Seeing Through the Fog of ‘Chemo-Brain’

Two weeks ago, Diem Brown, contestant of the Real World/Road Rules Challenge, shared on her PEOPLE.com blog her frustration with her chemo-brain, after having received chemotherapy over the Thanksgiving holiday for recently diagnosed ovarian cancer.

She writes, “Stressed out, overwhelmed and soooo annoyed that your mind isn’t working as it should. This, my friends, is an example of chemo brain!”

Unfortunately, as a surgeon, I have witnessed too many patients get the diagnosis of cancer. If they can transcend the initial shock, there is a desperation to understand what their lives will be like as cancer patients, and what the odds are that they will be cancer survivors.

But for many women, their fear of death is as strong as their fear of chemotherapy, the poison that along with hope, is inseparable from the Hollywood images of the sick, nauseated, thin and bald.

Diem refers to “chemo-brain”, also known as “chemo-fog”, a side effect of chemotherapy that causes problems with memory, information processing, and mood –- effects that can persistent for as many as 20 years after treatment has subsided.

Mental dullness or fatigue and an inability to focus characterized by difficulty organizing thoughts and keeping memories has also been described by patients who suffer from chemotherapy induced cognitive dysfunction.

For years, chemo-brain went largely unrecognized by health care professionals, and those who suffered from it were left without answers to their confusion.

Recently, through the Internet, web chatting and blogging, many women who suffered from chemo-brain realized they were not alone, and over the last few years, several studies have been done giving credit to the condition. But, as they say, you have to see it to believe it.

And now we can see it. In the process of presenting my own research discussing the use of imaging in breast cancer patients at this week’s San Antonio Breast Cancer Symposium, I stumbled across a presentation discussing how scientists are trying to clear the chemo-fog by imaging the brain.

Dr. Bernadine Cimprich from the University of Michigan, along with a group of scientists from the University of Washington and University of Toronto took the stage in San Antonio Friday to shed some light through the fog, and offer a strategy at prevention.

Since chemo-brain doesn’t affect all cancer patients to the same degree, they asked the question, are some patients who receive chemotherapy predisposed to developing the disease?

Chemo-brain has been studied before, but has been difficult to characterize because so many different types of drugs and regimens are used, and for the most part patient’s memory and cognition are not studied prior to starting cancer therapy.

To help shed some light on the subject, these researchers used functional magnetic resonance imaging, or fMRI – a technology that uses magnets to image the brain as it works.

By taking pictures of the brain before and after chemotherapy, they found that patients who suffered from this condition had inherently different function from those who did not before they had even received treatment.

“Brain imaging before treatment showed reduced function in frontal [brain] regions” says Dr. Cimprich, the precise regions that are needed to perform working memory and guide our day-to-day activities, such as remembering the shopping list, our finding our way home.

Identifying patients who may be predisposed to developing chemo-brain can help oncologists alter treatment strategies in efforts to reduce or eliminate the fog.

Who are the patients at highest risk? Dr. Cimprich’s team used surveys to evaluate pre-treatment cognitive function and found that fatigue is a major factor. He suggests that “early interventions targeting fatigue may improve cognitive function and reduce the distress of chemo-brain”.

While the small study involved 98 patients, only 29 of which received chemotherapy, it still lays ground to understand the true nature of chemo-brain, and as Dr. Cimprich emphasizes, identifying the problem early is crucial, because early cognitive problems can become worse over time.

In her blog, Diem suggests making lists as a way to overcome her chemo-brain. And while we all know that stressful times can side track our minds and dull our spirits, until science can give us better answers, research suggests that a deep breath and a little yoga may help do the job of lifting the fog on chemo-brain.

Dr. Christopher Tokin is a surgical resident at the University of California, San Diego School of Medicine and a resident alumnus of the ABC News Medical Unit.

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EU leaders in Norway to pick up Nobel Peace Prize

OSLO, Norway (AP) — European Union leaders on Sunday hailed the achievements of the 27-nation bloc, but acknowledged they need more integration and authority to solve problems, including its worst financial crisis, as they arrived in Norway to pick up this year’s Nobel Peace Prize.

Conceding that the EU lacked sufficient powers to stop the devastating 1992-95 Bosnia war, European Commission President Jose Manuel Barroso said that the absence of such authority at the time is “one of the most powerful arguments for a stronger European Union.”

