Surgeon infected patients during heart procedure, Cedars-Sinai admits

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

anna.gorman@latimes.com

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Lupus forces singer Toni Braxton into LA hospital

LOS ANGELES (AP) — Singer Toni Braxton has been hospitalized in Los Angeles.

The R&B performer says in a Tweet on Friday that she's been hospitalized because of "minor health issues" related to Lupus. A spokeswoman confirmed the hospitalization but had no other details. "But no worries!," Braxton wrote to fans. "I will be out any day now."

The 45-year-old singer of "Un-break My Heart" revealed two years ago she has Lupus, a potentially deadly autoimmune disease that killed Braxton's uncle. She also suffers from a narrowing of the blood vessels in her heart.

Braxton said in a recent "20/20" interview that doctors told her the Lupus diagnosis meant her performing career would likely be diminished and the disease helped push her into a recent bankruptcy.

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Online:

http://tonibraxton.com

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His goal is to make Evite more inviting

The gig: Since being named president of Evite in 2009, Hans Woolley has been in charge of modernizing the pioneer of online social planning. The West Hollywood firm, owned by Liberty Media, has about 16 million to 18 million unique users a month who create, send and manage email invitations. But by the time Woolley was named to the top post, the then-11-year-old company had fallen behind new rivals such as Facebook Events. Last month, Evite launched Postmark, a line of high-end, customizable e-cards — the company's first new offering since its founding in 1998.

Starting in start-ups: Woolley, 34, was born and raised in Port-au-Prince, Haiti. He graduated from Cal Poly Pomona with a degree in computer science in 2000. With funding from media conglomerate IAC/InterActiveCorp, Woolley co-founded Pronto in 2006. The desktop application for comparing prices on more than 65,000 shopping websites occupied a Manhattan office that was once a nuclear bunker. But Pronto downloads stalled in the months after the launch, and it became clear to Woolley's team that customers wanted their searches to be online. So Pronto spent four months building a Web-based shopping search engine from scratch. Traffic surged from 816,000 unique monthly U.S. visitors in February 2007 to 9.1 million in February 2008. "I learned the importance of accepting that you've messed up," Woolley said. "You have to be flexible, and pivot, and try again."

The big challenge: Woolley took the Evite job in 2009 because he saw room for growth. His greatest challenge was changing the culture of a company that was profitable but stagnant; its online invitations, which lead viewers to an ad-supported Web page, had acquired a reputation for being slow, rude and ugly. ("At the very least, allow me to commend the hostess for not having sent an Evite," a New York Times advice columnist recently sniped.) The Web system had not been overhauled since its launch.

Creating a culture: The new goals for Evite are innovation, speed, willingness to try new things — and the flexibility to fail, if it comes to that, Woolley said. The Evite team hand-coded a new, more seamless Web system to replace a rickety, patched version. In new offices on Sunset Boulevard, Woolley used interior design to instill a more open culture, including more natural light, chalk murals on blackboard walls and red-brick accents for a "New York loft feel." There is a ping-pong room but no cubicles. He hosts "hackathons," during which over-caffeinated employees have 24 hours to build new features for the website.

Innovation in a time of change: The company is learning to ease its customers, who may not be as receptive to change, into new features and modifications. Customer service is available around the clock by email, instant message and phone. The constant evolution of the tech industry makes staying ahead of the curve a challenge, particularly when a company is coming from behind, Woolley said. He has tried to strike a balance between responding to shifts in the industry and making changes that Evite needs, including making the service's much-maligned ads more integrated and artful.

Hiring the right people: He looks for smart people with diverse passions and a deep knowledge of Evite's operations and goals who can work in a collaborative setting. "I don't want to always be told that I'm right," Woolley said. "A little push-back from employees makes everything stronger."

