Ukraine fights spreading HIV epidemic

BUCHA, Ukraine (AP) — Andrei Mandrykin, an inmate at Prison No. 85 outside Kiev, has HIV. He looks ghostly and much older than his 35 years. But Mandrykin is better off than tens of thousands of his countrymen, because is he receiving treatment amid what the World Health Organization says is the worst AIDS epidemic in Europe.

Ahead of World AIDS Day on Saturday, international organizations have urged the Ukrainian government to increase funding for treatment and do more to prevent HIV from spreading from high-risk groups into the mainstream population, where it is even harder to manage and control.

An estimated 230,000 Ukrainians, or about 0.8 percent of people aged 15 to 49, are living with HIV, the virus that causes AIDS. Some 120,000 are in urgent need of anti-retroviral therapy, which can greatly prolong and improve the quality of their lives. But due to a lack of funds, fewer than a quarter are receiving the drugs — one of the lowest levels in the world.

Ukraine’s AIDS epidemic is still concentrated among high-risk groups such as intravenous drug users, sex workers, homosexuals and prisoners. But nearly half of new cases registered last year were traced to unprotected heterosexual contact.

“Slowly but surely the epidemic is moving from the most-at-risk, vulnerable population to the general population,” said Nicolas Cantau of The Global Fund to Fight AIDS, Tuberculosis and Malaria, who manages work in Eastern Europe and Central Asia. “For the moment there is not enough treatment in Ukraine.”

Stigma is also a big problem for those with HIV in Ukraine. Liliya, a 65-year-old woman who would give only her first name, recently attended a class on how to tell her 9-year-old great-granddaughter that she has HIV. The girl, who contacted HIV at birth from her drug-abusing mother, has been denied a place in preschool because of her diagnosis.

“People are like wolves, they don’t understand,” said Liliya. “If any of the parents found out, they would eat the child alive.”

While the AIDS epidemic has plateaued elsewhere in the world, it is still progressing in Eastern Europe and Central Asia, according to Cantau. Nearly 21,200 new cases were reported in Ukraine in 2011, the highest number since the former Soviet republic registered its first case in 1987, and a 3 percent increase over 2010. As a result of limited and often delayed treatment, the number of AIDS-related deaths grew 17 percent last year to about 3,800.

Two years ago, Mandrykin, the prisoner, was on the verge of becoming part of that statistic, with his level of crucial CD4 immune cells — a way to measure the strength of the immune system — dropping to 11. In a healthy person, the CD4 count is usually over 600.

“I was lying in the hospital, I was dying,” said Mandrykin, who is serving seven years for robbery, his fourth stint in jail. “It’s a scary disease.”

After two years of treatment in a small prison clinic, his CD4 count has risen to 159 and he feels much better, although he looks exhausted and is still too weak to work in the workshop of the medium-security prison.

The Ukrainian government currently focuses on testing and treating standard cases among the general population. The anti-retroviral treatment of more than 1,000 inmates, as well as some 10,000 HIV patients across Ukraine who also require treatment for tuberculosis and other complications and all prevention and support activities, are paid for by foreign donors, mainly the Global Fund.

The Global Fund is committed to spending $ 640 million through 2016 to fight AIDS and tuberculosis in Ukraine and then hopes to hand over most of its programs to the Ukrainian government.

Advocacy groups charge that corruption and indifference by government officials help fuel the epidemic.

During the past two years, Ukrainian authorities have seized vital AIDS drugs at the border due to technicalities, sent prosecutors to investigate AIDS support groups sponsored by the Global Fund and harassed patients on methadone substitution therapy, prompting the Global Fund to threaten to freeze its prevention grant.

Most recently, Ukraine’s parliament gave initial approval to a bill that would impose jail terms of up to five years for any positive public depiction of homosexuality. Western organizations say it would make the work of AIDS prevention organizations that distribute condoms and teach safe homosexual sex illegal and further fuel the epidemic. It is unclear when the bill will come up for a final vote.

AIDS drug procurement is another headache, with Ukrainian health authorities greatly overpaying for AIDS drugs. Advocacy groups accuse health officials of embezzling funds by purchasing drugs at inflated prices and then pocketing kickbacks.

Officials deny those allegations, saying their tender procedures are transparent.

Much also remains to be done in Ukraine to educate people about AIDS.

Oksana Golubova, a 40-year-old former drug user, infected her daughter, now 8, with HIV and lost her first husband to AIDS. But she still has unprotected sex with her new husband, saying his health is in God’s hands.

“Those who are afraid get infected,” Golubova said.

