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In surgery, practice makes perfect

Thu, 2015-03-12 09:10

From today's file of statistics that will scare you, a patient-safety organization called The Leapfrog Group finds survival rates for some high-risk surgeries can swing by as much as 23 percent depending on the hospital a patient visits.

In all, The Leapfrog Group looked at four risky surgeries including esophagectomy, replacing the aortic valve in the heart and removing some or all of the pancreas.

Dr. Tom Varghese, a surgeon at the University of Washington, often performs esophagectomies. He says there’s good reason why a patient dies during a procedure that involves removing some or all of the esophagus. The patient is often weak and malnourished. That patient has often gone through chemotherapy and radiation, and then, Varghese has to cut him open to perform a tough procedure.

“So you take out the esophagus, then you have to reconstruct the replacement which is most of the stomach. And then you have to make that stomach, which is a big sack, make it into a tube. Then you have to stretch it back up to reattach in the neck,” he says.

Varghese says he performs maybe 15 of these surgeries every year. The study found in general the hospitals that performed these procedures the most tended to have the best outcomes. That’s no surprise says Dr. Bob Wachter at the University of California, San Francisco.

“There’s clear evidence that practice does make perfect. The more cases you do in general the better you are,” he says.

Wachter says the hospital matters, too. Questions like: Does the facility report their mortality and readmission rates? Do members of the staff wash their hands? Do nurses feel comfortable calling a doctor at 3 a.m.? All play a role in patient quality.

The trouble has been it’s hard to find reliable information. Consumers in need of care today still must rely on a patchwork of sources. Wachter says for certain procedures, like transplants and some hearts surgeries there’s decent information.

Patients can also turn to Consumer Reports, U.S. News and World Report and other rankings. Ultimately though, Wachter says people are “stuck with sitting down and meeting with the [physician] and looking them in the eyes and seeing if this is a person I can trust,” he says.

But Leapfrog’s Erica Mobley says change is coming.

“Healthcare hasn’t really been held to the standards of other industries, having to publicly report information the good and the bad,” she says.

When Leapfrog began its hospital survey in 2001, only 200 hospitals responded. This year, 1,500, or one-third of all hospitals nationwide participated. And consumers are a driving force behind better quality information.

In a recent survey, Mobley says consumers said what disturbed them the most was not high infection rates, nor even when surgeons left an object inside a patient. It was when hospitals withheld information and failed to report data. And it appears hospital executives are listening.

Quiz: School lunch specifics

Thu, 2015-03-12 08:55

A school-cafeteria study published in Childhood Obesity finds students wasted less food after USDA lunch standards were implemented.

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PODCAST: Courts could upend Uber's model

Thu, 2015-03-12 08:20

First up: The ride services Uber and Lyft failed to convince a pair of U.S. judges on Wednesday that their drivers are “independent contractors” rather than regular employees. Class-action lawsuits – brought by drivers of both companies – will now go to jury trial, the results for which could have important consequences for the sharing economy. Then, Google is getting into "cold storage," taking on the masses of old data businesses like to squirrel away and making it available to them at a moment's notice. Finally, New Yorkers have been enjoying excellent ski conditions for most of this winter, but in Lake Tahoe, the slopes are bare and warm. We look at how small ski areas are scraping by while the bigger resorts are looking for new ways to turn a profit.

In Vietnam, a cemetery kicks out the living

Thu, 2015-03-12 07:54

Some of the world's fastest growing economies are in Asia. With more cash flow, more jobs, more people, Asian cities are getting a lot bigger. Some are overflowing.

In Ho Chi Minh City in Vietnam, it seems as if little can stand in the way of urban sprawl — not even the dead. The city's biggest cemetery is slated for demolition, with plans to use the space for a shopping mall, apartments and parks.

Moving 70,000 tombs is one challenge. Here's an even trickier one: What to do about the hundreds of people who work and live inside the cemetery? 

The cemetery, Binh Hung Hoa, is a relatively quiet place — to lay flowers, light incense at a loved one's grave, even say a solemn prayer.

And hey — before you leave, grab a massage. 

"Oil, full body, hand, head… everything! Very cheap!" a masseuse named Man says with a laugh. She says she's offering oil, full-body, hand, and head treatments for less than $5 an hour.

