Heavy Snow and Winds Batter Northeast

A powerful nor’easter swept fast and furiously across the Northeast on Saturday, dumping mountains of snow, forcing hundreds of motorists to abandon their cars at the height of the blizzard and knocking out power for hundreds of thousands of people.

Through the night, winds gusted with hurricane force strength in some places, downing powerlines and creating white-out conditions. More than three feet of snow fell in parts of Connecticut, and more than two feet were reported on Long Island and Massachusetts, with the storm still doing damage as day broke.

A state of emergency was declared in four states on Friday. The governor of Massachusetts banned travel on all roads as night fell, an order that remained in effect on Saturday. In Connecticut, where the governor had ordered no cars on state highways on Friday night, residents were told early Saturday morning to stay off all roads.

Still, whether by choice or necessity, hundreds of drivers tried to travel home and beat the storm as whipping winds created white-out conditions. On Long Island, the storm descending so quickly that hundreds were forced to abandon their cars on the highways and streets as roads became impassable.

Snowplow drivers worked furiously to clear roads, but the snow limited what they could do.

“It’s really hard right now, it’s wet, it’s heavy and it’s freezing, so everything is going slow,” said Jack Mandaneza, 31, as he took a break from plowing on the Long Island Expressway at the height of the storm.

Barbara Barkiano, 43, a housecleaner, tried to make her way along the highway behind the plows, but the snow snapped both windshield wipers on her Honda Civic hybrid.

“My knees are shaking,” she said stopping at a gas station to hand-scrape snow from her windshield. She added, “I’m going to stay right here for a while.”

The storm’s impact was felt by more than 40 million people, from northern New Jersey to Maine.

For many, the memory of Hurricane Sandy — and its terrible toll — was still fresh as they crowded supermarkets and supply stores to stock up as the stormed beared down on the region.

Long lines at gas stations, and scattered reports that places were running out of fuel led Mayor Michael R. Bloomberg of New York City to warn people not to “panic buy” gasoline.

The storm played out the way many forecasters said it would — with New York City spared from the worst of the storm, and points to the north and east hit harder.

In Central Park, a total snowfall of 11.4 inches was reported at 6 a.m., and the snowfall had ended by daybreak.

But people in Connecticut, Rhode Island and Massachusetts, as well as on Long Island, faced the prospect of a long weekend of digging out.

“We don’t have all the statistics in quite yet, but for some locations this is one for the record books,” said David Stark, a meteorologist at the National Weather Service based in Suffolk County Long Island.

With snow still falling, the Weather Service said they had reports out of New Haven County, in Connecticut, of more than three feet, including 36.2 inches in Oxford and 38 inches in Milford. In Commack, on Long Island, 29.1 inches of snowfall were reported at 6 a.m. and 27.5 inches at MacArthur Airport in Islip.

The deep snows and impassable roads will make it hard for utlitiy workers to restore power even as the storm abates.

There were 407,000 power failures reported in Massachusetts, and more than 180,000 were reported in Rhode Island. And the Pilgrim nuclear power plant in Plymouth, Mass., shut down because of the storm. On Long Island, about 10,000 customers were reported without power, the Long Island Power Authority said.

Marcy Reed, president of National Grid, said failures could last several days because repairs would not begin until the storm ended and would require unearthing power lines buried under mounds of snow.

Nate Schweber contributed reporting from Long Island.

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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John E. Karlin, 1918-2013: John E. Karlin, Who Led the Way to All-Digit Dialing, Dies at 94

Courtesy of Alcatel-Lucent USA

John E. Karlin, a researcher at Bell Labs, studied ways to make the telephone easier to use.

A generation ago, when the poetry of PEnnsylvania and BUtterfield was about to give way to telephone numbers in unpoetic strings, a critical question arose: Would people be able to remember all seven digits long enough to dial them?

And when, not long afterward, the dial gave way to push buttons, new questions arose: round buttons, or square? How big should they be? Most crucially, how should they be arrayed? In a circle? A rectangle? An arc?

For decades after World War II, these questions were studied by a group of social scientists and engineers in New Jersey led by one man, a Bell Labs industrial psychologist named John E. Karlin.

By all accounts a modest man despite his variegated accomplishments (he had a doctorate in mathematical psychology, was trained in electrical engineering and had been a professional violinist), Mr. Karlin, who died on Jan. 28, at 94, was virtually unknown to the general public.

But his research, along with that of his subordinates, quietly yet emphatically defined the experience of using the telephone in the mid-20th century and afterward, from ushering in all-digit dialing to casting the shape of the keypad on touch-tone phones. And that keypad, in turn, would inform the design of a spate of other everyday objects.

It is not so much that Mr. Karlin trained midcentury Americans how to use the telephone. It is, rather, that by studying the psychological capabilities and limitations of ordinary people, he trained the telephone, then a rapidly proliferating but still fairly novel technology, to assume optimal form for use by midcentury Americans.

“He was the one who introduced the notion that behavioral sciences could answer some questions about telephone design,” Ed Israelski, an engineer who worked under Mr. Karlin at Bell Labs in the 1970s, said in a telephone interview on Wednesday.

In 2013, the 50th anniversary of the introduction of the touch-tone phone, the answers to those questions remain palpable at the press of a button. The rectangular design of the keypad, the shape of its buttons and the position of the numbers — with “1-2-3” on the top row instead of the bottom, as on a calculator — all sprang from empirical research conducted or overseen by Mr. Karlin.

The legacy of that research now extends far beyond the telephone: the keypad design Mr. Karlin shepherded into being has become the international standard on objects as diverse as A.T.M.’s, gas pumps, door locks, vending machines and medical equipment.

Mr. Karlin, associated from 1945 until his retirement in 1977 with Bell Labs, headquartered in Murray Hill, N.J., was widely considered the father of human-factors engineering in American industry.

A branch of industrial psychology that combines experimentation, engineering and product design, human-factors engineering is concerned with easing the awkward, often ill-considered marriage between man and machine. In seeking to design and improve technology based on what its users are mentally capable of, the discipline is the cognitive counterpart of ergonomics.

“Human-factors studies are different from market research and other kinds of studies in that we observe people’s behavior and record it, systematically and without bias,” Mr. Israelski said. “The hallmark of human-factors studies is they involve the actual observation of people doing things.”

Among the issues Mr. Karlin examined as the head of Bell Labs’ Human Factors Engineering department — the first department of its kind at an American company — were the optimal length for a phone cord (a study that involved gentle, successful sabotage) and the means by which rotary calls could be made efficiently after the numbers were moved from inside the finger holes, where they had nestled companionably for years, to the rim outside the dial.

