Well: Getting the Right Addiction Treatment

“Treatment is not a prerequisite to surviving addiction.” This bold statement opens the treatment chapter in a helpful new book, “Now What? An Insider’s Guide to Addiction and Recovery,” by William Cope Moyers, a man who nonetheless needed “four intense treatment experiences over five years” before he broke free of alcohol and drugs.

As the son of Judith and Bill Moyers, successful parents who watched helplessly during a 15-year pursuit of oblivion through alcohol and drugs, William Moyers said his near-fatal battle with addiction demonstrates that this “illness of the mind, body and spirit” has no respect for status or opportunity.

“My parents raised me to become anything I wanted, but when it came to this chronic incurable illness, I couldn’t get on top of it by myself,” he said in an interview.

He finally emerged from his drug-induced nadir when he gave up “trying to do it my way” and instead listened to professional therapists and assumed responsibility for his behavior. For the last “18 years and four months, one day at a time,” he said, he has lived drug-free.

“Treatment is not the end, it’s the beginning,” he said. “My problem was not drinking or drugs. My problem was learning how to live life without drinking or drugs.”

Mr. Moyers acknowledges that treatment is not a magic bullet. Even after a monthlong stay at a highly reputable treatment center like Hazelden in Center City, Minn., where Mr. Moyers is a vice president of public affairs and community relations, the probability of remaining sober and clean a year later is only about 55 percent.

“Be wary of any program that claims a 100 percent success rate,” Mr. Moyers warned. “There is no such thing.”

“Treatment works to make recovery possible. But recovery is also possible without treatment,” Mr. Moyers said. “There’s no one-size-fits-all approach. What I needed and what worked for me isn’t necessarily what you or your loved one require.”

As with many smokers who must make multiple attempts to quit before finally overcoming an addiction to nicotine, people hooked on alcohol or drugs often must try and try again.

Nor does treatment have as good a chance at succeeding if it is forced upon a person who is not ready to recover. “Treatment does work, but only if the person wants it to,” Mr. Moyers said.

Routes to Success

For those who need a structured program, Mr. Moyers described what to consider to maximize the chances of overcoming addiction to alcohol or drugs.

Most important is to get a thorough assessment before deciding where to go for help. Do you or your loved one meet the criteria for substance dependence? Are there “co-occurring mental illnesses, traumatic or physical disabilities, socioeconomic influences, cultural issues, or family dynamics” that may be complicating the addiction and that can sabotage treatment success?

While most reputable treatment centers do a full assessment before admitting someone, it is important to know if the center or clinic provides the services of professionals who can address any underlying issues revealed by the assessment. For example, if needed, is a psychiatrist or other medical doctor available who could provide therapy and prescribe medication?

Is there a social worker on staff to address challenging family, occupational or other living problems? If a recovering addict goes home to the same problems that precipitated the dependence on alcohol or drugs, the chances of remaining sober or drug-free are greatly reduced.

Is there a program for family members who can participate with the addict in learning the essentials of recovery and how to prepare for the return home once treatment ends?

Finally, does the program offer aftercare and follow-up services? Addiction is now recognized to be a chronic illness that lurks indefinitely within an addict in recovery. As with other chronic ailments, like diabetes or hypertension, lasting control requires hard work and diligence. One slip need not result in a return to abuse, and a good program will help addicts who have completed treatment cope effectively with future challenges to their recovery.

How Families Can Help

“Addiction is a family illness,” Mr. Moyers wrote. Families suffer when someone they love descends into the purgatory of addiction. But contrary to the belief that families should cut off contact with addicts and allow them to reach “rock-bottom” before they can begin recovery, Mr. Moyers said that the bottom is sometimes death.

“It is a dangerous, though popular, misconception that a sick addict can only quit using and start to get well when he ‘hits bottom,’ that is, reaches a point at which he is desperate enough to willingly accept help,” Mr. Moyers wrote.

Rather, he urged families to remain engaged, to keep open the lines of communication and regularly remind the addict of their love and willingness to help if and when help is wanted. But, he added, families must also set firm boundaries — no money, no car, nothing that can be quickly converted into the substance of abuse.

Whether or not the addict ever gets well, Mr. Moyers said, “families have to take care of themselves. They can’t let the addict walk over their lives.”