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Amazon’s Robotic Future: A Work in Progress

If you were watching Bloomberg TV recently, you may have seen our correspondent, Cory Johnson, standing in the middle of Amazon’s (AMZN) newest distribution center in Arizona. It’s an impressive facility, brand-new and owned by one of the hardest-charging, most-innovative companies to come onto the retail scene since Sam Walton opened a five-and-dime.

So where are the robots?

After all, aren’t robots supposed to be the future of such places as distribution centers and warehouses? Didn’t Amazon buy a robot manufacturer, Kiva, in March? The online retailer announced in October that it was taking on 50,000 additional part-time workers for the holiday season. Shouldn’t some of those spots be taken up by mechanical arms and wheels?

Maybe not. For all the anxiety over robots coming to take jobs, there are still limitations to what they can do—or what they can do well. Bruce Welty is chief executive officer of Quiet Logistics, an order-fulfillment company that manages the online inventory and distribution for retailers like Gilt, Zara, and Bonobos. He uses robots made by Kiva, the company Amazon purchased, but his warehouse in Massachusetts is not bereft of humans. “Robots aren’t very good at picking up things,” he says. “They aren’t very good at looking at a bin of different things and distinguishing one item from another.”

Welty’s robots do one task and one task only: They move racks of merchandise to workers, who then remove the products from the racks and pack them up for shipping. Saving workers the time and effort to retrieve products offers considerable benefit. “In a typical warehouse, that’s about 60 to 70 percent of the labor,” Welty says.

In addition to what the current state of robotic arts does well, there are further reasons for the continued presence of human beings in warehouses. Labor flexibility is one of the larger ones. “Automation won’t help Amazon in periods of peak demand,” says Stephen Graves, a professor of management science at the Massachusetts Institute of Technology. “People are far more flexible.”

The capital expense to add robots means they need to make sense 12 months out of the year, not two. “The only way to handle spikes in demand is by adding temporary workers,” says Jim Tompkins, CEO of supply-chain consultancy Tompkins International. “If you bought a whole bunch of robots to handle the holiday shopping season, you’d have a whole bunch of robots looking at you, come January.”

So if Amazon just spent nearly a billion dollars buying Kiva, but the robots they produce can’t make a huge difference in how the company operates, what are Amazon’s intentions?

For starters, it’s still early. An acquisition like that of Kiva will take a while to digest, during which time new applications for the robots will surely be devised. “They’re really in a test mode,” says Welty. “They’re going to work on getting it right before any major rollout.”

The Kiva acquisition may have had as much to do with software as it does with hardware, adds Tompkins. “Mechanically, there’s nothing that special about Kiva,” he says. “But what they do have is software that makes sure the robots are in the right place at the right time. This was a software play.”

That’s not exactly how most people would view the deal. But it may be just the head-fake that Amazon CEO Jeff Bezos intended. “I bet Jeff Bezos loves that people are running around trying to put more robots in their distribution centers,” Tompkins says.

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Myanmar cracks down on mine protest; dozens hurt

MONYWA, Myanmar (AP) — Security forces used water cannons and other riot gear Thursday to clear protesters from a copper mine in in northwestern Myanmar, wounding villagers and Buddhist monks just hours before opposition leader Aung San Suu Kyi was to visit the area to hear their grievances.

The crackdown at the Letpadaung mine near the town of Monywa risks becoming a public relations and political fiasco for the reformist government of President Thein Sein, which has been touting its transition to democracy after almost five decades of repressive military rule.

The environmental and social damage allegedly produced by the mine has become a popular cause in activist circles, but was not yet a matter of broad public concern. However, hurting monks — as admired for their social activism as they are revered for their spiritual beliefs — is sure to antagonize many ordinary people, especially as Suu Kyi’s visit highlights the events.

“This is unacceptable,” said Ottama Thara, a 25-year-old monk who was at the protest. “This kind of violence should not happen under a government that says it is committed to democratic reforms.”

According to a nurse at a Monywa hospital, 27 monks and one other person were admitted with burns caused by some sort of projectile that released sparks or embers. Two of the monks with serious injuries were sent for treatment in Mandalay, Myanmar’s second biggest city, a 2 ½ hour drive away. Other evicted protesters gathered at a Buddhist temple about 5 kilometers (3 miles) from the mine’s gates.

Lending further sympathy to the protesters’ cause is whom they are fighting against. The mining operation is a joint venture between a Chinese company and a holding company controlled by Myanmar’s military. Most people remain suspicious of the military, while China is widely seen as having propped up army rule for years, in addition to being an aggressive investor exploiting the country’s many natural resources.

