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 brown 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.

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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.

Correction: The patient’s eyes were brown, not blue.

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Exelon cuts dividend by 41%

Exelon Corp. Thursday morning said it will slash its dividend by more than 40 percent in order to maintain an investment grade rating and free up money to "invest in growth."

Beginning in the second quarter, Exelon's divided will drop to $1.24 per share on an annualized basis from $2.10 per share. The company maintained the $2.10 dividend, among the highest of U.S. utilities, since late 2008.

Analysts predicted the move in light of stubbornly low natural gas prices that have been driving down the company's earnings and are largely responsible for the nearly two-thirds drop the company has seen in its stock price since a high in 2008.
 
Net income for 2012 fell to $1.16 billion, or $1.42 per share, from $2.5 billion, or $3.75 per share. In the fourth quarter, net income fell to $378 million, or 44 cents per share, from $606 million, 91 cents per share, a year earlier.

Revenue was $6.28 billion in the fourth quarter compared to $4.36 billion a year earlier. For the year, revenue rose to $23.49 billion, from $19.06 billion in 2011.

The results were within the company's guidance range.
 
Exelon said Thursday morning that lower prices for the energy it sells, as well as higher nuclear fuel costs,  diminished earnings. Storms, including Sandy, also affected earnings at its regulated utilities in Pennsylvania and Baltimore.
 
The addition of Constellation Energy's contribution to its margins since the merger and favorable weather elsewhere helped to partially offset some losses, the company said.
 
jwernau@tribune.com | Twitter @littlewern

EXC data by YCharts

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CTA to spend $2B for rail-car upgrade

Commuters wait to board a CTA Red Line train at the Belmont Street station in Chicago last December. (Antonio Perez, Chicago Tribune / December 14, 2012)

By Jon Hilkevitch




Tribune reporter

10:17 a.m. CST, February 6, 2013

The CTA will spend up to $2 billion to purchase as many as 846 next-generation rail cars as part of a continuing effort to modernize an aging fleet, officials said Wednesday.
 
The transit agency this week issued an invitation for bids to manufacturers for new rail cars, which will be called the 7000 Series, CTA president Forrest Claypool said.
 
Manufacturers were asked to submit exterior and interior design proposals, including seating configuration and aesthetics, officials said.

The CTA plans a base order of 100 7000 Series cars that would be paid for with federal funds and CTA bond proceeds already in place, CTA spokeswoman Tammy Chase said.

On the options to buy additional cars, up to 746 beyond the base order, the CTA did not identify funding sources.
 
If all goes according to plan, the new cars would start arriving in Chicago about 2016, following completion of delivery of 706 new rail cars that the CTA has already purchased from Bombardier Transportation for $1.14 billion.
 
The Bombardier cars, called the 5000 Series, provide a smoother ride than the old cars they are replacing. But they feature aisle-facing seats, which have proven unpopular with many riders.
 
About 190 of the 5000 Series cars are in operation on several rail lines, with more cars being delivered at a rate of one per weekday, officials said.
 
Replacing old rail cars will reduce service delays caused by mechanical breakdowns and save millions of dollars in operating costs, CTA officials said.
 
Adding the 7000 Series to the mix would potentially reduce the average age of the CTA's fleet to less than 10 years by 2022, officials said. Without the planned purchase, the average age of the fleet would exceed 20 years old by that time. The CTA currently operates about 1,280 rail cars.
 
The oldest rail cars on the CTA system include approximately 400 30-year-old 2600 Series cars that were built between 1981 and 1987, officials said.
 
If all the options were exercised on a 7000 Series purchase, some 256 cars in the 3200 series, which are 20 years old, would be retired in a timely manner, officials said.
 
The CTA could also expand its rail fleet if needed to handle increase ridership or expansion of the rail system, including the planned $1.5 billion extension of the Red Line south branch from 95th Street to 130th Street.
 
jhilkevitch@tribune.com
 
Twitter@jhilkevitch

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Well: Getting Into Your Exercise Groove

Phys Ed

Gretchen Reynolds on the science of fitness.

