Many States Say Cuts Would Burden Fragile Recovery

States are increasingly alarmed that they could become collateral damage in Washington’s latest fiscal battle, fearing that the impasse could saddle them with across-the-board spending cuts that threaten to slow their fragile recoveries or thrust them back into recession.

Some states, like Maryland and Virginia, are vulnerable because their economies are heavily dependent on federal workers, federal contracts and military spending, which will face steep reductions if Congress allows the automatic cuts, known as sequestration, to begin next Friday. Others, including Illinois and South Dakota, are at risk because of their reliance on the types of federal grants that are scheduled to be cut. And many states simply fear that a heavy dose of federal austerity could weaken their economies, costing them jobs and much-needed tax revenue.

So as state officials begin to draw up their budgets for next year, some say that the biggest risk they see is not the weak housing market or the troubled European economy but the federal government. While the threat of big federal cuts to states has become something of a semiannual occurrence in recent years, state officials said in interviews that they fear that this time the federal government might not be crying wolf — and their hopes are dimming that a deal will be struck in Washington in time to avert the cuts.

The impact would be widespread as the cuts ripple across the nation over the next year.

Texas expects to see its education aid slashed hundreds of millions of dollars, which could force local school districts to fire teachers, if the cuts are not averted. Michigan officials say they are in no position to replace the lost federal dollars with state dollars, but worry about cuts to federal programs like the one that helps people heat their homes. Maryland is bracing not only for a blow to its economy, which depends on federal workers and contractors and the many private businesses that support them, but also for cuts in federal aid for schools, Head Start programs, a nutrition program for pregnant women, mothers and children, and job training programs, among others.

Gov. Bob McDonnell of Virginia, a Republican, warned in a letter to President Obama on Monday that the automatic spending cuts would have a “potentially devastating impact” and could force Virginia and other states into a recession, noting that the planned cuts to military spending would be especially damaging to areas like Hampton Roads that have a big Navy presence. And he noted that the whole idea of the proposed cuts was that they were supposed to be so unpalatable that they would force officials in Washington to come up with a compromise.

“As we all know, the defense, and other, cuts in the sequester were designed to be a hammer, not a real policy,” Mr. McDonnell wrote. “Unfortunately, inaction by you and Congress now leaves states and localities to adjust to the looming threat of this haphazard idea.”

The looming cuts come just as many states feel they are turning the corner after the prolonged slump caused by the recession. Gov. Martin O’Malley of Maryland, a Democrat, said he was moving to increase the state’s cash reserves and rainy day funds as a hedge against federal cuts.

“I’d rather be spending those dollars on things that improve our business climate, that accelerate our recovery, that get more people back to work, or on needed infrastructure — transportation, roads, bridges and the like,” he said, adding that Maryland has eliminated 5,600 positions in recent years and that its government was smaller, on a per capita basis, than it had been in four decades. “But I can’t do that. I can’t responsibly do that as long as I have this hara-kiri Congress threatening to drive a long knife through our recovery.”

Federal spending on salaries, wages and procurement makes up close to 20 percent of the economies of Maryland and Virginia, according to an analysis by the Pew Center on the States.

But states are in a delicate position. While they fear the impact of the automatic cuts, they also fear that any deal to avert them might be even worse for their bottom lines. That is because many of the planned cuts would go to military spending and not just domestic programs, and some of the most important federal programs for states, including Medicaid and federal highway funds, would be exempt from the cuts.

States will see a reduction of $5.8 billion this year in the federal grant programs subject to the automatic cuts, according to an analysis by Federal Funds Information for States, a group created by the National Governors Association and the National Conference of State Legislatures that tracks the impact of federal actions on states. California, New York and Texas stand to lose the most money from the automatic cuts, and Puerto Rico, which is already facing serious fiscal distress, is threatened with the loss of more than $126 million in federal grant money, the analysis found.

Even with the automatic cuts, the analysis found, states are still expected to get more federal aid over all this year than they did last year, because of growth in some of the biggest programs that are exempt from the cuts, including Medicaid.

But the cuts still pose a real risk to states, officials said. State budget officials from around the country held a conference call last week to discuss the threatened cuts. “In almost every case the folks at the state level, the budget offices, are pretty much telling the agencies and departments that they’re not going to backfill — they’re not going to make up for the budget cuts,” said Scott D. Pattison, the executive director of the National Association of State Budget Officers, which arranged the call. “They don’t have enough state funds to make up for federal cuts.”

The cuts would not hit all states equally, the Pew Center on the States found. While the federal grants subject to the cuts make up more than 10 percent of South Dakota’s revenue, it found, they make up less than 5 percent of Delaware’s revenue.

Many state officials find themselves frustrated year after year by the uncertainty of what they can expect from Washington, which provides states with roughly a third of their revenues. There were threats of cuts when Congress balked at raising the debt limit in 2011, when a so-called super-committee tried and failed to reach a budget deal, and late last year when the nation faced the “fiscal cliff.”

John E. Nixon, the director of Michigan’s budget office, said that all the uncertainty made the state’s planning more difficult. “If it’s going to happen,” he said, “at some point we need to rip off the Band-Aid.”

Fernanda Santos contributed reporting.

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Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

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Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

Read More..

In a Slight Shift, North Korea Widens Internet Access, but Just for Visitors

HONG KONG — North Korea will finally allow Internet searches on mobile devices. But if you’re a North Korean, you’re out of luck — only foreigners will get this privilege.

Cracking the door open slightly to wider Internet use, the government will allow a company called Koryolink to give foreigners access to 3G mobile Internet service by next Friday, according to The Associated Press, which has a bureau in the North.

The North Korean police state is famously cloistered, a means for the government to keep news of the world from its impoverished people. Only the most elite North Koreans have been allowed access to the Internet, and even they are watched. And although many North Koreans are allowed to have cellphones, sanctioned phones cannot call outside the country.

Foreigners were only recently allowed to use cellphones in the country. Previously, most had to surrender their phones with customs agents.

But it is unlikely that the small opening will compromise the North’s tight control of its people; the relatively few foreigners who travel to North Korea — a group that includes tourists and occasional journalists — are assigned government minders.

The decision, announced Friday, to allow foreigners Internet access comes a month after Google’s chairman, Eric E. Schmidt, visited Pyongyang, the North’s capital. While there he prodded officials on allowing Internet access, noting how easy it would be to set up through the expanding 3G network of Koryolink, a joint venture of North Korean and Egyptian telecommunications corporations. Presumably, Mr. Schmidt’s appeal was directed at giving North Koreans such capability.

“As the world becomes increasingly connected, their decision to be virtually isolated is very much going to affect their physical world, their economic growth and so forth,” Mr. Schmidt told reporters following his visit. “We made that alternative very, very clear.”

North Koreans will get some benefit from the 3G service, as they will be allowed to text and make video calls, The Associated Press said. They can also view newspaper reports — but the news service mentioned only one source: Rodong Sinmun, the North’s main Communist Party newspaper.

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India Ink: In Hyderabad, Anger and Frustration

Srinivas Mahesh, 28, was snacking outside his hostel near the Konark Theater in Dishknagar, his usual hangout in Hyderabad, when he heard a loud explosion Thursday evening. Not long after, he saw smoke filling up the air. Once he realized it was a bomb blast, instead of rushing back to his hostel he resolved to helping the injured.

“I saw disfigured bodies for the first time in my life,” he said. He helped three severely injured people into ambulances and took another injured man by auto to Osmania Hospital.

Mr. Mahesh, who is originally from Kurnool, came to Hyderabad two years ago to do a graduation in engineering from Ashok Institute in Dilsukhnagar. After yesterday’s blasts though, he might have to return home.

“My parents were visiting Hyderabad in 2007, when there were blasts. They had a tough time then,” he said. “After yesterday, they are convinced that this city is cursed and want me home.”

