Egypt’s President Said to Limit Scope of Judicial Decree

Tara Todras-Whitehill for The New York Times

Egyptians at a burned-out school in Cairo on Monday before the funeral of an activist who was injured in a clash and died Sunday.

CAIRO — With public pressure mounting, President Mohamed Morsi appeared to pull back Monday from his attempt to assert an authority beyond the reach of any court. His allies in the Muslim Brotherhood canceled plans for a large demonstration in his support, signaling a chance to calm an escalating battle that has paralyzed a divided nation.

After Mr. Morsi met for hours with the judges of Egypt’s Supreme Judicial Council, his spokesman read an “explanation” on television that appeared to backtrack from a presidential decree placing Mr. Morsi’s official edicts above judicial scrutiny — even while saying the president had not actually changed a word of the statement.

Though details of the talks remained hazy, and it was not clear whether the opposition or the court would accept his position, Mr. Morsi’s gesture was another demonstration that Egyptians would no longer allow their rulers to operate above the law. But there appeared little chance that the gesture alone would be enough to quell the crisis set off by his perceived power grab.

Protesters remained camped in Tahrir Square, and the opposition was moving ahead with plans for a major demonstration on Tuesday.

The presidential spokesman, Yasser Ali, said for the first time that Mr. Morsi had sought only to assert pre-existing powers already approved by the courts under previous precedents, not to free himself from judicial oversight.

He said that the president meant all along to follow an established Egyptian legal doctrine suspending judicial scrutiny of presidential “acts of sovereignty” that work “to protect the main institutions of the state.” The judicial council had said Sunday that it could bless aspects of the decree deemed to qualify under the doctrine.

Mr. Morsi had maintained from the start that his purpose was to empower himself to prevent judges appointed by former President Hosni Mubarak from dissolving the constituent assembly, which is led by his fellow Islamists of the Muslim Brotherhood’s Freedom and Justice Party. The courts have already dissolved the Islamist-led Parliament and an earlier constituent assembly, and the Supreme Constitutional Court was widely expected to rule against this one next week.

But the text of the original decree had exempted all presidential edicts from judicial review until the ratification of a constitution, not just those edicts related to the assembly or justified as “acts of sovereignty.”

Legal experts said that the spokesman’s explanations of the president’s intentions, if put into effect, would amount to a revision of the decree Mr. Morsi issued last Thursday. But lawyers said that the verbal statements alone carried little legal weight.

How the courts would apply the doctrine remained hard to predict. And Mr. Morsi’s opposition indicated it was holding out for far greater concessions, including the breakup of the whole constituent assembly.

Speaking at a news conference while Mr. Morsi was meeting with the judges, the opposition activist and intellectual Abdel Haleem Qandeil called for “a long-term battle,” declaring that withdrawal of Mr. Morsi’s new powers was only the first step toward the opposition’s goal of “the withdrawal of the legitimacy of Morsi’s presence in the presidential palace.” Completely withdrawing the edict would be “a minimum,” he said.

Khaled Ali, a human rights lawyer and former presidential candidate, pointed to the growing crowd of protesters camped out in Tahrir Square for a fourth night. “The one who did the action has to take it back,” Mr. Ali said.

Moataz Abdel Fattah, a political scientist at Cairo University, said Mr. Morsi was saving face during a strategic retreat. “He is trying to simply say, ‘I am not a new pharaoh; I am just trying to stabilize the institutions that we already have,’ ” he said. “But for the liberals, this is now their moment, and for sure they are not going to waste it, because he has given them an excellent opportunity to score.”

Read More..

Thunder dominate first half, rout Bobcats 114-69

OKLAHOMA CITY (AP) — Russell Westbrook tipped away a pass, got into the open court all by himself and then braced for a big take-off and a signature throwdown dunk. Instead, he meekly flipped the ball into the basket and grinned sheepishly at the Oklahoma City Thunder bench after the miscue.

"I really thought he was going to do something a little better than what he did, but I'll take up for him and say he slipped a little bit," said Kevin Durant, the three-time NBA scoring champion.

"But he made up for it at the end of the half."

Did he ever.

Westbrook powered home a right-handed slam to put an exclamation point on one of the most dominant first halves in NBA history, putting Oklahoma City up by 40 on its way to a 114-69 blowout of the Charlotte Bobcats on Monday night.

The 64-24 advantage was the fifth-biggest halftime lead in NBA's shot clock era and the largest since Golden State set the record with an 88-41 edge on Sacramento on Nov. 2, 1991, according to STATS.

It ended up as the biggest blowout in Bobcats history.

"We struggled to hit shots, we struggled to get good shots, we got beat on the boards. We got beat in all facets of the game," Charlotte center Brendan Haywood said. "In a game like this tonight, you just basically say they beat us in every which way possible and you bounce back and you learn from the film."

Durant scored 18 points and Westbrook had 12 points and 11 assists. The defending Western Conference champions pulled their starters after Durant's 3-pointer from the right wing made it 79-25 less than 5 minutes into the second half.

"We came out and took care of business, regardless of who the opponent is," Westbrook said. "That's a good team. They came in tonight and had won some big games.

"We just took care of business."

Rookie Jeff Taylor scored 10 points to lead Charlotte, which had shown promise with seven early wins — the same number it had last season while going 7-59 and setting an NBA record for futility.

The franchise's worst blowout previously had been a 112-68 defeat against Portland on Feb. 1.

