Well: Ask Well: Squats for Aging Knees

You are already doing many things right, in terms of taking care of your aging knees. In particular, it sounds as if you are keeping your weight under control. Carrying extra pounds undoubtedly strains knees and contributes to pain and eventually arthritis.

You mention weight training, too, which is also valuable. Sturdy leg muscles, particularly those at the front and back of the thighs, stabilize the knee, says Joseph Hart, an assistant professor of kinesiology and certified athletic trainer at the University of Virginia, who often works with patients with knee pain.

An easy exercise to target those muscles is the squat. Although many of us have heard that squats harm knees, the exercise is actually “quite good for the knees, if you do the squats correctly,” Dr. Hart says. Simply stand with your legs shoulder-width apart and bend your legs until your thighs are almost, but not completely, parallel to the ground. Keep your upper body straight. Don’t bend forward, he says, since that movement can strain the knees. Try to complete 20 squats, using no weight at first. When that becomes easy, Dr. Hart suggests, hold a barbell with weights attached. Or simply clutch a full milk carton, which is my cheapskate’s squats routine.

Straight leg lifts are also useful for knee health. Sit on the floor with your back straight and one leg extended and the other bent toward your chest. In this position, lift the straight leg slightly off the ground and hold for 10 seconds. Repeat 10 to 20 times and then switch legs.

You can also find other exercises that target the knees in this video, “Increasing Knee Stability.”

Of course, before starting any exercise program, consult a physician, especially, Dr. Hart says, if your knees often ache, feel stiff or emit a strange, clicking noise, which could be symptoms of arthritis.

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7 Die in Fire At Factory In Bangladesh


A.M. Ahad/Associated Press


Firefighters and volunteers worked to extinguish the fire at a small garment factory in Bangladesh’s capital on Saturday.







DHAKA, Bangladesh — In the latest blow to Bangladesh’s garment industry, seven workers died Saturday after a fire swept through a factory here not long after seamstresses had returned from a lunch break. Workers said supervisors had locked one of the factory exits, forcing some people to jump out of windows to save their lives.









Abir Abdullah/European Pressphoto Agency

Relatives mourned beside the bodies of workers killed in the fire at a hospital in Dhaka.






Reuters

People sifted through the wreckage at the Smart Fashions factory.






The fatal fire comes roughly two months after the blaze at the Tazreen Fashions factory left 112 workers dead and focused global attention on unsafe conditions in Bangladesh’s garment industry. Tazreen Fashions, located just outside Dhaka, the capital, had been making clothing for some of the world’s biggest brands and retailers, including Walmart.


In the aftermath of the Tazreen Fashions fire, political and industrial leaders in Bangladesh pledged to quickly improve fire safety and even conducted high-profile, nationwide inspections of many of the country’s 5,000 clothing factories. And global brands promised they would not buy clothes from unsafe factories.


But Saturday’s fire in a densely populated section of Dhaka is a grim reminder that the problems remain. The blaze erupted about 2 p.m. at Smart Garment Export, a small factory that employed about 300 people, most of them young women who were making sweaters and jackets. All seven of the dead workers were women.


Masudur Rahman Akand, a supervisor in the fire department, said the factory’s workers were returning from lunch when the blaze erupted in a storage area. The factory was located on the second floor of a building, above a bakery, and it lacked proper exits and fire prevention equipment, Mr. Akand said.


“We did not find fire extinguishers,” he said. “We did not find any safety measures.”


With smoke filling the factory floor, workers apparently panicked. Mr. Akand said the seven workers who died either suffocated or were trampled by people trying to escape.


Eight other workers were hospitalized with injuries. Some of them told rescuers that many people could not quickly escape because one of the exits was blocked by a locked steel gate. Witnesses said people began jumping out of windows before the gate was unlocked.


Azizul Hoque, a police supervisor, said the investigation was continuing. “We do not know the reason or the source or the origin of the fire,” he said.


It was unclear whether the Smart Garment factory was making clothing for international brands or retailers. Dhaka’s industrial areas are filled with factories, large and small, that produce clothing for much of the Western world.


Julfikar Ali Manik reported from Dhaka, and Jim Yardley from New Delhi.



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St. John's in court fight over failed nurse recruitment effort









Short of hospital nurses in recent years, St. John's Health Center in Santa Monica hired a recruiter in England and flew one of its top executives to London to interview job candidates.


The recruiter's firm, Stateside Nursing, found 105 nurses and the hospital paid the company nearly $700,000 in recruiting fees and for providing "acculturation services" to help the foreigners adjust to life in Southern California.


