U.S. Economy Unexpectedly Contracted in Fourth Quarter

The United States economy unexpectedly reversed course in the final quarter of 2012 and contracted at a 0.1 percent rate, its worst performance since the aftermath of the financial crisis in 2009.

The drop was driven by a plunge in military spending, as well as fewer exports and a steep slowdown in the buildup of inventories by businesses. Anxieties about the fiscal impasse in Washington also contributed to the slowdown.

While economists expected output to decline substantially from the 3.1 percent annual growth rate recorded in the third quarter, the negative number caught Wall Street off-guard. It was the weakest economic report since the second quarter of 2009.

“I’m a little surprised,” said Michael Feroli, chief United States economist at JPMorgan. “It grabs your attention when you have a negative number across everyone’s screens.”

Stocks were modestly higher in early trading on Wall Street, as some traders shrugged off the unexpected drop.

Mr. Feroli had been expecting growth to come in at 0.4 percent, which was well below the 1.1 percent consensus among economists on Wall Street. Still, Mr. Feroli said there were some hints the economy was performing slightly better than the headline number suggested.

The 22.2 percent drop in military spending – the sharpest quarterly drop in more than four decades – along with the drop in inventories and exports overwhelmed more positive indicators in the private sector, he said.

For example, final sales to private domestic purchasers, which strips out government spending as well as trade and inventories, rose by 2.8 percent. “Consumers and businesses kept spending at a pretty steady pace,” Mr. Feroli said. “There was a lot of noise that moved the headline around.”

For the entire year, the economy grew by 2.2 percent, a slight improvement from the 1.8 percent annual rate in 2011.

Still, with unemployment stubbornly high at 7.8 percent and growth expected to remain slow in the first quarter, the poor report Wednesday was likely to set off more finger-pointing in Washington.

The compromise between President Obama and Congress earlier this month allowed a temporary cut in Social Security taxes to expire, which is expected to crimp growth in the first quarter. The change will cost a worker earning $50,000 a year an extra $1,000 annually.

Indeed, a consumer confidence survey released Tuesday by the Conference Board showed a sharp downturn in January, which economists attributed in part to financial anxiety arising from the reduction in take-home pay.

The consensus estimate for early 2013 is currently calling for output to rise at an annual rate of 1.5 percent, but that number may come down in the wake of Wednesday’s report.

This was the Commerce Department’s first estimate of fourth-quarter growth; revisions are due in February and March, so the final figure could go up or down significantly.

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The New Old Age Blog: For Some Caregivers, the Trauma Lingers

Recently, I spoke at length to a physician who seems to have suffered a form of post-traumatic stress after her mother’s final illness.

There is little research on this topic, which suggests that it is overlooked or discounted. But several experts acknowledge that psychological trauma of this sort does exist.

Barry Jacobs, a clinical psychologist and author of “The Emotional Survival Guide for Caregivers” (The Guilford Press, 2006), often sees caregivers who struggle with intrusive thoughts and memories months and even years after a loved one has died.

“Many people find themselves unable to stop thinking about the suffering they witnessed, which is so powerfully seared into their brains that they cannot push it away,” Dr. Jacobs said.

Flashbacks are a symptom of post-traumatic stress disorder, along with feelings of numbness, anxiety, guilt, dread, depression, irritability, apathy, tension and more. Though one symptom or several do not prove that such a condition exists — that’s up to an expert to determine — these issues are a “very common problem for caregivers,” Dr. Jacobs said.

Dolores Gallagher-Thompson, a professor of psychiatry at the Stanford University School of Medicine who treats many caregivers, said there was little evidence that caregiving on its own caused post-traumatic stress. But if someone is vulnerable for another reason — perhaps a tragedy experienced earlier in life — this kind of response might be activated.

“When something happens that the individual perceives and reacts to as a tremendous stressor, that can intensify and bring back to the forefront of consciousness memories that were traumatic,” Dr. Gallagher-Thompson said. “It’s more an exacerbation of an already existing vulnerability.”

