IHT Rendezvous: Environmental Warning Fatigue Sets in

Record levels of industrial smog? A dwindling number of fish in the world’s oceans? A 4° Celsius warming in global temperatures by the end of the century?

How about environmental warning fatigue?

Global concern for major environmental issues is at an all time low, according to the results of a global poll of more than 22,000 people in 22 countries, released earlier this week.

“Scientists report that evidence of environmental damage is stronger than ever — but our data shows that economic crisis and a lack of political leadership mean that the public are starting to tune out,” said Doug Miller, the chairman of GlobeScan, the company that carried out the study.

While respondents clearly still had grave environmental concerns, fewer people were “very concerned” about various environmental issues than at any point in the last 20 years. The sharpest decrease in global concern occurred over the last two years.

The issue of climate change, which 49 percent of respondents rated last year as “very serious” was the only exception to the general trend. Pollsters found that there was less concern between 1998 and 2003 than today.

Shortages of fresh water and water pollution were the highest global concern, with 58 percent of the respondents marking it as “very serious.”

Respondents were asked to rate seven different environmental issues – from climate change to loss of biodiversity – as being either a “very serious problem,” “somewhat serious problem,” “not very serious problem” or “not a serious problem at all.”

The latest numbers were gathered last summer in telephone and face-to-face interviews with participants in Australia, Brazil, Canada, China, France, Germany, India, Indonesia, Japan, Kenya, Malaysia, Mexico, Nigeria, Pakistan, Panama, Peru, Poland, South Korea, Spain, Turkey, the United Kingdom and the United States.

Join our sustainability conversation. Do you take the environmental issues more seriously now than in the past? Do you find yourself tuning out?

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Jennifer Sultan Pleads Guilty to Selling Prescription Drugs

At the height of dot-com mania 13 years ago, Jennifer Sultan and a few colleagues sold their small technology company for $70 million in stock and cash. She and her boyfriend rented a large house in the Hamptons for the summer and bought a spacious loft near Union Square.

John Marshall Mantel for The New York Times

Jennifer Sultan faced 15 years to life on the top charge against her, and a potential for more prison time on other counts.

In the years since, that temporary flush of wealth evaporated and Ms. Sultan, 38, developed an addiction to prescription painkillers.

On Friday, she sat handcuffed in a courtroom at State Supreme Court in Manhattan. In exchange for a promise of a four-year prison sentence, she pleaded guilty to selling prescription painkillers and conspiring to sell a firearm.

She was arrested last July and accused of being part of a ring that sold prescription drugs and guns. Four others arrested with Ms. Sultan had already pleaded guilty. One, Nicholas Mina, a former New York City police officer, agreed to serve more than 15 years in prison as part of a plea bargain under which he admitted stealing guns from his colleagues’ precinct house lockers and selling them. Mr. Mina was also addicted to prescription painkillers.

Though Ms. Sultan’s lawyer said she had hoped for less than four years, she faced 15 years to life in prison on the top count against her and the potential for more prison time on other charges. She said little in court but smiled broadly several times as she spoke quietly with her lawyer, Frank Rothman.

“She was happy to be done with it, but she was not happy with the sentence,” Mr. Rothman said afterward.

Ms. Sultan grew up in West Long Branch, N.J., five miles north of Asbury Park, and graduated from New York University in 1996. She and her boyfriend at the time, Adam Cohen, worked at a company, Live Online, that was an early pioneer in live streaming events on the Internet.

After the sale of Live Online, efforts by Ms. Sultan and Mr. Cohen to start other technology companies failed. Ms. Sultan explored other interests, including acupuncture and holistic health.

Early last year, a city narcotics investigator discovered an advertisement Ms. Sultan had placed on Craigslist offering prescription painkillers for sale. She and Mr. Cohen were still living in the penthouse loft near Union Square that they bought after the sale of Live Online.

Five times from February through June, she sold pills to an undercover officer, according to her indictment. One sale took place at the Starbucks on Union Square. In another, she sold 183 oxycodone tablets to the officer for $4,400 at a Starbucks in the Flatiron district near the school where she was studying acupuncture.

A separate investigation into the ring that sold stolen guns and pain medication picked up Ms. Sultan sending a text message to the man accused of being the ringleader, Ivan Chavez, saying she wanted to sell him a .357 Magnum handgun for $850, according to a separate indictment obtained by the Manhattan district attorney.

Mr. Chavez was sentenced to 20 years in prison.

Ms. Sultan and Mr. Cohen, who was not accused of participating in the drug and guns ring, filed for bankruptcy in 2010. Last August, the bankruptcy judge ordered them to vacate the loft to allow a bankruptcy trustee to sell it. The 5,600-square-foot loft is still listed for sale at just under $6 million.

She has been incarcerated since her arrest in July because she was unable to raise $85,000 for bail. With credit for good behavior and time served since her arrest, Ms. Sultan could be released from prison in about two years.

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U.S. Judges Offer Addicts a Way to Avoid Prison

Todd Heisler/The New York Times

Emily Leitch of Brooklyn, with her son, Nazir, 4, was arrested for importing cocaine but went to “drug court” to avoid prison.

Federal judges around the country are teaming up with prosecutors to create special treatment programs for drug-addicted defendants who would otherwise face significant prison time, an effort intended to sidestep drug laws widely seen as inflexible and overly punitive.

The Justice Department has tentatively embraced the new approach, allowing United States attorneys to reduce or even dismiss charges in some drug cases.

The effort follows decades of success for “drug courts” at the state level, which legal experts have long cited as a less expensive and more effective alternative to prison for dealing with many low-level repeat offenders.

But it is striking that the model is spreading at the federal level, where judges have increasingly pushed back against rules that restrict their ability to make their own determination of appropriate sentences.

So far, federal judges have instituted programs in California, Connecticut, Illinois, New Hampshire, New York, South Carolina, Virginia and Washington. About 400 defendants have been involved nationwide.

In Federal District Court in Brooklyn on Thursday, Judge John Gleeson issued an opinion praising the new approach as a way to address swelling prison costs and disproportionate sentences for drug trafficking.

“Presentence programs like ours and those in other districts mean that a growing number of courts are no longer reflexively sentencing federal defendants who do not belong in prison to the costly prison terms recommended by the sentencing guidelines,” Judge Gleeson wrote.

The opinion came a year after Judge Gleeson, with the federal agency known as Pretrial Services, started a program that made achieving sobriety an incentive for drug-addicted defendants to avoid prison. The program had its first graduate this year: Emily Leitch, a Brooklyn woman with a long history of substance abuse who was arrested entering the country at Kennedy International Airport with over 13 kilograms of cocaine, about 30 pounds, in her luggage.

“I want to thank the federal government for giving me a chance,” Ms. Leitch said. “I always wanted to stand up as a sober person.”

The new approach is being prompted in part by the Obama administration, which previously supported legislation that scaled back sentences for crimes involving crack cocaine. The Justice Department has supported additional changes to the federal sentencing guidelines to permit the use of drug or mental health treatment as an alternative to incarceration for certain low-level offenders and changed its own policies to make those options more available.

“We recognize that imprisonment alone is not a complete strategy for reducing crime,” James M. Cole, the deputy attorney general, said in a statement. “Drug courts, re-entry courts and other related programs along with enforcement are all part of the solution.”

For nearly 30 years, the United States Sentencing Commission has established guidelines for sentencing, a role it was given in 1984 after studies found that federal judges were giving defendants widely varying sentences for similar crimes. The commission’s recommendations are approved by Congress, causing judges to bristle at what they consider interference with their judicial independence.

“When you impose a sentence that you believe is unjust, it is a very difficult thing to do,” Stefan R. Underhill, a federal judge in Connecticut, said in an interview. “It feels wrong.”

The development of drug courts may meet resistance from some Republicans in Congress.

“It is important that courts give deference to Congressional authority over sentencing,” Representative F. James Sensenbrenner Jr., Republican of Wisconsin, a member and former chairman of the Judiciary Committee, said in a statement. He said sentencing should not depend “on what judge happens to decide the case or what judicial circuit the defendant happens to be in.”

At the state level, pretrial drug courts have benefited from bipartisan support, with liberals supporting the programs as more focused on rehabilitation, and conservatives supporting them as a way to cut spending.

Under the model being used in state and federal courts, defendants must accept responsibility for their crimes and agree to receive drug treatment and other social services and attend regular meetings with judges who monitor their progress. In return for successful participation, they receive a reduced sentence or no jail time at all. If they fail, they are sent to prison.

