A growing push to document surgeries with cameras in operating rooms

In each case, the families still don’t know the full story of what happened to their loved ones, due to lack of documentation and an inability to pursue a costly lawsuit.

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They are relatives of an estimated 400,000 people who die each year in the United States of preventable medical errors, the third-leading cause of death after heart disease and cancer. But the families say they could have known much more if cameras had been installed in the operating rooms, recording the actions and movements of the doctors and staffers involved.

They are enthusiastic supporters of a growing movement that is seeking to require hospitals and surgical suites to have video and audio recording capability. Now, a surgeon in Toronto has built a “black box” that synchronizes a patient’s physical data with video and audio recordings of an operation, enabling doctors to review their work the same way athletes watch video of their performances. And he said he has lined up two U.S. hospital systems to take part in the first testing of the system.

“If we don’t know what we’re doing wrong, we’ll never improve,” said Teodor Grantcharov, a professor of surgery at the University of Toronto. “This is what many other high-performance industries have been using for decades.”

A bill that would require cameras in every operating room in Wisconsin has been introduced in the state legislature, and supporters say that lawmakers in other states are closely watching the bill’s progress. The proposed legislation, known as the “Julie Ayer Rubenzer Law,” is named for a Wisconsin woman who died after she was given excessive amounts of propofol — the same anesthesic that killed singer Michael Jackson in 2009 — during breast-enhancement surgery.

Rubenzer’s brother, Wade Ayer, founded the National Organization for Medical Malpractice Victims and helped draft the Wisconsin bill, which is supported by patient-advocate groups around the country. Ayer said video and audio recordings can capture the reasons behind “adverse events,” as the medical industry terms them, and deter inept or simply bad behavior by medical personnel such as the anesthesiologist in suburban Washington who can be heard harshly criticizing her patient in an audio recording made by the patient. The physician was hit with a $500,000 jury verdict.

[Anesthesiologist trashes sedated patient — and it ends up costing her]

Currently, re-creating what went wrong in an operating room involves a mixture of memories and whatever notes were taken at the time or shortly afterward, a vague combination that vexes families trying to get to the truth about a failed procedure or a fatal complication. Recording surgeries “offers transparency, truth and accuracy,” Ayer said, “in collecting data for the medical record and testimony. It offers data and insight for medical boards and even prosecutors. It offers oversight and policing.”

The medical industry is treading cautiously. The American Hospital Association, the American Medical Association and the American College of Surgeons all declined to comment for this article. The AMA in 2005 adopted a policy on filming patients in health-care settings — it encouraged the practice for educational purposes — but focused on patient privacy and on filming only those who give their consent.

But the health-care industry has flexed its muscle where needed, sometimes driven by concerns about the effects that video recordings could have on medical malpractice lawsuits, as well as the cost of installing and maintaining complex recording systems. A bill in Massachusetts that would require hospitals to allow recording by a licensed videographer, at the patient’s expense, has repeatedly failed in recent years in the face of opposition from hospitals, according to news media reports.

In Wisconsin, Ayer said he has encountered opposition from the medical industry. But state Rep. Christine Sinicki, a Democrat, has pressed ahead with what would be the first law in the country to require cameras in operating rooms. “After hearing stories from families affected by malpractice,” Sinicki said in an interview, “a lot of people felt the way to rein this in and catch it is to record everything in the operating room.”

But there are “fantastic privacy issues” with cameras in operating rooms, not only with patients but also with doctors and staffers, according to Bruce Cranner, a medical malpractice defense lawyer in New Orleans who is a former chair of the Defense Research Institute’s Medical Liability and Health Care Law Committee. “Health-care providers have a justified right to be able to talk among themselves about a patient without fear that [they are] going to be second-guessed or overheard.”

Cranner also suggested that cameras would not necessarily capture the key parts of an operation, and that “we are going to have to have somebody explaining for the TV what’s going on, like PBS’s ‘Nova’. That’s not what medicine’s for; it’s not Hollywood.”

Ayer said Cranner is wrong. “They already have cameras in operating rooms,” he said. “That’s how they train medical students.” Although cameras may not always be conclusive on the finer points of a surgery, Ayer said, they would clearly show who was present during a procedure and when, details that often are at issue.

Ayer has also begun lobbying members of Congress in order to judge interest in a federal law regarding surgical cameras. He also is pushing for a national database of doctors who have had their licenses taken away after they made medical errors. The doctor whose actions killed Ayer’s sister had his license revoked in Florida but now practices in Pennsylvania, public records show.

Some advocates for operating-room cameras say the devices can only help. They add that tort reform in many states limits damages in malpractice cases, discouraging lawyers from taking on cases without clear-cut evidence — such as video.

“The medical records of what happened during surgery are often incomplete,” said John James of Patient Safety America, whose 19-year-old son died as a result of medical errors in Texas in 2002 and who authored a study that estimated that 400,000 people die of adverse medical events annually. “Cameras push us in the direction of the truth,” he said. “And if the surgical team knows they’re being videotaped, they’re going to do better.”

And that was the impetus for the University of Toronto’s Grantcharov to create a “black box” to record operations: improving surgeons’ performance. “The initial idea wasn’t to make it available to be used in the courts,” he said. “This is a way for our profession to reflect critically on what we do” and share knowledge industry-wide, not simply where cameras are being used.

He said that in one pilot project involving 54 procedures, there were adverse events in 38 of them, and 75 percent of the problems were not noticed by the surgical team. Using the video, audio and patient data from an operation can help surgeons learn from their mistakes, he said.

“In the majority of cases,” Grantcharov said, “the data will protect doctors in court. We will see a reduction of malpractice claims.” But he said that cameras and data must be rolled out carefully. “If it’s used for destructive purposes, the profession will shut it down. It’s a very delicate topic right now.”

The 2015 summer reading list for innovation junkies

In other cases, these books give you insights into the fields and disciplines — such as cybersecurity, space exploration and artificial intelligence — that are shaping the future of global innovation.

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_ “Who Gets What — and Why,” by Alvin E. Roth

Markets are part of our everyday life, whether it’s landing a vacation rental on Airbnb, bidding for an item on eBay, or finding your future life partner in the dating pool. Stanford professor Alvin E. Roth, the co-recipient of the 2012 Nobel Prize in Economics, explains the science of matchmaking and market design, pointing out how and why “matching markets” work. As Roth points out, these ideas about intelligent and effective market design are relevant for both business and government. Just another reminder that, for Silicon Valley start-ups, matchmaking should be top-of-mind when thinking about new products and new markets.

