A delicate new balancing act in senior healthcare

When Claire Gordon arrived at Cedars-Sinai Medical Center, nurses knew she needed extra attention.

She was 96, had heart disease and a history of falls. Now she had pneumonia and the flu. A team of Cedars specialists converged on her case to ensure that a bad situation did not turn worse and that she didn't end up with a lengthy, costly hospital stay.

Frail seniors like Gordon account for a disproportionate share of healthcare expenditures because they are frequently hospitalized and often land in intensive care units or are readmitted soon after being released. Now the federal health reform law is driving sweeping changes in how hospitals treat a rapidly growing number of elderly patients.

The U.S. population is aging quickly: People older than 65 are expected to make up nearly 20% of it by 2030. Linda P. Fried, dean of the Columbia University Mailman School of Public Health, said now is the time to train professionals and test efforts to improve care and lower healthcare costs for elderly patients.

"It's incredibly important that we prepare for being in a society where there are a lot of older people," she said. "We have to do this type of experiment right now."

At Cedars-Sinai, where more than half the patients in the medical and surgical wards are 65 or older, one such effort is dubbed the "frailty project." Within 24 hours, nurses assess elderly patients for their risk of complications such as falls, bed sores and delirium. Then a nurse, social worker, pharmacist and physician assess the most vulnerable patients and make an action plan to help them.

The Cedars project stands out nationally because medical professionals are working together to identify high-risk patients at the front end of their hospitalizations to prevent problems at the back end, said Herb Schultz, regional director of the U.S. Department of Health and Human Services.

"For seniors, it is better care, it is high-quality care and it is peace of mind," he said.

The effort and others like it also have the potential to reduce healthcare costs by cutting preventable medical errors and readmissions, Schultz said. The federal law penalizes hospitals for both.

Gordon, an articulate woman with brightly painted fingernails and a sense of humor, arrived at Cedars-Sinai by ambulance on a Monday.

Soon, nurse Jacquelyn Maxton was at her bedside asking a series of questions to check for problems with sleep, diet and confusion. The answers led to Gordon's designation as a frail patient. The next day, the project team huddled down the hall and addressed her risks one by one. Medical staff would treat the flu and pneumonia while at the same time addressing underlying health issues that could extend Gordon's stay and slow her recovery, both in the hospital and after going home.

To reduce the chance of falls, nurses placed a yellow band on her wrist that read "fall risk" and ensured that she didn't get up on her own. To prevent bed sores, they got her up and moving as often as possible. To cut down on confusion, they reminded Gordon frequently where she was and made sure she got uninterrupted sleep. Medical staff also stopped a few unnecessary medications that Gordon had been prescribed before her admission, including a heavy narcotic and a sleeping pill.

"It is really a holistic approach to the patient, not just to the disease that they are in here for," said Glenn D. Braunstein, the hospital's vice president for clinical innovation.

Previously, nurse Ivy Dimalanta said, she and her colleagues provided similar care but on a much more random basis. Under the project, the care has become standardized.

The healthcare system has not been well designed to address the needs of seniors who may have had a lifetime of health problems, said Mary Naylor, gerontology professor at the University of Pennsylvania School of Nursing. As a result, patients sometimes fall through the cracks and return to hospitals again and again.

"That is not good for them and that is not good for society to be using resources in that way," Naylor said.

Using data from related projects, Cedars began a pilot program in 2011 and expanded it last summer. The research is continuing but early results suggest that the interventions are leading to fewer seniors being admitted to the intensive care unit and to shorter hospital stays, said Jeff Borenstein, researcher and lead clinician on the frailty project. "It definitely seems to be going in the right direction," he said.

The hospital is now working with Naylor and the University of Pennsylvania to design a program to help the patients once they go home.

"People who are frail are very vulnerable when they leave the hospital," said Harriet Udin Aronow, a researcher at Cedars. "We want to promote them being safe at home and continuing to recover."

In Gordon's case, she lives alone with the help of her children and a caregiver. The hospital didn't want her experiencing complications that would lengthen the stay, but they also didn't want to discharge her before she was ready. Under the health reform law, hospitals face penalties if patients come back too soon after being released.