"There hasn't been any kind of damage control to be done on this game," first-year coach Mike Dunlap said. "We kind of know that OKC is a test for us, we failed it miserably but there are other, better days ahead."

The Bobcats opened with their worst offensive quarter of the season, scoring just 12 points while committing seven turnovers on their 20 possessions, and it only got worse.

Oklahoma City broke it open with a 22-3 run, scoring the final 10 points of the first quarter and then 12 of the first 15 to start the second. Eric Maynor and Kevin Martin hit 3-pointers on consecutive possessions, and Durant followed that by setting up back-to-back two-handed dunks by Hasheem Thabeet and Nick Collison to make it 40-15 with 8:23 left before halftime.

The Thunder shot 60 percent from the field in the first half while limiting Charlotte to 22 percent and forcing 11 turnovers. The Bobcats made only 3 of 20 shots in the second quarter while getting outscored 36-12.

The biggest concern for Dunlap, though, was a 28-15 disadvantage on the boards that he said comes down to "nothing more than raw bone effort."

"We're obviously better than last year. That shows," said ex-Thunder center Byron Mullens. "But tonight, they just got our number. I don't know what else to say. They got us tonight."

Dunlap said the Bobcats are "too young to throw the tape away" and just act like the game never happened.

"You have to take it serious. You have to look at it definitely seriously and you have to take it as a learning experience," Haywood said.

The last five players on the Thunder bench played the entire fourth quarter but Charlotte still couldn't avoid the most lopsided loss in the franchise's history, despite pulling within 38 twice in the fourth quarter.

It didn't come close to the NBA record for margin of victory — from Cleveland's 148-80 rout of Miami on Dec. 17, 1991.

"You can overreact in these situations, but we need to react and respond to it, no doubt," Dunlap said.

It still wasn't a Thunder franchise record for a halftime margin. When the team was based in Seattle, the SuperSonics held a 75-31 lead at Boston on Nov. 23, 1967 — the second-largest margin in the shot clock era, which started in the 1954-55 season.

Westbrook playfully dodged giving an explanation of his open-court flub, simply taking credit for it as "two points."

About a minute and a half later he atoned for it with the last of the Thunder's 13 straight points to finish the first half.

"They was sleeping. Everybody's head turned, so I decided to go and take off," Westbrook said.

Asked whether there was any reason he slammed the ball down so hard, he gave a big grin and said: "It's a tendency. I have a tendency of dunking the ball like that. Just natural, I guess."

Notes: Oklahoma City's highest-scoring first half this season came at New Orleans on Nov. 15, when the Thunder took a 66-37 lead. ... Charlotte's Bismack Biyombo missed his second straight game with a left leg contusion. Dunlap had called him a game-time decision. Gerald Henderson (sprained left foot) and Tyrus Thomas (left calf strain) also sat out.

Read More..

Puerto Rico Races to Rescue Its Pension Fund

Puerto Rico is fighting to stay afloat in a rising sea of debt.

Its economy is sputtering. Its population is shrinking. Its recent election is disputed. Its public pension fund is perilously low on cash. The American territory has just been through a brutal five-year recession, something not experienced in the United States as a whole since the 1930s.

Desperate to raise cash, Puerto Rican officials have been selling off anything they can: two toll roads and the main airport so far.

To bring in tax revenue, they are trying to lure people out of the underground economy. Coffee shops, hairdressers, even outdoor market stalls are being required to issue printed receipts with every sale. The receipts carry a lottery number, with a chance to win cars or cash, as an incentive to get shoppers to pay the island’s 7 percent sales tax.

Though many of Puerto Rico’s problems are reminiscent of Greece’s — tax noncompliance, a stagnant economy, years of issuing long-term debt to cover short-term payments — investors have had a nearly insatiable appetite for its bonds.

But now their support is dwindling. Some big investors are pruning their holdings. That is beginning to widen the cost of borrowing for Puerto Rico relative to other states and municipalities, which are benefiting from a big decline in borrowing costs. The interest rate its 30-year bonds now pay is about 2.5 percentage points higher than other municipal borrowers’, up from a difference of just 1.5 percentage points at the beginning of 2012, according to Municipal Market Data.

The possibility of a credit downgrade also hangs in the air, something that could lead to more selling.

“There is no specific event looming on the horizon,” said Alan Schankel, a managing director at Janney Capital Markets in Philadelphia. “But it’s a problem of immense magnitude, and it’s very challenging to sit here and see how they work their way out of it.”

Puerto Rico needs to be able to issue bonds at attractive rates to cover its short-term financing needs. Perhaps more important, it has to figure out how to salvage its retirement funds. After shortchanging them for years, it now has the weakest major public pension system in America.

The main fund, which serves about 250,000 government workers, past and present, is only 6 percent funded — a small percentage of what is considered the minimum needed for a marginally healthy pension plan — and could run out of money as soon as 2014. Another fund, for about 80,000 teachers, which is 20 percent funded, will last just a few years longer if nothing is done. Police officers and teachers in Puerto Rico have opted out of Social Security and rely entirely on their pensions.

“For now, I’m not totally shaken about the possibility of the fund going broke,” said Jorge Ramón Román, a 78-year-old retired instructor for the island’s Civil Air Patrol. “But I do fear for the future, when I’ll be an even older person, more infirm and with less of a pension.”

Héctor M. Mayol Kauffman, the executive director of the pension system, said it would be impossible to cut the benefits of people who are already retired, citing court precedent.

