Report Faults Priorities in Breast Cancer Research

Too little of the money the federal government spends on breast cancer research goes toward finding environmental causes of the disease and ways to prevent it, according to a new report from a group of scientists, government officials and patient advocates established by Congress to examine the research.

The report, “Breast Cancer and the Environment — Prioritizing Prevention,” published on Tuesday, focuses on environmental factors, which it defines broadly to include behaviors, like alcohol intake and exercise; exposures to chemicals like pesticides, industrial pollutants, consumer products and drugs; radiation; and social and socioeconomic factors.

The 270-page report notes that scientists have long known that genetic and environmental factors contribute individually and also interact with one another to affect breast cancer risk. Studies of women who have moved from Japan to the United States, for instance, show that their breast cancer risk increases to match that of American women. Their genetics have not changed, so something in the environment must be having an effect. But what? Not much is known about exactly what the environmental factors are or how they affect the breast.

“We know things like radiation might cause breast cancer, but we don’t know much that we can say specifically causes breast cancer in terms of chemicals,” said Michael Gould, a professor of oncology at the University of Wisconsin, Madison, and a co-chairman of the 23-member committee that prepared the report.

At the two federal agencies that spend the most on breast cancer, only about 10 percent of the research in recent years involved environment and prevention. From 2008 to 2010, the National Institutes of Health spent $357 million on environmental and prevention-related research in breast cancer, about 16 percent of all the financing for the disease. From 2006 to 2010, the Department of Defense spent $52.2 million on prevention-oriented research, about 8.6 percent of the money devoted to breast cancer. Those proportions were too low, the group said, though it declined to say what the level should be.

“We’re hedging on that on purpose,” Dr. Gould said. “It wasn’t the role of the committee to suggest how much.”

He added, “We’re saying: ‘We’re not getting the job done. We don’t have the money to get the job done.’ The government will have to figure out what we need.”

Jeanne Rizzo, another member of the committee and a member of the Breast Cancer Fund, an advocacy group, said there was an urgent need to study and regulate chemical exposures and inform the public about potential risks. “We’re extending life with breast cancer, making it a chronic disease, but we’re not preventing it,” she said.

“We have to look at early life exposures, in utero, childhood, puberty, pregnancy and lactation,” Ms. Rizzo said. “Those are the periods when you get set up for breast cancer. How does a pregnant woman protect her child? How do we create policy so that she doesn’t have to be a toxicologist when she goes shopping?”

Michele Forman, a co-chairwoman of the committee and an epidemiologist and professor of nutritional sciences at the University of Texas, Austin, said the group found that breast cancer research at various government agencies was not well coordinated and that it was difficult to determine whether there was duplication of efforts.

She said that it was essential to study how environmental exposures at different times of life affected breast-cancer risk, and that certain animals were good models for human breast cancer and should be used more.

The report is the result of the Breast Cancer and Environmental Research Act, which was passed in 2008 and required the secretary of health and human services to create a committee to study breast cancer research. A third of the members were scientists, a third were from government and a third were from advocacy groups. The advocates, Dr. Forman said, brought a sense of urgency to the group

“People who are not survivors need to have that urgency there,” she said.

Pointing to the vaccine now being offered to girls to prevent cervical cancer, Dr. Forman said, “I look forward to the day when we have an early preventive strategy for breast cancer.”

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Domino's hopes customers flock to 'pizza theater'

A pair of mustachioed pizza makers in blue aprons — visible from behind a glass display at a new Domino's store in Seattle — tossed dough into the air as a handful of corporate executives looked on.

Domino's calls the concept "pizza theater" because customers now can come in and watch their orders being made.

The new look is part of a four-year effort to freshen the pizza chain's image and boost its growing ranks of carryout customers.

The open-kitchen format includes seating for a dozen or so people, a chalkboard where customers can leave comments, and a refrigerated section for grab-and-go items such as salads and milk.

"This is the way we always made our pizzas. A lot of people just had no idea," said Domino's Chief Executive Patrick Doyle, who was in Seattle last week to see the new store. "It was sort of one of those lightning-bolt moments where we said, 'Gee, maybe we should show them.' "

Founded in 1960, Domino's long has been known for inexpensive pizza delivered to your doorstep. Its 30-minute guarantee helped make it the world's largest pizza-delivery company in the 1980s (though it later had to drop the pledge amid charges that it led to reckless driving).

Today, the Ann Arbor, Mich., company holds a 22% share of the U.S. pizza-delivery market and ranks No. 2 overall among U.S. pizza chains.

More than two-thirds of U.S. consumers buy carryout pizza at least once a month, making carryout the most popular pizza format, according to research firm Technomic Inc. Nearly half of all pizza orders are for carryout, while a third are for delivery and a fifth are for eat-in.

