Rhode Island Judge Has Stake in Pension Case Outcome

Can a judge rule impartially on pension cuts when her mother, her son, her uncle and even she herself all have a stake in preserving the status quo?

Rhode Island, the site of a sweeping pension overhaul last year, has brought in a prominent New York lawyer to litigate the question: David Boies, perhaps best known for representing Al Gore in the fight over the 2000 presidential election and for waging an antitrust battle against Microsoft on behalf of the government in the 1990s.

Rhode Island’s dispute may not reach quite those dramatic heights, but it is being closely watched as a first major test of whether, and how, financially strained states and cities can cut the benefits of their workers and retirees.

Several public employee unions have sued Gov. Lincoln Chafee and other Rhode Island officials, accusing them of acting illegally when they pushed through a package of money-saving pension cuts last year, including suspending annual cost-of-living increases for most retirees. The unions want the richer benefits restored.

Their five pension lawsuits were assigned to Judge Sarah Taft-Carter of the state Superior Court, who has handled public pension cases before and handed a big victory to the unions in one recent case. Mr. Boies, who at $50 an hour is working for a small fraction of his ordinary fee, is seeking a less conflicted judge, and could even ask to move the case into federal court.

The case has raised questions and strong feelings about the overhaul in Rhode Island, a state so small that it seems as if nearly everybody has friends or family in the pension system. Could the judge see beyond the harsh effects on her own family?

When the subject came up in a hearing in October, Judge Taft-Carter acknowledged that her son, a state trooper, was earning a pension, and her mother, the widow of a mayor, was already receiving one. (The uncle’s pension came to light only later.)

She said she had researched the matter, sought advice from a judicial ethics board and concluded that her relatives’ interests “will not reasonably impact my ability to be impartial.”

Her son joined the state patrol just three years ago, she said, so calculating his pension “requires a large degree of speculation and assumption.” Her mother’s pension was too small to be a factor, she said. (Court papers put it at about $22,000 a year.)

And while the overhaul means the judge’s pension will be smaller despite having to contribute more, she said that was true of all judges in the state: “If my financial interest should require disqualification, then all other state judges would be similarly required to recuse themselves.”

Mr. Boies is expected to appear in court on Friday and cite the state’s judicial code of conduct, which requires judges to recuse themselves when their spouses, parents or children have an economic stake in the litigation before them.

The state’s Supreme Court justices, who have been asked for a review, are also members of the state pension system.

In an interview, Mr. Boies said that challenging Judge Taft-Carter’s impartiality was just “the first step,” and the bigger issue was whether any judges in Rhode Island could handle the case, given their personal stakes. Companies routinely have their pension disputes decided by federal courts, which grant more leeway in changing pension plans.

“The plaintiffs brought this case the way they did to try to avoid federal jurisdiction,” Mr. Boies said.

Whatever the outcome of the hearing, Mr. Boies said he would continue to represent Rhode Island until all of the lawsuits and appeals were decided.

Mr. Boies, whose standard fee is $1,250 an hour, said $50 an hour was “the same fee that I charged the United States when I represented the Department of Justice in the Microsoft case.”

Mr. Boies became involved, he said, because he was convinced that Rhode Island’s pension troubles were just the tip of a $5 trillion iceberg of unsecured retirement promises to the nation’s millions of public workers. “This is something that can cripple state and municipal governments at a time when the federal government is, more and more, cutting back on the services it provides,” he said.

Public employee unions, in Rhode Island and elsewhere, argue that people like Mr. Boies are exaggerating the size of America’s total public pension shortfall.

This article has been revised to reflect the following correction:

Correction: December 4, 2012

An earlier version of this article wrongly attributed the following quotation: Rhode Island’s effort is “the clearest example of fundamental pension reform that we have right now,” Ms. Monahan said. “Even though whatever Rhode Island decides doesn’t serve as actual precedent for other states, other states and cities still want to know if it can work.” The quote was from Amy Monahan, not Gina Raimondo.

Read More..

Willis Whitfield, Clean Room Inventor, Dies at 92

The enemy was very small but it was everywhere. World peace, medical advancement, iTunes — all would eventually be threatened.

Half a century ago, as a rapidly changing world sought increasingly smaller mechanical and electrical components and more sanitary hospital conditions, one of the biggest obstacles to progress was air, and the dust and germs it contains.

Stray particles a few microns wide could compromise the integrity of a circuit board of a nuclear weapon. Unchecked bacteria could quickly infect a patient after a seemingly successful operation. Microprocessors, not yet in existence, would have been destroyed by dust. After all, an average cubic foot of air contained three million microscopic particles, and even the best efforts at vacuuming and wiping down a high-tech work space could only reduce the rate to one million.

Then, in 1962, Willis Whitfield invented the clean room.

“People said he was a fraud,” recalled Gilbert V. Herrera, the director of microsystems science and technology at Sandia National Laboratories in Albuquerque. “But he turned out to be right.”