Sometimes families or friends of an addict decide to do an intervention, confronting the addict with what they see happening and urging the person to seek help, often providing possible therapeutic contacts.

“An intervention can be the key that interrupts the process and enables the addict to recognize the extent of their illness and the need to take responsibility for their behavior,”Mr. Moyers said.

But for an intervention to work, Mr. Moyers said, “the sick person should not be belittled or demeaned.” He also cautioned families to “avoid threats.” He noted that the mind of “the desperate, fearful addict” is subsumed by drugs and alcohol that strip it of logic, empathy and understanding. It “can’t process your threat any better than it can a tearful, emotional plea.”

Resource Network

Mr. Moyer’s book lists nearly two dozen sources of help for addicts and their families. Among them:

Alcoholics Anonymous World Services www.aa.org;

Narcotics Anonymous World Services www.na.org;

Substance Abuse and Mental Health Services Administration treatment finder www.samhsa.gov/treatment/;

Al-Anon Family Groups www.Al-anon.alateen.org;

Nar-Anon Family Groups www.nar-anon.org;

Co-Dependents Anonymous World Fellowship www.coda.org.

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This is the second of two articles on addiction treatment. The first can be found here.

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Gadgetwise Blog: Q.& A.: Checking a PC's Graphics Card

How can I tell how much memory I have for graphics and video on my Windows 7 PC?

You can check out the video card your computer uses by going to the Start menu to Control Panel, selecting Appearance and Personalization and clicking on “Adjust screen resolution.” If you want a quicker way to get the same Control Panel, just right-click on the Windows desktop and select Screen Resolution.

Once you land in the Screen Resolution box, click the link for Advanced Settings. When the Advanced Settings box appears, click the Adapter tab to see more information about your computer’s video card, including the make, model and the amount of available memory it has.

Some desktop computers — especially those designed for gaming and other video-intensive activities — may have a dedicated or “discrete” video card installed inside the machine. Laptops and more modest desktop machines tend to use integrated graphics processors built into the computer’s motherboard that typically share some of the overall system memory.

Upgrading a laptop’s graphics card is difficult (if not impossible) depending on the model and the motherboard, but many desktop computers can be upgraded. Microsoft has a guide to upgrading a graphics card in a Windows 7 computer that outlines the process.

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Letter From Europe: France Takes a Step Back in Its History

PARIS — Many years ago in Ouagadougou, the dusty capital of Burkina Faso, a visiting couple from France ordered dinner in a French-owned restaurant called Le Safari whose offerings included dishes listed as “selon arrivage,” loosely translated as “depending on availability.”

The overhead thunder of a French airliner on final approach to landing offered a more telling definition.

“Not long now,” the owner told the impatient couple. And, as promised, a rickety moped driven by a man in robes arrived from the airport within minutes, bearing chilled oysters to landlocked northwest Africa, fresh from distant Paris.

The episode seemed to say something about the umbilical cord binding France and its former colonies, like Burkina Faso, in a hard-nosed relationship designed to anchor French ways and to secure French benefits in commerce, diplomacy and influence going far beyond a plate of fines de claire.

But the relationship always had its darker, more muscular side. A year before the dinner at Le Safari, in another West African nation, 1,000 French soldiers had deployed to resist a southward advance by Libyan troops in Chad, intent on blocking what was depicted as a vision of Islamic expansionism sponsored by the former Libyan leader, Col. Muammar el-Qaddafi.

Almost 30 years later, the echoes of that moment — and many others like it — resonate through the fighting in Mali, whose desert north has become a crucible of Islamic fervor where French troops now risk being drawn into a protracted campaign to cement at least a semblance of government control.

And, much as President François Hollande of France denies that his country is still the gendarme of francophone Africa, the columns of French soldiers and planeloads of paratroops embroiled in the newest fighting recall much earlier campaigns.

“There was a time when General Faidherbe pursued armed bands attacking the forts of the Sahel, and even then they professed radical Islam,” Bertrand Badie, a political science scholar in Paris, wrote in Le Monde, referring to Gen. Louis Faidherbe, who played a central role in solidifying French interests in the broad swath of desert known as the Sahel in the 19th century. “What have we done since then?”