The drug court option is not available to those facing more serious charges, like people accused of being high-level dealers or traffickers, or accused of a violent crime. (These programs differ from re-entry drug courts, which federal judges have long used to help offenders integrate into society after prison.)

In interviews, the federal judges who run the other programs pointed to a mix of reasons for their involvement.

Read More..

U.S. Judges Offer Addicts a Way to Avoid Prison

Todd Heisler/The New York Times

Emily Leitch of Brooklyn, with her son, Nazir, 4, was arrested for importing cocaine but went to “drug court” to avoid prison.

Federal judges around the country are teaming up with prosecutors to create special treatment programs for drug-addicted defendants who would otherwise face significant prison time, an effort intended to sidestep drug laws widely seen as inflexible and overly punitive.

The Justice Department has tentatively embraced the new approach, allowing United States attorneys to reduce or even dismiss charges in some drug cases.

The effort follows decades of success for “drug courts” at the state level, which legal experts have long cited as a less expensive and more effective alternative to prison for dealing with many low-level repeat offenders.

But it is striking that the model is spreading at the federal level, where judges have increasingly pushed back against rules that restrict their ability to make their own determination of appropriate sentences.

So far, federal judges have instituted programs in California, Connecticut, Illinois, New Hampshire, New York, South Carolina, Virginia and Washington. About 400 defendants have been involved nationwide.

In Federal District Court in Brooklyn on Thursday, Judge John Gleeson issued an opinion praising the new approach as a way to address swelling prison costs and disproportionate sentences for drug trafficking.

“Presentence programs like ours and those in other districts mean that a growing number of courts are no longer reflexively sentencing federal defendants who do not belong in prison to the costly prison terms recommended by the sentencing guidelines,” Judge Gleeson wrote.

The opinion came a year after Judge Gleeson, with the federal agency known as Pretrial Services, started a program that made achieving sobriety an incentive for drug-addicted defendants to avoid prison. The program had its first graduate this year: Emily Leitch, a Brooklyn woman with a long history of substance abuse who was arrested entering the country at Kennedy International Airport with over 13 kilograms of cocaine, about 30 pounds, in her luggage.

“I want to thank the federal government for giving me a chance,” Ms. Leitch said. “I always wanted to stand up as a sober person.”

The new approach is being prompted in part by the Obama administration, which previously supported legislation that scaled back sentences for crimes involving crack cocaine. The Justice Department has supported additional changes to the federal sentencing guidelines to permit the use of drug or mental health treatment as an alternative to incarceration for certain low-level offenders and changed its own policies to make those options more available.

“We recognize that imprisonment alone is not a complete strategy for reducing crime,” James M. Cole, the deputy attorney general, said in a statement. “Drug courts, re-entry courts and other related programs along with enforcement are all part of the solution.”

For nearly 30 years, the United States Sentencing Commission has established guidelines for sentencing, a role it was given in 1984 after studies found that federal judges were giving defendants widely varying sentences for similar crimes. The commission’s recommendations are approved by Congress, causing judges to bristle at what they consider interference with their judicial independence.

“When you impose a sentence that you believe is unjust, it is a very difficult thing to do,” Stefan R. Underhill, a federal judge in Connecticut, said in an interview. “It feels wrong.”

The development of drug courts may meet resistance from some Republicans in Congress.

“It is important that courts give deference to Congressional authority over sentencing,” Representative F. James Sensenbrenner Jr., Republican of Wisconsin, a member and former chairman of the Judiciary Committee, said in a statement. He said sentencing should not depend “on what judge happens to decide the case or what judicial circuit the defendant happens to be in.”

At the state level, pretrial drug courts have benefited from bipartisan support, with liberals supporting the programs as more focused on rehabilitation, and conservatives supporting them as a way to cut spending.

Under the model being used in state and federal courts, defendants must accept responsibility for their crimes and agree to receive drug treatment and other social services and attend regular meetings with judges who monitor their progress. In return for successful participation, they receive a reduced sentence or no jail time at all. If they fail, they are sent to prison.

The drug court option is not available to those facing more serious charges, like people accused of being high-level dealers or traffickers, or accused of a violent crime. (These programs differ from re-entry drug courts, which federal judges have long used to help offenders integrate into society after prison.)

In interviews, the federal judges who run the other programs pointed to a mix of reasons for their involvement.

Read More..

Economix Blog: Bernanke Defends Stimulus as Necessary and Effective

The Federal Reserve’s chairman, Ben S. Bernanke, picked an unusual time to offer his most recent defense of the Fed’s campaign to stimulate the economy: 7 p.m. on a Friday night in San Francisco, 10 p.m. back home on the East Coast.

The basic message was the same as Mr. Bernanke delivered to Congress earlier this week: The Fed regards its current efforts as necessary and effective, and the risks, while real, are under control.

“Commentators have raised two broad concerns surrounding the outlook for long-term rates,” Mr. Bernanke told a conference at the Federal Reserve Bank of San Francisco. “To oversimplify, the first risk is that rates will remain low, and the second is that they will not.”

If rates remain low, it may drive investors to take excessive risks. If rates jump, investors could lose money – not least the Fed.

Regarding the first possibility, Mr. Bernanke said that the Fed was keeping a careful eye on financial markets. But he noted that rates were low in large part because the economy was weak, and that keeping rates low was the best way to encourage stronger growth. “Premature rate increases would carry a high risk of short-circuiting the recovery, possibly leading — ironically enough — to an even longer period of low long- term rates,” he said.

At the other extreme, Mr. Bernanke said the Fed could “mitigate” any jump in rates by prolonging its efforts to hold rates down, for example by keeping some of its investments in Treasury and mortgage-backed securities.

Three more highlights from the question-and-answer session after the speech.

1. Mr. Bernanke, asked about the outlook for the Washington Nationals, responded by accurately quoting the “Las Vegas odds” of a World Series appearance: 8/1.

2. Although the decision may be made under a future chairman, Mr. Bernanke said the Fed should continue to offer “forward guidance” — predicting its policies — even after it concludes its long effort to revive the economy.

“Providing information about the future path of policy could be useful, probably would be useful, under even normal circumstances,” he said in response to a question. “I think we need to keep providing information.”

3. Not surprisingly, Mr. Bernanke often is asked to reflect on the financial crisis. He offered something a little different than his normal response on Friday night.

“In many ways, in retrospect, the crisis was a normal crisis,” he said. “It’s just that the intuitional framework in which it occurred was much more complex.”

In other words, there was a panic, and a run, and a collapse – but rather than a run on bank deposits, the run was in the money markets. Improving the stability of those markets is something regulators have yet to accomplish.

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Letter from Europe: Observing the Vatican From Within

ROME — On Feb. 11, the day Benedict XVI stunned the world with the announcement that he would resign from the papacy, Giovanni Maria Vian was at home, getting ready.

It was not surprising that the editor of L’Osservatore Romano, the Vatican’s newspaper, should have been among the handful of people who had advance notice. Sworn to secrecy, Mr. Vian told his staff to listen carefully to Vatican radio that morning.

Since his editors understand Latin, they immediately caught the gist of the pope's speech (so did a reporter for Ansa, the Italian news agency, who broke the story). Within hours, L’Osservatore hit the stands with the news, carefully packaged, and an editorial by Mr. Vian, which said Benedict had made his decision last spring after an exhausting trip to Cuba and Mexico.

“That was a scoop,” Mr. Vian said cheerfully, during an interview in his modest office on a Vatican side street, on a chilly evening after the rest of the staff had gone home.

Since then, Mr. Vian — a scholar whose doctoral thesis was on the writings of early Church leaders — has been calmly navigating the choppy waves of one of the biggest news stories of the year, as it veers from speculation about the next pope to rumors of more scandals in the Roman Catholic Church.

If Mr. Vian remains composed amid all the turmoil, it is because his eight-page newspaper, which comes out in Italian six days a week and weekly in several other languages, is hardly expected to follow the steady drip of slippery stories about gay lobbies, blackmail and dirty Vatican bank accounts.

“There’s nothing new,” he said. “With these articles, one should be very careful. It is normal that they come out now. On the eve of the election of a new pope, there are new dynamics afoot.”

The Vatican, he said, “is a small world, and there are different rumors, different voices. Many times, they are lies. It is very human, all this, but in the end, it all will serve to purify the church — the whole church, not just the Vatican.”

In Mr. Vian’s view, Benedict — who once said he had greeted his election with the dread of someone mounting the steps of the guillotine — had envisioned an early departure right from the start. But the pope, a frail 85, stayed on for almost eight years, Mr. Vian said.

“He doesn’t run away from the wolves,” he said.