Mr. Whitfield, who worked at Sandia from 1954 to 1984, died on Nov. 12 in Albuquerque. He was 92. The cause was prostate cancer, his wife, Belva, said.

His clean rooms blew air in from the ceiling and sucked it out from the floor. Filters scrubbed the air before it entered the room. Gravity helped particles exit. It might not seem like a complicated concept, but no one had tried it before. The process could completely replace the air in the room 10 times a minute.

Particle detectors in Mr. Whitfield’s clean rooms started showing numbers so low — a thousand times lower than other methods — that some people did not believe the readings, or Mr. Whitfield. He was questioned so much that he began understating the efficiency of his method to keep from shocking people.

“I think Whitfield’s wrong,” a scientist from Bell Labs finally said at a conference where Mr. Whitfield spoke. “It’s actually 10 times better than he’s saying.”

Willis James Whitfield was born in Rosedale, Okla., on Dec. 6, 1919. In addition to his wife, his survivors include his sons, James and Joe; a sister, Amy Blackburn; and a brother, Lawrence.

Mr. Whitfield became fascinated with electronics as a young man and received a two-year degree in the field after high school. He served in the Navy late in World War II, working with experimental electronic systems for aircraft. In 1952, he received a bachelor’s degree in physics and math from Hardin-Simmons University in Abilene, Tex.

By 1954 he was working at Sandia, which was involved in making parts for nuclear weapons and at the time was overseen by the Atomic Energy Commission. Mr. Whitfield’s duties soon included contamination control. By 1960, he had established his basic idea for the clean room.

“I thought about dust particles,” Mr. Whitfield told Time magazine in 1962. “Where are these rascals generated? Where do they go?”

The clean room was patented through Sandia, and the government shared it freely among manufacturers, hospitals and other industries.

Mr. Whitfield’s original clean room was only about six feet high, built as a small, self-contained unit. Some modern electronic devices, including the iPhone, are now built in China in huge clean rooms in structures that are more than a million square feet. Workers wear protective clothing, and other anticontamination methods have been added, but they still depend on Mr. Whitfield’s approach to suck up dust.

“Relative to these electronics, the particles are just massive boulders that would short out all of your electronics and make them not work,” Mr. Herrera said. “The core technology, just the cleaning part, hasn’t really changed a lot.”

Mrs. Whitfield said she was often been asked if her husband was a particularly fastidious man, and she always noted that he tended not to put his shoes away. He did live in a tidy house, though, and colleagues say he never tired of getting out a flashlight and shining it sideways across his coffee table to illuminate the prevalence of tiny dust particles that most people never notice.

Read More..

Willis Whitfield, Clean Room Inventor, Dies at 92

The enemy was very small but it was everywhere. World peace, medical advancement, iTunes — all would eventually be threatened.

Half a century ago, as a rapidly changing world sought increasingly smaller mechanical and electrical components and more sanitary hospital conditions, one of the biggest obstacles to progress was air, and the dust and germs it contains.

Stray particles a few microns wide could compromise the integrity of a circuit board of a nuclear weapon. Unchecked bacteria could quickly infect a patient after a seemingly successful operation. Microprocessors, not yet in existence, would have been destroyed by dust. After all, an average cubic foot of air contained three million microscopic particles, and even the best efforts at vacuuming and wiping down a high-tech work space could only reduce the rate to one million.

Then, in 1962, Willis Whitfield invented the clean room.

“People said he was a fraud,” recalled Gilbert V. Herrera, the director of microsystems science and technology at Sandia National Laboratories in Albuquerque. “But he turned out to be right.”

Mr. Whitfield, who worked at Sandia from 1954 to 1984, died on Nov. 12 in Albuquerque. He was 92. The cause was prostate cancer, his wife, Belva, said.

His clean rooms blew air in from the ceiling and sucked it out from the floor. Filters scrubbed the air before it entered the room. Gravity helped particles exit. It might not seem like a complicated concept, but no one had tried it before. The process could completely replace the air in the room 10 times a minute.

Particle detectors in Mr. Whitfield’s clean rooms started showing numbers so low — a thousand times lower than other methods — that some people did not believe the readings, or Mr. Whitfield. He was questioned so much that he began understating the efficiency of his method to keep from shocking people.

“I think Whitfield’s wrong,” a scientist from Bell Labs finally said at a conference where Mr. Whitfield spoke. “It’s actually 10 times better than he’s saying.”

Willis James Whitfield was born in Rosedale, Okla., on Dec. 6, 1919. In addition to his wife, his survivors include his sons, James and Joe; a sister, Amy Blackburn; and a brother, Lawrence.

Mr. Whitfield became fascinated with electronics as a young man and received a two-year degree in the field after high school. He served in the Navy late in World War II, working with experimental electronic systems for aircraft. In 1952, he received a bachelor’s degree in physics and math from Hardin-Simmons University in Abilene, Tex.