For many years, French military intervention in Africa functioned as the guardian of French economic interests and of the large expatriate French communities who benefited from them in cities like Libreville in Gabon and Abidjan in Ivory Coast. French troops defined the longevity of protégé African leaders. The French presence was a postcolonial bulwark, too, against British influence in southern and eastern Africa.

When Graham Greene crossed the border between Liberia and what was then the French colony of Guinea in the 1930s, as he recounted in his “Journey Without Maps,” the Liberians did not call their neighbor “Guinea” but “France,” so pervasive was French colonial influence.

But French Socialists, including Mr. Hollande, have long professed unease with the role of post-imperial puppet-masters.

As recently as December, when rebel forces advanced on Bangui, the capital of the Central African Republic, France dispatched 600 soldiers there. “If we’re present, it is not in order to protect a regime,” Mr. Hollande declared. “It’s to protect our citizens and our interests and in no way to intervene in the internal affairs of a country.”

The era of interference, he said, “is over with.”

A few days later, his words might have seemed somewhat premature when French warplanes halted a lightning southward advance by Islamist extremists in northern Mali. Paris deployed 4,000 soldiers for a ground campaign to recapture the insurgents’ northern redoubts.

After the quagmire of Afghanistan, welcome to the shifting sands of Sahelistan.

Mr. Hollande, indeed, had already cast the jihadi presence in northern Mali not in terms of a challenge to Francafrique, as the pervasive French presence in its former African colonies is known, but in the global terms of an international struggle against terrorism. “We face a threat that concerns the entire world,” Mr. Hollande told the United Nations in September.

That assessment, said Patrick Smith, the editor of a London-based newsletter, Africa Confidential, has spread a “geopolitical patina” over the “very, very local” mistakes and miscalculations in Mali and elsewhere.

Indeed, as France seeks an exit strategy based on handing over the fight to Malian and West African troops, “the next part of the war is going to be much more complicated,” Mr. Smith said in an interview.

Many years ago, when the French Foreign Legion had been drawn into an easy contest against rebels in what was called Zaire, a French diplomat in the capital, Kinshasa, concluded that “in Africa, there are never big battles.”

The official may have been making comparisons with cataclysms woven into French history, like the Somme during World War I, or Dien Bien Phu in Vietnam. But, if Mr. Hollande is borne out in his analysis of the jihadi menace, Sahelistan might just put the diplomat’s adage to a critical test.

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For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness

When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice.

“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

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IHT Rendezvous: Meditations on the F1 Season to Come - and on 20 Seasons Run

PARIS — The 2013 Formula One season has not really begun. The first race takes place on March 17 in Melbourne. But with the launches of the new cars and the first four days of test sessions ending on Friday, the seeds have been planted. What kind of plant is not easy to figure out.

I have been observing from the sidelines for a couple of weeks, watching the fanfare of the car launches —or rather, the lack of fanfare — and watching the lap-by-lap action on the track in Jerez, Spain. And I have, every day, kept throwing around ideas in my head and saying: So what’s the conclusion? What’s to say? The cars, most of them, are merely the technical evolutions of last year’s cars.

They all look fairly similar — although some, thank goodness, have smoothed out that ugly nose problem of last season — and there is a good reason for it: There is very little change in the technical regulations from last season. The big changes will all occur next year, especially with the change in the engine specification. So what is there to say about these cars?

Had to wait to see them on the track. Now, it is common knowledge within Formula One and to most fans that the first winter test sessions of the new cars reveal and mean very little. The engineers are not forced into running their cars to racing specifications, and they can test parts that would be deemed illegal in a race. They can run on low fuel to get great results to attract sponsors, or they can sandbag — run heavy with lots of fuel and ballast — to hide how fast their cars are to the competition.

That said, the tests often do give an idea of who is strong, and who is not. Last year, Ferrari was clearly off the pace — by 1.6 seconds, no less — and that weighed on the whole season for the Italian team. The Lotus was fast, though, and that showed early in the season too. So what about the last four days?

None of it seemed to make sense: Jenson Button started the first session as the fastest car in the McLaren Mercedes, setting his fastest time on the hard tires, which begged the question: “What could he do on the faster soft tires????”

