Chinese Imports and Exports Soar in January


HONG KONG — January trade data from China on Friday showed a surge in exports and imports from the levels of a year earlier — a phenomenon largely due to the timing of the Lunar New Year holiday but also supporting the view that the Chinese economy is firming up.


Economic data from China are often severely distorted by the holiday, when many factories shut down for a week or more.


The holiday this year takes place in February — the first day of the Lunar New Year is Sunday. Last year it fell squarely in January, cutting down on the number of working days during that month.


The trade data released Friday reflected this with a large increase, compared with the year before, as analysts had expected. Exports climbed 25 percent from January 2012, according to the General Administration of Customs, and imports rose 28.8 percent.


The increases were much lower when adjusted for the holiday-induced differences in the number of working days, with exports up 12.4 percent and imports just 3.4 percent higher.


Still, the data beat expectations by a wide margin, supporting the view that healthier domestic and overseas demand also had been significant.


“This strong export number cannot be fully explained by the Chinese New Year effect alone,” Zhiwei Zhang, chief China economist at Nomura in Hong Kong, said in a research note. “These data suggest that external and domestic demand are both strong, which supports our view that the economy is on track for a cyclical recovery” in the first half of this year, he added.


Dariusz Kowalczyk, an economist at Crédit Agricole in Hong Kong, said, “We need to wait for February results to have the full picture of trade at the start of 2013.” However, he added, “one trend is clear: exports have been doing very well recently. This may be a sign of improved external demand but is also a testimony to the resilience of Chinese exporters and to their competitiveness.”


Improved overseas demand and a string of government-mandated stimulus measures have gradually propped up growth and dispelled fears of a hard landing in China. While the Chinese economy expanded just 7.8 percent last year — down from 9.3 percent in 2011 and 10.4 percent in 2010 — many analysts expect growth to top 8 percent again in 2013.


Central bank data Friday that showed ample money had continued to flood into the economy also supported this view. Banks extended 1.07 trillion renminbi, or $172 billion, in new loans during January, more than analysts had expected. Total “social financing aggregate” in the economy, a broad measure of liquidity, or the ease of trading assets, more than doubled from a year earlier, to 2.54 trillion renminbi.


That figure, Mr. Kowalczyk commented, was a “blowout number.”


Like other data released Friday, the financing figure was lifted by the Lunar New Year effects, but even without these, Mr. Kowalczyk said, it was a “huge amount of funding” and would sustain solid economic growth in the near term at least.


Longer term, he cautioned, it would also “stoke inflationary pressures,” and could lead the central bank to tighten monetary policy further down the line as it seeks to stave off inflationary pressures.


For now, inflation remains benign. Consumer prices rose just 2 percent in January from a year earlier, a moderation from the 2.5 percent year-on-year increase in December. The low inflation number, released Friday, was in line with forecasts, but analysts widely expect a rebound in February.


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Well: Old Age and Motorcycles Are a Dangerous Mix

If you’re over 40 and planning to hop on a motorcycle, take care. Compared with younger riders, the odds of being seriously injured are high.

That is the message of a new study, published this week in the journal Injury Prevention, which found that older bikers are three times as likely to be severely injured in a crash as younger riders.

The percentage of older bikers on the road is quickly rising, and their involvement in accidents is a growing concern. Nationwide, from 1990 to 2003, the percentage of motorcyclists over age 50 soared from roughly 1 in 10 to about 1 in 4. At the same time, the average age of riders involved in motorcycle crashes has also been climbing. Injury rates among those 65 and older jumped 145 percent from 2000 to 2006 alone.

Because of the increase in motorcycle ridership among older Americans, the researchers, led by Tracy Jackson, a graduate student in the epidemiology department at Brown University, wanted a closer look at their injury patterns. So she and her colleagues combed through a federal database of motorcycle crashes that were serious enough to require emergency medical care. That yielded about 1.5 million incidents involving motorcyclists 20 or older from 2001 to 2008.

The researchers then split them into groups: those in their 20s and 30s, another group between 40 and 59, and those 60 and older.

