A delicate new balancing act in senior healthcare

When Claire Gordon arrived at Cedars-Sinai Medical Center, nurses knew she needed extra attention.

She was 96, had heart disease and a history of falls. Now she had pneumonia and the flu. A team of Cedars specialists converged on her case to ensure that a bad situation did not turn worse and that she didn't end up with a lengthy, costly hospital stay.

Frail seniors like Gordon account for a disproportionate share of healthcare expenditures because they are frequently hospitalized and often land in intensive care units or are readmitted soon after being released. Now the federal health reform law is driving sweeping changes in how hospitals treat a rapidly growing number of elderly patients.

The U.S. population is aging quickly: People older than 65 are expected to make up nearly 20% of it by 2030. Linda P. Fried, dean of the Columbia University Mailman School of Public Health, said now is the time to train professionals and test efforts to improve care and lower healthcare costs for elderly patients.

"It's incredibly important that we prepare for being in a society where there are a lot of older people," she said. "We have to do this type of experiment right now."

At Cedars-Sinai, where more than half the patients in the medical and surgical wards are 65 or older, one such effort is dubbed the "frailty project." Within 24 hours, nurses assess elderly patients for their risk of complications such as falls, bed sores and delirium. Then a nurse, social worker, pharmacist and physician assess the most vulnerable patients and make an action plan to help them.

The Cedars project stands out nationally because medical professionals are working together to identify high-risk patients at the front end of their hospitalizations to prevent problems at the back end, said Herb Schultz, regional director of the U.S. Department of Health and Human Services.

"For seniors, it is better care, it is high-quality care and it is peace of mind," he said.

The effort and others like it also have the potential to reduce healthcare costs by cutting preventable medical errors and readmissions, Schultz said. The federal law penalizes hospitals for both.

Gordon, an articulate woman with brightly painted fingernails and a sense of humor, arrived at Cedars-Sinai by ambulance on a Monday.

Soon, nurse Jacquelyn Maxton was at her bedside asking a series of questions to check for problems with sleep, diet and confusion. The answers led to Gordon's designation as a frail patient. The next day, the project team huddled down the hall and addressed her risks one by one. Medical staff would treat the flu and pneumonia while at the same time addressing underlying health issues that could extend Gordon's stay and slow her recovery, both in the hospital and after going home.

To reduce the chance of falls, nurses placed a yellow band on her wrist that read "fall risk" and ensured that she didn't get up on her own. To prevent bed sores, they got her up and moving as often as possible. To cut down on confusion, they reminded Gordon frequently where she was and made sure she got uninterrupted sleep. Medical staff also stopped a few unnecessary medications that Gordon had been prescribed before her admission, including a heavy narcotic and a sleeping pill.

"It is really a holistic approach to the patient, not just to the disease that they are in here for," said Glenn D. Braunstein, the hospital's vice president for clinical innovation.

Previously, nurse Ivy Dimalanta said, she and her colleagues provided similar care but on a much more random basis. Under the project, the care has become standardized.

The healthcare system has not been well designed to address the needs of seniors who may have had a lifetime of health problems, said Mary Naylor, gerontology professor at the University of Pennsylvania School of Nursing. As a result, patients sometimes fall through the cracks and return to hospitals again and again.

"That is not good for them and that is not good for society to be using resources in that way," Naylor said.

Using data from related projects, Cedars began a pilot program in 2011 and expanded it last summer. The research is continuing but early results suggest that the interventions are leading to fewer seniors being admitted to the intensive care unit and to shorter hospital stays, said Jeff Borenstein, researcher and lead clinician on the frailty project. "It definitely seems to be going in the right direction," he said.

The hospital is now working with Naylor and the University of Pennsylvania to design a program to help the patients once they go home.

"People who are frail are very vulnerable when they leave the hospital," said Harriet Udin Aronow, a researcher at Cedars. "We want to promote them being safe at home and continuing to recover."

In Gordon's case, she lives alone with the help of her children and a caregiver. The hospital didn't want her experiencing complications that would lengthen the stay, but they also didn't want to discharge her before she was ready. Under the health reform law, hospitals face penalties if patients come back too soon after being released.

Patients and their families often are unaware of the additional attention. Sitting in a chair in front of a vase of pink flowers, Gordon said she knew she would have to do her part to get out of the hospital quickly. "You have to move," she said. "I know you get bed sores if you stay in bed."

Gordon said she was comfortable at the hospital but she wanted to go back to her house as quickly as she could. "There's no place like home," she said.

Two days later, that's where she was.

anna.gorman@latimes.com

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DC Comics Turns the Occupy Movement Into a Superhero Title

Eighteen months after the phrase first entered the collective public consciousness, the plight of the 99 percent is coming to mainstream superhero comics — via a new series from the second biggest publisher in the American comic industry, which just happens to be a subsidiary of a multi-national corporation that makes around $12 billion a year. Irony, anybody?

In May, DC Comics will launch two new series taking place in their mainstream superhero universe that offer different insights into the class struggle in a world filled with superheroes, alien races and inexplicable events. The Green Team, written by Tiny Titans and Superman Family Adventures creators Art Baltazar and Franco, with art by Ig Guara, revives an obscure 1975 concept about teenage rich kids who try to make the world a better place with their outrageous wealth. In an interview promoting the series, Franco promised that it would address questions like “Can money make you happy?” and “If you had unlimited wealth, could you use that to make the lives of people better?”

Obviously, this is one of the more fanciful series DC will be publishing.

But while DC is promoting The Green Team series as the adventures of the “1%,” its companion title, The Movement, is teased as a chance for us to “Meet the 99%… They were the super-powered disenfranchised — now they’re the voice of the people!”

“It’s a book about power,” explained The Movement writer Gail Simone. “Who owns it, who uses it, who suffers from its abuse. As we increasingly move to an age where information is currency, you get these situations where a single viral video can cost a previously unassailable corporation billions, or can upset the power balance of entire governments. And because the sources of that information are so dispersed and nameless, it’s nearly impossible to shut it all down.”

“The thing I find fascinating and a little bit worrisome is, what happens when a hacktivist group whose politics you find completely repulsive has this same kind of power and influence,” she elaborated in an interview at Big Shiny Robot. “What if a racist or homophobic group rises up and organizes in the same manner?”

While the concept is ambitious, the idea that a comic capable of living up to the book’s populist inspiration could come from DC Entertainment still strikes some as unlikely. Matt Pizzolo, the editor of the Occupy Comics anthology, told Wired that “though DC Comics did help launch Alan Moore and David Lloyd’s seminal anarchist epic V For Vendetta over two decades ago, it’s unlikely they would do so today. Between dismantling Vertigo and frankensteining Watchmen, the past year has demonstrated DC isn’t a safe place for bold creators who want to tell the kinds of stories that would inspire things like Occupy, rather than just cash in on them.”

Still, Simone says that the use of the iconography and language of a real-world populist movement is deliberate, promising that the book will reflect today’s decentralized political world and offer ”a slice of rarity that we’re unlikely to see in most superhero books.”

