Georgian Soldier Missing in Afghanistan, NATO Says

KABUL, Afghanistan — A soldier from Georgia belonging to the NATO-led mission in Afghanistan has been missing since Wednesday in the southwest of the country, the coalition said on Friday.

The soldier’s disappearance was confirmed by the Georgian Defense Ministry on its Web site, but it gave few other details while search-and-rescue efforts were under way.

The circumstances were unclear, said Maj. Martyn Crighton, a spokesman for the NATO-led International Security Assistance Force here in Kabul. Major Crighton said coalition forces were searching for the soldier.

“I can confirm that there is an ISAF service member from Georgia who is based in southern Afghanistan who is listed as whereabouts unknown,” he said. “He was last seen on the 19th.” Major Crighton could not say which province in the southwest the soldier was serving in or whether he was on patrol duty outside a base when he was last seen.

The southwest has been one of the centers of the drawdown of American forces this year, but coalition levels were bolstered by the arrival of a second battalion from the Georgian Army. Georgia has 1,561 soldiers in Afghanistan, mostly in Helmand Province.

Niamatullah, the governor of the Musa Qala district of Helmand Province, said a Georgian soldier had walked out of a local base on his own.

“We have no idea why he left his base,” said Mr. Niamatullah, who, like many Afghans, goes by one name. “He was not missed during a patrol, nor was he taken away by someone. He walked out of the base by himself.”

The local base is in a small valley about 10 miles from the district center, where the Taliban have a strong presence and where local residents have dug wells to irrigate poppy fields.

In its statement, the Georgian Defense Ministry said all Georgian units in Afghanistan had been moved to the “highest security alert posture.”

The report of a missing soldier is rare. The only other ISAF service member in Afghanistan who is classified as missing is Sgt. Bowe Bergdahl, an American soldier who is known to be held by the Taliban.

Sharifullah Sahak contributed reporting from Kabul, and Taimoor Shah from Kandahar, Afghanistan.

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TSX ends flat as RIM buckles, gold miners bounce

TORONTO (Reuters) – Canada‘s main stock index ended little changed on Friday as gold miners gained on safe-haven buying amid U.S. budget uncertainty, while BlackBerry maker Research In Motion Ltd plunged more than 20 percent.

The index’s materials sector, which includes miners, rose 0.4 percent. Even though the price of gold was near its lowest level in four months, the gold-mining sub-sector added 0.9 percent as investors fretted over stalled U.S. budget talks that could throw Canada’s largest trading partner back into recession.

“As our tiptoes are over the (U.S.) fiscal cliff and we’re looking over the abyss, the markets are upset obviously, and this is sort of putting a damper on the stocks,” said John Ing, president of Maison Placements Canada.

“But we’ve had a mixed reaction in Canada, mainly because the resources have been much better, like gold for example, which is hedging into the uncertainty (around the budget talks),” he said, noting gold miners had been under pressure for the last two weeks.

Miner Barrick Gold Corp edged up 0.2 percent to C$ 33.29. Centerra Gold Inc jumped more than 3 percent to C$ 9.10.

Gold miners are playing catch-up after underperforming throughout the year and could rise further in 2013, said Gavin Graham, president at Graham Investment Strategy.

Shares of RIM dropped 22.2 percent to C$ 10.86 on fears that a new fee structure for its high-margin services segment could put pressure on the business that has set the company apart from its competitors.

The Toronto Stock Exchange‘s S&P/TSX composite index <.gsptse> fell 3.01 points, or 0.02 percent, to end at 12,385.70. It gained 0.7 percent for the week.</.gsptse>

Efforts to avoid the looming U.S. “fiscal cliff” were thrown into disarray on Friday with finger-pointing lawmakers fleeing Washington for Christmas vacations even as the year-end deadline for action edged ever closer.

Graham said that until a deal is reached in the U.S. budget talks, investors will avoid economically sensitive Canadian stocks and those most closely tied to the U.S. economy: auto parts manufacturers, forestry companies and resource stocks generally.