Barroso spoke to reporters with EU Council President Herman Van Rompuy and the president of the EU Parliament, Martin Schulz, in Oslo, where the three leaders were to receive this year’s award, granted to the European Union for fostering peace on a continent ravaged by war.

Nobel committee chairman Thorbjoern Jagland will present the prize, worth $ 1.2 million, at a ceremony in Oslo City Hall, followed by a banquet at the Grand Hotel, against a backdrop of demonstrations in this EU-skeptic country that has twice rejected joining the union.

About 20 European government leaders, including German Chancellor Angela Merkel, French President Francois Hollande and British Deputy Prime Minister Nick Clegg, will be joining the ceremonies. They will be celebrating far away from the EU’s financial woes in a prosperous, oil-rich nation of 5 million on the outskirts of Europe that voted in 1972 and 1994 in referendums to stay out of the union.

The decision to award the prize to the EU has sparked harsh criticism, including from three peace laureates — South African Archbishop Desmond Tutu, Mairead Maguire of Northern Ireland and Adolfo Perez Esquivel from Argentina — who have demanded the prize money not be paid out this year. They say the bloc contradicts the values associated with the prize because it relies on military force to ensure security.

The leader of Britain’s Independence Party, Nigel Farage, in a statement described rewarding the EU as “a ridiculous act which blows the reputation of the Nobel prize committee to smithereens.”

Hundreds of people demonstrated against this year’s prize winners in a peaceful torch-lit protest that meandered through the dark city streets to Parliament, including Tomas Magnusson from the International Peace Bureau, the 1910 prize winner.

“This is totally against the idea of Alfred Nobel who wanted disarmament,” he said, accusing the Nobel committee of being “too close to the power” elite.

Dimitris Kodelas, a Greek lawmaker from the main opposition Radical Left party, or Syriza, said a humanitarian crisis in his country and EU policies could cause major rifts in Europe. He thought it was a joke when he heard the peace prize was awarded to the EU. “It challenges even our logic and it is also insulting,” he said.

The EU is being granted the prize as it grapples with a debt crisis that has stirred deep tensions between north and south, caused soaring unemployment and sent hundreds of thousands into the streets to protest austerity measures.

It is also threatening the euro — the common currency used by 17 of its members — and even the structure of the union itself, and is fuelling extremist movements such as Golden Dawn in Greece, which opponents brand as neo-Nazi.

Barroso acknowledged that the current crisis showed the union was “not fully equipped to deal with a crisis of this magnitude.”

“We do not have all the instruments for a true and genuine economic union … so we need to complete our economic and monetary union,” he said, adding that the new measures, including on a banking and fiscal union, would be agreed on in coming weeks.

He stressed that despite the crisis all steps taken had been toward “more, not less integration.”

Van Rompuy was optimistic saying that EU would come out of the crisis stronger than before. “We want Europe to become again a symbol of hope,” he said.

The EU says it will donate the prize money to projects that help children in conflict zones and will double it with EU funds.

The European Union grew from the conviction that ever-closer economic ties would ensure century-old enemies like Germany and France never turned on each other again, starting with the creation in 1951 of the European Coal and Steel Community, declared as “a first step in the federation of Europe.”

In 60 years it has grown into a 27-nation bloc with a population of 500 million, with other nations eagerly waiting to join, even as its unity is being threatened by the financial woes.

While there have never been wars inside EU territory, the confederation has not been able to prevent European wars outside its borders. When the deadly Balkans wars erupted in the 1990s, the EU was unable by itself to stop them. It was only with the help of the United States and after over 100,000 lives were lost in Bosnia was peace eventually restored there, and several years later, to Kosovo.

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U.S. judge names lead plaintiffs in Facebook litigation

NEW YORK (Reuters) – A group of investors including state pension funds in North Carolina and Arkansas will be the lead plaintiffs in securities lawsuits arising out of Facebook Inc’s $ 16 billion initial public offering, a U.S. judge ruled on Thursday.

The investors, in a proposed class-action case, have accused Facebook of misrepresenting its financial condition in the run-up to the May stock offering. They are represented by law firms Bernstein Litowitz Berger & Grossmann and Labaton Sucharow.

The ruling helps set a structure for the Facebook IPO litigation, a headache for the social media company and a nagging reminder of the technical glitches in the highly anticipated stock market debut.