Outside the office: Woolley spends 10 to 12 hours a day at the office, but puts in even more time mentally. "When you love what you do, you always think about it." When he isn't in the office, he enjoys hiking, basketball, soccer and tennis, and spending time with his wife Michelle and 3-month-old son, Max, at their home in West Hollywood. He also volunteers in his native Haiti, where the economy largely depends on tourism and spending by nonprofit organizations. He is helping develop sustainable business plans and increase the availability and cultivation of food, including working with local fish farmers and advising on the board of several nonprofits.

laura.nelson@latimes.com

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Japan's post-quake tsunami warning lifted

TOKYO—

A strong earthquake Friday struck the same Japanese coast devastated by last year's massive quake and tsunami, generating small waves but no immediate reports of heavy damage. Several people along the northeastern coast were reportedly injured and buildings in Tokyo and elsewhere swayed for several minutes.

The earthquake had a preliminary magnitude of 7.3 and struck in the Pacific Ocean off the coast of Miyagi prefecture at 5:18 p.m. (0818 GMT), the Japan Meteorological Agency said. The epicenter was 6.2 miles beneath the seabed and 150 miles offshore.

The area was shaken by repeated, smaller aftershocks, the agency said.

After the quake, authorities issued a warning that a tsunami potentially as high as 2.2 yards could hit. Sirens whooped along the coast as people ran for higher ground.

Ishinomaki, a city in Miyagi, reported a tsunami 1 yard high and other towns reported smaller tsunamis.

About two hours after the quake struck, the tsunami warning was cancelled. The Pacific Tsunami Warning Center earlier said there was no risk of a widespread tsunami.

Aiko Hibiya, a volunteer for the recovery in Minami-Sanriku, a coastal town devastated by last year's tsunami, said she was at a friend's temporary housing when the quake struck.

“It shook for such a long time,” she said.

She said other volunteers who had been in coastal areas were evacuated to a square and a parking lot as they waited for the tsunami warning to be lifted.

Japan has barely begun to rebuild from last year's magnitude-9.0 earthquake, which triggered a tsunami that swelled to 20 meters high in some areas, ravaging dozens of coastal communities in Miyagi and elsewhere. About 19,000 people were killed and some 325,000 people remain displaced from their homes, living in barracks and other temporary quarters.

Miyagi prefectural police said there were no immediate reports of damage from Friday's quake and tsunami, although traffic was being stopped in some places to check on roads.

Public television broadcaster NHK reported that five people were injured, including a 75-year-old woman in Miyagi who fell while fleeing the tsunami. Police said they could not immediately confirm those reports.

Shortly before the earthquake struck, NHK broke off regular programming to warn that a strong quake was due to hit. Afterward, the announcer repeatedly urged all near the coast to flee to higher ground.

The Meteorological Agency has an early warning system that, using data from seismographs scattered across Japan, enables it to provide advance warning of the estimated intensity and timing of a major quake. The warning for Friday's quake was issued six minutes before it struck, according to an unnamed official from the Meteorological Agency who spoke on national television more than an hour after the quake.

The magnitude-9.0 earthquake and ensuing tsunami that slammed into northeastern Japan on March 11, 2011, killed or left missing some 19,000 people, devastating much of the coast. checks after the

Last year's earthquake and tsunami also caused meltdowns at the Fukushima Dai-Ichi nuclear plant in the worst nuclear disaster since the Chernobyl in 1986.

Immediately following Friday's quake, there were no problems at any of the nuclear plants operated by Fukushima Dai-Ichi operator Tokyo Electric Power Co., said a TEPCO spokesman, Takeo Iwamoto. Only two of Japan's 50 nuclear plants are currently operating; the rest have been shut down for maintenance and safety checks while the country re-examines the future of nuclear power there.

All Nippon Airways spokesman Takuya Taniguchi said government officials were checking on the runways at Sendai airport. The two jets that were in the air went to other airports and all seven flights scheduled to go to Sendai for the day were cancelled, he said.

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Netflix says CEO’s Facebook post triggered SEC notice

SAN FRANCISCO (Reuters) – Netflix Inc said on Thursday securities regulators warned they may bring civil action against the company and its chief executive for violating public disclosure rules with a Facebook post, in a case that raises questions about how public companies communicate on social media.

The high-profile Silicon Valley CEO, Reed Hastings, dismissed the contention and said he did not believe the Facebook post was “material” information.

Hastings wrote in the post on the company’s public Facebook page on July 3: “Netflix monthly viewing exceeded 1 billion hours for the first time ever in June.” The post was accessible to the more than 244,000 subscribers to the page.

