Cruise executive: 'Sorry for what guests had to endure'

MOBILE, Alabama—

Reeking of raw sewage, a crippled cruise ship carrying more than 4,200 people was limping into Mobile, Alabama, on Thursday as passengers awaited the end of a vacation voyage some described as hellish.

The Carnival Triumph was being towed into port by tugboats as the drama played out live on U.S. cable news stations, creating another public relations nightmare for cruise giant Carnival Corp. Last year, its Costa Concordia luxury ship grounded off the coast of Italy, with 32 people killed.

Passengers described an overpowering stench on board the ship four days after an engine room fire knocked out power and plumbing across most of the 893-foot vessel and left it adrift in the Gulf of Mexico. The ship, which went into service in 1999, was on a four-day cruise and on its way back from a stop in Cozumel, Mexico.

After the mishap, toilets and drainpipes overflowed, soaking many cabins and interior passages in sewage and turning the vessel into what some have described as a giant Petri dish.

"The thing I'm looking forward to most is having a working toilet and not having to breathe in the smell of fecal matter," said Jacob Combs, an Austin, Texas-based sales executive with a healthcare and hospice company.

Combs, 30, who said he had been traveling with friends and family on the Triumph, had nothing but praise for its crew members, saying they had gone through "hell" cleaning up after some of the passengers on the sea cruise.

"Just imagine the filth," Combs told Reuters. "People were doing crazy things and going to the bathroom in sinks and showers. It was inhuman. The stewards would go in and clean it all up. They were constantly cleaning," he said.

Terry Thornton, a Carnival Cruise Lines senior vice president, told reporters in Mobile that additional provisions were laid in on Wednesday and the ship was now "in excellent shape."

Passenger Donna Gutzman said those aboard the ship were treated to steak and lobster for lunch on Thursday afternoon.

"Our basic needs are being met. For the most part, they are making us happy," Gutzman told CNN.

The ship was expected to arrive in port around midnight CST, Carnival said. A senior Carnival official said it could take up to five hours to remove all the passengers from the ship, which has only one functioning elevator.

Operated by Carnival Cruise Lines, the flagship brand of Carnival Corp, the ship left Galveston, Texas, a week ago carrying 3,143 passengers and 1,086 crew. It was supposed to return there on Monday.

A Coast Guard cutter has been escorting the Triumph on its long voyage into port since Monday, and a Coast Guard helicopter ferried about 3,000 pounds of equipment including a generator to the stricken ship late on Wednesday.

Earlier in the week, some passengers reported on the poor conditions on the Triumph when they contacted relatives and media before their cell phone batteries died. They said people were getting sick and passengers had been told to use plastic "biohazard" bags as makeshift toilets.

'VERY CHALLENGING CIRCUMSTANCES'

Carnival Cruise Lines Chief Executive Gerry Cahill said in a statement late on Wednesday that the company had decided to add further payment of $500 a person to help compensate passengers for "very challenging circumstances" aboard the ship.

"We are very sorry for what our guests have had to endure," Cahill said.

Mary Poret, who spoke to her 12-year-old daughter aboard the Triumph on Monday, rejected Cahill's apology in comments to CNN on Thursday, as she waited anxiously in Mobile with a friend for the Triumph's arrival.

"Seeing urine and feces sloshing in the halls, sleeping on the floor, nothing to eat, people fighting over food, $500? What's the emotional cost? You can't put money on that," Porte said.

Carnival Corp Chairman and CEO Micky Arison faced criticism in January 2012 for failing to travel to Italy and take personal charge of the Costa Concordia crisis after the luxury cruise shop operated by Carnival's Costa Cruises brand grounded on rocks off the Tuscan island of Giglio. The tragedy unleashed numerous lawsuits against his company.

The cruise ship mogul has taken a low-key approach to the Triumph situation as well, even as it grabbed a growing share of the U.S. media spotlight. His only known public appearance since Sunday was courtside on Tuesday at a game played by his Miami Heat championship professional basketball team.

"I think they really are trying to do the right thing, but I don't think they have been able to communicate it effectively," said Marcia Horowitz, an executive who handles crisis management at Rubenstein Associates, a New York-based public relations firm.

"Most of all, you really need a face for Carnival," she added. "You can do all the right things. But unless you communicate it effectively, it will not see the light of day."

Carnival Corp shares closed down $0.11 at $37.35 in trading on Thursday on the New York Stock Exchange. The shares closed down 4 percent at $37.46 on Wednesday after the company said voyage disruptions and repair costs related to Carnival Triumph could shave up to 10 cents a share off its second-half earnings.