So who are the wolves? Mr. Vian was at first surprisingly literal. “The wolves?” he asked. “The most obvious are those who persecute Christians.” There are other wolves, in Christian countries, who are intolerant of believers, he added.

But, he continued, “'there are also wolves within the church, and inside all humans.”

Mr. Vian, ever the scholar, swiveled back and forth between his bookshelf and his computer, pulling out references, from the Roman poet Ovid, and St. Paul’s Letter to the Romans, to the perpetual struggle between good and evil.

Then he dug out, from a pile of newspapers, a lengthy discourse by Benedict himself, made without notes on Feb. 8, in which he spoke of “serious, dangerous omissions,” “errors” and a church that in some places “is dying because of the sins of men and women.”

Mr. Vian, who has run articles on the church's sex abuse scandals, believes that the VatiLeaks scandal, involving the theft of papal documents, was itself a sign that Benedict had succeeded in bringing about greater transparency, prompting a counterreaction. “The papacy of Benedict XVI has been very effective,” he said.

Five years ago, when he was named editor of L’Osservatore, Mr. Vian was hailed as an intellectual journalist, well suited to serve an intellectual pope, who was now his publisher. But his interests range beyond ecclesiastical subjects to include Tintin, the comic-book boy-hero whose posters hang in his office.

Mr. Vian was no stranger to the Vatican. The son of the secretary of the Vatican library, from a family that had ties to previous popes, he grew up within its walls, and played with his brothers in its gardens.

To his father’s dismay, Mr. Vian dabbled in journalism, writing for the Italian Catholic newspaper Avvenire and L’Osservatore, even as he pursued his doctorate and worked on the Italian encyclopedia.

“A rather strange career,” he said, “but it has helped prepare me, to take a critical approach, to respect history and facts. Writing for the encyclopedia is rigorous and sober: You can’t mix in ideology.”

When he took over in the fall of 2007, he wasted no time making changes to the paper. He expanded international news coverage while playing down Italian politics, devoted more attention to economic subjects and widened the cultural scope to include modern phenomena like the Beatles and James Bond. Non-Catholic commentators, including a Jewish columnist, are regularly invited to publish.

He added two women to the paper’s staff — the first in its 152-year history — and started publishing a monthly supplement on “Women, the Church, the World.”

Speaking of Benedict’s resignation, Mr. Vian did not hide his regret. “I am very attached to this pope,” he said. “He’s a real gentleman, a humble, nice man — in other words, a man of God.”

During the last two weeks, Mr. Vian has published a stream of articles on Benedict’s papacy from around the world, including one by a ranking member of the Russian Orthodox Church and one by Shimon Perez, the Israeli president.

The views have been, not surprisingly, uniformly positive. “That’s normal,” said Mr. Vian, asking whether other editors would publish articles critical of their publishers.

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Gadgetwise Blog: How to Beat Some Facebook Scammers

You’ve probably seen those wildly popular Facebook postings that entice you to share something — like a photo of a bear sneaking up on a man — with the instructions, “Press Like and type the number 1 and see what happens.” These posts often list hundreds of thousands of responses.

If you’ve tried it, here’s what you saw happen: nothing. Behind the scenes something is happening, though. With each click, a scammer gets a little closer to cashing in.

The most thorough explanation I’ve seen of how this deception works comes from Daylan Pearce, whose job title is Search Lead at Next Digital, described as Australia’s largest independent digital agency, in Melbourne.

Somewhat simplified, here’s how it works. There is a thriving business in selling Facebook pages. The idea is that a page builds an audience, then essentially sells that audience to someone else. It’s a practice Facebook opposes, but has limited control over.

If a company can buy that audience, its “edge rank” will increase. Edge rank — a term people like Mr. Pearce use, but which Facebook doesn’t officially acknowledge — measures how often someone’s posts show up in other people’s news feeds. “So,” Mr. Pearce said, “a page that has 50,000 likes will have greater exposure on people’s news feeds than a page with only 10,000.”

Edge rank is based on several factors, chief among them affinity, weight and decay, Mr. Pearce said. Affinity is largely based on the number of likes. Weight is based on what accompanies those likes. “A ‘like’ isn’t worth as much as a comment and a comment isn’t worth as much as a ‘share,’” he said.

Decay relates to the age of the post. More views, likes and shares over more time increases edge rank.

Facebook did not quarrel with the basics of Mr. Pearce’s explanation, but said it’s more complicated.

These scam posts are designed to do three things. Get you to like, comment and share the post. It’s a recipe to make it go viral, which takes care of decay.

To hook you, the posts make an intriguing promise, or ask you to support a worthy cause – “like this and share it if you know of someone who has suffered from cancer.”

While you can’t stop people from such postings, you can keep them off your page and reduce the potential profit. You lower their edge rank when you report or at least hide the post.

To do that, hold your cursor over the post and an arrow should appear in the upper right corner. Click it and a drop-down menu offers you the option of hiding or reporting the post.

The more often you report or hide these kinds of posts, the less often they will show up in your news feed.

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The New Old Age Blog: Why Can’t I Live With People Like Me?

“Aging in place” is the mantra of long-term care. Whether looking at reams of survey data, talking to friends or wishing on a star, who among us wouldn’t rather spend the final years — golden or less so — at home, surrounded by our cherished possessions, in our own bed, no cranky old coot as a roommate, no institutional smells or sounds, no lukewarm meals on a schedule of someone else’s making?

That works best, experts tell us, in dense cities, where we can hail a cab at curbside, call the superintendent when something breaks and have our food delivered from Fresh Direct or countless takeout restaurants. We’d have neighbors in the apartment above us, below us, just on the other side of the wall. Hearing their toilets flush and their children ride tricycles on uncarpeted floors is a small inconvenience compared to the security of knowing they are so close by in an emergency.

Urban planners, mindful that most Americans live in sprawling, car-reliant suburbs, are designing more elder-friendly, walkable communities, far from “real” cities. Houses and apartments are built around village greens, with pockets of commerce instead of distant strip malls. Some have community centers for congregate meals and activities; others share gardens, where people can get their hands in the warm spring dirt long after they can push a lawn mower.

All of this is a step in the right direction, despite the Potemkin-village look of so many of them. But it doesn’t take into account those who are too infirm to stay at home, even in cities or more manageable suburban environments. Some are alone, others with a loving spouse who by comparison is “well” but may not be for long, given the rigors of care-taking. It doesn’t take into account people who can’t afford a home health aide, who don’t qualify for a visiting nurse, who have no adult children to help them or whose children live far away.

But by now, aging in place, unrealistic for some, scary or unsafe for others and potentially very isolating, has become so entrenched as the right way to live out one’s life that not being able to pull it off seems a failure, yet another defeat at a time when defeats are all too plentiful. Are we making people feel guilty if they can’t stay at home, or don’t want to? Are we discouraging an array of other solutions by investing so much, program-wise and emotionally, in this sine qua non?

Regular readers of The New Old Age know that I am single, childless and terrified of falling off a ladder while replacing a light bulb, breaking a hip and lying on the floor, unattended, until my dog wails so loudly a neighbor comes by to complain. A MedicAlert pendant is not something that appeals to me at 65, but even if I give in to that, say at 75, I’m not sure my life will be richer for digging my heels in and insisting home is where I should be.

So I spend a lot of time thinking about the alternatives. I know enough to distinguish between naturally-occurring-retirement communities, or NORCs (some of which work better than others); age-restricted housing complexes (with no services); assisted living (which works fine when you don’t really need it and not so fine when you do); and continuing care retirement communities (which require big upfront payments and extensive due diligence to be sure the place doesn’t go belly up after you get there).

What I find so unappealing about all these choices is that each means growing old among people with whom I share no history. In these congregate settings, for the most part, people are guaranteed only two things in common: age and infirmity. Which brings us to what is known in the trade as “affinity” or “niche” communities,” long studied by Andrew J. Carle at the College of Health and Human Services at George Mason University in Fairfax, Va.

Mr. Carle, who trains future administrators of senior housing complexes, was a media darling a few years back, before the recession, with the first baby boomers approaching 65 and niche communities that included services for the elderly — not merely warm-weather developments adjacent to golf courses — expected to explode. In newspaper interviews as recently as 2011, Mr. Carle said there were “about 100 of them in existence or on the drawing board,” not counting the large number of military old-age communities.

Mr. Carle still believes that better economic times, when they come, will reinvigorate this sector of senior housing, after the failure of some in the planning stages and others in operation. In an e-mail exchange, Mr. Carle said there were now about 70 in operation, with perhaps 50 of those that he has defined as University Based Retirement Communities, adjacent to campuses and popular with alumni, as well as non-alumni, who enjoy proximity to the intellectual and athletic activities. Among the most popular are those near Dartmouth, Oberlin, the University of Alabama, Penn State, Notre Dame, Stanford and Cornell.

