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

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

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

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative, which will provide the vaccine and help pay for the campaign.

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

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

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

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

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

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

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

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

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

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Time Inc. and Meredith Prepare to Join Magazine Businesses

Mary Chind/The Des Moines Register

Meredith, a magazine company, is headquartered in Des Moines.

When Jack Griffin, the former president of the magazine company Meredith, took the reins at Time Inc., he threw a holiday party for his staff on the 34th floor of the Time & Life Building. For many employees at the famously hierarchal company, their first visit to the rambling executive suites that inspired the sets of “Mad Men” became known as “The Miracle on 34th.”

Mr. Griffin lasted just six months at Time before he was asked to leave by Jeffrey L. Bewkes, the chief executive of its parent company, Time Warner, who publicly rebuked Mr. Griffin, saying that his “leadership style and approach did not mesh with Time Inc. and Time Warner.”

As bankers and media executives hammer out the details of creating a new publicly traded company to house the magazine titles of the Meredith Corporation and the lifestyle titles of Time Inc., employees at both companies have been wondering how executives will take on the harder task of merging two very different corporate cultures.

Meredith’s headquarters in Des Moines have an open floor plan; the executives have their offices on the first floor and favor early-morning meetings. A recent lunch at one of Meredith’s magazines featured kale salad and rosemary-infused cucumber lemonade. Time executives tend toward lunches at Michael’s, where the dry-aged steak is a highlight, and after-work cocktails at the Lamb’s Club.

And then there are the postrecessionary approaches to travel: Meredith’s chief executive turned its corporate jets into shuttles with open seating, while Time still allows staff members to expense hotel rooms at the Four Seasons.

“It’s like the Yankees’ farm team taking over the Yankees,” according to a current Time Inc. executive who, like many who talked about the merger, declined to be identified while criticizing bosses or potential bosses.

The merger news appears to be more troubling to employees at the long revered Time Inc., whose lucrative titles like People and InStyle have been essentially sold off by Time Warner and are likely to be overseen by Meredith’s chief executive, Stephen M. Lacy. Time Inc. employees have made cracks about Des Moines and shared more sobering fears about the merger.

And unanswered questions swirl around the offices: Will Time Inc.’s Cooking Light and its fierce rival at Meredith, Eating Well, be expected to share intelligence? Can celebrity titles like People and InStyle flourish sharing a publisher with Wood magazine? And, most important of all, how many former Time Inc. executives might be moved to Iowa?

Press officers for both Time and Meredith declined to comment about any specific negotiations. But an earlier effort to blend Meredith’s folksy culture with the titans of Time failed quickly.

In August 2010, Mr. Griffin became the first chief executive to join Time Inc. from outside the company. His efforts to restructure some of the company’s entrenched hierarchy and infuse his management experiences from Meredith were largely rebuffed. While he garnered praise for the holiday party, staff members bristled when Mr. Griffin, a marathon runner, introduced 7:30 a.m. breakfast meetings — similar to the daily meetings he attended at Meredith, but a shock to the culture at Time Inc., where late nights on deadline are typical.

But this time, Time and Meredith are blending the titles that magazine industry executives say are more compatible. Time is holding onto the older titles that gave the company its gravitas, like Time, Fortune and Sports Illustrated. The new company will include titles it created or purchased in recent decades, like the cash cows People and InStyle and smaller titles like Southern Living and This Old House.

Both companies also have major workforces beyond their home cities. Only 3,000 of Time Inc.’s nearly 8,000 employees are based in New York City, with offices in London and Birmingham, Ala. Meredith has its 1,000 magazine employees split evenly between its midtown offices on Third Avenue and its headquarters in Des Moines.

“If you take Time, Fortune and Sports Illustrated from the mix, you have much greater similarity to the titles that are left than differences,” said Peter Kreisky, who worked as a senior adviser to Mr. Griffin at Time Inc. and who also has advised Meredith in the past.

This article has been revised to reflect the following correction:

Correction: February 25, 2013

An earlier version of this article misstated the year Nancy Williamson left Time Inc. She retired in 1998, not 1989.

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Brown's school funding plan draws mixed reactions

In the Anaheim City School District, where most students are low-income and struggling to learn English, teachers need special training, extra tutoring time and lots of visual materials to help their pupils achieve at grade level.

In the well-heeled Palos Verdes Peninsula Unified School District, poverty and limited English are not widespread problems. But officials there say their student needs include more expensive Advanced Placement classes to challenge them with college-level material in high school.