Experts say that if a Domino's store is nearby, many consumers prefer to pick up their orders and save a few dollars that otherwise would go to a delivery fee and tip.

Domino's jumped on the trend last year when it began offering a weekday pickup promotion of a large three-topping pizza for $7.99. It also redesigned its logo, dropping the word "pizza" to reflect a larger menu, including sandwiches, pasta and chocolate "lava" cakes.

Doyle said the plan is to redo the greater Seattle area's 74 franchised locations by midyear, which would make Seattle the first market to be completely overhauled.

Doyle said Domino's also is setting out to hire 800 new full-time and part-time employees in that area — something he attributed to new store openings, as well as solid sales growth.

Domino's has about 4,500 U.S. franchised stores, as well as 390 company-owned stores. Its U.S. sales at stores open at least a year rose 3.3% in the third quarter, and its stock has been trading at the upper end of a 52-week range of $28.17 to $47.91. Its shares rose 8 cents Monday to $46.81.

Pizza Hut is the largest U.S. pizza chain, with an 18% market share, followed by Domino's, at 11%, and Papa John's, at 7%, according to Technomic.

In late 2009, Domino's rolled out a new recipe promising a garlic-seasoned crust, bolder tomato sauce and tastier cheese. The new store format builds on that push to be more transparent, Doyle said.

"Consumers want to see what they're eating," he said. "We've always been known as delivery experts, but a third or more of our orders now are for carryout. We're proud of these pizzas, and we want people to see it."

Seattle resident James Johnson, 28, a longtime Domino's customer, said he welcomes the changes. Johnson stopped by the revamped Domino's on his way home from work last week to pick up dinner.

"You can watch the pizza being made from beginning to end," he said. "It's kind of cool to see, depending on whether you're engaged and not on your cellphone."

Martinez writes for the Seattle Times.

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Locals believe bobcat trappers are crossing the line in Joshua Tree

JOSHUA TREE — Annica Kreuter's backyard on the edge of Joshua Tree National Park has been a perfect place to chronicle the adventures of eight bobcats.

Over the last decade she has watched a young bobcat chased up a tree by a coyote; an alpha male surveying the landscape from the hood of her car; a kitten sauntering into the yard as she gardens; a matron sniffing the back of Kreuter's neck as she napped on a hammock.

Lately, seven of the eight have vanished. "At sunrise, I hear the one that is still here crying for his family," Kreuter said.

She and others in this high desert community of about 8,000 say bobcats have been disappearing lately, killed for the value of their pelts by trappers who often trespass on private property. The trappers come armed with wire cages, squirt bottles of potent scent and bobcat lures: battery-powered vibrating pet toys festooned with feathers to resemble dying birds.

Hunting and trapping bobcats is legal during hunting season outside of the national park boundaries. But to the locals, that makes little difference. "The very idea of trapping in a place where bobcats are so well-known they have nicknames — Big Gray, Leroy, Tomboy — is disturbing and heartbreaking," Kreuter said.

As one of the top predators of a 720,000-acre park visited by 1.4 million people each year, the bobcat's presence — or absence — has a cascade of consequences, making it a governing force of the ecosystem and the local ecotourism economy. An adult bobcat stands about 15 inches high and can cover 25 to 30 miles of territory in a day. Using razor-sharp claws and powerful legs, it preys on rabbits and makes a significant contribution to rodent control.

Critics believe the trappers are after bobcats that routinely crisscross the invisible park boundary lines.

"This is really, really bad," said astronomer and conservationist Tom O'Key, who was the first to discover a trap. "These guys are carpetbaggers coming onto private land to slaughter bobcats with no regard for a tight-knit community that cares deeply about the national park and its wildlife."

O'Key alerted the community after finding a trap chained to a jojoba bush and camouflaged with broken branches and leaves on his property north of the park. He notified the San Bernardino County Sheriff's Department and the Hi-Desert Star newspaper.

Bobcats are being targeted for the value of their pelts in top-dollar markets such as China, Russia and Greece. A premium pelt of heavily spotted white belly fur can earn a trapper more than $600, according to Nathan Brock, who skinned 10 bobcats that he captured in the Joshua Tree area during the hunting season that ended Jan. 31.

Brock, 38, an active-duty Marine stationed at nearby Twentynine Palms Marine Corps Base, acknowledged that one of his traps was set on private property and not on federal Bureau of Land Management grounds, where trapping is legal. The region is a patchwork of private property and BLM land.

"I feel horrible about that," Brock said. "It's my fault for not making sure."

The manufacturer of Brock's trap, Mercer Lawing of Barstow, said critics miss the point. "We love those animals more than the people who are complaining about us trapping them do," Lawing said. "Nathan and I harvest adult male cats and turn loose adult females and kittens."