This isn’t meant as an insult, but you are physiologically lazy. So am I. So are we all. Using treadmill testing, scientists have definitively established that, like other animals, humans naturally aim to use as little energy as possible during most movement. So when we walk or run, our bodies tend to choose a particular cadence, a combination of step length and step frequency, that allows us to move at any given speed with as little physiological effort as possible.

How we pick that cadence, though, and whether we can or would even want to change it has been unclear. But a series of recent studies involving runners, walkers, metronomes and virtual reality curtains suggests that while the tug of physiological laziness is strong, it can be controlled, or at least tweaked, with some conscious effort — and perhaps your iPhone playlist.

In the first and most revelatory of the studies, physiologists at Simon Fraser University in British Columbia asked adult volunteers to walk on a treadmill at an easy pace. Using motion capture technology, the scientists determined how many steps each person was taking per minute at this speed. A person’s pace depends, of course, on both step length and step frequency. But because the two are inextricably entwined — lengthen your stride and you’ll take fewer steps over a given distance — studying one provides sufficient information about the other, and frequency is easier to enumerate.

After establishing each volunteer’s preferred step frequency, the scientists then sped up or slowed the treadmill, and the researchers measured how quickly people’s legs responded.

The body, remember, wants things to be easy. When you increase or decrease the speed of your walking or running, various physiological changes occur; the amount of oxygen in your blood rises or falls, for instance, because your muscles start requiring more or less of the stuff. Other biochemical changes also occur within muscle cells. Sensing those changes, the body realizes that, at this new speed, your cadence isn’t ideal; you’re taking too few or too many steps to use the least possible amount of energy. Your body adjusts.

But that process takes a little while, at least five seconds or so for the oxygen levels to change and your body to recognize the alteration, says Max Donelan, a professor at Simon Fraser University who was a co-author of the study with his graduate student Mark Snaterse and others.

However, the walkers in the study were adjusting their step frequency within less than two seconds after the treadmill speed changed, Dr. Donelan points out. They then fine-tuned their pacing after that. But the first adjustment came almost instantly.

The same process occurred when the researchers repeated the experiment with runners. If the treadmill speed changed, the runners’ step frequency shifted almost immediately, too fast for internal physiology to have played much of a role.

These intsy adjustments suggest that our brains very likely contain huge libraries of preset paces, Dr. Donelan and his colleagues have concluded, of idealized, “physiologically efficient” step cadences for any given speed and condition. It seems probable, in fact, that over our lifetimes, Dr. Donelan says, our brains develop and store countless templates for most pacing situations. We learn and remember what cadence allows us to use the least energy at that speed, and when we reach that speed, we immediately default to our body’s most efficient pace.

Just how the brain recognizes that we are moving at any particular speed is not completely understood, Dr. Donelan says, but almost surely involves messages from the eyes, feet, ears, nervous system, skin and other bodily systems.

Interestingly, it seems to be quite difficult to fool your brain. When Dr. Donelan and his colleagues draped shower-curtain-like enclosures around the front of a treadmill, projected a virtual reality scene of a hallway onto it and then manipulated people’s sense of the speed with which they were moving through the hallway, they found that people’s step frequency would quickly change to match this supposed new speed. But then they would settle back into their former cadence, even as the virtual hallway continued to move past them at unnatural speed.

Visual cues simply were not strong enough to affect pacing for long.

But the scientists have found one signal that does seem effectively to override the body’s strong pull toward its preferred ways of moving: a strongly rhythmic beat. When Dr. Donelan and his colleagues fitted runners or walkers with headphones tuned to a metronome, they found that they could increase or decrease volunteers’ step frequency, even if that frequency was faster or slower than a person’s preferred step pattern. They would also maintain that pace for as long as the metronomic rhythm continued unaltered. The volunteers aligned their movement to the beat.

In practical terms, this finding suggests that music may be one of the best ways to affect the pace of your running or walking, especially if you are trying to maintain a pace with which you are not familiar or which feels awkward. Want to start jogging faster than you have in the past? Load your iPod with uptempo music, Dr. Donelan suggests (although obviously ease into any changes in training slowly, to lessen the risk of injuries).

