Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative. M.R.I. helped pay for previous vaccination campaigns in the country and the GAVI Alliance is helping to finance the upcoming one.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

This article has been revised to reflect the following correction:

Correction: February 27, 2013

An earlier version of this article misstated the source of the vaccine and some financing for the campaign. The vaccine and financing is being provided by the GAVI Alliance, not the Measles and Rubella Initiative.

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Author tells businesses to be like Mike

CAPTIONS

MJ in 1982
Michael Jordan in his college days with teammates Matt Doherty (44) and Sam Perkins and coach Dean Smith. (AP photo by Robert Willett /October 14, 1982)

By Samantha Bomkamp




Tribune reporter

10:11 a.m. CST, February 27, 2013

An author of a new book has some sage advice for business leaders: Be more like Michael Jordan.

Bruce Piasecki, who penned "Doing More with Teams: The New Way to Winning," says Michael Jordan's long and storied career "is a shining example of how the best teams operate."

Jordan shouldn't be emulated just because of the Bulls star's individual success, the author says, but by the way he showed leadership and helped create a seemingly unstoppable team, meshing with different personalities such as the quiet Scottie Pippen and outrageous Dennis Rodman to create a basketball dynasty.

Those team dynamics are similar in the business world, the author says. And businesses are most successful when they are led by the right leaders and are composed of a mix of people with varying talents, he argues.

Jordan also is held up as an example in other tenets of good business teamwork the author describes.

-- Ego and individual goals have no place on teams.

"When we pin all our hopes on a single individual and ignore the context in which he or she operates, we will be disappointed," he says.

--  Failure is part of winning.

"Leaders must instill in teams a tolerance of losing," he said. "We must convey that failure is a part of life and thus a part of business."

Jordan, who helped the Chicago Bulls win six NBA championships, famously said "I've failed over and over and over again in my life, and that is why I succeed."

The book is set to be released next month but is available for pre-order on Amazon.com.

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Winter storm: Lake, McHenry could see 10 inches of snow

Tom updates Tuesday's storm. (WGN - Chicago)

A winter storm warning for up 6 to 10 inches of snow has been issued for Lake and McHenry Counties, and a winter weather advisory for other Chicago-area counties has been extended into Wednesday as a strong storm made travel hazardous and grounded hundreds of flights.

The National Weather Service has extended its winter weather advisory in Cook, DuPage, Kane and DeKalb counties until 6 a.m. Wednesday, and has upgraded Lake and McHenry counties to a winter weather warning, also until 6 a.m. Wednesday.

The heaviest snow was expected to fall this afternoon, but some heavy snow is expected to fall into the  evening, with accumulations of up to 10 inches in north suburbs by daybreak, according to the winter storm warning for Lake and McHenry counties. 

Snow accumulation totals at O’Hare as of 6 p.m. was 3.8 inches, the highest single snow storm total so far this winter season, said Casey Sullivan, a meteorologist with the National Weather Service.

The northern suburbs have had the most snowfall today, with some areas reporting 6 to 7 inches of snow by this evening. Anything more than 6 inches of snowfall is upgraded to a winter weather warning, Sullivan said.

An advisory issued late this afternoon for Cook, DuPage, Kane and other northern Illinois counties called for up to 7 inches by late evening. Winds gusting at 35 to 40 mph will reduce visibility and glaze roads, the weather service warned.

"Snowfall rates in excess of an inch per hour could occur at times, along with wind whipped snow resulting in temporary white out conditions with near zero visibility at times in open areas," according to an advisory. "This will likely be a heavy wet snow sometimes referred to as heart attack snow."

The slow-moving storm weakens as it moves east, but will continue peppering Chicagoland with about another inch of snow overnight, Sullivan said. Temperatures will remain relatively steady, so the snow will be similarly wet and heavy.

By a little before 5:30 p.m., the weather service was reporting these snowfall accumulations: 6.4 inches in Northbrook; 5.2 inches in Streamwrood; and 4.5 inches in Winnetka.