Who should get more state educational dollars? Last week, school districts got their first glimpse of how that question would be answered under Gov. Jerry Brown's proposed new funding formula: Anaheim would receive an estimated $11,656 per student annually; Palos Verdes would get $8,429 by the time the plan is fully implemented in seven years.

And that disparity draws distinctly different reactions.

"It's great news," said Darren Dang, Anaheim's assistant superintendent of administrative services. "Given our demographics, we'll be getting much-needed resources for our students."

But Lydia Cano, Palos Verdes' deputy superintendent of business services, said she believed the new scheme would shortchange her students. Disadvantaged students already receive a bigger share of state and federal dollars, she said.

"It's not fair," she said. "It will make the divide even bigger."

In the most significant change in four decades in how school dollars would be distributed, Brown is proposing to give all districts a base grant, then add an extra 35% of that for each student who is low-income, struggling with English or in foster care. If such students make up more than 50% of a district's population, another 35% supplement would be given.

The formula is part of Brown's proposed budget, which requires the Legislature's approval.

Under the proposal, the state would do away with most so-called categorical funding — which was earmarked for such specific uses as textbooks, remediation and low-income student aid. Instead, the money would be given directly to districts with no strings attached, to promote Brown's goal of greater local control.

The plan is aimed at reforming what most educators agree is an inequitable, burdensome and overly complex funding system. It is grounded in a 2008 report coauthored by state Board of Education President Michael Kirst that compiled research showing that parental income and English language ability are two critical factors in academic achievement.

Kirst argued that it was more important to help needy students gain grade-level skills than it is to provide college-level work for top-achieving high schoolers. "These are judgments about political priorities," he said.

About 20 states currently distribute extra dollars to needier students, including Rhode Island and New York, according to Margaret Weston of the Public Policy Institute of California. Poor districts in California already receive about 20% more in state and federal dollars than do affluent ones, but Brown's formula would increase that share, she said.

After four years of crippling budget cuts, the Los Angeles Unified School District is expected to receive an estimated boost of $820 more per student over the next two years under Brown's proposal. By 2020, funding is expected to grow to $11,993 per student from $7,509 last year.

L.A. Supt. John Deasy hailed the governor's proposal. "It's morally the right thing to do and educationally the sound thing to do," he said.

Like many administrators, however, Deasy cautioned that it would take a few years of increases to make up for the state's devastating reductions since 2007. New spending could possibly begin in 2015, he said, adding that he would recommend restorations in summer school, counselors, arts and support staff, among other things.

He also said he would make it the district's "policy and practice" to send the state dollars for disadvantaged students directly to their schools to help them. Some officials, such as Dang in Anaheim, have expressed concerns about possible pressure to use the money for salary hikes.

Over the next five years, per-student funding is expected to grow by about $2,700, the state estimates showed. All school districts and charter schools would receive at least as much money this year as last.

In Los Angeles County, funding estimates range from a low of $7,863 per student in the Hermosa Beach City School District to $13,569 for Animo Leadership High, an independent charter school in Inglewood.

Long Beach, San Bernardino City and Santa Ana unified all are estimated to receive funding boosts of $800 to $1,000 per student over the next two years. But the state projects an increase of less than half that for more affluent districts, such as San Marino, Palos Verdes Peninsula and Manhattan Beach unified.

Julie Boucher, San Marino's assistant superintendent of business services, said she was dismayed that Brown was not proposing to first restore general funding that the state has cut since 2007 before allocating additional dollars to specific students.

San Marino's state funding has been slashed by $17 million since 2008 — a total equivalent to 60% of its annual budget. The district has received $3.1 million annually from its nonprofit fundraising foundation and $5.1 million from a parcel tax but still has worked with its employee unions to freeze salaries, require larger contributions for healthcare, cut 26 teaching positions and shorten the school calendar with unpaid furlough days, she said.

"It does not seem equitable given the fact that we're all down," she said of Brown's proposal. "First we need to be made whole. Don't rob Peter to pay Paul."

During a recent visit to Ponderosa Elementary School in Anaheim, however, educators demonstrated how teaching lower-income English learners is more costly and time-consuming.

In Bernadette Grzechowiak's fifth-grade classroom, for instance, students were learning how to find main ideas in a passage about Native Americans. But unlike fluent English speakers, she said, those with limited language skills need far more visual aids — presented every 60 to 90 seconds, according to research. Her room is filled with graphics about colonial America and sentence frames to teach them academic language, such as "One detail that supports the main idea is…"

Grzechowiak said she learned those and other techniques from a district-paid teaching coach.