Dr. Donelan and his colleagues even have recently launched an iPhone app called Cruise Control that allows people to coordinate their pacing with their playlists. Input your preferred running or walking speed and the app skims your music library (nonjudgmentally; if you like Nickelback, that’s your business) and strings together songs with the requisite beat, even subtly altering the tempo of songs, if needed.

But of course, if you’re comfortable with your pace as it is, stick with it. For me, the most stirring message of these recent experiments is that, left to its own devices, your body will almost always obligingly try to choose the least demanding pace for you, a goal with which I’m happy to fall into step.

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Chicago sees surge in foreclosure auctions

More than 35,000 homes and small multifamily buildings in the Chicago area completed the foreclosure process last year, the highest number since the housing crisis began, and the vast majority of them became bank-owned.

An increase in foreclosure auctions was expected since lenders shelved many foreclosure cases while state and federal authorities investigated allegations of faulty foreclosure processes. Still, the heightened level of auctions — 35,244 in 2012, compared with 20,281 in 2011 — along with an increase in initial foreclosure filings, shows the local housing market has a long road to recovery, according to the Woodstock Institute.

"There's going to be pain in the housing market in the short term," said Katie Buitrago, senior policy and communications associate at Woodstock. "There's still high levels of filings. Five years into it, there is still work to be done to help people save their homes."

The Chicago-based public policy and research group is expected to release its report on 2012 foreclosure activity Wednesday.

The year-end numbers show that, with few exceptions, all Chicago neighborhoods and suburban communities saw high double-digit percentage gains in auctions last year. Across the six-county area, 91.3 percent of the foreclosed properties were repossessed by lenders. At the same time, notices of initial default sent to homeowners, the first step in the foreclosure process, increased by 2.9 percent last year, to 66,783.

Real estate agents have worried for more than two years about a glut of foreclosed properties — a shadow inventory — that banks would list for sale en masse and cause home values to plunge. That largely has not happened, but the vast number of distressed properties in the market has kept a lid on local home values.

On Tuesday, for instance, Fannie Mae and Freddie Mac's websites listed 2,415 Cook County homes for sale that the two agencies had repossessed.

Chicago-area home prices, including distressed sales, fell 2.3 percent in December from a year ago, housing analytics firm CoreLogic said Tuesday. Illinois was one of only four states to see home-price depreciation.

The increase in auctions "is a mixed blessing," Buitrago said. "We've been having a lot of trouble in the region with vacant properties that have been languishing for years. The longer they're vacant, the more likely they are to be a destabilizing force in their communities."

Woodstock found that within the city of Chicago, there were 20 communities where more than 1 in 10 owner-occupied one- to four-unit residential buildings and condos went through foreclosure from 2008 to 2012. Five of those neighborhoods are included in the city's 18-month-old Micro-Market Recovery Program, a coordinated effort to stabilize neighborhoods and property values hit hard by foreclosures and vacant buildings.

Also designed to benefit hard-hit areas are the recent establishment of a Cook County Land Bank and legislation waiting for Gov. Pat Quinn's signature that will fast-track the foreclosure process for vacant, abandoned homes while providing financial resources to foreclosure prevention efforts.

mepodmolik@tribune.com

Twitter @mepodmolik

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Chicago commute one of nation's most unpredictable: study

Traffic congestion in Chicago is amongst the worst in the nation. (WGN - Chicago)

You can predict with a high degree of confidence that the time it takes to drive from Point A to B on any given day is unpredictable.

And it's not just snowy or rainy days. It can be any day.

If there is a bright side, it's that Chicago was not the worst.

Residents of the Chicago area are accommodating that increasing uncertainty by setting aside more time each day — just in case — for the commute, new research shows.

For the most important trips, such as going to work, medical appointments, the airport or making a 5:30 p.m. pickup at the child care center to avoid late fees, drivers in northeastern Illinois and northwest Indiana should count on allotting four times as much time as it would take to travel in free-flowing traffic, according to the "Urban Mobility Report" to be released Tuesday by the Texas A&M Transportation Institute. The analysis is based on 2011 data, which are the most recent available.