Earlier, about 4:30 p.m., the weather service had reported these snowfall accumulations: 5.5 inches in northwest suburban Bull Valley, 5 inches in north suburban Lake Bluff, 4.9 inches in northwest suburban Elk Grove Village, 4 inches in northwest suburban South Elgin and Schaumburg, 3.3 inches in west suburban Winfield, 1.8 inches in north suburban Morton Grove, and 1.5 inches at Midway International Airport and southwest suburban Romeoville.

About 600 flights have been canceled at O'Hare International Airport and about 170 at Midway, according to FlightStats, which gathers data from airports and airlines. There were about 734 flights delayed at O'Hare and 118 at Midway.

On the roads, spinouts have been reported on interstates 90, 94 and 55, according to the Illinois State Police.

The Illinois State Police Chicago District has instituted its emergency snow plan. In an accident where there are no injuries and the cars are driveable, the drivers should exchange information at a safe place and file accident reports with the state police within 10 days.

Chicago's Streets and Sanitation Department has deployed its entire fleet of 284 plows. Drivers will plow the main roads, such as Lake Shore Drive, through the evening rush hour. As the snow begins to taper off, the plows will clear residential roads, said department spokeswoman Anne Sheahan.

Extra plows are being deployed to the 2ndCongressional District to help residents get to their polling places for today's primary election, Sheahan said.

Road conditions were treacherous throughout the southwest suburbs, especially along Interstates 55 and 80 in Will County, police and fire officials said.

Several vehicles have slipped into ditches along I-55 near Plainfield, especially near U.S. Route 30, said Jon Stratton, a deputy chief with the Plainfield Fire Protection District.  "On I-55, there are vehicles everywhere in the ditch," Stratton said. "Visibility is going down and roads are getting all snow covered, so it's going to be an interesting day."

The most serious accident in the area so far today occurred when an SUV slid under a semi's trailer on the Route 30 overpass over I-55, Stratton said.

Firefighters extricated the woman who was driving the SUV, and she was taken by ambulance to Provena Saint Joseph Medical Center in Joliet, Stratton said. The woman was conscious and stable when removed from the SUV, he said.

A school bus carrying about 35 elementary students collided with a plow truck in Plainfield around 4 p.m., but no injuries were reported, officials said.

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Advanced Breast Cancer May Be Rising Among Young Women, Study Finds

The incidence of advanced breast cancer among younger women, ages 25 to 39, may have increased slightly over the last three decades, according to a study released Tuesday.

But more research is needed to verify the finding, which was based on an analysis of statistics, the study’s authors said. They do not know what may have caused the apparent increase.

Some outside experts questioned whether the increase was real, and expressed concerns that the report would frighten women needlessly.

The study, published in The Journal of the American Medical Association, found that advanced cases climbed to 2.9 per 100,000 younger women in 2009, from 1.53 per 100,000 women in 1976 — an increase of 1.37 cases per 100,000 women in 34 years. The totals were about 250 such cases per year in the mid-1970s, and more than 800 per year in 2009.

Though small, the increase was statistically significant, and the researchers said it was worrisome because it involved cancer that had already spread to organs like the liver or lungs by the time it was diagnosed, which greatly diminishes the odds of survival.

For now, the only advice the researchers can offer to young women is to see a doctor quickly if they notice lumps, pain or other changes in the breast, and not to assume that they cannot have breast cancer because they are young and healthy, or have no family history of the disease.

“Breast cancer can and does occur in younger women,” said Dr. Rebecca H. Johnson, the first author of the study and medical director of the adolescent and young adult oncology program at Seattle Children’s Hospital.

But Dr. Johnson noted that there is no evidence that screening helps younger women who have an average risk for the disease and no symptoms. “We’re certainly not advocating that young women get mammography at an earlier age than is generally specified,” she said.

Expert groups differ about when screening should begin; some say at age 40, others 50.

