Drug overdose deaths up for 11th consecutive year

CHICAGO (AP) — Drug overdose deaths rose for the 11th straight year, federal data show, and most of them were accidents involving addictive painkillers despite growing attention to risks from these medicines.

"The big picture is that this is a big problem that has gotten much worse quickly," said Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention, which gathered and analyzed the data.

In 2010, the CDC reported, there were 38,329 drug overdose deaths nationwide. Medicines, mostly prescription drugs, were involved in nearly 60 percent of overdose deaths that year, overshadowing deaths from illicit narcotics.

The report appears in Tuesday's Journal of the American Medical Association.

It details which drugs were at play in most of the fatalities. As in previous recent years, opioid drugs — which include OxyContin and Vicodin — were the biggest problem, contributing to 3 out of 4 medication overdose deaths.

Frieden said many doctors and patients don't realize how addictive these drugs can be, and that they're too often prescribed for pain that can be managed with less risky drugs.

They're useful for cancer, "but if you've got terrible back pain or terrible migraines," using these addictive drugs can be dangerous, he said.

Medication-related deaths accounted for 22,134 of the drug overdose deaths in 2010.

Anti-anxiety drugs including Valium were among common causes of medication-related deaths, involved in almost 30 percent of them. Among the medication-related deaths, 17 percent were suicides.

The report's data came from death certificates, which aren't always clear on whether a death was a suicide or a tragic attempt at getting high. But it does seem like most serious painkiller overdoses were accidental, said Dr. Rich Zane, chair of emergency medicine at the University of Colorado School of Medicine.

The study's findings are no surprise, he added. "The results are consistent with what we experience" in ERs, he said, adding that the statistics no doubt have gotten worse since 2010.

Some experts believe these deaths will level off. "Right now, there's a general belief that because these are pharmaceutical drugs, they're safer than street drugs like heroin," said Don Des Jarlais, director of the chemical dependency institute at New York City's Beth Israel Medical Center.

"But at some point, people using these drugs are going to become more aware of the dangers," he said.

Frieden said the data show a need for more prescription drug monitoring programs at the state level, and more laws shutting down "pill mills" — doctor offices and pharmacies that over-prescribe addictive medicines.

Last month, a federal panel of drug safety specialists recommended that Vicodin and dozens of other medicines be subjected to the same restrictions as other narcotic drugs like oxycodone and morphine. Meanwhile, more and more hospitals have been establishing tougher restrictions on painkiller prescriptions and refills.

One example: The University of Colorado Hospital in Aurora is considering a rule that would ban emergency doctors from prescribing more medicine for patients who say they lost their pain meds, Zane said.

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Stobbe reported from Atlanta.

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Online:

JAMA: http://www.jama.ama-assn.org

CDC: http://www.cdc.gov

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com

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L.A. Regional Food Bank is thriving at 40

David Navarro drove south from the Los Angeles Boys & Girls Club in Lincoln Heights on a recent sun-drenched day, headed to his weekly destination in a dust-gray Ford pickup.

As usual, he couldn't simply cruise into the crowded parking lot of the Los Angeles Regional Food Bank on 41st Street near Alameda. He was stopped by an employee who works miracles in the lot, arranging rigs in jigsaw patterns as drivers wait their turn to make food pickups.

The Salvation Army was already there, along with the Good News Central Church and the Episcopal Diocese of Los Angeles. Hollywood West Tenant Action Council was pulling in behind Navarro.

"I'll go in now and see what they have today," said Navarro, who told me that back at the Boys & Girls Club, people would be lining up for whatever he brought back.

Once inside the sprawling warehouse, Navarro moved as if he was in a race, trying to get his hands on as many perishables as he could before other drivers claimed them.

"They like any nice vegetables like this," he said, hoisting several crates of firm, stout zucchini onto his pushcart.

Over the course of an hour, Navarro worked up a sweat gathering boxes of bread and mounds of bananas, apples, lettuce and tomatoes. All of this tipped the scales at 556 pounds, and Navarro pushed the teetering cargo outside and loaded it onto his truck.

I thought he was done, but no.

"Now I go back," he said, "and fill the cart again."

In a region of staggering abundance, there is still desperate need. In a culture that wastes tons of food, there is still considerable hunger. And no charitable organization does more to balance the scales than the food bank, which began exactly 40 years ago, on Feb. 20, 1973.