More than 24 hours after two bombs went off near the ever-crowded Dilsukhnagar bus stand, there is palpable frustration and anger in the area. N.Pradeep Reddy, 29, a chartered accountant who lives in Dilsukhnagar, heard the first blast and came to the balcony of his house. Then he saw the second explosion. Aghast, he couldn’t move for several seconds, he said.

Mr. Reddy’s family has been in Hyderabad for 10 years now, but now he is disillusioned with the charm of the city, he said. “No one cares for our lives here – not the politicians, not the media not the police,” he added.

Hyderabad has been the site of numerous explosions in recent years, including two in 2007 attacks that killed dozens of people.

Soon after Thursday’s blasts, the road in front of the Dilsukhnagar bus stand had a median dividing it into two. While traffic was allowed on one side, the other side of the road was cordoned off by the police.

“This is obstructing traffic and adding to the commotion,” said P. Sadanandam, who commutes through the road regularly. “They are not doing this for security, it is just so that the VIPs can visit the blast site and have a photo-op,” he said angrily.

Andhra Pradesh Director General of Police and other senior police officers visited the at blast site today to look for evidence.

All the shops on a two kilometer stretch on the Dilsukhnagar main road were shuttered down all day today. Some security men outside the shops said that this was not due to the bandh, or shutdown, that the Bharatiya Janata Party had called, but because the shop owners were sure that there would be no customers today. They might open on Monday, they said.

Narsing Vennala, 25, sells flowers on the main road. He is one of the only three flower vendors who reopened their shops today. A temple next door needs flowers, he said, and therefore he had to come to work.

His 18-year-old sister is so paranoid about his coming to work a day after the blasts that she keeps calling him every half-an-hour to check if he is alright.  Mr Vennala walks home at 11 p.m. every night, and he plans to do the same even today.

“Whatever had to happen, happened,” he said. “Now how long can we stay hungry and not earn because of that?”

“Bharat mata ki jai,” (Victory for mother India) was loudly shouted by a bunch of residents. They said that was their answer to those that were against peace in the country.  There was also some anti-Pakistan sloganeering.

One resident estimated that there were 500 to 600 educational institutions in Dilsukhnagar. They have offerings ranging from short-term computer courses to three-year degrees. Thousands of students, from smaller towns and neighboring districts, live in hostels around their respective institutions. Many of them were on the streets yesterday to help the injured.

While some students don’t see any option but to stay in the city, others, like Mr. Mahesh, are packing their bags.

“I have to go home, even if I don’t like to,” he said “My family will be worried every day I stay in Hyderabad.”

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Cost-Cutting Helped Air France-KLM Trim Operating Loss in 2012

PARIS — An aggressive cost-cutting effort at Air France-KLM showed the first faint signs of bearing fruit on Friday, as the airline said it had managed to trim its operating losses last year despite a weakening European economy and higher fuel prices.

Air France-KLM, Europe's third-largest airline by passengers, recorded an operating loss of 300 million euros, or about $400 million, for 2012, compared with a 353 million euro loss a year earlier, as efforts to rein in seat capacity led to higher average fares. Revenue for the year rose 5.2 percent to 25.6 billion euros, while net debt declined to 6 billion euros from 6.5 billion euros in 2011.

But one-time expenses associated with a deep restructuring begun last year widened the airline’s net loss to 1.19 billion euros from 809 million euros in 2011.

“They have made a good start, but it is an improvement that is still just barely visible,” said Yan Derocles, an airline analyst at Oddo Securities in Paris.

Air France-KLM unveiled plans last June to shave more than 2 billion euros in costs, reduce debt and return to profit by the end of 2015. Despite the modest improvements achieved in the plan’s first six months, Jean-Cyril Spinetta, the group’s chief executive, stressed Friday in a statement that the company had laid the ground work for a more significant recovery this year.

“In 2013, we will maintain strict discipline in terms of capacity management, investments and costs,” Mr. Spinetta said.

Air France-KLM said passenger traffic rose by 2.1 percent last year, while seat capacity increased by just 0.6 percent. But while revenues per available seat rose by 5.9 percent from a year earlier, cargo revenues continued to slide, falling by 6.3 percent despite a 3.5 percent drop in capacity, as the economic slowdown reduced goods shipments.

Despite intense pressure from the French government to avoid layoffs, Air France-KLM moved ahead with plans in 2012 to slash more than 5,100 jobs at its Air France unit by the end of this year — just over 10 percent of its work force of 49,000. Another 1,300 jobs are being eliminated at its smaller KLM unit.

Philippe Calavia, the group’s chief executive officer, said Friday that the group had reduced staff by around 2,000 in 2012 through early retirements and other voluntary departures. Restructuring costs linked to those job cuts amounted to 471 million euros in 2012.

Labor costs have been a major drain on profit at Air France-KLM for years — equivalent to more than 30 percent of the group’s total revenue and even exceeding its fuel bill, which amounts to around 26 percent. By contrast, labor costs as a share of revenue are less than 10 percent at its low-cost rival Ryanair and 12.4 percent at EasyJet, according to the Center for Aviation in Brussels.

Given the uncertain outlook for the European economy this year, Air France-KLM declined to provide a forecast for 2013, although Mr. Calavia maintained the company’s targets of reaching net profit within two years. Analysts said they expected a modest improvement in operating profit this year, although annual restructuring costs were also expected to rise, possibly above 500 million euros.

Air France-KLM continues to lag behind its larger rival, Lufthansa of Germany, in its efforts to return to profitability. Lufthansa, which announced its own painful restructuring last year that involved 3,500 job losses. Lufthansa this week reported a net 2012 profit of 990 million euros, bolstered by asset sales, compared with a loss of 13 million euros in 2011. The German carrier also suspended dividend payments to shareholders in order to make more cash available to finance its turnaround.

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The New Old Age Blog: For Traumatized Caregivers, Therapy Helps

I recently wrote about caregivers who experienced symptoms of traumatic-like stress, and readers responded with heart-rending stories. Many described being haunted by distress long after a relative died.

Especially painful, readers said, was witnessing a loved one’s suffering and feeling helpless to do anything about it.

The therapists I spoke with said they often encountered symptoms among caregivers similar to those shown by people with post-traumatic stress — intrusive thoughts, disabling anxiety, hyper-vigilance, avoidance behaviors and more — even though research documenting this reaction is scarce. Improvement with treatment is possible, they say, although a sense of loss may never disappear completely.

I asked these professionals for stories about patients to illustrate the therapeutic process. Read them below and you’ll notice common themes. Recovery depends on unearthing the source of psychological distress and facing it directly rather than pushing it away. Learning new ways of thinking can change the tenor of caregiving, in real time or in retrospect, and help someone recover a sense of emotional balance.

Barry Jacobs, a clinical psychologist and author of “The Emotional Survival Guide for Caregivers” (Guilford Press, 2006), was careful to distinguish normal grief associated with caregiving from a traumatic-style response.

“Nightmares, lingering bereavement or the mild re-experiencing of events that doesn’t send a person into a panic every time is normal” and often resolves with time, he said.

Contrast that with one of his patients, a Greek-American woman who assisted her elderly parents daily until her father, a retired firefighter, went to the hospital for what doctors thought would be a minor procedure and died there of a heart attack in the middle of the night.

Every night afterward, at exactly 3 a.m., this patient awoke in a panic from a dream in which a phone was ringing. Unable to go back to sleep for hours, she agonized about her father dying alone at that hour.

The guilt was so overwhelming, the woman couldn’t bear to see her mother, talk with her sisters or concentrate at work or at home. Sleep deprived and troubled by anxiety, she went to see her doctor, who works in the same clinic as Dr. Jacobs and referred her to therapy.

The first thing Dr. Jacobs did was to “identify what happened to this patient as traumatic, and tell her acute anxiety was an understandable response.” Then he asked her to “grieve her father’s death” by reaching out to her siblings and her mother and openly expressing her sadness.

Dr. Jacobs also suggested that this patient set aside a time every day to think about her father — not just the end of his life, but also all the things she had loved about him and the good times they’d had together as a family.

