Southwest and AirTran Airlines: Mergers and Aggravations 
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Tyson Smith
Frustrated Frequent Fliers Wait as Kinks Get Ironed Out
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The wedding of Southwest and AirTran airlines is now in its third year. For many of the carriers' regular passengers, the honeymoon ended long ago.
As the two airlines, which combined carry more domestic passengers than any other, have started splicing together their flight schedules this year, travelers say Southwest Airlines LUV -0.94% agents struggle with AirTran Airways tickets and vice versa, sometimes leaving passengers who have been delayed and need rebooking in the lurch.
Last year United drove its customers crazy as it tried to line up its systems with Continental's. Now customers are complaining about the effects of the marriage of Southwest and AirTran. Scott McCartney looks at the details.
Different prices and seat availability sometimes show up for the same flight on Southwest's and AirTran's online sites. Buying early boarding privileges on Southwest doesn't get you early boarding on connecting AirTran flights. Frequent-flier credits remain separate and Southwest companion passes, awarded to top frequent fliers, can't be used on AirTran.
Merging airlines often equals delay, disruption and disappointment for travelers. The troubles at Southwest and AirTran, both regularly hailed for good service, offer a cautionary tale of what could be ahead for customers of American Airlines and US Airways, LCC +2.49% an even larger merger pending government approval.
In the spring and summer of 2012, United and Continental airlines suffered late flights, lost reservations, chaotic seat assignments and surging customer complaints when they combined into one reservation system. And Southwest and AirTran, which opted to go unusually slow with their combination to avoid problems, haven't even reached that point yet.
"It's very fragmented. All this talk about 'one airline' is a broken promise," said John Sullivan, a computer consultant who flies every week on AirTran from Dayton, Ohio, to Baltimore and connects on Southwest to Albany, N.Y.
Since late May, his bag has been lost twice and when his AirTran flight arrived late a connection was missed. Southwest agents "look at me like I'm from a different planet," he said.
Most frustrating: He took vouchers for two free round trips from AirTran to give up his seat on an overbooked flight so his wife could join him on business trips to Albany. When he called AirTran to redeem the vouchers, the agent said the airline didn't fly to Albany. He told her they did and she said no, that was Southwest and the vouchers couldn't be used on Southwest.
"I have learned just to calm myself and lower expectations," he said.
Southwest says the merger is on track and the airline is working through problems. "We know there have been some challenges in the background and we know they have bled out into some issues for our customers," Southwest spokesman Brad Hawkins said.
Southwest and AirTran are mishandling bags (not delivering them on the same flight as their owners) more frequently as the airlines connect bags between each other. In April and May, the most recent months reported by the Department of Transportation, the mishandled bag rate for AirTran more than doubled from the same period last year. Southwest was up 24% in May and 38% in April. Overbooking and complaints are up, too, though still lower than those for many competitors.
Ryan Snook
The two discount airlines face huge merger hurdles largely because Southwest lacks a reservation system capable of handling many aspects of AirTran's business, such as international flights.
So Southwest, which acquired AirTran in May 2011, decided on a go-slow approach. After two years, only 14 of the more than 50 AirTran destinations have been moved under Southwest's umbrella. The two basically still operate as separate airlines and will until the end of 2014. Ticket counters have been pushed side-by-side at many airports. Kiosks offer check-in on either airline. Connecting passengers between the airlines on one ticket started in January and rolled out fully in May.
Instead of merging into one computer system, Southwest, for now, has agents of both airlines trying to work two reservation systems on different windows of their computer screens so one airline can check in customers from the other. "We have our people moving between both systems," Mr. Hawkins said.
Southwest says it will have a unified system, new to both airlines, in place by the end of next year. The company is both folding AirTran into Southwest, mostly by replacing AirTran planes with new Southwest jets as they are delivered from Boeing Co., BA -0.78% and at the same time undertaking a companywide makeover.
Problems have been most noticeable when bad weather disrupts operations, Mr. Hawkins said, and employees have to deal with rescheduling passengers. Agents can't see all possible alternative flights in one place and have to check route by route to find open seats for stranded customers.