_”A Curious Mind,” by Brian Grazer and Charles Fishman

In addition to producing films such as “Apollo 13” and “A Beautiful Mind” (starring Russell Crowe as brilliant mathematician John Nash, who passed away in May), Hollywood filmmaker Brian Grazer was also the creative genius behind the Emmy-nominated “24” TV series. So what has inspired Grazer? It turns out that he’s a fan of weekly “curiosity conversations,” which are a way for him to find out more about subjects or people that he knows nothing about. Any innovator can learn from this approach — it’s not enough just to have deep domain knowledge, one also needs the ability to be inspired by ideas from a wide range of different disciplines.

_”Elon Musk: Tesla, SpaceX and the Quest for a Fantastic Future,” by Ashlee Vance

Elon Musk might just be the most famous innovator in America, if not the world, these days. If you want to get inside his head and see what makes him tick, this biography is a fascinating read. It turns out that Musk is just as driven and eccentric as you might expect him to be, working 23-hour days and reading up on Soviet rocket manuals in his spare time. Based on Musk’s unique experience starting companies such as Tesla and SpaceX, Vance suggests that he will come to be seen as an American innovation giant, in the mold of a Edison or Ford.

_”Work Rules! Insights from Inside Google That Will Transform How You Live and Lead,” by Laszlo Bock

While books about Google are not quite as unique as they used to be, this one comes from the head of Google’s People Operations. Laszlo Bock explains how Google goes about finding the best and the brightest employees and offers suggestions on how to make any workplace more innovative. (One important concept: Only hire people who are smarter than you, no matter how long it takes to find them.) These ideas can be used when trying to attract employees to a new start-up, or just trying to max out the creative throughput in your cubicle farm.

_”Future Crimes,” by Marc Goodman

Cybersecurity has emerged as an important issue — not just in the tech sector, but also as part of the evolving national security debate. Goodman, a former “futurist in residence at the FBI” and the founder of the Future Crimes Institute, takes you to the front lines of the cyber wars, showing how hackers are subjecting the world’s computers and information to constant attack. If you thought that cyberattacks by North Korea and China are isolated events, think again: there’s a vast, worldwide group of people who are using technology in ways you’d never expect, making all of us vulnerable. In some cases, software has become “crimeware.” In other cases, wearable devices could become the subject of attacks.

_ “Creative Schools,” by Ken Robinson

How will the schools of today prepare the innovators of tomorrow? There’s perhaps no one better on the planet to explain that than Sir Ken Robinson, one of the world’s preeminent experts on education and school creativity. He’s also the most-watched TED speaker in history. His TED video “Do Schools Kill Creativity?” has been watched nearly 34 million times on the TED website (and another 8 million times on YouTube), so it’s good to see that he’s back with more ideas about what he’s calling a “grassroots revolution” in school creativity.

_ “Beyond Measure: The Big Impact of Small Changes,” by Margaret Heffernan

Looking to introduce epic change and innovation in your company? You might be served by thinking in terms of innovation baby steps, says Margaret Heffernan. Small shifts, when well-executed, can have outsized results. That’s both instructive and inspiring — especially when trying to bring innovation to a large organization entrenched in the old ways of doing things. Watch Heffernan’s TED Talk on “Superchickens” — as she explains, trying to create a super company by staffing it entirely with “superchickens” could be a recipe for disaster. (Superchickens get to the top of the pecking order by pecking away everyone else.) In the same way, trying to create an innovative company by only focusing on super innovations may not turn out as planned.

_ “Sapiens: A Brief History of Humankind,” by Yuval Noah Harari

As you might guess, a “brief history” of humankind is not really all that brief — nearly 450 pages, with in-depth descriptions of biology, history and evolution. But it was a Mark Zuckerberg Book Club selection in June, and Israeli historian Yuval Noah Harari’s concept of a “Cognitive Revolution” for humankind is compelling. Cognitive adaptations during evolution — such as the embrace of language — have made humankind “the deadliest species in the annals of biology” as well as the most innovative. And there’s potentially more to come given humankind’s embrace of artificial intelligence and genetic engineering.

_ “Why Information Grows,” by Cesar Hidalgo

We may be drowning in a sea of informational complexity, but that’s okay, according to Hidalgo, a researcher at the MIT Media Lab who is often considered to be one of the most innovative people in the world. As Hidalgo explains, there’s an important correlation between information growth and economic growth, and between economic complexity and national competitiveness. The book builds on Hidalgo’s earlier work on “The Atlas of Economic Complexity,” which ranked national economies based on their “complexity,” not on their annual GDP or per capita income.

_ “The Martian,” by Andy Weir

Weir’s 2014 book, which has been described as “Robinson Crusoe in a space suit” will be hitting the big screens later this year as a Ridley Scott blockbuster starring Matt Damon as an American astronaut stranded on Mars. In much the same way as “Interstellar” launched public conversations about space exploration and the physics of deep space, it’s easy to see how “The Martian” could get people talking about Mars. In fact, NASA has been supportive of the book, seeing it as a way to build public support for additional Mars funding. As an added bonus, the book comes with a fascinating backstory, starting life as a series of self-published stories given away for free on the author’s personal Web site.

Basulto is a futurist and blogger based in New York City.

Reverse a historical injustice — literally. Give black voters a larger say.

Yet a year of protests over disparate law enforcement practices, a decade of particularly sharp income inequality and centuries of imparity in America show that racial reconciliation is impossible without some kind of broad-based, systemic reparations.

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Recognizing the original sin is simply not enough; we must also make moral and material amends for our nation’s treatment of African American citizens. But if a pecuniary answer can’t fix the structural disadvantage — and it can’t — what can?

Weighted voting.

Thanks to a compromise between Southern slaveholders who wanted enslaved blacks counted in the population, for the sake of boosting Southern congressional representation, and Northern whites who didn’t, the framers enshrined the three-fifths clause in the Constitution. This agreement set the census value of a slave as 60 percent of the value of a free person. Even after the 13th Amendment neutralized the political (and moral) compromise by abolishing slavery, Jim Crow laws, which contravened the right of equality guaranteed in the 14th Amendment, upheld the status quo. The just answer today is to invert that ratio. If black Americans were once counted as three-fifths of a person, let each African American voter now count as five-thirds.

Reparations in America have come to mean “free” money, so any serious discussion about them also mandates a discussion of how much — an exercise doomed to failure. Other ways of imagining reparations (as the spilled blood of more than half a million Union soldiers during the Civil War; as affirmative action in universities and workplaces; as subsidized education) don’t involve cash payments, but they also don’t do enough to combat the structural disadvantages black Americans face — disadvantages that have gone largely unaddressed by our legislative and executive branches.