U.S. District Judge Robert Sweet in Manhattan also named lead plaintiffs for lawsuits against NASDAQ OMX Group Inc stemming from the IPO. NASDAQ was sued over allegations that orders to buy and sell Facebook were not properly executed on the first day of trading.

Facebook, which has defended its pre-IPO disclosures, declined to comment on Thursday. A spokesman for NASDAQ declined to comment on the litigation.

Facebook shares made their debut at $ 38 per share, and later fell as much as 50 percent. On Thursday, they closed at $ 26.90, down 2.6 percent.

Sweet consolidated the cases and picked lead plaintiffs to head up most of the 42 lawsuits before him arising out of the IPO.

Under a federal law governing securities lawsuits, courts routinely select a lead plaintiff in class actions. The lead plaintiff typically is the shareholder with the biggest losses, though judges have discretion to pick a different investor.

The plaintiff group picked to lead 31 cases alleging securities violations against Facebook includes the North Carolina Retirement Systems, Arkansas Teacher Retirement System, the Fresno County Employees’ Retirement Association and Banyan Capital Master Fund Ltd.

The group has collectively claimed a combined $ 7.1 million in losses.

“Its members are large, institutional investors with experience representing shareholder classes in similar litigation with the resources to pursue the action,” Sweet said.

In the securities lawsuits against NASDAQ, the judge said First New York Securities LLC, T3 Trading Group LLC, and Avatar Securities LLC would act as co-lead plaintiffs. The group traded a combined $ 316 million in Facebook shares the day of the IPO, the decision said.

The case is In re Facebook, Inc, IPO Securities and Derivative Litigation, U.S. District Court, Southern District of New York, MDL No. 12-2389.

(Reporting by Nate Raymond; Editing by Martha Graybow)

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Cablevision to raise Internet prices by $5 a month

(Reuters) – Cablevision Systems Corp, the New York-based cable operator, said on Thursday it would raise its Internet prices by $ 5 in January, representing an average hike of 3.2 percent for customers’ total monthly bills.

The company said in a statement that prices for its video and phone services will not be affected and that prices for promotional packages, which generally last one year, will not rise.

But all customers who have Internet service as part of their video or phone package will see prices rise.

Cablevision said it had not raised Internet prices in a decade. It raised video prices in 2011, which saw customer bills rise by 2.88 percent on average.

The company said it has invested $ 140 million in improving its Internet network, deployed more than 50,000 WiFi “hotspots,” and puts no usage caps on its service, unlike some cable competitors.

Canaccord Genuity analyst Tom Eagan downgraded his Cablevision rating from “buy” to “hold” on November 27 and said that Cablevision would lose customers if it were to decide to raise prices not long after Superstorm Sandy.

“Given the massive service outages among its subscribers (after Sandy), we don’t believe the company can raise rates … without incurring material customer churn,” Eagan said.

The cable provider, which is controlled by the Dolan family, said in early November that costs from Sandy, which knocked out service for as many as half its customers, would be substantially higher than its $ 16 million bill from Hurricane Irene in 2011.

Like bigger operators Comcast and Time Warner Cable, Cablevision has been losing customers to rivals such as satellite television provider DirecTV and telephone operator Verizon Communications.

Cablevision shares closed up 2.6 percent, at $ 14.16, on Thursday.

(Reporting By Liana B. Baker; Editing by Steve Orlofsky and Leslie Adler)

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Health workers march in Spain’s capital against cuts, reforms

MADRID (Reuters) – Thousands of health workers, on strike since last month, marched on Sunday in Madrid to protest against budget cuts and plans from the Spanish capital’s regional government to privatize the management of public hospitals and medical centers.

It was the third time doctors, nurses and health workers have rallied since the local authorities put forward a plan in October to place six hospitals and dozens of medical practices under private management. The plan also calls for patients to be charged a fee of 1 euro for prescriptions.

Workers launched an indefinite strike last month against the plan, which has not been endorsed by the centre-right government of Prime Minister Mariano Rajoy. Health workers in the capital are striking Monday-Thursday each week and seeing patients only on Fridays, while also responding to emergencies.

Spain’s 17 autonomous regions control health and education policies and spending. They have all had to implement steep cuts this year as the country struggles to meet tough European Union-agreed deficit targets.

