A Breakthrough Against Leukemia Using Altered T-Cells

PHILIPSBURG, Pa. — Emma Whitehead has been bounding around the house lately, practicing somersaults and rugby-style tumbles that make her parents wince.

It is hard to believe, but last spring Emma, then 6, was near death from leukemia. She had relapsed twice after chemotherapy, and doctors had run out of options.

Desperate to save her, her parents sought an experimental treatment at the Children’s Hospital of Philadelphia, one that had never before been tried in a child, or in anyone with the type of leukemia Emma had. The experiment, in April, used a disabled form of the AIDS virus to reprogram Emma’s immune system genetically to kill cancer cells.

The treatment very nearly killed her. But she emerged from it cancer-free, and seven months later is still in complete remission. She is the first child and one of the first humans ever in whom new techniques have achieved a long-sought goal — giving a patient’s own immune system the lasting ability to fight cancer.

Emma had been ill with acute lymphoblastic leukemia since 2010, when she was 5, her parents, Kari and Tom, said. She is their only child.

She is among just a dozen patients with advanced leukemia to have received the experimental treatment, which was developed at the University of Pennsylvania. Similar approaches are also being tried at other centers, including the National Cancer Institute and Memorial Sloan-Kettering Cancer Center in New York.

“Our goal is to have a cure, but we can’t say that word,” said Dr. Carl June, who leads the research team at the University of Pennsylvania. He hopes the new treatment will eventually replace bone-marrow transplantation, an even more arduous, risky and expensive procedure that is now the last hope when other treatments fail in leukemia and related diseases.

Three adults with chronic leukemia treated at the University of Pennsylvania have also had complete remissions, with no signs of disease; two of them have been well for more than two years, said Dr. David Porter. Four adults improved but did not have full remissions, and one was treated too recently to evaluate. A child improved and then relapsed. In two adults, the treatment did not work at all. The Pennsylvania researchers are presenting their results on Sunday and Monday in Atlanta at a meeting of the American Society of Hematology.

Despite the mixed results, cancer experts not involved with the research say it has tremendous promise, because even in this early phase of testing it has worked in seemingly hopeless cases.

“I think this is a major breakthrough,” said Dr. Ivan Borrello, a cancer expert and associate professor of medicine at the Johns Hopkins University School of Medicine.

Dr. John Wagner, director of pediatric blood and marrow transplantation at the University of Minnesota, called the Pennsylvania results “phenomenal,” and said they were “what we’ve all been working and hoping for but not seeing to this extent.”

A major drug company, Novartis, is betting on the Penn team, and has committed $20 million to building a research center on the Penn campus to bring the treatment to market.

Hervé Hoppenot, president of Novartis Oncology, called the research “fantastic” and said it had the potential — if the early results hold up — to revolutionize the treatment of leukemia and related blood cancers. Researchers say the same approach, reprogramming the patient’s immune system, may also be used eventually against tumors like breast and prostate cancer.

To perform the treatment, doctors remove millions of the patient’s T-cells — a type of white blood cell — and insert new genes that enable the T-cells to kill cancer cells. The new genes program the T-cells to attack B-cells, a normal part of the immune system that turns malignant in leukemia.

The altered T-cells — called chimeric antigen receptor cells — are then dripped back into the patient’s veins, and if all goes well they multiply like crazy and start destroying the cancer.

The T-cells home in on a protein called CD-19 that is found on the surface of most B-cells, whether they are healthy or malignant.

A sign that the treatment is working is that the patient becomes terribly ill, with raging fevers and chills — a reaction that oncologists call “shake and bake,” Dr. June said. Its medical name is cytokine-release syndrome, or cytokine storm, referring to the natural chemicals that pour out of cells in the immune system as they are being activated, causing fevers and other symptoms. The storm can also flood the lungs and cause perilous drops in blood pressure — effects that nearly killed Emma.

Steroids sometimes ease the reaction, but did not help Emma. Her temperature hit 105. She wound up on a ventilator, unconscious and swollen almost beyond recognition, surrounded by friends and family who had come to say goodbye.

