Legendary Japanese filmmakers to be honored by Hollywood






LOS ANGELES (Reuters) – Legendary Japanese filmmaker Akira Kurosawa and three of his compatriots will be honored by the Writers Guild of America (WGA) next month for their lifetime of work on movies that organizers said have “given us all a taste of the sublime.”


The WGA’s West branch, which represents the U.S. West Coast writers of TV, films, radio and Internet programming, said that the late Kurosawa and his collaborators Ryuzo Kikushima, Hideo Oguni and Shinobu Hashimoto, will receive the Guild’s 2013 Jean Renoir Award for Screenwriting Achievement on February 17 in Los Angeles.






The 94-year-old Hashimoto is the lone surviving member of the group. He is not expected to attend the ceremony.


The annual award honors “those non-U.S. writers whose work has raised the bar for all of us,” said Writers Guild of America West Vice President Howard Rodman.


“These four men, working in loose collaboration, are responsible for writing many, many masterpieces – films that reflect the Japanese culture, and have given all of us a taste of the sublime,” Rodman added in a statement.


Kurosawa, who received an honorary Oscar in 1990 and died in 1998, found success in many films by collaborating with Kikushima, Hashimoto and Oguni on screenplays.


With Kikushima, the duo co-wrote such classics as “Stray Dog” (1949) and “Yojimbo” (1961). Hashimoto worked with Kurosawa on the seminal 1950 film “Rashomon.” Oguni, Hashimoto and Kurosawa came together on 1952′s “Ikiru” and 1954′s “Seven Samurai.” The entire quartet wrote such films as 1957′s “Throne of Blood” and 1958′s “The Hidden Fortress.”


Kikushima died in 1989. Oguni died in 1996.


Previous recipients of the award include the late Italian screenwriters Suso D’Amico in 2009 and Tonino Guerra in 2011.


(Reporting By Zorianna Kit; Editing by Jill Serjeant and Will Dunham)


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The New Old Age Blog: Grief Over New Depression Diagnosis

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

Traditionally, depression has been underdiagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” We don’t find depression in old age normal any longer.

But critics of the D.S.M. 5 now argue that depression may become overdiagnosed, because this version removes the so-called “bereavement exclusion.” That was a paragraph that cautioned against diagnosing depression in someone for at least two months after loss of a loved one, unless that patient had severe symptoms like suicidal thoughts.

Without that exception, you could be diagnosed with this disorder if you are feeling empty, listless or distracted, a month after your parent or spouse dies.

“D.S.M. 5 is medicalizing the expected and probably necessary process of mourning that people go through,” said Allen Frances, a professor emeritus at Duke who chaired the D.S.M. IV task force and has denounced several of the changes in the new edition. “Most people get better with time and natural healing and resilience.”

If they are diagnosed with major depression before that can happen, he fears, they will be given antidepressants they may not need. “It gives the drug companies the right to peddle pills for grief,” he said.

An advisory committee to the Association for Death Education and Counseling also argued that bereaved people “will receive antidepressant medication because it is cheaper and ‘easier’ to medicate than to be involved therapeutically,” and noted that antidepressants, like all medications, have side effects.

“I can’t help but see this as a broad overreach by the APA,” Eric Widera, a geriatrician at the University of California, San Francisco, wrote on the GeriPal blog. “Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.”

But Dr. Kupfer said the panel worried that with the exclusion, too many cases of depression could be overlooked and go untreated. “If these things go on and get worse over time and begin to impair someone’s day to day function, we don’t want to use the excuse, ‘It’s bereavement — they’ll get over it,’” he said.

The new entry for major depressive disorder will include a note — the wording isn’t final — pointing out that while grief may be “understandable or appropriate” after a loss, professionals should also consider the possibility of a major depressive episode. Making that distinction, Dr. Kupfer said, will require “good solid clinical judgment.”

Initial field trials testing the reliability of D.S.M. 5 diagnoses, recently published in The American Journal of Psychiatry, don’t bolster confidence, however. An editorial remarked that “the end results are mixed, with both positive and disappointing findings.” Major depressive disorder, for instance, showed “questionable reliability.”

