Electronic Records Systems Have Not Reduced Health Costs, Report Says

The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.

Jim Wilson/The New York Times

Dr. Alvin Rajkomar tracks patient data on a Samsung Galaxy Note. A new report questions whether electronic records reduce health care costs.

Optimistic predictions by RAND in 2005 helped drive explosive growth in the electronic records industry and encouraged the federal government to give billions of dollars in financial incentives to hospitals and doctors that put the systems in place.

“We’ve not achieved the productivity and quality benefits that are unquestionably there for the taking,” said Dr. Arthur L. Kellermann, one of the authors of a reassessment by RAND that was published in this month’s edition of Health Affairs, an academic journal.

RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.

The report predicted that widespread use of electronic records could save the United States health care system at least $81 billion a year, a figure RAND now says was overstated. The study was widely praised within the technology industry and helped persuade Congress and the Obama administration to authorize billions of dollars in federal stimulus money in 2009 to help hospitals and doctors pay for the installation of electronic records systems.

“RAND got a lot of attention and a lot of buzz with the original analysis,” said Dr. Kellermann, who was not involved in the 2005 study. “The industry quickly embraced it.”

But evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services.

Health care spending has risen $800 billion since the first report was issued, according to federal figures. The reasons are many, from the aging of the baby boomer population, to the cost of medical advances, to higher usage of medical services over all.

Officials at RAND said their new analysis did not try to put a dollar figure on how much electronic record-keeping had helped or hurt efforts to reduce costs. But the firm’s acknowledgment that its earlier analysis was overly optimistic adds to a chorus of concern about the cost of the new systems and the haste with which they have been adopted.

The recent analysis was sharply critical of the commercial systems now in place, many of which are hard to use and do not allow doctors and patients to share medical information across systems. “We could be getting much more if we could take the time to do a little more planning and to set more standards,” said Marc Probst, chief information officer for Intermountain Healthcare, a large health system in Salt Lake City that developed its own electronic records system and is cited by RAND as an example of how the technology can help improve care and reduce costs.

The RAND researchers pointed to a number of other reasons the expected savings had not materialized. The rate of adoption has been slow, they said, and electronic records do not address the fact that doctors and hospitals reap the benefits of high volumes of care.

Many experts say the available systems seem to be aimed more at increasing billing by providers than at improving care or saving money. Federal regulators are investigating whether electronic records make it easier for hospitals and doctors to bill for services they did not provide and whether Medicare and other federal agencies are adequately monitoring the use of electronic records.

Technology “is only a tool,” said Dr. David Blumenthal, who helped oversee the federal push for the adoption of electronic records under President Obama and is now president of the Commonwealth Fund, a nonprofit health group. “Like any tool, it can be used well or poorly.” While there is strong evidence that electronic records can contribute to better care and more efficiency, Dr. Blumenthal said, the systems in place do not always work in ways that help achieve those benefits.

Federal officials say they are drafting new rules to address many of the concerns about the current systems.

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World Briefing | The Americas: Mexico: Killer Dog Case Widens

A pack of feral dogs may be responsible for the deaths of as many as five people in a Mexico City park, the authorities said Wednesday. Last week, the police said dogs had killed four people, including a woman and a baby boy, whose mutilated bodies were found in the park in December. Now, prosecutors are investigating if the wounds found on a fifth person, a 15-year-old girl who died in December, are consistent with dog bites. The authorities have captured several dogs, spurring an online campaign to save them, but it is not clear if any are the culprits.

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‘Smart’ potty or dumb idea? Wacky gadgets at CES

LAS VEGAS (AP) — From the iPotty for toddlers to the 1,600-pound mechanical spider and the host of glitch-ridden “smart” TVs, the International CES show is a forum for gadget makers to take big — and bizarre — chances.

Many of the prototypes introduced at the annual gadget show over the years have failed in the marketplace. But the innovators who shop their wares here are fearless when it comes to pitching new gizmos, many of which are designed to solve problems you didn’t know you had.

A search for this year’s strangest (and perhaps least useful) electronic devices yielded an extra-loud pair of headphones from a metal band, an eye-sensing TV that didn’t work as intended and more. Take a look:

—MOTORHEADPHONES

Bass-heavy headphones that borrow the names of hip-hop luminaries like Dr. Dre have become extremely popular. Rock fans have been left out of the party — until now. British metal band Motorhead, famous for playing gut-punchingly loud, is endorsing a line of headphones that “go to eleven” and are hitting U.S. stores now.

Says lead singer and bassist Lemmy Kilmister, explaining his creative input: “I just said make them louder than everybody else’s. So that’s the only criteria, and that it should reflect every part of the sound, not just the bass.”

The Motorheadphone line consists of three over-the-ear headphones and six in-ear models. The initiative came from a Swedish music-industry veteran, and distribution and marketing is handled by a Swedish company, Krusell International AB.

WHO IT’S FOR: People who don’t care about their hearing. According to Kilmister, the headphones are ideal for Motorhead fans. “Their hearing is already damaged, they better buy these.”

PRICE: Prices range from $ 50 to $ 130.

—EYE-SENSING TV

A prototype of an eye-sensing TV from Haier didn’t quite meet viewers eye-to-eye. An on-screen cursor is supposed to appear where the viewer looks to help, say, select a show to watch. Blinking while controlling the cursor is supposed to result in a click. In our brief time with the TV, we observed may quirks and comic difficulties.

