Kidney Donors Given Mandatory Safeguards

ST. LOUIS — Addressing long-held concerns about whether organ donors have adequate protections, the country’s transplant regulators acted late Monday to require that hospitals thoroughly inform living kidney donors of the risks they face, fully evaluate their medical and psychological suitability, and then track their health for two years after donation.

Enactment of the policies by the United Network for Organ Sharing, which manages the transplant system under a federal contract, followed six years of halting development and debate.

Meeting at a St. Louis hotel, the group’s board voted to establish uniform minimum standards for a field long regarded as a medical and ethical Wild West. The organ network, whose initial purpose was to oversee donation from people who had just died, has struggled at times to keep pace with rapid developments in donations from the living.

“There is no question that this is a major development in living donor protection,” said Dr. Christie P. Thomas, a nephrologist at the University of Iowa and the chairman of the network’s living donor committee.

Yet some donor advocates complained that the measures did not go far enough, and argued that the organ network, in its mission to encourage transplants, has a conflict of interest when it comes to safeguarding donors.

Three years ago, the network issued some of the same policies as voluntary guidelines, only to have the Department of Health and Human Services insist they be made mandatory.

Although long-term data on the subject is scarce, few living kidney donors are thought to suffer lasting physical or psychological effects. Kidney donations, known as nephrectomies, are typically done laparoscopically these days through a series of small incisions. The typical patient may spend only a few nights in a hospital and feel largely recovered after several months.

Kidneys are by far the most transplanted organs, and there have been nearly as many living donors as deceased ones over the last decade. What data is available suggests that those with one kidney typically live as long as those with two, and that the risk of a donor dying during the procedure is roughly 3 in 10,000.

But kidney transplants, like all surgery, can sometimes end in catastrophe.

In May at Montefiore Medical Center in the Bronx, a 41-year-old mother of three died when her aorta was accidentally cut during surgery to donate a kidney to her brother. In other recent isolated cases, patients have received donor kidneys infected with undetected H.I.V. or hepatitis C.

Less clear are any longer-term effects on donors. Research conducted by the United Network for Organ Sharing shows that of roughly 70,000 people who donated kidneys between late 1999 and early 2011, 27 died within two years of medical causes that may — or may not — have been related to donation. For a small number of donors, their remaining kidney failed, and they required dialysis or a transplant.

The number of living donors — 5,770 in 2011 — has dropped 10 percent over the last two years, possibly because the struggling economy has made it difficult for prospective donors to take time off from work to recuperate. With the national kidney waiting list now stretching past 94,000 people, and thousands on the list dying each year, transplant officials have said they must improve confidence in the system so more people will donate.

The average age of donors has been rising, posing additional medical risks. And new ethical questions have been raised by the emergence of paired kidney exchanges and transplant chains started by good Samaritans who give an organ to a stranger.

Brad Kornfeld, who donated a kidney to his father in 2004, told the board that it had been impossible to find good information about what to expect, leaving him to search for answers on unreliable Internet chat rooms. He said he had almost backed out.

“If information is power,” said Mr. Kornfeld, a Coloradan who serves on the living donor committee, “the lack of information is crippling.”

Under the policies approved this week, the organ network will require hospitals to collect medical data, including laboratory test results, on most living donors to study lasting effects. Results must be reported at six months, one year and two years.

Similar regulations have been in place since 2000, but they did not require blood and urine testing, and hospitals were allowed to report donors who could not be found as simply lost.

That happened often. In recent years, hospitals have submitted basic clinical information — like whether donors were alive or dead — for only 65 percent of donors and lab data for fewer than 40 percent, according to the organ network. Although the network holds the authority, no hospital has ever been seriously sanctioned for noncompliance.

“It’s time we put some teeth into our policy,” said Jill McMaster, a board member from Tennessee.

By 2015, transplant programs will have to report thorough clinical information on at least 80 percent of donors and lab results on at least 70 percent. The requirements phase in at lower levels for the next two years.

Dr. Stuart M. Flechner of the Cleveland Clinic, the chairman of a coalition of medical societies that made recommendations to the organ network, said 9 of 10 hospitals would currently not meet the new requirement.

Donna Luebke, a kidney donor from Ohio who once served on the organ network’s board, said the new standards would matter only if enforcement were more rigorous. She noted that the organization was dominated by transplant doctors: “UNOS is nothing but the foxes watching the henhouse,” she said.

Another of the new regulations prescribes in detail the medical and psychological screenings that hospitals must conduct for potential donors. It requires automatic exclusion if the potential donor has diabetes, uncontrolled hypertension or H.I.V., among other conditions.

The new policies also require that hospitals appoint an independent advocate to counsel and represent donors, and that donors receive detailed information in advance about medical, psychological and financial risks.

