The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain

Matt Rainwaters for Texas Monthly

The Sherman grave of Andre Thomas’s victims.

SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org

Matt Rainwaters for Texas Monthly

Laura Boren

He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.

He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.

In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.

Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.

“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.

From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.

bgrissom@texastribune.org

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2 Palestinians Shot in Clashes With Israeli Settlers

JERUSALEM (AP) — Clashes erupted Saturday in the West Bank, with Jewish settlers shooting two Palestinian demonstrators in the northern village of Kusra, an Israeli military official and Palestinian residents said.

The unrest reflected mounting friction in the West Bank, where Palestinians have faced off against Israeli troops in recent weeks in a series of large demonstrations protesting Israel’s control of the territory in general and in solidarity with four prisoners on hunger strikes in Israeli jails.

Also on Saturday, a Palestinian prisoner died in an Israeli jail, an event that is likely to intensify tensions in the area.

In the West Bank skirmish, Helmi Abdul-Aziz, 24, was shot in the stomach by Jewish settlers, Palestinian demonstrators said. They said settlers also shot Mustafa Hilal, 14, in the foot.

An Israeli military official confirmed that two Palestinians had been shot, apparently by settlers, since the Israeli military forces there were not using live ammunition.

Villagers said the clashes began when a group of Jewish settlers encroached on their village lands and fired guns. They said settlers chased a Palestinian farmer and his family off land, prompting the farmer to call on other villagers to confront the settlers, and men on both sides hurled rocks at one another.

In an Israeli jail on Saturday, Arafat Shalish Shahin Jaradat, a Palestinian prisoner, died apparently of a heart attack, according to an Israeli prison services spokeswoman, Sivan Weizman. She said that Mr. Jaradat had not been on a hunger strike.

Israel’s domestic intelligence agency, the Shin Bet, said that Mr. Jaradat, 30, was arrested last week after he was involved in a rock-throwing attack that injured an Israeli citizen. Mr. Jaradat admitted to the charge, as well to another West Bank rock-throwing episode last year, the Shin Bet said.

A Shin Bet spokesman said that Mr. Jaradat had not been beaten during an interrogation.

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Dozens hurt after Daytona crash debris hits stands

DAYTONA BEACH, Fla. (AP) — At least 33 fans were injured Saturday during a NASCAR race when a car flew into the fence at Daytona International Speedway, hurling a tire and large pieces of debris into the stands.

The accident happened on the last lap of the second-tier Nationwide Series race on the eve of Sunday's Daytona 500, which officials said would go on as scheduled.

The crash began as the field approached the checkered flag and leader Regan Smith attempted to block Brad Keselowski to preserve the win. That triggered a chain reaction, and rookie Kyle Larson hit the cars in front of him and went airborne into the fence.

The entire front end was sheared off Larson's car, and his burning engine wedged through a gaping hole in the fence. Chunks of debris from the car were thrown into the stands, including a tire that cleared the top of the fence and landed midway up the spectator section closest to the track.

The 20-year-old Larson stood in shock several yards away from his car as fans in the stands waved frantically for help. Smoke from the burning engine briefly clouded the area, and emergency vehicles descended on the scene.

Ambulance sirens could be heard wailing behind the grandstands at a time the race winner would typically be doing celebratory burnouts.

"It was freaky. When I looked to my right, the accident happened," said Rick Harpster of Orange Park, Fla., who had a bird's-eye view of the wreck. "I looked over and I saw a tire fly straight over the fence into the stands, but after that I didn't see anything else That was the worst thing I have seen, seeing that tire fly into the stands. I knew it was going to be severe."

Shannan Devine, of Egg Harbor Township, N.J., was sitting about 250 feet away from where the car smashed into the fence and could see plumes of smoke directly in front of her.

"I didn't know if there was a car on top of people. I didn't know what to think. I'm an emotional person and I immediately started to cry. It was very scary. Absolutely scary. I love the speed of the sport. But it's so dangerous," said Devine who was planning to attend her second Daytona 500.

She said many fans got in the way of rescue efforts by trying to take pictures and videos, even jumping over fencing in hopes of getting closer to the scene.

Speedway President Joie Chitwood said 14 fans were treated on site, and 14 others were taken to hospitals. Chitwood didn't give any updates on their conditions. Local officials said 19 fans were taken to neighboring hospitals, including two who were in critical condition but were later upgraded to stable.

The accident happened the day before the Sprint Cup Series season-opening Daytona 500 — NASCAR's version of the Super Bowl. Daytona workers could be seen repairing the large section of fence where Larson hit, as well as the wall that was damaged in the accident.

"First and foremost our thoughts and prayers are with our race fans," Chitwood said. "Following the incident we responded appropriately according to our safety protocols, and had emergency medical personnel at the incident immediately.

"We're in the process of repairing the facility and will be ready to go racing tomorrow."

As emergency workers tended to injured fans and ambulance sirens wailed in the background, a somber Tony Stewart skipped the traditional post-race victory celebration.

Stewart, who won for the 19th time at Daytona and seventh time in the last nine season-opening Nationwide races, was in no mood to celebrate.

"The important thing is what is going on on the frontstretch right now," said Stewart, the three-time NASCAR champion. "We've always known, and since racing started, this is a dangerous sport. But it's hard. We assume that risk, but it's hard when the fans get caught up in it.

"So as much as we want to celebrate right now and as much as this is a big deal to us, I'm more worried about the drivers and the fans that are in the stands right now because that was ... I could see it all in my mirror, and it didn't look good from where I was at."

The accident spread into the upper deck and emergency crews treated fans on both levels. There were five stretchers that appeared to be carrying fans out, and a helicopter flew overhead. A forklift was used to pluck Larson's engine out of the fence.

"It's a violent wreck. Just seeing the carnage on the racetrack, it's truly unbelievable," driver Justin Allgaier said.

It was a chaotic finish to a race that was stopped for nearly 20 minutes five laps from the finish by a 13-car accident that sent driver Michael Annett to a hospital, where his Richard Petty Motorsports team said he would be held overnight with bruising to his chest.

The race resumed with three laps to go, and the final accident occurred with Smith trying to hold off Keselowski through the final turn.

