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 blue 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.

---

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.

Read More..

Profound Weight of Layoffs Seen in Survey

Layoffs have touched nearly every American household in some fashion over the last few years, according to new survey data to be released Thursday by the John J. Heldrich Center for Workforce Development at Rutgers University.

Joe Raedle/Getty Images

Lissette Marquez, center, and Amiel Ali looked for jobs last week in Miami with the help of a South Florida Workforce customer service representative, Nelson Munoz, left.

While about 8 percent of Americans are unemployed, nearly a quarter of Americans say they were laid off at some point during the recession or afterward, according to the survey. More broadly, nearly eight in 10 say they know someone in their circle of family and friends who has lost a job.

“This to me is why the recession was so all-consuming and is likely to influence the American psyche,” said Cliff Zukin, a public policy and political science professor at Rutgers and co-author of the report. “Almost everyone, four out of five, were directly or one step removed from unemployment and all that goes with it financially, socially, psychologically.”

The survey presented a bleak view of the economic future.

A majority of Americans say they think it will be at least six years before the economy is made whole again, if ever. Three in 10 said the economy would never fully recover from the Great Recession.

“Despite significant improvements in the nation’s labor market, American workers’ concerns about unemployment, the job market, job security and the future of the economy have not changed much since we conducted a similar survey in August 2010,” the report said.

Just a third of Americans surveyed in this poll, conducted from Jan. 9-16, said they thought the economy would be better next year, the same share that said so two years earlier.

Of those laid off in recent years, nearly a quarter said they still had not found a job. Re-employment rates for older workers have been particularly bad, with nearly two-thirds of unemployed people 55 and older saying they actively sought a job for more than a year before finding one or had still not found work.

Not surprisingly, those who are unemployed are especially downbeat about many economic issues in addition to their own finances. Of those who were jobless and looking for work, 31 percent said their jobless benefits had run out and 58 percent said they were concerned their benefits would run out before they found work.

Of those who have found work, nearly half say their current job is a step down from the one they lost, and a slim majority say they earn less than they did in their previous job. A quarter of those re-employed said they thought that the hit to their standard of living would be permanent.

The reliance on one’s personal network and savings rather than the social safety net showed up frequently in the survey data.

More people reported borrowing money from friends and family than reported using food stamps. A third cut back on doctors’ visits or medical treatment. A quarter of the unemployed said they had enrolled in retraining programs of some kind; half of them reported paying for the education on their own or through family assistance. Twenty-three percent received some type of government financing for their training programs.

Unemployed workers were more likely than employed workers to say that the government is primarily responsible for helping the jobless. But even then, a majority of the unemployed thought that workers and employers were more responsible for getting people back to work than the government was.

Americans over all were also somewhat less critical of bankers this time than they were two years earlier. About one in three (35 percent) respondents attributed high unemployment levels to the actions of Wall Street, compared with 45 percent in 2010.

Americans were most likely to attribute high unemployment to cheap foreign labor. Four in 10 also said they believed illegal immigrants were taking Americans’ job opportunities — which does not bode well for political support for an amnesty program now being discussed in Washington.

Most people surveyed lost at least some of their savings. Asked about their financial health, six in 10 Americans said their finances would not improve in the next few years; just 16 percent said their family finances were already back to prerecession levels or suffered no loss in the first place.

More educated, better-off people were substantially more likely to report being as financially secure as they were before the recession began.

Responses are based on an online survey conducted by GfK using a nationally representative sample of 1,090 adults. The margin of sampling error is plus or minus three percentage points.

Read More..

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 being sexually abused by 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 being sexually abused by 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

Read More..

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.

Pages: 1 2 View All

Read More..

Ipswich Journal: Paul Mason Is One-Third the Man He Used to Be

Paul Nixon Photography

Paul Mason in 2012, two years after gastric bypass surgery stripped him of the unofficial title of “the world’s fattest man.”

IPSWICH, England — Who knows what the worst moment was for Paul Mason — there were so many awful milestones, as he grew fatter and fatter — but a good bet might be when he became too vast to leave his room. To get him to the hospital for a hernia operation, the local fire department had to knock down a wall and extricate him with a forklift.

