Italy votes for center-left candidate for premier

ROME (AP) — Italians are choosing a center-left candidate for premier for elections early next year, an important primary runoff given the main party is ahead in the polls against a center-right camp in utter chaos over whether Silvio Berlusconi will run again.

Sunday’s runoff pits a veteran center-left leader, Pier Luigi Bersani, 61, against the 37-year-old mayor of Florence, Matteo Renzi, who has campaigned on an Obama-style “Let’s change Italy now” mantra.

Nearly all polls show Bersani winning the primary, after he won the first round of balloting Nov. 25 with 44.9 percent of the vote. Since he didn’t get an absolute majority, he was forced into a runoff with Renzi, who garnered 35.5 percent.

After battling all week to get more voters to the polling stations for round two, Renzi seemed almost resigned to a Bersani win by Sunday, saying he hoped that by Monday “we can all work together.”

Bersani, a former transport and industry minister, seemed confident of victory as well, joking about Berlusconi’s flip-flopping political ambitions by asking “What time did he say it?” when told that the media mogul had purportedly decided against running.

Next year’s general election will largely decide how and whether Italy continues on the path to financial health charted by Premier Mario Monti, appointed last year to save Italy from a Greek-style debt crisis.

The former European commissioner was named to head a technical government after international markets lost confidence in then-Premier Berlusconi’s ability to reign in Italy’s public debt and push through sorely needed structural reforms.

Berlusconi has largely stayed out of the public spotlight for the past year, but he returned with force in recent weeks, announcing he was thinking about running again, then changing his mind, then threatening to bring down Monti’s government, and most recently staying silent about his political plans.

His waffling has thrown his People of Freedom party into disarray and disrupted its own plans for a primary — all of which has only seemed to bolster the impression of order, stability and organization within the center-left camp.

A poll published Friday gave the Democratic Party 30 percent of the vote if the election were held now, compared with some 19.5 percent for the upstart populist movement of comic Beppe Grillo, and Berlusconi’s People of Freedom party in third with 14.3 percent. The poll, by the SWG firm for state-run RAI 3, surveyed 5,000 voting-age adults by telephone between Nov. 26 and 28. It had a margin of error of plus or minus 1.36 percentage points.

It’s quite a turnabout for Berlusconi’s once-dominant movement, and a similarly remarkable shift in fortunes for the Democratic Party, which had been in shambles for years, unable to capitalize on Berlusconi’s professional and personal failings while he was premier.

But Berlusconi’s 2011 downfall and a series of recent political party funding scandals that have targeted mostly center-right politicians have contributed to the party’s rise as Italy struggles through a grinding recession and near-record high unemployment.

Angelino Alfano, Berlusconi’s hand-picked political heir, seemed again exasperated Sunday after a long meeting with his patron over Berlusconi’s plans. News reports have suggested Berlusconi might split the party in two and re-launch the Forza Italia party that brought him to political power for the first time in 1994.

“We have to work to reconstruct the center-right, and reconstructing it means having a big center-right party,” not a divided one, Alfano said.

He added that Berlusconi didn’t say one way or another if he would run himself. “It’s his choice,” he said. “If there are any decisions in this regard, he’ll be the one to say so.”

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Follow Nicole Winfield at www.twitter.com/nwinfield

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Zynga stock falls after Facebook terms change

NEW YORK (AP) — Shares of Zynga slumped Friday after it disclosed with its partner Facebook that they have loosened their close ties to one another.

THE SPARK: The companies said in regulatory filings Thursday that they have amended their 2010 contract to say Zynga will no longer have to display Facebook ads or use Facebook payments on its own properties, such as Zynga.com.

In addition, Zynga, which makes the games “FarmVille” and “CityVille,” will no longer be required to use Facebook as the exclusive social site for its games, or to grant Facebook exclusive games. Any social game Zynga launches will also be available on Facebook either at the same time or shortly after it launches elsewhere.

Facebook, meanwhile, will be able to develop its own games after the end of March, though it said it has no plans to do so. Its deal with Zynga previously prohibited Facebook from developing games.

THE BIG PICTURE: While it’s not exactly splitsville, the original 2010 contract gave Zynga special status among Facebook game developers. Zynga relies on Facebook for most of the revenue it generates even as it works to establish its independence.