"I tried to throw a block. It's Daytona, you want to go for the win here," Smith said. "I don't know how you can play it any different other than concede second place, and I wasn't willing to do that today. Our job is to put them in position to win, and it was, and it didn't work out."

As the cars began wrecking all around Smith and Keselowski, Stewart slid through for the win, but Larson plowed into Keselowski and his car was sent airborne into the fence. When Larson's car came to a stop, it was missing its entire front end. The 20-year-old, who made his Daytona debut this week, stood apparently stunned, hands on his hips, several feet away from his car, before finally making the mandatory trip to the care center.

He said his first thought was with the fans.

"I hope all the fans are OK and all the drivers are all right," Larson said. "I took a couple big hits there and saw my engine was gone. Just hope everybody's all right."

He said he was along for the ride in the last-lap accident.

"I was getting pushed from behind, I felt like, and by the time my spotter said lift or go low, it was too late," Larson said. "I was in the wreck and then felt like it was slowing down and I looked like I could see the ground. Had some flames come in the cockpit, but luckily I was all right and could get out of the car quick."

It appeared fans were lined right along the fence when Larson's car sailed up and into it, but Chitwood indicated there was a buffer. He said there would be no changes to the seating before the Daytona 500.

"We don't anticipate moving any of our fans," Chitwood said. "We had our safety protocols in place. Our security maintained a buffer that separates the fans from the fencing area. With the fencing being prepared tonight to our safety protocols, we expect to go racing tomorrow with no changes."

Larson's car appeared to hit where the cross-over gate — a section that can be opened for people to travel back and forth from the infield to the grandstands — is located in the fence. Previous accidents in which drivers hit crossover gates were severe, but the gates were in the wall and not the fence for Mike Harmon's accident at Bristol in 2002 and Michael Waltrip's at the same track in 1990.

Still, NASCAR senior vice president Steve O'Donnell said it would be studied.

"I think we look at this after every incident," O'Donnell said. "We've learned in the past certain protocols put in place today are a result of prior incidents. Again, our initial evaluation is still ongoing. But it's certainly something we'll look at. If we can improve upon it, we'll certainly put that in play as soon as we can."

Larson had been scheduled to race his sprint car later Saturday night in Ocala, Fla., and even seemed restless to get there during the late stages of the Nationwide race. He pulled out of the event following the accident.

"Honestly, the race itself pales in comparison to the injuries sustained by the fans," said Chip Ganassi, the team owner who has Larson in his driver development program. "Our thoughts and prayers go out to all the fans that were injured as a result of the crash. As for Kyle, I am very happy that he is OK."

Keselowski watched a replay of the final accident, and said his first thoughts were with the fans. As for the accident, he agreed he tried to make a winning move and Smith tried to block.

"He felt like that's what he had to do, and that's his right. The chaos comes with it," Keselowski said. "I made the move and he blocked it, and the two of us got together and started the chain events that caused that wreck. First and foremost, just want to make sure everyone in the stands is OK and we're thinking about them."

Keselowski said the incident could cast a pall on the Daytona 500.

"I think until we know exactly the statuses of everyone involved, it's hard to lock yourself into the 500," Keselowski said. "Hopefully, we'll know soon and hopefully everyone's OK. And if that's the case, we'll staring focusing on Sunday."

___

AP Sports Writers Dan Gelston and Jerome Minerva in Daytona Beach and Associated Press writer Jennifer Kay in Miami contributed to this report.

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Major Banks Aid in Payday Loans Banned by States

Major banks have quickly become behind-the-scenes allies of Internet-based payday lenders that offer short-term loans with interest rates sometimes exceeding 500 percent.

With 15 states banning payday loans, a growing number of the lenders have set up online operations in more hospitable states or far-flung locales like Belize, Malta and the West Indies to more easily evade statewide caps on interest rates.

While the banks, which include giants like JPMorgan Chase, Bank of America and Wells Fargo, do not make the loans, they are a critical link for the lenders, enabling the lenders to withdraw payments automatically from borrowers’ bank accounts, even in states where the loans are banned entirely. In some cases, the banks allow lenders to tap checking accounts even after the customers have begged them to stop the withdrawals.

“Without the assistance of the banks in processing and sending electronic funds, these lenders simply couldn’t operate,” said Josh Zinner, co-director of the Neighborhood Economic Development Advocacy Project, which works with community groups in New York.

The banking industry says it is simply serving customers who have authorized the lenders to withdraw money from their accounts. “The industry is not in a position to monitor customer accounts to see where their payments are going,” said Virginia O’Neill, senior counsel with the American Bankers Association.

But state and federal officials are taking aim at the banks’ role at a time when authorities are increasing their efforts to clamp down on payday lending and its practice of providing quick money to borrowers who need cash.

The Federal Deposit Insurance Corporation and the Consumer Financial Protection Bureau are examining banks’ roles in the online loans, according to several people with direct knowledge of the matter. Benjamin M. Lawsky, who heads New York State’s Department of Financial Services, is investigating how banks enable the online lenders to skirt New York law and make loans to residents of the state, where interest rates are capped at 25 percent.

For the banks, it can be a lucrative partnership. At first blush, processing automatic withdrawals hardly seems like a source of profit. But many customers are already on shaky financial footing. The withdrawals often set off a cascade of fees from problems like overdrafts. Roughly 27 percent of payday loan borrowers say that the loans caused them to overdraw their accounts, according to a report released this month by the Pew Charitable Trusts. That fee income is coveted, given that financial regulations limiting fees on debit and credit cards have cost banks billions of dollars.

Some state and federal authorities say the banks’ role in enabling the lenders has frustrated government efforts to shield people from predatory loans — an issue that gained urgency after reckless mortgage lending helped precipitate the 2008 financial crisis.

Lawmakers, led by Senator Jeff Merkley, Democrat of Oregon, introduced a bill in July aimed at reining in the lenders, in part, by forcing them to abide by the laws of the state where the borrower lives, rather than where the lender is. The legislation, pending in Congress, would also allow borrowers to cancel automatic withdrawals more easily. “Technology has taken a lot of these scams online, and it’s time to crack down,” Mr. Merkley said in a statement when the bill was introduced.