That was nearly a decade ago, when Mr. Mason weighed about 980 pounds, and the spectacle made him the object of fascinated horror, a freak-show exhibit. The British news media, which likes a superlative, appointed him “the world’s fattest man.”

Now the narrative has shifted to one of redemption and second chances. Since a gastric bypass operation in 2010, Mr. Mason, 52 years old and 6-foot-4, has lost nearly two-thirds of his body weight, putting him at about 336 pounds — still obese, but within the realm of plausibility. He is talking about starting a jewelry business.

“My meals are a lot different now than they used to be,” Mr. Mason said during a recent interview in his one-story apartment in a cheerful public housing complex here. For one thing, he no longer eats around the clock. “Food is a necessity, but now I don’t let it control my life anymore,” he said.

But the road to a new life is uphill and paved with sharp objects. When he answered the door, Mr. Mason did not walk; he glided in an electric wheelchair.

And though Mr. Mason looks perfectly normal from the chest up, horrible vestiges of his past stick to him, literally, in the form of a huge mass of loose skin choking him like a straitjacket. Folds and folds of it encircle his torso and sit on his lap, like an unwanted package someone has set there; more folds encase his legs. All told, he reckons, the excess weighs more than 100 pounds.

As he waits to see if anyone will agree to perform the complex operation to remove the skin, Mr. Mason has plenty of time to ponder how he got to where he is. He was born in Ipswich and had a childhood marked by two things, he says: the verbal and physical abuse of his father, a military policeman turned security guard; and three years of sexual abuse, starting when he was 6, by a relative in her 20s who lived in the house and shared his bed. He told no one until decades later.

After he left school, Mr. Mason took a job as a postal worker and became engaged to a woman more than 20 years older than him. “I thought it would be for life, but she just turned around one day and said, ‘No, I don’t want to see you anymore — goodbye,’ ” he said.

His father died, and he returned home to care for his arthritic mother, who was in a wheelchair. “I still had all these things going around in my head from my childhood,” he said. “Food replaced the love I didn’t get from my parents.” When he left the Royal Mail in 1986, he said, he weighed 364 pounds.

Then things spun out of control. Mr. Mason tried to eat himself into oblivion. He spent every available penny of his and his mother’s social security checks on food. He stopped paying the mortgage. The bank repossessed their house, and the council found them a smaller place to live. All the while, he ate the way a locust eats — indiscriminately, voraciously, ingesting perhaps 20,000 calories a day. First he could no longer manage the stairs; then he could no longer get out of his room. He stayed in bed, on and off, for most of the last decade.

Social service workers did everything for him, including changing his incontinence pads. A network of local convenience stores and fast-food restaurants kept the food coming nonstop — burgers, french fries, fish and chips, even about $22 worth of chocolate bars a day.

“They didn’t deliver bags of crisps,” he said of potato chips. “They delivered cartons.”

His life became a cycle: eat, doze, eat, eat, eat. “You didn’t sleep a normal sleep,” he said. “You’d be awake most of the night eating and snacking. You totally forgot about everything else. You lose all your dignity, all your self-respect. It all goes, and all you focus on is getting your next fix.”

He added, “It was quite a lonely time, really.”

He got infections a lot and was transported to the hospital — first in a laundry van, then on the back of a truck and finally on the forklift. For 18 months after a hernia operation in 2003, he lived in the hospital and in an old people’s home — where he was not allowed to leave his room — while the local government found him a house that could accommodate all the special equipment he needed.

This article has been revised to reflect the following correction:

Correction: February 6, 2013

The headline on an earlier version of this article misstated Paul Mason’s current weight relative to what he weighed nearly a decade ago. He is now about one-third, not two-thirds, the weight he was then.

Read More..

Economic Scene: Immigration Reform Issue: The Effect on the Budget

The stars could hardly have shone brighter on the prospects for immigration reform than in the early months of 2007.