Dr. Judy Stone, the physician who was willing to share her mother’s end-of-life experience and her powerful reaction to it, fits that definition in spades.

Both of Dr. Stone’s Hungarian parents were Holocaust survivors: her mother, Magdus, called Maggie by family and friends, had been sent to Auschwitz; her father, Miki, to Dachau. The two married before World War II, after Maggie left her small village, moved to the city and became a corset maker in Miki’s shop.

Death cast a long shadow over the family. During the war, Maggie’s first baby died of exposure while she was confined for a time to the Debrecen ghetto. After the war, the family moved to the United States, where they worked to recover a sense of normalcy and Miki worked as a maker of orthopedic appliances. Then he died suddenly of a heart attack at the age of 50.

“None of us recovered from that,” said Dr. Stone, who traces her interest in medicine and her lifelong interest in fighting for social justice to her parents and trips she made with her father to visit his clients.

Decades passed, as Dr. Stone operated an infectious disease practice in Cumberland, Md., and raised her own family.

In her old age, Maggie, who her daughter describes as “tough, stubborn, strong,” developed macular degeneration, bad arthritis and emphysema — a result of a smoking habit she started just after the war and never gave up. Still, she lived alone, accepting no help until she reached the age of 92.

Then, in late 2007, respiratory failure set in, causing the old woman to be admitted to the hospital, then rehabilitation, then assisted living, then another hospital. Maggie had made her preferences absolutely clear to her daughter, who had medical power of attorney: doctors were to pursue every intervention needed to keep her alive.

Yet one doctor sent her from a rehabilitation center to the hospital during respiratory crisis with instructions that she was not to be resuscitated — despite her express wishes. Fortunately, the hospital called Dr. Stone and the order was reversed.

“You have to be ever vigilant,” Dr. Stone said when asked what advice she would give to families. “You can’t assume that anything, be it a D.N.R. or allergies or medication orders, have been communicated correctly.”

Other mistakes were made in various settings: There were times that Dr. Stone’s mother had not received necessary oxygen, was without an inhaler she needed for respiratory distress, was denied water or ice chips to moisten her mouth, or received an antibiotic that can cause hallucinations in older people, despite Dr. Stone’s request that this not happen. “People didn’t listen,” she said. “The lack of communication was horrible.”

It was a daily fight to protect her mother and make sure she got what she needed, and “frankly, if I hadn’t been a doctor, I think I would have been thrown out of there,” she said.

In the end, when it became clear that death was inevitable, Maggie finally agreed to be taken off a respirator. But rather than immediately arrange for palliative measures, doctors arranged for a brief trial to see if she could breathe on her own.

“They didn’t give her enough morphine to suppress her agony,” Dr. Stone recalled.

Five years have passed since her mother died, and “I still have nightmares about her being tortured,” the doctor said. “I’ve never been able to overcome the feeling that I failed her — I let her down. It wasn’t her dying that is so upsetting, it was how she died and the unnecessary suffering at the end.”

Dr. Stone had specialized in treating infectious diseases and often saw patients who were critically ill in intensive care. But after her mother died, “I just could not do it,” she said. “I couldn’t see people die. I couldn’t step foot in the I.C.U. for a long, long time.”

Today, she works part time seeing patients with infectious diseases on an as-needed basis in various places — a job she calls “rent a doc” — and blogs for Scientific American about medical ethics. “I tilt at windmills,” she said, describing her current occupations.

Most important to her is trying to change problems in the health system that failed her mother and failed her as well. But Dr. Stone has a sense of despair about that: it is too big an issue, too hard to tackle.

I’m grateful to her for sharing her story so that other caregivers who may have experienced overwhelming emotional reactions that feel like post-traumatic stress realize they are not alone.

It is important to note that both Dr. Jacobs and Dr. Gallagher-Thompson report successfully treating caregivers beset by overwhelming stress. It is hard work and it takes time, but they say recovery is possible. I’ll give a sense of treatment options they and others recommend in another post.

Read More..

