For Alzheimer’s, Detection Advances Outpace Treatment Options

Joshua Lott for The New York Times

Awilda Jimenez got a scan for Alzheimer’s after she started forgetting things. It was positive.

When Awilda Jimenez started forgetting things last year, her husband, Edwin, felt a shiver of dread. Her mother had developed Alzheimer’s in her 50s. Could his wife, 61, have it, too?

He learned there was a new brain scan to diagnose the disease and nervously agreed to get her one, secretly hoping it would lay his fears to rest. In June, his wife became what her doctor says is the first private patient in Arizona to have the test.

“The scan was floridly positive,” said her doctor, Adam S. Fleisher, director of brain imaging at the Banner Alzheimer’s Institute in Phoenix.

The Jimenezes have struggled ever since to deal with this devastating news. They are confronting a problem of the new era of Alzheimer’s research: The ability to detect the disease has leapt far ahead of treatments. There are none that can stop or even significantly slow the inexorable progression to dementia and death.

Families like the Jimenezes, with no good options, can only ask: Should they live their lives differently, get their affairs in order, join a clinical trial of an experimental drug?

“I was hoping the scan would be negative,” Mr. Jimenez said. “When I found out it was positive, my heart sank.”

The new brain scan technology, which went on the market in June, is spreading fast. There are already more than 300 hospitals and imaging centers, located in most major metropolitan areas, that are ready to perform the scans, according to Eli Lilly, which sells the tracer used to mark plaque for the scan.

The scans show plaques in the brain — barnaclelike clumps of protein, beta amyloid — that, together with dementia, are the defining feature of Alzheimer’s disease. Those who have dementia but do not have excessive plaques do not have Alzheimer’s. It is no longer necessary to wait until the person dies and has an autopsy to learn if the brain was studded with plaques.

Many insurers, including Medicare, will not yet pay for the new scans, which cost several thousand dollars. And getting one comes with serious risks. While federal law prevents insurers and employers from discriminating based on genetic tests, it does not apply to scans. People with brain plaques can be denied long-term care insurance.

The Food and Drug Administration, worried about interpretations of the scans, has required something new: Doctors must take a test showing they can read them accurately before they begin doing them. So far, 700 doctors have qualified, according to Eli Lilly. Other kinds of diagnostic scans have no such requirement.

In another unusual feature, the F.D.A. requires that radiologists not be told anything about the patient. They are generally trained to incorporate clinical information into their interpretation of other types of scans, said Dr. R. Dwaine Rieves, director of the drug agency’s Division of Medical Imaging Products.

But in this case, clinical information may lead radiologists to inadvertently shade their reports to coincide with what doctors suspect is the underlying disease. With Alzheimer’s, Dr. Rieves said, “clinical impressions have been misleading.”

“This is a big change in the world of image interpretation,” he said.

Like some other Alzheimer’s experts, Dr. Fleisher used the amyloid scan for several years as part of a research study that led to its F.D.A. approval. Subjects were not told what the scans showed. Now, with the scan on the market, the rules have changed.

Dr. Fleisher’s first patient was Mrs. Jimenez. Her husband, the family breadwinner, had lost his job as a computer consultant when the couple moved from New York to Arizona to take care of Mrs. Jimenez’s mother. Paying several thousand dollars for a scan was out of the question. But Dr. Fleisher found a radiologist, Dr. Mantej Singh Sra of Sun Radiology, who was so eager to get into the business that he agreed to do Mrs. Jimenez’s scan free. His plan was to be the first in Arizona to do a scan, and advertise it.

After Dr. Sra did the scan, the Jimenezes returned to Dr. Fleisher to learn the result.

Dr. Fleisher, sad to see so much plaque in Mrs. Jimenez’s brain, referred her to a psychiatrist to help with anxiety and suggested she enter clinical trials of experimental drugs.

But Mr. Jimenez did not like that idea. He worried about unexpected side effects.

“Tempting as it is, where do you draw the line?” he asks. “At what point do you take a risk with a loved one?”

At Mount Sinai Medical Center in New York, Dr. Samuel E. Gandy found that his patients — mostly affluent — were unfazed by the medical center’s $3,750 price for the scan. He has been ordering at least one a week for people with symptoms ambiguous enough to suggest the possibility of brain plaques.

Most of his patients want their names kept confidential, fearing an inability to get long-term care insurance, or just wanting privacy.

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Automated Bidding Systems Test Old Ways of Selling Ads

Publishers and broadcasters have long tried to offer advertisers the right audience for their products. Want to sell pick-ups to people who like sports? Buy ads at halftime during a football game. Selling luggage or airline tickets? Buy ads in the travel section of a newspaper or Web site.

In digital advertising, that formula is being increasingly tested by fast-paced, algorithmic bidding systems that target individual consumers rather than the aggregate audience publishers serve up. In the world of “programmatic buying” technologies, context matters less than tracking those consumers wherever they go. And that kind of buying is the reason that shoe ad follows you whether you’re on Weather.com or on a local news blog.

That shift is punishing traditional online publishers, like newspaper, broadcast and magazine sites, who are receiving a much lower percentage of ad dollars as marketers use programmatic buying across a much broader canvas. Some sites, like CNN.com, refuse to even accept advertising through programmatic buying because they do not want to cede control over what ads will appear.