Patients and their families often are unaware of the additional attention. Sitting in a chair in front of a vase of pink flowers, Gordon said she knew she would have to do her part to get out of the hospital quickly. "You have to move," she said. "I know you get bed sores if you stay in bed."

Gordon said she was comfortable at the hospital but she wanted to go back to her house as quickly as she could. "There's no place like home," she said.

Two days later, that's where she was.

anna.gorman@latimes.com

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DC Comics Turns the Occupy Movement Into a Superhero Title

Eighteen months after the phrase first entered the collective public consciousness, the plight of the 99 percent is coming to mainstream superhero comics — via a new series from the second biggest publisher in the American comic industry, which just happens to be a subsidiary of a multi-national corporation that makes around $12 billion a year. Irony, anybody?

In May, DC Comics will launch two new series taking place in their mainstream superhero universe that offer different insights into the class struggle in a world filled with superheroes, alien races and inexplicable events. The Green Team, written by Tiny Titans and Superman Family Adventures creators Art Baltazar and Franco, with art by Ig Guara, revives an obscure 1975 concept about teenage rich kids who try to make the world a better place with their outrageous wealth. In an interview promoting the series, Franco promised that it would address questions like “Can money make you happy?” and “If you had unlimited wealth, could you use that to make the lives of people better?”

Obviously, this is one of the more fanciful series DC will be publishing.

But while DC is promoting The Green Team series as the adventures of the “1%,” its companion title, The Movement, is teased as a chance for us to “Meet the 99%… They were the super-powered disenfranchised — now they’re the voice of the people!”

“It’s a book about power,” explained The Movement writer Gail Simone. “Who owns it, who uses it, who suffers from its abuse. As we increasingly move to an age where information is currency, you get these situations where a single viral video can cost a previously unassailable corporation billions, or can upset the power balance of entire governments. And because the sources of that information are so dispersed and nameless, it’s nearly impossible to shut it all down.”

“The thing I find fascinating and a little bit worrisome is, what happens when a hacktivist group whose politics you find completely repulsive has this same kind of power and influence,” she elaborated in an interview at Big Shiny Robot. “What if a racist or homophobic group rises up and organizes in the same manner?”

While the concept is ambitious, the idea that a comic capable of living up to the book’s populist inspiration could come from DC Entertainment still strikes some as unlikely. Matt Pizzolo, the editor of the Occupy Comics anthology, told Wired that “though DC Comics did help launch Alan Moore and David Lloyd’s seminal anarchist epic V For Vendetta over two decades ago, it’s unlikely they would do so today. Between dismantling Vertigo and frankensteining Watchmen, the past year has demonstrated DC isn’t a safe place for bold creators who want to tell the kinds of stories that would inspire things like Occupy, rather than just cash in on them.”

Still, Simone says that the use of the iconography and language of a real-world populist movement is deliberate, promising that the book will reflect today’s decentralized political world and offer ”a slice of rarity that we’re unlikely to see in most superhero books.”

This wouldn’t the first time that DC has attempted to offer pre-packaged populist rebellion, of course; in addition to the aforementioned publication of the anti-establishment V For Vendetta, the company’s Vertigo imprint also published Grant Morrison’s The Invisibles, a series centering around an international organization struggling against forces of authority and repression that included anti-corporate themes.

Only time will tell whether The Movement will live up to the subversive examples of these earlier books, or just end up a well-intentioned piece of topical super heroics that trades on, and commodifies, a real political movement.

The Movement #1 will be available in both print and digital formats on May 1, while The Green Team #1 will be released on May 22.

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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Digital Domain: Digital Tags Help Ensure That the Price Is Right

SOME decades ago, a grocery store’s aisles were often filled with “chunk-a-chunk-a” sounds, as clerks stamped prices to the tops of cans and boxes before putting them on shelves. It was a labor-intensive operation, but it did result in a price being affixed to most every item in the store.

Randy Stross

A paper “Sale” sign accompanies an Altierre screen in a Kohl’s store.

Altierre

Digital labels from Altierre are intended to help retailers keep prices up to date.

Then bar codes and computerized cash registers arrived. In most stores, prices were posted on shelves but not on the items themselves.

