Decision on gay conversion ban depends on other rulings

The fate of a new California law that would prohibit doctors and therapists from trying to change a minor's sexual orientation depends in part on rulings in other cases in which the government tried to restrict physicians' communications with their patients.

Will the law be viewed as similar to a federal policy that prevented doctors from recommending marijuana to their patients? If so, the law perishes. Or is California's ban on so-called conversion therapy akin to a regulation upheld by the Supreme Court that required doctors to tell patients about the possibly detrimental effects of abortion?

The dispute is before the U.S. 9th Circuit Court of Appeals, which is expected to decide within the next several days whether to put the law on hold before it takes effect Jan. 1. A ruling could take months.

The ban on trying to change a minor's sexual orientation, the first of its kind in the nation, has divided the lower courts. A federal judge in Sacramento appointed by President Obama found that the law did not violate free speech rights; her colleague, appointed by the first President Bush, concluded that it did.

Legal scholars also have conflicting assessments of whether the law will be overturned on 1st Amendment grounds.

UC Berkeley constitutional law scholar Jesse Choper said the law faces "a steep uphill battle" on free speech grounds.

"It is very hard to silence speech generally," Choper said.

But UC Irvine Law School Dean Erwin Chemerinsky said the law was constitutional because it banned an ineffective and harmful therapy.

Communications between professionals and their clients generally have less 1st Amendment protection than other forms of speech. A lawyer or doctor who negligently gives bad advice may be found liable for malpractice, and licensing requirements for professionals may be restrictive.

"The fact that it is speech doesn't immunize it from liability or punishment," Chemerinsky said.

California's law subjects doctors and therapists to discipline by their licensing boards for practicing the therapy known as "sexual orientation change efforts," or conversion therapy.

Treatments include psychoanalysis, behavioral therapy and religious and spiritual counseling. In the past, some licensed therapists have practiced aversion therapy, using nausea-inducing drugs to combat sexual impulses, and hormone treatments.

Therapists seeking to change a patient's orientation also have encouraged men to spend more time with heterosexuals, participate in sports and avoid members of the opposite sex, except for romantic contact.

One of the plaintiffs in the lawsuit now before the 9th Circuit is a 15-year-old boy who has been undergoing the therapy for 15 months.

Mathew Staver, the lead lawyer in that lawsuit, said the boy is receiving standard cognitive behavioral therapy. Shock treatment and aversion techniques are no longer used, he said.

"According to what I know, he has stopped experiencing same-sex attraction," said Staver, founder of Liberty Counsel, a nonprofit group that advocates for conservative Christian views.

Psychological efforts to change sexual orientation were once grounded in a 1952 classification of homosexuality as a mental disease in the Diagnostic and Statistical Manual of Mental Disorders.

But that classification was removed in 1973, and most psychological associations now recommend against the therapy, calling it ineffective and potentially harmful. A task force report by the American Psychological Assn. in 2009 said conversion therapy could trigger depression, suicide and substance abuse.

"Same-sex sexual attractions, behavior, and orientations per se are normal and positive variants of human sexuality — in other words, they do not indicate either mental or developmental disorders," the report said.

It said that there was no study demonstrating that therapy affected sexual orientation of children and teenagers, and that the prospect of effecting an enduring change in a person's sexual orientation was "unlikely."

But the report also said research on the therapy was too sketchy to draw conclusions about safety and efficacy and noted that some people said they had benefited from the counseling.

Initially, the bill that created the law was opposed by the California Psychological Assn., California Assn. for Licensed Professional Clinic Counselors, California Psychiatric Assn. and California Assn. of Marriage and Family Therapists. After the bill was amended, the associations of psychologists and family therapists supported the bill and the others withdrew their opposition. Organizations with religious viewpoints continued to oppose it.

In one of two lawsuits filed to block the law, a group of therapists, minors and parents said the ban prevented even the mention of possible therapy to change an undesired sexual orientation. The state countered that the law banned only a therapy, not the discussion of ways to change sexual orientation or the ability to refer patients to out-of-state therapists who practice the methods.