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World Briefing | Africa: South Africa: Stolen Paintings Believed to Be Found

An informer’s tip led the South African police on Tuesday to a private cemetery in Port Elizabeth where they found four paintings hundreds of miles from the Pretoria Art Museum, from which they were stolen on Sunday, the authorities said. One oil painting of a South African township streetscape by Gerard Sekoto, worth about $800,000, remains missing. Brig. Marinda Mills of the South African Police Service said the authenticity of the paintings was being verified. No arrests have been made. The robbers posed as eager students with their teacher, paying for tickets and asking a curator to show them specific paintings. Then they pulled out pistols, tied up the curator and fled with the works they had asked about, officials said.

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AP source: Marlins trade 3 stars to Blue Jays

MIAMI (AP) — The Miami Marlins' spending spree a year ago didn't work, so now they're trying another payroll purge, shedding some of their biggest stars and their multimillion-dollar salaries in one blockbuster deal.

Rebranded in a new ballpark at the start of 2012, the Marlins were up to their old ways Tuesday, swapping high-priced talent for top prospects. Miami traded All-Star shortstop Jose Reyes, left-hander Mark Buehrle and ace right-hander Josh Johnson to the Toronto Blue Jays, a person familiar with the agreement said.

The person confirmed the trade to The Associated Press on condition of anonymity because the teams weren't officially commenting. The person said the trade sent several of the Blue Jays' best young players to Miami.

The stunning agreement came less than a year after the Marlins added Reyes, Buehrle and closer Heath Bell in an uncharacteristic $191 million spending binge as they moved into a new ballpark. The acquisitions raised high hopes, but the Marlins instead finished last in the NL East.

The latest paring of salary actually began in July, when the Marlins parted with former NL batting champion Hanley Ramirez, second baseman Omar Infante and right-hander Anibal Sanchez, among others. Bell, the team's high-profile bust, was traded to Arizona last month.

Under owner Jeffrey Loria, long the target of fan acrimony, the Marlins have usually been among baseball's thriftiest teams. Management pledged that would change with the new ballpark, but team officials were disappointed with attendance in 2012, and revenue fell far short of their projections.

Even so, the blockbuster deal came as a shock. The players involved must undergo physicals before the trade becomes final.

Giancarlo Stanton, the Marlins' precocious slugger, wasn't involved in the deal but wasn't happy about it.

Stanton said he was mad about the trade "Plain & Simple," he tweeted shortly after the news broke.

The housecleaning was also the subject of much mirth on Twitter.

"Good trade, I think we won it," tweeted FakeSamson, a site that mocks Marlins president David Samson.

Toronto star Jose Bautista had a different interpretation.

"Its a good day to be a bluejay!" he tweeted.

The swap was easier for the Marlins to swing because of their longstanding policy of refusing to include no-trade clauses in contracts.

The deal gave an immediate boost to the Blue Jays, who have not reached the playoffs since winning their second consecutive World Series in 1993. Toronto went 73-89 this season and finished fourth in the AL East for the fourth straight year, again falling short in a division that includes big spenders.

The Marlins changed their name a year ago but failed to change their losing ways, and instead of contending for a playoff berth, they finished 69-93, their worst record since 1999.

The Marlins drew more than 2.2 million fans but had projected attendance of nearly 3 million. Team officials blamed the difference in part on manager Ozzie Guillen's laudatory comments early in the year about former Cuban leader Fidel Castro, which antagonized a large segment of an already-small fan base.

Guillen was fired after only one season with the team and replaced this month by the Marlins' former backup catcher, Mike Redmond.

President of baseball operations Larry Beinfest hinted at a big change in direction less than two weeks ago.

"We've kind of lost our Marlins way," he said. "The real Marlins way was we always outperformed our challenges. Whatever our challenges were, whether it was playing in a football stadium or weather or a lack of fans, or lack of revenue for that matter, we always found a way to outperform our challenges."

It now appears management will field a team with the expectation players will outperform their contracts, which was the franchise model for most of the past decade. The roster shake-up during the season reduced the payroll to $90.3 million from $112 million on opening day, and it now could be dramatically lower next season.

Reyes has $96 million left on a deal that expires in 2018. Buehrle has $52 million remaining on a deal that expires in 2015.

While the team was a disappointment, newcomers Buehrle and Reyes played up to expectations. Buehrle went 13-13 with a 3.74 ERA and topped 200 innings for the 12th year in a row. Reyes hit .287 with 40 steals in 160 games.

Johnson, who led the NL in ERA in 2010, went 8-14 this year with a 3.81 ERA. He was limited to nine starts in 2011 because of right shoulder inflammation.

In their 20 seasons the Marlins have reached the postseason only twice, as wild-card teams in 1997 and 2003. Both times they won the World Series.

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At Microsoft, Sinofsky Seen as Smart but Abrasive

On a warm night in late October, Steven Sinofsky stood on a platform in New York’s Times Square, smiling as a huge crowd roared at the unveiling of a Microsoft retail store, where Windows 8 and the company’s new Surface tablet were about to go on sale.

Less than three weeks later, Mr. Sinofsky — who, as the head of Windows, was arguably the second-most important leader at Microsoft — suddenly left the company. His abrasive style was a source of discord within Microsoft, and he and Steven A. Ballmer, Microsoft’s chief executive, agreed that it was time for him to leave, according to a person briefed on the situation who was not authorized to speak publicly about it.