Puerto Rican officials were racing this fall to put together a rescue plan for the pension fund. Voters, though, pushed out Gov. Luis Fortuño, who had tried austerity measures that included cutting tens of thousands of government workers along with a revamping of the fund.

They elected Alejandro García Padilla, who promised to create 50,000 new jobs in the next 18 months. But the margin was razor-thin and Mr. Fortuño has requested a recount. Mr. García Padilla’s party had dropped out of the retirement overhaul effort, but the governor-elect says he will deal with the looming pension crisis with “diligence and promptness” and has put together a task force of economists and financial advisers.

“We will not leave retired government workers stranded at a bus stop in their older years,” he said.

Since the election, yields on the island’s 30-year bonds have continued to widen.

“I don’t think that there’s a default that’s about to happen, but a default isn’t the only bad thing that can happen when you’ve got bonds,” Mr. Schankel said. Puerto Rico’s bonds are just a notch or two above junk status. If they fall to that level, at least some institutions would be forced to sell, potentially setting off a chain reaction. And individual investors could get a jolt if they saw the value of their holdings fall. Many people own Puerto Rican debt without knowing it, through their mutual funds.

“The concern is that Puerto Rico is a systemic risk to the municipal bond market because it’s so widely held,” said Robert Donahue, a managing director with Municipal Market Advisors.

Rafael Matos contributed reporting from San Juan, P.R.

Read More..

Agency Investigates Deaths and Injuries Associated With Bed Rails

Thomas Patterson for The New York Times

Gloria Black’s mother died in her bed at a care facility.

In November 2006, when Clara Marshall began suffering from the effects of dementia, her family moved her into the Waterford at Fairway Village, an assisted living home in Vancouver, Wash. The facility offered round-the-clock care for Ms. Marshall, who had wandered away from home several times. Her husband Dan, 80 years old at the time, felt he could no longer care for her alone.

Thomas Patterson for The New York Times

Gloria Black, visiting her mother’s grave in Portland, Ore. She has documented hundreds of deaths associated with bed rails and said families should be informed of their possible risks.

But just five months into her stay, Ms. Marshall, 81, was found dead in her room apparently strangled after getting her neck caught in side rails used to prevent her from rolling out of bed.

After Ms. Marshall’s death, her daughter Gloria Black, who lives in Portland, Ore., began writing to the Consumer Product Safety Commission and the Food and Drug Administration. What she discovered was that both agencies had known for more than a decade about deaths from bed rails but had done little to crack down on the companies that make them. Ms. Black conducted her own research and exchanged letters with local and state officials. Finally, a letter she wrote in 2010 to the federal consumer safety commission helped prompt a review of bed rail deaths.

Ms. Black applauds the decision to study the issue. “But I wish it was done years ago,” she said. “Maybe my mother would still be alive.” Now the government is studying a problem it has known about for years.

Data compiled by the consumer agency from death certificates and hospital emergency room visits from 2003 through May 2012 shows that 150 mostly older adults died after they became trapped in bed rails. Over nearly the same time period, 36,000 mostly older adults — about 4,000 a year — were treated in emergency rooms with bed rail injuries. Officials at the F.D.A. and the commission said the data probably understated the problem since bed rails are not always listed as a cause of death by nursing homes and coroners, or as a cause of injury by emergency room doctors.

Experts who have studied the deaths say they are avoidable. While the F.D.A. issued safety warnings about the devices in 1995, it shied away from requiring manufacturers to put safety labels on them because of industry resistance and because the mood in Congress then was for less regulation. Instead only “voluntary guidelines” were adopted in 2006.

More warnings are needed, experts say, but there is a technical question over which regulator is responsible for some bed rails. Are they medical devices under the purview of the F.D.A., or are they consumer products regulated by the commission?

“This is an entirely preventable problem,” said Dr. Steven Miles, a professor at the Center for Bioethics at the University of Minnesota, who first alerted federal regulators to deaths involving bed rails in 1995. The government at the time declined to recall any bed rails and opted instead for a safety alert to nursing homes and home health care agencies.

Forcing the industry to improve designs and replace older models could have potentially cost bed rail makers and health care facilities hundreds of million of dollars, said Larry Kessler, a former F.D.A. official who headed its medical device office. “Quite frankly, none of the bed rails in use at that time would have passed the suggested design standards in the guidelines if we had made them mandatory,” he said. No analysis has been done to determine how much it would cost the manufacturers to reduce the hazards.

Bed rails are metal bars used on hospital beds and in home care to assist patients in pulling themselves up or helping them out of bed. They can also prevent people from rolling out of bed. But sometimes patients — particularly those suffering from Alzheimer’s — can get confused and trapped between a bed rail and a mattress, which can lead to serious injury or even death.

While the use of the devices by hospitals and nursing homes has declined as professional caregivers have grown aware of the dangers, experts say dozens of older adults continue to die each year as more rails are used in home care and many health care facilities continue to use older rail models.

Since those first warnings in 1995, about 550 bed rail-related deaths have occurred, a review by The New York Times of F.D.A. data, lawsuits, state nursing home inspection reports and interviews, found. Last year alone, the F.D.A. data shows, 27 people died.

As deaths continued after the F.D.A. warning, a working group put together in 1999 and made up of medical device makers, researchers, patient advocates and F.D.A. officials considered requiring bed rail makers to add warning labels.