The Triumph is a Bahamian-flagged vessel and the Bahamas Maritime Authority will be the primary agency investigating the cause of its engine room fire.

For all the passengers' grievances, they will likely find it difficult to sue the cruise operator for any damages, legal sources said. Over the years, the cruise industry has put in place a legal structure that ring-fences operators from big-money lawsuits.

Rules for seeking redress are spelled out in complex, multi-page ticket contracts that have been the subject of decades of court battles. Victims are often required to proceed with any litigation in remote jurisdictions.

(Reporting by Tom Brown, Kevin Gray and David Adams; Editing by Peter Cooney)

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Doctor and Patient: Afraid to Speak Up to Medical Power

The slender, weather-beaten, elderly Polish immigrant had been diagnosed with lung cancer nearly a year earlier and was receiving chemotherapy as part of a clinical trial. I was a surgical consultant, called in to help control the fluid that kept accumulating in his lungs.

During one visit, he motioned for me to come closer. His voice was hoarse from a tumor that spread, and the constant hissing from his humidified oxygen mask meant I had to press my face nearly against his to understand his words.

“This is getting harder, doctor,” he rasped. “I’m not sure I’m up to anymore chemo.”

I was not the only doctor that he confided to. But what I quickly learned was that none of us was eager to broach the topic of stopping treatment with his primary cancer doctor.

That doctor was a rising superstar in the world of oncology, a brilliant physician-researcher who had helped discover treatments for other cancers and who had been recruited to lead our hospital’s then lackluster cancer center. Within a few months of the doctor’s arrival, the once sleepy department began offering a dazzling array of experimental drugs. Calls came in from outside doctors eager to send their patients in for treatment, and every patient who was seen was promptly enrolled in one of more than a dozen well-documented treatment protocols.

But now, no doctors felt comfortable suggesting anything but the most cutting-edge, aggressive treatments.

Even the No. 2 doctor in the cancer center, Robin to the chief’s cancer-battling Batman, was momentarily taken aback when I suggested we reconsider the patient’s chemotherapy plan. “I don’t want to tell him,” he said, eyes widening. He reeled off his chief’s vast accomplishments. “I mean, who am I to tell him what to do?”

We stood for a moment in silence before he pointed his index finger at me. “You tell him,” he said with a smile. “You tell him to consider stopping treatment.”

Memories of this conversation came flooding back last week when I read an essay on the problems posed by hierarchies within the medical profession.

For several decades, medical educators and sociologists have documented the existence of hierarchies and an intense awareness of rank among doctors. The bulk of studies have focused on medical education, a process often likened to military and religious training, with elder patriarchs imposing the hair shirt of shame on acolytes unable to incorporate a profession’s accepted values and behaviors. Aspiring doctors quickly learn whose opinions, experiences and voices count, and it is rarely their own. Ask a group of interns who’ve been on the wards for but a week, and they will quickly raise their hands up to the level of their heads to indicate their teachers’ status and importance, then lower them toward their feet to demonstrate their own.

It turns out that this keen awareness of ranking is not limited to students and interns. Other research has shown that fully trained physicians are acutely aware of a tacit professional hierarchy based on specialties, like primary care versus neurosurgery, or even on diseases different specialists might treat, like hemorrhoids and constipation versus heart attacks and certain cancers.

But while such professional preoccupation with privilege can make for interesting sociological fodder, the real issue, warns the author of a courageous essay published recently in The New England Journal of Medicine, is that such an overly developed sense of hierarchy comes at an unacceptable price: good patient care.

Dr. Ranjana Srivastava, a medical oncologist at the Monash Medical Centre in Melbourne, Australia, recalls a patient she helped to care for who died after an operation. Before the surgery, Dr. Srivastava had been hesitant to voice her concerns, assuming that the patient’s surgeon must be “unequivocally right, unassailable, or simply not worth antagonizing.” When she confesses her earlier uncertainty to the surgeon after the patient’s death, Dr. Srivastava learns that the surgeon had been just as loath to question her expertise and had assumed that her silence before the surgery meant she agreed with his plan to operate.

“Each of us was trying our best to help a patient, but we were also respecting the boundaries and hierarchy imposed by our professional culture,” Dr. Srivastava said. “The tragedy was that the patient died, when speaking up would have made all the difference.”

Compounding the problem is an increasing sense of self-doubt among many doctors. With rapid advances in treatment, there is often no single correct “answer” for a patient’s problem, and doctors, struggling to stay up-to-date in their own particular specialty niches, are more tentative about making suggestions that cross over to other doctors’ “turf.” Even as some clinicians attempt to compensate by organizing multidisciplinary meetings, inviting doctors from all specialties to discuss a patient’s therapeutic options, “there will inevitably be a hierarchy at those meetings of who is speaking,” Dr. Srivastava noted. “And it won’t always be the ones who know the most about the patient who will be taking the lead.”