It's kind of a steal — if you're okay with a rubdown among nearly two hundred football fields worth of above-ground cement tombs.

Man says her customers couldn't care less. Many local people who have colds, the flu, or fever often come here. There's been a big community living here for years and years, since before the early 1960's, when a much smaller cemetery first opened. After the U.S. war ended, the whole place just got bigger. More graves, and today, hundreds of people.

Thi Cuc Nguyen and her husband live here, where they work sweeping and looking after nearly 1,000 tombs.

"Are you scared of ghosts?!" Nguyen asks, laughing. "No ghosts here, only bodies. Their spirits are up in heaven already. So I feel totally peaceful living here."

The Catholic Church hired the couple almost 25 years ago. Nguyen says this gig sure beats her old job selling produce.

"Visitors often thank me, as they see that I am taking care of their families' tombs," she says. "I make $100 to $150 a month. And I have more freedom. I really enjoy taking care of the graves."

There are other ways to earn cash here. Some rent out rooms to day laborers, others run makeshift speakeasies. Want to order a whole roasted pig? One of the temple caretakers will hook you up.

Hoa Binh runs a small stand at a crossroads in the cemetery, where she sells sweet iced coffee, plus flowers and incense for the graves. Things have been tough for her since 2011, when the district People's Committee closed the cemetery to new burials. Families came and started emptying the tombs.

Since then, she says, business, well, it's been kind of like a graveyard around here.

"As soon as they started removing the tombs, the number of visitors dropped a lot," she says. "There used to be 500 tombs in this area. Sometimes there would be a line of cars here, just to visit one tomb, you know? But it's getting quiet. Very quiet!"

Quiet? Not exactly. The cemetery sits just two miles from Ho Chi Minh City's very busy international airport. This is where it's all supposed to happen: luxury apartments, a shopping mall, maybe a park, all by the year 2020.

Partly, yes, it's about sprawl, but there are public-health issues, too, says Yale anthropologist Erik Harms, who's written about urban redevelopment here.

"There's been stories about people drinking water from wells there," he says. "That's pretty nasty, right? To drink water from a well in a cemetery where corpse juices are dripping into the well, right?"

Some of those who live here are embracing the new plans. Harms says that with projects like this one, people often imagine a more comfortable way of life.

"They say, 'Yeah, it would be nice to live in a nice house or an apartment building with air conditioning, clean sewers … good schools for the kids.' That's in some ways preferable to living in a cemetery."

But the local government hasn't said what it's going to do for the residents. It's tricky in part because many people don't have any legal claims to the land.

One thing is clear: Soon, they'll have to pack up and move on, as this old graveyard gets set to start a new life.

Juries to decide if Uber drivers are 'contractors'

Thu, 2015-03-12 07:36

The ride services Uber and Lyft failed to convince a pair of U.S. judges Wednesday that their drivers are “independent contractors” rather than regular employees.

The class-action lawsuits – brought by drivers of both companies – will now go to jury trial, the results for which could have important consequences for the sharing economy.

By serving as middlemen in a market for surplus labor, or car rides, or whatever, many sharing economy startups have been able to skirt labor regulations such as social security, worker’s comp, or sick leave.

In yesterday’s ruling, Judge Edward Chen noted that Uber, “would not be a viable business entity without its drivers,” and that the company can also fire drivers for a variety of reasons, including low passenger ratings, or for no reason at all. Both of these reasons are cases for the drivers being considered employees.

By cautious estimates Uber has upwards of 160,000 drivers across 61 cities in the United States.  If it has to pay out benefits to all those drivers it will affect the profitability of their business model, as well as other gig-economy apps such as TaskRabbit, Wonolo, Instacart or Handy.

Still, given how much money Uber has already raked in from investors, even if a jury rules against them on the issue of independent contractors, they should still be able to adapt.

"I'm sure they have a contingency plan to deal with this,” says John Horton, from NYU’s Stern School of Business. “It may take some of the shine off them as an investment, but my guess is we're not going to see Uber close up shop if the jury rules against them."

Uber is valued somewhere north of $40 billion, Lyft is around $2.5 Billion. Horton points out that many of the labor regulations that apply to the workforce were written into law before companies like Uber were part of the marketplace.  Still, he cautions against re-writing laws too quickly.