Mr. Sinofsky was widely admired for his effectiveness in running one of the biggest and most important software development organizations on the planet. But his departure, which Microsoft announced late on Monday, parallels in many respects that of Scott Forstall, the headstrong former head of Apple’s mobile software development, who was fired by Apple’s chief executive, Timothy D. Cook, in late October.

Both cases underscore a quandary that chief executives sometimes face: when do the costs of keeping brilliant leaders who cannot seem to get along with others outweigh the benefits?

The tipping point that led to Mr. Sinofsky’s departure came after an accumulation of run-ins with Mr. Ballmer and other company leaders, rather than a single incident, according to interviews with several current and former Microsoft executives who declined to be named discussing internal matters.

One example of the kind of behavior that hurt Mr. Sinofsky’s standing at the company occurred this year at a two-day retreat for Microsoft’s senior executives at the Semiahmoo resort on the coast just below the Canadian border in Washington State. At the meeting, Microsoft’s various division heads were expected to make presentations on their businesses, answer questions and remain to hear their peers repeat the exercise.

When Mr. Sinofsky stood on the first day to speak about the Windows division, he told the group he had not prepared a presentation, and if they wanted to catch up on the progress of Windows 8, they could read his company blog, where he publicly chronicled the software’s development. He answered questions from the audience and then left the resort, while his colleagues remained until the next day, according to multiple people who were present.

Mr. Sinofsky’s early exit and halfhearted presentation were widely noted by his colleagues, irking even his admirers in the company. “He lost a lot of support,” one attendee said.

It wasn’t until this Monday, though, that Mr. Sinofsky and Mr. Ballmer both decided it would be best if Mr. Sinofsky left. Bill Gates, Microsoft’s chairman, supported the move, a person briefed on the matter said. Mr. Sinofsky served as a technical assistant to Mr. Gates in the 1990s.

In an e-mail to Microsoft employees, Mr. Sinofsky said the decision to leave “was a personal and private choice.” Many surprised Microsoft insiders noted that Mr. Sinofsky’s departure was immediate, an unusual arrangement for someone with a 23-year track record at the company. A Microsoft spokesman, Frank Shaw, said Mr. Sinofsky was not available to comment.

Although Mr. Ballmer grew increasingly impatient with Mr. Sinofsky throughout the year, he held back from taking any action earlier to avoid disrupting the release of Windows 8, the most important product Microsoft has unveiled in years, a person with knowledge of his thinking said.

The final decision could not have come lightly. Although many people at Microsoft viewed him as a ruthless corporate schemer, Mr. Sinofsky ran the highly complex organization responsible for Windows as a disciplined army that met deadlines, and he was respected by people on his team.

He achieved hero status within Microsoft several years ago by taking over the leadership of Windows after the debacle that was Windows Vista, a much-delayed operating system whose sluggish performance and technical problems worsened Microsoft’s reputation for mediocre software. Mr. Sinfosky led the development of a new version of the operating system, Windows 7, which was positively reviewed and sold well.

“He did great things with Windows,” said Michael Cusumano, a professor at the Sloan School of Management at the Massachusetts Institute of Technology. “That’s still the core of the company.”

But while Mr. Sinofsky was effective, Mr. Cusumano said, he could be secretive and difficult to get along with, as he learned while dealing with Mr. Sinofsky while Mr. Cusumano was writing a book on Microsoft in the early 1990s. “I could imagine that he burned a lot of bridges and created a bunch of enemies,” he said.

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Alzheimer’s Precursors Founds at Earlier Age

Scientists studying Alzheimer’s disease are increasingly finding clues that the brain begins to deteriorate years before a person shows symptoms of dementia.

Now, research on a large extended family of 5,000 people in Colombia with a genetically driven form of Alzheimer’s has found evidence that the precursors of the disease begin even earlier than previously thought, and that this early brain deterioration occurs in more ways than has been documented before.

The studies, published this month in the journal Lancet Neurology, found that the brains of people destined to develop Alzheimer’s clearly show changes at least 20 years before they have any cognitive impairment. In the Colombian family, researchers saw these changes in people ages 18 to 26; on average, members of this family develop symptoms of mild cognitive impairment at 45 and of dementia at 53.

These brain changes occur earlier than the first signs of plaques made from a protein called beta amyloid or a-beta, a hallmark of Alzheimer’s. Researchers detected higher-than-normal levels of amyloid in the spinal fluid of these young adults. They found suggestions that memory-encoding parts of the brain were already working harder than in normal brains. And they identified indications that brain areas known to be affected by Alzheimer’s may be smaller than in those who do not have the Alzheimer’s gene.

“This is one of the most important pieces of direct evidence that individual persons have the disease and all the pathology many years before,” said Dr. Kaj Blennow, a professor in clinical neurochemistry at the University of Gothenburg in Sweden, who was not involved in the research.

Dr. Nick Fox, a neurologist at University College London, who was also not part of the research, said the findings suggested that “some of the things that we thought were more downstream may not be quite so downstream; they may be happening earlier.”

