Stricken cruise ship reported awash in raw sewage nears port

MOBILE, Alabama—

More than 4,200 people trapped aboard the crippled cruise ship Carnival Triumph, having endured days of overflowing toilets, should return to land when tugboats haul the vessel into Mobile, Alabama late on Thursday.

The 893-foot vessel, notorious for reports of sewage and food shortages, has been without propulsion and running on emergency generator power since Sunday, when an engine room fire left it adrift in the Gulf of Mexico.

Operated by Carnival Cruise Lines, the flagship brand of global cruise ship giant Carnival Corp, the ship left Galveston, Texas a week ago carrying 3,143 passengers and 1,086 crew. It was supposed to return there on Monday.

Carnival Corp spokesman Vance Gulliksen in Miami said the Triumph was expected to arrive in Mobile at between 8 p.m. and 11 p.m. CST on Thursday night.

"This is going to be a long day," Terry Thornton, a senior Carnival Cruise Lines vice president, told reporters at the port in Mobile.

He said the ship, which he described as "in excellent shape" after additional provisions were laid in on Wednesday, was near the sea buoy at the entrance to Mobile Bay late on Thursday morning. Getting from the buoy into port normally takes about three hours, Thornton said.

"There is no way we could actually speed up the process to get the ship alongside sooner," he said. "We're making every effort we can to get the ship alongside here in Mobile as quickly as possible."

A Coast Guard cutter has been escorting the Triumph on its long voyage into port since Monday, and a Coast Guard helicopter ferried about 3,000 pounds of equipment including a generator to the stricken ship late on Wednesday.

Earlier in the week, some passengers reported on the poor conditions on the Triumph when they contacted relatives and media before their cellphone batteries died.

They said people were getting sick and passengers had been told to use plastic "biohazard" bags as makeshift toilets.

MORE COMPENSATION

Carnival Cruise Lines President and Chief Executive Gerry Cahill said in a statement late on Wednesday that the company had decided to add further payment of $500 per person to help compensate passengers for "very challenging circumstances" aboard the ship.

"We are very sorry for what our guests have had to endure," Cahill said.

Mary Poret, who spoke to her 12-year-old daughter aboard the Triumph on Monday, rejected Cahill's apology out of hand in comments to CNN on Thursday, as she waited anxiously in Mobile with a friend for the Triumph's arrival.

"Seeing urine and feces sloshing in the halls, sleeping on the floor, nothing to eat, people fighting over food, $500? What's the emotional cost? You can't put money on that," Poret said.

The troubles on the Carnival Triumph occurred a little more than a year after 32 people were killed when the Costa Concordia, a luxury cruise ship operated by Carnival Corp's Costa Cruises brand, was grounded on rocks off the Tuscan island of Giglio in Italy.

Carnival Corp Chairman and CEO Micky Arison faced criticism in January last year for failing to travel to Italy and take personal charge of the Costa Concordia crisis, which unleashed numerous lawsuits against his company.

The cruise ship mogul has taken a low-key approach to the Triumph situation as well, even as it grabbed a growing share of the U.S. media spotlight. His only known public appearance since Sunday was courtside on Tuesday at a game played by his championship Miami Heat basketball team.

Carnival Corp shares were down $0.12 at $37.34 in early afternoon trading on Thursday on the New York Stock Exchange. The shares closed down 4 percent at $37.46 on Wednesday after the company said voyage disruptions and repair costs related to Carnival Triumph could shave up to 10 cents per share off its second-half earnings.

Carnival said it had initially planned to tow the Triumph into Progreso in Mexico, the closest port to its location early on Sunday when the engine room fire occurred. But the ship drifted about 90 nautical miles north, due to strong currents, before the towing got under way, and that left it stranded roughly midway between Progreso and Mobile.

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Actor Steve Martin is first-time dad at age 67

LOS ANGELES (Reuters) – Actor, writer and comedian Steve Martin has become a dad for the first time at age 67 – and managed to keep it secret from the media for more than a month.

Martin and his second wife, Anne Stringfield, 41, “are new parents and recently welcomed a child,” a spokeswoman for the actor said on Wednesday.

The spokeswoman gave no details, including the sex of the child or the date of birth. But the New York Post cited unidentified sources as saying the baby arrived in December.