“It’s allowing advertisers to assign value to media rather than publishers,” said Ben Winkler, the chief digital officer at OMD, an agency in the Omnicom Media Group. Publishers, he said, “can’t control the price, but they can control the quality of the content and the audience on that site.”

About 10 percent of the display ads that consumers see online have been sold through programmatic bidding channels, according to Walter Knapp, the executive vice president of platform revenue and operations at Federated Media, one of the world’s largest digital advertising networks.

Advertisers like Nike, Comcast, Progressive and Procter & Gamble are now using the programmatic buying, and luxury advertisers are starting to follow. According to data from Forrester Research, all ads traded on exchanges, as programmatic ads are, increased more than 17.5 percent to about 629 billion impressions (the number of times an ad appears) in 2012, from 535 billion in 2011.

That growth is affecting publishers of all stripes, but few are willing to discuss their internal numbers. “For a publisher to admit they’ve been hurt is tough for the big guys,” said John Ebbert, the executive editor and publisher of the Web site AdExchanger.

When The New York Times Company announced its earnings last month, the company posted a profit, but said that digital advertising fell 2.2 percent. Jim Follo, the company’s senior vice president and chief financial officer, attributed the dip, in part, on a “shift toward ad exchanges, real-time bidding and other programmatic buying channels that allow advertisers to buy audience at scale.”

Programmatic buying began as a way for advertisers to place lower-cost ads for products like teeth-whitening products and belly fat pills that filled up the back pages of Web sites. But the practice has gained in sophistication and breadth, with major advertisers and many of the world’s largest ad agencies creating private exchanges to automate the buying and selling of ads.

Programmatic buying includes a number of different technologies and strategies, but it essentially allows advertisers to bid, often in real time, on ad space largely based on the value they have assigned to the consumer on the other side of the screen. Say, for example, that Nike wants to sell running gear to a particular consumer who has a high likelihood of buying shoes based on the data it has collected, including the type of Web sites that consumer typically visits. Because the ad-buying is done through computer trading, the price for that space can change rapidly.

“Accessing media is a commodity now,” said Sheldon Gilbert, the founder and chief executive of Proclivity Media, a company that specializes in digital advertising technologies. “Instead of having to commit four months in advance, you can now bid and buy an individual impression in real time.”

In the short run, the growth in programmatic buying has forced overall ad prices to fall. A media buyer who would have once spent $50,000 worth of advertising on a publisher’s site, at, say, an $8 cost-per-thousand, can now buy ad impressions on any Web site on which they happen to find their intended audience and pay less per ad, Mr. Ebbert said.

“There is no scarcity of premium online,” said Dan Salmon, an equity research analyst at BMO Capital Markets. “There’s only one Super Bowl, but there are lots of different places to buy banner ads online.”

While the “halo effect” of buying an ad against premium content has not disappeared entirely — many advertisers still want front-page placement on popular Web sites — the shift is prompting publishers to rethink how they sell their ads.

Clark Fredricksen, the vice president for communications at eMarketer, a data company, said that publishers were “going to have to double down to prove the value of their inventory as they compete with other, cheaper inventory.”

And some publishers are jumping into the game themselves. During the most recent AOL earnings call, Tim Armstrong, the company’s chairman and chief executive, said it was bullish on programmatic buying, despite being a publisher itself with properties that include TechCrunch and The Huffington Post. The company trades its ads through its own ad network, Ad.com, and others like it.

“We will continue to invest in people and technology to capture the programmatic business of advertising,” Mr. Armstrong said.

Like AOL, Weather.com is also aggressively moving into programmatic bidding. “Instead of thinking of us a publisher, think of us as a marketing engine,” said Curt Hecht, the chief global revenue officer for the Weather Company.

Neal Mohan, the vice president for product management at Google, which sells advertising though its DoubleClick network, says that in the long run, publishers could see higher returns from programmatic advertising. In the last year, the number of advertisers and publishers using the DoubleClick platform has doubled, Mr. Mohan said, while the rates for those using the platform have increased 11 percent. But that means publishers will have to play by different rules.

“Context still matters and so does placement,” Mr. Ebbert said. “But it’s only one element.”

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Attacks Resume After Israeli Assault Kills Hamas Leader

KIRYAT MALACHI, Israel — Israel and Hamas widened their increasingly deadly conflict over Gaza on Thursday, as a militant rocket killed three civilians in an apartment block in this small southern town. The deaths are likely to lead Israel to intensify its military offensive on Gaza, now in its second day of airstrikes.

In Gaza, the Palestinian death toll rose to 11 as Israel struck what the military described as medium- and long-range rocket and infrastructure sites and rocket-launching squads. The military said it had dispersed leaflets over Gaza warning residents to stay away from Hamas operatives and facilities, suggesting that more was to come.

The regional perils of the situation sharpened, meanwhile, as President Mohamed Morsi of Egypt warned on Thursday that his country stood by the Palestinians against what he termed Israeli aggression, echoing similar condemnation on Wednesday.

