In Filing, Casino Operator Admits Likely Violation of an Antibribery Law

 In its annual regulatory report published by the commission on Friday, the Sands reported that its audit committee and independent accountants had determined that “there were likely violations of the books and records and internal controls provisions” of the Foreign Corrupt Practices Act.

 The disclosure comes amid an investigation by the Securities and Exchange Commission as well as the Department of Justice and the Federal Bureau of Investigation into the company’s business activities in China.

 It is the company’s first public acknowledgment of possible wrongdoing. Ron Reese, a spokesman for the Sands, declined to comment further.

The company’s activities in mainland China, including an attempt to set up a trade center in Beijing and create a sponsored basketball team, as well as tens of millions of dollars in payments the Sands made through a Chinese intermediary, had become a focus of the federal investigation, according to reporting by The New York Times and The Wall Street Journal in August.

 In its filing, the Sands said that it did not believe the findings would have material impact on its financial statements, or that they warranted revisions in its past statements. The company said that it was too early to determine whether the investigation would result in any losses. “The company is cooperating with all investigations,” the statement said.

 The Sands’ activities in China came under the scrutiny of federal investigators after 2010, when Steven C. Jacobs, the former president of the company’s operations in Macau, filed a wrongful-termination lawsuit in which he charged that he had been pressured to exercise improper leverage against government officials. He also accused the company of turning a blind eye toward Chinese organized crime figures operating in its casinos.

 Mr. Adelson began his push into China over a decade ago, after the authorities began offering a limited number of gambling licenses in Macau, a semiautonomous archipelago in the Pearl River Delta that is the only place in the country where casino gambling is legal.

 But as with many lucrative business spheres in China, the gambling industry on Macau is laced with corruption. Companies must rely on the good will of Chinese officials to secure licenses and contracts. Officials control even the flow of visitors, many of whom come on government-run junkets from the mainland.

 As he maneuvered to enter Macau’s gambling market, Mr. Adelson, who is well known in the United States for his financial and political clout, became enmeshed in often intertwining political and business dealings. At one point he reportedly intervened on behalf of the Chinese government to help stall a House resolution condemning the country’s bid for the 2008 Summer Olympics on the basis of its human rights record.

 In 2004, he opened his first casino there, the Sands Macau, the enclave’s first foreign owned gambling establishment. This was followed by his $2.4 billion Venetian in 2007.

 Some Sands subsidiaries have also come under investigation by Chinese authorities for violations that included using money for business purposes not reported to the authorities, resulting in fines of over a million dollars.

 Success in Macau has made Mr. Adelson, 78, one of the richest people in the world. He and his wife, Miriam, own 53.2 percent of Las Vegas Sands, the world’s biggest casino company by market value. Last year, Forbes estimated his fortune at $24.9 billion.

 Mr. Adelson became the biggest single donor in political history during the 2012 presidential election, giving more than $60 million to eight Republican candidates, including Newt Gingrich and Mitt Romney, through “super PACs.” He presides over a global empire of casinos, hotels and convention centers.

Michael Luo and Thomas Gaffney contributed reporting.

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Texas Monthly: Sign Language Interpreters Bring Live Music to the Deaf

On the last night of the 2012 Lollapalooza music festival in Chicago, the sun set over a crowd of thousands who had stood for hours waiting to see Jack White, the headliner. A figure strode onto the stage, setting off a cascade of cheers.

But it was not Jack White, the singer-guitarist, it was Barbie Parker, the festival’s lead sign language interpreter.

Ms. Parker, a Texas native, and members of her Austin-based company, LotuSIGN, had interpreted more than 20 bands’ sets for deaf and hard of hearing festival attendees that weekend. As evidenced by the positive reception she received, her interpretations had won over a good part of the hearing audience as well.

At live music shows, Ms. Parker, 45, does not just sign lyrics — she communicates the entire musical experience. She mouths the words. She plays air guitar and air drums. She jams along with the bands.

“Music is such a large part of who I am,” she said. “I want to be able to open up that experience.”

Ms. Parker was bored in her accounting job and had two young children when she enrolled in her first formal American Sign Language class at San Antonio College about 20 years ago. She became fascinated with interpretation after reading a book about it at her local library and, in a chance encounter just hours after reading it, met the sister of a friend who happened to be an American Sign Language interpreter.

Ms. Parker is now an integral part of Austin’s deaf community. Her two adult sons are proficient in A.S.L., and her company has provided sign language interpretation at music festivals across the country for several years. Next week, she and other LotuSIGN interpreters will take the stage with artists at the South by Southwest music festival in Austin for the sixth year in a row.

The number of deaf and hard of hearing music fans taking advantage of interpretation at free shows held at Auditorium Shores as part of SXSW has risen noticeably in the past few years, Frank Schaefer, the officer manager for the festival, said in an e-mail. The increase can be attributed, at least in part, to a growing number of interpreters who specialize in that kind of work.

A good interpreter is adept at signing, but Ms. Parker also wants her team to impart the emotions and feelings music conveys. Lauren Kinast, 44, who lost her hearing gradually, attended a Rolling Stones concert signed by LotuSIGN interpreters. Ms. Kinast had listened to the Stones growing up, but when she saw Ms. Parker and a colleague interpret their music, she came away with a greater appreciation of the band.

“Everything made it different, better,” Ms. Kinast typed in an interview. “Having the songs interpreted in my language, understanding the emotions behind it, the meaning behind it, and being a part of the concert experience just took my love for them several notches up.”

Ms. Parker first gained recognition in the mid-2000s for interpreting music at the funeral of the parent of a well-known member of the deaf community in Austin. At one point during the service, she needed to sign an emotional musical performance.

“The singer got inspired, so the interpreting had to get inspired,” Ms. Parker said. The signing seemed to further stir the singer, which further moved Ms. Parker. “There was a kind of reverb,” she said. “The deaf audience was just — I just saw these jaws drop open like, ‘Oh, that’s what it’s like.’ ”

After that, she began receiving requests to interpret at weddings, children’s recitals and, of course, live shows. In 2007, she started her own company, Alive Performance Interpreting, which in 2009 became LotuSIGN.

“They’re five-star interpreters,” said Stacy Landry, the program manager for the local government’s deaf and hard of hearing services in Travis County. (Ms. Parker has obvious clout in the field — her traditional interpreting services were used in January when she intepreted President Obama’s Inaugural Address in Washington.)

LotuSIGN interpreters specialize in analyzing lyrics for the artist’s intent in a song. But sign language interpretation, no matter where it takes place, is about more than translating words into gestures and signs. The interpreter must communicate an overall experience by expressing the speaker’s tone, the meaning behind phrases and idioms, and even if someone’s cellphone interrupts an otherwise-silent lecture hall.

One year, Ms. Parker interpreted at a Sheryl Crow concert held to celebrate of one of Lance Armstrong’s Tour de France titles. He was asked to take over on the drums for one of Ms. Crow’s songs.

“Well,” Ms. Parker said, “he wasn’t any good.”

Ms. Parker let the discomfort show on her face as she imitated Mr. Armstrong’s uneven drumming. She nodded subtly to assure perplexed members of the deaf audience that she was indeed doing this on purpose.

As the audience reacted, Ms. Parker saw a deaf man elbow the hearing man next to him and cringe. The hearing man nodded and made a similar pained face.

“They had this shared experience,” Ms. Parker said. The deaf man was truly part of the crowd.

LotuSIGN is working to mentor others in the hope of expanding access to live events. “You can’t do it without a lot of experience,” Ms. Parker said. “It is the hardest work I have ever done.”

Kathryn Jepsen is the deputy editor of Symmetry magazine.

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Texas Monthly: Sign Language Interpreters Bring Live Music to the Deaf

On the last night of the 2012 Lollapalooza music festival in Chicago, the sun set over a crowd of thousands who had stood for hours waiting to see Jack White, the headliner. A figure strode onto the stage, setting off a cascade of cheers.

But it was not Jack White, the singer-guitarist, it was Barbie Parker, the festival’s lead sign language interpreter.

Ms. Parker, a Texas native, and members of her Austin-based company, LotuSIGN, had interpreted more than 20 bands’ sets for deaf and hard of hearing festival attendees that weekend. As evidenced by the positive reception she received, her interpretations had won over a good part of the hearing audience as well.

At live music shows, Ms. Parker, 45, does not just sign lyrics — she communicates the entire musical experience. She mouths the words. She plays air guitar and air drums. She jams along with the bands.

“Music is such a large part of who I am,” she said. “I want to be able to open up that experience.”