It all began with a Pasadena cook named Tony Collier, who hated seeing perfectly good food getting thrown out at the recovery center where he worked. He began redistributing it to those in need, and the operation just kept growing. Today, it distributes some 200,000 pounds of food daily. A staff of 106 is backed up by 32,000 volunteers who pitch in at least one day a year, sorting food that includes non-perishables such as canned corn, as well as foods such as navel oranges and frozen chicken that have to be turned around quickly, before they go bad.

Each morning, a convoy of food bank trucks retrieves surplus food from farms, supermarket chains and other donors and brings it back to the warehouse, where it is picked up by about 650 agencies. Another 600 groups are on a waiting list to be included in the daily giveaway.

"Four hundred thousand of the 1 million people we serve each year are kids," said Michael Flood, president and chief executive of the food bank.

The challenge of the food bank has been to hook up with farmers whose harvest is sometimes bigger than the demand, or with supermarkets that have stocked more perishable food than they can sell. Ralphs and Vons are among the biggest donors to the food bank.

Still, billions of dollars worth of food ends up in dumpsters every year in the U.S., Flood said. He encourages citizens to be more conscious of waste and get involved in food donations or volunteering at a local pantry or the food bank (for more information, http://www.lafoodbank.org).

If you do happen to wander into the food bank, watch your step or you could get run over by a forklift. They zip around like bumper cars, honking horns as they wheel hulking loads toward the exits. And one of the employees who supervises the flow from delivery trucks to conveyor belts to palates is Valerie Rodriguez.

Rodriguez, like the food she processes, didn't get where she was supposed to go on the first try. The food bank is her second chance. As a teen growing up in South El Monte, she got it all wrong, becoming a drug addict, getting married way too young, losing kids she couldn't care for, and ending up in rehab at several skid row agencies, including the L.A. Mission and Union Rescue Mission.

But then she began straightening herself out, and as part of a welfare-to-work program, Rodriguez was assigned to volunteer at the food bank, not knowing anything about it. That's when she saw the trucks roll in from the missions and made the connection:

The food she'd eaten at the missions came from the food bank. She'd gone from recipient to supplier. And the food bank liked her so much that she was offered a temp job.

"It was after about a year of volunteering here," Rodriguez said.

Later, she was promoted to full time, and she's since remarried and regained custody of her children.

"It's still a struggle," she said. "But my hope and dream and desire is to save and buy a home. I want to have a home for my kids to grow up in."

While Rodriguez supervised volunteers, David Navarro finished loading his pickup and drove north from the food bank with more than 1,000 pounds of food. That evening, volunteers bagged the goods as men and women inched closer to the door of the Boys & Girls Club, eagerly awaiting their care packages.

Jo Ellen Kitchen, a volunteer at the club since the 1980s, told me she'd heard that the country has started to see an economic recovery.

"But it never really seems to get here."

It was Valentine's Day, and 20 people were in line. As dusk drew in around them, Alvina Rodriguez and Teresa Olmeda talked about the challenges of temporary work, low pay and hungry children. On this night, they and the others would go home with dinner because a simple act of compassion 40 years ago keeps rippling across the city.

steve.lopez@latimes.com

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Nestlé Pulls 2 Products in Horse Meat Scandal

LONDON — First centered on Britain and Ireland, the scandal over beef products adulterated with horse meat escalated across continental Europe on Tuesday after Nestlé, one of the world’s best-known food companies, said it was removing pasta meals from store shelves in Italy and Spain.

Before the announcement late Monday, the crisis had already spread, with perhaps a dozen countries caught up in product recalls, but the involvement of Nestlé marks another significant act in a fast-moving drama which is forcing Europeans to question the contents of their meals.

Nestlé, which is based in Switzerland, said it had increased testing after the discoveries of horse meat in British foods and found “traces” of horse DNA in two products made with beef supplied by a German company named as H.J. Schypke.

The levels were above the 1 percent threshold used by the British Food Standards Agency  as an indicator of adulteration in testing being conducted by Britain’s food industry and therefore the products would be withdrawn, Nestlé said in a statement.

“There is no food safety issue, but the mislabeling of products means they fail to meet the very high standards consumers expect from us,” Nestlé added.

Two chilled pasta products, Buitoni Beef Ravioli and Beef Tortellini are being taken off supermarket shelves in Italy and Spain immediately. Meanwhile, Lasagnes à la Bolognaise Gourmandes, a frozen meat product made for the catering trade in France, will also be withdrawn and replaced with product made from 100 percent beef.

Nestlé knows only too well the importance of its brand image, having once been the object of a boycott after being embroiled in a controversy over the marketing of baby milk in developing countries.