Facebook also makes money from Zynga, though the portion of its revenue that the game maker accounts for has declined. In the third quarter, Facebook said that 7 percent of its total revenue came from Zynga, down from 12 percent in the third quarter of 2011.

ANALYSIS: Wedbush analyst Michael Pachter said while Zynga investors reacted badly to the news, he sees the changes as a long-term positive for both companies.

“Zynga now has an incentive to expand the reach of its most popular social games beyond Facebook and Zynga.com and be able to offer additional payment options, likely resulting in additional payers who are not Facebook users,” the analyst wrote in a note to investors.

Pachter rates Zynga “Outperform” with a target price of $ 4.

STOCK ACTION: Shares of San Francisco’S Zynga Inc. fell 19 cents, or 7.3 percent, to $ 2.43 in afternoon trading. Zynga went public in December 2011 at a price of $ 10 per share but its stock have fallen sharply amid concerns about its ability to keep growing quickly.

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Strauss-Kahn in preliminary deal to settle case with maid

NEW YORK/PARIS (Reuters) – Former IMF head Dominique Strauss-Kahn has reached a preliminary agreement to settle a civil lawsuit brought against him by a hotel maid who accused him of sexual assault last year, sources familiar with the case said.

U.S. and France-based lawyers for Strauss-Kahn, who was once tipped to become French president, on Friday acknowledged a deal was under discussion, but said it had not yet been finalized.

They also denied as “flatly false” and “fanciful” a report that he agreed on a $ 6 million settlement.

“The parties have discussed a resolution but there has been no settlement. Mr. Strauss-Kahn will continue to defend the charges if no resolution can be reached,” Strauss-Kahn’s U.S. lawyers, William Taylor and Amit Mehta, said in a statement.

“Media reports that Dominique Strauss-Kahn has agreed to pay six million dollars to settle the civil case are flatly false.”

French daily Le Monde, citing people close to Strauss-Kahn, said he and the maid Nafissatou Diallo would meet a judge in New York on December 7 to sign a $ 6 million settlement and close an affair that ended the Frenchman’s International Monetary Fund career and wrecked his presidential ambitions.

“The discussions have been going on for weeks, months. The agreement should be confirmed at the start of next week,” Michele Saban, a friend of Strauss-Kahn who saw him recently, told Reuters in Paris. She could not confirm the sum involved.

“We are moving towards the end of a tragedy,” she said, adding that Diallo had always been open to negotiating a settlement despite reticence from her lawyers.

Le Monde said 63-year-old Strauss-Kahn planned to take out a bank loan for $ 3 million and would be lent the other $ 3 million by his wife Anne Sinclair, despite the fact the couple separated in the summer and now live on different sides of Paris.

Strauss-Kahn’s Paris-based legal team declined to comment on whether a deal had been reached with Diallo, but denied Le Monde’s report of the sum involved.

“Neither Dominique Strauss-Kahn nor his lawyers will comment on proceedings in the United States. That said, however, they strenuously deny the erroneous and fanciful information relayed by Le Monde,” said a statement from the Paris lawyers.

The New York Times, which first reported the development, also said the pair would appear before a judge in New York next week. It said the settlement sum could not be determined.

END OF THE AFFAIR

News of the U.S. deal comes as Strauss-Kahn is awaiting a decision by a French court on December 19 on whether to call off a sex offence inquiry involving parties in Lille attended by prostitutes, where he risks trial on a charge of “aggravated pimping”.

If that case is dropped and Diallo ends her civil case, Strauss-Kahn would have a freer rein to pursue his consultancy work and could even consider a tentative return to public life in France, where he has been shunned since the Diallo scandal.

Images of the then IMF chief paraded before TV cameras in handcuffs before being charged with attempted rape shocked the world and led to French media raking over smutty details of the former finance minister’s private life.

“That’s the end, not only of this affair, but of any potential affair because one of the reasons for signing this kind of agreement is that both parties agree that they will never again bring a lawsuit,” Christopher Mesnooh, a U.S. lawyer who practices in France, said of the Diallo agreement.

“There will always be people who wonder about what happened in New York and in Lille, but from a legal standpoint if he gets all this behind him, he’s a free man,” he added.

Diallo alleged that Strauss-Kahn forced her to perform oral sex on May 14, 2011, in his suite at the Manhattan Sofitel.

The criminal prosecution fell apart after doubts emerged concerning Diallo’s credibility as a witness and the attempted rape charges against Strauss-Kahn were eventually dropped.