Government officials had publicly stated that the protest risked scaring off foreign investment that is key to building the economy after decades of neglect.

State television had broadcast an announcement Tuesday night that ordered protesters to cease their occupation of the mine by midnight or face legal action. It said operations at the mine had been halted since Nov. 18, after protesters occupied the area.

Some villagers among a claimed 1,000 protesters left the six encampments they had at the mine after the order was issued. But others stayed through Wednesday, including about 100 monks.

Police moved in to disperse them early Thursday.

“Around 2:30 a.m. police announced they would give us five minutes to leave,” said protester Aung Myint Htway, a peanut farmer whose face and body were covered with black patches of burned skin. He said police fired water cannons first and then shot what he and others called flare guns.

“They fired black balls that exploded into fire sparks. They shot about six times. People ran away and they followed us,” he said, still writhing hours later from pain. “It’s very hot.”

Photos of the wounded monks showed they had sustained serious burns on parts of their bodies. It was unclear what sort of weapon caused them.

The protest is the latest major example of increased activism by citizens since the elected government took over last year. Political and economic liberalization under Thein Sein has won praise from Western governments, which have eased sanctions imposed on the previous military government because of its poor record on human and civil rights. However, the military still retains major influence over the government, and some critics fear that democratic gains could easily be rolled back.

In Myanmar’s main city of Yangon, six anti-mine activists who staged a small protest were detained Monday and Tuesday, said one of their colleagues, who asked not to be identified because he did not want to attract attention from the authorities.

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Palm Springs Fest gives Robert Zemeckis’ awards campaign a boost

LOS ANGELES (TheWrap.com) – Robert Zemeckis has been named Director of the Year by the Palm Springs International Film Festival, making the “Flight” director the latest awards hopeful to be honored by one of the two big January film festivals that double as campaign stops on the awards circuit.

The announcement by Palm Springs organizers came one day after the Santa Barbara Film Festival declared “Silver Linings Playbook” star Jennifer Lawrence the Outstanding Performer of the Year.

Palm Springs holds its awards gala on the first Saturday of the new year, which this year falls on January 5, two days after Oscar polls close. Santa Barbara spreads out its awards over a two-week period in late January, after Oscar nominations are announced but before final voting begins.

Both festivals jockey to assemble lineups of probable Oscar nominees, and both are lobbied by Oscar campaigners as they make their selections. The two festivals try to stagger their announcements so as not to compete with each other.

Besides Zemeckis’ award, Palm Springs has announced that it will honor Naomi Watts with the Desert Palm Achievement Award for Acting and Helen Hunt with the Spotlight Award.

In addition to Lawrence, Santa Barbara will give its Modern Master Award to Ben Affleck. Robert De Niro will receive the festival’s Kirk Douglas Award for Excellence in Film, an honor that is presented at a separate black-tie event in December rather than during the festival.

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Deaths more common on popular heart drug: study

NEW YORK (Reuters Health) – People with a common type of abnormal heart rhythm were more likely to die within several years if they had been prescribed digoxin, a drug used to help control abnormal heart rates, in a new analysis.

The research involved 4,060 people with atrial fibrillation, in which the heart’s upper chambers quiver chaotically instead of contracting normally. More than two-thirds of the participants were treated with digoxin at some point either shortly before or during the 3.5-year study.

Dr. Samy Claude Elayi, from the University of Kentucky in Lexington, said digoxin – which is widely available in generic form – may benefit some people who have heart failure in addition to a heart arrhythmia.

“But in patients that have no heart failure and (have) atrial fibrillation, I think there is no reason to use this drug as a first line,” added Elayi, who worked on the study.

Another cardiology researcher, however, said the new study isn’t robust enough to warrant changing treatment strategies, and that earlier studies have shown digoxin is safe.

Elayi and his colleagues re-analyzed data from a past trial of people with atrial fibrillation and a high risk of stroke that were treated with a variety of drug combinations, including beta blockers and calcium channel blockers.

Over the study period, 666 people died, according to results published in the European Heart Journal.

People who had taken digoxin in the previous six months, the study team found, were 41 percent more likely to die of any cause and 61 percent more likely to die from a heart rhythm problem, in particular.

That increased risk of death was seen in people with and without heart failure, and in both men and women.

DIZZINESS, FAINTING

Digoxin works by helping to stabilize the upper heart chambers affected by atrial fibrillation, Elayi said – but it can also cause problems by creating a bad rhythm in the heart’s lower chambers. That can lead to dizziness, fainting and heart palpitations.