John Elias Karlin was born in Johannesburg on Feb. 28, 1918, and reared nearby in Germiston, where his parents owned a grocery store and tearoom.

He earned a bachelor’s degree in philosophy, psychology and music, and a master’s degree in psychology, both from the University of Cape Town. Throughout his studies he was a violinist in the Cape Town Symphony Orchestra and the Cape Town String Quartet.

Moving to the United States, Mr. Karlin earned a Ph.D. from the University of Chicago in 1942. Afterward, he became a research associate at Harvard; he also studied electrical engineering there and at the Massachusetts Institute of Technology.

At Harvard, Mr. Karlin did research for the United States military on problems in psychoacoustics that were vital to the war effort — studying the ways, for instance, in which a bomber’s engine noise might distract its crew from their duties.

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Flights and Trains Canceled as Storm Heads to Northeast

Richard Perry/The New York Times

In Jersey City, Jose Angelo, left, helped Isauro Palacios, a contractor from Belleville, N.J., as he loaded a new snow blower into the back of his truck Thursday as a snowstorm approached the region.

As heavy, wet snow started to blanket much of the Northeast on Friday morning, people rushed to stores to stock up on supplies, drivers lined up at gas stations to fill their tanks and local authorities from New York City to Maine started working to battle what forecasters said could be the biggest blizzard for some cities in a century.

National Weather Service

A satellite image taken at 10:15 p.m. Eastern time Thursday. Areas in blue indicate colder cloud tops or deeper cloud cover. The system over the Midwest and the system spread across the East are expected to merge on Friday.

Throughout the night and into the morning airlines announced the suspension of thousands of flights out of New York and Boston airports , as thousands of workers readied their plows, checked their stocks of salt and braced for what will most likely be a cold and busy weekend. Amtrak announced that it would suspend northbound service out of Penn Station in New York and southbound service out of Boston beginning early Friday afternoon.

Schools across New York, Connecticut, Massachusetts and Rhode Island announced they would close, or dismiss students early on Friday.

On Long Island, where some forecasts said there could be more than 18 inches of snow, the power company, which has received heavy criticism for its response to Hurricane Sandy, promised customers that they were prepared.

The city of Boston, where forecasts called for more than two feet of snow to fall by Saturday, announced that it would close all schools on Friday, joining other localities in trying to get ahead of the storm and keep people off the roads.

“We are taking this storm very seriously and you should take this storm very seriously,” said Jerome Hauer, the New York State Commissioner of the Division of Homeland Security and Emergency Services, at an afternoon news conference.

“If you don’t have to go to work tomorrow, we suggest that you do not,” he said. “If you do, we suggest that you plan for an early departure.”

The latest forecasts, he said, called for between 12 and 20 inches of snow in the New York City region and wind gusts that could exceed 60 miles per hour.

However, with the storm still some distance away, forecasters warned that predictions could change. The first sign of the storm will be a dusting of light snow that is expected to start falling across the region Friday morning.

At some point Friday night, the arctic jet stream will drop down from Canada and intersect with the polar jet stream, which usually travels through the lower 48 states.

“They will cross somewhere between New Jersey and Nantucket,” said Tim Morrin, a meteorologist at the National Weather Service. “That is where the center of the storm will deepen and explosively develop.”

If the current models hold, the storm could rival the blizzard of 1978 in New England, when more than 27 inches of snow fell in Boston and surrounding cities. That storm, which occurred on a weekday, resulted in dozens of deaths and crippled the region for days.

Peter Judge, a spokesman for the Massachusetts Emergency Management Agency, said more than 20 agencies had gathered at the agency’s operations center in Framingham, Mass., where they were preparing for a historic storm.

“From our perspective, this is a very severe, blizzard-type storm that we haven’t had for quite a long time,” Mr. Judge said. “Worst-case scenario, this will be the worst one that we’ve dealt with in many, many years. I can’t even come up with something comparable.”

Officials prepared for debris management, snow removal and supplies distribution, he said, as well as widespread power failures, which he said were the major concern. “People will lose their heat when they lose their power, and they’re certainly much more in harm’s way than at other times of the year,” he said.

Boston was bracing for the worst of the storm to hit between 2 and 5 p.m. Friday. Gov. Deval Patrick, who called the pending storm “a serious weather event,” has ordered all nonemergency personnel to work from home Friday and encouraged private employers to keep their workers home.

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Alicia Keys, Bobby Brown perform at Will.i.am show

LOS ANGELES (AP) — Fergie may have been absent — but the Black Eyed Peas were joined by another female diva onstage: Alicia Keys.

Keys sang "Where Is the Love" with the pop-rap group at will.i.am's charity event Thursday night at The Avalon Hollywood in Los Angeles. British singer Estelle also sang Fergie's portion of "The Time (Dirty Bit)."

Will.i.am's TRANS4M benefit show — which assists his i.am.angel foundation — also featured Bobby Brown and Ludacris, who both earned roaring cheers from the crowd of several hundred.

Will.i.am. said at the end of the evening that he raised $3.3 million.

"We're having fun, but we're also collecting funds," he told the crowd.

Will.i.am introduced Grammy-winning Keys to the audience saying: "Are you ready for a strong woman?"

The R&B singer performed "Girl on Fire" and "Try Sleeping With a Broken Heart."

Brown sang his jams "Every Little Step" and "Tenderoni." He performed at the same event in 2011, as will.i.am and Taboo of the Peas worked as his background dancers. They did the same Thursday night.

He told will.i.am in between his set that he was proud of the musician and his charity work.

The Peas closed the night with the massive hit "I Gotta Feeling."

___

Online:

http://iamangelfoundation.org .

___

Follow Mesfin Fekadu on twitter.com/MusicMesfin

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The New Old Age Blog: The Executor's Assistant

I’m serving as executor for my father’s estate, a role few of us are prepared for until we’re playing it, so I was grateful when the mail brought “The American Bar Association Guide to Wills and Estates” — the fourth edition of a handbook the A.B.A. began publishing in 1995.

This is a legal universe, I’m learning, in which every step — even with a small, simple estate that owes no taxes and includes no real estate or trusts — turns out to be at least 30 percent more complicated than expected.

If my dad had been wealthy or owned a business, or if we faced a challenge to his will, I would have turned the whole matter over to an estate lawyer by now. But even then, it would be helpful to know what the lawyer was talking about. The A.B.A. guide would help.

Written with surprising clarity (hey, they’re lawyers), it maps out all kinds of questions and decisions to consider and explains the many ways to leave property to one’s heirs. Updated from the third edition in 2009, the guide not only talks taxes and trusts, but also offers counsel for same-sex couples and unconventional families.

