The New Old Age Blog: For the Old, Less Sense of Whom to Trust

There’s a reason so many older people fall for financial scams, new research suggests. They don’t respond as readily to visual cues that suggest a person might be untrustworthy, and their brains don’t send out as many warning signals that ignite a danger ahead gut response.

The research, published Monday in the Proceedings of the National Academy of Sciences, is the first to show that older adults’ vulnerability to fraud may be rooted in age-related neurological changes.

Specifically, researchers from the University of California, Los Angeles, found that an area in the brain known as the anterior insula was muted when older people looked at photographs of suspicious-looking individuals. This part of the brain activates gut-level feelings that help individuals interpret the reliability of other people and assess potential risks and rewards associated with social interactions.

In one part of the U.C.L.A. study, both younger and older adults were asked to evaluate the trustworthiness of people portrayed in 60 photographs while undergoing brain scans. When the younger adults (21 altogether, from 23 to 46 years of age) labeled a person “not trustworthy,” their anterior insulas lit up. But this wasn’t true for older adults (23 altogether, age 55 to 80).

“The warning signals that convey a sense of potential danger to younger adults just don’t seem to be there for older adults,” said Shelley Taylor, the lead researcher and a psychology professor at U.C.L.A.

In another part of the study, researchers asked 119 older adults (55 to 84 years old) and 24 younger adults (age 20 to 42) to rate people in photographs as trustworthy, neutral or untrustworthy. Signs they were potentially untrustworthy included people with insincere smiles, averted gazes and postures that “leaned away” rather than toward the camera, among others, Dr. Taylor said.

Older adults were equally adept at identifying people judged to be trustworthy or neutral, but much more likely to miss signs of those who may be untrustworthy and view suspicious-looking people as approachable, the study found.

“We believe what’s going on is that older adults have a bias toward positive emotional experience and this keeps them from recognizing negative cues,” Dr. Taylor said.

This so-called “positivity effect” has been documented through research by Laura Carstensen, a professor of psychology and public policy at Stanford University, and it explains why older adults are, on the whole, happier than younger adults.

Asked to comment about the new study, Ms. Carstensen said in an e-mail that it was “very well done,” and observed that for older adults, “there are likely many benefits of looking on the bright side. However, there are likely some contexts where looking away from the negative and focusing on the positive is not good,” including financial scams and fraud.

Alexander Todorov, a professor of psychology at Princeton University, called the findings “interesting,” but warned that “there is an implicit assumption that these trustworthiness evaluations based on facial appearance are accurate. This is far from clear.”

Dr. Taylor became acutely aware of financial fraud practiced on the elderly almost 20 years ago when her elderly father handed $17,000 to two men who approached him on the street and walked with him to his bank.

“I got descriptions of the two men from someone who lived nearby — one had few teeth, both were dressed in a slovenly manner, and they’d been seen sleeping in doorways and were using the drug rehab center nearby,” the professor explained in an e-mail.

In other words, they would have been viewed skeptically by most people, but weren’t seen in that light by Dr. Taylor’s father.

Statistics show that financial exploitation of the elderly is on the rise. According to a study published last year by the MetLife Mature Market Institute and the National Committee for the Prevention of Elder Abuse, elder financial abuse — everything from fraudulent sweepstakes to bank accounts emptied out by guardians — totaled $2.9 billion in 2010, a 12 percent increase from only two years before.

Earlier this year, the Government Accountability Office weighed in on the issue, noting the inadequacy of existing safeguards and calling for a new national strategy to address the problem.

On Tuesday my colleague Paula Span wrote about a just-published consumer guide, “Protect Your Pocketbook,” intended for older adults and families who wanted to understand what put them at risk, how to prevent fraud, and where to turn for help.

As for Dr. Taylor, she advises that seniors never agree on the spot to a phone offer or a pitch from a door-to-door salesman. “Either hang up or wait and get someone else involved in your life to evaluate what’s being presented,” she said.

With financial fraud, almost half the time seniors end up being taken in by a caretaker or someone posing as a friend. “Make absolutely sure that you’ve carefully checked out the people taking care of an older relative,” or any “surprising new friend” that you’ve never heard of before that’s now on the scene, she tells family members.

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Gadgetwise Blog: Q&A: Changing a PC's Start-up Routine

I installed the Windows 8 preview on an old laptop, but now the computer won’t start up unless I have the DVD in the drive. Help!

When you installed the Windows 8 software on the computer from the DVD, the system may have been switched to start up from the disc drive instead of the hard drive, and never switched back. Unless the hard drive is damaged, you can usually fix this by adjusting a setting in the computer’s BIOS — Basic Input/Output System, a bit of software built into the hardware.

