Off the Charts: Globalization, as Measured by Investment, Takes a Step Backward

A FEW years ago, capital was flying around the globe faster than it ever had. The world economy became more tightly integrated and technology contributed to making it easier for banks and investors to deploy their money on the other side of the world if prospects looked more attractive there.

Then came the financial crisis, which, the McKinsey Global Institute noted in a report issued this week, “upended many of the world’s assumptions about the inevitability of growth and globalization.”

Last year, the report estimated, world capital flows were 13 percent below the levels of the previous year. And while they were higher than during the depths of the credit crisis, they are still 61 percent below the peak levels of 2007.

“Some of the shifts under way represent a healthy correction of the excesses of the bubble years,” the report stated, but there is a risk the reversal of globalization will be overdone.

“If we move to a system where the global financial system is more balkanized, that will raise the cost of capital for more borrowers and perhaps slow economic growth,” said Susan Lund, a principal of McKinsey Global Institute and the primary author of the report.

The accompanying charts show the institute’s estimates of global capital flows, which totaled $4.6 trillion in 2012, down from $11.8 trillion in 2007. Of the 2007 total, $10.2 trillion went to developed countries, and $1.6 trillion went to developing countries. Last year, capital flows were $3.1 trillion, a decline of 69 percent, for the developed countries, and $1.5 trillion, a decline of 10 percent, for the others.

The charts break out the flows into four types. The most stable is foreign direct investment, in which a company either builds a business or acquires at least 10 percent of an existing business. By far the least stable is loans, which are often short term and can be withdrawn on short notice, creating havoc. The others are bonds and equity, meaning stock market investments.

The Asian currency crisis of the late 1990s taught developing countries the potential hazards of loans that can be here today and gone tomorrow — a lesson that some European countries ignored to their regret. The institute calculated that in 2006 and 2007, the amount of capital flowing into Ireland was more than twice as large as the country’s gross domestic product. Moreover, most of that was in loans and bonds, debt instruments that in many cases could not be repaid.

International loans and bond issuances have particularly declined in Western Europe, where the euro crisis led many to withdraw funds and caused banks to concentrate on local markets. During four years in the middle of the last decade, more than $1 trillion in Western European bonds were purchased by foreigners each year. In each of the last two years, more bonds were sold back to the issuing country than were newly sold internationally.

For a number of years, China was the largest recipient of foreign direct investment, and that continues, with as estimated $260 billion flowing in last year. But it also sent $120 billion in such investment to other countries, about the same as Japan and more than was sent by any other country except the United States, according to the estimates.

Floyd Norris comments on finance and the economy at nytimes.com/economix.

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DNA science points to better treatment for acne

Ancient Egyptians were vexed by it, using sulfur to dry it out. Shakespeare wrote of its "bubukles, and whelks, and knobs, and flames o' fire."

Today, acne plagues us still. Doctors can cure some cancers and transplant vital organs like hearts, but they still have trouble getting rid of the pimples and splotches that plague 85% of us at some time in our lives — usually, when we're teenagers and particularly sensitive about they way we look.

But new research hints that there's hope for zapping zits in the future, thanks to advances in genetic research.

Using state-of-the-art DNA sequencing techniques to evaluate the bacteria lurking in the pores of 101 study volunteers' noses, scientists discovered a particular strain of Propionibacterium acnes bacteria that may be able to defend against other versions of P. acnes that pack a bigger breakout-causing punch.

As best as dermatologists can tell, zits occur when bacteria that reside in human skin, including P. acnes, feed on oils in the pores and prompt an immune response that results in red, sometimes pus-filled bumps. But the study subjects who had the newly discovered bacterial strain weren't suffering from whiteheads or blackheads, according to a report published Thursday in the Journal of Investigative Dermatology.

Someday, the realization that "not all P. acnes are created equal" might help dermatologists devise treatments that more precisely target bad strains while allowing beneficial ones to thrive, said Dr. Noah Craft, a dermatologist at the Los Angeles Biomedical Research Institute who conducted the study with colleagues from UCLA and Washington University in St. Louis.

