A delicate new balancing act in senior healthcare

When Claire Gordon arrived at Cedars-Sinai Medical Center, nurses knew she needed extra attention.

She was 96, had heart disease and a history of falls. Now she had pneumonia and the flu. A team of Cedars specialists converged on her case to ensure that a bad situation did not turn worse and that she didn't end up with a lengthy, costly hospital stay.

Frail seniors like Gordon account for a disproportionate share of healthcare expenditures because they are frequently hospitalized and often land in intensive care units or are readmitted soon after being released. Now the federal health reform law is driving sweeping changes in how hospitals treat a rapidly growing number of elderly patients.

The U.S. population is aging quickly: People older than 65 are expected to make up nearly 20% of it by 2030. Linda P. Fried, dean of the Columbia University Mailman School of Public Health, said now is the time to train professionals and test efforts to improve care and lower healthcare costs for elderly patients.

"It's incredibly important that we prepare for being in a society where there are a lot of older people," she said. "We have to do this type of experiment right now."

At Cedars-Sinai, where more than half the patients in the medical and surgical wards are 65 or older, one such effort is dubbed the "frailty project." Within 24 hours, nurses assess elderly patients for their risk of complications such as falls, bed sores and delirium. Then a nurse, social worker, pharmacist and physician assess the most vulnerable patients and make an action plan to help them.

The Cedars project stands out nationally because medical professionals are working together to identify high-risk patients at the front end of their hospitalizations to prevent problems at the back end, said Herb Schultz, regional director of the U.S. Department of Health and Human Services.

"For seniors, it is better care, it is high-quality care and it is peace of mind," he said.

The effort and others like it also have the potential to reduce healthcare costs by cutting preventable medical errors and readmissions, Schultz said. The federal law penalizes hospitals for both.

Gordon, an articulate woman with brightly painted fingernails and a sense of humor, arrived at Cedars-Sinai by ambulance on a Monday.

Soon, nurse Jacquelyn Maxton was at her bedside asking a series of questions to check for problems with sleep, diet and confusion. The answers led to Gordon's designation as a frail patient. The next day, the project team huddled down the hall and addressed her risks one by one. Medical staff would treat the flu and pneumonia while at the same time addressing underlying health issues that could extend Gordon's stay and slow her recovery, both in the hospital and after going home.

To reduce the chance of falls, nurses placed a yellow band on her wrist that read "fall risk" and ensured that she didn't get up on her own. To prevent bed sores, they got her up and moving as often as possible. To cut down on confusion, they reminded Gordon frequently where she was and made sure she got uninterrupted sleep. Medical staff also stopped a few unnecessary medications that Gordon had been prescribed before her admission, including a heavy narcotic and a sleeping pill.

"It is really a holistic approach to the patient, not just to the disease that they are in here for," said Glenn D. Braunstein, the hospital's vice president for clinical innovation.

Previously, nurse Ivy Dimalanta said, she and her colleagues provided similar care but on a much more random basis. Under the project, the care has become standardized.

The healthcare system has not been well designed to address the needs of seniors who may have had a lifetime of health problems, said Mary Naylor, gerontology professor at the University of Pennsylvania School of Nursing. As a result, patients sometimes fall through the cracks and return to hospitals again and again.

"That is not good for them and that is not good for society to be using resources in that way," Naylor said.

Using data from related projects, Cedars began a pilot program in 2011 and expanded it last summer. The research is continuing but early results suggest that the interventions are leading to fewer seniors being admitted to the intensive care unit and to shorter hospital stays, said Jeff Borenstein, researcher and lead clinician on the frailty project. "It definitely seems to be going in the right direction," he said.

The hospital is now working with Naylor and the University of Pennsylvania to design a program to help the patients once they go home.

"People who are frail are very vulnerable when they leave the hospital," said Harriet Udin Aronow, a researcher at Cedars. "We want to promote them being safe at home and continuing to recover."

In Gordon's case, she lives alone with the help of her children and a caregiver. The hospital didn't want her experiencing complications that would lengthen the stay, but they also didn't want to discharge her before she was ready. Under the health reform law, hospitals face penalties if patients come back too soon after being released.

