A Breakthrough Against Leukemia Using Altered T-Cells

PHILIPSBURG, Pa. — Emma Whitehead has been bounding around the house lately, practicing somersaults and rugby-style tumbles that make her parents wince.

It is hard to believe, but last spring Emma, then 6, was near death from leukemia. She had relapsed twice after chemotherapy, and doctors had run out of options.

Desperate to save her, her parents sought an experimental treatment at the Children’s Hospital of Philadelphia, one that had never before been tried in a child, or in anyone with the type of leukemia Emma had. The experiment, in April, used a disabled form of the virus that causes AIDS to reprogram Emma’s immune system genetically to kill cancer cells.

The treatment very nearly killed her. But she emerged from it cancer-free, and about seven months later is still in complete remission. She is the first child and one of the first humans ever in whom new techniques have achieved a long-sought goal — giving a patient’s own immune system the lasting ability to fight cancer.

Emma had been ill with acute lymphoblastic leukemia since 2010, when she was 5, said her parents, Kari and Tom. She is their only child.

She is among just a dozen patients with advanced leukemia to have received the experimental treatment, which was developed at the University of Pennsylvania. Similar approaches are also being tried at other centers, including the National Cancer Institute and Memorial Sloan-Kettering Cancer Center in New York.

“Our goal is to have a cure, but we can’t say that word,” said Dr. Carl June, who leads the research team at the University of Pennsylvania. He hopes the new treatment will eventually replace bone-marrow transplantation, an even more arduous, risky and expensive procedure that is now the last hope when other treatments fail in leukemia and related diseases.

Three adults with chronic leukemia treated at the University of Pennsylvania have also had complete remissions, with no signs of disease; two of them have been well for more than two years, said Dr. David Porter. Four adults improved but did not have full remissions, and one was treated too recently to evaluate. A child improved and then relapsed. In two adults, the treatment did not work at all. The Pennsylvania researchers were presenting their results on Sunday and Monday in Atlanta at a meeting of the American Society of Hematology.

Despite the mixed results, cancer experts not involved with the research say it has tremendous promise, because even in this early phase of testing it has worked in seemingly hopeless cases. “I think this is a major breakthrough,” said Dr. Ivan Borrello, a cancer expert and associate professor of medicine at the Johns Hopkins University School of Medicine.

Dr. John Wagner, the director of pediatric blood and marrow transplantation at the University of Minnesota, called the Pennsylvania results “phenomenal” and said they were “what we’ve all been working and hoping for but not seeing to this extent.”

A major drug company, Novartis, is betting on the Pennsylvania team and has committed $20 million to building a research center on the university’s campus to bring the treatment to market.

Hervé Hoppenot, the president of Novartis Oncology, called the research “fantastic” and said it had the potential — if the early results held up — to revolutionize the treatment of leukemia and related blood cancers. Researchers say the same approach, reprogramming the patient’s immune system, may also eventually be used against tumors like breast and prostate cancer.

To perform the treatment, doctors remove millions of the patient’s T-cells — a type of white blood cell — and insert new genes that enable the T-cells to kill cancer cells. The technique employs a disabled form of H.I.V. because it is very good at carrying genetic material into T-cells. The new genes program the T-cells to attack B-cells, a normal part of the immune system that turn malignant in leukemia.

The altered T-cells — called chimeric antigen receptor cells — are then dripped back into the patient’s veins, and if all goes well they multiply and start destroying the cancer.

The T-cells home in on a protein called CD-19 that is found on the surface of most B-cells, whether they are healthy or malignant.

A sign that the treatment is working is that the patient becomes terribly ill, with raging fevers and chills — a reaction that oncologists call “shake and bake,” Dr. June said. Its medical name is cytokine-release syndrome, or cytokine storm, referring to the natural chemicals that pour out of cells in the immune system as they are being activated, causing fevers and other symptoms. The storm can also flood the lungs and cause perilous drops in blood pressure — effects that nearly killed Emma.

Steroids sometimes ease the reaction, but they did not help Emma. Her temperature hit 105. She wound up on a ventilator, unconscious and swollen almost beyond recognition, surrounded by friends and family who had come to say goodbye.

But at the 11th hour, a battery of blood tests gave the researchers a clue as to what might help save Emma: her level of one of the cytokines, interleukin-6 or IL-6, had shot up a thousandfold. Doctors had never seen such a spike before and thought it might be what was making her so sick.

