Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

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Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

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Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

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Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

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This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

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Downtown condo market seeing rebound

Downtown Chicago's condo market is on the rebound after many moribund years, as sales volume and pricing improve in a market constrained by a lack of inventory.

It's a rare piece of good news for downtown condo owners as well as for developers pondering projects and trying to line up financing.

With a steady stream of apartment projects delivering in the next two years, the lack of new condo construction could signal opportunities for companies interested in pursuing smaller projects in key neighborhoods because the demand is there. Until those projects materialize, condo owners looking to sell face a better market than they have in several years.

Sales of existing downtown condos rose 31.2 percent last year, to 4,675 units sold, while the median sales price of $300,000 was a gain of about 2.6 percent from 2011, according to data from Appraisal Research Counselors.

Another piece of good news for current condo owners: Of the 65 downtown buildings studied by the firm, the average sales price per square foot of units sold during the second half of last year rose while the number of distressed condo sales in those buildings saw a substantial drop. Distressed sales, which accounted for  28 percent of sales since 2010, fell to 17 percent of sales during the second half of 2012.

In addition, only 1,104 newly constructed condo units remain unsold downtown.

"When we see more transactions occurring, that's a really good indication of demand," said Gail Lissner, a vice president at the firm. "The look of the condo market has changed in terms of unsold inventory."

Lissner's remarks came Tuesday during a lunchtime briefing on the local housing market.

Most of the unsold inventory, more than 500 units, is in the South Loop and the bulk of it is in the newly named and repositioned 500-unit South Loop Luxury by Related.

The three buildings, once called One Museum Park West, 1600 Museum Park and Museum Park Place 2 were taken over by New York-based Related Cos. in July have been renamed the Grant, Adler Place and Harbor View, respectively.

Since December, 40 units there are under contract, according to Related Midwest, which officially launched sales in the project Tuesday.

Other new projects reporting positive sales trends are Park Monroe Phase II, a 48-unit adaptive reuse project with 16 sales and CA3, a 40-unit building with 18 sales.

"These are all great indicators of strong sales," Lissner said. "Price stabilization has occurred in the market. You don't hear people talking about bottoming out. That was so yesterday."

mepodmolik@tribune.com | Twitter @mepodmolik

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No bail for suspects in Hadiya Pendleton slaying

Two suspects in the slaying of 15-year-old Hadiya Pendleton were ordered held without bond today.
Cook County Judge Israel Desierto ordered that Michael Ward, the alleged gunman, and Kenneth Williams, the alleged accomplice, remain in custody as they await trial.

Police say Ward, 18 and Williams, 20 were out for revenge from a previous shooting when they opened fire on a group of students in a South Side park Jan. 29 and hit Pendleton. Ward confessed to police that he and Williams mistook a Pendleton companion for rivals who had shot and wounded Williams last July, police and prosecutors say.

In court today, prosecutors disclosed that surveillance video captured the two as they fled in a white Nissan after the shooting. Police had identified Williams and Ward as occupants of the car "within approximately 10 minutes of the shooting," prosecutors said.

The two weren't arrested until this past weekend. Both made admissions to police about the shooting, with Ward telling detectives that Pendleton "had nothing to do with it. She was just there."

Williams told police he and Ward were driving around, looking for members of a rival gang, when they pulled up to the park. Ward got out and "snuck up on the group and they didn't see him coming," prosecutors quoted Ward as telling police. "Ward admitted he approached the fence and fired the gun six times. He ran back to the car and both defendants fled."

Ward told police that his gang and the rival gang "had been shooting at one another since 2010," and that one of Ward's friends have been killed by rival gang members. "It hurt, it hurt," he told police, according to prosecutors. "It hurt to a point where everyone had to go."

Detectives arrested the two Saturday night as the suspects were on their way to a suburban strip club to celebrate a friend's birthday, McCarthy said. Pendleton had been buried only hours earlier in a funeral attended by first lady Michelle Obama.
Williams did not confess and police have not recovered a weapon, McCarthy said.