Netflix received what is known as a Wells Notice from the U.S. Securities and Exchange Commission, which means the SEC staff will recommend the full commission pursue either a cease-and-desist action and/or a civil injunction against Netflix and Hastings over the alleged violation.

Netflix may have run afoul of the SEC’s Regulation FD, adopted in 2000, which requires public companies to make full and fair public disclosure of material non-public information.

“We think posting to over 200,000 people is very public, especially because many of my subscribers are reporters and bloggers,” Hastings said on Thursday in a letter. He also said that he did not believe the Facebook posting was “material” information.

The SEC believes that figure is material information that should have been disclosed in a press release or regulatory filing, according to Hastings’ letter.

“We remain optimistic this can be cleared up quickly through the SEC’s review process,” said Hastings in the public letter to shareholders that the online video streaming company submitted alongside a regulatory filing citing the receipt of the “Wells Notice” from the SEC.

Netflix’s stock jumped from $ 67.85 a share on July 2, the day before Hastings’ post, to $ 81.72 on July 5. On July 25 its stock fell 22 percent to $ 60.28 when the company reported second-quarter earnings fell from $ 68.2 million a year earlier to $ 6.2 million this year.

“It’s totally disingenuous to say that his statement wasn’t material when the stock went from under $ 70 a share to more than $ 80 and the only data point was that post,” said Wedbush Securities analyst Michael Pachter.

REGULATORY GREY AREAS?

But legal and securities experts say the fast-changing world of social media leaves room for regulatory grey areas.

“The evolution of social media presents the SEC with some very interesting regulatory challenges. But if they’re worried about social media, there are ways for them to address that without threatening to sue Reed Hastings. They should have a rulemaking where they can ventilate these issues,” said Joseph Grundfest, former SEC commissioner and Stanford Law School professor.

“This situation has nothing to do with the problems that Regulation FD was designed to address.”

Joseph Marrow, an attorney at the Waltham, Massachusetts law firm Morse Barnes-Brown Pendleton, said there are conflicting views on what constitutes disclosure in circumstances like this, also noting the rules are not settled in this area.

“I would not suggest companies publish material non-public information on Facebook and Twitter without discussing it before with in-house counsel. Companies are putting together social media policies,” he said.

“If Netflix doesn’t have a policy, I bet they will have one very soon,” he said, adding the issue was unlikely to be serious enough to threaten Hastings’ position as CEO of Netflix, but could result in some type of financial penalty for the company.

Netflix shares fell 1.4 percent to $ 85 in after-hours trading on Thursday.

(Reporting by Ronald Grover and Sue Zeidler in Los Angeles Additional reporting by Alexei Oreskovic and Alistair Barr in San Francisco; Editing by Dan Grebler, Phil Berlowitz and Muralikumar Anantharaman)

Social Media News Headlines – Yahoo! News

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AP Interview: Jackson, cast discuss 'The Hobbit'

WELLINGTON, New Zealand (AP) — Many fans are eagerly anticipating a return to the fictional world of Middle-earth with next week's general release of the first movie in "The Hobbit" trilogy. Director Peter Jackson and the film's stars speak to The Associated Press about making "The Hobbit: An Unexpected Journey":

— Jackson on shooting at 48 frames per second instead of the standard 24: "We've seen the arrival of iPhones and iPads and now there's a generation of kids — the worry that I have is that they seem to think it's OK to wait for the film to come out on DVD or be available for download. And I don't want kids to see 'The Hobbit' on their iPads, really. Not for the first time. So as a filmmaker, I feel the responsibility to say, 'This is the technology we have now, and it's different ... How can we raise the bar? Why do we have to stick with 24 frames? ...'"

"The world has to move on and change. And I want to get people back into the cinema. I want to play my little tiny role in encouraging that beautiful, magical, mysterious experience of going into a dark room full of strangers, and being transported into a piece of escapism."

— Martin Freeman (Bilbo Baggins) on shooting some scenes without other actors around: "I must admit I found the green screen and all that easier than I thought I would. ... I found the technical aspect of it quite doable. Some of it's difficult, but it's quite enjoyable, actually. It taps into when I used to play 'war' as a 6-year-old. And the Germans were all imaginary. Because I was playing a British person. So yeah, I was on the right side. ..."