But the F.D.A. decided against it after manufacturers resisted, citing legal issues. The agency said added cost to small manufacturers and difficulties of getting regulations through layers of government approval, were factors against tougher standards, according to a meeting log of the group in 2000 and interviews.

Read More..

As Rebels Gain, Congo Again Slips Into Chaos

GOMA, Democratic Republic of Congo — The lights are out in most of Goma. There is little water. The prison is an empty, garbage-strewn wasteland with its rusty front gate swinging wide open and a three-foot hole punched through the back wall, letting loose 1,200 killers, rapists, rogue soldiers and other criminals.

Now, rebel fighters are going house to house arresting people, many of whom have not been seen again by their families.

“You say the littlest thing and they disappear you,” said an unemployed man named Luke.

In the past week, the rebels have been unstoppable, steamrolling through one town after another, seizing this provincial capital, and eviscerating a chaotic Congolese Army whose drunken soldiers stumble around with rocket-propelled grenades and whose chief of staff was suspended for selling crates of ammunition to elephant poachers.

Riots are exploding across the country — in Bukavu, Butembo, Bunia, Kisangani and Kinshasa, the capital, a thousand miles away. Mobs are pouring into streets, burning down government buildings and demanding the ouster of Congo’s weak and widely despised president, Joseph Kabila.

Once again, chaos is courting Congo. And one pressing question is, why — after all the billions of dollars spent on peacekeepers, the recent legislation passed on Capitol Hill to cut the link between the illicit mineral trade and insurrection, and all the aid money and diplomatic capital — is this vast nation in the heart of Africa descending to where it was more than 10 years ago when foreign armies and marauding rebels carved it into fiefs?

“We haven’t really touched the root cause,” said Aloys Tegera, a director for the Pole Institute, a research institute in Goma.

He said Congo’s chronic instability is rooted in very local tensions over land, power and identity, especially along the Rwandan and Ugandan borders. “But no one wants to touch this because it’s too complicated,” he added.

The most realistic solution, said another Congo analyst, is not a formal peace process driven by diplomats but “a peace among all the dons, like Don Corleone imposed in New York.”

Congo’s problems have been festering for years, wounds that never quite scabbed over.

But last week there was new urgency after hundreds of rebel fighters, wearing rubber swamp boots and with belt-fed machine guns slung across their backs, marched into Goma, the capital of North Kivu Province and one of the country’s most important cities.

The rebels, called the M23, are a heavily armed paradox. On one hand, they are ruthless. Human rights groups have documented how they have slaughtered civilians, pulling confused villagers out of their huts in the middle of the night and shooting them in the head.

On the other hand, the M23 are able administrators — seemingly far better than the Congolese government, evidenced by a visit in recent days to their stronghold, Rutshuru, a small town about 45 miles from Goma.

In Rutshuru, there are none of those ubiquitous plastic bags twisted in the trees, like in so many other parts of Congo. The gravel roads have been swept clean and the government offices are spotless. Hand-painted signs read: “M23 Stop Corruption.” The rebels even have green thumbs, planting thousands of trees in recent months to fight soil erosion.

“We are not a rebellion,” said Benjamin Mbonimpa, an electrical engineer, a bush fighter and now a top rebel administrator. “We are a revolution.”

Their aims, he said, were to overthrow the government and set up a more equitable, decentralized political system. This is why the rebels have balked at negotiating with Mr. Kabila, though this weekend several rebels said that the pressure was increasing on them to compromise, especially coming from Western countries.

On Sunday, rebel forces and government troops were still squared off, just a few miles apart, down the road from Goma.

The M23 rebels are widely believed to be covertly supported by Rwanda, which has a long history of meddling in Congo, its neighbor blessed with gold, diamonds and other glittering mineral riches. The Rwandan government strenuously denies supplying weapons to the M23 or trying to annex eastern Congo. Rwanda has often denied any clandestine involvement in this country, only to have the denials later exposed as lies.

Read More..

Giants end slide, rout Packers 38-10

EAST RUTHERFORD, N.J. (AP) — So much for that tired arm for Eli Manning, and that offensive slump for the New York Giants. They got it fixed in their bye week, then routed the Green Bay Packers 38-10 Sunday night.

The Packers certainly can attest to New York's turnaround following a week off. The showcase game was decided early as the Giants outscored the Packers 31-10 in the opening half. Manning reached 200 career TD passes by throwing for three scores as New York (7-4) snapped a two-game slide, ended Green Bay's five-game winning streak, and opened a two-game lead in the NFC East.

"Play like world champions," coach Tom Coughlin said. "That was the theme of our meetings this week and Saturday."

The Packers (7-4) were missing such key starters as linebacker Clay Matthews, defensive back Charles Woodson and receiver Greg Jennings, and it showed as they fell one game behind NFC North leader Chicago. After being manhandled in last season's playoffs by the Giants, who went on to win the Super Bowl, the Packers weren't much more competitive this time. Aaron Rodgers was sacked five times, including twice by Mathias Kiwanuka, who spent much of the game at defensive tackle rather than in his usual linebacker spot.

New York's balanced attack was guided by Manning, who had his first strong game in a month with 249 yards passing.

"There was no doubt he was going to come back and play well," Coughlin said. "I think the rest really helped him. ... Eli said he felt as if he was coming back for the start of the season. I was very confident he would come back and be Eli."

Ahmad Bradshaw gained a combined 119 yards and scored a touchdown. He had the first big play of the night to begin the offensive onslaught.