Dr. June knew that a drug could lower IL-6 — his daughter takes it for rheumatoid arthritis. It had never been used for a crisis like Emma’s, but there was little to lose. Her oncologist, Dr. Stephan A. Grupp, ordered the drug. The response, he said, was “amazing.”

Within hours, Emma began to stabilize. She woke up a week later, on May 2, the day she turned 7; the intensive-care staff sang “Happy Birthday.”

Since then, the research team has used the same drug, tocilizumab, in several other patients.

In patients with lasting remissions after the treatment, the altered T-cells persist in the bloodstream, though in smaller numbers than when they were fighting the disease. Some patients have had the cells for years.

Dr. Michel Sadelain, who conducts similar studies at the Sloan-Kettering Institute, said: “These T-cells are living drugs. With a pill, you take it, it’s eliminated from your body and you have to take it again.” But T-cells, he said, “could potentially be given only once, maybe only once or twice or three times.”

The Pennsylvania researchers said they were surprised to find any big drug company interested in their work, because a new batch of T-cells must be created for each patient — a far cry from the familiar commercial strategy of developing products like Viagra or cholesterol medicines, in which millions of people take the same drug.

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Stocks edge higher; Dow is boosted by McDonald's

Stocks are inching higher on Wall Street after a strong sales report from McDonald's offset concerns about the sudden resignation of Italy's prime minister.

The Dow Jones industrial average was up 30 points at 13,172 shortly before midday Monday. The Standard and Poor's 500 was up two points at 1,420. The Nasdaq composite was up 15 points at 2,993.

McDonald's rose 1 percent to $89.67. A key sales figure rose in November as U.S. customers bought more breakfast offerings and limited-time Cheddar Bacon Onion sandwiches.

Italy's Mario Monti, who has been credited with restoring confidence in Italy's economy, said he would step down after former Prime Minister Silvio Berlusconi's party dropped its support of his government.

Italian government bond yields rose sharply and Milan's benchmark stock index fell.

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Chavez to have more cancer surgery in Cuba

CARACAS, Venezuela—

Venezuelan President Hugo Chavez is heading back to Cuba on Sunday for more surgery for cancer, announcing on television that the illness has returned after two previous operations, chemotherapy and radiation treatment.

Chavez acknowledged the seriousness of his situation in an address Saturday night, saying for the first time that if he suffers complications Vice President Nicolas Maduro should take his place as Venezuela's leader and continue his socialist movement.

"There are risks. Who can deny it?" Chavez said, seated at the presidential palace beside Maduro and other aides.

"In any circumstance, we should guarantee the advance of the Bolivarian Revolution," Chavez said.

Outside medical experts said that based on Chavez's account of his condition, he is facing a very difficult fight against an aggressive type of cancer.

The president, who just returned from Cuba early Friday, said tests had found a return of "some malignant cells" in the same area where tumors were previously removed.

Chavez, who has yet to be sworn in for his new term after winning re-election on Oct. 7, said he would return to Havana on Sunday and would undergo the operation in the coming days.

Chavez's quick trip home appeared aimed at sending a clear directive to his inner circle that Maduro is his chosen successor. He called for his allies to pull together, saying: "Unity, unity, unity."

Chavez said his doctors had recommended he have the surgery right away, but that he had told them he wanted to return to Venezuela first.

"I want to go there. I need to go to Venezuela," Chavez recalled telling his doctors. "And what I came for was this," he said, seated below a portrait of independence hero Simon Bolivar, the inspiration of his Bolivarian Revolution movement.

Chavez named Maduro, his longtime foreign minister, as his choice for vice president three days after winning re-election. Maduro, a burly former bus driver, has shown unflagging loyalty and become a leading spokesman for Venezuela's socialist leader in recent years.

The vice president's expression was solemn as Chavez said that Maduro should become president if any complication were to prevent him from finishing his current term, which concludes in early January. Chavez said that if new elections are held, his movement's candidate should be Maduro.

"In that scenario, which under the constitution would require presidential elections to be held again, you all elect Nicolas Maduro as president," Chavez said. "I ask that of you from my heart."