U.S. District Judge Kimberly J. Mueller, ruling for the state, said the law prohibits a form of conduct — therapy that uses pain or discomfort to combat sexual arousal and efforts to alter thought patterns, including hypnosis.

"Plaintiffs in this case do not have a fundamental right to receive a therapy that California has deemed harmful and ineffective," Mueller wrote.

But in a similar lawsuit brought by two therapists and a man who underwent conversion therapy, U.S. District Judge William B. Shubb blocked the state from enforcing the law on the three plaintiffs.

"Protecting an individual's First Amendment rights outweighs the public's interest in rushing to enforce an unprecedented law," Shubb wrote.

maura.dolan@latimes.com

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Microsoft, Motorola file to keep patent case details private

SEATTLE (Reuters) – Microsoft Corp and Google Inc‘s Motorola Mobility unit have requested a federal judge in Seattle to keep secret from the public various details from their recent trial concerning the value of technology patents and the two companies’ attempts at a settlement.

Microsoft and Motorola, acquired by Google earlier this year, are preparing post-trial briefs to present to a judge as he decides the outcome of a week-long trial last month to establish what rates Microsoft should pay Motorola for use of standard, essential wireless technology used in its Xbox game console and other products.

The case is just one strand of litigation in an industry-wide dispute over ownership of the underlying technology and the design of smartphones, which has drawn in Apple Inc, Samsung Electronics Co Ltd, Nokia and others.

In a filing with the Western District of Washington federal court in Seattle on Friday, Microsoft and Motorola asked the judge to allow them to file certain parts of their post-trial submissions under seal and redact those details in the public record.

The details concern terms of Motorola‘s licenses with third parties and Microsoft‘s business and marketing plans for future products. During the trial, which ran from November 13-20, U.S. District Judge James Robart cleared the court when such sensitive or trade secret details were discussed.

“For the same compelling reasons that the court sealed this evidence for purposes of trial, it would be consistent and appropriate to take the same approach in connection with the parties’ post-trial submissions,” the two companies argued in the court filing.

The judge has so far been understanding of the companies’ desire to keep private details of their patent royalties and future plans, although that has perplexed some spectators who believe trials in public courts should be fully open to the public.

In addition, Motorola asked the judge to seal some documents relating to settlement negotiations between the two companies, arguing that keeping those details secret would encourage openness in future talks and make a settlement more likely.

Judge Robart is not expected to rule on the case until the new year.

The case in U.S. District Court, Western District of Washington is Microsoft Corp. vs. Motorola Inc., 10-cv-1823.

(Reporting by Bill Rigby; Editing by Richard Chang)

Tech News Headlines – Yahoo! News

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Gunman's Father and Brother Are 'in Shock,' Says a Source

By Diane Herbst

12/14/2012 at 08:50 PM EST

State police personnel lead children to safety away from the Sandy Hook Elementary School

Shannon Hicks/Newtown Bee/Reuters/Landov

The father and older brother of the gunman who was blamed for the Connecticut school shooting are being questioned by authorities but are not suspects, a law enforcement source tells PEOPLE.

The Associated Press reports that the gunman has been identified as 20-year-old Adam Lanza.

His unidentified father, who lives in New York City, and his older brother, Ryan, 24, of Hoboken, N.J., are "in shock," the law enforcement source tells PEOPLE.

They were being questioned by the FBI in the Hoboken police station but "are not suspects, they have no involvement," the source says.

"Imagine the 24 year old – he's lost his mother. Imagine the father, his son killed 20 kids," the source says."   

As for Adam, "It looks like there's mental history there," the law enforcement source says.

Adam Lanza died at the scene of the shooting that killed 20 children and six adults at the Sandy Hook Elementary School in Newtown, Conn.

His mother, Nancy Lanza, was found dead at her home, according to CNN.

The source describes the weapons used by Lanza as "legitimate." According to CNN, Lanza used two hand guns that were registered to his mother and a rifle.

Adam's parents were no longer together, the source says.   