Patients and their families often are unaware of the additional attention. Sitting in a chair in front of a vase of pink flowers, Gordon said she knew she would have to do her part to get out of the hospital quickly. "You have to move," she said. "I know you get bed sores if you stay in bed."

Gordon said she was comfortable at the hospital but she wanted to go back to her house as quickly as she could. "There's no place like home," she said.

Two days later, that's where she was.

anna.gorman@latimes.com

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Stars salute MusiCares honoree Bruce Springsteen

LOS ANGELES (AP) — Be it concert or charity auction, Bruce Springsteen can bring any event to a crescendo.

Springsteen briefly took over auctioneering duties before being honored as MusiCares person of the year Friday night, exhorting the crowd to bid on a signed Fender electric guitar by amping up the deal. The 63-year-old rock 'n' roll star moved the bid north from $60,000 by offering a series of sweeteners.

"That's right, a one-hour guitar lesson with me," Springsteen shouted. "And a ride in my Harley Davidson sidecar. So dig in, one-percenters."

That moved the needle past $150,000. He added eight concert tickets and backstage passes with a bonus tour conducted by Springsteen himself. That pushed it to $200,000, but he wasn't done.

"And a lasagna made by my mother!" he shouted as an in-house camera at the Los Angeles Convention Center cut to his 87-year-old mother Adele Ann Springsteen.

And with an extra $250,000 in the musicians charity's coffers, Springsteen sat down and spent most of the evening in the unusual role of spectator as a string of stars that included Elton John, Neil Young, Sting, Kenny Chesney, John Legend, Faith Hill and Tim McGraw, Patti Smith, Jackson Browne took the stage two nights before the Grammy Awards.

"Here's a little secret about Bruce Springsteen: He loves this," host Jon Stewart joked. "There's nothing he'd rather do than come to Los Angeles, put on a suit ... and then have people talking about him like he's dead."

Alabama Shakes kicked things off with "Adam Raised A Cain" and over the course of the evening there were several interesting takes on Springsteen's voluminous 40-year catalog of hits. Natalie Manes, Ben Harper and Charlie Musselwhite played a stripped down "Atlantic City." Mavis Staples and Zac Brown put a gospel spin on "My City of Ruins." John added a funky backbeat to "Streets of Philadelphia." Kenny Chesney offered an acoustic version of "One Step Up."

Jim James and Tom Morello burned through a scorching version of "The Ghost of Tom Joad" that brought the crowd out of their seats as Morello finished the song with a fiery guitar solo. And Mumford & Sons took it the opposite way, playing a quiet, acoustic version of "I'm On Fire" in the round that had the crowd leaning in.

Legend offered a somber piano version of "Dancing in the Dark" and Young shut down the pre-Springsteen portion of the evening with a "Born in the USA" that included two sign-language interpreters dressed as cheerleaders signing along to the lyrics.

"John Legend made me sound like Gershwin," Springsteen said. "I love that. Neil Young made me sound like the Sex Pistols. I love that. What an evening."

Springsteen spoke of the "miracle of music," the importance of musicians in human culture and making sure everyone is cared for. And he joked that he somehow ended up being honored by MusiCares, a charity that offers financial assistance to musicians in need run by The Recording Academy, after his manager called up Grammys producer Ken Ehrlich to seek a performance slot on the show in a "mercenary publicity move."

In the end, though, he was moved by the evening.

"It's kind of a freaky experience, the whole thing," Springsteen said. "This is the huge Italian wedding Patti (Scialfa) and I never had. It's a huge Bar Mitzvah. I owe each and every one of you. You made me feel like the person of the year. Now give me that damn guitar."

He asked the several thousand attendees to move toward the stage — "Come on, it's only rock 'n' roll" — and kicked off his five-song set with his Grammy nominated song "We Take Care Of Our Own." At the end of the night he brought everyone on stage for "Glory Days."

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Online:

http://grammy.com

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Follow AP Music Writer Chris Talbott: http://twitter.com/Chris_Talbott.

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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Entrepreneur Brian Lee is business partner to the stars

The gig: Lawyer-turned-serial-entrepreneur Brian Lee, 41, is pulling double duty as the chief executive of two celebrity-backed e-commerce websites: ShoeDazzle, co-founded with Kim Kardashian, and Honest Co., co-founded with Jessica Alba. The companies are headquartered in Santa Monica and offer customers monthly subscription plans in addition to typical a la carte shopping for shoes and baby products, respectively.