"It's enormously complicated," he said of the merger integration.
Regular Southwest fliers should take extra sanity-saving precautions in the short term. It helps to leave lots of time to connect between Southwest and AirTran flights so that delays don't lead to missed connections. Avoid checking bags on trips with AirTran-Southwest connections. And carry your flight paperwork to help agents find confirmation numbers and itineraries.
Travelers say even though the airlines are trying to sell seamless travel together, lots of disconnects remain.
Book an AirTran flight through Southwest—the two airlines now code-share so AirTran flights carry a Southwest flight number and Southwest flights can be ticketed as an AirTran flight number—and you won't have to pay fees to check bags. (AirTran does charge fees to check bags to AirTran-booked customers.) But if you buy your ticket this way, you can't reserve seats on those AirTran flights.
Southwest hasn't developed a mobile phone app for AirTran, since the airline will be phased out (though it does have a robust app of its own where you can see AirTran flights).
Top-tier frequent fliers now get reciprocal benefits and frequent-flier points can be exchanged if customers call and ask for a transfer, Mr. Hawkins said. But some issues, like the vouchers, haven't been solved yet, he said. "There is an appreciable partition between the two carriers and there are some things we have not been able to break through the brick wall," he said.
For some AirTran loyalists, the slow phasing out of their airline has been hard to watch. AirTran had a strong following because upgrades to its business-class seats were relatively easy for business travelers to get.
No more, as Southwest's top-level customers have started flying more trips on AirTran planes, making upgrades harder to get. Eventually Southwest will end all upgrade possibilities, since it only flies with coach seats. Even small changes have hurt, such as switching AirTran business-class snacks to Southwest peanuts and crackers.
And Southwest regulars struggle when flying AirTran. Gary Zeune, a frequent traveler from Powell, Ohio, paid $12.50 on a recent trip and got early boarding on his first flight, on Southwest. When he got to his connecting AirTran flight, he was in Group 7. "It bothers me that they charged me the whole $12.50 and I only got half of it," he said.
David LaRue of Fort Worth, Texas, says he hasn't been able to use his Southwest frequent-flier points for international trips on AirTran. And he can't use his Southwest companion pass to take people with him on AirTran flights.
He got so mad bouncing between agents of both airlines trying to book trips that he offered to patch them together in a conference call. The agents declined.
"Right now, it's pretty rough. They have dragged their heels so long to integrate that it's frustrating. I don't understand why," he said.
Write to Scott McCartney at middleseat@wsj.com
ADHD Drugs Don't Boost Kids' Grades
Studies of Children With Attention-Deficit Hyperactivity Disorder Find Little Change
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Getty Images It's no longer shocking to hear of children with attention-deficit hyperactivity disorder—and others simply facing a big test—taking ADHD medicine to boost their performance in school. But new studies point to a problem: There's little evidence that the drugs actually improve academic outcomes.
Stimulants used to treat ADHD like Ritalin and Adderall are sometimes called "cognitive enhancers" because they have been shown in a number of studies to improve attention, concentration and even certain types of memory in the short-term. Similar drugs were given to World War II soldiers to improve their ability to stay alert while scanning radars for enemy aircraft.
However, a growing body of research finds that in the long run, achievement scores, grade-point averages or the likelihood of repeating a grade generally aren't any different in kids with ADHD who take medication compared with those who don't. (Typically, studies take into account accommodations schools provide kids with ADHD, such as more time to take tests.)
University of Pennsylvania
Dr. Martha Farah and colleagues found no cognitive benefit from Adderall taken by students.
A June study looked at medication usage and educational outcomes of nearly 4,000 students in Quebec over an average of 11 years and found that boys who took ADHD drugs actually performed worse in school than those with a similar number of symptoms who didn't. Girls taking the medicine reported more emotional problems, according to a working paper published on the website of the National Bureau of Economic Research, a nonprofit economics research firm.
"The possibility that [medication] won't help them [in school] needs to be acknowledged and needs to be closely monitored," says economics professor Janet Currie, an author on the paper and director of the Center for Health & Wellbeing, a health policy institute at Princeton University. Kids may not get the right dose to see sustained benefits, or they may stop taking the medication because side effects or other drawbacks outweigh the benefits, she says.