The New Old Age Blog: For Some Caregivers, the Trauma Lingers

Recently, I spoke at length to a physician who seems to have suffered a form of post-traumatic stress after her mother’s final illness.

There is little research on this topic, which suggests that it is overlooked or discounted. But several experts acknowledge that psychological trauma of this sort does exist.

Barry Jacobs, a clinical psychologist and author of “The Emotional Survival Guide for Caregivers” (The Guilford Press, 2006), often sees caregivers who struggle with intrusive thoughts and memories months and even years after a loved one has died.

“Many people find themselves unable to stop thinking about the suffering they witnessed, which is so powerfully seared into their brains that they cannot push it away,” Dr. Jacobs said.

Flashbacks are a symptom of post-traumatic stress disorder, along with feelings of numbness, anxiety, guilt, dread, depression, irritability, apathy, tension and more. Though one symptom or several do not prove that such a condition exists — that’s up to an expert to determine — these issues are a “very common problem for caregivers,” Dr. Jacobs said.

Dolores Gallagher-Thompson, a professor of psychiatry at the Stanford University School of Medicine who treats many caregivers, said there was little evidence that caregiving on its own caused post-traumatic stress. But if someone is vulnerable for another reason — perhaps a tragedy experienced earlier in life — this kind of response might be activated.

“When something happens that the individual perceives and reacts to as a tremendous stressor, that can intensify and bring back to the forefront of consciousness memories that were traumatic,” Dr. Gallagher-Thompson said. “It’s more an exacerbation of an already existing vulnerability.”

Dr. Judy Stone, the physician who was willing to share her mother’s end-of-life experience and her powerful reaction to it, fits that definition in spades.

Both of Dr. Stone’s Hungarian parents were Holocaust survivors: her mother, Magdus, called Maggie by family and friends, had been sent to Auschwitz; her father, Miki, to Dachau. The two married before World War II, after Maggie left her small village, moved to the city and became a corset maker in Miki’s shop.

Death cast a long shadow over the family. During the war, Maggie’s first baby died of exposure while she was confined for a time to the Debrecen ghetto. After the war, the family moved to the United States, where they worked to recover a sense of normalcy and Miki worked as a maker of orthopedic appliances. Then he died suddenly of a heart attack at the age of 50.

“None of us recovered from that,” said Dr. Stone, who traces her interest in medicine and her lifelong interest in fighting for social justice to her parents and trips she made with her father to visit his clients.

Decades passed, as Dr. Stone operated an infectious disease practice in Cumberland, Md., and raised her own family.

In her old age, Maggie, who her daughter describes as “tough, stubborn, strong,” developed macular degeneration, bad arthritis and emphysema — a result of a smoking habit she started just after the war and never gave up. Still, she lived alone, accepting no help until she reached the age of 92.

Then, in late 2007, respiratory failure set in, causing the old woman to be admitted to the hospital, then rehabilitation, then assisted living, then another hospital. Maggie had made her preferences absolutely clear to her daughter, who had medical power of attorney: doctors were to pursue every intervention needed to keep her alive.

Yet one doctor sent her from a rehabilitation center to the hospital during respiratory crisis with instructions that she was not to be resuscitated — despite her express wishes. Fortunately, the hospital called Dr. Stone and the order was reversed.

“You have to be ever vigilant,” Dr. Stone said when asked what advice she would give to families. “You can’t assume that anything, be it a D.N.R. or allergies or medication orders, have been communicated correctly.”

Other mistakes were made in various settings: There were times that Dr. Stone’s mother had not received necessary oxygen, was without an inhaler she needed for respiratory distress, was denied water or ice chips to moisten her mouth, or received an antibiotic that can cause hallucinations in older people, despite Dr. Stone’s request that this not happen. “People didn’t listen,” she said. “The lack of communication was horrible.”

It was a daily fight to protect her mother and make sure she got what she needed, and “frankly, if I hadn’t been a doctor, I think I would have been thrown out of there,” she said.

