Study questions kidney cancer treatment in elderly

In a stunning example of when treatment might be worse than the disease, a large review of Medicare records finds that older people with small kidney tumors were much less likely to die over the next five years if doctors monitored them instead of operating right away.

Even though nearly all of these tumors turned out to be cancer, they rarely proved fatal. And surgery roughly doubled patients' risk of developing heart problems or dying of other causes, doctors found.

After five years, 24 percent of those who had surgery had died, compared to only 13 percent of those who chose monitoring. Just 3 percent of people in each group died of kidney cancer.

The study only involved people 66 and older, but half of all kidney cancers occur in this age group. Younger people with longer life expectancies should still be offered surgery, doctors stressed.

The study also was observational — not an experiment where some people were given surgery and others were monitored, so it cannot prove which approach is best. Yet it offers a real-world look at how more than 7,000 Medicare patients with kidney tumors fared. Surgery is the standard treatment now.

"I think it should change care" and that older patients should be told "that they don't necessarily need to have the kidney tumor removed," said Dr. William Huang of New York University Langone Medical Center. "If the treatment doesn't improve cancer outcomes, then we should consider leaving them alone."

He led the study and will give results at a medical meeting in Orlando, Fla., later this week. The research was discussed Tuesday in a telephone news conference sponsored by the American Society of Clinical Oncology and two other cancer groups.

In the United States, about 65,000 new cases of kidney cancer and 13,700 deaths from the disease are expected this year. Two-thirds of cases are diagnosed at the local stage, when five-year survival is more than 90 percent.

However, most kidney tumors these days are found not because they cause symptoms, but are spotted by accident when people are having an X-ray or other imaging test for something else, like back trouble or chest pain.

Cancer experts increasingly question the need to treat certain slow-growing cancers that are not causing symptoms — prostate cancer in particular. Researchers wanted to know how life-threatening small kidney tumors were, especially in older people most likely to suffer complications from surgery.

They used federal cancer registries and Medicare records from 2000 to 2007 to find 8,317 people 66 and older with kidney tumors less than 1.5 inches wide.

Cancer was confirmed in 7,148 of them. About three-quarters of them had surgery and the rest chose to be monitored with periodic imaging tests.

After five years, 1,536 had died, including 191 of kidney cancer. For every 100 patients who chose monitoring, 11 more were alive at the five-year mark compared to the surgery group. Only 6 percent of those who chose monitoring eventually had surgery.

Furthermore, 27 percent of the surgery group but only 13 percent of the monitoring group developed a cardiovascular problem such as a heart attack, heart disease or stroke. These problems were more likely if doctors removed the entire kidney instead of just a part of it.

The results may help doctors persuade more patients to give monitoring a chance, said a cancer specialist with no role in the research, Dr. Bruce Roth of Washington University in St. Louis.

Some patients with any abnormality "can't sleep at night until something's done about it," he said. Doctors need to say, "We're not sticking our head in the sand, we're going to follow this" and can operate if it gets worse.

One of Huang's patients — 81-year-old Rhona Landorf, who lives in New York City — needed little persuasion.

"I was very happy not to have to be operated on," she said. "He said it's very slow growing and that having an operation would be worse for me than the cancer."

Landorf said her father had been a doctor, and she trusts her doctors' advice. Does she think about her tumor? "Not at all," she said.

___

Online:

Kidney cancer info: http://www.cancer.net/cancer-types/kidney-cancer

and http://www.cancer.gov/cancertopics/types/kidney

Study: http://gucasym.org

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Officials call for probe of sale of bulletproof vests

Local officials Tuesday called for investigations into the Los Angeles County Sheriff's Department funneling hundreds of bulletproof vests to Cambodia through the city of Gardena.

Supervisor Mark Ridley-Thomas requested an audit to determine whether officials violated the law in shipping the vests a decade ago to the Southeast Asian country. A Gardena official also said she would be asking for an investigation into her city being used as an intermediary for the unusual transaction.

The announcements Tuesday were prompted by a Times investigation published over the weekend that found that sheriff's ballistic vests were shipped to Cambodia and not declared to customs officials, as required by federal law. Instead, they were stuffed inside one of a number of patrol cars that the Sheriff's Department was shipping directly to Cambodia, avoiding the rigorous vetting process the U.S. government requires to prevent body armor from getting into the wrong hands abroad.