The coalition pushing for change included the oddest of bedfellows — roping together business groups like the United States Chamber of Commerce with the Service Employees International Union, the fastest-growing union in the country. It had an impeccable bipartisan pedigree, including President George W. Bush and Senator Jon Kyl, a staunchly conservative Republican, as well as the Democrats’ liberal lion, Senator Ted Kennedy.

The economy was growing. The unemployment rate was at its lowest level since the dot-com bubble burst six years before. And the flaws of our immigration laws — impotent to stop a river of unauthorized immigrants drawn across the border by job opportunities — were obvious to all.

Immigration reform, however, was not to be.

Immigrants’ rights groups balked at the hurdles put in immigrants’ path toward legalization. The A.F.L.-C.I.O. hated a provision creating temporary work visas, arguing that it was a license for businesses to bring in cheap foreign labor. Then, a Senate Democrat, Byron Dorgan, offered the coup de grâce with an amendment to phase out the worker visa program after five years. Though proposed at the behest of organized labor, the amendment got the support of some of the most anti-union Republicans in the Senate. And it killed the entire enterprise, stripping away corporate America’s main reason to support a deal.

Today, the economy is not growing much. Unemployment remains stubbornly high. Yet President Obama thinks the stellar alignment may be  better than six years ago. He is proposing a wholesale change to the same flawed immigration laws. He trusts that Republicans, who lost the Hispanic vote by an enormous margin in November, cannot afford to further alienate Hispanics by voting against their top priority.

Despite the strong case for an overhaul, however, changing our immigration laws may be tougher than the president appears to believe. While we may have overcome some of the obstacles of 2007, reform will probably face deep-seated opposition from many Americans — including most conservative Republicans — to what they will view as a potentially large expansion of welfare.

President Obama’s proposal is based on principles similar to those of the 2007 attempt: a path to citizenship for millions of illegal immigrants in the country, a legal channel for future immigrant workers and their families, and a plan to better enforce the nation’s borders and immigration laws.

Yet immigration reform today means something quite different than it did in 2007. Notably, the elements needed to stop the flow of illegal immigrants north are much less important to the enterprise. The Obama administration has already spent huge amounts of money on border enforcement. Today, border policing costs about $18 billion a year — nearly 50 percent more than it did in 2006. And deportations have soared. What’s more, illegal immigration has slowed to a trickle, as Mexico has grown more robustly than the United States. The illegal immigrant population has even been shrinking in the last few years. And it may continue to do so as the Mexican population of prime migration-age people stops growing.

Also, many employers have already gotten some of what they wanted: the number of workers entering the United States on temporary visas for low-end jobs in agriculture and other industries has increased sharply.

“The discussion is in a different environment,” said Gordon H. Hanson, an expert on the economics of immigration at the University of California, San Diego. “The flow of new immigrants is not the story anymore.”

This might help the cause of reform in some ways. It could allow the discussion about work visas to focus on the highly educated workers coveted by technology companies and pre-empt the kind of argument between business and labor over visas for cheap immigrant workers that sank reform in 2007. The A.F.L.-C.I.O., for instance, has heartily embraced President Obama’s plan.

But what supporters of an overhaul of immigration law seem to be overlooking is that these very changes could also make it more difficult to build a coalition across the political divide. If reform is mainly about granting citizenship to 11 million mostly poor illegal immigrants with relatively little education, it is going to land squarely in the cross hairs of our epic battle about taxes, entitlements and the role of government in society.

It’s hard to say with precision what impact offering citizenship would have on the budget, but the chances are good that it would cost the government money. Half to three-quarters of illegal immigrants pay taxes, according to studies reviewed in a 2007 report by the Congressional Budget Office. And they are relatively inexpensive, compared with Americans of similar incomes. Their children can attend public schools at government expense — putting a burden on state and local budgets. But they are barred from receiving federal benefits like the earned-income tax credit, food stamps and Medicaid. Only their American-born children can get those.

Government revenue might not change much with legalization. Most illegal immigrants who don’t pay taxes probably work in the cash economy — as nannies or gardeners — where tax compliance among citizens is low. Costs, of course, would increase. Once they became citizens, immigrants would be entitled to the same array of government benefits as other Americans. For Social Security and Medicare alone, offering citizenship to illegal immigrants would mean losing a subsidy worth several billion dollars a year in payroll taxes from immigrants who can’t collect benefits in old age.

