Doctors make progress toward 'artificial pancreas'

Doctors are reporting a major step toward an "artificial pancreas," a device that would constantly monitor blood sugar in people with diabetes and automatically supply insulin as needed.

A key component of such a system — an insulin pump programmed to shut down if blood-sugar dips too low while people are sleeping — worked as intended in a three-month study of 247 patients.

This "smart pump," made by Minneapolis-based Medtronic Inc., is already sold in Europe, and the U.S. Food and Drug Administration is reviewing it now. Whether it also can be programmed to mimic a real pancreas and constantly adjust insulin based on continuous readings from a blood-sugar monitor requires more testing, but doctors say the new study suggests that's a realistic goal.

"This is the first step in the development of the artificial pancreas," said Dr. Richard Bergenstal, diabetes chief at Park Nicollet, a large clinic in St. Louis Park, Minn. "Before we said it's a dream. We have the first part of it now and I really think it will be developed."

He led the company-sponsored study and gave results Saturday at an American Diabetes Association conference in Chicago. They also were published online by the New England Journal of Medicine.

The study involved people with Type 1 diabetes, the kind usually diagnosed during childhood. About 5 percent of the 26 million Americans with diabetes have this type. Their bodies don't make insulin, a hormone needed to turn food into energy. That causes high blood-sugar levels and raises the risk for heart disease and many other health problems.

Some people with the more common Type 2 diabetes, the kind linked to obesity, also need insulin and might benefit from a device like an artificial pancreas, too. For now, though, it's aimed at people with Type 1 diabetes who must inject insulin several times a day or get it through a pump with a narrow tube that goes under the skin. The pump is about the size of a cellphone and can be worn on a belt or kept in a pocket.

The pumps give a steady amount of insulin, and patients must monitor their sugar levels and give themselves more insulin at meals or whenever needed to keep blood sugar from getting too high.

A big danger is having too much insulin in the body overnight, when blood-sugar levels naturally fall. People can go into comas, suffer seizures and even die. Parents of children with diabetes often worry so much about this that they sneak into their bedrooms at night to check their child's blood-sugar monitor.

In the study, all patients had sensors that continuously monitored their blood sugar. Half of them had ordinary insulin pumps and the others had pumps programmed to stop supplying insulin for two hours when blood-sugar fell to a certain threshold.

Over three months, low-sugar episodes were reduced by about one-third in people using the pump with the shut-off feature. Importantly, these people had no cases of severely low blood sugar — the most dangerous kind that require medical aid or help from another person. There were four cases in the group using the standard pump.

"As a first step, I think we should all be very excited that it works," an independent expert, Dr. Irl Hirsch of the University of Washington in Seattle, said of the programmable pump.

The next step is to test having it turn off sooner, before sugar falls so much, and to have it automatically supply insulin to prevent high blood sugar, too.

Dr. Anne Peters, a diabetes specialist at the University of Southern California, said the study "represents a major step forward" for an artificial pancreas.

One participant, Spears Mallis, 34, a manager for a cancer center in Gainesville, Ga., wishes these devices were available now. He typically gets low-sugar about 8 to 10 times a week, at least once a week while he's asleep.

"I would set an alarm in the middle of the night just to be sure I was OK. That will cause you to not get a good night of rest," he said.

His "smart pump" stopped giving insulin several times during the study when his sugar fell low, and he wasn't always aware of it. That's a well-known problem for people with Type 1 diabetes — over time, "you become less and less sensitive to feeling the low blood sugars" and don't recognize symptoms in time to drink juice or do something else to raise sugar a bit, he said.

Besides Medtronic, Johnson & Johnson and several other research groups are working on artificial pancreas devices.

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Online:

Diabetes info: http://diabetes.niddk.nih.gov/

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Iran Oil Ministry denies cyberattack

TEHRAN, Iran — An Iranian oil ministry official on Saturday denied a report published by a government agency that it had successfully blocked a cyberattack on an oil sector computer network.

Ahmad Tavallaei, head of IT at the National Iranian Oil Company, said in comments posted on the oil ministry's website shana.ir that a technical problem, not a cyberattack, was the reason for a temporary shutdown of the network.

