Well: Officials Warn Against Baby Sleep Positioners

Health officials are warning parents not to use a special device designed to help keep babies in certain positions as they sleep. The device, called a sleep positioner, has been linked to at least 13 deaths in the last 15 years, officials with two federal agencies said on Wednesday.

“We urge parents and caregivers to take our warning seriously and stop using these sleep positioners,” Inez Tenenbaum, the chairman of the Consumer Product Safety Commission, said in a statement.

The sleep positioner devices come primarily in two forms. One is a flat mat with soft bolsters on each side. The other, known as a wedge-style positioner, looks very similar but has an incline, keeping a child in a very slight upright position.

Makers of the devices claim that by keeping infants in a specific position as they sleep, they can prevent several conditions, including acid reflux and flat head syndrome, a deformation caused by pressure on one part of the skull. Many are also marketed to parents as a way to help reduce a child’s risk of sudden infant death syndrome, or SIDS, which kills thousands of babies every year, most between the ages of 2 months and 4 months.

But the devices have never been shown in studies to prevent SIDS, and they may actually raise the likelihood of sudden infant death, officials say. One of the leading risk factors for sudden infant death is placing a baby on his or her stomach at bedtime, and health officials have routinely warned parents to lay babies on their backs. They even initiated a “Back to Sleep” campaign in the 1990s, which led to a sharp reduction in sudden infant deaths.

With the positioner devices, if an infant rolls onto the stomach, the child’s mouth and nose can press up against a bolster or some other part of the device, leading to suffocation. Even if placed on the back, a child can move up or down in the positioner, “entrapping its face against a bolster or becoming trapped between the positioner and the crib side,” Gail Gantt, a nurse consultant with the Food and Drug Administration, said in an e-mail. Or the child might scoot down the wedge in a way that causes the child’s mouth and nose to press into the device.

“The baby’s movement may also cause the positioner to flip on top of the baby, trapping the baby underneath the positioner or between the positioner and the side of the crib,” she said.

Of the 13 babies known to have suffocated in a sleep positioner since 1997, most died after they rolled from their sides onto their stomachs. The Consumer Product Safety Commission has also received dozens of reports of babies who were placed on their sides or backs, “only to be found later in hazardous positions within or next to the product,” the F.D.A. said in a statement.

Many baby books for new parents specifically urge against using sleep positioners, and the American Academy of Pediatrics does not support their use for SIDS prevention. Though the F.D.A. has never approved the positioners for the prevention of SIDS, it has in the past approved a number of the devices for the prevention of gastroesophageal reflux disease and flat head syndrome. But the agency said that in light of the new safety data, it believed any benefits from using the devices were outweighed by the risk of suffocation.

As of Wednesday, the agency is explicitly advising parents to stop using sleep positioners, and it has asked manufacturers of the devices to submit clinical data showing that the benefits of their products outweigh the risk of serious harm. In addition to avoiding the devices, experts say, parents should keep things like pillows, comforters, quilts and bumpers away from their infants and their cribs. Soft bedding can increase the likelihood of a baby suffocating.

“The safest crib is a bare crib,” Dr. Susan Cummins, a pediatric expect with the F.D.A., said in a statement. “Always put your baby on his or her back to sleep. An easy way to remember this is to follow the ABC’s of safe sleep – Alone on the Back in a bare Crib.”

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DealBook: Judge Approves Hostess Brands' Plan to Close Down

A federal bankruptcy judge on Wednesday approved plans for Hostess Brands to wind down its operations, but there is little doubt that its best-known brand, Twinkies, will live on.

The company, whose corporate ancestors go back 82 years, said it would put Twinkies on the auction block, along with its other famous brands, including Ho Hos, Sno Balls, Ring Dings and Wonder Bread.

In granting the motion by Hostess, Judge Robert D. Drain of the United States Bankruptcy Court for the Southern District of New York said it was important to have a quick and orderly shutdown of the company to prevent the deterioration of its factories and assets.

The company’s chief executive, Gregory F. Rayburn, testified in court that he needed to lay off 15,000 of his 18,500 employees on Wednesday afternoon so that they could begin applying for unemployment benefits as soon as possible. He said such speed was necessary for maximizing the remaining value of the company.

“From this point forward, I need two things to happen,” Mr. Rayburn told the judge. “I need to maximize the value of the estate, and I need to do the best thing for the employees.”

Wednesday’s hearing came after a last-ditch mediation session on Tuesday between Hostess and its bakery workers union. After several hours of talks, the mediation efforts collapsed.

Hostess announced its intention to liquidate last Friday, and since then the company has received expressions of interest for its bakery brands from a wide range of potential buyers. Without naming names, an investment banker for Hostess, Joshua S. Scherer of Perella Weinberg Partners, said in court on Wednesday that they included regional bakeries, national competitors and retail customers along the lines of Wal-Mart Stores and Kroger.

Mr. Scherer added that his firm had plans to contact around 145 financial firms, including private equity shops and liquidators, to gauge their interest.

Investment concerns like Sun Capital Partners and C. Dean Metropoulos & Company, the owner of Pabst Blue Ribbon beer, have already said that they are interested in buying some or all of Hostess’s remains. Sun Capital has said that it would like to buy all of Hostess, not just its brands, hoping to preserve the company and improve its often-tense relations with its unions.

Mr. Scherer said that he expected asset sales to reap “significant values,” perhaps more than $1 billion. Hostess had revenue of $2.5 billion in fiscal 2012, and a net loss of $1.1 billion.

Its famous brands have been sold and traded for decades among companies, including I.T.T., Ralston Purina and Continental Baking.

“These products will surely live on in one form or the other — because these brands are about as indestructible as Hostess’s baked goods are,” said Jeffrey A. Sonnenfeld, senior associate dean for executive programs at the Yale School of Management.