Strauss-Kahn, who in May 2011 was days from entering this year’s French presidential election, has maintained that the sexual encounter was consensual, although he said in a TV interview after his return to France that he regretted his “moral error”.

He filed his own countersuit against the maid earlier this year, claiming that Diallo’s accusations had destroyed his career and harmed his reputation.

In recent months, Strauss-Kahn has been making a comeback under-the-radar with a handful of speaking engagements at private conferences and by setting up a business consultancy firm in Paris.

(Reporting by Noeleen Walder in New York and Emmanuel Jarry, Johnny Cotton and Thierry Leveque in Paris; Writing by Catherine Bremer and Brian Love; Editing by Jon Hemming)

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Asperger’s dropped from revised diagnosis manual

CHICAGO (AP) — The now familiar term “Asperger‘s disorder” is being dropped. And abnormally bad and frequent temper tantrums will be given a scientific-sounding diagnosis called DMDD. But “dyslexia” and other learning disorders remain.

The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation’s psychiatrists. Changes were approved Saturday.

Full details of all the revisions will come next May when the American Psychiatric Association‘s new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.

This diagnostic guide “defines what constellations of symptoms” doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it “shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care.”

Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association’s board of trustees.

The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.

One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger’s disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.

And some Asperger’s families opposed any change, fearing their kids would lose a diagnosis and no longer be eligible for special services.

But the revision will not affect their education services, experts say.

The new manual adds the term “autism spectrum disorder,” which already is used by many experts in the field. Asperger’s disorder will be dropped and incorporated under that umbrella diagnosis. The new category will include kids with severe autism, who often don’t talk or interact, as well as those with milder forms.

Kelli Gibson of Battle Creek, Mich., who has four sons with various forms of autism, said Saturday she welcomes the change. Her boys all had different labels in the old diagnostic manual, including a 14-year-old with Asperger’s.

“To give it separate names never made sense to me,” Gibson said. “To me, my children all had autism.”

Three of her boys receive special education services in public school; the fourth is enrolled in a school for disabled children. The new autism diagnosis won’t affect those services, Gibson said. She also has a 3-year-old daughter without autism.

People with dyslexia also were closely watching for the new updated doctors’ guide. Many with the reading disorder did not want their diagnosis to be dropped. And it won’t be. Instead, the new manual will have a broader learning disorder category to cover several conditions including dyslexia, which causes difficulty understanding letters and recognizing written words.

The trustees on Saturday made the final decision on what proposals made the cut; recommendations came from experts in several work groups assigned to evaluate different mental illnesses.

The revised guidebook “represents a significant step forward for the field. It will improve our ability to accurately diagnose psychiatric disorders,” Dr. David Fassler, the group’s treasurer and a University of Vermont psychiatry professor, said after the vote.

The shorthand name for the new edition, the organization’s fifth revision of the Diagnostic and Statistical Manual, is DSM-5. Group leaders said specifics won’t be disclosed until the manual is published but they confirmed some changes. A 2000 edition of the manual made minor changes but the last major edition was published in 1994.

Olfson said the manual “seeks to capture the current state of knowledge of psychiatric disorders. Since 2000 … there have been important advances in our understanding of the nature of psychiatric disorders.”

Catherine Lord, an autism expert at Weill Cornell Medical College in New York who was on the psychiatric group’s autism task force, said anyone who met criteria for Asperger’s in the old manual would be included in the new diagnosis.

One reason for the change is that some states and school systems don’t provide services for children and adults with Asperger’s, or provide fewer services than those given an autism diagnosis, she said.

Autism researcher Geraldine Dawson, chief science officer for the advocacy group Autism Speaks, said small studies have suggested the new criteria will be effective. But she said it will be crucial to monitor so that children don’t lose services.

Other changes include:

—A new diagnosis for severe recurrent temper tantrums — disruptive mood dysregulation disorder. Critics say it will medicalize kids’ who have normal tantrums. Supporters say it will address concerns about too many kids being misdiagnosed with bipolar disorder and treated with powerful psychiatric drugs. Bipolar disorder involves sharp mood swings and affected children are sometimes very irritable or have explosive tantrums.