For one, the company’s demonstrator Hongzhao Guo said the system doesn’t work that well when viewers wear eyeglasses. (That kind of defeats the purpose of TV, no?) But it turns out, one bespectacled reporter was able to make it work. But the cursor appeared a couple inches below where the viewer was looking. This resulted in Guo snapping his fingers to attract the reporter’s eye to certain spots. The reporter dutifully looked, but the cursor was always a bit low. Looking down to see the cursor only resulted in it moving further down the TV screen.

WHO IT’S FOR: People too lazy to move their arms.

“It’s easy to do,” Guo said, taking the reporter’s place at the demonstration. He later said the device needs to be recalibrated for each person. It worked fine for him, but the TV is definitely not ready for prime-time.

—PARROT FLOWER POWER

A company named after a bird wants to make life easier for your plants. A plant sensor called Flower Power from Paris-based Parrot is designed to update your mobile device with a wealth of information about the health of your plant and the environment it lives in. Just stick the y-shaped sensor in your plant’s soil, download the accompanying app and — hopefully — watch your plant thrive.

“It basically is a Bluetooth smart low-energy sensor. It senses light, sunlight, temperature, moisture and soil as well as fertilizer in the soil. You can use it either indoors or outdoors,” said Peter George, vice president of sales and marketing for the Americas at Parrot. The device will be available sometime this year, the company said.

WHOT IT’S FOR: ‘Brown-thumbed’ folk and plants with a will to live.

PRICE: Unknown.

—HAPIFORK

If you don’t watch what you put in your mouth, this fork will — or at least try to. Called HAPIfork, it’s a fork with a fat handle containing electronics and a battery. A motion sensor knows when you are lifting the fork to your mouth. If you’re eating too fast, the fork will vibrate as a warning. The company behind it, HapiLabs, believes that using the fork 60 to 75 times during meals that last 20 to 30 minutes is ideal.

But the fork won’t know how healthy or how big each bite you take will be, so shoveling a plate of arugula will likely be judged as less healthy than slowly putting away a pile of bacon. No word on spoons, yet, or chopsticks.

WHO IT’S FOR? People who eat too fast. Those who want company for their “smart” refrigerator and other kitchen gadgets.

PRICE: HapiLabs is launching a fundraising campaign for the fork in March on the group-fundraising site Kickstarter.com. Participants need to pay $ 99 to get a fork, which is expected to ship around April or May.

— IPOTTY

Toilet training a toddler is no picnic, but iPotty from CTA Digital seeks to make it a little easier by letting parents attach an iPad to it. This way, junior can gape and paw at the iPad while taking care of business in the old-fashioned part of the plastic potty. IPotty will go on sale in March, first on Amazon.com.

There are potty training apps out there that’ll reward toddlers for accomplishing the deed. The company is also examining whether the potty’s attachment can be adapted for other types of tablets, beyond the iPad.

“It’s novel to a lot of people but we’ve gotten great feedback from parents who think it’d be great for training,” said CTA product specialist Camilo Gallardo.

WHO IT’S FOR: Parents at their wit’s end.

PRICE: $ 39.99

—MONDO SPIDER, TITANOBOA

A pair of giant hydraulic and lithium polymer battery controlled beasts from Canadian art organization eatART caught some eyes at the show. A rideable 8-legged creature, Mondo Spider weighs 1,600 pounds and can crawl forward at about 5 miles per hour on battery power for roughly an hour. The 1,200-pound Titanoboa slithers along the ground at an as yet unmeasured speed.

Computer maker Lenovo sponsored the group to show off the inventions at CES.

Hugh Patterson, an engineer who volunteers his time to making the gizmos, said they were made in part to learn more about energy use. One lesson from the snake is that “side winding,” in which the snake corkscrews its way along the ground, is one of the most efficient ways of moving along soft ground, like sand.

Titanoboa was made to match the size of a 50-foot long reptile whose fossilized remains were dated 50 million years ago, when the world was 5 to 6 degrees warmer. The creature was built “to provoke discussion about climate change,” Patterson said.

The original version of Mondo Spider, meanwhile, first appeared at the Burning Man arts gathering in Nevada in 2006.

WHO IT’S FOR: Your inner child, Burning Man participants, people with extra-large living rooms.

PRICE: The spider’s parts cost $ 26,000. The Titanoboa costs $ 70,000. Engineers provided their time for free and both took “thousands of hours” to build, Patterson said.

___

Ortutay contributed from New York. AP Technology Writer Peter Svensson and Luke Sheridan from AP Television contributed to this story from Las Vegas.

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Steroids fallout: No BB Hall for Bonds, Clemens

NEW YORK (AP) — No one was elected to the Hall of Fame this year. When voters closed the doors to Barry Bonds, Roger Clemens and Sammy Sosa, they also shut out everybody else.

For only the second time in four decades, baseball writers failed to give any player the 75 percent required for induction to Cooperstown, sending a powerful signal that stars of the Steroids Era will be held to a different standard.

All the awards and accomplishments collected over long careers by Bonds, Clemens and Sosa could not offset suspicions those feats were boosted by performance-enhancing drugs.

Voters also denied entry Wednesday to fellow newcomers Craig Biggio, Mike Piazza and Curt Schilling, along with holdovers Jack Morris, Jeff Bagwell and Lee Smith.

Among the most honored players of their generation, these standouts won't find their images among the 300 bronze plaques on the oak walls in Cooperstown, where — at least for now — the doors appear to be bolted shut on anyone tainted by PEDs.

"After what has been written and said over the last few years I'm not overly surprised," Clemens said in a statement he posted on Twitter.

Bonds, Clemens and Sosa retired after the 2007 season. They were eligible for the Hall for the first time and have up to 14 more years on the writers' ballot.