But at the eleventh hour, a battery of blood tests gave the researchers a clue as to what might help save Emma: Her level of one of the cytokines, interleukin-6 or IL-6, had shot up a thousandfold. Doctors had never seen such a spike before and thought it might be what was making her so sick. Dr. June knew that a drug could lower IL-6 — his daughter takes it, for rheumatoid arthritis. It had never been used for a crisis like Emma’s, but there was little to lose. Her oncologist, Dr. Stephan A. Grupp, ordered the drug. The response, he said, was “amazing.”

Within hours, Emma began to stabilize. She woke up a week later, on May 2, the day she turned 7; the intensive-care staff sang “Happy Birthday.”

Since then, the research team has used the same drug, tocilizumab, in several other patients.

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Jenni Rivera aboard plane missing in Mexico

Jenni Rivera (Reed Saxon / Associated Press / March 8, 2012)

By Meg James

December 9, 2012, 1:05 p.m.

A small plane carrying Mexican American singer Jenni Rivera is missing and believed to have crashed in northern Mexico early Sunday.

The Associated Press reported the plane, a Learjet, left Monterrey about 3:30 a.m. after a concert by Rivera. The pilot lost contact with air traffic contollers about 10 minutes after its departure. It was scheduled to arrive in Toluca, near Mexico City, about an hour later.

An NBCUniversal spokeswoman confirmed that Rivera was aboard the plane. Seven people, including the pilots and crew, were believed to be on the plane.

PHOTOS: Jenni Rivera missing

The Long Beach native's career has been soaring. The 43-year-old singer is best known for her interpretations of regional Mexican music, norteno and banda. She also is one of NBCUniversal's brightest bilingual television stars.

Her reality show on the Telemundo cable channel, mun2, "I Love Jenni," has been one of the channel's highest rated shows. The program is in its second year.

ABC television network was reportedly considering casting Rivera as a star of a prime-time sitcom in development about a strong-willed single Latina mother.

The AP said that a search for the plane was launched early Sunday.

ALSO:

Los Angeles bands swing into old school music revival

Live Review: Bloc Party at the Palladium

It's girl power on "Jenni Rivera Presents Chiquis and Raq-C"

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Surgeon infected patients during heart procedure, Cedars-Sinai admits

A heart surgeon at Cedars-Sinai Medical Center unwittingly infected five patients during valve replacement surgeries earlier this year, causing four of the patients to need a second operation.

The infections occurred after tiny tears in the latex surgical gloves routinely worn by the doctor allowed bacteria from a skin inflammation on his hand to pass into the patients' hearts, according to the hospital. The patients survived the second operation and are still recovering, hospital officials said.

The outbreak led to investigations by the hospital and both the L.A. County and California departments of public health. The federal Centers for Disease Control and Prevention was also consulted.

Hospital officials called it a "very unusual occurrence" probably caused by an unfortunate confluence of events: the nature of the surgery, the microscopic rips in the gloves and the surgeon's skin condition. Valve replacement requires the surgeon to use thick sutures and tie more than 100 knots, which can cause extra stress on the gloves, they said.

Nevertheless, the hospital's goal is to have zero infections, said Harry Sax, vice chairman of the hospital's department of surgery. "Any hospital-acquired infection is unacceptable," he said.

The infections raise questions about what health conditions should prevent a surgeon from operating and how to get the best protection from surgical gloves. Surgeons with open sores or known infections aren't supposed to operate, but there is no national standard on what to do if they have skin inflammation, said Rekha Murthy, medical director of the hospital's epidemiology department. She added that there were also no national standards on types of gloves used, whether to wear double gloves or how many times surgeons should change those gloves during a procedure.

Healthcare-acquired infections are very common throughout the United States. Each year, infections cause 99,000 deaths in the country, including about 12,000 in California. Hospitals in the state are required to report certain infections to the California Department of Public Health. That reporting makes the public more aware of the quality of care provided at local hospitals and is an important tool for reducing infections, said Debby Rogers, deputy director of the department's Center for Health Care Quality.

Cedars-Sinai has low rates for hospital-acquired infections compared with the state and national average but has not performed as well on other surgical quality measures recently, according to the Leapfrog Group, an employer-backed nonprofit focused on healthcare quality. The organization gave the hospital a C rating last month on its national report card, down from an A in June, though it was not related to the infection outbreak.

"Clearly this hospital is making attempts to reduce infections, but they have more work to do," said Leah Binder, Leapfrog's chief executive.