—Eliminating the term “gender identity disorder.” It has been used for children or adults who strongly believe that they were born the wrong gender. But many activists believe the condition isn’t a disorder and say calling it one is stigmatizing. The term would be replaced with “gender dysphoria,” which means emotional distress over one’s gender. Supporters equated the change with removing homosexuality as a mental illness in the diagnostic manual, which happened decades ago.

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner .

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Mexico’s Pena Nieto takes power vowing to end violence

MEXICO CITY (Reuters) – Enrique Pena Nieto took over as Mexico‘s president on Saturday, promising to end years of violence and sluggish economic growth, and giving the party that shaped modern Mexico a shot at redemption after 12 years out of office.

The 46-year-old Pena Nieto said the people had been let down since his centrist Institutional Revolutionary Party, or PRI, fell from power in 2000, and pledged a raft of changes to boost growth, create jobs and fight poverty.

“The state has lost ground in important areas. Lawlessness and violence have robbed various parts of the country of peace and freedom,” Pena Nieto said in his inaugural speech at a ceremonial palace in the old center of Mexico City. “My government’s first aim will be to bring peace to Mexico.”

Pena Nieto takes command of a country that was convulsed by the deaths of more than 60,000 people in violence between drug gangs and security forces during the six-year term of his conservative predecessor, Felipe Calderon.

Pena Nieto says he is committed to fighting organized crime, but has also stressed his main goal is to reduce the violence.

He paid tribute to Mexico’s armed forces early in his speech and then saluted them on the capital’s Field of Mars parade ground.

The torrent of gangland killings in Mexico has worried investors and tourists alike, and voters in the holiday resort of Cancun said they expected Pena Nieto to calm things down.

“I hope security improves, that there are no more decapitated bodies, that the drug gangs don’t continue shooting in the streets,” said Carlos Madrid, a tourism worker in the eastern city. “It’s no good for families, no good for business, no good for the population, it’s no good for anyone.”

PROTESTS

Calderon’s National Action Party, or PAN, took power in 2000 pledging to reinvigorate Mexico, but it never had a majority in Congress and struggled to push through legislation it wanted to create jobs in Latin America’s second-biggest economy.

Memories of the PRI’s unbroken 71-year rule are still vivid in Mexico, and the party was a byword for corruption, cronyism and vote-rigging by the time it left office.

“It’s like the Communist Party of the Soviet Union making a comeback,” said Lorenzo Meyer, a left-leaning political scientist and historian at the National Autonomous University of Mexico. “The PRI should be dead. Its time had passed.”

Demonstrators sought to take the shine off Pena Nieto’s swearing-in ceremony, and several thousand protesters, mainly from leftist groups that supported Pena Nieto’s main rival and oppose his reform plans, massed earlier outside Congress.

Police fired tear gas to disperse protesters, who rattled metal barriers in a bid to disrupt the upcoming ceremony. Elsewhere, small groups of protesters threw Molotov cocktails.

“They have imposed an illegitimate president. There’s lots of us here, this struggle is just beginning,” said a 16-year-old student who identified herself as Frida, her eyes stinging from the gas and wearing a T-shirt emblazoned with the image of a guerrilla leader.

Married to a popular actress, Pena Nieto, the telegenic former state of Mexico governor, won the July 1 election with about 38 percent of the vote, more than 6 points ahead of leftist Andres Manuel Lopez Obrador, who refused to accept the result.

Lopez Obrador also rejected the outcome of his narrow election loss in 2006 to Calderon, and the protests on Saturday were slight by comparison with the demonstrations then.

TWO-SPEED COUNTRY

Having helped shepherd a labor reform through Congress since his election victory, Pena Nieto now wants to pass legislation to strengthen Mexico’s tax base and allow more private investment in lumbering state oil giant Pemex.

“Mexico has not achieved the advances the people demand and deserve,” Pena Nieto said. “We are a country growing at two speeds. There’s a Mexico of progress and development. But there’s another one too that’s been left behind in poverty.”

If he is successful, the reforms could help spur stronger growth and create jobs, blunting the allure of organized crime.

Annual economic growth averaged less than 2 percent under the PAN over the past 12 years, far behind many other Latin American countries. That record and the drug war violence opened the door for a PRI comeback under Pena Nieto.

Still, inflation has been kept in check, debt levels are low and growth picked up toward the end of Calderon’s term, with the economy outperforming Brazil’s in the past two years.

Pena Nieto’s inner circle features several ambitious young economists and financial experts eager to prove the PRI can do a better job of managing the economy.