Ms. Parker was bored in her accounting job and had two young children when she enrolled in her first formal American Sign Language class at San Antonio College about 20 years ago. She became fascinated with interpretation after reading a book about it at her local library and, in a chance encounter just hours after reading it, met the sister of a friend who happened to be an American Sign Language interpreter.

Ms. Parker is now an integral part of Austin’s deaf community. Her two adult sons are proficient in A.S.L., and her company has provided sign language interpretation at music festivals across the country for several years. Next week, she and other LotuSIGN interpreters will take the stage with artists at the South by Southwest music festival in Austin for the sixth year in a row.

The number of deaf and hard of hearing music fans taking advantage of interpretation at free shows held at Auditorium Shores as part of SXSW has risen noticeably in the past few years, Frank Schaefer, the officer manager for the festival, said in an e-mail. The increase can be attributed, at least in part, to a growing number of interpreters who specialize in that kind of work.

A good interpreter is adept at signing, but Ms. Parker also wants her team to impart the emotions and feelings music conveys. Lauren Kinast, 44, who lost her hearing gradually, attended a Rolling Stones concert signed by LotuSIGN interpreters. Ms. Kinast had listened to the Stones growing up, but when she saw Ms. Parker and a colleague interpret their music, she came away with a greater appreciation of the band.

“Everything made it different, better,” Ms. Kinast typed in an interview. “Having the songs interpreted in my language, understanding the emotions behind it, the meaning behind it, and being a part of the concert experience just took my love for them several notches up.”

Ms. Parker first gained recognition in the mid-2000s for interpreting music at the funeral of the parent of a well-known member of the deaf community in Austin. At one point during the service, she needed to sign an emotional musical performance.

“The singer got inspired, so the interpreting had to get inspired,” Ms. Parker said. The signing seemed to further stir the singer, which further moved Ms. Parker. “There was a kind of reverb,” she said. “The deaf audience was just — I just saw these jaws drop open like, ‘Oh, that’s what it’s like.’ ”

After that, she began receiving requests to interpret at weddings, children’s recitals and, of course, live shows. In 2007, she started her own company, Alive Performance Interpreting, which in 2009 became LotuSIGN.

“They’re five-star interpreters,” said Stacy Landry, the program manager for the local government’s deaf and hard of hearing services in Travis County. (Ms. Parker has obvious clout in the field — her traditional interpreting services were used in January when she intepreted President Obama’s Inaugural Address in Washington.)

LotuSIGN interpreters specialize in analyzing lyrics for the artist’s intent in a song. But sign language interpretation, no matter where it takes place, is about more than translating words into gestures and signs. The interpreter must communicate an overall experience by expressing the speaker’s tone, the meaning behind phrases and idioms, and even if someone’s cellphone interrupts an otherwise-silent lecture hall.

One year, Ms. Parker interpreted at a Sheryl Crow concert held to celebrate of one of Lance Armstrong’s Tour de France titles. He was asked to take over on the drums for one of Ms. Crow’s songs.

“Well,” Ms. Parker said, “he wasn’t any good.”

Ms. Parker let the discomfort show on her face as she imitated Mr. Armstrong’s uneven drumming. She nodded subtly to assure perplexed members of the deaf audience that she was indeed doing this on purpose.

As the audience reacted, Ms. Parker saw a deaf man elbow the hearing man next to him and cringe. The hearing man nodded and made a similar pained face.

“They had this shared experience,” Ms. Parker said. The deaf man was truly part of the crowd.

LotuSIGN is working to mentor others in the hope of expanding access to live events. “You can’t do it without a lot of experience,” Ms. Parker said. “It is the hardest work I have ever done.”

Kathryn Jepsen is the deputy editor of Symmetry magazine.

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India Ink: Newswallah: Long Reads Edition

In Down to Earth, Alok Gupta analyzes the damaging effect violence has had on Bihar’s efforts to empower women and advance self-governance. The article argues that although the Bihar government announced a 50 percent quota for women in the panchayat (village council) in 2006, it has not helped in bringing about true empowerment for women. Instead, men force their homemaker wives to contest elections as the husbands continue to make all the decisions.

As sarpanchs (village council leaders) and mukhiyas (district leaders) have the power to approve development projects and administer social welfare programs, the posts are highly coveted. Often violence is used to discourage women from contesting elections. Mr. Gupta lists a number of incidents in which women standing for village council elections or their husbands were attacked, murdered and mutilated. In the three village council elections since 2006, 191 people were killed in Bihar before and during elections.

Rising violence along with continued gender discrimination have undermined the efficacy of the quota system for women in village council leadership. “In the past five years, the number of widowed mukhiyas and sarpanchs has spiraled, casting doubt if the Bihar government’s efforts to empower women were merely yet another political sop,” Mr. Gupta concludes.

In Tehelka, Kunal Majumder weighs in on last month’s events in Bangladesh, where young Muslim activists took to the streets of Dhaka protesting the Islamist political group Jamaat-e-Islami Bangladesh in an assertion of secularism and nationalism.

The protests were triggered on Feb. 5 when the War Crimes Tribunal, instituted by the government to try those accused of committing atrocities in Bangladesh’s liberation war in 1971, handed down a life sentence to Abdul Kader Mollah, who was convicted of rape and mass murder. Many Bangladeshis had expected a death sentence for Mr. Mollah, who is often called the “Butcher of Mirpur” for slaughtering 344 people.

In response to the sentence, four bloggers in their 20s — Imran H. Sarkar, Mahmadul Haq Munshi, Maruf Rosul and Amit Bikram Tripura — organized a protest near the National Museum adjacent to Shahbag Square. Within days, students from other universities joined the protest, which grew exponentially. The protesters demanded the death sentence for the perpetrators of war crimes, a ban on the Jamaat-e-Islami and its student wing, which are associated with the war crimes committed during Bangladesh’s liberation struggle, and a ban on enterprises controlled by the Jamaat.

Mr. Majumder compares the youth protesting at Shahbag Square to the uprisings in Tunisia, Egypt, Libya, Syria and Pakistan, where young Muslim populations massed on the streets. However, the critical difference in Bangladesh, Mr. Majumder writes, is that the young Muslims’ demands were extremely un-Islamic.

“A young generation of Bangladeshis set out to recapture the legacy of their country’s birth and reclaim the narrative of 1971, taking ownership of an event that occurred well before this generation was born,” Mr. Majumder writes. “Young Muslims came out on the streets, angry and impassioned. They were not advocating or emerging as the vanguard for Islamism; they were opposing it.”

In Open, Rahul Pandita critiques the draft Jammu and Kashmir Police Bill 2013, which empowers local police and reduces police accountability. He notes that while the Jammu and Kashmir chief minister, Omar Abdullah, has often publicly denounced the Armed Forces Special Powers Act that grants armed forces impunity, the draft Kashmir Police Bill gives similar powers to the state police. The bill, which has already stirred controversy in the Kashmir Valley, allows police personnel to bypass the district magistrate in law-and-order disputes.

Other controversial parts of the act include allowing a police officer “not authorized by rank or jurisdiction” to keep a person in custody for six hours before a competent officer takes over and the authorization to create “village defense committees” and appoint civilians as special police officers.

While the chief minister has said that the bill will only be passed after it goes through the state cabinet and both legislative houses, Mr. Pandita argues that Mr. Abdullah’s inaction with regards to the bill has hurt himself by giving his opponents plenty of ammunition in this debate.

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Economix Blog: Bernanke Defends Stimulus as Necessary and Effective

The Federal Reserve’s chairman, Ben S. Bernanke, picked an unusual time to offer his most recent defense of the Fed’s campaign to stimulate the economy: 7 p.m. on a Friday night in San Francisco, 10 p.m. back home on the East Coast.

The basic message was the same as Mr. Bernanke delivered to Congress earlier this week: The Fed regards its current efforts as necessary and effective, and the risks, while real, are under control.

“Commentators have raised two broad concerns surrounding the outlook for long-term rates,” Mr. Bernanke told a conference at the Federal Reserve Bank of San Francisco. “To oversimplify, the first risk is that rates will remain low, and the second is that they will not.”

If rates remain low, it may drive investors to take excessive risks. If rates jump, investors could lose money – not least the Fed.

Regarding the first possibility, Mr. Bernanke said that the Fed was keeping a careful eye on financial markets. But he noted that rates were low in large part because the economy was weak, and that keeping rates low was the best way to encourage stronger growth. “Premature rate increases would carry a high risk of short-circuiting the recovery, possibly leading — ironically enough — to an even longer period of low long- term rates,” he said.

At the other extreme, Mr. Bernanke said the Fed could “mitigate” any jump in rates by prolonging its efforts to hold rates down, for example by keeping some of its investments in Treasury and mortgage-backed securities.

Three more highlights from the question-and-answer session after the speech.