At the height of the “affinity” boom, L.G.B.T.-assisted living communities and nursing homes were all the rage, seen as a solution to the shoddy treatment that those of different sexual orientations in the pre-Stonewall generation experienced in generic facilities. A few failed, most never got built and, by all accounts, the only one to survive is the pricy Rainbow Vision community in Sante Fe, N.M.

A handful of nudist elder communities, and ones for old hippies, also fell by the wayside, perhaps too free-spirited for the task. According to Mr. Carle, despite the odds, at least one group of RV enthusiasts has added an assisted-living component to what began as collections of transient elderly, looking only for a parking spot and necessary water and power hook-ups for their trailers. Native Americans have made a go of an assisted-living community in Montana, and Asians have done the same in Northern California.

But professional affinity communities, which I find most appealing, are few and far between.

The storied Motion Picture & Television Country House and Hospital, a sliding-scale institution in the San Fernando Valley since 1940, survived near-closure in 2009 as a result of litigation, activism by the Screen Actors Guild and the local chapter of the Teamsters, and news media pressure. Among film legends who died there — along with cameramen, back-lot security guards and extras — were Mary Astor, Joel McCrea, Yvonne De Carlo and Stepin Fetchit.

New York State’s volunteer firefighters are all welcome to a refurbished facility in the Catskill region that offers far more in the way of care and activities, including a state-of-the-art gym, than when I visited there five years ago. At that time, the residents amused themselves by activating the fire alarm to summon the local hook and ladder company, which didn’t mind a bit.

Then there is Nalcrest, the retirement home for unionized letter carriers. Even as post offices nationwide are preparing to eliminate Saturday service, and snail mail becomes an artifact, the National Association of Letter Carriers holds monthly fees around the $500 mark, is located in central Florida so its members no longer have to brave rain and sleet to complete their appointed rounds, and bans dogs, the bane of their existence.

So why not aged journalists? We surely have war stories to embroider as we rock on the porch. Perhaps a mimeograph machine to produce an old-fashioned, dead-tree newspaper, which some of us will miss once it has given way to Web sites like this one. Pneumatic tubes, one colleague suggested, to whisk our belongings upstairs when we can no longer carry them. Other colleagues wondered about welcoming both editors and reporters. How can these two groups, which some consider natural adversaries, complain about each others’ tin ears or missed deadlines if we’re not segregated?

I disagree. The joy of this profession is its collaboration. We did the impossible day after day when young. We belong together when old.

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The New Old Age Blog: Why Can’t I Live With People Like Me?

“Aging in place” is the mantra of long-term care. Whether looking at reams of survey data, talking to friends or wishing on a star, who among us wouldn’t rather spend the final years — golden or less so — at home, surrounded by our cherished possessions, in our own bed, no cranky old coot as a roommate, no institutional smells or sounds, no lukewarm meals on a schedule of someone else’s making?

That works best, experts tell us, in dense cities, where we can hail a cab at curbside, call the superintendent when something breaks and have our food delivered from Fresh Direct or countless takeout restaurants. We’d have neighbors in the apartment above us, below us, just on the other side of the wall. Hearing their toilets flush and their children ride tricycles on uncarpeted floors is a small inconvenience compared to the security of knowing they are so close by in an emergency.

Urban planners, mindful that most Americans live in sprawling, car-reliant suburbs, are designing more elder-friendly, walkable communities, far from “real” cities. Houses and apartments are built around village greens, with pockets of commerce instead of distant strip malls. Some have community centers for congregate meals and activities; others share gardens, where people can get their hands in the warm spring dirt long after they can push a lawn mower.

All of this is a step in the right direction, despite the Potemkin-village look of so many of them. But it doesn’t take into account those who are too infirm to stay at home, even in cities or more manageable suburban environments. Some are alone, others with a loving spouse who by comparison is “well” but may not be for long, given the rigors of care-taking. It doesn’t take into account people who can’t afford a home health aide, who don’t qualify for a visiting nurse, who have no adult children to help them or whose children live far away.

But by now, aging in place, unrealistic for some, scary or unsafe for others and potentially very isolating, has become so entrenched as the right way to live out one’s life that not being able to pull it off seems a failure, yet another defeat at a time when defeats are all too plentiful. Are we making people feel guilty if they can’t stay at home, or don’t want to? Are we discouraging an array of other solutions by investing so much, program-wise and emotionally, in this sine qua non?

Regular readers of The New Old Age know that I am single, childless and terrified of falling off a ladder while replacing a light bulb, breaking a hip and lying on the floor, unattended, until my dog wails so loudly a neighbor comes by to complain. A MedicAlert pendant is not something that appeals to me at 65, but even if I give in to that, say at 75, I’m not sure my life will be richer for digging my heels in and insisting home is where I should be.

So I spend a lot of time thinking about the alternatives. I know enough to distinguish between naturally-occurring-retirement communities, or NORCs (some of which work better than others); age-restricted housing complexes (with no services); assisted living (which works fine when you don’t really need it and not so fine when you do); and continuing care retirement communities (which require big upfront payments and extensive due diligence to be sure the place doesn’t go belly up after you get there).

What I find so unappealing about all these choices is that each means growing old among people with whom I share no history. In these congregate settings, for the most part, people are guaranteed only two things in common: age and infirmity. Which brings us to what is known in the trade as “affinity” or “niche” communities,” long studied by Andrew J. Carle at the College of Health and Human Services at George Mason University in Fairfax, Va.

Mr. Carle, who trains future administrators of senior housing complexes, was a media darling a few years back, before the recession, with the first baby boomers approaching 65 and niche communities that included services for the elderly — not merely warm-weather developments adjacent to golf courses — expected to explode. In newspaper interviews as recently as 2011, Mr. Carle said there were “about 100 of them in existence or on the drawing board,” not counting the large number of military old-age communities.

Mr. Carle still believes that better economic times, when they come, will reinvigorate this sector of senior housing, after the failure of some in the planning stages and others in operation. In an e-mail exchange, Mr. Carle said there were now about 70 in operation, with perhaps 50 of those that he has defined as University Based Retirement Communities, adjacent to campuses and popular with alumni, as well as non-alumni, who enjoy proximity to the intellectual and athletic activities. Among the most popular are those near Dartmouth, Oberlin, the University of Alabama, Penn State, Notre Dame, Stanford and Cornell.

At the height of the “affinity” boom, L.G.B.T.-assisted living communities and nursing homes were all the rage, seen as a solution to the shoddy treatment that those of different sexual orientations in the pre-Stonewall generation experienced in generic facilities. A few failed, most never got built and, by all accounts, the only one to survive is the pricy Rainbow Vision community in Sante Fe, N.M.

A handful of nudist elder communities, and ones for old hippies, also fell by the wayside, perhaps too free-spirited for the task. According to Mr. Carle, despite the odds, at least one group of RV enthusiasts has added an assisted-living component to what began as collections of transient elderly, looking only for a parking spot and necessary water and power hook-ups for their trailers. Native Americans have made a go of an assisted-living community in Montana, and Asians have done the same in Northern California.

But professional affinity communities, which I find most appealing, are few and far between.

The storied Motion Picture & Television Country House and Hospital, a sliding-scale institution in the San Fernando Valley since 1940, survived near-closure in 2009 as a result of litigation, activism by the Screen Actors Guild and the local chapter of the Teamsters, and news media pressure. Among film legends who died there — along with cameramen, back-lot security guards and extras — were Mary Astor, Joel McCrea, Yvonne De Carlo and Stepin Fetchit.

New York State’s volunteer firefighters are all welcome to a refurbished facility in the Catskill region that offers far more in the way of care and activities, including a state-of-the-art gym, than when I visited there five years ago. At that time, the residents amused themselves by activating the fire alarm to summon the local hook and ladder company, which didn’t mind a bit.

Then there is Nalcrest, the retirement home for unionized letter carriers. Even as post offices nationwide are preparing to eliminate Saturday service, and snail mail becomes an artifact, the National Association of Letter Carriers holds monthly fees around the $500 mark, is located in central Florida so its members no longer have to brave rain and sleet to complete their appointed rounds, and bans dogs, the bane of their existence.