Dressed in white scrubs, the protesters shouted slogans such as “Health is not for sale” and “Health 100 percent public, no to privatizations”.

“Of course, privatization can be reversed. Actually the question is not if it can be reversed, because privatization should never have a future,” said Luis Alvarez, an unemployed man from Madrid attending the demonstration.

Belen Padilla, a doctor at Madrid’s hospital Gregorio Maranon, said one million citizens had already signed a petition rejecting the plan.

(Reporting by Reuters Television; Writing by Julien Toyer; Editing by Peter Graff)

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Syria's civil war spills into Lebanon, 4 dead

BEIRUT (AP) — Syria's civil war spilled over into neighboring Lebanon once again on Sunday, with gun battles in the northern city of Tripoli between supporters and opponents of President Bashar Assad's regime that left four dead.

Nine Syrian judges and prosecutors also defected to the opposition. It was the latest setback for the regime, which appears increasingly embattled with rebels making gains in northern Syria and near Damascus, the capital.

The defecting judges posted a joint statement online urging others to join them and break ranks with Assad's regime. There have been several high-level defections over the past year, including Assad's former prime minister.

In Geneva, the United Nation's Special Representative for Syria and the Arab League, Lakdhar Brahimi, met with Russian Deputy Foreign Minister Mikhail Bogdanov and U.S. Deputy Secretary of State William Burns to discuss the crisis in Syria. They said in a joint statement that the situation in Syria was "bad and getting worse," adding that a political process to end the conflict was "still necessary and still possible."

Russia and the United States have argued bitterly over how to address the conflict, which began with peaceful protests against Assad in March 2011 and escalated into a civil war that has killed an estimated 40,000 people. Activists said another 45 were killed on Sunday.

The U.S. has criticized Russia for shielding the Assad regime, while Moscow has accused Washington of encouraging the rebels and being intent on regime change.

In Moscow, Russian Foreign Minister Sergey Lavrov said that Russia agreed to take part in the Geneva talks on condition there would be no demand for Assad to step down. Washington and its allies, including Turkey and Qatar, have repeatedly called on the Syrian president to step down to help stop the bloodshed.

"We are not conducting any negotiations on the fate of Assad," Lavrov said, adding that the Americans were wrong to see Moscow as softening its position on Syria. "All attempts to portray things differently are unscrupulous, even for diplomats of those countries which are known to try to distort the facts in their favor."

Addressing fears that Assad could use chemical weapons in a last-ditch effort to save his regime, Lavrov once again said the Syrian government has given assurances that it has no intention of ever using the weapons of mass destruction. He said the greatest threat is that they would fall into the hands of militants.

Russia's foreign minister said that after he agreed to a U.S. proposal to have his and Secretary of State Hillary Rodham Clinton's deputies "brainstorm" on Syria, the Americans began to suggest that Russia was softening its position.

"No such thing," Lavrov said. "We have not changed our position."

He urged the international community to come together and "with one voice" to demand a cease-fire, return U.N. observers in bigger numbers and begin a political dialogue. Lavrov repeated that Russia was not wedded to Assad but believed that only the Syrians have the right to choose their leaders.

In Washington, a senior State Department official said the U.S. remains willing to hold additional discussions in the weeks ahead, if it would help "advance the process of political transition that the people of Syria seek." The official spoke on condition of anonymity because he was not authorized to discuss Sunday's meeting in Geneva with reporters.

Qatari Prime Minister and Foreign Minister Hamad bin Jassim Al Thani urged Assad to step down. With the rebels at the president's doorstep in Damascus, he said, Assad knows the regime will fall.

"But how much killing and destruction does he want before this inevitable outcome?" Hamad said after an Arab League meeting in the Qatari capital, Doha.

In Lebanon, fighting between pro-and anti-Assad gunmen flared as bodies of three Lebanese, who were killed after crossing into Syria to fight in the civil war were brought back home for burial, the state-run National News Agency said.

Four people were killed and 12 were wounded in the gunfights, the agency said. Two Lebanese soldiers were also injured, the Lebanese Armed Forces command said.

Syria civil war has often spilled into neighboring countries including Turkey, Lebanon and Israel, raising concerns of a wider war in the volatile region.

Lebanon, which Syria dominated for decades, is particularly vulnerable to getting sucked into the crisis. The two countries share a porous border and a complex web of political and sectarian ties.