This wouldn’t the first time that DC has attempted to offer pre-packaged populist rebellion, of course; in addition to the aforementioned publication of the anti-establishment V For Vendetta, the company’s Vertigo imprint also published Grant Morrison’s The Invisibles, a series centering around an international organization struggling against forces of authority and repression that included anti-corporate themes.

Only time will tell whether The Movement will live up to the subversive examples of these earlier books, or just end up a well-intentioned piece of topical super heroics that trades on, and commodifies, a real political movement.

The Movement #1 will be available in both print and digital formats on May 1, while The Green Team #1 will be released on May 22.

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Beyonce, Jay-Z, Rihanna hang at Roc Nation brunch

LOS ANGELES (AP) — Jay-Z and Beyonce sat tightly with Solange. Kelly Rowland embraced Beyonce with a huge hug. And Rihanna spilled some of her drink laughing with Rowland.

Music’s top stars attended the annual pre-Grammy Roc Nation brunch Saturday at the Soho House.

Grammy nominee Miguel, Timbaland, Jill Scott and Kylie Mingoue also attended the exclusive event.

Jay-Z is one of six acts nominated for six awards at Sunday’s Grammys. Rihanna is up for three trophies, and Beyonce is nominated for one award.

The crowd Saturday was full of members of music industry, who mingled with performers like The-Dream, Jordin Sparks, Melanie Fiona, Diane Warren, Christina Milian, MC Lyte and Santigold.

Entertainment News Headlines – Yahoo! News

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For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness

When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice.

“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

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Israeli Says Syria Twisted Comments by Rebel Supporter

BEIRUT, Lebanon — A public relations controversy erupted Saturday after a leading Israeli newspaper published comments from a brief interview with the leader of Syria’s main exile opposition group.

The news media outlets of the Syrian government, and its ally Hezbollah, the Lebanese militant group, reported that the opposition leader had declared that Israel had “nothing to fear” from a rebel-led Syrian government. Moreover, the reports said, the opposition was working with other countries to keep Syria’s chemical weapons away from Hezbollah, which he called a “son of the devil.”

But the opposition leader, Sheik Ahmad Moaz al-Khatib, never said any of that, according to the article in the Israeli newspaper, Yediot Aharonot, and its author, a prominent Israeli defense expert, Ronen Bergman.

Sheik Khatib was quoted in the article reiterating the opposition’s promise to keep Syria’s chemical arsenal out of “the hands of unauthorized elements,” and it was the international community, he said, not Israel, that had “nothing to fear.”

When Sheik Khatib realized that Mr. Bergman was an Israeli — after glancing at his business card — he abruptly ended the conversation, Mr. Bergman said in a Skype interview, repeating what he had written.

The original article was published only in Hebrew — and only in print — so it was the Arabic and English versions put out by the Syrian government and Hezbollah that raced around the Internet on Saturday, provoking outrage from government supporters and opponents at Sheik Khatib, who posted a message on his Facebook page denying that he had given the interview.

Yet the episode appeared to have been more than a simple misunderstanding. Syria’s conflict is not only a shooting war but also a propaganda war. Pro-government media apparently could not resist the chance to bolster their contention that the rebellion had been promoted by Israel and the West to punish Syria and its president, President Bashar al-Assad, for taking uncompromising positions against Israel.

“Unfortunately, the original text was less exciting,” Mr. Bergman said. “I would be happy if he would say something like, ‘Yes, we will make peace with Israel’ — then I would get the front page.” As it was, the article elicited little reaction in Israel.

But misrepresentation of the article suggested that it hit a nerve on one issue. An unnamed opposition member, not Sheik Khatib, called Hezbollah “sons of the devil,” according to Mr. Bergman, and said the rebel coalition was working with other countries to ensure that “not one piece of military equipment, not chemical weapons and not any other item, will pass into their hands.”

Syria is Hezbollah’s main conduit for arms, and Hezbollah has backed Mr. Assad’s bloody crackdown at great cost to its popularity in the wider Arab world.

Although Mr. Bergman said the opposition member was offering his own opinion and not presenting official policy, his comments bolstered the widely held view that a rebel-led government might halt the shipment of Iranian arms through Syria to Hezbollah. Hezbollah, a Shiite group and political party, is also concerned about the rise within the rebel movement of extremist Sunni jihadists who view Shiites as apostates.

The misleading reports appeared to be an attempt to further divide the opposition. Sheik Khatib found himself fending off critics from within the anti-Assad movement who objected to his even speaking with an Israeli reporter, though by all accounts he did not initially realize that Mr. Bergman was an Israeli.

It was the second time in a month that Sheik Khatib found himself on the defensive. He recently proposed talks with members of Mr. Assad’s government, but had not built political support for the proposal.

On Friday, Syria’s information minister, Omran al-Zoubi, gave the first official response to the proposal, saying that the government would negotiate with any opposition members who agreed to lay down their arms.

On Saturday, Mr. Assad named new cabinet ministers for oil, finance, social affairs, labor, housing, public works and agriculture, as Syria faces growing economic problems and shortages of electricity, fuel and bread.

Anne Barnard reported from Beirut, and Isabel Kershner from Jerusalem. Hania Mourtada contributed reporting from Beirut.

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Big Bear locked down amid manhunt

The bustling winter resort of Big Bear took on the appearance of a ghost town Thursday as surveillance aircraft buzzed overhead and police in tactical gear and carrying rifles patrolled mountain roads in convoys of SUVs, while others stood guard along major intersections.

Even before authorities had confirmed that the torched pickup truck discovered on a quiet forest road belonged to suspected gunman Christopher Dorner, 33, officials had ordered an emergency lockdown of local businesses, homes and the town's popular ski resorts. Parents were told to pick up their children from school, as rolling yellow buses might pose a target to an unpredictable fugitive on the run.

By nightfall, many residents had barricaded their doors as they prepared for a long, anxious evening.

PHOTOS: A tense manhunt amid tragic deaths

"We're all just stressed," said Andrea Burtons as she stocked up on provisions at a convenience store. "I have to go pick up my brother and get him home where we're safe."

Police ordered the lockdown about 9:30 a.m. as authorities throughout Southern California launched an immense manhunt for the former lawman, who is accused of killing three people as part of a long-standing grudge against the LAPD. Dorner is believed to have penned a long, angry manifesto on Facebook saying that he was unfairly fired from the force and was now seeking vengeance.

Forest lands surrounding Big Bear Lake are cross-hatched with fire roads and trails leading in all directions, and the snow-capped mountains can provide both cover and extreme challenges to a fugitive on foot. It was unclear whether Dorner was prepared for such rugged terrain.

Footprints were found leading from Dorner's burned pickup truck into the snow off Forest Road 2N10 and Club View Drive in Big Bear Lake.

San Bernardino County Sheriff John McMahon said that although authorities had deployed 125 officers for tracking and door-to-door searches, officers had to be mindful that the suspect may have set a trap.

"Certainly. There's always that concern and we're extremely careful and we're worried about this individual," McMahon said. "We're taking every precaution we can."

PHOTOS: A fugitive's life on Facebook

Big Bear has roughly 400 homes, but authorities guessed that only 40% are occupied year-round.

The search will probably play out with the backdrop of a winter storm that is expected to hit the area after midnight.

Up to 6 inches of snow could blanket local mountains, the National Weather Service said.