In an upcoming post, I’ll talk more about how patients might respond to the D.S.M. 5, and to a new diagnosis that might also affect a lot of older people — mild neurocognitive disorder.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”


This post has been revised to reflect the following correction:

Correction: January 24, 2013

An earlier version of this post misspelled the surname of a professor emeritus at Duke who chaired the D.S.M. IV task force. He is Allen Frances, not Francis.

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NTSB: Dreamliner grounding indefinite








Boeing 787 Dreamliners will remain flightless birds for some time, it appears.

Federal investigators said Thursday they are still early in their probe of a Dreamliner battery fire in Boston Jan. 7. That fire, along with a subsequent 787 battery problem in Japan, led to groundings of Boeing's breakthrough plane model in the U.S. and elsewhere.

The revelation at a news conference Thursday afternoon that investigators still have not found a cause may suggest grounded Dreamliners, including six owned by Chicago-based United Airlines, won't be airborne anytime soon.

"We are early in our investigation. We have a lot of activity to undertake," said National Transportation Safety Board Chairman Deborah A.P. Hersman, pointing to one upcoming forensic test that alone takes a week. "There is a lot more work to be done before we can identify what caused this event."

The NTSB is the lead investigator of the battery fire in Boston aboard a Japan Airlines 787 aircraft.

Despite many aviation experts calling the 787's numerous mechanical glitches "teething pains" that all new airplane models go through, Hersman emphasized the gravity of fires on planes.

"This is an unprecedented event. We are very concerned. ... We do not expect to see fire events on board aircraft," she said. "This is a very serious air safety concern."

Nobody was hurt in the fire on the 787 in Boston or in an emergency landing in Japan after battery-related smoke and fumes on a different 787 were discovered.

The NTSB investigation will try to explain why multiple backup protections in the battery and the electronics systems aimed at preventing a fire failed, Hersman said.

"These events should not happen," she said. "As far as the design of the aircraft, there are multiple systems to protect against a battery event like this. Those systems did not work as intended. We need to understand why."

Besides fire, NTSB investigators found evidence of short circuits in the charred eight-cell, 63-pound battery and "thermal runaway," essentially uncontrolled spreading of heat. But those were symptoms, not necessarily causes, Hersman said. The batteries were made in Japan by Kyoto-based GS Yuasa Corp.

News that the NTSB investigation may be protracted -- longer than the few days some had predicted -- is bad news for Chicago-based Boeing.

Boeing last week halted deliveries of new 787s, until the FAA lifts the flight ban. However, Dreamliner production continues. Boeing is working to double monthly output in 2013 to help shrink a backlog of about 800 orders that swelled during multiple delays to the jet's debut, which came in late 2011.

Deliveries are important because that's when planemakers get large bulk payments on the purchase price of a jet. The 787's list price starts at about $207 million, but airlines typically buy at discount.

In a statement Thursday, Boeing said it is assisting in multiple investigations in the U.S. and Japan.

"The company has formed teams consisting of hundreds of engineering and technical experts who are working around the clock with the sole focus of resolving the issue and returning the 787 fleet to flight status," Boeing said.

Earlier Thursday, Boeing received a vote of confidence from United Airlines, the only U.S. airline  to own the new jet, during an earnings call with United Continental Holdings CEO Jeff Smisek. "History teaches us that all new aircraft types have issues, and the 787 is no different," Smisek said. "We continue to have confidence in the aircraft and in Boeing's ability to fix the issues, just as they have done on every other new aircraft model they've produced."

United had been using a Dreamliners on a route between Chicago and Houston. After the grounding, the route has been flown with a different aircraft.

Dreamliners in the U.S., Japan, Europe and elsewhere have been grounded since Jan. 16, after a 787 operated by All Nippon Airways made an emergency landing in Japan because battery-related smoke and fumes. That followed the fire in Boston that the NTSB is investigating.

The Dreamliner grounding was the first since the McDonnell Douglas DC-10 had its airworthiness certificate suspended following a deadly crash in Chicago in 1979.