A central question puzzles those researching ADHD: If its drugs demonstrably improve attention, focus and self-control, why wouldn't grades improve as well?
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Millions of children and college students take medication to treat ADHD and to help them perform better in school. But there isn't great evidence to suggest that these drugs actually improve academic outcomes. Shirley Wang reports on the News Hub.
Scientists are trying to understand this paradox in hopes of being better able to treat ADHD, a condition characterized by difficulty with attention and emotional control. Many kids are diagnosed when they start having trouble in school and are put on medication, often to help improve their odds of succeeding academically and socially.
According to the Centers for Disease Control and Prevention, some 2.7 million kids were taking medication for ADHD in the U.S. as of 2007, the most recent data available. Some experts estimate that 15% to 20% of all ADHD medicine in the U.S. is diverted or shared with people who don't have a prescription. Whether the drugs help the academic performance of kids without the disorder is even less clear.
"I don't think that at this point we have any clear evidence that stimulants can enhance cognition in non-ADHD individuals," says James Swanson, a professor emeritus at the University of California, Irvine, who studies this issue with colleagues at Florida International University.
The lack of academic benefit has been surprising because the drugs seem to have the potential to improve memory, among other cognitive skills. For instance, Claire Advokat, a professor emerita in the psychology department at Louisiana State University, and her colleagues found in a small study that episodic memory—memory for experiences—improved when kids with ADHD took relevant medication.
Children with ADHD not taking stimulants did far worse than kids taking medication in tasks that involved remembering scenes from a story they both heard and saw illustrated. Kids taking medication did just as well as control children without ADHD, according to the study published in April in the journal Pharmacology Biochemistry and Behavior.
But the effects largely don't seem to translate into the classroom, especially in the long run. In one major, U.S. government-funded study known as the MTA that looked at the long-term effects of ADHD treatment, 579 children with the condition were randomized to one of three different kinds of treatment or a control group for 14 months.
For the first year of the study, the 8- and 9-year-old children who received medication and a combination treatment saw greater improvements in ADHD symptoms than the other two groups. Kids taking medicine also exhibited some improvement in educational outcomes in that first year.
But any benefit of the drug on symptoms dissipated by Year Three. At the most recent set of assessments, the eight-year follow-up, there were no differences between any of the groups on symptoms or academic achievement measures, suggesting that there wasn't any long-term residual benefit of the treatments during childhood.
One way of interpreting the findings is that the medicine proves effective on immediate classroom behaviors like sitting still and interrupting the teacher less, but it doesn't help with other factors important to successful completion of homework or test-taking, like family encouragement.
Other studies have shown that kids who take ADHD medication and study early for an exam tend to do just as well, if not better, than kids without ADHD. But those who take medication and study at the last minute don't do any better.
Together, these findings suggest that medication alone isn't enough to improve academic performance. The medicine may help with focus, but it doesn't help with deciding what to focus on, experts say. Rather, it needs to be coupled with skills training, such as learning how to organize or prioritize.
The medication's ability to improve concentration and attention may even backfire when it comes to studying.
Martha Farah, a cognitive neuroscientist at the University of Pennsylvania who sits on the American Academy of Neurology committee that is drafting new treatment guidelines, recalls a student saying that after she takes her medication, she heads to the library. If she keeps her head down and studies, she gets very absorbed in her work and accomplishes a tremendous amount. But if a friend stops by, she becomes equally engrossed in the chat. Many students report they find themselves absorbed in cleaning their rooms rather than studying.
In people without ADHD, there is even less information about whether stimulants lead to any real academic benefit.
Dr. Farah, who is also head of the Center of Neuroscience & Society, and her colleagues found no significant cognitive benefit from Adderall in students assessed on a number of psychological tests, including neurocognitive performance and I.Q. tests. The paper was published in Neuropharmacology in January.
In a separate study, a statistical review of existing data on the topic, still unpublished, suggests there are "very small effects—not zero but not a whole heck of a lot difference," Dr. Farah says.