Hostess was unable to resuscitate itself during this bankruptcy, its second in less than a decade. When it filed for bankruptcy last January, it had nearly $1 billion in debt and labor costs, and work rules that it insisted were unsustainable.

According to Mr. Raymond, what sent the company into bankruptcy was both the refusal of one of its largest unions, the Bakery, Confectionery, Tobacco Workers and Grain Millers International Union, to accept far-reaching concessions and a strike that the union began on Nov. 9, crippling two-thirds of the company’s 33 bakeries.

The bakery workers union, with 5,600 workers at Hostess, repeatedly said that it saw no reason to grant a new round of givebacks — after having granted major concessions in the previous bankruptcy of Hostess — because it was convinced that Hostess was heading toward liquidation, with or without concessions. That union and Hostess’s other major union, the Teamsters, repeatedly asserted that the company was mismanaged, having had six different chief executives since 2002. The unions maintained that Hostess’s top management had done little to modernize the company’s aging bakeries or its sugary product offerings — in an era when the nation has grown increasingly health conscious.

After filing for bankruptcy protection in January, Hostess demanded lower-cost contracts from the Teamsters, whose workers at Hostess average about $20 an hour, and the bakery workers, who average about $16. To help the company survive, the Teamsters, with 6,700 members at Hostess, most of them drivers, reluctantly agreed to a contract with numerous concessions. They include new work rules, an immediate 8 percent pay cut, a 17 percent reduction in Hostess’s contribution toward health coverage and a suspension of its pension payments until 2015. In return, the company agreed to give its unions two of the nine seats on its board and a 25 percent stake in the company.

But the bakery workers’ union resisted a similar deal, convinced it would drive down wages in the industry while in no way guaranteeing Hostess’s survival. That union went on strike rather than accept that offer, hoping the company would bend.

A week after the strike began, Mr. Rayburn said he would liquidate the company.

The looming liquidation of Hostess has been a topic of debate, with many on one side criticizing greedy, stubborn labor unions and many on the other blaming what the bakery workers’ president has called “vulture capitalists.” The company entered its first bankruptcy in 2004 with $450 million in debt, and exited five years later with even more debt — $670 million.

“The private equity owners put this thing in such deep debt and asked for such deep concessions that it put the unions in a difficult situation,” said Thomas A. Kochan, a professor at the Sloan School of Management at the Massachusetts Institute of Technology. “The unions weren’t sure whether these concessions would be enough to salvage the company.”

Hostess Brands has corporate roots going back to 1930, but the company has had that name only since 2009, when Ripplewood Holdings, the private equity firm that took control of Interstate Bakeries, renamed it. Ripplewood, which has close ties to Richard A. Gephardt, a former Democratic House majority leader and longtime ally of labor unions, is rarely viewed as a predatory private equity company — it originally bought Hostess as part of an effort to save distressed unionized companies.

“The company had plenty of time to figure out a new business model in terms of products, but it didn’t, so it was convenient to blame labor for the company’s failure,” said John W. Budd, a professor of industrial relations at the Carlson School of Management at the University of Minnesota. “Hostess’s creditors weren’t willing to make any more concessions, so if they didn’t see a viable business model, that raises questions of why labor should be making more concessions.”

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Toll Rises as U.S. Pushes for Israel-Hamas Truce

JERUSALEM — Efforts to agree on a cease-fire between Israel and Hamas intensified on Tuesday, but the struggle to achieve even a brief pause in the fighting emphasized the obstacles to finding any lasting solution.

On the deadliest day of fighting in the week-old conflict, Secretary of State Hillary Rodham Clinton arrived hurriedly in Jerusalem and met with Prime Minister Benjamin Netanyahu of Israel to push for a truce. She was due in Cairo on Wednesday to consult with Egyptian officials in contact with Hamas, placing her and the Obama administration at the center of a fraught process with multiple parties, interests and demands.

Officials on all sides had raised expectations that a cease-fire would begin around midnight, followed by negotiations for a longer-term agreement. But by the end of Tuesday, officials with Hamas, the militant Islamist group that governs Gaza, said any announcement would not come at least until Wednesday.

The Israelis, who have amassed tens of thousands of troops on the Gaza border and have threatened to invade for a second time in four years to end the rocket fire from Gaza, never publicly backed the idea of a short break in fighting. They said they were open to a diplomatic accord but were looking for something more enduring.

“If there is a possibility of achieving a long-term solution to this problem through diplomatic means, we prefer that,” Mr. Netanyahu said before meeting with Ms. Clinton at his office. “But if not, I’m sure you understand that Israel will have to take whatever actions necessary to defend its people.”

Mrs. Clinton spoke of the need for “a durable outcome that promotes regional stability and advances the security and legitimate aspirations of Israelis and Palestinians alike.” It was unclear whether she was starting a complex task of shuttle diplomacy or whether she expected to achieve a pause in the hostilities and then head home.

The diplomatic moves came as the antagonists on both sides stepped up their attacks. Israeli aerial and naval forces assaulted several Gaza targets in multiple strikes, including a suspected rocket-launching site near Al Shifa Hospital. That attack killed more than a dozen people, bringing the total number of fatalities in Gaza to more than 130 — roughly half of them civilians, the Gaza Health Ministry said.

A delegation visiting from the Arab League canceled a news conference at the hospital because of the Israeli aerial assaults as wailing ambulances brought victims in, some of them decapitated.

The Israeli assaults carried into early Wednesday, with multiple blasts punctuating the otherwise darkened Gaza skies.

Militants in Gaza fired a barrage of at least 200 rockets into Israel, killing an Israeli soldier — the first military casualty on the Israeli side since the hostilities broke out. The Israeli military said the soldier, identified as Yosef Fartuk, 18, had died from a rocket strike that hit an area near Gaza. Israeli officials said a civilian military contractor working near the Gaza border was also killed, bringing the number of fatalities in Israel from the week of rocket mayhem to five.