Boeing has sold about 850 of its new aircraft, with 50 delivered to date. The plane is half made of a composite material, leading some to call it a "plastic plane." It makes greater use of electronics, powered by batteries, rather than heavy hydraulics. That makes the plane lighter and helps improve fuel efficiency, which is a big deal for airlines.

Boeing has said in statements that it is confident the 787 is safe, and it stands by the plane's integrity. It is cooperating with investigations in the U.S. and abroad.

Because of the groundings, LOT Polish Airlines scrapped its inaugural flight from O'Hare International Airport to Warsaw Jan. 16, just hours after the FAA grounded the plane. LOT officials said they would seek compensation from Boeing for having its two Dreamliners grounded. It will take delivery of the three more due in March only if the problems are resolved, the airline said.

After Thursday, it's clear nobody knows just when that might be.

"There is a tremendous amount of work going on all around the world," Hersman said. "We actually have two shifts of employees both here and in Japan who really are working around the clock to try to solve this."

gkarp@tribune.com






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Pentagon chief to remove military ban on women in combat

Former Navy SEAL Dick Couch comments on U.S. Defense Secretary Leon Panetta's decision to lift the military's ban on women serving in combat.









WASHINGTON—





The U.S. military will formally end its ban on women serving in frontline combat roles, officials said on Wednesday, in a move that could open thousands of fighting jobs to female service members for the first time.

The move knocks down another societal barrier in the U.S. armed forces, after the Pentagon in 2011 scrapped its “Don't Ask, Don't Tell” ban on gays and lesbians serving openly in the military.






U.S. defense officials said the decision to end the ban had been taken by outgoing U.S. Defense Secretary Leon Panetta and individual military services would have until 2016 to seek exemptions if they believed any combat roles should remain closed to women.

Panetta is expected to announce the decision formally on Thursday. It will come after 11 years of non-stop war that has seen 84 women killed as a result of hostile action in the unpopular, costly wars in Iraq and Afghanistan.

The military services will have until May 15 to submit a plan on how they will comply by 2016.

Women have represented around 2 percent of the casualties of in Iraq and Afghanistan and some 12 percent - or 300,000 - of those deployed in the war efforts in the past 11 years, in which there were often no clearly defined front lines, and where deadly guerrilla tactics have included roadside bombs that kill and maim indiscriminately.

“This is an historic step for equality and for recognizing the role women have, and will continue to play, in the defense of our nation,” said Democratic Senator Patty Murray from Washington, the outgoing head of the Senate Veterans Affairs Committee.

The planned move was also welcomed by Democratic Senator Carl Levin of Michigan, head of the Senate Armed Services Committee, who said it reflected the “reality of 21st century military operations.”

The American Civil Liberties Union, which filed a suit in November seeking to force the Pentagon to end the ban, applauded the move, which overturns a 1994 policy preventing women from serving in small front-line combat units.

‘HISTORIC MOMENT'

A plan for implementing the decision will have to be approved by the defense secretary and notified to Congress. The plan will guide how quickly the new combat jobs open up and whether the services will seek exemptions to keep some closed.

Senator Jim Inhofe, a Republican from Oklahoma, questioned the extent to which women would ultimately gain access to front-line combat, saying he doubted there would be a “broad opening.”

Michael O'Hanlon, a defense analyst at the Brookings Institution think tank, noted that integrating women was “a very delicate matter.” He called for the Pentagon to take a gradual approach, perhaps starting with special forces.

Former female service members cheered the move.

Anu Bhagwati, a former Marine captain and head of the Service Women's Action Network, said her decision to leave the Marine Corps in 2004 was partly due to the combat exclusion policy.

“I know countless women whose careers have been stunted by combat exclusion in all the branches,” said Bhagwati, who called the decision an “historic moment.”

“I didn't expect it to come so soon,” she said.

The move comes nearly a year after the Pentagon unveiled a policy that opened 14,000 new jobs to women but still prohibited them from serving in infantry, armor and special operations units whose main function was to engage in frontline combat.