Syria's opposition is dominated by members of the Sunni Muslim minority. Assad's regime is predominantly Alawite, an offshoot of Shiite Islam.

Tripoli has been the scene of frequent sectarian clashes between the Alawite and Sunni Muslim communities. Last week, the Lebanese army sent additional troops to Tripoli to try to prevent clashes that broke out over reports that 17 Lebanese men were killed after entering Syria to fight alongside the rebels.

In Syria, fighting between opposition fighters and regime troops was concentrated in northern Idlib province, in the Damascus suburbs and in Aleppo, Syria's largest city, according to the Britain-based opposition activist group Syrian Observatory for Human Rights. At least 45 people were killed in fighting Sunday, said the group, which relies on reports from activists on the ground.

Syria's state-run SANA news agency said four people were killed when a rocket slammed into the Armenian quarter of the city of Homs. SANA said "terrorists" were behind the attack that also injured several others. Damascus refers to rebels as terrorists and mercenaries of Western and Gulf countries.

The Observatory also said rebels have made significant advances in the battle over a sprawling military base west of Aleppo after heavy clashes with regime troops Sunday.

_____

Associated Press writers Jamal Halaby in Amman, Jordan, Lynn Berry in Moscow, John Heilprin in Geneva, Switzerland, Matthew Lee in Washington, and Abdullah Rebhy, in Doha, Qatar, contributed to this report.

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As Syria's rebels close in, Assad has three options

The magnificent views across Damascus from the presidential palace on Mount Qassioun are unlikely to provide much comfort these days for Bashar al-Assad, Syria’s beleaguered head of state.

For several weeks, the skyline to the north, east, and south has been stained by black columns of smoke from artillery explosions and air strikes as Syrian government forces struggle to prevent the Free Syrian Army (FSA) rebels from inching ever closer to their goal of unseating Mr. Assad’s regime.

After 20 months of confrontation, Assad’s hold on power is looking increasingly frail, leaving him and his regime with few remaining options.

“There is no doubt that the regime’s capacity is declining and that the FSA continues to become ever stronger and better armed,” says a European diplomat closely following developments in Syria.

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The current status of the regime is uncertain and it is not even clear if Assad is still in charge. The diplomat says that Assad appears to have become a “prisoner of his own system,” no longer playing an active leadership role and confined to his palace. Instead, there are indications that an informal "security council” has emerged consisting of between 50 to 100 top regime and military figures drawn from the minority Alawite community which is handling the daily confrontation against the armed opposition.

THREE OPTIONS

Either way, the regime is steadily losing ground as the rebels attempt to encircle Damascus for an apparent final push into the city center, leaving Assad with three possible choices. The first – although least likely – option is to remain in the presidential palace to the bitter – and probably bloody – end, fulfilling a promise he made last month in an interview with Russian television to “live and die in Syria”.

A second possibility is to escape Damascus with his family and seek asylum in a third country, perhaps Iran or Venezuela, the governments of which openly support the Syrian regime. Faisal Miqdad, Syria’s deputy foreign minister, was reported to have visited Venezuela, Cuba, and Ecuador recently. Ecuador subsequently announced that it was not entertaining the idea of granting asylum to Assad.

The most likely option, however, and one that appears already to be under way, is for the regime and the core of the army and security forces to retreat to the Alawite-populated mountains on the Mediterranean coast. Diplomatic sources say that there are unconfirmed reports that the regime is planning to register all Sunnis who live in the coastal cities of Tartous, Banias, and Latakia which could potentially form part of an Alawite-dominated enclave. The coastal cities are predominantly Sunni-populated while the mountain hinterland is mainly Alawite.

EXODUS TO THE MOUNTAINS

Furthermore, there appears to be a steady and discreet trickle of families of pro-regime Alawite army officers leaving the upmarket Mezzeh neighborhood of Damascus for the coastal mountains.

“More and more regime supporters and, or their families are moving up the coast, and there are persistent rumors that at least part of the government now sits in Tartous,” the European diplomat says. “All indications are that the regime's fallback position is to retreat to the coastal area of ​​Tartous and Latakia.”

Significantly, units of the rebel Free Syrian Army operating north of Damascus appear to be limiting ambushes to south-bound military traffic heading to the capital along the main highway, the sources say. Vehicles heading north are left unmolested, raising the possibility that the highway, which leads to Tartous, is being offered as an escape route for the regime to prevent a protracted and bloody last stand in Damascus.