The researchers noted that they didn’t have data on what dose of digoxin people were prescribed – or how closely they stuck to those prescriptions.

Because the trial wasn’t originally intended to measure the negative effects of digoxin, and people weren’t assigned randomly to one arm or the other, the analysis also can’t prove that digoxin caused the extra deaths.

Dr. Ali Ahmed, who has studied digoxin at the University of Alabama at Birmingham, called that a major limitation of the new study.

He said an earlier randomized controlled trial – considered the gold standard of medical research – did not find more deaths among people with heart failure taking digoxin. Other research, Ahmed added, has suggested that low doses of the drug can actually lower the risk of death among some patients.

An analysis like this one can’t fully account for the likelihood that sicker patients are prescribed certain drugs more often, he said.

“When you do non-randomized studies, you always wonder, was it really digoxin or was it the other confounders” such as patients’ chronic diseases, that led to more deaths.

“This should be taken with extreme caution, because of the potential for confounding and bias from a variety of sources,” Ahmed, who wasn’t involved in the new research, told Reuters Health.

“The fundamental thing is you cannot overrule the findings of a randomized controlled trial with non-randomized data.”

‘NOT A KILLER’

Digoxin can be bought for about $ 10 for a month’s supply. It’s been used worldwide for decades to help control heart rate, the researchers said.

Elayi said the findings don’t mean that people with heart failure and atrial fibrillation shouldn’t be taking the drug.

But based on his team’s study, he said he would recommend other heart medications before digoxin for people without heart failure. However, if an atrial fibrillation patient also has very low blood pressure – which makes drugs such as beta blockers and calcium blockers unsafe – digoxin might be a reasonable second choice, he added.

In that case, doctors should prescribe digoxin at low doses and keep a close watch on the amount of the drug in patients’ blood, Elayi told Reuters Health.

In addition, he said, “From the patient perspective, if doctors put them on the drug they should check their rationale for that.”

But according to Ahmed, patients and doctors shouldn’t worry about taking or prescribing the drug because of this study. Digoxin, he said, “is not a killer.”

SOURCE: http://bit.ly/99ohTH European Heart Journal, online November 27, 2012.

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Stock futures gain ahead of data on fiscal hopes

NEW YORK (Reuters) – Stock futures rose on Thursday, building on the previous session’s steep gains, on expectations of progress toward a fiscal agreement in Washington that would avert an economic meltdown.

Market participants will continue to focus on discussions in Congress to avoid big spending cuts and tax hikes – dubbed the “fiscal cliff” – and equities may retreat, as they did Tuesday, if the upbeat negotiation environment in Washington shifts.

“There will be a deal before December 31 to avert the economy facing disaster,” said Peter Cardillo, chief market economist at Rockwell Global Capital in New York.

“We’re back on track for a year-end rally to continue,” he said, highlighting the continued support the Federal Reserve has given to equity markets.

Investors await data, including the second estimate of third-quarter gross domestic product, due at 8:30 a.m. ET (1330 GMT). Economists in a Reuters survey forecast a 2.8 percent annualized pace of growth, compared with a 2.0 percent rate in the first estimate.

The Commerce Department will issue preliminary corporate profits for the third quarter at 8:30 a.m. (1330 GMT). At the same time, the Labor Department will release first-time claims for jobless benefits; 390,000 new filings are forecast, compared with 410,000 in the prior week.

The yield on Italy’s 10-year bonds fell to the lowest in two years at an auction, amid relief that immediate risks over Greece had diminished.

“The fact that the bond sales in Europe went well suggest confidence is beginning to reenter some of the peripheral nations and that is a good sign,” Cardillo said.

The euro flirted with the $ 1.30 level and boosted commodity prices, which could lift the basic materials and energy stock sectors.

S&P 500 futures rose 9 points and were above fair value, a formula that evaluates pricing by taking into account interest rates, dividends and time to expiration on the contract. Dow Jones industrial average futures rose 78 points, and Nasdaq 100 futures added 17.5 points.

Also due for release Thursday are pending home sales for October at 10:00 a.m. (1500 GMT) and the Federal Reserve Bank of Kansas City November manufacturing survey at 11:00 a.m.

Tiffany shares fell 9 percent to $ 58.02 in premarket trading after the upscale jeweler reported quarterly results and lowered its full-year sales and profit forecasts.

U.S.-listed shares of BlackBerry maker Research In Motion soared 11.7 percent to $ 12.40 in premarket trading after Goldman Sachs upgraded the stock to “buy” from “neutral.”