"Curt Schilling made a good point, everyone was guilty. Either you used PEDs, or you did nothing to stop their use," Hall of Famer Mike Schmidt said in an email to The Associated Press after this year's vote was announced. "This generation got rich. Seems there was a price to pay."

Biggio, 20th on the career list with 3,060 hits, appeared on 68.2 percent of the 569 ballots, the highest total but 39 votes shy. The three newcomers with the highest profiles failed to come close to even majority support, with Clemens at 37.6 percent, Bonds at 36.2 and Sosa at 12.5.

Other top vote-getters were Morris (67.7), Jeff Bagwell (59.6), Piazza (57.8), Tim Raines (52.2), Lee Smith (47.8) and Schilling (38.8).

"I'm kind of glad that nobody got in this year," Hall of Famer Al Kaline said. "I feel honored to be in the Hall of Fame. And I would've felt a little uneasy sitting up there on the stage, listening to some of these new guys talk about how great they were. ... I don't know how great some of these players up for election would've been without drugs. But to me, it's cheating."

At ceremonies in Cooperstown on July 28, the only inductees will be three men who died more than 70 years ago: Yankees owner Jacob Ruppert, umpire Hank O'Day and barehanded catcher Deacon White. They were chosen last month by the 16-member panel considering individuals from the era before integration in 1947.

"It is a dark day," said Jose Canseco, the former AL MVP who was among the first players to admit using steroids. "I think the players should organize some type of lawsuit against major league baseball or the writers. It's ridiculous. Most of these players really have no evidence against them. They've never tested positive or they've cleared themselves like Roger Clemens."

It was the eighth time the BBWAA failed to elect any players. There were four fewer votes than last year and five members submitted blank ballots.

"With 53 percent you can get to the White House, but you can't get to Cooperstown," BBWAA secretary-treasurer Jack O'Connell said. "It's the 75 percent that makes it difficult."

There have been calls for the voting to be taken away from the writers and be given to a more diverse electorate that would include players and broadcasters. The Hall says it is content with the process, which began in 1936.

"It takes time for history to sort itself out, and I'm not surprised we had a shutout today," Hall President Jeff Idelson said. "I wish we had an electee. I will say that, but I'm not surprised given how volatile this era has been in terms of assessing the qualities and the quantities of the statistics and the impact on the game these players have had."

Bonds, baseball's only seven-time Most Valuable Player, hit 762 home runs, including a record 73 in 2001. He was indicted on charges he lied to a grand jury in 2003 when he denied using PEDs but a jury two years ago failed to reach a verdict on three counts he made false statements and convicted him on one obstruction of justice count, finding he gave an evasive answer.

"It is unimaginable that the best player to ever play the game would not be a unanimous first-ballot selection," said Jeff Borris of the Beverly Hills Sports Council, Bonds' longtime agent.

Clemens, the only seven-time Cy Young Award winner, is third in career strikeouts (4,672) and ninth in wins (354). He was acquitted last year on one count of obstruction of Congress, three counts of making false statements to Congress and two counts of perjury, all stemming from his denials of drug use.

"To those who did take the time to look at the facts," Clemens said, "we very much appreciate it."

Sosa, eighth with 609 home runs, was among those who tested positive in MLB's 2003 anonymous survey, The New York Times reported in 2009. He told a congressional committee in 2005 that he never took illegal performance-enhancing drugs.

Since 1961, the only years the writers didn't elect a candidate had been when Yogi Berra topped the 1971 vote by appearing on 67 percent of the ballots cast and when Phil Niekro headed the 1996 ballot at 68 percent — both got in the following years. The other BBWAA elections without a winner were in 1945, 1946, 1950, 1958 and 1960.

Morris will make his final ballot appearance next year, when fellow pitchers Greg Maddux and Tom Glavine are eligible for the first time along with slugger Frank Thomas.

"Next year, I think you'll have a rather large class, and this year, for whatever reasons, you had a couple of guys come really close," Commissioner Bud Selig said at the owners' meetings in Paradise Valley, Ariz. "This is not to be voted to make sure that somebody gets in every year. It's to be voted on to make sure that they're deserving. I respect the writers as well as the Hall itself. This idea that this somehow diminishes the Hall of baseball is just ridiculous in my opinion."

Players' union head Michael Weiner called the vote "unfortunate, if not sad."

"To ignore the historic accomplishments of Barry Bonds and Roger Clemens, for example, is hard to justify. Moreover, to penalize players exonerated in legal proceedings — and others never even implicated — is simply unfair. The Hall of Fame is supposed to be for the best players to have ever played the game. Several such players were denied access to the Hall today. Hopefully this will be rectified by future voting."

The BBWAA election rules say "voting shall be based upon the player's record, playing ability, integrity, sportsmanship, character, and contributions to the team(s) on which the player played."

An Associated Press survey of 112 eligible voters conducted in late November after the ballot was announced indicated Bonds, Clemens and Sosa would fall well short of 50 percent. The big three drew even less support than that as the debate raged over who was Hall worthy.

Voters are writers who have been members of the BBWAA for 10 consecutive years at any point.

BBWAA president Susan Slusser of the San Francisco Chronicle said she didn't vote for Bonds, Clemens or Sosa.

"The evidence for steroid use is too strong," she said.

As for Biggio, "I'm surprised he didn't get in."

Mark McGwire, 10th on the career home run list with 583, received 16.9 percent on his seventh try, down from 19.5 last year. He got 23.7 percent in 2010 — a vote before he admitted using steroids and human growth hormone.