Breast cancer is not common in younger women; only 1.8 percent of all cases are diagnosed in women from 20 to 34, and 10 percent in women from 35 to 44. However, when it does occur, the disease tends to be more deadly in younger women than in older ones. Researchers are not sure why.

The researchers analyzed data from SEER, a program run by the National Cancer Institute to collect cancer statistics on 28 percent of the population of the United States. The study also used data from the past when SEER was smaller.

The study is based on information from 936,497 women who had breast cancer from 1976 to 2009. Of those, 53,502 were 25 to 39 years old, including 3,438 who had advanced breast cancer, also called metastatic or distant disease.

Younger women were the only ones in whom metastatic disease seemed to have increased, the researchers found.

Dr. Archie Bleyer, a clinical research professor in radiation medicine at the Knight Cancer Institute at the Oregon Health and Science University in Portland who helped write the study, said scientists needed to verify the increase in advanced breast cancer in young women in the United States and find out whether it is occurring in other developed Western countries. “This is the first report of this kind,” he said, adding that researchers had already asked colleagues in Canada to analyze data there.

“We need this to be sure ourselves about this potentially concerning, almost alarming trend,” Dr. Bleyer said. “Then and only then are we really worried about what is the cause, because we’ve got to be sure it’s real.”

Dr. Johnson said her own experience led her to look into the statistics on the disease in young women. She had breast cancer when she was 27; she is now 44. Over the years, friends and colleagues often referred young women with the disease to her for advice.

“It just struck me how many of those people there were,” she said.

Dr. Donald A. Berry, an expert on breast cancer data and a professor of biostatistics at the University of Texas’ M. D. Anderson Cancer Center in Houston, said he was dubious about the finding, even though it was statistically significant, because the size of the apparent increase was so small — 1.37 cases per 100,000 women, over the course of 30 years.

More screening and more precise tests to identify the stage of cancer at the time of diagnosis might account for the increase, he said.

“Not many women aged 25 to 39 get screened, but some do, but it only takes a few to account for a notable increase from one in 100,000,” Dr. Berry said.

Dr. Silvia C. Formenti, a breast cancer expert and the chairwoman of radiation oncology at New York University Langone Medical Center, questioned the study in part because although it found an increased incidence of advanced disease, it did not find the accompanying increase in deaths that would be expected.

A spokeswoman for an advocacy group for young women with breast cancer, Young Survival Coalition, said the organization also wondered whether improved diagnostic and staging tests might explain all or part of the increase.

“We’re looking at this data with caution,” said the spokeswoman, Michelle Esser. “We don’t want to invite panic or alarm.”

She said it was important to note that the findings applied only to women who had metastatic disease at the time of diagnosis, and did not imply that women who already had early-stage cancer faced an increased risk of advanced disease.

Dr. J. Leonard Lichtenfeld
, deputy chief medical officer of the American Cancer Society, said he and an epidemiologist for the society thought the increase was real.

“We want to make sure this is not oversold or that people suddenly get very frightened that we have a huge problem,” Dr. Lichtenfeld said. “We don’t. But we are concerned that over time, we might have a more serious problem than we have today.”

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JPMorgan to eliminate 4,000 jobs in 2013

JPMorgan Chase & Co. plans to cut 3,000 to 4,000 jobs in its consumer bank in 2013, representing about 1.5 percent of the company's overall workforce, as the bank tries to improve the profitability of its branches.

The cuts will come mainly through attrition, spokeswoman Kristin Lemkau said. The bank's branches have 63,500 employees, representing about a quarter of JPMorgan Chase's total employees.

JPMorgan is one of the few big U.S. banks that is still adding branches to its network, but to boost profit it plans to scale back the tellers it has on hand for routine transactions and to add some salespeople for products and services like wealth management that can boost revenue.

The net effect will be to reduce staff per branch by 20 percent through 2015, the company's head of consumer banking, Ryan McInerney, said in a presentation to investors.