The national park has taken a neutral position on the issue, given that its jurisdictional reach extends only as far as its boundaries.

However, park biologist Michael Vamstad said, "Residents have every right to be upset. The fact that there is no limit on bobcats that can be legally taken during hunting season doesn't jibe along the edges of a national park. It's a relic regulation."

Conservationists are calling for a "no-trapping" buffer zone in the area because bobcats travel along a web of interconnected wildlife corridors stretching from the national park to the Marine base about 10 miles to the north.

"The law has to change if it's legal for a handful of people to line the boundary of a national park with traps to catch bobcats, then send their pelts to China for profit," said Brendan Cummings, public lands director for the Center for Biological Diversity. "We are not going to let this happen again."

Equally pointed words came from Nancy Karl, executive director of the Mojave Desert Land Trust, a nonprofit dedicated to preserving safe passage for wildlife between protected areas. "We are watching and paying close attention — and we are going to change things," Karl said. "Those trappers would be best advised to move it."

louis.sahagun@latimes.com

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Producers: 'Chicago' cast to join Oscar performers

LOS ANGELES (AP) — Academy Awards producers Craig Zadan and Neil Meron have run out of rehearsal space. Dressing rooms, too.

The award-winning production duo is planning the most performance-filled Oscar show ever. They promise a "wow moment" in each of its 13 acts, so the show demands a more dynamic stage and more dressing rooms and rehearsal time than previous Oscar productions.

"I don't think any Oscars have been as performance-based," Meron said.

It's no surprise, given the pair's hit-filled history: They produced 2003's best picture, "Chicago," and count TV's "Smash" and the recent Broadway revival of "How to Succeed in Business Without Really Trying" among their credits.

Running out of space for their Oscar production's A-list roster of performers — including Barbra Streisand, Adele and Norah Jones — is what Zadan calls a "great problem."

"When you do an Oscar show, you don't have a dressing room problem. The presenters don't get dressing rooms. And how many people perform on the Oscars, like one or two?" he said. "We have a staggering amount of performers, and each of them needs a dressing room... We're measuring the magnitude of how big the show is by the fact that we don't have (enough) dressing rooms."

Just added to the list of stars who may need spots? The cast of "Chicago."

The producers announced Monday that Renee Zellweger, Catherine Zeta-Jones, Queen Latifah and Richard Gere will reunite on the stage where "Chicago" won its Oscar 10 years ago.

"In a night of celebration of the music of the movies, we find it very appropriate," Meron said.

So will the musical cast sing?

"We can't talk about what they're going to do!" Zadan said.

Here's what they will talk about:

— Expect a dynamic, screen-filled set to accommodate the movie-focused numbers: "We're using a lot of cutting-edge technology with new LED screens of different sizes, shapes and configurations... It's kind of thrilling what we're doing with screens," Zadan said. "There will be, too, the regular screen that you have to use each year... but then we have all kinds of other screens that we're using in the show that are completely unique and different and allow us to do stuff with cinema, so it's not a concert thing where somebody comes out and sings a song. It's all integrated into movies."

— Look for a lot of host Seth MacFarlane: "He's going to be very present as a host, as a host should," Meron said.

— And expect to hear him show off his chops: "Seth will sing. He's got a great voice," Zadan said.

"Seth really does understand and have great reverence for the music of the movies," Meron added. "He loves it."

— And about those "wow moments?" Among them will be a celebration of the James Bond film franchise, a tribute to movie musicals, Streisand, Adele, a "special appearance" by Daniel Radcliffe, Charlize Theron, Channing Tatum and Joseph Gordon-Levitt, and maybe something from the cast of "Chicago."

"We think seeing the cast of 'The Avengers' is pretty wow," Meron said.

Better book them a dressing room.

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Contact Sandy Cohen at www.twitter.com/APSandy.

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Well: Getting the Right Addiction Treatment

“Treatment is not a prerequisite to surviving addiction.” This bold statement opens the treatment chapter in a helpful new book, “Now What? An Insider’s Guide to Addiction and Recovery,” by William Cope Moyers, a man who nonetheless needed “four intense treatment experiences over five years” before he broke free of alcohol and drugs.

As the son of Judith and Bill Moyers, successful parents who watched helplessly during a 15-year pursuit of oblivion through alcohol and drugs, William Moyers said his near-fatal battle with addiction demonstrates that this “illness of the mind, body and spirit” has no respect for status or opportunity.

“My parents raised me to become anything I wanted, but when it came to this chronic incurable illness, I couldn’t get on top of it by myself,” he said in an interview.

He finally emerged from his drug-induced nadir when he gave up “trying to do it my way” and instead listened to professional therapists and assumed responsibility for his behavior. For the last “18 years and four months, one day at a time,” he said, he has lived drug-free.