ShoeDazzle has more than 15 million registered users and last year posted $100 million in revenue, up 80% from 2011; it has raised $66 million from investors including venture capital firm Andreessen Horowitz. Honest Co., launched a year ago, has yet to release membership or financial numbers but has raised $27 million.

From Seoul to L.A.: Lee was born in Seoul. When he was 1, his family immigrated to Huntington Beach, where he grew up.

As an 8-year-old, Lee mapped out his trick-or-treating route on Halloween so he could collect as much candy as possible. When he got home, he separated his loot into Ziploc bags, which he sold at school for 25 cents each.

"Cost of goods: zero. Profit margins: 100%, outside of my own little labor," he said. "I probably did that for five years."

He now lives in Marina del Rey with his wife, Mira; their 4-year-old son, Davis; and their 1-year-old daughter, Madison.

Education: Bachelor's degree in business economics from UCLA in 1993, J.D. from UCLA School of Law in 1996.

Bold cold call: After practicing law for a few years, Lee came up with the idea for LegalZoom, which offers self-help legal documents such as divorce and bankruptcy forms, prenuptial agreements and wills. He wanted a high-profile name to represent the start-up, and decided to approach O.J. Simpson defense attorney Robert Shapiro.

Lee got Shapiro's number from 411 and called him at 10 p.m. "He picked up the phone and said, 'Hi, this is Robert Shapiro, how can I help you?' and I said, 'Well, my name is Brian Lee and I have a business opportunity I'd like to run by you.'... I think he heard the desperation in my voice and he said, 'You've got two minutes.'"

LegalZoom, based in Glendale, launched in 2001.

Online shoe shopping: ShoeDazzle was inspired by Lee's wife, who one day returned from a shopping spree on Robertson Boulevard with a pair of pricey designer shoes. When Lee asked her why she didn't just go to Loehmann's or DSW, she said discount chains didn't provide the type of personalized, one-on-one service that small boutiques did. Lee set out to replicate that experience online and met Kardashian through Shapiro, who is a family friend.

ShoeDazzle launched four years ago as an online subscription business, with members viewing a customized showroom of shoes based on a personal fashion quiz and choosing one new pair to receive every month for $39.95 including shipping.

Taking back the reins: In November, Lee became CEO of ShoeDazzle for a second time. He returned after the departure of Bill Strauss, who scrapped the company's subscription-based business model last year, leading to speculation that the company wasn't doing well.

In his first 100 days on the job, Lee laid off about two dozen employees and hired celebrity fashion stylist Rachel Zoe as the company's chief stylist; ShoeDazzle also began introducing one new shoe style every day. This month the company will roll out an optional $9.95-a-month VIP membership program that includes free shipping, early access to sales, discounts and an extended return policy.

Since a site relaunch in January, orders have increased 30% and repeat visits are up 12%, Lee said. The company sells as many as 250,000 pairs of shoes per month.

From shoes to babies: Lee was approached by Alba when the actress wanted to start an eco-friendly baby products line. Honest Co. sells diapers, shampoo, sunscreen and household items online that are nontoxic and made with organic ingredients.

Caffeine junkie: As the CEO of two companies, Lee arrives at Honest Co. offices by 7 a.m. every day and is there until 9:30 a.m. He then heads over to nearby ShoeDazzle, where he stays until 5 p.m. or so. Then it's back to Honest Co. until about 8 or 9 p.m.

"I drink seven Coca-Colas a day," he said. "Regular Coke, which is really bad for me."

Advice to entrepreneurs: "Believe in the idea with 100% certainty," Lee said. "But also don't be scared to change that idea and pivot very quickly. Because as an entrepreneur, nothing ever goes to plan."

For instance, Lee said that in the early days of LegalZoom, the company created do-it-yourself software programs such as Estate Planning in a Box that it hoped to sell at Staples and OfficeMax. When LegalZoom realized that Internet-based downloading was the future, it dropped those plans.