If you want to permit your second husband to live in the family home until he dies, but then guarantee that the house reverts to the children of your first marriage, the guide tells you how a “life estate” works. It explains what is taxable and what isn’t, and discusses how to choose executors and trustees. It lists lots of resources and concludes with an estate-planning checklist.

In general, the A.B.A. intends its guide for the person trying to put his or her affairs in order, more than for family members trying to figure out how to proceed after someone has died. But many of us will play both these parts at some point (and if you are already an executor, or have been, please tell us how that has gone, and mention your state). We’ll need this information.

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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Chinese Imports and Exports Soar in January

HONG KONG — January trade data from China on Friday showed a surge in exports and imports from the levels of a year earlier — a phenomenon largely due to the timing of the Lunar New Year holiday but also supporting the view that the Chinese economy is firming up.

Economic data from China are often severely distorted by the holiday, when many factories shut down for a week or more.

The holiday this year takes place in February — the first day of the Lunar New Year is Sunday. Last year it fell squarely in January, cutting down on the number of working days during that month.

The trade data released Friday reflected this with a large increase, compared with the year before, as analysts had expected. Exports climbed 25 percent from January 2012, according to the General Administration of Customs, and imports rose 28.8 percent.

The increases were much lower when adjusted for the holiday-induced differences in the number of working days, with exports up 12.4 percent and imports just 3.4 percent higher.

Still, the data beat expectations by a wide margin, supporting the view that healthier domestic and overseas demand also had been significant.

“This strong export number cannot be fully explained by the Chinese New Year effect alone,” Zhiwei Zhang, chief China economist at Nomura in Hong Kong, said in a research note. “These data suggest that external and domestic demand are both strong, which supports our view that the economy is on track for a cyclical recovery” in the first half of this year, he added.

Dariusz Kowalczyk, an economist at Crédit Agricole in Hong Kong, said, “We need to wait for February results to have the full picture of trade at the start of 2013.” However, he added, “one trend is clear: exports have been doing very well recently. This may be a sign of improved external demand but is also a testimony to the resilience of Chinese exporters and to their competitiveness.”

Improved overseas demand and a string of government-mandated stimulus measures have gradually propped up growth and dispelled fears of a hard landing in China. While the Chinese economy expanded just 7.8 percent last year — down from 9.3 percent in 2011 and 10.4 percent in 2010 — many analysts expect growth to top 8 percent again in 2013.

Central bank data Friday that showed ample money had continued to flood into the economy also supported this view. Banks extended 1.07 trillion renminbi, or $172 billion, in new loans during January, more than analysts had expected. Total “social financing aggregate” in the economy, a broad measure of liquidity, or the ease of trading assets, more than doubled from a year earlier, to 2.54 trillion renminbi.

That figure, Mr. Kowalczyk commented, was a “blowout number.”

Like other data released Friday, the financing figure was lifted by the Lunar New Year effects, but even without these, Mr. Kowalczyk said, it was a “huge amount of funding” and would sustain solid economic growth in the near term at least.

Longer term, he cautioned, it would also “stoke inflationary pressures,” and could lead the central bank to tighten monetary policy further down the line as it seeks to stave off inflationary pressures.

For now, inflation remains benign. Consumer prices rose just 2 percent in January from a year earlier, a moderation from the 2.5 percent year-on-year increase in December. The low inflation number, released Friday, was in line with forecasts, but analysts widely expect a rebound in February.

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European Central Bank Leaves Interest Rate Unchanged

FRANKFURT — The European Central Bank left its main interest rate unchanged at its current record low Thursday, as expected, amid signs that the euro zone economy could be crawling out of recession.

The E.C.B. left its main rate at 0.75 percent, where it has been since July. Recent surveys of business sentiment have raised expectations that the euro zone could be slowly recovering, although there is also concern that the rising value of the euro against the dollar could undercut the fragile gains.

Recent data have supported the E.C.B. view that the euro zone will emerge from recession later this year. New orders to German industry rose 0.8 percent in the fourth quarter of 2012.

But the recovery is threatened by the rising value of the common currency, which could hurt exports by making euro zone products more expensive for foreign buyers. In recent weeks, the euro has risen substantially against the dollar, to the highest levels in a year.

Few analysts had expected the E.C.B. to shift its monetary policy Thursday. Some predict that the benchmark rate could stay at its present level for an extended period as the euro zone slowly returns to growth.

“We expect interest rates to be on hold at 0.75 percent until 2017 and only significant changes in the economic environment would trigger a change one way or the other,” Marie Diron, senior economic adviser to the consulting firm Ernst & Young, said in an e-mail before the decision.

Although there was no change in rates, the E.C.B. news conference later Thursday afternoon could prove eventful. Mario Draghi, the E.C.B. president, is likely to face questions about whether the bank will respond to the appreciation of the euro, which was up again midday Thursday, to nearly $1.36. Back in July it was trading just above $1.21.

A stronger euro means that products ranging from cars to wine become more expensive abroad, putting European producers at a disadvantage to foreign competitors.

Analysts do not expect Mr. Draghi to take steps to devalue the euro, but he could remind his counterparts at other central banks outside the euro zone of their promise not to start a currency war. If the value of one currency goes up, another currency must come down, making exchange-rate manipulation by central banks a zero-sum game that economists believe is counterproductive.

Mr. Draghi is also likely to face numerous questions about problems at the Italian bank Monte dei Paschi di Siena, which has required a €3.9 billion bailout by the Italian government. Mr. Draghi was governor of the Bank of Italy, responsible for bank supervision, during the period when Monte dei Paschi was getting in trouble several years ago.

Mr. Draghi’s supporters have pointed out that there was a deliberate attempt by that bank’s previous management to conceal the extent of their losses, and that the Bank of Italy did not have the authority to prevent Monte dei Paschi managers from making foolish decisions. Part of the bank’s problems stem from its acquisition of regional bank Antonveneta in 2008 for €9 billion, a price considered much too high even at the time.

But at the very least, the case of Monte dei Paschi has illustrated the limits of bank supervision, and called into question whether the E.C.B. will be able to do a better job than national supervisors when it begins assuming supreme regulatory authority over banks in the course of this year.

The problems at Monti dei Paschi bank have also been exploited by Silvio Berlusconi, the former prime minister of Italy, as he attempts a comeback in elections at the end of this month. Mr. Berlusconi has run a populist campaign promising to undo some of the economic changes made by his successor, Mario Monti.

Italian politics aside, international investors are concerned about the new jitters the debacle could create in euro zone bond markets, which have calmed considerably lately.

