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

Read More..

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.

Read More..

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.

Read More..

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.

Read More..

DealBook: Massachusetts Fines Morgan Stanley Over Facebook I.P.O.

Morgan Stanley is paying for its role in the troubled stock market debut of Facebook.

On Monday, Massachusetts’s top financial authority fined the bank $5 million for violating securities laws, the first major regulatory action tied to Facebook’s initial public stock offering.

William F. Galvin, the secretary of the commonwealth of Massachusetts, accused the bank of improperly influencing the stock offering process. The regulator’s consent order asserts that a senior Morgan Stanley banker coached Facebook on how to share information with stock analysts who cover the social media company, a potential violation of a landmark legal settlement with Wall Street. While the banker never contacted the analysts directly, his actions, Mr. Galvin said, put ordinary investors at a disadvantage because they lacked access to the same research.

“The broader message here is we are going to use any means possible to enforce the strict code in place about giving out information,” Mr. Galvin said in an interview. “We want to get the message across that if Wall Street wants to get confidence back, they can’t disadvantage Main Street.”

The consent order did not name the Morgan Stanley banker, referring to him as a “senior investment banker.” But information in the regulator’s order indicated that it was Michael Grimes, one of the nation’s most influential technology bankers.

“Morgan Stanley is committed to robust compliance with both the letter and the spirit of all applicable regulations and laws,” a Morgan Stanley spokeswoman, Mary Claire Delaney, said. Morgan Stanley, in settling the case, neither admitted nor denied guilt.

Mr. Grimes, through Ms. Delaney, declined to comment. Although the banker was referred to in the order, Mr. Grimes has not been personally accused of any wrongdoing.

The Facebook public offering was one of the most highly anticipated debuts of the last decade. In the run-up to the offering, investor interest was robust, prompting the company to increase the size of the offering and raise the share price to $38.

But the I.P.O. quickly turned into a debacle. The first day of trading was plagued with problems. The shares quickly fell below their offering price. The stock closed on Monday at $26.75.

Since the offering, Mr. Galvin and other regulators have opened wide-ranging investigations into Facebook and the banks that handled its debut. The continuing inquiries by the Securities and Exchange Commission and the Financial Industry Regulatory Authority are examining how the banks disseminated nonpublic information to big investors — and whether it conflicted with Facebook’s public disclosures.

Regulators are also looking into Nasdaq, the exchange where Facebook trades. They are questioning whether the exchange failed to properly test its trading systems, which faltered during the stock offering.

The Massachusetts regulator is focused on Morgan Stanley’s communications with analysts.

Shortly before the Facebook offering, analysts at several banks lowered their growth estimates for the social network. The move came after Facebook issued an amended prospectus, detailing a potential slowdown in revenue.

A Facebook executive, whose name was not given in the order but who was referred to as the treasurer, also reached out to analysts. Mr. Galvin’s order asserted that the executive, in private conversations with analysts, had provided additional information on the revenue. The order indicated that Mr. Grimes was personally involved in the decision to file the new prospectus and to have Facebook communicate with analysts.

“Morgan Stanley’s senior investment banker did everything but make the phone calls himself,” the Massachusetts regulator said in a statement, referring to Mr. Grimes. “He not only rehearsed with Facebook’s treasurer who placed the calls to the research analysts, but he also drafted the majority of the script Facebook’s treasurer utilized.”

Just 12 minutes after filing the amended prospectus with regulators on May 9, the Facebook treasurer phoned Wall Street research analysts from her hotel, according to the order. She had a 15-minute conversation with Morgan Stanley analysts, and then spoke with JPMorgan Chase and other banks.

The calls provided the analysts with additional information that did not appear in the amended prospectus, the order said. The conversations, for example, included “quantitative information regarding Facebook’s” second-quarter 2012 projections.

This behavior, Mr. Galvin said, crossed the line, violating the regulatory settlement on stock research that Morgan Stanley and other companies signed in 2003. The agreement limits the communication between bankers and research analysts and bans companies from influencing stock reports to try to bolster banking operations.

The Morgan Stanley case falls into a curious gray area.

Bankers spend months preparing companies to go public, a role that includes providing guidance on research analysts. In this instance, Mr. Grimes did not personally place the calls, which would have been a clear violation of securities laws.