It is the potentially disastrous repercussions for patients that make this overly developed awareness of rank and boundaries a critical issue in medicine. Recent efforts to raise safety standards and improve patient care have shown that teams are a critical ingredient for success. But simply organizing multidisciplinary lineups of clinicians isn’t enough. What is required are teams that recognize the importance of all voices and encourage active and open debate.

Since their patient’s death, Dr. Srivastava and the surgeon have worked together to discuss patient cases, articulate questions and describe their own uncertainties to each other and in patients’ notes. “We have tried to remain cognizant of the fact that we are susceptible to thinking about hierarchy,” Dr. Srivastava said. “We have tried to remember that sometimes, despite our best intentions, we do not speak up for our patients because we are fearful of the consequences.”

That was certainly true for my lung cancer patient. Like all the other doctors involved in his care, I hesitated to talk to the chief medical oncologist. I questioned my own credentials, my lack of expertise in this particular area of oncology and even my own clinical judgment. When the patient appeared to fare better, requiring less oxygen and joking and laughing more than I had ever seen in the past, I took his improvement to be yet another sign that my attempt to talk about holding back chemotherapy was surely some surgical folly.

But a couple of days later, the humidified oxygen mask came back on. And not long after that, the patient again asked for me to come close.

This time he said: “I’m tired. I want to stop the chemo.”

Just before he died, a little over a week later, he was off all treatment except for what might make him comfortable. He thanked me and the other doctors for our care, but really, we should have thanked him and apologized. Because he had pushed us out of our comfortable, well-delineated professional zones. He had prodded us to talk to one another. And he showed us how to work as a team in order to do, at last, what we should have done weeks earlier.

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Buffet, 3G to buy Heinz for $23B

Warren Buffett's Berkshire Hathaway and private equity firm 3G Capital will buy ketchup and baby food maker H.J. Heinz Co for $23.2 billion in cash, a deal that combines 3G's ambitions in the food industry with Buffett's hunt for growth.

Including debt assumption, Heinz valued the transaction, which it called the largest in its industry's history, at $28 billion. Berkshire and 3G will pay $72.50 per share, a 19 percent premium to the stock's previous all-time high. Heinz shares actually rose slightly above the offer price, although Buffett cautioned he had no intention of raising his bid.

Analysts said the deal could be the first step in a broader wave of mergers for the food and beverage industry.

"Maybe for the consumer staples group in general this may start some talk about consolidation. Even corporate entities are flush with cash, interest rates are low, it would seemingly make sense," Edward Jones analyst Jack Russo said.

Companies like General Mills and Campbell Soup - itself long seen as a potential Heinz merge partner - rose on the news.

BUFFETT HUNTING GROWTH

The surprise purchase satisfies, at least in part, Buffett's hunt for growth through acquisition. He was frustrated in 2012 by the collapse of at least two deals in excess of $20 billion and said he might have to do a $30 billion deal this year to help fuel Berkshire's growth engine. In this case, Berkshire is putting up about $12 billion to $13 billion cash, Buffett told CNBC, leaving it ample room for another major transaction.

Berkshire Hathaway already has a variety of food assets, including the Dairy Queen ice cream chain, chocolatier See's Candies and the food distributor McLane. Buffett, famed for a love of cheeseburgers, joked he was well acquainted with Heinz's products already and that this was "my kind of deal."

It does represent an unusual teaming of Berkshire with private equity, though; historically, Buffett's purchases have been outright his own. He and 3G founder Jorge Paulo Lemann have known each other for years, and Buffett said Lemann approached him with the Heinz idea in December. One Berkshire investor said he had mixed feelings about the deal because of the limited growth prospects domestically.

"We're a little hesitant on the staple companies because they don't have any leverage in the United States," said Bill Smead, chief investment officer of Smead Capital Management in Seattle. But at the same time, he said, Buffett was likely willing to accept a bond-like steady return even if it was not necessarily a "home run."

3G EXPANDS

For 3G, a little-known firm with Brazilian roots, the purchase is something of a natural complement to its investment in fast-food chain Burger King, which it acquired in late 2010 and in which it still holds a major stake. Lemann, a globe-trotting financier with Swiss roots, made his money in banking and gained notoriety for helping to pull together the deals that ultimately formed the beer brewing giant AB InBev.