While the loans are simple to obtain — some online lenders promise approval in minutes with no credit check — they are tough to get rid of. Customers who want to repay their loan in full typically must contact the online lender at least three days before the next withdrawal. Otherwise, the lender automatically renews the loans at least monthly and withdraws only the interest owed. Under federal law, customers are allowed to stop authorized withdrawals from their account. Still, some borrowers say their banks do not heed requests to stop the loans.

Ivy Brodsky, 37, thought she had figured out a way to stop six payday lenders from taking money from her account when she visited her Chase branch in Brighton Beach in Brooklyn in March to close it. But Chase kept the account open and between April and May, the six Internet lenders tried to withdraw money from Ms. Brodsky’s account 55 times, according to bank records reviewed by The New York Times. Chase charged her $1,523 in fees — a combination of 44 insufficient fund fees, extended overdraft fees and service fees.

For Subrina Baptiste, 33, an educational assistant in Brooklyn, the overdraft fees levied by Chase cannibalized her child support income. She said she applied for a $400 loan from Loanshoponline.com and a $700 loan from Advancemetoday.com in 2011. The loans, with annual interest rates of 730 percent and 584 percent respectively, skirt New York law.

Ms. Baptiste said she asked Chase to revoke the automatic withdrawals in October 2011, but was told that she had to ask the lenders instead. In one month, her bank records show, the lenders tried to take money from her account at least six times. Chase charged her $812 in fees and deducted over $600 from her child-support payments to cover them.

“I don’t understand why my own bank just wouldn’t listen to me,” Ms. Baptiste said, adding that Chase ultimately closed her account last January, three months after she asked.

A spokeswoman for Bank of America said the bank always honored requests to stop automatic withdrawals. Wells Fargo declined to comment. Kristin Lemkau, a spokeswoman for Chase, said: “We are working with the customers to resolve these cases.” Online lenders say they work to abide by state laws.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Oscar Pistorius gets bail as murder trial looms

PRETORIA, South Africa (AP) — Oscar Pistorius walked out of court Friday — free at least for now — after a South African magistrate released him on bail, capping four days of often startling testimony that foreshadowed a dramatic trial in the Valentine's Day slaying of his girlfriend.

But as he was driven away, chased by photographers and cameramen, questions continued to hound the double-amputee Olympian about what actually happened the night he gunned down Reeva Steenkamp inside a locked bathroom in his home.

Pistorius is charged with premeditated murder, and even Chief Magistrate Desmond Nair expressed doubts about his story that he mistook the 29-year-old model for an intruder and fired out of fear.

"Why would (Pistorius) venture further into danger" by going into the bathroom at all, Nair asked.

Cries of "Yes!" went up from Pistorius' supporters when Nair announced his decision to a packed courtroom after a nearly two-hour explanation of the ruling.

Nair set bail at 1 million rand ($113,000), with $11,300 in cash up front and proof that the rest is available. The 26-year-old track star was also ordered to hand over his passports, turn in any guns he owns and keep away from his upscale home in a gated community in Pretoria, which is now a crime scene.

He cannot leave the district of Pretoria without his probation officer's permission and is not allowed to consume drugs or alcohol, the magistrate said. His next court appearance was set for June 4.

Earlier, Pistorius alternately wept and appeared solemn and composed, especially as Nair criticized police procedures in the case and as a judgment in the track star's favor appeared imminent. He showed no reaction as he was granted bail.

Pistorius left the courthouse in a silver Land Rover just over an hour after the bail conditions were set. The vehicle, tailed by motorcycles carrying television cameramen, later pulled into the home of Pistorius' uncle.

"We are relieved at the fact that Oscar got bail today, but at the same time we are in mourning for the death of Reeva, with her family," said Pistorius' uncle, Arnold Pistorius. "As a family, we know Oscar's version of what happened on that tragic night and we know that that is the truth and that will prevail in the coming court case."

Dozens of journalists and international and local television crews had converged on the red-brick courthouse to hear the decision — a sign of the global fascination with a case involving a once-inspirational athlete and his beautiful girlfriend, a law school graduate and budding reality TV show contestant.

Nair said Pistorius' sworn statement, an unusual written account of what happened during the pre-dawn hours of Feb. 14, had helped his application for bail.

"I come to the conclusion that the accused has made a case to be released on bail," Nair said.

Pistorius said he shot Steenkamp accidentally, believing she was an intruder in his house. He described "a sense of terror rushing over" him and feeling vulnerable because he stood only on his stumps before opening fire.

Prosecutors say he intended to kill Steenkamp as she cowered in fear behind the locked bathroom door after a loud argument between the two.

Yet despite poking holes in Pistorius' version of events and bringing up incidents they say highlight his temper, the state's case started to unravel during testimony by the lead investigator, Detective Warrant Officer Hilton Botha.

Botha, who faces seven charges of attempted murder in an unrelated incident, was removed from the case Thursday. His replacement, the nation's top detective, Vinesh Moonoo, stopped by the hearing briefly Friday.

While Nair leveled harsh criticism at Botha for "errors" and "blunders," he said one man does not represent an investigation and that the state could not be expected to put all "the pieces of the puzzle" together in such a short time.

The prosecution accepted the judge's decision without protest. "We're still confident in our case," prosecution spokesman Medupe Simasiku said.

Pistorius faced the sternest bail requirements in South Africa because of the seriousness of the charge, which carries a life sentence if convicted. His defense attorneys had to prove that he would not flee the country, would not interfere with witnesses or the case, and his release would not cause public unrest.

Nair questioned whether Pistorius would be a flight risk when he stood to lose a fortune in cash, cars, property and other assets. Nair also said that while it had been shown that Pistorius had aggressive tendencies, he did not have a prior record of offenses for violent acts.

Anticipating the shape of the state's case at trial, he said he had serious questions about Pistorius' account: Why didn't he try to locate his girlfriend if he feared an intruder was in the house? Why didn't he try to determine who was in the bathroom before opening fire? And why did he venture into perceived "danger" in the bathroom when he could have taken other steps to ensure his safety?

"There are improbabilities which need to be explored," Nair said, adding that Pistorius could clarify these matters by testifying under oath at trial.