In JPMorgan Chase's mortgage business, the company reiterated its previously announced plans to shed 13,000 to 15,000 jobs by 2014.

JPMorgan Chase had 5,614 branches at the end of 2012, and plans to increase its network by about 100 branches a year, it said. Chase's U.S. branch network is second to Wells Fargo & Co's in size.

The bank is hoping to focus on selling more to wealthy depositors. Its average consumer checking account has a balance of $4,276, and about half of all affluent U.S. households are within two miles a Chase branch or automated teller machine, the bank said.

JPMorgan Chase overall earned $21.9 billion last year, excluding accounting charges linked to changes in the value of its debt. The bank said it has the potential to earn about $27.5 billion, thanks in part to efficiency gains. It aims to cut overall expenses by $1 billion in 2013.

For overall staffing levels, JPMorgan Chase had 258,965 employees globally at the end of 2012. Its headcount rose following the financial crisis, to 262,882 in the second quarter of 2012 from 219,569 in the first quarter of 2009. Since last year's second quarter, staffing levels have drifted lower.

JPMorgan Chase shares were down 1.3 percent at $47.08 on Tuesday morning on the New York Stock Exchange.
 

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Emanuel to critics: McCarthy has my '100 percent support'

Mayor Rahm Emanuel gave Police Superintendent Garry McCarthy his “100 percent support” Monday despite complaints from some aldermen fed up with the department’s inability to bring down violence in their neighborhoods.

The mayor backed up his hand-picked superintendent during his first news conference since African-American aldermen said last week that their constituents are making louder demands that something be done to quash the epidemic of homicides that has drawn nationwide attention to Chicago.

“Both Garry McCarthy, (First Deputy Police Supt.) Al Wysinger and the entire leadership in the police department have my 100 percent support, but they also have my sense of impatience to get the results throughout the city to bring the type of safety we want in every neighborhood,” Emanuel said.

“I appreciate any of the aldermen’s expressions, their frustrations. That is no different than the urgency I want for public safety,” Emanuel said as Ald. Howard Brookins, head of the City Council’s black caucus, looked on.

Last week, Brookins, 21st, questioned McCarthy’s tactics. On Monday, Brookins said he liked the mayor’s urgency. “I think it shows the frustration. I think he captured the mood of the black caucus that we’re all frustrated,” the alderman said. “I’m glad that it’s such a high-level priority for the mayor, as well as all the members of the black caucus.”

But Brookins continued to sound the alarm about the number of killings, which have remained stubbornly high in Chicago even as Emanuel and McCarthy have tried a variety of police tactics and legislative maneuvers in recent months to bring them down.

“I’m not the expert with respect to crime reduction, and I’m a result-oriented guy, as much of my caucus is,” Brookins said. “We just are displaying the frustration that the public is pushing on us about crime within our communities, and primarily it is within African-American communities that we’re seeing this violence.”

The mayor gave his vote of confidence while telling reporters the city has enough money to greatly expand the police department’s “violence prevention initiative,” which pays officers overtime to come in on their days off to work patrol in high crime areas. The Tribune has reported McCarthy plans to double the size of the program to allow up to 400 officers to sign up, and to expand it to every day from five days per week.

“We’re making the right calls and we’re making the right decisions to invest, and it’s an extended period of time but the right call to do and we have the resources to do it. Don’t worry, the budget will be fully balanced as it has been when we proposed it, and we made the cuts where we need to and the investments where we must,” the mayor said.

Emanuel’s 2013 spending plan included a $3 million increase in the department’s overtime to $32 million, according to city budget documents. That's still less than the $33.7 million the department spent on overtime in 2011, documents show.

The mayor’s comments came at a news conference to announce an additional 4,200 children will attend full-day kindergarten next year at a cost of $15 million. That money was found through cost-cutting at the school district’s central office, he said.