Felipe Massa, days later, when he was the fastest car of the day, in a Ferrari, still moaned about the speed of Button’s lap, even though it was slower than his. But it all had to do with tires and track conditions. Then there was the Lotus, with Romain Grosjean setting a fastest lap, and then Kimi Raikkonen doing the same. And there were the amazingly fast laps of the new Toro Rosso car and the Force India.

And there was Lewis Hamilton’s first test as part of the Mercedes team. (Many people criticized him for changing teams while he was secure in his seat at McLaren.) Hamilton ended up running off the track with broken brakes after his first few lap. But he came back strongly and left the session on Friday smiling.

It was after taking all of this action in that I finally realized that there was a take-away, despite the story seeming to change ever day. And that was it: the story this coming season may well change from one race to another, one session to another, as it had for the first part of last season.

The cars are currently so close together — except for the ones like the Marussia and the Caterham, the smaller teams — that there could be a lot of shifting around of the powers that be.

If this be the case, we’re in for another great and interesting season. On the other hand, this was just the first winter test session, and we have two more to go, starting with the one in Barcelona on Feb. 19.

Oh, and another thing that left me asking myself metaphysical and existential questions in the last few days is that this whole first test session week happened at a time when a very little talked about, but significant thing happened in American journalism regarding Formula One.

I’m talking about an 8,152-word article in the Feb. 4th issue of the The New Yorker all about Formula One. “The Art of Speed; Bringing Formula One to America,” by Ben McGrath, is a well-written and entertaining, but surface-scratching story introducing Formula One to America.

I thoroughly enjoyed it, and felt really stimulated seeing the great New Yorker magazine, a high-brow literary colossus of American journalism, giving this much space and interest to the sport I have been covering for so many years for the International Herald Tribune and The New York Times. One of the things that intrigued me was that unlike, for instance, The Economist, or other major publications that don’t usually write about the sport, when they do they blast it for some scandal or another, the New Yorker story read like a beginner’s guide to F1.

It was, as the title suggested, an introduction to America of this series that has never pierced the American consciousness the way other forms of auto racing — like Nascar — have, probably simply because there are no American heroes involved in it today.

On the other hand, like the season testing, it also left me wondering just how often Formula One has to be introduced to America after a history that goes back more than 60 years, and two Formula One world champion American drivers, one of whom is named Mario Andretti.

Well, with a New Yorker magazine anointment, I’d say that’s a pretty big step right there.

Of course, this idea of how many times F1 has to be re-introduced to America also reminded me suddenly that 2013 marks the 20th anniversary of my own beginning covering the sport for the International Herald Tribune, when I published my first ever story in the paper on the series: Grand Prix Racing: 1993 Is Shaping Up Great Despite FISA

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John E. Karlin, 1918-2013: John E. Karlin, Who Led the Way to All-Digit Dialing, Dies at 94

Courtesy of Alcatel-Lucent USA

John E. Karlin, a researcher at Bell Labs, studied ways to make the telephone easier to use.

A generation ago, when the poetry of PEnnsylvania and BUtterfield was about to give way to telephone numbers in unpoetic strings, a critical question arose: Would people be able to remember all seven digits long enough to dial them?

And when, not long afterward, the dial gave way to push buttons, new questions arose: round buttons, or square? How big should they be? Most crucially, how should they be arrayed? In a circle? A rectangle? An arc?

For decades after World War II, these questions were studied by a group of social scientists and engineers in New Jersey led by one man, a Bell Labs industrial psychologist named John E. Karlin.

By all accounts a modest man despite his variegated accomplishments (he had a doctorate in mathematical psychology, was trained in electrical engineering and had been a professional violinist), Mr. Karlin, who died on Jan. 28, at 94, was virtually unknown to the general public.

But his research, along with that of his subordinates, quietly yet emphatically defined the experience of using the telephone in the mid-20th century and afterward, from ushering in all-digit dialing to casting the shape of the keypad on touch-tone phones. And that keypad, in turn, would inform the design of a spate of other everyday objects.

It is not so much that Mr. Karlin trained midcentury Americans how to use the telephone. It is, rather, that by studying the psychological capabilities and limitations of ordinary people, he trained the telephone, then a rapidly proliferating but still fairly novel technology, to assume optimal form for use by midcentury Americans.