Over all, the study showed that injury rates for all three groups were on the rise. But the rise was steepest for the oldest riders. Compared with the youngest motorcyclists, those who were 60 and older were two and a half times as likely to end up with serious injuries, and three times as likely to be admitted to a hospital. The riders who were middle age were twice as likely as their younger counterparts to be hospitalized.

For older riders, the consequences of a collision were also especially alarming. Older and middle-aged bikers were more likely to sustain fractures and dislocations, and they had a far greater chance of ending up with injuries to internal organs, including brain damage.

The researchers speculated that it was very likely that a number of factors played a role in older riders’ higher injury rates. For one, declines in vision and reaction time may make older riders more prone to mistakes that end up in collisions. Another theory is that older riders tend to ride bigger bikes, “which may be more likely to roll or turn over,” Ms. Jackson said.

Then there is the greater fragility that comes with age. Older riders may be involved in the same types of accidents as younger riders, Ms. Jackson said, but in some cases, a collision that a 20-year-old would walk away from might send a 65-year-old to the hospital.

“Your bones become more brittle, and you lose muscle mass as you get older,” she said. “It could just be a matter of aging and the body being less durable.”

Read More..

Well: Old Age and Motorcycles Are a Dangerous Mix

If you’re over 40 and planning to hop on a motorcycle, take care. Compared with younger riders, the odds of being seriously injured are high.

That is the message of a new study, published this week in the journal Injury Prevention, which found that older bikers are three times as likely to be severely injured in a crash as younger riders.

The percentage of older bikers on the road is quickly rising, and their involvement in accidents is a growing concern. Nationwide, from 1990 to 2003, the percentage of motorcyclists over age 50 soared from roughly 1 in 10 to about 1 in 4. At the same time, the average age of riders involved in motorcycle crashes has also been climbing. Injury rates among those 65 and older jumped 145 percent from 2000 to 2006 alone.

Because of the increase in motorcycle ridership among older Americans, the researchers, led by Tracy Jackson, a graduate student in the epidemiology department at Brown University, wanted a closer look at their injury patterns. So she and her colleagues combed through a federal database of motorcycle crashes that were serious enough to require emergency medical care. That yielded about 1.5 million incidents involving motorcyclists 20 or older from 2001 to 2008.

The researchers then split them into groups: those in their 20s and 30s, another group between 40 and 59, and those 60 and older.

Over all, the study showed that injury rates for all three groups were on the rise. But the rise was steepest for the oldest riders. Compared with the youngest motorcyclists, those who were 60 and older were two and a half times as likely to end up with serious injuries, and three times as likely to be admitted to a hospital. The riders who were middle age were twice as likely as their younger counterparts to be hospitalized.

For older riders, the consequences of a collision were also especially alarming. Older and middle-aged bikers were more likely to sustain fractures and dislocations, and they had a far greater chance of ending up with injuries to internal organs, including brain damage.

The researchers speculated that it was very likely that a number of factors played a role in older riders’ higher injury rates. For one, declines in vision and reaction time may make older riders more prone to mistakes that end up in collisions. Another theory is that older riders tend to ride bigger bikes, “which may be more likely to roll or turn over,” Ms. Jackson said.

Then there is the greater fragility that comes with age. Older riders may be involved in the same types of accidents as younger riders, Ms. Jackson said, but in some cases, a collision that a 20-year-old would walk away from might send a 65-year-old to the hospital.

“Your bones become more brittle, and you lose muscle mass as you get older,” she said. “It could just be a matter of aging and the body being less durable.”

Read More..

Gadgetwise Blog: Q.& A.: Saving Space and Shows on a TiVo

I have a bunch of TV programs recorded on my TiVo that I don’t want to erase, but I’m running tight on drive space. Can I copy these shows elsewhere, like to a DVD?

If you have the TiVo Desktop software for your Windows PC or Mac and have your TiVo recorder connected to your home network, you should be able to transfer the recorded shows to your computer and burn them to DVDs there. Shows that have copy-protection built in will not transfer, however.

TiVo has instructions for transferring the files from a PC or Mac on its site. According to the company’s support documentation, PC owners should use the $70 Roxio Creator program and Mac users should get the $80 Roxio Toast Titanium software to transfer and burn recordings.