Emanuel has in the past used the city’s shaky financial situation to help explain the need to close city-run mental health clinics, lay off city workers and raise water fees and other costs for residents. And Chicago Public Schools officials are on the verge of closing schools to save money over the long haul as they face a deficit of us much as $1 billion next year.

But as with his assurances on police overtime, the mayor said money is available for the kindergarten program. It’s a matter of priorities, he said. “What are your priorities? You’ve got to make them, and then you’ve got to be able to fund them,” he said.

jebyrne@tribune.com

Twitter @_johnbyrne

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Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative, which will provide the vaccine and help pay for the campaign.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

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Horsemeat found in IKEA meatballs

PRAGUE/STOCKHOLM (Reuters) - Sweden's Ikea stopped nearly all sales of meatballs at its furniture store cafeterias across Europe after tests in the Czech Republic on Monday showed some contained horsemeat.

The world's No. 1 furniture retailer, known also for the signature restaurants at its huge out-of-town stores, said it was pulling all meatballs produced by its main supplier in Sweden after the tests showed horsemeat in its beef and pork meatballs.

A European scandal erupted last month when tests in Ireland revealed some beef products contained horsemeat, triggering recalls of ready-made meals in several countries and damaging confidence in Europe's vast and complex food industry.

Meatballs, a famous Swedish dish often served with mashed potatoes, gravy and lingonberry jam, have become a trademark for IKEA, which sells them hot from the in-store cafeterias and packaged off the shelf.

The vast majority of Ikea's meatballs are made by Sweden's Familjen Dafgard, which said on its website that it was investigating the situation and would receive further test results in coming days.

The withdrawals did not affect meatballs in Norway, Russia, nor some in Switzerland or Poland, which were made by other suppliers, said Ikea spokeswoman Ylva Magnusson at the company's headquarters in Helsingborg, southern Sweden.

"We are now getting to the bottom of this and making extra tests, but we have decided to stop the meatball sales for a few days, so that no one needs to worry, until we have the results," Magnusson said.

IKEA stores in the United States, Canada, Australia and Japan were unaffected as they too have other suppliers.

Besides the Czech Republic, the batch containing horsemeat had also been on sale in Britain, Portugal, Netherlands, Belgium, Slovakia, Hungary, France, Italy, Spain, Greece, Cyprus and Ireland.

Magnusson said the test results would determine the percentage of horsemeat in the specific batch of meatballs. There was no indication that any other batch had been affected.

Earlier this month, food manufacturer Findus was forced to recall thousands of packages of frozen beef lasagnes in Sweden after discovering they contained 60 to 100 percent horsemeat.

On the sidelines of a meeting in Brussels, Sweden's rural affairs minister Eskil Erlandsson called the test results awful.

"Consumers should know that what is labelled on the package should also be inside the package and nothing else," he told Reuters, adding that it may damage IKEA's reputation.

"All fraud has an impact on the reputation of a company, especially when you talk about meat or other foodstuffs."

However, he did not see a need for the European Union to enforce mandatory origin labels for processed meat.

In Italy, consumer rights group Codacons called for checks on all meat products sold by IKEA in the country.

"We are ready to launch legal action and seek compensation not only against the companies who are responsible but also those whose duty it was to protect citizens," Codacons President Carlo Rienzi said in a statement.

The Czech State Veterinary Administration had reported its findings to the EU's Rapid Alert System for Food and Feed, it said in a statement.

The inspectors took samples for DNA tests in IKEA's unit in the city of Brno from a product labelled as "beef and pork meatballs", it said.

(Additional reporting by Mia Shanley in Stockholm, Maria Pia Quaglia in Milan and Charlie Dunmore in Brussels; Writing by Anna Ringstrom; Editing by Tom Pfeiffer)

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Oscars 2013 live: Rolling out the red carpet

LOS ANGELES -- The Oscars rolled out the red carpet on Sunday for the movie industry's biggest night, with Iran hostage drama "Argo" and presidential drama "Lincoln" in a tight race for Best Picture.