For Panetta, it will add to his legacy as a secretary who oversaw the end of “Don't Ask, Don't Tell” and pushed the process to end discrimination against women.

Asked last year why women who had served in Iraq and Afghanistan conducting security details and house-to-house searches were still being formally barred from combat positions, Pentagon officials said the services wanted to see how they performed in the new positions before opening up further.

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Obama inauguration TV viewership down by 17.2 million from 2009






LOS ANGELES (Reuters) – Some 20.6 million Americans watched President Barack Obama’s inauguration ceremony and related events on television, according to ratings data on Wednesday. That’s down sharply from his first inauguration in 2009.


TV ratings company Nielsen said 18 U.S. television networks and cable channels carried live coverage over about six hours of Monday’s swearing-in ceremony, speech and parade in Washington.






Monday’s TV audience was a drop of 17.2 million from 2009, when 37.8 million Americans – the highest number since Ronald Reagan’s 1981 inauguration – watched Obama formally take office as the first black president in U.S. history.


The Nielsen figures did not measure viewers who watched Monday’s daylong ceremonies online via live streaming on many TV channels, nor overseas audiences.


Second-term inaugurations of U.S. presidents have traditionally drawn smaller numbers of viewers than those for first terms.


Reagan’s 1981 inauguration drew the biggest television audience of the past 44 years, attracting some 41.8 million U.S. viewers, according to Nielsen.


(Reporting By Jill Serjeant; Editing by Bill Trott)


TV News Headlines – Yahoo! News





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Well: Long Term Effects on Life Expectancy From Smoking

It is often said that smoking takes years off your life, and now a new study shows just how many: Longtime smokers can expect to lose about 10 years of life expectancy.

But amid those grim findings was some good news for former smokers. Those who quit before they turn 35 can gain most if not all of that decade back, and even those who wait until middle age to kick the habit can add about five years back to their life expectancies.

“There’s the old saw that everyone knows smoking is bad for you,” said Dr. Tim McAfee of the Centers for Disease Control and Prevention. “But this paints a much more dramatic picture of the horror of smoking. These are real people that are getting 10 years of life expectancy hacked off — and that’s just on average.”

The findings were part of research, published on Wednesday in The New England Journal of Medicine, that looked at government data on more than 200,000 Americans who were followed starting in 1997. Similar studies that were done in the 1980s and the decades prior had allowed scientists to predict the impact of smoking on mortality. But since then many population trends have changed, and it was unclear whether smokers today fared differently from smokers decades ago.

Since the 1960s, the prevalence of smoking over all has declined, falling from about 40 percent to 20 percent. Today more than half of people that ever smoked have quit, allowing researchers to compare the effects of stopping at various ages.

Modern cigarettes contain less tar and medical advances have cut the rates of death from vascular disease drastically. But have smokers benefited from these advances?

Women in the 1960s, ’70s and ’80s had lower rates of mortality from smoking than men. But it was largely unknown whether this was a biological difference or merely a matter of different habits: earlier generations of women smoked fewer cigarettes and tended to take up smoking at a later age than men.

Now that smoking habits among women today are similar to those of men, would mortality rates be the same as well?

“There was a big gap in our knowledge,” said Dr. McAfee, an author of the study and the director of the C.D.C.’s Office on Smoking and Public Health.

The new research showed that in fact women are no more protected from the consequences of smoking than men. The female smokers in the study represented the first generation of American women that generally began smoking early in life and continued the habit for decades, and the impact on life span was clear. The risk of death from smoking for these women was 50 percent higher than the risk reported for women in similar studies carried out in the 1980s.

“This sort of puts the nail in the coffin around the idea that women might somehow be different or that they suffer fewer effects of smoking,” Dr. McAfee said.

It also showed that differences between smokers and the population in general are becoming more and more stark. Over the last 20 years, advances in medicine and public health have improved life expectancy for the general public, but smokers have not benefited in the same way.

“If anything, this is accentuating the difference between being a smoker and a nonsmoker,” Dr. McAfee said.