“A government may well be formed on a platform that rejects some, if not most, of the Monti government’s fiscal reforms,” Carl Weinberg, chief economist at High Frequency Economics in Valhalla, New York, wrote in a note to clients Wednesday. “As uncertainty grows, the bond markets are becoming increasingly unsettled.”

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Selena Gomez works the front row at Neo show

NEW YORK (AP) — Selena Gomez sat front and center at the fashion show to preview the first collection in her collaboration with Adidas' streetwear Neo label.

But the runway at Wednesday evening's show was a next-gen catwalk: Teenager bloggers were charged with styling the outfits instead of industry professionals.

Gomez thanked them as she stood on stage at the end of the show. She was flanked by models in denim shorts, Bermudas, slouchy sweats and T-shirts that read "Pirate Love." There were a few graffiti prints sprinkled in, and some varsity jackets.

The clothes, mostly in sunny yellow, bright pink and navy, were more surf than sport, which is Adidas' normal niche.

The show was very briefly interrupted by a protester trying to hand out leaflets about sweatshops.

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

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

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

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

The Presenting Problem:

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

The Patient’s Story:

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

A Sister’s Visit:

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

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

His 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.

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

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DealBook: Ireland to Liquidate Anglo Irish Bank

LONDON – The Irish government passed emergency legislation on Thursday to liquidate Anglo Irish Bank, one of the country’s largest financial institutions.

The legislation, which was signed into law after an all-night parliamentary session, came after negotiations with the European Central Bank over swapping so-called promissory notes, which were used to bail out the Irish lender in 2009, for long-term government bonds.

The move is an effort to reduce Ireland’s debt repayments at a time when the country is still struggling under a cloud of austerity measures and meager economic growth.

The Irish Parliament rushed through the legislation to liquidate Anglo Irish, which was renamed Irish Bank Resolution Corporation after its failure and bailout, because details of the debt-restructuring plan leaked on Wednesday. Politicians had hoped to announce the deal after agreeing on new terms with the European Central Bank.

“I would have preferred to be introducing this bill in tandem with a finalized agreement with the European Central Bank,” the Irish finance minister, Michael Noonan, said in a statement.

The European Central Bank is considering the country’s latest proposals on Thursday, though European policy makers are concerned that a deal with Ireland could set a precedent for other indebted countries, like Spain, whose local banks also are facing mountains of debt.

As part of the deal to save Anglo Irish, Dublin injected more than 30 billion euros ($41 billion) into the local lender, of which around 28 billion euros is still outstanding.

The bailout has saddled the government with 3.1 billion euros in annual interest payments, or roughly the same amount Irish politicians have said they would cut in yearly government spending to reduce the country’s debt levels. The local government has been eager to reduce that multibillion-euro figure by swapping the high-interest debt into long-term government bonds that can be repaid over a longer period.

Ireland racked up huge debts in bailing out Anglo Irish and the rest of the country’s financial industry, eventually requiring a rescue package of 67.5 billion euros from the European Union and the International Monetary Fund in 2010. The authorities have demanded that Irish politicians slash government spending to reduce the country’s debt burden.

Confusion reigned on Thursday at Anglo Irish’s headquarters in Dublin, a day after employees were sent home early in preparation for the government-mandated liquidation.

Some staff members had returned to work, but the atmosphere remained tense, according to a person with direct knowledge of the matter, who spoke on condition of anonymity because he was not authorized to speak publicly.

“People have been told it’s business as usual, but it’s anything but that,” the person said.

The accounting firm KPMG has been appointed to oversee the liquidation.

Under the terms of the liquidation, Anglo Irish’s assets will be transferred to the National Asset Management Agency, the so-called bad bank set up by the government, or sold to outside investors.

Anglo Irish has been at the center of controversy since the beginning of the financial crisis. Three of its former executives, including its former chief executive, Sean FitzPatrick, are facing fraud charges in connection with loans that were improperly administered.

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Postal Service to Cut Saturday Mail to Trim Costs

WASHINGTON (AP) — The U.S. Postal Service will stop delivering mail on Saturdays but continue to deliver packages six days a week under a plan aimed at saving about $2 billion, the financially struggling agency says.

In an announcement scheduled for later Wednesday, the service is expected to say the Saturday mail cutback would begin in August.

The move accentuates one of the agency's strong points — package delivery has increased by 14 percent since 2010, officials say, while the delivery of letters and other mail has declined with the increasing use of email and other Internet use.

Under the new plan, mail would still be delivered to post office boxes on Saturdays. Post offices now open on Saturdays would remain open on Saturdays.

Over the past several years, the Postal Service has advocated shifting to a five-day delivery schedule for mail and packages — and it repeatedly but unsuccessfully appealed to Congress to approve the move. Though an independent agency, the service gets no tax dollars for its day-to-day operations but is subject to congressional control.

It was not immediately clear how the service could eliminate Saturday mail without congressional approval.

But the agency clearly thinks it has a majority of the American public on its side regarding the change.

Material prepared for the Wednesday press conference by Patrick R. Donahoe, postmaster general and CEO, says Postal Service market research and other research has indicated that nearly 7 in 10 Americans support the switch to five-day delivery as a way for the Postal Service to reduce costs.

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Disney working on stand-alone 'Star Wars' films

LOS ANGELES (AP) — Disney is mining The Force for even more new films.

Walt Disney Co. CEO Bob Iger said Tuesday that screenwriters Larry Kasdan and Simon Kinberg are working on stand-alone "Star Wars" movies that aren't part of the new trilogy that's in the works.

"There has been speculation about some standalone films that have been in development, and I can confirm to you today that in fact we are working on a few stand-alone films," Iger told CNBC.

Iger said the movies would be based on "great 'Star Wars' characters that are not part of the overall saga." The films would be released during the six-year period of the new trilogy, which starts in 2015 with "Star Wars: Episode VII."

Disney confirmed last month that "Star Trek" director J.J. Abrams will direct the seventh installment of the "Star Wars" saga.

Disney bought "Star Wars" maker Lucasfilm last year for more than $4 billion.

The last "Star Wars" trilogy, a prequel to the original films, was released from 1999 to 2005.

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Online:

http://www.starwars.com/

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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.

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DealBook: Debevoise & Plimpton Drops Trusts and Estates Practice

Last month, the nation’s leading trusts and estates lawyers convened at a Florida resort to discuss the latest in estate planning.

Between lectures and workshops, some of the lawyers exchanged whispers about an unsettling piece of gossip: Debevoise & Plimpton, the prominent white-shoe law firm, was eliminating its trusts and estates practice.

Debevoise’s decision surprised members of the trusts and estates bar. If an institution as prestigious and financially sound as Debevoise was abandoning its practice, were they vulnerable too?