Although the current horse meat crisis has been seen mainly as an issue of fraud and mislabeling it emerged last week that a powerful equine painkiller, phenylbutazone – or bute – may have entered the food chain.

Eight horses slaughtered for food in Britain tested positive for the drug. Six of those carcasses had already been exported to France for use in human food.

In Britain, food manufacturers have embarked on a huge program of tests of food to try to stem a crisis of confidence in products originating in a long and bewilderingly complex supply  chain.

Last Friday, the British Food Standards Agency released the results of 2,501 tests conducted on beef products by the British food industry, of which 29 contained more than 1 percent horse meat.

But, just as that information was released, it emerged separately that food intended for school meals had also contained horse meat and a blame game has erupted between politicians and supermarket bosses over where responsibility ultimately lies.

The European Union has also announced an increase in food testing though there are growing calls for more regulation at a European level. Though tough traceability rules for fresh beef products were introduced after the crisis over mad cow disease more than a decade ago, a similar regime is not in place for processed food.

“What has been discovered in recent days is large-scale fraud,”  said Richard Seeber, the coordinator for the center-right group  in the Environment, Public Health and Food Safety Committee of the European Parliament. “This is a clear breach of current European food labeling rules. This is why the first thing we need is more controls and better enforcement of the existing rules.”

Glenis Willmott, the leader of the British Labour Party’s members of the European Parliament, said that the response of the E.U.’s executive, the European Commission, had been totally inadequate.

“The horse meat scandal should result in a Europe-wide comprehensive legislation on ‘origin labeling’ for all meat in processed foods, and a better E.U. enforcement procedure,” Ms. Willmott said.

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Mindy McCready: Under Police Scrutiny at Time of Suicide?

By Steve Helling and Mike Fleeman

02/18/2013 at 06:00 PM EST

Mindy McCready and David Wilson

Courtesy Mindy McCready

When Mindy McCready talked to police in recent weeks, her account of how her boyfriend came to be found with a fatal gunshot wound to the head concerned police, a law enforcement source tells PEOPLE.

"At first, she said she hadn't heard the gunshot because the TV was too loud. Then she said she had heard the gunshot," the source says. "So obviously there were a lot of questions, and the Sheriff was asking for clarification."

But before investigators could re-interview her, the long-troubled country singer also would die under eerily similar circumstances, her body discovered at the same Heber Springs, Ark., house just feet away from where David Wilson died.

McCready's death was blamed on what "appears to be a single self-inflicted gunshot wound," the Cleburne County Sheriff's Office said in a statement.

This differed from how the sheriff characterized Wilson's case. His cause and manner of death still have not been established by the coroner. It was McCready's publicist, and not a law enforcement official, who announced that Wilson had died of a self-inflicted gunshot wound.

After Wilson's death, McCready, 37, spoke to investigators three times, but they didn't feel as if they were through with her.

"At no point did [police] tell her she was a suspect, and she wasn't officially one," says the source. "But she knew that some of her answers didn't stand up to questioning. She was very cooperative, but she just wasn't making a lot of sense."

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Hip implants a bit more likely to fail in women

CHICAGO (AP) — Hip replacements are slightly more likely to fail in women than in men, according to one of the largest studies of its kind in U.S. patients. The risk of the implants failing is low, but women were 29 percent more likely than men to need a repeat surgery within the first three years.

The message for women considering hip replacement surgery remains unclear. It's not known which models of hip implants perform best in women, even though women make up the majority of the more than 400,000 Americans who have full or partial hip replacements each year to ease the pain and loss of mobility caused by arthritis or injuries.

"This is the first step in what has to be a much longer-term research strategy to figure out why women have worse experiences," said Diana Zuckerman, president of the nonprofit National Research Center for Women & Families. "Research in this area could save billions of dollars" and prevent patients from experiencing the pain and inconvenience of surgeries to fix hip implants that go wrong.

Researchers looked at more than 35,000 surgeries at 46 hospitals in the Kaiser Permanente health system. The research, published Monday in JAMA Internal Medicine, was funded by the U.S. Food and Drug Administration.

After an average of three years, 2.3 percent of the women and 1.9 percent of the men had undergone revision surgery to fix a problem with the original hip replacement. Problems included instability, infection, broken bones and loosening.

"There is an increased risk of failure in women compared to men," said lead author Maria Inacio, an epidemiologist at Southern California Permanente Medical Group in San Diego. "This is still a very small number of failures."