It is the first time that travel reliability was measured in the 30-year history of the annual report. The researchers created a Planning Time Index geared toward helping commuters reach their destinations on time in more than 95 percent of the trips. A second index, requiring less padding of travel time, would get an employee to work on time four out of five days a week.

"If you plan only for average traffic conditions on your trip in the Chicago area, you are going to be late at least half the time," said Bill Eisele, a senior research engineer at the Transportation Institute who co-authored the study.

The constant unreliability that hovers over commuting is stealing precious time from other activities, crimping lifestyles, causing mounting frustration for drivers and slapping extra costs on businesses that rely on just-in-time shipments to manage inventory efficiently, researchers found.

The Chicago region ranked No. 7 among very large urban areas and 13th among 498 U.S. cities on a scale of the most unreliable highway travel times. The Washington area was the worst. A driver using the freeway system in the nation's capital and surrounding suburbs should budget almost three hours to complete a high-priority trip that would take only 30 minutes in light traffic, the study said.

The Washington area was followed on the list by the metropolitan areas of Los Angeles, New York-Newark, Boston, Dallas-Fort Worth, and Seattle.

Rounding out the top 10, the Chicago metro area was trailed by San Francisco-Oakland, Atlanta, and Houston.

Truck driver Frank Denk said he usually adds an hour or two to his trip through the Chicago area. Sometimes, it's not enough, other times traffic isn't a problem, he said. The one constant, Denk said Monday afternoon while taking a break at the O'Hare Oasis on the Tri-State Tollway, is that it is almost impossible to anticipate correctly.

"Job-wise, it can be very detrimental to truckers," said Denk, who is based in Green Bay, Wis. "All of a sudden, you're not able to make your delivery."

But quadrupling the time to travel back and forth each day? That's excessive, said Mike Hennigan, a 64-year-old accountant who regularly commutes from his Evanston home to his office near the junction of the Kennedy and Edens expressways. He recommends doubling the anticipated travel time.

"I can predict when it's going to be bad," Hennigan said, although he is less optimistic about his travel times when he heads toward downtown.

"Coming into the Loop can be deadly, especially later in the week," Hennigan said.

Overall, traffic congestion in the Chicago region is getting worse as the economy improves, although it's not as severe as the grip that gridlock has taken recently on some other very large metropolitan areas in the U.S., according to the report. The Washington area again topped the list, followed by Los Angeles, San Francisco-Oakland, New York-Newark, Boston, Houston, Atlanta, Chicago, Philadelphia, and Seattle.

No longer being ranked at the very top of the congestion heap provides little consolation for Chicago-area drivers.

What should be a 20-minute jaunt across town in Chicago or the suburbs if highway capacity were sufficient to permit vehicles to travel the speed limit now becomes about an 80-minute ordeal, according to the Texas A&M study. Scheduling 80 minutes for the trip would ensure an on-time arrival 19 out of 20 times, the study concluded.

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The New Old Age Blog: In Blended Families, Responsibility Blurs

Every year, Fran McDowell waited for the summer week when she would sing in a choral festival in the North Carolina mountains, then spend a few days in a lakeside cabin with close women friends.

That getaway grew more complicated to arrange — but perhaps more necessary — after her husband, Herb Beadle, was diagnosed with Alzheimer’s disease. They had a “gloriously happy” marriage — her first, his second — for 11 years, and she was more than willing to care for him in sickness as in health. But he could no longer manage alone in their Atlanta home.

For a few years, other family members pitched in to allow Ms. McDowell her cherished vacation. Eventually, though, she had to ask her husband’s daughter, a medical professional in another state, to take him into her home for a week.

She said no, then yes. Then, the day before Ms. McDowell was to drive him there, her stepdaughter again refused, leaving no time for alternate arrangements. If this had been her biological child, “I would have said, ‘Come on, don’t do this to me,’” Ms. McDowell said. Instead, reluctant to make waves, she canceled her trip.

“I think confrontation is riskier for stepparents,” she told me. “I was the compliant one who would bite my tongue rather than say what I thought.”