Don’t expect your night time awakenings to go away immediately, the psychologist told his patient. Instead, plan for how you’re going to respond when these occur.

Seven months later, the patient reported her panic at a “3 or 4” level instead of a “10” (the highest possible number), Dr. Jacobs said.

“She’ll say, ‘oh, there’s the nightmare again,’ and she can now go back to sleep fairly quickly,” he continued. “Research about anxiety tells us that the more we face what we fear, the quicker we are to extinguish our fear response and the better able we are to tolerate it.”

Sara Qualls, a professor of psychology at the University of Colorado in Colorado Springs, said it’s natural for caregivers to be disgusted by some of what they have to do — toileting a loved one, for instance — and to be profoundly conflicted when they try to reconcile this feeling with a feeling of devotion. In some circumstances, traumatic-like responses can result.

Her work entails naming the emotion the caregiver is experiencing, letting the person know it’s normal, and trying to identify the trigger.

For instance, an older man may come in saying he’s failed his wife with dementia by not doing enough for her. Addressing this man’s guilt, Dr. Qualls may find that he can’t stand being exposed to urine or feces but has to help his wife go to the bathroom. Instead of facing his true feelings, he’s beating up on himself psychologically — a diversion.

Once a conflict of this kind is identified, Dr. Qualls said she can help a person deal with the trigger by using relaxation exercises and problem-solving techniques, or by arranging for someone else to do a task that he or she simply can’t tolerate.

Asked for an example, Dr. Qualls described a woman who traveled to another state to see her mother, only to find her in a profound disheveled, chaotic state. Her mother said that she didn’t want help, and her brother responded with disbelief. Soon, the woman’s blood pressure rose, and she began having nightmares.

In therapy, Dr. Qualls reassured the patient that her fear for her mother’s safety was reasonable and guided her toward practical solutions. Gradually, she was able to enlist her brother’s help and change her mother’s living situation, and her sense of isolation and helplessness dissipated.

“I think that a piece of the trauma reaction that is so devastating is the intense privacy of it,” Dr. Qualls said. “Our work helps people moderate their emotional reactivity through human contact, sharing and learning strategies to manage their responsiveness.”

Dolores Gallagher-Thompson, a professor of psychiatry at Stanford University School of Medicine in California, noted that stress can accumulate during caregiving and reach a tipping point where someone’s ability to cope is overwhelmed.

She tells of a vibrant, active woman in her 60s caring for an older husband who declined rapidly from dementia. “She’d get used to one set of losses, and then a new loss would occur,” Dr. Gallagher-Thompson said.

The tipping point came when the husband began running away from home and was picked up by the police several times. The woman dropped everything else and became vigilant, feeling as if she had to watch her husband day and night. Still, he would sneak away and became more and more difficult.

Both husband and wife had come from Jewish families caught up in the Holocaust during World War II, and the feeling of “complete and utter helplessness and hopelessness” that descended on this older woman was intolerable, Dr. Gallagher-Thompson said.

Therapy was targeted toward helping the patient articulate thoughts and feelings that weren’t immediately at the surface of her consciousness, like, for example, her terror at the prospect of abandonment. “I’d ask her ‘what are you afraid of? If you visualize your husband in a nursing home or assisted living, what do you see?’” Dr. Gallagher-Thompson said.

Then the conversation would turn to the choices the older woman had. Go and look at some long-term care places and see what you think, her psychologist suggested. You can decide how often you want to visit. “This isn’t an either-or — either you’re miserable 24/7 or you don’t love him,” she advised.

The older man went to assisted living, where he died not long afterward of pneumonia that wasn’t diagnosed right away. The wife fell into a depression, preoccupied with the thought that it was all her fault.

Another six months of therapy convinced her that she had done what she could for her husband. Today she works closely with her local Alzheimer’s Association chapter, “helping other caregivers learn how to deal with these kinds of issues in support groups,” Dr. Gallagher-Thompson said.

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The New Old Age Blog: For Traumatized Caregivers, Therapy Helps

I recently wrote about caregivers who experienced symptoms of traumatic-like stress, and readers responded with heart-rending stories. Many described being haunted by distress long after a relative died.

Especially painful, readers said, was witnessing a loved one’s suffering and feeling helpless to do anything about it.

The therapists I spoke with said they often encountered symptoms among caregivers similar to those shown by people with post-traumatic stress — intrusive thoughts, disabling anxiety, hyper-vigilance, avoidance behaviors and more — even though research documenting this reaction is scarce. Improvement with treatment is possible, they say, although a sense of loss may never disappear completely.

I asked these professionals for stories about patients to illustrate the therapeutic process. Read them below and you’ll notice common themes. Recovery depends on unearthing the source of psychological distress and facing it directly rather than pushing it away. Learning new ways of thinking can change the tenor of caregiving, in real time or in retrospect, and help someone recover a sense of emotional balance.

Barry Jacobs, a clinical psychologist and author of “The Emotional Survival Guide for Caregivers” (Guilford Press, 2006), was careful to distinguish normal grief associated with caregiving from a traumatic-style response.

“Nightmares, lingering bereavement or the mild re-experiencing of events that doesn’t send a person into a panic every time is normal” and often resolves with time, he said.

Contrast that with one of his patients, a Greek-American woman who assisted her elderly parents daily until her father, a retired firefighter, went to the hospital for what doctors thought would be a minor procedure and died there of a heart attack in the middle of the night.

Every night afterward, at exactly 3 a.m., this patient awoke in a panic from a dream in which a phone was ringing. Unable to go back to sleep for hours, she agonized about her father dying alone at that hour.

The guilt was so overwhelming, the woman couldn’t bear to see her mother, talk with her sisters or concentrate at work or at home. Sleep deprived and troubled by anxiety, she went to see her doctor, who works in the same clinic as Dr. Jacobs and referred her to therapy.

The first thing Dr. Jacobs did was to “identify what happened to this patient as traumatic, and tell her acute anxiety was an understandable response.” Then he asked her to “grieve her father’s death” by reaching out to her siblings and her mother and openly expressing her sadness.

Dr. Jacobs also suggested that this patient set aside a time every day to think about her father — not just the end of his life, but also all the things she had loved about him and the good times they’d had together as a family.

Don’t expect your night time awakenings to go away immediately, the psychologist told his patient. Instead, plan for how you’re going to respond when these occur.

Seven months later, the patient reported her panic at a “3 or 4” level instead of a “10” (the highest possible number), Dr. Jacobs said.

“She’ll say, ‘oh, there’s the nightmare again,’ and she can now go back to sleep fairly quickly,” he continued. “Research about anxiety tells us that the more we face what we fear, the quicker we are to extinguish our fear response and the better able we are to tolerate it.”

Sara Qualls, a professor of psychology at the University of Colorado in Colorado Springs, said it’s natural for caregivers to be disgusted by some of what they have to do — toileting a loved one, for instance — and to be profoundly conflicted when they try to reconcile this feeling with a feeling of devotion. In some circumstances, traumatic-like responses can result.

Her work entails naming the emotion the caregiver is experiencing, letting the person know it’s normal, and trying to identify the trigger.

For instance, an older man may come in saying he’s failed his wife with dementia by not doing enough for her. Addressing this man’s guilt, Dr. Qualls may find that he can’t stand being exposed to urine or feces but has to help his wife go to the bathroom. Instead of facing his true feelings, he’s beating up on himself psychologically — a diversion.

Once a conflict of this kind is identified, Dr. Qualls said she can help a person deal with the trigger by using relaxation exercises and problem-solving techniques, or by arranging for someone else to do a task that he or she simply can’t tolerate.

Asked for an example, Dr. Qualls described a woman who traveled to another state to see her mother, only to find her in a profound disheveled, chaotic state. Her mother said that she didn’t want help, and her brother responded with disbelief. Soon, the woman’s blood pressure rose, and she began having nightmares.