FULL COVERAGE: Sweeping manhunt for rampaging ex-cop

Gusts up to 50 mph could hit the region, said National Weather Service meteorologist Mark Moede, creating a wind-chill factor of 15 to 20 degrees.

Extra patrols were brought in to check vehicles coming and going from Big Bear, McMahon said, but no vehicles had been reported stolen.

"He could be anywhere at this point," McMahon said. When asked if the burned truck was a possible diversion, McMahon replied: "Anything's possible."

Dorner had no known connection to the area, authorities said.

Craig and Christine Winnegar, of Murrieta, found themselves caught up in the lockdown by accident. Craig brought his wife to Big Bear as a surprise to celebrate their 28th wedding anniversary. Their prearranged dinner was canceled when restaurant owners closed their doors out of fear.

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Fate of Historic Landsat Mission Hinges on Upcoming Launch

Since 1972 the Landsat mission has been monitoring natural and human-made changes to our planet. But the continuity of that scientifically precious dataset could be lost unless all goes according to plan on Monday, when the Landsat 8 satellite is scheduled to be launched into orbit from Vandenberg Air Force Base in California. Landsat 8 will take over for the hobbled 14-year old Landsat 7 that has been valiantly carrying the mission alone since December when, after 29 years in orbit, Landsat 5 began to be decommissioned after a gyroscope failure.

The launch is not likely to fail, but if it does, it won’t be the first time the continuity of the 40-year mission was jeopardized. Along the way funding has come under fire, ownership of the satellites has been transferred between government agencies and private companies, sensors have quit working, and one mission tragically failed to reach orbit. If Landsat 8 fails, Landsat 7 would run out of fuel near the end of 2016, before a replacement could be built and put into orbit.

“I’ve devoted the latter part of my career to the formulation and development of this mission,” the project’s lead scientist, James Irons, told Wired. “On Monday I go out there and look at my baby sitting on top of an enormous firecracker and hope everything goes well.”

“Yeah, I’ll be nervous.”

The scientists and engineers behind the Landsat mission will be hugely relieved once the craft is safely in place 700 kilometers above their heads and then begins beaming data back to Earth about a month later.

In addition to saving the mission from a gap in data, Landsat 8 — more officially known as the Landsat Data Continuity Mission – will boost the rate of coverage of the Earth and will also add more sensing capability and deliver better imagery than its predecessors.

Relying on Landsat 7 alone has meant only imaging the full Earth every 16 days. Once there are two eyes open, coverage will return to 8-day intervals, essentially doubling the resolution of landscape change that will be recorded.

“The major goal of the mission is for us to understand land cover and land use change, and determine the human impacts on the global landscape,” Irons said. “These changes are going on at rates unprecedented in human history.”

“Continuity is more important than ever.”

The new satellite will also add more sensing capability and deliver better imagery than its predecessors. Landsat 8 will measure all the spectral bands of its predecessors, but will add two new bands that are tailored for detecting the coastal zone and cirrus clouds.

The new satellite has a more advanced imaging design as well. Previous Landsat satellites used what is known as a whisk broom sensor system, where an oscillating mirror would sweep back and forth over a row of detectors that collect data across a 185-kilometer swath of the Earth. The new push system uses a very long array of more than 7,000 detectors that will view the 185 km swath simultaneously, alternately collecting light and recording data. This allows each detector to dwell on each pixel for a longer time, resulting in more detailed, accurate descriptions of the landscape.

Once Landsat 8 reaches orbit, the engineers will begin testing the spacecraft during the first week. The next few weeks will be dedicated to testing all the instruments. The satellite will then do a cross-over rendezvous with Landsat 7 to calibrate the two systems. Around day 25, the shutters will be opened and Landsat 8 will take its first look at Earth. By the end of May, the data should be flowing. The new satellite has a design life of five years, but it has enough fuel to operate for 10 years.

But first, the new craft has to get safely into orbit.

“I have a lot of assurance from everyone,” Irons said. “They are taking extraordinary care, proceeding very methodically, cautiously and rigorously.”

“Still, you realize all rocket launches have some inherent risk,” he said. “So, it’s just hold your breath and hope everything goes well.”

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Britney Spears considers long-term Las Vegas deal

LOS ANGELES (Reuters) – Pop star and former “X Factor” judge Britney Spears is in talks to sign a long-term contract to headline a show at a Las Vegas resort, Caesars Entertainment Corp. said on Friday.

“We can now confirm the company is actively engaged in discussions with Britney Spears‘ representatives regarding a potential headlining residency at Planet Hollywood Resort and Casino,” the company said in a statement.

Representatives for Spears were not immediately available for comment on Friday.

Caesars Entertainment, which owns casinos and resorts including Planet Hollywood, has hired some of the world’s top-selling artists for residencies at various Las Vegas sites.

Canadian singer Celine Dion has a three-year deal with Caesars Palace that is said to be worth $ 100 million. British singer Elton John also has a long-term commitment to perform at The Colosseum at Caesars Palace.

Singers Cher and Bette Midler had similar long-term deals at The Colosseum in recent years.

Spears, 31, shot to fame in the late 1990s with hits such as “… Baby One More Time” and has gone on to become one of the biggest pop figures of the 2000s.

She is waging a comeback after a turbulent few years in her life in which she lost custody of her children, entered rehab and shaved off her hair.

She landed a seat on “The X Factor” judging panel in May 2012, but left the show last month after one season. In the same week, she also split up with her fiancé Jason Trawick.

(Reporting By Piya Sinha-Roy and Eric Kelsey; Editing by Xavier Briand)

Music News Headlines – Yahoo! News

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Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

Friday Feb. 8 4:13 p.m. | Updated Thanks for all your responses. You can read about the winner at “Think Like a Doctor: A Confused and Terrified Patient Solved.”

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Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Correction: The patient’s eyes were brown, not blue.

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Venezuela Devalues Currency Amid Shortages and Inflation

CARACAS, Venezuela — Venezuela announced Friday that it was devaluing its currency, a step that had long been deemed necessary but could push the spiking inflation even higher.

The devaluation, which lowered the currency’s value against the dollar by nearly 50 percent, was aimed at solidifying government finances and easing a tight market for dollars that has choked back imports and led to shortages of basic goods.

The move had been widely anticipated, but it had been unclear whether officials would make what could be a politically risky decision with President Hugo Chávez still out of the country after undergoing cancer surgery in Cuba on Dec. 11.

If Mr. Chávez were to die or were too ill to continue as president, a special election would have to be called, and many analysts thought that the government might try to postpone a devaluation until after that occurred.

“It is a sign of pragmatism that they carry out a devaluation even though we’re all aware there is some likelihood of a presidential election being held soon,” said Francisco Rodríguez, an economist with Bank of America Merrill Lynch. “This shows that they’re willing to correct basic economic distortions.”

The currency, the bolívar, will be set at 6.3 to the dollar. It had been set at 4.3.

Venezuela’s finance minister, Jorge Giordani, said that Mr. Chávez, who has not been seen or heard in public for more than eight weeks, had approved the measures.

“Here is the president’s signature if you want to recognize it or if you still have doubts,” Mr. Giordani said, holding up a document during a televised news conference.