So why not aged journalists? We surely have war stories to embroider as we rock on the porch. Perhaps a mimeograph machine to produce an old-fashioned, dead-tree newspaper, which some of us will miss once it has given way to Web sites like this one. Pneumatic tubes, one colleague suggested, to whisk our belongings upstairs when we can no longer carry them. Other colleagues wondered about welcoming both editors and reporters. How can these two groups, which some consider natural adversaries, complain about each others’ tin ears or missed deadlines if we’re not segregated?

I disagree. The joy of this profession is its collaboration. We did the impossible day after day when young. We belong together when old.

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Peugeot Bets on a Different Kind of Hybrid

PARIS — What’s that car that just breezed past?

It’s the Hybrid Air — an experimental vehicle that the French automaker PSA Peugeot Citroën has been trumpeting lately as an exemplar of energy efficiency. While some skeptics doubt whether it is truly breakthrough technology, the Peugeot and Citroën concept cars containing it may prove to be some of the more intriguing models on display next week at the Geneva Motor Show.

Peugeot says a compact car like a Citroën C3 equipped with the technology will get about 100 kilometers per 2.9 liters, or 81 miles per gallon, in city driving. If so, that would be significantly more than existing hybrid electric vehicles like the Toyota Prius can achieve in stop-and-go traffic.

Peugeot, the second-biggest carmaker in Europe after Volkswagen, plans to begin rolling out Hybrid Air cars by 2015 or 2016.

Like a Toyota Prius, the Hybrid Air recovers energy each time the driver brakes or decelerates. But instead of using that braking energy to charge a battery, which then runs an electric motor — as in the Prius — the Hybrid Air has a reversible hydraulic pump that uses the braking energy to compress nitrogen gas in what looks like an oversized scuba tank. When the Hybrid Air driver next presses the accelerator, the compressed gas pushes hydraulic fluid, syringe fashion, through a gearbox to turn the wheels.

The energy stored in the nitrogen tank is small — equivalent to only about five teaspoons, or a couple dozen cubic centimeters, of gasoline — and enough to power the car only a few hundred meters before the standard gasoline motor takes over again. But repeated over the course of a day of city driving, Peugeot says, those extra teaspoons of energy add up to big improvement in gas mileage.

The idea of using so-called hybrid hydraulics to power a car has been around for a while, although Peugeot prefers to call it “hybrid air technology” because the energy is stored in the compressed gas, rather than the hydraulics. In the United States, Ford Motor and Chrysler have studied the approach with encouragement from the Environmental Protection Agency. UPS, the parcel service, has added several dozen hybrid hydraulic delivery vans to its alternative fuel fleet. Other companies are applying the technology to garbage trucks, which like UPS vans, are big, make frequent stops and stand to recover much of their wasted energy. The Indian auto company Tata has promised to produce a car powered solely by compressed air, although that uses a different technology than Peugeot’s approach.

Peugeot, with a 200-member Hybrid Air team led by Karim Mokaddem, an engineer, appears to be moving the fastest of any global automaker to bring the technology to the family car, while most of the industry has focused on hybrid electrics as the main alternative vehicles for reducing emissions and saving gasoline.

“The logic of an electric hybrid is completely different,” Andrés Yarce, another of the project leaders, said in Peugeot’s technical center in Carrières-sous-Poissy, near Paris. With an electric hybrid, “you let the vehicle run for a few kilometers, have the engine shut off, then run silently on an electric motor,” Mr. Yarce said. “It took time for people to grasp that the Hybrid Air works differently but gets the same results.”

When the car is ready for the market, Peugeot plans to price it below €20,000, or $26,000.

Mr. Mokaddem said the pricing was meant to make the Hybrid Air a viable option in emerging markets like China and India, where many hybrid electrics are too expensive for most consumers and too complex for local service and repair operations.

Peugeot says it can undercut hybrid electrics on price because its car does not require a special, expensive battery and electric motor that vehicles like the Prius use, although the Hybrid Air does employ a standard car battery. The hydraulic system also adds about 100 kilograms, or 220 pounds, to the weight of a conventional Citroën or Peugeot. And because of the heat generated by the energy transfer process, the designers have had to adapt the car’s cooling system.

The most obvious difference between the prototype Hybrid Air and an ordinary car is the presence of two air tanks (the second, smaller tank is a low-pressure receptacle) and a special gearbox that manages the energy handoffs between the hydraulics and the 1.2-liter standard gasoline engine. The designers say the setup left them room to keep a standard-size trunk and gas tank.

The accumulator, or pressurized nitrogen tank is 1.3 meters, or about 4 feet, long, with a volume of 20 liters, or 5.3 gallons, and a maximum pressure of 250 bar, or about 3,600 pounds per square inch.

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India Ink: What They Said: Budget 2013-14

Finance Minister Palaniappan Chidambaram presented the Union budget in Parliament on Thursday morning. Reactions were mixed from analysts who felt that while the finance minister had delivered a satisfactory budget given the country’s economic climate, more could have been done to attract foreign investment.

Prime Minister Manmohan Singh, speaking with Doordarshan News:

Given the challenges facing our economy, the finance minister has done a commendable job. India needs to create jobs for our growing labor force to the extent of about 10 million persons every year. To do that, we need to accelerate the tempo of our growth. We need, as the 12th Five-Year Plan has mentioned eloquently, a growth rate of about 8 percent. This is a growth rate which is consistent with our underlying potential. We have to get there. Although this is a difficult journey — it cannot be accomplished in a single year – but the finance minister has taken important steps to reverse the pessimistic view with regard to investment climate, with regard to the growth potential and possibilities of our economy.

The finance minister has laid out a road map. There is plenty of food for every ministry to chew upon. And each one of our ministries has to ask itself this question: If India needs an 8 percent growth rate, growth which is at the same time inclusive and sustainable, what is it that each ministry should do? The finance minister has, I think, mentioned these challenges. It is up to the collective wisdom of my Council of Ministers to convert these challenges into opportunities to accelerate the tempo of growth, to make it more inclusive, to make it more sustainable.

Dinesh Thakkar, chairman and managing director at Angel Broking in Mumbai:

The government’s reform momentum had been so strong since September that there were expectations of some exciting measures in the budget too. That was not the case, but it does not mean the budget was a disappointment. The finance minister has been seriously committed to bringing down the fiscal deficit, and he has delivered on that front, as he did not announce any major populist measure and largely maintained stability in tax policies, save for some tweaking for higher income brackets and corporates. In my view, there were no major positive or negative triggers for the markets or any particular sectors, and I think what the market will look forward to is the reform agenda being continued by the government outside the budget, in the coming Parliament sessions, for which the momentum still looks very much on track.

Anuj Puri, chairman and country head of Jones Lang LaSalle India:

We did not expect this budget to be a game-changer. The realities of the Indian economic situation need to viewed in context with the factors that drive it, not least of all the global economic situation. There is no escaping the fact that the business which comes to India from the European Union and the U.S. has a trickle-down effect on key economic drivers in India, and the Finance Ministry does not control these factors. The Union budget can only hope to address factors within its control.

This was a moderately encouraging budget in general, but tepid for the Indian real estate sector. There has been no proposal on certain key expectations from the real estate sector. These include implementation of the real estate regulator and the Land Acquisition Act. All said and done, Indian real estate will continue to struggle with its larger hurdles. While the affordable housing category has been rightly given due attention, aspects relating to improved transparency and corporate governance within the sector have been largely ignored.

That said, the budget has shown commitment to improving communication on taxation and regulatory policies. This should give more comfort to offshore real estate investors who have been bogged down by the political inertia and therefore unsure of India as an investment destination in the recent past.

Partha Iyengar, country manager for research, India, at Gartner:

The big overarching focus on growth by the finance minister is the fundamental “feel good” factor in this budget. Given the fact that one can argue that a lot of the weakness in the Indian economy is what I call a “sentimental recession,” his strong statement that there is no ground for “doom and gloom” heading into the new year.

The big specific positives of the budget are that he has focused both in terms of the letter and spirit of the budget on the key planks of growth for India and health of every industry, including IT, which is infrastructure, education, skills development and incentives for the growth of domestic manufacturing. Some of the other positive areas are support for entrepreneurship, the M.S.M.E. [micro, small and medium enterprises] sector, both in terms of financial and overall support. The recognition that the overseas “trust deficit” in terms of a comfort level on India’s investment climate has to be addressed is also welcome.

However, the budget is only a directional statement, and the challenge for India historically and even currently is in the execution of the statement of intent outlined in the budget. This has been India’s Achilles’ heel, in that bold pronouncements in the budget never see the light of day or are not implemented as effectively as they can or should be. So it was disappointing to not see any statements on what the government would do to ensure mechanisms and oversight to ensure speedy and efficient implementation of these programs. Overall, a 7/10 score for the budget.

