India Ink: What They Said: Budget 2013-14

Finance Minister Palaniappan Chidambaram presented the Union budget in Parliament on Thursday morning. Reactions were mixed from analysts who felt that while the finance minister had delivered a satisfactory budget given the country’s economic climate, more could have been done to attract foreign investment.

Prime Minister Manmohan Singh, speaking with Doordarshan News:

Given the challenges facing our economy, the finance minister has done a commendable job. India needs to create jobs for our growing labor force to the extent of about 10 million persons every year. To do that, we need to accelerate the tempo of our growth. We need, as the 12th Five-Year Plan has mentioned eloquently, a growth rate of about 8 percent. This is a growth rate which is consistent with our underlying potential. We have to get there. Although this is a difficult journey — it cannot be accomplished in a single year – but the finance minister has taken important steps to reverse the pessimistic view with regard to investment climate, with regard to the growth potential and possibilities of our economy.

The finance minister has laid out a road map. There is plenty of food for every ministry to chew upon. And each one of our ministries has to ask itself this question: If India needs an 8 percent growth rate, growth which is at the same time inclusive and sustainable, what is it that each ministry should do? The finance minister has, I think, mentioned these challenges. It is up to the collective wisdom of my Council of Ministers to convert these challenges into opportunities to accelerate the tempo of growth, to make it more inclusive, to make it more sustainable.

Dinesh Thakkar, chairman and managing director at Angel Broking in Mumbai:

The government’s reform momentum had been so strong since September that there were expectations of some exciting measures in the budget too. That was not the case, but it does not mean the budget was a disappointment. The finance minister has been seriously committed to bringing down the fiscal deficit, and he has delivered on that front, as he did not announce any major populist measure and largely maintained stability in tax policies, save for some tweaking for higher income brackets and corporates. In my view, there were no major positive or negative triggers for the markets or any particular sectors, and I think what the market will look forward to is the reform agenda being continued by the government outside the budget, in the coming Parliament sessions, for which the momentum still looks very much on track.

Anuj Puri, chairman and country head of Jones Lang LaSalle India:

We did not expect this budget to be a game-changer. The realities of the Indian economic situation need to viewed in context with the factors that drive it, not least of all the global economic situation. There is no escaping the fact that the business which comes to India from the European Union and the U.S. has a trickle-down effect on key economic drivers in India, and the Finance Ministry does not control these factors. The Union budget can only hope to address factors within its control.

This was a moderately encouraging budget in general, but tepid for the Indian real estate sector. There has been no proposal on certain key expectations from the real estate sector. These include implementation of the real estate regulator and the Land Acquisition Act. All said and done, Indian real estate will continue to struggle with its larger hurdles. While the affordable housing category has been rightly given due attention, aspects relating to improved transparency and corporate governance within the sector have been largely ignored.

That said, the budget has shown commitment to improving communication on taxation and regulatory policies. This should give more comfort to offshore real estate investors who have been bogged down by the political inertia and therefore unsure of India as an investment destination in the recent past.

Partha Iyengar, country manager for research, India, at Gartner:

The big overarching focus on growth by the finance minister is the fundamental “feel good” factor in this budget. Given the fact that one can argue that a lot of the weakness in the Indian economy is what I call a “sentimental recession,” his strong statement that there is no ground for “doom and gloom” heading into the new year.

The big specific positives of the budget are that he has focused both in terms of the letter and spirit of the budget on the key planks of growth for India and health of every industry, including IT, which is infrastructure, education, skills development and incentives for the growth of domestic manufacturing. Some of the other positive areas are support for entrepreneurship, the M.S.M.E. [micro, small and medium enterprises] sector, both in terms of financial and overall support. The recognition that the overseas “trust deficit” in terms of a comfort level on India’s investment climate has to be addressed is also welcome.

However, the budget is only a directional statement, and the challenge for India historically and even currently is in the execution of the statement of intent outlined in the budget. This has been India’s Achilles’ heel, in that bold pronouncements in the budget never see the light of day or are not implemented as effectively as they can or should be. So it was disappointing to not see any statements on what the government would do to ensure mechanisms and oversight to ensure speedy and efficient implementation of these programs. Overall, a 7/10 score for the budget.