By 1954 he was working at Sandia, which was involved in making parts for nuclear weapons and at the time was overseen by the Atomic Energy Commission. Mr. Whitfield’s duties soon included contamination control. By 1960, he had established his basic idea for the clean room.

“I thought about dust particles,” Mr. Whitfield told Time magazine in 1962. “Where are these rascals generated? Where do they go?”

The clean room was patented through Sandia, and the government shared it freely among manufacturers, hospitals and other industries.

Mr. Whitfield’s original clean room was only about six feet high, built as a small, self-contained unit. Some modern electronic devices, including the iPhone, are now built in China in huge clean rooms in structures that are more than a million square feet. Workers wear protective clothing, and other anticontamination methods have been added, but they still depend on Mr. Whitfield’s approach to suck up dust.

“Relative to these electronics, the particles are just massive boulders that would short out all of your electronics and make them not work,” Mr. Herrera said. “The core technology, just the cleaning part, hasn’t really changed a lot.”

Mrs. Whitfield said she was often been asked if her husband was a particularly fastidious man, and she always noted that he tended not to put his shoes away. He did live in a tidy house, though, and colleagues say he never tired of getting out a flashlight and shining it sideways across his coffee table to illuminate the prevalence of tiny dust particles that most people never notice.

Read More..

Video Games: Little Inferno; Hitman; Assassin’s Creed III; Persona 4 Golden; Angry Birds Star Wars; My Little Pony

Ubisoft

Ratonhnhaké:ton is a half-British, half-Mohawk assassin in Revolutionary America.

Released on Nov. 18

Developed by Tomorrow Corporation

For PC, Mac, Linux and Wii U

Rated T for Teen (drug reference and crude humor)

Here’s an odd one. Little Inferno is an interactive fireplace. It’s an emotional, interactive fireplace with a story line and some notions about the dangers of amusing ourselves with distracting trifles.

At first this strange creation appears to be a simple puzzle game consisting of little more than a fireplace, a catalog of items to burn and 99 clues that challenge the player to burn these things in proper combinations. One clue is “Movie Night.” Burn the popcorn. Burn the TV. A weirder one is “Bike Pirate.” Burn the wooden bike. Burn the pirate.

As you play, an unseen character begins to send letters. They burn, too, but something seems off. The messages are alternately cheerful and sad, a wee bit wicked and increasingly desperate.

The purpose of the pyromaniac pastime becomes smoky with doubt. Why are we doing this? What are we missing? It’s odd enough to play a new video game that questions our decision to play video games. That it’s an interactive fireplace game that does this is all the stranger and more wonderful. It’s a yule log for our times.

HITMAN

Absolution

Released on Nov. 20

Developed by IO Interactive

Published by Square Enix

For PC, Xbox 360 and

PlayStation 3

Rated M for Mature (intense violence, partial nudity and strong language)

It’s a vile, dangerous world in Hitman: Absolution. Nearly everyone is in need of a good killing, and Agent 47, the depilated murder machine at the center of the long-running Hitman franchise, is just the man for the job.

Absolution is consistent with the setup of past Hitman games: At the start of a level, 47 is given an assassination target, and he must make his way through semi-open areas by any of a number of possible routes. The reactive artificial intelligence keeps things enjoyably unpredictable, and the best levels feel like a buffet of sadistic improvisation.

The story is pure B-movie hogwash. It’s mostly enjoyable in a certain exploitive way, but it often feels as if the writers were trying too hard.

When it gets cooking, Hitman: Absolution evokes the feeling of a deadly, measured dance. It’s a tango between you and the computer, with each party alternately taking the lead through arenas that shift and upset expectations.

ASSASSIN’S CREED III

Released on Oct. 30

Developed and published by Ubisoft

For PlayStation 3, Xbox 360, Wii U and PC

Rated M for Mature (blood, intense violence, sexual themes and strong language)

Assassin’s Creed III is really the fifth major Assassin’s Creed game. The numbering signifies that this new historical epic is a shift, as this Ubisoft series about the ancestral lives of a man named Desmond Miles leaps to its third era. Finished with the 12th-century crusades and 15th-century Renaissance Italy, Assassin’s Creed now lets us do interactive historical tourism in Boston, New York and the nearby woods of Revolutionary America.

Assassin’s Creed games are lavish action-adventure blockbusters. In this new one, we primarily play as a young, bitter, half-British, half-Mohawk greenhorn assassin named Ratonhnhaké:ton, who finds himself crossing paths and sometimes doing the bidding of Sam Adams, Paul Revere, George Washington and other real figures. Most of the bad guys are red coats with slow-firing muskets. We’re best with a tomahawk and a bow and arrow.

The new game involves a lot of climbing and killing across a sprawling landscape of bustling cities and gorgeous frontier. Add in a mix of awkwardly instituted horseback riding, homestead building, trading, trapping, hunting and, at the wheel of your own tall-masted warship, epic naval combat. There is much to do and witness in a ripped-from-the-history-books adventure that is refreshingly unwilling to ignore the unsavory aspects of America’s birth. A lengthy production cycle didn’t spare the game from a wealth of bugs that are only now being patched out.