For much of the PRI’s rule, Mexico enjoyed stronger growth than the PAN mustered, but memories linger of default on the country’s debts in 1982 and a financial crash in 1994 and 1995.

“It’s very hard to believe in the PRI. They bankrupted Mexico,” said construction worker Jose Luis Mendoza.

Supporting a family of four on 1,300 pesos ($ 100) a week, Mendoza, 29, said he was worse off now than when Calderon took office, and doubted his life would improve under the PRI. “The cost of everything has gone up – but my wage hasn’t,” he said.

Pena Nieto has pledged to put more money in Mexicans’ pockets and shake up competition in a country where large swaths of the economy are concentrated in the hands of a few, like telecom billionaire Carlos Slim, the world’s richest man.

But Pena Nieto has been vague so far about how he plans to create a more level playing field, and pollster Jorge Buendia said it would be foolish to expect radical change.

“Pena Nieto’s not a reformist guy. He never has been,” Buendia said. “He’s an establishment guy and I don’t think he’s going to rock the establishment that much.”

(Additional reporting by David Alire Garcia, Isela Serrano, Alexandra Alper, Miguel Gutierrez, Simon Gardner, Gabriel Stargardter and Noe Torres; Editing by Kieran Murray, Simon Gardner and Peter Cooney)

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Cargo plane crashes in Brazzaville, 3 dead

BRAZZAVILLE, Republic of Congo (AP) — A cargo plane owned by a private company crashed Friday near the airport in Brazzaville, the capital of the Republic of Congo, killing at least three people, officials said.

The Soviet-made Ilyushin-76 belonged to Trans Air Congo and appeared to be transporting merchandise, not people, said an aviation official who requested anonymity because he was not authorized to speak to the media.

The plane was coming from Congo‘s second-largest city, Pointe Noire, and tried to land during heavy rain, he said.

Ambulances rushed to the scene in the Makazou neighborhood, located near the airport, but emergency workers were hampered by the lack of light in this capital, which like so many in Africa has a chronic shortage of electricity.

“At the moment, my team is having a hard time searching for survivors in order to find the victims of the crash because there is no light and also because of the rain,” Congolese Red Cross head Albert Mberi said.

He said that realistically, they will only be able to launch a proper search Saturday, when the sun comes up.

Reporters at the scene fought through a wall of smoke. Despite the darkness, they could make out the smoldering remains of the plane, including what looked like the left wing of the aircraft. A little bit further on, emergency workers identified the body of the plane’s Ukrainian pilot, and covered the corpse in a blanket.

Firefighters were trying to extinguish the blaze of a part of the plane that had fallen into a ravine. They were using their truck lights to try to illuminate the scene of the crash. Although the plane was carrying merchandise, emergency workers fear that there could be more people on board.

Because of the state of the road connecting Pointe Noire to Brazzaville, many traders prefer to fly the roughly 400 kilometers (250 miles).

Africa has some of the worst air safety records in the world. In June, a commercial jetliner crashed in Lagos, Nigeria, killing 153 people, just a few days after a cargo plane clipped a bus in neighboring Ghana, killing 10.

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Putin aide denies Russian president has health problems

TOKYO/MOSCOW (Reuters) – Vladimir Putin is in good health, his chief of staff said on Friday after Japanese media said Prime Minister Yoshihiko Noda had postponed a visit to Moscow next month because the Russian president had a health problem.

A former KGB officer who enjoys vast authority in Russia, Putin has long cultivated a tough-guy image, and health issues could damage that. His condition though has been questioned in some media since he was seen limping at a summit in September.

Three Russian government sources told Reuters late in October that Putin, who began a six-year term in May and turned 60 last month, was suffering from back trouble, but the Kremlin has dismissed talk that he had a serious back problem.

Putin’s health troubles stem from a recent judo bout, Belarussian President Alexander Lukashenko said this week.

Then on Friday Japanese news agencies Kyodo and Jiji reported that Prime Minister Noda talked about the delay of a visit planned for December in a meeting with municipal officials on the northern island of Hokkaido.

“It’s about (President Putin’s) health problem. This is not something that can easily be made public,” Jiji cited one of the officials as quoting Noda as saying.

But Putin’s chief of staff Sergei Ivanov denied there was any problem.

“Please don’t worry, don’t be concerned. Everything is in order with his health,” Putin’s said in Vienna, according to state-run Russian news agency RIA.