An Iranian government agency in charge of fighting sabotage said earlier Saturday in its website, paydarymelli.ir, that the networks of the Oil Ministry and the National Iranian Oil Company came under cyberattack the day before.

Iran periodically reports the discovery of viruses and other malicious programs in government, nuclear, oil and industrial networks, blaming Israel and the United States. In May, Iran shut down part of its oil facilities because of another such reported cyberattack.

Israel has done little to deflect suspicion that it uses viruses against Iran.

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FAA moving toward easing electronic device use

WASHINGTON — Relief may be on the way for airline passengers who can't bear to be separated even briefly from their personal electronic devices. The government is moving toward allowing gate-to-gate use of music players, tablets, laptops, smartphones and other gadgets, although it may take a few months.

Restrictions on cellphone calls and Internet use and transmission are not expected to be changed.

An industry-labor advisory committee was supposed to make recommendations next month to the Federal Aviation Administration on easing restrictions on using electronic devices during takeoffs and landings. But the agency said in a statement Friday the deadline has been extended to September because committee members asked for extra time to finish assessing whether it's safe to lift restrictions.

"The FAA recognizes consumers are intensely interested in the use of personal electronics aboard aircraft; that is why we tasked a government-industry group to examine the safety issues and the feasibility of changing the current restrictions," the statement said.

The agency is under public and political pressure to ease the restrictions as more people bring their devices with them when they fly in order to read e-books, listen to music, watch videos, and get work done.

Technically, the FAA doesn't bar use of electronic devices when aircraft are below 10,000 feet. But under FAA rules, airlines that want to let passengers use the devices are faced with a practical impossibility — they would have to show that they've tested every type and make of device passengers would use to ensure there is no electromagnetic interference with aircraft radios and electrical and electronic systems.

As a result, U.S. airlines simply bar all electric device use below 10,000 feet. Airline accidents are most likely to occur during takeoffs, landings and taxiing.

Using cellphones to make calls on planes is regulated by the Federal Communications Commission. There is concern that making calls from fast-flying planes might strain cellular systems, interfering with service on the ground. There is also the potential annoyance factor — whether passengers will be unhappy if they have to listen to other passengers yakking on the phone.

The Wall Street Journal reported Friday that a draft report by the advisory committee indicates its 28 members have reached a consensus that at least some of the current restrictions should be eased.

A member of the committee told The Associated Press that while the draft report is an attempt to reach consensus, no formal agreement has yet been reached. The member was not authorized to discuss the committee's private deliberations and requested anonymity.

There are also still safety concerns, the member said. The electrical interference generated by today's devices is much lower than those of a decade ago, but many more passengers today are carrying electronics.

Any plan to allow gate-to-gate electronic use would also come with certification processes for new and existing aircraft to ensure that they are built or modified to mitigate those risks. Steps to be taken could include ensuring that all navigational antennas are angled away from the plane's doors and windows. Planes that are already certified for Wi-Fi would probably be more easily certified.

Although the restrictions have been broadly criticized as unnecessary, committee members saw value in them.

One of the considerations being weighed is whether some heavier devices like laptops should continue to be restricted because they might become dangerous projectiles, hurting other passengers during a crash, the committee member said. There is less concern about tablets and other lighter devices.

FAA officials would still have the final say. An official familiar with FAA's efforts on the issue said agency officials would like to find a way to allow passengers to use electronic devices during takeoffs and landings the same way they're already allowed to use them when planes are cruising above 10,000 feet. The official requested anonymity because he wasn't authorized to speak by name.

FAA Administrator Michael Huerta told a Senate panel in April that he convened the advisory committee in the hope of working out changes to the restrictions.

"It's good to see the FAA may be on the verge of acknowledging what the traveling public has suspected for years — that current rules are arbitrary and lack real justification," Sen. Claire McCaskill, D-Mo., one of Congress' more outspoken critics of the restrictions, said in a statement. She contends that unless scientific evidence can be presented to justify the restrictions, they should be lifted.

Edward Pizzarello, the co-founder of frequent flier discussion site MilePoint, says lifting the restriction is "long overdue."