The researchers had information about the participants’ smoking histories and other details about their health and backgrounds, including diet, alcohol consumption, education levels and weight and body fat. Using records from the National Death Index, they calculated their mortality rates over time.

People who had smoked fewer than 100 cigarettes in their lifetimes were not classified as smokers. Those who had smoked at least 100 cigarettes but had not had one within five years of the time the data was collected were classified as former smokers.

Not surprisingly, the study showed that the earlier a person quit smoking, the greater the impact. People who quit between 25 and 34 years of age gained about 10 years of life compared to those who continued to smoke. But there were benefits at many ages. People who quit between 35 and 44 gained about nine years, and those who stopped between 45 and 59 gained about four to six years of life expectancy.

From a public health perspective, those numbers are striking, particularly when juxtaposed with preventive measures like blood pressure screenings, colorectal screenings and mammography, the effects of which on life expectancy are more often viewed in terms of days or months, Dr. McAfee said.

“These things are very important, but the size of the benefit pales in comparison to what you can get from stopping smoking,” he said. “The notion that you could add 10 years to your life by something as straightforward as quitting smoking is just mind boggling.”

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Chicago hotel occupancy climbs back









Visitors filled downtown hotel rooms in 2012 at a rate not seen since before the recession.

Hotel occupancy rose to 75.2 percent, up from 72.2 percent in 2011, according to an announcement by Choose Chicago, the city's tourism and convention agency, and Mayor Rahm Emanuel. The 2012 level matched a previous record set in 2007.

Hotel operators also saw increases in two other key measures, though those remain slightly below their peaks. The average daily room rate rose to $187.27, from $177.33 in 2011. And the revenue per available room, a key indicator of profitability, increased by 10 percent to $140.76.

The data comes from STR Global, with analysis by Choose Chicago.

Among the factors affecting performance, officials said, was a more aggressive marketing strategy. They cited Choose Chicago's regional advertising campaigns. An eight-week winter and 12-week summer campaign, at a combined cost of $2 million, targeted Cincinnati, Detroit, Grand Rapids, Indianapolis, Milwaukee and St. Louis.

The improved performance, along with a hike in the city's hotel tax rate, brought the city's hotel tax revenue to more than $100 million for the first time. This was an increase of $25 million, or 33 percent, from 2011.
 
The city share of the hotel tax increased by 1 percentage point last year, bringing the total Chicago hotel tax rate to 16.39 percent. The city's share of that is 4.5 percentage points.

 kbergen@tribune.com | Twitter@kathy_bergen



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Evanston condo owner sued over bedbug extermination









A condominium association in Evanston is suing a man, claiming he refused to let the association treat his unit for bedbugs.

In September 2011, the Maisonette Condominium Association discovered a bedbug infestation at its building on the 2000 block of Sherman Avenue in Evanston, according to the lawsuit filed Tuesday in Cook County Circuit Court.


At that point, an exterminator treated each unit, including the unit of James Collins, the defendant in the lawsuit.





Collins, 67, of Evanston, had a particularly bad case of bed bugsin his unit, according to the lawsuit, and the exterminator returned several times after September 2011 to treat his unit.


When the exterminator returned to confirm that the building was free of bed bugs on Nov. 13, 2012, Collins’ apartment tested again positive for bugs, according to the lawsuit. A couch and a wooden chair, in particular, were too infested to treat, according to the lawsuit.


The association says that because Collins did not return messages requesting that they treat his unit, he in effect was refusing treatment. Collins did not return a call for comment Tuesday night.


The association is requesting an injunction to treat the unit.


Chicago was named the worst city in 2012 for bedbugs by the national pest-control company Orkin. Bedbug extermination in Chicago jumped 33 percent for the company from 2011 to 2012, Orkin officials said.


ehirst@tribune.com





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“Zero Dark Thirty” heads to Europe: will torture controversy follow?






LOS ANGELES (TheWrap.com) – Best Picture Oscar nominee “Zero Dark Thirty” rolls out in several Western European countries starting Wednesday, absent – at least for now – the firestorm of criticism that has accompanied its U.S. release.