On marrying his performance to that of Ian Holm, who played an older Bilbo Baggins in the "Lord of the Rings" trilogy: "I knew I couldn't be a slave to it. Because as truly fantastic as Ian Holm is in everything, and certainly as Bilbo, I can't just go and do an impression of Ian Holm for a year and a half. Because it's my turn. But it was very useful for me to watch and listen to stuff he did, vocal ticks or physical ticks, that I can use but not feel hamstrung by."

— Hugo Weaving (Elrond) on the differences in tone to the "Rings" trilogy: "This one feels lighter, more buoyant, but it's got quite profoundly moving sequences in it, too ... I think it's very different in many ways, and yet it's absolutely the same filmmaker, and you are inhabiting the same world."

— Elijah Wood (Frodo) on returning to Middle-earth in a cameo role: "It was a gift to come back ... what they'd constructed was such a beautiful remembrance of the characters from the original trilogy."

— Cate Blanchett (Galadriel) on the toughest part of filming: "Trying to keep my children off the set."

— Richard Armitage (Thorin Oakenshield) on being a 6-foot-2 guy playing a dwarf: "It's amazing how quickly you get used to it. And also, we spent most of the shoot much bigger than a 6-foot-2 guy. I mean, I had lifts in my shoes, I was wider, I was taller, and bigger-haired. And I actually think that was quite an interesting place to be, because I do think dwarfs have big ideas about themselves ..."

— Andy Serkis (Gollum) on taking on the additional role of second-unit director: "There were only a couple of times where there were really, really black days where I went away thinking, 'This is it. I can't do it.' But on the whole, Pete (Jackson) was so brilliant at allowing me to set stuff up and then critiquing my work ... but at least I would have my stab at it."

On the film itself: "I think it's a great story. I think it's a beautifully crafted film with great heart. A rollicking adventure, and it feels to me like this really massive feast that everyone will enjoy eating."

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John McAfee hospitalized in Guatemala, delaying his deportation

Tech pioneer John McAfee's deportation to Belize, where he is wanted for questioning in connection with a murder investigation, was delayed when he was hospitalized in Guatemala, according to the U.S. Embassy in that country.

McAfee, 67, was arrested Wednesday in Guatemala City on suspicion of entering the country illegally. He had crossed the border with a 20-year-old girlfriend he calls Sam and two writers from Vice magazine in tow.

He had been dodging Belize police for nearly a month after being named a person of interest in the shooting death of his neighbor Gregory Faull.

No warrant for McAfee's arrest has been issued in Belize, but he claimed that if he was captured by officials there he would be killed. The Guatemalan government had denied his requests for asylum, according to the Associated Press.

McAfee was moved from an immigration detention center in Guatemala to a police-run hospital Thursday afternoon after complaining that he had suffered chest pains overnight, the Associated Press said.

The U.S. Embassy in Guatemala confirmed that McAfee was in the hospital and that embassy officials had provided "standard consular services" to him, but spokesman John Hishmeh said he could not comment further.

"We're following it just as much as you all," Hishmeh said.

McAfee's lawyers said they planned to appeal the denial of asylum to Guatemala's constitutional court. The process could give the American expatriate another day or two in the country, and the court would have to issue a decision within 48 hours, the Associated Press said.

Belize police had expected McAfee to be flown back to that nation Thursday morning, police spokesman Raphael Martinez said. He said the police have been told there was a delay.

"It's just a wait-and-see now," Martinez said. "As soon as he is released, he will be escorted by [Guatemalan] authorities and he will be received at whatever border is determined. "He will then be taken into police custody for detention and questioning."

Throughout this saga, McAfee has been blogging. In a post Thursday titled "Urgent from John," he implored supporters to "please email the president of Guatemala and beg him to allow the court system to proceed, to determine my status in Guatemala."

At a hotel in Guatemala City on Wednesday night, just before authorities whisked him off in a black pickup truck, McAfee turned to a video camera, saying: "Guatemalan jails have beds, dude. And food. That's pretty awesome." The video was released by Vice magazine.