In the end, when it became clear that death was inevitable, Maggie finally agreed to be taken off a respirator. But rather than immediately arrange for palliative measures, doctors arranged for a brief trial to see if she could breathe on her own.

“They didn’t give her enough morphine to suppress her agony,” Dr. Stone recalled.

Five years have passed since her mother died, and “I still have nightmares about her being tortured,” the doctor said. “I’ve never been able to overcome the feeling that I failed her — I let her down. It wasn’t her dying that is so upsetting, it was how she died and the unnecessary suffering at the end.”

Dr. Stone had specialized in treating infectious diseases and often saw patients who were critically ill in intensive care. But after her mother died, “I just could not do it,” she said. “I couldn’t see people die. I couldn’t step foot in the I.C.U. for a long, long time.”

Today, she works part time seeing patients with infectious diseases on an as-needed basis in various places — a job she calls “rent a doc” — and blogs for Scientific American about medical ethics. “I tilt at windmills,” she said, describing her current occupations.

Most important to her is trying to change problems in the health system that failed her mother and failed her as well. But Dr. Stone has a sense of despair about that: it is too big an issue, too hard to tackle.

I’m grateful to her for sharing her story so that other caregivers who may have experienced overwhelming emotional reactions that feel like post-traumatic stress realize they are not alone.

It is important to note that both Dr. Jacobs and Dr. Gallagher-Thompson report successfully treating caregivers beset by overwhelming stress. It is hard work and it takes time, but they say recovery is possible. I’ll give a sense of treatment options they and others recommend in another post.

Read More..

Gadgetwise Blog: Q&A: Tweeting in Public or Private

Can someone you block on Twitter still see your tweets?

Blocking another Twitter user prevents the person from following your account and automatically seeing your posts in his or her Twitter feed. Your tweets may still be visible, however, if you have not turned on certain privacy controls in your account’s settings.

Twitter allows you to have a public account, where anyone on the Web can see your posts on your Twitter profile page, or a protected account, where only the people you approve as followers can see your tweets. You can adjust this visibility on Twitter in your account’s settings, as explained in the site’s help guide.

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IHT Rendezvous: Mali's Culture War: The Fate of the Timbuktu Manuscripts

LONDON — Scholars are urgently trying to determine the fate of a treasure store of ancient manuscripts in the city of Timbuktu.

As French-led forces consolidated their hold on northern Mali, international scholars feared the worst: that retreating Islamic militants had torched the Ahmed Baba Institute, home to 30,000 priceless items of scholarship dating back to the 13th century.

But many volumes may have escaped destruction by being hidden from fundamentalist forces that seized the north last year. The militants launched a campaign to eradicate historic vestiges of a medieval Muslim civilization that they deemed un-Islamic.

South African researchers involved in a project to preserve the Timbuktu manuscripts have had word that most of the treasures survived in private libraries and secure locations.

Mohamed Mathee of the University of Johannesburg told eNews Channel Africa, “It seems most of the manuscripts are OK. These manuscripts are with families and are safe.”

National Geographic News quoted Sidi Ahmed, a reporter who fled Timbuktu during its occupation, as saying: “The people here have long memories. They are used to hiding their manuscripts. They go into the desert and bury them until it is safe.”

Whatever the fate of the city’s ancient texts, the French intervention came too late to save some of the city’s most valued monuments, including centuries-old shrines of Sufi saints demolished by the Islamists during their nine-month rule.

It was part of a culture war that they waged to impose Sharia law after their capture of the north. The strict Sunni Salafists reject the worship of saints that is part of the Shia and Sufi tradition.

When UNESCO, the United Nations’ cultural agency, placed Timbuktu on its list of endangered world heritage sites after the Islamist takeover, Oumar Ould Hamaha, a spokesman for the Ansar Dine militants, responded: “We are subject to religion and not to international opinion.”

Elsewhere in North Africa, militants have attacked Sufi shrines as well as remnants of the region’s pre-Islamic past.

Radical Islamists were blamed last October for the destruction of stone carvings in Morocco’s High Atlas Mountains that were more than 8,000 years old and depicted the sun as a pagan divinity.