With several contests too close to call, a slate of big box office hits to celebrate and an unpredictable first-time host in Seth MacFarlane, movie fans could be in for surprises when the curtain rises on the 85th annual Academy Awards.

MORE OSCARS: Red carpet pics | Live stream | Oscars trivia quiz

Before the festivities begin, nominees including Jennifer Lawrence, Hugh Jackman, Sally Field, Jessica Chastain, British singer Adele and "Argo" producer George Clooney, along with performers Barbra Streisand and Jennifer Hudson will parade along the 500-ft long (152 meter) red carpet before dozens of photographers and camera crews.

Inside Hollywood's Dolby Theatre, Academy Awards history could be re-written.

Daniel Day-Lewis as U.S. President Abraham Lincoln is considered an unstoppable force to become the first man to win three Best Actor Oscars.

Buzz is building over a possible late upset by France's Emmanuelle Riva, 86, in the Best Actress contest that would make the star of harrowing Austrian entry "Amour" the oldest person ever to win an acting Oscar.

"Lincoln" goes into Sunday's three-hour plus ceremony with a leading 12 nominations, including a directing nod for double Oscar winner Steven Spielberg.

But its front-runner Best Picture status has been dented by the six-week victory streak enjoyed at other Hollywood awards by Ben Affleck's "Argo."

"It's been an interesting year," said Matt Atchity, editor in chief of movie review website Rotten Tomatoes.

"I think 'Argo' probably has the best shot. It's certainly got the momentum. It has won so many top awards, and I think it's probably the movie to beat," Atchity told Reuters.

If "Argo" does prevail for the top prize, it will be the first movie to win Best Picture without its director even getting a nomination since "Driving Miss Daisy" in 1990.

ANNE HATHAWAY OSCAR BOUND

Musical "Les Miserables," comedy "Silver Linings Playbook," shipwreck tale "Life of Pi," Osama bin laden thriller "Zero Dark Thirty," slavery Western "Django Unchained," indie film "Beasts of the Southern Wild," and "Amour" round out the contenders for the best film of 2012.

In other categories, only Anne Hathaway is considered a sure bet to take home a golden statuette after starving herself and chopping off her long brown locks for her supporting turn as tragic heroine Fantine in "Les Miserables."

Awards pundits says Spielberg could lose out in the director's race to Taiwan's Ang Lee for his technical and imaginative feat in filming fantastical adventure "Life of Pi" with a cast of exotic animals.

And the supporting actor Oscar could go to any of the five nominees - Robert De Niro ("Silver Linings Playbook"), Alan Arkin ("Argo"), Christoph Waltz ("Django Unchained"), Tommy Lee Jones ("Lincoln") and Philip Seymour Hoffman ("The Master").

The Oscar winners are chosen in secret ballots by some 5,800 members of the Academy of Motion Picture Arts and Sciences and handed out before an audience of 3,300 guests and tens of millions more watching around the world on television.

After several years of nominating little-seen movies, this year's nine Best Picture contenders have pulled in more than $2 billion in tickets worldwide.

"We are so fortunate to inherit this great group of films that are also popular at the box office ... We just lucked out and had this fantastic year in film," Academy Awards telecast co-producer Neil Meron told Reuters.

Producers are promising a fast-paced show packed with music and big performances. But the man getting the early attention will be MacFarlane, the provocative comedian behind animated TV series "Family Guy" and an unknown quantity as Oscar host.

"We are not going to know what works until we put it out there and see what plays in front of an audience," co-producer Craig Zadan said.

"It's a live show and that is always unpredictable. Once the train has left the station, whatever happens, happens."

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The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain

Matt Rainwaters for Texas Monthly

The Sherman grave of Andre Thomas’s victims.

SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org

Matt Rainwaters for Texas Monthly

Laura Boren

He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.

He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.

In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.

Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.

“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.

From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.

bgrissom@texastribune.org

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