In therapy, Dr. Qualls reassured the patient that her fear for her mother’s safety was reasonable and guided her toward practical solutions. Gradually, she was able to enlist her brother’s help and change her mother’s living situation, and her sense of isolation and helplessness dissipated.

“I think that a piece of the trauma reaction that is so devastating is the intense privacy of it,” Dr. Qualls said. “Our work helps people moderate their emotional reactivity through human contact, sharing and learning strategies to manage their responsiveness.”

Dolores Gallagher-Thompson, a professor of psychiatry at Stanford University School of Medicine in California, noted that stress can accumulate during caregiving and reach a tipping point where someone’s ability to cope is overwhelmed.

She tells of a vibrant, active woman in her 60s caring for an older husband who declined rapidly from dementia. “She’d get used to one set of losses, and then a new loss would occur,” Dr. Gallagher-Thompson said.

The tipping point came when the husband began running away from home and was picked up by the police several times. The woman dropped everything else and became vigilant, feeling as if she had to watch her husband day and night. Still, he would sneak away and became more and more difficult.

Both husband and wife had come from Jewish families caught up in the Holocaust during World War II, and the feeling of “complete and utter helplessness and hopelessness” that descended on this older woman was intolerable, Dr. Gallagher-Thompson said.

Therapy was targeted toward helping the patient articulate thoughts and feelings that weren’t immediately at the surface of her consciousness, like, for example, her terror at the prospect of abandonment. “I’d ask her ‘what are you afraid of? If you visualize your husband in a nursing home or assisted living, what do you see?’” Dr. Gallagher-Thompson said.

Then the conversation would turn to the choices the older woman had. Go and look at some long-term care places and see what you think, her psychologist suggested. You can decide how often you want to visit. “This isn’t an either-or — either you’re miserable 24/7 or you don’t love him,” she advised.

The older man went to assisted living, where he died not long afterward of pneumonia that wasn’t diagnosed right away. The wife fell into a depression, preoccupied with the thought that it was all her fault.

Another six months of therapy convinced her that she had done what she could for her husband. Today she works closely with her local Alzheimer’s Association chapter, “helping other caregivers learn how to deal with these kinds of issues in support groups,” Dr. Gallagher-Thompson said.

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Gadgetwise Blog: Q&A: Moving the Mac’s Dock

It’s easy to move the Taskbar to a different edge of the screen on a Windows machine, but how do you move the Mac’s row of program icons from the bottom of the screen?

The Windows Taskbar — that row of program icons and open files that typically appears along the bottom edge of the screen — can be moved to the top or sides of the desktop by dragging it with the mouse, or in some later versions of Windows, by unlocking it first before dragging. The Dock, the Mac’s rough equivalent of the Taskbar, can also be moved to other edges of the screen in a few ways.

One method is to click the Mac’s Apple menu up in the top-left corner of the screen, select Dock and slide over to the submenu with the commands to position the dock on the left or right sides of the desktop. This same sub-menu holds options for automatically hiding the Dock on the screen until you pass the mouse cursor nearby, as well as the option for magnifying the icons stocked in the Dock when you pass the cursor over.

The Apple menu can take you right to the Dock’s settings in the Mac’s System Preferences if you want to fine-tune things further. You can also get to these settings by clicking the System Preferences icon in the Dock itself and clicking the Dock icon. In addition to the controls for positioning the Dock on the desktop, the preferences box contains settings for changing the overall size of it, adjusting the magnification size of the icons and other visual aspects of the Dock.

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India Ink: Can Doordarshan’s New Look Attract Profits?

A Doordarshan newscast from the late 1990s.

After it became the first TV channel in India in 1959, the public broadcaster Doordarshan enjoyed a monopoly on viewership for decades. Even after the government opened the airwaves to private players in 1992, Doordarshan enjoyed a 90 percent share of the audience in the 1990s and had no reason to take the threat of competition seriously.

Twenty years later, its rivals have not only caught up, but they have surpassed Doordarshan in terms of revenue. In the late 1990s, advertisers began to see Doordarshan, which dominates coverage in rural areas, as catering to only the lowest socioeconomic classes, and the public broadcaster slipped even further after an accounting scandal. Since then, Doordarshan has never turned a profit, and some media industry observers have even declared Doordarshan dead.

But Jawhar Sircar, chief executive of Prasar Bharati, the autonomous organization that includes Doordarshan and All India Radio, is betting that a complete overhaul of its TV programs, in both format and content, will draw the viewers that Doordarshan has lost to private satellite channels.

There is only one formula for success, said Mr. Sircar: “You bring out a good product, spend money, put in taste, autonomy and the right professionals, you will get the right product. You have the right product, you will get the right revenues,” he said.

Revenues are sorely needed at the government-financed broadcaster. According to the last five-year Broadcast Plan, which ended in March 2012, the Ministry of Information and Broadcasting spent 122 billion rupees ($2.2 billion) of taxpayers’ money to run Prasar Bharti, which generated only 60 billion rupees in revenue over the same period. That means a loss of 62 billion rupees, or more than $1 billion, over the five years.

Prasar Bharti accounts for about 60 percent of Ministry of Information and Broadcasting’s budget, and Doordarshan takes about half that amount, raising the rest of the money it needs through advertising.

Reliable data on Doordarshan’s viewership is difficult to find because the company that reports ratings, Television Audience Measurement, covers only satellite channels, and Doordarshan’s network, which now has 37 channels and four affiliated channels, is largely terrestrial. Doordarshan has sued Television Audience Measurement, accusing it of under-reporting its audience and costing the broadcaster advertising revenue.

The biggest move for Mr. Sircar, who took over in March 2012, was to push aside the appointed bureaucrats who ran operations even though they had no media experience. For the first time in its history, Doordarshan’s news channel, known as DD News, has hired several news professionals who have worked with CNN, Bloomberg and BBC for its board. DD News also poached top anchors at major Indian channels like NDTV and Times Now.

“This new team is one of the best DD has ever seen,” said Rajiv Mehrotra, managing trustee of the nonprofit Public Service Broadcasting Trust, referring to Doordarshan. “They have ensured that Prasar Bharati, especially DD, is breathing again.”

The main focus of the makeover is Doordarshan’s prime-time news program, “News Night,” which now tackles controversial topics – a marked change at a network that has been criticized for allowing the government to shape its media coverage in the past. The last time Doordarshan went through an overhaul was in 2003, a year before the national elections, and the Bharatiya Janata Party-controlled central government ordered Doordarshan to downplay certain events, like the deadly 2002 riots in Gujarat, a B.J.P. stronghold.

“DD News has always been known for dry reporting on government affairs,” said Paranjoy Guha Thakurta, an independent journalist who has worked with the public broadcaster.

On Wednesday night, DD News officially introduced its retooled show with a discussion on the state of the Indian TV news media and the role a public broadcaster should play, led by anchors already well known for their work at other channels, which lent the program a gravitas that had been missing when newsreaders used to present the news.

Given that this latest revamp also comes a year before national elections, many in the media industry are closely watching Doordarshan for any evidence of government meddling. Manish Tiwari, the information and broadcasting minister, promised at a news conference earlier this month that “this time, the government would keep an arm’s length from content and presentation of DD.”

But Rajiv Mehrotra, a longtime TV producer for Doordarshan, said Prasar Bharati’s “identity crisis” may limit the scope of the new changes.

“Prasar Bharati has to stay on the right side of the government as it gets a substantial monetary help from them, and it cannot go whole hog like the privately owned channels do,” he added.

Next in line for a makeover is the early morning show, with sharper reporting and market analysis planned, and then DD National, the entertainment channel, and DD Urdu.

On the technical side, Doordarshan will change from analog to digital transmitters, which will allow for enhanced picture quality, spectrum efficiency and multichannel transmission from a single transmitter. Other technological changes will allow Doordarshan to split screens so that more than one person can be shown on air, something private news channels have long been able to do.