3G's Alex Behring runs the fund out of New York. He appeared at a Pittsburgh news conference on Thursday with Heinz management to discuss the deal - and to reassure anxious local crowds that the company will remain based there and will continue to support local philanthropy.

But at the same time, Behring said it was too soon to talk about cost cuts at the company. Unlike Berkshire, which is a hands-off operator, 3G is known for aggressively controlling costs at its operations.

PITTSBURGH ROOTS Also to be determined is whether CEO Bill Johnson would stay on. Only the fifth chairman in the company's history, Johnson is widely credited with Heinz's recent strong growth.

"I am way too young to retire," he told the news conference, adding that discussions had not yet started with 3G over the details of Heinz's future management.

The company, known for its iconic ketchup bottles, Heinz 57 sauces as well as other brands including Ore-Ida frozen potatoes, has increased net sales for the last eight fiscal years in a row.

Heinz said the transaction would be financed with cash from Berkshire and 3G, debt rollover and debt financing from J.P. Morgan and Wells Fargo. Buffett told CNBC that Berkshire and 3G would be equal equity partners.

Heinz shares soared 19.9 percent, or $12.06, to $72.54 on the New York Stock Exchange. A week ago the stock hit a long-term high of $61 a share - near records it set in 1998 - having risen almost 5 percent this year and nearly 12 percent since the beginning of 2012.

The deal is also a potential boon for new U.S. Secretary of State John Kerry, whose wife Teresa is the widow of H.J. Heinz Co heir John Heinz.

Kerry's most recent financial disclosures from his time in the U.S. Senate show a position in Heinz shares of more than $1 million, although the precise size is unclear.

Centerview Partners and BofA Merrill Lynch were financial advisers to Heinz, with Davis Polk & Wardwell LLP the legal adviser. Moelis & Company was financial adviser to the transaction committee of Heinz's board and Wachtell, Lipton, Rosen & Katz served as its legal adviser. Lazard served as lead financial adviser. J.P. Morgan and Wells Fargo also served as financial advisers to the investment consortium. Kirkland & Ellis LLP was legal adviser to 3G Capital, and Munger, Tolles & Olson LLP was legal adviser to Berkshire Hathaway.

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Remains found in burned cabin after standoff with rogue cop

The manhunt for fugitive ex-cop Christopher Dorner appears to have come to a dramatic and deadly end at a burned-out cabin near Big Bear Lake, Calif. CBS News' Carter Evans reports.

Although San Bernardino County Sheriff John McMahon said he could not "absolutely, positively confirm" the body found in the charred rubble of a cabin was that of Christopher Dorner, he stressed that the manhunt for the fugitive former LAPD officer had been called off.

"We believe the investigation is over at this point," McMahon said at a news conference Wednesday.

Coroner's officials have yet to positively identify the body found in the Big Bear area cabin after a man thought to be Dorner engaged in an intense gun battle with officers. The cabin later caught fire and burned to its foundation.

PHOTOS: Manhunt for ex-LAPD officer

McMahon denied speculation that officers intentionally set the fire, saying officers first used traditional tear gas to flush the man out. When that didn't work, they opted to use CS gas canisters, which are known in law enforcement parlance as incendiary tear gas. These canisters, filled with more potent gas, have a significantly greater chance of starting a fire.

"We did not intentionally burn down that cabin," McMahon said.

Tuesday brought an end to a massive, days-long search for the wanted ex-police officer, sought in a series of killings that began Feb. 3 with the death of a newly engaged Irvine couple: Monica Quan, a Cal State Fullerton assistant basketball coach, and Keith Lawrence, a USC public safety officer.

WHO THEY WERE: Dorner's alleged victims

Quan was the daughter of the retired LAPD official who represented Dorner at his disciplinary hearing. According to a manifesto that officials say Dorner posted on Facebook, he felt the LAPD unjustly fired him after that hearing several years ago, when a disciplinary panel determined that he lied in accusing his training officer of kicking a mentally ill man during an arrest.

LAPD Chief Charlie Beck has promised to review the case.

While on the run Thursday, Dorner allegedly shot three police officers in Riverside County. Riverside Officer Michael Crain, 34, a married father of two, was killed. He was laid to rest Wednesday.

The search for Dorner — which triggered statewide alerts in California and Nevada, and stretched across the Mexican border — centered on Big Bear on Thursday when Dorner's burning truck was found on a forest road.

TIMELINE: Manhunt for ex-LAPD officer

Hundreds of officers swarmed the area, conducting cabin-by-cabin checks for any sign of the wanted man. But no fresh leads surfaced, and the search effort was scaled back Sunday.