Sheriff's media representatives gave The Times differing accounts about the transaction, initially denying any sheriff's officials were involved in sending the vests to Cambodia, then offering explanations contradicted by records and interviews. The officials involved in the transaction refused to discuss it.

"Federal, state and local statutory, legal and policy violations may have occurred with these transactions," read a motion by Ridley-Thomas.

Gardena Mayor Pro Tem Rachel Johnson said she was troubled by the alleged role that the city's mayor, Paul Tanaka, played in the sales. Tanaka is the second-in-command at the Sheriff's Department.

She said she also wanted to know why her city manager approved the transaction. Records showed the city manager pledged under the penalty of perjury that the vests were intended for Gardena, despite later telling federal authorities he knew they would be diverted to Cambodia.

"I'm concerned about the appearance of a cover-up," Johnson said in an interview with The Times.

It is not unusual for U.S. law enforcement agencies to donate used or obsolete equipment to other departments, including foreign ones. But in this case, the vests were shipped using an intermediary and were not declared on their way out of the country. The vests were ostensibly sold to Gardena, but were never claimed by the city before being shipped to Cambodia.

The U.S. Customs Service launched an investigation into the sale of the vests in 2002, and federal agents were told that the transactions were coordinated by Tanaka, according to records obtained by The Times. A sheriff's spokesman called Tanaka's role minimal, saying it was a former undersheriff who called the Gardena city manager to coordinate the sales.

Customs agents decided not to seek criminal charges, concluding that there wasn't enough evidence to show that anyone involved in the transactions knew the relevant export laws. One expert told The Times that that rationale was "curious" because authorities don't have to prove knowledge of the law to press charges.

After closing the case, federal authorities referred the matter to sheriff's investigators, but the department did not conduct its own investigation. But a sheriff's spokesman said the department did nothing wrong and sent the vests through Gardena because they were under the mistaken impression that county rules prevented them from dealing directly with foreign nations. Prompted by The Times' inquiry, Sheriff Lee Baca asked the county auditor-controller's office to examine the sale, and Baca's spokesman called that review "a complete vindication." But Baca only told the auditor-controller that the vests were sold to Gardena, not that Gardena was a go-between to get the vests to Cambodia.

The audit Ridley-Thomas proposed would include that, and determine if any sheriff's or Gardena officials committed "any fraudulent or illegal activity." If his motion is approved and the audit is launched, the final report would be forwarded to county and federal prosecutors for further action.

Johnson, who is running to replace Tanaka as mayor of Gardena, said she was a city clerk at the time of the transactions and never knew about them. "I'm very disappointed that [Tanaka] has involved our city manager, our city resources in these questionable practices," she said.

Sheriff's spokesman Steve Whitmore said that both Baca and Tanaka do not object to the new probes: "Don't forget this has been looked at by the feds and they said nothing was wrong."

jack.leonard@latimes.com

robert.faturechi@latimes.com

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North Korea Is Suspected of Conducting 3rd Nuclear Test

Lee Jin-Man/Associated Press

A South Korean watched news reporting about a possible nuclear test conducted by North Korea on a TV screen in Seoul on Tuesday.

WASHINGTON — American and South Korean officials reported seismic activity in North Korea on Tuesday that appeared to be evidence of the country’s third, and long-threatened nuclear test and a new challenge for the Obama administration in its effort to keep the country from becoming a full-fledged nuclear power.

“We believe that North Korea has conducted a nuclear test,” said Kim Min-seok, spokesman of the South Korean Defense Ministry.

The shock appeared to be centered in the same location where the North conducted tests in 2006 and 2009, and the United States Geological Survey said it was only a kilometer underground, all indications consistent with a nuclear blast.

If confirmed, the test would be the first under the country’s new leader, Kim Jong-un, and an open act of defiance to the Chinese, who urged the young leader not to risk open confrontation by setting off the weapon. Just in the past few days a Chinese newspaper that is often reflective of the government’s thinking said the North must “pay a heavy price” if it proceeded with the test.

But past United Nations Security Council sanctions have not deterred the country from accelerating its missile and nuclear programs. And recent actions, including a successful missile test nearly two months ago that reached as far as the Philippines and sent a washing-machine sized satellite into space have dashed hopes that the country’s Swiss-educated new leader might be willing to focus on economic reform rather than pursuing the path taken by his father and grandfather: open defiance of the country’s adversaries.