The series’s low-key multiplayer games of competitive assassination return, but the star of this epic is something that might seem almost quaint: Assassin’s Creed III is easily the best tree-climbing simulator in history.

PERSONA 4 GOLDEN

Released on Nov. 20

Developed and published by Atlus

For PlayStation Vita

Rated M for Mature (violence, alcohol reference and partial nudity)

Persona 4 Golden is part turn-based role-playing game, part high school simulator and a rerelease of a celebrated PlayStation 2 game on the portable Vita.

These edited and condensed reviews are from the writers and editors of the gaming Web site Kotaku.com. Full reviews are at kotaku.com/nytselects.

Read More..

Changing of the Guard: How Crash Cover-Up Altered China’s Succession

BEIJING — “Thank you. I’m well. Don’t worry,” read the post on a Chinese social networking site. The brief comment, published in June, appeared to come from Ling Gu, the 23-year-old son of a high-powered aide to China’s president, and it helped quash reports that he had been killed in a Ferrari crash after a night of partying.

It only later emerged that the message was a sham, posted by someone under Mr. Ling’s alias — almost three months after his death.

The ploy was one of many in a tangled effort to suppress news of the Ferrari crash that killed Mr. Ling and critically injured two young female passengers, one of whom later died. The outlines of the affair surfaced months ago, but it is now becoming clearer that the crash and the botched cover-up had more momentous consequences, altering the course of the Chinese Communist Party’s once-in-a-decade leadership succession last month.

China’s departing president, Hu Jintao, entered the summer in an apparently strong position after the disgrace of Bo Xilai, previously a rising member of a rival political network who was brought down when his wife was accused of murdering a British businessman. But Mr. Hu suffered a debilitating reversal of his own when party elders — led by his predecessor, Jiang Zemin — confronted him with allegations that Ling Jihua, his closest protégé and political fixer, had engineered the cover-up of his son’s death.

According to current and former officials, party elites, and others, the exposure helped tip the balance of difficult negotiations, hastening Mr. Hu’s decline; spurring the ascent of China’s new leader, Xi Jinping; and playing into the hands of Mr. Jiang, whose associates dominate the new seven-man leadership at the expense of candidates from Mr. Hu’s clique.

The case also shows how the profligate lifestyles of leaders’ relatives and friends can weigh heavily in backstage power tussles, especially as party skulduggery plays out under the intensifying glare of media.

Numerous party insiders provided information regarding the episode, speaking on the condition of anonymity for fear of reprisals from the authorities. Officials have investigated the aftermath of the car wreck, they say, including looking into accusations that a state oil company paid hush money to the families of the two women.

Under Mr. Hu, Mr. Ling had directed the leadership’s administrative center, the General Office, but was relegated to a less influential post in September, ahead of schedule. Last month, he failed to advance to the 25-person Politburo and lost his seat on the influential party secretariat.

Mr. Hu, who stepped down as party chief, immediately yielded his post as chairman of the military, meaning he will not retain power as Mr. Jiang did. “Hu was weakened even before leaving office,” said a midranking official in the Organization Department, the party’s personnel office.

Mr. Ling’s future remains unsettled, with party insiders saying that his case presents an early test of whether Mr. Xi intends to follow through on public promises to fight high-level corruption.

“He can decide whether to go after Ling Jihua or not,” said Wu Guoguang, a former top-level party speechwriter, now a political scientist at the University of Victoria in British Columbia. “Either way, this is a big card in Xi Jinping’s hand.”

Mr. Ling, 56, built his career in the Communist Youth League. At an early age, he secured the patronage of Mr. Hu, who led the Youth League in the early 1980s and brought Mr. Ling to the General Office in 1995. “Hu didn’t come with a lot of friends, but Ling was someone he knew he could trust,” said the Organization Department official. “Officials said that if Ling called, it was like Hu calling.”

Mr. Ling played a central role in moving Youth League veterans into high offices and undermining Mr. Hu’s adversaries. Mr. Ling also wielded leverage over Internet censorship of leaders’ affairs, and sought to use it to benefit his patron.

“Negative publicity, including untruths, about Xi Jinping were not suppressed the way publicity about Hu Jintao was,” said one associate of party leaders.

As his influence grew, Mr. Ling tried to keep a low profile. About a decade ago, his wife closed a software company she owned and formed a nonprofit foundation that incubates young entrepreneurs. The couple sent their son, Ling Gu, to an elite Beijing high school under an alias, Wang Ziyun. “Ling Jihua told his family not to damage his career,” a former Youth League colleague said. “But it seems it can’t be stopped.”

Still living under an alias, Ling Gu graduated from Peking University last year with an international relations degree and began graduate studies in education. One of his instructors said his performance plunged later in his undergraduate years. “I think there were too many lures, too much seduction,” he said.