Despite all those payments, none of the nurses ever arrived in Santa Monica.





Now the hospital is pursuing a court fight over this costly failure, saying it was the victim of fraud, bribery and unfair business practices. But the legal battle may also yield unflattering details about the inner workings of one of the area's best-known hospitals, which recently saw a high-profile management shake-up.


In the case headed to trial next month, St. John's accuses the recruiter, Lisa Taylor, of paying about $128,000 in bribes to Victor Melendez, the hospital's former vice president of human resources. The hospital is suing the pair in Los Angeles County Superior Court.


Both Melendez, through his lawyer, and Taylor deny the allegations, and they say the payments to Melendez were not bribes. He was paid for previous recruiting work unrelated to the hospital contracts, they said. Taylor says changes in U.S. immigration rules prevented the nurses from coming to work.


There's no indication that this nurse-recruitment saga prompted the recent dismissals of St. John's former chief executive, Lou Lazatin, and her chief operating officer, Eleanor Ramirez, by the hospital's owner, the Sisters of Charity of Leavenworth Health System in Denver. In November, the Catholic nonprofit escorted Lazatin and Ramirez off the hospital premises one morning and fired 15 of the hospital's 17 board members by email.


Taylor wants the two former executives to testify in this case and explain their departure. "We want to know why they aren't there anymore," she said. "It goes to their credibility." Neither Lazatin nor Ramirez could be reached for comment.


Michael Slubowski, chief executive of the Sisters of Charity, has declined to comment on the specific reasons for the St. John's dismissals, and he said the hospital "doesn't publicly discuss legal matters."


There have been discussions in recent months about selling the 266-bed hospital, which has tended to celebrities and politicians over the years. St. John's reported a loss of $13 million for 2011, the latest state data show, and patient revenue slipped 8% to $891 million.


The nursing shortage at St. John's was a common problem for many hospitals across California.


In 2006, Melendez, the hospital's newly hired human resources executive, set out to remedy that problem. He recommended three recruiting firms to the hospital, including Taylor's Stateside Nursing, according to his lawyer, Vincent S. Ammirato. In a contract that year, St. John's agreed to pay Stateside an $8,000 recruitment fee for each nurse it found.


The hospital sent Melendez to London, where he and Taylor interviewed dozens of nurses and 52 of them accepted job offers, according to the hospital's lawsuit. Stateside billed Saint John's for about $200,000 in initial fees.


Stateside then offered to provide "acculturation services" for the 52 nurses at $2,000 per nurse to help them acclimate to life in the U.S. because many were originally from the Philippines, India and other countries. In court filings, the hospital contends that Melendez didn't have the authority to approve those additional expenses because they weren't included in the contract. Rather, the hospital said, those payments were just a way for Taylor to pocket extra money for the alleged bribes.


By August 2007, even though no nurses had arrived, St. John's agreed to pay Stateside even more. The hospital boosted Stateside's recruitment fee to $13,000 per nurse from $8,000 earlier.


The hospital says Melendez wasn't authorized to sign the new contract. Ammirato, Melendez's lawyer, said that his client did not act alone and that Melendez's boss, the former chief operating officer, was involved in negotiating Stateside's agreements and approving its invoices.


In mid-2007, Melendez left St. John's for another job, so the hospital sent other human resource officials to London to interview nurses. Stateside found 53 more nurses and it billed for additional fees. Overall, according to court documents, the hospital paid Stateside $669,550 in upfront fees in 2007 and 2008.


St. John's said it became suspicious later in 2008 when Stateside's director of sales sent a letter to the hospital alleging that the recruitment firm was overcharging St. John's and paying bribes to Melendez. Based on this tip, St. John's sought to recoup its money and subpoenaed Melendez's bank records.


Stateside wired Melendez $51,843 in February 2007 and sent him an additional $51,943 the next month, according to the hospital's lawsuit. Those wire transfers took place shortly after Melendez authorized two payments of $52,000 apiece to Stateside. Later in 2007, Taylor wrote him another check, for $25,000. Taylor and Melendez don't dispute those payments.


In October 2010, an arbitrator found that Stateside engaged in "unlawful and fraudulent business practices" by paying Melendez to gain improper advantages in its contracts. The arbitrator awarded the hospital $1 million in damages, interest and legal fees.


Stateside went through liquidation in England, Taylor said, and she couldn't defend herself at the arbitration hearing. The hospital hasn't collected any portion of the arbitration award since her company shut down.


Taylor said she had satisfied her obligations by finding the nurses and getting them licensed to work at St. John's. The U.S. had adopted a policy in 2006 that made it more difficult for some foreign nurses to obtain work visas. St. John's said in its suit that Taylor misrepresented that she could handle those immigration issues.