Other Palestinian rockets hit the southern Israeli cities of Beersheba and Ashdod, and longer-range rockets were fired at Tel Aviv and Jerusalem. Neither main city was struck, and no casualties were reported. One Gaza rocket hit a building in Rishon LeZion, just south of Tel Aviv, injuring one person and wrecking the top three floors.

Senior Egyptian officials in Cairo said Israel and Hamas were “very close” to a cease-fire agreement. “We have not received final approval, but I hope to receive it any moment,” said Essam el-Haddad, President Mohamed Morsi’s top foreign affairs adviser.

Foreign diplomats who were briefed on the outlines of a tentative agreement said it had been structured in stages — first, an announcement of a cease-fire, followed by its implementation for 48 hours. That would allow time for Mrs. Clinton to involve herself in the process on the ground here and create a window for negotiators to agree on conditions for a longer-term cessation of hostilities.

But it seemed that each side had steep demands of a longer-term deal that the other side would reject.

Khaled Meshal, the Hamas leader, said in Cairo that Israel needed to end its blockade of Gaza. Israel says the blockade keeps arms from entering the coastal strip.

Ethan Bronner reported from Jerusalem, and David D. Kirkpatrick from Cairo. Reporting was contributed by Jodi Rudoren and Fares Akram from Gaza; Isabel Kershner from Jerusalem; Peter Baker from Phnom Penh, Cambodia; David E. Sanger and Mark Landler from Washington; and Rick Gladstone from New York.

This article has been revised to reflect the following correction:

Correction: November 20, 2012

Because of an editing error, an earlier version of this article misspelled the family name of the Israeli soldier who was killed in a Palestinian rocket attack on Tuesday. He is Yosef Fartuk, not Yosef Faruk. 

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Review: Gift guide to full-size tablets

NEW YORK (AP) — Tablets are at the top of many wish lists this holiday season. But what to get? The choice used to be pretty limited, with the iPad dominating the latecomers. But this year, the field is more even, as tablets from Apple‘s competitors have matured. In addition, Google and Microsoft are diving in with their own tablets, providing more choice.

The first step in the buying process is to decide on the size of the tablet. They fall into two rough categories: the full-sized tablet, pioneered by the iPad, and the half-size tablet, epitomized by the Kindle Fire.

Full-sized tablets, which generally have screens measuring about 10 inches on the diagonal, are better for surfing websites designed for PCs, and far better when it comes to displaying magazines and documents. Overall, they go further toward replacing a laptop. They cost $ 400 and up.

Half-sized tablets, which have screens measuring roughly 7 inches on the diagonal, are cheaper and lighter, but just as good as full-sized tablets for e-book reading. It’s an excellent first computing device for a kid, or a gentle nudge into the digital world for an older adult with little computing experience. This year’s crop costs $ 199 and up, but last year’s models are available for less.

If you’ve settled on a large tablet, here are some top choices. A review of smaller tablets ran Monday.

— Apple iPad, fourth generation (starts at $ 499)

Apple usually updates the iPad once a year, so it was a surprise when it dropped a new model in October, with a faster processor and the new “Lightning” connection and charging port, replacing the wide port inherited from the iPod. Like the third-generation iPad launched in March it has an ultra-high-resolution “Retina” screen. The model’s resolution of 2,048 by 1,536 pixels is only surpassed by the Google Nexus 10.

That means the current iPad is two generations ahead of the iPad 2 that was on sale last holiday season. It packs enough improvements to make the upgrade worth it. The iPad 2 is still on sale for $ 100 less, but it’s not a very good value for the money: if $ 400 is all you can spend, there are better tablets out there than the iPad 2.

While other tablets are starting to approach it in terms of hardware, the iPad still enjoys the best support by far from third parties, both in terms of quality applications and accessories like cases.

One caveat: the base model of the iPad has only 16 gigabytes of storage, which fills up fast these days. The thoughtful giver goes for at least a 32-gigabyte model, for $ 100 more.

Other than that, there are few downsides to the iPad: no one will frown when opening this package.

— Barnes & Noble Nook HD+ (starts at $ 269)

For a book store, Barnes & Noble makes some amazing tablets. The HD+ is its first model that approaches the iPad in size, with a screen that’s 9 inches on the diagonal. That makes it slightly smaller than the iPad, and the resolution is lower as well, but still very respectable. At 1,920 by 1,280 pixels, it can show more detail than a living-room HDTV.

The Nook is family-friendly too. You can create user accounts and restrict them from certain content, so there’s less risk that your kids will stumble on your copy of “Fifty Shades of Grey.”

Like the basic iPad, the basic Nook HD+ comes with just 16 gigabytes of storage memory, but it can be expanded with a microSD memory card. That means another 32 gigabytes will cost you just $ 25 — a good deal.

But the Nook is the least versatile tablet in our roundup. The number of apps available is small, and it’s focused on Barnes & Noble content like e-books, magazines and movies. It doesn’t have any cameras, while the competitors have two each. It’s best for someone who’s likely to stick to media consumption, and doesn’t need the latest apps and games.

— Samsung Galaxy Note 10.1 (starts at $ 499)

If the Nook is for the avid reader or movie watcher, the Galaxy Note 10.1 is for the creative type. It’s the only tablet in our roundup that comes with a “pen” that can be used to write and draw on the screen. In our test, this worked well, though the number of apps that take advantage of the pen is still small. (Other tablets, like the iPad, only respond to finger-like objects, so third-party styluses for them are of necessity thick and clumsy.)

The Note 10.1 runs Google‘s Android software, giving it access to a wide array of apps originally written for smartphones. The selection is not on par with the iPad’s but better than other alternatives.

The Note’s screen falls into the low-resolution category, sporting 1,280 by 800 pixels. That’s a third of what the iPad musters.

Like the Nook, the Note 10.1′s storage memory can be expanded with cards.

The Note’s appeal is somewhat niche, but it could be just the thing for the budding or established artist.