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Fewer health care options for illegal immigrants

ALAMO, Texas (AP) — For years, Sonia Limas would drag her daughters to the emergency room whenever they fell sick. As an illegal immigrant, she had no health insurance, and the only place she knew to seek treatment was the hospital — the most expensive setting for those covering the cost.

The family's options improved somewhat a decade ago with the expansion of community health clinics, which offered free or low-cost care with help from the federal government. But President Barack Obama's health care overhaul threatens to roll back some of those services if clinics and hospitals are overwhelmed with newly insured patients and can't afford to care for as many poor families.

To be clear, Obama's law was never intended to help Limas and an estimated 11 million illegal immigrants like her. Instead, it envisions that 32 million uninsured Americans will get access to coverage by 2019. Because that should mean fewer uninsured patients showing up at hospitals, the Obama program slashed the federal reimbursement for uncompensated care.

But in states with large illegal immigrant populations, the math may not work, especially if lawmakers don't expand Medicaid, the joint state-federal health program for the poor and disabled.

When the reform has been fully implemented, illegal immigrants will make up the nation's second-largest population of uninsured, or about 25 percent. The only larger group will be people who qualify for insurance but fail to enroll, according to a 2012 study by the Washington-based Urban Institute.

And since about two-thirds of illegal immigrants live in just eight states, those areas will have a disproportionate share of the uninsured to care for.

In communities "where the number of undocumented immigrants is greatest, the strain has reached the breaking point," Rich Umbdenstock, president of the American Hospital Association, wrote last year in a letter to Obama, asking him to keep in mind the uncompensated care hospitals gave to that group. "In response, many hospitals have had to curtail services, delay implementing services, or close beds."

The federal government has offered to expand Medicaid, but states must decide whether to take the deal. And in some of those eight states — including Texas, Florida and New Jersey — hospitals are scrambling to determine whether they will still have enough money to treat the remaining uninsured.

Without a Medicaid expansion, the influx of new patients and the looming cuts in federal funding could inflict "a double whammy" in Texas, said David Lopez, CEO of the Harris Health System in Houston, which spends 10 to 15 percent of its $1.2 billion annual budget to care for illegal immigrants.

Realistically, taxpayers are already paying for some of the treatment provided to illegal immigrants because hospitals are required by law to stabilize and treat any patients that arrive in an emergency room, regardless of their ability to pay. The money to cover the costs typically comes from federal, state and local taxes.

A solid accounting of money spent treating illegal immigrants is elusive because most hospitals do not ask for immigration status. But some states have tried.

California, which is home to the nation's largest population of illegal immigrants, spent an estimated $1.2 billion last year through Medicaid to care for 822,500 illegal immigrants.

The New Jersey Hospital Association in 2010 estimated that it cost between $600 million and $650 million annually to treat 550,000 illegal immigrants.

And in Texas, a 2010 analysis by the Health and Human Services Commission found that the agency had provided $96 million in benefits to illegal immigrants, up from $81 million two years earlier. The state's public hospital districts spent an additional $717 million in uncompensated care to treat that population.

If large states such as Florida and Texas make good on their intention to forgo federal money to expand Medicaid, the decision "basically eviscerates" the effects of the health care overhaul in those areas because of "who lives there and what they're eligible for," said Lisa Clemans-Cope, a senior researcher at the Urban Institute.

Seeking to curb expenses, hospitals might change what qualifies as an emergency or cap the number of uninsured patients they treat. And although it's believed states with the most illegal immigrants will face a smaller cut, they will still lose money.

The potential impacts of reform are a hot topic at MD Anderson Cancer Center in Houston. In addition to offering its own charity care, some MD Anderson oncologists volunteer at a county-funded clinic at Lyndon B. Johnson General Hospital that largely treats the uninsured.

"In a sense we've been in the worst-case scenario in Texas for a long time," said Lewis Foxhall, MD Anderson's vice president of health policy in Houston. "The large number of uninsured and the large low-income population creates a very difficult problem for us."