Doctors might prescribe probiotic creams that deliver "good" P. acnes to the face the same way a daily serving of yogurt helps restore healthy bacteria in the digestive tract.

"There are healthy strains that we need on our skin," Craft said. "The idea that you'd use a nuclear bomb to kill everything — what we're currently doing with antibiotics and other treatments — just doesn't make sense."

The research is part of a broad effort backed by the National Institutes of Health to characterize the so-called human microbiome: the trillions of microbes that live in and on our bodies and evolve along with us, sometimes causing illness and often promoting good health.

Most of the microbiome attention so far has gone to studying species in the gut, said study leader Huiying Li, an assistant professor of molecular and medical pharmacology at UCLA's Geffen School of Medicine. But the NIH's Human Microbiome Project, which funds her research, also looks at microbial communities in the nasal passages, the mouth, the urogenital tract and the skin.

Li said she became interested in studying acne because the skin microbiome seemed particularly understudied.

The research team recruited 101 patients in their teens and 20s from dermatology clinics in Southern California. Among them, 49 had acne and 52 had "normal skin" and were not experiencing breakouts but had come to the clinics for other problems.

Doctors used adhesive pore strips to remove skin bacteria from patients' noses. The researchers then collected the waxy plugs — a combination of bacteria, oils, dead skin cells and other stuff — and used DNA to figure out which bacteria were present.

They found that the P. acnes species accounted for about 90% of the bacteria in pores, in both healthy patients and acne sufferers. Digging a little deeper into the DNA, they found that two particular strains appeared in about 20% of acne sufferers, while a third strain was found only in acne-free patients.

"Dogs are dogs, but a Chihuahua isn't a Great Dane," Craft said. "People with acne had pit bulls on their skin. Healthy people had poodles."

The team then sequenced the complete genomes — about 2.6 million base pairs apiece — of 66 of the P. acnes specimens to explore in more depth how the good and bad strains differed.

The two notable bad strains had genes, probably picked up from other bacteria or viruses, that are thought to change the shape of a microbe to make it more virulent. The researchers hypothesized that the foreign DNA, perhaps by sticking more effectively to human host tissues, may help trigger an inflammatory response in the skin: acne.

The good strain, on the other hand, contained an element known to work like an immune system in bacteria, Li said. Perhaps it allows this P. acne to fight off intruders and prevent pimples from forming.

Li said the researchers did not know why some people had the bad P. acnes strains and others did not, and whether genetics or environment played a bigger role.

Dr. Vincent Young, who conducts microbiome research at the University of Michigan Medical School but wasn't involved in the acne project, said advances in sequencing technology and analysis made the new study possible. In the past, he said, scientists wouldn't have tried to sequence dozens of genomes in a single species.

"They'd say, why waste the money?" he said. "Now you can do this in a couple of days."

Li and Craft — neither of whom suffered bad acne as teens — plan to keep up the work.

More research is needed to come up with super-targeted anti-microbial therapies, or to develop a probiotic cream for acne sufferers.

Craft continues collecting samples from patients' pores. He hopes to study whether twins share the same microbial profiles, how acne severity is reflected in bacteria populations, and how things change in a single patient over the course of a treatment regimen.

One of the study volunteers, 19-year-old UC Santa Cruz student Brandon Pritzker, said he would have loved to have treated his acne without affecting the rest of his body. When he took Accutane, he suffered back pain and mood shifts.

Now off the drug, Pritzker said he is at peace with his pimples. "I still have breakouts, but I figure I'm 19, that's the way it's going to be," he said.

But, he added, "it hindered my confidence at the time. Kids with clear skin are probably a little happier."

eryn.brown@latimes.com

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Rodent Mind Meld: Scientists Wire Two Rats' Brains Together

It’s not exactly a Vulcan mind meld, but it’s not far off. Scientists have wired the brains of two rats together and shown that signals from one rat’s brain can help the second rat solve a problem it would otherwise have no clue how to solve.