The Obama administration has already threatened to take additional action to penalize the North if it conducts a test, through the United Nations. But the fact is that there are few sanctions left to apply against the most unpredictable country in Asia. The only penalty that would truly hurt the North would be a cutoff of oil and other aid from China. And until now, despite issuing warnings, the Chinese have feared instability and chaos in the North more than its growing nuclear and missile capability, and the Chinese leadership has refused to participate in sanctions.

Mr. Kim, believed to be about 29, appears betting that even a third test would not change the Chinese calculus.

It may take days or weeks to determine if the test, if that is what it proves to be, was successful. But American officials will also be looking for signs of whether the North, for the first time, conducted a test of a uranium weapon, based on a uranium enrichment capability it has been pursuing for a decade. The past two tests used plutonium, reprocessed from one of the country’s now-defunct nuclear reactors. While the country only has enough plutonium for a half-dozen or so bombs, it can produce enriched uranium well into the future.

No country is more interested in the results of the North’s nuclear program, or the Western reaction, than Iran, which is pursuing its own uranium enrichment program. The two countries have long cooperated on missile technology, and many intelligence officials believe they share nuclear knowledge as well, though so far there is no hard evidence. The Iranians are also pursuing uranium enrichment, and one senior American official said two weeks ago that “it’s very possible that the North Koreans are testing for two countries.” Some believe that the country may have been planning two simultaneous tests, but it could take time to sort out the data.

The timing of the test, if that is what it was, is critical. It comes just as a transition of power is about to take place in South Korea, and the North detested the South’s hard-line outgoing president, Lee Myung-bak. By conducting a test just before he leaves office, the North could be both sending a message and giving his successor, Park Guen-Hye, the chance to restore relations after the breach a test will undoubtedly cause.

Western officials considered the country’s first nuclear test, in 2006, a fizzle, but the next one in 2009 was judged more successful. It may take outside experts days or weeks to determine if the latest blast moved the program to a “higher level,” as Pyongyang recently promised, allowing it to improve, or even expand, an arsenal that intelligence experts say includes enough plutonium for roughly 6 to 10 nuclear bombs.

David E. Sanger reported from Washington, and Choe Sang-hun reported from Seoul, South Korea.

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It's a Girl for John Cho

Mom & Babies
Celebrity Baby Blog

02/11/2013 at 06:30 PM ET

Paul Drinkwater/NBC

Surprise: Actor John Cho is a dad again!

The Go On star and his wife welcomed a daughter recently, Cho’s rep confirms to PEOPLE exclusively.

Baby girl is the second child for the couple, who are also parents to a son. No further details are available.

Cho currently stars alongside Jason Bateman in Identity Thief and will reprise his role as Hikaru Sulu in Star Trek Into Darkness in May.

He is also well known for his roles in American Pie and the Harold and Kumar films.

– Anya Leon with reporting by Julie Jordan

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Pope shows lifetime jobs aren't always for life

The world seems surprised that an 85-year-old globe-trotting pope who just started tweeting wants to resign, but should it be? Maybe what should be surprising is that more leaders his age do not, considering the toll aging takes on bodies and minds amid a culture of constant communication and change.

There may be more behind the story of why Pope Benedict XVI decided to leave a job normally held for life. But the pontiff made it about age. He said the job called for "both strength of mind and body" and said his was deteriorating. He spoke of "today's world, subject to so many rapid changes," implying a difficulty keeping up despite his recent debut on Twitter.

"This seemed to me a very brave, courageous decision," especially because older people often don't recognize their own decline, said Dr. Seth Landefeld, an expert on aging and chairman of medicine at the University of Alabama at Birmingham.

Age has driven many leaders from jobs that used to be for life — Supreme Court justices, monarchs and other heads of state. As lifetimes expand, the woes of old age are catching up with more in seats of power. Some are choosing to step down rather than suffer long declines and disabilities as the pope's last predecessor did.

Since 1955, only one U.S. Supreme Court justice — Chief Justice William Rehnquist — has died in office. Twenty-one others chose to retire, the most recent being John Paul Stevens, who stepped down in 2010 at age 90.