In a post from jail, McAfee said he had been provided "excellent coffee."

"I asked for a computer and one magically appeared," McAfee blogged from behind bars. He said his Guatemalan cell was "vastly superior" to Belize jails.

McAfee was arrested by Belize police in April and charged with weapons possession and unlicensed drug manufacturing. The charges were later dropped.

The ongoing saga has included McAfee's repeated claims that he is innocent and that Belize officials were persecuting him. Documenting the bizarre journey in a blog about life on the run, McAfee detailed a series of elaborate disguises he claimed he used to hide in plain sight, including tamale seller and Speedo-clad German tourist.

It's unclear whether the self-professed prankster was telling the truth, but the blog and a series of videos released by the two Vice writers following him has resulted in a media frenzy.

The software mogul made his fortune when his antivirus company McAfee Associates went public in 1992.

He sold his stock within two years for about $100 million. He subsequently lost millions on real estate investments, bad business ventures and bonds linked to Lehman Bros., he told the New York Times in 2009. At that time, his fortune had dropped to about $4 million.

chrisine.maiduc@latimes.com

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Baca shifts course on compliance with deportation program

Los Angeles County Sheriff Lee Baca has reversed his support for a controversial deportation program, announcing Wednesday that he will not comply with federal requests to detain suspected illegal immigrants arrested in low-level crimes.

The sheriff's dramatic turnaround came a day after California Atty. Gen. Kamala Harris issued a legal directive advising that compliance with the requests is discretionary, not mandatory.

Until then, Baca had insisted that he would honor the requests from U.S. Immigration and Customs Enforcement to hold some defendants for up to 48 hours. He was an outspoken opponent of the Trust Act, which would have required California law enforcement officials to disregard the requests in many cases, declaring that he would defy the measure if it passed.

Baca has also been sued by the American Civil Liberties Union for allegedly denying bail to immigration detainees.

Now, he appears ready to do more or less what was proposed in the Trust Act, which was vetoed by Gov. Jerry Brown in September.

The change of heart from Baca, a Republican in a heavily Democratic county, comes as GOP leaders are warming to immigration reform in an effort to counteract dismal support from Latino voters. Last month, Baca closed the 1,100-bed Mira Loma immigration detention center, which earned his agency up to $154 a day for each detainee, after contract negotiations with ICE broke down.

None of those considerations were at play, a Baca spokesman said. The sheriff's reversal was prompted solely by Harris' opinion, which contradicted advice from Los Angeles County attorneys that the requests were mandatory, said the spokesman, Steve Whitmore.

Baca joins Los Angeles Police Chief Charlie Beck, who announced a similar policy in October. San Francisco and Santa Clara counties also decline to honor some types of ICE holds.

The change may not take effect until early next year. Baca's staff must first flesh out the details of the new policy, which would apply only to those arrested in misdemeanors who do not have significant criminal records. The department would still honor federal detention requests for those accused of serious or violent crimes.

Under the federal Secure Communities program, all arrestees' fingerprints are sent to immigration officials, who flag suspected illegal immigrants and request that they be held for up to 48 hours until transfer to federal custody.

Secure Communities has come under fire for ensnaring minor offenders when its stated purpose is to deport dangerous criminals and repeat immigration violators. According to federal statistics, fewer than half of those deported in Los Angeles County since the program's inception in 2008 have committed felonies or multiple misdemeanors. Critics say immigrants have become fearful of cooperating with police.

"The last thing we want is victims to be frightened to come forward," Whitmore said.

ICE officials said Baca's new policy is in line with federal priorities and will affect only a "very small number" of cases.

"The identification and removal of criminal offenders and other public safety threats is U.S. Immigration and Customs Enforcement's highest enforcement priority," the agency said in a statement.

Immigrant rights advocates called Baca's announcement a long overdue breakthrough.

"This will send a very strong message nationwide that in ... the most multicultural city in the nation, the sheriff is there to protect and to serve, not to deport," said Jorge-Mario Cabrera, communications director for the Coalition for Humane Immigrant Rights of Los Angeles.

Supporters of the Trust Act, which was reintroduced in modified form by Assemblyman Tom Ammiano (D-San Francisco) earlier this week, said it is still necessary because detention policies should not vary by jurisdiction.

