A delicate new balancing act in senior healthcare

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Two days later, that's where she was.

anna.gorman@latimes.com

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DC Comics Turns the Occupy Movement Into a Superhero Title

Eighteen months after the phrase first entered the collective public consciousness, the plight of the 99 percent is coming to mainstream superhero comics — via a new series from the second biggest publisher in the American comic industry, which just happens to be a subsidiary of a multi-national corporation that makes around $12 billion a year. Irony, anybody?

In May, DC Comics will launch two new series taking place in their mainstream superhero universe that offer different insights into the class struggle in a world filled with superheroes, alien races and inexplicable events. The Green Team, written by Tiny Titans and Superman Family Adventures creators Art Baltazar and Franco, with art by Ig Guara, revives an obscure 1975 concept about teenage rich kids who try to make the world a better place with their outrageous wealth. In an interview promoting the series, Franco promised that it would address questions like “Can money make you happy?” and “If you had unlimited wealth, could you use that to make the lives of people better?”

Obviously, this is one of the more fanciful series DC will be publishing.

But while DC is promoting The Green Team series as the adventures of the “1%,” its companion title, The Movement, is teased as a chance for us to “Meet the 99%… They were the super-powered disenfranchised — now they’re the voice of the people!”

“It’s a book about power,” explained The Movement writer Gail Simone. “Who owns it, who uses it, who suffers from its abuse. As we increasingly move to an age where information is currency, you get these situations where a single viral video can cost a previously unassailable corporation billions, or can upset the power balance of entire governments. And because the sources of that information are so dispersed and nameless, it’s nearly impossible to shut it all down.”

“The thing I find fascinating and a little bit worrisome is, what happens when a hacktivist group whose politics you find completely repulsive has this same kind of power and influence,” she elaborated in an interview at Big Shiny Robot. “What if a racist or homophobic group rises up and organizes in the same manner?”

While the concept is ambitious, the idea that a comic capable of living up to the book’s populist inspiration could come from DC Entertainment still strikes some as unlikely. Matt Pizzolo, the editor of the Occupy Comics anthology, told Wired that “though DC Comics did help launch Alan Moore and David Lloyd’s seminal anarchist epic V For Vendetta over two decades ago, it’s unlikely they would do so today. Between dismantling Vertigo and frankensteining Watchmen, the past year has demonstrated DC isn’t a safe place for bold creators who want to tell the kinds of stories that would inspire things like Occupy, rather than just cash in on them.”

Still, Simone says that the use of the iconography and language of a real-world populist movement is deliberate, promising that the book will reflect today’s decentralized political world and offer ”a slice of rarity that we’re unlikely to see in most superhero books.”

This wouldn’t the first time that DC has attempted to offer pre-packaged populist rebellion, of course; in addition to the aforementioned publication of the anti-establishment V For Vendetta, the company’s Vertigo imprint also published Grant Morrison’s The Invisibles, a series centering around an international organization struggling against forces of authority and repression that included anti-corporate themes.

Only time will tell whether The Movement will live up to the subversive examples of these earlier books, or just end up a well-intentioned piece of topical super heroics that trades on, and commodifies, a real political movement.

The Movement #1 will be available in both print and digital formats on May 1, while The Green Team #1 will be released on May 22.

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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Business Week in Pictures

Phil Libin, the chief executive of Evernote, during a staff meeting at Evernote’s headquarters in Redwood City, Calif. Evernote is among the privately held Silicon Valley start-ups that are worth more than $1 billion. An unprecedented number of high technology start-ups, easily 25 and possibly exceeding 40, have crossed that threshold. Many employees are quietly growing rich, or at least building a big cushion against a crash, as they sell shares to outside investors. Airbnb, Pinterest, SurveyMonkey and Spotify are among the better-known privately held companies that have reached $1 billion.

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Big Bear locked down amid manhunt

The bustling winter resort of Big Bear took on the appearance of a ghost town Thursday as surveillance aircraft buzzed overhead and police in tactical gear and carrying rifles patrolled mountain roads in convoys of SUVs, while others stood guard along major intersections.

Even before authorities had confirmed that the torched pickup truck discovered on a quiet forest road belonged to suspected gunman Christopher Dorner, 33, officials had ordered an emergency lockdown of local businesses, homes and the town's popular ski resorts. Parents were told to pick up their children from school, as rolling yellow buses might pose a target to an unpredictable fugitive on the run.