That’s because the problem is almost unfathomably large. In a report titled “The Unfinished March,” the Economic Policy Institute found that school segregation, black unemployment, lack of access to fair housing and living wages, and abysmal African American household wealth remain at essentially the same levels of disparity today as they did in 1963, when the March on Washington occurred. Median household wealth today is $141,900 for whites and only $11,000 for blacks. Despite making up only 13 percent of the population, black Americans are 27 percent of those living at or below the poverty line; the white unemployment rate is 4.6 percent, while it’s 9.6 percent for blacks; during the housing bubble of the mid-2000s, 53 percent of blacks received high-cost mortgages, while only 18 percent of whites did; the black incarceration rate is 2,207 per 100,000, compared with the national rate of 707 per 100,000; nearly 3 in 4 black children today attend segregated schools; in many communities, blacks have poorer health outcomes and access to just half the social services of whites. The list goes on ad nauseam.

These are national issues that require policy solutions — and the political will to implement them, which clearly doesn’t yet exist. That’s why reparations should be apportioned in the exercise of a civic right (a duty, even) long denied to the descendants of the enslaved. A five-thirds compromise would imbue African Americans with a larger political voice that could be used to fight the structural discrimination expressed in housing, education, criminal justice and employment. Allowing black votes to count for 167 percent of everyone else’s would mean that 3 million African American votes would count as 5 million, substituting super-votes for the implausible idea of cash payments.

This weighted vote, coupled with an increasingly active black electorate that in 2012 had a higher voter participation rate than whites for the first time in history, would offer African Americans an outsize influence on national and state elections. Politicians, finally, would have to truly compete for the black vote, or a substantial share of it, to attain or remain in office. This would provide an incentive, even for purely self-interested politicians, to prioritize African American policy concerns and act on them, or face a loss at the polls.

True, the five-thirds notion is out of sync with the “one person, one vote” mantra the nation prides itself on. But the precise legal meaning of that phrase is still unclear, which is why the Supreme Court will review it next term in Evenwel v. Abbott. That case is about the basis for determining a district’s size: Should it be the total population or just the population of eligible voters? Currently, a district with a significant number of ineligible voters (children, undocumented immigrants, transient military personnel) counts those residents toward its population, thereby adding weight to the ballots of its eligible voters. (Naturally, districts with low numbers of such ineligible voters don’t appreciate their residents’ votes counting for less.)

Even the U.S. Senate, where Delaware has just as much say as California, intentionally belies the notion of strict representation as a means to protect the rights of the minority. In the House of Representatives, Montana has one member to speak for its entire population of 1 million people, while Rep. Jim Langevin, from Rhode Island’s 2nd Congressional District, has just 525,000 constituents. Our votes are already weighted.

What’s more, five-thirds has a redemptive, lyrical quality to it: The weighted portion of the vote could be interpreted as the voice of those who earned the right to the ballot but were unjustly silenced. Too sentimental? Fine. Economics and statistics could help assign the right value for proper weighting. The magnitude of the challenges and the corresponding solution could be taken up by Congress as a giant math problem, but in the end, racial reconciliation requires America to acknowledge a moral and political mandate to make black America whole.

This plan should be temporally limited in scope, since the point is not to permanently install a historical equivalence but to erase structural disadvantages. Weighted voting could be fixed to some predetermined period of years, say 24, which is only about a third of the number of years the three-fifths compromise was in place. This amount of time would include multiple presidential, congressional, state and local elections, as well as referenda. Each elected office, no matter its term, would face several elections, allowing their constituencies successive opportunities to hold their representatives accountable.

And then the problem of who exactly is eligible must be addressed. Would a biracial voter qualify? A black immigrant? And what exactly is an election official to do when Rachel Dolezal shows up to claim her five-thirds vote? The government shouldn’t be the sole arbiter of who gets to be black — nor flirt with archaic prescriptions such as the one-drop rule in determining a voter’s race. The most straightforward approach would be to limit access to weighted voting to those American-born citizens who have demonstrated through government documents, such as drivers’ licenses or birth certificates, that they identify, and are identified by others, as black or African American. There are bound to be instances where this approach is challenged, and one way to address the issue would be to model guidelines after the general requirements for establishing American Indian or Alaska Native ancestry as outlined by the Bureau of Indian Affairs, which involve establishing that a lineal ancestor belongs to a specific tribe and then producing vital records that document a relationship to that ancestor.

Granting reparations in this way would empower African Americans but gift nothing: Black voters would still have to claim their share of reparations at every election — a suitable settlement in a nation allergic to handouts. Weighted-vote reparations would require African Americans to register and turn out in order to achieve the desired impact on public policy. It would require sustained civic and political engagement.

Of course, weighted-vote reparations are only slightly more politically feasible than a multi-trillion-dollar payout. But we have to consider novel approaches to racial reconciliation — including apology, forgiveness and, yes, some kind of restitution — if we are serious about ridding the nation of barriers to opportunity and overcoming the racial discrimination woven into America’s fabric. If racism is the culprit, then dismantling it requires the same tools that constructed it.

Theodore R. Johnson is a career naval officer, former White House fellow and doctoral candidate in law and policy at Northeastern University.

GE’s death perk for Immelt: a $22 million life insurance benefit

GE paid $314,511 last year for Immelt’s two life insurance plans, the most for a CEO in the Standard & Poor’s 100 Index, according to data compiled by Bloomberg.

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It’s one of a shrinking number of companies offering coverage designed exclusively for top managers. On the lower end, JPMorgan Chase and Apple spent $101 and $2,520, respectively, on policies for CEOs Jamie Dimon and Tim Cook.

While many boards have scaled back executive perquisites after increased disclosure requirements and heightened scrutiny of pay practices, life insurance benefits — a ubiquitous part of estate planning for high-earning Americans because of the tax advantages — have received little attention.

Life insurance expenses are often lumped together with “an array of deferred compensation-related items, making it hard for investors to parse the details,” said Michael Pryce-Jones, director of corporate governance at CtW Investment Group, which advocates for pension funds that collectively manage $250 billion. “I don’t think it’s on the radar for shareholders in the way it should be.”

Executive insurance policies are reserved for a limited group of top leaders, a review of proxy filings shows. Last year, at least 10 companies in the S&P 100 Index offered their CEOs universal, or permanent, policies typically designed to last the insured’s lifetime. Some of the annual premiums go into investment accounts that can grow tax-free.

Immelt’s coverage includes two universal life insurance policies. One will pay two times his annual salary and bonus, which totaled $9.2 million last year, and the other provides a $3 million death benefit that’s grown 4 percent annually since he first enrolled, according to Fairfield, Connecticut-based GE’s most-recent proxy filing. GE, the world’s largest maker of jet engines and gas turbines, has spent more than $1.43 million on premiums for Immelt since he became CEO in 2001, according to data compiled by Bloomberg.