When Thurgood Marshall stepped down in 1991 at the age of 82, citing health reasons, the Supreme Court justice's answer was blunt: "What's wrong with me? I'm old. I'm getting old and falling apart."

One in 5 U.S. senators is 70 or older, and some have retired rather than seek new terms, such as Hawaii's Daniel Akaka, who left office in January at age 88.

The Netherlands' Queen Beatrix, who just turned 75, recently said she will pass the crown to a son and put the country "in the hands of a new generation."

In Germany, where the pope was born, Chancellor Angela Merkel, who is 58, said the pope's decision that he was no longer fit for the job "earns my very highest respect."

"In our time of ever-lengthening life, many people will be able to understand how the pope as well has to deal with the burdens of aging," she told reporters in Berlin.

Experts on aging agreed.

"People's mental capacities in their 80s and 90s aren't what they were in their 40s and 50s. Their short-term memory is often not as good, their ability to think quickly on their feet, to execute decisions is often not as good," Landefeld said. Change is tougher to handle with age, and leaders like popes and presidents face "extraordinary demands that would tax anybody's physical and mental stamina."

Dr. Barbara Messinger-Rapport, geriatrics chief at the Cleveland Clinic, noted that half of people 85 and older in developed countries have some dementia, usually Alzheimer's. Even without such a disease, "it takes longer to make decisions, it takes longer to learn new things," she said.

But that's far from universal, said Dr. Thomas Perls, an expert on aging at Boston University and director of the New England Centenarians Study.

"Usually a man who is entirely healthy in his early 80s has demonstrated his survival prowess" and can live much longer, he said. People of privilege have better odds because they have access to good food and health care, and tend to lead clean lives.

"Even in the 1500s and 1600s there were popes in their 80s. It's remarkable. That would be today's centenarians," Perls said.

Arizona Sen. John McCain turned 71 while running for president in 2007. Had he won, he would have been the oldest person elected to a first term as president. Ronald Reagan was days away from turning 70 when he started his first term as president in 1981; he won re-election in 1984. Vice President Joe Biden just turned 70.

In the U.S. Senate, where seniority is rewarded and revered, South Carolina's Strom Thurmond didn't retire until age 100 in 2002. Sen. Robert Byrd of West Virginia was the longest-serving senator when he died in office at 92 in 2010.

Now the oldest U.S. senator is 89-year-old Frank Lautenberg of New Jersey. The oldest congressman is Ralph Hall of Texas who turns 90 in May.

The legendary Alan Greenspan was about to turn 80 when he retired as chairman of the Federal Reserve in 2006; he still works as a consultant.

Elsewhere around the world, Cuba's Fidel Castro — one of the world's longest serving heads of state — stepped down in 2006 at age 79 due to an intestinal illness that nearly killed him, handing power to his younger brother Raul. But the island is an example of aged leaders pushing on well into their dotage. Raul Castro now is 81 and his two top lieutenants are also octogenarians. Later this month, he is expected to be named to a new, five-year term as president.

Other leaders who are still working:

—England's Queen Elizabeth, 86.

—Abdullah bin Abd al-Aziz al-Saud, king of Saudi Arabia, 88.

—Sabah al-Ahmad al-Jaber al-Sabah, emir of Kuwait, 83.

—Ruth Bader Ginsburg, U.S. Supreme Court associate justice, 79.

__

Associated Press writers Paul Haven in Havana, Cuba; David Rising in Berlin; Seth Borenstein, Mark Sherman and Matt Yancey in Washington, and researcher Judy Ausuebel in New York contributed to this report.

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Ex-Bell officials defend themselves as honorable public servants

Less than three years ago, they were handcuffed and taken away in a case alleged to be so extensive that the district attorney called it "corruption on steroids."

But on Monday, two of the six former Bell council members accused of misappropriating money from the small, mostly immigrant town took to the witness stand and defended themselves as honorable public servants who earned their near-$100,000 salaries by working long hours behind the scenes.

During her three days on the stand, Teresa Jacobo said she responded to constituents who called her cell and home phone at all hours. She put in time at the city's food bank, organized breast cancer awareness marches, sometimes paid for hotel rooms for the homeless and was a staunch advocate for education.

"I was working very hard to improve the lives of the citizens of Bell," she said. "I was bringing in programs and working with them to build leadership and good families, strong families."