Depending on your home’s mix of hardware and software, you may be able to copy the shows to a disc with a connected DVD recorder or burn the shows to a DVD with other recording software. Wondershare’s $40 DVD Creator is one program that has its own online instructions (and a free trial version) for recording shows to disc and there are many others around the Web.

If the file-transfer and disc-burning process sounds too complicated, another way to make room for more shows on your TiVo recorder is to add an external drive that gives you more storage space. This approach only works with certain TiVo models, but you can find out more on TiVo’s approved method here. Companies like Weaknees sell upgrade kits for some TiVo models that can add more recording capacity as well.

Read More..

India Ink: Power Outage at Delhi Airport Affects Flights

An electrical power failure at the Indian capital’s main airport disrupted the radar system on Friday, delaying some flights.

“There was a power failure,” which was rectified quickly, said Harbhajan Singh, the public relations officer of the Airports Authority of India.

He explained that the Indira Gandhi International Airport has a three-tier system for electricity so when the power went out, the airport switched from the main supply to one of its two standby sources. The Airports Authority said in a statement that the power supply switched over from 12:21 p.m. to 12:31 p.m., but travelers reported experiencing much longer delays.

The power failure affected the servers that control the radar system, said Arun Mishra, director general of Civil Aviation, the regulatory body for airlines.

Mr. Mishra said the servers were affected for about 30 minutes in the morning, starting from about 6:50 a.m.

The Airports Authority of India denied in a statement that the radar system had failed, saying that flight arrivals had continued normally, although a few departures were delayed.

A spokesman from Air India said that four of the national air carrier’s flights were delayed by 10 minutes because of the radar problem.

Two New York Times reporters aboard an Allahabad-bound flight operated by the domestic airline Spicejet had to wait for an hour and a half on the runway before the plane took off from the Delhi airport.

The same airport last month handled 73 flights within an hour, which is believed to be a record for an Indian airport, according to a Press Trust of India report.

Spokespersons at the ministries of Civil Aviation and Home Affairs said that they had no immediate information about the power failure.

Read More..

DealBook: E-Mails Show Flaws in JPMorgan's Mortgage Securities

When an outside analysis uncovered serious flaws with thousands of home loans, JPMorgan Chase executives found an easy fix.

Rather than disclosing the full extent of problems like fraudulent home appraisals and overextended borrowers, the bank adjusted the critical reviews, according to documents filed early Tuesday in federal court in Manhattan. As a result, the mortgages, which JPMorgan bundled into complex securities, appeared healthier, making the deals more appealing to investors.

The trove of internal e-mails and employee interviews, filed as part of a lawsuit by one of the investors in the securities, offers a fresh glimpse into Wall Street’s mortgage machine, which churned out billions of dollars of securities that later imploded. The documents reveal that JPMorgan, as well as two firms the bank acquired during the credit crisis, Washington Mutual and Bear Stearns, flouted quality controls and ignored problems, sometimes hiding them entirely, in a quest for profit.

The lawsuit, which was filed by Dexia, a Belgian-French bank, is being closely watched on Wall Street. After suffering significant losses, Dexia sued JPMorgan and its affiliates in 2012, claiming it had been duped into buying $1.6 billion of troubled mortgage-backed securities. The latest documents could provide a window into a $200 billion case that looms over the entire industry. In that lawsuit, the Federal Housing Finance Agency, which oversees Fannie Mae and Freddie Mac, has accused 17 banks of selling dubious mortgage securities to the two housing giants. At least 20 of the securities are also highlighted in the Dexia case, according to an analysis of court records.

In court filings, JPMorgan has strongly denied wrongdoing and is contesting both cases in federal court. The bank declined to comment.

Dexia’s lawsuit is part of a broad assault on Wall Street for its role in the 2008 financial crisis, as prosecutors, regulators and private investors take aim at mortgage-related securities. New York’s attorney general, Eric T. Schneiderman, sued JPMorgan last year over investments created by Bear Stearns between 2005 and 2007.

Jamie Dimon, JPMorgan’s chief executive, has criticized prosecutors for attacking JPMorgan because of what Bear Stearns did. Speaking at the Council on Foreign Relations in October, Mr. Dimon said the bank did the federal government “a favor” by rescuing the flailing firm in 2008.