New York struck early with a brilliantly conceived screen pass to Bradshaw off a fake reverse to Victor Cruz. Bradshaw sped down the field before being caught at the Green Bay 2, a 59-yard pickup that led to Andre Brown's scoring run.

Brown later broke his leg; Coughlin did not say which leg after the game.

Green Bay didn't flinch, with Jordy Nelson getting behind Corey Webster in single coverage down the right sideline for a 61-yard TD reception from Rodgers.

The scoring flurry went back in the Giants' favor — and pretty much stayed there — when Manning hit Rueben Randle in the back of the end zone for a 16-yard TD. It was the first score for the rookie and Manning's first touchdown throw in four games, and he set it up with, of all things, a scramble in which he laid his shoulder into Packers cornerback Tramon Williams for a 13-yard gain.

"It sparked our sideline," Coughlin said. "It would not be the recommended way. To see him do that kind of sent the message to the rest of our team: Whatever you have to do to succeed, do it."

Webster's interception led to Lawrence Tynes' 43-yard field goal late in the first quarter for a 17-7 lead, and the Giants weren't nearly done. Manning's 9-yard connection with Cruz tied him for the club record with 199 career TD passes, and after Osi Umenyiora's strip-sack of Rodgers was recovered by Jason Pierre-Paul at the Green Bay 23, Bradshaw scored from the 13.

The 31 points were the most New York scored in a half all season and nearly equaled the 33 it scored in its two losses before the bye.

And the Giants had more offense in them. Manning threw his 200th TD pass to move ahead of Phil Simms, a 13-yarder over the middle to Hakeem Nicks, who stretched the ball over the goal line as he was tackled.

The Giants lost safety Kenny Phillips with a knee injury in the third quarter. He was making his first appearance since Week 4, when he was sidelined with a knee problem. Right tackle David Diehl sustained a stinger in the first half.

___

Online: http://pro32.ap.org/poll and http://twitter.com/AP_NFL

Read More..

Agency Investigates Deaths and Injuries Associated With Bed Rails

Thomas Patterson for The New York Times

Gloria Black’s mother died in her bed at a care facility.

In November 2006, when Clara Marshall began suffering from the effects of dementia, her family moved her into the Waterford at Fairway Village, an assisted living home in Vancouver, Wash. The facility offered round-the-clock care for Ms. Marshall, who had wandered away from home several times. Her husband Dan, 80 years old at the time, felt he could no longer care for her alone.

Thomas Patterson for The New York Times

Gloria Black, visiting her mother’s grave in Portland, Ore. She has documented hundreds of deaths associated with bed rails and said families should be informed of their possible risks.

But just five months into her stay, Ms. Marshall, 81, was found dead in her room apparently strangled after getting her neck caught in side rails used to prevent her from rolling out of bed.

After Ms. Marshall’s death, her daughter Gloria Black, who lives in Portland, Ore., began writing to the Consumer Product Safety Commission and the Food and Drug Administration. What she discovered was that both agencies had known for more than a decade about deaths from bed rails but had done little to crack down on the companies that make them. Ms. Black conducted her own research and exchanged letters with local and state officials. Finally, a letter she wrote in 2010 to the federal consumer safety commission helped prompt a review of bed rail deaths.

Ms. Black applauds the decision to study the issue. “But I wish it was done years ago,” she said. “Maybe my mother would still be alive.” Now the government is studying a problem it has known about for years.

Data compiled by the consumer agency from death certificates and hospital emergency room visits from 2003 through May 2012 shows that 150 mostly older adults died after they became trapped in bed rails. Over nearly the same time period, 36,000 mostly older adults — about 4,000 a year — were treated in emergency rooms with bed rail injuries. Officials at the F.D.A. and the commission said the data probably understated the problem since bed rails are not always listed as a cause of death by nursing homes and coroners, or as a cause of injury by emergency room doctors.

Experts who have studied the deaths say they are avoidable. While the F.D.A. issued safety warnings about the devices in 1995, it shied away from requiring manufacturers to put safety labels on them because of industry resistance and because the mood in Congress then was for less regulation. Instead only “voluntary guidelines” were adopted in 2006.

More warnings are needed, experts say, but there is a technical question over which regulator is responsible for some bed rails. Are they medical devices under the purview of the F.D.A., or are they consumer products regulated by the commission?

“This is an entirely preventable problem,” said Dr. Steven Miles, a professor at the Center for Bioethics at the University of Minnesota, who first alerted federal regulators to deaths involving bed rails in 1995. The government at the time declined to recall any bed rails and opted instead for a safety alert to nursing homes and home health care agencies.

Forcing the industry to improve designs and replace older models could have potentially cost bed rail makers and health care facilities hundreds of million of dollars, said Larry Kessler, a former F.D.A. official who headed its medical device office. “Quite frankly, none of the bed rails in use at that time would have passed the suggested design standards in the guidelines if we had made them mandatory,” he said. No analysis has been done to determine how much it would cost the manufacturers to reduce the hazards.

Bed rails are metal bars used on hospital beds and in home care to assist patients in pulling themselves up or helping them out of bed. They can also prevent people from rolling out of bed. But sometimes patients — particularly those suffering from Alzheimer’s — can get confused and trapped between a bed rail and a mattress, which can lead to serious injury or even death.