"We spent a lot of resources on it," he said, "but we weren't afraid at all to just cut it."

andrea.chang@latimes.com

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Big Bear locked down amid manhunt

The bustling winter resort of Big Bear took on the appearance of a ghost town Thursday as surveillance aircraft buzzed overhead and police in tactical gear and carrying rifles patrolled mountain roads in convoys of SUVs, while others stood guard along major intersections.

Even before authorities had confirmed that the torched pickup truck discovered on a quiet forest road belonged to suspected gunman Christopher Dorner, 33, officials had ordered an emergency lockdown of local businesses, homes and the town's popular ski resorts. Parents were told to pick up their children from school, as rolling yellow buses might pose a target to an unpredictable fugitive on the run.

By nightfall, many residents had barricaded their doors as they prepared for a long, anxious evening.

PHOTOS: A tense manhunt amid tragic deaths

"We're all just stressed," said Andrea Burtons as she stocked up on provisions at a convenience store. "I have to go pick up my brother and get him home where we're safe."

Police ordered the lockdown about 9:30 a.m. as authorities throughout Southern California launched an immense manhunt for the former lawman, who is accused of killing three people as part of a long-standing grudge against the LAPD. Dorner is believed to have penned a long, angry manifesto on Facebook saying that he was unfairly fired from the force and was now seeking vengeance.

Forest lands surrounding Big Bear Lake are cross-hatched with fire roads and trails leading in all directions, and the snow-capped mountains can provide both cover and extreme challenges to a fugitive on foot. It was unclear whether Dorner was prepared for such rugged terrain.

Footprints were found leading from Dorner's burned pickup truck into the snow off Forest Road 2N10 and Club View Drive in Big Bear Lake.

San Bernardino County Sheriff John McMahon said that although authorities had deployed 125 officers for tracking and door-to-door searches, officers had to be mindful that the suspect may have set a trap.

"Certainly. There's always that concern and we're extremely careful and we're worried about this individual," McMahon said. "We're taking every precaution we can."

PHOTOS: A fugitive's life on Facebook

Big Bear has roughly 400 homes, but authorities guessed that only 40% are occupied year-round.

The search will probably play out with the backdrop of a winter storm that is expected to hit the area after midnight.

Up to 6 inches of snow could blanket local mountains, the National Weather Service said.

FULL COVERAGE: Sweeping manhunt for rampaging ex-cop

Gusts up to 50 mph could hit the region, said National Weather Service meteorologist Mark Moede, creating a wind-chill factor of 15 to 20 degrees.

Extra patrols were brought in to check vehicles coming and going from Big Bear, McMahon said, but no vehicles had been reported stolen.

"He could be anywhere at this point," McMahon said. When asked if the burned truck was a possible diversion, McMahon replied: "Anything's possible."

Dorner had no known connection to the area, authorities said.

Craig and Christine Winnegar, of Murrieta, found themselves caught up in the lockdown by accident. Craig brought his wife to Big Bear as a surprise to celebrate their 28th wedding anniversary. Their prearranged dinner was canceled when restaurant owners closed their doors out of fear.

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Year after Houston's death, Davis gala returns

BEVERLY HILLS, Calif. (AP) — Last year, Whitney Houston died hours before Clive Davis' annual pre-Grammy gala went on. This year, the music executive says she'll be remembered.

"In saying I'm proud of her legacy, I'm going to make sure that she's felt somehow during that night, yes," the 80-year-old said in an interview Thursday.

Davis' gala will take place Saturday night at the Beverly Hilton, where Houston died on Feb. 11, 2012, at age 48.

The annual event is where Davis introduced a young Houston to the music world more than two decades ago. Davis — Houston's mentor, producer, champion and longtime friend — memorialized her at last year's gala, held downstairs from the hotel where she died and where her body was being examined by coroner's officials.

"Whitney and I had great times at this party over the years," he said, smiling. "I'd played her new songs and she'd come over in her pajamas and be listening late at night ... so it is bittersweet. Tragedy is still foul."

Houston was found drowned in a bathtub. Coroner's officials ruled her death accidental, with heart disease and cocaine use contributing factors.

The night continued last year after Houston's death — and the music will live on this year.

R&B singer Miguel, who's up for five awards at Sunday's Grammys — including song of the year for "Adorn" — will hit the stage. He rehearsed some of the song happily Thursday.