— Microsoft Surface (starts at $ 499)

Microsoft’s first tablet seems at first like a throwback to the first iPad. It’s thick, heavy and rugged. But it’s really doesn’t have much in common with the first iPad or any Apple- or Google-powered tablet. It runs Windows RT, a version of Windows 8 adapted for tablets. It comes with a version of Microsoft’s Office suite and the ability to connect to wireless printers and some other peripherals, like USB drives. The covers for it have functional keyboard printed on the inside.

The screen resolution is 1,366 by 768 pixels, placing it in the low-resolution category.

The Surface screams “work, work, work.” It’s the tablet for those who are wedded to Word and want to take their writing on the go.

One thing to note about the Surface: the basic model starts out with “32 gigabytes” of memory, but of that, only 16 gigabytes are available to the user. It accepts memory cards of up to 64 gigabytes, however, so expanding the memory is cheap.

Note that even though it runs Windows, the Surface doesn’t run standard Windows applications. It will run only programs specifically adapted for Windows RT. The selection is, for now, quite limited.

— Asus Vivo Tab RT (starts at $ 599 with a dock)

Asus has a quality line of Android tablets they call “Transformer” because they dock into a keyboard with an extra battery. The combination folds up just like a small laptop and has excellent battery life. The Vivo Tab RT essentially takes a Transformer and stuffs it with Windows RT instead of Android.

The tablet part is smaller and thinner than the Surface. Together with the keyboard, it makes for a familiar little setup: a tiny laptop running Windows. Like the Surface, it has a memory card slot and a USB port. The screen resolution is the same.

The Vivo Tab is a good tool for those who want to get some work done on the commute or plane, or those who can’t decide if they want a laptop or a tablet.

— Google Nexus 10 (starts at $ 399)

This is Google’s first full-size tablet and the only tablet from any manufacturer that beats the screen resolution of the iPad. It boasts 2,560 by 1,600 pixels, a third more than the fourth-generation iPad.

It’s also the only tablet in this roundup that has speakers on either side of the screen when it’s held horizontally, making for good stereo reproduction when you’re watching movies. It has a grippy, rubberized back and widely rounded corners. There’s no memory card slot or an option for a cellular modem.

The array of third-party software is wide, just as it is for the Note 10.1. Most people don’t associate Google with online books, music or movies, so it may feel odd that the Nexus steers buyers to Google’s Play store. Of course, given the open nature of Google’s Android operating system, there are apps available for other entertainment stores, including Amazon’s, and for streaming services like Netflix.

The Nexus 10 is a snappy performer, and among the iPad’s competitors, it comes the closest to matching the versatility of Apple products.

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Peter Svensson can be reached at http://www.twitter.com/petersvensson

Gadgets News Headlines – Yahoo! News

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Rutgers joins the Big Ten, leaving Big East behind

PISCATAWAY, N.J. (AP) — As the Big East was being picked apart, Rutgers was looking for a way out and a new place to show off a football program that has been resurrected in the past decade.

Not only did Rutgers find that escape hatch, the Scarlet Knights ended up in one of the most desirable neighborhoods in college sports.

Rutgers joined the Big Ten on Tuesday, leaving the Big East behind and cashing in on the school's investment in a football team that only 10 years ago seemed incapable of competing at the highest level.

The move follows Maryland's announcement a day earlier that it was heading to the Big Ten in 2014. The additions give the Big Ten 14 schools and a presence in lucrative East Coast markets.

Rutgers announced its decision Tuesday at a campus news conference attended by Big Ten Commissioner Jim Delany, Rutgers President Robert Barchi and athletic director Tim Pernetti.

"The Big Ten is really where Rutgers belongs," Barchi said. "This is not just a good fit for us athletically, it's a good fit for us academically and as an institution."

Rutgers has been competing in the Big East since 1991. But the league has been torn up by conference realignment, losing three key members last year.

Pernetti had insisted all along that Rutgers would land on its feet, that being a member of the prestigious American Association of Universities and residing in the largest media market in the country would ensure the school wouldn't be cast aside as the landscape of college sports changed.

The Scarlet Knights landed in the best possible spot. A spot that seemed unthinkable a decade ago when Rutgers football was a Big East cellar-dweller.

"It's a transformative day for Rutgers University, and transformative in so many ways," Pernetti said. "This is about collaboration at every level, the perspective the Big Ten institutions have, the balance between academics and athletics, proving over decades and decades that athletics at the highest level and academics at the highest level can coexist. It's the perfect place for Rutgers."

Rutgers left its entry date ambiguous, though clearly the Big Ten and the school would like it to line up with Maryland.

The Big East requires 27 months' notification for departing members. The Scarlet Knights will have to negotiate a deal with the Big East to leave early, the way Pittsburgh, Syracuse and West Virginia have done.

"Although we are disappointed that Rutgers has decided to leave the Big East Conference, we wish them well," Big East Commissioner Mike Aresco said in a statement.

In an interview later, Aresco said that the conference would survive. "We'll move judiciously to replace Rutgers, but we had already changed from the small, Northeast model," he said. "We're a national conference now. We became a bigger and better football conference."

The Big East is trying to rebuild itself as a 12-team football league next season, with the addition of Boise State and five other schools. Now the conference is again on the defensive. Connecticut or Louisville could be next to go with the ACC looking to replace Maryland.

Aresco said he had been in touch with the newcomers and they were still on board. He declined to speculate on other members leaving.

Whenever Rutgers enters the Big Ten, it will be the culmination of one of the most remarkable turnarounds in college sports.

In 2002, the Scarlet Knights football team went 1-11 under second-year coach Greg Schiano.

The team, however, steadily improved as the university made the huge financial commitment necessary to support major college football.

Facilities were upgraded, the on-campus stadium was expanded and as Schiano started to win, his salary began to rise into the millions. Not everyone on campus embraced the idea of turning Rutgers into a big-time football school, and it did come with a price.