"I actually feel like this regulation has been toughest on flight attendants. Nobody wants to shut off their phone, and the flight attendants are always left to be the bad guys and gals," said Pizzarello, 38, of Leesburg, Va.

Actor Alec Baldwin became the face of passenger frustration with the restrictions in 2011 when he was kicked off a New York-bound flight in Los Angeles for refusing to turn off his cellphone. Baldwin later issued an apology to fellow American Airlines passengers who were delayed, but mocked the flight attendant on Twitter.

"I just hope they do the sensible thing and don't allow people to talk on their cellphones during flight," said Pizzarello, who flies 150,000 to 200,000 miles a year. "There are plenty of people that don't have the social skills necessary to make a phone call on a plane without annoying the people around them. Some things are better left alone."

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Mayerowitz reported from New York.

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Follow Joan Lowy on Twitter at https://twitter.com/AP_Joan_Lowy

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How some states are addressing doctor shortages

How some states are working to address a shortfall of primary care doctors:

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CALIFORNIA

A package of bills moving through the Legislature is aimed at addressing California's medical provider gap. The legislation would allow nurse practitioners, optometrists and pharmacists to expand the types of services they can provide patients. The proposals face heavy opposition from doctors, who favor training and placing more primary care physicians in rural and other underserved communities. Opponents also worry such changes would create two classes of medical care — one for people who have access to doctors and another for people who don't.

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DELAWARE

Among the steps Delaware officials have taken to address the primary care physician shortage is a loan repayment program for primary care providers who commit to work in underserved areas. The program, funded by the state and federal governments, provided more than $360,000 in loan repayments to seven primary care providers in fiscal 2013. Officials say they are looking at expanding it.

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FLORIDA

Gov. Rick Scott funded an additional 700 residency slots this year, but Florida will still need additional residencies and fellowships just to bring the state up to the national average per capita. Scott also recently signed into law a long-debated bill that expands the drug-prescribing powers of optometrists. The state now allows optometrists to prescribe oral medications to treat eye diseases. House Republicans repeatedly used the shortage of primary care physicians and nurses in the state as a reason not to expand Medicaid under the federal Affordable Care Act.

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ILLINOIS

A state medical society succeeded in killing or gutting bills this year that would have given more medical decision-making authority to psychologists, dentists and advanced-practice nurses. That included one bill that would have allowed trained dentists to give flu shots and other immunizations. The dental society plans to bring the issue to lawmakers again but focus narrowly on flu shots. The group contends dentists should be prepared to respond to a future flu pandemic. They plan to make the case that the Affordable Care Act will increase the number of patients eligible for free flu shots and that the number of professionals who can give them also should increase.

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INDIANA

State officials and professional associations representing primary care physicians and other health providers are reviewing the state's primary care providers and where they are concentrated. Shortly after the federal health care law was signed in 2010, state officials determined that Indiana had not been properly tracking the density of primary care physicians and needed to do a complete review, said David Roos, executive director of Covering Kids and Families of Indiana.

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KANSAS

Efforts in Kansas to address medically underserved areas of the state began nearly a half-century ago at the University of Kansas, where a scholarship program is aimed at recruiting new physicians to start their practices in rural areas. Kansas has expanded those efforts in recent budget years, including legislation this year to increase the scope of study that would be eligible for the scholarships in return for serving in rural areas. Legislators also have expanded the laws to give pharmacists the ability to perform certain wellness functions, including administering vaccines.

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KENTUCKY

The state has not yet taken steps to deal with an influx of patients, but a recent study showed Kentucky's 10,475 doctors were not enough to keep pace with current patient loads. A report from Deloitte Consulting said Kentucky needs some 3,790 additional physicians, including primary care doctors and specialists, plus 612 more dentists, 5,635 more registered nurses, 296 more physician assistants and 269 more optometrists to meet current demand. The report's recommendations included expanding the use of telemedicine, particularly to put patients in contact with specialists.

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NEW JERSEY

Three bills in the New Jersey Legislature would give non-physicians more authority. The bills would let advanced-practice nurses determine causes of death if doctors are not available, let psychologists prescribe medications and let advanced-practice nurses prescribe drugs without the same oversight required for doctors. None of the bills has gotten far, and the Medical Society of New Jersey opposes all three.