To do so, restart the PC and watch the screen for information about which key to press to change the normal start-up routine or adjust the BIOS. This key varies by manufacturer, but it is often the F2, F8, F10 or the Delete key; your computer’s manual should have instructions.

Once you press the key and land on the text-based BIOS Setup Utility screen, use the keyboard’s right arrow key to move to the Boot menu. Use the down arrow key to get to the Boot Device Priority area and hit the Enter key. Here, you can change the first boot device from the disc drive to the hard drive. Select the option from the on-screen menu to save the setting and exit the BIOS Setup Utility. The computer should now start up from the hard drive and not require the DVD in the disc drive.

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Changing of the Guard: How Crash Cover-Up Altered China’s Succession





BEIJING — “Thank you. I’m well. Don’t worry,” read the post on a Chinese social networking site. The brief comment, published in June, appeared to come from Ling Gu, the 23-year-old son of a high-powered aide to China’s president, and it helped quash reports that he had been killed in a Ferrari crash after a night of partying.




It only later emerged that the message was a sham, posted by someone under Mr. Ling’s alias — almost three months after his death.


The ploy was one of many in a tangled effort to suppress news of the crash that killed Mr. Ling and critically injured two young female passengers, one of whom later died. The outlines of the affair surfaced months ago, but it is now becoming clearer that the crash and the botched cover-up had more momentous consequences, altering the course of the Chinese Communist Party’s once-in-a-decade leadership succession last month.


China’s departing president, Hu Jintao, entered the summer in an apparently strong position after the disgrace of Bo Xilai, previously a rising member of a rival political network who was brought down when his wife was accused of murdering a British businessman. But Mr. Hu suffered a debilitating reversal of his own when party elders — led by his predecessor, Jiang Zemin — confronted him with allegations that Ling Jihua, his closest protégé and political fixer, had engineered the cover-up of his son’s death.


According to current and former officials, party elites, and others, the exposure helped tip the balance of difficult negotiations, hastening Mr. Hu’s decline; spurring the ascent of China’s new leader, Xi Jinping; and playing into the hands of Mr. Jiang, whose associates dominate the new seven-man leadership at the expense of candidates from Mr. Hu’s clique.


The case also shows how the profligate lifestyles of leaders’ relatives and friends can weigh heavily in backstage power tussles, especially as party skulduggery plays out under the intensifying glare of media.


Numerous party insiders provided information regarding the episode, speaking on the condition of anonymity for fear of reprisals from the authorities. Officials have investigated the aftermath of the car wreck, they say, including looking into accusations that a state oil company paid hush money to the families of the two women.


Under Mr. Hu, Mr. Ling had directed the leadership’s administrative center, the General Office, but was relegated to a less influential post in September, ahead of schedule. Last month, he failed to advance to the 25-person Politburo and lost his seat on the influential party secretariat.


Mr. Hu, who stepped down as party chief, immediately yielded his post as chairman of the military, meaning he will not retain power as Mr. Jiang did. “Hu was weakened even before leaving office,” said a midranking official in the Organization Department, the party’s personnel office.


Mr. Ling’s future remains unsettled, with party insiders saying that his case presents an early test of whether Mr. Xi intends to follow through on public promises to fight high-level corruption.


“He can decide whether to go after Ling Jihua or not,” said Wu Guoguang, a former top-level party speechwriter, now a political scientist at the University of Victoria in British Columbia. “Either way, this is a big card in Xi Jinping’s hand.”


Mr. Ling, 56, built his career in the Communist Youth League. At an early age, he secured the patronage of Mr. Hu, who led the Youth League in the early 1980s and brought Mr. Ling to the General Office in 1995. “Hu didn’t come with a lot of friends, but Ling was someone he knew he could trust,” said the Organization Department official. “Officials said that if Ling called, it was like Hu calling.”


Mr. Ling played a central role in moving Youth League veterans into high offices and undermining Mr. Hu’s adversaries. Mr. Ling also wielded leverage over Internet censorship of leaders’ affairs, and sought to use it to benefit his patron.


“Negative publicity, including untruths, about Xi Jinping were not suppressed the way publicity about Hu Jintao was,” said one associate of party leaders.


As his influence grew, Mr. Ling tried to keep a low profile. About a decade ago, his wife closed a software company she owned and formed a nonprofit foundation that incubates young entrepreneurs. The couple sent their son, Ling Gu, to an elite Beijing high school under an alias, Wang Ziyun. “Ling Jihua told his family not to damage his career,” a former Youth League colleague said. “But it seems it can’t be stopped.”


Still living under an alias, Ling Gu graduated from Peking University last year with an international relations degree and began graduate studies in education. One of his instructors said his performance plunged later in his undergraduate years. “I think there were too many lures, too much seduction,” he said.


