Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative. M.R.I. helped pay for previous vaccination campaigns in the country and the GAVI Alliance is helping to finance the upcoming one.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

This article has been revised to reflect the following correction:

Correction: February 27, 2013

An earlier version of this article misstated the source of the vaccine and some financing for the campaign. The vaccine and financing is being provided by the GAVI Alliance, not the Measles and Rubella Initiative.

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Lockheed Criticized by F-35 Jet Program Chief

The general in charge of building the new F-35 fighter jet sharply criticized the main contractors on Wednesday, saying that Lockheed Martin and the engine maker, Pratt & Whitney, were trying to “squeeze every nickel” out of the program.

The comments, by Lt. Gen. Christopher Bogdan, echoed a pointed critique he made last September, when he suggested that a poor relationship between Lockheed and the government threatened the program.

General Bogdan also seemed frustrated by the grounding last week of all 64 of the high-tech planes after an inspection found a crack in the turbine blade of one of the engines made by Pratt & Whitney.

Loren B. Thompson, a consultant to Lockheed, said Wednesday that the problem might have been caused by a bad casting when that blade was made rather than a design flaw that might affect all the planes.

But Kyra Hawn, a spokeswoman for the F-35 office at the Pentagon, said the military would analyze data from an investigation by Pratt & Whitney before reaching any conclusions. She said the blade was in an engine that had been “driven to extreme tolerances” in ground and flight tests that went beyond its expected military use.

She said that also might have contributed to the cracking, and officials needed to determine whether the jets’ engines would require more frequent inspection than expected.

Pratt & Whitney, a unit of United Technologies, said it was close to completing its investigation of the blade cracking and would make recommendations to the Pentagon soon.

General Bogdan made his comments, first reported by Reuters, in Australia, where he was trying to persuade the Australian government to stick with plans to buy 100 of the jets.

“What I see Lockheed Martin and Pratt & Whitney doing today is behaving as if they are getting ready to sell me the very last F-35 and the very last engine and are trying to squeeze every nickel of that last F-35 and that last engine,” the general told reporters there.

“I want them both to start behaving like they want to be around for 40 years,” he said. “I want them to take on some of the risk of this program. I want them to invest in cost reductions. I want them to do the things that will build a better relationship. I’m not getting all that love yet.”

General Bogdan, who joined the program last summer as the top deputy and took charge in December, said he had seen some improvement from the companies. “Are they getting better at a rate that I want to see them getting better?” he asked. “No, not yet.”

Ms. Hawn, the government spokeswoman, said that with the Pentagon and foreign militaries facing budget cuts, the general was reflecting a wider view that military contractors have been “negotiating every contract as if it were their last.” His comments, she said, were “an attempt to reinforce that we have shared responsibility in driving down program costs.”

The F-35 is the Pentagon’s most expensive program. It could cost $396 billion if the Pentagon sticks to its plan to build 2,456 jets by the late 2030s.

Mr. Thompson, the Lockheed consultant, said an outside audit commissioned by Lockheed had found that the company earned a 7 percent profit since the program began in 2001.

Lockheed and Pratt & Whitney said they have taken a long-range view in reducing costs and sharing cost overruns and expect to achieve more savings.

Ms. Hawn said inspections of the other F-35s used in flight tests had not found any other cracked blades. She said inspections began Wednesday on jets used for training pilots.

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Tribune Co. hires advisors to explore sale of newspaper unit

Tribune Co. has hired investment bankers to advise the media company on the potential sale of its newspaper publishing unit.

The company announced that it has retained JPMorgan Chase & Co. and Evercore Partners to assess whether to sell the division that includes the Los Angeles Times, Chicago Tribune and six other daily newspapers.

The bankers will analyze bids from suitors, but their hiring does not necessarily mean that the assets would be sold.

"There is a lot of interest in our newspapers, which we haven't solicited," Gary Weitman, a Tribune spokesman, said in a statement. "Hiring outside financial advisors will help us determine whether that interest is credible, allow us to consider all of our options, and fulfill our fiduciary responsibility to our shareholders and employees."