“Treatment is not the end, it’s the beginning,” he said. “My problem was not drinking or drugs. My problem was learning how to live life without drinking or drugs.”

Mr. Moyers acknowledges that treatment is not a magic bullet. Even after a monthlong stay at a highly reputable treatment center like Hazelden in Center City, Minn., where Mr. Moyers is a vice president of public affairs and community relations, the probability of remaining sober and clean a year later is only about 55 percent.

“Be wary of any program that claims a 100 percent success rate,” Mr. Moyers warned. “There is no such thing.”

“Treatment works to make recovery possible. But recovery is also possible without treatment,” Mr. Moyers said. “There’s no one-size-fits-all approach. What I needed and what worked for me isn’t necessarily what you or your loved one require.”

As with many smokers who must make multiple attempts to quit before finally overcoming an addiction to nicotine, people hooked on alcohol or drugs often must try and try again.

Nor does treatment have as good a chance at succeeding if it is forced upon a person who is not ready to recover. “Treatment does work, but only if the person wants it to,” Mr. Moyers said.

Routes to Success

For those who need a structured program, Mr. Moyers described what to consider to maximize the chances of overcoming addiction to alcohol or drugs.

Most important is to get a thorough assessment before deciding where to go for help. Do you or your loved one meet the criteria for substance dependence? Are there “co-occurring mental illnesses, traumatic or physical disabilities, socioeconomic influences, cultural issues, or family dynamics” that may be complicating the addiction and that can sabotage treatment success?

While most reputable treatment centers do a full assessment before admitting someone, it is important to know if the center or clinic provides the services of professionals who can address any underlying issues revealed by the assessment. For example, if needed, is a psychiatrist or other medical doctor available who could provide therapy and prescribe medication?

Is there a social worker on staff to address challenging family, occupational or other living problems? If a recovering addict goes home to the same problems that precipitated the dependence on alcohol or drugs, the chances of remaining sober or drug-free are greatly reduced.

Is there a program for family members who can participate with the addict in learning the essentials of recovery and how to prepare for the return home once treatment ends?

Finally, does the program offer aftercare and follow-up services? Addiction is now recognized to be a chronic illness that lurks indefinitely within an addict in recovery. As with other chronic ailments, like diabetes or hypertension, lasting control requires hard work and diligence. One slip need not result in a return to abuse, and a good program will help addicts who have completed treatment cope effectively with future challenges to their recovery.

How Families Can Help

“Addiction is a family illness,” Mr. Moyers wrote. Families suffer when someone they love descends into the purgatory of addiction. But contrary to the belief that families should cut off contact with addicts and allow them to reach “rock-bottom” before they can begin recovery, Mr. Moyers said that the bottom is sometimes death.

“It is a dangerous, though popular, misconception that a sick addict can only quit using and start to get well when he ‘hits bottom,’ that is, reaches a point at which he is desperate enough to willingly accept help,” Mr. Moyers wrote.

Rather, he urged families to remain engaged, to keep open the lines of communication and regularly remind the addict of their love and willingness to help if and when help is wanted. But, he added, families must also set firm boundaries — no money, no car, nothing that can be quickly converted into the substance of abuse.

Whether or not the addict ever gets well, Mr. Moyers said, “families have to take care of themselves. They can’t let the addict walk over their lives.”

Sometimes families or friends of an addict decide to do an intervention, confronting the addict with what they see happening and urging the person to seek help, often providing possible therapeutic contacts.

“An intervention can be the key that interrupts the process and enables the addict to recognize the extent of their illness and the need to take responsibility for their behavior,”Mr. Moyers said.

But for an intervention to work, Mr. Moyers said, “the sick person should not be belittled or demeaned.” He also cautioned families to “avoid threats.” He noted that the mind of “the desperate, fearful addict” is subsumed by drugs and alcohol that strip it of logic, empathy and understanding. It “can’t process your threat any better than it can a tearful, emotional plea.”

Resource Network

Mr. Moyer’s book lists nearly two dozen sources of help for addicts and their families. Among them:

Alcoholics Anonymous World Services www.aa.org;

Narcotics Anonymous World Services www.na.org;

Substance Abuse and Mental Health Services Administration treatment finder www.samhsa.gov/treatment/;

Al-Anon Family Groups www.Al-anon.alateen.org;

Nar-Anon Family Groups www.nar-anon.org;

Co-Dependents Anonymous World Fellowship www.coda.org.

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This is the second of two articles on addiction treatment. The first can be found here.

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Dozens of airline fees rose or changed in 2012, study finds

Airline travel fees — including charges to check a bag and to board early — have become so prevalent that travelers almost need an advanced degree in mathematics to calculate overall trip costs.

Last year at least 36 airline fees increased, and 16 others were redefined, bundled or unbundled with other services, according to a recent study by the consumer travel website Travelnerd.

