DealBook: Einhorn Sues Apple Over Plan to Discard Preferred Stock

9:02 p.m. | Updated

Wall Street has had a long romance with Apple. Now one of the company’s best-known investors is saying: I love you, but you need to change.

The surprising declaration by the billionaire hedge fund manager David Einhorn adds to the growing dissatisfaction with Apple and its once soaring stock.

On Thursday, Mr. Einhorn urged his fellow shareholders to block a plan by Apple to scrap a certain class of stock. He says that the move limits the company’s ability to use its enormous war chest — some $137 billion in cash — to reward investors.

The campaign is an unusually aggressive one for Mr. Einhorn, who came to fame betting against Lehman Brothers. To thwart the proposal, Mr. Einhorn is suing Apple in Federal District Court in Manhattan, claiming that it violated securities rules by tying the plan with two other initiatives that he sees as good corporate governance.

The standoff sets up an unusual clash between two sides who can each claim a huge following on Wall Street. In one corner is Apple, whose stock’s almost unearthly growth has bewitched investors across the globe — at least until recently. In the other is Mr. Einhorn, widely regarded as an intelligent investor whose moves inspire legions of copycats. His merely asking a few questions on an earnings call for Herbalife, a nutritional supplement company, last May prompted a plunge in its shares.

So far, each side has remained cordial. Mr. Einhorn called Apple “phenomenal” and contended that his campaign had nothing to do with its recent stock decline. His firm, Greenlight Capital, currently holds 1.3 million shares, now worth nearly $609 million.

“We own more Apple today than we ever have before,” he said in a telephone interview. “We’re optimistic about the company’s prospects, and think too much bad news has been priced in.”

In a response, Apple said that it “welcomes” Mr. Einhorn’s views and added that its management and its board were actively discussing how to return more cash to shareholders.

But the spat underlines recent hand-wringing over Apple, whose stock has proved vulnerable in recent weeks. Over the decade that ended in late September, its share price soared an astounding 18,749 percent, to more than $700. Scores of hedge funds bought into the stock, riding its coat tails to bolster their own returns.

Since about Sept. 21, however, Apple’s stock price has tumbled almost 33 percent, closing on Thursday at $468.22. (Even so, its market capitalization stands at $439.7 billion, making Apple the most valuable public company in the world.)

As the shares have fallen, the volume of criticism has risen.

“Because the stock has sold off from its high, and because Apple’s earnings have declined for the first time in a decade, you’ll hear people become more vocal,” said Walter Piecyk Jr., an analyst at BTIG Research.

Since at least 2005, no shareholder has conducted a formal campaign against an Apple management proposal, according to the data provider FactSet.

Mr. Einhorn’s main concern is Apple’s cash hoard, which is bigger than Intel’s entire market value. Shareholders have long complained that the cash, invested in the likes of Treasury bonds, is increasingly a drag on the stock price and should either be invested in new opportunities for growth or returned to them.

Last spring, the company announced a plan to return $45 billion to shareholders over three years, in the form of share buybacks and a dividend for its common stock. But that will hardly make a dent in a cash pile that swelled by $117 million a day during its most recent quarter.

Mr. Einhorn on Thursday compared Apple to his grandmother, whose experience surviving the Great Depression molded her into an extreme saver who did not leave voice mail messages for fear of using extra cellphone minutes. The company’s own near-death experience in 1997, he said, left a similarly profound scar on its corporate psyche.

As an alternative, he has been proposing since last May what he calls a “win-win” for Apple and its investors. The company, he says, could issue $50 billion in preferred shares to existing shareholders, which would carry a roughly 4 percent annual dividend. Over time, Apple could issue more preferred stock and increase its overall payouts.

The idea, which Mr. Einhorn said had been discussed within his firm for some time, would reward shareholders while ensuring that Apple would spend that additional cash over time. He raised the idea with company executives, including Apple’s chief financial officer, Peter Oppenheimer, over several months, but was rebuffed.

Mr. Einhorn became more aggressive after seeing Apple’s proposal to eliminate so-called blank check preferred stock from its corporate charter. The move would prohibit it from issuing preferred stock without shareholder approval. To Mr. Einhorn, that would sharply limit options for “unlocking value.”