Sharon Steenkamp, Reeva's cousin, said the model's family would not be watching the bail decision and had not been following the hearing.

"It doesn't make any difference to the fact that we are without Reeva," she told The Associated Press.

Before the hearing, Pistorius' longtime coach, Ampie Louw, said he hoped to put the runner back into his training routine if he got bail.

"The sooner he can start working the better," said Louw, who persuaded the double-amputee to take up track as a teenager a decade ago. But he acknowledged Pistorius could be "heartbroken" and unwilling to immediately pull on the carbon-fiber running blades that earned him the nickname "Blade Runner."

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AP Sports Writer Gerald Imray contributed to this report from Johannesburg.

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Jon Gambrell can be reached at www.twitter.com/jongambrellAP .

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Many States Say Cuts Would Burden Fragile Recovery

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fernanda Santos contributed reporting.

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Governors Fall Away in G.O.P. Fight Against More Medicaid

Under pressure from the health care industry and consumer advocates, seven Republican governors are cautiously moving to expand Medicaid, giving an unexpected boost to President Obama’s plan to insure some 30 million more Americans.

The Supreme Court ruled last year that expanding Medicaid to include many more low-income people was an option under the new federal health care law, not a requirement, tossing the decision to the states and touching off battles in many capitols.

The federal government will pay the entire cost of covering newly eligible beneficiaries from 2014 to 2016, and 90 percent or more later. But many Republican governors and lawmakers immediately questioned whether that commitment would last, and whether increased spending on Medicaid makes sense, given the size of the federal budget deficit. Some flatly declared they would not consider it.

In Florida, where Gov. Rick Scott reversed his position and on Wednesday announced his support for expanding Medicaid, proponents say that doing so will not only save lives, but also create jobs and stimulate the economy. Similar arguments have swayed the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who in recent months have announced their intention to expand Medicaid.

The shift has delighted supporters of the law.

“I think this means the dominoes are falling,” said Ronald F. Pollack, the executive director of Families USA, a consumer group. “The message is, ‘Even though I may not have supported and even strongly opposed the Affordable Care Act, it would be harmful to the citizens of my state if I didn’t opt into taking these very substantial federal dollars to help people who truly need it.’ ”

 Nationwide, Medicaid covers 60 million people, most of them low-income or disabled. The Congressional Budget Office has estimated that 17 million more people could be enrolled if all states took the expansion option. So far, 22 states have said they will expand the program, 17 have opted against it, and 11 have not yet decided, according to Avalere Health, a consulting firm.

Some Republican governors remain firmly opposed to the expansion of Medicaid. In her State of the State address, Gov. Nikki R. Haley said, “As long as I am governor, South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion.”

Gov. Rick Perry affirmed that “Texas will not expand Medicaid” and said he was proud that Texas did not follow other states “scrambling to grab every tax dollar they can.”

The change of heart for some Republican governors has come after vigorous lobbying by health industry players, particularly hospitals. Hospital associations around the country signed off on Medicaid cuts under the health care law on the assumption that their losses would be more than offset by new paying customers, including many insured by Medicaid.

Politics could also be a factor in states where Republican governors have decided to expand Medicaid. Mr. Obama won all of those states except Arizona and North Dakota in last year’s election, a fact that may have influenced several of the governors’ decisions. Some of the seven are also up for re-election next year.

Religious leaders have added a moral dimension to the campaign in some states. The Roman Catholic bishops of Salt Lake City and Little Rock, Ark., for example, have urged state officials to expand Medicaid.

The Obama administration has tried to win over skeptical state officials by offering new flexibility to manage Medicaid as they like. On the same day that he agreed to expand Medicaid in Florida, Mr. Scott got federal permission to move more Medicaid beneficiaries into private managed care plans.

Mr. Scott’s support for expanding Medicaid is particularly significant — Florida is the fourth most populous state — and surprising. A onetime hospital executive, he has been among the most strident critics of the health care law, and his opposition to it was a cornerstone of his 2010 campaign for governor.

The battle is not over, however. In Florida, as in many other states, expansion is subject to approval by the Legislature, whose Republican leaders have expressed misgivings. The legislative session begins next month, and advocates say they plan to press ahead with a lobbying campaign.

Leah Barber-Heinz, a spokeswoman for Florida Chain, a health advocacy group, said it was trying to inform lawmakers and the public about who would benefit from an expansion of Medicaid. More than one-fifth of Florida residents, roughly 4 million of 19 million people, lack health insurance.

“There are so many misperceptions about the uninsured,” Ms. Barber-Heinz said. “So we’re trying to show faces of who would be impacted: people who have been hit by the recession, people who have been laid off, educated people, people who own homes.”

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The Lede: Syrian Television's Most Outraged Bystander

Last Update, 4:47 p.m. In the aftermath of a deadly bombing in Damascus on Thursday, a man emerged from a small knot of bystanders crowded around a camera crew from Syrian state television to vent his anger at the foreign Islamist fighters he held responsible. “We the Syrian people,” he said, “place the blame on the Nusra Front, the Takfiri oppressors and armed Wahhabi terrorists from Saudi Arabia that are armed and trained in Turkey.”

A report on Thursday’s bombing in Damascus from Syrian state television’s YouTube channel.

Pointing at the ruined street near the headquarters of President Bashar al-Assad’s ruling Baath Party, the man described the location as “a civilian place — a mosque, an elementary school, the homes of local families.”

Watching a copy of the report online, Rime Allaf, a Syrian writer monitoring the conflict from Vienna, noticed that this man on the street, whose views so closely echoed those of the Syrian government, had a very familiar face. That is because, as opposition activists demonstrated last June, the same man had already appeared at least 18 times in the forefront or background of such reports since the start of the uprising.

Man who appears on #Syria TV as “innocent bystander” with every Damascus car bomb has again appeared today. http://t.co/PmPRhzUUBN

— Rime Allaf (@rallaf) 21 Feb 13

After she posted a screenshot of the man’s latest appearance, Ms. Allaf observed on Twitter that “it would be funny if there weren’t so many victims of Syria regime terrorism!”

As The Lede noted last year, the man was even featured in two reports the same day during a small pro-Assad rally in Damascus.