Write to Shirley S. Wang at Shirley.Wang@wsj.com
Device Helps to Avoid Leaving Cancer Behind
Used in Breast-Cancer Surgery, MarginProbe Immediately Tests for Signs Entire Tumor Wasn't Removed
A new device promises to keep breast cancer patients from having to go back under the knife for a second surgery because the cancerous tissue was accidentally left behind. Dr. Deanna J. Attai, breast surgeon at Providence St. Joseph Medical Center, discusses whether it can help reduce repeat surgeries. Photo: Dune Medical Devices.
The Ache: Many women with breast cancer choose to get lumpectomies, in which just the tumor and a small amount of surrounding tissue is removed from the breast. But a downside of a lumpectomy is that it is often necessary to return for a second surgery after a lab report days or weeks later shows cancer on the "margins," or edges of the removed tissue, causing concern that cancerous tissue was left behind.
The Claim: A new device called MarginProbe uses radio-frequency energy to test just-removed tissue for cancer during surgery. That way, if cancer is found, the surgeon can remove more tissue immediately, reducing the likelihood of a second surgery.
The Verdict: MarginProbe doesn't eliminate the need for a lab test after surgery, but in a clinical trial its use improved the percentage of clean lab-test results following surgery. Some surgeons say it is too early to know whether patients in actual clinical practice will be helped by MarginProbe, which Dune Medical Devices Ltd. of Caesarea, Israel, put on the U.S. market earlier this year. Others say the very initial first results look promising. For now, the technology is available for only breast cancer.
During a lumpectomy, surgeons estimate how much tissue to take out based on scans of the lump and examine it by hand to see if the margins look or feel like cancer—a method that isn't very accurate, says Deanna Attai a breast surgeon at Providence St. Joseph Medical Center in Burbank, Calif. At Providence St. Joseph, one of the few hospitals in the U.S. to lease a MarginProbe machine, its use appears to have helped avoid second surgeries in two patients out of a dozen it has been used on since April, says Dr. Attai.
MarginProbe is a hand-held probe that uses radio-frequency energy to test the removed tumor to determine if its margins likely contain cancer, says device inventor Dan Hashimshony, chief executive of Dune. If cancer is detected, then the surgeon can remove additional tissue in the area next to where the cancerous portion had been.
The device isn't yet covered by insurance, but several hospitals say they are covering the cost, which is $995 per surgery, in the meantime.
In a 600-person study conducted by Dune to gain Food and Drug Administration approval, 31% of patients who had their removed tumors tested with MarginProbe ended up with cancer on the margins after surgery, compared with 42% in a control group. Not all patients with positive margins return for another surgery. Elderly patients or those with other medical issues, for example, may choose to risk cancer recurrence rather than undergo an additional operation, doctors say.
A downside of MarginProbe is that the device overestimates the presence of cancer, resulting in unnecessary removal of additional tissue, surgeons say.
At the end of the trial, which included patients' second surgeries, the MarginProbe group had a little more than 1½ teaspoons more tissue removed than a control group—equivalent to about 2.6% of the average breast of patients in the trial, according to the FDA data.
Since the bulk of Dune's results haven't yet been published in a peer-reviewed journal, it is difficult to evaluate the technology, says Monica Morrow, chief of breast surgery at Memorial Sloan-Kettering Cancer Center in New York. The device "may be useful," but it isn't the only way to deal with positive margins, she says.
—Email aches@wsj.comComfort-Food Fix Without Eating
A study found drawing pictures of comfort food can have positive effects on mood
Eating so-called comfort foods with large amounts of fat and sugar has been shown to vastly improve people's moods. A report in the Journal of Behavioral and Brain Science suggests that drawing pictures of unhealthy food can also have positive effects on mood.
Tyson Smith From September to November 2012, researchers recruited 61 students from St. Bonaventure University in upstate New York. The subjects included 22 men and 39 women in their early 20s. Most were slightly overweight based on measurements of body-mass index, or BMI. Daily sugar and fat consumption was calculated.