Tribune hopes to sell the newspaper group intact instead of selling each paper individually, according to a person familiar with the matter.

The Chicago company has a healthy balance sheet and doesn't feel financial pressure to sell the properties, according to the person. It's unclear how long the process could take.

There has been widespread speculation that Tribune would attempt to unload the newspaper business to focus on its more promising television operations. Rupert Murdoch's News Corp. is among the possible bidders for the newspaper assets.

Tribune emerged from its four-year bankruptcy at the end of 2012 and appointed broadcasting veteran Peter Liguori as chief executive in January.

JPMorgan Chase holds an ownership stake in Tribune.

Evercore Partners, a boutique investment bank, also is working for the parent company of the New York Times on its planned divestiture of the Boston Globe.

walter.hamilton@latimes.com

andrew.tangel@latimes.com

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Cellar victim Kampusch raped, starved in film of ordeal

VIENNA (Reuters) – A new film based on the story of Austrian kidnap victim Natascha Kampusch shows her being repeatedly raped by the captor who beat and starved her during the eight-and-a-half years that he kept her in a cellar beneath his house.

Kampusch was snatched on her way to school at the age of 10 by Wolfgang Priklopil and held in a windowless cell under his garage near Vienna until she escaped in 2006, causing a sensation in Austria and abroad. Priklopil committed suicide.

Kampusch had always refused to respond to claims that she had had sex with Priklopil, but in a German television interview on her 25th birthday last week said she had decided to reveal the truth because it had leaked out from police files.

The film, “3,096 Days” – based on Kampusch’s autobiography of the same name – soberly portrays her captivity in a windowless cellar less than 6 square metres (65 square feet) in area, often deprived of food for days at a time.

The emaciated Kampusch – who weighed just 38 kg (84 pounds) at one point in 2004 – keeps a diary written on toilet paper concealed in a box.

One entry reads: “At least 60 blows in the face. Ten to 15 nausea-inducing fist blows to the head. One strike with the fist with full weight to my right ear.”

The movie shows occasional moments that approach tenderness, such as when Priklopil presents her with a cake for her 18th birthday or buys her a dress as a gift – but then immediately goes on to chide her for not knowing how to waltz with him.

GREY AREAS

Antonia Campbell-Hughes, who plays the teenaged Kampusch, said she had tried to portray “the strength of someone’s soul, the ability of people to survive… but also the grey areas within a relationship that people don’t necessarily understand.”

The British actress said she had not met Kampusch during the making of the film or since. “It was a very isolated time, it was a bubble of time, and I wanted to keep that very focused,” she told journalists as she arrived for the Vienna premiere.

Kampusch herself attended the premiere, looking composed as she posed for pictures but declining to give interviews.

In an interview with Germany’s Bild Zeitung last week, she said: “Yes, I did recognize myself, although the reality was even worse. But one can’t really show that in the cinema, since it wasn’t supposed to be a horror film.”

The movie, made at the Constantin Film studios in Bavaria, Germany, also stars Amy Pidgeon as the 10-year-old Kampusch and Danish actor Thure Lindhardt as Priklopil.

“I focused mainly on playing the human being because… we have to remember it was a human being. Monsters do not exist, they’re only in cartoons,” Lindhart said.

“It became clear to me that it’s a story about survival, and it’s a story about surviving eight years of hell. If that story can be told then I can also play the bad guy.”

The director was German-American Sherry Hormann, who made her English-language debut with the 2009 move “Desert Flower”, an adaptation of the autobiography of Somali-born model and anti-female circumcision activist Waris Dirie.

“I’m a mother and I wonder at the strength of this child, and it was important for me to tell this story from a different perspective, to tell how this child using her own strength could survive this atrocious martyrdom,” Hormann said.

The Kampusch case was followed two years later by that of Josef Fritzl, an Austrian who held his daughter captive in a cellar for 24 years and fathered seven children with her.

The crimes prompted soul-searching about the Austrian psyche, and questions as to how the authorities and neighbors could have let such crimes go undetected for so long.