In his testimony before the Massachusetts regulator’s staff, Mr. Grimes indicated that the bank had pushed for Facebook to file publicly an amended prospectus to avoid “the appearance” that the company was sharing information with a select group of clients rather than broadly with investors. Mr. Grimes, the order noted, consulted with Morgan Stanley and Facebook lawyers. Ultimately, Facebook’s chief financial officer, David A. Ebersman, e-mailed the company’s board to say that the new filing would “help us to continue to deliver accurate” information without “someone claiming we are providing any selective disclosure.”

Mr. Grimes, in testimony with the regulator, further defended his role. While the Facebook treasurer was making the calls, he noted that “I was far down the hall so I wouldn’t hear anything.”

Even so, Mr. Grimes, according to the consent order, e-mailed Mr. Ebersman to say that the Facebook treasurer “was a champ in the hotel tonight,” after the treasurer wrapped up the calls.

A version of this article appeared in print on 12/18/2012, on page B1 of the NewYork edition with the headline: Morgan Stanley Is Fined Over Facebook I.P.O. Role.

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Attackers in Pakistan Kill Anti-Polio Workers

ISLAMABAD, Pakistan — Five Pakistani women and a man were killed on Tuesday in separate attacks on health workers participating in a national drive to eradicate polio from Pakistan.

Athar Hussain/Reuters

Family members mourned the death of Nasima Bibi, a female worker with an anti-polio drive campaign in Pakistan, who was shot by gunmen on Tuesday.

Akhtar Soomro/Reuters

The bodies of two female workers with an anti-polio drive lay in the morgue at Jinnah Hospital in Karachi on Tuesday.

The attacks forced health officials to temporarily suspend a large polio vaccination drive in Karachi, the country’s most populous city, where the disease has been making a worrisome comeback in recent years.

Saghir Ahmed, the health minister for southern Sindh Province, said he had ordered the 24,000 aid workers taking part in the campaign in Karachi to immediately stop work. It was not clear when they would resume.

The shooting represented a brutal setback to polio immunization efforts in Pakistan, one of just three countries in the world where the disease remains endemic. Pakistan accounted for 198 new cases last year — the highest rate in the world, followed by Afghanistan and Nigeria.

There was no immediate claim of responsibility, but Taliban insurgents have repeatedly vowed to target anti-polio workers, accusing them of being spies.

In the tribal areas along the Afghan border, Taliban leaders have issued religious edicts declaring that the United States runs a spy network under the guise of vaccination programs.

That perception was strengthened after the American commando raid that killed Osama bin Laden in June 2011, when it emerged that the Central Intelligence Agency had paid a Pakistani doctor to run a vaccination program in Abbottabad, where Bin Laden was hiding, in a bid to obtain DNA evidence from his family.

Pakistani authorities arrested the doctor, Shakil Afridi, shortly after the American raid, and he has been sentenced to 33 years in prison.

Despite the negative perceptions, the government has pressed ahead with a large polio vaccination campaign, usually conducted in three-day spurts involving tens of thousands of health workers who administer medicine to children under 5.

The shootings on Tuesday came on the second day of the latest drive, which has now been called off in Karachi. After an attack on a United Nations doctor from Ghana in Karachi last July, officials were braced for some sort of militant resistance. But the extent and scale of the attacks Tuesday caught the government by surprise.

In the attacks in Karachi, three teams of health volunteers were targeted in poor neighborhoods: Landhi, Orangi and Baldia Town.

Two female aid workers were killed in an attack in Landhi, according to local news reports. In Orangi, unknown gunmen opened fire on a health team, killing one woman and a male volunteer. Another female worker was killed in nearby Baldia Town.

The Karachi neighborhoods where aid workers were targeted Tuesday are being used as safe havens by militants, who have escaped American drone strikes in North and South Waziristan tribal regions, according to police officials. Security forces regularly conduct search operations in these neighborhoods.

In the northwestern city of Peshawar, gunmen riding a motorcycle opened fire on two sisters who had volunteered to help administer polio drops, killing one.

The attacks on polio workers followed a bold Taliban assault on a major Pakistan Air Force base in Peshawar over the weekend that killed at least 15 people and a militant bomb attack in a nearby tribal village on Monday that killed another 19.