Jacobo, 60, said she didn't question the appropriateness of her salary, which made her one of the highest-paid part-time council members in the state.

Former Councilman George Mirabal said he too worked a long, irregular schedule when it came to city affairs.

"I keep hearing time frames over and over again, but there's no clock when you're working on the council," he said Monday. "You're working on the circumstances that are facing you. If a family calls … you don't say, '4 o'clock, work's over.' "

Mirabal, 65, said he often reached out to low-income residents who didn't make it to council meetings, attended workshops to learn how to improve civic affairs and once even made a trip to a San Diego high school to research opening a similar tech charter school in Bell.

"Do you believe you gave everything you could to the citizens of Bell?" asked his attorney, Alex Kessel.

"I'd give more," Mirabal replied.

Both Mirabal and Jacobo testified that not only did they perceive their salaries to be reasonable, but they believed them to be lawful because they were drawn up by the city manager and voted on in open session with the city attorney present.

Mirabal, who once served as Bell's city clerk, even went so far as to say that he was still a firm supporter of the city charter that passed in 2005, viewing it as Bell's "constitution." In a taped interview with authorities, one of Mirabal's council colleagues — Victor Bello — said the city manager told him the charter cleared the way for higher council salaries.

Prosecutors have depicted the defendants as salary gluttons who put their city on a path toward bankruptcy. Mirabal and Jacobo, along with Bello, Luis Artiga, George Cole and Oscar Hernandez, are accused of drawing those paychecks from boards that seldom met and did little work. All face potential prison terms if convicted.

Prosecutors have cited the city's Solid Waste and Recycling Authority as a phantom committee, created only as a device for increasing the council's pay. But defense attorneys said the authority had a very real function, even in a city that contracted with an outside trash company.

Jacobo testified that she understood the introduction of that authority to be merely a legal process and that its purpose was to discuss how Bell might start its own city-run trash service.

A former contract manager for Consolidated Disposal Services testified that Bell officials had been unhappy with the response time to bulky item pickups, terminating their contract about 2005, but that it took about six years to finalize because of an agreement that automatically renewed every year.

Deputy Dist. Atty. Edward Miller questioned Mirabal about the day shortly after his 2010 arrest that he voluntarily told prosecutors that no work was done on authorities outside of meetings.

Mirabal said that if he had made such a statement, it was incorrect. He said he couldn't remember what was said back then and "might have heed and hawed."

"So it's easy to remember now?" Miller asked.

"Yes, actually."

"More than two years after charges have been filed, it's easier for you to remember now that you did work outside of the meetings for the Public Finance Authority?"

"Yes, sir."

Miller later asked Mirabal to explain a paragraph included on City Council agendas that began with the phrase, "City Council members are like you."

After some clarification of the question, Mirabal answered: "That everybody is equal and that if they look into themselves, they would see us."

corina.knoll@latimes.com

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Rome Journal: Itavia Flight 870 Ruling Adds Support to a Theory

Emiliano Grillotti/Associated Press

A police officer near Rome guarded the reconstructed wreckage of Itavia Flight 870, in 2003.

ROME — Itavia Flight 870 was entering the final leg of a routine domestic trip from Bologna, Italy, to Palermo, Sicily, one clear summer evening when it suddenly plunged into the Tyrrhenian Sea near the small island of Ustica, killing all 81 people aboard.

Mechanical failure was ruled out early on, and almost 33 years later, the causes that led to the crash on June 27, 1980, are still a topic of passionate debate in Italy, fueled by three decades of inquiry boards, parliamentary commissions, countless expert reports and one of the longest judicial inquiries in recent Italian history. But despite all that, no formal charges have ever been filed in connection with the crash.

The crash, known as the Ustica affair, has produced legions of conspiracy theories here, the way the Kennedy assassination — or, on a lesser scale, the crash of TWA Flight 800 off Long Island in 1996 — have in the United States. But in the Ustica affair, the case for a cover-up is far stronger.

Last week, when Italy’s highest court ruled that the country’s Defense and Transportation Ministries had to compensate the families of some of the victims, the court implicitly acknowledged the most widely accepted theory behind the crash: that a missile fired by a warplane had hit the twin-engine McDonnell Douglas DC-9 on Itavia, a now-defunct domestic Italian airline. But the court did not say where that missile came from.