3M Co. paid $286,115 in premiums last year for CEO Inge Thulin’s executive life insurance, which has a death benefit of about $10.4 million, according to a proxy filing. Exxon Mobil’s Rex Tillerson and Honeywell International’s David Cote have accumulated benefits worth $11.5 million and $10 million in their executive life insurance plans, respectively.

“We provide our named executives with additional benefits that we believe are reasonable, competitive and consistent with the company’s overall executive compensation program,” Dominic McMullan, a spokesman for GE, said in an emailed statement.

Spokesmen for 3M, Exxon and Honeywell declined to comment.

Of the 51 companies in the S&P 100 that disclosed expenses for CEO life insurance premiums last year, JPMorgan spent the least. Dimon’s plan, which provides a maximum coverage of $100,000, is available to all benefit-eligible employees, according to a filing.

“Our compensation philosophy is to have a transparent and fair compensation program for senior executives with no special insurance, health or medical benefits,” Joseph Evangelisti, a spokesman for the largest U.S. bank, wrote in an email. “The board thought this was the most fair way to do it.”

Apple offers Cook the same insurance that’s available to all employees. Fred Sainz, an Apple spokesman, declined to comment beyond its proxy filing.

Companies must report perks given to any named executive officer if the annual aggregate value exceeds $10,000. Specific dollar amounts must be disclosed for all benefits that make up more than 10 percent of that sum or are worth more than $25,000.

While most Americans who buy policies do so to replace lost income after the death of a household breadwinner, the nation’s affluent often beef up their coverage to help heirs avoid fire- sales of assets to pay estate taxes.

The federal tax on estates worth more than $5.43 million is 40 percent. Including state levies, the government’s total share can approach 50 percent, an amount that can be difficult to pay for estates with significant assets tied up in illiquid holdings such as real estate, said Ivan Taback, a trusts and estates partner at law firm Skadden Arps Slate Meagher & Flom LLP.

“Oftentimes, they do not realize that their beneficiaries will have to come up with a massive check nine months after they die,” Taback said.

Beneficiaries of company-owned plans can collect death benefits tax-free as long as the insured doesn’t have a controlling stake in the company. To avoid having the death benefit included in the taxable estate, many people assign ownership of their privately purchased plans to irrevocable trusts, according to Parker Beauchamp, CEO of Inguard, a Wabash, Indiana-based insurance firm.

“Creating the liquidity to pay estate taxes can literally save the beneficiaries millions” if it can help preserve income-generating assets, said Beauchamp, who specializes in plans for clients with complex needs such as billionaires and professional athletes.

The share of Fortune 500 companies offering supplemental policies to their CEOs fell to fewer than 25 percent in 2013, down from 52 percent in 2008, according to a study by Towers Watson & Co., a human resource consulting firm. Bolstered compensation-disclosure rules and the implementation of advisory say-on-pay votes at annual meetings have fueled a retrenchment of company-provided perks, said Keir Gumbs, a partner at law firm Covington & Burling LLP.

Johnson & Johnson closed its executive life insurance program to new participants in January “in response to feedback and market data,” according to a March 11 filing. Exxon stopped giving the benefit to new executives in 2007. Firms including PepsiCo Inc. and Schlumberger Ltd. highlight in proxy filings that they don’t offer company-paid supplemental insurance policies to executives.

Spokesmen for the companies declined to comment.

Term policies, such as those provided to JPMorgan’s Dimon and Apple’s Cook, usually lapse when the covered employee leaves. GE’s Immelt and 3M’s Thulin are both covered by universal, or permanent, policies, which are more expensive.

While the premiums for term plans cover only the insurance, part of the annual cost for a permanent plan goes into an investment account. The balance grows and can be withdrawn free of taxes, making such policies attractive to some clients, Inguard’s Beauchamp said.

Both General Motors Co. CEO Mary Barra and Caterpillar Inc.’s Douglas Oberhelman have company-paid variable life insurance policies, permanent plans that can give owners control over how the cash value is invested, proxy filings show. Spokesmen for GM and Caterpillar declined to comment beyond the filings.

Variable plans that offer investment opportunities in hedge funds or private-equity funds have grown in popularity among affluent clients in recent years, said Joshua Husbands, a partner at Holland & Knight.

“These are the types of investments high-income folks would be making anyway — and now they’re available on a tax- preferential basis through an insurance policy,” Husbands said. “Life insurance isn’t just about the death benefit anymore.”

_ Margaret Collins and Brandon Kochkodin contributed from New York.

Google’s self-driving car offers smooth test ride

Myself and a herd of other journalists gather around and snap photos.

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A Google employee jokes that our hands will be cut off if we take photos inside the SUVs.

I’m assigned to car no. 2 and hop in the back. The first thing I do is buckle my seat belt. Two Google safety drivers get in the front seats to guide me through the experience. The one in the passenger seat balances a laptop that shows a real-time look at what the car’s sensors see around it.

A dumbed-down feed of the same data plays on a horizontal screen centered on the dashboard. Aside from that screen – and a gray box the size of a suitcase in the trunk – the interior looks like a typical SUV.

We start to pull away in manual mode. The driver demonstrates how easy it is to switch in and out of autonomous mode with a button on the steering wheel.

“You’re free to call for a disengage if you ever feel uncomfortable,” I’m told.

Our driver makes the first turn out of the parking lot on his own. Then the adventure begins.

A chime sounds. “Autodriving,” says a female voice over the car’s speakers.

The guy in the driver seat calmly rests his hands on his knees. I can’t see his feet, but he says they typically hover over the pedals in case he needs to brake to turn off autopilot. It hits home that the car is really driving itself when I hear the click of a turn signal and his hands haven’t moved.

We’re gently cruising down neighborhood streets behind Google X’s building. The roads are quiet and we don’t encounter any pedestrians. A bicycle looms ahead and we’re gaining on it. But the man turns left and we carry on, unaffected.

Things remain uneventful. I feel free of stress, like I might be riding with any trusted driver behind the wheel – until a curvy stretch of road. A car coming the opposite direction – at speeds that feel a bit fast for a side street – whips around the bend. The Google SUV brakes sharply and we come to a complete stop.

Did we need to brake? Putting myself in the car’s shoes (or should I say tires?), I probably would have slowed. But the complete stop seems like overkill given the open path on our side of the road. Our driver agrees and said it was the type of situation that would be logged and studied.

Google’s cars have been trained to be extremely conservative in unusual situations.