“One of the things you worry about when crafting policy before the contours of the industry are already apparent,” Horton says. “It can happen where the people who seem to be already out in front, can use regulation to squash new entrants.”

Horton notes this frontrunner position could be leveraged by other companies in the surplus economy, not just Uber.  He also says it would likely result in increased costs being passed on to consumers.

If Uber or Lyft drivers are ultimately ruled to be employees, they'll be entitled to reimbursement for gas and vehicle maintenance, among other expenses, according to Reuters.

How to make an educational game kids want to play

Thu, 2015-03-12 04:05

There are plenty of serious conversations taking place this week at SXSWedu in Austin — student data, social learning, digital citizenship, online degrees.

But there is also a lot of serious talk about games, and how they can be used to help engage kids and improve learning. In 2013, the market for educational games was about $1.5 billion and growing rapidly. 

Rule No. 1: No chocolate-covered broccoli. That’s according to Phaedra Boinodiris, global lead for serious games and gamification at IBM. 

“You enter into the realm of what I call ‘chocolate-covered broccoli’ if you do it wrong,” she says. 

To Boinodiris, chocolate-covered broccoli is the thinly disguised, anti-fun. In other words, educational games still need to feel likes games. And that means something at stake, something to win. 

"Brain Chase" is an online educational treasure hunt for kids to complete over the summer, using geography and math skills to find a real “buried treasure”: a $10,000 scholarship. 

Founder Allan Staker says violence isn’t an option in educational games, so developers have to rely on something else to keep kids interested. 

“You have to start with a quest, get them in the shoes of a protagonist,” he says.

During the Brain Chase game, participants had to use a compass, map and clues from video prompts to help their fellow adventurers escape a cryptic hedge maze.

Kelsey Fowler/Marketplace Without having “Grand Theft Middle School,” Staker says, the answer is unsurprisingly, treasure.

Paul Darvasi, a high school English teacher in Toronto, says during the last month of the year, he turns his class into the psych ward from Ken Kesey’s “One Flew Over the Cuckoo’s Nest.” 

“My students are put into the role of mental patients, and I take on multiple roles either through videos, or live performances as the faculty that’s running the mental ward,” he says. 

Darvasi uses Twitter and Facebook to post challenges, questions and quests for his students. 

“A really interesting thing about Keasy’s novel is his critique of the industrial elements of the mental institution coincide well with the critiques of the education system,” he says.

Shawn Young shows off his creation Classcraft, a role-playing game designed to increase collaboration and engagement in the classroom.

Courtesy of Classcraft

Brothers Shawn and Devin Young of the role-playing game "Classcraft" say introducing games into the classroom faces the same challenges introducing new technology in schools has always faced: finding the money in the budget.

“There are a lot of great, empowering things about video games and using them to motivate and learn,” Shawn Young says.

The new digital classroom, brought to you by SXSW

Thu, 2015-03-12 02:04

Before the techies and music lovers descend on Austin for South by Southwest, or SXSW, there’s SXSWedu.

Senior reporter Adriene Hill, and the LearningCurve edtech team have been at the education conference all week. Adriene spoke with Marketplace host, Kai Ryssdal, about which new technologies were grabbing the attention of educators. 

Tom Leonard, superintendent of Eanes Independent School District in Austin, says introducing laptops and tablets into classrooms has been hard at times, and teachers took some time to get on board, but there's no going back. 

“Technology in schools right now is like the infancy of the automobile,” he says. “For a while when the automobile was just starting, the horse was more effective, it really was. But we knew we were going in the direction of the car, so we had to get there. And right now I think that’s what’s happening in classrooms. You are seeing teachers struggle with that, but good school districts know we need to get there.” 

And tech entrepreneurs want to get there right along with them. Billions of dollars are pouring into edtech as software makers, among others, vie for a place in the classroom.

One area that's getting a lot of attention is "making."  The “Playground” area of SXSWedu was full of products focused on kids building things, using 3D doodlers and Lego robots. 

There’s also a big focus on coding. “Coding is now pushing down into the lower grades, we’re talking kindergarten level,” says Claire Novy, a teacher from Miami. Get ready for second-graders to be showcasing their work in the app store. 

Along with all the tech talk, there has been a growing discussion about what's called social and emotional learning, or SEL. It focuses on kids' views of themselves as learners, and how their perceptions can help — or hinder — their ability to learn. Expect to hear more in the future about student emotional health.