“The resource sectors in Canada, which is half of the index, is going to be adversely affected, correctly or not,” he said.

“Chinese demand is likely to pick up somewhat now with the new leadership there but people will be focused on the U.S. given that it is still by far the most important export market for Canada.”

($ 1=$ 0.99 Canadian)

(Additional reporting by Claire Sibonney, Julie Gordon and Jeffrey Hodgson; Editing by Peter Galloway)

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About New York: One Boy’s Death Moves State to Action to Prevent Others

Prompted by the death of a 12-year-old Queens boy in April, New York health officials are poised to make their state the first in the nation to require that hospitals aggressively look for sepsis in patients so treatment can begin sooner. Under the regulations, which are now being drafted, the hospitals will also have to publicly report the results of their efforts.

The action by New York has elated sepsis researchers and experts, including members of a national panel who this month formally recommended that the federal government adopt standards similar to what the state is planning.

Though little known, sepsis, an abnormal and self-destructive immune response to infection or illness, is a leading cause of death in hospitals. It often progresses to severely low blood pressure, shock and organ failure.

Over the last decade, a global consortium of doctors, researchers, hospitals and advocates has developed guidelines on early identification and treatment of sepsis that it says have led to significant drops in mortality rates. But first hints of the problem, like a high pulse rate and fever, often are hard for clinicians to tell apart from routine miseries that go along with the flu or cold.

“First and foremost, they need to suspect sepsis,” Dr. Mitchell M. Levy, a professor at Brown University School of Medicine and a lead author of a paper on the latest sepsis treatment guidelines to be published simultaneously next month in the United States in a journal, Critical Care Medicine, and in Europe in Intensive Care Medicine.

“It’s the most common killer in intensive care units,” Dr. Levy said. “It kills more people than breast cancer, lung cancer and stroke combined.”

If started early enough, the treatment, which includes antibiotics and fluids, can help people escape from the drastic vortex of sepsis, according to findings by researchers working with the Surviving Sepsis Campaign, the global consortium. The tactics led to a reduction of “relative risk mortality by 40 percent,” Dr. Levy said.

Although studies of 30,000 patients show that the guidelines save lives, “the problem is that many hospitals are not adhering to them,” said Dr. Clifford S. Deutschman, director of the sepsis research program at the Perelman School of Medicine at the University of Pennsylvania and the president of the Society of Critical Care Medicine.

About 300 hospitals participate in the study, and the consortium has a goal of having 10,000. “The case is irrefutable: if you take these sepsis measures, and you build a program to help clinicians and hospitals suspect sepsis and identify it early, that will mean more people will survive,” Dr. Levy said.

At a symposium in October, the New York health commissioner, Dr. Nirav R. Shah, said that he would require state hospitals to adopt best practices for early identification and treatment of sepsis. Gov. Andrew M. Cuomo intends to make it a major initiative in 2013, said Josh Vlasto, a spokesman for the governor. “The state is taking unprecedented measures to prevent and effectively treat sepsis in health care facilities across the state and is looking at a wide range of additional measures to better protect patients,” Mr. Vlasto said.

In April, Rory Staunton, a sixth grader from Queens, died of severe septic shock after he became infected, apparently through a cut he suffered while playing basketball. The severity of his illness was not recognized when he was treated in the emergency room at NYU Langone Medical Center. He was sent home with a diagnosis of an ordinary bellyache. Hours later, alarming laboratory results became available that suggested he was critically ill, but neither he nor his family was contacted. For an About New York column in The New York Times, Rory’s parents, Ciaran and Orlaith Staunton, publicly discussed their son’s final days. Their revelations prompted doctors and hospitals across the country to seek new approaches to heading off medical errors.

In addition, Commissioner Shah in New York convened a symposium on sepsis, which included presentations from medical experts and Rory’s parents.

At the end of the meeting, Dr. Shah said that he had listened to all the statistics on the prevalence of the illness, and that one had stuck in his memory: “Twenty-five percent,” he said — the portion of the Staunton family lost to sepsis.