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NEW MEXICO

According to a state legislative report, New Mexico residents could have trouble accessing medical care due to the potential need of 2,000 physicians, 3,000 registered nurses and as many as 800 dentists. State lawmakers didn't act this year on a plan that would have allowed dental therapists to practice in the state. An association representing dentists opposed the measure, although supporters said therapists would help address the state's shortage of dentists.

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NEW YORK

The New York health department's 2013-14 budget includes $8.5 million for programs that place physicians in underserved areas. Doctors Across New York began in 2008 and has awarded $8.9 million to support practices and $7.6 million for loan repayments. So far this year, it has provided 26 awards totaling more than $2.5 million over two years.

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NORTH DAKOTA

North Dakota has a program that reimburses family doctors for student loans up to $90,000 for a two-year commitment to work in a rural or other underserved area. A community match is required. A related program gives similar loan repayments up to $30,000 to physician assistants and nurse practitioners for a two-year-commitment to work in rural or other underserved areas, again with a community match required.

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OHIO

The governor wants to target graduate medical education funding toward training in primary care. Under a budget proposal still being debated, medical schools would receive about $200 million over the two-year budget period that begins in July. The state would then work with medical deans on a plan to prioritize training in primary care services, with the idea that dollars would be more focused in that area in the 2015 budget year.

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SOUTH DAKOTA

South Dakota has a program that reimburses doctors double the University of South Dakota School of Medicine's resident tuition for the most recent four-year-period if they agree to practice for three years in underserved rural areas. The current amount is about $138,000. A related program also gives double tuition reimbursements to physician assistants, nurse practitioners and nurse midwives who agree to practice in rural areas for three years, while a third program gives a $10,000 payment to nurses, therapists, lab professionals and others who practice in a rural area for three years.

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WISCONSIN

So far, no Wisconsin bills have dealt specifically with increasing the number of physicians or granting medical decision-making authority to pharmacists and other health care workers. But the budget-writing committee of the Republican-controlled state Legislature unanimously approved a measure to shift more money toward residency programs in the state. Supporters said the bill will encourage new doctors to remain in Wisconsin.

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New England better on primary care than most of US

PLAINFIELD, Vt. — Ronald Pitkin, 84, remembers the day in the early 1960s when his brother Belmont got a gash in his leg while the two were cutting firewood. They went to the office of the town physician, Dr. Frank Corson.

Corson worked alone, and Pitkin was drafted to be his assistant. "He told me 'You're going to have to scrub up.' I was the operating room nurse that day."

Now Pitkin gets his health care at The Health Center, sleek, modern clinic that houses primary care, dentistry, psychiatry and other specialties under one roof. It's one of eight facilities in small towns around Vermont that charge based on patients' ability to pay. They provide primary care to about 25 percent of the mostly rural state's residents, and experts say they're a key part of the reason why Vermont leads the country in primary care doctors per capita.

"This is a terrific health care center," Pitkin said recently as he waited for a checkup with the center's senior physician, Dr. John Matthew. "It's more care, and help in general, for less dollars than just about anywhere."

With Vermont leading the way, five of New England's six states rank in the top six for primary care doctors per capita, according to data from the Association of American Medical Colleges. The sixth, Connecticut, ranks 12th. As the national shortage of primary care doctors expected to increase after the federal Affordable Care Act takes full effect next year, some are looking to New England's states with an eye to what they've been doing right.

Several factors contribute to New England's relatively strong position. Among them: strong public health programs ensuring that high percentages of residents have health coverage, meaning fewer doctors deliver uncompensated care. Massachusetts, which enacted a universal health care program in 2006, has about 97 percent of its residents carrying health coverage. In Vermont it's about 94 percent.

The high rates of people already insured means "we will not experience the same (influx of newly insured patients) in Vermont as in other states that have very high rates of uninsured people or low Medicaid eligibility," said Mark Larson, commissioner of the Vermont Department of Health Access.

Medical schools in New England, including the University of Vermont College of Medicine and the University of Massachusetts Medical School, have increased their emphasis on educating doctors for primary care in recent years, officials said. Vermont and New Hampshire augment a federal program that offers partial loan forgiveness for doctors willing to work in under-served areas with a similar state program.