“They understand their own limitations,” said Dmitri Dolgov, principle engineer on Google’s self-driving car project, at a briefing later. “They understand that there’s something really crazy going on and they might not be able to make really good, confident predictions about the future. So they take a very conservative approach.”

Once the car passed us, we were quickly back on our way. Most of the side streets we traveled at about 15 mph.

Soon we would get a chance at faster roads.

We smoothly turn onto a main road and the SUV steadily accelerates to about 35 mph.

“Left lane change ahead,” calls out the computerized voice.

As an intersection nears, the turn signal clicks again, and soon we’re in the left-turn lane. The traffic light turns yellow, but the car doesn’t slam on the brakes. It feels like what any driver would do, given how close we are to making our turn.

During our turn – as we’re in the middle of the intersection – the Google SUV brakes for a momentary beat. After about half a second we’re quickly back on the gas and complete our turn.

So why the braking? As we made our turn, a car coming the opposite direction made a left from the middle lane, not the far left lane. I ask if that was what concerned the car. One of the Google test drivers pointed to a different car – one that had just turned right from the opposite direction – as the trigger.

Ultimately it was a minor hiccup and we still had time to complete the turn safely before our signal turned red. After a few more uneventful minutes on suburban roads, we looped back toward Google’s headquarters.

A few blocks away from Google I got another glimpse of the SUV’s cautious nature. A car, also with a stop sign, arrived at the intersection just after us. The Google car inched forward in two spurts. After a pause we drove through the intersection. We got through it fine, but slower than I expect most drivers would have. Soon we pull back in front of GoogleX’s building, a 14-minute ride in the books.

“Manual,” calls out the female voice as our driver took control again, and turned the car off.

If I was grading the SUV on our brief trek I would give it a B+. It wasn’t perfect driving, but safe and effective. Of course, our route wasn’t especially difficult. The real challenges come when pedestrians, inclement weather, construction sites and cyclists arrive.

Afterward I also had a chance to ride in Google’s prototype of a self-driving car. Because Google has two test drivers in vehicles at all times – and the prototype only seats two – I couldn’t ride it on public roads. So we had to settle for the experience of cruising around Google X’s rooftop.

The electric vehicle makes a distinct humming sound (notice it in the background here). I hopped in the passenger seat alongside another journalist. The interior – without a steering wheel or pedals – looks a lot like these photos I shared earlier in the year . The windshield isn’t glass, so some things look slightly distorted, as if looking through Plexiglas.

(On my way out I walked by another prototype – not part of Google’s demo day – that had a distinctly different interior, including a steering device that was mounted between the passengers and resembled a large metal ring.)

After we hit a “Go” button on the main console, and sat through a brief countdown, we were off on an automated course.

We looped around the roof at low speeds for 2 1/2 minutes, avoiding a pedestrian, a cyclist and a vehicle that Google positioned to showcase the car’s abilities. It handled each situation cautiously and effectively.

Google’s fleet of self-driving vehicles are covering between 10,000 and 15,000 miles a week. At the briefing, leaders of the project – including Google co-founder Sergey Brin – all raved about the improvements they’ve made of late.

A deadline of sorts continues to approach – the eldest son of Chris Urmson, director of the self-driving car project, turned 12 a couple weeks ago.

“In the U.S., you need a driver’s license in four years,” Urmson said. “And so our team is working really hard so he doesn’t have to.”

For lawyers and lobbyists at gift season, it’s never just the thought that counts

For every federal employee or journalist prohibited from accepting anything because of ethics rules, there are thousands of other private sector professionals — lawyers, investment bankers, lobbyists and more — who both send and receive generous gifts every December.

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The trick, of course, is picking just the right gift: something memorable, and appropriate, that will impress important clients and valued employees.

But corporate gifts are fraught with all the same baggage as personal gift giving. And everyone who says it’s the thought that counts is lying. They’re judging.

Which is why that traditional fruit basket, big and impressive as it looks, may not really dazzle.

“People want clever more than they want expensive,” says David Adler, founder of BizBash, an online guide for corporate events and promotion. “Surprise and delight — that is the holy grail of marketing. Gifting is now about storytelling.”

The Tiny Jewel Box, D.C.’s go-to store for estate and antique jewelry, sits on Connecticut Avenue just a stone’s throw from some of Washington’s biggest law firms and trade associations. Which is why it has a corporate gift division with a separate staff just for business clients. Holiday orders, placed mostly in September and October by marketing or HR departments at various firms, account for 30 percent of the store’s corporate business.

The best selling items, every year, come from the Federal Collection, an exclusive series of made-in-America, high-end decorative boxes and collectibles popular with lobbyists and other folks based in the nation’s capital. “In Washington, there’s a certain restraint that you don’t necessarily find in other markets,” says TJB President Matt Rosenheim. “There’s a different definition of elegance and a pushback on lavish.”

The collection is popular, he says, because it appeals to a certain level of education and sophistication: The items incorporate historical images, vintage maps, art, architecture — things that people find intellectually interesting rather than blingy. If gifts tell a story, these say, “You’ve got a guy in Washington. We’re here in D.C. taking care of your Washington business.”

The vast majority of corporate gifts run $50 to $300 per piece, although Rosenheim does well in the $500 to $2,500 range and, for the most important of the VIP clients, $8,000 Swiss watches. Regardless of budget, the name of the game in business giving is “perceived value, so we need to create a $100 gift that looks like a $500 gift.” That’s easy to do with a custom item, because clients can’t Google the price. But it doesn’t appeal to every buyer: Some want to give an iconic and branded item (usually something really expensive) so recipients know exactly how much it costs.

It’s always a fine line between too little and too much: “There is definitely a threshold where it becomes too lavish and there’s a concern about the message that it sends,” he says.

The recession hit corporate giving hard. Companies stopped giving client gifts for a while, although they quietly rewarded top performers internally. The holiday business has inched back to pre-2008 levels, but it changed: Companies have moved away from centralized gifts — the same item to every client — to a more decentralized approach on which executives pick out personalized gifts for clients they work with all year.

Rosenheim sells custom pieces, like the “Constitution decoupage box,” designed to sit on a desk or credenza and preaches the staying power of something that’s a visual reminder of the giver for years to come. “That’s why I discourage people from doing consumables — you give them a gift basket, it’s eaten, it’s done.” He’s also not a big fan of tech gadgets, which the recipient is likely to already own or become quickly outdated.

A great corporate gift is, of course, in the eye of the seller: A wine vendor tells you there’s nothing more festive than a great bottle of champagne, a gourmet store argues that everyone loves specialty treats at Christmas. It’s hard enough to buy a good present for someone you know well; harder still for someone who you bill by the hour.