McCarthy said that two days before the killing, police had stopped Ward in his Nissan Sentra as part of a routine gang investigation. That information wound up being the starting point for detectives when witnesses in the shooting described seeing a similar car driving away from the shooting scene, he said.

Through surveillance and interviews — including several fruitful interviews with parolees in the neighborhood — detectives were able to home in on Ward and Williams, McCarthy said. On Saturday night, the decision was made to stop the two if they were spotted. Police watched as they departed in a caravan of cars headed to the strip club in Harvey. They were stopped near 67th Street and South King Drive and taken in for questioning.

McCarthy said Williams was shot July 11 at 39th Street and South Lake Park Avenue, and an arrest was made. But that gunman was let go after Williams refused to cooperate, McCarthy said.

McCarthy also noted that at the time of Hadiya's slaying, Ward was on probation for a weapons conviction. McCarthy said weak Illinois gun laws allowed Ward to avoid jail time because of the absence of mandatory minimum sentences.

"This incident did not have to occur," McCarthy said. "And if mandatory minimums existed in the state of Illinois, Michael Ward would not have been on the street to commit this heinous act."

jmeisner@tribune.com

jgorner@tribune.com

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The New Old Age Blog: Debate Over Brain Scans and Alzheimer's

Should brain scans for older adults with suspected Alzheimer’s disease be covered by Medicare?

Many medical experts say yes. But late last month, an expert panel convened by the Centers for Medicare and Medicaid Services concluded that data supporting use of the scans was weak.

Specifically, the panel noted there is no solid evidence that these imaging tests have a meaningful impact on patients’ health; studies that might establish this have not yet been done.

This controversy deserves attention because positron emission tomography, known as PET scans, are becoming available across the country, and proposed guidelines for their use have just been published by the Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging.

Currently, Medicare does not pay for the tests, which cost about $3,000 — an amount that puts them out of reach for many families. The expert panel’s findings will be used by the government later this year to determine whether Medicare should change this policy.

Nearly 400 medical centers already offer this technology or are preparing to do so, according to Eli Lilly, which makes a radioactive agent used in the scans. That agent binds to protein clusters known as amyloid plaques that are a signature characteristic of Alzheimer’s disease, making it possible to see them for the first time in the brains of living patients.

The Medicare panel confronted the question: “How useful is this information, for which patients and under what conditions?” Several experts who testified in late January suggested that the PET imaging tests could help physicians diagnose Alzheimer’s disease or other types of dementia. Currently, diagnosis proceeds from a comprehensive medical evaluation, a careful patient history, and typically, a round of neuropsychiatric tests.

“Should I tell my patients that we have a test available to help clarify their diagnosis but we can’t use it because Medicare doesn’t cover it?” asked Dr. Stephen Salloway, a professor of neurology at the Warren Alpert Medical School at Brown University.

If scans show a lack of amyloid plaques, the “worried well” could be reassured that they don’t have Alzheimer’s and doctors could pursue other lines of medical inquiry, like investigating the potential for thyroid problems, depression or vitamin B12 deficiency, said Dr. Paul Aisen, a professor of neuroscience at the University of California, San Diego, School of Medicine.

If the tests are positive, they could rule out conditions like frontotemporal dementia and motivate patients to start taking medications for Alzheimer’s, enroll in clinical trials and get their financial, legal and household affairs in order, other experts said.

But while amyloid plaques are closely associated with Alzheimer’s, their role has not yet been definitively established. They could be a cause of this condition, a byproduct or serve another function not yet understood. Underscoring this is a notable research finding: about 30 percent of older adults with no symptoms of dementia have been found to have amyloid plaque buildup in their brains.

That means the brain scans cannot ensure the accurate diagnosis of Alzheimer’s. “I see a big potential for overuse and misuse,” warned Dr. Raymond Faught, Jr., a member of the Medicare advisory panel and a professor of neurology at Emory University in Atlanta.