Community clinics are a key part of the reform plan and were supposed to take up some of the slack for hospitals. Clinics received $11 billion in new funding over five years so they could expand to help care for a swell of newly insured who might otherwise overwhelm doctors' offices. But in the first year, $600 million was cut from the centers' usual allocation, leaving many to use the money to fill gaps rather than expand.

There is concern that clinics could themselves be inundated with newly insured patients, forcing many illegal immigrants back to emergency rooms.

Limas, 44, moved to the border town of Alamo 13 years ago with her husband and three daughters. Now single, she supports the family by teaching a citizenship class in Spanish at the local community center and selling cookies and cakes she whips up in her trailer. Soon, she hopes to seek a work permit of her own.

For now, the clinic helps with basic health care needs. If necessary, Limas will return to the emergency room, where the attendants help her fill out paperwork to ensure the government covers the bills she cannot afford.

"They always attended to me," she said, "even though it's slow."

___

Sherman can be followed on Twitter at https://twitter.com/chrisshermanAP .

Plushnick-Masti can be followed on Twitter at https://twitter.com/RamitMastiAP .

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L.A. schools react after Sandy Hook massacre

By all accounts, the grade school in Newtown, Conn., had strict security procedures, tightened earlier this year in an effort to make sure the campus was as safe as possible. A letter had been sent out to all parents, alerting them to the upgrade.

But on Friday, it was all quickly defeated when a gunman opened fire inside Sandy Hook Elementary in the deadliest campus shooting since the Virginia Tech rampage in 2007. In all, 26 people were fatally shot at the school — 20 of them children — before the attacker killed himself.

In the wake of the carnage, school officials and experts said they expect — and understand — that a deluge of concerns and questions from parents lies ahead. They also remained firm that despite episodes of extreme violence such as the incident in Connecticut, campuses are generally safe and remain a haven for students.

"School remains one of the safest places for children to be," said Long Beach Unified Supt. Christopher J. Steinhauser. 

In the years since the 1999 mass shooting at Columbine High School in Colorado, schools nationwide have bolstered security measures. The biggest trends have been placing more police officers — rather than security guards — on campus, installing metal detectors and adding sophisticated locking systems on buildings.

Schools have also worked on developing robust emergency plans and have trained educators on how to respond to crises on campus, said Sonayia Shepherd, an analyst at Safe Havens International, a nonprofit that advises thousands of K-12 schools on safety and security.

Elementary schools in particular have focused heavily on crisis management, Shepherd said. "They understand that they have the most vulnerable populations — they have the young kids," she said.

At the grade school in Newtown, visitors are required to ring a doorbell to alert office staff, who have a video monitor for the front entrance. The entrance is locked at 9:30 a.m., at which point visitors must go to the office and sign in with identification.

But the gunman at the grade school — identified by authorities as 20-year-old Adam Lanza — was the son of a woman who worked at Sandy Hook and allegedly opened fired after arguing with a school official. Authorities said Lanza killed his mother at home before driving to the campus and committed suicide after the massacre.

Security measures at schools across the nation vary widely, and some experts, such as Cleveland-based school security consultant Ken Trump, worry that attention to safety has diminished in the years since Columbine or has buckled under the weight of budget cuts.

At a typical L.A. Unified School, the first person a visitor would greet is a parent volunteer or part-time worker stationed just inside the main entrance. That person manages a sign-in sheet, issues a visitor's pass and asks where the visitor is going. Sometimes, the gatekeeper will get permission from the office before allowing entry. At other times, the monitor will simply provide directions.

Yet in the minutes before and after school, it's easier to walk onto campus in the crush of students.

Most school systems don't employ their own police force, relying instead on local law enforcement.

L.A. Unified employs more than 200 police officers, but they are spread thin across more than 1,000 campuses and virtually never patrol elementary schools. Instead, they are trained to converge on a trouble spot when something happens. The district also employs unarmed security aides and relies on local law enforcement for assistance.

On Friday, the district's police force and law enforcement partners increased patrols around campuses to ease fear and anxiety stemming from the shooting, the district said.