The news also raised eyebrows across the legal industry because it seemed to run counter to Debevoise’s reputation for a strong partnership culture. At a time when many large law firms have discarded the traditional partnership model and embraced a more bottom-line approach, Debevoise has been seen as retaining an old-school ethos — a genteel law firm known for its camaraderie and decency.

“It saddens me to see a great law firm terminate its estates department,” said William D. Zabel, a partner at Schulte Roth & Zabel and one of the country’s leading trusts and estates lawyers. “Although I don’t know the reasons for this decision, it would seem to be a byproduct of the economics of our society, making the law into more of a business than a profession. That saddens me even more.”

In a statement, Michael W. Blair, Debevoise’s presiding partner, confirmed that it was jettisoning trusts and estates, and that the group’s eight lawyers — including Jonathan J. Rikoon, the partner in charge of the practice — were trying to find another home.

“Debevoise supports the group in this process and will work to ensure that in this transition the needs of the firm’s clients continue to be served,” he said.

New York-based Debevoise is the latest big corporate law firm to discontinue the practice. In 2011, Weil, Gotshal & Manges, a 1,200-lawyer firm, got out of trusts and estates, deciding it did not fit the firm’s business model. Another firm, Gibson Dunn & Crutcher, with 1,100 lawyers, ended its trusts and estates practice about a decade ago.

Corporate law firms once viewed trusts and estates as a small yet important practice that discreetly advised wealthy families. But drafting wills and trusts, and the legal matters that flow from that, is less lucrative than the primary revenue drivers at big law firms: multibillion-dollar corporate transactions and high-stakes litigation.

And there are problems with trusts and estates within a big law firm model. The practice, to use the law firm management parlance, is not as leverageable as other areas. Corporate and litigation partners generate big fees by assigning armies of junior lawyers to megamergers and complex lawsuits. By comparison, trusts and estates work requires far less manpower, which mean far less profit.

Another issue in sustaining these departments is that individual clients bristle at billable rates that now reach more than $1,000 an hour. While big corporations grudgingly pay those rates, wealthy families often resist them.

As a result of these dynamics, firms’ trusts and estates practices have remained small and, in many cases, decreased. At the same time, firms have aggressively built up their corporate and litigation practices across the globe. They have also embraced hot, moneymaking practice areas like patent law and white-collar criminal defense.

There are some counterexamples to this trend, however. In 2011, seven trusts and estates lawyers from Weil, led by Carlyn S. McCaffrey, moved to McDermott Will & Emery, a firm with about 65 trusts and estates lawyers, one of the larger such practices. Another firm committed to trusts and estates is Katten, which has more than 50 lawyers in the group.

Joshua S. Rubenstein, the head of Katten’s trusts and estates practice, said that his business went well beyond comforting bereaved spouses and children. A successful practice, he said, includes assignments like advising families in the sale of closely held companies, overseeing trust-related litigation or even assisting in the purchase of a yacht or private jet.

“If done right, a full-service, high-end trusts and estates practice can generate a lot of work for other areas of the firm,” Mr. Rubenstein said.

As large firms have de-emphasized their trusts and estates practices, boutiques have sprouted up. Sanford J. Schlesinger, a former partner at the New York corporate firm Kaye Scholer, left in 2004 along with several colleagues to set up an 11-lawyer shop, Schlesinger Gannon & Lazetera.

Mr. Schlesinger lamented the demise of the practice at big firms, and said he thought they were missing a business opportunity.

“Families are going to pass more wealth in the next 10 years than in the history of humankind, and someone is going to have to shepherd that wealth transfer,” he said. “These firms are making a shortsighted, profit-driven decision without a view of the long-term big picture.”

Debevoise, started in 1931 by two young patrician lawyers, Eli Whitney Debevoise and William E. Stevenson, does not see it that way. Three decades ago, the firm’s trusts and estates practice had six partners, including Barbara Paul Robinson, now retired and a former president of the New York City Bar Association, and Theodore A. Kurz, the former head of the department. Today, there is only one, Mr. Rikoon, 57, who declined to comment for this article.

The firm formed a committee to study its trusts and estates practice, which has advised families like the Lauders (cosmetics) and the Dolans (cable television), according to people with direct knowledge of the group. After concluding that the practice did not have enough business to expand, the committee recommended closing it down. The firm will continue to employ Mr. Rikoon and the seven other lawyers while they interview elsewhere, these people said.

One factor contributing to Debevoise’s move to discontinue the group, people say, is its unusual lock-step compensation system, which pays partners in a narrow range strictly according to seniority. That means that Mr. Rikoon is paid on par with a star deal maker from the same law school year, while bringing in less business. This created some discord in the partnership ranks. Debevoise’s profits per partner are $2.1 million, according to The American Lawyer magazine.

Debevoise, with 650 lawyers, recently made headlines away from trusts and estates. The firm advised a special committee of Dell’s board on the $24 billion leveraged buyout of the computer company. And President Obama nominated the Debevoise partner Mary Jo White to run the Securities and Exchange Commission.

Stephen J. Friedman, a onetime Debevoise partner who is now president of Pace University, said that he was unaware of the facts involved in his former firm’s decision to close the trusts and estates practice, but noted that organizations are often faced with business realities that require painful choices.

“It’s sometimes necessary to make a decision that’s in the best interest of the firm but can hurt individual partners and associates,” he said. “That’s not a happy experience, but it’s sometimes the right thing to do.”

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Iran Nuclear Talks to Resume This Month

LONDON – Breaking a deadlock over the location and timing of new talks on its disputed nuclear program, Iran reached agreement on Tuesday with world powers to resume the stuttering dialog later this month in Kazakhstan, according to the official IRNA news agency.

The agreement to meet there on Feb. 26 came in a telephone conversation between senior officials of Iran’s National Security Council and the European Union, representing the outside powers involved in the talks, IRNA said.

The news agency report followed remarks by Iran’s foreign minister, Ali Akbar Salehi, who said on Sunday that his country was open to a renewed offer of direct talks with the United States on its nuclear program and that it looked favorably on a proposal for a new round of multilateral nuclear negotiations in late February in Kazakhstan.

IRNA did not immediately allude to the prospect of direct talks with the United States. Vice President Joseph R. Biden Jr. offered such discussions last weekend in what Mr. Salehi described as “a step forward.” 

Iranian negotiators last met with the outside powers – the United States, Russia, China, France, Britain and Germany – for high-level talks in Moscow last June. The powers are represented by the European Union foreign policy chief, Catherine Ashton, who had suggested resumed talks on Feb. 25 to 26 in Kazakhstan.

In Moscow, Iran demanded the lifting of ever-tightening international economic sanctions as a precondition for discussions about reducing or eliminating its growing inventory of enriched uranium.