“He was the one who introduced the notion that behavioral sciences could answer some questions about telephone design,” Ed Israelski, an engineer who worked under Mr. Karlin at Bell Labs in the 1970s, said in a telephone interview on Wednesday.

In 2013, the 50th anniversary of the introduction of the touch-tone phone, the answers to those questions remain palpable at the press of a button. The rectangular design of the keypad, the shape of its buttons and the position of the numbers — with “1-2-3” on the top row instead of the bottom, as on a calculator — all sprang from empirical research conducted or overseen by Mr. Karlin.

The legacy of that research now extends far beyond the telephone: the keypad design Mr. Karlin shepherded into being has become the international standard on objects as diverse as A.T.M.’s, gas pumps, door locks, vending machines and medical equipment.

Mr. Karlin, associated from 1945 until his retirement in 1977 with Bell Labs, headquartered in Murray Hill, N.J., was widely considered the father of human-factors engineering in American industry.

A branch of industrial psychology that combines experimentation, engineering and product design, human-factors engineering is concerned with easing the awkward, often ill-considered marriage between man and machine. In seeking to design and improve technology based on what its users are mentally capable of, the discipline is the cognitive counterpart of ergonomics.

“Human-factors studies are different from market research and other kinds of studies in that we observe people’s behavior and record it, systematically and without bias,” Mr. Israelski said. “The hallmark of human-factors studies is they involve the actual observation of people doing things.”

Among the issues Mr. Karlin examined as the head of Bell Labs’ Human Factors Engineering department — the first department of its kind at an American company — were the optimal length for a phone cord (a study that involved gentle, successful sabotage) and the means by which rotary calls could be made efficiently after the numbers were moved from inside the finger holes, where they had nestled companionably for years, to the rim outside the dial.

John Elias Karlin was born in Johannesburg on Feb. 28, 1918, and reared nearby in Germiston, where his parents owned a grocery store and tearoom.

He earned a bachelor’s degree in philosophy, psychology and music, and a master’s degree in psychology, both from the University of Cape Town. Throughout his studies he was a violinist in the Cape Town Symphony Orchestra and the Cape Town String Quartet.

Moving to the United States, Mr. Karlin earned a Ph.D. from the University of Chicago in 1942. Afterward, he became a research associate at Harvard; he also studied electrical engineering there and at the Massachusetts Institute of Technology.

At Harvard, Mr. Karlin did research for the United States military on problems in psychoacoustics that were vital to the war effort — studying the ways, for instance, in which a bomber’s engine noise might distract its crew from their duties.

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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John E. Karlin, 1918-2013: John E. Karlin, Who Led the Way to All-Digit Dialing, Dies at 94

Courtesy of Alcatel-Lucent USA

John E. Karlin, a researcher at Bell Labs, studied ways to make the telephone easier to use.

A generation ago, when the poetry of PEnnsylvania and BUtterfield was about to give way to telephone numbers in unpoetic strings, a critical question arose: Would people be able to remember all seven digits long enough to dial them?

And when, not long afterward, the dial gave way to push buttons, new questions arose: round buttons, or square? How big should they be? Most crucially, how should they be arrayed? In a circle? A rectangle? An arc?

For decades after World War II, these questions were studied by a group of social scientists and engineers in New Jersey led by one man, a Bell Labs industrial psychologist named John E. Karlin.

By all accounts a modest man despite his variegated accomplishments (he had a doctorate in mathematical psychology, was trained in electrical engineering and had been a professional violinist), Mr. Karlin, who died on Jan. 28, at 94, was virtually unknown to the general public.

But his research, along with that of his subordinates, quietly yet emphatically defined the experience of using the telephone in the mid-20th century and afterward, from ushering in all-digit dialing to casting the shape of the keypad on touch-tone phones. And that keypad, in turn, would inform the design of a spate of other everyday objects.

It is not so much that Mr. Karlin trained midcentury Americans how to use the telephone. It is, rather, that by studying the psychological capabilities and limitations of ordinary people, he trained the telephone, then a rapidly proliferating but still fairly novel technology, to assume optimal form for use by midcentury Americans.