In rural northern New Hampshire, Edward Shanshala, executive director of Ammonoosuc Community Health Services, said he tries to use the lifestyle as a lure when recruiting new doctors. "If you like to hike, bike, ski, fish and things like that — great!" he said.

Doctors also have time to see more patients because physician's assistants and nurses deliver some basic care to patients, said Brian Rosman of the Boston-based consumer group Health Care for All.

"The goal is to have everybody working at the top of their license," Rosman said. "Doctors should do things that really need doctors."

Even in New England, though, the picture is "far from rosy," said Dr. Joseph Gravel, president of the Massachusetts Academy of Family Physicians. Starting family physicians at his Lawrence office make $130,000 a year; specialists can make three or four times that much, Gravel said. With many new doctors facing student loan debts in the hundreds of thousands of dollars, the incentives are clear.

A physician workforce study by the Massachusetts Medical Society reported that even a state ranking third in primary care doctors per capita had experienced a shortage for eight consecutive years. Half of all primary care physicians were not accepting new patients, with others reporting long wait times.

MMS spokesman Rick Gulla said the per-capita numbers may overstate access. "Many physicians in the state are teaching, doing research, or other activities. Some of those physicians only see patients a day a month, and this also affects patient access to care."

And the need for care is increasing, too, as the general population ages. Maine has the nation's highest median age; Vermont is second.

"It seems like not only is Maine's general population aging, but a significant percentage of primary care practitioners is also getting to an age of retirement," said Vanessa Santarelli, CEO of the Maine Primary Care Association, which promotes and supports 20 federally qualified health centers across the state.

And sometimes the hiking, skiing and fishing just aren't big enough attractions, Shanshala said. He described some of the lengths to which he's gone to recruit physicians. When doctors in training leave after brief stints, he invites them to return for the company picnic and tries to keep in touch in case they ever want to come back.

Still, the picture New England is better than elsewhere, Gravel said. He cited a 2007 report in the Journal of the American Medical Association saying that among new medical school graduates just beginning their residencies, just 3.3 percent nationwide were going into family practice.

Strong support from the community and from Vermont's political leadership were among the chief satisfactions of Matthew's 40-plus-year career, he said. Good primary care leads to good overall health, he said, noting Vermont has been ranked the healthiest state for several years running — six, according to the United Health Foundation.

"Vermont is a good society," Matthew said. "Everyone is concerned about the least amongst us."

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AP writers Holly Ramer in Concord, N.H., and David Sharp in Portland, Maine, contributed to this report.

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Newly insured to deepen primary care doctor gap

COLUMBUS, Ohio — Getting face time with the family doctor could soon become even harder.

A shortfall of primary care physicians in some parts of the country is expected to worsen as millions of newly insured Americans gain coverage next year when the federal health care law goes into full effect.

Patients could find it difficult to get quick appointments. Doctors could face a backlog.

Providers in impoverished inner cities and rural areas across the country say it already takes many months, years in some cases, to hire primary care doctors.

Many states have proposed expanding the medical duties of nurses and other health care professionals to help fill the gap.

As lawmakers struggle for answers, the shortage of primary care doctors is estimated to grow to almost 66,000 by 2025.

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Southwest cancels 57 flights after computer glitch

CHICAGO — Southwest Airlines expects some lingering delays Saturday morning after a system-wide computer failure caused it to ground 250 flights for nearly three hours late Friday night.

Full service was restored just after 2 a.m. EDT Saturday, but the Dallas-based airline is still working to clear a backlog of flights and reposition planes and crew.

The airline — the country's largest domestic carrier — canceled 43 flights Friday night and another 14 Saturday morning.

Southwest is the latest airline to ground flights because of a large computer outage. But its problem was minor compared to those experienced by two competitors — thanks in part to its late-day timing.

In April, American Airlines grounded all of its flights nationwide for several hours due to computer problems. The airline ultimately canceled 970 flights. And last year, United Airlines had two major outages: one in August delayed 580 flights; another in November delayed 636 flights.