That, in turn, said Dr. Fox, who wrote a commentary about the findings in Lancet Neurology, could have implications for when and how to treat people, because “there may be targets to attack, whether it’s high levels of a-beta or whatever, when people are still functioning very well.”

The Colombian family suffers from a rare form of Alzheimer’s that is caused by a genetic mutation; it strikes about a third of its members in midlife. Because the family is so large and researchers can identify who will get the disease, studying the family provides an unusual opportunity to learn about Alzheimer’s causes and pathology.

Researchers, led by Dr. Eric Reiman of the Banner Alzheimer’s Institute in Phoenix, and in Colombia by Dr. Francisco Lopera, a neurologist at the University of Antioquia, recently received a grant from the National Institutes of Health to conduct a clinical trial to test a drug on family members before they develop symptoms, to see if early brain changes can be halted or slowed.

The studies in Lancet Neurology used several tests, including spinal taps, brain imaging and functional M.R.I.

“The prevailing theory has been that development of Alzheimer’s disease begins with the progressive accumulation of amyloid in the brain,” Dr. Reiman said. “This study suggests there are changes that are occurring before amyloid deposition.”

One possibility is that brain areas are already impaired. Another possibility, experts said, is that these brain differences may go back to the young developing brain.

“It is a genetic disease, and it’s not hard to imagine that your gene results in some differences in the way your brain is formed,” said Dr. Adam Fleisher, director of brain imaging at the Banner Institute and an author of the studies.

In one of the Lancet Neurology studies, researchers examined 44 relatives between ages 18 to 26. Twenty had the mutation that causes Alzheimer’s. The cerebrospinal fluid of those with the mutation contained more amyloid than that of relatives without it. This was striking because researchers know that when people develop amyloid plaques — whether they have early-onset or late-onset Alzheimer’s — amyloid levels in their spinal fluid are lower than normal. That is believed to be because the fluid form of amyloid gets absorbed into the plaque form, Dr. Reiman said.

So, the high level of amyloid fluid in the Colombian family supports a hypothesis about a difference between the beginning phases of genetic early-onset Alzheimer’s and the more common late-onset Alzheimer’s. The difference may be that early-onset Alzheimer’s involves an overproduction of amyloid, while late onset involves a problem clearing amyloid from the brain.

In another result, when the subjects performed a task matching names with faces, those with the mutation had greater activity in the hippocampus and parahippocampus, areas involved in memory. Dr. Reiman suggested this could mean that the pre-Alzheimer’s brain has to expend more effort to encode memories than a normal brain.

Researchers also found that the mutation carriers had less gray matter in areas that tend to shrink when people develop dementia. Dr. Fox emphasized that seeing less gray matter so early was so novel that it should be treated cautiously unless other studies find a similar result.

In the second study, brain imaging was used to look for amyloid plaques in 50 people ages 20 to 56: 11 with dementia, 19 mutation carriers without symptoms and 20 normal family members. Plaques occurred at an average age of 28, more than 15 years before cognitive impairment would be expected and two decades before dementia.

The study also found that amyloid plaques increased steadily until about age 37, after which the brain did not seem to gain many more plaques. Dr. Blennow said that while researchers know that amyloid plaques plateau when people already have dementia, they did not know that the plateau appears to occur years before.

The researchers are currently analyzing data from family members ages 7 to 17 to see if some of the brain changes occur at an even younger age.

“Some people think that that may be scary, that you can see it so many years before,” Dr. Reiman said. “But it seems to me that that provides potential opportunities for the development of future therapies.”

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Afghan Warlord Ismail Khan’s Call to Arms Rattles Kabul

Bryan Denton for The New York Times

Supporters of Ismail Khan gathered outside Herat city on Nov. 1.

HERAT, Afghanistan — One of the most powerful mujahedeen commanders in Afghanistan, Ismail Khan, is calling on his followers to reorganize and defend the country against the Taliban as Western militaries withdraw, in a public demonstration of faltering confidence in the national government and the Western-built Afghan National Army.

Mr. Khan is one of the strongest of a group of warlords who defined the country’s recent history in battling the Soviets, the Taliban and one another, and who then were brought into President Hamid Karzai’s cabinet as a symbol of unity. Now, in announcing that he is remobilizing his forces, Mr. Khan has rankled Afghan officials and stoked fears that other regional and factional leaders will follow suit and rearm, weakening support for the government and increasing the likelihood of civil war.

This month, Mr. Khan rallied thousands of his supporters in the desert outside Herat, the cultured western provincial capital and the center of his power base, urging them to coordinate and reactivate their networks. And he has begun enlisting new recruits and organizing district command structures.

“We are responsible for maintaining security in our country and not letting Afghanistan be destroyed again,” Mr. Khan, the minister of energy and water, said at a news conference over the weekend at his office in Kabul. But after facing criticism, he took care not to frame his action as defying the government: “There are parts of the country where the government forces cannot operate, and in such areas the locals should step forward, take arms and defend the country.”