Given that large caveat, the question emerges of which patients would benefit most from getting the tests.

The Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging tried to address that in their recently published “appropriate use” guidelines. The guidelines, which have no binding force, suggest that scans should be considered for patients with Alzheimer’s-type symptoms but “an unclear clinical presentation”; those who develop dementia symptoms before age 65; and those with “persistent” mild cognitive impairment, a condition that often precedes Alzheimer’s.

Tests should not be given to “normal” patients or those who have Alzheimer’s disease already, they say. In other words, if you’re getting older, have mild memory loss, but are still functioning well, you’re not a candidate. Nor is there any value in giving the tests to people who are already deep in the throes of dementia.

The recommendations assume that there is value in knowing test results for physicians, patients and families; that physicians will be better able to manage patients’ care as a consequence; and that doctors will order fewer diagnostic tests or more appropriate tests once they have findings from amyloid PET imaging in hand.

But those assumptions are not backed up by solid evidence yet. Medications for patients with Alzheimer’s have a modest impact on symptoms for a limited period of time and no impact on the underlying illness. Given this, “the clinical utility of a diagnostic test to alter patient management and result in a quantifiable benefit is very difficult to establish,” the panel writes in the journal Alzheimer’s & Dementia. Also, they note, “data supporting specific outcomes for amyloid PET are not yet available.”

This lack of data was the reason the Medicare panel gave amyloid brain imaging such low marks late last month. Dr. Rita Redberg, chairwoman of the Medicare Evidence Development and Coverage Advisory Committee and a professor of medicine at the University of California, San Francisco, summed up that group’s deliberations this way:

We were there to evaluate the impact of this test on patient outcomes. But all of the speakers said there wasn’t any data linking amyloid scans to outcomes . . . They presented evidence that the test is very good at identifying amyloid, but they did not present evidence that it was very good at identifying the clinical presence of Alzheimer’s disease.

Wei-Li Shao, senior director of the Alzheimer’s business division of Eli Lilly, which stands to benefit from the greater use of the scans, disagreed, saying, “Lilly remains steadfast and resolved in its belief that amyloid imaging provides significant clinical value for clinicians and patients.” The company will work with Medicare going forward to try to secure coverage, he said.

For Dr. Redberg, the essential question is this: “Would you want to know you have an increased chance of getting a disease in (the future) when there are no effective treatments available and you might not even get it in the end? Is that of benefit to patients?”

What do you think, readers?

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Chicago leads nation in gas-price spikes

Drivers in Chicago are seeing a painful rise in gas prices get even worse this month.

The average price of regular unleaded in the Chicago metro area on Tuesday is $3.93, according to AAA. That's up 12 cents from a week ago. A month ago, the average was $3.42. Statewide, the average is about $3.79, up 8 cents from last week and 46 cents last month.

Prices are rising at pumps across the country, too, but not as dramatically. The national average is $3.60, up about 7 cents from a week ago and 30 cents higher than this time last month.

It's not typical to see gas price spikes at this time of year. Demand is typically low and picks up in the spring before driving season. And in general, gas is cheaper to produce in the winter because refineries can use less expensive blends.

The main reason for the spike is the higher price of crude oil. The price of oil has gone from around $85 a barrel in December to around $97 now because of improving economic certainty as the country moved past the election and the fiscal cliff deadline, according to energy analyst Phil Flynn. It's also being driven by better-than-expected growth in China, the world's second largest economy.

Prices in the Chicago area are typically some the highest in the nation, but the cost of a local fill-up is accelerating at almost double the national rate.

Flynn attributes this to a number of refinery issues in the region. Some scheduled maintenance at refineries -- where gasoline and other products are produced from oil -- occurred earlier than usual, which cut off some supply, affecting prices. Many close at this time of year to start the switchover to lower-emission summer blends of gasoline.

Besides a major overhaul of BP's Whiting refinery, the largest supplier of gasoline to Midwest markets, that's believed to be driving prices higher, a fire temporarily shut down a refinery in northwest Ohio.