He said he would issue new regulations requiring hospitals to use best practices in identifying and treating sepsis, actions that, he said, he was taking “in honor of Rory Staunton.”

The governor’s spokesman, Mr. Vlasto, said that “the Staunton family’s advocacy has been essential to creating a strong public will for action.”

Dr. Levy said New York’s actions were “bold, pioneering and grounded in good scientific evidence,” adding, “The commissioner has taken the first step even before the federal government.”

Dr. Deutschman said that initiatives like those in New York were needed to overcome resistance among doctors. “You’re talking about a profession that has always prided itself on its autonomy,” he said. “They don’t like to be told that they’re wrong about something.”

The availability of proven therapies should move treatment of sepsis into a new era, experts say, comparing it to how heart attacks were handled not long ago. People arriving in emergency rooms with chest pains were basically put to bed because not much could be done for them, said Dr. Kevin J. Tracey, the president of the Feinstein Institute for Medical Research at North Shore-Long Island Jewish Health System. Dr. Tracey, a neurosurgeon, has made major discoveries about the relationship between the nervous system and the runaway immune responses of sepsis.

If physicians and nurses were trained to watch for sepsis, as they now routinely do for heart attacks, many of its most dire problems could be headed off before they got out of control, he said. The Stauntons have awakened doctors and nurses to the possibility of danger camouflaged as a stomach bug.

“We are with sepsis where we were with heart attack in the early 1980s,” Dr. Tracey said.

“If you don’t think of it as a possibility, this story can happen again and again. This case could change the world.”

E-mail: dwyer@nytimes.com

Twitter: @jimdwyernyt

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As Shoppers Hop From Tablet to PC to Phone, Retailers Try to Adapt

Ryan O’Neil, a Connecticut government employee, was in the market to buy a digital weather station this month. His wife researched options on their iPad, but even though she found the lowest-price option there, Mr. O’Neil made the purchase on his laptop.

“I do use the iPad to browse sites,” Mr. O’Neil said, but when it comes time to close the deal, he finds it easier to do on a computer.

Many online retailers had visions of holiday shoppers lounging beneath the Christmas tree with their mobile devices in hand, making purchases. The size of the average order on tablets, particularly iPads, tends to be bigger than on PCs. So retailers poured money and marketing into mobile Web sites and apps with rich images and, they thought, easy checkout.

But while visits to e-commerce sites and apps on tablets and phones have nearly doubled since last year, consumers like Mr. O’Neil are more frequently using multiple devices to shop. In many cases, they are more comfortable making the final purchase on a computer, with its bigger screen and keyboard. So retailers are trying to figure out how to appeal to a shopper who may use a cellphone to research products, a tablet to browse the options and a computer to buy.

“I’ve been yelling at customers for two years, saying, ‘Mobile, mobile, mobile,’ ” said Jason Spero, director of mobile sales and strategy at Google. “But the funny thing is, now we’re going to say: ‘Don’t put mobile in a silo. It’s also about the desktop.’ ”

The challenges are daunting, though. It is technically difficult to track consumers as they hop from phone to computer to tablet and back again. This means customers who, say, fill shopping carts on their tablets have to do all the work again on their PCs or other devices. The biggest obstacle, retailers say, is that the tools used to track shoppers on computers — cookies, or bundles of data stored in Web browsers — don’t transfer across devices.

Instead, retailers are figuring out how to sync the experience in other ways, like prompting shoppers to log in on each device. And being able to track people across devices gives retailers more insight into how they shop.

The retailers’ efforts are backed by research. While one-quarter of the visits to e-commerce sites occur on mobile devices, only around 15 percent of purchases do, according to data from I.B.M. According to Google, 85 percent of online shoppers start searching on one device — most often a mobile phone — and make a purchase on another.

At eBags, customers are shopping on their tablets in the evening and returning on their work computers the next day. But eBags has not yet synced the shoppers across devices, so customers must build their shopping carts from scratch if they switch devices.