The expanded and renovated stadium cost of $102 million. The school had hoped to raise the money through private donors, but fell short. Rutgers scaled back plans for the expansion and issued bonds and borrowed money to complete the project.

In 2006, the school had to cut six varsity sports. As the football team has become a consistent winner — Rutgers has gone to a bowl six of the last seven years — the athletic department has received tens of millions in subsidies from the university.

Schiano left for the NFL last year, and Rutgers hired longtime assistant Kyle Flood, who has the Scarlet Knights poised to take make another big step. No. 21 Rutgers (9-1) is in position to win its first Big East championship and go to a BCS game for the first time.

In the Big Ten, the revenue Rutgers receives from the league's television and media deals should triple in the short term and could be even more than that in years to come.

The Big Ten reportedly paid its members about $24 million last year, though new members generally do not get a full share of revenue immediately. The Big East's payout to football members last year was $6 million.

In exchange, the Big Ten gets a member in the largest media market in the country, with Rutgers and Maryland as north and south bookends.

"You know, it was a factor," Delany said, referring to the New York television market. "I think it's been a factor that's been a little overplayed to be honest with you."

Losing access to that market is yet another blow to the Big East. The conference is again facing an uncertain future and at the worst possible time. The Big East is trying to negotiate a crucial new television contract.

With the Big East on shaky ground, there has been speculation that Boise State and San Diego State could renege on their commitments to the Big East and stay in the Mountain West.

San Diego State AD Jim Sterk told the North County Times that the Aztecs are not looking to bail.

"It's not great to lose UConn or Rutgers, but if that happens, it gives us an opportunity to have less travel in the Western division," Sterk told the newspaper. "We pick up someone further west, and we're in better shape than yesterday's Big East."

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Follow Ralph D. Russo at www.Twitter.com/ralphdrussoap

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Global Update: Meningitis Vaccine Gets Longer Window Without Refrigeration

In what may prove to be a major advance for Africa’s “meningitis belt,” regulatory authorities have decided that a new meningitis vaccine could be stored without refrigeration for up to four days.

The announcement was made last week at a conference in Atlanta of the American Society of Tropical Medicine and Hygiene. While a few days may seem trivial, the hardest part of protecting poor countries is often keeping a vaccine cold while moving it from electrified cities to villages with no power. In antipolio drives, for example, the freezers, generators and fuel needed to make ice for the shoulder bags of vaccinators can cost more than the vaccine.

The new vaccine, MenAfriVac, made in India for 50 cents a dose, was introduced in 2010. In bad years, epidemics during the hot harmattan winds have killed as many as 25,000 Africans and disabled 50,000 more. In Chad this year, vaccination drove down cases to near zero in districts where it was used, while others nearby had serious outbreaks.

Experts decided that the vaccine is safe for four days as long as it stays below 104 degrees.

While temperatures get higher than that in Africa, said Dr. Godwin Enwere, medical director for the Meningitis Vaccine Project, teams normally get the vaccine out of coolers at dawn, drive to villages and finish before the day heats up. Other experts said it should be kept in the shade and monitored with colored paper “dots” that darken after hours in the heat.

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DealBook: Ex-Trader Charged in $276 Million Insider Scheme

Over the last half-decade, as federal authorities secured dozens of insider trading convictions against hedge fund traders, they have tried doggedly to build a case against one of Wall Street’s most influential players: the billionaire stock picker Steven A. Cohen.

On Tuesday, the government appeared to inch closer to that goal. Prosecutors brought charges against a former portfolio manager at the hedge fund SAC Capital Advisors in a case that for the first time directly involves Mr. Cohen, the fund’s founder.

Mathew Martoma, a former portfolio manager at CR Intrinsic, a unit of SAC, was charged with making more than $276 million in a combination of illegal profits and avoided losses by obtaining secret information from a doctor about clinical trials for an Alzheimer’s drug being developed by the companies Elan and Wyeth.

The case is “the most lucrative insider trading scheme ever charged,” said Preet Bharara, the United States attorney in Manhattan, who brought the charges in Federal District Court in Manhattan.

It also draws in Mr. Cohen, whose fund has been in the cross hairs of government investigators since the crackdown on insider trading began. Though not charged or mentioned by name, Mr. Cohen is referred to repeatedly in the government’s court filings as either “Portfolio Manager A” or the “owner” of the funds involved. People briefed on the case confirmed that the reference was to Mr. Cohen.

Mr. Martoma worked closely with Mr. Cohen in buying and selling large blocks of Elan and Wyeth shares, according to a lawsuit also filed on Tuesday by the Securities and Exchange Commission.

The government does not say that Mr. Cohen — who has not been charged in the case — knew that Mr. Martoma had confidential information about the companies’ Alzheimer drug when he bought and sold the stocks.

“Mr. Cohen and SAC are confident that they have acted appropriately and will continue to cooperate with the government’s inquiry,” said Jonathan Gasthalter, a SAC spokesman.

From the middle of an expansive trading floor in SAC’s Stamford, Conn., headquarters, Mr. Cohen, 56, oversees a fund that manages about $13 billion and, including borrowing from banks, possesses about $39 billion in total buying power. The fund, which has about 900 employees, has generated some of the best investment returns on Wall Street, averaging about 30 percent over the last two decades.

Though the case against Mr. Martoma is the first time the government has pointed to Mr. Cohen’s participation in a trade that may have been improper, it is the latest in a spate of insider trading prosecutions of former SAC employees. At least seven former SAC employees have been tied to the government’s multiyear investigation; three of them have pleaded to insider trading while working for Mr. Cohen.

Previous cases involving SAC have highlighted the firm’s unusual structure: traders are allocated money and invest on their own with little direct input from Mr. Cohen. But in this case, Mr. Cohen is said to have had numerous contacts with Mr. Martoma and appeared to collaborate closely with him.

