Instagram Reversal Doesn’t Appease Everyone

Peter DaSilva for The New York Times

Kevin Systrom, right, co-founder of Instagram, with employees in the company office in San Francisco last year.

SAN FRANCISCO — Facebook may have quelled a full-scale rebellion by quickly dumping the contentious new terms of use for Instagram, its photo-sharing service. But even as the social network furiously backpedaled, some users said Friday they were carrying through on plans to leave.

Eric Piermont/Agence France-Presse — Getty Images

Kevin Systrom, Instagram’s co-founder, said the company would complete its plans, then explain its ad policy.

Ryan Cox, a 29-year-old management consultant at ExactTarget, an Indianapolis-based interactive marketing software company, said he had already moved his photos to Flickr, Yahoo’s photo-sharing app, where he could have better control.

Mr. Cox said the uproar this week over whether Instagram owned its users’ photos was “a wake-up call.”

“It’s my fault,” he continued. “I’m smart enough to know what Instagram had and what they could do — especially the minute Facebook acquired them — but I was a victim of naïve optimism.”

“Naïve optimism” is as good a term as any for the emotion that people feel as they put their private lives onto social networks.

Companies like Google, Twitter, Yelp and Facebook offer themselves as free services for users to store and share their most intimate pictures, secrets, messages and memories. But to flourish over the long term, they need to seek new ways to market the personal data they accumulate. They must constantly push the envelope, hoping users either do not notice or do not care.

So they sell ads against the content of an e-mail, as Google does, or transform a user’s likes into commercial endorsements, as Facebook does, or sell photographs of your adorable 3-year-old, which is what Instagram was accused of planning this week.

“The reality is that companies have always had to make money,” said Miriam H. Wugmeister, chair of Morrison Foerster’s privacy and data security group.

Even as Instagram was pulling back on its changed terms of service on Thursday night, it made clear it was only regrouping. After all, Facebook, as a publicly held corporation, must answer to Wall Street’s quarterly expectations.

“We are going to take the time to complete our plans, and then come back to our users and explain how we would like for our advertising business to work,” Kevin Systrom, Instagram’s youthful co-founder, wrote on the company’s blog.

Instagram’s actions angered many users who were already incensed over the company’s decision earlier this month to cut off its integration with Twitter, a Facebook rival, making it harder for its users to share their Instagram photos on Twitter.

Users were apprehensive that the new terms of service meant that data on their favorite things would be shared with Facebook and its advertisers. Users also worried that their photos would become advertising.

Instagram is barely two years old but has 100 million users. Last spring, Facebook announced plans to buy it in a deal that was initially valued at $1 billion. The deal was closed in September for a somewhat smaller amount.

For some users, Mr. Systrom’s apology and declaration that “Instagram has no intention of selling your photos, and we never did” was sufficient.

National Geographic, which suspended its account in the middle of the uproar, held a conference call with members of Facebook’s legal and policy teams. Afterward, the magazine, which has 658,000 Instagram followers, said it would resurrect its account.

Also mollified was Noah Kalina, who took wedding photographs earlier this year for Mark Zuckerberg, the founder of Facebook. In a widely circulated post on Twitter, Mr. Kalina said the new terms of service were “a contract no professional or nonprofessional should ever sign.” His advice: “Walk away.”

On Friday, the photographer said he had walked back. “It’s nice to know they listened.”

Kim Kardashian, the most followed person on Instagram, said on Tuesday that she “really loved” the service — note the past tense — and that the new rules were not “fair.” She had yet to update her 17 million Twitter followers on Friday, but since she is pushing her True Reflection fragrance it is a safe bet that she has forgiven and forgotten.

Read More..

The Neediest Cases: The Daughter of a Sick Woman Falls Prey to a Craigslist Scam

Sitting side by side on their living room sofa, Patricia Morales and her daughter, Katherine, could be any mother-daughter duo. Both have dark hair, dark eyes and welcoming, infectious smiles.

Librado Romero/The New York Times

Patricia Morales, 62, at home in the Bronx. Her treatment for ailments like rheumatoid arthritis and hepatitis C led to depression.

2012-13 Campaign

Previously recorded:

$3,375,394

Recorded Wednesday:

182,251

*Total:

$3,557,645

Last year to date:

$3,320,812

*Includes $709,856 contributed to the Hurricane Sandy relief efforts.

For the past 100 years, The New York Times Neediest Cases Fund has provided direct assistance to children, families and the elderly in New York. To celebrate the 101st campaign, an article will appear daily through Jan. 25. Each profile will illustrate the difference that even a modest amount of money can make in easing the struggles of the poor.

Last year donors contributed $7,003,854, which was distributed to those in need through seven New York charities.

The Youngest Donors

If your child or family is using creative techniques to raise money for this year’s campaign, we want to hear from you. Drop us a line on Facebook or talk to us on Twitter.

But the ties that bind them go beyond their genes, beyond the bodies they were born with.

“It’s called a neck ring. It’s a silver curved barbell, one inch,” Katherine, 20, said as she swept aside her shoulder-length black hair to show the piercing in the back of her neck, a show of solidarity with her mother. She had it done when she was 16. “I wanted to know what it felt like for my mom.”

Her mother then turned around and outlined with her finger two lengthy scars that run down her back.

“I’ve had a lot of physical problems,” Ms. Morales, 62, said. Shaking her head at her daughter’s piercing, she added, “I’ve had rods put in my upper and lower spine, but I could never do that.”

The rods were surgically planted to treat herniated discs, the result of having a cruel combination of osteoporosis, hepatitis C, fibromyalgia and rheumatoid arthritis. Ms. Morales contracted hepatitis C from a blood transfusion she received in 1972 after the birth of her only son, she said.

“I didn’t even know about it until 10 years ago,” she said. “My liver blood count was a little high.”

Since the diagnosis, Ms. Morales, a former schoolteacher, has ridden the arduous highs and lows common to patients with hepatitis C. Her treatments for the disease, which debilitates the liver over time, have included pills and injections that can cause depression. Ms. Morales, a single parent, found an unforgiving salve in alcohol.

“I was depressed; I was totally drunk,” she said. “I didn’t want to live anymore.”

Then, about a year ago, she reached a turning point when visiting her hepatitis C specialist.

“I was 210 pounds,” she said. “The doctor said: ‘You have to stop drinking. You have to lose weight.’ ”

To help combat the depression, her doctor referred her to Jewish Association Serving the Aging, a beneficiary agency of UJA-Federation of New York, one of the organizations supported by The New York Times Neediest Cases Fund. She began weekly counseling sessions with a social worker and started taking an antidepressant medication. The federation drew about $600 from the fund in May so that Ms. Morales could buy a mattress.

“I had a horrible bed,” she said. “I felt like I was sleeping on rocks, and with rods in my back, I was waking up every hour.”

After several months of therapy and starting a diet, Ms. Morales was on her way to losing 60 pounds. Today, she weighs 148.

Light was starting to show itself again when the family took an unexpected financial hit this summer. While taking time off from attending Hostos Community College, Katherine Morales looked for work on Craigslist.

“I saw my mom, and I realized I needed to get a job,” Katherine said shyly. “This guy asked me to be his personal assistant, and he asked me to wire money.”

Offering $400 a week, the man requested help transferring almost $2,000 from what he said was his wife’s account. He transferred the money to Katherine’s account, asking her to wire it to a bank account in Malaysia.

Shortly after she wired the money, the bank froze the account, which Katherine and her mother shared. It was then that Katherine realized she had been the victim of a scam. The money transferred into her account turned out to have been stolen, and she was responsible for repaying it.

Katherine went to detectives immediately with more than 20 pages of evidentiary e-mails, but found that she was unable to file a complaint.

“They told me it wasn’t enough,” she said. “These things happen all the time.”

They lost almost $2,000.

Ms. Morales lives on a fixed income. She receives just over $700 a month from Social Security and $200 month in food stamps. The rent for the apartment she shares with her daughter in the Throgs Neck neighborhood of the Bronx is $230, and Ms. Morales has a monthly combined phone and cable bill of $140. Ms. Morales has a son, but he is unable to help the family.

Falling behind on her bills, Ms. Morales turned once again to JASA for help paying a combined phone and cable bill of nearly $200, a grant the agency drew from the Neediest Cases Fund.