Cedars-Sinai Medical Center conducts about 360 valve replacement surgeries each year and said infections occur in fewer than 1% of its cases — lower than the national average.

The hospital learned about the problem in June after three patients who had undergone valve replacement surgery showed signs of infection. Doctors diagnosed the patients with an infection called endocarditis. Concerned there might be a connection among the cases, epidemiologists analyzed the bacteria, staphylococcus epidermidis, and determined that it was an identical strain and therefore must have come from a single source. "It led to the question of gee, I wonder where it came from?" Murthy said.

Epidemiologists homed in on the surgeon with the skin inflammation. The bacteria matched, and then they made a surprising discovery: microscopic tears in the gloves typically worn by surgeons after performing valve replacement surgery. The surgeon, whose name was not released, was not allowed to operate again until he healed. He is still a member of the medical staff but no longer performs surgeries at the hospital.

The hospital soon found the same infection in two more patients. Officials also reached out to 67 patients who had heart valve replacements with the same surgeon but didn't find any other cases. One of the five infected patients was treated with antibiotics, and the other four had new valve replacement surgeries. Sax said the hospital apologized to the patients and has continued to monitor their health. The hospital has also covered the cost of their care, including follow-up treatment and all the related surgeries.

All surgeons doing valve replacements are now required to change gloves more frequently, officials said. Some surgeons are wearing double gloves during the operations, Sax said.

Following the outbreak, Cedars-Sinai did the proper follow-up to ensure the safety of their patients, said Dawn Terashita, a medical epidemiologist with L.A. County, who was notified in September. What occurred at Cedars-Sinai was an unintentional consequence of the surgery, she said.

"There is no way to keep a room entirely sterile and all the people in it sterile," she said. "You will always have risk of infection."

anna.gorman@latimes.com

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Rolling Stones hit NY for 50th anniversary gig

NEW YORK (AP) — "Time Waits for No One," the Rolling Stones sang in 1974, but lately it's seemed like that grizzled quartet does indeed have some sort of exemption from the ravages of time.

At an average age of 68-plus years, the British rockers are clearly in fighting form, sounding tight, focused and truly ready for the spotlight at a rapturously received pair of London concerts last month.

On Saturday, Mick Jagger, Keith Richards, Ronnie Wood and Charlie Watts hit New York for the first of three U.S. shows on their "50 and Counting" mini-tour, marking a mind-boggling half-century since the band first began playing its unique brand of blues-tinged rock.

And the three shows — Saturday's at the new Barclays Center in Brooklyn, then two in Newark, N.J., on Dec. 13 and 15 — aren't the only big dates on the agenda. Next week the Stones join a veritable who's who of British rock royalty and U.S. superstars at the blockbuster 12-12-12 Sandy benefit concert at Madison Square Garden. Also scheduled to perform: Paul McCartney, the Who, Eric Clapton, Bruce Springsteen & The E Street Band, Alicia Keys, Kanye West, Eddie Vedder, Billy Joel, Roger Waters and Chris Martin.

The Stones' three U.S. shows promise to have their own special guests, too. Mary J. Blige will be at the Brooklyn gig, as well as guitarist Gary Clark Jr., the band has announced. (Blige performed a searing "Gimme Shelter" with frontman Jagger in London.) Rumors are swirling of huge names at the Dec. 15 show, which also will be on pay-per-view.

In a flurry of anniversary activity, the band also released a hits compilation last month with two new songs, "Doom and Gloom" and "One More Shot," and HBO premiered a new documentary on their formative years, "Crossfire Hurricane."

The Stones formed in London in 1962 to play Chicago blues, led at the time by the late Brian Jones and pianist Ian Stewart, along with Jagger and Richards, who'd met on a train platform a year earlier. Bassist Bill Wyman and drummer Charlie Watts were quick additions.

Wyman, who left the band in 1992, was a guest at the London shows last month, as was Mick Taylor, the celebrated former Stones guitarist who left in 1974 — to be replaced by Wood, the newest Stone and the youngster at 65.

The inevitable questions have been swirling about the next step for the Stones: another huge global tour, on the scale of their last one, "A Bigger Bang," which earned more than $550 million between 2005 and 2007? Something a bit smaller? Or is this mini-tour, in the words of their new song, really "One Last Shot"?

The Stones won't say. But in an interview last month, they made clear they felt the 50th anniversary was something to be marked.