I’ve always trusted that the system works well — and I’ve tapped my foot impatiently when a shopper ahead of me slowed the checkout process by closely watching the prices that came up, as if the scanner might have recorded the wrong product code. What I hadn’t realized was that there is valid reason to be vigilant. The potential problems originate on the shelves, in the form of the shelf tags, which may or may not match the current price in a store’s computer.

A typical grocery store puts 5,000 items on sale in a week and removes sale prices from another 5,000. That creates an abundance of opportunities for mismatches when workers print out the new price labels in a back room, then hunt for the proper place on the shelf to attach them.

This has left store technology in an incomplete state: mostly but not entirely computerized. The next step is to go completely paperless by putting small, battery-powered digital price tags on the shelves. Price changes can then be received wirelessly from the store’s network, ensuring that the price displayed on the shelf and the one called up at the checkout counter are the same.

Altierre, a digital tag and sensor maker based in San Jose, Calif., has raised more than $80 million from investors and spent 10 years developing the technology for digital tags and the wireless networks they require. It asserts that outfitting a store with 20,000 to 25,000 tags, each costing about $5, would produce labor savings that would pay back the investment in two to two-and-a-half years.

The tags can provide multiple screens of information. To reduce power consumption, Altierre uses black-on-gray liquid crystal displays, the same type used in digital watches and pocket calculators. The most generous thing that can be said about this type of display is that its legibility is satisfactory.

At Altierre’s headquarters, a full-size mock grocery store is set up with its tags installed on the shelves. There, I was surprised to find that the LCD’s legibility problems didn’t seem so significant: shoppers stand close to the shelves anyway. On some shelves, Altierre showed off an improved tag, at a higher price, that uses E Ink technology. Its text is noticeably crisper than that of an ordinary LCD tag.

I asked Sunit Saxena, Altierre’s chief executive, why grocery stores haven’t leapt at the chance to save themselves money by installing the tags. “They’re treading carefully because the fear is, they’ll put 30,000 of these in a store where people are used to seeing paper and it will be a drastic change,” he said. “They worry that their sales will drop.”

Digital sign technology is hardly new. In France, customers are accustomed to digital signs in grocery stores, where an LCD tag with limited display capacity has been on shelves for about 10 years, says Michel Itié, an I.T. consultant. It shows only the price and the price per weight, so it requires a separate paper tag to show an item’s name.

Many French hypermarkets, which combine grocery stores and department stores, also use the tags. Mr. Itié is working with a company that is installing Altierre’s technology for the hypermarket chain E.Leclerc, which has installed 300,000 new LCD tags in 10 stores and plans to deploy a total of two million tags by year-end.

In the United States, grocery stores still cannot justify making the investment in digital price tags, says Patrick C. Fitzpatrick, president of Atlanta Retail Consulting. “If the payback was advantageous, you’d see them everywhere.”

Stores are eager, however, to find an affordable way to reduce price-related errors. Mr. Fitzpatrick says that when grocery store managers conduct “price integrity audits” and compare price labels on the shelves with the prices in the store computer, paper labels are only 95 percent to 96 percent accurate.

Randall Stross is an author based in Silicon Valley and a professor of business at San Jose State University. E-mail: stross@nytimes.com.

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Big Bear locked down amid manhunt

The bustling winter resort of Big Bear took on the appearance of a ghost town Thursday as surveillance aircraft buzzed overhead and police in tactical gear and carrying rifles patrolled mountain roads in convoys of SUVs, while others stood guard along major intersections.

Even before authorities had confirmed that the torched pickup truck discovered on a quiet forest road belonged to suspected gunman Christopher Dorner, 33, officials had ordered an emergency lockdown of local businesses, homes and the town's popular ski resorts. Parents were told to pick up their children from school, as rolling yellow buses might pose a target to an unpredictable fugitive on the run.

By nightfall, many residents had barricaded their doors as they prepared for a long, anxious evening.

PHOTOS: A tense manhunt amid tragic deaths

"We're all just stressed," said Andrea Burtons as she stocked up on provisions at a convenience store. "I have to go pick up my brother and get him home where we're safe."