Kroger , the biggest U.S. supermarket operator, is due to report third-quarter earnings.

On Wednesday, the Dow Jones industrial average <.DJI> rose 106.98 points, or 0.83 percent, to 12,985.11. The S&P 500 <.SPX> gained 10.99 points, or 0.79 percent, to 1,409.93. The Nasdaq Composite <.IXIC> added 23.99 points, or 0.81 percent, to close at 2,991.78.

(Editing by Bernadette Baum)

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US rabbi says jailed American in good health

HAVANA (AP) — A prominent New York rabbi and physician visited an American subcontractor serving a long jail term in Cuba and said the man is in good health, despite his family’s concerns about a growth on his right shoulder.

Rabbi Elie Abadie, who is also a gastroenterologist, told The Associated Press in an exclusive interview following Tuesday’s 2 1/2-hour visit at a military hospital in Havana that he personally examined Alan Gross and received a lengthy briefing from a team of Cuban physicians who have attended him.

He said the 1 1/2-inch growth on Gross’s shoulder appeared to be a non-cancerous hematoma that should clear up by itself.

“Alan Gross does not have any cancerous growth at this time, at least based on the studies I was shown and based on the examination, and I think he understands that also,” Abadie said.

Abadie said the hematoma, basically internal bleeding linked to the rupture of muscle fiber, was likely caused by exercise Gross does in jail. He said the growth ought to eventually disappear on its own.

Gross’s plight has put already chilly relations between Cuba and the United States in a deep freeze. The Maryland native was arrested in December 2009 while on a USAID-funded democracy building program and later sentenced to 15 years in jail for crimes against the state.

He claims he was only trying to help the island’s small Jewish community gain Internet access.

Gross’s health has been an ongoing issue during his incarceration. The 63-year-old, who was obese when arrested, has lost more than 100 pounds while in jail.

Abadie, a rabbi at New York’s Edmund J. Safra Synagogue, said Gross’s weight is appropriate for a man his age and height.

Photos that Abadie and a colleague provided to AP of Tuesday’s meeting with Gross showed him looking thin, but generally appearing to be in good spirits.

In one photo, Gross holds up a handwritten note that says “Hi Mom.”

“He definitely feels strong. He is in good spirits. He feels fit, to quote him, physically. But of course, like any other person who is incarcerated or in prison, he wants to be free. He wants to be able to go back home,” Abadie said.

Gross’s family has repeatedly appealed for his release on humanitarian grounds, noting his health problems and the fact that his adult daughter and elderly mother have both been battling cancer.

Jared Genser, counsel to Alan Gross, said late Tuesday that Rabbi Abadie is not Gross’s physician and he would like an oncologist of his choosing to evaluate him.

“While we are grateful Rabbi Abadie was able to see Alan, we have asked an oncologist to review the test results to determine if they are sufficient to rule out cancer. More importantly, if Alan is so healthy, we cannot understand why the Cuban government has repeatedly denied him an independent medical examination by a doctor of his choosing as is required by international law,” said Genser.

Gross and his wife recently filed a $ 60 million lawsuit against his former Maryland employer and the U.S. government, saying they didn’t adequately train him or disclose risks he was undertaking by doing development work on the Communist-run island.

They filed another lawsuit against an insurance company they say has reneged on commitments to pay compensation in case of his wrongful detention.

Separately, a lawyer for Gross has written the United Nations’ anti-torture expert, saying Cuban officials’ treatment of his client “will surely amount to torture” if he continues to be denied medical care.

Rumors have been swirling in U.S. media that Cuba might soon release Gross as a gesture of good will or in the hopes of winning concessions from the administration of President Barack Obama, but Abadie said that those reports appeared to be false.

“As far as I know there is no truth to it,” he said.

Abadie said he met with senior Cuban officials who expressed their desire to resolve the case “as quickly as possible,” but would not say specifically who he spoke with or what they offered.

“They claim that they are more than willing to sit at the table,” he said.

Cuban officials have strongly implied they hope to trade Gross for five Cuban agents sentenced to long jail terms in the United States, one of whom is already free on bail.

Abadie said Gross made clear that he does not want his case linked to that of the agents, known in Cuba as “The Five Heroes,” because he does not believe he is guilty of espionage.

But Abadie said Gross is hoping for a “constructive and productive” dialogue between U.S. and Cuban officials to resolve his case.

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Follow Paul Haven on Twitter: http://www.twitter.com/paulhaven.

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U.S. for-profit colleges spend big on marketing while slashing other costs

(Reuters) – Google‘s biggest advertiser is neither a bank nor a retailer.