The film goes on general release on Thursday.

(Reporting by Georgina Prodhan, Editing by Paul Casciato)

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Advanced Breast Cancer May Be Rising Among Young Women, Study Finds

The incidence of advanced breast cancer among younger women, ages 25 to 39, may have increased slightly over the last three decades, according to a study released Tuesday.

But more research is needed to verify the finding, which was based on an analysis of statistics, the study’s authors said. They do not know what may have caused the apparent increase.

Some outside experts questioned whether the increase was real, and expressed concerns that the report would frighten women needlessly.

The study, published in The Journal of the American Medical Association, found that advanced cases climbed to 2.9 per 100,000 younger women in 2009, from 1.53 per 100,000 women in 1976 — an increase of 1.37 cases per 100,000 women in 34 years. The totals were about 250 such cases per year in the mid-1970s, and more than 800 per year in 2009.

Though small, the increase was statistically significant, and the researchers said it was worrisome because it involved cancer that had already spread to organs like the liver or lungs by the time it was diagnosed, which greatly diminishes the odds of survival.

For now, the only advice the researchers can offer to young women is to see a doctor quickly if they notice lumps, pain or other changes in the breast, and not to assume that they cannot have breast cancer because they are young and healthy, or have no family history of the disease.

“Breast cancer can and does occur in younger women,” said Dr. Rebecca H. Johnson, the first author of the study and medical director of the adolescent and young adult oncology program at Seattle Children’s Hospital.

But Dr. Johnson noted that there is no evidence that screening helps younger women who have an average risk for the disease and no symptoms. “We’re certainly not advocating that young women get mammography at an earlier age than is generally specified,” she said.

Expert groups differ about when screening should begin; some say at age 40, others 50.

Breast cancer is not common in younger women; only 1.8 percent of all cases are diagnosed in women from 20 to 34, and 10 percent in women from 35 to 44. However, when it does occur, the disease tends to be more deadly in younger women than in older ones. Researchers are not sure why.

The researchers analyzed data from SEER, a program run by the National Cancer Institute to collect cancer statistics on 28 percent of the population of the United States. The study also used data from the past when SEER was smaller.

The study is based on information from 936,497 women who had breast cancer from 1976 to 2009. Of those, 53,502 were 25 to 39 years old, including 3,438 who had advanced breast cancer, also called metastatic or distant disease.

Younger women were the only ones in whom metastatic disease seemed to have increased, the researchers found.

Dr. Archie Bleyer, a clinical research professor in radiation medicine at the Knight Cancer Institute at the Oregon Health and Science University in Portland who helped write the study, said scientists needed to verify the increase in advanced breast cancer in young women in the United States and find out whether it is occurring in other developed Western countries. “This is the first report of this kind,” he said, adding that researchers had already asked colleagues in Canada to analyze data there.

“We need this to be sure ourselves about this potentially concerning, almost alarming trend,” Dr. Bleyer said. “Then and only then are we really worried about what is the cause, because we’ve got to be sure it’s real.”

Dr. Johnson said her own experience led her to look into the statistics on the disease in young women. She had breast cancer when she was 27; she is now 44. Over the years, friends and colleagues often referred young women with the disease to her for advice.

“It just struck me how many of those people there were,” she said.

Dr. Donald A. Berry, an expert on breast cancer data and a professor of biostatistics at the University of Texas’ M. D. Anderson Cancer Center in Houston, said he was dubious about the finding, even though it was statistically significant, because the size of the apparent increase was so small — 1.37 cases per 100,000 women, over the course of 30 years.

More screening and more precise tests to identify the stage of cancer at the time of diagnosis might account for the increase, he said.

“Not many women aged 25 to 39 get screened, but some do, but it only takes a few to account for a notable increase from one in 100,000,” Dr. Berry said.

Dr. Silvia C. Formenti, a breast cancer expert and the chairwoman of radiation oncology at New York University Langone Medical Center, questioned the study in part because although it found an increased incidence of advanced disease, it did not find the accompanying increase in deaths that would be expected.