President Karzai and his aides, however, were not greeting it as an altruistic gesture. The governor of Herat Province called Mr. Khan’s reorganization an illegal challenge to the national security forces. And Mr. Karzai’s spokesman, Aimal Faizi, tersely criticized Mr. Khan.

“The remarks by Ismail Khan do not reflect the policies of the Afghan government,” Mr. Faizi said. “The government of Afghanistan and the Afghan people do not want any irresponsible armed grouping outside the legitimate security forces structures.”

In Kabul, Mr. Khan’s provocative actions have played out in the news media and brought a fierce reaction from some members of Parliament, who said the warlords were preparing to take advantage of the American troop withdrawal set for 2014.

“People like Ismail Khan smell blood,” Belqis Roshan, a senator from Farah Province, said in an interview. “They think that as soon as foreign forces leave Afghanistan, once again they will get the chance to start a civil war, and achieve their ominous goals of getting rich and terminating their local rivals.”

Indeed, Mr. Khan’s is not the only voice calling for a renewed alliance of the mujahedeen against the Taliban, and some of the others are just as familiar.

Marshal Muhammad Qasim Fahim, an ethnic Tajik commander who is President Karzai’s first vice president, said in a speech in September, “If the Afghan security forces are not able to wage this war, then call upon the mujahedeen.”

Another prominent mujahedeen fighter, Ahmad Zia Massoud, said in an interview at his home in Kabul that people were worried about what was going to happen after 2014, and he was telling his own followers to make preliminary preparations.

“They don’t want to be disgraced again,” Mr. Massoud said. “Everyone tries to have some sort of Plan B. Some people are on the verge of rearming.”

He pointed out that it was significant that the going market price of Kalashnikov assault rifles had risen to about $1,000, driven up by demand from a price of $300 a decade ago. “Every household wants to have an AK-47 at home,” he said.

“The mujahedeen come here to meet me,” Mr. Massoud added. “They tell me they are preparing. They are trying to find weapons. They come from villages, from the north of Afghanistan, even some people from the suburbs of Kabul, and say they are taking responsibility for providing private security in their neighborhood.”

Habib Zahori and Jawad Sukhanyar contributed reporting from Herat, Afghanistan, and an employee of The New York Times from Kabul.

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Ads are Invading Gadgets and Apps that You Already Paid For

Most of us are used to seeing ads on stuff that we get for free, like smartphone and tablet apps or online news websites. But you’re probably also used to being able to pay to remove ads, whether by getting the premium version of an app or even upgrading to a new computer that doesn’t have so much garbage on it.

As it turns out, this strategy doesn’t work so well anymore. That’s because companies are starting to put “special offers” all over things that you buy … and this time, it’s not just the usual preinstalled trashware. Here’s a look at some of the latest strikes in the war for your attention.

​Microsoft: Xbox Music and Xbox Live

Last year’s redesign of the Xbox 360 dashboard featured prominent ads, including videos that played automatically, even if you were paying for a $ 60/year Xbox Live Gold membership. This year, Microsoft introduced its new Xbox Music Pass, which allows you to stream millions of songs to your Xbox 360 or Windows 8 PC. It has an ad-supported free trial mode, which lets you listen to songs (and ads) for free for the first six months before imposing a monthly listening limit.

But according to Neowin.net editor Owen Williams, the ads stay even if you pay $ 99 per year for the subscription service. On top of that, you can’t use Xbox Music on the actual Xbox at all (beyond a 30-day trial) unless you ​also​ pay for an Xbox Live Gold Subscription. That’s almost $ 160 per year for two separate subscriptions, and in return you apparently get twice the ads.

​Microsoft: Windows 8

If the ads in the Xbox Music service aren’t enough, Microsoft has also put ads all over its Windows 8 operating system. Whether you buy a new Surface tablet or you pay for the upgrade from Windows 7 such as through buying a separate boxed copy, you still have to contend with ads in “many of the bundled [Modern] UI applications,” according to Williams.

​Amazon: The entire Kindle lineup

Amazon began selling Kindle e-readers with “special offers” a while back. These appeared on the lock screen, and replaced the normal screen saver, which was more literary.

When Amazon announced its new lineup of Kindle Fire HD tablets not too long ago, it turned out that every single one of them had advertisements. Not just on the lock screen, but now even in a corner on the home screen while you’re browsing through your books and apps.

At the time, Amazon wasn’t offering any way to get rid of these ads on the new Kindle Fire HD, but the company now gives people the option to buy Kindles sans ads for an extra $ 15. That won’t help you with in-app ads, though, if you use free apps.

Jared Spurbeck is an open-source software enthusiast, who uses an Android phone and an Ubuntu laptop PC. He has been writing about technology and electronics since 2008.

Linux/Open Source News Headlines – Yahoo! News

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Lakers intrigued by chance to play for D'Antoni

EL SEGUNDO, Calif. (AP) — Pau Gasol got home from the game and read about it on Twitter, while Dwight Howard got a midnight message on his BlackBerry. They shared most Los Angeles Lakers fans' mix of surprise, trepidation and anticipation.