Women tend to have smaller joints and bones than men, and so they tend to need smaller artificial hips. Devices with smaller femoral heads — the ball-shaped part of the ball-and-socket joint in an artificial hip — are more likely to dislocate and require a surgical repair.

That explained some, but not all, of the difference between women and men in the study. It's not clear what else may have contributed to the gap. Co-author Dr. Monti Khatod, an orthopedic surgeon in Los Angeles, speculated that one factor may be a greater loss of bone density in women.

The failure of metal-on-metal hips was almost twice as high for women than in men. The once-popular models were promoted by manufacturers as being more durable than standard plastic or ceramic joints, but several high-profile recalls have led to a decrease in their use in recent years.

"Don't be fooled by hype about a new hip product," said Zuckerman, who wrote an accompanying commentary in the medical journal. "I would not choose the latest, greatest hip implant if I were a woman patient. ... At least if it's been for sale for a few years, there's more evidence for how well it's working."

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Online:

Journal: http://www.jamainternalmed.com

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UC Irvine professor stops teaching online course in dispute

A UC Irvine professor has stopped teaching midway through a massive online course in microeconomics offered through the Coursera organization, saying he had disagreements on how to conduct the free class for thousands of students around the world.

The action by Richard A. McKenzie, an emeritus professor in the UC Irvine business school, highlights the uncertainties faculty face in adapting traditional face-to-face classes to the emerging universe of massive open online courses, known as MOOCs.

In his statements posted to the class website over the weekend, McKenzie appeared to be frustrated over his attempts to get the students to obtain and read as much of the textbook as possible.

"I will not cave on my standards. If I did, any statement of accomplishment will not be worth the digits they are printed on," he wrote.

The course, midway through its 10-week schedule, will continue since its lectures are already videotaped. But in chat room postings, students said they were confused over whether to stick with the non-credit Microeconomics for Managers course, one of six the UC Irvine online extension has in operation through the Coursera group.

McKenzie responded to an email inquiry Monday that the matter has been "a drain" on him and involves serious issues. In his message to the class, he wrote: "Because of disagreements over how best to conduct this course, I've agreed to disengage from it, with regret."

Gary Matkin, UC Irvine's dean of Continuing Education, Distance Learning and Summer Session, said in a statement that McKenzie is "not accustomed [as few are] in teaching university-level material to an open, large and quite diverse audience, including those who were not seriously committed to achieving the learning objectives of the course or who decided not to or could not gain access to supplemental learning materials."

Future lessons and assignments, as developed by McKenzie, will continue to be presented, Matkin said.

McKenzie, who retired from his regular faculty position in 2011, said that students "will not be left hanging" and that all assignments and discussion problems are ready to be posted as scheduled.

Under the Coursera model, much of the grading is automatic or performed by fellow students. Professors videotape lectures in advance and often comment in general on message boards without answering questions. Although enrollment is free, Coursera charges students $30 to $99 for a completion certificate.

larry.gordon@latimes.com

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India Ink: Thomas Friedman Answers Your Questions

New York Times op-ed columnist and author Thomas L. Friedman recently wrapped up a week-long trip to India, where he met with business executives, government ministers and other officials, entrepreneurs and development groups. Even as India’s economy has slowed considerably, Mr. Friedman remains a big believer in what he calls the “miracle of India.’’

Earlier we asked India Ink readers for their questions for Mr. Friedman about India’s changing role in the world economy. Here are his answers to a select few:

By far the most popular reader question was: Is the world still flat?

I wrote the “World Is Flat” in 2004.

I have to confess, I now realize the book was wrong. The world is so much flatter than I thought.

When I wrote “The World Is Flat,” Facebook didn’t exist, Twitter was still a sound, the cloud was still in the sky, 4G was a parking place, LinkedIn was a prison, applications were what you sent to college, Big Data was a rap star and Skype was a typo. All of that came after I wrote “The World Is Flat.”

And so what it tells you is all those trends have actually taken us from a connected world to what we’re now in, which is a hyper-connected world. It’s a difference of degree. It’s a difference in kind.

I believe it is changing every job, every industry and every market.

The trends I identified have only intensified in every direction, enabling individuals to complete, connect and collaborate so much faster, farther cheaper and deeper.

Venkat from N. J. said: The globalization of business is basically finding a way to justify exploitation of labor, resulting in an enormous concentration of wealth in fewer hands. The majority of labor working for low-end manufacturing work in pathetic conditions, while workers in the U.S. face layoffs, particularly the elderly. Who is paying for this social cost, and should globalization be regulated, somehow?