Mr. Sircar also put the network’s outside broadcasting vans to use so that reporters could do live reports outside the studio. “We never used our O.B. vans. It was such a waste of our resources,” he said.

DD News is also getting a new, more polished look. At his office in New Delhi, Mr. Sircar pointed at two large TV screens, which displayed the new DD News format on one screen and an NDTV 24×7 format on the other. Both screens had four boxes with an expert in each one discussing swine flu in Delhi.

“See the similarity?” he asked. “There used to be a miserable green board behind a sleepy anchor on DD News before. We have changed the color scheme to make it in tune with the younger generation.”

While there may be a similarity in form and presentation between the private channels and DD News, there will never be a similarity in content, pledged Mr. Sircar. “We will stick to the ideals of public service broadcasting and never sensationalize news,” he said.

In the current five-year Broadcast Plan, which ends in March 2017, the government has agreed to raise the amount it gives Prasar Bharati to 132 billion rupees. Whether its faith in Mr. Sircar is rewarded, however, is uncertain.

“Now is the time,” said Mr. Thakurta, the independent journalist. “DD can become the Indian version of the BBC or Al Jazeera or just a mouthpiece of those in authority. Only time will tell.”

---

This post has been revised to reflect the following correction:

Correction: February 22, 2013

"An earlier version of this article misstated the year of the Gujarat riots, which happened in 2002, not 2003. "

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DealBook: Office Supply Rivals' Merger Leaked by a Wayward Report

8:56 p.m. | Updated

It was a paragraph buried on Page 4 of an earnings release, under the heading of “other matters.” Yet what those four sentences revealed sent bankers and lawyers who had been working all night on a deal scrambling early Wednesday morning.

The earnings release, from the office supplies chain Office Depot, appeared shortly after 7 a.m. and inadvertently disclosed the terms of a long-awaited merger between the company and OfficeMax. The announcement disappeared from the company’s Web site quickly, but not before a gaggle of news outlets began running full-fledged reports about the deal.

At that time, bankers and lawyers for the two companies were still negotiating the final language of the merger agreement. The mistaken early publication of the release — since blamed on the data provider Thomson Reuters — prompted Office Depot’s chief executive, Neil R. Austrian, to call up his counterpart at OfficeMax, Ravi K. Saligram, and apologize.

More than two hours later, the companies formally announced their combination.

The episode recalls other times that major company news was published prematurely. Last fall, Google’s third-quarter earnings were published three hours early; the technology giant blamed R. R. Donnelley & Sons, its filings agent, for the mistake.

The chief executives played down the inadvertent disclosure as a harmless mistake, since the announcement was scheduled before the markets opened anyway.

“When two big Fortune 500 companies merge, occasionally mishaps happen,” Mr. Saligram said in an interview.

And Thomson Reuters apologized in a statement, saying it regretted the error and would take steps to prevent such a mistake from happening again.

But people involved in the deal privately bemoaned the unexpectedly bumpy ride, which knocked off kilter a carefully choreographed announcement meant to emphasize what they called a transformative merger of equals.

The union will combine two of the big retailers of staples and notepads, a major effort to combat years of losing sales to bigger, nimbler rivals. Both chief executives said that combining their companies could yield $400 million to $600 million in cost savings. It will probably lead to significant job cuts, as the companies seek to shrink their combined footprint of over 2,500 stores.

Both companies disclosed big drops in their sales for the fourth quarter on Wednesday: Office Depot’s revenue slipped 12 percent from the year-ago period, to $2.6 billion, while OfficeMax’s fell 7.4 percent, to $1.7 billion.

And both have also been under pressure from investors. Office Depot is fending off Starboard Value, an activist hedge fund that holds a 14.8 percent stake and has called for a major change in strategy. And OfficeMax has contended with Neuberger Berman, an investor with a 5 percent stake that has called for bigger payouts to shareholders.

“The whole industry and every analyst thought this made sense,” Mr. Austrian said in an interview. “The timing was right at this point in time.”

Shares of Office Depot fell 16.7 percent on Wednesday, to $4.18, while those of OfficeMax slid 7 percent, to $12.09. The decline wiped out some of the gains both stocks enjoyed after word of the deal talks emerged on Monday.

Negotiations have been held in earnest since at least last summer, people briefed on the matter said.

One important negotiating point that was resolved early on was ensuring that the deal could be presented as a “merger of equals.” Though Office Depot is paying a premium for OfficeMax — it is issuing 2.69 new shares for each share of the target, valuing the smaller retailer at about $1.2 billion as of Tuesday’s closing prices — neither company’s chief has a lock as the leader of the combined company.

Indeed, both Mr. Austrian and Mr. Saligram will remain in place while board members from each company run a search for a new chief executive, which could be either man. Also undecided: the new company’s name and whether it will have its headquarters in Office Depot’s home of Boca Raton, Fla., or OfficeMax’s base in Naperville, Ill.

People involved in the deal said that the compromise, which took about two months to complete, was important in bringing both companies to the negotiating table.

“We both put our egos aside,” Mr. Austrian of Office Depot said. “It’s not a win for one side and a loss for another.”

Both Office Depot and OfficeMax also wanted to emphasize that they would remain competitors until the deal was approved by shareholders and antitrust regulators. That is a nod to the collapse of a proposed merger of Office Depot and Staples more than a decade ago, which was blocked on anticompetitive grounds and left Office Depot reeling for years.

Mr. Saligram of OfficeMax argued on a call with analysts that the regulatory environment has shifted since. Both companies have lost ground not only to Staples, but also to online outlets like Amazon.com and bulk retailers like Target and Wal-Mart Stores.

“This industry has completely changed,” he said.

Should the deal fall apart because of antitrust concerns, neither company will be liable for a termination fee, executives said on the analyst call.

Company executives and advisers also spent significant amounts of time negotiating with BC Partners, an investment firm that owns the equivalent of 22 percent of Office Depot’s stock. Under the terms of Wednesday’s deal, BC Partners will own no more than 5 percent of the combined company’s voting shares and will have no representatives on its board.

A version of this article appeared in print on 02/21/2013, on page B5 of the NewYork edition with the headline: Office Supply Rivals’ Merger Leaked by a Wayward Report.

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In Reversal, Florida to Take Health Law’s Medicaid Expansion

MIAMI — Gov. Rick Scott of Florida reversed himself on Wednesday and announced that he would expand his state’s Medicaid program to cover the poor, becoming the latest — and, perhaps, most prominent — Republican critic of President Obama’s health care law to decide to put it into effect.

It was an about-face for Mr. Scott, a former businessman who entered politics as a critic of Mr. Obama’s health care proposals. Florida was one of the states that sued to try to block the law. After the Supreme Court ruled last year that though the law was constitutional, states could choose not to expand their Medicaid programs to cover the poor, Mr. Scott said that Florida would not expand its programs.

Mr. Scott said Wednesday that he now supported a three-year expansion of Medicaid, through the period that the federal government has agreed to pay the full cost of the expansion, and before some of the costs are shifted to the states.

“While the federal government is committed to paying 100 percent of the cost, I cannot in good conscience deny Floridians that needed access to health care,” Mr. Scott said at a news conference. “We will support a three-year expansion of the Medicaid program under the new health care law as long as the federal government meets their commitment to pay 100 percent of the cost during that time.”

He said there were “no perfect options” when it came to the Medicaid expansion. “To be clear: our options are either having Floridians pay to fund this program in other states while denying health care to our citizens,” he said, “or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other health care reforms.”

Mr. Scott said the state would not create its own insurance exchange to comply with another provision of the law.

His reversal sent ripples through the nation, especially given the change in tone and substance since the summer, when he said he would not create an exchange or expand Medicaid.

“Floridians are interested in jobs and economic growth, a quality education for their children, and keeping the cost of living low,” Mr. Scott said in a statement at the time. “Neither of these major provisions in Obamacare will achieve those goals, and since Florida is legally allowed to opt out, that’s the right decision for our citizens.”