Ponderosa has also spent $10,000 on a science book series heavy on photos and graphics to help students learning English. And the school has two full-time teachers to provide extra support for struggling students and a bilingual community liaison to help educate the school's largely immigrant parents about their children's academic needs.

"Kids are so hungry and ready to learn," said Maria Villegas, the principal. "It just takes time, opportunity and having a great staff."

teresa.watanabe@latimes.com

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Wired Space Photo of the Day: Glowing Gas in Omega Nebula

This image is a colour composite of the Omega Nebula (M 17) made from exposures from the Digitized Sky Survey 2 (DSS2). The field of view is approximatelly 4.7 x 3.7 degrees.

Image: ESO/Digitized Sky Survey 2. Acknowledgment: Davide De Martin. [high-resolution]

Caption: ESO

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The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain

Matt Rainwaters for Texas Monthly

The Sherman grave of Andre Thomas’s victims.

SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org

Matt Rainwaters for Texas Monthly

Laura Boren

He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.

He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.

In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.

Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.

“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.

From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.

bgrissom@texastribune.org

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Major Banks Aid in Payday Loans Banned by States

Major banks have quickly become behind-the-scenes allies of Internet-based payday lenders that offer short-term loans with interest rates sometimes exceeding 500 percent.

With 15 states banning payday loans, a growing number of the lenders have set up online operations in more hospitable states or far-flung locales like Belize, Malta and the West Indies to more easily evade statewide caps on interest rates.

While the banks, which include giants like JPMorgan Chase, Bank of America and Wells Fargo, do not make the loans, they are a critical link for the lenders, enabling the lenders to withdraw payments automatically from borrowers’ bank accounts, even in states where the loans are banned entirely. In some cases, the banks allow lenders to tap checking accounts even after the customers have begged them to stop the withdrawals.

“Without the assistance of the banks in processing and sending electronic funds, these lenders simply couldn’t operate,” said Josh Zinner, co-director of the Neighborhood Economic Development Advocacy Project, which works with community groups in New York.

The banking industry says it is simply serving customers who have authorized the lenders to withdraw money from their accounts. “The industry is not in a position to monitor customer accounts to see where their payments are going,” said Virginia O’Neill, senior counsel with the American Bankers Association.

But state and federal officials are taking aim at the banks’ role at a time when authorities are increasing their efforts to clamp down on payday lending and its practice of providing quick money to borrowers who need cash.

The Federal Deposit Insurance Corporation and the Consumer Financial Protection Bureau are examining banks’ roles in the online loans, according to several people with direct knowledge of the matter. Benjamin M. Lawsky, who heads New York State’s Department of Financial Services, is investigating how banks enable the online lenders to skirt New York law and make loans to residents of the state, where interest rates are capped at 25 percent.

For the banks, it can be a lucrative partnership. At first blush, processing automatic withdrawals hardly seems like a source of profit. But many customers are already on shaky financial footing. The withdrawals often set off a cascade of fees from problems like overdrafts. Roughly 27 percent of payday loan borrowers say that the loans caused them to overdraw their accounts, according to a report released this month by the Pew Charitable Trusts. That fee income is coveted, given that financial regulations limiting fees on debit and credit cards have cost banks billions of dollars.

Some state and federal authorities say the banks’ role in enabling the lenders has frustrated government efforts to shield people from predatory loans — an issue that gained urgency after reckless mortgage lending helped precipitate the 2008 financial crisis.

Lawmakers, led by Senator Jeff Merkley, Democrat of Oregon, introduced a bill in July aimed at reining in the lenders, in part, by forcing them to abide by the laws of the state where the borrower lives, rather than where the lender is. The legislation, pending in Congress, would also allow borrowers to cancel automatic withdrawals more easily. “Technology has taken a lot of these scams online, and it’s time to crack down,” Mr. Merkley said in a statement when the bill was introduced.

While the loans are simple to obtain — some online lenders promise approval in minutes with no credit check — they are tough to get rid of. Customers who want to repay their loan in full typically must contact the online lender at least three days before the next withdrawal. Otherwise, the lender automatically renews the loans at least monthly and withdraws only the interest owed. Under federal law, customers are allowed to stop authorized withdrawals from their account. Still, some borrowers say their banks do not heed requests to stop the loans.