For Pakistan’s beleaguered progressives, the attack on female health workers was another sign of how the country’s extremist fringe would stoop to attack the vulnerable and minorities.

“Ahmadis, Shias, Hazaras, Christians, child activists, doctors, anti-polio workers — who’s next on the target list, Pakistan?” asked Mira Hashmi in a post on Twitter.

Zia ur-Rehman contributed reporting from Karachi

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Fiscal Cliff Casts Big Shadow on Sunnier 2013 Economic Forecasts

The American economy could finally have a pretty good year next year — assuming Washington does its part.

Economists see a number of sources of underlying strength in the economy, but for the growth to gain traction, they say, political leaders need to avoid the broad tax increases and spending cuts now being debated.

The nascent housing rebound, the natural gas boom, record profit margins, a friendlier credit market for small businesses, along with pent-up demand for autos and other big purchases, could in combination unleash growth and hiring that the economy needs.

“Underneath all the shenanigans in Washington, there’s a lot of strengthening,” said Ian Shepherdson, chief economist at Pantheon Macroeconomics.

More robust growth next year — perhaps higher than 3 percent later in the year, according to some of the more optimistic forecasts — would certainly be a stark reversal from the current sluggish path.

There is a range of opinion among economists, though, and some warn of continued sluggishness, especially in the beginning of the year.

Estimates for the last quarter of 2012 are hovering around an unusually weak 1 percent annualized rate.

That dismal pace is driven partly by drags from Europe’s recession and China’s slowdown; partly by companies readjusting after potentially overstocking their back-room shelves in the third quarter; and largely by worries about the so-called fiscal cliff of spending cuts and tax increases set for early 2013.

Surveys of consumer and business confidence in recent weeks have plummeted to recession-era lows. With such uncertainty, businesses have also recently curtailed spending on capital investments like computers, delivery trucks and other equipment, apparently in anticipation of higher tax rates and the destructive side effects of government cutbacks. Given that capital expenditures have been weak recently, some economists believe businesses will start spending more if Congress ends or at least delays the risk of severe fiscal tightening.

“You would think there must be for most businesses a list of projects they’d like to do which they’ve just been pushing a little bit into the future because they haven’t been able to justify taking the risk because they don’t know what’s around the corner,” said Nigel Gault, chief United States economist for IHS Global Insight. “When they know more about the future, and what tax rates they’ll be paying, they will be able to dust off those plans and finally execute them.”

Improving access to credit helps these capital expenditures become not only more attractive, but also more accessible. Commercial and industrial loans have been rising in recent months, according to the Federal Reserve. The National Federation of Independent Business has also reported that the share of small business owners who say their credit needs are not being met has been falling.

Additionally, corporate profits reached a high, even adjusting for inflation, in the third quarter. Companies have amassed a lot of cash that they can use to buy equipment or hire people if they feel secure enough about the recovery.

Consumers, on the other hand, are still not exactly cash-rich, particularly since their disposable income has been flat to falling in recent months. But in the last few years they have deleveraged greatly — either by paying down debt or having it written off through default — and, more important, they are feeling a little wealthier because the housing market appears to have bottomed out. The country has finally worked its way through the excess housing inventory from the bubble years, and now housing prices and housing construction are rising.

Household formation is picking up: young people are finally moving into their own homes, as are other Americans who had lived with family or friends.

“We’re slowly but steadily improving, with more job opportunities in particular for younger households,” said Mark Zandi, chief economist at Moody’s Analytics. “They can only live with their parents for so long. There are powerful centrifugal forces in those households, on both sides. As soon as they have a chance to get out, many will take it.”

Demographic data suggests that there should be about a million more households headed by younger Americans today than there actually are. That bodes well for continued formation of households next year, and new household formation is typically accompanied by other spending like furniture and kitchenware. Under normal circumstances, each new household adds about $145,000 to output that year as the spending ripples through the economy, Mr. Zandi says.

As is the case with businesses, economists see consumers unleashing some of their pent-up demand for cars. The average age of all vehicles in operation in America is at a record high of 11.2 years, according to the research firm R. L. Polk, which tracks vehicle sales and registrations. Vehicle sales have already been posting large gains this year.