Their destruction was reminiscent to that of the Buddhist statues of Bamiyan, which were dynamited out of existence in 2001 by the Afghan Taliban despite appeals from fellow Muslims.

Such seemingly wanton acts of religiously inspired vandalism are not, of course, confined to Islamic fundamentalists, as my colleague Barbara Crossette wrote at the time.

“Certainly it evoked the religious triumphalism that plagues a broad swath of the world, from China to the Balkans,” she wrote, “the destruction of centuries-old mosques by Hindus at Ayodhya or by Serbs in Bosnia, or the assaults on heritage that defy peace itself in Jerusalem.”

From the Crusades to the conquest of the Americas, a militant Catholic Church also displayed a predilection for eradicating the artifacts of pagans and religious rivals alike. In the 17th century English Civil War, iconoclastic Puritans hacked down the statues of churches and cathedrals.

Recent events in Mali have highlighted how today’s ideological wars are fought with more than just weapons.

The Timbuktu manuscripts, which include texts on religion, medicine and mathematics, had been treasured by local families but largely neglected by the outside world until the end of French colonial rule in 1960.

That changed dramatically in recent years as rival African powers sought to use culture in their campaigns for influence in the region.

As my colleague Lydia Polgreen wrote from Timbuktu in 2007, both South Africa and the Libya of Col. Muammar el-Qaddafi were involved in efforts to revive the fortunes of the ancient city and its artifacts.

The South African initiative involved building a new library for the Ahmed Baba Institute, while Libya planned to build a luxurious 100-room resort to hold academic and religious conferences.

Charities and governments from Europe, the United States and the Middle East also poured hundreds of thousands of dollars into transforming the city’s family libraries.

“Timbuktu’s new seekers have a variety of motives,” she wrote. “South Africa and Libya are vying for influence on the African stage, each promoting its vision of a resurgent Africa.”

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Pfizer’s Profit Jumps on Sale of Nutrition Business

Pfizer Inc.'s fourth-quarter profit more than quadrupled, despite competition from generic drugs hurting sales of Lipitor and other medicines, because of a $4.8 billion gain from selling its nutrition business. The drugmaker's profit and sales both beat Wall Street expectations.

The world's biggest drugmaker said Tuesday that its net income was $6.32 billion, or 85 cents per share, up from $1.44 billion, or 19 cents per share, a year earlier.

Excluding the windfall from selling its nutrition business to Nestle SA for $11.5 billion on Nov. 30, and a total of $888 million for restructuring, legal and other one-time items, the Viagra maker would have had a profit of $3.51 billion, or 47 cents per share. That's 3 cents more than analysts surveyed by FactSet were expecting.

In early trading, the New York-based company's shares rose 26 cents, or 1 percent, to $27.10.

Revenue fell 7 percent to $15.1 billion, mainly due to generic competition to cholesterol blockbuster Lipitor. Analysts expected $14.35 billion.

"Overall, a good quarter driven by the revenue beat," BernsteinResearch analyst Dr. Timothy Anderson wrote to investors, calling Pfizer's 2013 financial forecast "a bit underwhelming."

Pfizer said it expects 2013 earnings per share of $2.20 to $2.30, excluding one-time items, and revenue of $56.2 billion to $58.2 billion. Analysts are expecting $2.28 per share and revenue of $57.55 billion.

Lipitor, which had reigned as the world's top-selling drug ever for nearly a decade, got U.S. generic competition in December 2011 and now has generic rivals in many major markets. The pill had been bringing Pfizer nearly $11 billion a year before then, down from its peak of $13 billion a year.

In the fourth quarter, Lipitor sales plunged 91 percent in the U.S. and 71 percent worldwide, to $584 million. A dozen other medicines also had lower sales due to generic competition.

Altogether, generic competition reduced prescription drug revenue by more than $2.1 billion. Unfavorable currency exchange rates lopped off another 2 percent, or $271 million.