Superintendent Leonard says he expects to see more entrepreneurial programs in schools, aimed at teaching kids how to create their own jobs in the future. 

Dallas Dance, superintendent of Baltimore County public schools, is looking forward to new organizational tools that will bring much of a school's data together.

"Usually school systems have about five different systems they operate from,” he says. “Your learning management system can be one, your grade book’s another, your student information system’s one, you may have a data dashboard or a warehouse somewhere else. We are creating [a database] which will be a one stop shop for everyone.”

That includes parents, who may have an easier time in the future keeping up with their childrens' educational lives.

Behind the scenes at a budget hedge-fund start-up

Wed, 2015-03-11 13:03

"Hedge fund manager." The words might conjure up an image of a gray-haired man in a tailored suit, standing in a room full of dark wood, making billions of dollars by boldly gambling with other billionaires' money. But add to that Howard Wang, a 29-year-old in sweatpants, sitting at a desk next to his bed, scrolling through hundreds of ticker symbols on a spreadsheet.

"Every single one is a position that we hold," he says. "For example, Apple. And Amazon."

The spreadsheet represents millions of dollars in stocks, bonds, commodities, futures and currencies from every corner of the world, invested according to algorithms created and calibrated by Wang and his partner Robert Wu — both alums of the high-flying Bridgewater hedge fund — and run out of Wang's apartment. 

"That is literally the hedge fund," says Wang of the positions on his computer screen. 

"Hedge fund is like the nickname," says Steve Nadel, a lawyer at Seward & Kissel who helps set up hedge funds. "I think you could just as easily call it a 'private investor fund' in that it's privately offered and you don't advertise to bring in investors."

Hedge funds are no longer distinguished by a "hedging" strategy, but by their legal and regulatory status. They employ one of two exemptions to minimize oversight and regulation in exchange for being open to only the wealthiest individual or institutional investors.

Traditionally, hedge-fund managers have also shared a method of charging those investors: A management fee of two cents of every dollar invested, and a performance fee of 20 cents of every dollar gained.

But that's changed since the financial crisis. 

"You go back to pre-2008, about every hedge fund had a management fee around 2 percent," says Nadel. "Right now the rate is around 1.7 percent."

Wang's fund, Convoy Investments, is going even lower, to 1.25 percent and discounts for early investors.

"And no performance fees," Wang says. 

Does it pay the rent? 

"Yeah," he says. "I mean, of course, it depends on how much money we're managing. Right now, it does not pay the rent. For the last few years, I've been basically working out of my own savings." 

This thrifty approach is meant to appeal to investors fed up not just with hedge funds' high fees, but the lackluster returns many have been getting in exchange.

"When speaking about returns, one word that I've heard a lot is, you know, mediocre," says Melissa Santaniello, founder of the Alignment of Interests Association, a group of several hundred hedge fund investors. Last year, her group put out a kind of aspirational "Hedge Fund Investing Principles." Among the suggestions were ways of making fees drop in years when returns are lousy. "It's just aligning their interests. It's just making it a bit more fair," she says.

Last year, while individual hedge funds performed well, the average hedge fund made just one or two percent; simply investing in the S&P 500 would have returned 11.4 percent. California's massive pension fund, CalPERS, cuts its hedge fund investments entirely, citing high costs among other factors. And more hedge funds have simply shut down than any year since 2009.

The drumbeat of news adds to an argument advanced by Simon Lack, author of The Hedge Fund Mirage, that the industry has gotten too big to reliably deliver on its promises. In the 1990s, he says hedge funds as a class were a good investment, but as the industry has ballooned to nearly $3 trillion, the number of potential profit-making opportunities hasn't kept up.

"Below $1 trillion in assets hedge funds were able to generate reasonably good returns, and as they went above a trillion dollars, that turned out to be too much money for the available opportunity set," says Lack. 

Since 2002, Lack finds that a standard, boring portfolio of cheap index funds, made up of 60 percent stocks and 40 percent bonds, beat hedge funds not just over the 13-year period, but every single year. That's before, during and after the financial crisis, in good stock market years as well as the bad years when hedge funds are thought to be a particularly valuable form of portfolio diversification. 

"It really sort of undercuts the whole rationale for having hedge funds in the portfolio," says Lack. "I mean, if they're always going to underperform — always — what's the point?"