Before dawn on March 18, a black Ferrari Spider speeding along Fourth Ring Road in Beijing ricocheted off a wall, struck a railing and cracked in two. Mr. Ling was killed instantly, and the two young Tibetan women with him were hospitalized with severe injuries. One died months later, and the other is recovering, party insiders said.

Ian Johnson and Edward Wong contributed reporting.

Read More..

More Dads Buy the Toys, So Barbie, and Stores, Get Makeovers

Barbies are for girls and construction sets are for boys. Or are they?

For the first time in Barbie’s more than 50-year history, Mattel is introducing a Barbie construction set that underscores a huge shift in the marketplace. Fathers are doing more of the family shopping just as girls are being encouraged more than ever by hypervigilant parents to play with toys (as boys already do) that develop math and science skills early on.

It’s a combination that not only has Barbie building luxury mansions — they are pink, of course — but Lego promoting a line of pastel construction toys called Friends that is an early Christmas season hit. The Mega Bloks Barbie Build ’n Style line, available next week, has both girls — and their fathers — in mind.

“Once it’s in the home, dads would very much be able to join in this play that otherwise they might feel is not their territory,” said Dr. Maureen O’Brien, a psychologist who consulted on the new Barbie set.

Consumer surveys show that men are increasingly making the buying decisions for families, reflecting the growth in two-income households and those in which the women work and the men stay home. One-fifth of fathers with preschool-age children and working wives said they were the primary caretaker in 2010, according to the latest Census Bureau data. And 37.6 percent of working wives earned more than their husbands in 2011, up from 30.7 percent 10 years earlier.

“Kids are going to grow up with dads that give them baths and drive them to soccer and are cutting up oranges for team snacks,” said Liz Ross, president for North America of BPN, part of the IPG Mediabrands holding company, which recently completed a study on male consumers. “What will go away, albeit slowly, is the image or the perception of the befuddled dad.”

The change is having consequences beyond toys. Consumer products have traditionally been marketed to appeal to women, and stores have been designed for women’s sensibilities. Now, some brands and stores are catering directly to male decision-makers. Sears is reorganizing stores to put tools next to work wear, for instance, based on men’s preferences. Procter & Gamble is working on men’s grooming aisles at top retailers, a nod to the fact that women are no longer choosing shampoos or shaving creams for their husbands. With the selling point that it helps girls develop spatial reasoning, the Barbie set, a joint effort of Mattel and the toy company Mega Bloks, is also meant to pique fathers’ interest.

“Dad is a bigger influencer in terms of toy purchases over all, and this sets up well for that, because the construction category is something Dad grew up with and definitely has strong feelings and emotions about,” said Vic Bertrand, chief innovation officer of Mega Brands, Mega Bloks’ parent company.

Construction sets for girls are a speedy growth category, thanks to Lego’s introduction of its Friends line in January. Despite criticism that those sets were sexist — themes include a beauty shop and a fashion studio — Lego’s chief executive said in August that the company sold twice as many of the sets in the first half of the year as it had expected, and retailers like Amazon and Target have named them hot holiday toys.

Anne Marie Kehoe, vice president of toys for Walmart U.S., said that, with the Barbie addition, construction toys aimed at girls will represent about 20 percent of the toy construction category by the end of this year, while last year there were just a handful of products.

Research shows that playing with blocks, puzzles and construction toys helps children with spatial development, said Dr. Susan C. Levine, chairwoman of the psychology department at the University of Chicago and co-principal investigator at the National Science Foundation’s Spatial Intelligence and Learning Center. Even controlling for other skills such as verbal and numerical skills, she said, children with better spatial thinking are more likely to eventually go into mathematics, engineering, science and technology.

She said that a set aimed at girls could be beneficial, if only because it might increase girls’ likelihood of participating in construction activities.

Dr. O’Brien, the consultant on the new Barbie set, said adults had traditionally been “the limiting factor” in why girls have not played with those toys as often.

Recently, she said, there has been a shift in attitudes, as parents study research on development and spatial play. “For this particular product, one of the advantages is you can appeal to both moms and dads,” she said of the construction set.

During her research, Dr. O’Brien said, she watched a grandfather jump in to explain building principles to his granddaughter, who was playing with the Barbie. Still, the construction set is not exactly dump trucks and dirt. It remains “unapologetically all girl,” said Stephanie Cota, senior vice president of global marketing for Barbie, girls’ brands and games at Mattel.

The Mega Bloks building pieces are pink (Pantone 219, the signature Barbie color), and the construction choices are scenes like a fashion boutique, a mansion and an ice cream cart. Each set comes with a small Barbie figure that can be snapped into the scene.

Mattel, the world’s largest toy maker, still leans heavily on Barbie, one of its most popular and longest-running franchises. However, pressure to update Barbie has been high — Mattel has introduced Barbies with video cameras and digital cameras in recent years.