Ivy Brodsky, 37, thought she had figured out a way to stop six payday lenders from taking money from her account when she visited her Chase branch in Brighton Beach in Brooklyn in March to close it. But Chase kept the account open and between April and May, the six Internet lenders tried to withdraw money from Ms. Brodsky’s account 55 times, according to bank records reviewed by The New York Times. Chase charged her $1,523 in fees — a combination of 44 insufficient fund fees, extended overdraft fees and service fees.

For Subrina Baptiste, 33, an educational assistant in Brooklyn, the overdraft fees levied by Chase cannibalized her child support income. She said she applied for a $400 loan from Loanshoponline.com and a $700 loan from Advancemetoday.com in 2011. The loans, with annual interest rates of 730 percent and 584 percent respectively, skirt New York law.

Ms. Baptiste said she asked Chase to revoke the automatic withdrawals in October 2011, but was told that she had to ask the lenders instead. In one month, her bank records show, the lenders tried to take money from her account at least six times. Chase charged her $812 in fees and deducted over $600 from her child-support payments to cover them.

“I don’t understand why my own bank just wouldn’t listen to me,” Ms. Baptiste said, adding that Chase ultimately closed her account last January, three months after she asked.

A spokeswoman for Bank of America said the bank always honored requests to stop automatic withdrawals. Wells Fargo declined to comment. Kristin Lemkau, a spokeswoman for Chase, said: “We are working with the customers to resolve these cases.” Online lenders say they work to abide by state laws.

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Athletes cash in on California's workers' comp

SACRAMENTO — In his seven-year career with the Denver Broncos, running back Terrell Davis, a former Super Bowl Most Valuable Player, dazzled fans with his speed and elusiveness.

At the end of his rookie year in 1995, he signed a $6.8-million, five-year contract. Off the field he endorsed Campbell's soup. And when he hung up his cleats, he reported for the National Football League Network and appeared in movies and TV shows.

So it may surprise Californians to find out that in 2011, Davis got a $199,000 injury settlement from a California workers' compensation court for injuries related to football. This came despite the fact Davis was employed by a Colorado team and played just nine times in California during an 88-game career, according to the NFL.

Davis was compensated for the lifelong effects of multiple injuries to the head, arms, trunk, legs and general body, according to California workers' compensation records.

He is not alone.

Over the last three decades, California's workers' compensation system has awarded millions of dollars in benefits for job-related injuries to thousands of professional athletes. The vast majority worked for out-of-state teams; some played as little as one game in the Golden State.

All states allow professional athletes to claim workers' compensation payments for specific job-related injuries — such as a busted knee, torn tendon or ruptured spinal disc — that happened within their borders. But California is one of the few that provides additional payments for the cumulative effect of injuries that occur over years of playing.

A growing roster of athletes are using this provision in California law to claim benefits. Since the early 1980s, an estimated $747 million has been paid out to about 4,500 players, according to an August study commissioned by major professional sports leagues. California taxpayers are not on the hook for these payments. Workers' compensation is an employer-funded program.

Now a major battle is brewing in Sacramento to make out-of-state players ineligible for these benefits, which are paid by the leagues and their insurers. They have hired consultants and lobbyists and expect to unveil legislation next week that would halt the practice.

"The system is completely out of whack right now," said Jeff Gewirtz, vice president of the Brooklyn Nets — formerly the New Jersey Nets — of the National Basketball Assn.

Major retired stars who scored six-figure California workers' compensation benefits include Moses Malone, a three-time NBA most valuable player with the Houston Rockets, Philadelphia 76ers and other teams. He was awarded $155,000. Pro Football Hall of Fame wide receiver Michael Irvin, formerly with the Dallas Cowboys, received $249,000. The benefits usually are calculated as lump-sum payments but sometimes are accompanied by open-ended agreements to provide lifetime medical services.

Players, their lawyers and their unions plan to mount a political offensive to protect these payouts.

Although the monster salaries of players such as Los Angeles Lakers guard Kobe Bryant and Denver Broncos quarterback Peyton Manning make headlines, few players bring in that kind of money. Most have very short careers. And some, particularly football players, end up with costly, debilitating injuries that haunt them for a lifetime but aren't sufficiently covered by league disability benefits.

Retired pros increasingly are turning to California, not only because of its cumulative benefits but also because there's a longer window to file a claim. The statute of limitations in some states expires in as little as a year or two.

"California is a last resort for a lot of these guys because they've already been cut off in the other states," said Mel Owens, a former Los Angeles Rams linebacker-turned-workers' compensation lawyer who has represented a number of ex-players.

To understand how it works, consider the career of Ernie Conwell. A former tight end for the St. Louis Rams and New Orleans Saints, he was paid $1.6 million for his last season in 2006.