“The Egyptian people, the Egyptian leadership, the Egyptian government, and all of Egypt is standing with all its resources to stop this assault, to prevent the killing and the bloodshed of Palestinians,” Mr. Morsi said in nationally televised remarks before a crisis meeting of senior ministers. He also said he had contacted President Obama to discuss strategies to “stop these acts and doings and the bloodshed and aggression.”

In language that reflected the upheaval in the political dynamics of the Middle East since the overthrow of Hosni Mubarak last year, Mr. Morsi said: “Israelis must realize that we don’t accept this aggression and it could only lead to instability in the region and has a major negative impact on stability and security in the region.”

The thrust of Mr. Morsi’s words seemed confined to diplomatic maneuvers, including calls to the United Nations secretary general, Ban Ki-moon, the head of the Arab League and President Obama.

In his conversation with Mr. Obama, Mr. Morsi said, he “clarified Egypt’s role and Egypt’s position; our care for the relations with the United States of America and the world; and at the same time our complete rejection of this assault and our rejection of these actions, of the bloodshed, and of the siege on Palestinians and their suffering.”

Mr. Obama had agreed to speak with Israeli leaders, Mr. Morsi said. Thursday’s deaths in Kiryat Malachi were the first casualties on the Israeli side since Israel launched its assault on Gaza, the most ferocious in four years, in response to persistent Palestinian rocket fire.

Southern Israel has been struck by more than 750 rockets fired from Gaza this year that have hit homes and caused injuries. On Thursday, a rocket smashed into the top floor of an apartment building in Kiryat Malachi, about 15 miles north of Gaza. Two women and a man were killed, according to rescue officials and Army Radio. A baby was among the injured and several Israelis were hospitalized with shrapnel wounds after rockets hit other southern cities and towns, they said.

The apartment house was close to a field in a blue-collar neighborhood and the rocket tore open top-floor apartments, leaving twisted metal window frames and bloodstains.

Nava Chayoun, 40, who lives on the second floor, said her husband, Yitzhak, ran up the stairs immediately after the rocket struck and saw the body of a woman on the floor. He rescued two children from the same apartment and afterward, she said, she and her family “read psalms.”

It was the first time that a building in Kiryat Malachi had been struck and the farthest north a projectile had landed in the current violence. With schools closed after Wednesday’s turmoil, residents said, many people had stayed home with their children.

Residents said people living on the lower floors of the apartment house had taken cover in stairwells, as the police urged residents to do when they heard warning sirens, but those on the top floor apparently had not. The police said 180 rockets had been fired at southern Israel since Wednesday.

Isabel Kershner reported from Kiryat Malachi, Israel, and Fares Akram from Gaza. Reporting was contributed by Rina Castelnuovo from Kiryat Malachi; Mayy El Sheikh and David D. Kirkpatrick from Cairo; Gabby Sobelman from Jerusalem; Rick Gladstone from New York; and Alan Cowell from Paris.

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In UK, Twitter, Facebook rants land some in jail

LONDON (AP) — One teenager made offensive comments about a murdered child on Twitter. Another young man wrote on Facebook that British soldiers should “go to hell.” A third posted a picture of a burning paper poppy, symbol of remembrance of war dead.

All were arrested, two convicted, and one jailed — and they’re not the only ones. In Britain, hundreds of people are prosecuted each year for posts, tweets, texts and emails deemed menacing, indecent, offensive or obscene, and the number is growing as our online lives expand.

Lawyers say the mounting tally shows the problems of a legal system trying to regulate 21st century communications with 20th century laws. Civil libertarians say it is a threat to free speech in an age when the Internet gives everyone the power to be heard around the world.

“Fifty years ago someone would have made a really offensive comment in a public space and it would have been heard by relatively few people,” said Mike Harris of free-speech group Index on Censorship. “Now someone posts a picture of a burning poppy on Facebook and potentially hundreds of thousands of people can see it.

“People take it upon themselves to report this offensive material to police, and suddenly you’ve got the criminalization of offensive speech.”

Figures obtained by The Associated Press through a freedom of information request show a steadily rising tally of prosecutions in Britain for electronic communications — phone calls, emails and social media posts — that are “grossly offensive or of an indecent, obscene or menacing character — from 1,263 in 2009 to 1,843 in 2011. The number of convictions grew from 873 in 2009 to 1,286 last year.

Behind the figures are people — mostly young, many teenagers — who find that a glib online remark can have life-altering consequences.

No one knows this better than Paul Chambers, who in January 2010, worried that snow would stop him catching a flight to visit his girlfriend, tweeted: “Crap! Robin Hood airport is closed. You’ve got a week and a bit to get your (expletive) together otherwise I’m blowing the airport sky high.”

A week later, anti-terrorist police showed up at the office where he worked as a financial supervisor.

Chambers was arrested, questioned for eight hours, charged, tried, convicted and fined. He lost his job, amassed thousands of pounds (dollars) in legal costs and was, he says, “essentially unemployable” because of his criminal record.

But Chambers, now 28, was lucky. His case garnered attention online, generating its own hashtag — (hash)twitterjoketrial — and bringing high-profile Twitter users, including actor and comedian Stephen Fry, to his defense.