Ms. McDowell never told her stepdaughter, or anyone in the family, how angry and disappointed she was, or how difficult it was becoming to care for their father, who died three years ago at 86. She told the members of her dementia caregivers support group instead.

It was that group’s leader, Moira Keller, who e-mailed me to suggest this topic. A clinical social worker with the Sixty Plus program at Piedmont Atlanta Hospital, she wrote that “one of the biggest challenges I have is blended families in later life.”

Though I’ve written about the way the 1970s’ spike in divorces could complicate caregiving for adult children — more households to sustain, more siblings to either help or hinder — I hadn’t considered the impact on the older people themselves.

But Ms. Keller seems to be onto something. “The generation most likely to have stepchildren” — the boomers — “don’t need much care yet,” said Merril Silverstein, a Syracuse University sociologist co-editing a coming issue of the Journal of Marriage and the Family on stepfamilies in later life. “The crunch will come in 10 or 20 years.”

Initially, many adult children whose divorced or widowed parents remarry seem delighted, Ms. Keller said when we spoke. “They’re thrilled that Mom or Dad isn’t alone,” she said. “It’s a wonderful thing — until somebody gets sick.”

Then, she has found, “it gets really blurry. Who’s going to do what?” Grown children don’t have much history with these new spouses; they often feel less responsibility to intervene or help out, and stepparents may be unwilling to ask. Perhaps it’s unclear whether children or new spouses have decision-making authority.

“Older couples in this situation fall through the cracks,” Ms. Keller said.

Research shows that the ties which lead adult children to become caregivers — depending on how much contact they have with parents, how nearby they live, how obligated they feel — are weaker in stepchildren, Dr. Silverstein said. Money sometimes enters the equation too, Ms. Keller added, if biological children resent a parent’s spending their presumed inheritance on care for an ailing stepparent.

Adela Betsill, another of Ms. Keller’s support group members, married her longtime partner five years ago — her second marriage, his third. She has since given up her interior design business to care for Robert who, at 72, has also developed Alzheimer’s disease. His two children have had little involvement — perhaps because she’s just 49 and presumed able to handle everything.

Thus, though Robert’s son works from an office in their home, if Ms. Betsill needed to go out and asked him to remind his father to eat lunch, “he might, or he might not,” she said. “I don’t think he realizes it’s a burden.” So she has not asked.

Would it be different if she were his biological mother and he saw her wearing out under the strain? She thinks so, but it’s hard to know. After all, biological families also experience plenty of conflict and avoidance as elders age.

Still, that sense of reciprocity we often hear from caregivers — she took care of me when I was young, so I need to help out now that she’s old — doesn’t apply in late-life stepfamilies. Ms. Betsill didn’t raise this man, or his half sister.

Older couples who marry or remarry often discuss their finances, Ms. Keller has found. (An elder attorney, Craig Reaves, discussed the legal consequences here.) But illness and dependence may prove even more difficult subjects to broach.

“If I could yell one thing from a mountaintop,” Ms. Keller said, “it’s to talk about this stuff, too. Who’s going to take care of you if you become sick? Talk about that while you’re still healthy.”

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

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U.S. sues S&P over mortgage bond ratings

The federal government is embarking on one of its most ambitious efforts to assign blame for the financial crisis, going after Wall Street's biggest credit rating firm for its role in pumping up the housing bubble.

The Justice Department filed a lawsuit late Monday in Los Angeles federal court against Standard & Poor's Corp. The suit accuses the company's analysts of issuing glowing reviews on troubled mortgage securities whose subsequent failure helped cause the worst financial crisis since the Great Depression.

The action marks the first federal crackdown against a major credit rater, and it signals an untested legal tack after limited success in holding the nation's banks accountable for the part they played in the crisis.

The government selected Los Angeles as the venue to file the lawsuit in part because it was one of the regions hardest hit when the bottom fell out of the housing market. Hundreds of thousands of California residents lost their homes to foreclosure, and others saw their wealth evaporate as properties plummeted in value.

"The DOJ is playing hardball and they're coming at the ratings agency in a very different direction with a potentially very powerful weapon to push S&P to the settlement table," said Jeffrey Manns, a law professor at George Washington University.