Chavez held a small blue copy of the constitution in his hands and waved it. The Venezuelan constitution says that if a president-elect dies before taking office, a new election should be held within 30 days and that in the meantime the president of the National Assembly is to be in charge of the government.

While he spoke, Chavez was flanked by both Maduro and National Assembly President Diosdado Cabello.

Chavez is scheduled to be sworn in for a new six-year term Jan. 10, and he called his relapse a "new battle."

This will be his third operation to remove cancerous tissue in about a year and a half.

The 58-year-old president first underwent surgery for an unspecified type of pelvic cancer in Cuba in June 2011, after an operation for a pelvic abscess earlier in the month found the cancer. He had another cancer surgery last February after a tumor appeared in the same area. He has also undergone chemotherapy and radiation treatments.

Chavez said tests immediately after his re-election win had shown no sign of cancer. But he said he had swelling and pain, which he thought was due to "the effort of the campaign and the radiation therapy treatment."

"It's a very sensitive area, so we started to pay a lot of attention to that," he said, adding that he had reduced his public appearances.

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Rolling Stones rock Brooklyn at anniversary gig

NEW YORK (AP) — It sure didn't feel like a farewell.

The Rolling Stones — average age 68-plus, if you're counting — were in rollicking form as they rocked the Barclays Center in Brooklyn for 2½ hours Saturday night, their first U.S. show on a mini-tour marking a mind-boggling 50 years as a rock band.

And although every time the Stones tour, the inevitable questions arise, — whether it's "The Last Time," to quote one of their songs — there was no sign that anything is ending anytime soon.

"People say, why do you keep doing this?" mused 69-year-old Mick Jagger, the band's impossibly energetic frontman, before launching into "Brown Sugar." ''Why do you keep touring, coming back? The answer is, you're the reason we're doing this. Thank you for buying our records and coming to our shows for the last 50 years."

Jagger was in fine form, with strong vocals and his usual swagger — strutting, jogging, skipping and pumping his arms like a man half his age. And though he briefly donned a flamboyant feathered black cape for "Sympathy for the Devil" and later, some red-sequined tails, he was mostly content to prowl the stage in a tight black T-shirt and trousers.

The band's guitarists, the brilliant Keith Richards and Ronnie Wood, alternated searing solos and occasionally ventured onto a stage extension that brought them closer to the crowd. The now-gray Richards, wearing a red bandana, exuded the easy familiarity of a favorite uncle: "While we wait for Ronnie," he said at one point, "I'll wish you happy holidays." Watts, the dapper drummer in a simple black T-shirt, smiled frequently at his band mates.

The grizzled quartet was joined on "Gimme Shelter" by Mary J. Blige, who traded vocals with Jagger and earned a huge cheer at the end. Also visiting: the Texas blues guitarist Gary Clark Jr.

The sense of nostalgia was heightened by projections on a huge screen of footage of the early days, when the Stones looked like teenagers. At one point, Jagger reminisced about the first time the band played New York — in 1964.

A carton of milk cost only a quarter then, he said. And a ticket to the Rolling Stones? "I don't want to go there," he quipped. It was a reference to the sky-high prices at the current "50 and Counting" shows, where even the "cheap" seats cost a few hundred dollars and a prime seat cost in the $700 range or higher.

From the opening number, "Get Off Of My Cloud," the band played a generous 23 songs, including two new ones — "Doom and Gloom" and "One More Shot" — but mostly old favorites. The rousing encore included "Jumping Jack Flash," of course, but the final song was "Satisfaction." And though the song speaks of not getting any, the consensus of the packed 18,000-seat arena was that it was a satisfying evening indeed.

"If you like the Stones, this was as good a show as you could have had," said one fan, Robert Nehring, 58, of Westfield, N.J., who'd paid $500 for his seat. "It was worth it," he said simply.

The Brooklyn show was a coup for the new Barclays Center — there are no Manhattan shows. It followed two rapturously received Stones shows in London late last month. The band also will play two shows in Newark, N.J., on Dec. 13 and 15.

And just before that, the Stones will join a veritable who's who of British rock royalty and U.S. superstars at the blockbuster 12-12-12 Superstorm Sandy benefit concert at Madison Square Garden. Also scheduled to perform: Paul McCartney, the Who, Eric Clapton, Bruce Springsteen & The E Street Band, Alicia Keys, Kanye West, Eddie Vedder, Billy Joel, Roger Waters and Chris Martin.