He was further irked by Apple’s tying the plan with two others that he said he would ordinarily support.

In its statement, Apple said that its proposal was actually aimed at making itself more responsive to investors. It added that the plan would not prevent the introduction of precisely the kind of initiative that Mr. Einhorn had discussed.

At least one major investor has sided with Apple. Calpers, the giant California public employee pension fund that is the company’s 43rd-biggest shareholder, said in a statement that the proposal “significantly strengthens share owner rights and deserves full support.”

For his part, Mr. Einhorn said he planned on trying to persuade other shareholders. And he has reconciled himself to Apple’s days of meteoric growth now lying in the past.

“It’s not going to grow 80 percent a year,” he said of the company, “but that doesn’t mean it’s going to go bankrupt.”

David Einhorn's Lawsuit Against Apple by

A version of this article appeared in print on 02/08/2013, on page B1 of the NewYork edition with the headline: Investor Sues Apple Over Plan For Stocks.

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The New Old Age Blog: The Executor's Assistant

I’m serving as executor for my father’s estate, a role few of us are prepared for until we’re playing it, so I was grateful when the mail brought “The American Bar Association Guide to Wills and Estates” — the fourth edition of a handbook the A.B.A. began publishing in 1995.

This is a legal universe, I’m learning, in which every step — even with a small, simple estate that owes no taxes and includes no real estate or trusts — turns out to be at least 30 percent more complicated than expected.

If my dad had been wealthy or owned a business, or if we faced a challenge to his will, I would have turned the whole matter over to an estate lawyer by now. But even then, it would be helpful to know what the lawyer was talking about. The A.B.A. guide would help.

Written with surprising clarity (hey, they’re lawyers), it maps out all kinds of questions and decisions to consider and explains the many ways to leave property to one’s heirs. Updated from the third edition in 2009, the guide not only talks taxes and trusts, but also offers counsel for same-sex couples and unconventional families.

If you want to permit your second husband to live in the family home until he dies, but then guarantee that the house reverts to the children of your first marriage, the guide tells you how a “life estate” works. It explains what is taxable and what isn’t, and discusses how to choose executors and trustees. It lists lots of resources and concludes with an estate-planning checklist.

In general, the A.B.A. intends its guide for the person trying to put his or her affairs in order, more than for family members trying to figure out how to proceed after someone has died. But many of us will play both these parts at some point (and if you are already an executor, or have been, please tell us how that has gone, and mention your state). We’ll need this information.

---

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

Read More..

The New Old Age Blog: The Executor's Assistant

I’m serving as executor for my father’s estate, a role few of us are prepared for until we’re playing it, so I was grateful when the mail brought “The American Bar Association Guide to Wills and Estates” — the fourth edition of a handbook the A.B.A. began publishing in 1995.

This is a legal universe, I’m learning, in which every step — even with a small, simple estate that owes no taxes and includes no real estate or trusts — turns out to be at least 30 percent more complicated than expected.

If my dad had been wealthy or owned a business, or if we faced a challenge to his will, I would have turned the whole matter over to an estate lawyer by now. But even then, it would be helpful to know what the lawyer was talking about. The A.B.A. guide would help.

Written with surprising clarity (hey, they’re lawyers), it maps out all kinds of questions and decisions to consider and explains the many ways to leave property to one’s heirs. Updated from the third edition in 2009, the guide not only talks taxes and trusts, but also offers counsel for same-sex couples and unconventional families.

If you want to permit your second husband to live in the family home until he dies, but then guarantee that the house reverts to the children of your first marriage, the guide tells you how a “life estate” works. It explains what is taxable and what isn’t, and discusses how to choose executors and trustees. It lists lots of resources and concludes with an estate-planning checklist.

In general, the A.B.A. intends its guide for the person trying to put his or her affairs in order, more than for family members trying to figure out how to proceed after someone has died. But many of us will play both these parts at some point (and if you are already an executor, or have been, please tell us how that has gone, and mention your state). We’ll need this information.