One bright spot in the Travelnerd study of 14 U.S. airlines is that most fee increases were only $5 to $10 each.

In one case an airline had a big fee reduction. The study found that United Airlines reduced its fee for checking an overweight bag to $100 from $200 for bags 50 to 70 pounds and to $200 from $400 for bags 71 to 100 pounds.

"Travelers really have to be extra cautious when booking a flight," said Alicia Jao, vice president of travel media at Travelnerd, who predicts travelers will see even more fees in 2013. "U.S. carriers are becoming creative at charging consumers extra fees."

But some airlines seem to charge fees arbitrarily, said Perach Mazol, a Los Angeles resident who recently flew to Florida with friends from Romania to take a cruise.

On her flight from L.A. to Fort Lauderdale, Fla., on Spirit Airlines, she said the Florida airline did not charge for the carry-on bags she and her friends were carrying, but the carrier asked for $50 each to carry the same bags on the flight back. (Spirit is one of only two airlines in the U.S. that charge passengers for carry-on luggage.)

"I don't understand why they charged us on one flight and they don't on the other," Mazol said. "It's confusing."

A spokeswoman for Spirit said the airline tries to enforce its policies consistently.

"Maybe she got lucky one way and didn't have to pay," Spirit spokeswoman Misty Pinson said.

United offering satellite-based Wi-Fi

United Airlines was one of the last major airlines to offer onboard wireless Internet. But the Chicago carrier is trying to make up for its tardiness.

United offers Wi-Fi in about 3% of its fleet of about 700 planes, one of the lowest rates of any major carrier in the nation, according to a recent study.

But United recently became the first U.S.-based international carrier to offer satellite-based Wi-Fi Internet for passengers traveling on long-haul overseas flights.

The carrier has installed satellite-based Wi-Fi on nearly a dozen planes, with plans to expand the service to more than 300 planes, or about 43% of the fleet, by the end of the year.

"With this new service, we continue to build the airline that customers want to fly," said Jim Compton, vice chairman and chief revenue officer at United.

Satellite-based Wi-Fi is typically as fast as ground-based Wi-Fi, experts say, but the advantage is that it can give passengers Internet access when flying over areas where cellular towers don't exist — such as the Pacific or Atlantic oceans.

But, of course, there is a price to pay for the service.

United is charging $3.99 to $14.99 for standard speed, depending on the duration of the flight, and $5.99 to $19.99 for faster speeds.

United is not the only airline to offer satellite-based Wi-Fi. Southwest Airlines, the nation's largest domestic carrier, offers it through Westlake Village-based Row 44.

Delta to raise fee to access lounges

Airline fees are rising not only for onboard services but for amenities at the airport too.

Delta Air Lines, which has invested more than $20 million in its airport lounges over the last two years, announced that it would raise the cost for annual membership to access its lounges across the country by $50, starting March 1.

The increase means that an annual membership will range from $350 to $450, depending on membership level. (The more miles passengers fly on Delta the less they pay for membership.)

Among the investments Delta has made is the addition of a new luxury bar that opened recently at Delta's lounge at Los Angeles International Airport. Instead of helping themselves at a self-serve bar, members can now belly up to a fully stocked bar and order a drink from a bartender.

hugo.martin@latimes.com

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Cardinal Mahony used cemetery money to pay sex abuse settlement

Pressed to come up with hundreds of millions of dollars to settle clergy sex abuse lawsuits, Cardinal Roger M. Mahony turned to one group of Catholics whose faith could not be shaken: the dead.

Under his leadership in 2007, the Archdiocese of Los Angeles quietly appropriated $115 million from a cemetery maintenance fund and used it to help pay a landmark settlement with molestation victims.

The church did not inform relatives of the deceased that it had taken the money, which amounted to 88% of the fund. Families of those buried in church-owned cemeteries and interred in its mausoleums have contributed to a dedicated account for the perpetual care of graves, crypts and grounds since the 1890s.

Mahony and other church officials also did not mention the cemetery fund in numerous public statements about how the archdiocese planned to cover the $660-million abuse settlement. In detailed presentations to parish groups, the cardinal and his aides said they had cashed in substantial investments to pay the settlement, but they did not disclose that the main asset liquidated was cemetery money.

In response to questions from The Times, the archdiocese acknowledged using the maintenance account to help settle abuse claims. It said in a statement that the appropriation had "no effect" on cemetery upkeep and enabled the archdiocese "to protect the assets of our parishes, schools and essential ministries."

Under cemetery contracts, 15% of burial bills are paid into an account the archdiocese is required to maintain for what church financial records describe as "the general care and maintenance of cemetery properties in perpetuity."