"I've dreamt about coming to this party," the singer said. "It's a huge honor to be included and perform."

Davis, per usual, was tight-lipped about the other performers.

"You should expect being blown away by the diversity of the music, by the vitality of the music, by the range of music today," Davis said.

Last year's performers included Elvis Costello, Ray Davies, Alicia Keys, Jessie J and others.

R&B singers Brandy and Monica, mentees of Houston, were supposed to perform their new duet at that time, but were heavily emotional due to Houston's death.

Emotional Houston moments will be captured in an hour-long CBS special titled "The Grammys Will Go On: A Death in the Family." It's a behind-the-scenes look at how Houston's death affected last year's Grammy Awards and will air the same night as Davis' gala. It includes interviews with Jennifer Hudson, Bruce Springsteen, Taylor Swift and other artists.

Saturday's event will honor Epic Records chairman and CEO Antonio L.A. Reid.

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Follow Mesfin Fekadu at http://www.twitter.com/MusicMesfin

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Well: One Dish, One Hour

Fast-food from a restaurant is not as fast as you think. There is drive time to and from the restaurant, waiting time to pay and collect your food, and then it still takes a few minutes to sort through it and set it on the table at home. (Assuming you don’t just eat it in the car.) But if you are willing to invest a few more minutes of time for a more healthful option, you can still make a homemade meal from scratch in less than an hour, writes Martha Rose Shulman in this week’s Recipes for Health column:

This week, in response to readers’ requests on the Recipes for Health Facebook page, I focused on quick one-dish dinners. You may have a different opinion than I do about what constitutes a quick meal. There are quick meals that involve little or no cooking — paninis and sandwiches, uncomplicated omelets, scrambled eggs, and meals that combine prepared items with foods that you cook — but I chose to focus on dishes that are made from scratch. I bought a cabbage and a generous bunch of kale at the farmers’ market, some sliced mushrooms and bagged baby spinach at Trader Joe’s, and used them in conjunction with items I had on hand in the pantry and refrigerator.

I decided to use the same rule of thumb that a close French friend uses. She refuses to spend more than a half hour on prep but always turns out spectacular dinners and lunches. My goal was to make one-dish meals that would put us at the table no more than 45 minutes after I started cooking (the soup this week went over by 5 or 10 minutes but I left it in because it is so good). For each recipe test I set the timer for 30 minutes, then let it count up once it went off. All of the meals are vegetarian and the only prepared foods I used were canned beans.

I do believe that it is healthy — and enjoyable — to take time to prepare meals for the family (or just for yourself), even when you are juggling one child’s afterschool soccer practice and homework with another child’s dance recitals and homework. Sometimes it is hard to find that half hour, but everybody benefits when you do.

Here are five new one-dish meals that you can make in an hour or less.

Soft Black Bean Tacos With Salsa and Cabbage: Canned black beans and lots of cabbage combine in a quick, utterly satisfying one-dish taco dinner.

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Couscous With Tomatoes, Kale and Chickpeas: A comforting topping that is both a stew and a sauce.

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Mushroom and Spinach Frittata: A hearty frittata that is good for any meal of the day.

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Quick Tomato, White Bean and Kale Soup: A hearty minestrone that can be made in under an hour, start to finish.

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Stir-Fried Cabbage, Tofu and Red Pepper: The chopping is the most time-consuming part of this recipe, but you can still be eating within 35 minutes.

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Stocks edge higher after trade deficit report

Stocks edged higher in on Wall Street after a report showed that the U.S. trade deficit narrowed sharply in December. The major indexes were also boosted by strong earnings reports.

The Dow Jones industrial average rose 49 points to 13,933 as of 11:54 a.m. (1654 GMT) Friday and climbed back above 14,000 during morning trading. On Feb. 1, the index closed above 14,000 for the first time since 2007.

The Standard & Poor's 500 index was up 7 points at 1,517 and the Nasdaq composite rose 29 points to 3,194.

The trade deficit fell nearly 21 percent in December from November to $38.6 billion, as exports rose while oil imports plummeted, the Commerce Department said Friday. That's the smallest in nearly three years. The smaller trade gap means the economy likely performed better in the final three months of last year than first estimated last week.