But the outside powers want Iran to suspend its enrichment program and satisfy the International Atomic Energy Agency, the United Nations nuclear watchdog, that it does not have a nuclear weapons program.

Iran denies Western accusations that its nuclear program is designed to provide access to the technology for nuclear weapons.

The Moscow talks ended in such mistrust and frustration that the negotiators did not commit to another high-level encounter.

Last week Iran told the I.A.E.A. at its headquarters in Vienna that it plans to install more sophisticated centrifuges at its principal nuclear enrichment plant at Natanz, enabling it to greatly accelerate processing of uranium.

Steven Erlanger contributed reporting from Paris.

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NJ Gov. Christie, Letterman laugh about fat jokes

TRENTON, N.J. (AP) — New Jersey Gov. Chris Christie and David Letterman have shared some laughs about the many fat jokes the comedian has made about the lawmaker's ample girth.

Christie has termed his plumpness "fair game" for comedians. And during his first appearance on "Late Show with David Letterman" on Monday, the outspoken Republican and potential 2016 presidential contender read two of Letterman's jokes that he said were "some of my personal favorites."

The governor also drew loud laughs when he pulled out a doughnut and started eating it while Letterman asked him if he was bothered by the digs that have been made about his weight. Christie said he wasn't, noting that he laughs at the jokes if he finds them funny.

"Late Show" airs on CBS at 11:35 p.m. Eastern time.

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The New Old Age Blog: In Blended Families, Responsibility Blurs

Every year, Fran McDowell waited for the summer week when she would sing in a choral festival in the North Carolina mountains, then spend a few days in a lakeside cabin with close women friends.

That getaway grew more complicated to arrange — but perhaps more necessary — after her husband, Herb Beadle, was diagnosed with Alzheimer’s disease. They had a “gloriously happy” marriage — her first, his second — for 11 years, and she was more than willing to care for him in sickness as in health. But he could no longer manage alone in their Atlanta home.

For a few years, other family members pitched in to allow Ms. McDowell her cherished vacation. Eventually, though, she had to ask her husband’s daughter, a medical professional in another state, to take him into her home for a week.

She said no, then yes. Then, the day before Ms. McDowell was to drive him there, her stepdaughter again refused, leaving no time for alternate arrangements. If this had been her biological child, “I would have said, ‘Come on, don’t do this to me,’” Ms. McDowell said. Instead, reluctant to make waves, she canceled her trip.

“I think confrontation is riskier for stepparents,” she told me. “I was the compliant one who would bite my tongue rather than say what I thought.”

Ms. McDowell never told her stepdaughter, or anyone in the family, how angry and disappointed she was, or how difficult it was becoming to care for their father, who died three years ago at 86. She told the members of her dementia caregivers support group instead.

It was that group’s leader, Moira Keller, who e-mailed me to suggest this topic. A clinical social worker with the Sixty Plus program at Piedmont Atlanta Hospital, she wrote that “one of the biggest challenges I have is blended families in later life.”

Though I’ve written about the way the 1970s’ spike in divorces could complicate caregiving for adult children — more households to sustain, more siblings to either help or hinder — I hadn’t considered the impact on the older people themselves.

But Ms. Keller seems to be onto something. “The generation most likely to have stepchildren” — the boomers — “don’t need much care yet,” said Merril Silverstein, a Syracuse University sociologist co-editing a coming issue of the Journal of Marriage and the Family on stepfamilies in later life. “The crunch will come in 10 or 20 years.”

Initially, many adult children whose divorced or widowed parents remarry seem delighted, Ms. Keller said when we spoke. “They’re thrilled that Mom or Dad isn’t alone,” she said. “It’s a wonderful thing — until somebody gets sick.”

Then, she has found, “it gets really blurry. Who’s going to do what?” Grown children don’t have much history with these new spouses; they often feel less responsibility to intervene or help out, and stepparents may be unwilling to ask. Perhaps it’s unclear whether children or new spouses have decision-making authority.

“Older couples in this situation fall through the cracks,” Ms. Keller said.

Research shows that the ties which lead adult children to become caregivers — depending on how much contact they have with parents, how nearby they live, how obligated they feel — are weaker in stepchildren, Dr. Silverstein said. Money sometimes enters the equation too, Ms. Keller added, if biological children resent a parent’s spending their presumed inheritance on care for an ailing stepparent.

Adela Betsill, another of Ms. Keller’s support group members, married her longtime partner five years ago — her second marriage, his third. She has since given up her interior design business to care for Robert who, at 72, has also developed Alzheimer’s disease. His two children have had little involvement — perhaps because she’s just 49 and presumed able to handle everything.

Thus, though Robert’s son works from an office in their home, if Ms. Betsill needed to go out and asked him to remind his father to eat lunch, “he might, or he might not,” she said. “I don’t think he realizes it’s a burden.” So she has not asked.

Would it be different if she were his biological mother and he saw her wearing out under the strain? She thinks so, but it’s hard to know. After all, biological families also experience plenty of conflict and avoidance as elders age.

Still, that sense of reciprocity we often hear from caregivers — she took care of me when I was young, so I need to help out now that she’s old — doesn’t apply in late-life stepfamilies. Ms. Betsill didn’t raise this man, or his half sister.

Older couples who marry or remarry often discuss their finances, Ms. Keller has found. (An elder attorney, Craig Reaves, discussed the legal consequences here.) But illness and dependence may prove even more difficult subjects to broach.

“If I could yell one thing from a mountaintop,” Ms. Keller said, “it’s to talk about this stuff, too. Who’s going to take care of you if you become sick? Talk about that while you’re still healthy.”

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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DealBook: Liberty Global in Talks to Buy Virgin Media

6:59 a.m. | Updated

LONDON – Liberty Global, the international cable company owned by the American billionaire John C. Malone, is in discussions to buy the British cable company Virgin Media.

In a brief statement on Tuesday, Virgin Media said it was in talks with Liberty Global, which serves almost 20 million customers worldwide.

“Any such transaction would be subject to regulatory and other conditions,” Virgin Media said in a statement. Spokesmen for both Virgin Media and Liberty Global declined to comment further.

Shares in Virgin Media, which was formed through several mergers of small British cable companies and a cellphone company in the 2000s, rose more than 15 percent in morning trading in London on Tuesday.

The company’s current market capitalization stands at $10.4 billion. Including debt, Virgin Media’s enterprise value is around $19.4 billion, according to data from Thomson Reuters.

To secure a deal, analysts at Espirito Santo said Liberty Global may have to pay as much as $24 billion, though they questioned whether the international cable company could afford to fund the acquisition because of its existing high levels of debt.