"We got the nurses as far as we could get them when the U.S. government ran out of visa numbers," said Taylor, 47, who now lives in Colorado. "I'm looking forward to telling my story at trial."


chad.terhune@latimes.com





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Man With 4th Amendment Written on Chest Wins Trial Over Airport Arrest



A Virginia man who wrote an abbreviated version of the Fourth Amendment on his body and stripped to his shorts at an airport security screening area won a trial Friday in his lawsuit seeking $250,000 in damages for being detained on a disorderly conduct charge.


Aaron Tobey claimed in a civil rights lawsuit (.pdf) that in 2010 he was handcuffed and held for about 90 minutes by the Transportation Security Administration at the Richmond International Airport after he began removing his clothing to display on his chest a magic-marker protest of airport security measures.


“Amendment 4: The right of the people to be secure against unreasonable searches and seizures shall not be violated,” his chest and gut read.


In sending the case to trial, unless there’s a settlement, the 4th U.S. Circuit Court of Appeals ruled 2-1 and reversed a lower court judge and invoked Benjamin Franklin in the process. According to the opinion by Judge Roger Gregory:


Here, Mr. Tobey engaged in a silent, peaceful protest using the text of our Constitution—he was well within the ambit of First Amendment protections. And while it is tempting to hold that First Amendment rights should acquiesce to national security in this instance, our Forefather Benjamin Franklin warned against such a temptation by opining that those ‘who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.’ We take heed of his warning and are therefore unwilling to relinquish our First Amendment protections—even in an airport.


Tobey didn’t want to go through the advanced imaging technology X-ray machines, or so-called nude body scanners, that were cropping up at airports nationwide. Instead, when it was his turn to be screened, he was going to opt for an intrusive pat-down, and removed most of his clothing in the process.


Among other things, the federal lawsuit claimed wrongful detention and a breach of the First Amendment and Fourth Amendment. Tobey was on his way to Wisconsin for his grandmother’s funeral. Despite his detainment, he made his flight.


According to the suit, while under interrogation, the authorities wanted to know “about his affiliation with, or knowledge of, any terrorist organizations, if he had been asked to do what he did by any third party, and what his intentions and goals were.”


Two weeks later, Henrico County prosecutors dropped the misdemeanor charge against him, and he sued the Transportation Security Administration and others.


In dissent, Judge J. Harvie Wilkinson wrote:


Had this protest been launched somewhere other than in the security-screening area, we would have a much different case. But Tobey’s antics diverted defendants from their passenger-screening duties for a period, a diversion that nefarious actors could have exploited to dangerous effect. Defendants responded as any passenger would hope they would, summoning local law enforcement to remove Tobey—and the distraction he was creating — from the scene.


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Dr. Phil to interview alleged girlfriend hoaxer






NEW YORK (AP) — Dr. Phil McGraw has booked the first on-camera interview with the man who allegedly concocted the girlfriend hoax that ensnared Notre Dame football star Manti Te’o.


A “Dr. Phil Show” spokesperson confirmed on Friday the interview with Ronaiah Tuiasosopo (roh-NY-ah too-ee-AH’-so-SO’-poh), the man accused of creating an online persona of a nonexistent woman who Te’o said he fell for without ever meeting face-to-face.






The ruse was uncovered last week by Deadspin.com, which reported that Tuiasosopo created the woman, named Lennay Kekua, who then supposedly died last September.


No further details of the “Dr. Phil” interview, including its airdate, were announced.


This interview follows the first on-camera interview with Te’o conducted this week by Katie Couric.


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Europe: Germany: Funds for Global Health Fund Reinstated





Signaling that it was pleased with changes in the Global Fund to Fight AIDS, Tuberculosis and Malaria, Germany announced Thursday that it would reinstate the annual pledge of 200 million euros (about $267 million) it had made since the fund’s early days. In 2011, Germany temporarily held back half its contribution and threatened to hold back future funds in protest against inefficiencies, thefts by some grantee countries and infighting among the fund’s top executives. Other contributions dried up, forcing the fund to cancel a planned round of grants. Since then, both the fund’s executive director and inspector general have departed, and it was run for one year by a Brazilian banker; he devised an overhaul of the grant-making process that is to take effect next month. In November, Dr. Mark Dybul, the Bush administration’s global AIDS czar, became the new executive director. The fund recently announced that it cut its operating expenses by 5 percent in 2012 while still making 26 percent more in grants than it did in 2011. Of the grants that had been audited, Dr. Dybul said, only 0.5 percent had been lost to fraud. The fund plans a new fund-raising round for later this year. The United States is the fund’s largest supporter, providing roughly a third of its budget.