In a flurry of anniversary activity, the band also released a hits compilation last month with two new songs, "Doom and Gloom" and "One More Shot," and HBO premiered a new documentary on their formative years, "Crossfire Hurricane."

The Stones formed in London in 1962 to play Chicago blues, led at the time by the late Brian Jones and pianist Ian Stewart, along with Jagger and Richards, who'd met on a train platform a year earlier. Bassist Bill Wyman and Watts were quick additions.

Wyman, who left the band in 1992, was a guest at the London shows last month, as was Mick Taylor, the celebrated former Stones guitarist who left in 1974 and replaced by Wood, the newest Stone and the youngster at 65.

The inevitable questions have been swirling about the next step for the Stones: another huge global tour, on the scale of their last one, "A Bigger Bang," which earned more than $550 million between 2005 and 2007? Something a bit smaller? Or is this mini-tour, in the words of their new song, really "One Last Shot?"

The Stones won't say. But in an interview last month, they made clear they felt the 50th anniversary was something to be marked.

"I thought it would be kind of churlish not to do something," Jagger told The Associated Press. "Otherwise, the BBC would have done a rather dull film about the Rolling Stones."

There certainly was nothing dull about the band's performance on Saturday, a show that brought together many middle-aged fans, to be sure, but also some of their children, who seemed to be enjoying the classic Stones brand of blues-tinged rock as much as their parents.

Yes, a Stone's average age might be a bit higher than that of the average Supreme Court justice. (To be fair, the newest justices bring the average down). But to watch these musicians play with vitality and vigor a half-century on is to believe that maybe they were right when they sang, "Time Is On My Side." At least for a few more years.

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Associated Press writer David Bauder contributed to this report.

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New Taxes to Take Effect to Fund Health Care Law

WASHINGTON — For more than a year, politicians have been fighting over whether to raise taxes on high-income people. They rarely mention that affluent Americans will soon be hit with new taxes adopted as part of the 2010 health care law.

The new levies, which take effect in January, include an increase in the payroll tax on wages and a tax on investment income, including interest, dividends and capital gains. The Obama administration proposed rules to enforce both last week.

Affluent people are much more likely than low-income people to have health insurance, and now they will, in effect, help pay for coverage for many lower-income families. Among the most affluent fifth of households, those affected will see tax increases averaging $6,000 next year, economists estimate.

To help finance Medicare, employees and employers each now pay a hospital insurance tax equal to 1.45 percent on all wages. Starting in January, the health care law will require workers to pay an additional tax equal to 0.9 percent of any wages over $200,000 for single taxpayers and $250,000 for married couples filing jointly.

The new taxes on wages and investment income are expected to raise $318 billion over 10 years, or about half of all the new revenue collected under the health care law.

Ruth M. Wimer, a tax lawyer at McDermott Will & Emery, said the taxes came with “a shockingly inequitable marriage penalty.” If a single man and a single woman each earn $200,000, she said, neither would owe any additional Medicare payroll tax. But, she said, if they are married, they would owe $1,350. The extra tax is 0.9 percent of their earnings over the $250,000 threshold.

Since the creation of Social Security in the 1930s, payroll taxes have been levied on the wages of each worker as an individual. The new Medicare payroll is different. It will be imposed on the combined earnings of a married couple.

Employers are required to withhold Social Security and Medicare payroll taxes from wages paid to employees. But employers do not necessarily know how much a worker’s spouse earns and may not withhold enough to cover a couple’s Medicare tax liability. Indeed, the new rules say employers may disregard a spouse’s earnings in calculating how much to withhold.

Workers may thus owe more than the amounts withheld by their employers and may have to make up the difference when they file tax returns in April 2014. If they expect to owe additional tax, the government says, they should make estimated tax payments, starting in April 2013, or ask their employers to increase the amount withheld from each paycheck.

In the Affordable Care Act, the new tax on investment income is called an “unearned income Medicare contribution.” However, the law does not provide for the money to be deposited in a specific trust fund. It is added to the government’s general tax revenues and can be used for education, law enforcement, farm subsidies or other purposes.