“It was terrible, because my intention was to help my mom,” said Katherine, who has since found a part-time job at a vitamin shop.

Ms. Morales has been feeling much better, but she is nervous about an appointment with her hepatitis C specialist in January.

“I’m taking things one day at a time, but I’m looking forward to someone taking care of me,” she said. “I want to live a little bit longer, but not that long.”

“Why are you putting a time limit on it?” Katherine said, jokingly. “Seventy’s the new 20!” she added, nudging her mother in the side. “Remember, the doctor said you wouldn’t live past your late 50s, but you did.”

Read More..

The Neediest Cases: The Daughter of a Sick Woman Falls Prey to a Craigslist Scam

Sitting side by side on their living room sofa, Patricia Morales and her daughter, Katherine, could be any mother-daughter duo. Both have dark hair, dark eyes and welcoming, infectious smiles.

Librado Romero/The New York Times

Patricia Morales, 62, at home in the Bronx. Her treatment for ailments like rheumatoid arthritis and hepatitis C led to depression.

2012-13 Campaign

Previously recorded:

$3,375,394

Recorded Wednesday:

182,251

*Total:

$3,557,645

Last year to date:

$3,320,812

*Includes $709,856 contributed to the Hurricane Sandy relief efforts.

For the past 100 years, The New York Times Neediest Cases Fund has provided direct assistance to children, families and the elderly in New York. To celebrate the 101st campaign, an article will appear daily through Jan. 25. Each profile will illustrate the difference that even a modest amount of money can make in easing the struggles of the poor.

Last year donors contributed $7,003,854, which was distributed to those in need through seven New York charities.

The Youngest Donors

If your child or family is using creative techniques to raise money for this year’s campaign, we want to hear from you. Drop us a line on Facebook or talk to us on Twitter.

But the ties that bind them go beyond their genes, beyond the bodies they were born with.

“It’s called a neck ring. It’s a silver curved barbell, one inch,” Katherine, 20, said as she swept aside her shoulder-length black hair to show the piercing in the back of her neck, a show of solidarity with her mother. She had it done when she was 16. “I wanted to know what it felt like for my mom.”

Her mother then turned around and outlined with her finger two lengthy scars that run down her back.

“I’ve had a lot of physical problems,” Ms. Morales, 62, said. Shaking her head at her daughter’s piercing, she added, “I’ve had rods put in my upper and lower spine, but I could never do that.”

The rods were surgically planted to treat herniated discs, the result of having a cruel combination of osteoporosis, hepatitis C, fibromyalgia and rheumatoid arthritis. Ms. Morales contracted hepatitis C from a blood transfusion she received in 1972 after the birth of her only son, she said.

“I didn’t even know about it until 10 years ago,” she said. “My liver blood count was a little high.”

Since the diagnosis, Ms. Morales, a former schoolteacher, has ridden the arduous highs and lows common to patients with hepatitis C. Her treatments for the disease, which debilitates the liver over time, have included pills and injections that can cause depression. Ms. Morales, a single parent, found an unforgiving salve in alcohol.

“I was depressed; I was totally drunk,” she said. “I didn’t want to live anymore.”

Then, about a year ago, she reached a turning point when visiting her hepatitis C specialist.

“I was 210 pounds,” she said. “The doctor said: ‘You have to stop drinking. You have to lose weight.’ ”

To help combat the depression, her doctor referred her to Jewish Association Serving the Aging, a beneficiary agency of UJA-Federation of New York, one of the organizations supported by The New York Times Neediest Cases Fund. She began weekly counseling sessions with a social worker and started taking an antidepressant medication. The federation drew about $600 from the fund in May so that Ms. Morales could buy a mattress.

“I had a horrible bed,” she said. “I felt like I was sleeping on rocks, and with rods in my back, I was waking up every hour.”

After several months of therapy and starting a diet, Ms. Morales was on her way to losing 60 pounds. Today, she weighs 148.

Light was starting to show itself again when the family took an unexpected financial hit this summer. While taking time off from attending Hostos Community College, Katherine Morales looked for work on Craigslist.

“I saw my mom, and I realized I needed to get a job,” Katherine said shyly. “This guy asked me to be his personal assistant, and he asked me to wire money.”

Offering $400 a week, the man requested help transferring almost $2,000 from what he said was his wife’s account. He transferred the money to Katherine’s account, asking her to wire it to a bank account in Malaysia.

Shortly after she wired the money, the bank froze the account, which Katherine and her mother shared. It was then that Katherine realized she had been the victim of a scam. The money transferred into her account turned out to have been stolen, and she was responsible for repaying it.

Katherine went to detectives immediately with more than 20 pages of evidentiary e-mails, but found that she was unable to file a complaint.

“They told me it wasn’t enough,” she said. “These things happen all the time.”

They lost almost $2,000.

Ms. Morales lives on a fixed income. She receives just over $700 a month from Social Security and $200 month in food stamps. The rent for the apartment she shares with her daughter in the Throgs Neck neighborhood of the Bronx is $230, and Ms. Morales has a monthly combined phone and cable bill of $140. Ms. Morales has a son, but he is unable to help the family.

Falling behind on her bills, Ms. Morales turned once again to JASA for help paying a combined phone and cable bill of nearly $200, a grant the agency drew from the Neediest Cases Fund.

“It was terrible, because my intention was to help my mom,” said Katherine, who has since found a part-time job at a vitamin shop.

Ms. Morales has been feeling much better, but she is nervous about an appointment with her hepatitis C specialist in January.

“I’m taking things one day at a time, but I’m looking forward to someone taking care of me,” she said. “I want to live a little bit longer, but not that long.”

“Why are you putting a time limit on it?” Katherine said, jokingly. “Seventy’s the new 20!” she added, nudging her mother in the side. “Remember, the doctor said you wouldn’t live past your late 50s, but you did.”

Read More..

Instagram Reversal Doesn’t Appease Everyone

Peter DaSilva for The New York Times

Kevin Systrom, right, co-founder of Instagram, with employees in the company office in San Francisco last year.

SAN FRANCISCO — Facebook may have quelled a full-scale rebellion by quickly dumping the contentious new terms of use for Instagram, its photo-sharing service. But even as the social network furiously backpedaled, some users said Friday they were carrying through on plans to leave.

Eric Piermont/Agence France-Presse — Getty Images

Kevin Systrom, Instagram’s co-founder, said the company would complete its plans, then explain its ad policy.

Ryan Cox, a 29-year-old management consultant at ExactTarget, an Indianapolis-based interactive marketing software company, said he had already moved his photos to Flickr, Yahoo’s photo-sharing app, where he could have better control.

Mr. Cox said the uproar this week over whether Instagram owned its users’ photos was “a wake-up call.”

“It’s my fault,” he continued. “I’m smart enough to know what Instagram had and what they could do — especially the minute Facebook acquired them — but I was a victim of naïve optimism.”

“Naïve optimism” is as good a term as any for the emotion that people feel as they put their private lives onto social networks.

Companies like Google, Twitter, Yelp and Facebook offer themselves as free services for users to store and share their most intimate pictures, secrets, messages and memories. But to flourish over the long term, they need to seek new ways to market the personal data they accumulate. They must constantly push the envelope, hoping users either do not notice or do not care.

So they sell ads against the content of an e-mail, as Google does, or transform a user’s likes into commercial endorsements, as Facebook does, or sell photographs of your adorable 3-year-old, which is what Instagram was accused of planning this week.

“The reality is that companies have always had to make money,” said Miriam H. Wugmeister, chair of Morrison Foerster’s privacy and data security group.

Even as Instagram was pulling back on its changed terms of service on Thursday night, it made clear it was only regrouping. After all, Facebook, as a publicly held corporation, must answer to Wall Street’s quarterly expectations.

“We are going to take the time to complete our plans, and then come back to our users and explain how we would like for our advertising business to work,” Kevin Systrom, Instagram’s youthful co-founder, wrote on the company’s blog.

Instagram’s actions angered many users who were already incensed over the company’s decision earlier this month to cut off its integration with Twitter, a Facebook rival, making it harder for its users to share their Instagram photos on Twitter.

Users were apprehensive that the new terms of service meant that data on their favorite things would be shared with Facebook and its advertisers. Users also worried that their photos would become advertising.