The analysts added that it would be difficult for Liberty Global to make costs savings between its current European operations and those of Virgin Media.

“A bid from Liberty would not offer any in-market synergies but would add to the company’s scale on a European basis,” Espirito Santo analysts said in a note to investors on Tuesday.

Virgin Media’s share price has jumped almost 60 percent in the last 12 months, as more consumers sign up for so-called bundled services, including Internet and cellphone contracts.

The cable company, whose primary listing is on Nasdaq, is the second-largest pay-TV provider in Britain after BSkyB, which is partly owned by Rupert Murdoch‘s News Corporation.

The British billionaire Richard Branson, whose Virgin brand is now used for a variety of products and services, including airlines and banks, owns less than 3 percent of Virgin Media.

While the British cable operator has been picking up market share, the company currently has 4.9 million customers, or roughly half the number of subscribers as its larger rival, BskyB, according to filings from the companies.

A potential deal for Virgin Media would put Mr. Malone head-to-head with Mr. Murdoch, his longtime rival.

In 2008, the Liberty Group, which has operations in 13 countries, completed its purchase of a controlling stake in DirecTV, the satellite television provider, from News Corporation in a cash-and-equity deal worth roughly $11 billion.

The deal came after Mr. Malone’s purchase of a 16 percent stake in News Corporation, which he then traded for the satellite television operator, a number of regional sports networks and around $550 million cash.

Liberty Global has been expanding its presence in Europe and has operations from Ireland to Romania, though it failed last month in its bid to acquire the Belgian telecommunications company Telenet Group for $2.7 billion. Liberty Global currently owns a 58 percent stake in Telenet.

In August, Liberty Media, the media conglomerate also controlled by Mr. Malone, agreed to buy a stake in Barnes & Noble for $204 million, but declined to buy the bookseller outright.

The move disappointed some investors after Liberty had earlier offered to buy a 70 percent stake of Barnes & Noble for $17 a share if its chairman, Leonard S. Riggio, who owns around 30 percent of the company, agreed to the deal.

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Bolshoi Ballet Director Says He Knows Who Attacked Him

MOSCOW – Bolshoi Ballet artistic director Sergei Filin, who was severely burned by an acid attack on Jan. 17, said he believes he may have been targeted by a group of people who hoped to replace the theater’s current leadership, and who had previously attacked another top executive at the ballet, prompting him to leave his post in 2011.

Mr. Filin, who left Russia for a clinic in Germany on Monday for a rehabilitation that may last for months, made the comments in a telephone interview with the New York Times.He has said he knows who is behind the attack, but that he would not offer further details for fear of interfering with the investigation. A police spokesman told Interfax on Monday that the names of suspects in the attack would be made public only after they have been detained and indicted.

Mr. Filin said he stepped into a pre-existing power struggle in March of 2011, when he accepted the position of artistic director at the Bolshoi Ballet, which is the world’s largest ballet company. That same month, Gennady Yanin – who occupied the more managerial post of the company’s director – filed for voluntary leave after erotic photographs featuring a man resembling him were published on the Internet.

“From the first day of work, when I arrived, I immediately felt that those things that happened with Gennady Yanin” would continue, Mr. Filin said. “I felt that I became a continuer, the next participant in this story. As one might say, ‘You’ll be next.’”

“I am practically sure it is exactly the same story, and I think it is not one person – but I don’t want to, and cannot, talk about this now because there is a serious investigation,” he said. “I think it is a group of people who have their own views and ideas regarding the Bolshoi Theater.”

Asked if members of the group would like to run the theater, he said, “I am sure that is the case.”

No one was ever publicly accused of publishing the photographs of Mr. Yanin, who was widely considered a candidate to temporarily fill the powerful position of artistic director while the Bolshoi negotiated a contract with a permanent replacement. Mr. Yanin resigned swiftly, and never gave a public account of the incident, which some journalists dubbed “Pornogate.”

“It was clear that it was someone who did not want him to become artistic director, unfortunately,” said Tatyana Kuznetsova, who covers ballet for Kommersant, a daily newspaper. “But who? That is unknown.”

Shortly thereafter, the Bolshoi announced the appointment of Mr. Filin as artistic director.

He had not been the first choice for the job, but seemed uniquely capable of managing tension between the old and the new at the ballet: A Bolshoi dancer and protégé of its iconic director, Yuri Grigorovich, he left for Moscow’s second-tier ballet company in 2008 and established himself as an innovator, introducing modern European choreographers. Threats began soon after he took the job in 2011, his associates have said, and grew more serious toward the end of 2012, when his personal email was hacked and correspondence published online.

Katerina Novikova, the Bolshoi Theater’s spokeswoman, said she thought Internet-based attacks on Mr. Filin and Mr. Yanin may have been related, but would not speculate on whether the same perpetrators had planned the acid attack.

“It might be all in one line,” she said. “Or it might be some crazy person.”

Mr. Filin, 42, said he met late last week with the team of investigators assigned to the case, and said they had compiled a voluminous case file and he was “very happy with the work they have done.” Mr. Filin said they had questioned a large number of Bolshoi employees and reported that only four people had spoken critically of Mr. Filin or his work. He confirmed that detectives had been given a list of three or four names when they began work.

He also said the detectives were increasingly bewitched by the world of ballet.

“They told us, ‘we never loved the ballet – we never even knew which direction to approach it from,’” Mr. Filin said. “Now they have become not just ballet fans, but they said, ‘We have a big request: As soon as you get back on your feet, please make it possible for us to go to the Bolshoi as often as possible, because we have heard such a huge number of positive and good comments about you and your work.”

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Estonian pleads guilty in U.S. court to Internet advertising scam

NEW YORK (Reuters) – An Estonian man pleaded guilty on Friday in U.S. federal court for his role in a massive Internet scam that targeted well-known websites such as iTunes, Netflix and The Wall Street Journal.

The scheme infected at least four million computers in more than 100 countries, including 500,000 in the United States, with malicious software, or malware, according to the indictment. It included a large number of computers at data centers located in New York, federal prosecutors said.

Valeri Aleksejev, 32, was the first of six Estonians and one Russian indicted in 2011 to enter a plea. They were indicted on five charges each of wire and computer intrusion. One of the defendants, Vladimir Tsastsin, was also charged with 22 counts of money laundering.

In U.S. District Court in Manhattan on Friday, Aleksejev pleaded guilty to conspiracy to commit wire fraud and conspiracy to commit computer intrusion. He faces up to 25 years in prison, deportation and the forfeiture of $ 7 million.