"I thought it would be kind of churlish not to do something," Jagger told The Associated Press. "Otherwise, the BBC would have done a rather dull film about the Rolling Stones."

__

Associated Press writer David Bauder contributed to this report.

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Auto execs share insights on the industry and what's next

It's hard to get America's most senior auto executives together in the same building to address the same topics, but we managed to do it with Mark Reuss, president of General Motors Co.'s North American operations, and Mark Fields, the newly appointed chief operating officer of Ford Motor Co.

They came to town for the Los Angeles Auto Show, which ends Sunday. Even then, they weren't in the same room — so we just asked them identical questions, in separate interviews, to create this virtual debate.

Both executives address key issues facing the industry, including the future of in-dash technology, fuel economy, electric cars and the prospects for the industry at large. They don't always agree.

Do vehicle embedded features such as MyFord Touch or Cadillac Cue make sense when smartphones can do many of the same tasks with fewer glitches? Why not use architecture that allows people to use phone apps for vehicle infotainment?

Reuss: There is no way that the auto industry in the long haul should be carrying all that technology in a car. Phones will move faster in technology than anything we can put into a car. Embedding those functions in a car and then trying to guess where phones are going is not a solution. We will experiment with technology in Cadillac, but that's not where the mainline brands will be going.

Fields: It is very clear that for younger consumers, staying connected in their lives is hugely important whether they are in their bedrooms, walking outside or in their cars. That's why we started Sync and MyFord Touch.

In the future, you might end up seeing a hybrid of embedded technology and smartphone connectivity. There are certain things that we want to ensure, such as safety and integration into the rest of the vehicle. There could be some issues with just plugging in a smartphone and allowing it to do a lot of vehicle functions. We're already engaging in those discussions, thinking like a technology company.

The U.S. auto industry has been one of the better-performing segments of the U.S. economy recently but is still well below the 16 million to 17 million vehicles it once sold regularly. Can it shift to a higher gear?

Fields: We expect the market to continue to improve based on two factors. One is the age of the car park out there. [Registration data show the average age of vehicles on the road today is 10 to 11 years.] Cars are old and trucks are old. Look at that, combined with the fuel economy consumers can get from new cars right now, and there are some good reasons to buy. And then there is the gradual improvement of the economy.

This is a great business … but when you look out on the horizon in North America, do I think we will go back to the days of 18 million units anytime soon? No. But when you look at the components that set demand, I think it is very encouraging. The opportunities and growth in front of us are pretty substantial.

Reuss: It can happen based on population growth and the car-park age. But sales are throttled by the variance in consumer confidence and in jobs.

The industry is in a place it has never been in before. It has a break-even point of just 11 [million] to 12 million units. [Automakers are expected to sell about 14.5 million vehicles in the U.S. this year.] That's providing profits to invest in good cars, even if we haven't seen that quick sales growth.

That's a great place to be…. You could really be happy driving 98% of the stuff that is on display here.

What's the deal with electric vehicles? They garnered a lot of attention when automakers started selling them again two years ago, but sales are poor.

Reuss: The range has to grow and the cost of the battery and the car has to come down. The quickest way for the cost to come down is to build a platform-specific electric vehicle. Otherwise, you will always have a battery that is heavier than what you want and have less range than you want.

Our Spark EV will work, because it is already small and lightweight and close to what you want to do in a platform-specific vehicle.... We will sell a few thousand, and we are doing it in California, where there already is interest and some infrastructure for electric vehicles.

I don't think you will see bigger people-carrier EVs. It's just a harder sell. Who wants to be stranded with your family [because the battery drained down] and pay a lot of money to do it?

Fields: The simple answer is that we don't know what percentage of the marketplace battery-electric vehicles will occupy next year or even five years from now. Our strategy is to align our manufacturing so that wherever it goes, we will be able to flex.

Demand for full-electric vehicles depends on a lot of factors, including getting the cost down lower, and the price of fuel and the infrastructure to be able to support mass EVs with charging stations, etc.

It is so dynamic right now. At gas at $3.40 a gallon, will sales of EVs bump up appreciably? If gas is $5 a gallon, you would get another answer. Whatever the continuum, we will be able to meet the demand.

What single feature or attribute of a vehicle is the consumer most focused on right now?