In July, two and half years after Chambers’ arrest, the High Court overturned his conviction. Justice Igor Judge said in his judgment that the law should not prevent “satirical or iconoclastic or rude comment, the expression of unpopular or unfashionable opinion about serious or trivial matters, banter or humor, even if distasteful to some or painful to those subjected to it.”

But the cases are coming thick and fast. Last month, 19-year-old Matthew Woods was sentenced to 12 weeks in jail for making offensive tweets about a missing 5-year-old girl, April Jones.

The same month Azhar Ahmed, 20, was sentenced to 240 hours of community service for writing on Facebook that soldiers “should die and go to hell” after six British troops were killed in Afghanistan. Ahmed had quickly deleted the post, which he said was written in anger, but was convicted anyway.

On Sunday — Remembrance Day — a 19-year-old man was arrested in southern England after police received a complaint about a photo on Facebook showing the burning of a paper poppy. He was held for 24 hours before being released on bail and could face charges.

For civil libertarians, this was the most painfully ironic arrest of all. Poppies are traditionally worn to commemorate the sacrifice of those who died for Britain and its freedoms.

“What was the point of winning either World War if, in 2012, someone can be casually arrested by Kent Police for burning a poppy?” tweeted David Allen Green, a lawyer with London firm Preiskel who worked on the Paul Chambers case.

Critics of the existing laws say they are both inadequate and inconsistent.

Many of the charges come under a section of the 2003 Electronic Communications Act, an update of a 1930s statute intended to protect telephone operators from harassment. The law was drafted before Facebook and Twitter were born, and some lawyers say is not suited to policing social media, where users often have little control over who reads their words.

It and related laws were intended to deal with hate mail or menacing phone calls to individuals, but they are being used to prosecute in cases where there seems to be no individual victim — and often no direct threat.

And the Internet is so vast that policing it — even if desirable — is a hit-and-miss affair. For every offensive remark that draws attention, hundreds are ignored. Conversely, comments that people thought were made only to their Facebook friends or Twitter followers can flash around the world.

While the U.S. Supreme Court has ruled that First Amendment protections of freedom of speech apply to the Internet, restrictions on online expression in other Western democracies vary widely.

In Germany, where it is an offense to deny the Holocaust, a neo-Nazi group has had its Twitter account blocked. Twitter has said it also could agree to block content in other countries at the request of their authorities.

There’s no doubt many people in Britain have genuinely felt offended or even threatened by online messages. The Sun tabloid has launched a campaign calling for tougher penalties for online “trolls” who bully people on the Web. But others in a country with a cherished image as a bastion of free speech are sensitive to signs of a clampdown.

In September Britain’s chief prosecutor, Keir Starmer, announced plans to draw up new guidelines for social media prosecutions. Starmer said he recognized that too many prosecutions “will have a chilling effect on free speech.”

“I think the threshold for prosecution has to be high,” he told the BBC.

Starmer is due to publish the new guidelines in the next few weeks. But Chambers — reluctant poster boy of online free speech — is worried nothing will change.

“For a couple of weeks after the appeal, we got word of judges actually quoting the case in similar instances and the charges being dropped,” said Chambers, who today works for his brother’s warehouse company. “We thought, ‘Fantastic! That’s exactly what we fought for.’ But since then we’ve had cases in the opposite direction. So I don’t know if lessons have been learned, really.”

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Jill Lawless can be reached at http://Twitter.com/JillLawless

Social Media News Headlines – Yahoo! News

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R.A. Dickey, David Price win Cy Young awards

NEW YORK (AP) — R.A. Dickey languished in the minors for 14 years, bouncing from one team to another before finally perfecting that perplexing knuckleball that made him a major league star.

David Price was the top pick in the draft and an ace by age 25, throwing 98 mph heat with a left arm live enough to make the most hardened scout sing.

Raised only 34 miles apart in central Tennessee, Dickey and Price won baseball's Cy Young awards on Wednesday — one by a wide margin, the other in a tight vote.

Two paths to the pantheon of pitching have rarely been more different.

"Isn't that awesome?" said Dickey, the first knuckleballer to win a Cy Young. "It just shows you there's not just one way to do it, and it gives hope to a lot of people."

Dickey said he jumped up and yelled in excitement, scaring one of his kids, when he saw on television that Price edged Justin Verlander for the American League prize. Both winners are represented by Bo McKinnis, who watched the announcements with Dickey at his home in Nashville, Tenn.

"I guess we can call him Cy agent now," Price quipped on a conference call.

The hard-throwing lefty barely beat out Verlander in balloting by the Baseball Writers' Association of America, preventing the Detroit Tigers' ace from winning consecutive Cy Youngs.

Runner-up two years ago, Price was the pick this time. He received 14 of 28 first-place votes and finished with 153 points to 149 for Verlander, chosen first on 13 ballots.

"It means a lot," Price said. "It's something that I'll always have. It's something that they can't take away from me."

Other than a 1969 tie between Mike Cuellar and Denny McLain, it was the closest race in the history of the AL award.

Rays closer Fernando Rodney got the other first-place vote and came in fifth.