In addition to the Justice Department, several state attorneys general are investigating the ratings agency. States such as California and New York are expected to pursue their own investigations and legal action, people familiar with the matter said.

S&P has faced other lawsuits from investors and the states of Illinois and Connecticut.

California is expected to sue S&P under the state's False Claims Act, one person familiar with the matter said. The law makes it a crime to defraud the state, and damages of up to three times the amount of the claim can be awarded if the victim was an institutional investor, such as one of the state's pension funds.

The federal action does not involve any criminal allegations. Critics have complained that the government has yet to send any senior bankers or Wall Street executives to jail for potential illegal behavior that led to the crisis.

But civil actions typically require a much lower burden of proof.

Investors rely in part on rating agencies to decide what stocks, bonds or other securities to buy based on the agencies' recommendations about their safety. The three major raters – S&P, Moody's Investors Service and Fitch Ratings — have all been criticized for giving perfect AAA ratings to complex bonds in 2007 that later turned out to be nearly worthless.

It was not known why Standard & Poor's was singled out in the federal lawsuit.

The government and S&P have tangled before. The rating agency in August 2011 issued a historic downgrade of U.S. creditworthiness and threatened to lower it even further.

The two sides were reportedly in settlement talks that broke down during the past week. The ratings firm could face hundreds of millions of dollars in fines and new restrictions on its business model if found liable of civil violations.

S&P, which is a unit of publisher McGraw Hill, denounced the lawsuit in a detailed and strongly worded response. The company said the claims were unjustified, adding that it acted in "good faith" to warn the world about some of the securities that went belly up.

"A DOJ lawsuit would be entirely without factual or legal merit," the company said, adding that even the U.S. government "publicly stated that problems in the subprime market appeared to be contained."

The rating firm has steadfastly maintained that it was protected under the 1st Amendment to state an opinion about certain financial products. That argument may not hold up if federal or state investigators are able to prove that the ratings agency knowingly gave improper evaluations.

The lawsuit zeros in on a series of collateralized debt obligations that were created at the height of the housing boom in 2007, according to S&P. The value of these exotic mortgage securities was nearly wiped out when the subprime mortgages they were tied to imploded.

Lawrence J. White, an economics professor at New York University's business school, believes that the housing crisis could have been more contained if ratings agencies had been more careful.

"If they had been more conservative in their ratings, fewer bonds would have been sold, the interest rates would have been higher, fewer mortgages would have been granted," White said. "There would still have been a housing bubble, but it might not have been quite so severe."

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$5 million bail in 'exceptionally brutal' Aurora murder

An Aurora man was ordered held on $5 million bail today for allegedly beating a young woman to death with a hammer and then torching her body and her car, a crime a prosecutor labeled “exceptionally brutal.”

Juan Garnica Jr., 18, of the 400 block of East Ashland Avenue, appeared briefly via video in Kane County bond court, his first court appearance since he was charged with first-degree murder and other crimes in the death of Abigail Villalpando, 18, of Aurora.

It was the first homicide in Aurora since 2011, more than 400 days ago, according to city spokesman Dan Ferrelli.

Two other men have been charged with concealing the homicide.

Judge Christine Downs set bail for one of the men, Enrique Prado, 19, of Aurora, at $100,000. Assistant State’s Attorney Bill Engerman told the judge that police have no evidence that Prado, who also faces arson charges, participated in the murder of Villalpando. Prado has also been cooperative with police since his arrest, the prosecutor said.

A third man, 20-year-old Jose Becerra, did not appear in court this morning. He may appear this afternoon on his charge of concealment of a homicidal death.

Villalpando’s body, which was so badly burned that it had to be identified through dental records, was discovered in a wooded area near Montgomery Sunday morning, about two days after her car was found engulfed in flames under a bridge in Aurora.

Police said the victim met Prado and Garnica Thursday at Prado’s home, and that Garnica hit Villalpando in the head several times with a hammer after Prado left the room. Engerman declined to disclose why VIllalpando went to the house, but police did say she knew Garnica and Prado.

Police have not disclosed a motive for the attack.