The subjects were randomly assigned to one of four groups. One group drew high-fat, high-sugar cupcakes. Another drew pictures of a high-fat, low-sugar food, pizza. A third drew low-fat, high-sugar strawberries, while a fourth drew low-fat, low-sugar peppers. Each participant was instructed to use red, green and black pencils. Using a research tool that assesses mood changes, subjects rated their hunger, mood and level of interest and excitement before and after the five-minute drawing exercise, which was done on an empty stomach.
Drawing pizzas improved the subjects' mood by 28%, while sketching cupcakes and strawberries boosted spirits by 27% and 22%, respectively. Mood in the pepper group improved by only 1%. There were no significant differences in hunger or excitement levels between the groups.
As all subjects used the same colors in their drawings, the mood changes were likely due to the food depictions, researchers said. Mood changes were unrelated to BMI, or sugar and fat intake. This suggests creating images of high-fat and sweet-tasting foods could be an effective way to enhance mood in individuals with varying BMIs and dietary histories, they said.
Caveat: The long-term effects on mood of drawing food aren't known.
• Building trust: Imitation is said to be the highest form of flattery. It also could help to win a child's trust, suggests a study in Social Development.
Researchers recruited 16 girls and 16 boys ages 5 and 6 from day-care centers in Germany. In the first part of the study, half of the children viewed 18 animal photos, with three on a page, and picked their favorite one on each page. The other half answered simple animal-related questions. Two adults also picked their favorite animal photos and answered the animal-related questions. One, the designated mimic, always agreed with the children's selections and answers, while the other always differed.
A New Way to Spot Blockages in Neck Arteries
Carotid stenosis is a narrowing of the neck arteries due to a buildup of plaque in the vessel walls. The condition, which usually develops after age 65, is widely believed to have no symptoms, but a study in the Journal of Neurolinguistics challenges that assumption.
The research found significant language impairment in patients with carotid stenosis, which could be useful in diagnosing the disease and lead to more focused treatments, the researchers said.
The study involved 48 Hungarian men and women in their mid-60s, 24 with asymptomatic carotid stenosis and 24 controls without the disease. Fourteen of the stenosis patients had stenosis in arteries on both sides of the neck; 10 patients had one artery affected, either the right or left side. Arteries were 75% to 87% blocked. Both groups performed at normal levels on verbal and visual short-term memory tests.
Subjects were shown pictures of animals and people designed to elicit different grammatical responses based on 81 nouns, 42 regular and 39 irregular. Subjects looked at four photos for every noun and voiced the correct grammatical form for each one.
In English, irregular nouns are usually plural, where an "s" or "es" is added to the end, or the letters in the word change. For instance, the plural of mouse, mice, and the plural of foot, feet, are irregular nouns.
In Hungarian, irregular nouns involve more complex changes specific to each word.
In the stenosis group, 67% of subjects made errors involving one or both types of nouns compared with 46% of controls. A third of the stenosis subjects—but no controls—made errors on both noun types.
Patients with stenosis on both sides of the neck made the most errors, though errors were unrelated to the degree of blockage.
These grammatical errors may indicate small neurological changes that could cause a decline in a person's behavior, researchers said. The pattern of impairment observed in the study wouldn't be unique to Hungarian-speaking patients, they said.
Caveat: The study's small size may limit its ability to be generalized, researchers said.
Ann Lukits In the study's second part, the children were asked to choose a cardboard box from two nearly identical boxes, one favored by the mimic and the other by the non-mimic. The mimic and non-mimic also gave silly names to two toys and the children were asked to pick the toy they believed had the silly name.
The majority of the children in both groups were more likely to imitate the adult mimic: 11 in the animal-photos group and 12 in the animal-questions group chose the same box as the mimic. On the toy test, 12 children in the photos group picked the silly toy tagged by the mimic, and 11 in the questions group also selected the mimic's toy.
The findings showed that being imitated influences social behavior in children, including their preferences and trust in others, researchers said.
Caveat: It isn't known if children would respond to an imitator who was a friend or relative.