“That is a blind spot with a lot of sites,” said Peter Cobb, co-founder of eBags. “It is a requirement moving forward.”

At eBay, one-third of the purchases involve mobile devices at some point, even if the final purchase is made on a computer.

At eBay, once shoppers log in on a device, they do not need to log in again. Their information, like shipping and credit card details and saved items, syncs across all their devices. If an eBay shopper is interested in a certain handbag, and saves that search on a computer, eBay will send alerts to her cellphone when a new handbag arrives or an auction is about to end.

“They might discover an item on a phone or tablet, do a saved-search push alert later on some other screen and eventually close on the Web site,” said Steve Yankovich, who runs eBay Mobile. “People are buying and shopping and consuming potentially every waking moment of the day.”

ModCloth, an e-commerce site for women’s clothes, said that while a quarter of its visits come from mobile devices, people are not yet buying there in the same proportion, though they are becoming more comfortable with checking out on those devices.

“She’s visiting us more on the phone, but she’s actually transacting somewhere else,” said Sarah Rose, vice president of product at ModCloth.

For example, a shopper will skim through new arrivals on her phone while on the bus and add items to her wish list, then visit that evening on her tablet to make a purchase, Ms. Rose said.

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World Briefing | Europe: France’s 2013 Budget Proposal Approved

The Parliament on Thursday approved the Socialist government’s 2013 budget proposal, a rigorous and contested plan to drop the deficit to 3 percent of the gross domestic product with $26 billion in increased taxes on individuals and businesses and savings of $13 billion through a freeze in public spending. Members of the opposition called the tax increases unfair, citing, for instance, a 75 percent rate applied to income over $1.3 million and $13 billion in additional taxes on corporations already worried about high labor costs. Some on the left said the spending cuts were out of step with President François Hollande’s promises to promote growth and avoid austerity measures. The budget was based on growth projections of 0.8 percent for 2013, a figure some economists said was too optimistic.

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Video game shares down in wake of shooting

LOS ANGELES (AP) — Shares of video game makers and sellers fell Thursday in the aftermath of a mass shooting at a Connecticut elementary school, which has renewed debate about violent games and their potential influence on crime.

Shares of GameStop Corp., whose stores sell video games as well as systems like the Xbox and Wii, fell 5 percent in afternoon trading.

Investors are seen as being increasingly concerned that the government may impose tougher rules on the sales of games rated for “mature” and older audiences.

Investors may be worried that parents will also avoid buying first-person shooter games like “Call of Duty: Black Ops 2″ after the tragedy Friday morning at Sandy Hook Elementary, in which 20 children and six adults were shot and killed by 20-year-old Adam Lanza.

“Maybe there will be more stringent efforts to make sure youth are not playing games that they’re not old enough to play,” said Mike Hickey, an analyst with National Alliance Securities. “Maybe there will be a greater effort by parents in managing the content their kids are playing.”

Shares of companies involved in the video game industry, many of which had been dropping since the shooting, declined further Thursday.

— GameStop stock lost $ 1.37, or 5 percent, to $ 26.18. Shares have barely changed since last Thursday’s close, the day before the shooting, to Wednesday’s close.

— Shares of Activision Blizzard Inc., the publisher of “Call of Duty: Black Ops 2,” fell 9 cents to $ 10.70. The stock had already dropped 5.6 percent.

— Electronic Arts Inc. shares fell 41 cents, or 2.9 percent, to $ 13.99. Shares had dropped 5.6 percent.

— Take-Two Interactive Software Inc. shares slipped 29 cents, or 2.5 percent, to $ 11.69. The stock had dropped 8 percent.

The declines came as broader markets rose. The Dow Jones industrial average was up 0.3 percent at 13,295.

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Michael Phelps voted AP male athlete of year

Now that he's away from the pool, Michael Phelps can reflect — really reflect — on what he accomplished.

Pretty amazing stuff.

"It's kind of nuts to think about everything I've gone through," Phelps said. "I've finally had time to myself, to sit back and say, '... that really happened?' It's kind of shocking at times."