To conspiracy buffs, it was vindication — to a point.

“It’s like the O. J. Simpson affair, where he got off in criminal court but was found guilty in a civil procedure and had to pay damages,” said Andrea Purgatori, an investigative reporter whose exhaustive book on the disaster and the presumed cover-up was made into a 1992 film.

Over the years, several Air Force officials have been investigated for withholding evidence — wiping clean flight tracks and radar scans — and four generals were tried on charges of treason and obstructing investigations. But no one has been convicted.

In this hothouse atmosphere, it is not surprising that conspiracy theories have proliferated over the years. The crash has been blamed on U.F.O.’s (several Web sites subscribe to this reconstruction) or domestic terrorism (the Bologna train station was bombed not five weeks later, killing 85 and wounding dozens more). In this scenario, the plane went down after a bomb exploded onboard, most likely in the toilet.

The missile theory gained a new impetus in 2008 when Francesco Cossiga, the prime minister at the time of the Ustica affair, said in an interview that the flight had been shot down by French military planes. Mr. Cossiga did not provide further details, nor can he. He died in 2010, at age 82.

Cover-up theories have been fueled through the years by what news reports have described as a “suspiciously high mortality” among military personnel and others connected to the case. (Mr. Cossiga is not included among them.)

Through traffic accidents, shooting deaths and suicides by hanging, there were 36 untimely deaths by 2011, according to a television report about Ustica. The program also cited a number of “bizarre accidents” that befell Ustica witnesses, like being run over by a tricycle and slipping on a banana peel in a Rome subway station.

“What terrifying truth warranted a cover-up at the cost of the lives of all these people?” asked the show’s host, Adam Kadmon, who plays a mysterious masked vigilante who investigates topics like Ustica, underskin microchip implants and, more recently, Michael Jackson’s prophecy about Sept. 11, and favors the French missile theory.

At the time, proponents say, Italy was covertly allowing Libyan aircraft to fly through its airspace undisturbed. They did so by gliding in the slipstream of Italian domestic aircraft, where they could not be detected by radar. On the night of June 27, 1980, there were unsubstantiated reports that Col. Muammar el-Qaddafi was on one of those planes, the theory goes, and French forces tried to shoot it down to kill the Libyan leader, but hit the DC-9 by mistake. Don’t ask why. It has to do with rebels in North Africa and jockeying for oil concessions between Italy and France.

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Relive All the Grammy One-Liners & Tweets

01/04/2011 at 10:00 AM EST

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After early start, worst of flu season may be over

NEW YORK (AP) — The worst of the flu season appears to be over.

The number of states reporting intense or widespread illnesses dropped again last week, and in a few states there was very little flu going around, U.S. health officials said Friday.

The season started earlier than normal, first in the Southeast and then spreading. But now, by some measures, flu activity has been ebbing for at least four weeks in much of the country. Flu and pneumonia deaths also dropped the last two weeks, the Centers for Disease Control and Prevention reported.

"It's likely that the worst of the current flu season is over," CDC spokesman Tom Skinner said.

But flu is hard to predict, he and others stressed, and there have been spikes late in the season in the past.

For now, states like Georgia and New York — where doctor's offices were jammed a few weeks ago — are reporting low flu activity. The hot spots are now the West Coast and the Southwest.

Among the places that have seen a drop: Lehigh Valley Hospital-Cedar Crest in Allentown, Pa., which put up a tent outside its emergency room last month to help deal with the steady stream of patients. There were about 100 patients each day back then. Now it's down to 25 and the hospital may pack up its tent next week, said Terry Burger, director of infection control and prevention for the hospital.

"There's no question that we're seeing a decline," she said.

In early December, CDC officials announced flu season had arrived, a month earlier than usual. They were worried, saying it had been nine years since a winter flu season started like this one. That was 2003-04 — one of the deadliest seasons in the past 35 years, with more than 48,000 deaths.

Like this year, the major flu strain was one that tends to make people sicker, especially the elderly, who are most vulnerable to flu and its complications

But back then, that year's flu vaccine wasn't made to protect against that bug, and fewer people got flu shots. The vaccine is reformulated almost every year, and the CDC has said this year's vaccine is a good match to the types that are circulating. A preliminary CDC study showed it is about 60 percent effective, which is close to the average.