The rats were in different cages with no way to communicate other than through the electrodes implanted in their brains. The transfer of information from brain to brain even worked with two rats separated by thousands of kilometers, one in a lab in North Carolina and another in a lab in Brazil.

“We basically created a computational unit out of two brains,” says neuroscientist Miguel Nicolelis of Duke University, who led the study.

Nicolelis is a leading figure in brain-machine interface research and the man behind a bold plan to develop a brain-controlled exoskeleton that would allow a paralyzed person to walk onto the field and kick a soccer ball at the opening ceremony of next year’s World Cup in Brazil.

He says the new findings could point the way to future therapies aimed at restoring movement or language after a stroke or other brain injury by using signals from a healthy part of the brian to retrain the injured area. Other researchers say it’s an interesting idea, but it’s a long way off.

But Nicolelis’s group is known for pushing the envelope. Previously, they have given monkeys an artificial sense of touch they can use to distinguish the “texture” of virtual objects. More recently, they gave rats the ability to detect normally invisible infrared light by wiring an infrared detector to a part of the brain that processes touch. All this work, Nicolelis says, is relevant to developing neural prostheses to restore sensory feedback to people with brain injuries.

In the new study, the researchers implanted small electrode arrays in two regions of the rats’ brains, one involved in planning movements, and one involved in the sense of touch.

Then they trained several rats to poke their noses and whiskers through a small opening in the wall of their enclosure to determine its width. The scientists randomly changed the width of the opening to be either narrow or wide for each trial, and the rats had to learn to touch one of two spots depending on its width. They touched a spot to the right of the opening when it was wide and the spot on the left when it was narrow. When they got it correct, they received a drink. Eventually they got it right 95 percent of the time.

Next, the team wanted to see if signals from the brain of a rat trained to do this task could help another rat in a different cage choose the correct spot to poke with its nose — even if it had no other information to go on.

They tested this idea with another group of rats that hadn’t learned the task. In this experiment, one of these new rats sat in an enclosure with two potential spots to receive a reward but without an opening in the wall. On their own, they could only guess which of the two spots would produce a rewarding drink. As expected, they got it right 50 percent of the time.

Then the researchers recorded signals from one of the trained rats as it did the nose-poke task and used those signals to stimulate the second, untrained rat’s brain in a similar pattern. When it received this stimulation, the second rat’s performance climbed to 60 or 70 percent. That’s not nearly as good as the rats who could actually use their sense of touch to solve the problem, but it’s impressive given that the only information they had about which spot to chose came from another animal’s brain, Nicolelis says.

Both rats had to make the correct choice, otherwise neither one got a reward. When that happened, the first rat tended to make its decision more quickly on the next trial, and its brain activity seemed to send a clearer signal to the second rat, the team reports today in Scientific Reports. That suggests to Nicolelis that the rats were learning to cooperate.

The brain-to-brain communication link enables the rats to collaborate in a novel way, he says. ”The animals compute by mutual experience,” he said. ”It’s a computer that evolves, that’s not set by instructions or an algorithm.”

From an engineering perspective, the work is a remarkable demonstration that animals can use brain-to-brain communication to solve a problem, said Mitra Hartmann, a biomedical engineer who studies rats’ sense of touch at Northwestern University. “This is a first, to my knowledge, although the enabling technology has been around for a while.”

“From a scientific point of view, the study is noteworthy for the large number of important questions it raises, for example, what allows neurons to be so ‘plastic’ that the animal can learn to interpret the meaning of a particular stimulation pattern,” Hartmann said.

“It’s a pretty cool idea that they’re in tune with each other and working together,” said neuroscientist Bijan Pesaran of New York University. But Pesaran says he could use some more convincing that this is what’s actually going on. For example, he’d like to see the researchers extend the experiment to see if the rats on the receiving end of the brain-to-brain communication link could improve their performance even more. ”If you could see them learning to do it better and faster, then I’d really be impressed.”

Pesaran says he’s open to the idea that brain-to-brain communication could one day be used to rehabilitate brain injury patients, but he thinks it might be possible to accomplish the same thing by stimulating the injured brain with computer-generated patterns of activity. ”I don’t get why you’d need another brain to do that,” he said.