Mr. Scott now joins the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who have decided to join the Medicaid expansion. Some, like Gov. Jan Brewer of Arizona, were also staunch opponents of Mr. Obama’s overall health care law.

Shortly before his announcement, the governor received word from the federal government that it planned to grant Florida the final waiver needed to privatize Medicaid, a process the state initially undertook as a pilot project. Mr. Scott, who is running for re-election next year, has heavily lobbied for the waiver, arguing that Florida could not expand Medicaid without it.

Mr. Scott’s support of Medicaid expansion is significant, but is far from the last word. The program requires approval from Florida’s Republican-dominated Legislature, which has been averse to expanding Medicaid under the health care law. The Legislature’s two top Republican leaders said that before making a decision they would consider recommendations from a select committee, which has been asked to review the state’s options.

“The Florida Legislature will make the ultimate decision,” Will Weatherford, the state House speaker, said. “I am personally skeptical that this inflexible law will improve the quality of health care in our state and ensure our long-term financial stability.”

Medicaid, which covers three million people in Florida, costs the state $21 billion a year. The expansion would extend coverage to one million more people.

Mr. Scott’s reversal is sure to anger his original conservative supporters.

The governor “was elected because of his principled conservative leadership against Obamacare’s overreach,” said Slade O’Brien, state director for Americans for Prosperity, an influential conservative advocacy organization. “Hopefully our legislative leaders will not follow in Governor Scott’s footsteps, and will reject expansion.”

During his announcement on Wednesday, Mr. Scott said his mother’s recent death and her lifetime struggle to raise five children “with very little money” played a role in his decision.

“Losing someone so close to you puts everything in a new perspective, especially the big decisions,” he said.

Michael Cooper contributed reporting from New York.

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In Reversal, Florida to Take Health Law’s Medicaid Expansion

MIAMI — Gov. Rick Scott of Florida reversed himself on Wednesday and announced that he would expand his state’s Medicaid program to cover the poor, becoming the latest — and, perhaps, most prominent — Republican critic of President Obama’s health care law to decide to put it into effect.

It was an about-face for Mr. Scott, a former businessman who entered politics as a critic of Mr. Obama’s health care proposals. Florida was one of the states that sued to try to block the law. After the Supreme Court ruled last year that though the law was constitutional, states could choose not to expand their Medicaid programs to cover the poor, Mr. Scott said that Florida would not expand its programs.

Mr. Scott said Wednesday that he now supported a three-year expansion of Medicaid, through the period that the federal government has agreed to pay the full cost of the expansion, and before some of the costs are shifted to the states.

“While the federal government is committed to paying 100 percent of the cost, I cannot in good conscience deny Floridians that needed access to health care,” Mr. Scott said at a news conference. “We will support a three-year expansion of the Medicaid program under the new health care law as long as the federal government meets their commitment to pay 100 percent of the cost during that time.”

He said there were “no perfect options” when it came to the Medicaid expansion. “To be clear: our options are either having Floridians pay to fund this program in other states while denying health care to our citizens,” he said, “or using federal funding to help some of the poorest in our state with the Medicaid program as we explore other health care reforms.”

Mr. Scott said the state would not create its own insurance exchange to comply with another provision of the law.

His reversal sent ripples through the nation, especially given the change in tone and substance since the summer, when he said he would not create an exchange or expand Medicaid.

“Floridians are interested in jobs and economic growth, a quality education for their children, and keeping the cost of living low,” Mr. Scott said in a statement at the time. “Neither of these major provisions in Obamacare will achieve those goals, and since Florida is legally allowed to opt out, that’s the right decision for our citizens.”

Mr. Scott now joins the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who have decided to join the Medicaid expansion. Some, like Gov. Jan Brewer of Arizona, were also staunch opponents of Mr. Obama’s overall health care law.

Shortly before his announcement, the governor received word from the federal government that it planned to grant Florida the final waiver needed to privatize Medicaid, a process the state initially undertook as a pilot project. Mr. Scott, who is running for re-election next year, has heavily lobbied for the waiver, arguing that Florida could not expand Medicaid without it.

Mr. Scott’s support of Medicaid expansion is significant, but is far from the last word. The program requires approval from Florida’s Republican-dominated Legislature, which has been averse to expanding Medicaid under the health care law. The Legislature’s two top Republican leaders said that before making a decision they would consider recommendations from a select committee, which has been asked to review the state’s options.

“The Florida Legislature will make the ultimate decision,” Will Weatherford, the state House speaker, said. “I am personally skeptical that this inflexible law will improve the quality of health care in our state and ensure our long-term financial stability.”

Medicaid, which covers three million people in Florida, costs the state $21 billion a year. The expansion would extend coverage to one million more people.

Mr. Scott’s reversal is sure to anger his original conservative supporters.

The governor “was elected because of his principled conservative leadership against Obamacare’s overreach,” said Slade O’Brien, state director for Americans for Prosperity, an influential conservative advocacy organization. “Hopefully our legislative leaders will not follow in Governor Scott’s footsteps, and will reject expansion.”

During his announcement on Wednesday, Mr. Scott said his mother’s recent death and her lifetime struggle to raise five children “with very little money” played a role in his decision.

“Losing someone so close to you puts everything in a new perspective, especially the big decisions,” he said.

Michael Cooper contributed reporting from New York.

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Some Victims of Online Hacking Edge Into the Light

Steve Ruark for The New York Times

Alan Paller of the SANS Institute said recently hacked companies were seeking safety in numbers.

SAN FRANCISCO — Hackers have hit thousands of American corporations in the last few years, but few companies ever publicly admit it. Most treat online attacks as a dirty secret best kept from customers, shareholders and competitors, lest the disclosure sink their stock price and tarnish them as hapless.

Rarely have companies broken that silence, usually when the attack is reported by someone else. But in the last few weeks more companies have stepped forward. Twitter, Facebook and Apple have all announced that they were attacked by sophisticated cybercriminals. The New York Times revealed its experience with hackers in a front-page article last month.

The admissions reflect the new way some companies are calculating the risks and benefits of going public. While companies once feared shareholder lawsuits and the ire of the Chinese government, some can’t help noticing that those that make the disclosures are lauded, as Google was, for their bravery. Some fear the embarrassment of being unable to fend off hackers who may still be in high school.

But as hacking revelations become more common, the threat of looking foolish fades and more companies are seizing the opportunity to take the leap in a crowd.

“There is a ‘hide in the noise’ effect right now,” said Alan Paller, director of research at the SANS Institute, a nonprofit security research and education organization. “This is a particularly good time to get out the fact that you got hacked, because if you are one of many, it discounts the starkness of the announcement.”

In 2010, when Google alerted some users of Gmail — political activists, mostly — that it appeared Chinese hackers were trying to read their mail, such disclosures were a rarity. In its announcement, Google said that it was one of many — two dozen — companies that had been targeted by the same group. Google said it was making the announcement, in part, to encourage other companies to open up about the problem.

But of that group, only Intel and Adobe Systems reluctantly stepped forward, and neither provided much detail.

Twitter admitted that it had been hacked this month. Facebook and Apple followed suit two weeks later. Within hours after The Times published its account, The Wall Street Journal chimed in with a report that it, too, had been attacked by what it believed to be Chinese hackers. The Washington Post followed.

Not everyone took advantage of the cover. Bloomberg, for example, has repeatedly denied that its systems were also breached by Chinese hackers, despite several sources that confirmed that its computers were infected with malware.

Computer security experts estimate that more than a thousand companies have been attacked recently. In 2011, security researchers at McAfee unearthed a vast online espionage campaign, called Operation Shady Rat, that found more than 70 organizations had been hit over a five-year period, many in the United States.

“I am convinced that every company in every conceivable industry with significant size and valuable intellectual property and trade secrets has been compromised (or will be shortly) with the great majority of the victims rarely discovering the intrusion or its impact,” Dmitri Alperovitch, then McAfee’s vice president for threat research, wrote in his findings.