Police ordered the lockdown about 9:30 a.m. as authorities throughout Southern California launched an immense manhunt for the former lawman, who is accused of killing three people as part of a long-standing grudge against the LAPD. Dorner is believed to have penned a long, angry manifesto on Facebook saying that he was unfairly fired from the force and was now seeking vengeance.

Forest lands surrounding Big Bear Lake are cross-hatched with fire roads and trails leading in all directions, and the snow-capped mountains can provide both cover and extreme challenges to a fugitive on foot. It was unclear whether Dorner was prepared for such rugged terrain.

Footprints were found leading from Dorner's burned pickup truck into the snow off Forest Road 2N10 and Club View Drive in Big Bear Lake.

San Bernardino County Sheriff John McMahon said that although authorities had deployed 125 officers for tracking and door-to-door searches, officers had to be mindful that the suspect may have set a trap.

"Certainly. There's always that concern and we're extremely careful and we're worried about this individual," McMahon said. "We're taking every precaution we can."

PHOTOS: A fugitive's life on Facebook

Big Bear has roughly 400 homes, but authorities guessed that only 40% are occupied year-round.

The search will probably play out with the backdrop of a winter storm that is expected to hit the area after midnight.

Up to 6 inches of snow could blanket local mountains, the National Weather Service said.

FULL COVERAGE: Sweeping manhunt for rampaging ex-cop

Gusts up to 50 mph could hit the region, said National Weather Service meteorologist Mark Moede, creating a wind-chill factor of 15 to 20 degrees.

Extra patrols were brought in to check vehicles coming and going from Big Bear, McMahon said, but no vehicles had been reported stolen.

"He could be anywhere at this point," McMahon said. When asked if the burned truck was a possible diversion, McMahon replied: "Anything's possible."

Dorner had no known connection to the area, authorities said.

Craig and Christine Winnegar, of Murrieta, found themselves caught up in the lockdown by accident. Craig brought his wife to Big Bear as a surprise to celebrate their 28th wedding anniversary. Their prearranged dinner was canceled when restaurant owners closed their doors out of fear.

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Huge Snowstorm Headed for New England Looks Even Scarier From Space

The gigantic snowstorm headed for New England is predicted to be a mean one that will dump feet of snow on an area from New York to Maine. But the ominous picture the National Weather Service is painting isn’t as frightening as the view from space.

The massive storm can be seen taking shape in this image, taken by NOAA’s GOES-13 satellite today at 9:01 ET, as a western front that stretches from Canada to the Gulf of Mexico prepares to merge with a curling low-pressure system over the Atlantic Ocean off the shore of Virginia.

Image: NASA

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Well: One Dish, One Hour

Fast-food from a restaurant is not as fast as you think. There is drive time to and from the restaurant, waiting time to pay and collect your food, and then it still takes a few minutes to sort through it and set it on the table at home. (Assuming you don’t just eat it in the car.) But if you are willing to invest a few more minutes of time for a more healthful option, you can still make a homemade meal from scratch in less than an hour, writes Martha Rose Shulman in this week’s Recipes for Health column:

This week, in response to readers’ requests on the Recipes for Health Facebook page, I focused on quick one-dish dinners. You may have a different opinion than I do about what constitutes a quick meal. There are quick meals that involve little or no cooking — paninis and sandwiches, uncomplicated omelets, scrambled eggs, and meals that combine prepared items with foods that you cook — but I chose to focus on dishes that are made from scratch. I bought a cabbage and a generous bunch of kale at the farmers’ market, some sliced mushrooms and bagged baby spinach at Trader Joe’s, and used them in conjunction with items I had on hand in the pantry and refrigerator.

I decided to use the same rule of thumb that a close French friend uses. She refuses to spend more than a half hour on prep but always turns out spectacular dinners and lunches. My goal was to make one-dish meals that would put us at the table no more than 45 minutes after I started cooking (the soup this week went over by 5 or 10 minutes but I left it in because it is so good). For each recipe test I set the timer for 30 minutes, then let it count up once it went off. All of the meals are vegetarian and the only prepared foods I used were canned beans.