Yet sales of Barbie in North America through September fell 1 percent, even as sales of Mattel’s other girl brands, like Disney Princess dolls, rose 44 percent. Mega Brands makes just a fraction of what its larger rival Lego does, and had revenues of about $376 million last year.

The Barbie brand, which tends to raise feminists’ ire for its overly sexualized dolls, not to mention the 1992 version saying “Math class is tough,” has already taken some high-arched steps toward gender equality. A computer-engineer Barbie was introduced two years ago, for instance, with the support of the Society of Women Engineers.

This time, though, the introduction appears to be a response more to market changes than to critics.

Girls “don’t necessarily care about, ‘That’s a boy toy; that’s not for me,’ ” said Ms. Cota of Mattel. “Now, more so than ever, girls are looking at what’s fun, what they like.”

Read More..

With Some Hospitals Closed After Hurricane Sandy, Others Pick Up Slack

A month after Hurricane Sandy struck New York City, unexpectedly shutting down several hospitals, one Upper East Side medical center had so many more emergency room patients than usual that it was parking them in its lobby.

White and blue plastic screens had been set up between the front door and the elevator banks in the East 68th Street building of that hospital, NewYork-Presbyterian/Weill Cornell. The screens shielded 10 gurneys and an improvised nursing station from the view of people obliviously walking in and out of the soaring, light-filled atrium.

“It’s like a World War II ward,” Teri Daniels, who had been waiting a day and a half with a relative who needed to be admitted, said last week.

Since the storm, a number of New York City hospitals have been scrambling to deal with a sharp increase in patients, forcing them to add shifts of doctors and nurses on overtime, to convert offices and lobbies to use for patients’ care, and even, in one case, to go to a local furniture store to buy extra beds.

At Beth Israel Medical Center, 11 blocks south of the Bellevue Hospital Center emergency room, which was shuttered because of storm damage, the average number of visits to the E.R. per day has risen to record levels. Visits have increased by 24 percent this November compared with last, and the numbers show no sign of dropping. Hospital admissions have risen 12 percent compared with last November.

Most of the rise in volume is from patients who had never been to Beth Israel before. An emergency room doctor at the hospital described treating one patient who said he had been born at Bellevue and had never before gone anywhere else.

Emergency room visits have gone up 25 percent at NewYork-Presybterian/Weill Cornell, which in Bellevue’s absence is the closest high-level trauma center — treating stab wounds, gun wounds, people hit by cars and the like — in Manhattan from 68th Street south. Stretchers holding patients have been lined up like train cars around the nursing station and double-parked in front of stretcher bays.

In Brooklyn, some patients in Maimonides Medical Center’s emergency room who need to be admitted are waiting two or three days for a bed upstairs, instead of four or five hours. Almost every one of the additional 1,100 emergency patients this November compared with last November came from four ZIP codes affected by the storm and served by Coney Island Hospital, a public hospital that was closed because of storm damage.

The number of psychiatric emergency patients from those same ZIP codes has tripled, in a surge that began three days before the hurricane, perhaps fueled by anxiety, as well as by displacement from flooded adult homes or programs at Coney Island Hospital, doctors said.

The Maimonides psychiatric emergency room bought five captain’s beds — which do not have railings that can be used for suicide attempts — at a local furniture store, to accommodate extra patients. The regular emergency room had to buy 27 new stretchers after the hurricane, “and we probably need a few more,” the department’s chief, Dr. John Marshall, said.

The emergency room and inpatient operations of four hospitals remain closed because of flooding and storm damage. Besides Bellevue and Coney Island, NYU Langone Medical Center and the VA New York Harbor Healthcare System, both near Bellevue on the East Side of Manhattan, are closed.

While the surge in traffic to other hospitals has been a burden, it has also been a boon, bringing more revenue.

On the Upper East Side, the storm has helped Lenox Hill Hospital, which has a history of financial problems. It took two or three wards that had been turned into offices and converted them back to space for patients. Emergency room visits are up 10 percent, and surgery has been expanded to seven days a week from five.

“We usually operate at slightly over 300 beds, and now we’re at well over 550,” Carleigh Gustafson, director of emergency nursing, said.

Conversely, administrators at the shuttered hospitals, especially NYU Langone, a major teaching center, worry that their patients and doctors are being raided, with some never to return.

NYU’s salaried doctors are being paid through January, on the condition that they do not take another job. But at the same time, they need a place to practice, so NYU administrators have been arranging for them to work as far away as New Jersey until the hospital reopens. Lenox Hill alone has taken on close to 300 NYU doctors, about 600 nurses, and about 150 doctors in training, fellows and medical students.

Obstetricians and surgeons from the closed hospitals have been particularly disadvantaged, since they are dependent on hospitals to treat their patients. Many displaced surgeons have been reduced to treating only the most desperately ill, and operating on nights and weekends, when hospitals tend to be least well staffed.

“I think there’s no question that a lot of people have postponed anything that they can postpone that is elective,” said Dr. Andrew W. Brotman, senior vice president at NYU.