But Dorner apparently resurfaced Tuesday morning, when two cleaning workers discovered him inside a Big Bear condo not far from where authorities had been holding news conferences about the manhunt. He allegedly tied them up, stole a Nissan and took off. About 12:20 p.m., one of the women broke free and called police.

Nearly half an hour later, officers with the California Department of Fish and Wildlife spotted the stolen vehicle and called for backup, authorities said. The suspect turned down a side road in an attempt to elude the officers but crashed the vehicle, police said.

DOCUMENT: Read the manifesto

A short time later, authorities said, the suspect carjacked a light-colored pickup truck from a local camp ranger. That man, Rick Heltebrake, said he noticed something moving in the trees as he drove down Glass Road. It was a person with a gun dressed in camouflage and a ballistics vest, with pockets that were full.

“He was ready for action,” Heltebrake said. “Right away I knew it was Mr. Dorner.”

And behind the man alleged to be Dorner was a wrecked vehicle.

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Phys Ed: Getting the Right Dose of Exercise

Phys Ed

Gretchen Reynolds on the science of fitness.

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A common concern about exercise is that if you don’t do it almost every day, you won’t achieve much health benefit. But a commendable new study suggests otherwise, showing that a fairly leisurely approach to scheduling workouts may actually be more beneficial than working out almost daily.

For the new study, published this month in Exercise & Science in Sports & Medicine, researchers at the University of Alabama at Birmingham gathered 72 older, sedentary women and randomly assigned them to one of three exercise groups.

One group began lifting weights once a week and performing an endurance-style workout, like jogging or bike riding, on another day.

Another group lifted weights twice a week and jogged or rode an exercise bike twice a week.

The final group, as you may have guessed, completed three weight-lifting and three endurance sessions, or six weekly workouts.

The exercise, which was supervised by researchers, was easy at first and meant to elicit changes in both muscles and endurance. Over the course of four months, the intensity and duration gradually increased, until the women were jogging moderately for 40 minutes and lifting weights for about the same amount of time.

The researchers were hoping to find out which number of weekly workouts would be, Goldilocks-like, just right for increasing the women’s fitness and overall weekly energy expenditure.

Some previous studies had suggested that working out only once or twice a week produced few gains in fitness, while exercising vigorously almost every day sometimes led people to become less physically active, over all, than those formally exercising less. Researchers theorized that the more grueling workout schedule caused the central nervous system to respond as if people were overdoing things, sending out physiological signals that, in an unconscious internal reaction, prompted them to feel tired or lethargic and stop moving so much.

To determine if either of these possibilities held true among their volunteers, the researchers in the current study tracked the women’s blood levels of cytokines, a substance related to stress that is thought to be one of the signals the nervous system uses to determine if someone is overdoing things physically. They also measured the women’s changing aerobic capacities, muscle strength, body fat, moods and, using sophisticated calorimetry techniques, energy expenditure over the course of each week.

By the end of the four-month experiment, all of the women had gained endurance and strength and shed body fat, although weight loss was not the point of the study. The scientists had not asked the women to change their eating habits.

There were, remarkably, almost no differences in fitness gains among the groups. The women working out twice a week had become as powerful and aerobically fit as those who had worked out six times a week. There were no discernible differences in cytokine levels among the groups, either.

However, the women exercising four times per week were now expending far more energy, over all, than the women in either of the other two groups. They were burning about 225 additional calories each day, beyond what they expended while exercising, compared to their calorie burning at the start of the experiment.

The twice-a-week exercisers also were using more energy each day than they had been at first, burning almost 100 calories more daily, in addition to the calories used during workouts.

But the women who had been assigned to exercise six times per week were now expending considerably less daily energy than they had been at the experiment’s start, the equivalent of almost 200 fewer calories each day, even though they were exercising so assiduously.

“We think that the women in the twice-a-week and four-times-a-week groups felt more energized and physically capable” after several months of training than they had at the start of the study, says Gary Hunter, a U.A.B. professor who led the experiment. Based on conversations with the women, he says he thinks they began opting for stairs over escalators and walking for pleasure.

The women working out six times a week, though, reacted very differently. “They complained to us that working out six times a week took too much time,” Dr. Hunter says. They did not report feeling fatigued or physically droopy. Their bodies were not producing excessive levels of cytokines, sending invisible messages to the body to slow down.

Rather, they felt pressed for time and reacted, it seems, by making choices like driving instead of walking and impatiently avoiding the stairs.

Despite the cautionary note, those who insist on working out six times per week need not feel discouraged. As long as you consciously monitor your activity level, the findings suggest, you won’t necessarily and unconsciously wind up moving less over all.