The multi-talented Martin, whose career as a writer and performer dates back more than 45 years, has played a father in movies such as “Parenthood,” Cheaper by the Dozen,” and “Father of the Bride.”

Martin, who has hosted the Oscars ceremony three times, married Stringfield, a former writer at the New Yorker magazine, in 2007. His eight-year marriage to British actress Victoria Tennant ended in divorce in 1994.

(Reporting by Eric Kelsey: Editing by Jill Serjeant and Peter Cooney)

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U.S. Approves First Method to Give the Blind Limited Vision

The F.D.A. Approves a Bionic Eye:
The Argus II allows Barbara Campbell, who lost her sight 20 years ago, to see the world through patterns of light. Scientists hope it is the beginning of even more treatments.

The Food and Drug Administration on Thursday approved the first treatment to give limited vision to people who are blind, involving a technology called the “artificial retina.”

With it, people with certain types of blindness can detect crosswalks on the street, burners on a stove, the presence of people or cars, and sometimes even oversized numbers or letters.

The artificial retina is a sheet of electrodes surgically implanted in the eye. The patient is also outfitted with a pair of glasses with an attached camera and a portable video processor. These elements together allow visual signals to bypass the damaged portion of the retina and be transmitted to the brain. The F.D.A. approval covers this integrated system, which the manufacturer calls Argus II.

The approval marks the first milestone in a new frontier in vision research, a field in which scientists are making strides with gene therapy, optogenetics, stem cells and other strategies.

“This is just the beginning,” said Grace Shen, director of the retinal diseases program at the National Eye Institute, which helped finance the artificial retina research and is supporting many other blindness therapy projects. “We have a lot of exciting things sitting in the wings, multiple approaches being developed now to address this.”

With the artificial retina or retinal prosthesis, a blind person cannot see in the conventional sense, but can identify outlines and boundaries of objects, especially when there is contrast between light and dark — fireworks against a night sky or black socks mixed with white ones in the laundry.

“Without the system, I wouldn’t be able to see anything at all, and if you were in front of me and you moved left and right, I’m not going to realize any of this,” said Elias Konstantopolous, 74, a retired electrician in Baltimore, one of about 50 Americans and Europeans who have been using the device in clinical trials for several years. He said it helps him differentiate curbs from asphalt roads, and detect contours, but not details, of cars, trees and people. “When you don’t have nothing, this is something. It’s a lot.”

The F.D.A. approved Argus II, made by Second Sight Medical Products, to treat people with severe retinitis pigmentosa, a group of inherited diseases in which photoreceptor cells, which take in light, deteriorate.

The first version of the implant had a sheet of 16 electrodes, but the current version has 60. A tiny camera mounted on eyeglasses captures images, and the video processor, worn on a belt, translates those images into pixelized patterns of light and dark. The processor transmits those signals to the electrodes, which send them along the optic nerve to the brain.

About 100,000 Americans have retinitis pigmentosa, but initially between 10,000 and 15,000 will likely qualify for the Argus II, according to the company. The F.D.A. says that up to 4,000 people a year can be treated with the device. That number represents people who are older than 25, who once had useful vision, have evidence of an intact inner retinal layer, have at best very limited light perception in the retina, and are so visually impaired that the device would prove an improvement. Second Sight will begin making Argus II available later this year.

But experts said the technology holds promise for other people who are blind, especially those with advanced age-related macular degeneration, the major cause of vision loss in older people, affecting about two million Americans. About 50,000 of them are currently severely impaired enough that the artificial retina would be helpful, said Dr. Robert Greenberg, Second Sight’s president and chief executive.

In Europe, Argus II received approval in 2011 to treat a broader group of people, those with severe blindness caused by any type of outer retinal degeneration, not just retinitis pigmentosa, although it is currently only marketed in Europe for that condition. In the U.S., additional clinical trials need to be completed before the company can seek broader FDA approval.

Eventually, Dr. Greenberg said, the plan is to implant electrodes not in the eye, but directly into the brain’s visual cortex. “That would allow us to address blindness from all causes,” he said.

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Buffet, 3G to buy Heinz for $23B

Warren Buffett's Berkshire Hathaway and private equity firm 3G Capital will buy ketchup and baby food maker H.J. Heinz Co for $23.2 billion in cash, a deal that combines 3G's ambitions in the food industry with Buffett's hunt for growth.