The devaluation will help the government balance its books by giving it nearly 50 percent more bolívars for the dollars it earns selling oil on the world market. Venezuela’s economy is highly dependent on oil, with petroleum sales making up about 95 percent of total exports. The country is the fourth-largest foreign oil supplier to the United States.

Government spending soared last year during the campaign to re-elect Mr. Chávez, leading to a large deficit, even though, at more than $100 a barrel, the price of oil is very high.

Pressure to devalue had been building for months, as the black market exchange rate rose to more than four times the official rate. The imbalance was evident in the prices of many goods. A Big Mac at McDonald’s costs 70 bolívars, or $16.27, at the official pre-devaluation rate.

But the devaluation will also make imported goods more expensive, which will probably make inflation worse. Inflation for the 12 months ended on Jan. 31 was 22.2 percent, one of the highest rates in Latin America.

Surging inflation could cause political problems for the government. But the exchange rate had reduced the dollars available to importers, leading to shortages of goods like sugar, chicken and toilet paper. Many analysts believe that voters blame the government more for shortages than for inflation.

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FBI searches Las Vegas home of fugitive

Federal and local authorities served a search warrant at the Las Vegas home of an ex-police officer sought in connection with a series of shootings in Southern California, but said the suspect was not located.

FBI spokeswoman Laura Eimiller confirmed agents and Las Vegas police searched the home Thursday as part of the ongoing investigation into Christopher Jordan Dorner, 33, but did not elaborate as to what was recovered. The surrounding neighborhood was cleared as a precaution, she said.

No one was home at the time, Eimiller said.

PHOTOS: Manhunt for ex-LAPD officer

Several law enforcement agencies are involved in the ongoing manhunt for Dorner and alerts have been issued all across California and in Nevada, warning Dorner was considered "armed and extremely dangerous." Dorner was believed to be carrying multiple weapons, including an assault rifle.

In California, a SWAT team clad in military fatigues spent Thursday afternoon combing the mountain community of Big Bear after Dorner's burned-out truck was found on a forest road. Authorities were going door-to-door and checking all vehicles coming and going from the mountain.

Dorner, who was fired from the LAPD in 2009, is suspected of shooting three police officers, one of whom died, in Riverside County early Thursday.

PHOTOS: Manhunt for ex-LAPD officer

He also is suspected of killing a couple who were found shot in a car in Orange County earlier this week. One of the victims was the daughter of a former LAPD captain named in a lengthy online manifesto that law enforcement officials attributed to Dorner.

The Los Angeles Police Department had dispatched units across the region to protect at least 40 officers and others named in the document, which threatened "unconventional and asymmetrial warfare" against police.

Dorner received awards for his expertise with a rifle and pistol, according to military records obtained by The Times. He received an Iraq Campaign Medal and was a member of a mobile inshore undersea warfare unit.

Riverside Police Chief Sergio Diaz, calling the attack on his officers a "cowardly ambush," said Dorner is suspected of opening fire with a rifle about 1:30 a.m. Thursday as he pulled up to two police officers waiting at a traffic light.

The attack was carried out about 20 minutes after Dorner wounded an LAPD officer in a shooting in nearby Corona, police said.

Early Thursday, two women delivering the Los Angeles Times in Torrance were shot by Los Angeles police who were headed to the home of a police captain named in the manifesto.

The women, shot in the 19500 block of Redbeam Avenue, were taken to area hospitals, Torrance Police Lt. Devin Chase said. One suffered a minor wound, and the other was struck twice and listed in stable condition, LAPD Chief Charlie Beck told reporters.

"Tragically," Beck said, "we believe this is a case of mistaken identity."

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Apparent Facebook Widget Snafu Brings Down Sites

Several sites across the web could not be reached by some visitors on Thursday afternoon, apparently because of a problem with Facebook widgets embedded in the sites. Several sites — including Business Insider, Huffington Post and Salon — were reportedly affected, redirecting visitors to a Facebook error page.

Facebook did not immediately respond to a request for comment, but the problem has apparently been fixed. The problem was first reported by Marketing Land.

When trying to visit a page that used Facebook Connect or Like widgets, users were redirected to a page saying simply “An error occurred. Please try again later.” When they clicked the “Okay” button, they were taken to an error page. If they hit back, they would get to the page they were trying to visit momentarily before being automatically forwarded to the error page again.

Facebook provides code to embed widgets that display information such as which of your friends like a site’s Facebook page, or which articles have recently been “liked” by a friend. These widgets execute JavaScript code in the user’s web browser that originates at Facebook, not the site that the user is trying to view. The problem only seems to affect users who are not logged into Facebook.

Home Page Photo: Pshab / Flickr

Update: Facebook has now said: “For a short period of time, there was a bug that redirected people logging in with Facebook from third party sites to Facebook.com. The issue was quickly resolved, and Login with Facebook is now working as usual.”

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Martial arts drama kicks off Berlin film festival

BERLIN (Reuters) – The 2013 Berlin film festival kicks off on Thursday with the red carpet premiere of “The Grandmaster”, Hong Kong director Wong Kar Wai‘s martial arts period drama set in China at the time of the Japanese invasion in the 1930s.

Starring regular collaborator Tony Leung Chiu Wai as kung fu master Ip Man and Zhang Ziyi as his rival and friend Gong Er, the heavily stylized picture is a story of honor, principle, betrayal and forbidden love all set in a time of turmoil.

Wong, also president of the jury at the cinema showcase this year, said he was determined to get beneath the surface of martial arts in a way most films in the genre had not.

“‘Grandmaster’ is a film about kung fu. It tells you more than the skill,” he told reporters after a press screening and ahead of the opening night gala.

“It tells you more about these people, martial artists, the world of martial arts. What is their code of honor? What is their value? What is their philosophy?

“I hope this film can bring the audience a new perspective about martial arts, kung fu and also Chinese,” he added, wearing his trademark dark glasses and speaking in English.

The idea for “The Grandmaster” was first announced more than a decade ago and it took the notoriously slow filmmaker four years to make, involving rigorous training for both Leung and Zhang which both actors said changed them profoundly.

Leung’s character, which dominates the first part of the film, is based on a real-life master of the same name who developed the Wing Chun school of martial arts and counted Bruce Lee among his students.

Gong Er’s character gradually takes a central role, and her repressed longing for Ip Man brings to the fore Wong’s mastery of melancholy, which he showed so memorably in his best known film to date “In the Mood for Love” also starring Leung.

IRANIAN FILM DEFIES BAN

Leung, 50, said he started training for the part four years ago, and reportedly broke his arm early in the process.

“There is a spiritual side of kung fu and that side cannot be learned from books or by fact-finding,” he said. “It grows spontaneously. So that’s why I had to practice four years. You can only achieve that thing through practice.”

“The Grandmaster” marks the official start of 11 days of screenings, photocalls, interviews and parties across Berlin where hundreds of movies will be screened, reviewed and traded at a film market that accompanies the Berlinale.

Matt Damon, Anne Hathaway and Nicolas Cage are expected on the red carpet, as are European heavyweights Catherine Deneuve and Jude Law and Asian stars including Leung and Zhang.