Just when everybody thought the Lakers were getting back together with Phil Jackson, they switched course in the middle of the night and went with Mike D'Antoni.

What a weekend in Hollywood — and the real drama isn't over yet.

The Lakers reacted with ample excitement and a little bewilderment Monday to their front office's surprising decision to hire D'Antoni as coach Mike Brown's replacement over Jackson, the 11-time champion who discussed the job at his home Saturday and apparently wanted to return. D'Antoni didn't even interview for the job in person, speaking to the Lakers over the phone.

"It has been crazy, but all this stuff will just make this team stronger," said Howard, who has been in a Lakers uniform for about six weeks. "Everything that we've been through so far, it's going to make us stronger, and we have to look at this as a positive situation."

The Lakers' third coach in four days won't take over the team until later in the week. D'Antoni still hadn't been cleared to travel Monday after undergoing knee replacement surgery earlier in the month, although the Lakers are optimistic the former Knicks and Suns coach will arrive in Los Angeles on Wednesday.

So interim coach Bernie Bickerstaff was still in charge Monday when the Lakers gathered for an informal workout ahead of Tuesday's game against San Antonio. Just two weeks into the regular season, the Lakers (3-4) are about to start over with a new offense and another coaching staff — and a renewed certainty they're expected to compete for a title this season.

"It's been a zoo," said forward Antawn Jamison, a 15-year NBA veteran who played for D'Antoni on a U.S. national team. "But as I was telling somebody, it's just a typical day here in L.A. It's interesting. ... It should be a lot easier to adjust to than the system we were trying to get adjusted to early on in the season. We've got Steve (Nash) that can help us out."

Two Lakers who supported both Brown and his two potential replacements weren't available in El Segundo to weigh in on the hire. Nash missed the workout while getting treatment on his injured leg, while Kobe Bryant left before it ended to share a helicopter ride back home to Orange County with point guard Steve Blake, who needed an exam on his abdominal injury.

And the tall, professorial coach with all the rings wasn't at the Lakers' training complex at all.

Just 24 hours after Jackson seemed headed back to his oversized chair on the Staples Center bench, D'Antoni had the job.

It's too soon to tell how the Buss family's latest counterintuitive move will sit with Lakers fans, who chanted "We want Phil!" during the club's weekend games, both victories after a 1-4 start.

"I think everybody had expectations about it, and they were all pretty high," Gasol said of Jackson's potential return. "We all understood what Phil brings to the table ... and what he means to the city and the franchise. It just couldn't work out for whatever reason."

Jackson issued a statement to a handful of media outlets Monday, implying he was essentially offered the job after meeting with Lakers owner Jim Buss and general manager Mitch Kupchak. Jackson thought he would be able to come back to the Lakers on Monday with his decision, but instead was awakened by a midnight phone call from Kupchak.

"The decision is of course theirs to make," Jackson said in his statement. "I am gratified by the groundswell of support from the Laker fans who endorsed my return, and it is the principal reason why I considered the possibility."

The Lakers largely echoed the thoughts of Howard, who was looking forward to playing for Jackson: "Management had to do what they felt is best for the team, and we as players have got to find a way to win."

The Lakers publicly offered no reason for passing over the coach with the most championships in NBA history. Although nobody could claim the Buss family is afraid of spending money, Brown is still owed well over $10 million for the remaining three seasons on his four-year, $18 million contract, while D'Antoni will make $4 million a season for the next three years — and their salaries together might be less than what Jackson would command.

The Lakers largely know what they would get with Jackson, but D'Antoni intrigues this older, top-heavy team with an urgency to contend for a title before Howard's free agency next summer and Bryant's possible retirement in a few years.

Howard and Gasol both believe D'Antoni's up-tempo style can work well for the Lakers. Howard would seem to be a natural to partner with Nash in the pick-and-roll attacks loved by D'Antoni and Nash, although Gasol doesn't immediately fit into the definition of a big man who can play on the perimeter and shoot 3-pointers.

"It's a great system, (but) I don't think he ever had a defender such as myself or a defender such as Dwight Howard on those teams," Metta World Peace said. "I don't think he ever coached those type of players, so his defense should be self-explanatory, and his offense is amazing, so it should be fun for Laker fans."

The rest of the NBA sat back and watched the Lakers' drama with amusement over the past two days, with Dallas owner Mark Cuban weighing in gleefully on the mess: "I hope they have to do it again and again and again."

Jackson's flirtation with the job is the strongest indication yet that he's interested in coaching again, which makes him a prime candidate for another franchise. Yet D'Antoni also received praise around the league — even from New York, where he resigned last March after failing to win a playoff game in four years with the Knicks.

"Despite all the hoopla ... that was going on about me and Mike, we actually have a pretty good relationship, especially behind closed doors," Carmelo Anthony said. "We actually talked a lot, talked basketball. Hopefully he brings some positive energy over there. Anytime guys are losing like that, there's always negativity, a lot of negative energy. So sometimes change is better."