Before dawn on March 18, a black Ferrari Spider speeding along Fourth Ring Road in Beijing ricocheted off a wall, struck a railing and cracked in two. Mr. Ling was killed instantly, and the two young Tibetan women with him were hospitalized with severe injuries. One died months later, and the other is recovering, party insiders said.


Ian Johnson and Edward Wong contributed reporting.



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Michigan Movie Studio Gets Tax Breaks, but Results in Few Jobs





PONTIAC, Mich. — Even the great and powerful Oz could not save the film studio that was supposed to save this town.




The studio, a state-of-the-art facility fit for Hollywood blockbusters, had risen from the ruins of a General Motors complex here. It was the brainchild of a small group of investors with big plans: the studio would attract prestigious filmmakers, and the movie productions would create jobs and pump money into the local economy. A glamorous sheen would rub off on this down-on-its-luck town.


But in Pontiac, happy endings do not usually come Hollywood-style. The tale behind the studio, though, was cinematic in its own right, filled with colorful characters, calls from the White House and a starring role for Michigan’s taxpayers. Rounding out the cast was a big-budget Disney movie, “Oz: The Great and Powerful.”


It all started back in August 2007, when Gov. Jennifer M. Granholm met with Mike Binder, a Michigan-born actor and director who was lamenting the state’s lackluster program to award financial aid — otherwise known as film credits — to the movie industry. Ms. Granholm, an aspiring actress when she was in her early 20s, became determined to make Michigan competitive, she recalled.


Eight months later, the capital of the flailing auto industry became the capital of film tax credits. For every dollar spent locally, filmmakers would receive almost half back from Michigan. That sort of money turns heads at even the richest film studios, and word spreads fast. Janet Lockwood, the director of the state’s film office, said that a week after the enhanced credits were announced, she was besieged at a movie conference in Santa Monica, Calif., by “the baby studios to the big guys.”


Hollywood may make movies about the evils of capitalism, but it rarely works without incentives, which are paid for by taxpayers. Nationwide, about $1.5 billion in tax breaks is awarded to the film industry each year, according to a state-by-state survey by The New York Times.


Within two months, 24 movies had signed up to film in Michigan — up from two the entire year before. The productions estimated that they would spend $195 million filming there, and in return they would be refunded about $70 million in cash.


Before long, residents were rushing out on their lunch breaks to catch a glimpse of celebrities like Drew Barrymore, who was filming her movie “Whip It” in Ann Arbor, and Clint Eastwood, who was shooting “Gran Torino” in the Detroit area. Even Michael Moore, who was filming a movie about corporate welfare called “Capitalism: A Love Story,” sought and received incentives.


A ‘No-Brainer’ for Michigan


It was a time when most financial news was bad. Housing prices plunged, and thousands of automobiles went unsold. Michigan was facing growing budget shortfalls, and some lawmakers who voted for the film credits soon began questioning whether the state could actually afford them.


In Pontiac, tax revenue plummeted as General Motors pulled out and workers left. Half of downtown was boarded up, and landlords accepted rent checks through slits in doors locked for safety. For some, Hollywood provided distraction and hope.


By 2008, a plan was being hatched for what would become the movie studio in Pontiac. The man behind it, Linden Nelson, was a well-connected local entrepreneur with a charismatic personality. He had made a name for himself by creating the removable key chain for valet parkers in the 1980s. His company later manufactured promotional trinkets for brands like AT&T and Harley-Davidson. In the late 1990s, Mr. Nelson found himself in the headlines when a fire broke out at his office in Beverly Hills, Mich. It was ruled accidental.


Mr. Nelson got the idea for the studio, he said, from his college-age son, who had heard that the Michigan tax credits were the talk of the Cannes Film Festival in France that year. Mr. Nelson soon met an old friend, Ari Emanuel, over coffee in Aspen, Colo., to discuss the idea. Mr. Emanuel was the force behind what would become William Morris Endeavor Entertainment, and his fast-talking, take-no-prisoners style had been immortalized in HBO’s “Entourage.” His brother Rahm would soon be named the chief of staff to President Obama.


Intrigued, Mr. Emanuel did not take long to sign on. “I’m, like, blown away by it,” he told a gathering of the Detroit Regional Chamber of Commerce. “Not to use an L.A. phrase — I think this is a no-brainer for the state of Michigan.”


Motown Motion Pictures LLC was incorporated in May 2008, and two more partners came on board. One, John Rakolta Jr., had building expertise as the head of a commercial construction company. The other, A. Alfred Taubman, was a longtime friend of Mr. Nelson and a prominent investor who made billions building shopping malls nationwide.