Girish Vanvari, co-head of tax at KPMG:

This budget is along anticipated lines, given the economic scenario in the country. There is a stable tax regime. There is no weird tax introduced; nothing much has been tinkered with. The expenditure outlays of the government have not gone down and so the government is not going to stop spending, which means continued growth.

There is a tax on the super-rich with income above 10 million, but this will only affect about 42,000 people and not impact the larger base. Also, the tax is only a 10 percent surcharge and only effective for one year. In this situation, we have limited choices to manage the fiscal deficit, and the budget is quite good given the situation. It is generally an investor-friendly budget because the crux of this budget is growth. Without growth, the fiscal deficit will not be able to be constrained.

Sujan Hajra, chief economist and executive director at Anand Rathi Financial Services in Mumbai:

Given the macroeconomic climate – slowing growth, stable inflation, high fiscal deficit and current account deficit – this is the best budget that could be rolled out in these circumstances. The overarching priority in this budget is to affect some level of fiscal consolidation, and that has been delivered, having kept the fiscal deficit to 5.2 percent for this year.  The other priority for this budget is to induce financial saving and investment, and many measures have been introduced towards that, such as special incentives for over 1 billion rupees investment, a boost to infrastructure investment, particularly in the power and road sector, widening the scope for investing in mutual funds and the inflation index bond.

Despite this being the last full budget before the next election, the budget has largely resisted taking measures of overt populism. The two largely populist measures taken are the Food Security Act and the Direct Benefit Transfer, and none of these involve any major outlay. The subsidy component of the budget has been reduced rather than increased.

Also there has been some kind of benefit for the bottom of the pyramid with tax benefits for the lowest tax bracket and benefits on housing interest payment for the lower end of the spectrum.

Nobody can term this as a dream budget, but it is trying to address macro concerns and bring about some sort of revival in growth.

Chandrajit Banerjee, director general of the Confederation of India Industry, a trade group:

It is a very well thought through and analytical budget and not a political budget. It is a growth-oriented budget, where the focus on investment has been kept high.

Jaijit Bhattacharya, director for South Asia at Hewlett-Packard:

The IT and electronics manufacturing industry was looking forward to budgetary support to the government’s stated policy of promoting IT & electronics manufacturing in India. But this has not been done in this budget.

Dipen Shah, head of private client group, research, Kotak Securities:

The finance minister has projected a fiscal deficit in line with what he had promised, and it is far better than what the situation was when he had come in. To that extent, he has presented a responsible budget. We believe that the budget focuses rightly on higher investments, which can lead to better growth rates in the future. Several initiatives have been announced in the infrastructure sector. Followup action, in terms of removing infrastructure bottlenecks, will be needed and will go a long way in helping the government achieve the growth targets.

Nishith Desai, managing partner at Nishith Desai Associates, a research-based international law firm:

The budget brings some relief but not much excitement – in particular for foreign investors. It was expected that the finance minister would introduce new tax rates and this did not happen. We expected that estate duty would be reintroduced and this was not done. It was expected that there would be a whole host of new indirect taxes, and that was not done to a large extent. Therefore, it was not the draconian budget expected in the current macroeconomic situation. Only the super-rich have been charged a 10 percent surcharge, which is not too much of a burden, in my view.

However, we expected some big bang reforms for bringing foreign investment to India, which did not happen. The finance minister started by saying that foreign investment is “imperative,” but that imperative was soon lost. There was no assurance made to guarantee a stable regulatory environment and that there would not be any more retroactive amendments in general. It was expected that the finance minister would address cases that involve the offshore transfer of shares like Vodafone so that there could be some certainty, but this was not done.

I believe the finance minister will have to present another round of liberalization and reforms to attract foreign investment. I think that he has tried to please everybody, which is not a bad thing. But at the same time, if you look at this from the viewpoint of attracting the foreign investment necessary for growth – that has not happened.

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Gadgetwise Blog: Tip of the Week: Clean Your Phone and Its Camera

Smartphones spend a lot of time in hand, where they can pick up germs and dirt. Wiping down the phone regularly with an antibacterial cloth intended for use with touch screens can help keep it clean. Many office supply stores like Staples or Office Depot carry disposable wipes for use on phone and tablet screens.

If your phone has a camera and your photos have been looking blurry, you can clean its lens with a microfiber cloth or other wipe for use with camera lenses; a cotton swab moistened with distilled water can also take off stubborn grime. Whatever you do, though, do not spray the phone with industrial cleansers or use cleaning wipes designed for household chores, because these can damage the screen and other parts of the handset.

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The New Old Age Blog: For the Elderly, Lists of Tests to Avoid

The Choosing Wisely campaign, an initiative by the American Board of Internal Medicine Foundation in partnership with Consumer Reports, kicked off last spring. It is an attempt to alert both doctors and patients to problematic and commonly overused medical tests, procedures and treatments.

It took an elegantly simple approach: By working through professional organizations representing medical specialties, Choosing Wisely asked doctors to identify “Five Things Physicians and Patients Should Question.”

The idea was that doctors and their patients could agree on tests and treatments that are supported by evidence, that don’t duplicate what others do, that are “truly necessary” and “free from harm” — and avoid the rest.

Among the 18 new lists released last week are recommendations from geriatricians and palliative care specialists, which may be of particular interest to New Old Age readers. I’ve previously written about a number of these warnings, but it’s helpful to have them in single, strongly worded documents.

The winners — or perhaps, losers?

Both the American Geriatrics Society and the American Academy of Hospice and Palliative Medicine agreed on one major “don’t.” Topping both lists was an admonition against feeding tubes for people with advanced dementia.

“This is not news; the data’s been out for at least 15 years,” said Sei Lee, a geriatrician at the University of California, San Francisco, and a member of the working group that narrowed more than 100 recommendations down to five. Feeding tubes don’t prevent aspiration pneumonia or prolong dementia patients’ lives, the research shows, but they do exacerbate bedsores and cause such distress that people often try to pull them out and wind up in restraints. The doctors recommended hand-feeding dementia patients instead.

The geriatricians’ list goes on to warn against the routine prescribing of antipsychotic medications for dementia patients who become aggressive or disruptive. Though drugs like Haldol, Risperdal and Zyprexa remain widely used, “all of these have been shown to increase the risk of stroke and cardiovascular death,” Dr. Lee said. They should be last resorts, after behavioral interventions.

The other questionable tests and treatments:

No. 3: Prescribing medications to achieve “tight glycemic control” (defined as below 7.5 on the A1c test) in elderly diabetics, who need to control their blood sugar, but not as strictly as younger patients.

No. 4: Turning to sleeping pills as the first choice for older people who suffer from agitation, delirium or insomnia. Xanax, Ativan, Valium, Ambien, Lunesta — “they don’t magically disappear from your body when you wake up in the morning,” Dr. Lee said. They continue to slow reaction times, resulting in falls and auto accidents. Other sleep therapies are preferable.

No. 5: Prescribing antibiotics when tests indicate a urinary tract infection, but the patient has no discomfort or other symptoms. Many older people have bacteria in their bladders but don’t suffer ill effects; repeated use of antibiotics just causes drug resistance, leaving them vulnerable to more dangerous infections. “Treat the patient, not the lab test,” Dr. Lee said.

The palliative care doctors’ Five Things list cautions against delaying palliative care, which can relieve pain and control symptoms even as patients pursue treatments for their diseases.

It also urges discussion about deactivating implantable cardioverter-defibrillators, or ICDs, in patients with irreversible diseases. “Being shocked is like being kicked in the chest by a mule,” said Eric Widera, a palliative care specialist at the San Francisco V.A. Medical Center who served on the American Academy of Hospice and Palliative Medicine working group. “As someone gets close to the end of life, these ICDs can’t prolong life and they cause a lot of pain.”

Turning the devices off — an option many patients don’t realize they have — requires simple computer reprogramming or a magnet, not the surgery that installed them in the first place.

The palliative care doctors also pointed out that patients suffering pain as cancer spreads to their bones get as much relief, the evidence shows, from a single dose of radiation than from 10 daily doses that require travel to hospitals or treatment centers.

Finally, their list warned that topical gels widely used by hospice staffs to control nausea do not work because they aren’t absorbed through the skin. “We have lots of other ways to give anti-nausea drugs,” Dr. Widera said.

You can read all the Five Things lists (more are coming later this year), and the Consumer Reports publications that do a good job of translating them, on the Choosing Wisely Web site.