The White House and other backers of reform have made much of a 2007 Congressional Budget Office analysis concluding that the failed immigration overhaul would have increased government revenue by $48 billion over a decade while adding only $23 billion to direct spending on entitlements and other programs. But the report also said that including the costs of carrying out the new law would actually increase the budget deficit by $18 billion over the decade and several billion a year after that. What’s more, it noted that most of the expected new tax revenue came from new immigrant workers, not from the newly legalized population.

Our history suggests we could have much to gain by turning illegal immigrants into citizens and putting an end to unauthorized immigration. The last time we permitted illegal immigrants to legalize, in 1986, incomes jumped for those who took advantage of the opportunity. Their children became more proficient in English and completed more years of school — becoming more productive and paying more taxes over their lifetimes.

But the same history underscores how immigration sets off fears about further sharing of government resources. Ten years after the immigration reform of 1986, reeling from some public anger, Congress passed a law barring legal immigrants from means-tested government services. The same issue is likely again to be a major flash point. Professor Hanson pointed to “the older white man who sees his entitlements at risk because of the demands placed by legalization on our fiscal resources.”

Conservative Republicans set on cutting government spending share those concerns. And for all their reasons to reach out to Hispanics, they might not find making illegal immigrants legal politically advantageous. On Tuesday, Republicans in the House argued against granting citizenship to illegal immigrants at all.

Hispanics are more liberal than the general population on economic matters, polls suggest, and more supportive of Big Government initiatives. Granting them citizenship would give them the vote.

As Steven A. Camarota, director of research at the Center for Immigration Studies, an advocacy group in Washington that favors more limits on immigration, said, “They will see legalization as a voter-registration drive for Democrats.”

E-mail: eporter@nytimes.com; Twitter: @portereduardo

This article has been revised to reflect the following correction:

Correction: February 5, 2013

An earlier version misspelled the first name of one of the two United States senators from Arizona.  His name is Jon Kyl, not John.

Read More..

Tour bus had poor safety record before fatal crash

Federal inspectors over the last year found faulty axles and brakes and other safety violations on the tour bus that careened out of control on a winding mountain road near Yucaipa on Sunday evening, killing seven passengers, records show.

Maintenance citations of the tour buses owned by Scapadas Magicas of National City were numerous and serious enough that the company was placed on a federal watch list that flagged its buses for increased roadside inspections.

Bald tires, defective or missing axle parts, and insufficient brake linings were among 59 maintenance violations inspectors found on the firm's buses in the last two years, U.S. Department of Transportation safety records show.

PHOTOS: Tour bus crash

The tour bus was operating under a contract with InterBus Tours and Charters, based in Tijuana, which closed its office Monday, shortly after sending a busload of day tourists to Knott's Berry Farm. The Scapadas Magicas office in National City, in San Diego County, was not open Monday.

Maria McDade, who said she was Scapadas Magicas' administrator for more than 20 years before retiring last year, said none of the company's buses had ever been in an accident and, aside from a fine of $2,500, the company had complied with all U.S. Department of Transportation regulations.

"I feel really, really sad, but accidents happen," she said by walkie-talkie phone from her home in Tijuana. "I feel so sad for all these people." Current company officials could not be contacted for comment.

A message posted on InterBus' Facebook page expressed regret for the accident and told clients that its contractor was insured.

Sales Manager Jordi Garcia said the agency's insurance would be handling burial expenses for the deceased. He said the agency had been open for one year and offered daily trips to Disneyland, Six Flags Magic Mountain and Universal Studios. The trips attracted people from all walks of life, including students, families and young professionals.

"Big Bear is also very popular this time of year. They want to experience nature," he said. The daylong excursion cost $40, he said.

He said the business contracts with independently owned bus operators and that they are responsible for complying with all U.S. and Mexican regulations.

"We're only interested in their availability and the condition of their buses," he said, adding that the agency has never had a problem with any of the several operators with whom they contract.