But for Howard Wang, bad news for hedge funds is reinforcement to his pitch. In a Skype call with a potential investor in Louisiana, he sounds less like a hedge-fund manager than an index fund rep, as he repeats a number of seemingly self-deprecating claims: He will not be a genius manager who beats the market day to day. He will not be making predictions about the future. Instead, his strategy is mostly passive, mostly automated, and mostly transparent. 

"I'm basically just the guy who's going out and executing on this strategy for you," he says. 

It's a modest pitch, but it works with this investor. He agrees to invest $500,000, putting Wang's fund at around $18 million. It's a small fund, and the discounted fees that he and his partner earns are made smaller still by auditors, lawyers and taxes.

"It may come out to be maybe 40k per person that we can take home, 30k," Wang says. 

Not exactly what you think of as a "hedge-fund manager" salary. 

"Right, right," he agrees. "But we're OK with that."

He says it's worth it to run a hedge fund of his own, and to run it a little bit differently.

In Atlanta housing recovery, the neighborhood matters

Wed, 2015-03-11 12:34

Robin O'Neil owns a four-bedroom home in what looks like a little piece of suburban paradise: the Chapel Lake subdivision in DeKalb County, east of Atlanta. The large yellow house has a generous lawn, a patio and even a little sunroom. But O'Neil, who works in real estate, says her home is worth less than when she bought it in 1997. Still, she has faith that her neighborhood, and her home, will bounce back.

The recession and the housing crash hit Atlanta hard, but since 2012 recovery has seemed imminent. Is it?

Dan Immergluck, a professor of city and regional planning at Georgia Tech, decided to investigate how and whether greater Atlanta housing was recovering. He used home price estimates from Zillow and compared three-bedroom houses in every zip code in the metro region. Home prices in zip codes Immergluck calls "the favored half" had rebounded to where they were at the market's peak. In other zip codes, homes are still worth only about half of what they were in 2001.

Immergluck found that one of the primary differences between neighborhoods that have recovered fully and those that have recovered only partially is their racial demographics. Majority-African-American and Hispanic zip codes are recovering more slowly than majority-white zip codes with similar housing stock. 

Immergluck says the nature of the housing crash might explain the uneven recovery. In the years before the housing bubble burst, minorities were more likely to have had subprime loans and were more likely to have lost their houses. In some neighborhoods, the result was large swaths of homes lost to foreclosure, depressing the value of houses around them.

Others see more endemic and worrying factors. Dorothy Brown, a professor at Emory University's School of Law, cites studies which show that, even before the housing crash, homes in predominantly African-American neighborhoods were likely to be valued at lower prices than similar homes in majority-white neighborhoods. Brown's advice to those seeking to buy homes is not beware, but be smart. Make sure, she advises, that you don't expect your net worth to come solely from your home.

In Chicago, police misconduct has a hefty price tag

Wed, 2015-03-11 11:34

The White House has been looking at problems with local law enforcement. Not only did the Justice Department issue its report on Ferguson, Missouri, but a presidential task force on 21st Century Policing issued a report in March. 

In addition to the social costs, police misconduct costs money.  One watchdog group found that Chicago paid out more than half a billion dollars over a 10-year period. How does the tab get so high?

Start with laywers:  Scandalously bad policing is Jon Loevy’s bread-and-butter. He runs a for-profit law firm in Chicago, with 25 attorneys, built on big wins in police misconduct cases.

"We like to say it’s a non-depletable good — injustice," he says. "You know, there’s a million cases out there where people have their rights violated, or wrongfully convicted, or falsely arrested."

What’s tough is winning those cases, which can take years and lots of upfront investment.

"This is not for the faint of heart," says Loevy. "Because you don’t get paid unless you win."  

So, having lawyers who are willing and able to take those cases on — and win them — is one variable.

Another is how a city responds to lawsuits. For years, the city of Chicago had a not-quite-official “no-settlements” policy, which is a strategy that may scare away some potential plaintiffs. However, it also means defending cases that are clear losers.  

That gets expensive, says Lou Reiter, a law-enforcement consultant and former deputy chief of the Los Angeles police department. Juries will award more in damages than lawyers would settle for. "Then, the attorney gets reasonable fees on top of that," says Reiter. "And many times that’s much more than the actual jury verdict." 