Girish Vanvari, co-head of tax at KPMG:

This budget is along anticipated lines, given the economic scenario in the country. There is a stable tax regime. There is no weird tax introduced; nothing much has been tinkered with. The expenditure outlays of the government have not gone down and so the government is not going to stop spending, which means continued growth.

There is a tax on the super-rich with income above 10 million, but this will only affect about 42,000 people and not impact the larger base. Also, the tax is only a 10 percent surcharge and only effective for one year. In this situation, we have limited choices to manage the fiscal deficit, and the budget is quite good given the situation. It is generally an investor-friendly budget because the crux of this budget is growth. Without growth, the fiscal deficit will not be able to be constrained.

Sujan Hajra, chief economist and executive director at Anand Rathi Financial Services in Mumbai:

Given the macroeconomic climate – slowing growth, stable inflation, high fiscal deficit and current account deficit – this is the best budget that could be rolled out in these circumstances. The overarching priority in this budget is to affect some level of fiscal consolidation, and that has been delivered, having kept the fiscal deficit to 5.2 percent for this year.  The other priority for this budget is to induce financial saving and investment, and many measures have been introduced towards that, such as special incentives for over 1 billion rupees investment, a boost to infrastructure investment, particularly in the power and road sector, widening the scope for investing in mutual funds and the inflation index bond.

Despite this being the last full budget before the next election, the budget has largely resisted taking measures of overt populism. The two largely populist measures taken are the Food Security Act and the Direct Benefit Transfer, and none of these involve any major outlay. The subsidy component of the budget has been reduced rather than increased.

Also there has been some kind of benefit for the bottom of the pyramid with tax benefits for the lowest tax bracket and benefits on housing interest payment for the lower end of the spectrum.

Nobody can term this as a dream budget, but it is trying to address macro concerns and bring about some sort of revival in growth.

Chandrajit Banerjee, director general of the Confederation of India Industry, a trade group:

It is a very well thought through and analytical budget and not a political budget. It is a growth-oriented budget, where the focus on investment has been kept high.

Jaijit Bhattacharya, director for South Asia at Hewlett-Packard:

The IT and electronics manufacturing industry was looking forward to budgetary support to the government’s stated policy of promoting IT & electronics manufacturing in India. But this has not been done in this budget.

Dipen Shah, head of private client group, research, Kotak Securities:

The finance minister has projected a fiscal deficit in line with what he had promised, and it is far better than what the situation was when he had come in. To that extent, he has presented a responsible budget. We believe that the budget focuses rightly on higher investments, which can lead to better growth rates in the future. Several initiatives have been announced in the infrastructure sector. Followup action, in terms of removing infrastructure bottlenecks, will be needed and will go a long way in helping the government achieve the growth targets.

Nishith Desai, managing partner at Nishith Desai Associates, a research-based international law firm:

The budget brings some relief but not much excitement – in particular for foreign investors. It was expected that the finance minister would introduce new tax rates and this did not happen. We expected that estate duty would be reintroduced and this was not done. It was expected that there would be a whole host of new indirect taxes, and that was not done to a large extent. Therefore, it was not the draconian budget expected in the current macroeconomic situation. Only the super-rich have been charged a 10 percent surcharge, which is not too much of a burden, in my view.

However, we expected some big bang reforms for bringing foreign investment to India, which did not happen. The finance minister started by saying that foreign investment is “imperative,” but that imperative was soon lost. There was no assurance made to guarantee a stable regulatory environment and that there would not be any more retroactive amendments in general. It was expected that the finance minister would address cases that involve the offshore transfer of shares like Vodafone so that there could be some certainty, but this was not done.

I believe the finance minister will have to present another round of liberalization and reforms to attract foreign investment. I think that he has tried to please everybody, which is not a bad thing. But at the same time, if you look at this from the viewpoint of attracting the foreign investment necessary for growth – that has not happened.

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Gadgetwise Blog: Tip of the Week: Clean Your Phone and Its Camera

Smartphones spend a lot of time in hand, where they can pick up germs and dirt. Wiping down the phone regularly with an antibacterial cloth intended for use with touch screens can help keep it clean. Many office supply stores like Staples or Office Depot carry disposable wipes for use on phone and tablet screens.