1. Mr. Bernanke, asked about the outlook for the Washington Nationals, responded by accurately quoting the “Las Vegas odds” of a World Series appearance: 8/1.

2. Although the decision may be made under a future chairman, Mr. Bernanke said the Fed should continue to offer “forward guidance” — predicting its policies — even after it concludes its long effort to revive the economy.

“Providing information about the future path of policy could be useful, probably would be useful, under even normal circumstances,” he said in response to a question. “I think we need to keep providing information.”

3. Not surprisingly, Mr. Bernanke often is asked to reflect on the financial crisis. He offered something a little different than his normal response on Friday night.

“In many ways, in retrospect, the crisis was a normal crisis,” he said. “It’s just that the intuitional framework in which it occurred was much more complex.”

In other words, there was a panic, and a run, and a collapse – but rather than a run on bank deposits, the run was in the money markets. Improving the stability of those markets is something regulators have yet to accomplish.

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U.S. Judges Offer Addicts a Way to Avoid Prison

Todd Heisler/The New York Times

Emily Leitch of Brooklyn, with her son, Nazir, 4, was arrested for importing cocaine but went to “drug court” to avoid prison.

Federal judges around the country are teaming up with prosecutors to create special treatment programs for drug-addicted defendants who would otherwise face significant prison time, an effort intended to sidestep drug laws widely seen as inflexible and overly punitive.

The Justice Department has tentatively embraced the new approach, allowing United States attorneys to reduce or even dismiss charges in some drug cases.

The effort follows decades of success for “drug courts” at the state level, which legal experts have long cited as a less expensive and more effective alternative to prison for dealing with many low-level repeat offenders.

But it is striking that the model is spreading at the federal level, where judges have increasingly pushed back against rules that restrict their ability to make their own determination of appropriate sentences.

So far, federal judges have instituted programs in California, Connecticut, Illinois, New Hampshire, New York, South Carolina, Virginia and Washington. About 400 defendants have been involved nationwide.

In Federal District Court in Brooklyn on Thursday, Judge John Gleeson issued an opinion praising the new approach as a way to address swelling prison costs and disproportionate sentences for drug trafficking.

“Presentence programs like ours and those in other districts mean that a growing number of courts are no longer reflexively sentencing federal defendants who do not belong in prison to the costly prison terms recommended by the sentencing guidelines,” Judge Gleeson wrote.

The opinion came a year after Judge Gleeson, with the federal agency known as Pretrial Services, started a program that made achieving sobriety an incentive for drug-addicted defendants to avoid prison. The program had its first graduate this year: Emily Leitch, a Brooklyn woman with a long history of substance abuse who was arrested entering the country at Kennedy International Airport with over 13 kilograms of cocaine, about 30 pounds, in her luggage.

“I want to thank the federal government for giving me a chance,” Ms. Leitch said. “I always wanted to stand up as a sober person.”

The new approach is being prompted in part by the Obama administration, which previously supported legislation that scaled back sentences for crimes involving crack cocaine. The Justice Department has supported additional changes to the federal sentencing guidelines to permit the use of drug or mental health treatment as an alternative to incarceration for certain low-level offenders and changed its own policies to make those options more available.

“We recognize that imprisonment alone is not a complete strategy for reducing crime,” James M. Cole, the deputy attorney general, said in a statement. “Drug courts, re-entry courts and other related programs along with enforcement are all part of the solution.”

For nearly 30 years, the United States Sentencing Commission has established guidelines for sentencing, a role it was given in 1984 after studies found that federal judges were giving defendants widely varying sentences for similar crimes. The commission’s recommendations are approved by Congress, causing judges to bristle at what they consider interference with their judicial independence.

“When you impose a sentence that you believe is unjust, it is a very difficult thing to do,” Stefan R. Underhill, a federal judge in Connecticut, said in an interview. “It feels wrong.”

The development of drug courts may meet resistance from some Republicans in Congress.

“It is important that courts give deference to Congressional authority over sentencing,” Representative F. James Sensenbrenner Jr., Republican of Wisconsin, a member and former chairman of the Judiciary Committee, said in a statement. He said sentencing should not depend “on what judge happens to decide the case or what judicial circuit the defendant happens to be in.”

At the state level, pretrial drug courts have benefited from bipartisan support, with liberals supporting the programs as more focused on rehabilitation, and conservatives supporting them as a way to cut spending.

Under the model being used in state and federal courts, defendants must accept responsibility for their crimes and agree to receive drug treatment and other social services and attend regular meetings with judges who monitor their progress. In return for successful participation, they receive a reduced sentence or no jail time at all. If they fail, they are sent to prison.

The drug court option is not available to those facing more serious charges, like people accused of being high-level dealers or traffickers, or accused of a violent crime. (These programs differ from re-entry drug courts, which federal judges have long used to help offenders integrate into society after prison.)

In interviews, the federal judges who run the other programs pointed to a mix of reasons for their involvement.

Read More..

U.S. Judges Offer Addicts a Way to Avoid Prison

Todd Heisler/The New York Times

Emily Leitch of Brooklyn, with her son, Nazir, 4, was arrested for importing cocaine but went to “drug court” to avoid prison.

Federal judges around the country are teaming up with prosecutors to create special treatment programs for drug-addicted defendants who would otherwise face significant prison time, an effort intended to sidestep drug laws widely seen as inflexible and overly punitive.

The Justice Department has tentatively embraced the new approach, allowing United States attorneys to reduce or even dismiss charges in some drug cases.

The effort follows decades of success for “drug courts” at the state level, which legal experts have long cited as a less expensive and more effective alternative to prison for dealing with many low-level repeat offenders.

But it is striking that the model is spreading at the federal level, where judges have increasingly pushed back against rules that restrict their ability to make their own determination of appropriate sentences.

So far, federal judges have instituted programs in California, Connecticut, Illinois, New Hampshire, New York, South Carolina, Virginia and Washington. About 400 defendants have been involved nationwide.

In Federal District Court in Brooklyn on Thursday, Judge John Gleeson issued an opinion praising the new approach as a way to address swelling prison costs and disproportionate sentences for drug trafficking.

“Presentence programs like ours and those in other districts mean that a growing number of courts are no longer reflexively sentencing federal defendants who do not belong in prison to the costly prison terms recommended by the sentencing guidelines,” Judge Gleeson wrote.

The opinion came a year after Judge Gleeson, with the federal agency known as Pretrial Services, started a program that made achieving sobriety an incentive for drug-addicted defendants to avoid prison. The program had its first graduate this year: Emily Leitch, a Brooklyn woman with a long history of substance abuse who was arrested entering the country at Kennedy International Airport with over 13 kilograms of cocaine, about 30 pounds, in her luggage.

“I want to thank the federal government for giving me a chance,” Ms. Leitch said. “I always wanted to stand up as a sober person.”

The new approach is being prompted in part by the Obama administration, which previously supported legislation that scaled back sentences for crimes involving crack cocaine. The Justice Department has supported additional changes to the federal sentencing guidelines to permit the use of drug or mental health treatment as an alternative to incarceration for certain low-level offenders and changed its own policies to make those options more available.

“We recognize that imprisonment alone is not a complete strategy for reducing crime,” James M. Cole, the deputy attorney general, said in a statement. “Drug courts, re-entry courts and other related programs along with enforcement are all part of the solution.”

For nearly 30 years, the United States Sentencing Commission has established guidelines for sentencing, a role it was given in 1984 after studies found that federal judges were giving defendants widely varying sentences for similar crimes. The commission’s recommendations are approved by Congress, causing judges to bristle at what they consider interference with their judicial independence.

“When you impose a sentence that you believe is unjust, it is a very difficult thing to do,” Stefan R. Underhill, a federal judge in Connecticut, said in an interview. “It feels wrong.”

The development of drug courts may meet resistance from some Republicans in Congress.

“It is important that courts give deference to Congressional authority over sentencing,” Representative F. James Sensenbrenner Jr., Republican of Wisconsin, a member and former chairman of the Judiciary Committee, said in a statement. He said sentencing should not depend “on what judge happens to decide the case or what judicial circuit the defendant happens to be in.”

At the state level, pretrial drug courts have benefited from bipartisan support, with liberals supporting the programs as more focused on rehabilitation, and conservatives supporting them as a way to cut spending.

Under the model being used in state and federal courts, defendants must accept responsibility for their crimes and agree to receive drug treatment and other social services and attend regular meetings with judges who monitor their progress. In return for successful participation, they receive a reduced sentence or no jail time at all. If they fail, they are sent to prison.