“The law of averages would tell you that all of these instances at one firm are not coincidences,” said Mark Zauderer, a securities lawyer in New York. “People take their cues from the top, and these cases must reflect a culture there.”

F.B.I. agents arrested Mr. Martoma, 38, early Tuesday morning at his home in Boca Raton, Fla. He was released on bail after making an appearance in Federal District Court in West Palm Beach. Mr. Martoma, who has been unemployed since leaving SAC in 2010, is expected to appear in federal court in Manhattan on Monday and enter a plea.

“Mathew Martoma was an exceptional portfolio manager who succeeded through hard work and the dogged pursuit of information in the public domain,” said his lawyer, Charles A. Stillman. “What happened today is only the beginning of a process that we are confident will lead to Mr. Martoma’s full exoneration.”

Also accused in the scheme by the Securities Exchange Commission on Tuesday was Sidney Gilman, a neurology professor at the University of Michigan. The S.E.C. said Dr. Gilman, 80, an Alzheimer’s expert who helped oversee the clinical trials for the drug, gave Mr. Martoma the confidential information.

Dr. Gilman is cooperating with the government and has entered into a nonprosecution with the United States attorney’s office in Manhattan, meaning that criminal charges will not be brought against him. Marc Mukasey, a lawyer for Dr. Gilman, said that he expected the S.E.C.’s case to be resolved shortly.

Mr. Martoma met Dr. Gilman through the Gerson Lehrman Group, a so-called expert network firm based in New York. Once an obscure pocket of Wall Street, expert network firms became popular among the hedge fund set in the last decade as a way to gain an investment edge. The services linked traders to specialists and consultants in various industries.

But these firms came under scrutiny after the government brought more than a dozen insider trading cases involving these expert networks. In some cases, hedge fund managers paid outside consultants handsome fees for providing confidential information about publicly traded companies. In others, the government charged executives at the expert network firms with knowingly facilitating the exchange of illegal stock tips.

A spokesman for Gerson Lehrman declined to comment. The government’s complaint details how Dr. Gilman hid his communications about the trial from the expert network firm.

Dr. Gilman’s consulting work for Mr. Martoma earned him about $108,000, according to court filings. Based in part on Dr. Gilman’s leaks about positive developments related to the clinical trials of a new Alzheimer’s drug, SAC accumulated a roughly $700 million position in the stocks of Wyeth and Elan, according to the government.

The S.E.C. said that the fund’s owner, Mr. Cohen, took a large position in Wyeth and Elan in his personal portfolio based on Mr. Martoma’s recommendation. Mr. Cohen maintained his holdings even though there was significant debate about the wisdom of such a large position in the companies, the government said.

But in July 2008, as the trials neared completion, Dr. Gilman told Mr. Martoma that patients were experiencing serious side effects, prosecutors say. Afterward, Mr. Martoma e-mailed Mr. Cohen, telling him “it’s important” that they speak. They spoke on the phone for nearly 20 minutes, the government says, and Mr. Martoma told his boss that he was no longer “comfortable” with the investments.

The following day, SAC reversed course. Mr. Cohen’s head trader sold the firm’s entire inventory of roughly 10.5 million shares of Elan and about seven million shares of Wyeth, the government said. Once it had dumped the shares, SAC built a short position in the two stocks, betting their value would drop.

According to the S.E.C., the trader, Mr. Cohen and Mr. Martoma kept the sales confidential. The trade, wrote the head trader in an e-mail to Mr. Cohen, “was executed quietly and efficiently over a four-day period through algos and darkpools” — referring to trades using algorithms and to trading platforms that do not have the same reporting requirements as the stock exchanges — “and booked into two firm accounts that have very limited viewing access.”

After the companies announced the results of the trials, Elan’s stock fell about 42 percent and Wyeth’s about 12 percent.

The trading allowed SAC to avoid about $194 million in losses and earn about $83 million in profits on Elan and Wyeth, according to prosecutors.

At the end of 2008, Mr. Martoma received a bonus of about $9.3 million, the S.E.C. said. Mr. Martoma’s stock picks were less successful in 2009 and 2010, and he received no bonuses then.

According to the government, in 2010 an SAC executive suggested in an e-mail that the firm let Mr. Martoma go, describing him as a “one-trick pony.”

SAC CAPITAL UNDER A MICROSCOPE The firm has been under a cloud since a former employee, Richard Choo-Beng Lee, pleaded guilty in 2009 to insider trading and began helping the government in its investigation. The crimes he confessed to were committed after he left SAC, but he agreed to provide information about his five years at the firm, which ended in 2004.

NAMES	THE CASES
Jonathan Hollander	The former analyst paid more than $220,000 to settle civil charges brought by the Securities and Exchange Commission accusing him of trading in his personal account on confidential information about the 2006 takeover of the Albertsons grocery store chain.
Jon Horvath and Michael Steinberg	Mr. Horvath, right, a former technology industry analyst, pleaded guilty in September to participating in a conspiracy that illegally traded in the shares of Dell computer. His boss, the former portfolio manager Mr. Steinberg, has been named as an unindicted co-conspirator but has not been charged in the case. Federal prosecutors contend they were part of a seven-person conspiracy — a “circle of friends” — that earned about $62 million in illegal gains trading on secret tips from executives at publicly traded technology companies.
Donald Longueuil and Noah Freeman	The two former portfolio managers admitted in 2011 to trading on illegal tips about publicly traded technology companies. Mr. Longueuil, right, was swept up in a crackdown on so-called expert networks. He is one of roughly a dozen implicated in the case. Mr. Longueuil is serving a two-and-a-half-year jail term at a federal prison in Otisville, N.Y.; Mr. Freeman, who is cooperating with prosecutors, has yet to be sentenced.
Mathew Martoma	The former trader at CR Intrinsic, a unit of the hedge fund, was charged with making about $276 million in combined profits and avoided losses by obtaining confidential information about a drug trial for an Alzheimer’s drug developed by the pharmaceutical companies Elan and Wyeth.