INCREMENTAL RETREAT

Still, there might not be a mad dash for the mountains as Damascus falls but more of an incremental retreat.

“I think that the Assad regime will go in stages,” says Andrew Tabler, Syria expert at the Washington Institute for Near East Policy. “You have the north and east go and then after that there will be a real effort to hold on to Damascus as long as possible. But in the end I don't see that as viable.”

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Mr. Tabler says he envisages a staged pullback from Damascus first to the area west of Homs, Syria’s third largest city which lies two-thirds of the way along the Damascus-Tartous highway, and then to the mountains.

“Those areas are viable, I think, in the short- to medium-term,” he says.

A fallback to Homs would explain the fierce fighting that erupted in September and October in a string of villages between Homs and the border with Lebanon, 20 miles to the south. Syrian troops assisted by pro-regime Shabiha militiamen and combatants from Hezbollah, the Lebanese militant Shia group, fought rebel forces to maintain control of the villages which flank the vital Damascus-Tartous highway.

ALAWITE STATELET?

While there appears to be consensus among analysts that the regime will eventually decamp to the coastal region, what remains unclear is the nature of the enclave – if any – that would be established there. The prospect of creating a mini Alawite state along the lines of the French-engineered statelet between 1920 and 1937 appears improbable under current circumstances. It would require the suppression of hostile Sunnis in the coastal cities and would be internationally ostracized and subject to attack by the FSA.

The chief motivation for retreating to the mountains in the first place is self-preservation rather than state-building (Alawites represent about 12 percent of Syria’s 23 million, while Sunnis comprise about 70 percent).

“The Alawite community … is counting on [Assad’s] army to protect them from possible retribution from the rebel militias,” writes Joshua Landis, professor of Middle East history at the University of Oklahoma and author of the influential Syria Comment blog. “Sectarian hatred has been driven to a fever pitch by the brutality of the regime. Syrians have been putting hate into their hearts over the past two years, making the likelihood of some sort of retribution ever more likely and the ethnic cleansing a possibility, even if a small one at the time.”

A rump regime well-entrenched into the mountain villages defended by the Alawite core of the army and security services equipped with armor, artillery, air power and possibly even chemical and biological weapons could buy the Assads some breathing space during a likely period of chaos caused by a sudden leadership vacuum in Damascus. But it is questionable whether it would provide a long-term solution for the Assad clan’s survival.

ALAWITE DIVISIONS

Also working against a more formally established enclave is the fact that not all Alawites support the Assad regime. Some may prefer to cut a deal with the opposition rather than link the fate of the community to that of the Assads. Even Assad’s home town of Qordaha, 15 miles south east of Latakia, has reportedly seen some intra-Alawite unrest between supporters and opponents of the Assad clan.

The Assad family, under Bashar’s 12-year rule, has “all but seceded socially and economically” from its roots and has done “precious little” for the Alawites which remains one of the poorest communities in Syria, says Fred Hof, a senior fellow at the Atlantic Council’s Rafik Hariri Center for the Middle East and former special adviser for transition in Syria at the State Department.

“On top of that, they have placed this community in grave jeopardy by recklessly pursuing a sectarian strategy to save their skins and preserve their ability to acquire material wealth,” he says. “In sum, I think it would be inadvisable for the [Assads] and their chief enablers to try and set up shop in Latakia and vicinity. If they have to escape in that direction because of a closed Damascus airport, they’d do well to keep moving. Where to? I don’t know who would have them at this point.”

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Peru’s capital highly vulnerable to major quake

LIMA, Peru (AP) — The earthquake all but flattened colonial Lima, the shaking so violent that people tossed to the ground couldn’t get back up. Minutes later, a 50-foot (15-meter) wall of Pacific Ocean crashed into the adjacent port of Callao, killing all but 200 of its 5,000 inhabitants. Bodies washed ashore for weeks.

Plenty of earthquakes have shaken Peru‘s capital in the 266 years since that fateful night of Oct. 28, 1746, though none with anything near the violence.

The relatively long “seismic silence” means that Lima, set astride one of the most volatile ruptures in the Earth’s crust, is increasingly at risk of being hammered by a one-two, quake-tsunami punch as calamitous as what devastated Japan last year and traumatized Santiago, Chile, and its nearby coast a year earlier, seismologists say.