Rafael Palmeiro, among just four players with 500 homers and 3,000 hits along with Hank Aaron, Willie Mays and Eddie Murray, received 8.8 percent in his third try, down from 12.6 percent last year. Palmeiro received a 10-day suspension in 2005 for a positive test for performance-enhancing drugs, claiming it was due to a vitamin vial given to him by teammate Miguel Tejada.

MLB.com's Hal Bodley, the former baseball columnist for USA Today, said Biggio and others paid the price for other players using PEDs.

"They got caught in the undertow of the steroids thing," he said.

Bodley said this BBWAA vote was a "loud and clear" message on the steroids issue. He said he couldn't envision himself voting for stars linked to drugs.

"We've a forgiving society, I know that," he said. "But I have too great a passion for the sport."

NOTES: There were four write-in votes for career hits leader Pete Rose, who never appeared on the ballot because of his lifetime ban that followed an investigation of his gambling while manager of the Cincinnati Reds. ... Two-time NL MVP Dale Murphy received 18.6 percent in his 15th and final appearance. ... At the July 28 ceremonies, the Hall also will honor Lou Gehrig and Rogers Hornsby among a dozen players who never received formal inductions because of restrictions during World War II. ... Piazza has a book due out next month that could change the view of voters before the next election.

___

AP Sports Writers Dan Gelston, Mike Fitzpatrick, John Marshall and Ben Walker contributed to this report.

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Pap Test May Prove Useful at Detecting More Types of Cancer, Study Suggests

The Pap test, which has prevented countless deaths from cervical cancer, may eventually help to detect cancers of the uterus and ovaries as well, a new study suggests.

For the first time, researchers have found genetic material from uterine or ovarian cancers in Pap smears, meaning that it may become possible to detect three diseases with just one routine test.

But the research is early, years away from being used in medical practice, and there are caveats. The women studied were already known to have cancer, and while the Pap test found 100 percent of the uterine cancers, it detected only 41 percent of the ovarian cancers. And the approach has not yet been tried in women who appear healthy, to determine whether it can find early signs of uterine or ovarian cancer.

On the other hand, even a 41 percent detection rate would be better than the status quo in ovarian cancer, particularly if the detection extends to early stages. The disease is usually advanced by the time it is found, and survival rates are poor. About 22,280 new cases were expected in the United States in 2012, and 15,500 deaths. Improved tests are urgently needed.

Uterine cancer has a better prognosis, but still kills around 8,000 women a year in the United States.

These innovative applications of the Pap test are part of a new era in which advances in genetics are being applied to the detection of a wide variety of cancers or precancerous conditions. Scientists are learning to find minute bits of mutant DNA in tissue samples or bodily fluids that may signal the presence of hidden or incipient cancers.

Ideally, the new techniques would find the abnormalities early enough to cure the disease or even prevent it entirely. But it is too soon to tell.

“Is this the harbinger of things to come? I would answer yes,” said Dr. Bert Vogelstein, director of the Ludwig Center for Cancer Genetics and Therapeutics at Johns Hopkins University, and a senior author of a report on the Pap test study published on Wednesday in the journal Science Translational Medicine. He said the genomes of more than 50 types of tumors had been sequenced, and researchers were trying to take advantage of the information.

Similar studies are under way or are being considered to look for mutant DNA in blood, stool, urine and sputum, both to detect cancer and also to monitor the response to treatment in people known to have the disease.

But researchers warn that such tests, used for screening, can be a double-edged sword if they give false positive results that send patients down a rabbit hole of invasive tests and needless treatments. Even a test that finds only real cancers may be unable to tell aggressive, dangerous ones apart from indolent ones that might never do any harm, leaving patients to decide whether to watch and wait or to go through surgery, chemotherapy and radiation with all the associated risks and side effects.

“Will they start recovering mutations that are not cancer-related?” asked Dr. Christopher P. Crum, a professor at Harvard Medical School who was not involved in the research.

But he also called the study a “great proof of principle,” and said, “Any whisper of hope to women who suffer from endometrial or ovarian cancer would be most welcome.”

DNA testing is already performed on samples from Pap tests, to look for the human papillomavirus, or HPV, which causes cervical cancer. Dr. Vogelstein and his team decided to try DNA testing for cancer. They theorized that cells or DNA shed from cancers of the ovaries and the uterine lining, or endometrium, might reach the cervix and turn up in Pap smears.

The team picked common mutations found in these cancers, and looked for them in tumor samples from 24 women with endometrial cancer and 22 with ovarian cancer. All the cancers had one or more of the common mutations.

Then, the researchers performed Pap tests on the same women, and looked for the same DNA mutations in the Pap specimens. They found the mutations in 100 percent of the women with endometrial cancer, but in only 9 of the 22 with ovarian cancer. The test identified two of the four ovarian cancers that had been diagnosed at an early stage.

Finally, the team developed a test that would look simultaneously for cancer-associated mutations in 12 different genes in Pap samples. Used in a control sample of 14 healthy women, the test found no mutations — meaning no false-positive results.

Dr. Luis A. Diaz, the other senior author of the report and an associate professor of oncology at Johns Hopkins, called the research a step toward a screening test that at first blush appears very effective at detecting endometrial cancer, though obviously less so at finding ovarian cancer.

“Probably one of the most exciting features of this approach,” Dr. Diaz said, “is that we wanted a test that would seamlessly integrate with routine medical practice that could be utilized with the same test that women get every day all over the world, the Pap smear.”

But, he added: “We can’t say it’s ready for prime time. Like all good science, it needs to be validated.”