The problem was detected around 11 p.m. EDT Friday, Southwest spokesman Brad Hawkins said. It impaired the airline's ability to do such things as conduct check-ins, print boarding passes and monitor the weight of each aircraft. Some flights were on the taxiway and diverted back to the terminal, Hawkins said. Flights already in the air were unaffected.

Most of Southwest's cancelations Friday night were in the western half of the country, according to airline spokeswoman Michelle Agnew. Saturday's cancelations were scattered across the U.S. They included planes leavings from Minneapolis, Chicago, Phoenix, Denver and San Diego, according to flight tracking service FlightAware.

Southwest flies an average of 3,400 flights each day.

Agnew said in an email Saturday morning that the airline's technology team is "still working to confirm the source of the issue."

Shortly after 2 a.m., Southwest posted on its Twitter page that "systems are operating and we will begin work to get customers where they need to be. Thanks for your patience tonight."

Agnew said the computer system was "running at full capacity" by early Saturday. Before that, though, officials used a backup system that was much more sluggish.

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AP Airlines Writer Scott Mayerowitz in New York contributed to this report.

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Small farmers turn to creative projects to survive

DEL REY, Calif. — Farmer David Mas Masumoto knows his small peach orchard can't compete with the giant agribusinesses that dominate the nation's produce aisles.

So as he walks through his central California grove at harvest time, showing his two workers which trees to pick, his wife and daughter, Marcy and Nikiko, work a different side of the operation, preparing a recipe from the family's newly published cookbook.

They saute fresh peach slices in butter and brandy, then whip heavy cream and pour wholegrain batter into a waffle iron, creating one of the dozens of dishes from "The Perfect Peach."

"The cookbook," says Nikiko Masumoto, 27, who co-authored the book with her parents, "is a natural extension of what we've been trying to do for years on the farm: to use creative ways to share our story and galvanize people about our fruit."

Like the Masumotos, small-scale growers throughout the U.S. are looking for creative ways to set themselves apart as they find that survival requires more than just selling crops. Experts say these practices are shifting notions of how small farms operate. Since the little guys can't beat corporate giants on price or production, they're cashing in on something the big shots can't provide: an intimate, personal experience.

Across the nation, family businesses are capitalizing on small farm culture by selling products such as jam, olive oil and lemonade. They're also writing books, hosting dinners and renting rooms. The ventures allow the public to share the experience and flavor of small farm life.

"The opportunities for farmers are significant today, because many of us as eaters want to make the connection to the food system, the land and the farmer," says Craig McNamara, founder and president of the Center for Land-Based Learning in Winters, Calif., which trains and mentors new farmers.

In industry terms, it's called value-added agriculture, and statistics show the practice is growing. According to the most recent data available, farm operators generated $10 billion in 2007 from farm-related activities other than crop or livestock wholesale, an increase of nearly 80 percent from 2002.

Value-added agriculture projects are "a way to have a product to sell year-round, even during winter months," says Shermain Hardesty, leader of the small farm program at the University of California, Davis.

"It reinforces farmers' connection to consumers," says Hardesty, who teaches a popular class on the specialty food business. "And by getting involved in marketing their identities, they can expand their profitability."

The examples abound. Just south of Hood River, Ore., Draper Girls' Country Farm lets people pick their own fruit or rent a room, in addition to selling jams and jellies and cinnamon-sugar dried apples. The 40-acre farm also makes fresh non-pasteurized apple cider in its own mill.

The Free Spirit Farm in Winters, Calif., grows produce on 7 acres and delivers it directly to over 40 restaurant chefs in the San Francisco Bay Area.

And the 40-acre Green Mountain Girls Farm in Northfield, Vt., which raises pastured goats, chickens, pigs and turkeys and grows vegetables and fruit trees, offers farm stays, cooking classes and workshops on how to milk goats and make cheese and yogurt.

"Contemporary people are fairly distant from farms, so we're trying to reconnect them directly with family scale faming and rebuild their skills, so they can use them on a daily basis," said farm co-owner Mari Omland. "We offer something deeply personal, highly authentic, hands on."

For the Masumotos, who have worked California's fields for four generations, it took time to figure out how to best sustain their operation as giant agribusinesses swallowed other family farms.