Added Dwyane Wade, who has played for D'Antoni on the U.S. national team: "He has a tough job ahead of him, but I'm sure he's excited about the opportunity that he gets to be with America's team."

___

AP Sports Writers Brian Mahoney and Chris Duncan contributed to this report.

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False Posts on Facebook Undermine Its Credibility

SAN FRANCISCO — The Facebook page for Gaston Memorial Hospital, in Gastonia, N.C., offers a chicken salad recipe to encourage healthy eating, tips on avoiding injuries at Zumba class, and pictures of staff members dressed up at Halloween. Typical stuff for a hospital in a small town.

But in October, another Facebook page for the hospital popped up. This one posted denunciations of President Obama and what it derided as “Obamacare.” It swiftly gathered hundreds of followers, and the anti-Obama screeds picked up “likes.” Officials at the hospital, scrambling to get it taken down, turned to their real Facebook page for damage control. “We apologize for any confusion,” they posted on Oct. 8, “and appreciate the support of our followers.”

The fake page came down 11 days later, as mysteriously as it had come up. The hospital says it has no clue who was behind it.

Fakery is all over the Internet. Twitter, which allows pseudonyms, is rife with fake followers, and has been used to spread false rumors, as it was during Hurricane Sandy. False reviews are a constant problem on consumer Web sites.

Gaston Memorial’s experience is an object lesson in the problem of fakery on Facebook. For the world’s largest social network, it is an especially acute problem, because it calls into question its basic premise. Facebook has sought to distinguish itself as a place for real identity on the Web. As the company tells its users: “Facebook is a community where people use their real identities.” It goes on to advise: “The name you use should be your real name as it would be listed on your credit card, student ID, etc.”

Fraudulent “likes” damage the trust of advertisers, who want clicks from real people they can sell to and whom Facebook now relies on to make money. Fakery also can ruin the credibility of search results for the social search engine that Facebook says it is building.

Facebook says it has always taken the problem seriously, and recently stepped up efforts to cull fakes from the site. “It’s pretty much one of the top priorities for the company all the time,” said Joe Sullivan, who is in charge of security at Facebook.

The fakery problem on Facebook comes in many shapes. False profiles are fairly easy to create; hundreds can pop up simultaneously, sometimes with the help of robots, and often they persuade real users into friending them in a bid to spread malware. Fake Facebook friends and likes are sold on the Web like trinkets at a bazaar, directed at those who want to enhance their image. Fake coupons for meals and gadgets can appear on Facebook newsfeeds, aimed at tricking the unwitting into revealing their personal information.

Somewhat more benignly, some college students use fake names in an effort to protect their Facebook content from the eyes of future employers.

Mr. Sullivan declined to say what portion of the company’s now one billion plus users were fake. The company quantified the problem last June, in responding to an inquiry by the Securities and Exchange Commission. At that time, the company said that of its 855 million active users, 8.7 percent, or 83 million, were duplicates, false or “undesirable,” for instance, because they spread spam.

Mr. Sullivan said that since August, the company had put in place a new automated system to purge fake “likes.” The company said it has 150 to 300 staff members to weed out fraud.

Flags are raised if a user sends out hundreds of friend requests at a time, Mr. Sullivan explained, or likes hundreds of pages simultaneously, or most obvious of all, posts a link to a site that is known to contain a virus. Those suspected of being fakes are warned. Depending on what they do on the site, accounts can be suspended.

In October, Facebook announced new partnerships with antivirus companies. Facebook users can now download free or paid antivirus coverage to guard against malware.

“It’s something we have been pretty effective at all along,” Mr. Sullivan said.

Facebook’s new aggressiveness toward fake “likes” became noticeable in September, when brand pages started seeing their fan numbers dip noticeably. An average brand page, Facebook said at the time, would lose less than 1 percent of its fans.

But the thriving market for fakery makes it hard to keep up with the problem. Gaston Memorial, for instance, first detected a fake page in its name in August; three days later, it vanished. The fake page popped up again on Oct. 4, and this time filled up quickly with the loud denunciations of the Obama administration. Dallas P. Wilborn, the hospital’s public relations manager, said her office tried to leave a voice-mail message for Facebook but was disconnected; an e-mail response from the social network ruled that the fake page did not violate its terms of service. The hospital submitted more evidence, saying that the impostor was using its company logo.

Eleven days later, the hospital said, Facebook found in its favor. But by then, the local newspaper, The Gaston Gazette, had written about the matter, and the fake page had disappeared.

Facebook declined to comment on the incident, and pointed only to its general Statement of Rights and Responsibilities.

The election season seems to have increased the fakery.

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Well: Quitting Smoking for Good

Few smokers would claim that it’s easy to quit. The addiction to nicotine is strong and repeatedly reinforced by circumstances that prompt smokers to light up.

Yet the millions who have successfully quit are proof that a smoke-free life is achievable, even by those who have been regular, even heavy, smokers for decades.