He and other members of the team said it might be possible to improve the detection rate for ovarian cancer by looking for more mutations and by changing the technique of performing Pap tests to increase the likelihood of capturing cells from the ovary. The change might involve timing the test to a certain point in a woman’s monthly cycle, using a longer brush to collect cells from deeper within the cervix or prescribing a drug that would raise the odds of cells being shed from the ovary.

The technique also needs to be tested in much larger groups of women, including healthy ones, to find out whether it works, particularly at finding cancers early enough to improve survival. And studies must also find out whether it generates false positive results, or identifies cancers that might not actually need to be treated.

Michael H. Melner, a program director in molecular genetics and biochemistry for the American Cancer Society, called the research “very promising,” in part because it is based on finding mutations.

“It tells you not just that cancer is there, but which mutation is there,” Dr. Melner said. “As we learn more and more about which mutations are associated with more or less severe forms of cancer, it’s more information, and possibly more diagnostic.”

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Shares Rise as Companies Report Earnings

Stocks rose on Wall Street on Wednesday after corporate earnings reports got off to a good start.

The Dow Jones industrial average climbed 61.66 points to 13,390.51. The Standard & Poor’s 500-stock index gained 3.87 points to 1,461.02, and the Nasdaq composite rose 14 to 3,105.81.

Stocks are facing their first big challenge of the year as companies start to report earnings for the fourth quarter of 2012. Throughout last year, analysts cut their outlook for earnings growth in the period and now expect them to rise by 3.21 percent, according to data from S&P Capital IQ.

“Maybe earnings expectations were a little too low,” Ryan Detrick, a strategist at Schaeffer’s Investment Research, said. “You don’t need to have great earnings, you just need to beat those expectations” for stocks to rally, he said.

Early indications were decent. The aluminum maker Alcoa reported late Tuesday that it swung to a profit for the fourth quarter, with earnings that met Wall Street’s expectations. The company brought in more revenue than analysts had expected, and the company predicted rising demand for aluminum this year as the aerospace industry gains strength. Alcoa is usually the first Dow component to report earnings every quarter.

Despite the better revenue number, Alcoa’s stock performance Wednesday was lackluster. It traded higher for part of the day, then ended down 2 cents at $9.08 a share.

Other companies fared better after reporting earnings. Helen of Troy, which sells personal care products under brands like Dr. Scholl’s and Vidal Sassoon, rose 2.7 percent, up 90 cents to $34.43 after reporting a 15 percent increase in quarterly net income.

Boeing was the biggest gainer of the 30 stocks in the Dow. It jumped 3.5 percent, up $2.63 to $76.76, after two days of sharp declines set off by new problems for its 787 Dreamliner. Boeing said it had “extreme confidence” in the plane even as federal investigators tried to determine the cause of a fire on Monday aboard an empty Japan Airlines plane in Boston and a fuel leak in another Japan Airlines 787 on Tuesday.

The wireless network operator Clearwire rose 7.2 percent, or 21 cents, to $3.13, after Dish network made an unsolicited offer to buy the company, which has already agreed to sell itself to Sprint. Dish rose 88 cents to $36.85, and Sprint fell 9 cents to $5.88.

The online education company Apollo Group fell 7.8 percent after reporting a sharp decline in fall term student sign-ups at the University of Phoenix, which it operates. The stock fell $1.62, to $19.32 a share.

Interest rates were steady. The Treasury’s benchmark 10-year note rose 1/32, to 97 29/32, and the yield was unchanged at 1.86 percent.

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Communists and Liberals Face Off in China Censorship

GUANGZHOU, China — Protests over censorship at one of China’s most liberal newspapers descended into ideological confrontation in this southeastern provincial capital on Tuesday, pitting advocates of free speech against supporters of Communist Party control, who wielded red flags and portraits of Mao Zedong.

The face-off between liberals and leftists outside the headquarters of the company that publishes the weekly newspaper, Southern Weekend, came after disgruntled editors and reporters at the paper last week deplored what they said was crude meddling by the top propaganda official in Guangdong Province, which has long had a reputation as a bastion of a relatively free press.

With a number of celebrities and business leaders rallying online to the liberal cause, senior propaganda officials in Beijing began this week to roll out a national strategy of demonizing the rebel journalists and their supporters. The Central Propaganda Department issued a directive to news organizations saying that the defiant outburst at Southern Weekend, also known as Southern Weekly, had involved “hostile foreign forces.”

The order, translated by China Digital Times, a research group at the University of California, Berkeley, that studies Chinese news media, said that Chinese journalists must drop their support for Southern Weekend and insisted that “party control of the media is an unwavering basic principle.”

An editor at a party news organization said the term “hostile forces” had been used in an internal discussion with a senior editor about the Southern Weekend conflict. Several Chinese journalists outside Guangdong said Tuesday that a positive outcome for the frustrated Southern Weekend reporters and editors appeared uncertain, and that their call for the dismissal of Tuo Zhen, the top provincial propaganda official, who took up his post in May, was probably too radical for higher authorities to accept.

The protesting journalists at Southern Weekend blame Mr. Tuo, a former journalist himself, for ordering a drastic change in a New Year’s editorial that had originally called for greater respect for constitutional rights. The revised editorial instead praised party policies. Mr. Tuo has not commented.

A former editor at the Nanfang Media Group, which includes Southern Weekend, said negotiations continued on Tuesday between provincial propaganda officials and representatives of the disgruntled journalists and editors.

The former editor, who asked that his name not be used for fear it could jeopardize his current job, said the talks focused on the protesting journalists’ demands for an inquiry into the New Year’s episode and for the newspaper’s managers to rescind a statement that absolved Mr. Tuo of responsibility for the editorial.