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

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The New Old Age Blog: For the Elderly, Lists of Tests to Avoid

The Choosing Wisely campaign, an initiative by the American Board of Internal Medicine Foundation in partnership with Consumer Reports, kicked off last spring. It is an attempt to alert both doctors and patients to problematic and commonly overused medical tests, procedures and treatments.

It took an elegantly simple approach: By working through professional organizations representing medical specialties, Choosing Wisely asked doctors to identify “Five Things Physicians and Patients Should Question.”

The idea was that doctors and their patients could agree on tests and treatments that are supported by evidence, that don’t duplicate what others do, that are “truly necessary” and “free from harm” — and avoid the rest.

Among the 18 new lists released last week are recommendations from geriatricians and palliative care specialists, which may be of particular interest to New Old Age readers. I’ve previously written about a number of these warnings, but it’s helpful to have them in single, strongly worded documents.

The winners — or perhaps, losers?

Both the American Geriatrics Society and the American Academy of Hospice and Palliative Medicine agreed on one major “don’t.” Topping both lists was an admonition against feeding tubes for people with advanced dementia.

“This is not news; the data’s been out for at least 15 years,” said Sei Lee, a geriatrician at the University of California, San Francisco, and a member of the working group that narrowed more than 100 recommendations down to five. Feeding tubes don’t prevent aspiration pneumonia or prolong dementia patients’ lives, the research shows, but they do exacerbate bedsores and cause such distress that people often try to pull them out and wind up in restraints. The doctors recommended hand-feeding dementia patients instead.

The geriatricians’ list goes on to warn against the routine prescribing of antipsychotic medications for dementia patients who become aggressive or disruptive. Though drugs like Haldol, Risperdal and Zyprexa remain widely used, “all of these have been shown to increase the risk of stroke and cardiovascular death,” Dr. Lee said. They should be last resorts, after behavioral interventions.

The other questionable tests and treatments:

No. 3: Prescribing medications to achieve “tight glycemic control” (defined as below 7.5 on the A1c test) in elderly diabetics, who need to control their blood sugar, but not as strictly as younger patients.

No. 4: Turning to sleeping pills as the first choice for older people who suffer from agitation, delirium or insomnia. Xanax, Ativan, Valium, Ambien, Lunesta — “they don’t magically disappear from your body when you wake up in the morning,” Dr. Lee said. They continue to slow reaction times, resulting in falls and auto accidents. Other sleep therapies are preferable.

No. 5: Prescribing antibiotics when tests indicate a urinary tract infection, but the patient has no discomfort or other symptoms. Many older people have bacteria in their bladders but don’t suffer ill effects; repeated use of antibiotics just causes drug resistance, leaving them vulnerable to more dangerous infections. “Treat the patient, not the lab test,” Dr. Lee said.

The palliative care doctors’ Five Things list cautions against delaying palliative care, which can relieve pain and control symptoms even as patients pursue treatments for their diseases.

It also urges discussion about deactivating implantable cardioverter-defibrillators, or ICDs, in patients with irreversible diseases. “Being shocked is like being kicked in the chest by a mule,” said Eric Widera, a palliative care specialist at the San Francisco V.A. Medical Center who served on the American Academy of Hospice and Palliative Medicine working group. “As someone gets close to the end of life, these ICDs can’t prolong life and they cause a lot of pain.”

Turning the devices off — an option many patients don’t realize they have — requires simple computer reprogramming or a magnet, not the surgery that installed them in the first place.

The palliative care doctors also pointed out that patients suffering pain as cancer spreads to their bones get as much relief, the evidence shows, from a single dose of radiation than from 10 daily doses that require travel to hospitals or treatment centers.

Finally, their list warned that topical gels widely used by hospice staffs to control nausea do not work because they aren’t absorbed through the skin. “We have lots of other ways to give anti-nausea drugs,” Dr. Widera said.

You can read all the Five Things lists (more are coming later this year), and the Consumer Reports publications that do a good job of translating them, on the Choosing Wisely Web site.

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

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DealBook: In Europe, Risks and Opportunities

BERLIN – Is Europe a risk or an opportunity?

As its economies struggle, private equity managers offer differing views about the region.

Speaking at the SuperReturn conference in Berlin, Henry R. Kravis, co-founder of Kohlberg Kravis Roberts, said Europe was an attractive market, particularly the Continent’s southern countries, which have been hit by high unemployment and meager growth.

“I like Spain, they are doing a number of right things,” Mr. Kravis told a somewhat empty conference room early on Thursday morning after many private equity managers had attended late-night dinners the previous evening. “In Europe, there clearly are opportunities. I may be in the minority.”

Other private equity giants, including David M. Rubenstein of the Carlyle Group, are also scouting for opportunities from Italy to Ireland despite concerns that the Continent may fall back into recession.

Lionel Assant, European head of private equity at the Blackstone Group, liked Spain because of its close ties to fast-growing Latin American markets and efforts to revamp its local labor market.

Not every manager is so bullish, however.

J. Christopher Flowers, whose private equity firm bought an insurance broker from the struggling Belgian bank KBC for 240 million euros ($315 million) in 2011, said the future of the euro zone remained a major risk.

Europe’s recovery prospects were hurt again this week after Italian national elections on Monday failed to provide a definitive winner. The political impasse prompted significant losses in the Continent’s stock markets as investors fretted about the future of one of Europe’s largest economies.

For Mr. Flowers, there are still some potential investment opportunities, including the pending forced sale of bank branches in Britain from the nationalized Royal Bank of Scotland. The United States, however, still remains his preferred region in which to invest.

“If a major economy like Spain defaults, we would prefer to be in Germany,” Mr. Flowers said. “If I had to pick one region, I would pick the U.S.”

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This post has been revised to reflect the following correction:

Correction: February 28, 2013

An earlier version of this article contained an incorrect conversion of 240 million euros. It is the equivalent of $315 million, not $310.

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India Ink: Revisiting the Horror in Sri Lanka

NEW DELHI — In the series of photographs shot in 2009, the bare-chested boy is first shown seated on a bench watching something outside the frame. Then he is seen having a snack. In the third image he is lying on the ground with bullet holes in his chest. The photographs, which were released last week by the British broadcaster Channel 4, appear to document the final moments in the life of 12-year-old Balachandran Prabhakaran, the youngest son of the slain founder of the Liberation Tigers of Tamil Eelam, Velupillai Prabhakaran.

The images are from the documentary film “No Fire Zone,” which tells the story of Sri Lanka’s violent suppression of Mr. Prabhakaran’s equally violent revolution, which had come very close to securing a separate state for the Tamil minority of Sri Lanka. After 26 years of civil war between the Tamils, who are chiefly Hindus, and the Sinhalese majority, who are chiefly Buddhists, the Sri Lankan state won decisively in 2009. Human rights activists say that hundreds of Tamil fighters, political leaders and their families, including Mr. Prabhakaran and his family, did not die in action but were executed. They estimate that more than 40,000 Tamil civilians died in the final months of the war.

Within its borders, the Sri Lankan government appears to wink at its Sinhalese population to accept their congratulations for ending the war, but it maintains a righteous indignation when the world accuses its army of planned genocide.

“No Fire Zone” includes video footage and photographs shot on mobile phones by Tamil survivors and Sinhalese soldiers that were somehow leaked. The film’s director, Callum Macrae, told me that it will be screened at the 22nd session of the U.N. Human Rights Council, now under way in Geneva, where the United States plans to introduce a resolution asking Sri Lanka to investigate the allegations of war crimes by its army.

It is not clear what such a resolution will achieve because Sri Lanka’s powerful president, Mahinda Rajapaksa, who has a rustic swagger about him and a manly black mustache, is the triumphant face of Sri Lanka’s victory in the war. The Sri Lankan Army is unambiguously under his control. Whatever the worth of the resolution, India is expected to support it more enthusiastically than it did a similar resolution last March.

Over the years, the shape and location of Sri Lanka have inspired several Indian cartoonists to portray the island nation as a tear drop beneath India’s peninsular chin. This is an illogical depiction of Sri Lanka’s trauma because a tear drop is not sorrowful; it is a consequence of someone’s sorrow. Some caricatures that appeared in the late 1980s and early 1990s, however, showed the Indian peninsula weeping and Sri Lanka as the consequent tear drop. This imagery had a stronger logic. India’s history with Sri Lanka is, in a way, about a bumbling giant being hurt by a cunning dwarf.