AAA, which tracks daily gasoline prices around the country, predicts they will continue their rapid climb as local refinery issues continue into the beginning of peak driving season.

Flynn is more optimistic.

He believes that once the major Whiting refinery overhaul is complete later this year, gas prices will stabilize.

"I'm probably in the minority but I think we are starting to see some light at the end of the tunnel," he said.

sbomkamp@tribune.com | Twitter: @SamWillTravel

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Charges in Hadiya Pendleton slaying could come soon: McCarthy

Charges against two people being questioned in the shooting death of 15-year-old Hadiya Pendleton could come this evening, Chicago Police Superintendent Garry McCarthy said.

"We will bring this all to closure, probably sometime this evening we're anticipating hopefully that we'll have charges," McCarthy said at a news conference with Mayor Rahm Emanuel and Cook County State's Attorney Anita Alvarez to announce a push for stiffer state prison terms for people convicted of gun crimes.

McCarthy declined to provide more specifics, saying the investigation is ongoing.

"We're still doing lineups. We're still crossing some t's and dotting some i's that we need to do before we can get charges approved for these individuals," he said.

Chicago police on Sunday were questioning two persons of interest in Hadiya's slaying, according to law enforcement sources. On Saturday, first lady Michelle Obama attended the funeral for the teenager whose death has become a symbol of escalating violence in Chicago.

The suspects, are 18 and 20 year old men who were pulled over near East 67th Street and South Chicago Avenue late Saturday night or early Sunday morning after detectives canvassed the area of the park where she was shot and killed Jan. 29 and tracked down witnesses, the sources said. No charges have been filed.

Hadiya was fatally shot in Vivian Gordon Harsh Park, about a mile north of President Barack Obama's Kenwood neighborhood home on the South Side, a little more than a week after the honor student performed with the King College Prep band in Washington during inauguration festivities. Two other teens were wounded.

The shooting in the 4400 block of South Oakenwald Avenue happened after classes were dismissed for the day during finals week at King. Hadiya, a sophomore at King, was at the park with a group of teens, primarily other students from the school, when a male gunman climbed over a fence, ran to the group and started firing, police have said. The shooter escaped in what has been described as a white Nissan vehicle, possibly driven by a getaway driver.

One of the sources said at least one of the men brought into custody was riding in a Nissan Sentra, one of the two vehicles police pulled over when bringing the pair into custody. The source didn't know that Nissan's color.

Police have insisted that the teens in Hadiya's group who had gathered in the park were not involved in gangs. But police have been looking into whether the gunman may have mistaken them for rival gang members.

While police and neighbors have generally described Harsh Park and its immediate surroundings as safe, there has been an internal gang conflict brewing in the area between factions of the Gangster Disciples, police said. The two men being questioned Sunday are alleged members of the Gangster Disciples, sources said.

One of the two men has a previous weapons conviction, according to court records.

In addition to Hadiya's homicide, there have been at least three other shootings within blocks of Harsh Park so far this year, according to police records.

No charges have been filed against the men, who are being held at Area Central police headquarters on the South Side.

Mayor Rahm Emanuel personally called Hadiya's parents, Cleopatra Cowley-Pendleton and Nathaniel Pendleton, to inform them of the development, according to a source. Nathaniel Pendleton told the Tribune on Sunday night that he didn't want to say too much about the men being questioned because charges have not been filed.

“Right now, we're just happy that Chicago police have some leads and things are moving,” he said.

Shatira Wilks, a cousin of Hadiya's and a family spokesperson, said the development is a “good response” and better news than the family had Saturday.

Arrests and charges “will bring a small level of closure to the family, although (the shooter) still will be allowed to eat, drink, mingle,” Wilks said. “The thing about that is, Hadiya is no longer (able) to do so.”

On how Hadiya's family is doing, Wilks said, “Everyone keeps asking that. I don't know if you'll ever get an answer that we're feeling good or we're feeling fine.”