Mr. Taubman is among the most generous donors to universities and institutions in Michigan and elsewhere. He went to prison for nearly 10 months in 2002 over price-fixing accusations related to Sotheby’s auction house, which his company owned. He has maintained that he was innocent.


When Mr. Taubman first visited the vacated General Motors site in Pontiac, he was brought to tears. “What happened to all the people?” he said, according to Mr. Nelson, who was at his side. “Where are the cars? What happened to their families?”


In early 2009, the four investors bought the property from G.M. for “virtually nothing,” said Mr. Rakolta. General Motors, which had just received a hefty federal bailout, “spent more on the carpet than we spent on this building,” he said.


The investors agreed that they would put in a total of $10 million to $12 million of their own money, according to the studio’s chief financial officer. They would pay for the rest — $70 million or so — using borrowed money and state and federal incentives. “Michigan’s current tax incentive program appears to be the largest competitive advantage for the company,” one studio document said.


Ms. Lockwood, the film commissioner at the time, said she visited Mr. Taubman’s office in early 2009. Over lunch served by a butler, Mr. Taubman filled her in on the plan. “He believed that there was money to be made,” she recalled.


A Town on the Ropes


In public, the investors extolled the studio as an altruistic effort on behalf of Pontiac. “I go into things to make money, but on this, I don’t really care,” Mr. Taubman told The Detroit Free Press. “I just want to help create jobs, and this can create 3,600 jobs.”


Pontiac desperately needed them. In March of that year, roughly one of every two residents was without work, according to federal data. Food pantries had record requests. Pontiac was consistently listed among the top 10 most dangerous cities by the F.B.I. The city had made national news when a group of teenagers approached homeless people on the street and beat them to death.


Ms. Granholm declared the city in a financial crisis in February 2009 and appointed an emergency manager, Fred Leeb. The city’s budget was $54 million a year, but it was overspending by an estimated $7 million to $12 million. Pontiac was also still weighted down by old incentives it had given to businesses like G.M.


The movie studio was an added challenge, since it was seeking financial incentives from the city — not to mention from other branches of the government. It won redevelopment tax credits from the federal government and separate aid from the state that included incentives for technology companies that hire residents.


Job creation became a point of contention with beleaguered Pontiac, which was being asked to waive virtually all property taxes for the studio. The investors claimed that thousands of people would be employed, but Mr. Leeb said that when he asked for job numbers to be written into the contract, the investors refused. “We started seeing some backpedaling,” said Mr. Leeb, who added that the negotiations featured “knock-down, drag-out fights.”


Mr. Nelson said he did not recall that request, but added that his company could not have guaranteed jobs anyway, since they were mainly supposed to be created by filmmakers renting out the studio.


Under pressure from the governor’s office, Mr. Leeb said he had little choice but to approve the investors’ requests.


Ms. Granholm announced the project in her 2009 State of the State address, saying she thought the industry would create a flood of new jobs. “It was very exciting,” recalled Ms. Granholm, a Democrat. “A classic transformation, the phoenix rising from the ashes. This plant in Pontiac — it was a really great moment for a community that really wanted and needed hope.”


That summer, as the studio moved forward, Mr. Nelson was in local headlines for a second fire, this one at his 23,000-square-foot lakefront home in Bloomfield Hills. The fire extensively damaged the home, and its cause was not determined. Mr. Nelson declined to discuss it.


Not long after, he and the other studio investors hit a major hurdle. They would be borrowing around $18 million in municipal bonds, but they needed someone to back them.


Over the objections of some local officials, the state agreed to use the state workers’ pension funds to guarantee the bonds. If the investors failed to pay, the retirees would be on the hook.


At the time of the deal, the governor was speaking regularly with Mr. Obama, who was negotiating the General Motors bailout. Edward B. Montgomery, who was leading the White House’s efforts on communities and workers affected by the automaker’s bankruptcy, was engaged on the studio plans.


Mr. Montgomery said in an interview that he had expressed support for the studio and other projects that he believed would help diversify Michigan’s economy. He said the studio’s investors received assistance from the Treasury Department to qualify for a federal tax credit program. Mr. Montgomery said he was unaware of the bond guarantee involving the state pension fund.


On July 27, 2010, the governor and other officials gathered for the studio’s groundbreaking. Also on hand were Hollywood players like Mr. Binder, a creator of HBO’s “The Mind of the Married Man,” who had been instrumental in persuading the governor to expand the film subsidies.


Mr. Nelson, the studio’s main impresario, talked up the job numbers on local radio that day and said the incentives were necessary. “It’s a very competitive landscape out there,” he said. “There are very, very competitive rebates going on with other states. People don’t realize this, but 40 states have some kind of rebate or another in this industry. It’s an industry that’s fought after.”