It’s the for-profit University of Phoenix, which has recently been spending nearly $ 400,000 a day on ads, more than any financial firm or retailer, the traditional big spenders on online advertising, according to search analytics firm SpyFu.

That kind of spending may seem surprising coming from a college, but marketing has become vital for the university and its for-profit rivals as enrollments plummet and they fight back against a host of criticisms, including low job-placement rates.

Colleges such as University of Phoenix, the industry leader owned by Apollo Group Inc, will not only have to boost enrollments to reverse their fortunes, analysts say. They will also need to consider cutting tuition fees as well as continue to slash costs and take market share from rivals.

“I have witnessed several versions of this cycle but none as extreme as this,” said Trace Urdan, an analyst with Wells Fargo Securities, who has been covering the U.S. for-profit education industry for about 15 years.

“We are going to see more pointed efforts at marketing and more price competition in an effort to try to capture more market share both from each other as well as from traditional schools,” Urdan said.

Operators of other for-profit colleges, whose ranks include the Washington Post Co’s Kaplan business, DeVry Inc and ITT Educational Services Inc, are also boosting their spending on marketing and are among the 25 biggest advertisers on Google.

But no one is spending like the University of Phoenix, which doubled its spending on Google ads to about $ 380,000 per day on average between October 12 and November 12, compared with $ 170,000 a day in the previous month, according to SpyFu.

Increased marketing alone will not be enough to fatten fast-shrinking profit margins and increase enrollments, however. Lower tuition fees and increased specialization of the type of programs offered, along with further streamlining of operations, will also be necessary, analysts say.

Industry bellwether University of Phoenix, which offers courses at about 230 campuses as well as online, announced plans last month to shut about half its locations and cut 800 jobs in order to save about $ 300 million a year by 2014.

New enrollments in the Apollo system are down nearly 50 percent in the past two years. As of August 31, enrollment totaled about 328,000.

Career Education Corp, which owns American InterContinental University and the Le Cordon Bleu colleges, and Lincoln Educational Services Corp have also announced closures.

LOW-COST MODEL

The $ 25 billion industry, which typically serves adults looking for a career change or a program to enhance job skills, is reeling after government investigations revealed fraud related to financial aid, worryingly high student debt loads and low rates of graduation and job placement.

“Many for-profit colleges make decisions that prioritize their bottom line, even when those decisions limit their students’ opportunities for academic success,” a U.S. Senate report said earlier this year.

Tuition fees, and therefore profits, is one area under pressure as potential students need to be convinced to take out loans in an uncertain job market.

Apollo, whose stock has lost about 65 percent of its value this year, implemented a tuition freeze earlier this year and promised students it will not increase prices through the course of their programs.

Apollo is also looking at different cost models, with a view to serving segments of the population that it cannot serve with current University of Phoenix tuition prices.

“We have certainly seen a lot more competition at the lower end of the price scale, and that’s something we are focusing on,” Apollo spokesman Mark Brennar said, while declining to offer specifics.

Wells Fargo’s Urdan said it is likely that Apollo wants to compete in the low-cost end of the market by building a second brand, which it would likely do by acquiring another college rather than starting from scratch.

As colleges lower their revenue base by cutting tuition fees even as they spend more on marketing, lower margins could become the norm, analysts say. That has spooked investors already worried about sliding enrollments.

The S&P 1500 Education Services index has lost three-quarters of its value since April 2010, including a 50 percent decline in 2012.

Some for-profit colleges already differentiate themselves in the crowded higher-education market by offering programs in a particular field or by targeting students of a particular background, and that trend could accelerate.

American Public Education, for example, is known for enrolling those who work in the military and public services, while Universal Technical Institute offers programs related to the automotive industry.

For-profit colleges play up their links to employers to attract students who may otherwise opt for traditional or community colleges, said Rob Lytle, head of the education practice at advisory firm Parthenon Group.

“They are about getting people workforce employability skills, and I think they are going to be focusing tighter on that,” said Lytle.

(Reporting by A. Ananthalakshmi in Bangalore; Editing by Ted Kerr)

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Van Gogh, John Lennon letters coming to NY auction

NEW YORK (AP) — An upcoming auction of over 300 historical documents includes rare letters written by Vincent van Gogh, George Washington, John Lennon and other iconic figures.

The property of an anonymous American collector is being offered by Profiles in History in an online and phone auction on Dec. 18.

Among the highlights is a two-page letter from Washington to an Anglican clergyman.