In mid-November, Dr. Michael L. Brodman, chairman of obstetrics at Mount Sinai Medical Center, sent out a memo saying his department had taken on 26 NYU physicians, as well as nurses and residents, but “clearly, that is too much for us to handle long term.”

Since then, 15 of the physicians have gone to New York Downtown Hospital, while Mount Sinai has retained 11 doctors and 26 nurses.

“We are guests in other people’s homes,” Dr. Brotman of NYU said, “and we are guests who have to some degree overstayed their welcome.”

Joanna Walters contributed reporting.

Read More..

With Some Hospitals Closed After Hurricane Sandy, Others Pick Up Slack

A month after Hurricane Sandy struck New York City, unexpectedly shutting down several hospitals, one Upper East Side medical center had so many more emergency room patients than usual that it was parking them in its lobby.

White and blue plastic screens had been set up between the front door and the elevator banks in the East 68th Street building of that hospital, NewYork-Presbyterian/Weill Cornell. The screens shielded 10 gurneys and an improvised nursing station from the view of people obliviously walking in and out of the soaring, light-filled atrium.

“It’s like a World War II ward,” Teri Daniels, who had been waiting a day and a half with a relative who needed to be admitted, said last week.

Since the storm, a number of New York City hospitals have been scrambling to deal with a sharp increase in patients, forcing them to add shifts of doctors and nurses on overtime, to convert offices and lobbies to use for patients’ care, and even, in one case, to go to a local furniture store to buy extra beds.

At Beth Israel Medical Center, 11 blocks south of the Bellevue Hospital Center emergency room, which was shuttered because of storm damage, the average number of visits to the E.R. per day has risen to record levels. Visits have increased by 24 percent this November compared with last, and the numbers show no sign of dropping. Hospital admissions have risen 12 percent compared with last November.

Most of the rise in volume is from patients who had never been to Beth Israel before. An emergency room doctor at the hospital described treating one patient who said he had been born at Bellevue and had never before gone anywhere else.

Emergency room visits have gone up 25 percent at NewYork-Presybterian/Weill Cornell, which in Bellevue’s absence is the closest high-level trauma center — treating stab wounds, gun wounds, people hit by cars and the like — in Manhattan from 68th Street south. Stretchers holding patients have been lined up like train cars around the nursing station and double-parked in front of stretcher bays.

In Brooklyn, some patients in Maimonides Medical Center’s emergency room who need to be admitted are waiting two or three days for a bed upstairs, instead of four or five hours. Almost every one of the additional 1,100 emergency patients this November compared with last November came from four ZIP codes affected by the storm and served by Coney Island Hospital, a public hospital that was closed because of storm damage.

The number of psychiatric emergency patients from those same ZIP codes has tripled, in a surge that began three days before the hurricane, perhaps fueled by anxiety, as well as by displacement from flooded adult homes or programs at Coney Island Hospital, doctors said.

The Maimonides psychiatric emergency room bought five captain’s beds — which do not have railings that can be used for suicide attempts — at a local furniture store, to accommodate extra patients. The regular emergency room had to buy 27 new stretchers after the hurricane, “and we probably need a few more,” the department’s chief, Dr. John Marshall, said.

The emergency room and inpatient operations of four hospitals remain closed because of flooding and storm damage. Besides Bellevue and Coney Island, NYU Langone Medical Center and the VA New York Harbor Healthcare System, both near Bellevue on the East Side of Manhattan, are closed.

While the surge in traffic to other hospitals has been a burden, it has also been a boon, bringing more revenue.

On the Upper East Side, the storm has helped Lenox Hill Hospital, which has a history of financial problems. It took two or three wards that had been turned into offices and converted them back to space for patients. Emergency room visits are up 10 percent, and surgery has been expanded to seven days a week from five.

“We usually operate at slightly over 300 beds, and now we’re at well over 550,” Carleigh Gustafson, director of emergency nursing, said.

Conversely, administrators at the shuttered hospitals, especially NYU Langone, a major teaching center, worry that their patients and doctors are being raided, with some never to return.

NYU’s salaried doctors are being paid through January, on the condition that they do not take another job. But at the same time, they need a place to practice, so NYU administrators have been arranging for them to work as far away as New Jersey until the hospital reopens. Lenox Hill alone has taken on close to 300 NYU doctors, about 600 nurses, and about 150 doctors in training, fellows and medical students.

Obstetricians and surgeons from the closed hospitals have been particularly disadvantaged, since they are dependent on hospitals to treat their patients. Many displaced surgeons have been reduced to treating only the most desperately ill, and operating on nights and weekends, when hospitals tend to be least well staffed.

“I think there’s no question that a lot of people have postponed anything that they can postpone that is elective,” said Dr. Andrew W. Brotman, senior vice president at NYU.