By nightfall, many residents had barricaded their doors as they prepared for a long, anxious evening.

PHOTOS: A tense manhunt amid tragic deaths

"We're all just stressed," said Andrea Burtons as she stocked up on provisions at a convenience store. "I have to go pick up my brother and get him home where we're safe."

Police ordered the lockdown about 9:30 a.m. as authorities throughout Southern California launched an immense manhunt for the former lawman, who is accused of killing three people as part of a long-standing grudge against the LAPD. Dorner is believed to have penned a long, angry manifesto on Facebook saying that he was unfairly fired from the force and was now seeking vengeance.

Forest lands surrounding Big Bear Lake are cross-hatched with fire roads and trails leading in all directions, and the snow-capped mountains can provide both cover and extreme challenges to a fugitive on foot. It was unclear whether Dorner was prepared for such rugged terrain.

Footprints were found leading from Dorner's burned pickup truck into the snow off Forest Road 2N10 and Club View Drive in Big Bear Lake.

San Bernardino County Sheriff John McMahon said that although authorities had deployed 125 officers for tracking and door-to-door searches, officers had to be mindful that the suspect may have set a trap.

"Certainly. There's always that concern and we're extremely careful and we're worried about this individual," McMahon said. "We're taking every precaution we can."

PHOTOS: A fugitive's life on Facebook

Big Bear has roughly 400 homes, but authorities guessed that only 40% are occupied year-round.

The search will probably play out with the backdrop of a winter storm that is expected to hit the area after midnight.

Up to 6 inches of snow could blanket local mountains, the National Weather Service said.

FULL COVERAGE: Sweeping manhunt for rampaging ex-cop

Gusts up to 50 mph could hit the region, said National Weather Service meteorologist Mark Moede, creating a wind-chill factor of 15 to 20 degrees.

Extra patrols were brought in to check vehicles coming and going from Big Bear, McMahon said, but no vehicles had been reported stolen.

"He could be anywhere at this point," McMahon said. When asked if the burned truck was a possible diversion, McMahon replied: "Anything's possible."

Dorner had no known connection to the area, authorities said.

Craig and Christine Winnegar, of Murrieta, found themselves caught up in the lockdown by accident. Craig brought his wife to Big Bear as a surprise to celebrate their 28th wedding anniversary. Their prearranged dinner was canceled when restaurant owners closed their doors out of fear.

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Fate of Historic Landsat Mission Hinges on Upcoming Launch

Since 1972 the Landsat mission has been monitoring natural and human-made changes to our planet. But the continuity of that scientifically precious dataset could be lost unless all goes according to plan on Monday, when the Landsat 8 satellite is scheduled to be launched into orbit from Vandenberg Air Force Base in California. Landsat 8 will take over for the hobbled 14-year old Landsat 7 that has been valiantly carrying the mission alone since December when, after 29 years in orbit, Landsat 5 began to be decommissioned after a gyroscope failure.

The launch is not likely to fail, but if it does, it won’t be the first time the continuity of the 40-year mission was jeopardized. Along the way funding has come under fire, ownership of the satellites has been transferred between government agencies and private companies, sensors have quit working, and one mission tragically failed to reach orbit. If Landsat 8 fails, Landsat 7 would run out of fuel near the end of 2016, before a replacement could be built and put into orbit.

“I’ve devoted the latter part of my career to the formulation and development of this mission,” the project’s lead scientist, James Irons, told Wired. “On Monday I go out there and look at my baby sitting on top of an enormous firecracker and hope everything goes well.”

“Yeah, I’ll be nervous.”

The scientists and engineers behind the Landsat mission will be hugely relieved once the craft is safely in place 700 kilometers above their heads and then begins beaming data back to Earth about a month later.

In addition to saving the mission from a gap in data, Landsat 8 — more officially known as the Landsat Data Continuity Mission – will boost the rate of coverage of the Earth and will also add more sensing capability and deliver better imagery than its predecessors.

Relying on Landsat 7 alone has meant only imaging the full Earth every 16 days. Once there are two eyes open, coverage will return to 8-day intervals, essentially doubling the resolution of landscape change that will be recorded.

“The major goal of the mission is for us to understand land cover and land use change, and determine the human impacts on the global landscape,” Irons said. “These changes are going on at rates unprecedented in human history.”

“Continuity is more important than ever.”