The legal onslaught has been costly. In November, JPMorgan, the nation’s largest bank, agreed to pay $296.9 million to settle claims by the Securities and Exchange Commission that Bear Stearns had misled mortgage investors by hiding some delinquent loans. JPMorgan did not admit or deny wrongdoing.

“The true price tag for the ongoing costs of the litigation is terrifying,” said Christopher Whalen, a senior managing director at Tangent Capital Partners.

The Dexia lawsuit centers on complex securities created by JPMorgan, Bear Stearns and Washington Mutual during the housing boom. As profits soared, the Wall Street firms scrambled to pump out more investments, even as questions emerged about their quality.

With a seemingly insatiable appetite, JPMorgan scooped up mortgages from lenders with troubled records, according to the court documents. In an internal “due diligence scorecard,” JPMorgan ranked large mortgage originators, assigning Washington Mutual and American Home Mortgage the lowest grade of “poor” for their documentation, the court filings show.

The loans were quickly sold to investors. Describing the investment assembly line, an executive at Bear Stearns told employees “we are a moving company not a storage company,” according to the court documents.

As they raced to produce mortgage-backed securities, Washington Mutual and Bear Stearns also scaled back their quality controls, the documents indicate.

In an initiative called Project Scarlett, Washington Mutual slashed its due diligence staff by 25 percent as part of an effort to bolster profit. Such steps “tore the heart out” of quality controls, according to a November 2007 e-mail from a Washington Mutual executive. Executives who pushed back endured “harassment” when they tried to “keep our discipline and controls in place,” the e-mail said.

Even when flaws were flagged, JPMorgan and the other firms sometimes overlooked the warnings.

JPMorgan routinely hired Clayton Holdings and other third-party firms to examine home loans before they were packed into investments. Combing through the mortgages, the firms searched for problems like borrowers who had vastly overstated their incomes or appraisals that inflated property values.

According to the court documents, an analysis for JPMorgan in September 2006 found that “nearly half of the sample pool” — or 214 loans — were “defective,” meaning they did not meet the underwriting standards. The borrowers’ incomes, the firms found, were dangerously low relative to the size of their mortgages. Another troubling report in 2006 discovered that thousands of borrowers had already fallen behind on their payments.

But JPMorgan at times dismissed the critical assessments or altered them, the documents show. Certain JPMorgan employees, including the bankers who assembled the mortgages and the due diligence managers, had the power to ignore or veto bad reviews.

In some instances, JPMorgan executives reduced the number of loans considered delinquent, the documents show. In others, the executives altered the assessments so that a smaller number of loans were considered “defective.”

In a 2007 e-mail, titled “Banking overrides,” a JPMorgan due diligence manager asks a banker: “How do you want to handle these loans?” At times, they whitewashed the findings, the documents indicate. In 2006, for example, a review of mortgages found that at least 1,154 loans were more than 30 days delinquent. The offering documents sent to investors showed only 25 loans as delinquent.

A person familiar with the bank’s portfolios said JPMorgan had reviewed the loans separately and determined that the number of delinquent loans was far less than the outside analysis had found.

At Bear Stearns and Washington Mutual, employees also had the power to sanitize bad assessments. Employees at Bear Stearns were told that they were responsible for “purging all of the older reports” that showed flaws, “leaving only the final reports,” according to the court documents.

Such actions were designed to bolster profit. In a deposition, a Washington Mutual employee said revealing loan defects would undermine the lucrative business, and that the bank would suffer “a couple-point hit in price.”

Ratings agencies also did not necessarily get a complete picture of the investments, according to the court filings. An assessment of the loans in one security revealed that 24 percent of the sample was “materially defective,” the filings show. After exercising override power, a JPMorgan employee sent a report in May 2006 to a ratings agency that showed only 5.3 percent of the mortgages were defective.

Such investments eventually collapsed, spreading losses across the financial system.

Dexia, which has been bailed out twice since the financial crisis, lost $774 million on mortgage-backed securities, according to court records.