Including debt assumption, Heinz valued the transaction, which it called the largest in its industry's history, at $28 billion. Berkshire and 3G will pay $72.50 per share, a 19 percent premium to the stock's previous all-time high. Heinz shares actually rose slightly above the offer price, although Buffett cautioned he had no intention of raising his bid.

Analysts said the deal could be the first step in a broader wave of mergers for the food and beverage industry.

"Maybe for the consumer staples group in general this may start some talk about consolidation. Even corporate entities are flush with cash, interest rates are low, it would seemingly make sense," Edward Jones analyst Jack Russo said.

Companies like General Mills and Campbell Soup - itself long seen as a potential Heinz merge partner - rose on the news.

BUFFETT HUNTING GROWTH

The surprise purchase satisfies, at least in part, Buffett's hunt for growth through acquisition. He was frustrated in 2012 by the collapse of at least two deals in excess of $20 billion and said he might have to do a $30 billion deal this year to help fuel Berkshire's growth engine. In this case, Berkshire is putting up about $12 billion to $13 billion cash, Buffett told CNBC, leaving it ample room for another major transaction.

Berkshire Hathaway already has a variety of food assets, including the Dairy Queen ice cream chain, chocolatier See's Candies and the food distributor McLane. Buffett, famed for a love of cheeseburgers, joked he was well acquainted with Heinz's products already and that this was "my kind of deal."

It does represent an unusual teaming of Berkshire with private equity, though; historically, Buffett's purchases have been outright his own. He and 3G founder Jorge Paulo Lemann have known each other for years, and Buffett said Lemann approached him with the Heinz idea in December. One Berkshire investor said he had mixed feelings about the deal because of the limited growth prospects domestically.

"We're a little hesitant on the staple companies because they don't have any leverage in the United States," said Bill Smead, chief investment officer of Smead Capital Management in Seattle. But at the same time, he said, Buffett was likely willing to accept a bond-like steady return even if it was not necessarily a "home run."

3G EXPANDS

For 3G, a little-known firm with Brazilian roots, the purchase is something of a natural complement to its investment in fast-food chain Burger King, which it acquired in late 2010 and in which it still holds a major stake. Lemann, a globe-trotting financier with Swiss roots, made his money in banking and gained notoriety for helping to pull together the deals that ultimately formed the beer brewing giant AB InBev.

3G's Alex Behring runs the fund out of New York. He appeared at a Pittsburgh news conference on Thursday with Heinz management to discuss the deal - and to reassure anxious local crowds that the company will remain based there and will continue to support local philanthropy.

But at the same time, Behring said it was too soon to talk about cost cuts at the company. Unlike Berkshire, which is a hands-off operator, 3G is known for aggressively controlling costs at its operations.

PITTSBURGH ROOTS Also to be determined is whether CEO Bill Johnson would stay on. Only the fifth chairman in the company's history, Johnson is widely credited with Heinz's recent strong growth.

"I am way too young to retire," he told the news conference, adding that discussions had not yet started with 3G over the details of Heinz's future management.

The company, known for its iconic ketchup bottles, Heinz 57 sauces as well as other brands including Ore-Ida frozen potatoes, has increased net sales for the last eight fiscal years in a row.

Heinz said the transaction would be financed with cash from Berkshire and 3G, debt rollover and debt financing from J.P. Morgan and Wells Fargo. Buffett told CNBC that Berkshire and 3G would be equal equity partners.

Heinz shares soared 19.9 percent, or $12.06, to $72.54 on the New York Stock Exchange. A week ago the stock hit a long-term high of $61 a share - near records it set in 1998 - having risen almost 5 percent this year and nearly 12 percent since the beginning of 2012.

The deal is also a potential boon for new U.S. Secretary of State John Kerry, whose wife Teresa is the widow of H.J. Heinz Co heir John Heinz.

Kerry's most recent financial disclosures from his time in the U.S. Senate show a position in Heinz shares of more than $1 million, although the precise size is unclear.

Centerview Partners and BofA Merrill Lynch were financial advisers to Heinz, with Davis Polk & Wardwell LLP the legal adviser. Moelis & Company was financial adviser to the transaction committee of Heinz's board and Wachtell, Lipton, Rosen & Katz served as its legal adviser. Lazard served as lead financial adviser. J.P. Morgan and Wells Fargo also served as financial advisers to the investment consortium. Kirkland & Ellis LLP was legal adviser to 3G Capital, and Munger, Tolles & Olson LLP was legal adviser to Berkshire Hathaway.