A spokeswoman for an advocacy group for young women with breast cancer, Young Survival Coalition, said the organization also wondered whether improved diagnostic and staging tests might explain all or part of the increase.

“We’re looking at this data with caution,” said the spokeswoman, Michelle Esser. “We don’t want to invite panic or alarm.”

She said it was important to note that the findings applied only to women who had metastatic disease at the time of diagnosis, and did not imply that women who already had early-stage cancer faced an increased risk of advanced disease.

Dr. J. Leonard Lichtenfeld
, deputy chief medical officer of the American Cancer Society, said he and an epidemiologist for the society thought the increase was real.

“We want to make sure this is not oversold or that people suddenly get very frightened that we have a huge problem,” Dr. Lichtenfeld said. “We don’t. But we are concerned that over time, we might have a more serious problem than we have today.”

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Deal Professor: In Wall St. Tax, a Simple Idea but Unintended Consequences

Some say that a financial transaction tax is a cost-free way to kill many a bird with one stone — raising revenue, preventing financial crashes and making markets safer. But advocates of this neat idea conveniently ignore the century of less-than-successful experience with this tax, including New York State’s own failed attempt.

The idea behind a financial transaction tax, which is a tax on individual market trades, has a smart pedigree. John Maynard Keynes suggested it, and James Tobin, a Nobel laureate in economics, was its most famous modern advocate. Tobin, who died in 2002, wanted to “throw some sand in the wheels” of the markets, and his idea, endorsed by Joseph Stiglitz and Lawrence H. Summers among others, is based on an increasingly held belief that markets are far from efficient. Imposing a transaction tax on each individual trade would eliminate wasteful trading and reduce market volatility, ending short-term speculation and mispricing of assets.

This net benefit is paired with a simple budget argument. The Robin Hood Tax campaign in Britain, for example, has used the slogan “Not complicated. Just brilliant” to support a 0.05 percent tax on transactions as an effective way to ease the budget without harming markets. Let’s face it, the banks are an easy target after the financial crisis.

It seems to be a win for everyone.

Unfortunately, the reality has been much different.

Let’s start with New York State, which has had such a tax since 1905. Over the next eight decades, the tax was revised up and down nine times, including a large increase in the middle of the Great Depression. In 1966, Mayor John V. Lindsay of New York City ended up raising the tax by 25 percent. It led to an immediate reaction as the New York Stock Exchange threatened to jump across the Hudson River to New Jersey.

In the 1970s, the tax began to be phased out. New York State still collects the tax — some $14.5 billion annually — but since 1981, the state has simply returned it to traders instead of keeping it. In other words, the tax is collected and immediately given back, something that can happen only in the strange world of taxes. (Other financial transaction taxes include a federal version, which was put in effect in 1914 to help pay for World War I and eliminated in 1966, and taxes in Massachusetts and Pennsylvania that were also done away with in the 1950s.)

A study of New York State’s tax over those eight decades by Anna Pomeranets and Daniel G. Weaver found that it increased the cost of capital for investors and reduced trading volume. Most important, they found the tax actually increased trading volatility by as much as 10 percent.

Increasing volatility is exactly what advocates of the tax don’t want. They want volatility reduced to prevent market disruptions, but the decline in traders in the markets mean fewer buyers and sellers and more price jumps. This finding of increased volatility is in general accord with nine other major papers to study this issue, including studies of the tax in 23 countries, among them Britain, Sweden and Japan. Only one of these papers found that a financial transaction tax reduced volatility.

The New York State tax experience raises a bigger issue — that of traders just going elsewhere. This problem was mirrored in Sweden.

In 1984, Sweden adopted a financial transaction tax. Some 30 percent to 50 percent of the country’s trading volume then shifted to Britain. The lower amount of trading meant that not only did the tax yield less money than predicted but that the country lost more in capital gains taxes than the financial transaction tax raised. The tax was abolished in 1991.

The Swedish and New York State examples show that not only will traders leave to trade elsewhere; the money that people think this tax will reap will not appear, as that trading migrates and volume declines. Japan decided to eliminate its financial transaction tax in 1999 for this reason.