Fields: I think fuel economy is now embedded in people's minds, no matter what the price of oil is. In the 1970s to get fuel economy you had to get really small, inconvenient vehicles, but now you don't have to compromise on size or performance.

Reuss: It is reliability and durability. You can do the styling right, the technology right and price right. But if you don't have the durability and reliability, you won't get retention. People won't buy your car again. No one wants to be accused of buying something stupid. Fuel economy would be the next reason to buy.

jerry.hirsch@latimes.com

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Supreme Court to rule on California's Prop. 8 ban on gay marriage

Justices will rule for the first time on same-sex marriage by deciding the constitutionality of Prop. 8.

The Supreme Court announced Friday it will rule for the first time on same-sex marriage by deciding the constitutionality of California’s Proposition 8, the voter initiative that limited marriage to a man and a woman.

The justices also said they would decide whether legally married gay couples have a right to equal benefits under federal law.

The California case raises the broad question of whether gays and lesbians have an equal right to marry.

FULL COVERAGE: The battle over gay marriage 

If the justices had turned down the appeal from the defenders of Prop. 8, it would have allowed gay marriages to resume in California, but without setting a national precedent.

Now, the high court has agreed to decide whether a state’s ban on same-sex marriages violates the U.S. Constitution. The court’s intervention came just one month after voters in three states — Maine, Maryland and Washington — approved gay marriages. This brought the total to nine states having legalized same-sex marriages. 

But the justices also left themselves a way out. They said they would consider whether the defenders of Prop. 8 had legal standing to bring their appeal.

The justices made the announcement after meeting behind closed doors. They did not say which justices voted to hear the appeals.

Last year, the U.S. 9^th Circuit Court of Appeals struck down Prop. 8, but it did so on a narrow basis. Judge Stephen Reinhardt reasoned that the voter initiative was unconstitutional because it took away from gays and lesbians a right to marry that they had won before the state Supreme Court.

The justices now will have at least three options before them: They could reverse the 9^th Circuit and uphold Prop. 8, thereby making it clear that the definition of marriage will be left to the discretion of each state and its voters.

They could rule broadly that denying gays and lesbians the fundamental right to marry violates the Constitution’s guarantee of equal protection of the laws. Such a decision would open the door to gay marriages nationwide.

Or as a third option, they could follow the approach set by the 9^th Circuit and strike down Prop. 8 in a way that limits the ruling to California only.

In the other gay-marriage cases, the court will decide the constitutionality of part of the Defense of Marriage Act  that denies federal benefits to legally married couples. Judges in New England, New York and California have ruled this provision unconstitutional.

The justices are expected to hear arguments in the two sets of gay marriage cases in March and issue decisions by late June.

FULL COVERAGE: The battle over gay marriage 

Follow Politics Now on Twitter and Facebook

david.savage@latimes.com

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Long-sealed Notorious B.I.G. autopsy released

LOS ANGELES (AP) — An attorney for the family of Notorious B.I.G. said Friday it's ridiculous that Los Angeles police have not arrested anyone for the rapper's 1997 killing, which has returned to the spotlight after coroner's officials released a long-sealed autopsy report.

The report revealed that injuries cause by a single bullet killed the rapper, whose real name was Christopher Wallace, during a drive-by shooting in March 1997. Wallace was hit by four bullets after leaving a music industry event, but one that hit his heart, left lung and colon caused his death, the 23-page report states.

Perry Sanders Jr. said he was not given any notice that the report would be released, and he criticized police for not closing one of Los Angeles' highest-profile unsolved murders, especially since he had been told that police had identified those responsible.

"I've been advised by the homicide detective that was in charge of the investigation and is no longer with the department that the crime has been solved for several years now," Sanders told The Associated Press. "This was confirmed by at least one other person who is currently on the force, and it is ridiculous that an arrest has not been made for a crime that's allegedly been solved for several years."

A 2011 book by former Los Angeles police detective Greg Kading claimed both murders had been solved, although no arrests have been made and federal prosecutors in 2005 declined to file charges after a lengthy, bi-coastal investigation.

Police spokesman Richard French declined to comment, saying Wallace's killing remained an open investigation.

The coroner's report had been sealed for more than 15 years until police lifted a hold on it last week, Chief Coroner Investigator Craig Harvey said. The report details the trajectory of each of the shots that hit the rapper from Brooklyn, N.Y., and states there were no signs of alcohol or drugs in his system when he died.