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Cellar victim Kampusch raped, starved in film of ordeal

VIENNA (Reuters) – A new film based on the story of Austrian kidnap victim Natascha Kampusch shows her being repeatedly raped by the captor who beat and starved her during the eight-and-a-half years that he kept her in a cellar beneath his house.

Kampusch was snatched on her way to school at the age of 10 by Wolfgang Priklopil and held in a windowless cell under his garage near Vienna until she escaped in 2006, causing a sensation in Austria and abroad. Priklopil committed suicide.

Kampusch had always refused to respond to claims that she had had sex with Priklopil, but in a German television interview on her 25th birthday last week said she had decided to reveal the truth because it had leaked out from police files.

The film, “3,096 Days” – based on Kampusch’s autobiography of the same name – soberly portrays her captivity in a windowless cellar less than 6 square metres (65 square feet) in area, often deprived of food for days at a time.

The emaciated Kampusch – who weighed just 38 kg (84 pounds) at one point in 2004 – keeps a diary written on toilet paper concealed in a box.

One entry reads: “At least 60 blows in the face. Ten to 15 nausea-inducing fist blows to the head. One strike with the fist with full weight to my right ear.”

The movie shows occasional moments that approach tenderness, such as when Priklopil presents her with a cake for her 18th birthday or buys her a dress as a gift – but then immediately goes on to chide her for not knowing how to waltz with him.

GREY AREAS

Antonia Campbell-Hughes, who plays the teenaged Kampusch, said she had tried to portray “the strength of someone’s soul, the ability of people to survive… but also the grey areas within a relationship that people don’t necessarily understand.”

The British actress said she had not met Kampusch during the making of the film or since. “It was a very isolated time, it was a bubble of time, and I wanted to keep that very focused,” she told journalists as she arrived for the Vienna premiere.

Kampusch herself attended the premiere, looking composed as she posed for pictures but declining to give interviews.

In an interview with Germany’s Bild Zeitung last week, she said: “Yes, I did recognize myself, although the reality was even worse. But one can’t really show that in the cinema, since it wasn’t supposed to be a horror film.”

The movie, made at the Constantin Film studios in Bavaria, Germany, also stars Amy Pidgeon as the 10-year-old Kampusch and Danish actor Thure Lindhardt as Priklopil.

“I focused mainly on playing the human being because… we have to remember it was a human being. Monsters do not exist, they’re only in cartoons,” Lindhart said.

“It became clear to me that it’s a story about survival, and it’s a story about surviving eight years of hell. If that story can be told then I can also play the bad guy.”

The director was German-American Sherry Hormann, who made her English-language debut with the 2009 move “Desert Flower”, an adaptation of the autobiography of Somali-born model and anti-female circumcision activist Waris Dirie.

“I’m a mother and I wonder at the strength of this child, and it was important for me to tell this story from a different perspective, to tell how this child using her own strength could survive this atrocious martyrdom,” Hormann said.

The Kampusch case was followed two years later by that of Josef Fritzl, an Austrian who held his daughter captive in a cellar for 24 years and fathered seven children with her.

The crimes prompted soul-searching about the Austrian psyche, and questions as to how the authorities and neighbors could have let such crimes go undetected for so long.

The film goes on general release on Thursday.

(Reporting by Georgina Prodhan, Editing by Paul Casciato)

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The New Old Age Blog: For the Elderly, Lists of Tests to Avoid

The Choosing Wisely campaign, an initiative by the American Board of Internal Medicine Foundation in partnership with Consumer Reports, kicked off last spring. It is an attempt to alert both doctors and patients to problematic and commonly overused medical tests, procedures and treatments.

It took an elegantly simple approach: By working through professional organizations representing medical specialties, Choosing Wisely asked doctors to identify “Five Things Physicians and Patients Should Question.”

The idea was that doctors and their patients could agree on tests and treatments that are supported by evidence, that don’t duplicate what others do, that are “truly necessary” and “free from harm” — and avoid the rest.