Two pro-Assad television channels in Syria interviewed the same man on the street at a rally in July 2012.

Mocking the dark comedy of government-run channels recycling the same die-hard Assad supporter in so many reports, activists put together several video compilations of his appearances in the state media. The most comprehensive, posted online last June, featured excerpts from 18 reports.

A compilation of Syrian state media reports featuring the same Assad supporter again and again.

Another highlight reel, uploaded to YouTube 13 months ago by a government critic, showed that after the man had spoken at least five times on state-run television, he appeared in the background of a BBC report wearing a military uniform.

A man who is frequently interviewed on Syrian state television in civilian dress appeared in the background of a BBC report wearing a military uniform.

As longtime readers of The Lede may recall, during the dispute over Iran’s 2009 presidential election, opposition bloggers noticed that one particularly die-hard supporter of Mahmoud Ahmadinejad also appeared again and again and again in photographs of pro-government rallies.

While there is no way to determine just who is responsible for Syrian television’s frequent interviews with this same man on the street, there is some evidence that Iran has advised Syria on how to report bombings on state television.

Last year, when The Guardian published a trove of hacked e-mails taken from the in-boxes of Syrian officials, one message forwarded to the president appeared to include advice from Iranian state television’s bureau chief in Damascus on what his Syrian counterparts should report after bombings. That e-mail, from Hussein Mortada, a Lebanese journalist who runs coverage of Syria for the Iranian government’s satellite news channels, complained that the government was not heeding directions he had received “from Iran and Hezbollah,” the Lebanese militant group, about who Syria should blame for bomb attacks. “It is not in our interest to say that Al Qaeda is behind” every bombing, Mr. Mortada wrote, “because such statements clear the U.S. administration and the Syrian opposition of any responsibility.”

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A 1-2 knockout: McIlroy, Woods lose in Match Play

MARANA, Ariz. (AP) — Rory McIlroy and Tiger Woods knocked out in the first round of the Match Play Championship? Not many would have given that a snowball's chance in the desert.

Almost as surprising as the freakish snowstorm on Dove Mountain was the sight of golf's two biggest stars heading to the airport, only the second time in the 15-year history of this wild tournament that No. 1 and No. 2 didn't last more than a day.

Shane Lowry of Ireland chipped in twice and drilled a fairway metal to 3 feet to seize control, and then knocked out McIlroy with a bunker shot to 4 feet to save par on the final hole. Just as the shock was wearing off, Charles Howell III came up with kind of shots he's used to seeing Woods make in the clutch — a wedge that stopped inches from the cup on the 15th hole, and a 25-foot birdie on the 16th that carried him to a 2-and-1 victory.

"It's definitely a day I'm going to remember," said Lowry, the third player in the last four years to eliminate the No. 1 seed in the opening round.

"I had nothing to lose," Howell said.

The biggest loser Thursday might have been NBC Sports, which lost the two biggest draws.

Not even Phil Mickelson can save the day. He's not playing this year.

Howell had not faced Woods in match play since he was 17 and lost to him in the third round of the 1996 U.S. Amateur. He said he had never beaten him even in the dozens of casual games they played over the years at Isleworth before Woods moved away to south Florida.

What a time to change that losing streak.

Howell, who qualified for this World Golf Championship for the first time in five years, played a fabulous round in cold conditions. They matched scores 10 times in 14 holes before Howell came through with back-to-back birdies.

"In this format, match play is crazy," Howell said. "He's Tiger Woods. I was lucky to hang in there."

The final matches were played in near darkness, and they could have stopped after 15 holes. Woods wanted to play on, even though Howell had the momentum. Woods was 2 under for the day, and neither of them made a bogey.

"We both played well," Woods said. "He made a couple of more birdies than I did. He played well, and he's advancing."

McIlroy, the No. 1 player in the world, built a 2-up lead early in the match until Lowry rallied and grabbed the momentum by chipping in for birdie on the par-5 11th to avoid falling behind, chipping in from behind the 12th green for birdie and then ripping a fairway metal to within a few feet for a conceded eagle on the 13th to go 2 up.

Lowry missed a short par putt on the 14th, only for McIlroy to give away the next hole with a tee shot into the desert and a bunker shot that flew over the 15th green and into a cactus. But the two-time major champion hung tough, coming up with a clutch birdie on the 16th to stay in the game.

McIlroy nearly holed his bunker on the 18th, and Lowry followed with a steady shot out to 4 feet and calmly sank the putt.

"Deep down, I knew I could beat him," Lowry said. "There's a reason I'm here, and this is match play."

For McIlroy, more questions are sure to follow him to Florida for his road to the Masters. He now has played only 54 holes in the first two months of the season, missing the cut in Abu Dhabi and losing in the first round at Dove Mountain.

"You want to try and get as far as you can, but I guess that's match play," McIlroy said. "I probably would have lost by more if I had played someone else in the field. It wasn't a great quality match. But it would have been nice to get through and just get another day here and another competitive round under my belt."

The only other time the top two seeds lost in the opening round was in 2002, when Woods and Phil Mickelson lost at La Costa.

Luke Donald nearly made it the top three seeds except for a clutch performance. He holed a 10-foot birdie putt to halve the 17th hole and stay tied with Marcel Siem of Germany. Donald then birdied the 18th from 7 feet to win the match.

Louis Oosthuizen, the No. 4 seed, rallied to get past Richie Ramsay of Scotland.

The opening round was halted Wednesday after 3½ hours because of a freak snowstorm that covered Dove Mountain with nearly 2 inches. It continued to snow at times overnight, and it took nearly five hours to clear snow from the golf course for the tournament to resume.

Turns out, snow wasn't the only surprise.

"I had to play extremely well to have a chance, and I still kept waiting for that Tiger moment," Howell said.

It never came.

Woods missed short birdie chances at the 10th and 11th, but the real damage came on the 15th when he went long of the green with a wedge in hand. Howell also missed a pair of short putts on the back nine, but he came up big with the putt on the 16th.

"Really, I didn't even realize I was 2 up with two to go until I got right to the tee on 17, and it actually threw me for a bit because I never maybe was really in the moment and didn't quite realize how things were," Howell said. "And as far as beating Tiger Woods, it shows you that match play is crazy. I did have to play a good round. But yeah, it's a bit hard to believe I'm sitting here today."