Not that his career needed a capper, but Phelps added one more honor to his staggering list of accomplishments Thursday — The Associated Press male athlete of the year.

Phelps edged out LeBron James to win the award for the second time, not only a fitting payoff for another brilliant Olympics (four gold medals and two silvers in swimming at the London Games) but recognition for one of the greatest careers in any sport.

Phelps finished with 40 votes in balloting by U.S. editors and broadcasters, while James was next with 37. Track star Usain Bolt, who won three gold medals in London, was third with 23.

Carl Lewis is the only other Olympic-related star to be named AP male athlete of the year more than once, taking the award for his track and field exploits in 1983 and '84. The only men honored more than twice are golf's Tiger Woods and cyclist Lance Armstrong (four times each), and basketball's Michael Jordan (three times).

"Obviously, it's a big accomplishment," Phelps said. "There's so many amazing male athletes all over the world and all over our country. To be able to win this is something that just sort of tops off my career."

Phelps retired at age 27 as soon as he finished his final race in London, having won more gold medals (18) and overall medals (22) than any other Olympian.

No one else is even close.

"That's what I wanted to do," Phelps said. "Now that it's over, it's something I can look back on and say, 'That was a pretty amazing ride.'"

The current ride isn't so bad either.

Set for life financially, he has turned his fierce competitive drive to golf, working on his links game with renowned coach Hank Haney as part of a television series on the Golf Channel. In fact, after being informed of winning the AP award, Phelps called in from the famed El Dorado Golf & Beach Club in Los Cabos, Mexico, where he was heading out with Haney to play a few more holes before nightfall.

"I can't really complain," Phelps quipped over the phone.

Certainly, he has no complaints about his swimming career, which helped turn a sport that most Americans only paid attention to every four years into more of a mainstream pursuit.

More kids took up swimming. More advertisers jumped on board. More viewers tuned in to watch.

While swimming is unlikely to ever match the appeal of football or baseball, it has carved out a nice little niche for itself amid all the other athletic options in the United States — largely due to Phelps' amazing accomplishments and aw-shucks appeal.

Just the fact that he won over James shows just how much pull Phelps still has. James had an amazing year by any measure: The league MVP won his first NBA title with the Miami Heat, picking up finals MVP honors along the way, and then starred on the gold medal-winning U.S. basketball team in London.

Phelps already had won the AP award in 2008 after his eight gold medals in Beijing, which broke Mark Spitz's record. Phelps got it again with a performance that didn't quite match up to the Great Haul of China, but was amazing in its own right.

After the embarrassment of being photographed taking a hit from a marijuana pipe and questioning whether he still had the desire to go on, Phelps returned with a vengeance as the London Games approached. Never mind that he was already the winningest Olympian ever. Never mind that he could've eclipsed the record for overall medals just by swimming on the relays.

He wanted to be one of those rare athletes who went out on top.

"That's just who he is," said Bob Bowman, his longtime coach. "He just couldn't live with himself if knew he didn't go out there and give it good shot and really know he's competitive. He doesn't know anything else but to give that kind of effort and have those kind of expectations."

Phelps got off to a rocky start in London, finishing fourth in the 400-meter individual medley, blown out of the water by his friend and rival, Ryan Lochte. It was only the second time that Phelps had not at least finished in the top three of an Olympic race, the first coming way back in 2000 when he was fifth in his only event of the Sydney Games as a 15-year-old.

To everyone looking in, Lochte seemed poised to become the new Phelps — while the real Phelps appeared all washed up.

But he wasn't going out like that.

No way.

Phelps rebounded to become the biggest star at the pool, edging Lochte in the 200 IM, contributing to a pair of relay victories, and winning his final individual race, the 100 butterfly. There were two silvers, as well, leaving Phelps with a staggering resume that will be awfully difficult for anyone to eclipse.