---

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

Read More..

Gadgetwise Blog: Q.& A.: Saving Space and Shows on a TiVo

I have a bunch of TV programs recorded on my TiVo that I don’t want to erase, but I’m running tight on drive space. Can I copy these shows elsewhere, like to a DVD?

If you have the TiVo Desktop software for your Windows PC or Mac and have your TiVo recorder connected to your home network, you should be able to transfer the recorded shows to your computer and burn them to DVDs there. Shows that have copy-protection built in will not transfer, however.

TiVo has instructions for transferring the files from a PC or Mac on its site. According to the company’s support documentation, PC owners should use the $70 Roxio Creator program and Mac users should get the $80 Roxio Toast Titanium software to transfer and burn recordings.

Depending on your home’s mix of hardware and software, you may be able to copy the shows to a disc with a connected DVD recorder or burn the shows to a DVD with other recording software. Wondershare’s $40 DVD Creator is one program that has its own online instructions (and a free trial version) for recording shows to disc and there are many others around the Web.

If the file-transfer and disc-burning process sounds too complicated, another way to make room for more shows on your TiVo recorder is to add an external drive that gives you more storage space. This approach only works with certain TiVo models, but you can find out more on TiVo’s approved method here. Companies like Weaknees sell upgrade kits for some TiVo models that can add more recording capacity as well.

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Horse Meat in Food Stirs Furor in British Isles

LONDON — Few things divide British eating habits from those of continental Europe as much as a distaste for consuming horse meat, so the news that many Britons may have unknowingly done so has prompted alarm among consumers and plunged the country’s food industry into crisis.

A trickle of discoveries of horse meat in burgers, first found in Ireland last month, has turned into a steady stream, culminating in the revelation that lasagna labeled beef from one frozen food big retailer, Findus, was in some cases 100 percent horse meat.

With concern growing, the Food Standards Agency ordered retailers to test all processed food, and large notices have been displayed in British supermarkets seeking to calm worried customers.  The scandal has raised new concerns about the standards applied by the meat processing industry, and fueled worries about what exactly has been going into cheaper burgers consumed in millions in British schools, hospitals and prisons.

Meat from horses is no more harmful than that from cattle, though there were some fears — as yet not substantiated by tests — that phenylbutazone, an equine drug, could find its way into the food chain.

But the labeling of horse meat as beef has breached one of the great culinary taboos of Britain, a country that prides itself on its love of certain animals, particularly horses.

The fact that the source of the meat appears to have been mainland Europe, where the consumption of horse meat is more common, has only increased the continental divide.

“It is completely unacceptable that a product which says it’s beef lasagna turns out to be mainly horse meat,” the environment secretary, Owen Paterson, said in a statement. “Consumers have a right to expect that food is exactly what it says on the label.”

He added, “The presence of unauthorized ingredients cannot be tolerated. This is especially true when those ingredients are likely to be unacceptable to consumers, or where there is any conceivable risk to human health.”

The latest episode came to light when Findus withdrew the beef lasagna products after Comigel, its French supplier, raised concerns about the type of meat used, while maintaining that food safety was not at risk. Some supermarkets have also removed products made by Comigel.

Earlier, Irish food inspectors revealed that some horse meat, which is cheaper than beef, had been found in some burgers stocked by a number of British supermarket chains, including Tesco, Iceland and Lidl. The meat was supplied by two plants in Ireland.

After millions of burgers were removed from supermarket shelves in Ireland and Britain, Poland was identified as the source of that horse meat.

The Irish agriculture minister, Simon Coveney, said he had instructed the police to join an inquiry conducted by his department’s special investigation unit after tests on Monday evening confirmed 75 percent equine DNA in a raw material ingredient at the Rangeland Foods processing plant in County Monaghan.

That was the fifth such instance at processing plants across Ireland over the last month. The latest discovery follows similar incidents last month in the Irish Republic and in Northern Ireland, where samples from other beef processing plants contained up to 80 percent horse DNA.

On Tuesday, the chief executive of the Food Safety Authority of Ireland, Alan Reilly, said fraud was behind the mislabeling of meat, which had been traced to Poland.