The Scapadas bus left Tijuana early Sunday with 38 passengers, including children, and was descending California 38 from the ski resort town of Big Bear Lake when the driver apparently lost control about four miles from Yucaipa.

The bus clipped a small Saturn sedan before it veered into oncoming traffic and began to roll, tossing out passengers who were not wearing seat belts. It crushed an oncoming Ford pickup before coming to rest upright atop a boulder and10-foot elderberry bush on a stretch of highway along Mill Creek. Backpacks, clothing and body parts were strewn across the crash site and, on Monday morning, a body remain draped out one of the bus windows.

"It is a gruesome and horrible scene. It's one of the most horrific scenes I've ever seen in 10 years with the department," said Officer Leon Lopez, spokesman for the California Highway Patrol.

CHP officials were joined Monday by investigators from the National Transportation Safety Board at the scene of the accident, which occurred about 6:30 p.m. Sunday just north of the U.S. Forest Service ranger station in the San Bernardino National Forest. The highway was closed most of Monday.

The bus driver, as well as passengers, reported that the vehicle was experiencing mechanical problems before the accident occurred, authorities said. Investigators believe a problem with the brakes may have led the bus to speed out of control down the highway's sweeping curves.

On Monday, those officials questioned the driver, identified as Norberto B. Perez, 52, of San Ysidro, but did not disclose his account of the crash.

"Everything happened so fast. When the bus spun everything flew, even the people," passenger Gerardo Barrientos, who was sitting on the bus next to his girlfriend, told the Associated Press. "I saw many people dead. There are very, very horrendous images in my head, things I don't want to think about."

Ramon Ramirez, who is listed in documents as the owner of Scapadas Magicas, lives in Tijuana and rents an apartment in Chula Vista. No one answered the door at the Chula Vista residence.

Read More..

Navy's Next-Gen Binoculars Will Recognize Your Face

Take a close look, because the next generation of military binoculars could be doing more than just letting sailors and soldiers see from far away. The Navy now wants binoculars that can scan and recognize your face from 650 feet away.

That’s according to a Jan. 16 contract announcement from the Navy’s Space and Naval Warfare Systems Command, which is seeking a “Wireless 3D Binocular Face Recognition System.” During a testing period of 15 months, the plan is to improve “stand-off identification of uncooperative subjects” during daylight, using binoculars equipped with scanners that can read your mug from “100 to 200 meters” away, or about 328 to 650 feet. After scanning your mug, the binoculars then transmit the data to a database over a wireless network, where the data is then analyzed to determine a person’s identity. The no-bid contract, for an unspecified amount of money, went to California biometrics firm StereoVision Imaging.

“High level, it’s a surveillance and identification system,” Greg Steinthal, StereoVision’s president, tells Danger Room. “It’s using the ubiquitous binocular for real-time identification. The data point here is that this is to be used to add objectivity to an operation that’s highly subjective. So this is not intended for kinetic action to go arrest or detain someone. It’s more a tool to put other eyes on him or her.”

It helps that the technology — at least in a more limited form — already exists. StereoVision has developed a face-recognizing binocular system called 3DMobileID, with a maximum distance of around 328 feet, or 100 meters. “You have an unfair advantage,” the company touts in one promotional video, showing images of a human face being scanned at a distance, before the background is stripped out for a blue screen and then matched up to a database.

Depending on how well the binoculars work — and there’s reason to be cautious — it could give the Navy the ability to take advanced facial recognition into a much more portable and long-distance version than many current systems. Facebook uses the technology to match faces when users upload new photos. Google has its own version as well for its its Picasa photo service, and Apple has been researching face recognition as a way to unlock smartphones. (There are apps for iOS that do this, too.)

But the ranges on most systems also tend to max out at a few feet. For the military, that can be dangerous. Close-range biometric scanners (iris scanners are currently used by soldiers in Afghanistan) can pose a danger to the operator, as a person walking up to have their features scanned from a few inches away could be preparing to detonate an explosive vest. And what if a person happens to be on the move, or is bobbing and weaving through a crowd? That can render the scanners ineffective. Once upon a time, many face scanners also depended on the relatively crude practice of scanning 2-D images of the human face, which are an imprecise method when there are varying lighting conditions.