The scam had several components, including a “click-hijacking fraud” in which the malware re-routed searches by users on infected computers to sites designated by the defendants, prosecutors said in the indictment. Users of infected computers trying to access Apple Inc’s iTunes website or Netflix Inc‘s movie website, for example, instead ended up at websites of unaffiliated businesses, according to the indictment.

Another component of the scam replaced legitimate advertisements on websites operated by News Corp’s The Wall Street Journal, Amazon.com Inc and others with advertisements that triggered payments for the defendants, prosecutors said.

The defendants reaped at least $ 14 million from the fraud, prosecutors said. However, Aleksejev’s lawyer, William Stampur, said in court on Friday that Aleksejev has no assets.

Estonian police arrested Aleksejev and the other Estonians in November 2011. One other Estonian, Anton Ivanov, has been extradited, and the extradition of the other four is pending, according to the U.S. Attorney’s office in Manhattan. The Russian, Andrey Taame, remains at large, according to the U.S. Attorney’s office.

Aleksejev told Magistrate Judge James Francis he assisted in blocking anti-virus software updates on infected computers. Francis asked Aleksejev if he knew what he was doing was illegal.

“I thought it was wrong,” Aleksejev said in broken English after a long pause. “But of course I didn’t know all the laws in the U.S.”

Francis set a tentative sentencing date of May 31 for Aleksejev.

The case is USA v. Tsastsin et al, U.S. District Court in Manhattan, No. 11-00878.

(Reporting by Bernard Vaughan; Editing by Dan Grebler)

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Beyonce electrifies at Super Bowl halftime show

If naysayers still doubted Beyonce's singing talents — even after her national anthem performance this week at a press conference — the singer proved she is an exceptional performer at the Super Bowl halftime show.

Beyonce opened and closed her set belting songs, and in between she danced hard and heavy — and better than most contemporary pop stars.

She set a serious tone as she emerged onstage in all black, singing lines from her R&B hit "Love on Top." The stage was dark as fire and lights burst from the sides. Then she went into her hit "Crazy In Love," bringing some feminine spirit to the Superdome as she and her background dancers did the singer's signature booty-shaking dance. Beyonce ripped off part of her shirt and skirt. She even blew a kiss. She was ready to rock, and she did so like a pro.

Her confidence — and voice — grew as she worked the stage with and without her Destiny's Child band mates during her 13-minute set, which comes days after she admitted she sang to a pre-recorded track at President Barack Obama's inauguration less than two weeks ago.

Beyonce proved not only that she can sing, but that she can also entertain on a stage as big as the Super Bowl's. The 31-year-old was far better than Madonna, who sang to a backing track last year, and miles ahead of the Black Eyed Peas' disastrous set in 2011.

Beyonce was best when she finished her set with "Halo." She asked the crowd to put their hands toward her as she sang the slow groove on bended knee — and that's when she the performance hit its high note.

"Thank you for this moment," she told the crowd. "God bless y'all."

Her background singers helped out as Beyonce danced around the stage throughout most of her performance. There was a backing track to help fill in when Beyonce wasn't singing — and there were long stretches when she let it play as she performed elaborate dance moves.

She had a swarm of background dancers and band members spread throughout the stage, along with videotaped images of herself dancing that may have unintentionally played on the live-or-taped question. And the crowd got bigger when she was joined by her Destiny's Child band mates.

Kelly Rowland and Michelle Williams popped up from below the stage to sing "Bootylicious." They were in similar outfits, singing and dancing closely as they harmonized. But Rowland and Williams were barely heard when the group sang "Independent Woman," as their voices faded into the background.

They also joined in for some of "Single Ladies (Put a Ring On It)," where Beyonce's voice grew stronger. That song featured Beyonce's skilled choreography, as did "End of Time" and "Baby Boy," which also showcased Beyonce's all-female band, balancing out the testosterone levels on the football field.

Before the game, Alicia Keys performed a lounge-y, piano-tinged version of the national anthem that her publicist assured was live. The Grammy-winning singer played the piano as she sang "The Star Spangled Banner" in a long red dress with her eyes shut.

She followed Jennifer Hudson, who sang "America the Beautiful" with the 26-member Sandy Hook Elementary School chorus. It was an emotional performance that had some players on the sideline on the verge of tears. Hudson also sang live, her publicist said.

The students wore green ribbons on their shirts in honor of the 20 first-graders and six adults who were killed in a Dec. 14 shooting rampage at the school in Newton, Conn.

The students began the song softly before Hudson, whose mother, brother and 7-year-old nephew were shot to death five years ago, jumped in with her gospel-flavored vocals. She stood still in black and white as the students moved to the left and right, singing background.

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Follow Mesfin Fekadu on Twitter at http://twitter.com/MusicMesfin

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Medicines Co. Licenses Rights to Cholesterol Drug

The drug, known as ALN-PCS, inhibits a protein in the body known as PCSK9. Such drugs might one day be used to treat millions of people who do not achieve sufficient cholesterol-lowering from commonly used statins, such as Lipitor.

The Medicines Company will pay $25 million initially and as much as $180 million later if certain development and sales goals are met, under the deal expected to be formally announced Monday. It will also pay Alnylam, which is based in Cambridge, Mass., double-digit royalties on global sales.

That is small payment for a drug with presumably a huge potential market, probably reflecting that Alnylam is still in the first of three phases of clinical trials, well behind some far bigger competitors.

The team of Sanofi and Regeneron Pharmaceuticals is already entering the third and final stage of trials with their PCSK9 inhibitor, as is Amgen. Pfizer and Roche are in midstage trials.

ALN-PCS is different from the other drugs. It uses a gene-silencing mechanism called RNA interference, aimed at shutting off production of the PCSK9 protein. The other drugs are proteins called monoclonal antibodies that inhibit the action of PCSK9 after it has been formed.

Alnylam and the Medicines Company hope that turning off the faucet, as it were, will be more efficient than mopping the floor, allowing their drug to be given less frequently and in smaller amounts.

But that has yet to be proved. No drug using RNA interference has reached the market.

The Medicines Company, based in Parsippany, N.J., generates almost all of its revenue from one product — Angiomax, an anticlotting drug used when patients receive stents to open clogged arteries.

Dr. Clive A. Meanwell, chief executive of the company, said that PCSK9 inhibitors are likely to be used at first mainly by patients with severe lipid problems under the care of interventional cardiologists, the same doctors who use Angiomax. “It really is quite adjacent to what we do,” he said.

The Medicines Company licensed Angiomax from Biogen Idec, where the drug was invented and initially developed under a team led by Dr. John M. Maraganore, who is now the chief executive of Alnylam.

“It’s a bit like getting the band back together,” Dr. Maraganore said.

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