In the main competition of 19 movies eligible for awards is “Promised Land”, about the controversial drilling technique for extracting gas known as “fracking” and starring Matt Damon directed by his “Good Will Hunting” collaborator Gus Van Sant.

Steven Soderbergh‘s “Side Effects” is in part a critique of the pharmaceutical industry and boasts Law, Channing Tatum and Catherine Zeta-Jones in the cast.

Soderbergh, an Oscar winner for his 2000 narcotics drama “Traffic”, has announced it will be his final big screen feature film, at least for the foreseeable future.

One of the most eagerly awaited pictures at the festival is “Closed Curtain”, co-directed by acclaimed Iranian director Jafar Panahi who made it in defiance of a 20-year ban on film making imposed by authorities at home.

Out of competition is 3D prehistoric animation comedy “The Croods”, featuring the voices of Cage and Ryan Reynolds, and “Dark Blood”, which River Phoenix was filming when he died aged 23 in 1993.

(Reporting by Mike Collett-White, editing by Paul Casciato)

Movies News Headlines – Yahoo! News

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Daniel Doctoroff Enlists Bloomberg in A.L.S. Research

Nicole Bengiveno/The New York Times

Daniel L. Doctoroff, second from right, chief executive of Bloomberg L.P., at Columbia University’s Motor Neuron Center.

Daniel L. Doctoroff watched in pain as his father developed a limp one day, was found to have Lou Gehrig’s disease, and died within two years. Then an uncle also developed symptoms of the same disease, and died soon after.

Now Mr. Doctoroff, like many other relatives of Lou Gehrig’s disease victims, worries that he or his children may someday develop the illness.

But unlike many, he is in a position to try to do something about it. At a time when scientists are making rapid gains in the genetic roots of many diseases, Mr. Doctoroff, a former deputy mayor and private equity investor, is working with Mayor Michael R. Bloomberg and a private equity director, David M. Rubenstein, to put together a $25 million package of donations to support research to try to cure this rare and usually fatal degenerative neurological illness.

“This is a devastating disease,” Mr. Doctoroff said in an interview this week in the glass high-rise on the Upper East Side that houses Bloomberg L.P., the mayor’s media and financial information company, where Mr. Doctoroff is now chief executive. “Up to now, there’s been basically no hope. I have the resources, and I think it’s my obligation to do that.”

The gift is part of a wave of investment based on the booming field of genomic analysis. The money will go to a project called Target A.L.S., a consortium of at least 18 laboratories, including ones at Columbia and at Johns Hopkins, the mayor’s alma mater, working to find biological “targets,” like gene mutations, and the biochemical changes they cause in the spinal cord, that could be used to test potential drug therapies for the disease, formally known as amyotrophic lateral sclerosis.

It comes on top of a previous $15 million gift by Mr. Doctoroff, Bloomberg Philanthropies and other donors. By comparison, the National Institutes of Health, the single largest source of research financing for the disease, expects to give $44 million in 2013.

This is not Mr. Bloomberg’s first time supporting charitable causes that are dear to his close associates. The mayor quietly gave at least $1 million to put the name of his top deputy mayor, Patricia E. Harris, on a new academic center at her alma mater, Franklin & Marshall College in Lancaster, Pa.

Mr. Doctoroff said the conversation about A.L.S. in which he got Mr. Bloomberg involved “lasted about five seconds.” He declined to say what share of the money each of the three donors was giving.

Mr. Rubenstein, a founder of the Carlyle Group, said Wednesday that he had long been fascinated with A.L.S. because of its association with Gehrig, the baseball player who died of it. He wondered why more than 70 years later so little progress had been made in treating it.

He said he jumped at the chance to join in because he thought that A.L.S. research was underfinanced owing to the rarity of the disease, and that even a small amount of money could make a big difference.

In the Bloomberg administration, where he was deputy mayor for economic development and rebuilding from 2002 to 2008, Mr. Doctoroff was best known for his dogged — and ultimately dashed — attempt to bring the 2012 Olympics to New York City. (London got the Games.) Now that he has left City Hall, he no longer rides his bike to work — he says the 2.6-mile route from the Upper West Side to his office is too short — but he sometimes runs.

At Bloomberg, he sits in front of a conference room with walls of hot-pink glass, while carp swim in a giant fish tank nearby. He keeps no family photos or other personal mementos on his desk, and talking about his family’s disease history does not seem easy for him.

A.L.S. is rare, with about 2 new cases diagnosed a year per 100,000 people, according to the A.L.S. Association. A vast majority of cases are “sporadic,” in people who have no family history, while only 5 to 10 percent of cases are inherited. There appear to be no racial, ethnic or socioeconomic predispositions.

There is some speculation about environmental factors, like exposure to toxic chemicals and high physical activity that athletes might endure, “but nothing firm,” said Christopher E. Henderson, a researcher at Columbia and the Target A.L.S. project’s scientific director. Some researchers suspect a link between A.L.S. and head trauma suffered by professional football players.

Mr. Doctoroff’s father, Martin, an appeals court judge in Michigan, received the diagnosis in 2000 and died in 2002. One of Martin Doctoroff’s brothers, Michael, was found to have the disease in 2009 and died in 2010.

“When my father contracted the disease and passed away, it was very easy to chalk it up to bad luck,” Mr. Doctoroff said. “When my uncle got it, it obviously had broader implications.”

Given his family history, Mr. Doctoroff estimates that there is a 50-50 chance that he has the gene, C9orf72, that could lead to A.L.S. But he has chosen not to be tested, which would have implications not just for him but for his three children. “It’s very personal, but I’m not sure that I want to know,” he said.

Even when family members develop the disease, it can occur at vastly different ages, so he could still be in suspense even after testing. “Assuming you have the gene, you don’t know when you would actually get the disease,” he said. His uncle was 71. His father was 66. He is now 54.

Sheelagh McNeill contributed reporting.

This article has been revised to reflect the following correction:

Correction: February 8, 2013

Because of an editing error, a picture caption on Thursday with an article about efforts by Daniel L. Doctoroff, a former deputy mayor of New York, to research Lou Gehrig’s disease misstated his title at Bloomberg L.P. in some editions. He is the chief executive, not the executive director.

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States’ Group Calls for 45% Cut in Amount of Carbon Emissions Allowed

The Regional Greenhouse Gas Initiative, the country’s first regional system for capping carbon emissions and creating a market in carbon allowances, proposed a fundamental change on Thursday to increase electrical utilities’ incentive to cut emissions from fossil-fuel plants by raising the cost of compliance.

The regional group proposed a 45 percent reduction next year in the total carbon dioxide emissions allowed. The cut is not as draconian as that number suggests, however, because the new total of 91 million tons reflects the current emissions level after five years of a slumping economy and increases in renewable energy and energy-efficiency measures.

The reduction from 165 million tons is expected to raise the price of compliance, and further reductions of 2.5 percent annually were likely to increase the value of the allowances that utilities must submit for every ton of carbon dioxide, or its equivalent, that they emit.

If the proposal goes into effect, the analysis done by the group, which is a collaboration of nine states to cut carbon emissions, indicates that by 2020, allowances that are now trading at $1.93 could trade as high as $10. That would be roughly at the level where allowances for California’s new economywide cap-and-trade system were auctioned last fall.