While the use of the devices by hospitals and nursing homes has declined as professional caregivers have grown aware of the dangers, experts say dozens of older adults continue to die each year as more rails are used in home care and many health care facilities continue to use older rail models.

Since those first warnings in 1995, about 550 bed rail-related deaths have occurred, a review by The New York Times of F.D.A. data, lawsuits, state nursing home inspection reports and interviews, found. Last year alone, the F.D.A. data shows, 27 people died.

As deaths continued after the F.D.A. warning, a working group put together in 1999 and made up of medical device makers, researchers, patient advocates and F.D.A. officials considered requiring bed rail makers to add warning labels.

But the F.D.A. decided against it after manufacturers resisted, citing legal issues. The agency said added cost to small manufacturers and difficulties of getting regulations through layers of government approval, were factors against tougher standards, according to a meeting log of the group in 2000 and interviews.

Read More..

Indian Prostitutes’ New Autonomy Imperils AIDS Fight

Kuni Takahashi for The New York Times

Sex workers in Mumbai’s long-established red-light district, where brothels are dwindling.

MUMBAI, India — Millions once bought sex in the narrow alleys of Kamathipura, a vast red-light district here. But prostitutes with inexpensive mobile phones are luring customers elsewhere, and that is endangering the astonishing progress India has made against AIDS.

Indeed, the recent closings of hundreds of ancient brothels, while something of an economic victory for prostitutes, may one day cost them, and many others, their lives.

“The place where sex happens turns out to be an important H.I.V. prevention point,” said Saggurti Niranjan, program associate of the Population Council. “And when we don’t know where that is, we can’t help stop the transmission.”

Cellphones, those tiny gateways to modernity, have recently allowed prostitutes to shed the shackles of brothel madams and strike out on their own. But that independence has made prostitutes far harder for government and safe-sex counselors to trace. And without the advice and free condoms those counselors provide, prostitutes and their customers are returning to dangerous ways.

Studies show that prostitutes who rely on cellphones are more susceptible to H.I.V. because they are far less likely than their brothel-based peers to require their clients to wear condoms.

In interviews, prostitutes said they had surrendered some control in the bedroom in exchange for far more control over their incomes.

“Now, I get the full cash in my hand before we start,” said Neelan, a prostitute with four children whose side business in sex work is unknown to her husband and neighbors. (Neelan is a professional name, not her real one.)

“Earlier, if the customer got scared and didn’t go all the way, the madam might not charge the full amount,” she explained. “But if they back out now, I say that I have removed all my clothes and am going to keep the money.”

India has been the world’s most surprising AIDS success story. Though infections did not appear in India until 1986, many predicted the nation would soon become the epidemic’s focal point. In 2002, the C.I.A.’s National Intelligence Council predicted that India would have as many as 25 million AIDS cases by 2010. Instead, India now has about 1.5 million.

An important reason the disease never took extensive hold in India is that most women here have fewer sexual partners than in many other developing countries. Just as important was an intensive effort underwritten by the World Bank and the Bill and Melinda Gates Foundation to target high-risk groups like prostitutes, gay men and intravenous drug users.

But the Gates Foundation is now largely ending its oversight and support for AIDS prevention in India, just as efforts directed at prostitutes are becoming much more difficult. Experts say it is too early to identify how much H.I.V. infections might rise.

“Nowadays, the mobility of sex workers is huge, and contacting them is very difficult,” said Ashok Alexander, the former director in India of the Gates Foundation. “It’s a totally different challenge, and the strategies will also have to change.”

An example of the strategies that had been working can be found in Delhi’s red-light district on Garstin Bastion Road near the old Delhi railway station, where brothels have thrived since the 16th century. A walk through dark alleys, past blind beggars and up narrow, steep and deeply worn stone staircases brings customers into brightly lighted rooms teeming with scores of women brushing each other’s hair, trying on new dresses, eating snacks, performing the latest Bollywood dances, tending small children and disappearing into tiny bedrooms with nervous men who come out moments later buttoning their trousers.

A 2009 government survey found 2,000 prostitutes at Garstin Bastion (also known as G. B.) Road who served about 8,000 men a day. The government estimated that if it could deliver as many as 320,000 free condoms each month and train dozens of prostitutes to counsel safe-sex practices to their peers, AIDS infections could be significantly reduced. Instead of broadcasting safe-sex messages across the country — an expensive and inefficient strategy commonly employed in much of the world — it encircled Garstin Bastion with a firebreak of posters with messages like “Don’t take a risk, use a condom” and “When a condom is in, risk is out.”

Surprising many international AIDS experts, these and related tactics worked. Studies showed that condom use among clients of prostitutes soared.

“To the credit of the Indian strategists, their focus on these high-risk groups paid off,” said Dr. Peter Piot, the former executive director of U.N.AIDS and now director of the London School of Hygiene and Tropical Medicine. A number of other countries, following India’s example, have achieved impressive results over the past decade as well, according to the latest United Nations report, which was released last week.

Sruthi Gottipati contributed reporting in Mumbai and New Delhi.

Read More..

White House Presses for Drone Rule Book

WASHINGTON — Facing the possibility that President Obama might not win a second term, his administration accelerated work in the weeks before the election to develop explicit rules for the targeted killing of terrorists by unmanned drones, so that a new president would inherit clear standards and procedures, according to two administration officials.

The matter may have lost some urgency after Nov. 6. But with more than 300 drone strikes and some 2,500 people killed by the Central Intelligence Agency and the military since Mr. Obama first took office, the administration is still pushing to make the rules formal and resolve internal uncertainty and disagreement about exactly when lethal action is justified.