The movie has been a lightning rod for detractors in the U.S. over its perceived endorsement of torture, an allegation that director Kathryn Bigelow and Sony executives have repeatedly denied.






“Overall, I believe Europeans are far less ambiguous than Americans when it comes to the use of torture,” Bruce Nash of box-office tracking service TheNumbers told TheWrap.


“To the extent that the film is perceived as pro-torture — whether it is or not, and I don’t believe it is — if that somehow became how the film is defined, that would hurt it at the box office,” Nash said. “But I don’t think that’s the case.”


Bigelow, screenwriter Marc Boal and several others involved with the picture have been in Europe for the past two weeks to promote the film. Boal told the New York Times that interviewers in France seemed to regard the torture issue as belonging to the Americans, and in fact appreciated the film’s head-on approach.


Indeed, the film begins its foreign run with a lot of momentum. The dark thriller about the hunt for Osama bin Laden was No. 1 in its first week of wide release on January 11 and has finished a strong second for the past two weeks.


Of course, the publicity surrounding the torture issue hasn’t hurt it at the box office in the U.S. The domestic haul for “Zero Dark Thirty” to this point is nearly $ 57 million, ahead of pre-release projections and likely heading for $ 100 million.


The film’s five Oscar nominations and the critical acclaim it has received have helped, too, but even Sony has acknowledged the flood of news stories raised the film’s profile.


Universal will be handling the film’s release in most countries in Western Europe, after buying rights to those territories from Megan Ellison’s Annapurna Pictures, which financed it and cut distribution deals territory by territory.


It will open in France and Switzerland on Wednesday and in the U.K and Finland on Friday. Its debut in Germany will be on January 31, and Austria, Sweden, Denmark, Italy, Norway and South Africa will follow in February. Regional distributors will handle the film’s February releases in Russia and Latin America, and the Annapurna is still considering a China run.


“Zero Dark Thirty” is one of three Best Picture Oscar nominees that is currently hitting overseas theaters with a distributor different than the one that handled its U.S.release.


Sony, which along with the Weinstein Company co-financed “Django Unchained,” is overseeing the foreign release of Quentin Tarantino’s slave saga. It opened last weekend and took in $ 48 million from 54 overseas markets.


DreamWorks’ “Lincoln,” distributed by Disney in North America, debuted in Spain and Mexico this past weekend via Fox.


With an explanatory preamble approved by director Steven Spielberg added, “Lincoln” opened to $ 2.3 million on 344 screens in Spain and to $ 729,000 on 259 screens in Mexico. “Lincoln” goes much wider next weekend, when it opens in 19 markets including Brazil, Germany, Italy, Russia and the U.K..


As for the torture controversy that accompanied “Zero Dark Thirty’s” U.S. release, it doesn’t seem to have caused the slightest ripple.


Indeed, the fact that torture has been used in the war against terror has been seen as a reality in Europe for some time.


In December, Europe’s highest court, the Grand Chamber of the European Court of Human Rights, concluded that techniques used routinely by the Bush-era CIA in connection with its extraordinary-renditions program constituted torture.


If torture does not become an issue, The Numbers’ Nash said it should do solid business. He pointed out that other U.S. films about the war on terror have done pretty well overseas. In 2006, “United 93″ made $ 31 million domestically and nearly $ 45 million overseas. Oliver Stone’s “World Trade Center” did $ 70 million in the U.S. and went to make $ 92 million abroad that same year.


Bigelow’s last movie, “The Hurt Locker,’” was about a U.S. bomb squad in the Iraq war, and it nearly doubled its $ 17 million domestic take, with $ 32 million from abroad in 2009. The bulk of that foreign run came after its surprise victory over “Avatar” for the Best Picture Oscar, however.


This weekend’s U.K. and France debuts will be telling, but Universal quietly opened “Zero Dark Thirty” on just 250 screens in Spain on January 4. With a minimum of criticism, politicians’ ire or public furor, the movie has taken in nearly $ 4 million over three weekends.