Donald B. Marron Jr., the director of the Tax Policy Center, a joint venture of the Urban Institute and the Brookings Institution, said the burden of this tax would be borne by the most affluent taxpayers, with about 85 percent of the revenue coming from 1 percent of taxpayers. By contrast, the biggest potential beneficiaries of the law include people with modest incomes who will receive Medicaid coverage or federal subsidies to buy private insurance.

Wealthy people and their tax advisers are already looking for ways to minimize the impact of the investment tax — for example, by selling stocks and bonds this year to avoid the higher tax rates in 2013.

The new 3.8 percent tax applies to the net investment income of certain high-income taxpayers, those with modified adjusted gross incomes above $200,000 for single taxpayers and $250,000 for couples filing jointly.

David J. Kautter, the director of the Kogod Tax Center at American University, offered this example. In 2013, John earns $160,000, and his wife, Jane, earns $200,000. They have some investments, earn $5,000 in dividends and sell some long-held stock for a gain of $40,000, so their investment income is $45,000. They owe 3.8 percent of that amount, or $1,710, in the new investment tax. And they owe $990 in additional payroll tax.

The new tax on unearned income would come on top of other tax increases that might occur automatically next year if President Obama and Congress cannot reach an agreement in talks on the federal deficit and debt. If Congress does nothing, the tax rate on long-term capital gains, now 15 percent, will rise to 20 percent in January. Dividends will be treated as ordinary income and taxed at a maximum rate of 39.6 percent, up from the current 15 percent rate for most dividends.

Under another provision of the health care law, consumers may find it more difficult to obtain a tax break for medical expenses.

Taxpayers now can take an itemized deduction for unreimbursed medical expenses, to the extent that they exceed 7.5 percent of adjusted gross income. The health care law will increase the threshold for most taxpayers to 10 percent next year. The increase is delayed to 2017 for people 65 and older.

In addition, workers face a new $2,500 limit on the amount they can contribute to flexible spending accounts used to pay medical expenses. Such accounts can benefit workers by allowing them to pay out-of-pocket expenses with pretax money.

Taken together, this provision and the change in the medical expense deduction are expected to raise more than $40 billion of revenue over 10 years.

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Leaders and their feeders

A favorite question at entrepreneurship conferences is which world city has the entrepreneurial dynamism to become a major start-up capital on par with Silicon Valley. London, Singapore, Tel Aviv, New York and Berlin are usually cited.

Seldom, however, do you hear anyone propose Boulder, Colo.

That is, unless you are in the company of Brad Feld, an early-stage investor, technology entrepreneur and author of "Startup Communities: Building an Entrepreneurial Ecosystem in Your City," published by Wiley.

Feld is a regular speaker on venture capital investing and entrepreneurship, having founded his first company in 1987. Twitter is not a perfect measure of the quality of a person's opinions, but you do not get 113,000 followers without having a degree of respect from your peer group.

He is a Texan who co-founded his first company in Boston and for 20 years has been proud to call Boulder his home.

To him, this city of just 100,000 people, nestled near Rocky Mountain National Park and a short drive from Denver, is not just the best place to live. He also sees Boulder as an excellent example for those who wish to turn their own town into a start-up community.

"Although I don't have the data to support it, Boulder may have the highest entrepreneurial density in the world," he writes.

Having said that, Feld wants to make clear that all sorts of cities across the world can become home to job-creating new businesses if only they foster the necessary culture.

He sets out a framework for a successful start-up community — that it be led by entrepreneurs with a long-term commitment to the area, that the community be inclusive of anyone who wants to participate and that there be a constant stream of activities that engage all the parties.

Feld differentiates between the entrepreneurial "leaders" of a community and the "feeders," who must support but not try to take charge.

Feeders include government agencies, lawyers, accountants, local universities and angel investors. Problems often occur and areas fail to become start-up communities, he notes, when feeders, rather than the people creating the businesses, try to control the development of an entrepreneurial ecosystem.

This should serve as a warning to Mayor Michael Bloomberg's administration in New York, which is trying to nurture the city's collection of fast-growing Web businesses, nicknamed Silicon Alley.

The book is also an insight into why the U.S. is such an entrepreneurial nation. The generosity of spirit still prevalent in U.S. society shines through Feld's writing. It is a key reason why so many have felt it is where they can achieve their dreams.

"Give before you get" is a mantra repeated several times by Feld. A key message is the power of community, which relies on people committing to their neighborhood for a couple of decades at least.