The drug court option is not available to those facing more serious charges, like people accused of being high-level dealers or traffickers, or accused of a violent crime. (These programs differ from re-entry drug courts, which federal judges have long used to help offenders integrate into society after prison.)

In interviews, the federal judges who run the other programs pointed to a mix of reasons for their involvement.

Read More..

Jennifer Sultan Pleads Guilty to Selling Prescription Drugs

At the height of dot-com mania 13 years ago, Jennifer Sultan and a few colleagues sold their small technology company for $70 million in stock and cash. She and her boyfriend rented a large house in the Hamptons for the summer and bought a spacious loft near Union Square.

John Marshall Mantel for The New York Times

Jennifer Sultan faced 15 years to life on the top charge against her, and a potential for more prison time on other counts.

In the years since, that temporary flush of wealth evaporated and Ms. Sultan, 38, developed an addiction to prescription painkillers.

On Friday, she sat handcuffed in a courtroom at State Supreme Court in Manhattan. In exchange for a promise of a four-year prison sentence, she pleaded guilty to selling prescription painkillers and conspiring to sell a firearm.

She was arrested last July and accused of being part of a ring that sold prescription drugs and guns. Four others arrested with Ms. Sultan had already pleaded guilty. One, Nicholas Mina, a former New York City police officer, agreed to serve more than 15 years in prison as part of a plea bargain under which he admitted stealing guns from his colleagues’ precinct house lockers and selling them. Mr. Mina was also addicted to prescription painkillers.

Though Ms. Sultan’s lawyer said she had hoped for less than four years, she faced 15 years to life in prison on the top count against her and the potential for more prison time on other charges. She said little in court but smiled broadly several times as she spoke quietly with her lawyer, Frank Rothman.

“She was happy to be done with it, but she was not happy with the sentence,” Mr. Rothman said afterward.

Ms. Sultan grew up in West Long Branch, N.J., five miles north of Asbury Park, and graduated from New York University in 1996. She and her boyfriend at the time, Adam Cohen, worked at a company, Live Online, that was an early pioneer in live streaming events on the Internet.

After the sale of Live Online, efforts by Ms. Sultan and Mr. Cohen to start other technology companies failed. Ms. Sultan explored other interests, including acupuncture and holistic health.

Early last year, a city narcotics investigator discovered an advertisement Ms. Sultan had placed on Craigslist offering prescription painkillers for sale. She and Mr. Cohen were still living in the penthouse loft near Union Square that they bought after the sale of Live Online.

Five times from February through June, she sold pills to an undercover officer, according to her indictment. One sale took place at the Starbucks on Union Square. In another, she sold 183 oxycodone tablets to the officer for $4,400 at a Starbucks in the Flatiron district near the school where she was studying acupuncture.

A separate investigation into the ring that sold stolen guns and pain medication picked up Ms. Sultan sending a text message to the man accused of being the ringleader, Ivan Chavez, saying she wanted to sell him a .357 Magnum handgun for $850, according to a separate indictment obtained by the Manhattan district attorney.

Mr. Chavez was sentenced to 20 years in prison.

Ms. Sultan and Mr. Cohen, who was not accused of participating in the drug and guns ring, filed for bankruptcy in 2010. Last August, the bankruptcy judge ordered them to vacate the loft to allow a bankruptcy trustee to sell it. The 5,600-square-foot loft is still listed for sale at just under $6 million.

She has been incarcerated since her arrest in July because she was unable to raise $85,000 for bail. With credit for good behavior and time served since her arrest, Ms. Sultan could be released from prison in about two years.

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India Ink: Newswallah: Bharat Edition

Jammu and Kashmir: Demands for a discussion over the recent execution of Muhammad Afzal, who was convicted in a deadly attack on India’s Parliament, rocked the state legislature on Friday, according to an IANS report on the NDTV Web site. The call for debate was initiated by the opposition People’s Democratic Party, and it found support from the governing National Conference party in the state.

Northeast: State Assembly election results for the northeastern states of Tripura, Meghalaya and Nagaland were announced Thursday evening, Press Trust of India reported. The Communist Party of India (Marxist) was voted back to power in Tripura, while the regional Naga People’s Front (NPF) won a majority in Nagaland. The Congress party, which fared poorly in the two states, emerged as the single largest party in Meghalaya but fell short of an absolute majority by two seats.

Arunachal Pradesh: The state will get its first-ever rail link that will connect it to the rest of the country, The Times of India reported. During the railways budget speech on Tuesday, Railways Minister Pawan Kumar Bansal said that this year the government would commission a project linking Harmuti region in the northeastern state of Assam to Naharlagun in Arunachal Pradesh.

Uttar Pradesh: A police officer’s son has been charged with raping a woman in the state’s Ghaziabad district, on the outskirts of Delhi, according to an IANS report on the IBNLive Web site.

Gujarat: Ahead of the 11th anniversary of the 2002 Gujarat riots, a group of citizens led by the social activist Teesta Setalvad launched a year-long protest on Thursday in Ahmedabad, demanding the “dignified rehabilitation for displaced riot victims,” according to a Press Trust of India report in The Indian Express. A memorandum on the demands of those affected by the riots will be submitted to the Gujarat government, the report said.

Karnataka: The percentage of severely malnourished children in the state has increased, The New Indian Express reported. According to the latest Economic Survey their numbers increased to 1.86 percent of the population in September 2012 from 1.6 percent in March 2012, despite measures to treat such cases.

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F-35 Jets Returned to Service by Pentagon

The Pentagon lifted its grounding of the new F-35 jet fighter on Thursday after concluding that a turbine blade had cracked on a single plane after it was overused in test operations.

The office that runs the program said no other cracks were found in inspections of the other engines made so far, and no engine redesign was needed.

It said the engine in which the blade cracked was in a plane that “had been operated at extreme parameters in its mission to expand the F-35 flight envelope.”

The program office added that “prolonged exposure to high levels of heat and other operational stressors on this specific engine were determined to be the cause of the crack.”

All flights were suspended last week for the 64 planes built so far once the crack, which stretched for six-tenths of an inch, was found during a routine inspection.

Pratt & Whitney, which makes the engines, investigated the problem with military experts. The company, a unit of United Technologies, said on Wednesday that the crack occurred after that engine was operated more than four times longer in a high-temperature flight environment than the engines would in normal use.

The F-35, a supersonic jet meant to evade enemy radar, is the Pentagon’s most expensive program and has been delayed by various technical problems. The program could cost $396 billion if the Pentagon builds 2,456 jets by the late 2030s.

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Jane C. Wright, Pioneering Oncologist, Dies at 93

Dr. Jane C. Wright, a pioneering oncologist who helped elevate chemotherapy from a last resort for cancer patients to an often viable treatment option, died on Feb. 19 at her home in Guttenberg, N.J. She was 93.

Her death was confirmed by her daughter Jane Jones, who said her mother had dementia.

Dr. Wright descended from a distinguished medical family that defied racial barriers in a profession long dominated by white men. Her father, Dr. Louis T. Wright, was among the first blacks to graduate from Harvard Medical School and was reported to be the first black doctor appointed to the staff of a New York City hospital. His father was an early graduate of what became the Meharry Medical College, the first medical school in the South for African-Americans, founded in Nashville in 1876.

Dr. Jane Wright began her career as a researcher working alongside her father at a cancer center he established at Harlem Hospital in New York.

Together, they and others studied the effects of a variety of drugs on tumors, experimented with chemotherapeutic agents on leukemia in mice and eventually treated patients, with some success, with new anticancer drugs, including triethylene melamine.

After her father died in 1952, Dr. Wright took over as director of the center, which was known as the Harlem Hospital Cancer Research Foundation. In 1955, she joined the faculty of the New York University Medical Center as director of cancer research, where her work focused on correlating the responses of tissue cultures to anticancer drugs with the responses of patients.

In 1964, working as part of a team at the N.Y.U. School of Medicine, Dr. Wright developed a nonsurgical method, using a catheter system, to deliver heavy doses of anticancer drugs to previously hard-to-reach tumor areas in the kidneys, spleen and elsewhere.

That same year, Dr. Wright was the only woman among seven physicians who, recognizing the unique needs of doctors caring for cancer patients, founded the American Society of Clinical Oncologists, known as ASCO. She was also appointed by President Lyndon B. Johnson to the President’s Commission on Heart Disease, Cancer and Stroke, led by the heart surgeon Dr. Michael E. DeBakey. Its recommendations emphasized better communication among doctors, hospitals and research institutions and resulted in a national network of treatment centers.

In 1967, Dr. Wright became head of the chemotherapy department and associate dean at New York Medical College. News reports at the time said it was the first time a black woman had held so high a post at an American medical school.