“They want that statement to be removed, and they also want assurances about relaxing controls on journalists — not removing party oversight, but making it more reasonable, allowing reporters to challenge officials,” he said. “The other main demand is for an impartial explanation of what happened, an accounting so it won’t happen again.”

The former editor said a continued standoff into Wednesday could jeopardize the newspaper’s usual publication on Thursday. “In effect, it’s a strike,” he said. “It looks unclear whether it can come out on Thursday.”

So far, senior Chinese officials have not commented publicly on the censorship dispute at the paper, which could test how far the recently appointed Communist Party leader, Xi Jinping, will go in support of more open economic and political policies. “I don’t believe that Xi is totally hypocritical when he talks about reform,” said Chen Min, a prominent former opinion writer for Southern Weekend who was forced out of the newspaper in 2011 during a party-led crackdown on potential dissent.

Defenders of Communist orthodoxy turned up at the newspaper headquarters on Tuesday to make the case for firm party control of the media.

“We support the Communist Party, shut down the traitor newspaper,” said a cardboard sign held up by one of 10 or so conservative demonstrators.

“Southern Weekend has an American dream,” another sign said. “We don’t want the American dream, we want the Chinese dream.”

Most of the party supporters refused to give their names. One who did, Yang Xingfa, 50, from Hunan Province, said: “Southern Weekend belongs to the people. However, the paper always ignores the achievements of the Chinese Communist Party and asks why China isn’t more like the United States. Outrageous!”

Some of the participants held portraits of Mao; others waved the red flags of China and of the Communist Party. They said they had come on their own initiative and not at the behest of officials.

The dueling protests outside the newspaper headquarters reflected the political passions and tensions raised by the quarrel over censorship. Internet chatter about the conflict has become widespread, and finding a resolution to the standoff poses a challenge both to the central authorities and to Hu Chunhua, the new party chief of Guangdong and a potential candidate to succeed Mr. Xi in a decade.

Hundreds of bystanders watched and took photos on cellphones as the leftists shouted at the 20 or more protesters who had gathered to denounce censorship, and shoving matches broke out between the demonstrators. The 70 or so police officers and security guards mostly watched, stepping in on occasion to separate the two sides.

At one point, leftists were showered with 50-cent renminbi currency notes, which are worth about 8 United States cents. The Fifty-Cent Party has become a popular term used to disparage pro-party leftists, who are accused by critics of taking 50 cents as payment for each pro-party message they post on the Internet.

One defender of the Southern Weekend journalists was Liang Taiping, 28, a poet who wore a mask popularized by the Hollywood movie and British comic book “V for Vendetta.” Mr. Liang said he had bought the mask after watching the movie recently on state-run China Central Television, which had surprised many Chinese with its willingness to show the film uncut, since the film advocates the overthrow of a one-party dictatorship.

“It’s the only newspaper in China that’s willing to tell the truth,” said Mr. Liang, who added that he had traveled by train about 350 miles from the southern city of Changsha to show his support. “What’s the point of living if you can’t even speak freely?”

Edward Wong reported from Guangzhou, and Chris Buckley from Hong Kong. Jonah M. Kessel contributed reporting from Guangzhou, and Jonathan Ansfield from Beijing. Mia Li contributed research from Guangzhou.

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U.S. Franciscan friars go digital, accept prayer requests via text

NEW YORK (Reuters) – The largest group of Franciscan friars in the United States is offering the faithful a new way to pray in the digital age by accepting prayer requests via text messages.

The Friars of Holy Name Province, who staff 40 parishes and have colleges, soup kitchens and food centers along the eastern seaboard, as well as groups in Peru and Tokyo, are among a few religious groups offering this type of digital service.

Its “Text a Prayer Intention to a Franciscan Friar” initiative, which is described as faith at your fingertips, is a novel way for Roman Catholics to connect.

“People are always saying to friars, ‘Can you say a prayer for me?’ Or ‘Can you remember my mother who has cancer?’” Father David Convertino, the New York-based executive director of development for the Franciscan Friars of the Holy Name Province, said in an interview.

“I was thinking that a lot of people text everything now, even more than email, so why not have people have the ability to ask us to pray for them … by texting.”

The faithful simply text the word ‘prayer’ to 306-44, free of charge. A welcome message from the friars comes up along with a box to type in the request. When the it is sent, the sender receives a reply.

The intentions are received on a website and will be included collectively in the friars’ prayers twice a day and at Mass.

It is one of several ways the friars hope to reach a younger audience, increase the number of faithful and spread the faith. They have already renovated their website and the next step is moving into Facebook and tweeting.

“If the Pope can tweet, friars can text,” said Father David.

The friars also have a presence on LinkedIn and have been streaming some of their church services.

“We’re trying,” said Father David when asked if the friars are well into the digital age, adding that they were “rushing madly into the 19th century.”

Most of the 325 friars, whose average age is about 60, are comfortable with the technology.

“We have a friar who is 80 who was texting today,” said Father David.

The friars are following the example of 85-year-old Pope Benedict, the leader of the world’s 1.2 billion Roman Catholics, whom the Vatican said had 2.1 million followers on Twitter just eight days after sending his first tweet.

The Pontiff tweets in several languages, including Arabic, and plans to add Latin and Chinese to them.

“We’re really excited about this working,” said Father David, about the new program. “I think we’ll be able to keep up (with all the intentions). That’s what we do, we pray for people.”

(Reporting by Patricia Reaney; Editing by Piya Sinha-Roy)

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Bucks coach Scott Skiles out, Boylan to fill in

MILWAUKEE (AP) — Once again, an NBA team has parted ways with head coach Scott Skiles. Once again, veteran assistant Jim Boylan is being asked to pick up the pieces.