Among the 18 new lists released last week are recommendations from geriatricians and palliative care specialists, which may be of particular interest to New Old Age readers. I’ve previously written about a number of these warnings, but it’s helpful to have them in single, strongly worded documents.

The winners — or perhaps, losers?

Both the American Geriatrics Society and the American Academy of Hospice and Palliative Medicine agreed on one major “don’t.” Topping both lists was an admonition against feeding tubes for people with advanced dementia.

“This is not news; the data’s been out for at least 15 years,” said Sei Lee, a geriatrician at the University of California, San Francisco, and a member of the working group that narrowed more than 100 recommendations down to five. Feeding tubes don’t prevent aspiration pneumonia or prolong dementia patients’ lives, the research shows, but they do exacerbate bedsores and cause such distress that people often try to pull them out and wind up in restraints. The doctors recommended hand-feeding dementia patients instead.

The geriatricians’ list goes on to warn against the routine prescribing of antipsychotic medications for dementia patients who become aggressive or disruptive. Though drugs like Haldol, Risperdal and Zyprexa remain widely used, “all of these have been shown to increase the risk of stroke and cardiovascular death,” Dr. Lee said. They should be last resorts, after behavioral interventions.

The other questionable tests and treatments:

No. 3: Prescribing medications to achieve “tight glycemic control” (defined as below 7.5 on the A1c test) in elderly diabetics, who need to control their blood sugar, but not as strictly as younger patients.

No. 4: Turning to sleeping pills as the first choice for older people who suffer from agitation, delirium or insomnia. Xanax, Ativan, Valium, Ambien, Lunesta — “they don’t magically disappear from your body when you wake up in the morning,” Dr. Lee said. They continue to slow reaction times, resulting in falls and auto accidents. Other sleep therapies are preferable.

No. 5: Prescribing antibiotics when tests indicate a urinary tract infection, but the patient has no discomfort or other symptoms. Many older people have bacteria in their bladders but don’t suffer ill effects; repeated use of antibiotics just causes drug resistance, leaving them vulnerable to more dangerous infections. “Treat the patient, not the lab test,” Dr. Lee said.

The palliative care doctors’ Five Things list cautions against delaying palliative care, which can relieve pain and control symptoms even as patients pursue treatments for their diseases.

It also urges discussion about deactivating implantable cardioverter-defibrillators, or ICDs, in patients with irreversible diseases. “Being shocked is like being kicked in the chest by a mule,” said Eric Widera, a palliative care specialist at the San Francisco V.A. Medical Center who served on the American Academy of Hospice and Palliative Medicine working group. “As someone gets close to the end of life, these ICDs can’t prolong life and they cause a lot of pain.”

Turning the devices off — an option many patients don’t realize they have — requires simple computer reprogramming or a magnet, not the surgery that installed them in the first place.

The palliative care doctors also pointed out that patients suffering pain as cancer spreads to their bones get as much relief, the evidence shows, from a single dose of radiation than from 10 daily doses that require travel to hospitals or treatment centers.

Finally, their list warned that topical gels widely used by hospice staffs to control nausea do not work because they aren’t absorbed through the skin. “We have lots of other ways to give anti-nausea drugs,” Dr. Widera said.

You can read all the Five Things lists (more are coming later this year), and the Consumer Reports publications that do a good job of translating them, on the Choosing Wisely Web site.

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

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DealBook: As Losses Mount, R.B.S. Unveils Plan to Sell Assets

LONDON – The Royal Bank of Scotland, hammered by losses, announced plans on Thursday to sell assets and pare back its investment banking business, in an effort to appease regulators and its biggest shareholder, the British government.

R.B.S. said it planned to sell a stake in the Citizens Financial Group, the American lender it bought in 1988, through an initial public offering in two years. The bank will also continue to reduce its investment banking operations, with plans to cut risky assets and eliminate jobs.

The moves are designed to help bolster the bank’s capital levels and refocus its operations, part of a multiyear turnaround effort initiated by its chief executive, Stephen Hester. In the end, R.B.S. will emerge a much smaller bank, largely focused on Britain.