"It's imperative that California have a uniform statewide policy. It's essential that people not receive different treatment under the law as they're driving up and down the 5," said Chris Newman, legal director of the National Day Laborer Organizing Network.

Baca has not taken a position on the new Trust Act, which is likely to evolve during the legislative process, Whitmore said.

cindy.chang@latimes.com

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Individuality takes center stage at Grammys

Fun. helped break up the sound of dance and electronic music on Top 40 radio with its edgy pop-rock grooves. Frank Ocean made a bold statement in R&B — with an announcement about his sexuality and with his critically revered, multi-genre album, "channel ORANGE." And Mumford & Sons continued to bring its folk-rock swag and style to the Billboard charts with its sophomore album.

They all were rewarded Wednesday when The Recording Academy announced the nominees for the 2013 Grammy Awards.

Those acts, who scored the most nominations with six each, were joined by typical Grammy contenders like Jay-Z and Kanye West, who also got six nominations. The Black Keys' drummer, Dan Auerbach, is also up for six awards, thanks to his nomination for producer of the year. His band earned five nods, along with R&B singer Miguel and jazz pianist Chick Corea.

"It feels like alternative music is back," said fun. guitarist Jack Antonoff. His band's gold-selling "Some Nights" is up for album of the year, competing with Black Keys' "El Camino," Mumford & Sons' "Babel," Jack White's "Blunderbuss" and "channel ORANGE," the major label debut from Ocean.

Fun. is nominated in all of the major categories, including best new artist, and record and song of the year for its breakthrough anthem "We Are Young."

Ocean, whose mother attended the nominations special, scored nods in three of the top four categories. His song "Thinkin Bout You" — which he originally wrote for another singer — will compete for record of the year with Black Keys' "Lonely Boy" and four No. 1 hits: Taylor Swift's "We Are Never Ever Getting Back Together," ''Somebody I Used to Know" by Gotye and Kimbra, Kelly Clarkson's "Stronger (What Doesn't Kill You)" and "We Are Young" by fun.

Song of the year, too, features some No. 1 hits, including fun. and Clarkson's jams, as well as Carly Rae Jepsen's viral smash "Call Me Maybe." But then there's Ed Sheeran's "The A Team," a slow groove about a homeless prostitute, and Miguel's "Adorn," the R&B singer-songwriter's crossover hit.

"It's like one of those songs that wrote itself and I was the vessel," the 26-year-old said in an phone interview from New York City late Wednesday, where he performed with Trey Songz and Elle Varner.

While Miguel's excited to compete for song of the year, he's more thrilled about his sophomore album's nomination for best urban contemporary album, a new category that recognizes R&B albums with edge and multiple sounds.

"That's a huge complement to say that your entire body of work was the best of the year," he said of "Kaleidoscope Dream." ''That's the one that means the most to me. I'm really hoping maybe, just maybe."

Miguel, along with Gotye, Alabama Shakes and the Lumineers, is part of the pack of nominees who have showcased individuality and have marched to the beat of their own drum in today's music industry.

Though nominated albums by The Black Keys and Mumford & Sons are platinum-sellers, their songs are not regularly heard on Top 40 radio. Electronic and dance music, which has dominated radio airplay for a few years, were left out of the top awards this year. Also, One Direction — the boy band that released two top-selling albums this years and sold-out many arenas — was snubbed for best new artist.

Lionel Richie has one of the year's top-selling albums with his country collaboration collection, "Tuskegee," but he didn't earn any nominations. And Nicki Minaj, who released a gold-selling album this year and had a hit with "Starships," wasn't nominated for a single award.

Jay-Z and West dominated the rap categories, a familiar refrain at the Grammys. Nas scored four nominations, including best rap album for "Life Is Good." Jeff Bhasker, the producer behind fun.'s breakthrough album, also scored four nods.

Swift, who released her latest album, "Red," after the Grammy eligibility date, still scored three nominations, including two for "Safe & Sound" with The Civil Wars. Country acts were mainly left out of the major categories this year, though the genre usually has success at the Grammys. Aside from Swift's pop song competing for record of the year, there is 21-year-old Hunter Hayes, who is up for best new artist against fun., Ocean, Alabama Shakes and the Lumineers.