One day after Milwaukee and Skiles agreed it was time for a change, the Bucks said Tuesday that Boylan will coach the team for the rest of the season. General manager John Hammond downplayed the notion that Skiles had lost control of the locker room or otherwise felt friction with management.

"Scott and I did not have a frosty relationship. Scott did not hate this team," said Hammond, who noted that more than half the season remains. "We're not a team in dire straits ... we're expecting good things to happen."

Boylan met with reporters before Tuesday night's home game against Phoenix.

"We'll do what we've been doing as far as being professional, getting ourselves ready for every game and getting out there and competing," Boylan said. "That's my job right now, to get us back on the right track, move us in the right direction and I think the guys we have on the team right now are quality people and committed to that task. That'll be our ultimate goal."

If this change sounds familiar, it should: Skiles was fired as head coach in Chicago on Christmas Eve in 2007 after the Bulls started 9-16. Boylan, an assistant in Chicago, took over and went 24-32. He was fired at the end of the season.

In an interview Tuesday with the Milwaukee Journal Sentinel, Skiles disputed the notion that he didn't like his team.

"There's always the normal coach-player friction that goes on," Skiles said in the Journal Sentinel interview. "Guys at this level are great players. This is, as NBA teams go, this is a good group of guys."

Hammond said he and Skiles had been having a number of conversations recently about the future of the team. He said there was no single factor in Skiles' departure, and that no other assistant coaches were leaving.

"It was a mutual decision. We both agreed to make this decision," he said.

Skiles had a 162-182 record in four-plus seasons with Milwaukee, with one playoff appearance — a first-round loss to Atlanta in seven games during the 2009-10 season. He was a hard-nosed, defensive-minded coach who sometimes seemed to have difficulty meshing with a roster built around volume shooters Brandon Jennings and Monta Ellis.

Jennings said he heard about the change in a phone call Monday night from Skiles and not from anyone within the organization.

"I think that's why I was a little bit frustrated at first," he said. "Just the fact that I had to hear it from my own coach and not the team. If I'm supposed to be their franchise player, why don't I hear the news first?"

Jennings said he was shocked but not upset about the change. He said he spoke with Skiles for about 20 minutes.

"We had our ups and downs, we had great times here," he said. "I have nothing but respect for him because as a rookie he did put the ball in my hands first."

Luc Mbah a Moute said he was shocked and had a great experience playing for Skiles, but coaching changes simply were part of the business of the NBA.

"I kind of had an idea of hearing that the team wasn't really happy with the way everything was going, and not just this year, you know the last couple of years with Skiles," he said. "This year we were kind of like started a good start and then went through a patch where we didn't play so great."

Boylan said the initial change he would make was to insert forward Ersan Ilyasova into the starting lineup for Ekpe Udoh.

Ilyasova re-signed with the Bucks during the summer, but saw his minutes decrease to 22 per game this year after playing 27 in the 2011-12 season. He said he was looking forward to playing for Boylan.

"For me, it's not a big deal you know, if you start or not, my concern has been about the minutes," Ilyasova said. "When you come from the season I had last year, I didn't expect to play less than last year."

Skiles' agent, Keith Glass, said it was hard to pinpoint when Skiles began thinking of stepping aside, but all parties agreed the timing was right.

"There was no blowup. There was no animosity going on. I think everybody made the right decision for their own respective sides," he said.

Two other coaches, the Lakers' Mike Brown and Brooklyn's Avery Johnson, are also out of work in this young season. Brown was fired after five games and Johnson late last month, about three weeks after being named Eastern Conference coach of the month.

The 57-year-old Boylan has been the lead assistant for the Bucks the past four seasons. In a 20-year NBA coaching career, he has also been an assistant in Cleveland, Vancouver, Phoenix, Atlanta and Chicago.

Boylan said he was too worried about keeping the job when he succeeded Skiles in Chicago.

"Last time, from a personal standpoint, I was too worried about trying to keep the job and it kind of restricted me as time went on," he said. "I made the determination when this happened last night, that I was going to try and enjoy this and just do what I like to do which is coach these guys, being around these guys and the coaching staff and the organization and just enjoy it.

"Have a good time with it and get the guys to play hard and compete and let the chips fall where they may at the end," he said.

Milwaukee, losers of four straight when the coaching change was announced, started out a surprising 6-2, only to lose seven of its next nine. The Bucks followed that with a four-game winning streak, the kind of wild swings that didn't sit well with a coach who values consistency — both in play and preparation.

"Considering like a week ago we were 16-12 and beat Miami, you probably wouldn't have guessed this would have happened a week later," forward Mike Dunleavy said.

Skiles did help coax a breakout season out of Larry Sanders, who has emerged as a rebounding and shot-blocking monster over the last few weeks. The demanding coach pushed Sanders to be more consistent, and the lanky forward/center has responded. He grabbed 20 rebounds against Boston on Dec. 21 to start a string of double-digit rebound nights in five of his last eight games and leads the league with 3.07 blocks per game.

Skiles' focus on defense was always going to be tested by a roster revolving around Jennings and Ellis, two flashy scorers who prefer to get up and down the court and lure opposing teams into shootouts.

Jennings and Ellis have been giving plenty of effort, but the Bucks were in the middle of the pack in points allowed per game (15th) and field goal percentage defense (18th), below Skiles' lofty expectations.

Still, the Bucks are only a few games behind Indiana in the Central Division, despite injuries to Beno Udrih and top defender Mbah a Moute, and in seventh place in the Eastern Conference playoff chase.