“Not only was her work scientific, but it was visionary for the whole science of oncology,” Dr. Sandra Swain, the current president of ASCO, said in a telephone interview. “She was part of the group that first realized we needed a separate organization to deal with the providers who care for cancer patients. But beyond that it’s amazing to me that a black woman, in her day and age, was able to do what she did.”

Jane Cooke Wright was born in Manhattan on Nov. 30, 1919. Her mother, the former Corinne Cooke, was a substitute teacher in the New York City schools.

Ms. Wright attended the Ethical Culture school in Manhattan and the Fieldston School in the Bronx (now collectively known Ethical Culture Fieldston School) and graduated from Smith College, where she studied art before turning to medicine. She received a full scholarship to New York Medical College, earning her medical degree in 1945. Before beginning research with her father, she worked as a doctor in the city schools.

Dr. Wright’s marriage, in 1947, to David D. Jones, a lawyer, ended with his death in 1976. She is survived by their two daughters, Jane and Alison Jones, and a sister, Barbara Wright Pierce, who is also a doctor.

As both a student and a doctor, Dr. Wright said in interviews, she was always aware that as a black woman she was an unusual presence in medical institutions. But she never felt she was a victim of racial prejudice, she said.

“I know I’m a member of two minority groups,” she said in an interview with The New York Post in 1967, “but I don’t think of myself that way. Sure, a woman has to try twice as hard. But — racial prejudice? I’ve met very little of it.”

She added, “It could be I met it — and wasn’t intelligent enough to recognize it.”

Read More..

Jane C. Wright, Pioneering Oncologist, Dies at 93

Dr. Jane C. Wright, a pioneering oncologist who helped elevate chemotherapy from a last resort for cancer patients to an often viable treatment option, died on Feb. 19 at her home in Guttenberg, N.J. She was 93.

Her death was confirmed by her daughter Jane Jones, who said her mother had dementia.

Dr. Wright descended from a distinguished medical family that defied racial barriers in a profession long dominated by white men. Her father, Dr. Louis T. Wright, was among the first blacks to graduate from Harvard Medical School and was reported to be the first black doctor appointed to the staff of a New York City hospital. His father was an early graduate of what became the Meharry Medical College, the first medical school in the South for African-Americans, founded in Nashville in 1876.

Dr. Jane Wright began her career as a researcher working alongside her father at a cancer center he established at Harlem Hospital in New York.

Together, they and others studied the effects of a variety of drugs on tumors, experimented with chemotherapeutic agents on leukemia in mice and eventually treated patients, with some success, with new anticancer drugs, including triethylene melamine.

After her father died in 1952, Dr. Wright took over as director of the center, which was known as the Harlem Hospital Cancer Research Foundation. In 1955, she joined the faculty of the New York University Medical Center as director of cancer research, where her work focused on correlating the responses of tissue cultures to anticancer drugs with the responses of patients.

In 1964, working as part of a team at the N.Y.U. School of Medicine, Dr. Wright developed a nonsurgical method, using a catheter system, to deliver heavy doses of anticancer drugs to previously hard-to-reach tumor areas in the kidneys, spleen and elsewhere.

That same year, Dr. Wright was the only woman among seven physicians who, recognizing the unique needs of doctors caring for cancer patients, founded the American Society of Clinical Oncologists, known as ASCO. She was also appointed by President Lyndon B. Johnson to the President’s Commission on Heart Disease, Cancer and Stroke, led by the heart surgeon Dr. Michael E. DeBakey. Its recommendations emphasized better communication among doctors, hospitals and research institutions and resulted in a national network of treatment centers.

In 1967, Dr. Wright became head of the chemotherapy department and associate dean at New York Medical College. News reports at the time said it was the first time a black woman had held so high a post at an American medical school.

“Not only was her work scientific, but it was visionary for the whole science of oncology,” Dr. Sandra Swain, the current president of ASCO, said in a telephone interview. “She was part of the group that first realized we needed a separate organization to deal with the providers who care for cancer patients. But beyond that it’s amazing to me that a black woman, in her day and age, was able to do what she did.”

Jane Cooke Wright was born in Manhattan on Nov. 30, 1919. Her mother, the former Corinne Cooke, was a substitute teacher in the New York City schools.

Ms. Wright attended the Ethical Culture school in Manhattan and the Fieldston School in the Bronx (now collectively known Ethical Culture Fieldston School) and graduated from Smith College, where she studied art before turning to medicine. She received a full scholarship to New York Medical College, earning her medical degree in 1945. Before beginning research with her father, she worked as a doctor in the city schools.

Dr. Wright’s marriage, in 1947, to David D. Jones, a lawyer, ended with his death in 1976. She is survived by their two daughters, Jane and Alison Jones, and a sister, Barbara Wright Pierce, who is also a doctor.

As both a student and a doctor, Dr. Wright said in interviews, she was always aware that as a black woman she was an unusual presence in medical institutions. But she never felt she was a victim of racial prejudice, she said.

“I know I’m a member of two minority groups,” she said in an interview with The New York Post in 1967, “but I don’t think of myself that way. Sure, a woman has to try twice as hard. But — racial prejudice? I’ve met very little of it.”

She added, “It could be I met it — and wasn’t intelligent enough to recognize it.”

Read More..

Media Decoder Blog: Barnes & Noble Rethinks Its Strategy for the Nook

7:15 p.m. | Updated Barnes & Noble, reporting a sharp drop in sales of its Nook tablets, said on Thursday that it would pull back on its ambitions for its device business, shrinking it in size while focusing more on digital content.

Calling Nook sales over the holiday period an “obvious disappointment,” the bookseller’s chief executive, William Lynch, said the company was taking “significant actions to right size investments” in its digital hardware division through steep cuts in advertising and the manufacturing of devices. Mr. Lynch made his remarks in a conference call with analysts shortly after Barnes & Noble reported a 26 percent decline in the fiscal third quarter for the Nook segment, which includes digital tablets and e-readers.

The retrenching of the Nook unit represents a setback to the Barnes & Noble plan to build up its device business as a way of staying competitive in the rapidly changing e-book market. Last year, the company separated the division from the rest of its operations and struck deals with Microsoft and Pearson for hundreds of millions of dollars in financing — signs that it viewed its digital business as the linchpin of future growth.

But the Nook, while drawing favorable reviews, failed to gain traction against more popular tablets like Amazon’s Kindle Fire and Apple’s iPad, and its performance over the 2012 holiday season was tepid. Barnes & Noble warned last month that Nook sales for the quarter would fall below expectations, and executives hinted recently that the strategy of operating in the highly competitive tablet space had run its course.

“The Nook is not a failure, not technically,” said James McQuivey, an analyst at Forrester Research. “If you go back two years and ask the Nook product managers how many Nooks they would want to sell by now, I bet they have blown past that number. The problem is the fact that the overall tablet market has actually blown way past the Nook’s performance.”

While saying that Barnes & Noble remained committed to the tablet and e-reader market, Mr. Lynch said the company would adjust its strategy quickly. “We are not going to continue doing what we’re doing,” he said in the conference call.

The results announced Thursday underscored the challenges. The company said that Nook revenue declined to $316 million for the quarter that ended Jan. 26, from $426 million over the same period a year ago. Losses in the unit increased to $190 million, from $83 million last year, as measured before interest, taxes, depreciation and amortization.

Over all, the company had a net loss in the quarter of just over $6 million, compared with net income of $52 million a year ago. Revenue in all three major units — Nook, retail and college — was down.

The losses were largely because of lower-than-anticipated sales, inventory charges and higher operating expenses because of advertising costs, the company said.

Mr. Lynch said Thursday that a reformulated Nook strategy would focus more on digital content like e-books and magazines, sales of which increased by 6.8 percent in the quarter. He also said the company planned to be a leader in “digital education” and that it expected that to be a growth area.

In the call with analysts, Mr. Lynch was pressed on whether Barnes & Noble’s digital content was really proprietary. Mr. Lynch acknowledged that what the bookseller possessed was the ability to sell publishers’ content, but he insisted that it was “a strategic asset that is hard to replicate.”

Wall Street seemed heartened by the company’s acknowledgment that it needed to recalibrate its device business, perhaps anticipating that it would accelerate a breakup of the device and retail units. Shares of Barnes & Noble rose 3.35 percent, to close at $15.74.

The company said that there was clear evidence that digital trade book sales were “flattening,” meaning that the bookseller’s physical retail position would be strong in the future. Mr. Lynch said Barnes & Noble continued to take market share from other physical book retailers. The company also promoted prototypes for new stores to be opened in malls and the growth of the college bookstore business.

Combined with the announcement on Monday that Leonard Riggio, the company’s chairman and largest shareholder, was considering purchasing the retail segment, the news added a positive gloss to the brick-and-mortar business that it had not had for some time.