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Hamas Strengthens as Palestinian Authority Weakens

RAMALLAH, West Bank — In the daily demonstrations here of solidarity with Gaza, a mix of sympathy and anguish, there is something else: growing identification with the Islamist fighters of Hamas and derision for the Palestinian Authority, which Washington considers the only viable partner for peace with Israel.

“Strike a blow on Tel Aviv!” proclaim the lyrics of a new hit song blasting from shops and speakers at Monday’s demonstration, in a reference to Hamas rockets that made it nearly to Israel’s economic and cultural capital. “Don’t let the Zionists sleep! We don’t want a truce or a solution! Oh Palestinians, you can be proud!”

Pop songs everywhere are filled with bravado and aggression. But this one reflects a widespread sentiment that does not augur well for President Mahmoud Abbas and his Palestinian Authority, which is rapidly losing credibility, even relevance. The Gaza truce talks in Cairo, involving Egypt, Turkey and Qatar, offer a telling tableau. The Palestinian leader seen there is not Mr. Abbas, but Khaled Meshal, the leader of the militant group Hamas, who seeks to speak for all Palestinians as his ideological brothers in the Muslim Brotherhood rise to power around the region.

Israel is also threatening Mr. Abbas, even hinting that it may give up on him, as he prepares to go to the United Nations General Assembly on Nov. 29 to try to upgrade the Palestinian status to that of a nonmember state. The Israelis consider this step an act of aggression, and even some Palestinians say it is somewhat beside the point at this stage.

“His people are being killed in Gaza, and he is sitting on his comfortable chair in Ramallah,” lamented Firas Katash, 20, a student who took part in the Ramallah demonstration.

For the United States, as for other countries hoping to promote a two-state solution to this century-old conflict, a more radicalized West Bank with a discredited Palestinian Authority would mean greater insecurity for Israel and increased opportunity for anti-Western forces to take root in a region where Islamism is on the rise.

Since Hamas, which won parliamentary elections in 2006, threw the Fatah-controlled authority out of Gaza a year later, Mr. Abbas has not set foot there. Yet he will be asking the world to recognize the two increasingly distinct entities as a unified state.

Manar Wadi, who works in an office in Ramallah, put the issue this way: “What is happening in Gaza makes the Palestinian Authority left behind and isolated. Now we see the other face of Hamas, and its popularity is rising. It makes us feel that the Palestinian Authority doesn’t offer a path to the future.”

In Cairo on Monday, Mr. Meshal seemed defiant and confident in his new role, daring the Israelis to invade Gaza as a sixth day of Israeli aerial assaults brought the death toll there to more than 100 people, many of them militants of Hamas and its affiliates. Rockets launched from Gaza hit southern Israel, causing some damage and panic, but no casualties, leaving the death toll there at three.

“Whoever started the war must end it,” Mr. Meshal said at a news conference. “If Israel wants a cease-fire brokered through Egypt, then that is possible. Escalation is also possible.”

Officials in the authority have been holding leadership meetings, staying in close touch with the talks in Cairo and issuing statements of solidarity. They have also sent a small medical delegation to Gaza and argue that there is a new opportunity to forge unity between the two feuding movements. But they are acutely aware of their problem.

“The most dangerous thing is the fact that what we could not do in negotiations, Hamas did with one rocket,” one official said, speaking on the condition of anonymity. “The people had such excitement seeing the occupiers run in panic. It’s a very dangerous message.”

Mr. Abbas, whose popularity has been on the decline as the Palestinian Authority faces economic difficulty and growing Israeli settlements, also ran into trouble not long before the Gaza fighting began when he seemed to give up on the Palestinian demand of a right of return to what is now Israel.

Many Palestinians believe that Israel launched its latest operation in Gaza to block the Palestinian Authority’s United Nations plans by embarrassing it. Israeli officials say that is ridiculous: the operation’s purpose is to stop the growing number of rockets being fired at their communities, and Israelis interrupted their deliberations over the United Nations bid to wage the military campaign.

But Israel says anything that does not involve direct negotiations is a waste of time. The government of Prime Minister Benjamin Netanyahu has repeatedly threatened to take severe retaliatory steps against the Palestinian Authority, including cutting off badly needed tax receipts to Palestinian coffers, should Mr. Abbas go ahead at the United Nations.

In a speech here on Sunday night at a Palestinian leadership meeting, Mr. Abbas repeated his determination to go to New York and ask for a change in status to that of nonmember state. He has chosen the symbolically significant date of Nov. 29, when the General Assembly voted in 1947 to divide this land into two states, one Jewish and the other Palestinian Arab.

The United States has asked Mr. Abbas not to do so, but instead to resume direct negotiations with Israel, which have essentially been frozen since 2008.

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Marlins salary dump to Toronto finalized

MIAMI (AP) — The Miami Marlins' latest payroll purge received final approval Monday from the commissioner's office, and as the team's top baseball executive began to discuss the deal during a conference call, a bad connection generated waves of reverberating noise that filled the phone line.

Nearly a week after the Marlins swung their widely ridiculed trade with Toronto, negative feedback keeps coming.

Commissioner Bud Selig approved the blockbuster deal, however, even though it made Marlins fans irate and made the team a nationwide punch line. The trade sends All-Star shortstop Jose Reyes to the Blue Jays along with pitchers Mark Buehrle and Josh Johnson, catcher John Buck and outfielder Emilio Bonifacio for seven players, none of whom has a big-money contract.

Miami received infielders Yunel Escobar and Adeiny Hechavarria, pitchers Henderson Alvarez, Anthony DeSclafani and Justin Nicolino, catcher Jeff Mathis and outfielder Jake Marisnick.

By swinging the deal only months after the Marlins moved into a new stadium built with taxpayer money, they pared from their books $146.5 million in payroll. That's their net savings after agreeing to send $8.5 million to the Blue Jays as part of the trade.