Mr. Obama and his advisers are still debating whether remote-control killing should be a measure of last resort against imminent threats to the United States, or a more flexible tool, available to help allied governments attack their enemies or to prevent militants from controlling territory.

Though publicly the administration presents a united front on the use of drones, behind the scenes there is longstanding tension. The Defense Department and the C.I.A. continue to press for greater latitude to carry out strikes; Justice Department and State Department officials, and the president’s counterterrorism adviser, John O. Brennan, have argued for restraint, officials involved in the discussions say.

More broadly, the administration’s legal reasoning has not persuaded many other countries that the strikes are acceptable under international law. For years before the Sept. 11, 2001, attacks, the United States routinely condemned targeted killings of suspected terrorists by Israel, and most countries still object to such measures.

But since the first targeted killing by the United States in 2002, two administrations have taken the position that the United States is at war with Al Qaeda and its allies and can legally defend itself by striking its enemies wherever they are found.

Partly because United Nations officials know that the United States is setting a legal and ethical precedent for other countries developing armed drones, the U.N. plans to open a unit in Geneva early next year to investigate American drone strikes.

The attempt to write a formal rule book for targeted killing began last summer after news reports on the drone program, started under President George W. Bush and expanded by Mr. Obama, revealed some details of the president’s role in the shifting procedures for compiling “kill lists” and approving strikes. Though national security officials insist that the process is meticulous and lawful, the president and top aides believe it should be institutionalized, a course of action that seemed particularly urgent when it appeared that Mitt Romney might win the presidency.

“There was concern that the levers might no longer be in our hands,” said one official, speaking on condition of anonymity. With a continuing debate about the proper limits of drone strikes, Mr. Obama did not want to leave an “amorphous” program to his successor, the official said. The effort, which would have been rushed to completion by January had Mr. Romney won, will now be finished at a more leisurely pace, the official said.

Mr. Obama himself, in little-noticed remarks, has acknowledged that the legal governance of drone strikes is still a work in progress.

“One of the things we’ve got to do is put a legal architecture in place, and we need Congressional help in order to do that, to make sure that not only am I reined in but any president’s reined in terms of some of the decisions that we’re making,” Mr. Obama told Jon Stewart in an appearance on “The Daily Show” on Oct. 18.

In an interview with Mark Bowden for a new book on the killing of Osama bin Laden, “The Finish,” Mr. Obama said that “creating a legal structure, processes, with oversight checks on how we use unmanned weapons, is going to be a challenge for me and my successors for some time to come.”

The president expressed wariness of the powerful temptation drones pose to policy makers. “There’s a remoteness to it that makes it tempting to think that somehow we can, without any mess on our hands, solve vexing security problems,” he said.

Despite public remarks by Mr. Obama and his aides on the legal basis for targeted killing, the program remains officially classified. In court, fighting lawsuits filed by the American Civil Liberties Union and The New York Times seeking secret legal opinions on targeted killings, the government has refused even to acknowledge the existence of the drone program in Pakistan.

But by many accounts, there has been a significant shift in the nature of the targets. In the early years, most strikes were aimed at ranking leaders of Al Qaeda thought to be plotting to attack the United States. That is the purpose Mr. Obama has emphasized, saying in a CNN interview in September that drones were used to prevent “an operational plot against the United States” and counter “terrorist networks that target the United States.”

But for at least two years in Pakistan, partly because of the C.I.A.’s success in decimating Al Qaeda’s top ranks, most strikes have been directed at militants whose main battle is with the Pakistani authorities or who fight with the Taliban against American troops in Afghanistan.

In Yemen, some strikes apparently launched by the United States killed militants who were preparing to attack Yemeni military forces. Some of those killed were wearing suicide vests, according to Yemeni news reports.

“Unless they were about to get on a flight to New York to conduct an attack, they were not an imminent threat to the United States,” said Micah Zenko, a fellow at the Council on Foreign Relations who is a critic of the strikes. “We don’t say that we’re the counterinsurgency air force of Pakistan, Yemen and Somalia, but we are.”

Then there is the matter of strikes against people whose identities are unknown. In an online video chat in January, Mr. Obama spoke of the strikes in Pakistan as “a targeted, focused effort at people who are on a list of active terrorists.” But for several years, first in Pakistan and later in Yemen, in addition to “personality strikes” against named terrorists, the C.I.A. and the military have carried out “signature strikes” against groups of suspected, unknown militants.

Originally that term was used to suggest the specific “signature” of a known high-level terrorist, such as his vehicle parked at a meeting place. But the word evolved to mean the “signature” of militants in general — for instance, young men toting arms in an area controlled by extremist groups. Such strikes have prompted the greatest conflict inside the Obama administration, with some officials questioning whether killing unidentified fighters is legally justified or worth the local backlash.

Many people inside and outside the government have argued for far greater candor about all of the strikes, saying excessive secrecy has prevented public debate in Congress or a full explanation of their rationale. Experts say the strikes are deeply unpopular both in Pakistan and Yemen, in part because of allegations of large numbers of civilian casualties, which American officials say are exaggerated.

Gregory D. Johnsen, author of “The Last Refuge: Yemen, Al Qaeda and America’s War in Arabia,” argues that the strike strategy is backfiring in Yemen. “In Yemen, Al Qaeda is actually expanding,” Mr. Johnsen said in a recent talk at the Brookings Institution, in part because of the backlash against the strikes.