Howell and Lowry will have to wait until Friday to find out their opponents.

Carl Pettersson was 1 up on Rickie Fowler through 17 holes when they stopped because of darkness. The winner gets Lowry, who will be fighting some history. Of the previous three players to beat the No. 1 seed in the opening round, all of them lost in the second round.

Howell gets either Gonzalo Fernandez-Castano or Francesco Molinari, who were all square through 15 holes.

In other matches:

— Ernie Els lost in the opening round for the sixth time. He missed a 3-foot par putt on the 16th hole that would have given him the lead, and he missed a 5-foot par putt on the 18th hole to lose to Fredrik Jacobson.

— Russell Henley, two months into his rookie season, defeated the hottest player in the field when he took down Charl Schwartzel, who had won twice and finished no worse than fifth in his last six tournaments worldwide.

— Rafael Cabrera Bello beat Lee Westwood in 19 holes after Westwood missed a 6-foot par putt on the last hole.

The opening round of the Match Play is typically the best day in golf. This one took two days, and it was unlike any other.

Nearly 2 inches of snow covered Dove Mountain on Wednesday, and with more snow overnight, nothing had changed when players began arriving Thursday morning. There already was a two-hour delay when they arrived.

"There was a guy building a snowman this morning at 8, and they said they were going off at 10:30," Henley said. "I figured it was going to be awhile"

No one had an easier day than Bo Van Pelt.

Having won six straight holes to go 5 up before snow suspended play on Wednesday, Van Pelt finally got back on the golf course and struck all of two shots — an 8-iron and a 45-foot putt. He won the 13th hole with a par to complete a 6-and-5 win over John Senden of Australia.

And then there was Sergio Garcia. He was one putt away from winning when play stopped Wednesday. He three-putted from 12 feet to lose the hole, and on the 18th hole, Thongchai Jaidee made a 6-foot birdie to send the match into overtime.

On the first extra hole, Garcia removed his cap and was putting his golf ball and tees in the bag as Jaidee settled over a 10-foot birdie. The putt ran around the back edge of the cup, giving Garcia life. He made birdie on the par-5 second hole to win in 20 holes.

So instead of hitting one shot Thursday, he had to play 19 of them. Garcia's was the first match of the tournament. It took him about 30 hours to finish.

"It's weirdness, I guess," Garcia said. "I guess at the end of the day, I was pleased to get through."

That's one thing McIlroy and Woods can't say.

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Sheryl Sandberg, ‘Lean In’ Author, Hopes to Spur Movement

Before Sheryl Sandberg, the chief operating officer of Facebook, started to write “Lean In,” her book-slash-manifesto on women in the workplace, she reread Betty Friedan’s “The Feminine Mystique.” Like the homemaker turned activist who helped start a revolution 50 years ago, Ms. Sandberg wanted to do far more than sell books.

Todd Heisler/The New York Times

Sheryl Sandberg, the chief operating officer of Facebook, is trying to create her own version of consciousness-raising groups.

Ms. Sandberg, whose ideas about working women have prompted both enthusiasm and criticism, is attempting nothing less than a Friedan-like feat: a national discussion of a gender-problem-that-has-no-name, this time in the workplace, and a movement to address it.

When her book is published on March 11, accompanied by a carefully orchestrated media campaign, she hopes to create her own version of the consciousness-raising groups of yore: “Lean In Circles,” as she calls them, in which women can share experiences and follow a Sandberg-crafted curriculum for career success. (First assignment: a video on how to command more authority at work by changing how they speak and even sit.)

“I always thought I would run a social movement,” Ms. Sandberg, 43, said in an interview for “Makers,” a new documentary on feminist history.

And yet no one knows whether women will show up for Ms. Sandberg’s revolution, a top-down affair propelled by a fortune worth hundreds of millions on paper, or whether the social media executive can form a women’s network of her own. Only a single test “Lean In Circle” exists. With less than three weeks until launch — which will include a spread in Time magazine and splashy events like a book party at Mayor Michael R. Bloomberg’s home — organizers cannot say how many more groups may sprout up.

Even her advisers acknowledge the awkwardness of a woman with double Harvard degrees, dual stock riches (from Facebook and Google, where she also worked), a 9,000-square-foot house and a small army of household help urging less fortunate women to look inward and work harder. Will more earthbound women, struggling with cash flow and child care, embrace the advice of a Silicon Valley executive whose book acknowledgments include thanks to her wealth adviser and Oprah Winfrey?

“I don’t think anyone has ever tried to do this from anywhere even close to her perch,” said Debora L. Spar, president of Barnard College, who invited Ms. Sandberg to deliver a May 2011 commencement address about gender in the workplace that caught fire online. (Ms. Sandberg, who will grant her first book interview to the CBS program “60 Minutes,” declined to comment for this article.)

Despite decades of efforts, and some visible exceptions, the number of top women leaders in many fields remains stubbornly low: for example, 21 of the current Fortune 500 chief executives are women. In her book, to be published by Knopf, Ms. Sandberg argues that is because women face invisible, even subconscious, barriers in the workplace, and not just from bosses. In her view, women are also sabotaging themselves. “We hold ourselves back in ways both big and small, by lacking self-confidence, by not raising our hands, and by pulling back when we should be leaning in,” she writes, and the result is that “men still run the world.”

Ms. Sandberg wants to take women through a collective self-awareness exercise. In her book, she urges them to absorb the social science showing they are judged more harshly and paid less than men; resist slowing down in mere anticipation of having children; insist that their husbands split housework equally; draft short- and long-term career plans; and join a “Lean In Circle,” which is half business school and half book club.

The project has the feel of a social experiment: what if women at major corporations could review research on how to overcome gender barriers, along with instruction on skills like negotiation and communication? Will working women, already stretched thin, attend nighttime video lectures on “Unconditional Responsibility” and “Using Stories Powerfully”? The instructions for the gatherings, provided to The New York Times by an outside adviser to the project, are precise, down to membership requirements (participants can miss no more than two monthly meetings per year) and the format (15-minute check-in, 3 minutes each for personal updates, a 90-minute presentation, then discussion).