But the more fundamental finding of this study, Dr. Hunter says, is that “less may be more,” a message that most likely resonates with far more of us. The women exercising four times a week “had the greatest overall increase in energy expenditure,” he says. But those working out only twice a week “weren’t far behind.”

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Sources: American, US Airways boards approve merger

The boards of AMR Corp and US Airways Group Inc each met on Wednesday to approve a merger that would create the world's largest airline with an expected market value of around $11 billion, people familiar with the matter said.

The all-stock merger, which is set to be announced early on Thursday, would finalize the consolidation of legacy U.S. air carriers that helped put the industry on a more solid financial footing.

AMR's bankruptcy creditors will own 72 percent of the combined airline, which will do business under the American Airlines brand and be based in Fort Worth, Texas, the people said. US Airways shareholders will own the rest.

The board approval came after AMR's unsecured creditors committee, which includes all three of AMR's major unions, met earlier on Wednesday to approve a proposed merger agreement, the people said.

The merged company will have a board of 12 members: four from US Airways including its chief executive Doug Parker, three from AMR including chief executive Tom Horton and five to be designated by the AMR creditors, two of the people said.

That will shrink to 11 members in 2014 after Horton steps down following the combined company's first annual meeting, the person added. Parker becomes chief executive of the new airline.

AMR's unsecured creditors are expected to be made whole on their claims in the form of stock in the merged company and also get accrued interest, the people said. AMR's shareholders will get a small equity stake as well, they added.

All the sources asked not to be named because the matter was not public. US Airways declined to comment while AMR representatives could not be immediately reached for comment.

The deal comes more than 14 months after the bankrupt parent of American Airlines filed for bankruptcy in November 2011, and would mark the last combination of legacy U.S. carriers, following the Delta-Northwest and United-Continental mergers.

A tie-up with US Airways would create the world's top airline by passenger traffic and help American and US Air better compete with United Continental Holdings and Delta Air Lines.

Some $11 billion valuation of the combined American-US Airways compares to the roughly $12.4 billion market capitalization for Delta, and $8.7 billion for United Continental.

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Ex-cop shootout: Cabin on fire, search for suspect

Raw footage of Christopher Dorner's cabin engulfed in flames. It is unclear who set it. There are also reports of ammo exploding inside.

A single gunshot was heard as authorities moved into the cabin where Christopher Dorner was believed holed up.

According to a law enforcement source, police had broken down windows, pumped in tear gas and blasted a loud speaker urging Dorner to give up. When they got no response, police deployed a vehicle to rip down the walls of cabin "one by one, like peeling an onion," one law enforcement official said.

By the time they got to the last wall, authorities heard a single gunshot, the source said. Then flames began to spread through the structure. Then, they heard gunshots likely set off by the fire.

Dorner's body has not been found. Police will search will be focused in the basement area, the source said.

A tall plume of smoke was rising from the area where the standoff occurred. Hundreds of law enforcement personnel swooped down on the site near Big Bear after the gun battles between Dorner and officers that broke out in the snow-covered mountains where the fugitive had been eluding a massive manhunt since his truck was found burning in the area late last week.

Law enforcement personnel in military-style gear and armed with high-powered weapons were involved in a tense standoff after Dorner took refuge in the cabin Tuesday afternoon. 

One San Bernardino County sheriff's deputy died of his wounds after he and another deputy were wounded in an exchange of gunfire outside the cabin in which hundreds of rounds were fired, sources told The Times. The deputy was airlifted to Loma Linda University Medical Center, where he died of his wounds.

The afternoon gun battle was part of a quickly changing situation that began after Dorner allegedly broke into a home, tied up a couple and held them hostage before fleeing with their white pickup truck, authorities said. 

Then Dorner was allegedly spotted by a state Fish and Wildlife officer in the pickup truck, sources said. A vehicle-to-vehicle shootout ensued. The officer's vehicle was peppered with multiple rounds, according to authorities.

Dorner crashed his vehicle and took refuge in a nearby cabin, sources said. One deputy was hit as Dorner fired out of the cabin and a second deputy was injured when Dorner exited the back of the cabin, deployed a smoke bomb and opened fire again in an apparent attempt to flee. Dorner was driven back inside the cabin, the sources said.

During the unprecedented manhunt, officers had crisscrossed California for days pursuing the more than 1,000 tips that poured in about Dorner's possible whereabouts -- including efforts in Tijuana, San Diego County and Big Bear -- and serving warrants at homes in Las Vegas and the Point Loma area of San Diego.

Statewide alerts were issued in California and Nevada, and border authorities were alerted. The Transportation Security Administration also had issued an alert urging pilots and other aircraft operators to keep an eye out for Dorner.