Shuja Nawaz, a Pakistan-born analyst now at the Atlantic Council in Washington, said the United States should start making public a detailed account of the results of each strike, including any collateral deaths, in part to counter propaganda from jihadist groups. “This is a grand opportunity for the Obama administration to take the drones out of the shadows and to be open about their objectives,” he said.

But the administration appears to be a long way from embracing such openness. The draft rule book for drone strikes that has been passed among agencies over the last several months is so highly classified, officials said, that it is hand-carried from office to office rather than sent by e-mail.

Read More..

No. 1 Notre Dame beats USC 22-13, earns title shot

LOS ANGELES (AP) — The Fighting Irish punched their ticket to Miami.

Theo Riddick rushed for 146 yards and a touchdown, Kyle Brindza kicked five field goals, and No. 1 Notre Dame secured a spot in the BCS championship game with a 22-13 victory over Southern California on Saturday night.

Everett Golson passed for 217 yards as the Irish (12-0) completed their first perfect regular season since 1988, earning a trip to south Florida on Jan. 7 to play for the storied program's first national title in 24 years.

Although they did little with flash on an electric night at the Coliseum, the Irish woke up more echoes of past Notre Dame greats with a grinding effort in this dynamic intersectional rivalry with USC (7-5), which has lost four of five.

Notre Dame's hard-nosed defense appropriately made the decisive stand in the final minutes, keeping USC out of the end zone on four plays from the Irish 1 with 2:33 to play.

"Well, that's who we are," Notre Dame coach Brian Kelly said. "It's been our defense all year. Our offense is able to manage enough points."

After spending more than a decade looking up at the Trojans, the Irish are back on top of this rivalry with two straight wins in Los Angeles. The school of Knute Rockne, the Four Horsemen and Paul Hornung has new heroes now, from inspirational linebacker Manti Te'o to Kelly, who took the Irish from unranked to start the season to No. 1 in the AP Top 25 for the first time in 19 years.

Te'o, the Heisman Trophy hopeful, had a key interception against USC and became the second Irish defender with three 100-tackle seasons — and he took particular pride in that last defensive stand, which included three straight Trojans runs resulting in nothing.

"It doesn't matter where the ball is," Te'o said. "We're going to protect the end zone at all costs."

After Brindza's school record-tying fifth field goal put the Irish up by nine points with 5:58 left, Marqise Lee caught a 53-yard pass from USC freshman Max Wittek at the Notre Dame 2.

But after USC failed on three straight runs at a defense that has allowed just 11 rushing TDs in 30 games, Wittek threw incomplete to fullback Soma Vainuku, setting off a leaping, chest-bumping celebration on the Notre Dame sideline and in the Irish sections of the sold-out Coliseum.

"They've had a great goal-line defense all year," USC coach Lane Kiffin said. "They've done that to everybody down on the goal line. ... It's just so hard to score touchdowns versus them. When the ball is on the 2-inch line, you'd think you could score touchdowns."

The grind-it-out win highlighted an unforgettable season for the Irish, who began the year with questions about their relevancy and survived some uninspiring performances and nail-biting finishes with their unbeaten record intact.

Notre Dame is likely to face an Southeastern Conference opponent in Miami, but won't know for another week which one. Alabama and Georgia play for the SSEC title in Atlanta.

With the Irish offense repeatedly stalling in the red zone against the Trojans, Brindza went five for six on field goals, even hitting a 52-yarder at the halftime gun.

Wittek passed for 186 yards with two interceptions in his first career start for the Trojans, who completed their tumble from the preseason No. 1 ranking with four losses in five games in an enormously disappointing season. Wittek filled in capably for injured Matt Barkley, but USC is headed to a lower-tier bowl in the first year after its NCAA-mandated two-year postseason ban ended.

Lee caught five passes for 75 yards, yet still broke the Pac-12 single-season receptions record established last year by teammate Robert Woods, who had seven catches for 92 yards.

Barkley watched from the sideline in a grey hoodie with a sling on his right arm after spraining his shoulder in last week's loss at UCLA. The senior and Pac-12 career passing leader won twice in South Bend during his career, but never got to face the Irish at the Coliseum, sidelined by injuries for both visits.

Barkley still ran down the Coliseum tunnel with the rest of the USC seniors for their final home game. He participated in the coin toss, but could only watch while the Irish opened the game with three clock-consuming drives resulting in 13 points.

USC's much-criticized defensive caution under assistant head coach Monte Kiffin was exploited by the Irish, with Golson patiently finding the sags in the Trojans' pass coverage for 181 yards passing in the first half. Riddick went 9 yards for a TD in the first quarter, but USC also stiffened to hold Notre Dame to field goals twice in the red zone.

Notre Dame held its 12th straight opponent without a first-quarter touchdown, but Wittek found Woods for a 9-yard score on the first play of the second quarter — just the ninth touchdown allowed by Notre Dame all season long. The Irish took a 16-10 lead to halftime when Brindza hit the second-longest field goal in Notre Dame history.

Te'o made the seventh interception of his phenomenal season when Wittek threw directly to him on USC's second play of the second half. Both teams struggled to move the ball in the third quarter, and USC settled for a field goal with 9:20 to play just a few moments after Kiffin called a timeout right before a play that ended with Lee appearing to catch a pass on the goal line.

Read More..