Instagram is barely two years old but has 100 million users. Last spring, Facebook announced plans to buy it in a deal that was initially valued at $1 billion. The deal was closed in September for a somewhat smaller amount.

For some users, Mr. Systrom’s apology and declaration that “Instagram has no intention of selling your photos, and we never did” was sufficient.

National Geographic, which suspended its account in the middle of the uproar, held a conference call with members of Facebook’s legal and policy teams. Afterward, the magazine, which has 658,000 Instagram followers, said it would resurrect its account.

Also mollified was Noah Kalina, who took wedding photographs earlier this year for Mark Zuckerberg, the founder of Facebook. In a widely circulated post on Twitter, Mr. Kalina said the new terms of service were “a contract no professional or nonprofessional should ever sign.” His advice: “Walk away.”

On Friday, the photographer said he had walked back. “It’s nice to know they listened.”

Kim Kardashian, the most followed person on Instagram, said on Tuesday that she “really loved” the service — note the past tense — and that the new rules were not “fair.” She had yet to update her 17 million Twitter followers on Friday, but since she is pushing her True Reflection fragrance it is a safe bet that she has forgiven and forgotten.

Read More..

The Saturday Profile: In Cindy From Marzahn, an Offbeat Comedian of the People

WHEN a career counselor in the East German town of Luckenwalde asked Ilka Bessin what she wanted to be when she grew up, the teenager answered that she had always wanted to be a clown. “Cook” was also a creative job, the counselor suggested, and a lot more realistic.

It was still a few years before the fall of the Berlin Wall, and Ms. Bessin (pronounced bess-EEN) ended up an apprentice chef at a state-owned enterprise, preparing breakfast and lunch every day for more than 1,000 workers. She never could have guessed that two decades later she would be a comedy superstar in a reunified Germany, making millions of her compatriots laugh in clubs and theaters across the land, with television stations fighting over her appearances.

Audiences know Ms. Bessin, 41, as Cindy from Marzahn, her louder, ruder and more profane alter ego. With her curly peroxide wig and swathes of hot-pink eye shadow, Cindy hails from the notorious East Berlin neighborhood of Marzahn, synonymous with the enormous Communist high-rise housing estates.

An overweight 6-foot-2-inch Valkyrie of a woman in a pink velour sweatsuit, Cindy plays up the worst stereotypes of Germany’s contemporary version of the welfare queen. She wakes up at 2 o’clock in the afternoon and begins drinking. Her dream man, Enrico, stands 4-foot-10, weighs 375 pounds and works as a bouncer.

“No neck, no hair and no brain,” she says approvingly.

IN October, Ms. Bessin was named Germany’s female comedian of the year for the fourth time in a row. The daily newspaper Tagesspiegel recently called her “a phenomenon,” under the headline “Princess of the Plattenbau,” the prefabricated housing blocs built in the former East. She hosts her own television series and recently began appearing on “Wetten Dass,” the long-running variety show whose name translates loosely as “Wanna Bet?”

Yet when asked in a recent interview how it felt to be an established star, Ms. Bessin quickly replied, “As far as I’m concerned, I’m really not there yet.” Quieter than Cindy and extremely considerate, Ms. Bessin is hardly recognizable out of costume, just one of the facts that helps keep her grounded.

“I drink absolutely no Champagne, and I don’t fit in Jean Paul Gaultier’s clothes,” she said, with a toned-down version of the self-deprecation she shares with Cindy.

Germany may have more money than its neighbors on the whole, but the middle class is shrinking and much of its recent gains in economic competitiveness came from labor-market changes that cut jobless benefits and pressured people to work, sometimes for as little as an additional $1.30 an hour. Cindy brought the low-paying jobs and the secondhand stores onstage, with songs as well as monologues.

It was a language Ms. Bessin spoke fluently, having herself lived on Hartz IV welfare payments for several years. “You sleep a lot, because you don’t see the point in getting up, and you eat what’s around you,” Ms. Bessin recalled. “You go to the employment office because you have appointments, but generally you go home even more demoralized.”

Out of the crucible of humiliation emerged Cindy, crass and cagey, driven by appetites. She hides a bratwurst in a banana peel and asks the audience for chocolate, then eats what they throw onstage. “I have Alzheimer’s bulimia,” Cindy likes to say, stomach bulging under her pink sweatshirt, tiara perched atop her wig. “I eat everything in sight and then forget to throw up.”

Critics call her act offensive, lowbrow and worse, mixing high-minded attacks on her with patronizing depictions of her supposedly benighted fans. Those fans answer by buying her concert videos and turning out to her shows in droves, where they scream and applaud like mad, many wearing their own tiaras and pink sweatshirts emblazoned with the words “Alzheimer’s bulimia” on the front.

Cindy regales them with tales of her time as a member of the Socialist Children’s Television Ballet or her efforts to get adopted by Zsa Zsa Gabor’s husband Frédéric Prinz von Anhalt. Her performances are marathons with musical numbers. Fans often bring her presents and handmade cards. She is a star but also a hero, one of them, one who made it.

“I win,” Cindy sings in one of her songs, “although I’m not a winner.”

Ms. Bessin said in the interview that her act was not about East and West, which are outdated concepts in her view. Cindy happened to come from the East because Ms. Bessin did too. Her memory of the end of Communism was typically understated. “My mother was in the living room. I was in the kitchen washing dishes. She said, ‘The Wall fell,’ and I said, ‘Yeah, O.K.,’ and went back to washing dishes.”

Over the next decade she worked a dozen jobs at hotels and restaurants, including Planet Hollywood Berlin, and even did a stint on a cruise ship. She was working as a restaurant manager in 2001 and went on sick leave. When she came back she had been fired and her job had been given to someone else.

A long, demoralizing stretch on welfare followed. Between her hundreds of job applications Ms. Bessin said she ate, lay in bed and watched television, gaining weight and losing motivation. She was slowly sliding into a growing German underclass best known to the rest of the country from talk shows about paternity tests and plastic surgery. Unbeknown to Ms. Bessin, she was researching a character that had not yet found her outlet. Ms. Bessin’s break was not just lucky, it was accidental. In 2004, she called up the Quatsch Comedy Club in Berlin looking for a job as a waitress. After listening to her for a while the man on the other end of the line announced that he was not the person responsible for hiring service personnel. He was in charge of booking the acts.

“Do you have any interest in doing stand-up?” she recalled him asking. He told her about a talent competition the club was hosting. She agreed and began writing a few minutes of material. When she read through her jokes at rehearsal, people told her there was no way her act was going to work.

She decided she had nothing to lose; the wig and the costume were like a disguise and a suit of armor all at once. “No one is going to recognize me anyway, I thought,” Ms. Bessin said. On stage during the actual performance, the crowd responded immediately. Ms. Bessin talks about the similarities between her stage persona and herself, saying Cindy is “80 percent me,” but she talks about the character in the third person. Donning the costume unlocks something impish and ferocious in Ms. Bessin. She won the grueling competition, and eventually earned an appearance on the popular late-night show “TV total” in March 2006.

More offers to perform quickly followed. In 2007, Ms. Bessin won the German Comedy Prize for newcomer of the year. She has a comedy showcase, “Cindy and the Young Wild Ones,” on the private television network RTL.

The set for her first comedy special, “Schizophrenic: I Wanted to Be a Princess,” was a Communist housing bloc. The second, “Not Every Prince Comes on Horseback,” was a pink fairy castle, a home fit for Barbie.

The former welfare queen stood onstage, soaking up the audience’s applause, surrounded by men with guts, a few of them bald, but all wearing skimpy shorts and shaking pink and black pom-poms. Maybe none of them was Enrico, but it was certainly a dream come true.

Read More..

About New York: One Boy’s Death Moves State to Action to Prevent Others

Prompted by the death of a 12-year-old Queens boy in April, New York health officials are poised to make their state the first in the nation to require that hospitals aggressively look for sepsis in patients so treatment can begin sooner. Under the regulations, which are now being drafted, the hospitals will also have to publicly report the results of their efforts.

The action by New York has elated sepsis researchers and experts, including members of a national panel who this month formally recommended that the federal government adopt standards similar to what the state is planning.

Though little known, sepsis, an abnormal and self-destructive immune response to infection or illness, is a leading cause of death in hospitals. It often progresses to severely low blood pressure, shock and organ failure.