He also has a short answer for the people who ask how they can create the next Silicon Valley: They can't.

"Trying to create the next Silicon Valley is a fool's errand," he writes. "If that's really your goal, save yourself a lot of heartache and simply move to Silicon Valley."

It is clear from the way he writes about Boulder that Feld has no intention of moving farther west himself any time soon. "I can't imagine a better place to live," he says.

My only criticism is that almost all of his frame of reference is the U.S. His only mention of anywhere else in the world is a brief account of a trip to see some start-ups in Iceland.

But if more people loved and contributed to the places they live, as Feld and others have evidently done in Boulder, we probably would have more start-up communities around the world for him to visit.

Moules is the enterprise correspondent of the Financial Times of London, in which this review first appeared. He is also author of "The Rebel Entrepreneur," published by Kogan Page.

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Surgeon infected patients during heart procedure, Cedars-Sinai admits

A heart surgeon at Cedars-Sinai Medical Center unwittingly infected five patients during valve replacement surgeries earlier this year, causing four of the patients to need a second operation.

The infections occurred after tiny tears in the latex surgical gloves routinely worn by the doctor allowed bacteria from a skin inflammation on his hand to pass into the patients' hearts, according to the hospital. The patients survived the second operation and are still recovering, hospital officials said.

The outbreak led to investigations by the hospital and both the L.A. County and California departments of public health. The federal Centers for Disease Control and Prevention was also consulted.

Hospital officials called it a "very unusual occurrence" probably caused by an unfortunate confluence of events: the nature of the surgery, the microscopic rips in the gloves and the surgeon's skin condition. Valve replacement requires the surgeon to use thick sutures and tie more than 100 knots, which can cause extra stress on the gloves, they said.

Nevertheless, the hospital's goal is to have zero infections, said Harry Sax, vice chairman of the hospital's department of surgery. "Any hospital-acquired infection is unacceptable," he said.

The infections raise questions about what health conditions should prevent a surgeon from operating and how to get the best protection from surgical gloves. Surgeons with open sores or known infections aren't supposed to operate, but there is no national standard on what to do if they have skin inflammation, said Rekha Murthy, medical director of the hospital's epidemiology department. She added that there were also no national standards on types of gloves used, whether to wear double gloves or how many times surgeons should change those gloves during a procedure.

Healthcare-acquired infections are very common throughout the United States. Each year, infections cause 99,000 deaths in the country, including about 12,000 in California. Hospitals in the state are required to report certain infections to the California Department of Public Health. That reporting makes the public more aware of the quality of care provided at local hospitals and is an important tool for reducing infections, said Debby Rogers, deputy director of the department's Center for Health Care Quality.

Cedars-Sinai has low rates for hospital-acquired infections compared with the state and national average but has not performed as well on other surgical quality measures recently, according to the Leapfrog Group, an employer-backed nonprofit focused on healthcare quality. The organization gave the hospital a C rating last month on its national report card, down from an A in June, though it was not related to the infection outbreak.

"Clearly this hospital is making attempts to reduce infections, but they have more work to do," said Leah Binder, Leapfrog's chief executive.

Cedars-Sinai Medical Center conducts about 360 valve replacement surgeries each year and said infections occur in fewer than 1% of its cases — lower than the national average.

The hospital learned about the problem in June after three patients who had undergone valve replacement surgery showed signs of infection. Doctors diagnosed the patients with an infection called endocarditis. Concerned there might be a connection among the cases, epidemiologists analyzed the bacteria, staphylococcus epidermidis, and determined that it was an identical strain and therefore must have come from a single source. "It led to the question of gee, I wonder where it came from?" Murthy said.

Epidemiologists homed in on the surgeon with the skin inflammation. The bacteria matched, and then they made a surprising discovery: microscopic tears in the gloves typically worn by surgeons after performing valve replacement surgery. The surgeon, whose name was not released, was not allowed to operate again until he healed. He is still a member of the medical staff but no longer performs surgeries at the hospital.

The hospital soon found the same infection in two more patients. Officials also reached out to 67 patients who had heart valve replacements with the same surgeon but didn't find any other cases. One of the five infected patients was treated with antibiotics, and the other four had new valve replacement surgeries. Sax said the hospital apologized to the patients and has continued to monitor their health. The hospital has also covered the cost of their care, including follow-up treatment and all the related surgeries.