And even if the trading does not shift to other places, financial people are adept at avoiding it. In Britain, for example, where the financial transaction tax has fluctuated from half a percent to 2 percent, the tax has raised significantly less revenue than one might expect, about £3 billion a year. The reason is that investors who trade regularly in Britain use options to avoid the tax, which applies only to trading in stock. The result may be that the tax pushes investors into more risky securities in their efforts to avoid it.

And the reduced volume does not just reduce the amount of revenue collected. It may impose the largest costs on people who cannot afford or avoid the tax. The money management firm BlackRock has calculated that if the financial transaction tax were set at 0.1 percent per trade, an investor putting $10,000 in its global equity fund would lose more than $2,300 in expected returns over a 10-year period. This amount would rise to $15,000 if the money were invested in a more actively managed European fund.

This means not only less in retirement funds, but fewer jobs. Although disputed, one study in 2004 by the Partnership for the City of New York found that if New York State started keeping a tax of 0.25 cents per share traded, it would lose 23,000 to 33,000 jobs for every 10 percent drop in volume and more than $3 billion in lost revenue and economic value, probably more than offsetting the amount it collected.

This is not to say that a financial transaction tax by itself is such a terrible idea. My point is that we already have lots of experience with this kind of tax, and it argues for caution. If you think a financial transaction tax will reduce volatility, then you have to account for the fact that taxes in the past have shown the opposite. And if the tax is not imposed globally, it will force migrations of trading to less regulated places and in more byzantine forms, possibly making the world markets less safe.

As for seeking revenue gains to solve budget problems, if the tax is too small, it will have no effect. But the larger it is — and the Robin Hood Foundation’s proposal is in the large sphere — the more markets will be affected. It is for these reasons that Canada has rejected such a tax.

Now, we are about to get a real-life case study. France has adopted a 0.2 percent financial transaction tax involving securities of a company with a market capitalization of more than 1 billion euros. The full effects of France’s tax are not yet known, but a preliminary study by Credit Suisse, according to The Economist, found that stocks not subject to a tax rose 19 percent by volume, but those affected by the tax declined 16 percent. And the net effect of the tax appears to have shifted trading to smaller stocks not subject to it, distorting the allocation of capital, which is another problem with the tax. And the European Union has proposed a tax for 11 of its member countries, giving us a possible second test.

Instead of rushing into the adoption of a financial transaction tax, it may behoove us to watch and see whether these new taxes in Europe work. And even if the United States plunges ahead, history tells us that any tax should be carefully structured and considered before being put into effect. For there are likely to be many unintended consequences. There’s a reason that economists say there is no free lunch.

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Bill would bar some athletes from California workers' comp claims

SACRAMENTO — Players for professional sports teams based outside of California would be barred from filing compensation claims for job-related injuries under proposed legislation supported by owners of football, baseball, basketball, hockey and soccer franchises.

A bill unveiled Monday by Assembly Insurance Committee Chairman Henry Perea (D-Fresno) would ban retired athletes from seeking workers' compensation benefits from California courts after they've played relatively few games in California stadiums and arenas during their careers.

The proposal, AB 1309, is expected to be one of the most hotly debated issues of the legislative session, with team owners lining up against the players' unions and their labor allies.

The bill, said Perea, is expected to be a "starting point" for a lively legislative debate over whether claims from out-of-state retired players represent abuse of the California workers' compensation system and wind up hitting all California employers with higher premiums and surcharges that pay for outstanding claims left by failed insurance companies.

"It's a question of fairness," Perea said.

Workers' compensation is 100% employer funded and does not depend on taxpayers' support.

The cost argument is phony, countered Richard Berthelsen, a consulting lawyer with the National Football League Players Assn. A prorated share of a team's workers' compensation bill is calculated into athletes' salary caps, so, in effect, they're paying for their own insurance coverage, Berthelsen contended. "They pay for their own benefits," he said.