• Excess skin from weight loss: Patients who lose at least 110 pounds following bariatric surgery are often plagued by hanging skin that can cause significant discomfort, especially for women, according to a report in the Journal of Plastic, Reconstructive & Aesthetic Surgery. About a quarter of patients undergo surgery to eliminate the skin.
Researchers in Finland surveyed 360 bariatric surgery patients, 250 women and 110 men in their early 50s, about physical problems with surplus skin after surgery and the affected body areas. Before surgery, the subjects' average BMI was 45.7, or morbidly obese. After surgery, BMIs dropped to 33.6, the low end of the obesity category. On average, patients shed 78 pounds over 3.6 years.
Subjects rated the inconvenience of surplus skin on a scale of 0 to 100, and the degree of daily impairment in six categories ranging from none to very high. Excess skin caused mostly minor problems for 89% of the subjects but significantly interfered with daily activities in 9.2%. Skin complaints were more common in subjects who lost 110 pounds or more compared with those who lost 44 pounds or less. Significantly more women than men reported problems with excess skin.
Caveat: Patient information was self-reported on questionnaires.
• Post-stroke fractures: Bone fractures that occur in the first 24 hours after a stroke can increase the size of the brain damage caused by stroke, worsen neurological symptoms and significantly interfere with a patient's recovery, according to a study in the journal Anesthesiology.
An estimated 70,000 Americans fall and break a bone in the first 12 months after a stroke, and about 11,000 of these fractures occur within the first 24 hours, data from previous studies shows. Understanding the interaction between stroke and fractures may lead to earlier and more effective treatments, researchers said.
University of California scientists surgically induced ischemic strokes in mice. Some of the stroke mice also had surgically induced leg fractures 24 hours after the stroke procedure. A third group of mice didn't have stroke or fractures and acted as controls. Blood samples taken six hours after the induced fractures were analyzed for inflammatory compounds. After three days, brain samples from all the mice were analyzed.
The area of brain damage was 2.5 times larger in mice with both stroke and bone fracture than mice with stroke alone. Mice with both injuries had significantly higher levels of inflammatory proteins and alarmins, molecules that activate the immune system and contribute to inflammation, in their brain tissue than stroke-only and control mice. Behavioral abnormalities were more common in mice with both injuries.
Injecting mice with compounds that neutralized alarmins and inflammatory proteins significantly reduced the neurological symptoms and brain damage associated with post-stroke fractures, posing possible treatment opportunities for human patients with both injuries, researchers said.
Caveat: Fractures that occurred at different times, either before or after stroke, might have different effects on stroke outcome, researchers said.
• Bowel disease and birth defects:Children born to mothers with chronic bowel disease had significantly more birth defects and developmental problems than those born to mothers without bowel disease, according to a study in the Journal of Crohn's and Colitis.
Inflammatory bowel conditions such as Crohn's disease and ulcerative colitis are often diagnosed during a woman's childbearing years. Previous studies have associated inflammatory bowel disease (IBD) with an increased risk of miscarriage, prematurity and low birth weight.
This study compared health outcomes of 829 children born in Israel from 2004 to 2009, about half of whose mothers had IBD. Mothers completed questionnaires about their health history and use of IBD medications before and during pregnancy.
Information about children's birth weight, congenital anomalies, illnesses and developmental milestones was reported separately.
Congenital abnormalities were more than twice as common in IBD children than controls, and even more prevalent in offspring of mothers diagnosed with IBD before the pregnancy. The rate of abnormalities in these children was 6% compared with 1.4% for those born to mothers diagnosed after pregnancy.
The most common were limb deformities, hydrocephalus, spina bifida, hearing impairment, cleft lip and palate, and ventricular heart defects. Congenital anomalies were reported in 5.5% of children born to mothers who used IBD medications during pregnancy and 1.6% of those with mothers who used no medications, though the difference wasn't statistically significant, researchers said.
IBD mothers also had more offspring with IBD compared with controls. Although breast-feeding is associated with preventing IBD, only 61% of IBD children were breast-fed compared with 80% of controls.
Caveat:The study was based on self-reported information. The underlying mechanisms between IBD and adverse outcomes in children weren't explored.
Write to researchreport@wsj.com
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