That notion got some support with the earnings report. Retail sales fell just more than 10 percent in the quarter, largely because of the closing of some unprofitable stores. But Barnes & Noble had largely anticipated the lower revenue and despite the sales decline, retail profits increased 7.3 percent, to $212 million, in part because of higher sales margins and “expense management,” the company said.

Despite the shift in digital strategy, Mr. Lynch emphasized that the company was not abandoning the Nook division.

“Nook Media has been financing itself since October of 2012 due to the strong investment partners we’ve been able to attract in Microsoft and Pearson,” he said. He added that the Nook segment and the physical stores drove traffic to each other and needed to remain in partnership.

But analysts sounded a skeptical note. “Barnes & Noble stands at a fork in the road and rather than choose one path, it will likely need to split into two companies and let the retail business go down one path while freeing the Nook division to go down another,” said Mr. McQuivey, of Forrester. “There’s no guarantee that either path will lead to the promised land, but the two units are facing such different challenges and such unique prospects that it doesn’t make sense for them to try to work together to solve such different problems.”

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South Africa Suspends 8 Police Officers Accused of Dragging Man

PRETORIA (Reuters) - South Africa suspended eight police officers on Friday after the death of a man they had bound to a vehicle and dragged through a busy street in a videotaped incident that has further blackened the reputation of the police.

Mido Macia, a 27-year-old taxi driver from Mozambique, was found dead in detention with signs of head injuries and internal bleeding, according to an initial post-mortem report released by South Africa's police watchdog.

"We would like to assure the country and the world that what is in the video is not how the South African Police Service in a democratic South Africa goes about its work," Commissioner Riah Phiyega told a news conference.

She said the eight officers involved had been suspended and the station commander would be removed from his duties.

President Jacob Zuma and opposition politicians have condemned the incident, caught on video on Tuesday and broadcast nationwide on Thursday.

"The visuals of the incident are horrific, disturbing and unacceptable. No human being should be treated in that manner", Zuma said of what he called "the tragic death of a man in the hands of the police".

Police told media they had detained Macia after he parked illegally, creating a traffic jam, and then resisted arrest.

The video shows the man scuffling with police, who subdue him. He is then bound to the back of a pick-up truck by his arms before the vehicle drives off in front of scores of witnesses in the east Johannesburg area of Daveyton.

It was the latest in a series of scandals to hit South Africa's police force in recent months.

The lead detective in the murder case against Olympic and Paralympic star Oscar Pistorius was removed from the investigation last week when it emerged he was facing seven attempted murder charges for allegedly opening fire on a minibus full of passengers.

Police shot dead 34 striking workers at a platinum mine in August last year - the deadliest security incident since apartheid ended in 1994.

The latest video footage and the taxi driver's death raised fresh concerns about police brutality in a country where more than 1,200 people a year die while in custody.

(Reporting by Jon Herskovitz; Editing by Alistair Lyon)

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European Union Moves Toward Bonus Cap for Bankers

BRUSSELS — The European Union moved a step closer early on Thursday to imposing strict curbs on bonus pay for bankers, which has been blamed by many politicians for inciting the risk-taking behavior that triggered the recent financial crisis.

A provisional agreement struck between the European Parliament, the European Commission and national representatives could mean that the coveted bonuses many bankers receive are capped at the level of their annual salaries starting next year.

The agreement, as it stands, was seen as some as a blow to Britain, which partly relies on generous remuneration packages to ensure that the City of London remains the biggest financial center in Europe and the overseas headquarters of banks from around the globe.

’We need to make sure that regulation put in place in Brussels is flexible enough to allow those banks to continue competing and succeeding while being located in the U.K.,” David Cameron, the British prime minister, said on a visit to Riga, the capital of Latvia. A majority of E.U. states still must give their final approval for the legislation to go into force and there are expected to be more discussions on the rules at the European Parliament and among governments.

The goal of the bonus cap proposal is to balance many different interests, including “the desire to limit bankers pay while maintaining a competitive European banking sector,” Michael Noonan, the finance minister of Ireland, which holds the rotating E.U. presidency, said in a statement after the talked ended.

Under the proposal, the bonus rules would also apply to bankers employed by E.U. banks but working outside the bloc, for example in New York. E.U. authorities are drafting separate rules that could restrict remuneration at private equity firms and hedge funds.

Mr. Noonan said he would present the plan at a meeting of finance ministers next week.

Alex Beidas, a lawyer with Linklaters, a global legal and consulting firm based in London, warned that the legislation represented “a major disadvantage in the global market” for banks and said there was “a real danger that this will result in bankers moving to the U.S. and Asia.” 

The rules were “also likely to lead to an increase in salaries which is undesirable as banks are trying to minimize their fixed costs,” she said.

Amid concerns that capping bonuses could mean bankers begin to migrate to banks in more economically dynamic locations, lawmakers emphasized that the proposal would include provisions for monitoring such side effects and, if necessary, allow leeway for remedies.  

“If the bonus cap is shown to cause bankers to begin relocating outside the E.U., then we will have the ability to swiftly look again at the provisions in place through an early review,” said Vicky Ford, a member of the European Conservatives and Reformists group from Britain.

Political leaders who hailed the preliminary deal included Martin Schulz, the president of the European Parliament and a German member of the Alliance of Socialists and Democrats.

"The cap on bonuses is a groundbreaking measure that in my view will make the economic system fairer and safer," Mr. Schulz said in a statement. "Exuberant bonuses often provided a wrong incentive for financial markets, encouraging risky behavior and short-term, purely speculative investment," he said.

An E.U. diplomat stressed that a significant amount of technical work still needed to be done before the rules were finalized by governments.

The diplomat, who spoke on customary condition of anonymity, said the rules would contain a review clause requiring authorities to assess whether the rules were having damaging effects on the banking sector. The envoy said no date was fixed for the review but that could be finalized during discussions over coming weeks.

The proposal would also allow higher bonuses if a sufficient number of shareholders agreed.

It is part of a set of laws requiring higher capital requirements for banks, called the Basel III rules, which the E.U. officials also approved early Thursday.

Mr. Noonan said the Basel III package would “make sure that banks in the future have enough capital, both in terms of quality and quantity, to withstand shocks” and that “will ensure that taxpayers across Europe are protected into the future.”

David Jolly contributed reporting from Paris.

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Well: Think Like a Doctor: The Man Who Wobbled

The Challenge: Can you solve the medical mystery of a man who suddenly becomes too dizzy to walk?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to try their hand at solving a medical mystery. Below you will find the story of a 56-year-old factory worker with dizziness and panic attacks. I have provided records from his two hospital visits that will give you all the information available to the doctor who finally made the diagnosis.

The first reader to offer the correct diagnosis gets a signed copy of my book, “Every Patient Tells a Story,” and the satisfaction of solving a case that stumped a roomful of specialists.

The Patient’s Story:

The middle-aged man clicked his way through the multiple reruns of late-late-night television. He should have been in bed hours ago, but lately he hadn’t been able to get to sleep. Suddenly his legs took on a life of their own. Stretched out halfway to the center of the room, they began to shake and twitch and jump around. The man watched helplessly as his legs disobeyed his mental orders to stop moving. He had no control over them. He felt nauseous, sweaty and out of breath, as if he had been running some kind of race. He called out to his wife. She hurried out of bed, took one look at him and called 911.

The Patient’s History:

By the time the man arrived at Huntsville Hospital, in Alabama, the twitching in his legs had subsided and his breathing had returned to normal. Still, he had been discharged from that same hospital for similar symptoms just two weeks earlier. They hadn’t figured out what was going on then, so they weren’t going to send him home now.

The patient considered himself pretty healthy, but the past year or so had been tough. In 2011, at the age of 54, he had had a mild stroke. He had no medical problems that put him at risk for stroke — no high blood pressure, no high cholesterol, no diabetes. A work-up at that time showed that he had a hole in his heart that allowed a tiny clot from somewhere in his body to travel to the brain and cause the stroke. He was discharged on a couple of blood thinners to keep his blood from making more clots. He hadn’t really felt completely well, though, ever since. His balance seemed a little off, and he was subject to these weird panic attacks, in which his heart would pound and he would feel short of breath whenever he got too stressed. Mostly he could manage them by just walking away and focusing on his breathing. Still, he never felt as if he was the kind of guy to panic.

And he had always been quick on his feet. The first half of his career he had been in the steel business — building huge metal trusses and supports. He and his team put together 60-plus tons of steel structures every day. For the past decade he had been machining car parts. After his stroke, work seemed to get a lot harder.