Marlins president of baseball operations Larry Beinfest said he understood why fans were mad, and confirmed the trade was necessary because owner Jeffrey Loria wanted to pare payroll. Beinfest also conceded the deal will make it harder for the team to recruit free agents in the future.

But Selig decided not to block it.

"This transaction, involving established major leaguers and highly regarded young players and prospects, represents the exercise of plausible baseball judgment on the part of both clubs (and) does not violate any express rule of Major League Baseball and does not otherwise warrant the exercise of any of my powers to prevent its completion," Selig said in a statement. "It is, of course, up to the clubs involved to make the case to their respective fans that this transaction makes sense and enhances the competitive position of each, now or in the future."

The players traded by the Marlins have combined guaranteed salaries of $163.75 million through 2018, including $96 million due Reyes.

"I understand the pause the fans have with the instability in our roster at a time when we were hoping to be very stable in the new stadium," Beinfest said. "It's not a lot of fun."

By contrast, the trade stamps the Blue Jays as contenders in the AL East. They haven't reached the playoffs since winning their second consecutive World Series in 1993.

Miami also finalized a deal with outfielder Juan Pierre, who agreed to a $1.6 million, one-year contract. That leaves the Marlins with an estimated opening-day payroll of $36 million for active players, which would be their lowest since 2008. In the latest figures, Oakland had the lowest payroll in the majors this year at $59.5 million.

While Beinfest said the Marlins acquired championship-caliber talent, fans believe Loria's goal was to increase his profits in the new ballpark rather than put increased revenue into the roster.

"We did receive a payroll range from ownership that we needed to achieve," Beinfest said. "With this transaction, we have achieved that payroll range."

The Marlins flopped as big spenders. They began the year with a franchise-record payroll of $112 million, then went 69-93, their worst record since 1999.

After sinking to last place by midseason, the Marlins traded former NL batting champion Hanley Ramirez, second baseman Omar Infante, right-hander Anibal Sanchez and closer Heath Bell.

"We've finished in last place the past two years, and that is unacceptable," Loria said in a statement. "It's incumbent on us to make the changes necessary to make us a winner again. It may not happen overnight. But with the players we acquired in the second half of last season, coupled with the infusion of players we are acquiring now, we will be returning to Marlins baseball: high energy and hungry."

Reyes, Buehrle and Bell signed multiyear deals as newcomers a year ago during an unprecedented Marlins spending spree, and Beinfest acknowledged other free agents might be now reluctant to sign with Miami.

"It'll be a factor," he said. "I don't think we're happy about this at all. I understand there may be some disdain in the marketplace. We won't know until we get into those negotiations with free agents. It's definitely not great for the club, and we're going to have to deal with it."

Miami's biggest remaining star, slugger Giancarlo Stanton, has been among those expressing anger about the trade. Beinfest said he hadn't talked with Stanton about the deal.

"I know this is an emotional time," Beinfest said. "I'm sure it has been tough for him. Our feeling was to maybe let the dust settle a little bit and then talk to Giancarlo. I hear the frustration. It's not unexpected. This has been a tough go, but we think it's best for us moving forward."

Players' union head Michael Weiner withheld comment, saying he was awaiting more input from Major League Baseball.

In January 2009, the union reached an agreement with MLB and the Marlins covering 2010-12 which Weiner said was a "response to our concerns that revenue sharing proceeds have not been used as required. As part of the deal, Weiner said the team planned to "use such proceeds to increase player payroll annually as they move toward the opening of their new ballpark."

Selig said he was sensitive to how Marlins fans reacted to the trade.

"Baseball is a social institution with important social responsibilities, and I fully understand that the Miami community has done its part to put the Marlins into a position to succeed with beautiful new Marlins Park," Selig said. "Going forward, I will continue to monitor this situation with the expectation that the Marlins will take into account the sentiments of their fans, who deserve the best efforts and considered judgment of their club. I have received assurances from the ownership of the Marlins that they share these beliefs and are fully committed to build a long-term winning team that their fans can be proud of."

NOTES: Pierre would earn a $25,000 bonus if he's an All-Star, $25,000 each for winning a Gold Glove or Silver Slugger, $50,000 if he's an LCS MVP, $100,000 if he's the World Series MVP and $100,000 if he's the league MVP.

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AP Sports Writer Ronald Blum in New York contributed to this report.

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Really?: The Claim: Eye Problems Can Cause Headaches in Children

Really?

Anahad O’Connor tackles health myths.

THE FACTS When a child complains of frequent headaches, many pediatricians order an eye exam. “In some pediatric ophthalmology practices, it’s a daily occurrence,” said Dr. Zachary Roth, a resident in ophthalmology at Albany Medical Center in New York.

Often, a child may experience headaches while reading or doing schoolwork, leading parents to think the child needs glasses. But are eye problems really a cause of childhood headaches?

In a recent study, Dr. Roth and his colleagues examined 158 children under age 18 who were referred to ophthalmologists for frequent headaches. Then, they evaluated the children’s medical records and looked at the results of earlier vision exams.

Ultimately, the researchers could not find any significant link between headaches and diagnoses of vision problems. In three-quarters of the subjects, the headaches went away over time, both in those who received new glasses and those who did not.

The study, which was presented at a recent American Academy of Ophthalmology conference, was not designed to look for causes of the headaches. But there were “quite a few” children with family histories of migraine, Dr. Roth said. Sinus problems and stress headaches also appeared to be common issues, he added.

“I think the take-away message is that it’s very unlikely for headaches to be caused by an eye problem,” he said. “The experience of all the ophthalmologists we talked to is that it almost never seems to be related to the eyes, so it’s probably more fruitful to investigate other causes.”

THE BOTTOM LINE Vision problems are often blamed for childhood headaches, but in reality, the two are rarely related.

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