His 18 golds are twice as many as anyone else in Olympic history. His 22 medals are four clear of Larisa Latynina, a Soviet-era gymnast, and seven more than the next athlete on the list. Heck, if Phelps was a nation, he'd be 58th in the medal standings, just one behind India (population: 1.2 billion).

"When I'm flying all over the place, I write a lot in my journal," Phelps said. "I kind of relive all the memories, all the moments I had throughout my career. That's pretty special. I've never done that before. It's amazing when you see it all on paper."

Four months into retirement, Phelps has no desire to get back in the pool. Oh, he'll swim every now and then for relaxation, using the water to unwind rather than putting in one of his famously grueling practices. Golf is his passion at the moment, but he's also found time to cheer on his hometown NFL team, the Baltimore Ravens, and start looking around for a racehorse that he and Bowman can buy together.

Phelps hasn't turned his back on swimming, either. He's got his name attached to a line of schools that he wants to take worldwide. He's also devoting more time to his foundation, which is dedicated to teaching kids to swim and funding programs that will grow the sport even more.

He's already done so much.

"His contribution to the way the world thinks about swimming is so powerful," Bowman said. "I don't think any other athlete has transformed his sport the way he's transformed swimming."

Phelps still receives regular texts from old friends and teammates, asking when he's going to give up on this retirement thing and come back the pool as a competitor.

He scoffs at the notion, sounding more sure of himself now than he did in London.

And if there's anything we've learned: Don't doubt Michael Phelps when he sets his mind on something.

"Sure, I could come back in another four years. But why?" he asked, not waiting for an answer. "I've done everything I wanted to do. There's no point in coming back."

___

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Iraq’s Stricken President To Be Flown to Germany for Treatment

BAGHDAD — Jalal Talabani, the president of Iraq, will be flown to Germany for medical treatment for a stroke suffered this week, officials said on Wednesday. The president, 79, was said to be in “stable” condition, and the decision was announced after medical specialists from abroad were dispatched to the hospital to assess the possibility of sending him out of the country for further treatment.

Andrew Gombert/European Pressphoto Agency

President Jalal Talabani in September 2011.

Mr. Talabani, whose influence in mediating disputes among the country’s many political factions has far outweighed the limited powers of the office he occupies, was rushed to the hospital on Monday after having the stroke.

In a brief update on Wednesday, the Iraqi medical staff at the Baghdad Medical City said that “his health is stable” and that doctors were using the same medical procedures on him that they had used when he was admitted to the facility, where newly arrived medical experts from Iran, Germany and Britain had begun to monitor his condition, the Iraqi staff said.

The head of the president’s media office, Barazan Sheikh Othman, said that the medical teams “have seen that his health is better” and that he can travel to Germany on Thursday to continue treatment.

One of the country’s two vice presidents, Khudayr al-Khuzai, a Shiite, will take on Mr. Talabani’s duties in his absence. Mr. Talabani’s illness, announced in a statement from his office on Tuesday, cast a shadow over the Kurdish lands in the north where he once fought a guerrilla war and where he now lives. It added a new element of uncertainty to the country’s divided politics a year after the American military departed, leaving Iraq’s leaders to steer the country’s shaky democracy on their own.

Mr. Talabani has been treated abroad for medical conditions in recent years. At a news conference on Tuesday at the same hospital, a doctor had also described Mr. Talabani’s condition as “stable” and said he expected it to improve. On Twitter, Mr. Talabani’s son, Qubad Talabani, who represents the Kurdistan Regional Government in Washington, wrote that “we hope can begin his recovery soon.”

But privately other officials have suggested his condition was more serious. A hospital official, as well as a high-level government official — both of whom requested anonymity out of respect for Mr. Talabani’s family — said Tuesday that the president was in a coma.

The Iraqi medical staff did not take questions in their comments on Wednesday.

Duraid Adnan reported from Baghdad, and Christine Hauser from New York.

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Cruz: Meeting Pinto family was "toughest by far"

EAST RUTHERFORD, N.J. (AP) — For much of his hour-long visit with the family of a 6-year-old boy killed in the Connecticut school shootings, Victor Cruz talked about football, life and young Jack, the child who idolized him.