All surgeons doing valve replacements are now required to change gloves more frequently, officials said. Some surgeons are wearing double gloves during the operations, Sax said.

Following the outbreak, Cedars-Sinai did the proper follow-up to ensure the safety of their patients, said Dawn Terashita, a medical epidemiologist with L.A. County, who was notified in September. What occurred at Cedars-Sinai was an unintentional consequence of the surgery, she said.

"There is no way to keep a room entirely sterile and all the people in it sterile," she said. "You will always have risk of infection."

anna.gorman@latimes.com

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FCC chairman urges FAA to revise in-flight iPad rules

No, it doesn’t make any sense that you have to turn off your iPad or Kindle during airplane landings, and now the chairman of the Federal Communications Commission wants to see that change. In a letter to the Federal Aviation Administration, FCC chairman Julius Genachowski urged the agency to “enable greater use of tablets, e-readers, and other portable devices” on flights, The Hill reports. Genachowski went on to say that letting passengers use their devices more during flights is important because “mobile devices are increasingly interwoven in our daily lives” and that they “enable both large and small businesses to be more productive and efficient, helping drive economic growth and boost U.S. competitiveness.”

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Rolling Stones hit NY for 50th anniversary gig

NEW YORK (AP) — "Time Waits for No One," the Rolling Stones sang in 1974, but lately it's seemed like that grizzled quartet does indeed have some sort of exemption from the ravages of time.

At an average age of 68-plus years, the British rockers are clearly in fighting form, sounding tight, focused and truly ready for the spotlight at a rapturously received pair of London concerts last month.

On Saturday, Mick Jagger, Keith Richards, Ronnie Wood and Charlie Watts hit New York for the first of three U.S. shows on their "50 and Counting" mini-tour, marking a mind-boggling half-century since the band first began playing its unique brand of blues-tinged rock.

And the three shows — Saturday's at the new Barclays Center in Brooklyn, then two in Newark, N.J., on Dec. 13 and 15 — aren't the only big dates on the agenda. Next week the Stones join a veritable who's who of British rock royalty and U.S. superstars at the blockbuster 12-12-12 Sandy benefit concert at Madison Square Garden. Also scheduled to perform: Paul McCartney, the Who, Eric Clapton, Bruce Springsteen & The E Street Band, Alicia Keys, Kanye West, Eddie Vedder, Billy Joel, Roger Waters and Chris Martin.

The Stones' three U.S. shows promise to have their own special guests, too. Mary J. Blige will be at the Brooklyn gig, as well as guitarist Gary Clark Jr., the band has announced. (Blige performed a searing "Gimme Shelter" with frontman Jagger in London.) Rumors are swirling of huge names at the Dec. 15 show, which also will be on pay-per-view.

In a flurry of anniversary activity, the band also released a hits compilation last month with two new songs, "Doom and Gloom" and "One More Shot," and HBO premiered a new documentary on their formative years, "Crossfire Hurricane."

The Stones formed in London in 1962 to play Chicago blues, led at the time by the late Brian Jones and pianist Ian Stewart, along with Jagger and Richards, who'd met on a train platform a year earlier. Bassist Bill Wyman and drummer Charlie Watts were quick additions.

Wyman, who left the band in 1992, was a guest at the London shows last month, as was Mick Taylor, the celebrated former Stones guitarist who left in 1974 — to be replaced by Wood, the newest Stone and the youngster at 65.

The inevitable questions have been swirling about the next step for the Stones: another huge global tour, on the scale of their last one, "A Bigger Bang," which earned more than $550 million between 2005 and 2007? Something a bit smaller? Or is this mini-tour, in the words of their new song, really "One Last Shot"?

The Stones won't say. But in an interview last month, they made clear they felt the 50th anniversary was something to be marked.

"I thought it would be kind of churlish not to do something," Jagger told The Associated Press. "Otherwise, the BBC would have done a rather dull film about the Rolling Stones."

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Associated Press writer David Bauder contributed to this report.

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Auto execs share insights on the industry and what's next

It's hard to get America's most senior auto executives together in the same building to address the same topics, but we managed to do it with Mark Reuss, president of General Motors Co.'s North American operations, and Mark Fields, the newly appointed chief operating officer of Ford Motor Co.