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Famous film couple back 9 years on in “Before Midnight”

BERLIN (Reuters) – Ethan Hawke and Julie Delpy reprise the roles of Jesse and Celine in “Before Midnight”, the third but not necessarily the last movie in their long-running series based on the same characters as they age over time.

In this film, set 18 years after “Before Sunrise”, the couple is on holiday in Greece and we learn that they live with their twin daughters in Paris while Jesse’s son has stayed with his mother in Chicago.

Screening at the Berlin film festival on Monday, “Before Midnight” examines how life’s twists have taken their toll on the American tourist and French student who met on a train bound for Vienna in 1995 and again in Paris nine years later in “Before Sunset”.

They still love each other but this time they are older, heavier, and bicker more, and the forces pulling Jesse back towards his teenage son and Celine’s determination to pursue her career in France test that bond to its limits.

Director Richard Linklater, on board throughout the series, underlined the organic nature of the “Before…” films when he was asked whether there might be a fourth installment, presumably sometime around 2022.

“The fact that we’ve made two sequels, I guess it begs the question, but I think I speak for the group here, I’m sure we have absolutely no idea what that (sequel) could possibly be,” he told reporters at the 11-day film festival.

“We probably won’t for another six years. Who knows the future?”

French actress Delpy joked that the final film in the series would be a remake of Michael Haneke’s Oscar-nominated drama “Amour”, about an elderly couple aged in their 80s facing the inevitability of imminent death.

“STIFLING” EXPECTATIONS

Critical reaction to “Before Midnight” has been mixed.

In its review, the Guardian newspaper said the movie felt forced, but The Hollywood Reporter wrote: “Though this stage is harder to watch, audiences who have aged along with Celine and Jesse will treasure this new episode.”

Hawke said he, Delpy and Linklater, who jointly developed the script over two years, felt the weight of expectation as they embarked on the third part of a story which many viewers identified with so closely.

“I haven’t met a director in the last nine years that didn’t tell me what he or she thought the third film should be. So we knew we were up against a lot of people having an agenda about where Jesse and Celine should be. That agenda is stifling.”

“Before Midnight” consists of a handful of long, single-shot scenes focusing on the couple as they navigate a life complicated by broken families, work pressures and the familiarity of living together.

In the first scene Jesse sees his son off at the airport in an awkward exchange that underlines how the two have grown apart. In the next Jesse and Celine discuss children, work and their relationship in frank and often funny exchanges.

At one point Celine says men measure themselves against leading figures from history. When Jesse counters that women do too, he mentions Joan of Arc.

“She was burned at the stake and was a virgin,” jokes Celine. “Who wants to be Joan of Arc?”

As the film goes on, banter becomes bickering, then descends into a blazing row. Linklater stressed that the dialogue may seem off-the-cuff but it required a lot of hard work.

“It feels improvised. It’s not,” he said. “It’s meticulously rehearsed and structured.”

(Reporting by Mike Collett-White; Editing by Belinda Goldsmith)

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Dozens of airline fees rose, changed in 2012

Airline travel fees — including charges to check a bag and to board early — have become so prevalent that travelers almost need an advanced degree in mathematics to calculate overall trip costs.

Last year at least 36 airline fees increased, and 16 others were redefined, bundled or unbundled with other services, according to a recent study by the consumer travel website Travelnerd.

One bright spot in the Travelnerd study of 14 U.S. airlines is that most fee increases were only $5 to $10 each.

In one case an airline had a big fee reduction. The study found that United Airlines reduced its fee for checking an overweight bag to $100 from $200 for bags 50 to 70 pounds and to $200 from $400 for bags 71 to 100 pounds.

"Travelers really have to be extra cautious when booking a flight," said Alicia Jao, vice president of travel media at Travelnerd, who predicts travelers will see even more fees in 2013. "U.S. carriers are becoming creative at charging consumers extra fees."