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Obama to visit Hyde Park Academy during trip to Chicago

WASHINGTON — President Barack Obama will visit Hyde Park Academy High School on Chicago’s South Side on Friday when he travels to the city as part of a three-state tour following his State of the Union speech.

The academy is at 6220 S. Stony Island Ave. The White House has distributed an invitation to the event instructing people to arrive no later than 1 p.m. on Friday and to expect “airport-like security.”
It was not immediately known what time Obama will speak.

Tickets are available only to invited guests, who were instructed to pick up their tickets at a specific location on Thursday afternoon, the invitation said.

His visit comes in the wake of the slaying of Hadiya Pendleton, a 15-year-old honor student whose parents were guests Tuesday of the president and first lady at the State of the Union speech.

Pendleton was shot and killed on Jan. 29 a mile from Obama's residence in the Kenwood neighborhood.

She and the King College Prep band and drill team had performed in Washington on Jan. 21, the day of Obama’s public swearing-in, at an inauguration-viewing reception hosted by Rep. Danny Davis in the House Ways and Means Committee Room, according to Yul Edwards, chief of staff to Davis, a Chicago Democrat.

Earlier, the band and drill team took part in a competition in Severn, Md., in the Washington suburbs, on Jan. 19. That competition, called the Presidential Inauguration Heritage Music Festival, was timed for the inaugural weekend but was not an officially sanctioned inaugural event.

kskiba@tribune.com

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Beyonce shows marriage, miscarriage and Blue Ivy in documentary

LOS ANGELES (Reuters) – Beyonce is letting fans into her charmed life, introducing daughter Blue Ivy to the world and talking about motherhood, marriage and miscarriage in a new documentary.

The 31-year-old pop singer and her rapper husband, Jay-Z, 43, one of music’s most influential couples, have been guarded about their private life.

But in “Life is But a Dream,” airing on Saturday on cable channel HBO, Beyonce gives fans a glimpse of her working life and even a peek at baby Blue Ivy, who has been fiercely shielded from paparazzi since her birth in January 2012.

The “Crazy in Love” singer addresses the widely reported claim from 2011 that she was faking her pregnancy, calling it “the most ridiculous rumor I’ve ever heard of me.”

“To think that I’d be that vain … especially after losing a child. The pain and trauma from that just makes it mean so much more to get an opportunity to bring life into the world,” she says in the documentary.

The Grammy-winning singer shows footage of a sonogram, her growing bump and grainy video of herself posing nude as she neared her due date.

The HBO film, which Beyonce co-directed, is part of a return to performing by the singer, who took a year off after her first child was born.

The arrival last year of Blue Ivy Carter gained worldwide media attention and prompted Beyonce to share more with her fans, launching a Tumblr page with snapshots that showed glimpses of her family life, including the baby.

Her miscarriage had been kept secret from the public until Jay-Z referred to it in his song “Glory,” that he released following the birth of Blue Ivy.

In the documentary, Beyonce touched on the topic briefly, saying, “It was the saddest thing I’ve ever been through.”

“My life is a journey. … I had to go through my miscarriage, I believe I had to go through owning my company and managing myself … ultimately your independence comes from knowing who you are and you being happy with yourself,” she said.

“Life is But a Dream” serves as a coming-of-age for the star as she entered motherhood.

She gives audiences a peek into her four-year marriage to Jay-Z, showing footage of the couple singing Coldplay’s “Yellow” to each other.

“This baby has made me love him more than I ever thought I could love another human being,” she says.

The documentary shows Beyonce putting herself and her team through grueling choreography rehearsals in 2011 and planning every second of her performances at big awards shows that year.

Beyonce began her comeback with a controversial lip-synched performance of the national anthem at President Barack Obama’s inauguration in January, followed by a live performance at the Super Bowl halftime show that wowed critics.

She has also announced a new album for this year. “The Mrs Carter Show World Tour” – Jay-Z’s real name is Shawn Carter – will kick off in April with more than 40 performances in Europe and North America.