The new satellite will also add more sensing capability and deliver better imagery than its predecessors. Landsat 8 will measure all the spectral bands of its predecessors, but will add two new bands that are tailored for detecting the coastal zone and cirrus clouds.

The new satellite has a more advanced imaging design as well. Previous Landsat satellites used what is known as a whisk broom sensor system, where an oscillating mirror would sweep back and forth over a row of detectors that collect data across a 185-kilometer swath of the Earth. The new push system uses a very long array of more than 7,000 detectors that will view the 185 km swath simultaneously, alternately collecting light and recording data. This allows each detector to dwell on each pixel for a longer time, resulting in more detailed, accurate descriptions of the landscape.

Once Landsat 8 reaches orbit, the engineers will begin testing the spacecraft during the first week. The next few weeks will be dedicated to testing all the instruments. The satellite will then do a cross-over rendezvous with Landsat 7 to calibrate the two systems. Around day 25, the shutters will be opened and Landsat 8 will take its first look at Earth. By the end of May, the data should be flowing. The new satellite has a design life of five years, but it has enough fuel to operate for 10 years.

But first, the new craft has to get safely into orbit.

“I have a lot of assurance from everyone,” Irons said. “They are taking extraordinary care, proceeding very methodically, cautiously and rigorously.”

“Still, you realize all rocket launches have some inherent risk,” he said. “So, it’s just hold your breath and hope everything goes well.”

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Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

Friday Feb. 8 4:13 p.m. | Updated Thanks for all your responses. You can read about the winner at “Think Like a Doctor: A Confused and Terrified Patient Solved.”

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Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Correction: The patient’s eyes were brown, not blue.

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Trade Deficit Narrows, Brightening Outlook

The United States economy most likely expanded slightly in the fourth quarter, instead of contracting, according to trade data released Friday that suggested a surprise drop in gross domestic product reported last week may have been overstated.

The country’s trade deficit narrowed to $38.5 billion in December, its lowest reading in nearly three years, Commerce Department data showed. The decrease was driven by a drop in oil imports and a surge in exports. The overall trade gap was far smaller than analysts polled by Reuters had expected.

“Trade data for December paint a reassuring and encouraging picture of the U.S. economy at the end of last year,” said Chris Williamson, chief economist at Markit.

A separate report from the Commerce Department showed that wholesale inventories unexpectedly declined in December, a factor that could hamper the stronger trade figures’ effect on growth.

Still, the two reports together suggested the government could revise up its reading on fourth-quarter G.D.P., which showed the economy contracting at a 0.1 percent annual rate. That decline was driven by an expected drop in exports, smaller gains in inventories and a plunge in military spending.

Barclays said that even with December’s decline in wholesale inventories, the economy most likely expanded 0.3 percent in the fourth quarter, thanks to the higher export numbers in Friday’s trade report.

American exports increased by $8.6 billion in December over the year-ago month, lifted by sales of industrial supplies, including a $1.2 billion rise from November in nonmonetary gold.

Reflecting the country’s current boom in oil and natural gas, petroleum exports rose by nearly $1 billion during the month to a record high.

A fall in petroleum purchases led overall imports to decline by $4.6 billion in December from the year-ago period.

For the entire year, the country’s imports of crude oil fell to their lowest levels since 1997 in terms of volume.

Stocks prices on American exchanges rose as investors took note of the strong trade data, which included the United States figures as well as readings showing stronger exports and imports in China during January. The price of the benchmark 10-year Treasury note also rose.

For all of 2012, the United States trade gap shrank by 3.5 percent, to $540.4 billion. Running trade deficits means the country loses dollars, which drags on the economy; rising exports reduce that effect.

Exports last year rose 4.4 percent.

Even the American trade balance with China had a silver lining. While imports from China increased to a record high last year, so did American exports there. The December trade deficit in goods with China, not seasonally adjusted, narrowed by $4.5 billion from the previous month on a drop in imports.

Also in December, United States wholesale inventories unexpectedly fell as auto dealers and agricultural suppliers drew down their stocks.

The Commerce Department said stocks of unsold goods at wholesalers dropped 0.1 percent during the month and grew less than initially estimated in November.

Economists polled by Reuters had expected wholesale inventories to rise 0.4 percent.

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Ex-cop at center of manhunt called 'depraved,' 'cowardly'

Those who knew Christopher Jordan Dorner during college expressed shock at the news that the former college football player is allegedly responsible for shootings that have left three people dead and two wounded.