For students in L.A. Unified and many other districts, Friday marked the last day of classes before winter break, which creates special circumstances, said UC Berkeley Professor Frank Worrell, the director of the university's School Psychology program.

"Many schools are closing [for the break], which means they may not have a chance to deal with the grieving process as a community. It's hugely important for children and adults to express grief," he said.

Desiree Manuel, principal at Huerta Elementary in Los Angeles, sent students home with a letter to parents and also put out an automated phone alert to families that the school is aware of the shooting and that parents could feel confident that all measures were being taken to keep children safe.

The template was quickly put together by the Partnership for Los Angeles Schools, a nonprofit that manages about 15 campuses in conjunction with the Los Angeles Unified School District.

"As you know, this sort of tragedy can be terribly upsetting to children," the prepared message states. "… We encourage you to be alert to your child's potential anxieties as a result of this terrible incident, and please do not hesitate to talk with your child about this shooting: Let them express their fears and concerns and gently reassure them that their school and environment are safe."

At Huerta Elementary, the front gate is open only from 7:20 a.m. to 7:55 a.m. and under staff supervision. Afterward, all visitors must enter by the office, where they sign in and receive a visitor's badge. A part-time security aide helps supervise the playground. As a new campus, Huerta also has a secure faculty garage with a video monitor.

In addition, Manuel invested in extra walkie-talkies for teachers in classrooms farthest from the office. They'll be able to coordinate with each other even if phone lines and power go down.

The South L.A. school's rituals include a lockdown drill. Students are taught to go to the safest, nearby, supervised room when the alarm sounds. And they also know a code phrase signifying that all is clear.

"We talk about safety every day," Manuel said. Her goal is to make sure that "our school is the safest place in the community."

stephen.ceasar@latimes.com

howard.blume@latimes.com

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In Cairo Crisis, Unheard Voice From the Poor

Tara Todras-Whitehill for The New York Times

In Boulaq, so long neglected that houses regularly collapse, there had been little expectation that leaders would provide. But the disregard of the new president has been harder to take. More Photos »

CAIRO — A faded poster of Hosni Mubarak hangs on a wall in a crumbling neighborhood here, reminding residents of an empty pledge to find jobs for young people. Down the street, a campaign banner for his successor, Mohamed Morsi, hangs across the road, a reminder of more recent promises unkept.

In the neighborhood, called Boulaq, so long neglected that houses regularly collapse, there was little expectation that Mr. Mubarak would provide. But Mr. Morsi’s disregard has been much harder to take.

“We had high hopes in God, that things would improve,” Fathi Hussein said as he built a desk of dark wood for one of his clients, who are dwindling. “I elected a president to be good for the country. I did not elect him to impose his opinions on me.”

Away from the protests and violence that have marked the painful struggle over Egypt’s identity in the run-up to a referendum on Saturday on a constitution, residents of Boulaq have their own reasons to be consumed with the crisis. The chants of the protesters, for bread and freedom, resonate in Boulaq’s alleyways. In many of its industrial workshops, passed from struggling fathers to penniless sons, disappointment with the president, his Muslim Brotherhood supporters as well as the leaders of the opposition grows daily.

There is a sense in Boulaq that the raging arguments would be better resolved in places like this, where most Egyptians live, carrying the burdens of poverty with no help from an indifferent state, and where the revolution’s promise of dignity is long overdue.

When he took office five months ago, Mr. Morsi seemed to understand. “He talked about the conditions of the poor, the people in the slums,” said Amr Abdul Hafiz, a barber. “He talked about the street vendors and the tuk-tuk drivers. We thought he felt for us.”

The barber and many of his neighbors were convinced that Mr. Morsi and the Brotherhood had earned their chance to rule. People remembered the Brotherhood’s charity after the earthquake in 1992, and its decades of struggle as an outlaw movement. In stages, though, doubts grew as the Brotherhood broke its promises and Mr. Morsi seized power, culminating in his decision to ram through his constitution. Boulaq’s residents, including the president’s supporters, bristled at the thought of being treated as subjects again.