In an interview published on Friday in the popular Russian tabloid Komsomolskaya Pravda, Putin’s spokesman Dmitry Peskov said rumors about a spine problem were “strongly exaggerated”.

“He is working as he has before and intends to continue working at the same pace,” Peskov said.

“He also does not plan to give up his sports activities and for this reason, like any athlete, his back, his arm, his leg might sometimes hurt a little – this has never gotten in the way of his ability to work.”

Putin had been expected to make several foreign trips in late October or November, but they did not take place.

Putin is however due to visit Turkey on Monday and Turkmenistan on Wednesday.

Putin’s foreign policy adviser, Yuri Ushakov, made amply clear the Kremlin was displeased by the public discussion of scheduling by Japanese officials and denied that Noda’s visit had been postponed, saying no date had been set.

“It is just unethical to name the dates that were discussed. There were several: at first it was October, November, December, January … then we even shifted to February,” Ushakov said, adding that the sides eventually agreed tentatively on January.

He said the diplomatic process of agreeing dates for the visit should have been “hermetically sealed”.

Putin’s image as a fit, healthy man helped bring him popularity when he rose to power 13 years ago because of the stark contrast with his predecessor Boris Yeltsin, who was sometimes drunk in public and had heart surgery when president.

He has used activities like scuba diving and horseback riding to maintain that image.

On Friday, Putin met leaders of parliamentary factions in his Novo-Ogaryovo residence outside Moscow. He appeared in good health and was walking without any sign of a limp.

Likely to be on the agenda in talks between Russian and Japanese officials are energy cooperation and a decades-old dispute over islands north of Hokkaido known as the Southern Kurils in Russia and the Northern Territories in Japan.

(Additional reporting by Darya Korsunskaya; Writing by Tomasz Janowski and Steve Gutterman; Editing by Nick Macfie and Jon Hemming)