Even as Michigan celebrated the studio, the Motion Picture Association of America was facing criticism of the use of film credits in a report by a Washington tax research group. The film association estimated that the industry employs just over two million people and supports 115,000 businesses. The report, conducted by the nonprofit Tax Foundation, which opposes film incentives, said that states justified them using “fanciful estimates of economic activity.”


The Pontiac studio was complete by the summer of 2011. Its first big production moved in after being awarded about $40 million from the state — the largest single movie payout yet. The Disney “Oz” film was being directed by Sam Raimi, a Michigan native who made the recent “Spider-Man” movies.


Over the coming months, the studio’s seven stages were filled with a yellow brick road and a haunted forest. The designers planted live grass and built a huge waterfall and pond where James Franco, the star of the film, could land in a hot-air balloon. Perhaps the most elaborate set was the courtyard around the good witch Glinda’s castle, which took 75,000 hours of work to build and used $9 million worth of wood, according to Mr. Nelson.


Sahir Rashid, a 35-year-old production assistant and Detroit resident, said that walking into the studio had been overwhelming. It was his first time on a soundstage, and he was thankful that the state’s movie boom allowed him to give up construction work. “For me, the films saved my life,” he said. “It’s not a dead-end job. It’s actually a career.”


As for the crew and actors, “the majority of them I think were from L.A.,” said London Moore, a local actress. Ms. Moore was the body double for Michelle Williams, who was playing Glinda. “I went into this thinking these people were probably going to be stuck up, but they welcomed me with open arms. They are like a family to me.”


Film Jobs Prove Scarce


The studio had created only 200 positions by the summer of 2011, according to correspondence between the company and local officials. And when temporary construction workers were excluded from the tally, Pontiac’s records show, the studio reported only two employees in 2010 and 12 the next year. The studio’s chief financial officer said it had not been able to cash in on $110 million in tax credits that were contingent on creating jobs. But the studio did cash in on other credits, including $14 million for a “Film and Digital Media Infrastructure Investment Tax Credit,” he said.


As the “Oz” shoot was under way, Pontiac moved on to its third emergency manager, Louis Schimmel, and he was not a fan of incentives. A former municipal bond analyst, Mr. Schimmel spent decades warning Michigan towns against trading tax revenues for jobs. “I’m just about the biggest critic of these programs, because giving away the taxes of the city is so detrimental,” he said. “The money is needed for police, fire and trash pickup.”


Mr. Schimmel said Disney had offered to prepay its workers’ personal income tax to the city, but Pontiac declined. The city later had problems collecting some of the taxes because Disney operated through a separate business entity that was difficult to track down, he said.


“This is a glamorous industry if you want to talk about Hollywood, but it’s not very glamorous for the municipality that wants to collect something,” Mr. Schimmel said. Pontiac, he said, was outgunned.


Disney declined to comment. Mr. Nelson said the studio and Disney were responsive to the city.


Mr. Schimmel was not alone in his opposition to incentives. Michigan elected a new governor in 2010, Rick Snyder, a Republican who believed that it made better sense to lower taxes for all businesses. The governor’s budget director, John Nixon, said in an interview, “States harm themselves by competing on tax credits.” The governor quickly began reining in the program.


Almost immediately, filmmakers pulled out of Michigan. The change hit hard at “Hollywood-land in Pontiac,” as Mr. Nelson sometimes refers to his studio, now called Michigan Motion Picture Studios. He said the makers of “Iron Man 3” had been considering filming there but opted for North Carolina after Mr. Snyder slashed incentives.


When the bill for the studio’s bond interest came due in February this year, it paid only a portion, $210,000. The state pension fund had to pick up the remaining $420,000. Mr. Nelson said he and his partners would have made the payment if the state had not changed the tax credit program. “No one would have missed a bond payment,” he said. “No one would have missed anything.”


The situation is galling to even longtime government officials, who over the years have seen plenty of economic development deals fail. “Taubman could write the whole check for that himself,” said Doug Smith, an official at the state’s economic development agency. The state pension fund may “end up owning these studios,” he said.


One of the development agency’s board members is Mr. Rakolta, the construction executive who invested in the Pontiac studio. He and Mr. Nelson said in separate interviews that they had never considered personally paying for the bond interest. A deal is a deal, they said, and the state agreed to cover the bond. The studio’s chief financial officer said the investors already stood to lose twice as much as they originally intended to invest.


A spokesman for Mr. Emanuel said he was not willing to discuss the situation on the record. A spokesman for Mr. Taubman said he was unavailable.


In August, the studio defaulted on the entire $630,000 payment on the bond, despite a decision by Mr. Snyder to temporarily allocate some film incentives.