The 38-year-old Dickey was listed first on 27 of 32 National League ballots and totaled 209 points, 113 more than 2011 winner Clayton Kershaw of the Los Angeles Dodgers. Washington lefty Gio Gonzalez finished third.

Cincinnati right-hander Johnny Cueto and Atlanta closer Craig Kimbrel each received a first-place vote, as did Gonzalez. Kershaw had two.

Dickey joined Dwight Gooden (1985) and three-time winner Tom Seaver as the only Mets to win the award. The right-hander went 20-6 with a 2.73 ERA, making him the club's first 20-game winner since Frank Viola in 1990, and became the first major leaguer in 24 years to throw consecutive one-hitters.

Perhaps most impressive, Dickey did it all during a season when the fourth-place Mets finished 74-88.

"It just feels good all over," he said on MLB Network.

Dickey switched from conventional pitcher to full-time knuckleballer in a last-ditch effort to save his career. It took him years to finally master the floating, darting pitch, which he often throws harder (around 80 mph) and with more precision than almost anyone who used it before him.

"I knew what I was going to be up against in some regard when I embraced this pitch," Dickey said.

He was the first cut at Mets spring training in 2010 but earned a spot in the big league rotation later that season and blossomed into a dominant All-Star this year. He led the NL in strikeouts (230), innings (233 2-3), complete games (five) and shutouts (three) — pitching through an abdominal injury most of the way.

"I am not a self-made man by any stretch of the imagination," Dickey said. "The height of this story, it's mind-blowing to me, it really is."

A member of the 1996 U.S. Olympic team and a first-round draft pick out of Tennessee, Dickey was devastated when the Texas Rangers reduced their signing-bonus offer from more than $800,000 to $75,000 after they discovered during a physical that he was missing a major ligament in his pitching elbow.

Undeterred, perseverance got him to the big leagues anyway. When he failed, the knuckleball brought him back.

Among those he thanked ceaselessly for helping him on that long and winding road to success were all his proud knuckleball mentors, including Charlie Hough, Tim Wakefield and Hall of Famer Phil Niekro.

"It brings a real degree of legitimacy I think to the knuckleball fraternity and I'm glad to represent them and I'm certainly grateful to all those guys," Dickey said. "This was a victory for all of us."

Dickey said he received 127 text messages and 35-40 phone calls in the moments immediately following the Cy Young announcement.

The only call he took was from Niekro, a 318-game winner from 1964-87. The first texts Dickey responded to were from Wakefield and Hough.

"Most well-deserved," Niekro said in a comment provided by the Hall of Fame. "I'm super proud of him, as a pitcher and as an individual."

Dickey has one year left on his contract at $5.25 million and New York general manager Sandy Alderson has said signing the pitcher to a multiyear deal is one of his top offseason priorities. Alderson, however, would not rule out trading his unlikely ace.

"I believe the Mets are going to be a lot better and I want to be part of the solution," Dickey said, adding that he hopes the sides can strike a deal and he'd be happy to end his career in New York.

"I want to be loyal to an organization that's given me an opportunity," he said. "At the same time, you don't want to be taken advantage of. I've been on that side of it, too, as a player."

Price went 20-5 to tie Jered Weaver for the American League lead in victories and winning percentage. The 27-year-old lefty had the lowest ERA at 2.56 and finished sixth in strikeouts with 205.

Verlander, also the league MVP a year ago, followed that up by going 17-8 with a 2.64 ERA and pitching the Detroit Tigers to the World Series. He led the majors in strikeouts (239), innings (238 1-3) and complete games (six).

Price tossed 211 innings in 31 starts, while Verlander made 33. One factor that could have swung some votes, however, was this: Price faced stiffer competition in the rugged AL East than Verlander did in the AL Central.

"I guess it's a blessing and a curse at the same time," Price said. "There's not an easy out in the lineups every game. It feels like a postseason game."

The No. 1 pick in the 2007 amateur draft out of Vanderbilt, Price reached the majors the following year and has made three straight All-Star teams.

Despite going 19-6 with a 2.72 ERA in 2010, he finished a distant second in Cy Young voting to Felix Hernandez, who won only 13 games for last-place Seattle but dominated most other statistical categories that year.

The two MVP awards will be announced Thursday. Verlander's teammate, Triple Crown winner Miguel Cabrera, is a leading contender in the American League.

NOTES: The last AL pitcher to win back-to-back Cy Youngs was Boston's Pedro Martinez in 1999 and 2000. San Francisco RHP Tim Lincecum did it in the National League in 2008-09. ... Price and Dickey became the fourth pair of Cy Young winners born in the same state, according to STATS. The others were Jim Lonborg and Mike McCormick in 1967 (California), Viola and Orel Hershiser in 1988 (New York) and Pat Hentgen and John Smoltz in 1996 (Michigan). ... Niekro and his brother, Joe, both finished second in Cy Young voting, as did fellow knuckleballer Wilbur Wood.

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Hospital Death in Ireland Renews Fight Over Abortion

DUBLIN — The death of a woman who was reportedly denied a potentially lifesaving abortion even while she was having a miscarriage has revived debate over Ireland’s almost total ban on abortions.