Day-to-day upkeep at the archdiocese's 11 cemeteries and its cathedral mausoleum is financed by cemetery sales revenue separate from the 15% deposited into the fund, spokeswoman Carolina Guevara said. Based on actuarial predictions, it would be at least 187 years before cemeteries are fully occupied and the church started to draw on the maintenance account, she said.

"We estimate that Perpetual Care funds will not be needed until after the year 2200," Guevara wrote in an email.

The church's use of fund money appears to be legal. State law prohibits private cemeteries from touching the principal of their perpetual care funds and bars them from using the interest on those funds for anything other than maintenance. Those laws, however, do not apply to cemeteries run by religious organizations.

Mary Dispenza, who received a 2006 settlement from the archdiocese over claims of molestation by her parish priest in the 1940s, said her great-uncle and great-aunt are buried in Calvary Cemetery in East L.A.

"I think it's very deceptive," she said of the way the appropriation was handled. "And I think in a way they took it from people who had no voice: the dead. They can't react, they can't respond."

The fund dates to the tenure of Bishop Francis Mora, who opened Calvary in 1896. An official archdiocese history published in 2006 recounts how the faithful of Mora's era were assured their money was "in the custody of an organization of unquestionable integrity and endurance" — the Catholic Church.

Over the next century, the archdiocese built more cemeteries, and each person laid to rest meant a new deposit into the maintenance account. By the time of the sex abuse settlement, there were cemeteries from Pomona to Santa Barbara and $130 million in the fund. Church officials removed $114.9 million in October 2007.

"Management plans to repay these appropriated funds from future cemetery sales ... after all liabilities associated with the lawsuits ... are paid off," a December 2012 church financial report stated.

It's unclear when that will happen. The archdiocese is still repaying a $175-million loan it took to help cover the settlement. Archbishop Jose Gomez, who took over from Mahony two years ago, is mulling over a $200-million fundraising campaign. Cemeteries have been a reliable source of income for the church, and the use of the upkeep-fund money is one of several ways the archdiocese is depending on them to erase its abuse debts.

When Mahony agreed to the settlement six years ago, he did so knowing his archdiocese couldn't afford it. But he had little choice. If cases brought by more than 500 victims went to trial, the archdiocese feared it could be facing jury awards and legal bills in excess of $1 billion.

The deal reached after lengthy negotiations paid an average of $1.3 million per victim. Even with contributions from its insurance companies, religious orders and others, the archdiocese was on the hook for more than $300 million, vastly more cash than it had on hand.

Bishops in other cities had closed parishes and schools or filed for bankruptcy, moves that angered the faithful and that Mahony wanted to avoid. He went to Rome at least twice to consult with Vatican officials, who must approve the transfer of archdiocese property worth more than $10 million. He later told the National Catholic Reporter he got permission to "alienate" — the Vatican's term for sale or transfer — $200 million in church assets. Asked whether the Vatican had signed off on the use of cemetery funds, archdiocese Chief Financial Officer Randolph E. Steiner said in a statement, "All approvals under the Church's Code of Canon Law were obtained."

After the settlement, Mahony and others from the archdiocese said publicly that the money would come from administrative cuts, liquidation of investments, a bank loan and sales of real estate not directly related to their religious mission. Such real estate included the archdiocese's Wilshire Boulevard headquarters, which eventually sold for $31 million.

Three months later, with no announcement, the archdiocese reached into the cemetery account. Steiner said that during an internal review of church assets, the money "was determined to be excess funding and was made available to the 2007 settlement."

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Mardi Gras ball 1st Superdome event since blackout

NEW ORLEANS (AP) — This time, the lights stayed on in the Superdome.

The glitzy Mardi Gras Krewe of Endymion rolled its parade and super float through the Superdome on Saturday night and Kelly Clarkson performed amid purple, green and gold lights in the first major event at the venue since the Super Bowl blackout.

While the black tie ball was nowhere near the size of the championship game a week ago, it was a test for dome officials and the stadium's electricity provider, Entergy, which has come under scrutiny since the lights went dark for more than a half hour.

The bright stadium lights were dimmed for the ball, but there were no signs of any electrical problems.

Darin Coker and his wife, Jeannine, wondered whether the ball would be affected in any way after the outage.

"I got my dress six months ago," she said. "I was hoping they would get it fixed before tonight, and I was glad to hear they did."

The couple, both former New Orleans residents, drove in for the weekend from their home in Ruston, La., to attend the ball and catch other parades with friends and family. Darin Coker said he loved the sight of the dome's exterior, all aglow in purple, green and gold lights — traditional colors of Mardi Gras — and hoped outsiders wouldn't see the blackout as a black eye for a city still recovering from Hurricane Katrina.

"I was watching the game from home, and I was like, oh no, we were doing so good. The city looked so good," he said. "The city has come so far, and I hate to hear people say, 'Oh look at them, they just can't get it together.'"