The corporations that produce millions upon millions of pounds of fruit in the San Joaquin Valley take up massive tracts of land. Gerawan Farming, for example, controls 9,000 acres. And nearby Wawona Packing Co. grows stone fruit on 6,000 acres.

The Masumotos, by comparison, run just 25 acres.

David Mas Masumoto switched to organics in the 1980s, but found that selling sustainably-farmed fruit proved challenging in an era of perfectly uniform supermarket peaches.

He wrote a book, "Epitaph for a Peach," about the struggle to save his heirloom peaches and way of life. And over the years, the family turned that unlikely crop and uncommon lifestyle into a hip, profitable business by involving consumers in the farm through stories.

Each year, people from Los Angeles, San Francisco and beyond come to the farm to pick their own ripe fruit and spend the day interacting with the farmers. Masumoto writes a farming column for the local paper, and Nikiko Masumoto uses Twitter and Facebook to update the public about the harvest.

The family hopes the cookbook adds to those efforts.

In addition to recipes ranging from peach gazpacho to peach shortcake, the book includes essays that provide glimpses into a small farm's life and vulnerabilities — the sweat, the mistakes, even death. It's an intentional effort, says Masumoto, because artisanal agriculture is highly personal and transparent when compared with the anonymity and homogeneity of corporate farming.

"The new agriculture is about story-based farming. It cares about the community, the farmworkers and the environment," Masumoto says. "The more we can differentiate from corporate farms, the more we can gain a new identity and be financially successful."

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Follow Gosia Wozniacka on Twitter at https://twitter.com/GosiaWozniacka

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Voters in Mass. city weigh in on Wynn casino plan

EVERETT, Mass. — Voters in Everett headed to the polls Saturday in the state's first binding referendum on a casino plan since the expanded gambling law was enacted.

The outcome will determine whether Las Vegas casino mogul Steve Wynn's proposal to develop a $1.2 billion resort casino on a site along the Mystic River that once housed a chemical plant can move forward and eventually be submitted to the Massachusetts Gaming Commission.

Voters are deciding whether to approve a host community agreement Wynn signed with city officials that called for his company to make $30 million in advance payments to Everett and more than $25 million in annual payments if and when the casino opens for business.

In the agreement, Wynn also promised to mitigate traffic impacts in the city and complete a multimillion-dollar cleanup of pollution at the site.

He also promised to give hiring preference to Everett residents for the estimated 8,000 temporary and permanent jobs that would be created by the project and to make a "good faith effort" to use contractors and suppliers for the city.

Wynn turned his focus to Everett, a city of about 42,000 residents just north of Boston, after an earlier proposal to build a casino in Foxborough ran into opposition from many residents and officials.

In Everett, Mayor Carlo DeMaria and other top city officials have embraced the proposal.

Sandy Guliano, president of the pro-casino group Everett United, said that the host community agreement is "fair and generous" to Everett and that she was encouraged by Wynn's commitment to clean up the former Monsanto Chemical Co. site.

"It's highly polluted," she said. "We don't know how else this will be cleaned up if it wasn't for a project like this."

No organized group formed to oppose the plan, but some residents are wary that a casino will lead to traffic gridlock.

"The traffic is a nightmare already," said Evmorphia Stratis, who also worries about the potential for increased crime and residents falling victim to gambling addiction.

The 2011 casino law that allows for up to three regional resort casinos in Massachusetts requires that voters approve a host community agreement in a binding referendum before a casino developer can apply for a license from the gaming commission.

Wynn's plan could be in competition for the sole eastern Massachusetts casino license with proposals from Suffolk Downs and Foxwoods Resorts, which is backing a proposed casino in Milford.

Polls in Everett close at 8 p.m.

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No word from Hong Kong on Snowden's return

WASHINGTON — Edward Snowden, the former government contractor who says he revealed that the National Security Agency collects Americans' phone records and Internet data from U.S. communication companies, now faces charges of espionage and theft of government property.

Snowden is believed to be in Hong Kong, which could complicate efforts to bring him to a U.S. federal court to answer charges that he engaged in unauthorized communication of national defense information and willful communication of classified communications intelligence information.

In addition to those charges, both brought under the Espionage Act, the government charged Snowden with theft of government property. Each crime carries a maximum sentence of 10 years in prison.