They came to town for the Los Angeles Auto Show, which ends Sunday. Even then, they weren't in the same room — so we just asked them identical questions, in separate interviews, to create this virtual debate.

Both executives address key issues facing the industry, including the future of in-dash technology, fuel economy, electric cars and the prospects for the industry at large. They don't always agree.

Do vehicle embedded features such as MyFord Touch or Cadillac Cue make sense when smartphones can do many of the same tasks with fewer glitches? Why not use architecture that allows people to use phone apps for vehicle infotainment?

Reuss: There is no way that the auto industry in the long haul should be carrying all that technology in a car. Phones will move faster in technology than anything we can put into a car. Embedding those functions in a car and then trying to guess where phones are going is not a solution. We will experiment with technology in Cadillac, but that's not where the mainline brands will be going.

Fields: It is very clear that for younger consumers, staying connected in their lives is hugely important whether they are in their bedrooms, walking outside or in their cars. That's why we started Sync and MyFord Touch.

In the future, you might end up seeing a hybrid of embedded technology and smartphone connectivity. There are certain things that we want to ensure, such as safety and integration into the rest of the vehicle. There could be some issues with just plugging in a smartphone and allowing it to do a lot of vehicle functions. We're already engaging in those discussions, thinking like a technology company.

The U.S. auto industry has been one of the better-performing segments of the U.S. economy recently but is still well below the 16 million to 17 million vehicles it once sold regularly. Can it shift to a higher gear?

Fields: We expect the market to continue to improve based on two factors. One is the age of the car park out there. [Registration data show the average age of vehicles on the road today is 10 to 11 years.] Cars are old and trucks are old. Look at that, combined with the fuel economy consumers can get from new cars right now, and there are some good reasons to buy. And then there is the gradual improvement of the economy.

This is a great business … but when you look out on the horizon in North America, do I think we will go back to the days of 18 million units anytime soon? No. But when you look at the components that set demand, I think it is very encouraging. The opportunities and growth in front of us are pretty substantial.

Reuss: It can happen based on population growth and the car-park age. But sales are throttled by the variance in consumer confidence and in jobs.

The industry is in a place it has never been in before. It has a break-even point of just 11 [million] to 12 million units. [Automakers are expected to sell about 14.5 million vehicles in the U.S. this year.] That's providing profits to invest in good cars, even if we haven't seen that quick sales growth.

That's a great place to be…. You could really be happy driving 98% of the stuff that is on display here.

What's the deal with electric vehicles? They garnered a lot of attention when automakers started selling them again two years ago, but sales are poor.

Reuss: The range has to grow and the cost of the battery and the car has to come down. The quickest way for the cost to come down is to build a platform-specific electric vehicle. Otherwise, you will always have a battery that is heavier than what you want and have less range than you want.

Our Spark EV will work, because it is already small and lightweight and close to what you want to do in a platform-specific vehicle.... We will sell a few thousand, and we are doing it in California, where there already is interest and some infrastructure for electric vehicles.

I don't think you will see bigger people-carrier EVs. It's just a harder sell. Who wants to be stranded with your family [because the battery drained down] and pay a lot of money to do it?

Fields: The simple answer is that we don't know what percentage of the marketplace battery-electric vehicles will occupy next year or even five years from now. Our strategy is to align our manufacturing so that wherever it goes, we will be able to flex.

Demand for full-electric vehicles depends on a lot of factors, including getting the cost down lower, and the price of fuel and the infrastructure to be able to support mass EVs with charging stations, etc.

It is so dynamic right now. At gas at $3.40 a gallon, will sales of EVs bump up appreciably? If gas is $5 a gallon, you would get another answer. Whatever the continuum, we will be able to meet the demand.

What single feature or attribute of a vehicle is the consumer most focused on right now?

Fields: I think fuel economy is now embedded in people's minds, no matter what the price of oil is. In the 1970s to get fuel economy you had to get really small, inconvenient vehicles, but now you don't have to compromise on size or performance.

Reuss: It is reliability and durability. You can do the styling right, the technology right and price right. But if you don't have the durability and reliability, you won't get retention. People won't buy your car again. No one wants to be accused of buying something stupid. Fuel economy would be the next reason to buy.

jerry.hirsch@latimes.com

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