Entergy said the blackout appeared to have been caused by a problem with a device the company installed to prevent power outages. It's still unclear whether the device had a design flaw or a manufacturing defect, causing an outage to about half of the stadium during the NFL's championship game between the Baltimore Ravens and San Francisco 49ers.

Entergy removed the equipment that failed, "and we're looking forward to hosting the Endymion ball," said Eric Eagan, spokesman for the Superdome.

The dome looked much different than a week ago, set up for a crowd of more than 30,000. The turf was covered with a floor and tables were set up where the field usually is.

The only hiccup Saturday occurred when the Endymion float had trouble negotiating a turn along its parade route on the way to the dome. The 330-foot float — the largest-ever for Mardi Gras — had to be separated and then re-attached to resume its journey.

The parade has 25 floats that roll through the dome, as revelers aboard them toss beads and trinkets to ball attendees gathered at tables and lower-level stadium seats.

Clarkson, the first winner of TV's "American Idol," was the parade's celebrity grand marshal. Her hits include "Because of You" and "Since You've Been Gone." She is one of several stars serving as celebrity riders in this year's Carnival parades.

On Sunday, actor G.W. Bailey of TNT's "Major Crimes" and the "Police Academy" movies is scheduled to reign as the king of the Bacchus parade.

On Monday, actor Gary Sinise and New Orleans musicians Troy "Trombone Shorty" Andrews and Harry Connick Jr. will ride in the Krewe of Orpheus parade with Emmy- and Golden Globe-winning actress Mariska Hargitay.

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Hazards of having an ex-wife as credit card joint owner

Dear Liz: My boyfriend is deployed. I have his power of attorney, and during his deployment I have paid off all of his credit card debt. The accounts now need to be closed because they are ones that were acquired with his former wife. I know you say that it will hurt his credit to close accounts, but I'd rather close them because they're tied to his ex.

Answer: If the former wife is a joint account holder on the cards, they should have been closed and the balances transferred to other credit cards in his name only before the divorce was final. The credit score dings from closing accounts and opening new ones pale compared with the potential damage a vengeful, or neglectful, former spouse could do with those cards. She could have run up big balances or tried to wrest control of the accounts and then failed to pay them, ruining his credit scores.

If your boyfriend has several other open credit cards, you could simply close these. If he doesn't, you might talk to the credit card companies about closing these cards and simultaneously opening new ones in his name only. This might be tricky to do while he's deployed, however, even with a power of attorney. Another option is to simply open a new card for him online before closing the others.

Rising rate for homeowner insurance

Dear Liz: My homeowners insurance just went up 25%. I've made no claims and made no changes. I want to get quotes from other providers, but I'm afraid I'm going to get some type of "teaser" rate. I tried changing companies a few years ago and the rate was good, but when it came time for the renewal, they doubled the price! Again, I made no changes nor had any claims. So, now I want to change, but I'm afraid of falling into the same trap. Any suggestions?

Answer: You can't assume you're locking in a low rate for life when you buy homeowners insurance. Companies that want to expand their market share may lower their prices awhile to lure customers away from their competitors, then raise premiums when their claims costs go up or they simply want to cut their risk.

The company's reputation for customer service should be at least as important a factor as price in your decision-making. Check the complaint surveys that many state insurance departments maintain on their websites to see which companies have the best (and worst) reputations.

One way to reduce your homeowner premium is to increase your deductible. Raising the amount you pay out of pocket from $250 to $1,000 can lower your premiums 25%. You should be paying small damages out of pocket anyway, since filing small claims can cause your rates to rise.

You also should shop around every few years, even if a company doesn't dramatically raise your rates, to make sure you're getting a decent deal. But again, chasing the lowest-cost insurance could be only a short-term win — an insurer that charges slightly more could be the more stable, and consumer-friendly, choice.

Remodel a home before selling?

Dear Liz: It has been almost one year since my domestic partner passed away, and our home of 43 years is fully paid for. I am ready to sell. The house is structurally in good shape but needs upgrades and a backyard redo. I have heard that painting both inside and out is a plus, but I'm concerned that any other improvements, such as flooring, would be my taste and not the buyer's. Is it a wise idea to indicate that any major improvements be deducted from escrow funds?

Answer: You're smart not to take on any major remodeling just before you sell, since few home improvements come anywhere close to paying for themselves. The fix-ups that typically do return more than they cost include painting, deep cleaning, trimming and freshening your landscaping, and de-cluttering. Consider storing half or more of your possessions. You'll have to pack them up anyway to move, and getting them out of the way now will make your house look bigger.

Talk to your real estate agent about the advisability of replacing your floors. If yours are quite worn, the investment may pay for itself. Otherwise, a cleaning may be enough. You don't have to offer to pay for the next owner's improvements. Just price the home appropriately to reflect the fact that it needs updates.