“R.B.S. is four years into its recovery plan,” Mr. Hester said in a statement, “and good progress has been made. We are a much smaller, more focused and stronger bank. Our target is for 2013 to be the last big year of restructuring.”

Like many rivals, R.B.S. is struggling with the legacy of the financial crisis and a spate of legal issues. On Thursday, it reported a bigger-than-expected loss, in part tied to its legal troubles.

The bank, in which the British government holds an 82 percent stake after a bailout in 2008, posted a net loss of £5.97 billion ($9 billion) in 2012, much larger than the £2 billion loss recorded in 2011. Analysts had been expecting a loss of £5.1 billion. For the last quarter of 2012, R.B.S. reported a £2.6 billion loss, up from a £1.8 billion loss in the period a year earlier.

The rising losses reflect the bank’s regulatory and legal problems.

R.B.S. said on Thursday that it had set aside an additional £1.1 billion to compensate clients to which it improperly sold insurance products, bringing the total provision to £2.2 billion. It also estimated it would have to pay £700 million to compensate small businesses to which it improperly sold some interest-rate hedging products.

The bank agreed this year to pay $612 million to British and American authorities to settle accusations of rate-rigging. Since then, Mr. Hester has promised to tighten controls at the bank to limit the risk of future rate manipulation.

The head of R.B.S.’s investment banking division, John Hourican, resigned at the beginning of February as a result of the scandal related to manipulating the London interbank offered rate, or Libor. The bank plans to pay its fine with money clawed back from bonuses.

‘‘Along with the rest of the banking industry we faced significant reputational challenges,’’ Mr. Hester said in the statement. ‘‘We are determined to overcome the cultural and reputational baggage of precrisis times with the same focus we have applied to the financial cleanup from that era.’’

Eager to get back some of the £45.5 billion it invested in R.B.S., the British government recently increased pressure on the bank’s management to speed up the reorganization.

Some analysts said the government could start selling parts of its investment in the bank, even at a loss, before the next general election, which is set for 2015. R.B.S.’s shares are still trading at about half what the government paid for them in 2008. Some lawmakers said they would favor handing out shares to the public instead of a possible sale of the stake on the open market.

Richard Hunter, head of equities at Hargreaves Lansdown Stockbrokers, said there were signs that Mr. Hester’s efforts to turn around the bank had started to pay off, but that “the ongoing absence of a dividend and overhang of the government stake are negatives which need to be resolved.”

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Race for L.A. city controller heats up

A previously low-profile race for Los Angeles city controller has begun to heat up as opponents of City Councilman Dennis Zine accuse him of "double dipping" the city's payroll and question why he is considering lucrative tax breaks for a Warner Center developer.

Zine, who for 12 years has represented a district in the southeast San Fernando Valley, is the better known of the major candidates competing to replace outgoing Controller Wendy Greuel.

The others are Cary Brazeman, a marketing executive, and lawyer Ron Galperin. Zine has raised $766,000 for his campaign, more than double that of Galperin, the next-highest fundraiser, and has the backing of several of the city's powerful labor unions.

He also has been endorsed by Mayor Antonio Villaraigosa and several of his council colleagues. Galperin is backed by the Service Employees International Union, one the city's largest labor groups, and Brazeman is supported by retired Rep. Diane Watson and several neighborhood council representatives.

With the primary ballot less than a week away, Brazeman and Galperin have turned up the heat on Zine, hoping to push the race beyond the March 5 vote. If no one wins more than 50% of the ballots cast, the top two vote-getters will face a runoff in the May general election.

In a recent debate, Zine's opponents criticized him for receiving a $100,000 annual pension for his 33 years with the Los Angeles Police Department and a nearly $180,000 council salary. Brazeman and Galperin called it an example of "double dipping" that should be eliminated.

That brought a forceful response from Zine, who shot back that he gives a big portion of his police pension check to charities.

"I am so tired of hearing 'double dipping,' " he said. "I worked 33 years on the streets of Los Angeles. I have given over $300,000 to nonprofits that need it.... That's what's happened with that pension."