“The trade balance was surprisingly very good,” said Phil Orlando, chief market strategist at Federated Investors.

The government estimated last week that the U.S. economy contracted at an annual rate of 0.1 percent in the last three months of 2012. Orlando estimates that growth may now be revised to show growth of 0.5 percent.

Shares of LinkedIn, the online professional networking service, jumped $23.55, or 19 percent, to $147.60 after the company reported fourth-quarter results late Thursday that beat analysts' forecasts. AOL soared $2.15 to $33.56 Friday after the Internet company said its quarterly revenue grew for the first time in eight years, helped by strength in worldwide advertising.

Currently, analysts are expecting earnings for the fourth quarter of 2012 to rise 6.5 percent for S&P 500 companies, according to data from S&P Capital I&Q. That's an increase from the 2.4 percent growth rate recorded for the preceding quarter.

Wall Street is also bracing for what is forecast to be the largest winter storm in more than a year with up to 2 feet (0.6 meters) of snow forecast along the densely populated Interstate 95 corridor from the New York City area to Boston and beyond.

Markets are little changed for the week, suggesting that a rally that pushed the major indexes close to record levels early this year may have stalled.

The Dow had its best January in almost two decades and is up 6.9 percent on the year. The S&P 500 is 6.4 percent higher in the same period. A last-minute budget deal to avoid the “fiscal cliff” and optimism about the housing market and a gradually improving jobs market have powered the rally.

Stocks have benefited as investors poured a net $4.1 billion into stock mutual funds since the start of the year, according to data provided by Lipper.

As stocks have gained, Treasurys have slumped. The yield on the 10-year note rose, which moves inversely to its price, rose one basis point to 1.97 percent.

Among other stocks making big moves;

— Microchip Technology, a semiconductor maker, jumped $2.22 to $36.16 after its earnings beat estimates. The company said it was seeing “exceptionally strong” bookings.

— Moody's slumped $2.60 to $44.45 even after reporting that fourth-quarter net income jumped 66 percent and revenue blew away expectations. Many are expecting the ratings agency will be the next target of the Justice Department, which filed a suit against rival Standard & Poor's for its actions before the housing market collapse.

— Activision Blizzard, the video game maker that counts blockbuster “Call of Duty” among its titles, rose $1.32, or 10.9 percent, to $13.48. The company posted sharply higher earnings and revenue in the fourth quarter, surpassing Wall Street's expectations.

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Search for ex-cop in shootings extended statewide, into Nevada

As authorities scoured Southern California for an ex-Los Angeles police officer suspected of shooting three officers, killing one, officials broadened the alert to include the entire state Thursday morning, and authorities in Nevada were warned.

The California Highway Patrol originally issued a "blue alert" for nine Southern California counties, warning that suspect Christoper Jordan Dorner, 33, was considered "armed and extremely dangerous," early Thursday. Shortly after 9 a.m. that alert was broadened to the include the entire state.

A statewide “high alert” was sent out about 8:30 a.m. across Nevada for Dorner, authorities with the Nevada Highway Patrol said.

PHOTOS: Manhunt for ex-LAPD officer

Arizona authorities were aware of the situation but had not issued any formal alerts, said Officer Carrick Cook with the state's Department of Public Safety.

Local, state and federal authorities are involved in the search for Dorner, who threatened "unconventional and asymmetrical warfare" against police in an online manifesto. Dorner is also wanted in connection with a double homicide Sunday in Irvine, where the daughter of a retired LAPD captain and her fiance were killed.

The search intensified early Thursday after three police officers were shot in Riverside County and Dorner was identified as a possible suspect.

The first shooting occurred about 1:30 a.m. Thursday in Corona, where two Los Angeles Police Department officers were providing protection for someone mentioned in Dorner's manifesto, officials said. One officer suffered a graze wound to the head during a shootout and Dorner fled the scene, police said.

Ex-LAPD officer threatened to kill in online manifesto

A short time later, two Riverside officers were shot at the corner of Magnolia Avenue and Arlington Avenue in Riverside. Toussaint said the officers were sitting at a red light when they were ambushed. One was killed, the other was undergoing surgery Thursday morning.