Conwell said that during his 11-year career, he underwent about 18 surgeries, including 11 knee operations. Now 40, he works for the NFL players union and lives in Nashville.

Hobbled by injuries, he filed for workers' compensation in Louisiana and got $181,000 in benefits to cover his last, career-ending knee surgery in 2006, according to the Saints. The team said it also provided $195,000 in injury-related benefits as part of a collective-bargaining agreement with the players union.

But such workers' compensation benefits paid by Louisiana cover only specific injuries. So, to deal with what he expects to be the costs of ongoing health problems that he said affect his arms, legs, muscles, bones and head, Conwell filed for compensation in California and won.

Even though he played only about 20 times in the state over his professional career, he received a $160,000 award from a California workers' compensation judge plus future medical benefits, according to his lawyer. The Saints are appealing the judgment.

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That Syncing Feeling

“Smart, or stylish?” That’s the question facing casual watch aficionados looking for a new, high-tech addition to their collection.

On one hand (er, wrist), you’ve got the Pebble and other smartwatch upstarts, which come with built-in smartphone connectivity, customizable screens, and burgeoning developer communities eager to feed their app ecosystems. They also, by and large, look like uninspired pieces of mass-produced Chinese plastic, and that’s because they are.

On the “stylish” end of the spectrum is … not much. Except this: Citizen’s Eco-Drive Proximity.

The Citizen learns the current time from your phone, and the watch’s hands spin around to the correct positions.

By all outward appearances, the Proximity looks like any another chronograph in a sea of handsome mechanical watches. It has all the features you’d expect, including a 24-hour dial, day and date, perpetual calendar and second time zone. But housed within its slightly oversized 46mm case is a Bluetooth 4.0 radio, so it’s capable of passing data over the new low-energy connectivity standard appearing in newer smartphones, including the iPhone 5 and 4S. And for now, the Promixity is only compatible with those Apple devices.

Initial pairing is relatively easy. After downloading Citizen’s notably low-rent iOS app, you can link the watch to your phone with a few turns and clicks on the crown.

The gee-whiz feature is the automatic time sync that takes place whenever you land in a different time zone. Once connected, the Citizen learns the current time from your phone, and the watch’s hands spin around to the correct positions — a welcome bit of easy magic, considering the initial setup is a tedious finger dance.

The watch can also notify you of incoming communications. Once you’ve configured the mail client (it only supports IMAP accounts), you’ll get notified whenever you get a new e-mail — there’s a slight vibration and the second hand sweeps over to the “mail” tab at the 10-o’clock position. If a phone call comes in, the second hand moves to the 11-o’clock marker. If the Bluetooth connection gets lost because the watch or phone is outside the 30-foot range, you get another vibration and the second hand moves to the “LL” indicator. And really, that’s the extent of the functionality around notifications.

But notable in its absence is the notification I’d like the most: text message alerts. And it’s not something Citizen will soon be rectifying because the dials and hardware aren’t upgradable.

I also experienced frequent connection losses, particularly when attending a press conference with scads of Mi-Fis and tethered smartphones around me. This caused dozens of jarring vibrations both on my wrist and in my pocket, followed by a raft of push notifications on my phone informing me of the issue. Reconnecting is easy (and generally happens automatically), but the lack of stability in certain environments matched with the limited capabilities of the notifications had me forgetting to reconnect and not even worrying about it later on.

But actually, I’m OK with that. I still like the fact that it never needs charging. Even though there aren’t any solar cells visible on the dial, the watch does have them. They’re hidden away beneath the dial, and yet they still work perfectly. And even when its flagship connectivity features aren’t behaving, it’s still a damn handsome watch. It feels solid, and it looks good at the office, out to dinner, or on the weekend — something very few other “smart” watches on the market can claim.

However, those things can be said of almost all of Citizen’s EcoDrive watches. The big distinguishing feature here is the Bluetooth syncing and notifications, and they just don’t work that well.

WIRED A smart watch you won’t be embarrassed to wear. Charges using light. Combines classic styling with cutting-edge connectivity. Subtle notifications keep you informed without dominating your attention.

TIRED Loses Bluetooth connection with disturbing frequency. Limited notification abilities. No text message alerts. Janky iPhone app.

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Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

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Major Banks Aid in Payday Loans Banned by States

Major banks have quickly become behind-the-scenes allies of Internet-based payday lenders that offer short-term loans with interest rates sometimes exceeding 500 percent.