If your phone has a camera and your photos have been looking blurry, you can clean its lens with a microfiber cloth or other wipe for use with camera lenses; a cotton swab moistened with distilled water can also take off stubborn grime. Whatever you do, though, do not spray the phone with industrial cleansers or use cleaning wipes designed for household chores, because these can damage the screen and other parts of the handset.

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The New Old Age Blog: For the Elderly, Lists of Tests to Avoid

The Choosing Wisely campaign, an initiative by the American Board of Internal Medicine Foundation in partnership with Consumer Reports, kicked off last spring. It is an attempt to alert both doctors and patients to problematic and commonly overused medical tests, procedures and treatments.

It took an elegantly simple approach: By working through professional organizations representing medical specialties, Choosing Wisely asked doctors to identify “Five Things Physicians and Patients Should Question.”

The idea was that doctors and their patients could agree on tests and treatments that are supported by evidence, that don’t duplicate what others do, that are “truly necessary” and “free from harm” — and avoid the rest.

Among the 18 new lists released last week are recommendations from geriatricians and palliative care specialists, which may be of particular interest to New Old Age readers. I’ve previously written about a number of these warnings, but it’s helpful to have them in single, strongly worded documents.

The winners — or perhaps, losers?

Both the American Geriatrics Society and the American Academy of Hospice and Palliative Medicine agreed on one major “don’t.” Topping both lists was an admonition against feeding tubes for people with advanced dementia.

“This is not news; the data’s been out for at least 15 years,” said Sei Lee, a geriatrician at the University of California, San Francisco, and a member of the working group that narrowed more than 100 recommendations down to five. Feeding tubes don’t prevent aspiration pneumonia or prolong dementia patients’ lives, the research shows, but they do exacerbate bedsores and cause such distress that people often try to pull them out and wind up in restraints. The doctors recommended hand-feeding dementia patients instead.

The geriatricians’ list goes on to warn against the routine prescribing of antipsychotic medications for dementia patients who become aggressive or disruptive. Though drugs like Haldol, Risperdal and Zyprexa remain widely used, “all of these have been shown to increase the risk of stroke and cardiovascular death,” Dr. Lee said. They should be last resorts, after behavioral interventions.

The other questionable tests and treatments:

No. 3: Prescribing medications to achieve “tight glycemic control” (defined as below 7.5 on the A1c test) in elderly diabetics, who need to control their blood sugar, but not as strictly as younger patients.

No. 4: Turning to sleeping pills as the first choice for older people who suffer from agitation, delirium or insomnia. Xanax, Ativan, Valium, Ambien, Lunesta — “they don’t magically disappear from your body when you wake up in the morning,” Dr. Lee said. They continue to slow reaction times, resulting in falls and auto accidents. Other sleep therapies are preferable.

No. 5: Prescribing antibiotics when tests indicate a urinary tract infection, but the patient has no discomfort or other symptoms. Many older people have bacteria in their bladders but don’t suffer ill effects; repeated use of antibiotics just causes drug resistance, leaving them vulnerable to more dangerous infections. “Treat the patient, not the lab test,” Dr. Lee said.

The palliative care doctors’ Five Things list cautions against delaying palliative care, which can relieve pain and control symptoms even as patients pursue treatments for their diseases.

It also urges discussion about deactivating implantable cardioverter-defibrillators, or ICDs, in patients with irreversible diseases. “Being shocked is like being kicked in the chest by a mule,” said Eric Widera, a palliative care specialist at the San Francisco V.A. Medical Center who served on the American Academy of Hospice and Palliative Medicine working group. “As someone gets close to the end of life, these ICDs can’t prolong life and they cause a lot of pain.”

Turning the devices off — an option many patients don’t realize they have — requires simple computer reprogramming or a magnet, not the surgery that installed them in the first place.

The palliative care doctors also pointed out that patients suffering pain as cancer spreads to their bones get as much relief, the evidence shows, from a single dose of radiation than from 10 daily doses that require travel to hospitals or treatment centers.

Finally, their list warned that topical gels widely used by hospice staffs to control nausea do not work because they aren’t absorbed through the skin. “We have lots of other ways to give anti-nausea drugs,” Dr. Widera said.

You can read all the Five Things lists (more are coming later this year), and the Consumer Reports publications that do a good job of translating them, on the Choosing Wisely Web site.

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

Read More..