The woman, Savita Halappanavar, 31, a dentist who lived near Galway, was 17 weeks pregnant when she sought treatment at University Hospital Galway on Oct. 21, complaining of severe back pain.

Dr. Halappanavar was informed by senior hospital physicians that she was having a miscarriage and that her fetus had no chance of survival. However, despite repeated pleas for an abortion, she was told that it would be illegal while the fetus’s heart was still beating, her husband, Praveen Halappanavar, said.

It was not until Oct. 24 that the heartbeat ceased and the remains of the fetus were surgically removed. But Dr. Halappanavar contracted a bacterial blood disease, septicemia. She was admitted to intensive care but never recovered, dying on Oct. 28.

Mr. Halappanavar, in an interview with The Irish Times from his home in India, said his wife was told after one request, “This is a Catholic country.”

Two investigations into the case have been announced, and politicians have been quick to express their condolences and to call for legal clarity. Kathleen Lynch, a junior health minister, said medical professionals needed guidelines to deal with such circumstances.

In a statement, the hospital said it would cooperate fully with any inquest but that it had not started its own review because it wanted to consult the woman’s family first.

Mr. Halappanavar told the newspaper that he still could not believe his wife was dead. “I was with her those four days in intensive care,” he said. “They kept telling me: ‘She’s young. She’ll get over it.’ But things never changed; they only got worse. She was so full of life. She loved kids.

“It was all in their hands, and they just let her go. How can you let a young woman go to save a baby who will die anyway?”

But Mr. Halappanavar said he saw no use in being angry. “I’ve lost her,” he said. “I am talking about this because it shouldn’t happen to anyone else.”

Medical professionals were less forgiving. During a miscarriage, the cervix is opened, exposing the woman to infection, and the longer the miscarriage persists, the greater the risk, said a prominent medical commentator here, Dr. Muiris Houston. While Dr. Halappanavar’s death was “on the rare end of the spectrum,” and the facts surrounding the case are not all known, Dr. Houston said, she “undoubtedly needed to go to theater,” meaning to surgery.

“If she had gone to theater earlier she might still have died, but perhaps not,” he said. “Medicine is now increasingly driven by guidelines, and the question must be, ‘Did the hospital have protocols in place when a woman presented with such a condition?’ ”

The legal issues are, if anything, more clouded. In 1992, the Irish Supreme Court ruled that abortion was permissible in cases where there was a “real and substantial risk” to the life of a pregnant woman — including the possibility of suicide. But 20 years later, the Irish government has still not passed a law to this effect.

In 2010, the European Court of Human Rights found that Ireland was in violation of the European Convention on Human Rights by failing to provide an accessible and effective procedure to ascertain whether a woman qualified for a legal abortion.

In response, the current coalition government commissioned a report from an expert group on the issue. It was initially expected in July, but was then postponed until September — a deadline also missed. Given the divisiveness of the abortion issue in Ireland, which has prompted two bitterly fought referendums, successive governments have avoided passing any legislation.

The report was eventually delivered Tuesday night, hours before news broke of Dr. Halappanavar’s death. The government warned people not to link the two, but inevitably the death has led to calls for urgent reform.

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Greece Looks at Offering Creditors a Buyback to Lower Its Debt

LONDON — As Greece’s creditors bicker over the terms of its bailout, the government is examining a more radical approach that could reduce the country’s escalating debt pile in one fell swoop.

Milos Bicanski/Getty Images

An anti-austerity protest on Wednesday in Athens. The government this month narrowly secured parliamentary approval for yet another round of spending cuts and tax increases.

Fotis Plegas G./European Pressphoto Agency

Charles Dallara of the Institute of International Finance argues that the real issue is Greece’s inability to revive its economy.

Essentially, Greece would propose that its private sector bondholders sell back their sovereign debt holdings for a small profit, but at a price favorable to Greece. The move takes a page from the playbook Greece used earlier this year in which the government pressured banks and other private holders to take a loss on their sovereign bonds so Greece could ease its debt load. This time, they would not be forced to take a haircut, but some would most likely balk at being forced to accept a new deal.

The aim is to further reduce an ever-increasing sovereign debt burden that is fast approaching 200 percent of gross domestic product, far beyond Europe’s ideal of 60 percent or less.

Many different strategies about how to address Greece’s debt load are being discussed by its creditors, with the buyback option being just one of several. The government this month narrowly secured parliamentary approval for yet another round of spending cuts and tax increases, putting Greece on the verge of receiving 31 billion euros, or $39 billion, in desperately needed bailout loans. The euro zone is also weighing measures — like extending loan maturities and paring interest rates — that would further ease the country’s financial burden.

While the most pressing need is securing the 31 billion euros Greece needs to survive, arriving at a long-term solution for its bloated sovereign debt is also seen as crucial, given that the economy continues to shrink. An estimate released Wednesday showed Greece’s economy contracted by 7 percent in the third quarter — which makes the debt relative to economic output all the more onerous.

 To that end, a small circle of lawyers and bankers are suggesting that Greece offer to buy back its deeply discounted debt at a price of 27 to 33 euro cents, compared to the 25-cent level where it currently trades. If investors hold out for a higher price, the government could invoke collective action clauses (C.A.C.’s) in the bond contracts that, in theory, would prevent a bidding war, thus allowing the country to retire as much as 40 billion euros of its 340 billion euros in debt.