“Life is But a Dream” airs on HBO on Saturday, the same day as Beyonce’s interview with Oprah Winfrey on the OWN cable channel.

(This version of the story corrects the spelling of Shawn Carter to “Shawn” from “Sean” Carter in paragraph 17.)

(Reporting By Piya Sinha-Roy, editing by Jill Serjeant and Doina Chiacu)

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Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

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Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

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Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

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Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

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This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

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Feds OK insurance exchange partnership

Health and Human Services Secretary Kathleen Sebelius on Wednesday said her department conditionally approved Illinois’ plan to operate a health insurance exchange in a partnership with the federal government, a widely expected move that makes the state the third to receive the official go ahead. 

Sebelius plans to make the announcement Wednesday afternoon at a West Side clinic alongside Gov. Pat Quinn, Sebelius said the approval will allow the state and the federal government to continue work on readying the online marketplace for Oct. 1, when uninsured Illinoisans can begin signing up for health insurance offered under the 2010 health care overhaul law.

Under the partnership model, Illinois will maintain its responsibility for regulating the insurance market, a function that will allow the state to tailor the types of private health insurance plans offered through the exchange. Illinois also will be in charge of customer assistance, which will allow it to conduct outreach efforts and aid people in signing up.

The federal government is responsible for building and operating the exchange.

Illinois becomes the third state to have its partnership plan approved, following Delaware and Arkansas. A handful of other states, including Iowa, Michigan, West Virginia and New Hampshire, also are interested in the partnership model. Other states have opted to set up and run their own exchanges, while a majority refused to participate, relying on the federal government to do so.

Sebelius is in town through Thursday to meet with several large stakeholders, including union leaders, clergy and community groups, to raise awareness about the forthcoming exchanges, a spokesman said.

The exchanges are a crucial part of the government's plan to expand the number of Americans who have some form of health insurance.

Eventually, an estimated 20 million people will benefit from federal tax credits starting in 2014 that will help offset the cost of paying for insurance premiums. Even so, the government estimates that about 6 million Americans will not sign up and will start paying tax penalties in 2014.

In the first year, those penalties are relatively modest, starting at $95 for adults and $47.50 per child. But they’re expected to increase in future years, eventually totaling nearly $7 billion in 2016, an average fine of about $1,200 per person.

While states were given the option of setting up and running their own exchanges, only 18 chose to do so, with most of the rest opting to allow the federal government to operate them, at least in the beginning.

Julie Hamos, director of the state Department of Healthcare and Family Services, has said she hopes to get legislation passed this spring to authorize a purely state-run exchange that will be up and ready in time for open enrollment for 2015.

Meanwhile, consumers can expect a marketing blitz during the summer and into the fall touting the exchanges, which will serve individuals who are not eligible for Medicare or Medicaid and not offered health insurance through their employers.

pfrost@tribune.com | Twitter: @peterfrost

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How Oscar played matchmaker for a Scandinavian mutual admiration society

LOS ANGELES (TheWrap.com) – Two Scandinavian directors.

Nikolaj Arcel, nominated for his smart Danish costume drama “A Royal Affair,” and Espen Sandberg, the co-director with Joachim Roenning of the Norwegian epic “Kon-Tiki,” had never met before this awards season – but when both films were nominated for Oscars and Golden Globes, the two men began to find themselves at the same events in Los Angeles, far from where they grew up.

Is there a kinship between Scandinavian filmmakers?

SANDBERG: Absolutely. It is a small scene, and I think every

Scandinavian movie that does well helps me.

ARCEL: When we heard the Oscar nomination announcements, me and my friends were in the room, and obviously at first we were screaming about our own nomination.

But then we immediately went into talking about how fantastic it was that “Kon-Tiki” got nominated, too. For two Scandinavian countries to be in one nomination pool is quite good for us.

SANDBERG: It’s a phenomenon. A small one, but still …

ARCEL: There is also something worth mentioning, which is that me and Espen and Joachim are sort of alike in the way we work. We are very un-Scandinavian. I think they are known in Norway as being the Hollywood guys in Norway, and I am known as the Hollywood guy in Denmark.

We’re both lovers of Hollywood films, and I think it’s fun that we both have these big films at the same time.

SANDBERG: I totally agree. We make movies sort of in the vein of the movies that they used to make here. They’re the kind of movies we grew up with, and we miss.