The New Old Age Blog: For the Elderly, Lists of Tests to Avoid

The Choosing Wisely campaign, an initiative by the American Board of Internal Medicine Foundation in partnership with Consumer Reports, kicked off last spring. It is an attempt to alert both doctors and patients to problematic and commonly overused medical tests, procedures and treatments.

It took an elegantly simple approach: By working through professional organizations representing medical specialties, Choosing Wisely asked doctors to identify “Five Things Physicians and Patients Should Question.”

The idea was that doctors and their patients could agree on tests and treatments that are supported by evidence, that don’t duplicate what others do, that are “truly necessary” and “free from harm” — and avoid the rest.

Among the 18 new lists released last week are recommendations from geriatricians and palliative care specialists, which may be of particular interest to New Old Age readers. I’ve previously written about a number of these warnings, but it’s helpful to have them in single, strongly worded documents.

The winners — or perhaps, losers?

Both the American Geriatrics Society and the American Academy of Hospice and Palliative Medicine agreed on one major “don’t.” Topping both lists was an admonition against feeding tubes for people with advanced dementia.

“This is not news; the data’s been out for at least 15 years,” said Sei Lee, a geriatrician at the University of California, San Francisco, and a member of the working group that narrowed more than 100 recommendations down to five. Feeding tubes don’t prevent aspiration pneumonia or prolong dementia patients’ lives, the research shows, but they do exacerbate bedsores and cause such distress that people often try to pull them out and wind up in restraints. The doctors recommended hand-feeding dementia patients instead.

The geriatricians’ list goes on to warn against the routine prescribing of antipsychotic medications for dementia patients who become aggressive or disruptive. Though drugs like Haldol, Risperdal and Zyprexa remain widely used, “all of these have been shown to increase the risk of stroke and cardiovascular death,” Dr. Lee said. They should be last resorts, after behavioral interventions.

The other questionable tests and treatments:

No. 3: Prescribing medications to achieve “tight glycemic control” (defined as below 7.5 on the A1c test) in elderly diabetics, who need to control their blood sugar, but not as strictly as younger patients.

No. 4: Turning to sleeping pills as the first choice for older people who suffer from agitation, delirium or insomnia. Xanax, Ativan, Valium, Ambien, Lunesta — “they don’t magically disappear from your body when you wake up in the morning,” Dr. Lee said. They continue to slow reaction times, resulting in falls and auto accidents. Other sleep therapies are preferable.

No. 5: Prescribing antibiotics when tests indicate a urinary tract infection, but the patient has no discomfort or other symptoms. Many older people have bacteria in their bladders but don’t suffer ill effects; repeated use of antibiotics just causes drug resistance, leaving them vulnerable to more dangerous infections. “Treat the patient, not the lab test,” Dr. Lee said.

The palliative care doctors’ Five Things list cautions against delaying palliative care, which can relieve pain and control symptoms even as patients pursue treatments for their diseases.

It also urges discussion about deactivating implantable cardioverter-defibrillators, or ICDs, in patients with irreversible diseases. “Being shocked is like being kicked in the chest by a mule,” said Eric Widera, a palliative care specialist at the San Francisco V.A. Medical Center who served on the American Academy of Hospice and Palliative Medicine working group. “As someone gets close to the end of life, these ICDs can’t prolong life and they cause a lot of pain.”

Turning the devices off — an option many patients don’t realize they have — requires simple computer reprogramming or a magnet, not the surgery that installed them in the first place.

The palliative care doctors also pointed out that patients suffering pain as cancer spreads to their bones get as much relief, the evidence shows, from a single dose of radiation than from 10 daily doses that require travel to hospitals or treatment centers.

Finally, their list warned that topical gels widely used by hospice staffs to control nausea do not work because they aren’t absorbed through the skin. “We have lots of other ways to give anti-nausea drugs,” Dr. Widera said.

You can read all the Five Things lists (more are coming later this year), and the Consumer Reports publications that do a good job of translating them, on the Choosing Wisely Web site.

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

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DealBook: In Europe, Risks and Opportunities

BERLIN – Is Europe a risk or an opportunity?

As its economies struggle, private equity managers offer differing views about the region.

Speaking at the SuperReturn conference in Berlin, Henry R. Kravis, co-founder of Kohlberg Kravis Roberts, said Europe was an attractive market, particularly the Continent’s southern countries, which have been hit by high unemployment and meager growth.

