news briefing.

And he will no longer wear the red shoes typically worn by popes, symbolizing the blood of the martyrs, Father Lombardi said, opting instead for a more quotidian brown. “Mexicans will be happy to know that the pope very much appreciated the shoes” he received as a gift last year in León, Mexico, he added. “He finds them very comfortable.” It was after the grueling trip in March 2012 that the pope began to seriously consider resigning, the Vatican said after the pope announced his resignation on Feb. 11.

Father Lombardi said the pope had decided on his couture in consultation with other Vatican officials. Benedict will also stop using the so-called fisherman’s ring to seal documents. It will be destroyed by the cardinal camerlengo, the acting head of state of Vatican City during the “sede vacante,” the canon law term used when the papacy is vacant.

As his staff finishes packing up his personal belongings, the pope will hold his scheduled weekly audience Wednesday — to which 50,000 tickets have already been requested — and then meet with several dignitaries, including the presidents of Slovakia and of the German region of Bavaria, who have traveled to Rome to bid their respects.

Thursday will be a day of goodbyes, to the cardinals already present in Rome, and later to some members of the Curia. In the afternoon, he will depart for Castel Gandolfo, the summer residence of popes, where he will remain until restorations are complete on the convent inside the Vatican where he will live out his days.

Father Lombardi said the College of Cardinals would probably begin meeting next Monday to discuss various issues, like the problems facing the church and the qualities required of its next leader, and determine the date of the start of the conclave to choose Benedict’s successor.

Gaia Pianigiani reported from Vatican City, and Elisabetta Povoledo from Rome.

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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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