“He became occupied with other issues,” Mr. Abdul Hafiz said. “They want power, to make up for all the injustice they suffered, as if we were the ones who inflicted the injustice on them.”

At night, the arguments rage at a storied cafe on Abu Talib Street, with an intensity that no one here recalls seeing before. By day, the arguments simmer, in a neighborhood whose former grandeur still peeks out from underneath the rot.

Everywhere, people tell stories about the government’s failures, suggesting that the new leaders had turned out no better than the old ones.

In the shadow of a fallen dwelling, one of many that make Boulaq look as if it suffered a war, a widow stood over workmen she had hired to fix a ruptured sewer pipe. The ministry assigned to handle such matters had ignored her calls for three months, so she and her neighbors collected the money to pay for the repairs themselves.

On Abu Talib Street, Mr. Abdul Hafiz fretted over the dangers facing his pregnant wife, whose belly was swelling with excessive amniotic fluid. An appointment to see a doctor at a private hospital, which would cost $80, was too expensive. The administrators at a public hospital told her she could see a doctor a month after she was supposed to give birth.

Security guards threw Mr. Abdul Hafiz out of the hospital when he pointed out how ridiculous that was.

He wanted a change from Mr. Mubarak, who had coverings placed over the houses in Boulaq during the public opening of a nearby building “to hide insects like us.” It was part of a pattern of neglect that stretched back for decades, when the land under the residents was sold to investors in shady deals that no one has untangled.

Mai Ayyad contributed reporting.

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The X Factor Reveals Season 2 Finalists

TV Watch

The X Factor

12/13/2012 at 09:10 PM EST

Carly Rose Sonenclar, Emblem3, Tate Stevens and Fifth Harmony

Ray Mickshaw/FOX (4)

Sparks will fly at the finale!

On Thursday, The X Factor revealed its top three acts, who will perform next week in the final night of competition – in hopes of taking home the $5 million recording contract.

Simon Cowell said it would take a miracle to get his girl group, Fifth Harmony, to the finale after they performed Shontelle's "Impossible" and Ellie Goulding's "Anything Could Happen" on Wednesday. Keep reading to find out if their dream came true ...

Apparently, miracles do happen! Fifth Harmony was the first act to be sent through to the finale.

They will compete against departing judge L.A. Reid's country singer, Tate Stevens, and Britney Spears's only remaining contestant, Carly Rose Sonenclar.

That means Simon's promising boy band, Emblem3, are out of the running for the big prize.

"This is the way it goes on competitions," Simon said. "I'm gutted really for them ... But it happens."

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Study: People worldwide living longer, but sicker

LONDON (AP) — Nearly everywhere around the world, people are living longer and fewer children are dying. But increasingly, people are grappling with the diseases and disabilities of modern life, according to the most expansive global look so far at life expectancy and the biggest health threats.

The last comprehensive study was in 1990 and the top health problem then was the death of children under 5 — more than 10 million each year. Since then, campaigns to vaccinate kids against diseases like polio and measles have reduced the number of children dying to about 7 million.

Malnutrition was once the main health threat for children. Now, everywhere except Africa, they are much more likely to overeat than to starve.

With more children surviving, chronic illnesses and disabilities that strike later in life are taking a bigger toll, the research said. High blood pressure has become the leading health risk worldwide, followed by smoking and alcohol.

"The biggest contributor to the global health burden isn't premature (deaths), but chronic diseases, injuries, mental health conditions and all the bone and joint diseases," said one of the study leaders, Christopher Murray, director of the Institute of Health Metrics and Evaluation at the University of Washington.

In developed countries, such conditions now account for more than half of the health problems, fueled by an aging population. While life expectancy is climbing nearly everywhere, so too are the number of years people will live with things like vision or hearing loss and mental health issues like depression.

The research appears in seven papers published online Thursday by the journal Lancet. More than 480 researchers in 50 countries gathered data up to 2010 from surveys, censuses and past studies. They used statistical modeling to fill in the gaps for countries with little information. The series was mainly paid for by the Bill & Melinda Gates Foundation.