But some airlines seem to charge fees arbitrarily, said Perach Mazol, a Los Angeles resident who recently flew to Florida with friends from Romania to take a cruise.

On her flight from L.A. to Fort Lauderdale, Fla., on Spirit Airlines, she said the Florida airline did not charge for the carry-on bags she and her friends were carrying, but the carrier asked for $50 each to carry the same bags on the flight back. (Spirit is one of only two airlines in the U.S. that charge passengers for carry-on luggage.)

"I don't understand why they charged us on one flight and they don't on the other," Mazol said. "It's confusing."

A spokeswoman for Spirit said the airline tries to enforce its policies consistently.

"Maybe she got lucky one way and didn't have to pay," Spirit spokeswoman Misty Pinson said.

United offering satellite-based Wi-Fi

United Airlines was one of the last major airlines to offer onboard wireless Internet. But the Chicago carrier is trying to make up for its tardiness.

United offers Wi-Fi in about 3% of its fleet of about 700 planes, one of the lowest rates of any major carrier in the nation, according to a recent study.

But United recently became the first U.S.-based international carrier to offer satellite-based Wi-Fi Internet for passengers traveling on long-haul overseas flights.

The carrier has installed satellite-based Wi-Fi on nearly a dozen planes, with plans to expand the service to more than 300 planes, or about 43% of the fleet, by the end of the year.

"With this new service, we continue to build the airline that customers want to fly," said Jim Compton, vice chairman and chief revenue officer at United.

Satellite-based Wi-Fi is typically as fast as ground-based Wi-Fi, experts say, but the advantage is that it can give passengers Internet access when flying over areas where cellular towers don't exist — such as the Pacific or Atlantic oceans.

But, of course, there is a price to pay for the service.

United is charging $3.99 to $14.99 for standard speed, depending on the duration of the flight, and $5.99 to $19.99 for faster speeds.

United is not the only airline to offer satellite-based Wi-Fi. Southwest Airlines, the nation's largest domestic carrier, offers it through Westlake Village-based Row 44.

Delta to raise fee to access lounges

Airline fees are rising not only for onboard services but for amenities at the airport too.

Delta Air Lines, which has invested more than $20 million in its airport lounges over the last two years, announced that it would raise the cost for annual membership to access its lounges across the country by $50, starting March 1.

The increase means that an annual membership will range from $350 to $450, depending on membership level. (The more miles passengers fly on Delta the less they pay for membership.)

Among the investments Delta has made is the addition of a new luxury bar that opened recently at Delta's lounge at Los Angeles International Airport. Instead of helping themselves at a self-serve bar, members can now belly up to a fully stocked bar and order a drink from a bartender.

hugo.martin@latimes.com

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Woman killed when 2 cars collide on Tri-State

Photo: Scene of crash (February 10, 2013)

by Carlos Sadovi and Adam Sege




Tribune reporters

12:42 p.m. CST, February 10, 2013

Danielle M. Pisterzi hoped to graduate from Northern Illinois University this year with an accounting degree, but first she needed to complete an internship at a firm.

Her family believes Pisterzi, 21, was returning to her home on the Northwest Side late Saturday night from her job when she collided with an SUV near Willow Road on the Tri-State Tollway.

Pisterzi had been working long hours because the firm was busy with the tax season, her father Frank Pisterzi said. "She was my baby," he said.

Danielle Pisterzi was driving a 2004 Hyundai when she struck an Audi SUV carrying four people around 10:45 a.m., state police said. people inside, police said. Pisterzi was taken to Advocate Lutheran General Hospital, where she was pronounced dead at 11:52 p.m.

Police told the woman's family that her car also struck a wall before the car flipped on its roof. No one else was taken to the hospital, police said.

After having spent semesters in Dekalb, Pisterzi was back home living with her family in the 5700 block of North Nina Avenue where she grew up, her father said.