With 15 states banning payday loans, a growing number of the lenders have set up online operations in more hospitable states or far-flung locales like Belize, Malta and the West Indies to more easily evade statewide caps on interest rates.

While the banks, which include giants like JPMorgan Chase, Bank of America and Wells Fargo, do not make the loans, they are a critical link for the lenders, enabling the lenders to withdraw payments automatically from borrowers’ bank accounts, even in states where the loans are banned entirely. In some cases, the banks allow lenders to tap checking accounts even after the customers have begged them to stop the withdrawals.

“Without the assistance of the banks in processing and sending electronic funds, these lenders simply couldn’t operate,” said Josh Zinner, co-director of the Neighborhood Economic Development Advocacy Project, which works with community groups in New York.

The banking industry says it is simply serving customers who have authorized the lenders to withdraw money from their accounts. “The industry is not in a position to monitor customer accounts to see where their payments are going,” said Virginia O’Neill, senior counsel with the American Bankers Association.

But state and federal officials are taking aim at the banks’ role at a time when authorities are increasing their efforts to clamp down on payday lending and its practice of providing quick money to borrowers who need cash.

The Federal Deposit Insurance Corporation and the Consumer Financial Protection Bureau are examining banks’ roles in the online loans, according to several people with direct knowledge of the matter. Benjamin M. Lawsky, who heads New York State’s Department of Financial Services, is investigating how banks enable the online lenders to skirt New York law and make loans to residents of the state, where interest rates are capped at 25 percent.

For the banks, it can be a lucrative partnership. At first blush, processing automatic withdrawals hardly seems like a source of profit. But many customers are already on shaky financial footing. The withdrawals often set off a cascade of fees from problems like overdrafts. Roughly 27 percent of payday loan borrowers say that the loans caused them to overdraw their accounts, according to a report released this month by the Pew Charitable Trusts. That fee income is coveted, given that financial regulations limiting fees on debit and credit cards have cost banks billions of dollars.

Some state and federal authorities say the banks’ role in enabling the lenders has frustrated government efforts to shield people from predatory loans — an issue that gained urgency after reckless mortgage lending helped precipitate the 2008 financial crisis.

Lawmakers, led by Senator Jeff Merkley, Democrat of Oregon, introduced a bill in July aimed at reining in the lenders, in part, by forcing them to abide by the laws of the state where the borrower lives, rather than where the lender is. The legislation, pending in Congress, would also allow borrowers to cancel automatic withdrawals more easily. “Technology has taken a lot of these scams online, and it’s time to crack down,” Mr. Merkley said in a statement when the bill was introduced.

While the loans are simple to obtain — some online lenders promise approval in minutes with no credit check — they are tough to get rid of. Customers who want to repay their loan in full typically must contact the online lender at least three days before the next withdrawal. Otherwise, the lender automatically renews the loans at least monthly and withdraws only the interest owed. Under federal law, customers are allowed to stop authorized withdrawals from their account. Still, some borrowers say their banks do not heed requests to stop the loans.

Ivy Brodsky, 37, thought she had figured out a way to stop six payday lenders from taking money from her account when she visited her Chase branch in Brighton Beach in Brooklyn in March to close it. But Chase kept the account open and between April and May, the six Internet lenders tried to withdraw money from Ms. Brodsky’s account 55 times, according to bank records reviewed by The New York Times. Chase charged her $1,523 in fees — a combination of 44 insufficient fund fees, extended overdraft fees and service fees.

For Subrina Baptiste, 33, an educational assistant in Brooklyn, the overdraft fees levied by Chase cannibalized her child support income. Ms. Baptiste said she applied for a $400 loan from Loanshoponline.com and a $700 loan from Advancemetoday.com in 2011. The loans, with annual interest rates of 730 percent and 584 percent respectively, skirt New York law.

Ms. Baptiste said she asked Chase to revoke the automatic withdrawals in October 2011, but was told that she had to ask the lenders instead. In one month, her bank records show, the lenders tried to take money from her account at least six times. Chase charged her $812 in fees and deducted more than $600 from her child-support payments to cover them.

“I don’t understand why my own bank just wouldn’t listen to me,” Ms. Baptiste said, adding that Chase ultimately closed her account last January, three months after she asked.

A spokeswoman for Bank of America said the bank always honored requests to stop automatic withdrawals. Wells Fargo declined to comment. Kristin Lemkau, a spokeswoman for Chase, said: “We are working with the customers to resolve these cases.” Online lenders say they work to abide by state laws.

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