Over the last decade, a global consortium of doctors, researchers, hospitals and advocates has developed guidelines on early identification and treatment of sepsis that it says have led to significant drops in mortality rates. But first hints of the problem, like a high pulse rate and fever, often are hard for clinicians to tell apart from routine miseries that go along with the flu or cold.

“First and foremost, they need to suspect sepsis,” Dr. Mitchell M. Levy, a professor at Brown University School of Medicine and a lead author of a paper on the latest sepsis treatment guidelines to be published simultaneously next month in the United States in a journal, Critical Care Medicine, and in Europe in Intensive Care Medicine.

“It’s the most common killer in intensive care units,” Dr. Levy said. “It kills more people than breast cancer, lung cancer and stroke combined.”

If started early enough, the treatment, which includes antibiotics and fluids, can help people escape from the drastic vortex of sepsis, according to findings by researchers working with the Surviving Sepsis Campaign, the global consortium. The tactics led to a reduction of “relative risk mortality by 40 percent,” Dr. Levy said.

Although studies of 30,000 patients show that the guidelines save lives, “the problem is that many hospitals are not adhering to them,” said Dr. Clifford S. Deutschman, director of the sepsis research program at the Perelman School of Medicine at the University of Pennsylvania and the president of the Society of Critical Care Medicine.

About 300 hospitals participate in the study, and the consortium has a goal of having 10,000. “The case is irrefutable: if you take these sepsis measures, and you build a program to help clinicians and hospitals suspect sepsis and identify it early, that will mean more people will survive,” Dr. Levy said.

At a symposium in October, the New York health commissioner, Dr. Nirav R. Shah, said that he would require state hospitals to adopt best practices for early identification and treatment of sepsis. Gov. Andrew M. Cuomo intends to make it a major initiative in 2013, said Josh Vlasto, a spokesman for the governor. “The state is taking unprecedented measures to prevent and effectively treat sepsis in health care facilities across the state and is looking at a wide range of additional measures to better protect patients,” Mr. Vlasto said.

In April, Rory Staunton, a sixth grader from Queens, died of severe septic shock after he became infected, apparently through a cut he suffered while playing basketball. The severity of his illness was not recognized when he was treated in the emergency room at NYU Langone Medical Center. He was sent home with a diagnosis of an ordinary bellyache. Hours later, alarming laboratory results became available that suggested he was critically ill, but neither he nor his family was contacted. For an About New York column in The New York Times, Rory’s parents, Ciaran and Orlaith Staunton, publicly discussed their son’s final days. Their revelations prompted doctors and hospitals across the country to seek new approaches to heading off medical errors.

In addition, Commissioner Shah in New York convened a symposium on sepsis, which included presentations from medical experts and Rory’s parents.

At the end of the meeting, Dr. Shah said that he had listened to all the statistics on the prevalence of the illness, and that one had stuck in his memory: “Twenty-five percent,” he said — the portion of the Staunton family lost to sepsis.

He said he would issue new regulations requiring hospitals to use best practices in identifying and treating sepsis, actions that, he said, he was taking “in honor of Rory Staunton.”

The governor’s spokesman, Mr. Vlasto, said that “the Staunton family’s advocacy has been essential to creating a strong public will for action.”

Dr. Levy said New York’s actions were “bold, pioneering and grounded in good scientific evidence,” adding, “The commissioner has taken the first step even before the federal government.”

Dr. Deutschman said that initiatives like those in New York were needed to overcome resistance among doctors. “You’re talking about a profession that has always prided itself on its autonomy,” he said. “They don’t like to be told that they’re wrong about something.”

The availability of proven therapies should move treatment of sepsis into a new era, experts say, comparing it to how heart attacks were handled not long ago. People arriving in emergency rooms with chest pains were basically put to bed because not much could be done for them, said Dr. Kevin J. Tracey, the president of the Feinstein Institute for Medical Research at North Shore-Long Island Jewish Health System. Dr. Tracey, a neurosurgeon, has made major discoveries about the relationship between the nervous system and the runaway immune responses of sepsis.

If physicians and nurses were trained to watch for sepsis, as they now routinely do for heart attacks, many of its most dire problems could be headed off before they got out of control, he said. The Stauntons have awakened doctors and nurses to the possibility of danger camouflaged as a stomach bug.

“We are with sepsis where we were with heart attack in the early 1980s,” Dr. Tracey said.

“If you don’t think of it as a possibility, this story can happen again and again. This case could change the world.”

E-mail: dwyer@nytimes.com

Twitter: @jimdwyernyt

Read More..

About New York: One Boy’s Death Moves State to Action to Prevent Others

Prompted by the death of a 12-year-old Queens boy in April, New York health officials are poised to make their state the first in the nation to require that hospitals aggressively look for sepsis in patients so treatment can begin sooner. Under the regulations, which are now being drafted, the hospitals will also have to publicly report the results of their efforts.

The action by New York has elated sepsis researchers and experts, including members of a national panel who this month formally recommended that the federal government adopt standards similar to what the state is planning.

Though little known, sepsis, an abnormal and self-destructive immune response to infection or illness, is a leading cause of death in hospitals. It often progresses to severely low blood pressure, shock and organ failure.

Over the last decade, a global consortium of doctors, researchers, hospitals and advocates has developed guidelines on early identification and treatment of sepsis that it says have led to significant drops in mortality rates. But first hints of the problem, like a high pulse rate and fever, often are hard for clinicians to tell apart from routine miseries that go along with the flu or cold.

“First and foremost, they need to suspect sepsis,” Dr. Mitchell M. Levy, a professor at Brown University School of Medicine and a lead author of a paper on the latest sepsis treatment guidelines to be published simultaneously next month in the United States in a journal, Critical Care Medicine, and in Europe in Intensive Care Medicine.

“It’s the most common killer in intensive care units,” Dr. Levy said. “It kills more people than breast cancer, lung cancer and stroke combined.”

If started early enough, the treatment, which includes antibiotics and fluids, can help people escape from the drastic vortex of sepsis, according to findings by researchers working with the Surviving Sepsis Campaign, the global consortium. The tactics led to a reduction of “relative risk mortality by 40 percent,” Dr. Levy said.

Although studies of 30,000 patients show that the guidelines save lives, “the problem is that many hospitals are not adhering to them,” said Dr. Clifford S. Deutschman, director of the sepsis research program at the Perelman School of Medicine at the University of Pennsylvania and the president of the Society of Critical Care Medicine.

About 300 hospitals participate in the study, and the consortium has a goal of having 10,000. “The case is irrefutable: if you take these sepsis measures, and you build a program to help clinicians and hospitals suspect sepsis and identify it early, that will mean more people will survive,” Dr. Levy said.

At a symposium in October, the New York health commissioner, Dr. Nirav R. Shah, said that he would require state hospitals to adopt best practices for early identification and treatment of sepsis. Gov. Andrew M. Cuomo intends to make it a major initiative in 2013, said Josh Vlasto, a spokesman for the governor. “The state is taking unprecedented measures to prevent and effectively treat sepsis in health care facilities across the state and is looking at a wide range of additional measures to better protect patients,” Mr. Vlasto said.

In April, Rory Staunton, a sixth grader from Queens, died of severe septic shock after he became infected, apparently through a cut he suffered while playing basketball. The severity of his illness was not recognized when he was treated in the emergency room at NYU Langone Medical Center. He was sent home with a diagnosis of an ordinary bellyache. Hours later, alarming laboratory results became available that suggested he was critically ill, but neither he nor his family was contacted. For an About New York column in The New York Times, Rory’s parents, Ciaran and Orlaith Staunton, publicly discussed their son’s final days. Their revelations prompted doctors and hospitals across the country to seek new approaches to heading off medical errors.

In addition, Commissioner Shah in New York convened a symposium on sepsis, which included presentations from medical experts and Rory’s parents.

At the end of the meeting, Dr. Shah said that he had listened to all the statistics on the prevalence of the illness, and that one had stuck in his memory: “Twenty-five percent,” he said — the portion of the Staunton family lost to sepsis.

He said he would issue new regulations requiring hospitals to use best practices in identifying and treating sepsis, actions that, he said, he was taking “in honor of Rory Staunton.”