The first thing you need to understand about globalization is that it is everything and its opposite. So it is take it with one hand and give it with another hand.

On the one hand it is automating more things faster. On the other hand I met with young Indian entrepreneurs who are leveraging the cloud, open-source tools and very small amounts of capital, and are able to invent companies that can complete globally like never before.

So, who is the exploiter and who is the exploitee in this system? If horses could vote, there never would have been cars.

What we’re getting here is rapid change. The question the reader raises, though, is a very important one, because something has changed which we have not figured out how to adjust to. This is a point that Erik Brynjolfsson and Andrew McAfee make in their book “The Race Against the Machine,” which I wrote my last column about.

The point they make is that over the last 200 hundred years, three things grew together: productivity, median income and employment. Whether you were an Indian or an American, productivity grew, median income grew and employment grew, and inequality tended to shrink.

That’s a good thing.

Once we hit the flattening of the world, and now the hyper-flattening of the world, those three things are splitting apart. And that’s what the reader is, rightly, concerned about.

I’m concerned about it too.

So what happens when the world gets this hyper-connected? Well, first of all, the returns to education grow enormously. To be able to use these new technologies properly, you need to be educated.

In America today, unemployment for people with four-year college degrees is 3.6 percent, basically nothing. Unemployment for someone who dropped out of high school is now infinity. I exaggerate but you get the point.
It’s called skills-bias polarization.

If you want to have a factory job in America today, doing high-end manufacturing, you need to know algebra and calculus. It’s not just a repetitive motion any more, you need to program the robot.

Second thing is the returns to capital are so much more than the returns to labor. If I have a lot of capital and I can buy a lot of machines, the returns are so much more than if I hire a lot of people.

The third thing causing this phenomenon is in a hyper-connected world, the returns to superstar talent are just staggering. If you are, say, Madonna, well, every Indian kid who has an iPad can now download your songs. That wasn’t the case 10 years ago. You couldn’t reach this market.

So all three of these things are creating much bigger income gaps, much lower employment for people with lower skills, yet much higher productivity and great wealth for owners of capital.

That’s the big change.

The challenge for every developed and developing society is how do you maintain a middle class in such a world. That’s what I’m thinking about for the topic of my next book.

D.C. Agrawal from Princeton, New Jersey, asks: “How would you rate India on governance and public institutional structures compared to other democratic countries?’’

Let’s look at the countries I visited in the last six months: India, China and Egypt. India in my mind has relatively weak governance in terms of delivering services, but a very strong civil society — very vibrant active, social movements, whether it’s Anna Hazare or reaction to the rape case.

China has a very muscular government, in terms of delivering infrastructure and education, but a very weak civil society, although it is getting stronger. And Egypt has a very flabby, overweight government and a very weak civil society. That’s why when the government collapsed — you got the Muslim Brotherhood taking advantage of the revolution, not strong-rooted democratic movements.

I think India’s governance will improve. The government here is not utterly ineffective. It does do some things very well, but clearly it has weaknesses around policing, infrastructure building and providing consistent education. It holds elections very well, it does the census very well.

Let’s remember it is still a billion people. I don’t want to be too hard on it, but people want more, they want better.

India today has, because of hyper-connection of the world, and diffusion of technology, experienced the pushing down to lower and lower income levels more technology empowerment and education. That’s why India today seems like it has a 300 million-person middle class and a 300 million-person virtual middle class.

These are people who now have available to them, whether it’s a cell phone or other technologies, things that you would normally have to have a middle-class income to have. And they have access to certain learning opportunities.

So they’re actually in their minds middle class, thinking like middle class and putting middle-class demands on the government. I think the young woman who was raped in this terrible tragedy was a member of that virtual middle class – the tools she had, what she was doing, expectations of the government.

That’s a big change. It’s putting more pressure on the government. And the government will eventually respond because it has to.

Jason Richardson-White from Bethlehem, Georgia, said: Studies indicate that equal treatment between the sexes is important to slowing the birth rate. I don’t see that globalization is contributing significantly to that end in India. An argument can be made that globalization has made it possible for the people who are most likely to start egalitarian families to leave India for the West?

First let me make a general response:

I did not invent globalization. I promise you. I just wrote about it.

I wrote about the upsides and the downsides. I didn’t start it and I can’t stop it. I have my own problems with it.

Having said that, I profile in my column an N.G.O. that is providing cell phone-based SMS messaging to alert women about their menstrual cycle, on when exactly they are fertile and when they should not be having unprotected sex, if they want to do family planning.