“I like Spain, they are doing a number of right things,” Mr. Kravis told a somewhat empty conference room early on Thursday morning after many private equity managers had attended late-night dinners the previous evening. “In Europe, there clearly are opportunities. I may be in the minority.”

Other private equity giants, including David M. Rubenstein of the Carlyle Group, are also scouting for opportunities from Italy to Ireland despite concerns that the Continent may fall back into recession.

Lionel Assant, European head of private equity at the Blackstone Group, liked Spain because of its close ties to fast-growing Latin American markets and efforts to revamp its local labor market.

Not every manager is so bullish, however.

J. Christopher Flowers, whose private equity firm bought an insurance broker from the struggling Belgian bank KBC for 240 million euros ($315 million) in 2011, said the future of the euro zone remained a major risk.

Europe’s recovery prospects were hurt again this week after Italian national elections on Monday failed to provide a definitive winner. The political impasse prompted significant losses in the Continent’s stock markets as investors fretted about the future of one of Europe’s largest economies.

For Mr. Flowers, there are still some potential investment opportunities, including the pending forced sale of bank branches in Britain from the nationalized Royal Bank of Scotland. The United States, however, still remains his preferred region in which to invest.

“If a major economy like Spain defaults, we would prefer to be in Germany,” Mr. Flowers said. “If I had to pick one region, I would pick the U.S.”

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This post has been revised to reflect the following correction:

Correction: February 28, 2013

An earlier version of this article contained an incorrect conversion of 240 million euros. It is the equivalent of $315 million, not $310.

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India Ink: Revisiting the Horror in Sri Lanka

NEW DELHI — In the series of photographs shot in 2009, the bare-chested boy is first shown seated on a bench watching something outside the frame. Then he is seen having a snack. In the third image he is lying on the ground with bullet holes in his chest. The photographs, which were released last week by the British broadcaster Channel 4, appear to document the final moments in the life of 12-year-old Balachandran Prabhakaran, the youngest son of the slain founder of the Liberation Tigers of Tamil Eelam, Velupillai Prabhakaran.

The images are from the documentary film “No Fire Zone,” which tells the story of Sri Lanka’s violent suppression of Mr. Prabhakaran’s equally violent revolution, which had come very close to securing a separate state for the Tamil minority of Sri Lanka. After 26 years of civil war between the Tamils, who are chiefly Hindus, and the Sinhalese majority, who are chiefly Buddhists, the Sri Lankan state won decisively in 2009. Human rights activists say that hundreds of Tamil fighters, political leaders and their families, including Mr. Prabhakaran and his family, did not die in action but were executed. They estimate that more than 40,000 Tamil civilians died in the final months of the war.

Within its borders, the Sri Lankan government appears to wink at its Sinhalese population to accept their congratulations for ending the war, but it maintains a righteous indignation when the world accuses its army of planned genocide.

“No Fire Zone” includes video footage and photographs shot on mobile phones by Tamil survivors and Sinhalese soldiers that were somehow leaked. The film’s director, Callum Macrae, told me that it will be screened at the 22nd session of the U.N. Human Rights Council, now under way in Geneva, where the United States plans to introduce a resolution asking Sri Lanka to investigate the allegations of war crimes by its army.

It is not clear what such a resolution will achieve because Sri Lanka’s powerful president, Mahinda Rajapaksa, who has a rustic swagger about him and a manly black mustache, is the triumphant face of Sri Lanka’s victory in the war. The Sri Lankan Army is unambiguously under his control. Whatever the worth of the resolution, India is expected to support it more enthusiastically than it did a similar resolution last March.

Over the years, the shape and location of Sri Lanka have inspired several Indian cartoonists to portray the island nation as a tear drop beneath India’s peninsular chin. This is an illogical depiction of Sri Lanka’s trauma because a tear drop is not sorrowful; it is a consequence of someone’s sorrow. Some caricatures that appeared in the late 1980s and early 1990s, however, showed the Indian peninsula weeping and Sri Lanka as the consequent tear drop. This imagery had a stronger logic. India’s history with Sri Lanka is, in a way, about a bumbling giant being hurt by a cunning dwarf.