However, several key newer drugs had double-digit sales increases, including fibromyalgia and pain treatment Lyrica, at $1.13 billion, painkiller Celebrex at $750 million, and the Prevnar 13 vaccine against meningitis and other pneumococcal infections, at $993 million. Viagra was up 6 percent at $553 million.

Altogether, Pfizer's prescription drug revenue fell 9 percent in the quarter, to $12.89 billion. The division was led by sales of primary-care medicines, which totaled $3.83 billion. Still, that was down 29 percent as Lipitor's sales in the two biggest markets, the U.S. and Japan, where shifted into the established products category. That segment, which markets off-patent drugs still popular in many countries, posted a 3 percent rise in revenue, to $2.37 billion.

Specialty products, such as Enbrel for psoriasis and rheumatoid arthritis, and hemophilia treatments Refacto AF and Benefix, had revenue dip 4 percent, to a combined $3.67 billion. Sales in emerging markets such as China and India jumped 17 percent, to $2.65 billion, while sales of cancer drugs, a newer focus for Pfizer, rose 9 percent to $370 million.

The animal health business saw revenue increase 6 percent, to $1.17 billion. Pfizer is set to sell about a 20 percent share in the business, called Zoetis, in an initial public offering on Friday.

The consumer health business saw revenue jump 16 percent, to $936 million, due to strong growth of Advil pain reliever and Centrum vitamins.

He said Pfizer will soon launch two new medicines, rheumatoid arthritis treatment Xeljanz and — with partner Bristol-Myers Squibb Co. — potential blockbuster Eliquis, for preventing heart attacks and dangerous clots in patients with the irregular heartbeat atrial fibrillation. CEO Ian Read said Pfizer's mid- to late-stage drug pipeline "continues to strengthen with key potential opportunities," including drugs for advanced breast cancer and three other types of cancer, one for high cholesterol and a meningococcal B vaccine for adolescents and young adults.

For the full year, net income was $14.57 billion, or $1.94 per share. That was down from $10.01 billion, or $1.27 per share, in 2011. Revenue totaled $58.99 billion, down 10 percent from $65.26 billion in 2011, before generic competition slashed sales of Lipitor and schizophrenia drug Geodon.

___

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Rescuer Appears for New York Downtown Hospital

Manhattan’s only remaining hospital south of 14th Street, New York Downtown, has found a white knight willing to take over its debt and return it to good health, hospital officials said Monday.

NewYork-Presbyterian Hospital, one of New York City’s largest academic medical centers, has proposed to take over New York Downtown in a “certificate of need” filed with the State Health Department. The three-page proposal argues that though New York Downtown is projected to have a significant operating loss in 2013, it is vital to Lower Manhattan, including Wall Street, Chinatown and the Lower East Side, especially since the closing of St. Vincent’s Hospital after it declared bankruptcy in 2010.

The rescue proposal, which would need the Health Department’s approval, comes at a precarious time for hospitals in the city. Long Island College Hospital, just across the river in Cobble Hill, Brooklyn, has been threatened with closing after a failed merger with SUNY Downstate Medical Center, and several other Brooklyn hospitals are considering mergers to stem losses.

New York Downtown has been affiliated with the NewYork-Presbyterian health care system while maintaining separate operations.

“We are looking forward to having them become a sixth campus so the people in that community can continue to have a community hospital that continues to serve them,” Myrna Manners, a spokeswoman for NewYork-Presbyterian, said.

Fred Winters, a spokesman for New York Downtown, declined to comment.

Presbyterian’s proposal emphasized that it would acquire New York Downtown’s debt at no cost to the state, a critical point at a time when the state has shown little interest in bailing out failing hospitals.

The proposal said that if New York Downtown were to close, it would leave more than 300,000 residents of Lower Manhattan, including the financial district, Greenwich Village, SoHo, the Lower East Side and Chinatown, without a community hospital. In addition, it said, 750,000 people work and visit in the area every day, a number that is expected to grow with the construction of 1 World Trade Center and related buildings.