Another top item is a signed van Gogh letter, written in 1890, to Joseph and Marie Ginoux, who were proprietors of the Cafe de la Gare in Arles, France, where the Dutch post-impressionist artist lived for a time.

Each of those letters is estimated to bring $ 200,000 to $ 300,000.

A handwritten letter from John Lennon to Eric Clapton has a pre-sale estimate of $ 20,000 to $ 30,000.

The collection will be exhibited Dec. 3-9 at Douglas Elliman’s Madison Avenue art gallery.

Washington‘s letter was written on Aug. 15, 1798, to the Rev. Jonathan Boucher, amid an undeclared naval war with France. Washington thanks Boucher for sending him his “View of the Causes and Consequences of the American Revolution,” a book of 13 discourses Boucher preached.

“Peace, with all the world is my sincere wish, I am sure it is our true policy — and am persuaded it is the ardent desire of the Government,” the former president and Founding Father wrote.

In a Jan. 20, 1890, four-page letter, handwritten in French to his friends Monsieur and Madame Ginoux, van Gogh wishes the ailing proprietress a speedy recovery.

“Illnesses are there to make us remember again that we are not made of wood,” the artist wrote. “That’s what seems the good side of all this to me. Then afterwards one goes back to one’s everyday work less fearful of the annoyances, with a new store of serenity.” Van Gogh died less than seven months later.

He suffered from acute anxiety and bouts of depression throughout his life. Madame Ginoux and the cafe were frequent subjects of his work.

The eight-page letter from Lennon is a draft he wrote to Clapton on Sept. 29, 1971, and signed “John and Yoko.” The whereabouts of the final version is unknown.

Lennon writes candidly about his admiration for the great British guitarist and suggests forming a “‘nucleus’ group (Plastic Ono Band) . — and of course had YOU!!! In mind as soon as we decided.” He writes that drummer Jim Kelnter, artist Klaus Voormann, pianist Nicky Hopkins and producer Phil Spector “all agreed so far” to join.

“Anyway, the point is, after missing the Bangla-Desh concert, we began to feel more and more like going on the road, but not the way I used with the Beatles — night after night of torture. We mean to enjoy ourselves, take it easy, and maybe even see some of the places we go to! We have many ‘revolutionary’ ideas for presenting shows that completely involve the audience .”

Other luminaries whose papers will be sold include Lou Gehrig, Louis Pasteur, Sigmund Freud, Charles Darwin, Marie Curie, Giuseppe Verdi, Peter Tchaikovsky, Cole Porter, King Henry II and Napoleon I.

The December auction is the first of several sales that will be held over two years. The entire collection contains 3,000 items.

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Online:

Information on how to bid is available on www.profilesinhistory.com.

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Flu Can Kill Quickly, Taking Lives of Healthy Children

In just eight months at his new school in Rifle, Colo., Austin Booth made a name for himself as a star athlete, honor student and a popular classmate with a promising future.

But within six days after he contracted the flu last January, Austin was dead. He was 17. His parents had never even considered giving a flu shot to their otherwise healthy teen.

“It was flu season and we knew other kids who were sick and we didn’t think that much about it,” said his mother, Regina Booth, 42. “He was a healthy teenager.”

“He was just one of those kids that excelled at everything,” she said. “And he was the type of kid who made friends instantly.”

“It was pretty tough — and it seems like just yesterday,” said Booth, who is 38 weeks pregnant and now annually immunizes her four other children, aged 3 to 16.

“Now that we are expecting a new baby, it protects us and the baby,” she said.

Debunking Four of the Most Common Flu Shot Myths

Between 3,000 and 49,000 Americans die of influenza each year, according to the Centers for Disease Control and Prevention.More than 200,000 are hospitalized annually with flu-related complications like pneumonia.

In the past four years, the CDC has changed its recommendations and now urges all Americans six months and older get a flu shot. Children under the age of 9, who are getting immunized for the first time, should get two doses, one month apart.

Booth said she still cannot believe how sudden her son’s death was. On Tuesday night, he had started and played a full basketball game. By Wednesday night, he was coughing up blood and was rushed to the hospital with pneumonia.

“They intubated him as he struggled to breathe,” said his mother. “It was the last time I talked to him.”

His father Carl, who worked on an oil rig and couldn’t be reached, was never able to see his son conscious again. Austin was airlifted to St. Mary’s Hospital in Grand Junction and at first, doctors thought he would survive.

But soon, his condition got worse — even on “every antibiotic in the world” — and Austin had to be taken off the ventilator and manually “bagged.” Tests showed the teen positive for the virulent infection MRSA.