Cap-and-trade, a system of controlling carbon emissions by putting a price on them and therefore creating economic incentives for businesses to cut energy use — and for investors to back new businesses creating energy from renewable sources — was abandoned by Congress in 2009, leaving the regional group and the California system to forge new markets on their own.

States in the group are Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New York, Rhode Island and Vermont.

Richard K. Sullivan Jr., the Massachusetts secretary of energy and environmental affairs, said in an interview that the proposed change was being made in accordance with group’s original plans for a five-year review of the program. “I think there was a genuine expectation that the cap would be reduced to hew to the goal of driving down greenhouse-gas emissions,” he said.

He said that in his state, 71,000 new jobs had been created in the clean energy sector since the cap-and-trade system covering state utilities was put into place.

But conservative opponents of such systems were quick to label the proposal a new tax on energy consumers. Americans for Prosperity, one such group, released a statement by Steve Lonegan, its New Jersey state director, saying, “Electricity consumers have been paying a job-killing tax with zero benefit. Now ratepayers in the remaining nine R.G.G.I. states are going to be walloped thanks to this diktat from a bunch of unaccountable bureaucrats.”

New Jersey withdrew from the regional compact after the election of Gov. Chris Christie.

Mr. Sullivan of Massachusetts pointed out that the new proposal included a safety valve for utilities should prices rise too far too fast. That takes the form of a reserve pool of allowances that can be drawn on if prices exceed set levels: $4 in 2014, increasing $2 a year through 2017.

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Obama names REI chief to lead the Interior Department

President Obama nominated REI business executive Sally Jewell to lead his second-term Interior Department.

WASHINGTON – President Obama on Wednesday nominated Sally Jewell, a former oil engineer and banker and current chief executive of a national outdoor retailer, to lead the Interior Department, making an unorthodox pick for his first woman nominee to his second-term Cabinet.

The president and CEO of Recreational Equipment Inc., Jewell has no government and little public policy experience, and has spent her career far from Washington. But her resume has elements that appealed to both of the two feuding interests that consume much of the debate at the department that controls public lands: the oil and gas extraction industries seeking access to public lands, as well as environmentalists seeking to preserve them.

Jewell, 56, started her career as a petroleum engineer working in the oil fields of Oklahoma and Colorado for Mobil Oil Corp. She then moved to the corporate banking industry, and joined the REI board in 1996,  becoming chief operating officer four years later.

PHOTOS: President Obama’s past

She has been credited with expanding the Washington state-based retailer's Internet operations and contributing the membership cooperative’s resources to environmental stewardship. Jewell, an avid outdoorswoman, serves on the board of the National Parks Conservation Assn. as well as the Board of Regents of the University of Washington.

In announcing his choice, Obama cast her as someone who would seek a balance between protection and economic development of public lands. 

“She knows the link between conservation and good jobs,” Obama said in remarks at the White House. “She knows that there’s no contradiction between being good stewards of the land and our economic progress, that in fact, those two things need to go hand-in-hand. She’s shown that a company with more than $1 billion in sales can do the right thing for our planet.”

In fact, little is known about Jewell’s policy positions. And while environmental groups largely praised her nomination, Republicans and some Democrats withheld judgment.

“The livelihoods of Americans living and working in the West rely on maintaining a real balance between conservation and economic opportunity,” said Sen. Lisa Murkowski (R-Alaska), the ranking member of the Senate committee on energy and national resources.  “I look forward to hearing about the qualifications Ms. Jewell has that make her a suitable candidate to run such an important agency, and how she plans to restore balance to the Interior Department.”

PHOTOS: President Obama’s second inauguration

If confirmed, Jewell will replace Ken Salazar, who served in the post throughout the president’s first term and led a period of expansion of oil and gas drilling on public lands. Salazar plans to return to Colorado. Obama on Wednesday praised the former senator as a close friend and trusted advisor.

Salazar, he said, had “ushered in a new era of conservation of our land, our water and our wildlife.”

“He’s opened more public land and water for safe and responsible energy production – not just gas and oil, but also wind and solar – creating thousands of new jobs and nearly doubling our use of renewable energy in this country,” Obama said. 

Jewell is the first woman to be named to lead a Cabinet-level department in the second term. After naming a few white men to top jobs, Obama said the next round of nominees would include more women and be more racially diverse.

Follow Politics Now on Twitter and Facebook

Kathleen.hennessey@latimes.com

Twitter: @khennessey

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Microsoft Teases Future Surface Pro Accessories With Extra Battery Power

Days before Surface Pro’s release date, Microsoft is already teasing the types of accessories we’ll see for the device.

In a Reddit AMA hosted on Wednesday, members of the Surface Team responded to user questions, and suggested that a Surface Pro cover that would double as an extra battery pack is in the works. Good thing, too, since we found that the Surface Pro could barely get around four hours of normal usage.

Naturally, that’s a major concern for people considering buying the computer — Reddit members brought it up on multiple occasions. Asked about the new connectors at the bottom of the Surface Pro on either side of the cover port, a Microsoft rep said, “At launch we talked about the ‘accessory spine’ and hinted at future peripherals that can click in and do more. Those connectors look like can carry more current than the pogo pins, don’t they?”

The cryptic answer was fleshed out in another response. A redditor specifically asked if Microsoft plans to make a thicker keyboard with an extra battery pack.

“That would require extending the design of the accessory spine to include some way to transfer higher current between the peripheral and the main battery. Which we did,” a Surface Team member replied.

Considering that Microsoft already has released two covers for Surface Pro and Surface RT, along with a Surface-branded Wedge Touch Mouse, it’s not hard to imagine the company expanding its Surface accessory lineup. It’s a natural next step as the company continues to focus on its hardware division, which has traditionally offered accessories like mice and keyboards.

The Reddit AMA also covered issues like Surface Pro’s lack of storage space and whether the company plans to release a 3G or 4G Surface. The latter answer was a roundabout “no.” As for storage space, the Surface Team’s Marc DesCamp said, once again, that you can extend storage through the USB 3.0 port and microSDX card slot. He also mentioned that initial reports of available storage space (23GB for the 64GB model, and 83GB for the 128GB model) are conservative; you actually get around 6 to 7GB more than that.

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Personal Health: Effective Addiction Treatment

Countless people addicted to drugs, alcohol or both have managed to get clean and stay clean with the help of organizations like Alcoholics Anonymous or the thousands of residential and outpatient clinics devoted to treating addiction.

But if you have failed one or more times to achieve lasting sobriety after rehab, perhaps after spending tens of thousands of dollars, you’re not alone. And chances are, it’s not your fault.

Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free. Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse.

According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives. People typically do more research when shopping for a new car than when seeking treatment for addiction.

A groundbreaking report published last year by the National Center on Addiction and Substance Abuse at Columbia University concluded that “the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.” The report added, “Only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works.”

The Columbia report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors suggested that such insufficient care could be considered “a form of medical malpractice.”

The failings of many treatment programs — and the comprehensive therapies that have been scientifically validated but remain vastly underused — are described in an eye-opening new book, “Inside Rehab,” by Anne M. Fletcher, a science writer whose previous books include the highly acclaimed “Sober for Good.”