The proposal argues that New York Downtown is essential partly because of its long history of responding to disasters in the city. One of its predecessors was founded as a direct result of the 1920 terrorist bombing outside the J. P. Morgan Building, and the hospital has responded to the 1975 bombing of Fraunces Tavern, the 1993 and 2001 attacks on the World Trade Center, and, this month, the crash of a commuter ferry from New Jersey.

Like other fragile hospitals in the city, New York Downtown has shrunk, going to 180 beds, down from the 254 beds it was certified for in 2006, partly because the more affluent residents of Lower Manhattan often go to bigger hospitals for elective care.

The proposal says that half of the emergency department patients at New York Downtown either are on Medicaid, the program for the poor, or are uninsured.

NewYork-Presbyterian would absorb the cost of the hospital’s maternity and neonatal intensive care units, which have been expanding because of demand, but have been operating at a deficit of more than $1 million a year, the proposal said.

Read More..

Rescuer Appears for New York Downtown Hospital

Manhattan’s only remaining hospital south of 14th Street, New York Downtown, has found a white knight willing to take over its debt and return it to good health, hospital officials said Monday.

NewYork-Presbyterian Hospital, one of New York City’s largest academic medical centers, has proposed to take over New York Downtown in a “certificate of need” filed with the State Health Department. The three-page proposal argues that though New York Downtown is projected to have a significant operating loss in 2013, it is vital to Lower Manhattan, including Wall Street, Chinatown and the Lower East Side, especially since the closing of St. Vincent’s Hospital after it declared bankruptcy in 2010.

The rescue proposal, which would need the Health Department’s approval, comes at a precarious time for hospitals in the city. Long Island College Hospital, just across the river in Cobble Hill, Brooklyn, has been threatened with closing after a failed merger with SUNY Downstate Medical Center, and several other Brooklyn hospitals are considering mergers to stem losses.

New York Downtown has been affiliated with the NewYork-Presbyterian health care system while maintaining separate operations.

“We are looking forward to having them become a sixth campus so the people in that community can continue to have a community hospital that continues to serve them,” Myrna Manners, a spokeswoman for NewYork-Presbyterian, said.

Fred Winters, a spokesman for New York Downtown, declined to comment.

Presbyterian’s proposal emphasized that it would acquire New York Downtown’s debt at no cost to the state, a critical point at a time when the state has shown little interest in bailing out failing hospitals.

The proposal said that if New York Downtown were to close, it would leave more than 300,000 residents of Lower Manhattan, including the financial district, Greenwich Village, SoHo, the Lower East Side and Chinatown, without a community hospital. In addition, it said, 750,000 people work and visit in the area every day, a number that is expected to grow with the construction of 1 World Trade Center and related buildings.

The proposal argues that New York Downtown is essential partly because of its long history of responding to disasters in the city. One of its predecessors was founded as a direct result of the 1920 terrorist bombing outside the J. P. Morgan Building, and the hospital has responded to the 1975 bombing of Fraunces Tavern, the 1993 and 2001 attacks on the World Trade Center, and, this month, the crash of a commuter ferry from New Jersey.

Like other fragile hospitals in the city, New York Downtown has shrunk, going to 180 beds, down from the 254 beds it was certified for in 2006, partly because the more affluent residents of Lower Manhattan often go to bigger hospitals for elective care.

The proposal says that half of the emergency department patients at New York Downtown either are on Medicaid, the program for the poor, or are uninsured.

NewYork-Presbyterian would absorb the cost of the hospital’s maternity and neonatal intensive care units, which have been expanding because of demand, but have been operating at a deficit of more than $1 million a year, the proposal said.

Read More..

Gadgetwise Blog: Q&A: Reading Google Books on an iPhone

I know Apple has its own e-book store, but can I download and read the free stuff from Google Books on an iPhone, or do I need an Android phone?

You do not need an Android device to get e-books from the Google Play store. You just need the Google Play Books app installed on your iPhone and a Google account, both of which are free. The Google Play Books app is available in Apple’s App Store and you can sign up for a Google account on the Web, or through the books app.