Ms. Sandberg has asked a wide array of women to contribute their success stories to her new Web site. (Jill Abramson, the executive editor of The Times, wrote an essay, and the newspaper is one of many corporations to sign on to the project.) The written requests ask for positive endings, suggesting that tales closing with missed promotions or broken marriages are unwelcome. Hoping to reach beyond an elite audience, Ms. Sandberg and her foundation joined forces with Cosmopolitan magazine, which is publishing a 40-page supplement to its April issue devoted to Ms. Sandberg’s ideas, and plan to spread her message to community colleges, according to those involved in the project.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Michael Cooper contributed reporting from New York.

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World Briefing | Africa: Nigeria: Security Service Says It Halted Group Watching Israeli and U.S. Targets

Nigeria’s State Security Service said Wednesday that it broke up what it characterized as a terrorist group, backed by “Iranian handlers,” that wanted to gather intelligence about locations frequented by Americans and Israelis. The service said it arrested three suspects, but one remained at large. A spokeswoman, Marilyn Ogar, who was reading from a statement, identified the head of the group as Abdullahi Mustaphah Berende, a leader of a local Shiite sect. “He personally took photographs of the Israeli culture center in Ikoyi, Lagos,” she said. The group also conducted surveillance on USAID and the United States Peace Corps, she said. Ms. Ogar did not take questions.

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The Trade: A Revolving Door in Washington With Spin, but Less Visibility

Obsess all you’d like about President Obama’s nomination of Mary Jo White to head the Securities and Exchange Commission. Who heads the agency is vital, but important fights in Washington are happening in quiet rooms, away from the media gaze.

After a widely praised stint as a tough United States attorney, Ms. White spent the last decade serving so many large banks and investment houses that by the time she finishes recusing herself from regulatory matters, she may be down to overseeing First Wauwatosa Securities.

Ms. White maintains she can run the S.E.C. without fear or favor. But the focus shouldn’t be limited to whether she can be effective. For lobbyists, the real targets are regulators and staff members for lawmakers.

Ms. White, at least, will have to sit for Congressional testimony, answer occasional questions from the media and fill out disclosure forms. Staff members, however, work in untroubled anonymity for the most part. So, while everyone knows there’s a revolving door — so naïve to even bring it up! — few realize just how fluidly it spins.

Take what happened late last month as Washington geared up for more fights about the taxing, spending and the deficit. The Senate majority leader, Harry Reid, Democrat of Nevada, decided to bolster his staff’s expertise on taxes.

So on Jan. 25, Mr. Reid’s office announced that he had appointed Cathy Koch as chief adviser to the majority leader for tax and economic policy. The news release lists Ms. Koch’s admirable and formidable experience in the public sector. “Prior to joining Senator Reid’s office,” the release says, “Koch served as tax chief at the Senate Finance Committee.”

It’s funny, though. The notice left something out. Because immediately before joining Mr. Reid’s office, Ms. Koch wasn’t in government. She was working for a large corporation.

Not just any corporation, but quite possibly the most influential company in America, and one that arguably stands to lose the most if there were any serious tax reform that closed corporate loopholes. Ms. Koch arrives at the senator’s office by way of General Electric.

Yes, General Electric, the company that paid almost no taxes in 2010. Just as the tax reform debate is heating up, Mr. Reid has put in place a person who is extraordinarily positioned to torpedo any tax reform that might draw a dollar out of G.E. — and, by extension, any big corporation.

Omitting her last job from the announcement must have merely been an oversight. By the way, no rules prevent Ms. Koch from meeting with G.E. or working on issues that would affect the company.

The senator’s office, which declined to make Ms. Koch available for an interview, says that she will support the majority leader in his efforts to close corporate tax loopholes. His office said in a statement that the senator considered her knowledge of the private sector to be an asset and that she complied with “all relevant Senate ethics rules and disclosures.”

In a statement, the senator’s spokesman said, “The impulse in some quarters to reflexively cast suspicion on private sector experience is part of what makes qualified individuals reluctant to enter public service.”

Over in bank regulatory land, meanwhile, January was playing out like a Beltway remake of “Freaky Friday.”

Julie Williams, chief counsel for the Office of the Comptroller of the Currency and a major friend of the banks for years, had been recently shown the door by Thomas J. Curry, the new head of the regulator. Banking reform advocates took that to be an omen that a new era might be dawning at the agency, which has often been a handmaiden to large banks.

Ms. Williams, of course, landed on her feet. She’s now at the Promontory Financial Group, a classic Washington creature that is a private sector mirror image of a regulatory body. Promontory is the Shadow O.C.C. The firm was founded by a former head of the agency, Eugene A. Ludwig, and if you were to walk down the halls swinging a copy of the Volcker Rule, you would be sure to hit a former O.C.C. official. Promontory says only about 5 percent of its employees come from the O.C.C., but concedes that more than a quarter are former regulators.

Promontory, as the firm explains on its Web site, “excels at helping financial companies grapple with and resolve critical issues, particularly those with a regulatory dimension.” But it plays for the other team, too, by helping the O.C.C. put into effect regulatory reviews. The dreary normality of this is a Washington scandal in the Michael Kinsley sense: a perfectly legal one.

Promontory, which demurred on a request to talk with Ms. Williams, has a different view. The firm doesn’t lobby or help in litigation. It argues that after banks stop fighting regulators and lobbying against rules, then they come to Promontory to figure out how to fix their problems and comply.

“We are known in the industry as the tough-love doctors,” said Mr. Ludwig, the chief executive of Promontory. “I am deeply committed to financial stability, and the only way to have stability is to do the right thing in both the spirit and letter of the law.”

Hmm. Remember the Independent Foreclosure Review, the program that the O.C.C. and other federal bank regulators trumpeted as the largest effort to compensate victims of big banks’ foreclosure abuses? As my colleague at ProPublica, Paul Kiel, detailed last year, that review involved consultants like Promontory essentially letting banks decide who was victimized. How well did that work? So well that the regulators had to scuttle the program because it hadn’t given one red cent to homeowners but somehow, I don’t know how, managed to send more than $1.5 billion to consultants — including Promontory.