Under the late Prime Minister Indira Gandhi, the type of strategists who imagine they are great Machiavellian characters, and love to add the prefix “geo” to “politics” to feel good about their advisory jobs, ensured that India armed and financed the Tamil rebels. In 1984, when she was assassinated and her son Rajiv Gandhi took over as prime minister, Sri Lanka was engaged in a full-fledged civil war. Now, India wanted to play gracious giant in the region and bring peace to Sri Lanka. In 1987, it sent troops to achieve that end. It was a disastrous move, and resulted in the deaths of nearly 1,200 Indian soldiers and thousands of Tamil fighters. In an act of vengeance, Mr. Prabhakaran made his greatest strategic blunder: ordering the assassination of Rajiv Gandhi.

On the early morning of May 22, 1991, as the news spread through Madras (now Chennai) by phone and radio, I saw people run out of their homes in some kind of delirium to pick up the newspapers from their porches. The city had just woken up to the improbable fact that a suicide bomber had killed Mr. Gandhi the previous night in a small town not far from Chennai. Until then, the southern state of Tamil Nadu, whose capital is Chennai, was a haven for the Tamil Tigers. Bound by a common language, the masses of Tamil Nadu felt a deep compassion for the struggle of Sri Lankan Tamils. But Mr. Gandhi’s assassination was seen by them as an act of war against India. The chief minister of Tamil Nadu at the time, Muthuvel Karunanidhi, who was accused of being a friend of the Tigers, went around Chennai in an open-roof van, standing with his palms joined in apology. That was not good enough. In the 1991 Tamil Nadu assembly elections, his party won only two seats.

But now, the plight of the Sri Lankan Tamils has returned as a passionate political issue in Tamil Nadu. Mr. Karunanidhi is too old to stand anymore but even as a patriarch who uses a wheelchair, he is a useful ally of the Indian National Congress party, which heads the national government. He has often demanded that the accomplices of Mr. Gandhi’s assassin now on death row in India be pardoned, and that President Rajapaksa be tried on war crimes charges. Last year, when the United States introduced a resolution against Sri Lanka, India was reluctant to back it for strategic reasons, including that it has commercial interests in Sri Lanka, which China is fast grabbing. But Mr. Karunanidhi and public sentiment in Tamil Nadu finally persuaded the Indian government to support it.

In a few days, when the United States introduces its new resolution against Sri Lanka, the brute forces of politics and practicality will ensure that the Indian government led by the Congress party, whose leader is Sonia Gandhi, will join other nations in asking Sri Lanka to explain how exactly it eliminated the organization that made her a widow.

Manu Joseph is editor of the Indian newsweekly Open and author of the novel “The Illicit Happiness of Other People.”

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Gadgetwise Blog: Q&A: Moving iTunes Libraries

How do I transfer my iTunes library from a desktop PC to a laptop, neither of which are Apple computers?

All the items in your iTunes library, like music, TV shows and podcasts, are stored in folders on the computer. The iTunes software itself, which is basically a big database program crossed with a media player, displays the items in your library in lists and makes it relatively easy to manage your collection.

To move your library to a new computer, you just need to move your iTunes library folder from the old machine to the new one with a copy of the iTunes software installed. You can do this in several ways depending on how you use iTunes — including transferring all the files over your network with the Home Sharing feature, copying your iTunes folder to an external hard drive or set of DVDs for transport between computers, or transferring content from the iTunes Store with an iPod, iPad or iPhone.

Apple has step-by-step, illustrated instructions for all these moving methods (and others) on its site. If you plan to get rid of the old computer, be sure to deauthorize it for use with your iTunes purchases, as explained here.

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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. M.R.I. helped pay for previous vaccination campaigns in the country and the GAVI Alliance is helping financing 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 financing for the upcoming vaccination campaign in Rwanda. It is being financed by the GAVI Alliance, not the Measles and Rubella Initiative.

Read More..

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 financing 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 financing for the upcoming vaccination campaign in Rwanda. It is being financed by the GAVI Alliance, not the Measles and Rubella Initiative.

Read More..

DealBook: Regulators Block Ryanair’s Latest Attempt to Buy Aer Lingus

BRUSSELS — The European Commission on Wednesday blocked the third attempt by Ryanair to take over Aer Lingus, saying the tie-up of the two Irish airlines would damage competition and raise prices on air routes to Ireland.