Questions may be sent to 3940 Laurel Canyon, No. 238, Studio City, CA 91604, or by using the "Contact" form at asklizweston.com. Distributed by No More Red Inc.

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A delicate new balancing act in senior healthcare

When Claire Gordon arrived at Cedars-Sinai Medical Center, nurses knew she needed extra attention.

She was 96, had heart disease and a history of falls. Now she had pneumonia and the flu. A team of Cedars specialists converged on her case to ensure that a bad situation did not turn worse and that she didn't end up with a lengthy, costly hospital stay.

Frail seniors like Gordon account for a disproportionate share of healthcare expenditures because they are frequently hospitalized and often land in intensive care units or are readmitted soon after being released. Now the federal health reform law is driving sweeping changes in how hospitals treat a rapidly growing number of elderly patients.

The U.S. population is aging quickly: People older than 65 are expected to make up nearly 20% of it by 2030. Linda P. Fried, dean of the Columbia University Mailman School of Public Health, said now is the time to train professionals and test efforts to improve care and lower healthcare costs for elderly patients.

"It's incredibly important that we prepare for being in a society where there are a lot of older people," she said. "We have to do this type of experiment right now."

At Cedars-Sinai, where more than half the patients in the medical and surgical wards are 65 or older, one such effort is dubbed the "frailty project." Within 24 hours, nurses assess elderly patients for their risk of complications such as falls, bed sores and delirium. Then a nurse, social worker, pharmacist and physician assess the most vulnerable patients and make an action plan to help them.

The Cedars project stands out nationally because medical professionals are working together to identify high-risk patients at the front end of their hospitalizations to prevent problems at the back end, said Herb Schultz, regional director of the U.S. Department of Health and Human Services.

"For seniors, it is better care, it is high-quality care and it is peace of mind," he said.

The effort and others like it also have the potential to reduce healthcare costs by cutting preventable medical errors and readmissions, Schultz said. The federal law penalizes hospitals for both.

Gordon, an articulate woman with brightly painted fingernails and a sense of humor, arrived at Cedars-Sinai by ambulance on a Monday.

Soon, nurse Jacquelyn Maxton was at her bedside asking a series of questions to check for problems with sleep, diet and confusion. The answers led to Gordon's designation as a frail patient. The next day, the project team huddled down the hall and addressed her risks one by one. Medical staff would treat the flu and pneumonia while at the same time addressing underlying health issues that could extend Gordon's stay and slow her recovery, both in the hospital and after going home.

To reduce the chance of falls, nurses placed a yellow band on her wrist that read "fall risk" and ensured that she didn't get up on her own. To prevent bed sores, they got her up and moving as often as possible. To cut down on confusion, they reminded Gordon frequently where she was and made sure she got uninterrupted sleep. Medical staff also stopped a few unnecessary medications that Gordon had been prescribed before her admission, including a heavy narcotic and a sleeping pill.

"It is really a holistic approach to the patient, not just to the disease that they are in here for," said Glenn D. Braunstein, the hospital's vice president for clinical innovation.

Previously, nurse Ivy Dimalanta said, she and her colleagues provided similar care but on a much more random basis. Under the project, the care has become standardized.

The healthcare system has not been well designed to address the needs of seniors who may have had a lifetime of health problems, said Mary Naylor, gerontology professor at the University of Pennsylvania School of Nursing. As a result, patients sometimes fall through the cracks and return to hospitals again and again.

"That is not good for them and that is not good for society to be using resources in that way," Naylor said.

Using data from related projects, Cedars began a pilot program in 2011 and expanded it last summer. The research is continuing but early results suggest that the interventions are leading to fewer seniors being admitted to the intensive care unit and to shorter hospital stays, said Jeff Borenstein, researcher and lead clinician on the frailty project. "It definitely seems to be going in the right direction," he said.

The hospital is now working with Naylor and the University of Pennsylvania to design a program to help the patients once they go home.

"People who are frail are very vulnerable when they leave the hospital," said Harriet Udin Aronow, a researcher at Cedars. "We want to promote them being safe at home and continuing to recover."

In Gordon's case, she lives alone with the help of her children and a caregiver. The hospital didn't want her experiencing complications that would lengthen the stay, but they also didn't want to discharge her before she was ready. Under the health reform law, hospitals face penalties if patients come back too soon after being released.

Patients and their families often are unaware of the additional attention. Sitting in a chair in front of a vase of pink flowers, Gordon said she knew she would have to do her part to get out of the hospital quickly. "You have to move," she said. "I know you get bed sores if you stay in bed."

Gordon said she was comfortable at the hospital but she wanted to go back to her house as quickly as she could. "There's no place like home," she said.

Two days later, that's where she was.

anna.gorman@latimes.com

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