The search turned to Big Bear last week after Dorner's burning truck was found on a local forest road.

At the search's height, more than 200 officers scoured the mountain, conducting cabin-by-cabin checks. It was scaled back Sunday -- about 30 officers were out in the field Tuesday, the San Bernardino County Sheriff's Department said.

Dorner allegedly threatened "unconventional and asymmetrical warfare" against police in a lengthy manifesto that authorities say he posted on Facebook. The posting named dozens of potential targets, including police officers, whom Dorner allegedly threatened to attack, according to authorities.

Records state that the manifesto was discovered by authorities last Wednesday, three days after the slaying of an Irvine couple: Monica Quan, a Cal State Fullerton assistant basketball coach, and her fiance, Keith Lawrence, a USC public safety officer.

Quan was the daughter of a retired LAPD captain whom Dorner allegedly blamed in part for his firing from the force in 2009.

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Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

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Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

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Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

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Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

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This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

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Chicago leads nation in gas-price spikes

Drivers in Chicago are seeing a painful rise in gas prices get even worse this month.

The average price of regular unleaded in the Chicago metro area on Tuesday is $3.93, according to AAA. That's up 12 cents from a week ago. A month ago, the average was $3.42. Statewide, the average is about $3.79, up 8 cents from last week and 46 cents last month.

Prices are rising at pumps across the country, too, but not as dramatically. The national average is $3.60, up about 7 cents from a week ago and 30 cents higher than this time last month.

It's not typical to see gas price spikes at this time of year. Demand is typically low and picks up in the spring before driving season. And in general, gas is cheaper to produce in the winter because refineries can use less expensive blends.

The main reason for the spike is the higher price of crude oil. The price of oil has gone from around $85 a barrel in December to around $97 now because of improving economic certainty as the country moved past the election and the fiscal cliff deadline, according to energy analyst Phil Flynn. It's also being driven by better-than-expected growth in China, the world's second largest economy.

Prices in the Chicago area are typically some the highest in the nation, but the cost of a local fill-up is accelerating at almost double the national rate.

Flynn attributes this to a number of refinery issues in the region. Some scheduled maintenance at refineries -- where gasoline and other products are produced from oil -- occurred earlier than usual, which cut off some supply, affecting prices. Many close at this time of year to start the switchover to lower-emission summer blends of gasoline.

Besides a major overhaul of BP's Whiting refinery, the largest supplier of gasoline to Midwest markets, that's believed to be driving prices higher, a fire temporarily shut down a refinery in northwest Ohio.

AAA, which tracks daily gasoline prices around the country, predicts they will continue their rapid climb as local refinery issues continue into the beginning of peak driving season.

Flynn is more optimistic.

He believes that once the major Whiting refinery overhaul is complete later this year, gas prices will stabilize.

"I'm probably in the minority but I think we are starting to see some light at the end of the tunnel," he said.

sbomkamp@tribune.com | Twitter: @SamWillTravel

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Slain teen's dad: 'The healing can start' after 2 charged with murder

Two men have  been charged in the shooting death of 15-year-old Hadiya Pendleton in a case of mistaken identity in which one of those charged was trying to retaliate for his being shot last year, authorities said.

Charged were Michael Ward, 18, and Kenneth Williams, 20. The two face charges of first-degree murder, attempted murder, and aggravated battery with a firearm in the attack that also left two other teens wounded. Ward, of the 3900 block of South Lake Park Avenue, confessed in the shooting, police said.

Ward and Williams told police that they were en route to a strip club in Harvey when they were arrested Saturday night--just hours after Hadiya's funeral, said Police Superintendent Garry McCarthy in a news conference at Area Central police headquarters this evening.

Williams, of the 300 block of West 59th Street, had been shot in July, but refused to sign a complaint against those police suspected in that attack. Williams and Ward targeted the group Hadiya was with because they believed, mistakenly, they were members of the gang responsible for that shooting, .

With news of the charges, Hadiya's father Nathaniel Pendleton said this is the first time since the shooting that he's had a "legitimate" smile on his face.

"I'm ecstatic that they found the two guys," he told the Tribune during a brief telephone interview Monday night from a Washington, D.C. restaurant, where he was with his wife, Cleopatra Cowley-Pendleton, and other relatives. "(I'm) thanking God that these two guys are off the streets, so that this doesn't happen to another innocent person."

Pendleton and his family were in the nation's capital to be guests of President Barack Obama while he delivers the State Of The Union address Tuesday night.

Still, Pendleton acknowledged that true closure will come if the men are convicted of the crimes. But the charges, he said, are a good start.