But the key to solving many of these problems could be a simple upgrade: StereoVision’s system scans in 3-D. When the system first scans you, it creates a 3-D model of your face instead of a 2-D image. That allows the system to isolate your face from a crowd, sharpen the image — which boosts the range — and then compares the image to a database. A filter also adjusts for varying degrees of light by smoothing out light across the face into a uniform pattern.

Now for the flaws in the system. The binoculars are not intended to work at night, and have difficulty scanning faces in twilight. When the binoculars can’t draw an image, it gives off a an audible beep to the operator, which is helpful. Otherwise, the process takes “about five to 10 seconds,” says Steinthal.

It’s also less effective when a subject is on the move. “[It] depends on how fast the target is walking,” Steinthal says. “We’re at walking, one-and-half meters per second. Somebody running? We’re not going to be able to do that right now.”

The concept of binoculars that scan and identify is also — perhaps unnervingly — not limited to the military. For one, StereoVision’s binoculars were developed in part with a $409,226 contract from the National Institute of Justice, and face scanners are a popular research topic for the FBI more broadly.

The FBI is spending $1 billion on a program called Next Generation Identification based around developing face scanners and combining the technology with other biometrics like the iris, voice, and fingerprints. A static face recognition system has also been installed at Toucumen International Airport in Panama City that can scan travelers’ faces and match them to criminal databases maintained by the FBI and Interpol. The Los Angeles County Sheriff’s Department and the San Diego Police Department have also tested out the binoculars, according to Steinthal, and are intended there for gang enforcement units and even to track “celebrity stalkers” in the L.A. area. Maybe if the FBI wants its special agents to also have some pretty far-out binoculars too, it should take a peek.

Read More..

NBC Universal reshuffles, Hammer takes over cable networks

(Reuters) – Longtime NBC Universal executive Bonnie Hammer will soon be running all of the media company’s cable networks besides sports and news, as part of a reshuffling, NBC‘s CEO Steve Burke said on Monday.

In a memo to staff, Burke said that starting immediately, Hammer will oversee the entire cable portfolio, including Bravo and Oxygen, which are cable networks previously controlled by Lauren Zalaznick. The new unit, which also includes USA Network, SYFY and E!, will be renamed the cable entertainment group.

Burke said this new division will “represent approximately 50 percent of the company’s operating cash flow.”

In the first three quarters of 2012, NBC generated $ 2.9 billion in operating cash flow. Comcast, which has been the majority owner of NBC since 2011, will report its fourth quarter and full year results on February 13. Cable networks, including sports and news channels overseen by other executives, by far generates the most revenue and profit at NBC Universal.

“I know that with this structure Bonnie and her team will maximize the power and profitability of this portfolio,” Burke said in the memo.

Zalaznick, who will no longer run any cable networks, will become the executive vice president of NBC Universal and will focus on digital initiatives such as “TV Everywhere” as well as “windowing strategies,” which means how soon to make shows available on the Internet after they air on television. She will continue to oversee NBC’s digital assets such as movie ticketing website Fandango.

NBC also said that Joe Uva, a former Univision executive, will become Chairman of Hispanic Enterprises and Content in April, a newly created position. UVA, along with Hammer and Zalaznick will report to Burke.

The moves come a few days after NBC News President Steve Capus said he would be leaving the network after struggles at the unit, including lower ratings for its flagship morning TV show, “Today.”

(This version of the story changes the last word in second paragraph to reflect that new unit name will be “cable entertainment group” and not “cable entertainment business.”)

(Reporting By Liana B. Baker; Editing by Marguerita Choy)

TV News Headlines – Yahoo! News

Title Post: NBC Universal reshuffles, Hammer takes over cable networks
Url Post: http://www.news.fluser.com/nbc-universal-reshuffles-hammer-takes-over-cable-networks/
Link To Post : NBC Universal reshuffles, Hammer takes over cable networks
Rating:
100%

based on 99998 ratings.
5 user reviews.
Author: Fluser SeoLink
Thanks for visiting the blog, If any criticism and suggestions please leave a comment

Read More..