The investors are lobbying state lawmakers to put more money into the tax credits and have formed a political action committee. Donating to the PAC are the four investors; Mr. Emanuel’s agency, William Morris Endeavor; and the Teamsters union. To rally public support, the studio offers public tours. “Please don’t hesitate to contact your state representative,” Mr. Nelson tells visitors. “Tell them you’ve been here, you believe in it, so please appropriate enough money so it will work.”


Mr. Nelson said that if the state did not improve the incentives, the Pontiac studio would probably shut down. For now, the soundstages are empty. Filming wrapped up last month on a Warner Brothers movie called “Black Sky.” It is about a town ravaged by deadly tornadoes.

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Software Programs Help Doctors Diagnose, but Can’t Replace Them





SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.




At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.


Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice today.


The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.


To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.


Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?


The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.


And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.


In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.


Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.


Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.


Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.


When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.


Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”


He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”


Clinical Precision


Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.


One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.


There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.


“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.


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Software Programs Help Doctors Diagnose, but Can’t Replace Them





SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.




At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.


Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice today.


The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.


To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.


Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?


The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.


And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.


In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.


Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.


Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.


Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.


When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.


Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”


He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”


Clinical Precision


Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.


One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.


There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.


“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.


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Gadgetwise Blog: Q&A: Locking Up the Mac

I’m new to Macs. What is FileVault and do I need to use it?

FileVault is a data-security feature built into the Mac’s OS X operating system. With FileVault, you can encrypt the Mac’s hard drive to keep its contents locked up with a password, even if someone gets access to your computer. FileVault can also encrypt the data on external drives and can be used to completely erase the Mac’s hard drive when it comes time to recycle the computer.

As to whether you need to use FileVault, it depends on your personal need for file security and keeping your data confidential. You can get a better idea of how it might fit into your computing life from Apple’s current guide to the software on its site. Some versions of Windows include a similar feature, BitLocker.

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Assad Facing Setbacks as Syrian Capital Is Besieged


Narciso Contreras/Associated Press


A kitchen in a residence in Aleppo, Syria, damaged Sunday in fighting between Free Syrian Army fighters and government forces.







BEIRUT, Lebanon — Fierce fighting on the battlefield and setbacks on the diplomatic front increased pressure on the embattled Syrian government as fresh signs emerged on Tuesday of a sustained battle for control of the capital.




News reports quoted activists as saying fighting was raging in the southern suburbs of Damascus and near the international airport for a fifth straight day as government forces sought to dislodge rebels and reverse their recent gains.


While the government has superior firepower and rebels are reporting heavy losses, loyalist forces have been carrying out a serious counteroffensive in the suburbs without being able to subdue the insurgents.


The latest reports followed developments on Monday when a senior Turkish official said that Russia had agreed to a new diplomatic approach to seek ways to persuade President Bashar al-Assad to relinquish power, a possible weakening in Russia’s steadfast support for the government.


In Damascus, a prominent Foreign Ministry spokesman was said to have left the country amid reports of his defection, and both President Obama and Secretary of State Hillary Rodham Clinton issued warnings that any use of chemical weapons by a desperate government would be met with a strong international response. The NATO secretary general, Anders Fogh Rasmussen, echoed this warning on Tuesday.


“The possible use of chemical weapons would be completely unacceptable to the whole international community,” Mr. Rasmussen said, according to Agence France-Presse.


A Western diplomat confirmed that there were grave concerns in United States intelligence circles that Syrian leaders could resort to the use of the weapons as their position deteriorates.


The Syrian Foreign Ministry, repeating earlier statements, told state television that the government “would not use chemical weapons, if it had them, against its own people under any circumstances.”


The United Nations said it was withdrawing nonessential international staff from Syria, and the European Union said it was reducing activities in Damascus “to a minimum,” as security forces pummeled the suburbs with artillery and airstrikes in a struggle to seal off the city from its restive outskirts and control the airport road. A senior Russian official spoke for the first time in detail about the possibility of evacuating Russian citizens.


The United Nations World Food Program reported on Tuesday that “the recent escalation of violence in Syria is making it more difficult to reach the country’s hardest-hit areas.”


“Food insecurity is on the rise due to bread shortages and higher food prices in many parts of the country. High prices are also affecting neighboring countries hosting Syrian refugees,” the organization said in a statement.


“Road access to and from Damascus has become more dangerous, making it difficult to dispatch food from World Food Program warehouses to some parts of the country, the organization said, adding that there had been increasing indiscriminate attacks on its trucks in different parts of the country.


It also said it would relocate seven nonessential staff members to neighboring Jordan while about “20 international and 100 national W.F.P. staff remain in the country to carry out the emergency operation to feed 1.5 million vulnerable Syrians.” Mr. Assad has held on longer than many had predicted at the start of the 21-month uprising. He still has a strong military advantage and undiminished support from his closest ally, Iran. Military analysts doubt the rebels are capable of taking Damascus by force, and one fighter interviewed on Monday said the government counteroffensive was taking a heavy toll. There were still no firm indications from Russia that it was ready to join Turkey and Western nations in insisting on Mr. Assad’s immediate departure.