I do believe that it is healthy — and enjoyable — to take time to prepare meals for the family (or just for yourself), even when you are juggling one child’s afterschool soccer practice and homework with another child’s dance recitals and homework. Sometimes it is hard to find that half hour, but everybody benefits when you do.

Here are five new one-dish meals that you can make in an hour or less.

Soft Black Bean Tacos With Salsa and Cabbage: Canned black beans and lots of cabbage combine in a quick, utterly satisfying one-dish taco dinner.

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Couscous With Tomatoes, Kale and Chickpeas: A comforting topping that is both a stew and a sauce.

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Mushroom and Spinach Frittata: A hearty frittata that is good for any meal of the day.

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Quick Tomato, White Bean and Kale Soup: A hearty minestrone that can be made in under an hour, start to finish.

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Stir-Fried Cabbage, Tofu and Red Pepper: The chopping is the most time-consuming part of this recipe, but you can still be eating within 35 minutes.

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Bits Blog: Google Changes Its Ad Program to Try to Solve the Mobile Ad Riddle

Google has a mobile problem, and it is trying to fix it.

Searches on desktop computers, Google’s most lucrative way to sell ads, are slowing. Searches on mobile devices are increasing, but mobile ads cost less.

The result has been that an important business metric for Google — the amount that advertisers pay each time someone clicks on an ad — has declined for five quarters in a row.

This week, Google tried to reverse this trend by introducing one of the biggest changes in years to its AdWords program, which it called enhanced campaigns. The program, which will thrust advertisers onto mobile devices, has become the talk of the ad industry, and some advertisers are already protesting against it.

Until now, advertisers have had to create separate campaigns for different devices and audiences. Now, they will create a single campaign and give Google directions about how they want to target the campaign by bidding higher on certain devices, locations and times of day. Then, Google’s algorithms will place the ads.

Say a pizza restaurant in San Francisco wanted to advertise. If someone searched for “pizza” using a computer at noon in the financial district, Google might show an ad with a link to the take-out menu. If someone did the same search on a cellphone at 8 p.m. a half-mile from the restaurant, Google might show a click-to-call ad and walking directions.

The theory is that the distinctions among devices have blurred. People use their phones on the sidewalk and on the sofa, and switch indiscriminately between tablets and computers. Now, according to Google, context is most important, like time of day and whether someone is on the go or at home.

The change will make things simpler for some advertisers, and enable many who did not have the resources to try mobile advertising to jump onto mobile devices.

But many advertisers are also complaining. Google’s ads are sold in an auction system, and mobile ads have been less expensive partly because their demand has been relatively low. But now all Google ad campaigns will include mobile devices by default (though advertisers can opt out of mobile.) This will drive more bidders into each auction and likely forcing up mobile ad rates. This is good for Google but disappointing to advertisers.

Some advertisers also say they do not want to lose their fine-grained control over their ad campaigns and cede that control to Google. For example, iPad users generally spend more on e-commerce sites than users of other kinds of tablets, so many retailers showed ads only to iPad users, but now they will lose that option.

Like any change Google makes to its advertising rules, this will force advertisers — who, following Google’s previous instructions, have spent money and time creating separate campaigns for separate devices — to revise their ad campaigns for the new, multi-device era.

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Search for ex-cop in shootings extended statewide, into Nevada

As authorities scoured Southern California for an ex-Los Angeles police officer suspected of shooting three officers, killing one, officials broadened the alert to include the entire state Thursday morning, and authorities in Nevada were warned.

The California Highway Patrol originally issued a "blue alert" for nine Southern California counties, warning that suspect Christoper Jordan Dorner, 33, was considered "armed and extremely dangerous," early Thursday. Shortly after 9 a.m. that alert was broadened to the include the entire state.

A statewide “high alert” was sent out about 8:30 a.m. across Nevada for Dorner, authorities with the Nevada Highway Patrol said.

PHOTOS: Manhunt for ex-LAPD officer

Arizona authorities were aware of the situation but had not issued any formal alerts, said Officer Carrick Cook with the state's Department of Public Safety.

Local, state and federal authorities are involved in the search for Dorner, who threatened "unconventional and asymmetrical warfare" against police in an online manifesto. Dorner is also wanted in connection with a double homicide Sunday in Irvine, where the daughter of a retired LAPD captain and her fiance were killed.