For example, the 62 billion euros’ worth of new bonds that Greece issued as part of its landmark debt restructuring deal reached with private bondholders in March are now valued at about 15 billion euros, or $19 billion. If Greece were to borrow the money to buy back this debt, it could retire 30 billion to 40 billion euros’ worth of its obligations, depending on the ultimate price it pays.

While borrowing such an amount would be a challenge, Germany — the biggest euro zone economy and thus the biggest contributor to the Greek bailout — could take the view that this would be a better way to reduce Greek debt than to ask taxpayers to swallow a loss via a write-down of public sector bailout loans.

Unlike the last time around, when the protracted wrangling between the Greek government and private bondholders centered on banks, hedge funds and other investors’ accepting a reduction in the bonds’ value, they will not have to suffer a large loss on their bond holdings. Depending on the price, however, they may have to forgo some further upside if the bonds continue to rally after the buyback.

If successful, the debt buyback could significantly reduce Greece’s debt and afford the country a realistic chance of meeting the target of a debt ratio of 120 percent of G.D.P. by 2020 that the International Monetary Fund has set as a condition for it to lend more money. European leaders have said that this benchmark is too stringent and needs to be relaxed.

Of course, the idea has infuriated the many hedge funds that in past months have scooped up more than 22 billion euros’ worth of Greek bonds at rock-bottom prices. With many sitting on big profits after the recent market rally, they are in no mood to sell out cheaply, especially if Greece resorts to wielding a legal cudgel to complete the deal.

“It’s really the dumbest thing that Greece can do right now,” said Hans Humes of Greylock Capital, who has been one of the more aggressive investors in terms of accumulating discounted Greek bonds.

Collective action clauses are legal riders in bond contracts that can make it easier for a debtor country to restructure its loans by forcing holdouts to accept the country’s proposal for a bond swap if a certain majority of creditors agree to it. They were used to great effect during the 100 billion euro restructuring of Greece’s private sector debt earlier this year.

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Ordering More Airstrikes, Syria Calls French Recognition of Rebels ‘Immoral’

Javier Manzano/Agence France-Presse — Getty Images

Smoke billowed from burning tires as a Syria rebel fired towards regime forces during clashes in the Al-Amariya district of Aleppo in Syria on Tuesday.

PARIS — Syrian authorities ordered airstrikes for a third consecutive day close to the tense Turkish border on Wednesday, and said a French decision to recognize and consider arming a newly formed Syrian rebel coalition was an “immoral” act “encouraging the destruction of Syria.”

The French move was depicted by analysts as an attempt to inject momentum into a broad Western and Arab effort to build a viable and effective opposition to hasten the end of a stalemated civil war which has further destabilized the Middle East. For its part, the United States on Wednesday signaled a reluctance to go beyond its characterization of the rebel alliance as a legitimate representative of the Syrian people, rather than as their sole representative.

Speaking in Perth, Australia, Secretary of State Hillary Rodham Clinton said Washington first wanted to see the coalition influencing events on the ground.

“As the Syrian opposition takes these steps and demonstrates its effectiveness in advancing the cause of a unified, democratic, pluralistic Syria, we will be prepared to work with them to deliver assistance to the Syrian people,” news reports quoted her saying.

At the same time, she announced $30 million in American humanitarian aid to feed people affected by the civil war, bringing the total American assistance to almost $200 million.

The airstrikes on Wednesday underscored the urgency of the diplomatic maneuvers. Journalists along the 550-mile border between Turkey and Syria near the Turkish border town of Ceylanpinar said they witnessed a Syrian airstrike in the adjacent Syrian town of Ras al-Ain, where rebels say they have ousted troops loyal to Mr. Assad. It was the third such strike there in as many days.

In response, Reuters reported, Turkey scrambled fighter jets to its southeastern border with Syria, recalling Turkey’s insistence that it will not refrain from a tougher reaction against Syria.

The official SANA news agency in Syria made no direct reference to the Western moves. But the deputy foreign minister, Faisal Muqdad, told the Agence France-Presse news agency that the establishment of the opposition coalition in Doha, Qatar, was a “ declaration of war.” "We read the Doha document and they reject any dialogue with the government."

Referring to the French recognition of the alliance, he said: “Allow me to use the word, this is an immoral position. They are supporting killers, terrorists and they are encouraging the destruction of Syria.”The announcement by President François Hollande on Tuesday made France the first Western country to fully embrace the new coalition, which came together this past weekend under Western pressure after days of difficult negotiations in Doha, Qatar.

The goal was to make an opposition leadership — both inside and outside the country — representative of the array of Syrian groups pressing for the downfall of President Bashar al-Assad. Although Mr. Assad is increasingly isolated as his country descends further into mayhem and despair after 20 months of conflict, he has survived partly because of the disagreements and lack of unity among his opponents. Throughout the conflict, the West has taken half measures and been reluctant to back an aggressive effort to oust Mr. Assad. This appears to be the first time that Western nations, with Arab allies, are determined to build a viable opposition leadership that can ultimately function as a government. Whether it can succeed remains unclear.