Dorner attended Southern Utah University from 1997 to 2001 and graduated with a bachelor of science with a major in political science and a minor in psychology, a university spokesman said.

Neil Gardner, an assistant athletic director who works with the student athletes in media relations, interacted with Dorner when he was on the school’s football team during the 1999 and 2000 seasons. Gardner said Dorner was a backup running back who didn’t play a lot, but was “never a disgruntled guy.”

PHOTOS: Manhunt for ex-LAPD officer

“When he was in college he was a great kid,” Gardner said. “He was a kid you hoped would do well. He was polite. I liked him.” 

Jamie Usera, an attorney in Salem, Ore., said he met Dorner in the spring of 1998 at Southern Utah. Usera, who grew up in Alaska, said he and Dorner, an African American from Southern California, bonded over their shared feelings of culture shock that came with being outsiders on the predominantly white, Mormon campus.

Usera and Dorner eventually joined the football team as running backs and became good friends, Usera said. They shared long hours on the practice field, but neither saw much playing time and both decided to quit the team after two years.

PHOTOS: Manhunt for ex-LAPD officer

The friendship endured throughout their remaining years at the school. Usera said he introduced Dorner to the world of hunting and other outdoor sporting. Usera recalled frequent trips into the Utah desert to hunt rabbits with Dorner.

Nothing about Dorner in college raised any red flags that he was mentally unstable or capable of such violence, Usera said.

“He was a typical guy. I liked him an awful lot,” Usera said. “Nothing about him struck me as violent or irrational in any way.  He was opinionated, but always seemed level-headed.”

Usera said he and Dorner frequently had lively discussions. A recurring theme was race relations in the U.S., and the two often had heated but respectful arguments about the extent of racism in the county, Usera said.

A manifesto that police say was published on what they believe was Dorner’s Facebook page  made reference to Usera. A section read:

“James Usera, great friend, attorney, father, husband, and the most cynical/blatant/politically incorrect friend a man can have. Best quality about you in college and now is that you never sugar coated the truth. I will miss our political discussions that always turned argumentative. Thanks for introducing me to outdoor sports like fishing, hunting, mudding, and also respect for the land and resources. Us city boys don’t get out much like you Alaskans. You even introduced me to PBR. A beer, that when you’re a poor college student is completely acceptable to get buzzed off of. I’m sorry I’ll never get to go on that moose and bear hunt with you. I love you bro.”

Usera could not recall Dorner ever discussing a dream or plan to become a police officer. He remembered his friend talking excitedly with a Marine or Navy recruiter on campus when he was either considering enlisting or after he had already made the decision to do so.

The two lost touch quickly after graduating, Dorner said, but later reconnected out of the blue about four years ago with a phone call. Dorner made passing reference to his discipline problems with the LAPD but did not go into detail. Usera said Dorner did not seem troubled during the 10- to 15-minute conversation. A few text messages followed in the days after the call, but Usera said he had not heard from Dorner since.

“Of all the people I hung out with in college, he is the last guy I would have expected to be in this kind of situation.”

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Investigators Pinpoint a Short Circuit Within a 787 Dreamliner Battery

The National Transportation Safety Board believes an internal short circuit within a single cell inside a lithium-ion battery led to a fire aboard a Boeing 787, shedding new light on the battery problem that has grounded every one of the 50 Dreamliners in service worldwide.

The agency said Wednesday that it has completed disassembling the 32-volt battery that caught fire on a Japan Airlines 787 after passengers had disembarked in Boston on January 7. Investigators found evidence that the fire — called “thermal runaway” — started with a short circuit in cell no 6. There are eight cells in the 63-pound lithium-ion battery, and the NTSB said it found evidence that cell no. 6 sustained multiple short circuits. Investigators have ruled out mechanical damage as a cause of the short, as well as the possibility that the short circuit occurred between the cell and the battery case. Rather, the damage to the case containing the battery was caused by the fire that resulted from the short.

“The short circuit came first, the thermal runaway followed in cell no. 6 and it propagated to the other cells,” NTSB chairman Deborah Hersman told reporters in a press conference this morning. Hersman said they have yet to find the cause of the short circuit but are looking at several possibilities.

“We are looking at the state of charge of the battery cells, we are looking at manufacturing processes and we are looking at the design of the battery,” she said.