“In fact,” said Mr. Alperovitch, now the chief technology officer at Crowdstrike, a security start-up, “I divide the entire set of Fortune Global 2000 firms into two categories: those that know they’ve been compromised and those that don’t yet know.”

Of that group, there are still few admissions. A majority of companies that have at one time or another been the subject of news reports of online attacks refuse to confirm them. The list includes the International Olympic Committee, Exxon Mobil, Baker Hughes, Royal Dutch Shell, BP, ConocoPhillips, Chesapeake Energy, the British energy giant BG Group, the steel maker ArcelorMittal and Coca-Cola.

David E. Sanger contributed reporting from Washington.

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Car Bomb in Damascus Kills Dozens, Opposition Says

Sana/European Pressphoto Agency

An injured man was carried near the site of a car bomb explosion in Damascus on Thursday.

In renewed violence reaching the center of the Syrian capital, a car bomb exploded in Damascus on Thursday near the headquarters of President Bashar al-Assad’s ruling party, killing more than two dozen people, mainly civilians and but also including security forces, according to opposition sources.

The Syrian Observatory for Human Rights, an anti-Assad group based in Britain that has a network of contacts in Syria, reported that at least 31 people were killed by the bomb in the neighborhood of Mazraa.

Syrian state television said two children were wounded, while Al Ikhbariya, a pro-government television channel, showed footage of two dead bodies and body parts in a park.

The area where the bomb exploded was near the headquarters of Mr. Assad’s ruling Baath Party and the Russian embassy. State television and the Syrian Observatory also said that mortar shells exploded near the Syrian Army General Command in the center of the capital, but there were no reported casualties.

The strikes were the latest to extend to the heart of the Syrian capital.

Reports this week appeared to show that rebel shells have reached new areas in Damascus.

Both state media and opposition activists reported on Wednesday that mortar rounds had hit the Tishreen sports stadium in the downtown neighborhood of Baramkeh. The state news agency, SANA, said the explosion killed an athlete from the Homs-based soccer team Al Wathba as he was practicing.

Government forces hit a rebel command center in a suburb east of the capital on Wednesday, injuring a founder of the Liwaa al-Islam brigade, Sheik Zahran Alloush, the brigade said in a statement.

On Tuesday, activists reported that up to seven mortar rounds had been fired by fighters of the Free Syrian Army toward Mr. Assad’s Tishreen Palace in Damascus.

There were no immediate reports of casualties, and it was not known whether Mr. Assad was there at the time. The palace, surrounded by a park, is in a wealthy area that has largely been insulated from the insurgency and it lies less than a mile from the main presidential palace.

Syrian rebels are entrenched in suburbs south and east of the capital, but they have been unable to push far into the center, although they strike the area with occasional mortars and increasingly frequent car bombs.

Such indiscriminate attacks however risk killing passersby, exposing the rebels to charges that they are careless with civilian life and property. Many Damascus residents are undecided about taking sides and fear their ancient city will be ravaged like Aleppo and other urban centers to the north.

At the same time, the government has decimated pro-rebel suburbs with air strikes and artillery, leaving vast areas depopulated or terrorized.

Fighting continued also for control of the main civilian airport in Aleppo on Wednesday.

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DealBook: F.B.I. Said to Be Looking at Suspicious Heinz Trades

The Federal Bureau of Investigation has opened a criminal inquiry into suspicious trades placed ahead of the $23 billion acquisition of H.J. Heinz, a person briefed on the matter said on Tuesday.

The F.B.I.’s involvement adds to the scrutiny surrounding the deal and further highlights the temptation that major takeovers present to traders.

Last week, a day after the deal was announced, the Securities and Exchange Commission promptly froze a Swiss account linked to possible insider trading in the Heinz takeover.

Like the S.E.C., the F.B.I. is examining a series of well-timed options trades made just before Berkshire Hathaway and the investment firm 3G Capital announced that they had agreed to buy Heinz. News of the deal sent the company’s shares, and the value of the options contracts, soaring.

“The F.B.I. is consulting with the S.E.C. to see if a crime was committed,” an F.B.I. spokesman said. He added that the bureau’s New York office, a main player behind the government’s recent insider trading crackdown, was handling discussions with the S.E.C.

The S.E.C. has not identified the trader or traders who placed the suspicious bets. The F.B.I. declined to comment further.

Authorities did acknowledge that the investigation centers on an unusual spike in options trades involving Heinz. The trades involved 2,533 options bought last Wednesday through a Swiss account at Goldman Sachs, according to the S.E.C.

Using what is known as a call option, the trades placed a bullish bet on Heinz without actually buying the company’s shares. Instead, the trades grant the opportunity to buy the stock at a given price through June.

The move struck authorities as out of the ordinary. For months leading up to the deal, there had been scant activity in Heinz options.

“The timing, size and profitability of the defendants’ trades, as well as the lack of prior history of significant trading in Heinz” in the account, the commission said in the complaint, “makes these trades highly suspicious.”

The anonymous investors spent nearly $90,000 on the call options, a position that skyrocketed on paper to $1.8 million after the deal was announced on Thursday. At the time, Heinz’s stock rose to $72.50, up 20 percent from Wednesday, matching Berkshire’s offer price.

The trades were funneled through the Goldman account, identified as “GS & Co c/o Zurich Office.” The bank, which is not accused of wrongdoing, has said it is cooperating with the investigation.

The growing inquiry may cast a cloud over the Heinz deal. While the S.E.C. already raised concerns, the F.B.I.’s examination adds to the scrutiny and for the first time raises the prospect of criminal actions.

Once authorities identify the traders, the S.E.C. and F.B.I. will turn their focus to the limited universe of insiders who could have leaked details of the deal. Dozens of people — including executives at both the buyers and the seller — possessed confidential information about the deal.

As authorities pursue the Heinz case, they are building on a recent campaign to root out insider trading on Wall Street. The S.E.C. filed 58 such actions last year, and the F.B.I. helped bring criminal cases in a number of actions against hedge funds and corporate insiders.

A version of this article appeared in print on 02/20/2013, on page B3 of the NewYork edition with the headline: F.B.I. Said to Be Looking at Heinz Trades.

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The New Old Age Blog: The Reluctant Caregiver

Now and then, I refer to the people that caregivers tend to as “loved ones.” And whenever I do, a woman in Southern California tells me, I set her teeth on edge.

She visits her mother-in-law, runs errands, helps with the paperwork — all tasks she has shouldered with a grim sense of duty.  She doesn’t have much affection for this increasingly frail 90something or enjoy her company; her efforts bring no emotional reward. Her husband, an only child, feels nearly as detached. His mother wasn’t abusive, a completely different scenario, but they were never very close.

Ms. A., as I’ll call her because her mother-in-law reads The Times on her computer, feels miserable about this. “She says she appreciates us, she’s counting on us. She thanks us,” Ms. A. said of her non-loved one. “It makes me feel worse, because I feel guilty.”

She has performed many services for her mother-in-law, who lives in a retirement community, “but I really didn’t want to. I know how grudging it was.”

Call her the Reluctant Caregiver. She and her husband didn’t invite his parents to follow them to the small city where they settled to take jobs. The elders did anyway, and as long as they stayed healthy and active, both couples maintained their own lives. Now that her mother-in-law is widowed and needy, Ms. A feels trapped.

Ashamed, too. She knows lots of adult children work much harder at caregiving yet see it as a privilege. For her, it is mere drudgery. “I don’t feel there’s anybody I can say that to,” she told me — except a friend in Phoenix and, anonymously, to us.

The friend, therapist Randy Weiss, has served as both a reluctant caregiver to her mother, who died very recently at 86, and a willing caregiver to her childless aunt, living in an assisted living dementia unit at 82. Spending time with each of them made Ms. Weiss conscious of the distinction.