Unlike Apple’s own iBooks app and online iBookstore, you cannot browse and buy books directly through the Google Play Books app. To get new e-books on your phone, open the iPhone’s Safari Web browser and go to this site. From here, you can browse Google’s collection and select the books (free or paid) you want to download and read on your phone. After you log into the Web store with your Google account, your books appear in the Google Play Books app on the iPhone.

Google has full instructions for using its books app here. You can get books from Amazon and Barnes & Noble’s e-book stores on the Web with the Kindle and Nook apps for iPhone, which are also available free in the App Store.

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IHT Rendezvous: Argentina Celebrates Its First Queen ...

LONDON — The announcement by Queen Beatrix of the Netherlands that she is stepping down in favor of her eldest son, Prince Willem-Alexander, has generated a flurry of excitement in faraway Argentina, the homeland of his popular and charismatic wife, the former Máxima Zorreguieta.

“Argentina’s First Queen,” and “A Throne for Princess Máxima,” newspaper headlines enthused above profiles of the couple and tributes to the royal consort as a “queen of hearts” and a monarch of “style and glamor.”

Social media reflected the buzz, sparking a Twitter trend with the hashtag #MaximaReina — Maxima Queen.

“Mirror, mirror…who’s the most famous Argentine woman of them all?” asked Maria Xacur Puw in Buenos Aires, adding that Cristina Fernández de Kirchner, the Argentine president, must be dying of jealousy.

“Fairy tales do exist…” posted Verónica Videla.

Not everyone was impressed. “Why should we take any pride in it?” asked one dissenter. “Being married to a prince? So what?”

There was one shadow over the celebrations, however, that was mentioned in reports from both Argentina and the Netherlands.

A notable absentee at the April 30 coronation at Amsterdam’s Nieuwe Kerk, the New Church, will be Jorge Zorreguieta, the father of the 41-year-old princess.

Mr. Zorreguieta was a minister under the Argentine dictatorship of President Jorge Videla in which the ruling military junta killed thousands of dissidents during the so-called “dirty war” of the late-1970s and early 1980s.

A decade ago, the controversy over his past cast a shadow over the romance between the Dutch royal heir and the former New York-based banking executive.

Mr. Zorreguieta was obliged to promise that he would not attend their 2002 wedding before the Dutch Parliament would give its required approval to the match.

As Marlise Simons wrote from Amsterdam at the time, the prince had let it be known that he would rather abandon the throne and have a wedding in Buenos Aires than lose his bride.

Mr. Zorreguieta, a wealthy landowner who served for two years as agriculture minister under the junta, has insisted he had nothing to do with the disappearance of dissidents and was ignorant of the “dirty war.”

Skeptics would say that makes him one of the few Argentines to have lived through that era who was not aware of what was going on.

Although Princess Máxima has distanced herself from her father’s past, the 85-year-old Mr. Zorreguieta has made private visits to the Netherlands and the royal couple takes a regular New Year holiday in Argentina.

Before her 2002 wedding, she told the Dutch public that she abhorred the military regime and ”the disappearances, the tortures, the murders and all the other terrible events of that time.” Of her father, she said, “I regret that while doing his best for agriculture, he did so during a bad regime.”

Her family background has done little in the long term to dent her popularity with the Dutch.

The princess’s spontaneity on her wedding day endeared her to the Dutch public after all the controversy over her father, according to Argentina’s La Nación, which said that over the years she had become the Netherlands’ favorite royal.

When it comes to Mr. Zorreguieta, however, not everyone is so ready to forget the past. The “dirty war” remains a sensitive issue in Argentina almost 40 years on.

As the Netherlands prepares for the coronation, a federal judge in Argentina is investigating a complaint from the families of four victims of the “dirty war” who disappeared after they were fired from a farm institute that Mr. Zorregueita headed.

Commenting on the case, Argentina’s Pagina 12 said the former minister had always denied all knowledge of unlawful repression, murders, disappearances and the concentration camps that were employed by the dictatorship.

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