In the same debate, Brazeman accused Zine of cozying up to a Warner Center developer by pushing for tax breaks on a project that already has been approved. The nearly 30-acre Village at Westfield Topanga project would add 1 million square feet of new shops, restaurants, office space and a hotel to a faded commercial district on Topanga Canyon Boulevard.

"The councilman proposed to give developers at Warner Center tens of millions of dollars in tax breaks even though it's a highly successful project," he said. "He wants to give it away."

City records show that less than a month after the development was approved in February 2012, Zine asked the council for a study looking at possible "economic development incentives" that could be given to Westfield in return for speeding up street and landscaping enhancements to the project's exterior.

The motion's language notes that similar tax breaks have been awarded to large projects in the Hollywood and downtown areas, and that "similar public investment in the Valley has been lacking." Westfield is paying for the $200,000 study.

Zine defended his decision before the debate audience, saying if the study finds that the city will not benefit, no tax breaks will be awarded. "If there's nothing there, then they get nothing," Zine said.

The controller serves as a public watchdog over the city's $7.3-billion annual operation, auditing the general fund, 500 special fund accounts and the performance of city departments. Those audits often produce recommendations for reducing waste, fraud and abuse.

But the mayor and the council are not obligated to adopt those recommendations, and as a result the job is part accountant, part scolder in chief. All the candidates say they will use their elective position not only to perform audits but also to turn them into action.

Their challenge during the campaign has been explaining how they will do that.

Zine, 65, says his City Hall experience has taught him how to get things done by working with his colleagues. He won't be afraid to publicly criticize department managers, he said, but thinks collaboration works better than being combative.

"You can rant and rave and people won't work with you," he said. "Or you can sit down and talk it out, and you can accomplish things."

Galperin, 49, considers himself a policy wonk who relishes digging into the details to come up with ways to become more efficient with limited dollars and to find ways to raise revenue using the city's sprawling assets. For instance, the city owns two asphalt plants that could expand production and sell some of its material to raise money to fix potholes, he said.

He's served on two city commissions, including one that found millions of dollars in savings by detailing ways to be more efficient. Zine is positioning himself as a "tough guy for tough times," but the controller should be more than that, Galperin said.

"What we really need is some thoughtfulness and some smarts and some effectiveness," he said. "Just getting up there and saying we need to be tough is not going to accomplish what needs to be done."

Brazeman, 46, started his own marketing and public relations firm in West Los Angeles a decade ago and became active in city politics over his discontent with a development project near his home. He has pushed the council to change several initiatives over the last five years, including changes to the financing of the Farmers Field stadium proposal that will save taxpayer dollars, he said.

As controller, he would pick and choose his battles, and, Brazeman said, be "the right combination of constructive, abrasive and assertive."

catherine.saillant@latimes.com

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Doctors Supercharge Their iPads With Box.net

Doctors love their iPads — even more than you might think.

Over in Winston-Salem, North Carolina, a group of more than 60 doctors have revamped their mobile phones and iPads for use in emergency departments across the region with a little help from a familiar application: the popular Box.net file-sharing services. Using Box, they’ve built a new system that lets them share procedures, journal articles and — perhaps most importantly — conversations.

It’s a small step, but doctors like Iltifat Husain at the Wake Forest Baptist Medical Center love the thing.

Husain is a big advocate of mobile devices. He edits a website for iPad-loving doctors called iMedicalApps.com. But the collaborative cloud computing thing really clicked for Husain — an emergency medicine resident physician at Wake Forest — when he was still testing the service back in October. He was at a remote emergency room in Greensboro, North Carolina, where a patient came in with fluid on the belly. Husain needed to perform a procedure called an abdominal paracentesis to drain the fluid. It’s not the kind of procedure that most doctors do every day, so Husain gave himself a quick refresher on the procedure.

A year earlier, this would have meant trudging over to the ER’s workstation and looking up a PDF on the hospital’s intranet. Instead, he tapped open the Box software on his mobile phone and looked it up right there.

It saved maybe a handful of minutes. But for Husain, minutes count. “In the ER, the faster I can do something, the more time I can spend with other patients,” he says.