Perea's bill would affect professional athletes from only the five big sports and not members of other professions whose work takes them from state to state, such as horse racing jockeys, truck drivers and salesmen. It would bar the filing of claims for cumulative trauma — caused by years of stress and pounding on a body rather than a broken bone or other specific injury — unless a player worked at least 90 days in California during the year prior to seeking benefits.

California is the only state that makes it relatively easy for long-retired players to claim cumulative trauma injuries. About 4,500 out-of-state players have won judgments or settlements since the early 1980s, according to a study commissioned by the professional sports leagues.

The bill, if it should become law, would apply to thousands of out-of-state athletes' claims currently pending before California workers' compensation judges.

Perea's legislation, by restricting benefits only for professional athletes, is potentially unfair, labor officials argued.

Regardless of whether they play for out-of-state teams, said Angie Wei, legislative director of the California Labor Federation, "these players are workers and they deserve to have access to their benefits. They work for short durations of time at an intense level and get injured."

marc.lifsher@latimes.com

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‘Identity Thief’ tops box office with $14 million

NEW YORK (AP) — A week after losing the box office title to Bruce Willis, Melissa McCarthy took it back again.

McCarthy’s road trip comedy “Identity Thief” topped the box office in its third week of release on Oscar weekend with $ 14 million for Universal. 20th Century Fox‘s “A Good Day to Die Hard,” starring Willis, slid to fifth with $ 10.1 million.

The top 20 movies at U.S. and Canadian theaters Friday through Sunday, followed by distribution studio, gross, number of theater locations, average receipts per location, total gross and number of weeks in release, as compiled Monday by Hollywood.com are:

1. “Identity Thief,” Universal, $ 14,017,085, 3,222 locations, $ 4,350 average, $ 93,619,615, three weeks.

2. “Snitch,” Lionsgate, $ 13,167,607, 2,511 locations, $ 5,244 average, $ 13,167,607, one week.

3. “Escape From Planet Earth,” Weinstein Co., $ 10,682,037, 3,353 locations, $ 3,186 average, $ 34,812,699, two weeks.

4. “Safe Haven,” Relativity Media, $ 10,454,713, 3,223 locations, $ 3,244 average, $ 47,916,356, two weeks.

5. “A Good Day to Die Hard,” Fox, $ 10,165,633, 3,555 locations, $ 2,860 average, $ 51,967,897, two weeks.

6. “Dark Skies,” Weinstein Co., $ 8,189,166, 2,313 locations, $ 3,540 average, $ 8,189,166, one week.

7. “Silver Linings Playbook,” Weinstein Co., $ 5,750,866, 2,012 locations, $ 2,858 average, $ 107,176,012, 15 weeks.

8. “Warm Bodies,” Lionsgate, $ 4,825,388, 2,644 locations, $ 1,825 average, $ 58,243,441, four weeks.

9. “Beautiful Creatures,” Warner Bros., $ 3,608,333, 2,950 locations, $ 1,223 average, $ 16,570,598, two weeks.

10. “Side Effects,” Open Road Films, $ 3,357,039, 2,070 locations, $ 1,622 average, $ 25,099,555, three weeks.

11. “Zero Dark Thirty,” Sony, $ 2,230,084, 1,197 locations, $ 1,863 average, $ 91,539,075, 10 weeks.

12. “Argo,” Warner Bros., $ 1,827,165, 802 locations, $ 2,278 average, $ 129,653,502, 20 weeks.

13. “Hansel and Gretel: Witch Hunters,” Paramount, $ 1,684,532, 1,425 locations, $ 1,182 average, $ 52,945,086, five weeks.

14. “Life of Pi,” Fox, $ 1,605,366, 572 locations, $ 2,807 average, $ 113,525,126, 14 weeks.

15. “Lincoln,” Disney, $ 1,481,081, 875 locations, $ 1,693 average, $ 178,603,571, 16 weeks.

16. “Mama,” Universal, $ 1,173,900, 1,163 locations, $ 1,009 average, $ 70,230,570, six weeks.

17. “Quartet,” Weinstein Co., $ 1,125,886, 356 locations, $ 3,163 average, $ 8,844,950, seven weeks.