That’s one reason patriotic themes are so popular with Washington-based offices. Americana has always been the big draw at Ann Hand, the design firm founded by the D.C. jeweler who created the now iconic gold eagle and pearl brooch that has adorned every A-List shoulder and remains her all-time bestselling product.

Her holiday corporate sales are almost all political, military and patriotic-themed brooches, cuff links and lapel pins, or ties and scarves. “A scarf or tie is something they’re drawn to because most people will wear silk and it fits everybody,” Hand says . Her olive branch pin is especially popular this year.

Her items range from $45 to $100 for smaller pieces, but many of her clients spend $500 to $800 per gift.

Her business accounts are primarily men, and many come back year after year. They’re escorted to the second floor of her Georgetown store, where she unveils a variety of options on the table in front of them and they decide what they want and how many.

“They’re out the door in 30 minutes and have done all their shopping,” Hand says.

Back in the day (we’re talking 35 years ago) business giving in Washington was divided into two camps: inexpensive gifts — holiday turkeys or poinsettias — presented to politicians and the occasional over-the-top largesse for those less constrained by official rules.

When David Adler was running the society magazine Washington Dossier in the late 1970s, he received a number of gifts from wealthy Washingtonians eager to curry his favor. But none topped Ardeshir Zahedi, the famously charming and indulgent Iranian ambassador representing the soon-to-be-deposed shah.

“He would send cases of Dom Perignon along with caviar by the bucket,” Adler says . Memorable, even 40 years later. Those days are long gone; diplomats now give tasteful coffee table books or calendars depicting scenes from their country.

Corporate executives have a harder task — they have to come up with gifts that reflect their brand without being too promotional, but still stand above the fray.

“Experiential is the biggest gift-giving trend,” Adler says. “Events are the new luxury.” Tickets to, say, the Super Bowl or the U.S. Open are “like gold.”

Another trending theme is “purposeful” gifts: something environmentally conscious or a donation to charity. For companies that choose to send an actual present, there are more “concept baskets” of artfully curated items inspired by current pop culture obsessions: “Downton Abbey” teas and sweets, for example.

Even white shoe law firms, those bastions of tradition and quiet elegance, are under pressure to give something innovative. Today clients are both more demanding and discerning, quick to dismiss the obvious or the run-of-the-mill.

“Now, it’s all about personalization,” says one local executive, who has worked in business development for a number of Washington’s top law firms. Most offices now use “CRM”: client relationship management software that tracks birthdays, anniversaries, hobbies and other personal information.

A number of firms now expect individual partners to select and personally buy gifts for their own clients. Given the number of mergers and other financial sensitivities in big law, more are choosing less conspicuous gifts or gatherings. Last week, an international firm hosted an exclusive reception at D.C.’s Metropolitan Club, where partners spent two hours schmoozing their top 700 customers instead of sending individual presents to their offices. “These parties cost $200 a person to entertain at that level,” she says. “I think the client appreciates it more than a gift.”

Another trend: holiday parties created as family events, like one recently at the Kennedy Center where clients could bring their children and still network. “It was a huge hit,” she says, “because these people work all the time.”

This year, businessman Winston Lord had to come up with a corporate gift that is “creative, quirky, fun and memorable — on a limited budget.” The chief marketing officer of Venga, a start-up that supplies data to restaurants, wanted something that his customers would use and remember.

He has three Harry and David fruit boxes on his desk, and he can’t say who gave them to him. Portable phone chargers, the go-to corporate present this year, are practical and fun, and he’s already received six or seven of them. “It’s all appreciated, but nothing really stands out,” he explains.

His four-year-old company is still trying to build relationships in the restaurant industry, so he decided to create a 2015 calendar as this year’s gift. Each month features company execs in food-themed photos recreating famous movie scenes; Lord is July’s cover boy, being doused with macaroni a la the bath scene in “The Good, the Bad and the Ugly.”

“They’ll open it up and get a laugh,” he says. “I’m not expecting them to put it on their home refrigerator. But maybe the office refrigerator.”

Supreme Court faces politically charged election-year docket

The nine justices enter the next decade of the Roberts court likely to confront issues that animate the political agenda: the legality of racial preferences to encourage diversity; how far government must go to accommodate religious liberty; how far government may go to restrict a woman’s right to abortion.

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The last term ended on a high note for liberals, with a landmark decision finding a constitutional right for same-sex couples to marry. It was the first time since John Roberts Jr. debuted as chief justice 10 years ago that, in some of the court’s most closely contested and important decisions, the court’s liberal minority attracted one conservative or another to consistently prevail.

Few look for a repeat based on the issues the court will hear this term.

“I would expect a return to the norm, in which the right side of the court wins a majority, but by no means all, of the big cases,” said Irv Gornstein, head of the Supreme Court Institute at Georgetown Law Center.

“The big question for this term is, how big will the big wins be?”

The court already has a track record on the likely marquee cases of the term, and that record is giving the right a reason to be optimistic.

Back for further review are the affirmative-action remedies employed by the University of Texas to increase diversity at the flagship campus in Austin. The court has previously expressed its skepticism about these measures.

The contraceptive mandate of the Affordable Care Act is also making a return. The court already told the government last year, in Burwell v. Hobby Lobby, that the mandate can impinge on the religious freedoms of employers directed to carry it out.

And, because the court long ago decided that states may impose some restrictions on abortion, the question in a coming case will be, how far may they go before it becomes an “undue burden” on a woman’s right? The court has provided little guidance on what that term means.

The pivotal justice on each issue will probably be Justice Anthony Kennedy. The issues all appeal to Kennedy’s conservative side, but he does not always share the zeal for dramatic change that his colleagues on the right might pursue.

“I have the greatest respect for him, but I long ago gave up trying to predict him,” conservative U.S. Circuit Judge Harvie Wilkinson III said recently at a panel discussion at William and Mary Law School.

“The best thing you can do is issue one of those weather forecasts that says sunny with considerable clouds and a chance of rain.”

Conservatives long ago gave up on Kennedy as a reliable vote, but the surprise of the summer and fall is the suspicion with which many now view Roberts.

At the most recent debate of Republican presidential candidates, Sen. Ted Cruz, R–Texas, bluntly called Roberts a “mistake.” Former Florida governor Jeb Bush said Roberts “did not have a proven, extensive record” when his brother President George W. Bush chose him, and he pledged that he would not make “politically expedient” choices for the court.

Dozens of conservative activists last weekend signed on to letter from former attorney general Edwin Meese calling for the next president to appoint justices such as Antonin Scalia, Clarence Thomas and Samuel Alito Jr. – no mention of Roberts.