Today, 19 percent of American adults smoke, down from more than 42 percent half a century ago, when Luther Terry, the United States surgeon general, formed a committee to produce the first official report on the health effects of smoking. Ever-increasing restrictions on where people can smoke have helped to swell the ranks of former smokers.

Now, however, as we approach the American Cancer Society’s 37th Great American Smokeout on Thursday, the decline in adult smoking has stalled despite the economic downturn and the soaring price of cigarettes.

Currently, 45 million Americans are regular smokers who, if they remain smokers, can on average expect to live 10 fewer years. Half will die of a tobacco-related disease, and many others will suffer for years with smoking-caused illness. Smoking adds $96 billion to the annual cost of medical care in this country, Dr. Nancy A. Rigotti wrote in The Journal of the American Medical Association last month. Even as some adult smokers quit, their ranks are being swelled by the 800,000 teenagers who become regular smokers each year and by young adults who, through advertising and giveaways, are now the prime targets of the tobacco industry.

People ages 18 to 25 now have the nation’s highest smoking rate: 40 percent. I had to hold my breath the other day as dozens of 20-somethings streamed out of art gallery openings and lighted up. Do they not know how easy it is to get hooked on nicotine and how challenging it can be to escape this addiction?

Challenging, yes, but by no means impossible. on the Web you can download a “Guide to Quitting Smoking,” with detailed descriptions of all the tools and tips to help you become an ex-smoker once and for all.

Or consult the new book by Dr. Richard Brunswick, a retired family physician in Northampton, Mass., who says he’s helped hundreds of people escape the clutches of nicotine and smoking. (The printable parts of the book’s provocative title are “Can’t Quit? You Can Stop Smoking.”)

“There is no magic pill or formula for beating back nicotine addiction,” Dr. Brunswick said. “However, with a better understanding of why you smoke and the different tools you can use to control the urge to light up, you can stop being a slave to your cigarettes.”

Addiction and Withdrawal

Nicotine beats a direct path to the brain, where it provides both relaxation and a small energy boost. But few smokers realize that the stress and lethargy they are trying to relieve are a result of nicotine withdrawal, not some underlying distress. Break the addiction, and the ill feelings are likely to dissipate.

Physical withdrawal from nicotine is short-lived. Four days without it and the worst is over, with remaining symptoms gone within a month, Dr. Brunswick said. But emotional and circumstantial tugs to smoke can last much longer.

Depending on when and why you smoke, cues can include needing a break from work, having to focus on a challenging task, drinking coffee or alcohol, being with other people who smoke or in places you associate with smoking, finishing a meal or sexual activity, and feeling depressed or upset.

To break such links, you must first identify them and then replace them with other activities, like taking a walk, chewing sugar-free gum or taking deep breaths. These can help you control cravings until the urge passes.

If you’ve failed at quitting before, try to identify what went wrong and do things differently this time, Dr. Brunswick suggests. Most smokers need several attempts before they can become permanent ex-smokers.

Perhaps most important is to be sure you are serious about quitting; if not, wait until you are. Motivation is half the battle. Also, should you slip and have a cigarette after days or weeks of not smoking, don’t assume you’ve failed and give up. Just go right back to not smoking.

Aids for Quitting

Many if not most smokers need two kinds of assistance to become lasting ex-smokers: psychological support and medicinal aids. Only about 4 percent to 7 percent of people are able to quit smoking on any given attempt without help, the cancer society says.

All 50 states and the District of Columbia have free telephone-based support programs that connect would-be quitters to trained counselors. Together, you can plan a stop-smoking method that suits your smoking pattern and helps you avoid common pitfalls.

Online support groups and Nicotine Anonymous can help as well. To find a group, ask a local hospital or call the cancer society at (800) 227-2345. Consider telling relatives and friends about your intention to quit, and plan to spend time in smoke-free settings.

More than a dozen treatments can help you break the physical addiction to tobacco. Most popular is nicotine replacement therapy, sold both with and without a prescription. The Food and Drug Administration has approved five types: nicotine patches of varying strengths, gums, sprays, inhalers and lozenges that can curb withdrawal symptoms and help you gradually reduce your dependence on nicotine.

Two prescription drugs are also effective: an extended-release form of the antidepressant bupropion (Zyban or Wellbutrin), which reduces nicotine cravings, and varenicline (Chantix), which blocks nicotine receptors in the brain, reducing both the pleasurable effects of smoking and the symptoms of nicotine withdrawal. Combining a nicotine replacement with one of these drugs is often more effective than either approach alone.

Other suggested techniques, like hypnosis and acupuncture, have helped some people quit but lack strong proof of their effectiveness. Tobacco lozenges and pouches and nicotine lollipops and lip balms lack evidence as quitting aids, and no clinical trials have been published showing that electronic cigarettes can help people quit.

The cancer society suggests picking a “quit day”; ridding your home, car and workplace of smoking paraphernalia; choosing a stop-smoking plan, and stocking up on whatever aids you may need.

On the chosen day, keep active; drink lots of water and juices; use a nicotine replacement; change your routine if possible; and avoid alcohol, situations you associate with smoking and people who are smoking.

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