There was no indication the officers were "actively seeking Dorner," Toussaint said.

“Our officers were stopped at an intersection at a red light when they were ambushed," he said. "Because of the close proximity to the timeline, we believe there is a strong likelihood that former LAPD Officer Christopher Dorner was involved in our incident.”

As authorities swarmed the area, two officer-involved shootings occurred in Torrance after police came across vehicles they thought might be Dorner's.

The first Torrance incident occurred about 5:20 a.m. in the 19500 block of Redbeam Avenue in Torrance, Lt. Devin Chase said. That incident involved Los Angeles police detectives from the Hollywood division, sources said.

Two women delivering newspapers were struck by gunfire and transported to an area hospital with unknown injuries, Chase said. No officers were injured. The women were not identified.

The second incident, which involved Torrance police officers, occurred at Flagler Lane and Beryl Street about 5:45 a.m. No injuries were reported in that incident.

Chase said both incidents involved vehicles matching the description of the one sought in connection with Dorner.

"Now it appears neither of them are directly related," Chase said. "In both of them, officers believed they were at the time."

Authorities said they believe Dorner attempted to steal a boat from an elderly man about 10:30 p.m. Wednesday at the Point Loma Yacht Club in San Diego, hours before the shootings in Riverside County.

The boat owner reported being accosted by a burly man who tied him up, threatened him with a gun and said he wanted the boat to flee to Mexico.

But while they were trying to get underway, a rope became entangled in the propeller and the boat was inoperable, authorities said.

The suspect fled the scene and the boat owner was unharmed.

About 2 a.m., a citizen reported finding property belonging to Dorner on a street near Lindbergh Field, not far from the scene of the attempted boat theft. The property included a briefcase and Dorner's LAPD badge.

In the online manifesto, Dorner specifically named the father of Monica Quan, the Cal State Fullerton assistant basketball coach who was found dead Sunday in Irvine along with her fiance, Keith Lawrence.

Randy Quan, a retired LAPD captain, was involved in the review process that ultimately led to Dorner’s dismissal. A former U.S. Navy reservist, Dorner was fired in 2009 for allegedly making false statements about his training officer. In the manifesto, he complained that Randy Quan and others did not fairly represent him at the review hearing.

“The violence of action will be high .... I will bring unconventional and asymmetrical warfare to those in LAPD uniform whether on or off duty," Dorner wrote.

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Afghan boys from nominated film to walk red carpet

KABUL, Afghanistan (AP) — Fawad Mohammadi has spent half his life peddling maps and dictionaries to foreigners on a street of trinket shops in Kabul. Now the 14-year-old Afghan boy with bright green eyes is getting ready for a trip down the red carpet at the Oscars.

It will also be his first time out of the country and his first time on a plane.

Mohammadi was plucked from the dingy streets of the Afghan capital to be one of the main stars of "Buzkashi Boys," a coming-of-age movie filmed entirely in a war zone and nominated in the Best Live Action Short Film category.

The movie is about two penniless young boys — a street urchin and a blacksmith's son — who are best friends and dream of becoming professional players of buzkashi, a particularly rough and dangerous game that somewhat resembles polo: Horseback riders wrangle to get a headless goat carcass into a circular goal at one end of the field.

It's also part of an American director's effort to help revive a film industry devastated by decades of civil war and by the Taliban, an Islamic fundamentalist movement that banned entertainment and burned films and theaters during its five years in power.

Sam French, a Philadelphia native who has lived in Afghanistan for about five years, said his 28-minute movie was initially conceived as a way of training local film industry workers — the first installment in his nonprofit Afghan Film Project.

"We never dreamed of having the film come this far and get an Oscar nomination," French, 36, said in a telephone interview from Los Angeles, where he is preparing for the Feb. 24 Academy Awards and raising money to fly the two young co-stars in for the ceremony.

The two boys playing the main characters — Mohammadi and Jawanmard Paiz — can barely contain their excitement about going to the Oscars.

"It will be a great honor for me and for Afghanistan to meet the world's most famous actors," said Mohammadi, whose real-life dream is to become a pilot. He's also hoping to go see the cockpit during the flight.

The farthest Mohammadi has ever traveled was to the northern Afghan city of Mazar-i-Sharif when he was younger.