Under the late Prime Minister Indira Gandhi, the type of strategists who imagine they are great Machiavellian characters, and love to add the prefix “geo” to “politics” to feel good about their advisory jobs, ensured that India armed and financed the Tamil rebels. In 1984, when she was assassinated and her son Rajiv Gandhi took over as prime minister, Sri Lanka was engaged in a full-fledged civil war. Now, India wanted to play gracious giant in the region and bring peace to Sri Lanka. In 1987, it sent troops to achieve that end. It was a disastrous move, and resulted in the deaths of nearly 1,200 Indian soldiers and thousands of Tamil fighters. In an act of vengeance, Mr. Prabhakaran made his greatest strategic blunder: ordering the assassination of Rajiv Gandhi.

On the early morning of May 22, 1991, as the news spread through Madras (now Chennai) by phone and radio, I saw people run out of their homes in some kind of delirium to pick up the newspapers from their porches. The city had just woken up to the improbable fact that a suicide bomber had killed Mr. Gandhi the previous night in a small town not far from Chennai. Until then, the southern state of Tamil Nadu, whose capital is Chennai, was a haven for the Tamil Tigers. Bound by a common language, the masses of Tamil Nadu felt a deep compassion for the struggle of Sri Lankan Tamils. But Mr. Gandhi’s assassination was seen by them as an act of war against India. The chief minister of Tamil Nadu at the time, Muthuvel Karunanidhi, who was accused of being a friend of the Tigers, went around Chennai in an open-roof van, standing with his palms joined in apology. That was not good enough. In the 1991 Tamil Nadu assembly elections, his party won only two seats.

But now, the plight of the Sri Lankan Tamils has returned as a passionate political issue in Tamil Nadu. Mr. Karunanidhi is too old to stand anymore but even as a patriarch who uses a wheelchair, he is a useful ally of the Indian National Congress party, which heads the national government. He has often demanded that the accomplices of Mr. Gandhi’s assassin now on death row in India be pardoned, and that President Rajapaksa be tried on war crimes charges. Last year, when the United States introduced a resolution against Sri Lanka, India was reluctant to back it for strategic reasons, including that it has commercial interests in Sri Lanka, which China is fast grabbing. But Mr. Karunanidhi and public sentiment in Tamil Nadu finally persuaded the Indian government to support it.

In a few days, when the United States introduces its new resolution against Sri Lanka, the brute forces of politics and practicality will ensure that the Indian government led by the Congress party, whose leader is Sonia Gandhi, will join other nations in asking Sri Lanka to explain how exactly it eliminated the organization that made her a widow.

Manu Joseph is editor of the Indian newsweekly Open and author of the novel “The Illicit Happiness of Other People.”

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Gadgetwise Blog: Q&A: Moving iTunes Libraries

How do I transfer my iTunes library from a desktop PC to a laptop, neither of which are Apple computers?

All the items in your iTunes library, like music, TV shows and podcasts, are stored in folders on the computer. The iTunes software itself, which is basically a big database program crossed with a media player, displays the items in your library in lists and makes it relatively easy to manage your collection.

To move your library to a new computer, you just need to move your iTunes library folder from the old machine to the new one with a copy of the iTunes software installed. You can do this in several ways depending on how you use iTunes — including transferring all the files over your network with the Home Sharing feature, copying your iTunes folder to an external hard drive or set of DVDs for transport between computers, or transferring content from the iTunes Store with an iPod, iPad or iPhone.

Apple has step-by-step, illustrated instructions for all these moving methods (and others) on its site. If you plan to get rid of the old computer, be sure to deauthorize it for use with your iTunes purchases, as explained here.

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Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative. M.R.I. helped pay for previous vaccination campaigns in the country and the GAVI Alliance is helping financing the upcoming one.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

This article has been revised to reflect the following correction:

Correction: February 27, 2013

An earlier version of this article misstated the source of the financing for the upcoming vaccination campaign in Rwanda. It is being financed by the GAVI Alliance, not the Measles and Rubella Initiative.

Read More..

Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative. M.R.I. helped pay for previous vaccination campaigns in the country and the GAVI Alliance is helping financing the upcoming one.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

This article has been revised to reflect the following correction:

Correction: February 27, 2013

An earlier version of this article misstated the source of the financing for the upcoming vaccination campaign in Rwanda. It is being financed by the GAVI Alliance, not the Measles and Rubella Initiative.

Read More..

DealBook: Regulators Block Ryanair’s Latest Attempt to Buy Aer Lingus

BRUSSELS — The European Commission on Wednesday blocked the third attempt by Ryanair to take over Aer Lingus, saying the tie-up of the two Irish airlines would damage competition and raise prices on air routes to Ireland.

The decision was widely expected after Ryanair — the largest budget carrier in Europe — said earlier that the commission would prohibit the deal, worth about 700 million euros or $900 million.

“The Commission’s decision protects more than 11 million Irish and European passengers who travel each year to and from Dublin, Cork, Knock and Shannon,” the European Union competition commissioner, Joaquín Almunia, said in a statement before a news conference.

Proposals made by Ryanair “were simply inadequate to solve the very serious competition problems which this acquisition would have created on no less than 46 routes,” Mr. Almunia said.

Shares of Ryanair were down 6 euro cents to 5.60 euros by early afternoon in Dublin; Aer Lingus stock was up 1 cent at 1.25 euros.

On Wednesday, Aer Lingus, which had rejected Ryanair’s offers, said that it welcomed the commission decision. Ryanair, which owns about 30 percent of Aer Lingus, reiterated that it would appeal the decision to the European Court of Justice.

Ryanair accused Mr. Almunia of protecting Aer Lingus, the Irish flag carrier, against a takeover by an upstart. The company also contends that the regulator applied a double standard because he approved the takeover by British Airways and Iberia of British Midland International last year under a simplified procedure.

“We regret that this prohibition is manifestly motivated by narrow political interests rather than competition concerns and we believe that we have strong grounds for appealing and overturning this politically inspired prohibition,” said Robin Kiely, a spokesman for Ryanair.

Prolonged litigation could have wider ramifications, making it more difficult for the Irish government to sell its 25 percent stake in Aer Lingus. Ireland agreed to sell that stake under the terms of an international bailout finalized in November 2010, although that agreement did not set a deadline for the sale.

The deal is the fourth Mr. Almunia has blocked since he took over the role of the region’s antitrust chief in February 2010. Earlier this year, the regulator thwarted U.P.S.‘s attempt to buy TNT Express.

The decision on Wednesday marks the latest chapter in years of acrimony between the commission and Ryanair’s pugnacious chief executive, Michael O’Leary, who has repeatedly criticized commission officials for decisions that curtailed his ambitions.

The enmity between Mr. O’Leary and the commission developed early last decade when the two sides began a running battle over whether Ryanair received illegal state subsidies that enabled the airline to open up routes to regional airports. Those airports were often some distance from major transport hubs, but still close enough to lure passengers away from more established carriers.

Last year, the commission announced new investigations into the effect of discounts Ryanair had received at the Lübeck-Blankensee airport in Germany and the Klagenfurt regional airport in Austria.

Mr. O’Leary has sharply criticized the commission for failing to do more to save money by booking its officials on low-cost airlines like his own. Ryanair also has said its arrangements with all E.U. airports comply with the bloc’s competition rules.

The E.U. competition authority blocked Ryanair’s first bid for Aer Lingus in 2007 on the grounds that the combined airline would have had a monopoly on too many routes. Back then, Mr. O’Leary accused the commission of bowing to political pressure from the Irish government, which opposed the deal. The airline abandoned a second attempt in 2009 because of opposition from the Irish government.

On Wednesday, Ryanair accused the commission of holding it to a higher standard than other airlines seeking mergers after it had offered ‘‘historic and unprecedented’’ concessions.

Among them: allowing two competitor airlines to serve Dublin, Cork and Shannon; giving those airlines more than half of the short-distance business that currently belongs to Aer Lingus; and agreeing to transfer airport slots in Britain to allow British Airways to serve Ireland from both Gatwick and Heathrow. Ryanair also had offered Flybe, a competitor, 100 million euros in funding to make it “a commercially profitable and viable entity” in Ireland.

On Wednesday, the commission spelled out the reasons behind its decision.

It said that both Ryanair and Aer Lingus had strengthened their positions in the Irish market since the commission refused the previous deal in 2007, and that the merger would have created an ‘‘outright monopoly’’ on 28 short-distance routes serving Ireland. The commission also said that there were such high barriers to entry to the Irish market that any new competitors would face too many challenges.

The commission’s “market investigation showed that there was no prospect that any new carrier would enter the Irish market after the merger, in particular by the creation of a base at the relevant Irish airports, and challenge the new entity on a sufficient scale,” it said in a statement. “Higher prices for passengers would have been the likely outcome,”

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