Yet this city of 9 million people is sorely unprepared. Its acute vulnerability, from densely clustered, unstable housing to a dearth of first-responders, is unmatched regionally. Peru’s National Civil Defense Institute forecasts up to 50,000 dead, 686,000 injured and 200,000 homes destroyed if Lima is hit by a magnitude-8.0 quake.

“In South America, it is the most at risk,” said architect Jose Sato, director of the Center for Disaster Study and Prevention, or PREDES, a non-governmental group financed by the charity Oxfam that is working on reducing Lima’s quake vulnerability.

Lima is home to a third of Peru’s population, 70 percent of its industry, 85 percent of its financial sector, its entire central government and the bulk of international commerce.

“A quake similar to what happened in Santiago would break the country economically,” said Gabriel Prado, Lima’s top official for quake preparedness. That quake had a magnitude of 8.8.

Quakes are frequent in Peru, with about 170 felt by people annually, said Hernando Tavera, director of seismology at the country’s Geophysical Institute. A big one is due, and the chances of it striking increase daily, he said. The same collision of tectonic plates responsible for the most powerful quake ever recorded, a magnitude-9.5 quake that hit Chile in 1960, occurs just off Lima’s coast, where about 3 inches of oceanic crust slides annually beneath the continent.

A 7.5-magnitude quake in 1974 a day’s drive from Lima in the Cordillera Blanca range killed about 70,000 people as landslides buried villages. Seventy-eight people died in the capital. In 2007, a 7.9-magnitude quake struck even closer, killing 596 people in the south-central coastal city of Pisco.

A shallow, direct hit is the big danger.

More than two in five Lima residents live either in rickety structures on unstable, sandy soil and wetlands that amplify a quake’s destructive power or in hillside settlements that sprang up over a generation as people fled conflict and poverty in Peru’s interior. Thousands are built of colonial-era adobe.

Most quake-prone countries have rigorous building codes to resist seismic events. In Chile, if engineers and builders don’t adhere to them they can face prison. Not so in Peru.

“People are building with adobe just as they did in the 17th century,” said Carlos Zavala, director of Lima’s Japanese-Peruvian Center for Seismic Investigation and Disaster Mitigation.

Environmental and human-made perils compound the danger.

Situated in a coastal desert, Lima gets its water from a single river, the Rimac, which a landslide could easily block. That risk is compounded by a containment pond full of toxic heavy metals from an old mine that could rupture and contaminate the Rimac, said Agustin Gonzalez, a PREDES official advising Lima’s government.

Most of Lima’s food supply arrives via a two-lane highway that parallels the river, another potential chokepoint.

Lima’s airport and seaport, the key entry points for international aid, are also vulnerable. Both are in Callao, which seismologists expect to be scoured by a 20-foot (6-meter) tsunami if a big quake is centered offshore, the most likely scenario.

Mayor Susana Villaran’s administration is Lima’s first to organize a quake-response and disaster mitigation plan. A February 2011 law obliged Peru’s municipalities to do so. Yet Lima’s remains incipient.

“How are the injured going to be attended to? What is the ability of hospitals to respond? Of basic services? Water, energy, food reserves? I don’t think this is being addressed with enough responsibility,” said Tavera of the Geophysical Institute.

By necessity, most injured will be treated where they fall, but Peru’s police have no comprehensive first-aid training. Only Lima’s 4,000 firefighters, all volunteers, have such training, as does a 1,000-officer police emergency squadron.

But because the firefighters are volunteers, a quake’s timing could influence rescue efforts.

“If you go to a fire station at 10 in the morning there’s hardly anyone there,” said Gonzalez, who advocates a full-time professional force.

In the next two months, Lima will spend nearly $ 2 million on the three fire companies that cover downtown Lima, its first direct investment in firefighters in 25 years, Prado said. The national government is spending $ 18 million citywide for 50 new fire trucks and ambulances.

But where would the ambulances go?

A 1997 study by the Pan American Health Organization found that three of Lima’s principal public hospitals would likely collapse in a major quake, but nothing has been done to reinforce them.

And there are no free beds. One public hospital, Maria Auxiliadora, serves more than 1.2 million people in Lima’s south but has just 400 beds, and they are always full.

Contingency plans call for setting up mobile hospitals in tents in city parks. But Gonzalez said only about 10,000 injured could be treated.