The Dizziness:

A few weeks ago, he stood up and wham — suddenly the whole world went off-kilter. He felt as if he was constantly about to fall over in a world that no longer lay down flat. His first thought was that he was having another stroke. He went straight to his doctor’s office. The doctor wasn’t sure what was going on and sent him to that same emergency room at Huntsville Hospital. After three days of testing and being evaluated by lots of specialists, his doctors still were not sure what was going on. He hadn’t had a heart attack; he hadn’t had a stroke. There was no sign of infection. All the tests they could think of were normal.

The only abnormal finding was that when he stood up, his blood pressure dropped. Why this happened wasn’t clear, but the doctors in the hospital gave him compression stockings and a pill — both could help keep his blood pressure in the normal range. Then they sent him home. He was also started on an antidepressant to help with the panic attacks he continued to have from time to time.

You can read the report from that hospital admission below.

You can also read the consultation and discharge notes from that hospital visit here.

He had been home for nearly two weeks and still he felt no better. He tried to go back to work after a week or so at home, but after driving for less than five miles, he felt he had to turn around. He wasn’t sure what was wrong; he just knew he didn’t feel right. Then his legs started jumping around, and he ended up back in the hospital.

The Doctor’s Exam:

It was nearly dawn by the time Dr. Jeremy Thompson, the first-year resident on duty that night, saw the patient. Awake but tired, the patient told his story one more time. He had been at home, watching TV, when his legs started jumping on their own and he started feeling short of breath. His wife sat at the bedside. She looked just as worried and exhausted as he did. She told the resident that when he spoke that night at home, his speech was slurred. And when the ambulance came, he could barely walk. He has never missed this much work, she told the young doctor. It’s not like him. Can’t you figure out what’s wrong?

The resident had already reviewed the records from the patient’s previous hospital admissions. He asked a few more questions: the patient had never smoked and rarely drank; his father died at age 80; his mother was still alive and well. The patient exam was normal, as were the studies done in the E.R.

The first E.R. doctor thought that his symptoms were a result of anxiety, culminating in a full-blown panic attack. The resident thought that was probably right. In any case he would discuss the case with the attending in a couple of hours during rounds on the new patients. Till then, he told the worried couple, they should just try to get a little sleep.

An Important Clue:

Dr. Robert Centor was definitely a morning person. His cheerful enthusiasm about teaching and taking care of patients made him a favorite among residents. At 7:30 that morning, he stood outside the patient’s door as Dr. Thompson relayed the somewhat frustrating case of the middle-aged man with worsening dizziness and panic attacks. Then they went into the room to meet the patient. He was a big guy, tall and muscular with the first signs of middle-aged thickening around his middle. His complexion had the look of someone who spent a lot of time outdoors. Dr. Centor introduced himself and pulled up a chair as the rest of the team watched. He asked the patient what brought him to the hospital.

“Every time I get up, I get dizzy,” the man replied. Sure, he had had some balance problems ever since his stroke, he explained, but this felt different – somehow worse. He could hardly walk, he told the doctor. He just felt too unstable.

“Can you get up and show us how you walk?” Dr. Centor asked.

“Don’t let me fall,” the patient responded. He carefully swung his legs over the side of the bed. The resident and intern stood on either side as he slowly rose. He stood with his feet far apart. When asked to close his eyes as he stood there, he wobbled and nearly fell over. When he took a few steps, his heel and toes hit the ground at the same time, making a strange slapping sound.

Seeing that, Dr. Centor knew where the problem lay and ordered a few tests to confirm his diagnosis.

You can see the review report and notes for the patient’s second hospital visit below.

Solving the Mystery:

What tests did Dr. Centor order? Do you know what is making this middle-aged man wobble? Enter your guesses below. I’ll post the answer tomorrow.

---

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

.

Read More..

Well: Think Like a Doctor: The Man Who Wobbled

The Challenge: Can you solve the medical mystery of a man who suddenly becomes too dizzy to walk?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to try their hand at solving a medical mystery. Below you will find the story of a 56-year-old factory worker with dizziness and panic attacks. I have provided records from his two hospital visits that will give you all the information available to the doctor who finally made the diagnosis.

The first reader to offer the correct diagnosis gets a signed copy of my book, “Every Patient Tells a Story,” and the satisfaction of solving a case that stumped a roomful of specialists.

The Patient’s Story:

The middle-aged man clicked his way through the multiple reruns of late-late-night television. He should have been in bed hours ago, but lately he hadn’t been able to get to sleep. Suddenly his legs took on a life of their own. Stretched out halfway to the center of the room, they began to shake and twitch and jump around. The man watched helplessly as his legs disobeyed his mental orders to stop moving. He had no control over them. He felt nauseous, sweaty and out of breath, as if he had been running some kind of race. He called out to his wife. She hurried out of bed, took one look at him and called 911.

The Patient’s History:

By the time the man arrived at Huntsville Hospital, in Alabama, the twitching in his legs had subsided and his breathing had returned to normal. Still, he had been discharged from that same hospital for similar symptoms just two weeks earlier. They hadn’t figured out what was going on then, so they weren’t going to send him home now.

The patient considered himself pretty healthy, but the past year or so had been tough. In 2011, at the age of 54, he had had a mild stroke. He had no medical problems that put him at risk for stroke — no high blood pressure, no high cholesterol, no diabetes. A work-up at that time showed that he had a hole in his heart that allowed a tiny clot from somewhere in his body to travel to the brain and cause the stroke. He was discharged on a couple of blood thinners to keep his blood from making more clots. He hadn’t really felt completely well, though, ever since. His balance seemed a little off, and he was subject to these weird panic attacks, in which his heart would pound and he would feel short of breath whenever he got too stressed. Mostly he could manage them by just walking away and focusing on his breathing. Still, he never felt as if he was the kind of guy to panic.

And he had always been quick on his feet. The first half of his career he had been in the steel business — building huge metal trusses and supports. He and his team put together 60-plus tons of steel structures every day. For the past decade he had been machining car parts. After his stroke, work seemed to get a lot harder.

The Dizziness:

A few weeks ago, he stood up and wham — suddenly the whole world went off-kilter. He felt as if he was constantly about to fall over in a world that no longer lay down flat. His first thought was that he was having another stroke. He went straight to his doctor’s office. The doctor wasn’t sure what was going on and sent him to that same emergency room at Huntsville Hospital. After three days of testing and being evaluated by lots of specialists, his doctors still were not sure what was going on. He hadn’t had a heart attack; he hadn’t had a stroke. There was no sign of infection. All the tests they could think of were normal.

The only abnormal finding was that when he stood up, his blood pressure dropped. Why this happened wasn’t clear, but the doctors in the hospital gave him compression stockings and a pill — both could help keep his blood pressure in the normal range. Then they sent him home. He was also started on an antidepressant to help with the panic attacks he continued to have from time to time.

You can read the report from that hospital admission below.

You can also read the consultation and discharge notes from that hospital visit here.

He had been home for nearly two weeks and still he felt no better. He tried to go back to work after a week or so at home, but after driving for less than five miles, he felt he had to turn around. He wasn’t sure what was wrong; he just knew he didn’t feel right. Then his legs started jumping around, and he ended up back in the hospital.

The Doctor’s Exam:

It was nearly dawn by the time Dr. Jeremy Thompson, the first-year resident on duty that night, saw the patient. Awake but tired, the patient told his story one more time. He had been at home, watching TV, when his legs started jumping on their own and he started feeling short of breath. His wife sat at the bedside. She looked just as worried and exhausted as he did. She told the resident that when he spoke that night at home, his speech was slurred. And when the ambulance came, he could barely walk. He has never missed this much work, she told the young doctor. It’s not like him. Can’t you figure out what’s wrong?

The resident had already reviewed the records from the patient’s previous hospital admissions. He asked a few more questions: the patient had never smoked and rarely drank; his father died at age 80; his mother was still alive and well. The patient exam was normal, as were the studies done in the E.R.

The first E.R. doctor thought that his symptoms were a result of anxiety, culminating in a full-blown panic attack. The resident thought that was probably right. In any case he would discuss the case with the attending in a couple of hours during rounds on the new patients. Till then, he told the worried couple, they should just try to get a little sleep.

An Important Clue:

Dr. Robert Centor was definitely a morning person. His cheerful enthusiasm about teaching and taking care of patients made him a favorite among residents. At 7:30 that morning, he stood outside the patient’s door as Dr. Thompson relayed the somewhat frustrating case of the middle-aged man with worsening dizziness and panic attacks. Then they went into the room to meet the patient. He was a big guy, tall and muscular with the first signs of middle-aged thickening around his middle. His complexion had the look of someone who spent a lot of time outdoors. Dr. Centor introduced himself and pulled up a chair as the rest of the team watched. He asked the patient what brought him to the hospital.