So far, the season has been labeled moderately severe.

Like others, Lehigh Valley's Burger was cautious about making predictions. "I'm not certain we're completely out of the woods," with more wintry weather ahead and people likely to be packed indoors where flu can spread around, she said.

The government does not keep a running tally of flu-related deaths in adults, but has received reports of 59 deaths in children. The most — nine — were in Texas, where flu activity was still high last week. Roughly 100 children die in an average flu season, the CDC says

On average, about 24,000 Americans die each flu season, according to the CDC.

According to the CDC report, the number of states with intense activity is down to 19, from 24 the previous week, and flu is widespread in 38 states, down from 42.

Flu is now minimal in Florida, Kentucky, Maine, Montana, New Hampshire and South Carolina.

___

Online:

CDC: http://www.cdc.gov/flu/

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Irvine shooting victims shared a love of basketball

Four days before her death, Monica Quan had news for her team. Quan, an assistant coach at Cal State Fullerton, held up her hand to show off an engagement ring. The players screamed and huddled around her for a closer look, head coach Marcia Foster recalled.

Quan was as happy as her basketball players, and later said she wished she had recorded the moment. She loved to have pictures taken with her friends. She wanted a big wedding, and her fiance, Keith Lawrence, a public safety officer at USC, was trying to work extra hours to make it possible.

The couple was talking about who would be in the wedding party. They had yet to pick a date and a location when they were found Feb. 3, shortly after the Super Bowl, shot to death in their car in the parking structure of their Irvine condominium complex.

They had multiple gunshot wounds. There were no signs of a robbery, and investigators ruled out a murder-suicide.

The next day, Quan's father got a call from a close friend of the family. Randall Quan, a former captain with the Los Angeles Police Department, and Wayne Caffey, a detective with the Southeast Division, had known one another for almost 25 years. Caffey recalled their conversation.

"We lost her," Quan said. "She's gone."

The two men were overwhelmed by the senselessness of the slayings. We don't know anything, Quan said; we don't know what happened.

He would later learn that his daughter and her fiance were probably killed by a former LAPD officer who had been fired in 2009; Randall Quan had represented Christopher Jordan Dorner at his termination hearing.

What was once incomprehensible — the deaths of these two young people — was now considered a revenge killing. The reasons were spelled out in an 11,000-word post police found on a Facebook page that they believe belonged to Dorner, 33, who is now a fugitive.

"I never had the opportunity to have a family of my own," Dorner supposedly wrote. "I'm terminating yours."

The killings have left the Quan and Lawrence families struggling with their loss. The Quans are in seclusion and not ready to talk about their daughter.

Lawrence's father, who lives in Denver, had just gotten to work when he heard the news from his wife. "I was caught in a whirlwind," said Kevin Lawrence, who could not immediately comprehend his son's death. "My first instinct was to get down there and protect him."

Lawrence met with the Quans last week and talked with them on the phone. They've discussed funeral arrangements and agreed that Monica and Keith should be buried at the same time. Neither family is ready to share details.

"Keith loved his life, and he loved Monica," Lawrence said.

Basketball was the center of the couples' lives, but it was more than a game for them.

"Basketball was an avenue for her to learn about other people," said Caffey, who coached Monica in a local league. "She was a competitor, and this was a way for her to enjoy friendships and build relationships."

She was 28, a year older than Keith. He was calm and collected on the court; she was spirited and fiery. He was a Clippers fan, and she rooted for the Lakers. She modeled herself after Michael Jordan, taking his number — 23 — as her own. Keith admired the play of point guard Steve Nash.

She wore red-and-black Air Jordans, and he didn't care about the brand as long as they were brightly colored, highlighter yellow, lime green, red. They both could have spent hours together shooting hoops or shopping at Nike, their favorite store. They would often meet friends at the restaurant and arcade, Dave & Busters.

"We joke that they are up in heaven at a Nike store, or playing basketball at Dave & Buster's," said Natasha Belou, a friend of Keith's.

He grew up playing ball with his father, who would try to block his outside shot with a broom to help him get more arc. His Moorpark High School coach, Tim Bednar, believed that Keith, who was just under 6 feet, would have made it to the NBA if he had been taller. After Keith's graduation, the school retired his jersey.

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