The governor’s spokesman, Mr. Vlasto, said that “the Staunton family’s advocacy has been essential to creating a strong public will for action.”

Dr. Levy said New York’s actions were “bold, pioneering and grounded in good scientific evidence,” adding, “The commissioner has taken the first step even before the federal government.”

Dr. Deutschman said that initiatives like those in New York were needed to overcome resistance among doctors. “You’re talking about a profession that has always prided itself on its autonomy,” he said. “They don’t like to be told that they’re wrong about something.”

The availability of proven therapies should move treatment of sepsis into a new era, experts say, comparing it to how heart attacks were handled not long ago. People arriving in emergency rooms with chest pains were basically put to bed because not much could be done for them, said Dr. Kevin J. Tracey, the president of the Feinstein Institute for Medical Research at North Shore-Long Island Jewish Health System. Dr. Tracey, a neurosurgeon, has made major discoveries about the relationship between the nervous system and the runaway immune responses of sepsis.

If physicians and nurses were trained to watch for sepsis, as they now routinely do for heart attacks, many of its most dire problems could be headed off before they got out of control, he said. The Stauntons have awakened doctors and nurses to the possibility of danger camouflaged as a stomach bug.

“We are with sepsis where we were with heart attack in the early 1980s,” Dr. Tracey said.

“If you don’t think of it as a possibility, this story can happen again and again. This case could change the world.”

E-mail: dwyer@nytimes.com

Twitter: @jimdwyernyt

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Gadgetwise Blog: App Smart Extra: More Holiday Apps

As befits the date, this week’s App Smart column was about Christmas-related apps. We talked about a variety of them, like photo effects or storytelling ones.

My favorite book at this time of year has always been “The Night Before Christmas,” and there’s a fabulous interactive e-book version on iTunes free (Peter, Paul and Mary’s “The Night Before Christmas”). It’s great to read with your kids, letting them tap on the screen to activate the hidden special effects in the images — like jingling the stockings hung by the fire. You can also let the app run by itself, reading the story aloud. Older children will be able to work out how to tap the right icon to turn the page.

Fitting for a year where the “Gangnam Style” video became the biggest YouTube hit, there’s a free Gangnam SantaBooth app on iOS that may tickle you. It does exactly what you think it does, placing a photo of your head (sporting a Santa hat) into an animation of a character dancing just like the music video. It’s great for mates, but perhaps not for sending seasonal messages to grandma. For your grandmother, you might find the $2 iOS app Vintage Christmas Cards a suitable alternative; it has a hundred classic greeting card designs to download. You can e-mail them or print them out, personalize them and send them.

Android device owners can customize their devices with live wallpapers. And there are a lot of seasonal options, including another amusing animated Gangnam Santa one. One of the more elegant apps is the Christmas Tree Live Wallpaper app. It’s clever enough to let you customize various aspects of the tree to suit your taste. It’s free on Google Play.

If you want to track Santa on his speedy journey around the planet delivering gifts, an alternative to the popular NORAD app is Santa Tracker Christmas Free (on iOS or Android). This app graphically maps the sleigh’s flight at the right time. But until then it has a lovely 3-D animated graphic of the Earth. And it follows Santa as he prepares, either organizing at the North Pole or flying to check if children have been naughty or nice. Since the animation zips to different parts of the globe, it may be a neat trick for teaching children some geography.

Quick Call

The fun app maker Toca Boca has a new $1 app for iOS and Kindle Fire: Toca Hair Salon 2, successor to the successful first edition. Like the original, but with some new tricks like better graphics and extra styling tools, the light-hearted app is about styling and preparing the hair of some cartoonish characters.

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Cluster Bombs Used on Civilians in Syria

A cluster bomb attack on Dec. 12 in the town of Marea, Syria, killed 4 people and injured at least 23. Each bomb disperses bomblets that can cause destruction over hundreds of yards. In Marea, pieces of the finned bomblets and their dispensers were found throughout the town and even on its outskirts.

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DealBook: Leniency Denied, UBS Unit Admits Guilt in Rate Case

UBS on Wednesday became the first big global bank in more than two decades to have a subsidiary plead guilty to fraud.

UBS, the Swiss bank, scrambled until the last minute to avoid that fate. A week ago, in a bid for leniency over interest-rate manipulation, the bank’s chairman traveled to Washington to plead his case to the Justice Department, according to people briefed on the matter. Knowing the long odds, the chairman, Axel Weber, asked the criminal division for a lighter punishment.

But the government did not budge. With support from Attorney General Eric H. Holder Jr., the agency’s criminal division decided the bank’s actions were simply too egregious, people briefed on the matter said.

On Wednesday, UBS announced it would plead guilty to one count of felony wire fraud as part of a broader settlement. With federal prosecutors, British, Swiss and American regulators secured about $1.5 billion in fines, more than triple the only other rate-rigging case, against Barclays. The Justice Department also filed criminal charges against two former UBS traders.

The guilty plea and the individual charges provide the Justice Department with a long-awaited case to prove it is taking a hard line against financial wrongdoing.

Since the financial crisis, the government has faced criticism that it has not brought significant criminal actions. The money-laundering case against HSBC, which averted indictment when it agreed instead last week to pay $1.9 billion, raised more concerns that the world’s largest and most interconnected banks were too big to indict.

Libor Explained

With UBS, prosecutors wanted to send a warning.

The Justice Department’s decision stops short of imperiling the broader financial system because it shields UBS’s parent company from losing its charter, among other major repercussions. But by securing a guilty plea against a subsidiary, the department has shown that it is willing to punish severely one of the world’s most powerful banks. It was the first guilty plea from a major financial institution since Drexel Burnham Lambert admitted to six counts of fraud in 1989.

“We are holding those who did wrong accountable,” Lanny A. Breuer, the head of the Justice Department’s criminal division, said at a news conference on Wednesday. “We cannot, and we will not, tolerate misconduct on Wall Street.”

The rate-rigging inquiry, which has ensnared more than a dozen big banks, is focused on major benchmarks like the London interbank offered rate, or Libor. Such rates are central to determining the borrowing rates for trillions of dollars of financial products like corporate loans, mortgages and credit cards.

The fallout from the UBS case is expected to increase pressure on some of the world’s largest financial institutions and spur settlement talks across the banking industry. The Royal Bank of Scotland has said it expects to pay fines before its next earnings statement in February, while American institutions, including JPMorgan Chase, also remain in regulators’ cross hairs.

The UBS case highlighted a pattern of abuse that authorities have uncovered in a multiyear investigation into the rate-setting process. The government complaints laid bare a 10-year scheme, describing how the bank had reported false rates to squeeze out extra profits and deflect concerns about its health during the financial crisis.

“The settlement reflects the magnitude of the wrongdoing and how critical it is that these be honest and reliable,” said Gary S. Gensler, chairman of the Commodity Futures Trading Commission, the American regulator that opened the UBS investigation.

Six months ago, authorities did not seem ready to take an aggressive stance with UBS.

They had just scored their first Libor settlement, a $450 million payout from Barclays. UBS, which had already struck a conditional immunity deal with the Justice Department’s antitrust division, figured its penalty would be similar.

The immunity deal, some UBS executives contended, would protect the bank from criminal charges. Even officials at the Justice Department were skeptical about the prospect of levying large penalties, according to people briefed on the matter.

Then the tone shifted this fall. After examining thousands of e-mails and hours of taped phone calls, the agency’s criminal division concluded that the conduct at the Japanese subsidiary warranted a criminal charge.

Agency officials also cited the bank’s repeated run-ins with authorities. For example, the Swiss bank had agreed in 2009 to pay $780 million to settle charges that it had helped clients avoid taxes.

Not everyone in the Justice Department agreed on the course of action. According to people briefed on the matter, the antitrust unit pushed for less-onerous penalties, citing the cooperation of UBS. With officials split over how to proceed, Mr. Holder cast the deciding vote in favor of securing a guilty plea from the subsidiary.

The move caught UBS off guard. The bank dispatched several lawyers to Washington to negotiate the fine print of the deal, setting up makeshift offices at the Four Seasons hotel in Georgetown.

Mr. Weber joined the lawyers, in a typical last-ditch appeal to the criminal division. Last Wednesday, Mr. Weber and his general counsel explained to the agency how UBS had overhauled its management ranks, bolstered internal controls and generally tried to clean up its act.