As in 1990, Japan topped the life expectancy list in 2010, with 79 for men and 86 for women. In the U.S. that year, life expectancy for men was 76 and for women, 81.

The research found wide variations in what's killing people around the world. Some of the most striking findings highlighted by the researchers: — Homicide is the No. 3 killer of men in Latin America; it ranks 20th worldwide. In the U.S., it is the 21st cause of death in men, and in Western Europe, 57th.

— While suicide ranks globally as the 21st leading killer, it is as high as the ninth top cause of death in women across Asia's "suicide belt," from India to China. Suicide ranks 14th in North America and 15th in Western Europe.

— In people aged 15-49, diabetes is a bigger killer in Africa than in Western Europe (8.8 deaths versus 1 death per 100,000).

— Central and Southeast Asia have the highest rates of fatal stroke in young adults at about 15 cases per 100,000 deaths. In North America, the rate is about 3 per 100,000.

Globally, heart disease and stroke remain the top killers. Reflecting an older population, lung cancer moved to the 5th cause of death globally, while other cancers including those of the liver, stomach and colon are also in the top 20. AIDS jumped from the 35th cause of death in 1990 to the sixth leading cause two decades later.

While chronic diseases are killing more people nearly everywhere, the overall trend is the opposite in Africa, where illnesses like AIDS, malaria and tuberculosis are still major threats. And experts warn again shifting too much of the focus away from those ailments.

"It's the nature of infectious disease epidemics that if you turn away from them, they will crop right back up," said Jennifer Cohn, a medical coordinator at Doctors Without Borders.

Still, she acknowledged the need to address the surge of other health problems across Africa. Cohn said the agency was considering ways to treat things like heart disease and diabetes. "The way we treat HIV could be a good model for chronic care," she said.

Others said more concrete information is needed before making any big changes to public health policies.

"We have to take this data with some grains of salt," said Sandy Cairncross, an epidemiologist at the London School of Hygiene and Tropical Medicine.

He said the information in some of the Lancet research was too thin and didn't fully consider all the relevant health risk factors.

"We're getting a better picture, but it's still incomplete," he said.

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Online:

www.lancet.com

http://healthmetricsandevaluation.org

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State population rises in signs of economic recovery

California's population has grown to 37.8 million, continuing the state's trend of slowing but steady growth — about 1% annually — over the last decade, according to new population estimates released by the state Department of Finance.

The population increased by 256,000 people since July 2011, a growth rate of 0.7%. It's roughly the same growth rate as last year, but some experts pointed to an uptick in the number of people moving in and out of California and between counties as a sign of economic recovery.

"We've been mired in this deep slump, economically and demographically, and we're all looking for signs of revival," said USC demography and urban planning professor Dowell Myers. "During the recession, everyone froze. People didn't move as fast as normal."

In Los Angeles County, more people moved out than into the county in 2011, but at a significantly slower rate than in 2010, the state numbers show.

"Overall, movements are speeding up in both directions, but L.A.'s attraction is winning the war," said Myers, who also noticed an increase in movement in the entire western region, particularly among young adults. "It means the system is unfreezing, it's loosening up....This is the beginning."

Recent estimates by the American Community Survey showed that about 100,000 more Californians left the state than moved here. Most of those who left headed to Texas, Arizona and Oregon.

But state demographers cautioned that the out-of-state migration numbers may appear misleading because immigrants often enter through California before settling in other states.

"People see that so many people are leaving the state, and they think 'oh, it's because California business is bad,' " said Bill Schooling, chief of demographics research for the state Department of Finance. "It's more that California, particularly with counties like L.A., is a huge gateway state."

Los Angeles remains the state's most populous county, with more than 9.9 million residents. More than 26% of the state's entire population lives within the Los Angeles County limits.

Schooling noted that much of the state's population growth was concentrated in coastal counties, where people tend to be younger and more mobile.

Economists also said that job growth has been much stronger along the coast, particularly with growth in foreign trade, technology and tourism.