“We are no longer talking about trace amounts,” he told RTE, the national broadcaster. “We are talking about horse meat. Somebody, some place is drip-feeding horse meat into the burger manufacturing industry. We don’t know exactly where this is happening.”

A Grant Thornton report released last week before the announcement on Monday of the latest discovery expressed concern about the fallout from the horse meat fiasco.

“The recent issue with traces of imported horse DNA in beef burgers could translate into millions of euro lost for the industry,” it said. 

Stephen Castle reported from London and Douglas Dalby from Dublin, Ireland.

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European Central Bank Leaves Interest Rate Unchanged

FRANKFURT — The European Central Bank left its main interest rate unchanged at its current record low Thursday, as expected, amid signs that the euro zone economy could be crawling out of recession.

The E.C.B. left its main rate at 0.75 percent, where it has been since July. Recent surveys of business sentiment have raised expectations that the euro zone could be slowly recovering, although there is also concern that the rising value of the euro against the dollar could undercut the fragile gains.

Recent data have supported the E.C.B. view that the euro zone will emerge from recession later this year. New orders to German industry rose 0.8 percent in the fourth quarter of 2012.

But the recovery is threatened by the rising value of the common currency, which could hurt exports by making euro zone products more expensive for foreign buyers. In recent weeks, the euro has risen substantially against the dollar, to the highest levels in a year.

Few analysts had expected the E.C.B. to shift its monetary policy Thursday. Some predict that the benchmark rate could stay at its present level for an extended period as the euro zone slowly returns to growth.

“We expect interest rates to be on hold at 0.75 percent until 2017 and only significant changes in the economic environment would trigger a change one way or the other,” Marie Diron, senior economic adviser to the consulting firm Ernst & Young, said in an e-mail before the decision.

Although there was no change in rates, the E.C.B. news conference later Thursday afternoon could prove eventful. Mario Draghi, the E.C.B. president, is likely to face questions about whether the bank will respond to the appreciation of the euro, which was up again midday Thursday, to nearly $1.36. Back in July it was trading just above $1.21.

A stronger euro means that products ranging from cars to wine become more expensive abroad, putting European producers at a disadvantage to foreign competitors.

Analysts do not expect Mr. Draghi to take steps to devalue the euro, but he could remind his counterparts at other central banks outside the euro zone of their promise not to start a currency war. If the value of one currency goes up, another currency must come down, making exchange-rate manipulation by central banks a zero-sum game that economists believe is counterproductive.

Mr. Draghi is also likely to face numerous questions about problems at the Italian bank Monte dei Paschi di Siena, which has required a €3.9 billion bailout by the Italian government. Mr. Draghi was governor of the Bank of Italy, responsible for bank supervision, during the period when Monte dei Paschi was getting in trouble several years ago.

Mr. Draghi’s supporters have pointed out that there was a deliberate attempt by that bank’s previous management to conceal the extent of their losses, and that the Bank of Italy did not have the authority to prevent Monte dei Paschi managers from making foolish decisions. Part of the bank’s problems stem from its acquisition of regional bank Antonveneta in 2008 for €9 billion, a price considered much too high even at the time.

But at the very least, the case of Monte dei Paschi has illustrated the limits of bank supervision, and called into question whether the E.C.B. will be able to do a better job than national supervisors when it begins assuming supreme regulatory authority over banks in the course of this year.

The problems at Monti dei Paschi bank have also been exploited by Silvio Berlusconi, the former prime minister of Italy, as he attempts a comeback in elections at the end of this month. Mr. Berlusconi has run a populist campaign promising to undo some of the economic changes made by his successor, Mario Monti.

Italian politics aside, international investors are concerned about the new jitters the debacle could create in euro zone bond markets, which have calmed considerably lately.

“A government may well be formed on a platform that rejects some, if not most, of the Monti government’s fiscal reforms,” Carl Weinberg, chief economist at High Frequency Economics in Valhalla, New York, wrote in a note to clients Wednesday. “As uncertainty grows, the bond markets are becoming increasingly unsettled.”