“There are exceptions, but of the many thousands of treatment programs out there, most use exactly the same kind of treatment you would have received in 1950, not modern scientific approaches,” A. Thomas McLellan, co-founder of the Treatment Research Institute in Philadelphia, told Ms. Fletcher.

Ms. Fletcher’s book, replete with the experiences of treated addicts, offers myriad suggestions to help patients find addiction treatments with the highest probability of success.

Often, Ms. Fletcher found, low-cost, publicly funded clinics have better-qualified therapists and better outcomes than the high-end residential centers typically used by celebrities like Britney Spears and Lindsay Lohan. Indeed, their revolving-door experiences with treatment helped prompt Ms. Fletcher’s exhaustive exploration in the first place.

In an interview, Ms. Fletcher said she wanted to inform consumers “about science-based practices that should form the basis of addiction treatment” and explode some of the myths surrounding it.

One such myth is the belief that most addicts need to go to a rehab center.

“The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually,” she wrote.

Contrary to the 30-day stint typical of inpatient rehab, “people with serious substance abuse disorders commonly require care for months or even years,” she wrote. “The short-term fix mentality partially explains why so many people go back to their old habits.”

Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism, said in an interview, “You don’t treat a chronic illness for four weeks and then send the patient to a support group. People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it.”

Dr. Willenbring now practices in St. Paul, where he is creating a clinic called Alltyr “to serve as a model to demonstrate what comprehensive 21st century treatment should look like.”

“While some people are helped by one intensive round of treatment, the majority of addicts continue to need services,” Dr. Willenbring said. He cited the case of a 43-year-old woman “who has been in and out of rehab 42 times” because she never got the full range of medical and support services she needed.

Dr. Willenbring is especially distressed about patients who are treated for opioid addiction, then relapse in part because they are not given maintenance therapy with the drug Suboxone.

“We have some pretty good drugs to help people with addiction problems, but doctors don’t know how to use them,” he said. “The 12-step community doesn’t want to use relapse-prevention medication because they view it as a crutch.”

Before committing to a treatment program, Ms. Fletcher urges prospective clients or their families to do their homework. The first step, she said, is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with the program you are considering.

Check on the credentials of the program’s personnel, who should have “at least a master’s degree,” Ms. Fletcher said. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine.

Does the facility’s approach to treatment fit with your beliefs and values? If a 12-step program like A.A. is not right for you, don’t choose it just because it’s the best known approach.

Meet with the therapist who will treat you and ask what your treatment plan will be. “It should be more than movies, lectures or three-hour classes three times a week,” Ms. Fletcher said. “You should be treated by a licensed addiction counselor who will see you one-on-one. Treatment should be individualized. One size does not fit all.”

Find out if you will receive therapy for any underlying condition, like depression, or a social problem that could sabotage recovery. The National Institute on Drug Abuse states in its Principles of Drug Addiction Treatment, “To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems.”

Look for programs using research-validated techniques, like cognitive behavioral therapy, which helps addicts recognize what prompts them to use drugs or alcohol, and learn to redirect their thoughts and reactions away from the abused substance.

Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, “Get Your Loved One Sober,” with co-author Brenda L. Wolfe. It helps addicts adopt a lifestyle more rewarding than one filled with drugs and alcohol.

This is the first of two articles on addiction treatment.

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DealBook: R.B.S. Settlement a Burden for Britain

LONDON — The British government is taking aim at an unlikely target in the latest rate-rigging case: the British government.

The $612 million settlement that the Royal Bank of Scotland reached with authorities on Wednesday over rate manipulation will leave British taxpayers liable for part of the fine.

The government still owns a 82 percent stake in the bank, which was bailed out in 2008 during the height of the financial crisis.

The British government finds itself on the other side of its case as well because the Financial Services Authority, the country’s main financial regulator, has been part of the global investigation into the manipulation of benchmark rates like the London interbank offered rate, or Libor.

The case against the Royal Bank of Scotland has been politically charged after British politicians demanded that bankers’ bonuses should be used to pay for the settlement.

“There is a legitimate concern that British taxpayers, who already have bailed out the bank, will be asked to pay for past mistakes at R.B.S.,” said Pat McFadden, a British politician who is a member of the opposition party and part of the Parliament’s Treasury select committee that oversees the country’s finance industry. On Monday, George Osborne, the chancellor of the Exchequer, also called on the bank to use bonuses to pay the Libor fine.

To help pay for the global settlement, the British bank said it would claw back past and present bonuses totaling $471 million from both the traders implicated in the rate-rigging scandal as well as from employees in the bank’s operations, particularly its investment banking unit, which have not been part of the wrongdoing.

Bank officials said the clawbacks were related to the reputational damage caused to the bank, and would also cover potential future legal liabilities. But that money will be used primarily to pay the fines levied against the bank by the United States authorities.

The Financial Services Authority’s share of the fine is expected not to come from the bonuses. The money will, in a sense, be recycled since it will go to the British government’s coffers.

One of the casualties of the Libor scandal was John Hourican, head of the firm’s investment banking division, who resigned on Wednesday. He will forgo past and present compensation worth a combined $14.1 million. Mr. Hourican, who took over the investment banking unit in 2008 and has not been implicated in the wrongdoing, will receive a one-time payout from the bank of around $1 million.

Libor Explained

“This has been a soap opera for the last four years because of the ups and downs of this job,” the bank’s chairman, Philip Hampton, told reporters on Wednesday. “The bank was in a hell of a mess.”

The taxpayer stake in the bank sets the latest deal apart from the other two big Libor settlements. Last summer, the British bank Barclays agreed to pay $450 million to settle accusations that it reported false rates. In December, the Swiss giant UBS struck a sweeping $1.5 billion deal with authorities in which its Japanese subsidiary pleaded guilty to felony wire fraud.

But despite the vested interest of taxpayers, the Financial Services Authority did not take the government’s ownership stake into consideration when reaching the settlement, according to a person with direct knowledge of the matter who spoke on the condition of anonymity.

The renewed scrutiny on the bank, however, could hinder the government’s ability to sell its stake for a profit, as private investors remain wary of the bank’s future liabilities. Since the bailout in 2008, the bank’s shares have plummeted, and are currently trading around 32 percent below the initial purchase price.

As part of plans to sell the government’s stake in the bank, Vince Cable, the British business secretary, said Royal Bank of Scotland should have been fully nationalized when it was bailed out in 2008. In a speech on Wednesday, he added that one option could be to return shares in the bank to British taxpayers.

“The early hope of reprivatization now looks a very long way off, unless at an unacceptable loss,” Mr. Cable said.

Government officials have held preliminary discussions with a number of investors about selling stakes in the Royal Bank of Scotland, according to a person with direct knowledge of the matter who spoke on the condition of anonymity.

The potential losses facing British taxpayers contrast with the $182 billion bailout of the American International Group in 2008. Over the last two years, A.I.G. issued a series of stock offerings to reduce the United States government’s ownership, generating profit of around $22 billion for American taxpayers.

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Child porn suspect indicted by federal grand jury

A North Hills woman whom authorities allege plied a young girl with crack cocaine and photographed her having sex with an older man was indicted Tuesday on federal charges of producing child pornography and sex trafficking.