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The Economy of Surgery

When I was twelve, my sister and I accompanied my grandparents to their annual yoga retreat in the hilly ranges of southern India. We had never been before, but the summer heat was particularly blistering that year, so we persuaded our grandparents to take us along. I envisioned a blissful two-week vacation in a photogenic little hamlet, nestled among tea plantations, in temperatures that were thirty degrees cooler than on the mainland. It was just that, and yet, it was even less complicated than that.The mean age of folk at the retreat was 67. Bells sounded every morning at 3:30am, and everyone filed out of their cabins and to a little gymnasium in the center of the dwelling, where we all meditated for two hours to the sounds of sitar music and transcendental humming. Meals were served at strict hours three times a day, and consisted of boiled vegetables and grains, with not a lick of salt or spice. The library in the middle of this utopian dwelling held only spiritual and philosophical texts, not the Nancy Drew or Hardy Boys I hoped for. In the afternoons, there were a variety of classes offered – cooking lessons, devotional classes, music and instrumental classes, and yoga. My sister and I stopped by the latter occasionally, and were always put to shame by octogenarians holding themselves up in impossible poses, such as balancing their entire habitus on the tips of their fingers. I journaled in the evenings, writing each day about a new facet of human life that I’d observed. In the absence of stimulus, my dreams grew vivid and exceedingly detailed.Over the course of the two weeks, my sister and I grew quiet and reflective. It was then that we began an important switch in our minds, something that has lasted to this day. We began to see value in living leanly, economically, functionally. We began to separate needs from wants, and to discard the ornamentation.*Third year of medical school has finally brought me around to my surgery rotation: three months of waking up at 4am, stuffing my white coat pockets to the brim with gauze and tape, retracting skin and fat during long abdominal surgeries, and practicing suturing techniques on pig’s feet procured at the local Stop&Shop grocery market. It’s fast and exhilarating, and deeply satisfying. I was skeptical when I first heard that my preceptor’s favorite procedure of all time was draining a deep-seated abscess. But when I saw it being done in clinic, how a single stab of the thing blade led to the gushing of what felt like liters of pus, I couldn’t help but agree. What a joy to just go in and fix a problem so dramatically, reconstruct a failing human body in a matter of hours!During orientation on the first day of the rotation, two residents sat down and gave my classmates and me some hard advice. Surgery is a demanding rotation, they said, and it reflects the demanding residency ahead that awaits the select few. We could expect to go in while it is still dark out, and leave after the sun had set, almost every day. Residents and attendings can be rough around the edges, and may be gruff with you, even kick you out of their operating room if they feel like it, but it’s not personal. Or even if it is, we’ve got to shrug it off and keep it moving. Gone are the days of noon conferences and luxurious afternoon didactics, with their promise of free lunches and coffee. We were to eat when we can, sit when we can, sleep when we can.After an hour of such grim prognostications, my classmates and I took a break and debriefed our feelings with each other outside the bathrooms. Some were giggling nervously with panicked eyes, but most looked inspired. I too felt like I had voluntarily signed up for a warrior training program, and was feeling pretty zen about it. I saw it as a character-building experience: surgery was the time to cut out the silly frills, and embrace a leaner, meaner way of living. It was time to lose the pretty business casual outfits and fancy footwear of internal medicine, and trade them in for utilitarian scrubs and clogs. It promised to be a time of talking less and getting things done.*During a recent health management class, my classmates and I discussed the case of a medical center based in Seattle that benefited from industry principles gleaned from, of all places, the Toyota car manufacturing company. Toyota’s revolution as a manufacturing miracle began in the supply-scarce post-WWII Japan, when management was confronted with the challenge of meeting customer needs in the face of little spare capital to hold inventory as a buffer to fluctuating demand. The company then developed a set of principles focused on cutting muda or waste, while pursuing kaizen, or continuous self -improvement by way of complete intolerance for redundancy. Toyota integrated these principles into every step of production and management.For instance, Toyota emphasizes innovation on the shop floor by frontline workers to solve problems in production in real time. If a problem is discovered that cannot be fixed within the production cycle time, workers pull a cord that halts the entire assembly line and brings a senior supervisor to the scene. The management aggressively seeks ideas for improvement from employees, resulting in an average yield of close to a million ideas annually, 90% of which go on to be implemented.Analysts attribute Toyota’s success to its emphatic optimization of flow – information flow, physical flow of parts, and overall production flow, via standardized processes and continuous improvement. Standardized processes are ones that are streamlined to eliminate aberrations and unplanned redundancies. Waste, measured even in the seconds, is simply not tolerated, forcing a redesign of processes, again and again, which any employee can take on.In 2004, Toyota surpassed Ford Motors to become the world’s second-largest manufacturer of cars and trucks, surpassing the latter consistently in quality, dependability and value assessments. In turn, Ford began to take cues from Toyota, transforming its assembly-line system to similarly cut out waste.*There are two kinds of people in the world: surgeons, and everyone else.Really, what does it mean to live leanly? I rediscovered it in this rotation. A life in surgery isn’t for everyone, but such an experience is something I truly feel everyone should have. These past 6 weeks have been teaching me to think fast, move fast. They’ve been teaching me to suffice with less, be it food, sleep, or words of appreciation. They’ve been teaching me to appreciate the vulnerabilities of the human body – for no matter how exhausted or sleep-deprived I may feel, actually laying hands on the more tangible deficits of another’s is always startling and humbling. The end result is a beautiful dance, for surgeons and their assistants, working with their hands, rediscovering the grace of human movement, bring art back into medicine.I never leave the OR thinking that more is better. I watch instruments fly, I watch the players push and pull, cut and stitch, wash and dry, and I think about things like symmetry, precision, and above all, the beauty of economy.

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China Nov official factory PMI hits seven-month high

BEIJING (Reuters) – China‘s official manufacturing purchasing managers’ index rose to a seven-month high of 50.6 in November from 50.2 in October, the National Bureau of Statistics said on Saturday.

The headline figure is in line with an economist poll by Reuters this week, and confirms a trend toward recovering growth in the world’s second-largest economy.

A PMI reading below 50 suggests growth slowed, while a number above 50 indicates accelerating growth.

While growth accelerated for large firms for the third month in a row, medium and smaller companies saw a retrenchment, with the decline more pronounced for the smaller firms, the NBS said in an accompanying statement.

“The improving numbers are mostly because of government investment. From the second quarter the government has unleashed a lot of projects, and that has started to be felt in the economy, but it’s not a very healthy recovery yet,” said Dong Xian’an, economist with Peking First Advisory.

The HSBC China flash PMI – which gathers more data from smaller, privately-held firms that have a strong export focus – signaled that November growth in the manufacturing sector had quickened for the first time in 13 months with a reading of 50.4 when it was published last week, reflecting a steady uptick in the economy.