Mr. Schneiderman, the New York attorney general, said that overall losses from flawed mortgage-backed securities from 2005 and 2007 were $22.5 billion.

In a statement shortly after he sued JPMorgan Chase, Mr. Schneiderman said the lawsuit was a template “for future actions against issuers of residential mortgage-backed securities that defrauded investors and cost millions of Americans their homes.”

Read More..

Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His blue eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.


Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Read More..

Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His blue eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.


Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Read More..

Gadgetwise Blog: Tip of the Week: A Quick Trip Through the iTunes Libraries

Apple’s iTunes 11 program moves all the various media libraries from a vertical panel on the left side of the window to a small Library pop-up menu in the top-left corner. For a quicker way to switch between media types instead of moving the mouse up to the menu, Apple has also included iTunes keyboard shortcuts to jump instantly to the desired collection.

For example, on the Mac, press Command-1 on the keyboard to go right to the Music library from elsewhere in the program. The other shortcuts include Command-2 (Movies); Command-3 (TV Shows); Command-4 (Podcasts); Command-5 (iTunes U); Command-6 (Books) and Command-7 (Apps). Windows users should substitute the Control key for the Mac’s Command key in each shortcut.

Hate the look of iTunes 11? Go to the program’s View menu and choose Show Sidebar to restore the panel on the left side that displays the program’s libraries, playlists, connected devices, iTunes Store link and other elements.

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India Ink: Economic Growth in India to Fall to Five Percent

India’s Gross Domestic Product is expected to drop significantly to 5 percent for the fiscal year ending in March 2013, according to advance estimates released by India’s Central Statistics Office on Thursday, declining from 6.2 percent growth rate seen in 2011-2012.

The estimate by the Central Statistics Office represents a marked drop from earlier growth projections issued by the government for this year. In January, the central bank projected G.D.P. growth of 5.5 percent for the current fiscal year, a decline from an earlier estimate of 5.8 percent.

The provisional estimates are contingent upon the “anticipated level of agricultural and industrial production, analysis of budget estimates of government expenditure and performance of key sectors like, railways, transport other than railways, communication, banking and insurance, available so far,” the report said.

According to the preliminary data released on Thursday, national income registered a growth rate of 4.2 percent in the current fiscal year as compared to 6.1 percent in the previous year, and per capita income grew at a rate of 2.9 percent as compared to 4.7 percent growth last year. Meanwhile, capital investment in the country is expected to drop to 2.48 percent from 4.39 percent in the previous year.

Slow growth may be attributed to the sluggish performance of the manufacturing, agriculture and services sector. The manufacturing sector is expected to grow by 1.9 percent this year, while India’s farm sector is projected to grow at an estimated 1.8 percent.

The services sector saw a decline in its growth rate from previous years, expanding by 6.6 percent, the lowest in over a decade. Other sectors that are expected to have performed relatively poorly include electricity, gas & water supply (4.9 percent growth) and mining and quarrying (0.4 percent growth).

Sectors that have performed relatively well with a growth rate of over 5 percent are construction, the trade, hotels, transport and communication sector, the financing, insurance, real estate and business services sector, and the community, social and personal services sector.

As India prepares to for a national election in 2014, slowing economic growth is putting pressure on the current government to push for reform. The projection of 5 percent GDP growth is the lowest figure since 2002-2003 when the GDP grew at 4 percent, after which the Indian economy has grown at an average of 6 percent each year.

This year, the government has taken measures to rein in the fiscal deficit to 5.3 percent of  GDP, has raised the price of fertilizer and diesel, and has allowed further foreign investment in the retail sector by opening up the insurance, pension and aviation sectors for foreign investment. On Jan. 29, India’s central bank lowered its benchmark interest rate for the first time in nine months to fuel higher growth.

If India continues on the reform path, analysts believe that strong growth will resume in the coming year.

“The government’s advance estimates for real GDP growth at 4.9% is disappointing, especially coming on the back of a downward revision in growth for FY2012 from 6.5 percent to 6.2 percent,” said Ms. Bhupali Gursale, an economist at Angel Broking. “On a positive note though, with the government pushing ahead its reform agenda, the outlook for growth in FY2014 is likely to improve.”

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