The search intensified early Thursday after three police officers were shot in Riverside County and Dorner was identified as a possible suspect.

The first shooting occurred about 1:30 a.m. Thursday in Corona, where two Los Angeles Police Department officers were providing protection for someone mentioned in Dorner's manifesto, officials said. One officer suffered a graze wound to the head during a shootout and Dorner fled the scene, police said.

Ex-LAPD officer threatened to kill in online manifesto

A short time later, two Riverside officers were shot at the corner of Magnolia Avenue and Arlington Avenue in Riverside. Toussaint said the officers were sitting at a red light when they were ambushed. One was killed, the other was undergoing surgery Thursday morning.

There was no indication the officers were "actively seeking Dorner," Toussaint said.

“Our officers were stopped at an intersection at a red light when they were ambushed," he said. "Because of the close proximity to the timeline, we believe there is a strong likelihood that former LAPD Officer Christopher Dorner was involved in our incident.”

As authorities swarmed the area, two officer-involved shootings occurred in Torrance after police came across vehicles they thought might be Dorner's.

The first Torrance incident occurred about 5:20 a.m. in the 19500 block of Redbeam Avenue in Torrance, Lt. Devin Chase said. That incident involved Los Angeles police detectives from the Hollywood division, sources said.

Two women delivering newspapers were struck by gunfire and transported to an area hospital with unknown injuries, Chase said. No officers were injured. The women were not identified.

The second incident, which involved Torrance police officers, occurred at Flagler Lane and Beryl Street about 5:45 a.m. No injuries were reported in that incident.

Chase said both incidents involved vehicles matching the description of the one sought in connection with Dorner.

"Now it appears neither of them are directly related," Chase said. "In both of them, officers believed they were at the time."

Authorities said they believe Dorner attempted to steal a boat from an elderly man about 10:30 p.m. Wednesday at the Point Loma Yacht Club in San Diego, hours before the shootings in Riverside County.

The boat owner reported being accosted by a burly man who tied him up, threatened him with a gun and said he wanted the boat to flee to Mexico.

But while they were trying to get underway, a rope became entangled in the propeller and the boat was inoperable, authorities said.

The suspect fled the scene and the boat owner was unharmed.

About 2 a.m., a citizen reported finding property belonging to Dorner on a street near Lindbergh Field, not far from the scene of the attempted boat theft. The property included a briefcase and Dorner's LAPD badge.

In the online manifesto, Dorner specifically named the father of Monica Quan, the Cal State Fullerton assistant basketball coach who was found dead Sunday in Irvine along with her fiance, Keith Lawrence.

Randy Quan, a retired LAPD captain, was involved in the review process that ultimately led to Dorner’s dismissal. A former U.S. Navy reservist, Dorner was fired in 2009 for allegedly making false statements about his training officer. In the manifesto, he complained that Randy Quan and others did not fairly represent him at the review hearing.

“The violence of action will be high .... I will bring unconventional and asymmetrical warfare to those in LAPD uniform whether on or off duty," Dorner wrote.

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After the Dinosaurs Died This Furball Started the Next Big Thing

From the chaotic aftermath of a massive asteroid impact sprang the mother of all placental mammals — the most recent common ancestor of everything from monkeys to whales to sloths. Not until at least 200,000 years after a giant space rock smashed into the Yucatan and obliterated the dinosaurs was the small, furry critter scurrying around, eating insects and birthing hairless young. This timing, based on a large study of mammalian physical characteristics and reported today in Science, suggests that the placental tree of life began sprouting its many branches about 36 million years later than genomic clocks indicate.

Scientists reached this conclusion after making 4,541 measurements of characteristics such a hair type, wings, and brain structures in 86 species, living and extinct. Combining those observations with molecular data helped the team reconstruct a mammalian tree pointing toward the last common ancestor of all mammals. Then they generated an image of what such an animal might have looked like, based on comparisons of characteristics shared by closely related species. The result critter is a long-tailed, rat-size furball that resembles both a mouse and a shrew — and perhaps luckily for it, it didn’t have to contend with too many giant reptiles.

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