Skiles' departure could be the first in a series of big shake-ups for the Bucks. Hammond is in the final year of his deal, while Jennings and Ellis can both become restricted free agents after this season.

Hammond said he and team owner Herb Kohl are in discussions about an extension, but he declined to elaborate on the progress of their conversations.

As for Skiles, he is now 443-433 as an NBA head coach in 12-plus seasons, which also includes stints with Chicago and Phoenix. He started this season with a host of new players, though the biggest trade during his tenure was the deal that sent former No. 1 draft pick Andrew Bogut to Golden State for Ellis.

"I never heard Scott say a negative thing to me about that trade or anything else," Glass said. "Everybody has their own opinions on the way things are done, but Scott was always on board with — in terms of support — whatever move was made. ... And I think he liked Monta. I never heard him say a word about that at all in a negative sense."

Glass said it was too early to say whether Skiles was looking to stay in coaching.

"Today is not the day for that ... but I'm sure we will discuss that in the next month or so," he said. "But he's not burning right now."

AP Sports Writers Jon Krawczynski in Minneapolis and Andrew Seligman in Chicago and AP Freelancer DiGiovanni in Milwaukee contributed to this report.

___

Dinesh Ramde can be reached at dramde(at)ap.org.

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Gaps Seen in Therapy for Suicidal Teenagers

Most adolescents who plan or attempt suicide have already received at least some mental health treatment, raising questions about the effectiveness of current approaches to helping troubled youths, according to the largest in-depth analysis to date of suicidal behaviors in American teenagers.

The study, in the journal JAMA Psychiatry, found that 55 percent of suicidal teenagers had received some therapy before they thought about suicide, planned it or tried to kill themselves, contradicting the widely held belief that suicide is due in part to a lack of access to treatment.

The findings, based on interviews with a nationwide sample of more than 6,000 teenagers and at least one parent of each, linked suicidal behavior to complex combinations of mood disorders like depression and behavior problems like attention-deficit and eating disorders, as well as alcohol and drug abuse.

The study found that about one in eight teenagers had persistent suicidal thoughts at some point, and that about a third of those who had suicidal thoughts had made an attempt, usually within a year of having the idea.

Previous studies have had similar findings, based on smaller, regional samples. But the new study is the first to suggest, in a large nationwide sample, that access to treatment does not make a big difference.

The study suggests that effective treatment for severely suicidal teenagers must address not just mood disorders, but also behavior problems that can lead to impulsive acts, experts said. According to the Centers for Disease Control and Prevention, 1,386 people between the ages of 13 and 18 committed suicide in 2010, the latest year for which numbers are available.

“I think one of the take-aways here is that treatment for depression may be necessary but not sufficient to prevent kids from attempting suicide,” said Dr. David Brent, a professor of psychiatry at the University of Pittsburgh, who was not involved in the study. “We simply do not have empirically validated treatments for recurrent suicidal behavior.”

The report said nothing about whether the therapies given were state of the art or carefully done, said Matt Nock, a professor of psychology at Harvard and the lead author, and it is possible that some of the treatments prevented suicide attempts. “But it’s telling us we’ve got a long way to go to do this right,” Dr. Nock said. His co-authors included Ronald C. Kessler of Harvard and researchers from Boston University and Children’s Hospital Boston.

Margaret McConnell, a consultant in Alexandria, Va., said her daughter Alice, who killed herself in 2006 at the age of 17, was getting treatment at the time. “I think there might have been some carelessness in the way the treatment was done,” Ms. McConnell said, “and I was trusting a 17-year-old to manage her own medication. We found out after we lost her that she wasn’t taking it regularly.”

In the study, researchers surveyed 6,483 adolescents from the ages of 13 to 18 and found that 9 percent of male teenagers and 15 percent of female teenagers experienced some stretch of having persistent suicidal thoughts. Among girls, 5 percent made suicide plans and 6 percent made at least one attempt (some were unplanned).

Among boys, 3 percent made plans and 2 percent carried out attempts, which tended to be more lethal than girls’ attempts.

(Suicidal thinking or behavior was virtually unheard-of before age 10.)

Over all, about one-third of teenagers with persistent suicidal thoughts went on to make an attempt to take their own lives.

Almost all of the suicidal adolescents in the study qualified for some psychiatric diagnosis, whether depression, phobias or generalized anxiety disorder. Those with an added behavior problem — attention-deficit disorder, substance abuse, explosive anger — were more likely to act on thoughts of self-harm, the study found.

Doctors have tested a range of therapies to prevent or reduce recurrent suicidal behaviors, with mixed success. Medications can ease depression, but in some cases they can increase suicidal thinking. Talk therapy can contain some behavior problems, but not all.

One approach, called dialectical behavior therapy, has proved effective in reducing hospitalizations and suicide attempts in, among others, people with borderline personality disorder, who are highly prone to self-harm.

But suicidal teenagers who have a mixture of mood and behavior issues are difficult to reach. In one 2011 study, researchers at George Mason University reduced suicide attempts, hospitalizations, drinking and drug use among suicidal adolescent substance abusers. The study found that a combination of intensive treatments — talk therapy for mood problems, family-based therapy for behavior issues and patient-led reduction in drug use — was more effective than regular therapies.

“But that’s just one study, and it’s small,” said Dr. Brent of the University of Pittsburgh. “We can treat components of the overall problem, but that’s about all.”

Ms. McConnell said that her daughter’s depression had seemed mild and that there was no warning that she would take her life. “I think therapy does help a lot of people, if it’s handled right,” she said.

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