ARCEL: Some of the other Scandinavian directors are arthouse directors, more inspired by the French Wave and by filmmakers like Godard. Our generation, we are slightly younger, and we are inspired by Spielberg and Scorsese and Coppola.

Both of your stories are very dear to the countries you come from: “A Royal Affair” is about Johann Struensee, the German doctor who became the lover of the queen and helped push for human rights in Denmark, and “Kon-Tiki” is the story of a voyage by the legendary Norwegian explorer Thor Heyerdahl. Were you thinking of the international audience when you made them, or were you just trying to please your home countries?

SANDBERG: We were thinking about both. We even shot a version in English, which was a demand from the financiers, and we also knew that the story, when it happened, was an international phenomenon. But we of course knew that we had to succeed at home first.

ARCEL: Didn’t it make you go crazy that you actually had to edit two films?

SANDBERG: Yeah, but we did the Norwegian one first. And then we matched the English and then adjusted slightly.

ARCEL: I have to say, we didn’t think about the international stuff, other than we knew that it had to be big in Germany – which was the only country where it totally flopped, by the way. It’s a period drama in Danish, and I never thought it would travel outside of Northern Europe.

Was it hard to pull off a period drama on a limited budget?

ARCEL: It was extremely difficult. It was the most difficult thing I ever had to do, and I think I will never do that again. It was $ 7 million to do the film, and I had to do five or six big scenes a day. So we worked 14, 15, 16 hours a day. And we didn’t focus so much on the surroundings. It’s still a little bit of a chamber piece.

I have to say, I am even more impressed with the work that the guys did on “Kon-Tiki,” because that looks like a $ 150 million Hollywood film. I still can’t figure out how you guys are doing that.

SANDBERG: Thank you. We are very proud of the effects work. I don’t think the effects houses made any money on this. I think they thought, like the actors did, ‘This is our chance to show the world what we can do.’ And they did. We sort of promised them that this movie can really break out, so it’s great now that we’ve come so far.

We had to be very well-prepared. We had to storyboard everything and make pre-visualizations of the scenes that had a lot of effects work. We shot digital, so we could shoot more with the actors in a shorter time. And then we were just being very economical about everything. We shot the two versions, the Norwegian version and the English version, in 59 days in six countries. It was very, very hard work, and four of those weeks were open sea.

Casting somebody to play Thor Heyerdahl, a national hero, must have been a big job.

SANDBERG:Yeah, it’s tough on the actor. We knew from beforehand, because he also plays a smaller part in Max Manus. He’s an amazing actor; he looks the part, but he was actually on his way to study biology when he got accepted to theater school. So I knew he would understand Thor on a deeper level. He is interested in the things that Thor was interested in. We knew very early on that it had to be him, and we cast around him.

ARCEL: I was actually wondering about these specific moments in “Kon-Tiki.” Whenever he gets faced with a real tough challenge, the actor has this little smile on his face, like ‘I can beat this.’ Was that something that Thor Heyerdahl was known for?

SANDBERG: Yes. He put on a smile whenever things got tough.

ARCEL: That was a great touch. You guys must have felt a little bit of the same thing that I did, because as much as Thor is a huge icon in Norway, in Denmark Streunsee is equally known and a very iconic character.

You must have felt the same pressure, that if you fuck this up the whole country’s going to hate you!

SANDBERG: Yes.

You’re both living in Los Angeles these days. Are you looking to do Hollywood films?

ARCEL: Absolutely!

SANDBERG: When Joachim and I started out making movies, we were watching American movies. That was what we dreamt of since we were kids. We always wanted to do that. We would love to do a movie here, and preferably a studio movie. We’re getting close. We’ll see how it goes.

ARCEL: I’m getting some very interesting things as well. But I have a process that’s very important to me. I need to develop my own stuff. Otherwise I have a problem steering the ship. So I’m looking for things that I can write – or maybe books, maybe scripts that are not good so I can fix them and rewrite them. So I don’t think I’m going to be directing right now. I might take a year or so and write.

SANDBERG: I was very happy to hear that you and your writing partner also work as scriptwriters. I would love to have you write something…

ARCEL: Oh yeah. Any time. Absolutely.

SANDBERG: Let’s make a deal here in the room. Anybody have a napkin?

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Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

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Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

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Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

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Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

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This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

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