But the latest grim developments follow a week of events that suggested the Assad government was being forced to fight harder to keep its grip on power. Rebels threatened its vital control of the skies, using surface-to-air missiles to down a fighter plane and other aircraft. The opposition also gained control of strategic military bases and their arsenals, and forced the government to shut down the Damascus airport periodically. The Internet was off for two days.


A Russian political analyst with contacts at the Foreign Ministry said that “people sent by the Russian leadership” who had contact with Mr. Assad two weeks ago described a man who has lost all hope of victory or escape.


“His mood is that he will be killed anyway,” Fyodor Lukyanov, editor of a Russian foreign affairs journal and the head of an influential policy group, said in an interview in Moscow, adding that only an “extremely bold” diplomatic proposal could possibly convince Mr. Assad that he could leave power and survive.


“If he will try to go, to leave, to exit, he will be killed by his own people,” Mr. Lukyanov said, speculating that security forces dominated by Mr. Assad’s minority Alawite sect would not let him depart and leave them to face revenge. “If he stays, he will be killed by his opponents. He is in a trap. It is not about Russia or anybody else. It is about his physical survival.”


Anne Barnard reported from Beirut, Lebanon, and Ellen Barry from Moscow. Reporting was contributed by Alan Cowell in London, Sebnem Arsu in Istanbul, Peter Baker in Washington, Hwaida Saad, Neil MacFarquhar and Hania Mourtada in Beirut, and Christine Hauser in New York.



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DealBook: Delta Air Lines Ponders Stake in Virgin Atlantic Airways

Delta Air Lines is in talks to buy Singapore Airlines’ 49 percent stake in Virgin Atlantic Airways, in an effort to bolster its international operations, particularly flights between New York and London, a person briefed on the matter said on Sunday.

Talks are continuing but a deal will not be announced soon, this person said. Singapore Airlines confirmed that it was in discussions about a potential sale of its Virgin stake, but provided no further details.

A transaction would be the latest in a round of mergers that has reshaped the airline industry, as companies in the United States and Europe have looked to consolidation to restore profitability.

With oil prices remaining stubbornly high and the economic outlook uncertain, many airlines have continued to struggle. That may precipitate even more takeovers, analysts say.

A deal would also be Delta’s most significant strategic move since its 2008 merger with Northwest Airlines, which made it the biggest American carrier until the union of United Airlines and Continental Airlines last year.

It would provide more access to London’s Heathrow Airport, one of the world’s busiest, and expand Delta’s North Atlantic business.

It would also bolster its partnership with Air France KLM, Europe’s biggest airline. Both companies are part of the Sky Team global alliance, and also run a joint business in the North Atlantic market, sharing flights, revenues and costs.

“Delta has shown time and time again that it is extremely opportunistic,” said Brett Snyder, an airline expert. “If it sees a good opportunity, nothing is off the table.”

If it proceeded, a transaction would directly challenge the Oneworld global alliance, whose biggest members are American Airlines and British Airways. The two airlines have an international joint venture. Virgin does not belong to any of the three major airline alliances — Star, Oneworld and Sky Team — depriving it of the ability to coordinate flights and cut costs, which has helped many of its competitors. Star’s major carriers are United, US Airways and Lufthansa. The deal would also give Virgin a strong partner as it struggles to compete against rivals with deeper pockets. Founded by Richard Branson in 1984, the company has long embraced an image of fun travel and cheaper fares.

But that has not helped the airline’s financial condition of late. Virgin lost £80 million, or $128 million, in the year that ended in February, compared with a profit of £18.5 million in the previous year.

The company has been under pressure from the likes of British Airways, whose corporate parent, IAG, bought BMI British Midlands earlier this year. Virgin fought against that deal, arguing that it would give British Airways too much of a presence at Heathrow. But the takeover was completed, after IAG complied with a European Commission order to give back 14 slots at the airport.

The deal may also pave the way for an eventual change of control of Virgin. The company’s chief executive, Steve Ridgway, told The Financial Times in an interview in January that Mr. Branson was prepared to sell some of his 51 percent controlling stake in the airline.

“For Virgin, it’s an exit strategy in an environment where they are being marginalized by alliances on the Atlantic,” said Robert W. Mann, an airline analyst based in Port Washington, N.Y.

A Delta spokeswoman declined to comment. A representative for Virgin was not immediately available for comment.