Mr. Breuer and other Justice Department officials agreed to consider the bank’s request to abandon the guilty plea, people briefed on the talks said. But hours later, a prosecutor phoned to say the agency was standing firm.

UBS agreed to the guilty plea, conceding that the Japanese unit would otherwise most likely face an indictment. In turn, prosecutors credited the bank for its recent efforts to improve.

“We are pleased that the authorities gave us credit for the important and positive changes we have already made,” Mr. Weber said in a statement.

The Commodity Futures Trading Commission adopted a similarly tough attitude.

Since Thanksgiving, UBS has tried to negotiate lower penalties with the regulator, according to people briefed on the matter. But David Meister, the agency’s enforcement chief, would not back down from $700 million in fines, an agency record.

“Even for a megabank, that amount serves as a direct deterrent,” said Bart Chilton, a commissioner at the regulator.

Authorities’ strict stance stems from the extent of the bank’s actions. The Commodity Futures Trading Commission cited more than 2,000 instances of illegal acts involving dozens of UBS employees across continents.

The most significant wrongdoing took place within the Japanese unit, where traders colluded with other banks and brokerage firms to tinker with yen-denominated Libor and bolster their returns.

In colorful e-mails, instant messages and phone calls, traders tried to influence the rates. “I need you to keep it as low as possible,” one UBS trader said to an employee at another brokerage firm, according to the complaint filed by the Financial Services Authority of Britain.

As the employees carried out the ostensible manipulation, they also celebrated the efforts, with one trader referring to a partner in the scheme as “superman.” “Be a hero today,” he urged, according the complaint.

The Justice Department also took aim at two former UBS traders, Tom Hayes, 33, and Roger Darin, 41, bringing the first criminal charges against individuals connected to the Libor case.

Like other traders at UBS, Mr. Hayes was willing to reward others for their efforts. He trumpeted the work of an outside broker who had helped, writing in a message, “i reckon i owe him a lot more.” Another broker responded that the person was “ok with an annual champagne shipment,” and “a small bonus every now and then.”

As prosecutors ramped up their investigation, Mr. Hayes even tried to dissuade former colleagues from cooperating, the complaint said. “The U.S. Department of Justice, mate, you know,” he said, they are the “dudes who…put people in jail. Why…would you talk to them?”

Mark Scott, Ashley Southall and Julia Werdigier contributed reporting.

A version of this article appeared in print on 12/20/2012, on page A1 of the NewYork edition with the headline: Leniency Denied, UBS Unit Admits Guilt In Rate Case.

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Senators Say ‘Zero Dark Thirty’ Torture Scenes Are Misleading

WASHINGTON — In an unusual Congressional critique of Hollywood moviemaking, three United States senators on Wednesday lambasted “Zero Dark Thirty,” the new fictionalized film about the hunt for Osama bin Laden, calling it “grossly inaccurate and misleading in its suggestion that torture resulted in information that led to the location” of the terrorist leader.

In a letter to Michael Lynton, chairman and chief executive of Sony Pictures Entertainment, the senators — Dianne Feinstein, Democrat of California; Carl Levin, Democrat of Michigan; and John McCain, Republican of Arizona — weighed in on a public debate over how the film portrays the Central Intelligence Agency’s use of brutal interrogations against Qaeda suspects.

Ms. Feinstein leads the Senate Intelligence Committee, whose Democratic staff members just completed a highly critical 6,000-page study of the C.I.A. detention and interrogation program, which began after the 9/11 attacks and was ended by President Obama in 2009. The report remains classified, but Ms. Feinstein has said it showed that information derived from waterboarding and other brutal techniques did not play a significant role in locating Bin Laden, who was killed in a raid by Navy SEALs in May 2011.

Some human rights advocates have described the film as ambiguous on the question of whether torture was useful, while others believe it implies that torture produced some early clues.

The senators take the latter view and say the movie is “factually inaccurate” and “has the potential to shape American public opinion in a disturbing and misleading manner.” Their letter asks Sony Pictures to “consider correcting the impression that the C.I.A.’s use of coercive interrogation techniques led to the operation” against Bin Laden, but they do not explain exactly how that could be done.

The director of “Zero Dark Thirty,” Kathryn Bigelow, and its writer, Mark Boal, have said that to leave torture scenes out would have meant whitewashing history and that the film made clear that the most important break in the Bin Laden hunt did not come from a coercive interrogation.

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Irish Government Set to Allow Abortion in Rare Cases

DUBLIN — The Irish government said Tuesday that it was preparing to allow abortion under limited circumstances in an effort to comply with demands by the European Court of Human Rights to clarify the country’s legal position on the issue.

Cathal Mcnaughton/Reuters

A vigil was held in Dublin on Monday in memory of Dr. Savita Halappanavar, a 31-year-old dentist who died after being denied an abortion.

The proposed legislative and regulatory changes would allow abortion only in cases where there is a real and substantial risk to a woman’s life — as distinct from her health.

The Supreme Court ruled in 1992 that abortion was permissible when risk was present, but the government never passed a law to that effect.

Addressing Parliament after the announcement, Prime Minister Enda Kenny was at pains to emphasize that the proposals would allow abortion only in certain cases. He added that the threat of suicide could be among them.

The abortion debate has convulsed Ireland for decades, but calls for change reached a crescendo after the death of Dr. Savita Halappanavar, a 31-year-old dentist, in October. Dr. Halappanavar arrived at a Galway hospital in severe pain and was found to be miscarrying. Her fetus had a heartbeat, making termination of the pregnancy illegal under Irish law. She died of septicemia a week after admission.

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Irish Government Set to Allow Abortion in Rare Cases

DUBLIN — The Irish government said Tuesday that it was preparing to allow abortion under limited circumstances in an effort to comply with demands by the European Court of Human Rights to clarify the country’s legal position on the issue.

Cathal Mcnaughton/Reuters

A vigil was held in Dublin on Monday in memory of Dr. Savita Halappanavar, a 31-year-old dentist who died after being denied an abortion.

The proposed legislative and regulatory changes would allow abortion only in cases where there is a real and substantial risk to a woman’s life — as distinct from her health.

The Supreme Court ruled in 1992 that abortion was permissible when risk was present, but the government never passed a law to that effect.

Addressing Parliament after the announcement, Prime Minister Enda Kenny was at pains to emphasize that the proposals would allow abortion only in certain cases. He added that the threat of suicide could be among them.

The abortion debate has convulsed Ireland for decades, but calls for change reached a crescendo after the death of Dr. Savita Halappanavar, a 31-year-old dentist, in October. Dr. Halappanavar arrived at a Galway hospital in severe pain and was found to be miscarrying. Her fetus had a heartbeat, making termination of the pregnancy illegal under Irish law. She died of septicemia a week after admission.

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U.S. Is Expected to Extend Google Antitrust Inquiry

WASHINGTON — The Federal Trade Commission is unlikely to finish until January its investigation into whether Google abused its power in the search market, people briefed on the investigation said on Tuesday.

The agency’s chairman, Jon Leibowitz, has consistently said that the commission was aiming to finish its inquiry by the end of 2012, and all signs have been pointing to an imminent settlement, including reports of a Google proposal to avoid formal punishment by promising to change some of its practices.

Two people who have been briefed on the investigation said that some commissioners had asked for more time to consider possible penalties after recent reports portrayed Google as having persuaded the F.T.C. to give the company little more than a slap on the wrist.

For almost two years, the F.T.C. has been studying whether Google’s dominant search engine intentionally produces search results that favor its own commerce and other services. Companies with competing search engines as well as commercial sites that specialize in airline ticket information or shopping have complained that Google has stifled competition by its actions.

Those competitors have reacted with outrage over the last week to reports that the F.T.C. planned not to file charges of antitrust violations or unfair competition. The commission was prepared to accept Google’s written assurances that it would alter some practices related to search, according to the reports. The F.T.C. could enforce compliance with such a written assurance.

Google’s competitors, which have been urging regulators to take action, stepped up their protests after the recent reports. That outrage has apparently reverberated in the halls of the commission, where displeasure has grown at the portrayals of the commission as having been cowed by the technology giant.

The people briefed on the inquiry said that the F.T.C. would most likely conclude its effort in early to mid-January.