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Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His blue eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

---

Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Read More..

Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His blue eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

---

Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Read More..

Gadgetwise Blog: This Robot Does Do Windows

The robots at this year’s Consumer Electronics Show fell largely into two categories: floor cleaners and toys. But there was an exception.

That was a robot taken to new heights – literally. It is the Winbot 7 Series from Ecovacs, and this robot does do windows.

The Winbot works much like any of the floor cleaning robots, only it works on vertical surfaces. Stick it outside on your window glass and it figures out the size of your window, then travels in a zigzag pattern to clean the surface.

The Winbot has to be plugged into an electrical outlet that feeds a powerful vacuum motor that keeps it stuck to the glass as it creeps around. There is a safety tether to keep the Winbot from bombing pedestrians below if it were to lose power. If the Winbot encounters a problem it sounds an alarm.

The Winbot has a damp cleaning pad on its leading edge that is followed by a squeegee and a drying pad in back. The reusable pads could require machine washing after a single large dirty window, but more typically the company said they needed a wash every few months.

The price of replacement parts and cleaning solution have not been yet determined. The Winbot becomes available in April at a list price of $200 for the 710 model that cleans framed windows, and $300 for the 730 model that cleans framed and frameless windows.

They will be available through the Ecovacs Web site.

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India Ink: Economic Growth in India to Fall to Five Percent

India’s Gross Domestic Product is expected to drop significantly to 5 percent for the fiscal year ending in March 2013, according to advance estimates released by India’s Central Statistics Office on Thursday, declining from 6.2 percent growth rate seen in 2011-2012.

The estimate by the Central Statistics Office represents a marked drop from earlier growth projections issued by the government for this year. In January, the central bank projected G.D.P. growth of 5.5 percent for the current fiscal year, a decline from an earlier estimate of 5.8 percent.

The provisional estimates are contingent upon the “anticipated level of agricultural and industrial production, analysis of budget estimates of government expenditure and performance of key sectors like, railways, transport other than railways, communication, banking and insurance, available so far,” the report said.

According to the preliminary data released on Thursday, national income registered a growth rate of 4.2 percent in the current fiscal year as compared to 6.1 percent in the previous year, and per capita income grew at a rate of 2.9 percent as compared to 4.7 percent growth last year. Meanwhile, capital investment in the country is expected to drop to 2.48 percent from 4.39 percent in the previous year.

Slow growth may be attributed to the sluggish performance of the manufacturing, agriculture and services sector. The manufacturing sector is expected to grow by 1.9 percent this year, while India’s farm sector is projected to grow at an estimated 1.8 percent.

The services sector saw a decline in its growth rate from previous years, expanding by 6.6 percent, the lowest in over a decade. Other sectors that are expected to have performed relatively poorly include electricity, gas & water supply (4.9 percent growth) and mining and quarrying (0.4 percent growth).

Sectors that have performed relatively well with a growth rate of over 5 percent are construction, the trade, hotels, transport and communication sector, the financing, insurance, real estate and business services sector, and the community, social and personal services sector.

As India prepares to for a national election in 2014, slowing economic growth is putting pressure on the current government to push for reform. The projection of 5 percent GDP growth is the lowest figure since 2002-2003 when the GDP grew at 4 percent, after which the Indian economy has grown at an average of 6 percent each year.

This year, the government has taken measures to rein in the fiscal deficit to 5.3 percent of  GDP, has raised the price of fertilizer and diesel, and has allowed further foreign investment in the retail sector by opening up the insurance, pension and aviation sectors for foreign investment. On Jan. 29, India’s central bank lowered its benchmark interest rate for the first time in nine months to fuel higher growth.

If India continues on the reform path, analysts believe that strong growth will resume in the coming year.

“The government’s advance estimates for real GDP growth at 4.9% is disappointing, especially coming on the back of a downward revision in growth for FY2012 from 6.5 percent to 6.2 percent,” said Ms. Bhupali Gursale, an economist at Angel Broking. “On a positive note though, with the government pushing ahead its reform agenda, the outlook for growth in FY2014 is likely to improve.”

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