Tears were shed. Feelings were shared. Cleats and gloves worn by Cruz to honor Jack Pinto at Sunday's game against Atlanta were given to his family.

The New York Giants wide receiver somberly recounted Wednesday his meeting with Pinto's parents and brother in Newtown, Conn.

He struggled in his retelling only when asked about the family's decision to bury the child in the receiver's No. 80 Giants jersey. The father of an infant girl, Cruz stopped for a moment, and his eyes became watery.

"You never go through some circumstances like this and circumstances where a kid faces or a family faces something of this magnitude at their school," Cruz said. "This definitely was the toughest by far."

Jack Pinto was buried on Monday and Cruz telephoned the family to ask whether he could visit them Tuesday.

The family disclosed after Friday's massacre that Cruz was Jack's favorite player. The boy was one of 20 first-graders and six adults killed in the shootings at the Sandy Hook Elementary School.

Cruz drove to Newtown with his girlfriend, Elaina Watley, and their daughter, Kennedy.

"I had no expectations. I was a little nervous," Cruz said. "I just didn't know how I was going to be received. You never know when they are going through something like that. You never know how it is going to go down."

Seeing the family outside the home along with some local children made Cruz feel better.

"They were still pretty emotional, crying and stuff like that," Cruz said. "I saw how affected they were by just my presence alone. I got out and gave them the cleats and the gloves and they appreciated it. The older brother (Ben) was still emotional, so I gave them to him."

Cruz had written "Jack Pinto, My Hero" and "R.I.P. Jack Pinto" on his cleats before the Giants' loss to the Falcons Sunday in Atlanta.

The 26-year-old player best known for his salsa dances after touchdowns, signed autographs for the children before heading inside.

"I didn't want to go in there and make a speech," Cruz said. "I just wanted to go and spend some time with them and be someone they could talk to, and be someone they can vent to, talk about how much of a fans they are of the team, or different times they watched the Super Bowl."

Cruz spent that part of the visit sitting in the chair where Jack's father, Dean, sat when he watched the Giants' Super Bowl win over the New England Patriots in February.

It was a day Jack got to see his favorite team win a championship.

"It was just an emotional time," Cruz said. "I spent a little bit of time with them. We got to smile a little bit, which was good for them. It was a time where I just wanted to be a positive voice, a positive light in the tunnel where it can really be negative, so it was a good time. They are a great family and they're really united at this time and it was good to see."

Cruz said it was strange thinking about a child being buried in his jersey. He did not know how to react. Should he thank the family?

"It leaves you kind of blank," Cruz said. "I am definitely honored by it. I am definitely humbled by it, and it's definitely an unfortunate but humbling experience for me."

The visit also gave Cruz time to reflect, especially looking at his daughter.

"Ever since it happened I've kind of been spending more time with her, just cherishing the little moments, the little time you get with her because you never know when that can be taken from you," he said.

Giants coach Tom Coughlin said he was incredibly proud of Cruz for visiting with the Pinto family.

"Hopefully some of their grief might at least temporarily be suspended in being able to embrace Victor Cruz," Coughlin said, adding what he did speaking volumes of what he has inside.

Baltimore Ravens running back Ray Rice said what Cruz did took heart.

"You've got to be able to put yourself in that family's situation to understand at least what they're going through," Rice said in a conference call with the New York media about Sunday's game against the Giants. "That's what it's about. That's something that you don't just say, 'I'm going to do it.' You do it from the heart, from within and what he did was amazing."

___

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F.D.A. and States Meet About Regulation of Drug Compounders

Mary Calvert/Reuters

Margaret Hamburg, the F.D.A. commissioner, testified on the meningitis outbreak before Congress in November. She addressed the need for greater federal oversight of large compounding pharmacies, which mix batches of drugs on their own, often for much lower prices than major manufacturers charge.