Mr. Hollande went beyond other Western pledges of support for the new Syrian umbrella rebel group, which calls itself the National Coalition of Syrian Revolutionary and Opposition Forces. But Mr. Hollande’s announcement clearly signaled expectations that if the group can establish political legitimacy and an operational structure inside Syria, creating an alternative to the Assad family’s four decades in power, it will be rewarded with further recognition, money and possibly weapons.

“I announce that France recognizes the Syrian National Coalition as the sole representative of the Syrian people and thus as the future provisional government of a democratic Syria and to bring an end to Bashar al-Assad’s regime,” said Mr. Hollande, who has been one of the Syrian president’s harshest critics.

As for weapons, Mr. Hollande said, France had not supported arming the rebels up to now, but “with the coalition, as soon as it is a legitimate government of Syria, this question will be looked at by France, but also by all countries that recognize this government.”

The six Arab countries of the Gulf Cooperation Council, including key opposition supporters Qatar and Saudi Arabia, recognized the rebel coalition on Monday as the legitimate Syrian government. Political analysts called Mr. Hollande’s announcement an important moment in the Syrian conflict, which began as a peaceful Arab Spring uprising in March 2011. It was harshly suppressed by Mr. Assad, turned into a civil war and has left nearly 40,000 Syrians dead, displaced about 2.5 million and forced more than 400,000 to flee to neighboring countries, according to international relief agencies.

Steven Erlanger reported from Paris, Rick Gladstone from New York, and Alan Cowell from Paris. Reporting was contributed by Neil MacFarquhar and Hwaida Saad from Beirut, Lebanon and Nick Cumming-Bruce from Geneva.

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Facebook stock up as lock-up expires on largest block of shares

SAN FRANCISCO (Reuters) – Shares of Facebook Inc jumped 10 percent in early trading on Wednesday, even as the biggest block of shares held by insiders became eligible for sale for the first time since the social media company’s disappointing debut in May.

In heavy morning trading, Facebook gained $ 2.02 to $ 21.89.

“While the lock-up is expiring, there is nothing requiring anybody to sell,” said Tim Ghriskey, chief investment officer at Solaris Group in Bedford Hills, New York. “Given the low price, these long-term holders are deciding to hold the stock and that is lifting it here as the fear of the expiration subsides.”

Roughly 800 million Facebook shares could begin trading on Wednesday after restrictions on insider selling were lifted on the biggest block of shares since the May initial public offering.

The lock-up expiration greatly expanded the 921 million-share “float” available for trading on the market until now.

Facebook, the world’s No. 1 online social network, became the only U.S. company to debut with a market value of more than $ 100 billion. But its value has dropped nearly 50 percent since the IPO on concerns about its long-term money-making prospects.

Insider trading lock-up provisions started to expire in August, and the rolling expirations have added to the pressure on Facebook’s stock.

Pivotal Research Group analyst Brian Wieser said he didn’t expect Facebook insiders to sell all of their shares as the lock-ups expired.

“I would expect heavy volumes over the next few weeks, but not undigestible volumes,” said Wieser. By his estimates, roughly 486 million of the nearly 800 million newly freed Facebook shares will be sold.

There is some evidence that the heavy interest in shorting the stock was dissipating, given the poor performance since it first sold shares in May.

According to Markit’s Data Explorers, about 28 percent of the shares available for short-selling were being borrowed for that purpose, down from a high of more than 80 percent in early August.

Similarly, SunGard’s Astec Analytics, which also tracks interest in shorting, noted in a comment on Tuesday that the cost of borrowing Facebook shares is down more than 50 percent since the beginning of the month.

“Everything would seem to indicate the market is losing its appetite to short Facebook,” wrote Karl Loomes, market analyst at Astec.

Several members of Facebook’s senior management have sold millions of dollars worth of shares in recent weeks through pre-arranged stock trading plans as lock-up restrictions expired.

Chief Operating Officer Sheryl Sandberg has sold roughly 530 million shares this month, netting just over $ 11 million, though she still owns roughly 20 million vested shares in Facebook.

In August, Facebook board member Peter Thiel sold roughly $ 400 million worth of Facebook stock, the majority of his stake, when an earlier phase of lock-up restrictions expired.

Facebook’s 28-year-old chief executive, Mark Zuckerberg, has committed to not sell any shares before September 2013.

(Reporting by Alexei Oreskovic; Editing by Jeffrey Benkoe)

Internet News Headlines – Yahoo! News

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Leftwich to start at QB for Steelers on Sunday

PITTSBURGH (AP) — The Pittsburgh Steelers say Byron Leftwich will start for injured quarterback Ben Roethlisberger in Sunday's key matchup against the Baltimore Ravens.

Roethlisberger sprained his right shoulder in the third quarter of Monday night's win over Kansas City when he was slammed to the ground by two Chiefs linebackers in the third quarter.

Leftwich will be making his first start for the Steelers. His last start came in 2009 with the Tampa Bay Buccaneers.

Leftwich was 7 of 14 for 73 yards after replacing Roethlisberger on Monday night.

The Ravens (7-2) are a game ahead of the Steelers (6-3) for first place in the AFC North.

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

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