He consulted with the plaintiff's attorneys on an infamous Chicago case, in which an off-duty cop beat up a bartender in front of a security camera. The video went viral, and the city refused to settle. The jury awarded the woman $850,000, and the court gave her attorneys more than twice that amount.

Reiter thinks the city could have saved itself a lot of money. "Initially, they probably could have settled that for maybe two, three hundred thousand dollars," he says.

Legal fees, including payments to the city's own outside counsel, amounted to about a quarter of the city's $521 million police-misconduct tab, as tallied by the Better Government Association.

The city of Chicago didn’t comment for this story, but plaintiffs’ lawyers say Chicago’s policy has shifted since Rahm Emanuel became mayor in 2011.

"They've really moved to nip some of these cases in the bud," says Andrew Schroeder, a reporter for the BGA. "If they identify a case where they were clearly in the wrong, they are trying to settle that early on, before it results in an expensive judgment."

Chicago is not alone in facing these expenses. The Ramparts police scandal alone cost Los Angeles an estimated $125 million.

The "Blurred Lines" case could have a chilling effect

Wed, 2015-03-11 11:13

Borrowing, sampling, covering and other appropriation are commonplace among musicians, but an LA jury ruled Monday that Robin Thicke and Pharrell Williams took things too far with their monster hit "Blurred Lines." The court ruled the pair's track was a little too inspired by Marvin Gaye's "Got to Give it Up," and awarded Gaye's family about $7.4 million for copyright infringement.

The verdict could put artists more on notice when appropriating other tracks, says George Washington University Law Professor Robert Brauneis, who helps us unpack the complexities of the case.

Listen to the full conversation in the audio player above.

Apple saves on rent thanks to long iPhone lines

Wed, 2015-03-11 10:01
31

All 31 banks subjected to the Federal Reserve's stress tests passed the first round last week, showing they can continue to lend even amid economic collapse. But the second round of results, due Wednesday, might not go quite as well for all the banks.

21,944.66 points

That's where the Dow Jones Industrial average would have sat Tuesday, in theory, if Apple had joined in 2008 instead of Bank of America, Bloomberg reported. In reality, Apple joined this week, displacing AT&T and B of A left in 2013.

Courtesy:Bloomberg 2 percent per square foot

Speaking of Apple, that's the portion of sales its retail stores pay for space in American malls, the Wall Street Journal reported. Compare that to the up to 15 percent other retailers typically pay per square foot. Apple has reportedly negotiated for lower rent because of their stores' massive draw.

$10 billion

That's how much General Motors is giving back to shareholders in dividends and stock buyback, quelling a potential spat with activist investors. But the move could mean GM will lose some ground as it attempts to keep wages down during negotiations with the autoworkers union this summer.

20

The number of deaths tied to film or TV production from 2010 to 2014, doubling the previous five years. An LA Times investigation found the uptick is tied in part to reality TV production and the drive to create thrilling footage

$7.3 million

The damages an LA jury ordered "Blurred Lines" co-writers Robin Thicke and Pharrell Williams to pay Marvin Gaye's family for infringing on Gaye's "Got to Give it Up" copyright with the 2013 megahit. Quartz joins the flurry of "soundalike" lists with a playlist, so you can decide for yourself who's a copycat and who's not.

Ahead of labor talks, GM puts pressure on itself

Wed, 2015-03-11 09:54

GM announced this week it’ll give shareholders $5 billion in dividends and a $5 billion stock buyback. That’s good news for investors, and for GM, which managed to avoid a major clash with hedge fund interests on the board.

Times are good for automakers like GM.  But when the company opens negotiations with the United Autoworkers Union this summer, it’s going to try to keep a lid on wages, says Kristin Dziczek, director of the Industry and Labor Group at the Center for Automotive Research.

The union will think, "If they had the kind of money that they had to pay out for this stock play, they’ve got money to fund what the union is looking for,” she says.

Some workers haven’t had a raise in more than eight years. And Dziczek says the UAW says the ones who did still aren’t earning enough.

Ross Eisenbrey, vice-president of the Economic Policy Institute, says GM can increase share prices at the risk of everything else, or take the long view: investing in new equipment and the workforce. He says GM has to balance all of those things against a desire to reward shareholders. 

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