The new information came the same day that Boeing flew a 787 from its paint facility in Texas back to its factory north of Seattle. The flight was a one-time-only ferry flight approved by the Federal Aviation Administration, and only the pilots were allowed aboard. They closely monitored the battery during the flight to Paine Field and experienced no problems during the three-and-a-half-hour trip. It was the first flight of a 787 since the entire fleet of Dreamliners was grounded pending an investigation by the FAA.

Late today the FAA announced they will allow limited test flights by Boeing to collect data about the battery and electrical systems during flight. The test flights will be flown over unpopulated areas with just the Boeing crew on board the aircraft. Like today’s flight, pilots will carefully monitor the batteries and will be required to land immediately in the case of a battery malfunction. One of Boeing’s 787 flight-test work horses, ZA005, will be used for the flights.

Boeing, along with investigators in the United States and Japan, have focused on the lithium-ion battery from the start. And today’s announcement that the problem appears to have started with a short circuit within a cell is exactly what battery expert Dr. K.M. Abraham suggested was the problem when we spoke with him last month. The lithium-ion cells within the 787 batteries use a graphite-coated copper anode and a lithium cobalt oxide-coated aluminum cathode. The anode and cathode are separated by a very thin polyethylene film known as the separator.

The separator is roughly the same thickness as cellophane and behaves in a similar way. There doesn’t need to be a tear or a hole to create a short circuit that can cause thermal runaway. The material is very thin – typically around 25 microns, according to Abraham – and small irregularities in the thickness can be enough to lead to problems. A section of the separator that is just 20 microns thick might be enough.

“It could be a stretch, it doesn’t necessarily have to be a big hole, just a weak point where you have low resistance,” Abraham said. “It can be a problem when you have such a very large surface area electrode where there is a lot of inhomogeneity in the current distribution.”

The variable thickness of the separator material could be a result of manufacturing, but also could occur during charging and discharging of the battery. A very small short might lead to the growth of a lithium crystal within the battery cell.

“Sometimes what happens is you start with a very small dendrite growth due to an internal short,” Abraham says of the small fibers of lithium metal that can grow in the cell, “but it gradually heats up because gas can pass through it and heat up that location.”

And just like cellophane, the separator can shrink when it is heated, Abraham says, “once it starts heating up slowly it will shrink and then a small short will become a massive short.”

Abraham, agreeing with comments made by Tesla Motors CEO Elon Musk, said the relatively large cells in the 787 battery pose a problem. The large surface area of each cell makes the separators particularly susceptible to shorting, Abraham said. The problem of the separator changing thickness due to heating is something addressed in the batteries used in the Chevrolet Volt. The separator is less likely to change thickness due to heating, according to Abraham.

“That was overcome in the Chevrolet Volt separator where they reinforced the separator with ceramic particles to mitigate the shrinking problem,” he said.

According to the NTSB, the separators used in the 787 batteries are not reinforced with ceramic particles.

The NTSB chairwoman told reporters the agency also is looking into the certification of the Dreamliner. Because the 787 is replete with new technology, the FAA had to create nine special conditions for use of the lithium-ion batteries. Much of the testing was performed by Boeing, which performed several rigorous tests including one so grueling as to be called “abusive” to the battery, Hersman said.

Boeing saw no evidence during testing of a problem that would lead to the cell failure propagation the NTSB saw in the battery that caught fire in Boston. Hersman also said Boeing’s tests indicated it was extremely unlikely that a battery problem would generate smoke, much less fire. The difference between the predicted likelihood and the recent events did not sit well with Hersman.

“The design and certification assessment and the assumptions that were made were not born out by what we saw,” she said, speaking about the battery fires in Boston and Japan. “We had two events in two weeks on two separate aircraft. The fleet has less than 100,000 hours and [Boeing] did not expect in their assessment to see a smoke event in but less than 1 in every 10,000,000 hours.”

In a statement released after the NTSB press conference, Boeing said it welcomes the progress being made in the investigation. The company also said it worked within FAA guidelines during certification.

“The 787 was certified following a rigorous Boeing test program and an extensive certification program conducted by the FAA,” the statement read. “We provided testing and analysis in support of the requirements of the FAA special conditions associated with the use of lithium ion batteries.”

Hersman said the NTSB will release an interim report within 30 days. That means the fleet most likely will remain grounded at least another month. Boeing is working on several possible fixes to the issue, including designs that will better protect the electrical bays and aircraft from any potential fire damage.

Meanwhile, several airlines, including All Nippon Airways and United, continue cancelling 787 flights many weeks into the future.

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