The commission is also continuing its look at whether Google abused its control of certain patents concerning mobile phone technology.

Adam Kovacevich, a Google spokesman, said the company would “continue to work cooperatively with the Federal Trade Commission and are happy to answer any questions they may have.” An F.T.C. representative declined to comment.

Google will also apparently be extending into 2013 a parallel three-year inquiry in Europe, but with hope of avoiding a big fine or a finding of wrongdoing.

After meeting with Eric E. Schmidt, Google’s executive chairman, the European Union’s competition commissioner, Joaquín Almunia, said in a statement Tuesday that “we have substantially reduced our differences.”

“I now expect Google to come forward with a detailed commitment text in January 2013,” Mr. Almunia said.

Mr. Almunia is also focusing on whether Google’s search engine thwarted competition by favoring the company’s services in presenting results of search queries.

He said Tuesday that in their discussion, the company indicated it would change “the way in which Google’s vertical search services are displayed within general search results as compared to services of competitors.”

The other areas in which Mr. Almunia said he expected to reach a deal included how Google uses and displays content from other companies in its search tool, and the restrictions that Google places on advertising and advertisers. Any concessions Google offered would be tested in the marketplace to assess their acceptability to other companies, before becoming binding, Mr. Almunia said.

If there is a settlement, Google will avoid a possible fine of as much as 10 percent of its annual global revenue, about $37.9 billion last year. It would also avoid a guilty finding that could restrict its activities in Europe. “We continue to work cooperatively with the commission,” Al Verney, a Google spokesman in Brussels, said.

Exactly what concessions on search services Mr. Almunia can wring from Google remained an open question Tuesday, though antitrust specialists agreed that he had more leverage than his American counterparts.

While Google is the dominant search engine in the United States, it holds even greater sway in Europe, accounting for more than 90 percent of searches in a number of large markets. That is one factor giving the Europeans greater leverage in trying to set rules on how Google ranks competing services.

Another factor is European antitrust law, which has long given competitors more protection than United States law provides.

Antitrust law in Europe, and the commission’s approach to it, has shifted in recent years, raising the hurdles for complainants against dominant companies, said Emanuela Lecchi, an antitrust lawyer in London with Watson, Farley & Williams.

Even so, Ms. Lecchi said, Europe still offers rivals greater protection. Compared with the United States, European regulators “are more inclined to try and make sure there is always a choice of players on markets, and that’s something that might allow Google’s rivals to make more progress at the end of the day,” she said.

Edward Wyatt reported from Washington and James Kanter from Brussels. Steve Lohr contributed reporting from New York.

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India Ink: A Guide to Protests for Women's Safety in Delhi

A woman who was raped on a bus by several men on Sunday found an unlikely supporter: everyone.

Outrage swept across India after the news of the gang rape broke, with elected officials and citizens alike demanding justice for the young medical student. Even more unusual, justice looks possible. On Wednesday, police announced that four of the six men accused had been arrested.

While the young woman struggles for her life in a hospital in New Delhi, students and activists are galvanizing support to pressure law enforcement and the justice system to change the way crimes against women are prosecuted in order to make the capital city safer.

Here are some of the scheduled events, although not all the protests have been confirmed.

1. India Gate on Wednesday, 5 p.m:
The student union of Jawaharlal Nehru University is calling concerned citizens of Delhi to assemble at India Gate to demand justice for the rape victim and a safer city for women.

“The lack of safety for women in Delhi is based in systemic apathy of the Delhi Police, Home Ministry and Delhi C.M. towards crimes against women,” V. Lenin Kumar, the union’s president, said on this Facebook page. “We want the criminal justice system to provide immediate justice in this case, but we also demand general policy level steps to improve the safety situation in Delhi.”

2. “If you seriously want to do something & are committed to not let #DelhiRape go just as a story, be at Lodhi Garden, 2:30 p.m. on Thurs Dec. 20,” one user wrote on his Twitter feed.

3. Harbhajan Singh, the cricket player, announced a protest march at India Gate on Twitter. The march, “Save Women, Save India,” is scheduled for 11 a.m. on Thursday. “Plz Be there.. No passes, No money… BRING EVERYONE,” he declared.

If you know of anymore such protests happening in Delhi, write to IndiaInk@NYTimes.com

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President Delivers a New Offer on the Fiscal Crisis to Boehner

Joshua Roberts/Reuters

Speaker John A. Boehner returned to his office on Monday after meeting with President Obama.

WASHINGTON — President Obama delivered to Speaker John A. Boehner a new offer on Monday to resolve the pending fiscal crisis, a deal that would raise revenues by $1.2 trillion over the next decade but keep in place the Bush-era tax rates for any household with earnings below $400,000.

The offer is close to a plan proposed by the speaker on Friday, and both sides expressed confidence that they were closing in on a major deficit-reduction plan that could be passed well before January, when more than a half-trillion dollars in automatic tax increases and spending cuts would kick in.

Senior Republican aides said the speaker was to meet with House Republicans on Tuesday morning to discuss the state of negotiations. But they cautioned that obstacles remained.

“Any movement away from the unrealistic offers the president has made previously is a step in the right direction,” said Brendan Buck, a spokesman for Mr. Boehner. “We hope to continue discussions with the president so we can reach an agreement that is truly balanced and begins to solve our spending problem.”

The two sides are now dickering over price, not philosophical differences, and the numbers are very close.

Mr. Boehner had offered the president a deficit framework that would raise $1 trillion over 10 years, with the details to be settled next year by Congress’s tax-writing committees and the Obama administration. In response, Mr. Obama reduced his proposal to $1.2 trillion from $1.4 trillion on Monday at a 45-minute meeting with the speaker at the White House. That was down from $1.6 trillion initially.

The White House plan would permanently extend Bush-era tax cuts on household incomes below $400,000, meaning that only the top tax bracket, 35 percent, would increase to 39.6 percent. The current cutoff between the top rate and the next highest rate, 33 percent, is $388,350.

On spending, the two sides are also converging.

The White House says the president’s plan would cut spending by $1.22 trillion over 10 years, compared with $1.2 trillion in cuts from the Republicans’ initial offer. Of that, $800 billion is cuts to programs, and $122 billion comes from adopting a new measure of inflation that slows the growth of government benefits, especially Social Security. The White House is also counting on $290 billion in savings from lower interest costs on a reduced national debt.

Of the $800 billion in straight cuts, the president said half would come from federal health care programs; $200 billion from other so-called mandatory programs, like farm price supports, not subject to Congress’s annual spending bills; $100 billion from military spending; and $100 billion from domestic programs under Congress’s annual discretion.

To make all this happen, Mr. Obama proposed fast-track procedures to help Congressional tax writers overhaul the individual and corporate tax code and make changes to other programs.

Senior Republican aides made it clear that differences remain. For instance, they say the president is still pressing for $1.3 trillion in higher taxes because the change in the way inflation is calculated would not only slow the growth of spending but also raise more revenue by slowing the rate at which tax brackets rise each year with the cost of living. That would mean that incomes would probably grow faster than the rise in tax brackets, pushing people more quickly into higher tax rates.

They also disagree with the president over counting lower interest payments on the national debt as savings.

“A proposal that includes $1.3 trillion in revenue for only $930 billion in spending cuts cannot be considered balanced,” said another spokesman for Mr. Boehner, Michael Steel, using the Republicans’ calculation for the president’s offer.

The president is also insisting on some protections for what he has called the “most vulnerable populations,” which Republican aides said they had not been expecting. The new inflation calculations, for instance, would probably not affect wounded veterans and disabled people on Supplemental Security Income.

And Mr. Obama is sticking by his request for additional upfront spending on infrastructure and an extension of expiring unemployment benefits.

He would also secure some tax and policy changes long sought by both parties but unattainable in the context of smaller budget deals. His proposal would permanently extend popular business tax breaks like the credit for corporate research and development, permanently stop the expansion of the alternative minimum tax so it does not affect more of the middle class, and stop a long-planned and deep cut to Medicare health providers, which Congress has never had the stomach to allow to kick in.

To keep the country from returning to fiscal showdowns, Mr. Obama wants the government’s borrowing limit to rise high enough to take the issue off the table for two years, although he said that Congress could periodically weigh in and try to override a presidential lifting of the debt ceiling, should it want to.