The major caveat to all these relatively upbeat indicators, of course, is that Congress might override all this strength with deep austerity measures.

Even without all of the federal tax increases and spending cuts scheduled for 2013, the government sector will slow growth because state and local governments are still shrinking, said Michael Feroli, chief United States economist for JPMorgan Chase. The sharp fiscal tightening at the federal level under current law would not only drag on growth but throw the entire economy back into recession, according to numerous private and government forecasters.

The nonpartisan Congressional Budget Office has estimated that the entirety of the so-called fiscal cliff would shave about three percentage points off gross domestic product growth next year.

A more modest tightening along the lines of what President Obama wants — which would include extending most existing tax rates and spending programs — would still substantially reduce growth, analysts say. Charles Dumas, the chairman of Lombard Street Research, forecasts about a two percentage point subtraction from output growth next year under a situation where most of the Bush tax cuts are kept, the payroll tax holiday is phased out and most of the scheduled spending cuts are eliminated.

“The full drag posed by the cliff is sufficient to erase roughly two and a half years’ worth of economic gains,” said Joseph A. LaVorgna, chief United States economist at Deutsche Bank.

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Experts Say Thimerosal Ban Would Imperil Global Health Efforts

A group of prominent doctors and public health experts warns in articles to be published Monday in the journal Pediatrics that banning thimerosal, a mercury compound used as a preservative in vaccines, would devastate public health efforts in developing countries.

Representatives from governments around the world will meet in Geneva next month in a session convened by the United Nations Environmental Program to prepare a global treaty to reduce health hazards by banning certain products and processes that release mercury into the environment.

But a proposal that the ban include thimerosal, which has been used since the 1930s to prevent bacterial and fungal contamination in multidose vials of vaccines, has drawn strong criticism from pediatricians.

They say that the ethyl-mercury compound is critical for vaccine use in the developing world, where multidose vials are a mainstay.

Banning it would require switching to single-dose vials for vaccines, which would cost far more and require new networks of cold storage facilities and additional capacity for waste disposal, the authors of the articles said.

“The result would be millions of people, predominantly in low- and middle-income countries, with significantly restricted access to lifesaving vaccines for many years,” they wrote.

In the United States, thimerosal has not been used in children’s vaccines since the early 2000s after the Food and Drug Administration and public health groups came under pressure from advocacy groups that believed there was an association between the compound and autism in children.

At the time, few, if any, studies had evaluated the compound’s safety, so the American Academy of Pediatrics called for its elimination in children’s vaccines, a recommendation that the authors argued was made under the principle of “do no harm.”

Since then, however, there has been a lot of research, and the evidence is overwhelming that thimerosal is not harmful, the authors said. Louis Z. Cooper, a former president of the academy and one of the authors, said that if the members had known then what they know now, they never would have recommended against using it. “Science clearly documented that we can’t find hazards from thimerosal in vaccines,” he said. “The preservative plays a critical role in distribution of vaccine to the global community. It was a no-brainer what our position needed to be.”

Advocacy groups have lobbied to include the substance in the ban, and some global health experts worry that because the government representatives due to vote next month are for the most part ministers of environment, not health, they may not appreciate the consequences of banning thimerosal in vaccines. The Pediatrics articles are timed to raise a warning before the meeting.

“If you don’t know about this, and you’re a minister of environment who doesn’t usually deal with health, it’s confusing,” said Heidi Larson, senior lecturer at the London School of Hygiene and Tropical Medicine, who runs the Vaccine Confidence Project.

In an open letter to the United Nations Environmental Program and the World Health Organization this year, the Coalition for Mercury-Free Drugs, a nonprofit group that supports the ban, disputed the assertion that scientific studies had offered proof that thimerosal is safe, and urged member states to include it in the ban.

That it is being used in developing countries, but not developed countries, is an “injustice,” the letter said.

The World Health Organization has also weighed in. In April, a group of experts on immunization wrote in a report that they were “gravely concerned that current global discussions may threaten access to thimerosal-containing vaccines without scientific justification.”

Dr. Larson said she believed that the efforts of pediatricians and global health experts, including the W.H.O., would influence the negotiations in Geneva and that the compound would most likely be left out of the final ban.

“You can’t just pull the plug on something without having a plan for an alternative,” she said.

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