"I'm so proud to be, as you say, representing country music in the new artist category," said Hayes, who is also nominated for best country album and country solo performance. "I don't even feel worthy of saying that, but it's so cool for me to be able to say that."

Swift hosted the CBS special with LL Cool J and it featured performances by The Who and Maroon 5, who received multiple nominations.

The five-year-old nominations show spent its first year outside Los Angeles, making its debut in Nashville, Tenn., at the Bridgestone Arena. It marked the largest venue the show has been held in.

The 55th annual Grammy Awards take place Feb. 10 in Los Angeles.

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Online:

http://www.grammys.com

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AP Music Writer Chris Talbott and AP Writer Caitlin R. King in Nashville contributed to this report.

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Antismoking Outlays Drop Despite Tobacco Revenue

Faced with tight budgets, states have spent less on tobacco prevention over the past two years than in any period since the national tobacco settlement in 1998, despite record high revenues from the settlement and tobacco taxes, according to a report to be released on Thursday.

Paul J. Richards/Agence France-Presse — Getty Images

State antismoking spending is the lowest since the 1998 national tobacco settlement.

States are on track to collect a record $25.7 billion in tobacco taxes and settlement money in the current fiscal year, but they are set to spend less than 2 percent of that on prevention, according to the report, by the Campaign for Tobacco-Free Kids, which compiles the revenue data annually. The figures come from state appropriations for the fiscal year ending in June.

The settlement awarded states an estimated $246 billion over its first 25 years. It gave states complete discretion over the money, and many use it for programs unrelated to tobacco or to plug budget holes. Public health experts say it lacks a mechanism for ensuring that some portion of the money is set aside for tobacco prevention and cessation programs.

“There weren’t even gums, let alone teeth,” Timothy McAfee, the director of the Office on Smoking and Health at the Centers for Disease Control and Prevention, said, referring to the allocation of funds for tobacco prevention and cessation in the terms of the settlement.

Spending on tobacco prevention peaked in 2002 at $749 million, 63 percent above the level this year. After six years of declines, spending ticked up again in 2008, only to fall by 36 percent during the recession, the report said.

Tobacco use is the No. 1 cause of preventable death in the United States, killing more than 400,000 Americans every year, according to the C.D.C.

The report did not count federal money for smoking prevention, which Vince Willmore, the vice president for communications at the Campaign for Tobacco-Free Kids, estimated to be about $522 million for the past four fiscal years. The sum — about $130 million a year — was not enough to bring spending back to earlier levels.

The $500 million a year that states spend on tobacco prevention is a tiny fraction of the $8 billion a year that tobacco companies spend to market their products, according to a Federal Trade Commission report in September.

Nationally, 19 percent of adults smoke, down from over 40 percent in 1965. But rates remain high for less-educated Americans. Twenty-seven percent of Americans with only a high school diploma smoke, compared with just 8 percent of those with a college degree or higher, according to C.D.C. data from 2010. The highest rate — 34 percent — was among black men who did not graduate from high school.

“Smoking used to be the rich man’s habit,” said Danny McGoldrick, the vice president for research at the Campaign for Tobacco-Free Kids, “and now it’s decidedly a poor person’s behavior.”

Aggressive antismoking programs are the main tools that cities and states have to reach the demographic groups in which smoking rates are the highest, making money to finance them even more critical, Mr. McGoldrick said.

The decline in spending comes amid growing certainty among public health officials that antismoking programs, like help lines and counseling, actually work. California went from having a smoking rate above the national average 20 years ago to having the second-lowest rate in the country after modest but consistent spending on programs that help people quit and prevent children from starting, Dr. McAfee said.

An analysis by Washington State, cited in the report, found that it saved $5 in tobacco-related hospitalization costs for every $1 spent during the first 10 years of its program.

Budget cuts have eviscerated some of the most effective tobacco prevention programs, the report said. This year, state financing for North Carolina’s program has been eliminated. Washington State’s program has been cut by about 90 percent in recent years, and for the third year in a row, Ohio has not allocated any state money for what was once a successful program, the report said.

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