Sanders, who dropped a federal civil lawsuit against the city in 2010 in order to give investigators an opportunity to investigate further, said solving the case was more important than any lawsuit.

"In no way shape or form is this about civil litigation," he said. "This is about the criminal justice system and it functioning properly."

The lawsuit Sanders filed on behalf of Wallace's family and widow Faith Evans ended in a mistrial in 2005 after attorneys discovered the city withheld a trove of LAPD documents.

The civil case could be refiled, although that has not yet occurred.

Both Los Angeles police and the FBI investigated Wallace's killing, which came just months after another rap superstar, Tupac Shakur, was gunned down in Las Vegas. The FBI looked into whether any Los Angeles police officers were involved in Wallace's shooting.

The deaths of Wallace and Shakur have been the subject of rampant speculation about the motives. The one-time friends became rivals and instigators in an East Coast-West Coast rap rivalry during the mid-1990s.

In March 2011, the FBI electronically released files on its investigation, which were heavily redacted but shed new light on the efforts that investigators took to try to find those responsible for the rapper's death. Agents conducted surveillance and interviews in Los Angeles, San Diego and New York, the files showed.

The agency did not have an immediate comment Friday on the release of the coroner's report or whether it was still investigating Wallace's death.

___

Anthony McCartney can be reached at http://twitter.com/mccartneyAP .

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The New Old Age Blog: A Son Lost, a Mother Found

My friend Yvonne was already at the front door when I woke, so at first I didn’t realize that my mother was missing.

It was less than a week after my son Spencer died. Since that day, a constant stream of friends had been coming and going, bringing casseroles and soup, love, support and chatter. Mom hated it.

My 94-year-old mother, who has vascular dementia, has been living in my home in upstate New York for the past few years. Like many with dementia, mom is courteous but, underneath, irascible. Pride defines her, especially pride in her Phi Beta Kappa intellect. She hates to be confronted with how she has become, as she calls it, “stupid.”

The parade of strangers confused her. She had to be polite, field solicitous questions, endure mundane comments. She could not remember what was going on or why people were there. It must have been stressful and annoying.

That night, like every night since the state troopers brought the news, I woke hourly, tumbling in panic. As if it were not too late to save my son. Mom knew something was wrong, but she could not remember what. As I overslept that morning, she must have decided enough was enough. She was going home.

In a cold sky, the sun blazed over tall pines. As I opened the door, the dogs raced out to greet Yvonne and her two housecleaners. Yvonne often brags about her cleaning duo. They were her gift to me. They were going to clean my house before the funeral reception, which was scheduled for later that week. This was a very big gift because, like my mother before me, I am a very bad housekeeper.

Mom’s door was shut. I cautioned the housecleaners to avoid her room as I showed them around. Yvonne went to the kitchen to listen to the 37 unheard messages on my answering machine; the housecleaners went out to their van to get their instruments of dirt removal.

I ducked into Mom’s room to warn her about the upcoming noise. The bed was unmade; the floor was littered with crumpled tissues; the room was empty.

Normally, I would have freaked out right then. I knew Mom was not in the house, because I had just shown the whole house to the cleaners. Although Mom doesn’t wander like some dementia patients, she does on occasion run away. But I could not muster a shred of anxiety.

“Yvonne,” I called, “did you see my mother outside?”

Yvonne popped her head into the living room, eyebrows raised.“Outside? No!” She was alarmed. “Is she missing?”

“Yeah,” I said wearily, “I’ll look.” I stepped out onto the front porch, tightening the belt of my bathrobe and turning up the collar. Maybe she had walked off into the woods. The dogs danced around my legs, wanting breakfast.

I had no space left in my body to care. Either we would find her, or we would not. Either she was alive, or she was not. My child was gone. How could I care about anything ever again?

Then I saw my car was missing. My mouth fell open and my eyeballs rolled up to the right, gazing blindly at the abandoned bird’s nest on top of the porch light: What had I done with the keys?

Mom likes to run away in the car when she is angry. She used to do it a lot when my father was still alive — every time they fought. Since Mom took off in my car almost a year ago, after we had had a fight, I’d kept the keys hidden. Except for this week; this week, I had forgotten.