This is totally based on cloud computing. Without globalization it doesn’t exist. It allows a woman in a remote place to do this. There’s privacy to it. You do one interview on the phone to set it up.

People need to keep in mind, globalization giveth and globalization taketh. The biggest revolution about to hit India, in the next two years, is distance learning. Any woman from any village who knows English will be able to take courses from Harvard, Stanford and M.I.T.

Do you know what this means for women in conservative families, who don’t want them to go to school? It’s going to be a revolution. I’m very excited about the kind of educational empowerment that is going to be coming the way of Indian women that will give them greater earning power, greater control over their own bodies and greater ability to negotiate with their sexual partners.

Anand Kumar from Chicago, Illinois, asks: Tom, China may not be loved in the West, but is respected and admired for its accomplishments. How do you think India ranks on the loved vs. respected and admired spectrum?

What an interesting question.

I think India’s brand remains very strong around the world. I appreciate India’s democracy.

What if 1 billion 50 million Indians were living like Syria today? The whole world would be different. Literally, the whole world would feel different today.

So to me India is a miracle. One billion fifty million people holding free and fair elections, just about every day, in the country. We now take it for granted because it has gone on for so long. I think it’s amazing.

I can’t generalize about the whole world, but I’m still enormously optimistic about what I see here.

Zaigum Kashmiri from Clarence, New York, asks: Tom, I know you are an Indophile and write great things about India. But, honestly, how can anybody be hopeful about India’s economic and social progress, keeping in view the lawlessness, dysfunctional government, corrupt police, a huge incompetent and corrupt bureaucracy and poverty?

I think the important thing to always remember when you look at India is not the snapshot, but the slope of the change.

If you take a snapshot, those will be some of the things you see.

But if you came with me to my meeting with NASSCOM [National Association of Software and Services Companies, India's technology industry association] this week, you’d see eight young entrepreneurs leveraging the flat world to start global businesses that not only contribute to the world but that make Indians unpoor.

They’re amazing.

So you always have to keep these things in balance. What excites me most about India today is the trend line. Every time I come here, I see more and more Indians starting things, collaborating on things and inventing things to make Indians unpoor. And to me that’s the most important thing you have to keep in mind.

By the way, everything the reader cited there, you could say that about America. We have all that, plus guns.

No country is a paradise. Everyone is a work in progress. You have to think about where the thrust is.

I’d like to think that with all our problems in America, we’re still tilted in a positive direction. I’d like to say the same about India.

(Interview has been lightly edited and condensed.)

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Downton Abbey's Season 3 Finale: Shocking, Says PEOPLE's TV Critic

Downton Abbey

By Tom Gliatto

02/17/2013 at 10:00 PM EST

Downton Abbey season 3 cast

Carnival Film & Television/PBS

Downton Abbey's third season finale on PBS's Masterpiece was, to say the least, a spoiler's paradise. The episode, which saw the Granthams and servants going on holiday in the Scottish Highlands, started on a joyful note – Lady Mary was pregnant! – and ended with a shock that would have knocked the hat off Lady Violet wobbling head.

SPOLIER ALERT: Major plot points to be revealed immediately.

Cousin Matthew (Dan Stevens) died in a car accident. He was driving back to Downton, so happy he was practically whistling, just after Lady Mary (Michelle Dockery) had given birth to their son – the male Downton heir everyone has been so obsessed with since Season 1.

Many viewers probably saw this coming: For one thing, Stevens had said he was thinking of decamping before season 4 started shooting. And after the finale had its premiere broadcast in Britain in December, he blabbed all about it, including for an interview posted online by The New York Times.

Even so, the death was almost sadistically abrupt and arbitrary, especially after the soft tenderness and growing love between Mary and Matthew in recent episodes. Now we saw dead poor Matthew dumped on the cold mossy ground, eyes wide open.

You can never be sure Downton writer-creator Julian Fellowes won't pull some shameless stunt to kick-start a story – in season 2 Matthew, paralyzed during the war, suddenly leaped out of his wheelchair – but he seemed to want us to be sure that Matthew was 100% gone. I wouldn't have been surprised if the car backed over the corpse.

So ended a terribly sad season of Downton.

We already suffered the loss in childbirth of Lady Sybil (Jessica Brown Findlay). Her deathbed scene was unflinching and deeply moving as she gasped for breath and called for help. Her poor mother (Elizabeth McGovern) sobbed in despair, and the doctors couldn't agree on what to do.