“He was the one who introduced the notion that behavioral sciences could answer some questions about telephone design,” Ed Israelski, an engineer who worked under Mr. Karlin at Bell Labs in the 1970s, said in a telephone interview on Wednesday.

In 2013, the 50th anniversary of the introduction of the touch-tone phone, the answers to those questions remain palpable at the press of a button. The rectangular design of the keypad, the shape of its buttons and the position of the numbers — with “1-2-3” on the top row instead of the bottom, as on a calculator — all sprang from empirical research conducted or overseen by Mr. Karlin.

The legacy of that research now extends far beyond the telephone: the keypad design Mr. Karlin shepherded into being has become the international standard on objects as diverse as A.T.M.’s, gas pumps, door locks, vending machines and medical equipment.

Mr. Karlin, associated from 1945 until his retirement in 1977 with Bell Labs, headquartered in Murray Hill, N.J., was widely considered the father of human-factors engineering in American industry.

A branch of industrial psychology that combines experimentation, engineering and product design, human-factors engineering is concerned with easing the awkward, often ill-considered marriage between man and machine. In seeking to design and improve technology based on what its users are mentally capable of, the discipline is the cognitive counterpart of ergonomics.

“Human-factors studies are different from market research and other kinds of studies in that we observe people’s behavior and record it, systematically and without bias,” Mr. Israelski said. “The hallmark of human-factors studies is they involve the actual observation of people doing things.”

Among the issues Mr. Karlin examined as the head of Bell Labs’ Human Factors Engineering department — the first department of its kind at an American company — were the optimal length for a phone cord (a study that involved gentle, successful sabotage) and the means by which rotary calls could be made efficiently after the numbers were moved from inside the finger holes, where they had nestled companionably for years, to the rim outside the dial.

John Elias Karlin was born in Johannesburg on Feb. 28, 1918, and reared nearby in Germiston, where his parents owned a grocery store and tearoom.

He earned a bachelor’s degree in philosophy, psychology and music, and a master’s degree in psychology, both from the University of Cape Town. Throughout his studies he was a violinist in the Cape Town Symphony Orchestra and the Cape Town String Quartet.

Moving to the United States, Mr. Karlin earned a Ph.D. from the University of Chicago in 1942. Afterward, he became a research associate at Harvard; he also studied electrical engineering there and at the Massachusetts Institute of Technology.

At Harvard, Mr. Karlin did research for the United States military on problems in psychoacoustics that were vital to the war effort — studying the ways, for instance, in which a bomber’s engine noise might distract its crew from their duties.

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Berlusconi Remains the Wild Card in Italy Race

ROME — One candidate promised to drop an unpopular new property tax and refund all prior payments in cash. Another called that proposal a “poisoned meatball,” disconnected from reality. A third suggested that Al Qaeda blow up the Italian Parliament — then backtracked — and the man generally considered the front-runner is campaigning on vague promises of stability, so has often been ignored.

With only two weeks to go before national elections, the Italian campaign has become a surreal spectacle in which a candidate many had given up for dead, former Prime Minister Silvio Berlusconi, has surged. Although he is not expected ever to govern again, with his media savvy and pie-in-the-sky offers of tax refunds, Mr. Berlusconi now trails the front-runner, Pierluigi Bersani, the leader of the Democratic Party, by about five or six points, according to a range of opinion polls published on Friday.

The polls found that the former comedian Beppe Grillo, who made the Qaeda quip as part of his antipolitical campaign, is close behind in third place, while the caretaker prime minister, Mario Monti, who made the “poisoned meatball” remark as he stepped up attacks on Mr. Berlusconi in an awkward transition from technocrat to candidate, is taking up the rear with around 10 percent to 15 percent of the vote.

Most analysts predict that the center-left will win, but with not enough votes to govern without forming an alliance with Mr. Monti’s centrists. Yet in a complex political landscape — and with significant policy differences between Mr. Monti and Mr. Bersani, who have been criticizing each other in their campaigns — nothing is a given, and the political uncertainty weighs on financial markets.