China’s economic health has improved since September, with an array of indicators from factory output to retail sales and investment showing Beijing’s pro-growth policies are starting to gain traction.

Analysts said the end of a destocking cycle and a greater pace of investment would keep driving up domestic demand, and extend the recovery trend into the final quarter of this year.

Smaller and private firms are still pleading for greater access to credit and investment incentives, which have gone disproportionately to the state sector, particularly since the financial crisis of 2008-2009.

China’s annual economic growth dipped to 7.4 percent in the third quarter, slowing for seven quarters in a row and leaving the economy on course for its weakest showing since 1999.

Given the recent signs of recovery, many analysts expect the economy to snap out of its longest downward cycle since the global financial crisis, and start to trend upwards in the fourth quarter.

But economists also warn of downside risks from still cloudy external markets. The European debt crisis and listless U.S. economy continue to crimp demand from China’s two largest trade partners.

China’s central bank has moved cautiously in easing monetary policy to underpin economic growth, wary of reigniting inflation and fanning property prices which are still high.

It cut interest rates twice in June and July and lowered banks’ reserve requirement ratio by 150 basis points in three stages since last November, but has refrained from further cuts since July. The authorities have opted to inject liquidity via open market operations to pump short-term cash into money markets.

The official PMI generally paints a rosier picture of the factory sector than the HSBC PMI because the official survey focuses on big, state-owned firms, while the HSBC PMI targets smaller, private companies. There are also differing approaches to seasonal adjustment between the two surveys.

This year’s final HSBC PMI reading is due to be published at 0145 GMT on Monday.

(Reporting By Lucy Hornby; Editing by Daniel Magnowski)

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African Union asks UN for immediate action on Mali

DAKAR, Senegal (AP) — In an open letter Thursday to U.N. Secretary-General Ban Ki-moon, the president of the African Union urged the U.N. to take immediate military action in northern Mali, which was seized by al-Qaida-linked rebels earlier this year.

Yayi Boni, the president of Benin who is also head of the African Union, said any reticence on the part of the U.N. will be interpreted as a sign of weakness by the terrorists now operating in Mali. The AU is waiting for the U.N. to sign off on a military plan to take back the occupied territory, and the Security Council is expected to discuss it in coming days.

In a report to the Security Council late Wednesday, Ban said the AU plan “needs to be developed further” because fundamental questions on how the force will be led, trained and equipped. Ban acknowledged that with each day, al-Qaida-linked fighters were becoming further entrenched in northern Mali, but he cautioned that a botched military operation could result in human rights abuses.

The sprawling African nation of Mali, once an example of a stable democracy, fell apart in March following a coup by junior officers. In the uncertainty that ensued, rebels including at least three groups with ties to al-Qaida, grabbed control of the nation’s distant north. The Islamists now control an area the size of France or Texas, an enormous triangle of land that includes borders with Mauritania, Algeria and Niger.

Two weeks ago, the African Union asked the U.N. to endorse a military intervention to free northern Mali, calling for 3,300 African soldiers to be deployed for one year. A U.S.-based counterterrorism official who saw the military plan said it was “amateurish” and had “huge, gaping holes.” The official insisted on anonymity because he was not authorized to speak on the matter.

Boni, in his letter, said Africa was counting on the U.N. to take decisive action.

“I need to tell you with how much impatience the African continent is awaiting a strong message from the international community regarding the resolution of the crisis in Mali. … What we need to avoid is the impression that we are lacking in resolve in the face of these determined terrorists,” he said.

The most feared group in northern Mali is al-Qaida in the Islamic Maghreb, or AQIM, al-Qaida’s North African branch, which is holding at least seven French hostages, including a 61-year-old man kidnapped last week.

On Thursday, SITE Intelligence published a transcript of a recently released interview with AQIM leader, Abu Musab Abdul Wadud, in which he urges Malians to reject any foreign intervention in their country. He warned French President Francois Hollande that he was “digging the graves” of the French hostages by pushing for an intervention.

Also on Thursday, Islamists meted out the latest Shariah punishment in northern city of Timbuktu. Six young men and women were each given 100 lashes for having talked to each other on city streets, witnesses said.

___

Associated Press writer Virgile Ahissou in Cotonou, Benin and Baba Ahmed in Bamako, Mali contributed to this report.

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