Letha Montemayor Tucker was named Tuesday in a four-count indictment returned by a federal grand jury. If convicted of all the charges, Tucker would face a mandatory minimum federal sentence of 10 years and could get up to life in prison, authorities said.

The charges come a month after authorities sought the public's help in the investigation by releasing photographs of a man and woman depicted in a set of widely circulated child pornography photos.

Tips started pouring in immediately after the photos were released, investigators said.

Tucker, who goes by the name Butterfly, was located about 10 hours after the release of the photos and taken into custody, said Claude Arnold, special agent in charge for Homeland Security Investigations in Los Angeles, a division of U.S. Immigration and Customs Enforcement.

The alleged victim, who was about 12 when the photos were taken, was found within a week of the case going public, Arnold said. She is an adult now and is cooperating with authorities, he said.

In addition to photographing the girl having sex with the man, authorities said, Tucker also committed sex acts with the alleged victim.

The photos were part of a child pornography collection known as the "Jen Series."

The 40-plus photos were first discovered by investigators in the Chicago area in 2007. Investigators said images in the series have been reported about 300 times and have been found on computers across the country.

The victim "didn't even know these images were out there," Arnold said.

"The horror of child pornography is it's for life, the victimization," Arnold said. "Once the photos are there in cyberspace, they're there forever."

The girl, identified in court records only by the initials J.M.M., lived in the same Los Angeles County residential hotel as Tucker, who worked as a prostitute, authorities said.

Around 2000 or 2001, the girl stopped attending school regularly and spent more and more time in Tucker's room, smoking crack cocaine Tucker provided, according to the indictment.

The girl was present when Tucker engaged in prostitution with clients and was usually high when this happened, authorities allege. Tucker instructed the child to take off her clothes in front of the clients, prosecutors alleged in court papers.

The faces of Tucker and the girl are "clearly visible" in the photos, according to the indictment. Tucker had an eyebrow piercing and a tattoo of a sleeping cat behind her shoulder, which made her easier to identify, authorities said.

The face of the man, however, is blacked out in the photographs. Authorities are still trying to identify the man, Arnold said.

"Obviously, we want him also to answer for his crimes," Arnold said.

Arnold said the alleged victim is "going to be dealing with this for a long time."

Now that she has been identified, she will receive a victim notification every time one of the images turns up in an investigation, he said.

Tucker is being held without bond and is scheduled to be arraigned in federal court on Feb. 13. Her attorney could not be reached for comment.

hailey.branson@latimes.com

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Don't Call It a Tablet

The Surface Pro looks like a tablet, but it’s not a mobile device. It’s a portable device.

Sure, put the Surface Pro next to the Surface RT and it’s hard to spot many differences. One’s a little thicker, but their shapes are otherwise identical. Both have the same matte-black, magnesium-based casing. They both can be used with snap-in keyboards and they’re both propped up into typing position by built-in kickstands.

It’s a full-blown computer, but one that folds up into a tablet-sized package.

While the differences are blurry on the outside, if you use them both for a little while, the dissimilarities become distinct. The Surface RT is thoroughly a tablet, and it exists to directly challenge the iPad. It closely matches Apple’s larger slate in size, weight, performance and price. The Surface Pro, however — which goes on sale Feb. 9 for a starting price of $900 — is something more ambitious than a tablet. It’s a full-blown computer, but one that folds up into a tablet-sized package.

It’s also more expensive than a tablet — and comes with many hidden costs — but is far more capable since it runs full Windows 8 Pro. And though it isn’t perfect, the Surface Pro is certainly very compelling.

Ever since Windows 8 launched in October of last year, Microsoft’s hardware partners have been experimenting with ways of incorporating the OS’s touchscreen capabilities into their computer designs. The result, so far, has been a flood of tablet/PC Frankenbeasts with keyboards that twist, slide, fold, or otherwise play peek-a-boo beneath the touchscreen. The success of these devices varies, but most are flimsy and awkward. They want to be tablets, but they don’t want to leave the laptop behind, and they end up stuck somewhere in the middle.

The Surface Pro is more well-constructed and thoughtfully designed than any of them. It’s the best of the hybrids. The quality of the hardware, the performance, and the simplicity of the design make it a success.

But let me be clear: The Surface Pro is not a tablet. Many people have confusedly asked me if the Surface Pro is even a good tablet. The answer is a clear and resounding, “No.” It’s heavy and thick. It doesn’t invite you to curl up with it on the couch. It’s tough to read with it in bed, and it works much better propped up on a desk than it does resting on a knee or in a lap.

And while it’s portable, it isn’t an amazing laptop, either. Microsoft’s Touch and Type covers don’t come bundled with Surface Pro — you have to pay an extra $120 or $130, respectively, if you want to avoid touchscreen typing (and trust me, you will want to avoid touchscreen typing). And with either keyboard attached, the thing is so top-heavy, it’s physically challenging to use on your lap.

So why bother? Because the Surface Pro is a Windows 8 PC through and through. It comes with an Intel Core i5 processor, and it can run all of your legacy desktop applications. You can surf using your favorite browser, you can type and save and share using the full versions of Office and all your other regular work applications. You can freely download software from the web without depending on the (still anemic) Windows Store.

Microsoft has also given the Surface Pro a killer screen. The 10.6-inch, 1980×1080 pixel resolution display is a visible step up from the Surface RT. With the same 16:9 aspect ratio, it’s great for watching movies. It feels a little silly to use it in portrait mode because it’s so tall, but text is much crisper on the higher-res display, so browsing the web and reading text is more pleasurable. It’s not quite on par with the iPad’s Retina display, but I could barely see a difference between the two. Ten-point touch gestures are supported, as well as the standard swipe gestures.

The touchpads found on both keyboard covers don’t support the standard swipe gestures. They’re accurate enough for pointing, but if you try to swipe in from the right for Charms, or from the left to switch applications, they won’t respond. You’ll need to reach up and use the screen, or buy an extra mouse or trackpad like Logitech’s Rechargeable Trackpad ($80, another additional cost).

The Surface Pro does come with a great pressure-sensitive pen that magnetically attaches to the power connector. The pen really shined in handwriting-driven apps like One Note, or the painting app, Fresh Paint. And the top of the pen acts as an eraser, which is neat.

Performance is generally excellent across all Windows 8 apps I tested. However, one thing that stuck out is a general problem with screen rotations. When switching between portrait and landscape modes, it takes about a second for the Surface Pro to register the rotations. I found this lag to be disconcerting. Also, some apps displayed rotation quirks. The worst offender was Chrome. The desktop version worked flawlessly, but when I used the version made for the tile-based Windows 8 interface, the app repeatedly refused to resize properly when I flipped between landscape and portrait modes. Likewise, whenever I put Chrome in Snap View mode — a Windows 8 trick that lets you run two applications side-by-side in a split-screen arrangement — the Chrome window got smaller and would not readjust back to full-screen size when I exited Snap View.

Otherwise, I was happy with Windows 8 Pro on the Surface. All the apps I used during my tests were super-responsive. Scrolling was smooth, and there were no input latency problems to speak of.

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