"The state recovery really started in the Bay Area, spread to Orange County and San Diego, and in the last six months, has spread to L.A. County," said Stephen Levy, director of the Center for Continuing Study of the California Economy. "Slow population growth is consistent with the early phase of recovery."

Births helped maintain the population growth, with 503,000 babies born in California between July 2011 and July 2012. There were 234,000 deaths in the state during the same time, a slight increase from past years, according to the state estimates.

Until the state becomes more stable economically, it is difficult to make long-term population projections, experts said.

"This is a step in the right direction," Myers said. "And we will, we should, have much better news next year."

rosanna.xia@latimes.com

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North Koreans Launch Rocket in Defiant Act

KCNA, via Reuters

This photo released by the state-run Korean Central News Agency shows North Korean technicians monitoring the launch of an Unha-3 rocket carrying the satellite Kwangmyongsong-3, or Shining Star-3, into orbit on Wednesday.

WASHINGTON — The United States and its Asian allies began an effort on Wednesday to impose additional sanctions on North Korea after its largely successful rocket launching, but this time Washington added a warning to China: Failure to rein in Kim Jong-un, the North’s new leader, will result in an even greater American military presence in the Pacific.

The Chinese government, which sent a delegation to Pyongyang last month to warn against the missile test, said it “regrets” the launching, which put a 200-pound earth surveillance satellite into orbit.

The Chinese Foreign Ministry spokesman, Hong Lei, said that North Korea’s right to a peaceful space program was subject to “limitations” by United Nations Security Council resolutions. But he declined to say whether North Korea had failed to live up to those obligations, which include a prohibition on launchings like the one on Wednesday morning that could be used to advance missile technology.

In fact, after a preliminary meeting of the Security Council members in New York, it was far from clear how far the Chinese are willing to go in further punishing an ally they once called as close as “lips and teeth.” Beijing’s biggest fear has always been destabilizing North Korea, and setting off a collapse that could put South Korean forces, and perhaps their American allies, on China’s border.

But the essence of the American strategy, as described Wednesday by administration officials, was to force the Chinese into an uncomfortable choice.

“The kinds of things we would do to enhance the region’s security against a North Korean nuclear missile capability,” one senior administration official said in an interview, “are indistinguishable from the things the Chinese would view as a containment strategy” aimed at Beijing.

They would include increased patrols in waters the Chinese are trying to claim as part of their exclusive zone, along with military exercises with allies in the region. “It’s the right approach, but whether it works is another matter,” said Christopher R. Hill, who was the chief negotiator with North Korea during President George W. Bush’s second term, and is now dean of the Korbel School of International Studies at the University of Denver, on Wednesday. “The approach of thickening up the antimissile effort is something that would get China’s attention.”

Many of those efforts are planned anyway as part of President Obama’s “rebalancing” strategy to ensure a continued American presence in Asia. The president has repeatedly said he has neither the desire nor the ability to contain China’s rise, but the rebalancing is clearly intended to keep the Chinese from nudging the United States out of the region.

Already, the Chinese believe that America’s antimissile efforts from Alaska to the Pacific are designed to counter their own nuclear arsenal.

Administration officials said that while the launching was successful — and advanced the North’s missile program — it was hardly a threat to the United States, despite a warning by Robert M. Gates in 2011, when he was secretary of defense, that the North would have a missile capable of reaching the United States by 2016.

“I am not disparaging this demonstration of 1950s Sputnik-quality technology,” the administration official said, referring to the Soviet satellite that prompted the space race during the cold war. He then went on to disparage it, noting that Mr. Kim “is in the family business, like his daddy before him, and it’s a form of extortion.”

South Korean officials sounded similar themes, saying that the North’s effort was to extract a higher price — in aid, investment and diplomatic concessions — for restraining future launchings or nuclear tests.

Riki Ellison, chairman of the Missile Defense Advocacy Alliance, a private group in Washington, called the North Korean satellite launching “a fundamental breakthrough” that showed the main elements of an intercontinental ballistic missile.

David E. Sanger reported from Washington, and William J. Broad from New York. Choe Sang-hun contributed reporting from Seoul, South Korea.

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