Doctors may be the people who change our lives most profoundly with cutting-edge science and drugs, but the sad truth is that medicine is only just starting to enter the digital era, says Eric J.Topol, director of the Scripps Translational Science Institute and the author of, Creative Destruction of Medicine, a 2012 book about how digital technology is changing health care. “Medicine is ultra-conservative, historically.”

But it’s also an area that’s most primed for change. As the digital walls go down, doctors are becoming better about sharing information with their patients, and with other doctors.

Last year, a startup called Doximity launched a kind of social network for doctors — letting them share information, ask each other questions, and even provide referrals. It now has more than 100,000 doctors.

At Wake Forest, the Box set-up isn’t a full-fledged social network. It’s a document sharing workhorse. And with hundreds of journal articles and procedures — all uploaded, available via mobile phone and set up for comments — the system has in just a few short months become an important tool for the doctors who use it.

More than that, it’s also a great learning tool for residents, says James O’Neill, an M.D. and assistant professor with the hospital’s department of emergency medicine.

Online discussions have replaced the residents monthly “Journal Club” meetings, where doctors meet do discuss the latest medical research. The system gives them an easy-to-use discussion platform where doctors and residents can debate what works and what does not work, direct from the emergency department. “When the residents find something that works for them, they can get it up there,” O’Neill says.

“We’ve been able to create this community in the cloud among residents,” says Husain. “You can literally have free flowing comments using Box, which really has the potential to change the way medical education is done.”

Topol says that this kind of social document sharing is only the beginning of a bigger shift that he’d like to see as the medical profession takes a cue from everyone else on the Internet and becomes better about collaborating and sharing information. “It’s a nice baby step, but it’s not a giant thing in the way that medicine is going to be shifting,” he says.

“We just have to take the walls down and we haven’t even started to do that yet.”

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Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative. M.R.I. helped pay for previous vaccination campaigns in the country and the GAVI Alliance is helping financing the upcoming one.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

This article has been revised to reflect the following correction:

Correction: February 27, 2013

An earlier version of this article misstated the source of the financing for the upcoming vaccination campaign in Rwanda. It is being financed by the GAVI Alliance, not the Measles and Rubella Initiative.

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Little Movement on Wall Street

Wall Street stocks opened little changed on Wednesday as investors awaited a second round of testimony in Congress by the Federal Reserve chairman, Ben S. Bernanke, for clarity on the longevity of the Fed’s economic stimulus program.

The Standard & Poor’s 500-stock index added 0.2 percent, the Dow Jones industrial average rose 0.2 percent and the Nasdaq composite index was flat in morning trading.

“Of course, Bernanke is in the spotlight again but I don’t expect him to vary from his comments from yesterday,” said Peter Cardillo, chief market economist at Rockwell Global Capital in New York.

A day earlier, Mr. Bernanke strongly defended the Fed’s monetary stimulus efforts before Congress, easing financial market worries over an early retreat from the Fed’s bond buying program, which had been triggered by minutes of the Fed’s January meeting released a week ago.

His remarks, along with data showing sales of new homes hit a four and a half year high, helped Wall Street stocks rebound Tuesday from their worst decline since November.

Despite the bounce, the benchmark S.&P. 500 was unable to move back above 1,500, a closely watched level that may prove to be a resistance point.

Up 6 percent for the year, the S.&P. 500 was within reach of record highs a week ago, before the minutes from the Fed’s January meeting were released. Since then, the index has shed 1 percent.

In earnings news, Target posted a lower quarterly profit as sales of food and value-priced items only partially mitigated weakness in holiday spending. The stock fell 1.7 percent.

Dollar Tree reported a higher quarterly profit as the chain controlled costs and as consumer spending improved. The stock rose 4.5 percent.

In Europe, shares rose, steadying after the previous session’s sharp losses, though jitters over the euro zone kept a lid on gains.

Italy’s 10-year debt costs rose more than half a percentage point at the first longer-term auction since an inconclusive parliamentary election, although they remained below the psychologically important level of 5 percent.

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