In mid-November, Dr. Michael L. Brodman, chairman of obstetrics at Mount Sinai Medical Center, sent out a memo saying his department had taken on 26 NYU physicians, as well as nurses and residents, but “clearly, that is too much for us to handle long term.”

Since then, 15 of the physicians have gone to New York Downtown Hospital, while Mount Sinai has retained 11 doctors and 26 nurses.

“We are guests in other people’s homes,” Dr. Brotman of NYU said, “and we are guests who have to some degree overstayed their welcome.”

Joanna Walters contributed reporting.

Read More..

Software Programs Help Doctors Diagnose, but Can’t Replace Them

SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.

At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.

Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice today.

The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.

To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.

Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?

The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.

And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.

In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.

Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.

Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.

Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.

When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.

Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”

He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”

Clinical Precision

Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.

One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.

There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.

“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.

Read More..

Syrian Government Beset by Battles and Diplomatic Setbacks

Narciso Contreras/Associated Press

A kitchen in a residence in Aleppo, Syria, damaged Sunday in fighting between Free Syrian Army fighters and government forces.

BEIRUT, Lebanon — Fierce fighting on the battlefield and setbacks on the diplomatic front increased pressure on the embattled Syrian government on Monday as fresh signs emerged of a worsening battle for control of the capital.

A senior Turkish official said that Russia had agreed on Monday to a new diplomatic approach that would seek ways to persuade President Bashar al-Assad to relinquish power, a possible weakening in Russia’s steadfast support for the government. Fighting raged around Damascus, the Syrian capital, and its airport, disrupting commercial flights for a fourth straight day.

A prominent Foreign Ministry spokesman was said to have left the country amid reports of his defection, and both President Obama and Secretary of State Hillary Rodham Clinton issued warnings that any use of chemical weapons by a desperate government would be met with a strong international response. A Western diplomat confirmed that there were grave concerns in United States intelligence circles that Syrian leaders could resort to the use of the weapons as their position deteriorates.

The Syrian Foreign Ministry, repeating earlier statements, told state television that the government “would not use chemical weapons, if it had them, against its own people under any circumstances.”

The United Nations said it was withdrawing nonessential international staff from Syria, and the European Union said it was reducing activities in Damascus “to a minimum,” as security forces pummeled the suburbs with artillery and airstrikes in a struggle to seal off the city from its restive outskirts and control the airport road. A senior Russian official spoke for the first time in detail about the possibility of evacuating Russian citizens.

Mr. Assad has held on longer than many had predicted at the start of the 21-month uprising. He still has a strong military advantage and undiminished support from his closest ally, Iran. Military analysts doubt the rebels are capable of taking Damascus by force, and one fighter interviewed on Monday said the government counteroffensive was inflicting heavy losses. There were still no firm indications from Russia that it was ready to join Turkey and Western nations in insisting on Mr. Assad’s immediate departure.

But the latest grim developments follow a week of events that suggested the Assad government was being forced to fight harder to keep its grip on power. Rebels threatened its vital control of the skies, using surface-to-air missiles to down a fighter plane and other aircraft. The opposition also gained control of strategic military bases and their arsenals, and forced the government to shut down the Damascus airport periodically. The Internet was off for two days.

A Russian political analyst with contacts at the Foreign Ministry said that “people sent by the Russian leadership” who had contact with Mr. Assad two weeks ago described a man who has lost all hope of victory or escape.

“His mood is that he will be killed anyway,” Fyodor Lukyanov, editor of a Russian foreign affairs journal and the head of an influential policy group, said in an interview in Moscow, adding that only an “extremely bold” diplomatic proposal could possibly convince Mr. Assad that he could leave power and survive.

“If he will try to go, to leave, to exit, he will be killed by his own people,” Mr. Lukyanov said, speculating that security forces dominated by Mr. Assad’s minority Alawite sect would not let him depart and leave them to face revenge. “If he stays, he will be killed by his opponents. He is in a trap. It is not about Russia or anybody else. It is about his physical survival.”

Many observers — United Nations personnel in Syria, Arab diplomats and opposition activists — stress that it is difficult to reliably assess the state of the government. But taken together, the day’s events suggested that the government’s position was declining more sharply than it had in months and that an international scramble to find a solution to the crisis was intensifying.

Nabil al-Araby, the head of the Arab League, said on Monday that the government could fall at “any time,” Agence France-Presse reported.

“I think there will be something soon,” he said. “Facts on the ground indicate very clearly now that the Syrian opposition is gaining, politically and militarily.”

The Arab League has long called for Mr. Assad to step down. But Russia, Mr. Assad’s most powerful ally, has held out the possibility of his staying in power during a transition, so the Russian government’s apparent shift of emphasis carried more weight.

Anne Barnard reported from Beirut, Lebanon, and Ellen Barry from Moscow. Reporting was contributed by Sebnem Arsu in Istanbul, Peter Baker in Washington, Hwaida Saad, Neil MacFarquhar and Hania Mourtada in Beirut and Christine Hauser in New York.

Read More..