I was reverting to old habits. I had left the doors unlocked and the keys in the cupholder next to the driver’s seat. Exactly like Mom used to do.

“Uh-oh,” I said aloud. Mom was still capable of driving, even though she did not know where she was going. I just really, really hoped that she didn’t hurt anybody on the road. I pulled out my cellphone, about to call the police.

“Celia!” Yvonne shouted from the kitchen. She hurried up behind me, excited. “They found your mother. There are two messages on your machine.”

At that very moment, Mom was holed up at the College Diner in New Paltz, a 20-minute drive over the mountain, through the fields, left over the Wallkill River and away down Main Street.

Yvonne called the diner. They promised to keep the car keys until someone arrived. By that time, Yvonne had to go to work. She drove my friend Elizabeth to the diner, and Elizabeth drove Mom home in my car.

Half an hour later, they walked in the front door. Mom’s cheeks were rouged by the chill air and her eyes sparkled, her white hair riffing with static electricity. “Hello, hello,” she sang out. “Here we are.” She was wearing the flannel nightgown and robe I had dressed her in the night before. It was covered by her oversized purple parka, and her bare feet were shoved into sneakers.

I started laughing as soon as I saw her. I couldn’t help it. Elizabeth and Mom started laughing too. “You had a big adventure,” I said, hugging them both. “How are you?”

“I’m just marvelous,” said my mother. Mom always feels great after doing something rakish. We settled her on the sofa with her feet on the ottoman. By the time I got her blanket tucked in around her shoulders, she had fallen asleep.

Elizabeth couldn’t stop laughing as she described the scene. “Your mother was holding court in this big booth. She was sitting there in her nightgown and her parka, talking to everybody, with this plate of toast and coffee and, like, three of the staff hovering around her.”

The waitress said Mom seemed “a little disoriented” when she got there. Mom said she was meeting a friend for breakfast, but since she was wearing a nightgown and didn’t know whom she was meeting or where she lived, the staff thought there might be a problem. They convinced Mom to let them look in the glove compartment of the car, where they found my name and number.

It was then that I realized I was laughing – something I’d thought I would never be able to do again. “Elizabeth, Elizabeth, I’m laughing,” I said.

“Ha, ha, ha,” laughed Elizabeth, holding her belly.

“Ha, ha, ha,” I laughed, rolling on the floor.

And she who gave me life, who had suffered the death of my child and the extinction of her own intellect, snoozed on: oblivious, jubilant, still herself, still mine.

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Stocks close higher after jobs report beats forecasts

Apple spoiled the stock market's party on Friday.

Stocks shot higher in the early morning, after the government reported that the U.S. added jobs in November. But Apple, which has been flailing in recent weeks as investors wonder how long its momentum can continue, dragged down the indexes that it's part of.

The Dow Jones industrial average, which doesn't include Apple, rose. The Standard & Poor's 500 and Nasdaq, which do, were less impressive. The S&P rose by a smaller amount, and the Nasdaq fell.

The headline numbers from the jobs report sent the market higher in early trading. The Labor Department said the U.S. added 146,000 jobs last month, more than economists had expected. The unemployment rate fell to 7.7 percent from 7.9 percent, the lowest in nearly four years.

The overall report, however, painted a more restrained view of the economy.

“If you delve into that report a little more, there are some disturbing issues,” said Brian Lund, who is based in Los Angeles as executive vice president and co-founder of the online brokerage Ditto Trade.

Among them: The unemployment rate fell largely because discouraged unemployed workers stopped looking for work, which meant they were no longer counted among the unemployed. Also, the Labor Department revised previously released jobs numbers downward, saying that employers added 49,000 fewer jobs in October and September than initially estimated.

Lund also wasn't so sure about the government's statement that Hurricane Sandy “did not substantively impact” the unemployment numbers. He expected Sandy's detrimental effects to show up in jobs reports over the next couple of months, as businesses figure out their post-storm plans.

“If you have Sandy, you don't automatically lose your job,” Lund said. “Businesses take time to say, `Oh, what's going on, can we go forward, do we need to cut people to survive? It's not until later that they start laying off.”

Nicholas Colas, chief market strategist for ConvergEx in New York, was similarly unimpressed by the jobs numbers. In a note to clients, he said U.S. unemployment seems to be more consistent with “an ongoing recession than expansion.”