The decision was widely expected after Ryanair — the largest budget carrier in Europe — said earlier that the commission would prohibit the deal, worth about 700 million euros or $900 million.

“The Commission’s decision protects more than 11 million Irish and European passengers who travel each year to and from Dublin, Cork, Knock and Shannon,” the European Union competition commissioner, Joaquín Almunia, said in a statement before a news conference.

Proposals made by Ryanair “were simply inadequate to solve the very serious competition problems which this acquisition would have created on no less than 46 routes,” Mr. Almunia said.

Shares of Ryanair were down 6 euro cents to 5.60 euros by early afternoon in Dublin; Aer Lingus stock was up 1 cent at 1.25 euros.

On Wednesday, Aer Lingus, which had rejected Ryanair’s offers, said that it welcomed the commission decision. Ryanair, which owns about 30 percent of Aer Lingus, reiterated that it would appeal the decision to the European Court of Justice.

Ryanair accused Mr. Almunia of protecting Aer Lingus, the Irish flag carrier, against a takeover by an upstart. The company also contends that the regulator applied a double standard because he approved the takeover by British Airways and Iberia of British Midland International last year under a simplified procedure.

“We regret that this prohibition is manifestly motivated by narrow political interests rather than competition concerns and we believe that we have strong grounds for appealing and overturning this politically inspired prohibition,” said Robin Kiely, a spokesman for Ryanair.

Prolonged litigation could have wider ramifications, making it more difficult for the Irish government to sell its 25 percent stake in Aer Lingus. Ireland agreed to sell that stake under the terms of an international bailout finalized in November 2010, although that agreement did not set a deadline for the sale.

The deal is the fourth Mr. Almunia has blocked since he took over the role of the region’s antitrust chief in February 2010. Earlier this year, the regulator thwarted U.P.S.‘s attempt to buy TNT Express.

The decision on Wednesday marks the latest chapter in years of acrimony between the commission and Ryanair’s pugnacious chief executive, Michael O’Leary, who has repeatedly criticized commission officials for decisions that curtailed his ambitions.

The enmity between Mr. O’Leary and the commission developed early last decade when the two sides began a running battle over whether Ryanair received illegal state subsidies that enabled the airline to open up routes to regional airports. Those airports were often some distance from major transport hubs, but still close enough to lure passengers away from more established carriers.

Last year, the commission announced new investigations into the effect of discounts Ryanair had received at the Lübeck-Blankensee airport in Germany and the Klagenfurt regional airport in Austria.

Mr. O’Leary has sharply criticized the commission for failing to do more to save money by booking its officials on low-cost airlines like his own. Ryanair also has said its arrangements with all E.U. airports comply with the bloc’s competition rules.

The E.U. competition authority blocked Ryanair’s first bid for Aer Lingus in 2007 on the grounds that the combined airline would have had a monopoly on too many routes. Back then, Mr. O’Leary accused the commission of bowing to political pressure from the Irish government, which opposed the deal. The airline abandoned a second attempt in 2009 because of opposition from the Irish government.

On Wednesday, Ryanair accused the commission of holding it to a higher standard than other airlines seeking mergers after it had offered ‘‘historic and unprecedented’’ concessions.

Among them: allowing two competitor airlines to serve Dublin, Cork and Shannon; giving those airlines more than half of the short-distance business that currently belongs to Aer Lingus; and agreeing to transfer airport slots in Britain to allow British Airways to serve Ireland from both Gatwick and Heathrow. Ryanair also had offered Flybe, a competitor, 100 million euros in funding to make it “a commercially profitable and viable entity” in Ireland.

On Wednesday, the commission spelled out the reasons behind its decision.

It said that both Ryanair and Aer Lingus had strengthened their positions in the Irish market since the commission refused the previous deal in 2007, and that the merger would have created an ‘‘outright monopoly’’ on 28 short-distance routes serving Ireland. The commission also said that there were such high barriers to entry to the Irish market that any new competitors would face too many challenges.

The commission’s “market investigation showed that there was no prospect that any new carrier would enter the Irish market after the merger, in particular by the creation of a base at the relevant Irish airports, and challenge the new entity on a sufficient scale,” it said in a statement. “Higher prices for passengers would have been the likely outcome,”

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