Millions of viewers cried, too, and sighed for a long time afterward. Those who didn't are probably evil.

That scene was the heart of the season: Sybil was so beautiful and kind and gracious and spirited, and so different from her fractious sisters. It was if one were to discover a rare, transcendent soul among the Kardashians. Her death robbed the show of a lovely presence, and also brought out the best moments yet from McGovern and Maggie Smith, as Lady Violet.

It never ceases to annoy me, to be honest, that Lady Violet's feeble witticisms are treated as if they were Oscar Wilde one-liners on loan, like Harry Winston jewels. If you want real witticisms, try any contemporary American sitcom, including FX's Archer.

But this season, as Violet grieved, we saw how much depth Smith can invest in a single moment. At one point in the finale, she looked up as dinner was announced, and in her enormous eyes you saw a woman who wished she could just chuck the whole damn thing and dwell on her memories.

I wish I could say I will miss Matthew, but all in all an unattached Lady Mary is better than a married one. She was never sexier than in the first season, when she sneaked off to bed with velvety, sensual Mr. Pamuk, who unfortunately kicked the bucket while they made love.

Mary is a wonderful creation – the show's most original, complex character – capable of bouncing from romance to sorrow to sarcasm. You could say her love for Matthew transformed her, but it also had the potential to dull her.

Matthew was blandly handsome and good and patient and full of improving notions, but not terribly exciting. He was like a Bachelor from a much earlier period.

There isn't much else to say about the finale. Fellowes worked through a number of plots with his usual tangy glibness. The performances were all delightful, tart, full of emotion, humor and regret.

For now, we can look forward to Lady Mary at her most beautiful, because most woeful, in season 4.

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Study: Better TV might improve kids' behavior

SEATTLE (AP) — Teaching parents to switch channels from violent shows to educational TV can improve preschoolers' behavior, even without getting them to watch less, a study found.

The results were modest and faded over time, but may hold promise for finding ways to help young children avoid aggressive, violent behavior, the study authors and other doctors said.

"It's not just about turning off the television. It's about changing the channel. What children watch is as important as how much they watch," said lead author Dr. Dimitri Christakis, a pediatrician and researcher at Seattle Children's Research Institute.

The research was to be published online Monday by the journal Pediatrics.

The study involved 565 Seattle parents, who periodically filled out TV-watching diaries and questionnaires measuring their child's behavior.

Half were coached for six months on getting their 3-to-5-year-old kids to watch shows like "Sesame Street" and "Dora the Explorer" rather than more violent programs like "Power Rangers." The results were compared with kids whose parents who got advice on healthy eating instead.

At six months, children in both groups showed improved behavior, but there was a little bit more improvement in the group that was coached on their TV watching.

By one year, there was no meaningful difference between the two groups overall. Low-income boys appeared to get the most short-term benefit.

"That's important because they are at the greatest risk, both for being perpetrators of aggression in real life, but also being victims of aggression," Christakis said.

The study has some flaws. The parents weren't told the purpose of the study, but the authors concede they probably figured it out and that might have affected the results.

Before the study, the children averaged about 1½ hours of TV, video and computer game watching a day, with violent content making up about a quarter of that time. By the end of the study, that increased by up to 10 minutes. Those in the TV coaching group increased their time with positive shows; the healthy eating group watched more violent TV.

Nancy Jensen, who took part with her now 6-year-old daughter, said the study was a wake-up call.

"I didn't realize how much Elizabeth was watching and how much she was watching on her own," she said.

Jensen said her daughter's behavior improved after making changes, and she continues to control what Elizabeth and her 2-year-old brother, Joe, watch. She also decided to replace most of Elizabeth's TV time with games, art and outdoor fun.

During a recent visit to their Seattle home, the children seemed more interested in playing with blocks and running around outside than watching TV.

Another researcher who was not involved in this study but also focuses his work on kids and television commended Christakis for taking a look at the influence of positive TV programs, instead of focusing on the impact of violent TV.

"I think it's fabulous that people are looking on the positive side. Because no one's going to stop watching TV, we have to have viable alternatives for kids," said Dr. Michael Rich, director of the Center on Media and Child Health at Children's Hospital Boston.

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Online:

Pediatrics: http://www.pediatrics.org

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Contact AP Writer Donna Blankinship through Twitter (at)dgblankinship

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Major donor to GOP helping L.A. mayoral candidate Kevin James

Dallas billionaire Harold Simmons and Los Angeles mayoral candidate Kevin James crossed paths just once.