This post has been revised to reflect the following correction:

Correction: December 3, 2012

An earlier version of this article misstated the date of Delta's merger with Northwest Airlines. It was 2008, not 2010.

A version of this article appeared in print on 12/03/2012, on page B2 of the NewYork edition with the headline: Delta, Seeking London Access, Ponders Stake in Virgin.
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Call That Kept Nursing Home Patients in Sandy’s Path


Chang W. Lee/The New York Times


Workers were shocked that nursing and adult homes in areas like Rockaway Park, Queens, weren’t evacuated.







Hurricane Sandy was swirling northward, four days before landfall, and at the Sea Crest Health Care Center, a nursing home overlooking the Coney Island Boardwalk in Brooklyn, workers were gathering medicines and other supplies as they prepared to evacuate.




Then the call came from health officials: Mayor Michael R. Bloomberg, acting on the advice of his aides and those of Gov. Andrew M. Cuomo, recommended that nursing homes and adult homes stay put. The 305 residents would ride out the storm.


The same advisory also took administrators by surprise at the Ocean Promenade nursing home, which faces the Atlantic Ocean in Queens. They canceled plans to move 105 residents to safety.


“No one gets why we weren’t evacuated,” said a worker there, Yisroel Tabi. “We wouldn’t have exposed ourselves to dealing with that situation.”


The recommendation that thousands of elderly, disabled and mentally ill residents remain in more than 40 nursing homes and adult homes in flood-prone areas of New York City had calamitous consequences.


At least 29 facilities in Queens and Brooklyn were severely flooded. Generators failed or were absent. Buildings were plunged into a cold, wet darkness, with no access to power, water, heat and food.


While no immediate deaths were reported, it took at least three days for the Fire Department, the National Guard and ambulance crews from around the country to rescue over 4,000 nursing home and 1,500 adult home residents. Without working elevators, many had to be carried down slippery stairwells.


“I was shocked,” said Greg Levow, who works for an ambulance service and helped rescue residents at Queens. “I couldn’t understand why they were there in the first place.”


Many sat for hours in ambulances and buses before being transported to safety through sand drifts and debris-filled floodwaters. They went to crowded shelters and nursing homes as far away as Albany, where for days, they often lacked medical charts and medications. Families struggled to locate relatives.


The decision not to empty the nursing homes and adult homes in the mandatory evacuation area was one of the most questionable by the authorities during Hurricane Sandy. And an investigation by The New York Times found that the impact was worsened by missteps that officials made in not ensuring that these facilities could protect residents.


They did not require that nursing homes maintain backup generators that could withstand flooding. They did not ensure that health care administrators could adequately communicate with government agencies during and after a storm. And they discounted the more severe of the early predictions about Hurricane Sandy’s surge.


The Times’s investigation was based on interviews with officials, health care administrators, doctors, nurses, ambulance medics, residents, family members and disaster experts. It included a review of internal State Health Department status reports. The findings revealed the striking vulnerability of the city’s nursing and adult homes.


On Sunday, Oct. 28, the day before Hurricane Sandy arrived, Mr. Bloomberg ordered a mandatory evacuation in Zone A, the low-lying neighborhoods of the city. But by that point, Mr. Bloomberg, relying on the advice of the city and state health commissioners, had already determined that people in nursing homes and adult homes should not leave, officials said.


The mayor’s recommendations that health care facilities not evacuate startled residents of Surf Manor adult home in Coney Island, said one of them, Norman Bloomfield. He recalled that another resident exclaimed, “What about us! Why’s he telling us to stay?”


The commissioners made the recommendation to Mr. Bloomberg and Mr. Cuomo because they said they believed that the inherent risks of transporting the residents outweighed the potential dangers from the storm.


In interviews, senior Bloomberg and Cuomo aides did not express regret for keeping the residents in place.


“I would defend all the decisions and the actions” by the health authorities involving the storm, said Linda I. Gibbs, a deputy mayor. “I feel like I’m describing something that was a remarkable, lifesaving event.”


Dr. Nirav R. Shah, the state health commissioner, who regulates nursing homes, said: “I’m not even thinking of second-guessing the decisions.”


Still, officials in New Jersey and in Nassau County adopted a different policy, evacuating nursing homes in coastal areas well before the storm.


Contradictory Forecasts


The city’s experience with Tropical Storm Irene last year weighed heavily on state and city health officials and contributed to their underestimating the impact of Hurricane Sandy, according to records and interviews.


Before Tropical Storm Irene, the officials ordered nursing homes and adult homes to evacuate. The storm caused relatively minor damage, but the evacuation led to millions of dollars in health care, transportation, housing and other costs, and took a toll on residents.


As a result, when Hurricane Sandy loomed, the officials were acutely aware that they could come under criticism if they ordered another evacuation that proved unnecessary.


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