The case against Roberts consists almost entirely of his votes upholding the Affordable Care Act. In 2012, he wrote the opinion turning down a constitutional challenge to President Obama’s signature domestic achievement. In June, Roberts and Kennedy were part of a 6-to-3 decision that rejected a reading of the law that would have drastically cut back the number of Americans it covered.

On the other side of the ideological ledger, Roberts has voted to restrict abortion rights, overturn campaign finance restrictions, recognize a Second Amendment right for individual gun ownership, and severely cut back the reach of the Voting Rights Act.

Studies have shown him to be one of the modern justices most protective of business interests. He is a consistent supporter of the death penalty, an issue that bitterly divides the court and which will be again be a common thread on the term’s docket.

Any change in even a single justice could tilt the balance of the court, and many predict that the next president may have the chance to nominate as many as three members of the court.

Liberal Justice Ruth Bader Ginsburg, Scalia and Kennedy will all be in their 80s on Inauguration Day 2017, and liberal Justice Stephen Breyer will be 78. The court currently has five Republican nominees and four chosen by Democratic presidents.

Ginsburg was the lone member of the court to find no fault with the University of Texas’s unique admissions policy when the court first considered it in 2013.

Most of the university’s freshmen are admitted under a unique plan in which the top students at every Texas high school are accepted. Because many of the schools are segregated, this makes for a diverse population. To fill out the rest of the class, admissions officials say they use a holistic approach in which race is one of the factors considered.

An appeals court upheld the plan as being consistent with the Supreme Court’s previous rulings on when race could be considered. But the justices sent it back and told the lower court to demand more proof from University of Texas officials that they could not ensure diversity without resorting to racial classifications. The appellate judges again sided with the university, and challengers of the plan are returning to Supreme Court.

Kennedy has never ruled in favor of an affirmative-action plan, but he also has refused to join conservative colleagues in saying race can never be considered. Kennedy “really believes in the value of integration,” said Georgetown’s Gornstein, but at the same time “he desperately wants it to be achieved by race-neutral means.”

The court has yet to accept the abortion or contraception cases for this term, but they are considered highly probable.

The former case concerns new restrictions on abortion providers that have been enacted by states around the country, such as requiring doctors at abortion clinics to have admitting privileges at nearby hospitals and that clinics must meet surgical standards that abortion providers say are unnecessary and prohibitively expensive.

At issue is whether the standards put an undue burden on women seeking abortions, a standard the Supreme Court set in a 1992 case, Planned Parenthood of Southeast Pennsylvania v. Casey. Kennedy was one of the justices who set the standard.

The court is likely to look at Texas’s new law, and “I think it will be the most important case since Casey,” said Jennifer Dalven, director of the ACLU Reproductive Freedom Project.

“It will give us some guidance on the meaning of the undue burden standard and how courts should evaluate the multitude of abortion restrictions that are coming out of the states.”

The contraception case would be a sequel to the court’s decision last year that some private employers do not have to comply with the ACA mandate to provide employees with health plans that include contraceptives when this violates the owners’ religious beliefs.

This time, it is religious organizations such as hospitals, charities and universities that want to be freed from the requirement.

The Obama administration has provided an accommodation for objectors, which would allow them to object in writing and then have third-party insurers or the government to step in to provide the cost-free care. But the organizations say any involvement violates their religious liberties.

Seven appeals courts have agreed with the government, but an eighth recently sided with challengers. That almost requires the court to settle the conflict, and the Obama administration recently also asked the court to step in.

Two other cases on the court docket also have partisan overtones.

One concerns whether public employee unions may collect a fee from nonmembers to cover the cost of collective bargaining. Challengers say that violates the First Amendment rights of those who don’t want to pay for union speech with which they disagree. The unions say the fees are warranted because they are obligated to represent all public employees, whether or not they are union members.

The political context is that public employee unions, which overwhelmingly support Democratic candidates, are powerful players in elections. A loss would weaken them at the same time the court has made it easier for wealthy individuals and corporations to spend unlimited amounts on elections.

And a challenge to the way almost every state draws electoral districts presents a partisan dilemma. States use total population numbers from the census to meet a constitutional requirement that they are roughly balanced for “one person, one vote.”

But conservative groups are challenging that, saying the districts should be drawn based on the number of eligible voters in the districts. Most analysts say that would hurt urban areas with larger numbers of children and noncitizens – most likely to trend Democratic – and shift the power to more rural, less ethnic areas that tend to vote Republican.

“Anytime the court is asked to engage in policing the electoral process, there is a risk of the results appearing to be partisan,” said David Cole, a law professor at Georgetown.

Cord-cutting isn’t killing Comcast

Comcast did lose 69,000 video customers over the course of the quarter, but that always happens this time of year.

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The company has actually lost customers in the second quarter in six of the last eight years. Last year it lost more than twice as many customers as it did this year during the same period, an indication that 2015 hasn’t been so bad, after all.

It wasn’t supposed to be easy for cable companies this year. HBO Now and Sling TV led a batch of new Internet video offerings, and Netflix added almost a million subscribers in the U.S. last quarter. This quarter will be a “put up or shut up time for the cord-cutting thesis,” industry analyst Craig Moffett wrote in a note to analysts earlier this month. On average, analysts expected Comcast to lose 112,000 customers, according to data compiled by Bloomberg.

Comcast attributed its strength to a sincere attempt at customer service, bolstered by improved technology that keeps people from having to call its representatives as often, and on its X1 cable boxes. The devices have gotten consistently positive reviews, and one-third of Comcast’s triple play subscribers now use them. The company’s theory seems to be that people who are tempted to cancel their cable service can be convinced to stay by experiential-rather than financial-incentives.

On the financial side, there’s continued increase in a metric that investors refer to as “average revenue per user” and customers refer to as “the cable bill.” The cable company’s average subscriber paid $143.48 per month, up 4.5 percent from a year ago.

Even if Comcast does lose customers to cord-cutting, higher bills for existing customers more than compensate for it. In the forecast that Moffett put out earlier this month, he predicted that Comcast would lose 113,000 video subscribers over the next five years, while also increasing the amount that each one pays by about $16. Even without Comcast’s other business-high-speed Internet, NBC’s thriving broadcast network business, theme parks-the old-fashioned cable company seems to be surviving just fine in the brave new world.

‘Chapo’ Guzmán’s prison guards reportedly played solitaire while he escaped

And perhaps that’s what the two prison guards at Mexico’s Altiplano maximum-security prison were pondering when, instead of guarding the world’s most famous drug lord, Joaquin “El Chapo” Guzmán, they were playing solitaire.

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While they were immersed in the game, Guzmán slipped out of his cell in July through a hole in the shower, according to a report in Mexico’s El Universal newspaper.