Pisterzi said his daughter knew what she meant to her family. "I was pretty fortunate, I told her everyday that I loved her," her father said.

chicagobreaking@tribune.com

Twitter: @ChicagoBreaking

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The fine line between legitimate businesses and pyramid schemes

Controversy is again casting a shadow over the multilevel marketing industry, as nutritional supplement company Herbalife Inc., which has thousands of distributors in the Chicago region, has been publicly called a pyramid scheme by a prominent investor — an allegation the company vigorously denies.

Meanwhile, a different multilevel marketer, Fortune Hi-Tech Marketing, was shut down in recent weeks after a lawsuit was brought by regulators and several states, including Illinois, alleging the company scammed consumers out of $169 million. The scheme affected an estimated 100,000 Americans, including some in Chicago, where it targeted Spanish-speaking consumers, the Federal Trade Commission alleged.

Most people outside the industry might have only a vague notion about multilevel marketing, also called network marketing and direct selling. It often involves personal sales of cosmetics, wellness products or home decor items — or as critics flippantly call it, "pills, potions and lotions" — usually sold through product parties hosted by friends or relatives.

For sellers, the companies offer the appeal of starting a business on the cheap with little training, working from home and being their own boss, if only for part-time money. Some might recruit friends and family to become sellers, which augments their own commissions and gives them a shot at the six-figure compensation many such marketing companies tout but few distributors attain.

The largest multilevel marketing companies, often known as MLMs, are household names: Avon, Mary Kay, Pampered Chef and Amway. MLMs have annual sales of about $30 billion, with about 16 million people in the United States selling their products, according to the industry group Direct Selling Association, which represents these firms and others.

The recent controversies might raise the question: What's the difference between a legitimate multilevel marketing company and an illegal pyramid scheme, in which only people who get in first — at the top of the pyramid-like structure — make money and everyone else is a dupe?

The harshest critics maintain there is no difference, that there's no such thing as a legitimate MLM and that the industry's secrets stay safe because of a cultlike mentality and a blind eye of regulators.

Jon M. Taylor, who was once a seller for an MLM company, said he has studied the industry for 18 years and analyzed more than 500 MLM companies. He maintains the website MLM-thetruth.com and offers a free e-book there.

"I have not yet found a good MLM — a good MLM is an oxymoron," Taylor said.

He said all MLM companies have the same flaw: They depend on endless chains of recruiting new members.  "There is no more unfair and deceptive practice than multilevel marketing," Taylor said.

Tracy Coenen, a forensic accountant and fraud investigator with Sequence Inc. in Chicago and Milwaukee, is author of the Fraud Files Blog. She is also a critic.

"Multilevel marketing companies are pyramid schemes that the government allows to operate," said Coenen. "The only difference is that Herbalife, or any multilevel marketing company, has a tangible product that they use to make their pyramid appear legitimate."

The Direct Selling Association says MLMs are legitimate businesses, and that the group has about 200 members carefully screened by the organization to ensure they are not pyramid schemes and don't use deceptive practices.

The Federal Trade Commission agrees there are legitimate MLMs. The difference between a legitimate business and pyramid scheme comes down to products.

If the company and its distributors make money primarily from the sale of products to end-users (and not boxes of product accumulating in a distributor's garage), it's OK.

By contrast, a pyramid scheme compensates those at the top of the pyramid with participation fees paid by those recruited at the bottom. It eventually collapses when the scheme can't recruit more people.

But identifying a pyramid scheme can be difficult because MLMs typically have product sales, along with recruitment fees and recruitment incentives.

"It gets cloudy when you have a situation where you have fees being paid for both," said Monica Vaca, assistant director of the FTC's division of marketing practices. "It's very nuanced."

While prosecuting an MLM can seem somewhat of a judgment call, cases have a common factor: deceptive promises about how much money distributors will earn, Vaca said.

In the Fortune Hi-Tech Marketing case filed last month, C. Steven Baker, director of the FTC's Midwest region, said, "These defendants were promising people that if they worked hard they could make lots of money. But it was a rigged game, and the vast majority of people lost money."

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