Water is also a worry. The fire threat to Lima is severe — from refineries to densely-backed neighborhoods honeycombed with colonial-era wood and adobe. Lima’s firefighters often can’t get enough water pressure to douse a blaze.

“We should have places where we can store water not just to put out fires but also to distribute water to the population,” said Sato, former head of the disaster mitigation department at Peru’s National Engineering University.

The city’s lone water-and-sewer utility can barely provide water to one-tenth of Lima in the best of times.

Another big concern: Lima has no emergency operations center and the radio networks of the police, firefighters and the Health Ministry, which runs city hospitals, use different frequencies, hindering effective communication.

Nearly half of the city’s schools require a detailed evaluation to determine how to reinforce them against collapse, Sato said.

A recent media blitz, along with three nationwide quake-tsunami drills this year, helped raise consciousness. The city has spent more than $ 77 million for retention walls and concrete stairs to aid evacuation in hillside neighborhoods, Prado said, but much more is needed.

At the biggest risk, apart from tsunami-vulnerable Callao, are places like Nueva Rinconada.

A treeless moonscape in the southern hills, it is a haven for economic refugees who arrive daily from Peru’s countryside and cobble together precarious homes on lots they scored into steep hillsides with pickaxes.

Engineers who have surveyed Nueva Rinconada call its upper reaches a death trap. Most residents understand this but say they have nowhere else to go.

Water arrives in tanker trucks at $ 1 per 200 liters (52 gallons) but is unsafe to drink unless boiled. There is no sanitation; people dig their own latrines. There are no streetlamps, and visibility is erased at night as Lima’s bone-chilling fog settles into the hills.

Homes of wood, adobe and straw matting rest on piled-rock foundations that engineers say will crumble and rain down on people below in a major quake.

A recently built concrete retaining wall at the valley’s head lies a block beneath the thin-walled wood home of Hilarion Lopez, a 55-year-old janitor and community leader. It might keep his house from sliding downhill, but boulders resting on uphill slopes could shake loose and crush him and his neighbors.

“We’ve made holes and poured concrete around some of the more unstable boulders,” he says, squinting uphill in a strong late morning sun.

He’s not so worried if a quake strikes during daylight.

“But if I get caught at night? How do I see a rock?”

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Associated Press writer Franklin Briceno contributed to this report.

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Frank Bajak on Twitter: http://twitter.com/fbajak

Latin America News Headlines – Yahoo! News

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Kevin Smith: “Clerks III” will be my last writing/directing effort

LOS ANGELES (TheWrap.com) – “Clerks III” will be Kevin Smith‘s last writing/directing effort, the filmmaker tweeted on Friday morning:

“So with the ‘HIT SOMEBODY‘ shift, the minute Jeff Anderson signs on, my last cinematic effort as a writer/director will be ‘CLERKS III’”

Referring to the ice-hockey comedy he’s writing that takes place over the course of 30 years, the “shift” means now it will be not a theatrical release but a television mini-series.

“Since ‘HIT SOMEBODY’ is now gonna be a mini-series,” the 42-year-old wrote. “Yes – that leaves room for a new final flick before I retire from directing feature films.”

So pending the participation of Anderson, the actor who played Randal Graves in the first two “Clerks” films, Smith’s fans will get the ultimate goodbye gift – a complete trilogy for the convenient store comedy franchise.

The first installment was the director’s mirco-budgeted breakthrough independent film, which launched characters Jay and Silent Bob into pop culture and led to four more spinoffs.

Minimum-wage earners Randal and Dante (Brian O’Halloran) were featured in a series of “Clerks” comics in the late ’90s before becoming the focus of a short-lived animated television series in 2000 (and eventually making it back to the big screen for a quick cameo in 2001′s “Jay and Silent Bob Strike Back”). Smith finally finished their story in 2006′s “Clerks II.”

Or so we thought. Apparently, he wants to end his film-directing career with the characters and actors that helped it begin. However, the tweet heard around the world of cinema suggests it may be somewhat of a challenge to persuade at least one half of the “Clerks” duo to come aboard.

Beyond “Hit Somebody” and “Clerks III,” Smith will keep himself busy with “SModcast,” a weekly podcast, and AMC’s “Comic Book Men,” which has been renewed for a second season.

Movies News Headlines – Yahoo! News

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