Some compare the election to a power struggle on a corporate board. “Mr. Berlusconi knows he can’t govern, but wants a strong seat at the table,” said Marco Damilano, a political reporter for L’Espresso, a weekly. The Democratic Party will have the majority of seats but will not be able to govern without making accords, he said, adding that “Monti wants the golden share,” in which his few seats count for a lot.

Many outsiders marvel at the survival skills of Mr. Berlusconi, who dragged down Italy’s finances and international standing to the point that Mr. Monti was brought on in November 2011 to lead an emergency technocratic government that lasted a year. But at least a good part of Mr. Berlusconi’s success has to do with his competition.

Mr. Monti lacks a strong party and has hit Italians with unpopular taxes, and centrists who might lean left are concerned that Mr. Bersani would be weak on the flagging economy. On top of that, Mr. Berlusconi, whose center-right People of Liberty is more a charismatic movement than a party, has true loyalists who do not know where else to turn.

“Berlusconi is politically dead, but his electorate is still there and it is looking for a new leader, and there isn’t one,” said Massimo Franco, a political columnist for the daily newspaper Corriere della Sera. “So it’s a sort of a nostalgic operation.”

In an auditorium near the Vatican, Mr. Berlusconi was greeted Thursday by rows of adoring fans, most of them retirees. “Ah,” he said. “It reminds me of the good old days.” Joking about his age, the 76-year-old former premier added: “I looked at myself in the mirror and saw someone who didn’t look like me. They don’t make mirrors the way they used to.”

In a two-hour off-the-cuff speech, he returned to familiar themes: depicting the left as unreconstructed, cold-war Communists; magistrates as politically motivated; the euro and Chancellor Angela Merkel of Germany as harming Italy; and Mr. Monti as a leader beholden to foreign interests who did nothing but raise taxes.

His supporters were mostly buying it. “Even if he doesn’t refund us the property tax, at least he’ll take it away,” said Francesca Cipriani, 70, a retiree, as she cheered Mr. Berlusconi.

“My house is worth 20 percent less,” Nicola Manichelli, 75, a retired taxi driver, chimed in.

Marcello Sorgi, a columnist for the Turin daily newspaper La Stampa, said: “Berlusconi voters fear that Monti will raise taxes, and that under Berlusconi that won’t happen. It’s not at all true, but Berlusconi’s propaganda works with his electorate.”

“His electorate still has a messianic, religious rapport with him,” Mr. Sorgi added.“Berlusconi is considered a kind of guru.”

Not so with Mr. Monti, who is beloved in Brussels, Berlin and Washington, but has been less popular with Italian voters. As he learns to campaign, Mr. Monti, an economist with no previous political experience, has sought the services of the political consulting firm AKPD Message and Media, whose co-founder, David Axelrod, President Obama’s key political strategist, visited Mr. Monti in Rome last month.

Mr. Monti, who is trying to capture the civic-minded centrists from both right and left who once voted for the centrist Christian Democrats before the party disbanded in a corruption scandal in the early 1990s, also opened a Facebook page. He uses it to post folksy musings that some critics say are undermining the authority of the slyly ironic but hardly showmanlike candidate instead of humanizing him.

Last week, an interviewer presented Mr. Monti with a puppy on live television, days after Mr. Berlusconi had appeared with one. “This is a mean blackmail,” Mr. Monti said with a smile, before stroking the fluffy pet and saying, “Feel how soft it is.”

Mr. Bersani, a longtime party veteran and former economic growth minister, speaks more to the old guard of the Italian left. He defeated Matteo Renzi, the charismatic 38-year-old mayor of Florence, in a rare party primary and has been running on the slogan “A Just Italy,” a message aimed at reassuring voters but which may not inspire them.

In a half-hour speech on Thursday to party loyalists, including municipal workers and frustrated university adjunct teachers, Mr. Bersani called attention to youth unemployment and the disconnect between the real economy and financial markets, and called for economic stimulation to help more people have steady jobs. “Europe isn’t just the fiscal compact,” he said.

Both Mr. Berlusconi and Mr. Bersani appear to speak more to their own constituencies than to the nation as a whole, long a characteristic of Italian politics. Faced with a political class that seems stuck in the past, Mr. Grillo and his antipolitical Five Star Movement have been gaining ground in the polls, campaigning in piazzas across Italy.

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