18. “Django Unchained,” Weinstein Co., $ 971,655, 659 locations, $ 1,474 average, $ 158,783,430, nine weeks.

19. “Amour,” Sony Pictures Classics, $ 716,186, 328 locations, $ 2,183 average, $ 5,147,242, 10 weeks.

20. “Wreck-It Ralph,” Disney, $ 645,870, 402 locations, $ 1,607 average, $ 186,676,411, 17 weeks.

___

Universal and Focus are owned by NBC Universal, a unit of Comcast Corp.; Sony, Columbia, Sony Screen Gems and Sony Pictures Classics are units of Sony Corp.; Paramount is owned by Viacom Inc.; Disney, Pixar and Marvel are owned by The Walt Disney Co.; Miramax is owned by Filmyard Holdings LLC; 20th Century Fox and Fox Searchlight are owned by News Corp.; Warner Bros. and New Line are units of Time Warner Inc.; MGM is owned by a group of former creditors including Highland Capital, Anchorage Advisors and Carl Icahn; Lionsgate is owned by Lions Gate Entertainment Corp.; IFC is owned by AMC Networks Inc.; Rogue is owned by Relativity Media LLC.

___

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Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative, which will provide the vaccine and help pay for the campaign.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

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DealBook: Confirmation Hearing for Mary Jo White Said to Be Scheduled for March

Mary Jo White appears poised to face a confirmation hearing next month, a crucial step for the former federal prosecutor on her path to becoming the top Wall Street regulator.

Ms. White, whose nomination to lead the Securities and Exchange Commission has lingered for over a month, plans to testify in March before the Senate Banking Committee, two Congressional officials briefed on the matter said. The committee has not set a firm date for the confirmation hearing, the officials said, though lawmakers have tentatively scheduled her to appear the week of March 11.

The committee, which oversees the S.E.C. and other financial regulators, must bless her appointment before the full Senate holds a vote. While some officials have quietly expressed concerns about Ms. White’s role as a Wall Street defense lawyer, her nomination is not expected to face major complications.

The timetable laid out on Monday represents a slight delay from earlier plans. An S.E.C. official who spoke anonymously said the agency initially expected Ms. White to face a confirmation hearing in early February. An S.E.C. spokesman did not immediately respond to a request for comment.

The extra time has proved helpful. Over the last couple of weeks, Ms. White has received multiple briefings from agency staff members about new securities rules and the structure of the stock market, the official said. The briefings will in part prepare her for the confirmation hearing, which is expected to cover a broad scope of topics.

While Ms. White is a skilled litigator, she lacks experience in financial rule-writing and regulatory minutiae, a potential stumbling block for her nomination. Lawmakers also expect to raise questions about her movements in and out of the revolving door that bridges government service and private practice. Some Democrats, a person briefed on the matter said, will question whether she is too cozy with Wall Street.

In private practice, Ms. White defended some of Wall Street’s biggest names, including Kenneth D. Lewis, a former chief of Bank of America. As the head of litigation at Debevoise & Plimpton, she also represented JPMorgan Chase and the board of Morgan Stanley. Her husband, John White, is co-chairman of the corporate governance practice at Cravath, Swaine & Moore, where he represents many of the same companies that the S.E.C. regulates.

(Ms. White has agreed to recuse herself from many matters that involve former clients, while her husband agreed to convert his partnership at Cravath from equity to nonequity status.)

Despite some reservations, she is expected to receive broad support on Capitol Hill. When President Obama nominated her last month, Senator Charles E. Schumer of New York was one of several Democrats to praise her prosecutorial prowess, calling her “tough-as-nails” during stints as a federal prosecutor in Brooklyn and as the first female United States attorney in Manhattan.

While she handled some white-collar and securities cases, her specialty was terrorism and mafia cases. As a top federal prosecutor in New York City for more than a decade, she helped oversee the prosecution of the crime boss John Gotti and directed the case against those responsible for the 1993 World Trade Center bombing. She also supervised the original investigation into Osama bin Laden and Al Qaeda.

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