“Doctor’s said it was a perfect storm of pneumonia and MRSA,” said Booth. “He fought Thursday until Monday, but it was more than his body could handle.”

Hundreds of Austin’s new friends showed up for his funeral. The basketball team retired his #2 jersey and Austin was recognized with a school bench and a memory stone.

“We had never gotten the flu shot — not any of us,” she said. “We thought, we don’t need it, we are healthy. If we get the shot it will make us sick.”

Dr. William Schaffner, professor and chairman of preventive medicine at Vanderbilt University in Nashville, said that people are fooled into thinking that influenza, a serious respiratory infection, is just like a cold.

“People use the word ‘flu‘ very casually to refer to a whole variety of winter illnesses, including a stuffy nose, and that tends to trivialize it,” said Schaffner. “It is a serious viral infection — it wreaks havoc on all the body’s systems.”

“Although it can be mild and often is, it is often very, very serious and can strike an otherwise normal child and put them in intensive care, usually within 48 hours.”

The most serious complications occur among older people, but each year children die of the disease — and “it’s potentially preventable,” according to Schaffner.

“While it is an imperfect vaccine, it is the best influenza vaccine at the present time,” he said. Though it does not always prevent infection, because viruses change each year, it can “turn a more serious flu into a milder one, so you won’t die.”

With 120 million doses given each year in the U.S. alone, it is a “wonderfully safe” vaccine, whose only side effects can be a sore arm or, rarely, a day of fever. It cannot give a person the flu. “That’s an urban myth,” said Schaffner.

The vaccine is covered by insurance carriers and only costs about $ 30 out of pocket. But only about half of all children are immunized.

Advocacy efforts by the nonprofit organization Families Fighting the Flu were part the gradual change of the CDC recommendation toward universal immunization.

About 100 American children die each year from the flu, according to its executive director, Laura Scott. “It’s devastating.”

“The more people who get vaccinated, the less disease there is that spreads,” said Scott. “You can build a cocoon around your family. Even if you don’t have the infant vaccinated, you still have to vaccinate everyone around that baby.”

Julie Moise of Kansas City, Mo., lost her 7-month-old son Ian to the flu in 2003. He got sick just 10 days after he had received his first of two flu shots. Her other children had full doses of the vaccine and never got sick.

Moise, a 41-year-old flight attendant, said she was initially “unconcerned” when Ian was diagnosed with the flu by his pediatrician. But by the end of the first day, he was “panting.” The doctor reassured her that was normal in a child with a fever.

“His panting turned into more of a sigh and I thought that was a good thing,” said Moise. “But later the doctor told me that happens when people’s organs are shutting down.”

Moise, too, was bedridden with the flu and called her husband to come home from work and help. She called the doctor’s office again.

“Glen walks in the door and the phone rings — it’s the nurse,” she said. “He told her, ‘I don’t like his coloring, let’s take him to the emergency room.’ Then Ian stopped breathing.”

Moise, who is trained in CPR, attempted to save Ian while they rushed to the ER. They stopped at a nearby fire station and rescue workers also tried unsuccessfully to revive the baby. He died that afternoon at the hospital.

“The message is: First of all, take the flu seriously,” she said. “We didn’t think healthy children die of the flu. It’s a preventable disease … And it doesn’t discriminate. It can hit anyone.”

After their son’s death, the Moises founded Ian’s Rainbow Flu Foundation to raise awareness.

Those who have survived influenza say its effects can be devastating.

Luke Duvall, now 20, came down with the flu in October 2009, and it took him a whole year to recover fully.

One-third of his Atkins, Ark., high school was hit hard with that strain of the flu.

Duvall was rushed to the hospital by ambulance. He nearly collapsed in the shower because he couldn’t breathe.

“My blood pressure was so low that they couldn’t draw blood and I almost crashed in the ambulance on the road,” he said. “They had to pull over and stabilize me.”

The next morning he was flown to Little Rock, where he stayed for 34 days, much of the time in a coma and on a respirator. “At one time, they had 20 IVs pumping all kinds of things into me,” he said.

Duvall spent 17 days in rehab because he had lost 36 of his 157 pounds. “I had to relearn how to walk and how to drink and eat,” he said. “I had to relearn daily functions like dressing myself.”

All this, according to Duvall, because one student who boarded a football bus for a game had the flu and infected the entire team.

“He was a star athlete,” he said. “If he had just had the vaccine, all of this would have stopped. It would have ended there. You don’t just get it for yourself, but for those around you. It’s a cycle that keeps going.”

ABC News information specialist Nicholas Tucker contributed to this report.

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