SILVER SPRING, Md. – The Food and Drug Administration conferred with public health officials from 50 states on Wednesday about how best to strengthen rules governing compounding pharmacies in the wake of a national meningitis outbreak caused by a tainted pain medication produced by a Massachusetts pharmacy.

It was the first public discussion of what should be done about the practice of compounding, or tailor-making medicine for individual patients, since the F.D.A. commissioner, Dr. Margaret Hamburg, testified in Congress last month about the need for greater federal oversight of large compounding pharmacies. So far, 620 people in 19 states have been sickened in the outbreak, and 39 of them have died.

Pharmacies fall primarily under state law, and the F.D.A. convened the meeting to get specifics from states on gaps in the regulatory net and how the states see the federal role. Some states said they would prefer to see the F.D.A. handle large-scale compounders like the New England Compounding Center, or N.E.C.C., the Massachusetts pharmacy that was the source of the outbreak.

“The consensus in our group was that there is a role for the F.D.A. to be involved in facilities like N.E.C.C.,” said Cody Wiberg, the executive director of the Minnesota Board of Pharmacy. “If you’re talking about compounding, most states have the authority and resources to handle that. If you’re talking about nontraditional compounding,” he said, referring to large-scale enterprises like N.E.C.C., “fewer states may have the resources to do that.”

Large-scale compounding has expanded drastically since the early 1990s, driven by changes in the health care system, including the rise of hospital outsourcing.

“It is very clear that the health care system has evolved and the role of the compounding pharmacies has really shifted,” Dr. Hamburg said in a telephone interview on Tuesday. She said the laws had not kept pace.

“We need legislation that reflects the current environment and the known gaps in our state and federal oversight systems,” Dr. Hamburg said.

Under current law, compounders are not required to give the F.D.A. access to their books, and about half of all the court orders the agency obtained over the past decade were for pharmacy compounders, although compounders are only a small part of the agency’s regulatory responsibilities.

The F.D.A.'s critics argue that the agency already has all the legal authority it needs to police compounders. They say that many compounders have been operating as major manufacturers, shipping to states across the country, and that the F.D.A. should be using its jurisdiction over manufacturers to regulate those companies’ activities.

“There should be one uniform federal standard that is enforced by one agency – the F.D.A.,” said Michael Carome, deputy director of Public Citizen’s Health Research Group, a nonprofit consumer organization, who has been a critic of the agency’s approach. “They have been lax in enforcing that standard.”

But Dr. Hamburg contends that the distinction is not so simple. Lumping large compounders in with manufacturers would mean they would have to file new drug applications for every product they make, a costly and time-consuming process that is not always necessary for the products they make, like IV feeding tube bags, for example. Dr. Hamburg has proposed creating a new federal oversight category for large-scale compounders, separate from manufacturers.

“What concerns me is the idea that we could assert full authority over some of these facilities as though they were manufacturers, as though there were an on-off, black-white option,” Dr. Hamburg said. “That is a heavy-handed way to regulate a set of activities that can make a huge positive difference in providing necessary health care to people.”

The central problem, state representatives said, is how to define large-scale compounding. Should companies be measured by how much they produce, whether they ship across state lines, the types of products they produce, or some combination of those factors?

“It’s easy to stand at a distance and ask why can’t there be a bright line?” said Jay Campbell, executive director of the North Carolina Board of Pharmacy. “Let’s not let the perfect get in the way of the good. We won’t be able to make a distinction that is razor sharp.”

Large-scale compounders play an important role in the health care supply chain when they produce high-quality products, F.D.A. officials say. They fill gaps during shortages and supply hospitals with products that can be made more safely and cost-effectively in bulk than in individual hospitals.

Officials said they wanted to make sure the products made by such suppliers were safe, but were also concerned about disrupting that supply.

Carmen Catizone, head of the National Association of Boards of Pharmacy, said that states were not equipped to regulate the large-scale compounders and that the F.D.A. needed to find a middle path for regulating them.

“Either hospitals are not going to like the solution, or the manufacturers aren’t going to like the fact that these guys get a shorter path,” he said. “But something’s got to give.”

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