Senior Republican aides made it clear on Monday night that the plan was not what the speaker had wanted. He had proposed higher income tax rates on income over $1 million. That revenue would be supplemented by reinstating a provision in the tax code — phased out by the Bush-era tax cuts — that automatically limits tax deductions and credits for the affluent. The speaker was also ready to accept a White House proposal from Mr. Obama’s first days in office that would limit tax deductions to 28 percent, trimming back deductions for charitable giving and other activities from the top rate paid by the giver, 35 percent currently.

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The New Old Age Blog: In the Middle: Helping Unhappy Couples

A post on Monday discussed the forces that can make an older couple’s good marriage suddenly go bad — an array of subtle, and often-misunderstood, mental, physical and emotional factors that can upset the equilibrium of even the happiest marriages.

Now we have consulted marriage counselors and geriatricians to find out what caregivers — either the grown children of the couple, or one of the spouses involved– can do to help restore peace and balance to these relationships. The experts consulted uniformly agreed that even older people can at least take steps to reduce tensions and improve their relationship, even if they cannot actually change. (Really, who can, at any age?)

“Even though the situation may seem overwhelming, take heart,” said Dr. Gordon Herz, a psychologist in private practice in Madison, Wisc., who specializes in neuropsychology and rehabilitation psychology. “Couples who have been together for 60 years tend to have worked out ways to manage conflict – or they wouldn’t still be together.”

Retreat to a neutral corner

When grown children see their parents fight, many want to run and hide. But those who are assuming an increased caregiving role often feel impelled to jump in and “fix” the problem, as they do with the other caregiving issues.

If you are so inclined, experts speak with one loud voice to advise: Don’t!

Trying to act as emotional broker between your parents can backfire. (Now they tell me! Suffice it to say that after one such effort my sister said to me in not exactly the friendliest tone, “Well, that went well, didn’t it?”)

“It’s better if your parents can find somebody else to talk to than you,” said Dr. Nancy K. Schlossberg, professor emerita of counseling psychology at the University of Maryland and the author of “Overwhelmed: Coping With Life’s Ups and Downs.”

Don’t give up on marital therapy

“Marital therapy for individuals over 65 years of age is difficult, since habits of a lifetime are deeply ingrained,” stated a study in The Canadian Journal of Medicine, one of the few in the medical literature about marital therapy among older people.

“Yet, in a sense, marital therapy is more crucial for the elderly than for younger patients,” the study continued. “At a time when they are least adaptable and most vulnerable to stress and are entering perhaps the most difficult period of their lives, the elderly must learn new methods of relating and coping” because of the physical and mental changes described in our earlier post.

There’s another reason learning to cope with life changes as a couple is even more critical for older couples: Unlike younger couples, the elderly are rarely in a position to leave the marriage and start over.

Help at least one spouse get counseling

What if only half the couple is ready to seek counseling? Not a problem, therapists said. “You want to help the part of the couple that is suffering,” said Dr. Elaine Rodino, a therapist in private practice in State College, Penn. “The other person may still be the curmudgeon, but I think of it as the law of physics: When you change one aspect of the formula, things change in the total.”

When dementia affects one of the spouses, therapy can help the caregiving spouse learn coping techniques, “which can reduce the marital discord and stress that can make conditions, especially cognitive difficulties, worse,” said Dr. William Dale, chief of geriatrics at the University of Chicago Geriatrics Medicine.

Consider the general practitioner or internist

If the couple won’t see a marriage counselor or therapist, can a family doctor be of any use? The experts had mixed responses.

Many pointed out that general practitioners have neither the time nor the training to offer much relationship help, unless the origin of the problem is exclusively physical. Others thought they could be of use, if given a little direction from the family.

“I encourage the kids to talk to the doctor in advance and let him know something is going on – signs of depression or other problems the parents won’t talk about,” advised Dr. Dale, adding that a consultation with a geriatrician who is more familiar with problems of the aging might be even more productive. “Then the doctor can say, ‘Gee, you sound really frustrated or down — are there any reasons we can explore?’”

Don’t overlook the importance of intimacy

“Mutually stimulating sexual relationships need care and feeding by both partners at any age, but especially in the geriatric years,” according to a study on marital therapy for the elderly. “The need for physical contact, warmth and touching perhaps reaches a peak in this age of loneliness, decreased self-esteem and poor health.”

Forget the idea that elderly couples are too shy to talk about intimacy, insisted Dr. Rodino. “I saw a couple in their 80s, the husband was getting penile injections at the doctor’s office, and then they hurried home to have sex.”

But Dr. Rodino does concede that for older patients it is especially important to focus not only on sexual function and performance, but on “touching, and non-intercourse sexual relations; I help them rekindle the affection and emotional closeness,” Dr. Rodino said.

Address any neuropsychological issues.

To find out whether the sudden marital conflict may stem from early mental cognitive impairment (M.C.I.) —or to rule M.C.I. out and find the real source of trouble — make sure the spouse obtains a full neuropsychological evaluation. If it is M.C.I., “it convinces everybody that there is more than just abstinence, it’s not a personality problem — and they need to address it,” said Dr. Dale.

Don’t overlook simple solutions

“Sometimes a memory problem is something simple, like low Vitamin B12, that is easily fixed,” said Dr. Dale. “Or hypothyroidism, which is quite common, can affect memory.”

In that case, doctors administer synthroid, a thyroid hormone replacement that Dr. Dale said is “very safe, with almost no side effects.” Other changes in behavior can also be the result of a simple problem or be remedied by a change in medication. Don’t assume the worst.

Put an end to the blame game

Help reframe the problem. “Even if dementia is involved, let them know it’s not that their partner hates them, it’s that he is having cognitive changes,” said Dr. Linda Waite, director of the Center on Demography and Economics of Aging at NORC/University of Chicago.

“When you re-frame it like that, it’s easier for the spouse not to take it personally and not blame themselves and feel it’s something they did,” said Dr. Waite. “It can make a difference.”

A 2009 study in the journal Gerontologist supports this notion: “Care partners likely would benefit from strategies aimed at reducing self-blame, enhancing coping skills … and communicating effectively with the person with M.C.I and significant others.”

Separate the anxiety

Divide and conquer — time away improves time together.

“Older couples, especially those with disabilities, spend way too much time together,” said Dr. Lisa Gwyther, director of the Duke Center for Aging Family Support Program. “It would be a problem for any couple.”

Caregivers can best help by arranging for an activity or outing that each spouse can do separately so they can return to each other refreshed and more cheerful. “That can help a lot,” said Dr. Gwyther.

Dial down the tone

For spouse caregivers, it is important to watch not just what is said, but how it is said. In any relationship, tone influences our interpretation of what our partner says. Those with M.C.I. will especially react to tone, rather than the substance of the exchange, Dr. Dale said.

“Ratchet down the emotions, repeat things calmly,” Dr. Dale said. The person with cognitive problems doesn’t know he asked the same question five times — he only knows that you sound angry at him for no reason he can fathom. One spouse’s anger fuels the other’s, and pretty soon there is a fight or withdrawal.

Zero tolerance for violence

If a spouse becomes violent, “that’s an entirely different issue,” said Dr. Schlossberg. “Call in an expert on family violence” or the police.

Help them help others

Nobody likes feeling dependent and having to ask for help. Finding a way to have your loved one volunteer, help others and continue to feel useful can improve moods and marital interactions – even if M.C.I. is involved.

With one couple Dr. Gwyther saw, the wife was not only “driving her husband nuts because she was asking him the same questions over and over,” but she could no longer drive and deliver food in a mobile meals program as she used to. “So her husband agreed to be the driver — and she took the meals to the doors,” Dr. Gwyther recalled.”It made her feel good to continue to do that — and it made them feel good to do it together.”

Caregiver, heal thyself

You have heard it a million times here and elsewhere but, unlike us, this advice never gets old.

If you are exhausted from caregiving, you are bound to be cranky, and that will make everybody around you edgy and irritable, too — especially the spouse who requires your care. Taking the time to look after your own health and engage in activities that bring you pleasure can go a long way toward reducing stress and reestablishing a peaceful balance in a marriage.

How have you coped with tensions in your marriage — or in your elderly parents’ marriage, as you care for them in their old age? Share in the comments below.

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