"Right now, I can say to you that the healing can start," he said.

Chicago police picked up the two men, 18 and 20, over the weekend, hours after first lady Michelle Obama attended the funeral for the teenager whose death has become a symbol of escalating violence in Chicago.

The men were pulled over near 67th Street and South Chicago Avenue late Saturday night or early Sunday morning after detectives canvassed the area of the park where she was fatally shot Jan. 29 and tracked down witnesses, the sources said.

Hadiya was shot in Vivian Gordon Harsh Park, about a mile north of President Barack Obama's Kenwood neighborhood home on the South Side. Her slaying took place a little more than a week after the honor student performed with the King College Prep band in Washington during inauguration festivities. Two other teens were wounded.

The shooting in the 4400 block of South Oakenwald Avenue happened after classes were dismissed for the day during finals week at King. Hadiya, a sophomore at King, was at the park with a group of teens, primarily other students from the school, when a male gunman climbed over a fence, ran to the group and started firing, police have said. The shooter escaped in what has been described as a white Nissan vehicle, possibly driven by a getaway driver.

One of the sources said at least one of the men brought into custody was riding in a Nissan Sentra, one of the two vehicles police pulled over when bringing the pair into custody. The source didn't know that Nissan's color.

After police News Affairs initially--and mistakenly--said that her companions included gang members, Police have said the teens in Hadiya's group who had gathered in the park were not involved in gangs. But police have been looking into whether the gunman may have mistaken them for rival gang members.

While police and neighbors have generally described Harsh Park and its immediate surroundings as safe, there has been an internal gang conflict brewing in the area between factions of the Gangster Disciples, police said. The two men who are charged are alleged members of the Gangster Disciples, sources said.

Ward pleaded guilty early last year in a 2011 aggravated unlawful use of a weapon case, and was given two years probation, according to court records. After an arrest on criminal trespass to a vehicle last summer, he was held without bond for a few weeks, but was released after a Sept. 9, 2012, hearing.

Williams was arrested on a misdemeanor retail theft charge in October 2011, but the charge was dismissed.

In addition to Hadiya's homicide, there have been at least three other shootings within blocks of Harsh Park so far this year, according to police records.

Mayor Rahm Emanuel personally called Hadiya's parents, Cleopatra Cowley-Pendleton and Nathaniel Pendleton, to inform them of the development, according to a source. Nathaniel Pendleton told the Tribune on Sunday night that he didn't want to say too much about the men being questioned because charges have not been filed.
“Right now, we're just happy that Chicago police have some leads and things are moving,” he said.

Shatira Wilks, a cousin of Hadiya's and a family spokesperson, said the development is a “good response” and better news than the family had Saturday.

Arrests and charges “will bring a small level of closure to the family, although (the shooter) still will be allowed to eat, drink, mingle,” Wilks said. “The thing about that is, Hadiya is no longer (able) to do so.”

On how Hadiya's family is doing, Wilks said, “Everyone keeps asking that. I don't know if you'll ever get an answer that we're feeling good or we're feeling fine.”

Hadiya's godmother, LaKeisha Stewart, said questioning the men is a good start, but she's more eager to find out when or if charges are filed.

“Until this person is off the streets for good, that an example is made to … other people like him -- that's when I'll breathe a sigh of relief,” Stewart said. “For me, when the person is in court and a judge says they are responsible for her murder … to me, that's when this will make a difference.”

Hadiya's death occurred during the deadliest January for Chicago since 2002. It also came on the heels of a homicide total last year that was the highest since 2008, and the second highest since 2003.

The playground where Hadiya was shot was the setting for an amateur rap video posted to YouTube. The video, which also highlights the intersection at South Oakenwald and East 44th Place, uses the moniker of a local gang in an opening credit and features a rapper shown leaving the Cook County Jail, then threatening to shoot down his foes.

The video ends at a house party with a smiling teenage girl flashing gang signs at the camera.

The first lady's attendance at Hadiya's funeral placed Chicago even further into the spotlight of a national debate over gun violence that has polarized Congress and led the president to take his gun-control initiatives on the road to garner more public support.

Neither the first lady nor elected officials gave remarks during the funeral. Only the friends and relatives who knew Hadiya best were allowed to speak.

In the days following Hadiya's death, clergy and community leaders raised $40,000 in reward money for information leading to the arrest and conviction of the teen's killer or killers. McCarthy has said that detectives have received numerous tips to follow up on for the homicide investigation.

Tribune reporter Carlos Sadovi contributed to this story.

tlighty@tribune.com

jgorner@tribune.com

Jdelgado@tribune.com

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