Sometime Thursday night , Garnica allegedly drove the victim’s car to the High Street bridge over the railroad tracks on the city’s near east side an left it there. Villalpando’s body was concealed in a container in Prado’s garage, police said.

On Friday, Garnica and Prado bought a can of gas, which Garncia used to torch Villalpando’s 2003 Nissan Altima. Garnica then allegedly burned the victim’s body in a barrel in the backyard at Prado’s house. He then enlisted Becerra to help dump the body, police said.

Villalpando’s family reported her missing about 2:30 a.m. Friday, after she failed to show up at her waitress job at a  Denny’s at the Fox Valley Center shopping center. A restaurant employee called the family around 5 p.m. Thursday to report that she had not showed up for work.

Engerman said Garnica has a 2011 arrest for a stolen car, a charge that was later reduced to criminal trespass to a vehicle.

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The Future of BlackBerry 10 Sales Looks Hazy

Early sales figures from abroad suggest high demand for one of BlackBerry‘s two big comeback phones… in the struggling Canadian company’s strongest market. As the U.S. market remains on standby for sales and even ads, reports from both analysts and suppliers suggest sold-out new models in the United Kingdom, the first and only place the BlackBerry Z10 is available yet. “We believe Carphone Warehouse is seeing widespread sell-outs, while O2, Vodafone, Orange and EE are seeing robust demand,” Jefferies analyst Peter Misek writes. “We estimate sell-in to be at least several hundred thousand units,” he added. It’s not that these sales aren’t deserved — the gadget reviewers loved the touchscreen Z10, for the most part, and the full-keyboard Q10 model that also works with the new BlackBerry 10 OS isn’t on sale anywhere yet. But if any place would like a touchscreen BlackBerry, it would be the UK. Because the British may not have abandoned the smartphone keyboard, but they fell out of love it with a lot more slowly than Americans did  — BlackBerry held on to 12 percent of its market share there last year, compared to the 2 percent in the U.S. Unfortunately for the company formerly known as Research in Motion, the earliest signs suggest the Z10 may not change that lack of enthusiasm in the states.

RELATED: Everything You Need to Know About BlackBerry 10

The lack of stateside BlackBerry enthusiasm starts with American wireless carriers. U.S. customers can’t even buy the Z10 until sometime in March — we’ll be the last country to get it in this initial wave. The delay stems from a Federal Communications Commission approval process that will take weeks. While that might sound like a regulatory technicality, it may also reflect a lack of excitement to get the phone out there. None of the cellphone companies have started taking pre-sale orders, and all but one failed to provide an executive quote playing up the new BlackBerry, as PC Mag’s Sascha Segan pointed out. Sprint won’t even sell the Z10, opting to push out the more traditional Q10 and its signature keyboard when that phone starts to hit carriers in April. 

RELATED: Blackberry’s New OS Met With Resounding ‘Meh’

The Z10 sales delay could work in BlackBerry’s favor in one peculiar way — it should give consumers enough time to forget about the very weird, very desperate product unveiling. Still, two months is also enough time for initial hype to wear off, as other, newer phones get more and more attention — the much anticipated Samsung Galaxy SIV will supposedly come out around March as well. To keep Americans excited, BlackBerry has spent hundreds of millions on an ad campaign in the U.S., reports The Wall Street Journal. But the company’s new Super Bowl ad, which focused on all the things the new BlackBerry can’t do, has techies baffled:

RELATED: Look How Desperate the BlackBerry 10 Unveiling Event Actually Was

RELATED: RIM Says Sorry to Customers with Free Apps

“It’s just hard to see how you can introduce a new product without covering a single feature,” wrote The Verge’s T.C. Sotteck of the new spot. Lucky for BlackBerry, the ad was a one-time Super Sunday move. Its “Keep Moving” campaign, which focuses on what the phone can do, will debut today. The 60-second preview sampled over at The Verge sounds like it does a better job selling Z10′s features. “[The ad] featured a side-scrolling view of people moving through different variations on work and play: a nod to the company’s enterprise-focused heritage,” Sottech writes.

Gadgets News Headlines – Yahoo! News

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