In the recession of the early 1990s and its aftermath, the highest rate of unemployment was 7.8 percent. In the recession of the early 2000s and its aftermath, the unemployment rate never got above 6.3 percent.

This time has been harsher. In late 2009, shortly after the recession officially ended, the unemployment rate peaked at 10 percent. For two years after that, it stayed above 9 percent.

At the end of the day, the Dow was up 81.09 points to 13,155.13. The S&P 500, where Apple's weight is 4 percent, was up but by a smaller proportion, rising 4.13 to 1,418.07. The Nasdaq composite index, where Apple accounts for a hefty 12 percent, fell 11.23 to 2,978.04.

Apple fell $13.99 to $533.25, or 2.6 percent. That's part of a longer trend: Apple's stock has plunged nearly 24 percent since the iPhone 5 went on sale Sept. 21. Investors are wondering how long the company can keep the momentum going with its popular iPhone and iPad devices.

Outside of Apple, there's another significant cloud hanging over the market. Congress and the White House are trying to hammer out an agreement on government spending and tax rates before Jan. 1. If they don't, lower government spending and higher taxes will kick in, a situation that's been nicknamed the “fiscal cliff.”

The fiscal cliff is already taking a toll on people's confidence and making them nervous about spending, said Bernie Williams, vice president of discretionary money management at USAA Investments in San Antonio, Texas. He pointed to recent announcements from retailers like Target and Kohl's, both of which reported lower November sales, even though analysts had expected increases.

“There are more things on the plate to worry about than normal,” Williams said. “The consumer is weak, their confidence is being hit by the fiscal cliff, and then more importantly, you look ahead to next year and all the taxes are (likely) rising. … If you're a paycheck-to-paycheck person, that's going to hurt.”

Traders have been indecisive as well. In the 22 trading days since the presidential election, the Dow has been up 11 and down 11.

AIG, the bailed-out insurance company, rose more than 2 percent, up 87 cents to $34.13. A group of Chinese companies is in talks to buy AIG's aircraft leasing unit, which could help AIG raise cash to pay off more of its government loans.

The yield on the benchmark 10-year Treasury note rose to 1.63 percent from 1.59 percent late Thursday, a sign that investors were putting more money in stocks.

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18 arrested in federal crackdown on gang that operated near USC

Federal authorities on Thursday announced a sweeping racketeering indictment against a Mexican Mafia-controlled gang that operated in an L.A. neighborhood just north of USC and was allegedly involved in at least one slaying, drug sales, extortion and robberies.

Eighteen members of the Harpys gang, also known as the Harpys-Dead End gang, were arrested Thursday morning on charges in three federal indictments resulting from “Operation Roman Empire.”

Those arrested include Vianna Roman, 37, daughter of a Mexican Mafia member, Danny Roman, who allegedly controlled the gang while serving a life sentence at Pelican Bay State Prison.

A total of 29 defendants were named in the racketeering indictment, eight of whom were already in state custody. Among them is Miguel Delgado, 18, accused of committing armed robbery against three USC students.

Federal prosecutors alleged that Vianna Roman and her husband, Aaron Soto, 40, traveled to and from Pelican Bay passing along orders from Danny Roman and collecting taxes to be funneled to him through profits the gang made through dealing in methamphetamine, cocaine, crack cocaine and heroin and through extorting businesses, including swap-meet vendors, via threats of violence.

Members of the gang are suspected in the slaying of one gang member who owed a debt, as well as plotting to kill a witness slated to testify against a gang member in a state court case, according to the indictment.

The gang has previously been targeted by the Los Angeles city attorney’s office in injunctions alleging the gang’s members were engaged in shakedowns, robberies, vandalism and murder. A judge issued a court order in 1998 that barred 30 of the gang’s members from associating with one another in the area.

At the time, one business owner said the Harpys asked for $150 to $180 a month for protection from the gang.

The gang controlled an area southwest of downtown that spanned from Normandie Avenue to Figueroa Street and Washington Boulevard to Jefferson Boulevard. Over the course of the operation, authorities seized 8½ pounds of methamphetamine, approximately one-half pound of heroin, approximately one pound of cocaine, 23 pounds of marijuana and 22 guns, according to a press release from the U.S. attorney's office.

If convicted of the racketeering charges, all but one of the defendants face a maximum sentence of life in prison, prosecutors said.

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