Hong Kong was silent Saturday on whether Snowden should be extradited to the United States now that he has been charged, but some of Hong Kong's legislators said the decision should be up to the Chinese government.

The one-page criminal complaint against Snowden was unsealed Friday in federal court in Alexandria, Va., part of the Eastern District of Virginia where his former employer, government contractor Booz Allen Hamilton, is headquartered, in McLean.

The complaint is dated June 14, five days after Snowden's name first surfaced as the person who had leaked to the news media that the NSA, in two highly classified surveillance programs, gathered telephone and Internet records to ferret out terror plots.

It was unclear Friday whether the U.S. had yet to begin an effort to extradite Snowden from Hong Kong. He could contest extradition on grounds of political persecution. In general, the extradition agreement between the U.S. and Hong Kong excepts political offenses from the obligation to turn over a person. Hong Kong could consider the charges under the Espionage Act political crimes.

Hong Kong had no immediate reaction to word of the charges against Snowden.

The Obama administration has now used the Espionage Act in seven criminal cases in an unprecedented effort to stem leaks. In one of them, Army Pfc. Bradley Manning acknowledged he sent more than 700,000 battlefield reports, diplomatic cables and other materials to the anti-secrecy website WikiLeaks. His military trial is underway.

Sen. Bill Nelson, D-Fla., a member of the Senate Armed Services Committee, welcomed the charges against Snowden.

"I've always thought this was a treasonous act," he said in a statement. "I hope Hong Kong's government will take him into custody and extradite him to the U.S."

But the Government Accountability Project, a whistle-blower advocacy group, said Snowden should be shielded from prosecution by whistle-blower protection laws.

"He disclosed information about a secret program that he reasonably believed to be illegal, and his actions alone brought about the long-overdue national debate about the proper balance between privacy and civil liberties, on the one hand, and national security on the other," the group said in a statement.

Michael di Pretoro, a retired 30-year veteran with the FBI who served from 1990 to 1994 as the legal liaison officer at the American consulate in Hong Kong, said "relations between U.S. and Hong Kong law enforcement personnel are historically quite good."

"In my time, I felt the degree of cooperation was outstanding to the extent that I almost felt I was in an FBI field office," di Pretoro said.

The U.S. and Hong Kong have a standing agreement on the surrender of fugitives. However, Snowden's appeal rights could drag out any extradition proceeding.

The success or failure of any extradition proceeding depends on what the suspect is charged with under U.S. law and how it corresponds to Hong Kong law under the treaty. In order for Hong Kong officials to honor the extradition request, they have to have some applicable statute under their law that corresponds with a violation of U.S. law.

Hong Kong lawmakers said Saturday that the Chinese government should make the final decision on whether Snowden should be extradited to the United States.

Outspoken legislator Leung Kwok-hung said Beijing should instruct Hong Kong to protect Snowden from extradition before his case gets dragged through the court system.

Leung urged the people of Hong Kong to "take to the streets to protect Snowden."

In Iceland, a business executive said Friday that a private plane was on standby to transport Snowden from Hong Kong to Iceland, although Iceland's government says it has not received an asylum request from Snowden.

Business executive Olafur Vignir Sigurvinsson said he has been in contact with someone representing Snowden and has not spoken to the American himself. Private donations are being collected to pay for the flight, he said.

"There are a number of people that are interested in freedom of speech and recognize the importance of knowing who is spying on us," Sigurvinsson said. "We are people that care about privacy."

Disclosure of the criminal complaint came as President Barack Obama held his first meeting with a privacy and civil liberties board and as his intelligence chief sought ways to help Americans understand more about sweeping government surveillance efforts exposed by Snowden.

The five members of the little-known Privacy and Civil Liberties Oversight Board met with Obama for an hour in the White House Situation Room, questioning the president on the two NSA programs that have stoked controversy.

One program collects billions of U.S. phone records. The second gathers audio, video, email, photographic and Internet search usage of foreign nationals overseas, and probably some Americans in the process, who use major Internet service providers, such as Microsoft, Google, Apple, and Yahoo.

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Associated Press writer Jenna Gottlieb in Reykjavik, Iceland, contributed to this report.

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