Movies News Headlines – Yahoo! News





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Medicaid Patients Could Face Higher Fees Under a Proposed Federal Policy





WASHINGTON — Millions of low-income people could be required to pay more for health care under a proposed federal policy that would give states more freedom to impose co-payments and other charges on Medicaid patients.




Hoping to persuade states to expand Medicaid, the Obama administration said state Medicaid officials could charge higher co-payments and premiums for doctors’ services, prescription drugs and certain types of hospital care, including the “nonemergency use” of emergency rooms. State officials have long asked for more leeway to impose such charges.


The 2010 health care law extended Medicaid to many childless adults and others who were previously ineligible. The Supreme Court said the expansion of Medicaid was an option for states, not a requirement as Congress had intended. The administration has been trying to persuade states to take the option, emphasizing that they can reconfigure Medicaid to hold down their costs and “promote the most effective use of services.”


In the proposed rule published Tuesday in the Federal Register, the administration said it was simplifying a complex, confusing array of standards that limit states’ ability to charge Medicaid beneficiaries. Under the proposal, a family of three with annual income of $30,000 could be required to pay $1,500 in premiums and co-payments.


As if to emphasize the latitude given to states, the administration used this heading for part of the new rule: “Higher Cost Sharing Permitted for Individuals With Incomes Above 100 Percent of the Federal Poverty Level” (that is, $19,090 for a family of three).


Barbara K. Tomar, director of federal affairs at the American College of Emergency Physicians, said the administration had not adequately defined the “nonemergency services” for which low-income people could be required to pay. In many cases, she said, patients legitimately believe they need emergency care, but the final diagnosis does not bear that out.


“This is just a way to reduce payments to physicians and hospitals” from the government, Ms. Tomar said.


With patients paying more, the federal government and states would pay less than they otherwise would. Medicaid covers 60 million people, and at least 11 million more are expected to qualify under the 2010 law. The federal government pays more than half of Medicaid costs and will pay a much larger share for those who become eligible under the law.


In the proposed rule, the administration said it had discovered several potential problems in its efforts to carry out the law.


First, it said, it has not found a reliable, comprehensive and up-to-date source of information about whether people have employer-sponsored health insurance. The government needs such information to decide whether low- and middle-income people can obtain federal subsidies for private insurance.


The subsidies can be used to buy coverage in competitive marketplaces known as insurance exchanges. Under the law, people can start enrolling in October for coverage that starts in January 2014, when most Americans will be required to have health insurance. People who have access to affordable coverage from employers will generally be ineligible for subsidies.


In applying for subsidies, people must report any employer-sponsored insurance they have. But the administration said it could be difficult to verify this information because the main sources of data reflect only “whether an individual is employed and with which employer, and not whether the employer provides health insurance.”


Since passage of the health care law, the administration has often said that people seeking insurance would use a single streamlined application for Medicaid and the subsidies for private coverage. Moreover, the state Medicaid agency and the exchange are supposed to share data and issue a “combined eligibility notice” for all types of assistance.


But the administration said this requirement would be delayed to Jan. 1, 2015, because more time was needed to establish electronic links between Medicaid and the exchanges.


Leonardo D. Cuello, who represents Medicaid beneficiaries as a lawyer at the National Health Law Program, expressed concern.


“Under the proposed rule,” Mr. Cuello said, “many people will be funneled into health insurance exchanges even though they have special needs that are better met in Medicaid. And if you asked the right questions, you would find out that they are eligible for Medicaid.”


The federal government will have the primary responsibility for running exchanges in more than half the states. About 20 states are expected to expand Medicaid; governors in other states are opposed or uncommitted.


The proposed rule allows hospitals to decide, “on the basis of preliminary information,” whether a person is eligible for Medicaid. States must provide immediate temporary coverage to people who appear eligible.


Kenneth E. Raske, president of the Greater New York Hospital Association, said this could be a boon to low-income people. “Currently,” he said, “only children and pregnant women are presumed eligible for inpatient admissions under Medicaid in New York.”


The public has until Feb. 13 to comment on the proposed rule. Comments can be submitted at www.regulations.gov.


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