“Every time I get up, I get dizzy,” the man replied. Sure, he had had some balance problems ever since his stroke, he explained, but this felt different – somehow worse. He could hardly walk, he told the doctor. He just felt too unstable.

“Can you get up and show us how you walk?” Dr. Centor asked.

“Don’t let me fall,” the patient responded. He carefully swung his legs over the side of the bed. The resident and intern stood on either side as he slowly rose. He stood with his feet far apart. When asked to close his eyes as he stood there, he wobbled and nearly fell over. When he took a few steps, his heel and toes hit the ground at the same time, making a strange slapping sound.

Seeing that, Dr. Centor knew where the problem lay and ordered a few tests to confirm his diagnosis.

You can see the review report and notes for the patient’s second hospital visit below.

Solving the Mystery:

What tests did Dr. Centor order? Do you know what is making this middle-aged man wobble? Enter your guesses below. I’ll post the answer tomorrow.

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

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I.B.M. Exploring New Feats for Watson

Robert Caplin for The New York Times

I.B.M. plans to serve a breakfast pastry devised by Watson and the chef James Briscione at its meeting on Thursday.

I.B.M.’s Watson beat “Jeopardy” champions two years ago. But can it whip up something tasty in the kitchen?

That is just one of the questions that I.B.M. is asking as it tries to expand its artificial intelligence technology and turn Watson into something that actually makes commercial sense.

The company is betting that it can build a big business by taking the Watson technology into new fields. The uses it will be showing off to Wall Street analysts at a gathering in the company’s Almaden Research Center in San Jose, Calif., on Thursday include helping to develop drugs, predicting when industrial machines need maintenance and even coming up with novel recipes for tasty foods. In health care, Watson is training to become a diagnostic assistant at a few medical centers, including the Cleveland Clinic.

The new Watson projects — some on the cusp of commercialization, others still research initiatives — are at the leading edge of a much larger business for I.B.M. and other technology companies. That market involves helping corporations, government agencies and science laboratories find useful insights in a rising flood of data from many sources — Web pages, social network messages, sensor signals, medical images, patent filings, location data from cellphones and others.

Advances in several computing technologies have opened this opportunity and market, now called Big Data, and a key one is the software techniques of artificial intelligence like machine learning.

I.B.M. has been building this business for years with acquisitions and internal investment. Today, the company says it is doing Big Data and analytics work with more than 10,000 customers worldwide. Its work force includes 9,000 business analytics consultants and 400 mathematicians.

I.B.M. forecasts that its revenue from Big Data work will reach $16 billion by 2015. Company executives compare the meeting in San Jose to one in 2006, when Samuel J. Palmisano, then chief executive, summoned investment analysts to I.B.M.’s offices in India to showcase the surging business in developing markets, which has proved to be an engine of growth for the company.

I.B.M. faces plenty of competitors in the Big Data market, ranging from start-ups to major companies, including Microsoft, Oracle, SAP and the SAS Institute. These companies, like I.B.M., are employing the data-mining technology to trim costs, design new products and find sales opportunities in banking, retailing, manufacturing, health care and other industries.

Yet the Watson initiatives, analysts say, represent pioneering work. With some of those applications, like suggesting innovative recipes, Watson is starting to move beyond producing “Jeopardy” style answers to investigating the edges of human knowledge to guide discovery.

“That’s not something we thought of when we started with Watson,” said John E. Kelly III, I.B.M.’s senior vice president for research.

I.B.M.’s Watson projects are not yet big money makers. But the projects, according to Frank Gens, chief analyst for IDC, make the case that I.B.M. has the advanced technology and deep industry expertise to do things other technology suppliers cannot, which should be a high-margin business and give I.B.M. an edge as a strategic partner with major customers. And the new Watson offerings, he said, are services that future users might be able to tap into through a smartphone or tablet.

That could significantly broaden the market for Watson, Mr. Gens said, as well as ward off potential competition if question-answering technology from consumer offerings, like Apple’s Siri and Google, improve.

“It will take years for these consumerized technologies to compete with Watson, but that day could certainly come,” Mr. Gens said.

John Baldoni, senior vice president for technology and science at GlaxoSmithKline, got in touch with I.B.M. shortly after watching Watson’s “Jeopardy” triumph. He was struck that Watson frequently had the right answer, he said, “but what really impressed me was that it so quickly sifted out so many wrong answers.”

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Benedict XVI Begins Final Day as Pope

VATICAN CITY — In his final hours as head of the Roman Catholic church, a day after blessing the faithful for the last time as pope, Benedict XVI met on Thursday with the cardinals who will elect his successor urging them to be “like an orchestra” that harmonizes well for the good of the Church. It was one of the concluding acts of a nearly eight-year papacy that he said was filled with “light and joy” but also darker moments. Benedict will later leave the Vatican by helicopter for the papal summer residence where his retirement will formally take effect at 8 p.m. local time.

The pope greeted the cardinals individually, after thanking them for their service. Each cardinal came up to greet him and kiss his ring, as Benedict stood, draped in a red mantle lined with snow-white ermine, before a golden throne in the Clementine Hall of the Apostolic Palace. 

As the cardinals meet in coming days to choose a new pope, Benedict told them, “I will be close to you in prayer” and said he would behave with “unconditional reverence and obedience” toward his successor. The comment underscored the concern among Vatican-watchers about what it will mean to have two popes residing in the Vatican.

Benedict will initially reside in Castel Gandolfo, a hilltop town outside Rome where popes have summered for centuries. He is expected to stay there for several months before returning to the Vatican, where he will live in a convent with a fountain and gardens that look out with a perfect view of the dome of St. Peter’s Basilica.

The cardinals, sometimes called the princes of the church, lined up to bid farewell to Benedict, who, along with his predecessor, John Paul II, had elevated many of them to their powerful positions.

In an emotional and unusually personal message on Wednesday, his final public audience in St. Peter’s Square, Benedict said that sometimes he felt that “the waters were agitated and the winds were blowing against” the church, and other days when “the Lord seemed to be sleeping.”

Benedict shocked the world on Feb. 11 when he announced that, feeling his age and diminishing strength, he would retire, a dramatic step that sent the members of the Vatican hierarchy into a tailspin. He reassured the faithful on Sunday that he was not “abandoning” the church, but would continue to serve, even in retirement.

Starting Thursday night, Benedict will be called “pope emeritus” and will don a white cassock and brown shoes from Mexico, replacing the red slippers that he and other popes have traditionally worn, the red symbolizing the blood of the martyrs.

The conclave to elect the next pope, which is expected to start by mid-March, will begin amid a swirl of scandal. On Monday, Cardinal Keith O’Brien, Britain’s senior Roman Catholic cleric said that he would not participate in the conclave, after having been accused of “inappropriate acts” with several priests, charges that he denies. Other cardinals have also come under fire in sex abuse scandals, but only Cardinal O’Brien has recused himself.

On Monday, Benedict met with three cardinals he had asked to conduct an investigation into the “VatiLeaks” scandal in which hundreds of confidential documents were leaked to the press and published in a tell-all book last May, the worst security breach in the church’s modern history. The three cardinals compiled a hefty dossier on the scandal, which Benedict has entrusted only to his successor, not to the cardinals entering the conclave, the Vatican spokesman said earlier this week.

On Thursday, Panorama, a weekly magazine, reported that the Vatican secretary of state, Cardinal Tarcisio Bertone, had been conducting his own investigation into the leaks scandal, including requesting wiretaps on the phones of some members of the Vatican hierarchy.

A shy theologian who appeared to have little interest in the internal politics of the Vatican, Benedict has said that he is retiring “freely, and for the good of the church,” entrusting it to a successor who has more strength than he. But shadows linger. The next pope will inherit a hierarchy buffeted by crises of governance as well as power struggles over the Vatican Bank, which has struggled to conform to international transparency norms.

Many faithful have welcomed Benedict’s gesture as a sign of humility and humanity, a rational decision taken by a man who no longer feels up to the job.

As he stood near St. Peter’s Square on Wednesday after attending the pope’s last public audience, Vincenzo Petrucci, 26, said he had come to express “not so much solidarity, but more like closeness” to the pope. “At first we felt astonished, shocked and disoriented,” he said. “But then we saw what a weighty decision it must have been. He seemed almost lonely.”

Many in the Vatican hierarchy, known as the Roman Curia, are still reeling from the news. Many are bereaved and others seem almost angry. “We are terribly, terribly, terribly shocked,” one senior Vatican official said, speaking on condition of anonymity.

Alan Cowell contributed reporting from Paris.

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