Her visits involved many of the same activities, “but it feels very different,” she said. “I feel the appreciation from my aunt, even if she’s much less able to verbalize it.” A cherished confidante since adolescence, her aunt breaks into smiles when Ms. Weiss arrives and exclaims over every small gift, even a doughnut. She worked in the music industry for decades and, despite her memory loss, happily sings along with the jazz CDs Ms. Weiss brings.

Because she had no such connection with her mother, whom Ms. Weiss described as distant and critical, “it’s harder to do what I have to do,” she said. (We spoke before her mother’s death.) “One is an obligation I fulfill out of duty. One is done with love.”

Unlike her friend Ms. A, “I don’t feel guilty that I don’t feel warmly towards my mother,” Ms. Weiss said. “I’ve made my peace.”

Let’s acknowledge that at times almost every caregiver knows exhaustion, anger and resentment.  But to me, reluctant caregivers probably deserve more credit than most. They are not getting any of the good stuff back, no warmth or laughter, little tenderness, sometimes not even gratitude.

Yet they are doing this tough work anyway, usually because no one else can or will. Maybe an early death or a divorce means that the person who would ordinarily have provided care can’t. Or maybe the reluctant caregiver is simply the one who can’t walk away.

“It’s important to acknowledge that every relationship doesn’t come from ‘The Cosby Show,’” said Barbara Moscowitz when I called to ask her about reluctance. Ms. Moscowitz, a senior geriatric social worker at Massachusetts General Hospital, has heard many such tales from caregivers in her clinical practice and support groups.

“We need to allow people to be reluctant,” she said. “It means they’re dutiful; they’re responsible. Those are admirable qualities.”

Yet, she recognizes, “they feel oppressed by the platitudes. ‘Your mother is so lucky to have you!’” Such praise just makes people like Ms. A. squirm.

Ms. Moscowitz also worries about reluctant caregivers, and urges them to find support groups where they can say the supposedly unsay-able, and to sign up early for community services — hotlines, senior centers, day programs, meals on wheels — that can help lighten the load.

“Caregiving only goes one way – it gets harder, more complex,” she said. “Support groups and community resources are like having a first aid kit. It’s going to feel like even more of a burden, and you need to be armed.”

I wonder, too, if reluctant caregivers have a romanticized view of what the task is like for everyone else. Elder care can be a wonderful experience, satisfying and meaningful, but guilt and resentment are also standard parts of the job description, at least occasionally.

For a reluctant caregiver, “the satisfaction is, you haven’t turned your back,” Ms. Moscowitz said. “You can take pride in that.”

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

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The New Old Age Blog: The Reluctant Caregiver

Now and then, I refer to the people that caregivers tend to as “loved ones.” And whenever I do, a woman in Southern California tells me, I set her teeth on edge.

She visits her mother-in-law, runs errands, helps with the paperwork — all tasks she has shouldered with a grim sense of duty.  She doesn’t have much affection for this increasingly frail 90something or enjoy her company; her efforts bring no emotional reward. Her husband, an only child, feels nearly as detached. His mother wasn’t abusive, a completely different scenario, but they were never very close.

Ms. A., as I’ll call her because her mother-in-law reads The Times on her computer, feels miserable about this. “She says she appreciates us, she’s counting on us. She thanks us,” Ms. A. said of her non-loved one. “It makes me feel worse, because I feel guilty.”

She has performed many services for her mother-in-law, who lives in a retirement community, “but I really didn’t want to. I know how grudging it was.”

Call her the Reluctant Caregiver. She and her husband didn’t invite his parents to follow them to the small city where they settled to take jobs. The elders did anyway, and as long as they stayed healthy and active, both couples maintained their own lives. Now that her mother-in-law is widowed and needy, Ms. A feels trapped.

Ashamed, too. She knows lots of adult children work much harder at caregiving yet see it as a privilege. For her, it is mere drudgery. “I don’t feel there’s anybody I can say that to,” she told me — except a friend in Phoenix and, anonymously, to us.

The friend, therapist Randy Weiss, has served as both a reluctant caregiver to her mother, who died very recently at 86, and a willing caregiver to her childless aunt, living in an assisted living dementia unit at 82. Spending time with each of them made Ms. Weiss conscious of the distinction.

Her visits involved many of the same activities, “but it feels very different,” she said. “I feel the appreciation from my aunt, even if she’s much less able to verbalize it.” A cherished confidante since adolescence, her aunt breaks into smiles when Ms. Weiss arrives and exclaims over every small gift, even a doughnut. She worked in the music industry for decades and, despite her memory loss, happily sings along with the jazz CDs Ms. Weiss brings.

Because she had no such connection with her mother, whom Ms. Weiss described as distant and critical, “it’s harder to do what I have to do,” she said. (We spoke before her mother’s death.) “One is an obligation I fulfill out of duty. One is done with love.”

Unlike her friend Ms. A, “I don’t feel guilty that I don’t feel warmly towards my mother,” Ms. Weiss said. “I’ve made my peace.”

Let’s acknowledge that at times almost every caregiver knows exhaustion, anger and resentment.  But to me, reluctant caregivers probably deserve more credit than most. They are not getting any of the good stuff back, no warmth or laughter, little tenderness, sometimes not even gratitude.

Yet they are doing this tough work anyway, usually because no one else can or will. Maybe an early death or a divorce means that the person who would ordinarily have provided care can’t. Or maybe the reluctant caregiver is simply the one who can’t walk away.

“It’s important to acknowledge that every relationship doesn’t come from ‘The Cosby Show,’” said Barbara Moscowitz when I called to ask her about reluctance. Ms. Moscowitz, a senior geriatric social worker at Massachusetts General Hospital, has heard many such tales from caregivers in her clinical practice and support groups.

“We need to allow people to be reluctant,” she said. “It means they’re dutiful; they’re responsible. Those are admirable qualities.”

Yet, she recognizes, “they feel oppressed by the platitudes. ‘Your mother is so lucky to have you!’” Such praise just makes people like Ms. A. squirm.

Ms. Moscowitz also worries about reluctant caregivers, and urges them to find support groups where they can say the supposedly unsay-able, and to sign up early for community services — hotlines, senior centers, day programs, meals on wheels — that can help lighten the load.

“Caregiving only goes one way – it gets harder, more complex,” she said. “Support groups and community resources are like having a first aid kit. It’s going to feel like even more of a burden, and you need to be armed.”

I wonder, too, if reluctant caregivers have a romanticized view of what the task is like for everyone else. Elder care can be a wonderful experience, satisfying and meaningful, but guilt and resentment are also standard parts of the job description, at least occasionally.

For a reluctant caregiver, “the satisfaction is, you haven’t turned your back,” Ms. Moscowitz said. “You can take pride in that.”

---

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

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Gadgetwise Blog: Q&A: Locking Caps on an iPhone

While I have no desire to SHOUT MY WAY through text messages, I do have to use ALL UPPERCASE sometimes and would like to have CAPS LOCK available on my iPhone. Do I have ANY HOPE?

While the phone’s software keyboard has no dedicated Caps Lock key, quickly tapping the Shift key twice turns on the Caps Lock function. The Shift key turns blue when in Caps Lock mode. To turn off the Caps Lock mode, tap the Shift key again.

The iPhone keyboard has a few other shortcuts to make typing in such a small area more efficient. For example, instead of tapping the .?123 key in the bottom-left corner to switch over to the section of the keyboard that holds the numbers and punctuation keys (and then having to tap the corner key again to switch back to the ABC keyboard), just press the .?123 key down and slide your finger to the number or punctuation mark you need. Once you slide over and select the character, you can resume typing without having to tap back and forth between the different keyboards.

Pressing and holding keys for vowels (and other letters) that use accent marks reveals a pop-up list of accented characters to choose from, like é or ü. When you tap the space bar twice at the end of a sentence, the iPhone inserts a period and capitalizes the next letter you type to begin a new sentence. Apple’s site has an illustrated page of other tips and tricks for the iPhone 5.

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