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Pictures from the Week in Business

The port of Tokyo. Following the lead of their counterparts in the United States, Japan’s central bankers announced on Tuesday what they called a groundbreaking effort to reinvigorate the country’s long-moribund economy and defeat deflation. With no room left to cut interest rates and previous steps unsuccessful, the Bank of Japan is taking a page from the Federal Reserve’s playbook and will pump trillions more yen into the economy by directly buying government bonds and other assets.
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787 Dreamliner's safety systems failed, NTSB says









After investigating a fire that broke out on Boeing Co.'s 787 Dreamliner passenger jet, the National Transportation Safety Board said that backup protections in the aircraft's lithium-ion batteries and electronics systems failed.


But the safety agency hasn't reached a conclusion on the cause of the fire that occurred in Boston on Jan. 7 and partly led to last week's grounding of Dreamliners worldwide that remains in effect.


Speaking to reporters Thursday from Washington, NTSB Chairwoman Deborah Hersman said the agency hadn't determined what happened, but she added that the redundant safety systems installed by Boeing did not work.





The Federal Aviation Administration grounded the jet Jan. 16 after an emergency landing by All Nippon Airways in Japan because of a second fire believed to involve the plane's onboard lithium-ion batteries. Shortly after the FAA's decision, countries around the world prohibited the new plane from flying.


"These events should not happen," said the safety board's chairwoman. "As far as design of the aircraft, there are multiple systems to protect against a battery event like this. Those systems did not work as intended."


The decision on whether 787s should continue to be grounded in the U.S. belongs to the FAA. The independent safety board is responsible for collecting forensic evidence and conducting tests to determine what happened.


There is no timeline to when tests will be completed, but Hersman said the agency has "all hands on deck" looking into the problem. Investigators around the world are disassembling and scanning the batteries.


In its search for the exact cause of the fires, the NTSB has said it is looking for possible contaminants or manufacturing defects. The agency is also working with officials from Boeing, the FAA and the Navy, as well as investigators in France and Japan.


Japan, where the second fire occurred, is also where Boeing's lithium-ion batteries are made by Kyoto-based GS Yuasa Corp. The Japan Transport Safety Board, the country's version of the FAA, is heading up the investigation into All Nippon's emergency landing and reported fire.


So far, the NTSB's investigators in the Boston fire have found that overheating was caused by short circuits and "thermal runaway," a chain reaction in which heat spreads rapidly from cell to cell, Hersman said. "The significance of these events cannot be understated."


Boeing said in a statement that it is working with its airline customers and the regulatory agencies to get the matter resolved but that it is not permitted to comment directly on the ongoing investigations.


"The company has formed teams consisting of hundreds of engineering and technical experts who are working around the clock with the sole focus of resolving the issue and returning the 787 fleet to flight status," Boeing said. "The safety of passengers and crew members who fly aboard Boeing airplanes is our highest priority."


The 787's battery systems were called into question on Jan. 7 when a smoldering fire was discovered on the underbelly of the plane operated by Japan Airlines after the 183 passengers and 11 crew members had deplaned at the gate.


In the second incident, which involved All Nippon Airways, smoke was seen swirling from the right side of the cockpit after an emergency landing related to the plane's electrical systems. All 137 passengers and crew members were evacuated from the aircraft and slid down the 787's emergency slides. Video of the event was captured by an onboard passenger and has been broadcast worldwide.


No one has been reported hurt or injured. But the recent events have become a public relations nightmare for the Chicago company, which has long heralded the Dreamliner as a representation of 21st century air travel.


Boeing has taken 848 orders for 787s from airlines and aircraft leasing firms around the world. Depending on the version ordered, the price ranges from $206.8 million to $243.6 million per jet.


The company has delivered 50 787s to eight airlines worldwide. Six are owned by Chicago-based United Airlines — the only U.S. carrier that currently has 787s in its fleet.


In an earnings conference call on Thursday, United Continental Holdings Inc. Chief Executive Jeff Smisek defended the plane.


"History teaches us that all new aircraft types have issues, and the 787 is no different," Smisek said. "We continue to have confidence in the aircraft and in Boeing's ability to fix the issues, just as they have done on every other new aircraft model they've produced."


In trading Thursday, Boeing's stock closed up $1.03, or 1.4%, at $75.32. But the stock fell in after-hours trading, at one point dropping 30 cents, or 0.4%, to $75.02.