It was an intimate cocktail fundraiser for James in the tony Montecito enclave near Santa Barbara, where Simmons owns a weekend retreat and counts Oprah Winfrey among his neighbors. Simmons, one of the top donors to Republican "super PACs" in 2012, turned to the candidate and asked, "What on Earth can you do to save L.A.?"

James, recounting the exchange, said he launched into his political pitch, railing against the city's flirtation with bankruptcy and the power of its labor unions. "I remember him telling me he was impressed," James said.

Later, when James made formal remarks to the group, which included a few of Simmons' fellow Texans, the industrial magnate stood up and announced that he would give. By mid-January, Simmons had given $600,000 to an independent group backing James, making him the largest single contributor to any political committee affiliated with the L.A. mayor's race — a sphere most often dominated by labor unions.

His contributions made it possible for a super PAC known as Better Way LA, created by GOP ad man Fred Davis, to buy half a million dollars of TV ad time last week promoting James, the only Republican in the race.

But that political help could come at a price in a city as liberal and Democratic as Los Angeles, where James needs to win over moderates, as well as conservatives, to reach a two-way runoff in May. In recent years, Simmons has funded some of the most controversial conservative groups in presidential politics, and last year he called President Obama "the most dangerous American alive."

Simmons' interest in city politics and a long shot like James remains something of a mystery. A corporate investor whose net worth was valued at $7.1 billion by Forbes last September, Simmons declined to be interviewed. He votes in Texas and has not contributed to any other Los Angeles city candidates in recent years, according to election records.

By the standards of his past political giving, Simmons' support for the pro-James super PAC has been small.

In last year's presidential race, Simmons, his wife, his companies and their employees gave $31 million to a network of super PACs that proliferated after the Supreme Court's 2010 Citizens United ruling, which loosened the reins on political spending by corporations and labor unions, according to the Center for Responsive Politics.

"This is one of a handful of mega-donors in U.S. politics who has given extraordinary sums of money over many, many years," said Sheila Krumholz, the center's executive director who has monitored Simmons' political giving for two decades. "He's a savvy donor, somebody who is very familiar with how this game is played at the highest levels and on down."

James, an openly gay Republican, said he knew of no specific business that Simmons has before the city. And Simmons did not mention any particular Los Angeles issue, he said.

James suggested that Simmons, 81, may be interested in elevating a moderate Republican voice statewide. Simmons has contributed to another California moderate, former Gov. Arnold Schwarzenegger, and told the Wall Street Journal last year that he was "probably pro-choice."

"For donors who are looking for the Republican Party to be able to plant a flag again in California," James said, "I'm the kind of Republican that's a bigger-tent Republican."

In that rare interview he granted the Wall Street Journal last year, Simmons said he wanted to make the U.S. tax and regulatory structure more friendly to business by electing Republicans at all levels of government. He said he hoped like-minded individuals would make political donations to help counter spending by labor unions.

In 2004, Simmons donated $3 million to Swift Boat Veterans for Truth, a group that ran ads accusing then-Democratic presidential candidate John Kerry of exaggerating his record in the Vietnam War. And during President Obama's first run, Simmons was the sole funder of the American Issues Project, which ran TV ads tying Obama to a founder of the Weather Underground, which planned a series of bombings to protest the Vietnam War.

In his interview with the Journal, Simmons described Obama as "a socialist" who "would eliminate free enterprise in this country."

At times, Simmons' political contributions have tracked closely with his business interests — a network of companies that include hazardous waste disposal and metal component manufacturers.

He was a generous backer of Texas Gov. Rick Perry at a time when one of those companies, Waste Control Specialists, needed the governor's backing to build a low-level radioactive waste disposal site, the nation's first such new facility in three decades.

After a fierce lobbying campaign, Perry signed a law opening the way for the proposal. Perry appointees later approved the license for the $500-million site in West Texas despite concerns of some state environmental experts about potential harm to aquifers near the site. Simmons' spokesman has said that Simmons' connections to Perry did not work to his company's advantage and in fact increased the state's scrutiny of the deal.

Krumholz said Simmons' companies span so many fields that it has been difficult to trace possible ties between his business interests and his giving even at the federal level.

"He's kind of like the AT&T of individual donors," said Krumholz, noting that the telecommunications giant has interests in defense contracting and other industries. "He might have reason to be involved at various levels of government and in specific races because his investments are so diverse."

maeve.reston@latimes.com

Molly Hennessy-Fiske contributed to this report.

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