A lot has been written since Guzmán tunneled out of jail over the summer, but not much of it has clarified who helped him or how. There have been reports that the tunnel-building wasn’t much of a secret in the prison before his escape, that other inmates and guards could hear loud noises as his accomplices cut through the concrete floor of his cell.

The El Universal story, by prominent columnist Carlos Loret de Mora, raises the possibility that garden-variety office ennui might have been a factor. It said Juan Carlos Sánchez Garcia and José Daniel Aureoles Tabares, two agents from the Mexican intelligence service, had initially told investigators that their computer screens froze minutes before Guzmán’s escape at 9 p.m. on July 11 and that they made more than two dozen frantic calls when they realized he had disappeared. But a judge in the confidential proceedings has determined that at the time of the escape the two men were playing cards and that other computer screens were turned off, according to the report. It remains unclear whether the inattention was intentional.

One of Guzmán’s attorneys, Juan Pablo Badillo, declined to comment about the allegation, as did the attorney general’s office, which is investigating the case.

Guzmán’s escape, a year after he was imprisoned, was a massive embarrassment for the Mexican government. At least 13 prison officials, including the top official at the Altiplano facility, have been arrested. Guzmán’s Sinaloa cartel has been known to buy off public officials at all levels of government to grease the group’s drug-trafficking operations. So even if solitaire was involved, that distraction probably was a bit player in this drama.

Dollar’s surge against euro comes with pluses and minuses alike

The dollar ended Wednesday at its highest value — $1.

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05 — against the euro in 12 years, and many analysts expect it to become more valuable than the common European currency in coming days. Other currencies have also taken a slide, making overseas travel cheaper but goods and services priced in dollars more expensive for foreigners.

The unexpected surge has led economists to reduce their expectations for U.S. economic growth this spring; this week, it pushed markets into negative territory for the year. It’s largely happening because the U.S. economy has been unusually strong amid a global slowdown, giving the dollar an advantage over other currencies.

Still, “it’s negative” for growth, said John Silva, chief economist at Wells Fargo Securities, adding: “It’s the unexpected movement of the dollar that has really caught a lot of people offsides.”

A wide range of companies report sales declines as a result of the trend. For instance, Avon, the New York-based direct-sales cosmetics company, which counts Brazil, Mexico and Russia among its largest markets, is now planning to sell millions of dollars less of lipstick, powder and eyeliner abroad.

Massachusetts-based retailer Staples announced last week that it has sold fewer office supplies abroad this year, citing the dollar.

Meat and poultry companies are expecting to sell less as the price of imports rises in Europe and other countries. Beverages aren’t safe, either. The Wine Institute, a trade association for California winemakers, said that exports declined last year after four consecutive years of record revenues.

Linsey Gallagher, the institute’s vice president of international marketing, said much of the slowdown was attributable to a decline in exports to Europe and Canada, the biggest foreign buyers of Golden State wine.

“We’re quite exposed, with 75 percent of our exports going in that direction right now,” Gallagher said. “We’ve got our work cut out for us.”

While the jobs market has been strong in recent months, the strong dollar could eventually send employment up. Manufacturers have perhaps the most to lose from a surging dollar; they already report declining orders.

As a result, manufacturing hiring appears to be taking a hit. Factories added just 8,000 new workers in February, down from an average of 18,000 a month last year.

“You’ve seen a drop-off the last couple of months,” said Scott Paul, president of the Alliance for American Manufacturing, a Washington group that advocates for policies to spur more factory jobs. “It’s going to present a big challenge to manufacturing.”

For American consumers, the flip side of the dollar’s rise will most immediately be felt in lower prices for imported goods at home — and cheaper trips abroad.

A stronger dollar will eventually mean Americans will pay less for French wine, Italian shoes and Belgian chocolates, said Silva, the Wells Fargo economist. But he cautioned that it could be a while before retailers will pass those savings on to their customers.

International airline prices — denominated in dollars — aren’t falling, but hotel prices are. The popular travel website TripAdvisor forecast recently that hotel room prices would decline 7 percent overseas this year, with a 9 percent fall in Europe.

The biggest savings will come in places that Americans might not want to visit — Russia and Ukraine — but also in more likely destinations such as Sweden (down 19 percent), France (down 13 percent) and Morocco (down 12 percent).

Marriott International, with its fleet of 4,100 hotels around the world, is feeling both the ups and the downs of those trends.

Chief executive Arne Sorenson said in a recent conference call that the company is bullish about business at its European hotels this summer: About 20 percent of lodgers then typically come from North America.

On the other hand, international arrivals were down 3 percent in New York in the fourth quarter.

Economists warn that companies depending on foreign tourists could face trouble. David Huether, senior vice president of research at the U.S. Travel Association, said that foreigners slowed their spending in the United States last year.

“The travel habits likely changed,” Huether said. “It could be that people shortened their trip,” he added, or that they spent less on souvenirs and meals while they were here.

The dollar is rising because the United States has emerged as an outlier in the global economy. Many other countries around the world, particularly in Europe, are struggling. In response, central banks in Europe and elsewhere are lowering interest rates. That has the effect of reducing the value of currencies.

In the United States, by contrast, growth is relatively robust. Federal Reserve officials are preparing to raise interest rates later this year. That strengthens the dollar.

Few forecasters saw the surge coming. The dollar has risen nearly 20 percent against the euro in the last six months. It has hit its highest value against the Japanese yen in eight years.

When the dollar is strong, it is easier for Americans to buy foreign goods and harder for foreigners to buy things from America. That usually adds up to a decline in net exports and lower overall growth for the economy.

As a result, economists have in recent weeks have reduced their forecasts for U.S. economic growth this year by a few tenths of a percentage point.

In official statements, companies tend to welcome the symbolism of a strong dollar while bemoaning its effects on bottom lines.

“On the positive side, a strong U.S. dollar indicates strength in our economy, and obviously, that’s good, given our position in the market here,” Mark Fields, chief executive of Ford Motor Co., told investors during a recent earnings call.

“Alternatively,” he said, “a strong dollar has an effect . . . on our competitive position, especially against competitors who import here into the U.S.”

Some exporters also hope that while the strong dollar may be a negative for the U.S. economy in the short term, attempts to boost growth through monetary policy in Europe, Japan and elsewhere will ultimately lead to a stronger economy at home and abroad.

By making foreign countries more competitive, the reasoning goes, their economies will improve, their currencies will strengthen and locals will have more ability to buy U.S. goods.

“We want a strong Europe” in terms of growth and buying power, said Chad Moutray, chief economist for the National Association of Manufacturers. “We want a strong China and Japan. . . . In the sense that those actions lead to stronger economies and stronger export markets for us, that’s a positive in the long term.”