Well: Expressing the Inexpressible

When Kyle Potvin learned she had breast cancer at the age of 41, she tracked the details of her illness and treatment in a journal. But when it came to grappling with issues of mortality, fear and hope, she found that her best outlet was poetry.

How I feared chemo, afraid
It would change me.
It did.
Something dissolved inside me.
Tears began a slow drip;
I cried at the news story
Of a lost boy found in the woods …
At the surprising beauty
Of a bright leaf falling
Like the last strand of hair from my head

Ms. Potvin, now 47 and living in Derry, N.H., recently published “Sound Travels on Water” (Finishing Line Press), a collection of poems about her experience with cancer. And she has organized the Prickly Pear Poetry Project, a series of workshops for cancer patients.

“The creative process can be really healing,” Ms. Potvin said in an interview. “Loss, mortality and even hopefulness were on my mind, and I found that through writing poetry I was able to express some of those concepts in a way that helped me process what I was thinking.”

In April, the National Association for Poetry Therapy, whose members include both medical doctors and therapists, is to hold a conference in Chicago with sessions on using poetry to manage pain and to help adolescents cope with bullying. And this spring, Tasora Books will publish “The Cancer Poetry Project 2,” an anthology of poems written by patients and their loved ones.

Dr. Rafael Campo, an associate professor of medicine at Harvard, says he uses poetry in his practice, offering therapy groups and including poems with the medical forms and educational materials he gives his patients.

“It’s always striking to me how they want to talk about the poems the next time we meet and not the other stuff I give them,” he said. “It’s such a visceral mode of expression. When our bodies betray us in such a profound way, it can be all the more powerful for patients to really use the rhythms of poetry to make sense of what is happening in their bodies.”

On return visits, Dr. Campo’s patients often begin by discussing a poem he gave them — for example, “At the Cancer Clinic,” by Ted Kooser, from his collection “Delights & Shadows” (Copper Canyon Press, 2004), about a nurse holding the door for a slow-moving patient.

How patient she is in the crisp white sails
of her clothes. The sick woman
peers from under her funny knit cap
to watch each foot swing scuffing forward
and take its turn under her weight.
There is no restlessness or impatience
or anger anywhere in sight. Grace
fills the clean mold of this moment
and all the shuffling magazines grow still.

In Ms. Potvin’s case, poems related to her illness were often spurred by mundane moments, like seeing a neighbor out for a nightly walk. Here is “Tumor”:

My neighbor walks
For miles each night.
A mantra drives her, I imagine
As my boys’ chant did
The summer of my own illness:
“Push, Mommy, push.”
Urging me to wind my sore feet
Winch-like on a rented bike
To inch us home.
I couldn’t stop;
Couldn’t leave us
Miles from the end.

Karin Miller, 48, of Minneapolis, turned to poetry 15 years ago when her husband developed testicular cancer at the same time she was pregnant with their first child.

Her husband has since recovered, and Ms. Miller has reviewed thousands of poems by cancer patients and their loved ones to create the “Cancer Poetry Project” anthologies. One poem is “Hymn to a Lost Breast,” by Bonnie Maurer.

Oh let it fly
let it fling
let it flip like a pancake in the air
let it sing: what is the song
of one breast flapping?

Another is “Barn Wish” by Kim Knedler Hewett.

I sit where you can’t see me
Listening to the rustle of papers and pills in the other room,
Wondering if you can hear them.
Let’s go back to the barn, I whisper.
Let’s turn on the TV and watch the Bengals lose.
Let’s eat Bill’s Doughnuts and drink Pepsi.
Anything but this.

Ms. Miller has asked many of her poets to explain why they find poetry healing. “They say it’s the thing that lets them get to the core of how they are feeling,” she said. “It’s the simplicity of poetry, the bare bones of it, that helps them deal with their fears.”

---

Have you written a poem about cancer? Please share them with us in the comments section below.

Read More..