Mohammadi's father died a few years ago, leaving him with his mother, five brothers and a sister. He started selling chewing gum when he was about 7 years old and soon expanded his trade to maps and dictionaries.

He learned to speak English hustling foreigners on Chicken Street, the main tourist area in Kabul with shops selling multicolor rugs, lapis bowls and other crafts and souvenirs, and gained a reputation for being polite, helpful and trustworthy. He was even able to enroll in a private school, thanks to the generosity of some other foreigners unrelated to the film project.

In the movie Mohammadi plays the blacksmith's son, Rafi, whose father wants him to follow in his footsteps.

"His life was so much harder than mine," Mohammadi said. "The blacksmith made him go out on the streets. I came myself here (to Chicken Street). My family didn't make me come. I wanted to make money to feed myself and to feed my family. He didn't have a home. They lived in the blacksmith shop."

Ironically it's not Mohammadi but Paiz, the youngest son of a well-known Afghan actor, who plays the homeless boy Ahmad.

Paiz, also 14, already was an experienced actor: He's appeared in films since the age of 5 and has gone to the Cannes Film Festival.

Paiz and Mohammadi had a lot to learn from each other and became friends. He gave Mohammadi tips for acting and handling himself in live interviews, while Fawad taught him about life outside his sheltered surroundings.

"When I saw Fawad was such a good actor even though he was a street boy and he was so brave in acting, I was very surprised and I said to myself, 'Everybody can achieve what they desire to do,'" Paiz said during an interview this week, shivering in the snow-covered courtyard of the Afghan Film Institute while a local TV series was being filmed nearby.

French, who co-wrote the script and produced "Buzkashi Boys" with Martin Roe of the Los Angeles-based production company Dirty Robber, launched a fundraising drive that's raised almost $10,000 so far to help bring the boys to Los Angeles for the ceremony. Any extra money will be placed in a fund to provide for Mohammadi's education and help his family. The boys will travel with an escort and will stay with the extended Afghan family of one of the film's producers, French said.

French said he's aware of the pitfalls in working with child actors from developing countries.

The makers of "Slumdog Millionaire," the rags-to-riches blockbuster about three poor Indian children, have struggled to make a better life for the young stars, and four boys who acted in "The Kite Runner" had to leave Afghanistan out of concern they could be ostracized or subject to violence because of a rape scene in the movie.

French said he and others involved in the "Buzkashi Boys" took pains to involve the community and made sure to avoid any scenes that could be offensive.

"We're not filmmakers who just do a film and leave. We remain there and present," he said. "We had lots and lots of tea with lots and lots of people."

The Academy of Motion Picture Arts and Sciences says there have been three documentary features nominees filmed at least in part in Afghanistan since 2007 — all about the U.S. military. The Kite Runner, which was nominated for original score in 2007, was set in Afghanistan but not filmed there.

Afghanistan had a burgeoning film industry starting in the early 20th century, but it suffered from fighting during the civil war and the Taliban campaign to stamp out entertainment. Actors and film industry workers like Paiz's father and the actor who plays the blacksmith, Wali Talash, fled the country. They returned only after the 2001 U.S.-led assault that ousted the Islamic movement and its al-Qaida allies.

Talash, 56, said he hopes the "Buzkashi Boys" will show the world the rich culture of Afghanistan, which too few in the world know beyond reports of roadside bombs and suicide attacks.

"I hope if this movie wins that it will be an earthquake that will shake the industry and help Afghan filmmakers get back on their feet," he said.

Mohammadi, meanwhile, says he knows the money and fame he earned from the movie can carry him only so far. He still sells maps, though not so often as before, because he has school.

"For my work I used to know a lot of foreigners and I still do, but before they used to know me as a map seller. Now they know me as an actor," he said, waving a plastic-covered map as weary Afghans walked by on the muddy street. "Most of them take pictures with me and sometimes they buy maps from me even if they don't need any just because they spotted me in the movie."

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Associated Press writer Steve Loeper in Los Angeles contributed to this report.

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Online:

Fundraising site — https://rally.org/buzkashiboys/c/h95pGSpJAiE

Film website — http://www.buzkashiboys.com/

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