Problems are expected with any new plane — especially one as complicated and sophisticated as the 787. But the last time the FAA grounded a large commercial jet out of safety concerns was almost 34 years ago after a DC-10 crashed at Chicago O'Hare International Airport, killing all 271 aboard.


The 787, a twin-aisle aircraft that can seat 210 to 290 passengers, is the first large commercial jet with more than half its structure made of composite materials (carbon fibers meshed together with epoxy) rather than aluminum sheets. It's also the first large commercial aircraft that extensively uses electrically powered systems involving lithium-ion batteries.


william.hennigan@latimes.com





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Vine's Launch-Day Woes Include Bugs and Facebook Block











Twitter’s new social video app isn’t having a smooth launch day.


Despite being well-received, Vine has faced a mess of issues since it launched Thursday morning. First, server-side bugs led to users signing into other people’s accounts. Then the app had to disable video-sharing to social networks. And all day long, there’s been the general bugginess of trying to sign in via Twitter and find friends through Twitter or Facebook.


And as of Thursday evening, it appears that Facebook has blocked Vine’s access to its network.


When you try to find Facebook-connected friends on the app, an error message pops up: “Vine is not authorized to make this Facebook request.” This is only hours after the app had no problem connecting to, and pulling friend data from, your Facebook network.


Neither Facebook nor Vine or Twitter responded for comment at the time of publication.


Facebook cutting off Vine is another way for the social giant to exert its powers. Considering Facebook just released data about how third-party, Facebook-connected mobile apps have much more engaged users, it’s clear that Facebook doesn’t want to give Vine the same benefits.


But it’s a development that further illustrates the battles taking place between social giants — it comes on the heels of other competitive shenanigans, including Instagram dropping Twitter card integration, and Twitter subsequently cutting Instagram off from finding friends within its app.


All this strategic posturing is much more than just a headache for Vine. The app continues to enjoy a tremendous amount of launch-day buzz, and as new users are flocking in and signing up, they’re the ones being greeted with super-annoying roadblocks. It proves once again that when the social networks decide to stop playing nice, ultimately, the loser is you.






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The New Old Age Blog: Grief Over New Depression Diagnosis

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

Traditionally, depression has been underdiagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” We don’t find depression in old age normal any longer.

But critics of the D.S.M. 5 now argue that depression may become overdiagnosed, because this version removes the so-called “bereavement exclusion.” That was a paragraph that cautioned against diagnosing depression in someone for at least two months after loss of a loved one, unless that patient had severe symptoms like suicidal thoughts.

Without that exception, you could be diagnosed with this disorder if you are feeling empty, listless or distracted, a month after your parent or spouse dies.

“D.S.M. 5 is medicalizing the expected and probably necessary process of mourning that people go through,” said Allen Frances, a professor emeritus at Duke who chaired the D.S.M. IV task force and has denounced several of the changes in the new edition. “Most people get better with time and natural healing and resilience.”

If they are diagnosed with major depression before that can happen, he fears, they will be given antidepressants they may not need. “It gives the drug companies the right to peddle pills for grief,” he said.

An advisory committee to the Association for Death Education and Counseling also argued that bereaved people “will receive antidepressant medication because it is cheaper and ‘easier’ to medicate than to be involved therapeutically,” and noted that antidepressants, like all medications, have side effects.

“I can’t help but see this as a broad overreach by the APA,” Eric Widera, a geriatrician at the University of California, San Francisco, wrote on the GeriPal blog. “Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.”

But Dr. Kupfer said the panel worried that with the exclusion, too many cases of depression could be overlooked and go untreated. “If these things go on and get worse over time and begin to impair someone’s day to day function, we don’t want to use the excuse, ‘It’s bereavement — they’ll get over it,’” he said.

The new entry for major depressive disorder will include a note — the wording isn’t final — pointing out that while grief may be “understandable or appropriate” after a loss, professionals should also consider the possibility of a major depressive episode. Making that distinction, Dr. Kupfer said, will require “good solid clinical judgment.”

Initial field trials testing the reliability of D.S.M. 5 diagnoses, recently published in The American Journal of Psychiatry, don’t bolster confidence, however. An editorial remarked that “the end results are mixed, with both positive and disappointing findings.” Major depressive disorder, for instance, showed “questionable reliability.”

In an upcoming post, I’ll talk more about how patients might respond to the D.S.M. 5, and to a new diagnosis that might also affect a lot of older people — mild neurocognitive disorder.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”


This post has been revised to reflect the following correction:

Correction: January 24, 2013

An earlier version of this post misspelled the surname of a professor emeritus at Duke who chaired the D.S.M. IV task force. He is Allen Frances, not Francis.

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