Promontory maintains that it complied with the conditions set out by the O.C.C. And the review was replaced by a settlement, which the regulators say will compensate victims — though the average payout is small beer.

Who, exactly, makes the rules at the O.C.C.? I mentioned “Freaky Friday.” That’s because at the agency, Ms. Williams is being replaced by Amy Friend. And where is Ms. Friend coming from? Wait for it … Promontory. In March, maybe they’ll do the switcheroo back.

The O.C.C. didn’t make Ms. Friend available but said that her “talent, integrity and commitment to public service are beyond reproach” and would be subject to the rule requiring her to recuse herself for a year on matters specifically relating to her former employer.

I spoke with people who said she was a smart and dedicated public servant, an expert on the Dodd-Frank Act who can help complete the scandalously long list of unfinished rules and expedite its adoption.

“Amy Friend is absolutely rowing in the right direction,” said a Senate staff member who worked on efforts to push for stronger financial regulation.

Let’s hope so.

But people also described Ms. Friend as pragmatic. In Washington, that’s the ultimate compliment. Sadly, that has come to mean someone who seeks compromise and never pushes for an overhaul when a quarter-measure will do.

Washington today resembles something like the end of “Animal Farm.” People move from one side of the table to the other and up and down the Acela corridor with ease. An outsider looking at a negotiating table would glance from lobbyist to staff member, from colleague to former colleague, from pig to man and from man to pig and find it impossible to say which is which.

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Well: No Consensus on Plantar Fasciitis

Phys Ed

Gretchen Reynolds on the science of fitness.

There are more charismatic-sounding sports injuries than plantar fasciitis, like tennis elbow, runner’s knee and turf toe. But there aren’t many that are more common. The condition, characterized by stabbing pain in the heel or arch, sidelines up to 10 percent of all runners, as well as countless soccer, baseball, football and basketball players, golfers, walkers and others from both the recreational and professional ranks. The Lakers star Kobe Bryant, the quarterback Eli Manning, the Olympic marathon runner Ryan Hall and the presidential candidate Mitt Romney all have been stricken.

But while plantar fasciitis is democratic in its epidemiology, its underlying cause remains surprisingly enigmatic. In fact, the mysteries of plantar fasciitis underscore how little is understood, medically, about overuse sports injuries in general and why, as a result, they remain so insidiously difficult to treat.

Experts do agree that plantar fasciitis is, essentially, an irritation of the plantar fascia, a long, skinny rope of tissue that runs along the bottom of the foot, attaching the heel bone to the toes and forming your foot’s arch. When that tissue becomes irritated, you develop pain deep within the heel. The pain is usually most pronounced first thing in the morning, since the fascia tightens while you sleep.

But scientific agreement about the condition and its causes ends about there.

For many years, “most of us who treat plantar fasciitis believed that it involved chronic inflammation” of the fascia, said Dr. Terrence M. Philbin, a board-certified orthopedic surgeon at the Orthopedic Foot and Ankle Center in Westerville, Ohio, who specializes in plantar fasciitis.

It was thought that by running or otherwise repetitively pounding their heels against the ground, people strained the plantar fascia, and the body responded with a complex cascade of inflammatory biochemical processes that resulted in extra blood and fluids flowing to the injury site, as well as enhanced pain sensitivity.

But instead of lasting only a few days and then fading, as acute inflammation usually does, the process can become chronic and create its own problems, causing tissue damage and continuing pain.

This progression is also what experts believed was happening when people developed chronic Achilles tendon pain, tennis elbow or other lingering, overuse injuries.

But when scientists actually biopsied fascia tissue from people with chronic plantar fasciitis, “they did not find much if any inflammation,” Dr. Philbin said. There were virtually none of the cellular markers that characterize that condition.

“Plantar fasciitis does not involve inflammatory cells,” said Dr. Karim Khan, a professor of family practice medicine at the University of British Columbia and editor of The British Journal of Sports Medicine, who has written extensively about overuse sports injuries.

Instead, plantar fasciitis more likely is caused by degeneration or weakening of the tissue. This process probably begins with small tears that occur during activity and that, in normal circumstances, the body simply repairs, strengthening the tissue as it does. That is the point of exercise training.

But sometimes, for unknown reasons, this ongoing tissue damage overwhelms the body’s capacity to respond. The small tears don’t heal. They accumulate. The tissue begins subtly to degenerate, even to shred. It hurts.

By and large, most sports medicine experts now believe that this is how we develop other overuse injuries, like tennis elbow or Achilles tendinopathy, which used to be called tendinitis. The suffix “itis” means inflammation. But since the injury isn’t thought to involve chronic inflammation, its name has changed.

This has not yet happened with plantar fasciitis, and may not, given what a mouthful fasciopathy would be.

The evolving medical opinions about plantar fasciitis matter, beyond nomenclature, though, because treatments depend on causes. At the moment, many physicians rely on injections of cortisone, a steroid that is both a pain reliever and anti-inflammatory, to treat plantar fasciitis. And cortisone shots do reduce the soreness. In a study published last year in BMJ, patients who received cortisone injections reported less heel pain after four months than those whose shots had contained a placebo saline solution.

But whether those benefits will last is unknown, especially if plantar fasciitis is, indeed, degenerative. In studies with people suffering from tennis elbow, another injury that is now considered degenerative, cortisone shots actually slowed tissue healing.

We need similar studies in people with plantar fasciitis, Dr. Khan said. “They have not been done.”

Thankfully, most people who develop plantar fasciitis will recover within a few months without injections or other invasive treatments, Dr. Philbin said, if they simply back off their running mileage somewhat or otherwise rest the foot and stretch the affected tissues. Stretching the plantar fascia, as well as the Achilles tendon, which also attaches to the heel bone, and the hamstring muscles seems to result in less strain on the fascia during activity, meaning less ongoing trauma and, eventually, time for the body to catch up with repairs.

To ensure that you are stretching correctly, Dr. Philbin suggests consulting a physical therapist, after, of course, visiting a sports medicine doctor for a diagnosis. Not all heel or arch pain is plantar fasciitis. And comfort yourself if you do have the condition with the knowledge that Kobe Bryant, Eli Manning and Ryan Hall have all returned to competition and Mr. Romney still runs.

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