AP source: ACC presidents vote to add Louisville

The Atlantic Coast Conference's presidents and chancellors have voted unanimously to add Louisville as the replacement for Maryland, a person familiar with the situation said Wednesday morning.

The person said ACC leaders also considered Connecticut and Cincinnati over the past week before choosing to add the Cardinals from the Big East. The person spoke to The Associated Press on condition of anonymity because the ACC has not publicly discussed future expansion plans.

The vote came during a conference call of ACC presidents and chancellors, the person said.

It's unclear exactly when Louisville will join the ACC. The Cardinals will be the seventh Big East school to leave for the ACC in the past decade.

The Big East has a 27-month notification period for any member that wants to leave, and a $5 million exit fee. The Big East has shown a willingness to negotiate, as it did with Pittsburgh and Syracuse, who paid $7.5 million each to get out early.

This latest rapid-fire round of realignment was set off last week by the Big Ten's additions of Maryland and Rutgers, which will join that conference in 2014.

On Tuesday, the Big East added Tulane for all sports and East Carolina for football only, also beginning in 2014.

Adding Louisville will bring the ACC to an even 14 full members, with Pittsburgh and Syracuse beginning conference play in 2013.

Two months ago, the ACC announced the addition of Notre Dame for all the conference's sports but football, with the fiercely independent Fighting Irish committing to play five ACC football opponents each season. Most of Notre Dame's non-football sports have competed in the Big East since 1995.

Louisville's addition will add some extra juice to what's already one of the nation's premier conferences for men's basketball.

Louisville, currently ranked No. 5, brings a tradition-rich program to the ACC that has won two national championships and reached its ninth Final Four last season. In addition, Rick Pitino will give the league another marquee coaching name alongside Duke's Mike Krzyzewski, North Carolina's Roy Williams and soon Jim Boeheim of Syracuse.

The school's football program is a win away from earning a BCS berth. Charlie Strong's Cardinals travel to Rutgers on Thursday night for a game in which they could clinch the Big East's BCS bid.

The ACC's decision to add Louisville is a blow for Connecticut, which had been looking for a landing spot since Pittsburgh and Syracuse announced their Big East exits. UConn President Susan Herbst had indicated that an invitation to join that ACC is something the school would welcome.

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AP Sports Writer Joedy McCreary in Raleigh, N.C., contributed to this report.

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The New Old Age Blog: Doctor's Orders? Another Test

It is no longer news that Americans, and older Americans in particular, get more routine screening tests than they need, more than are useful. Prostate tests for men over 75, annual Pap smears for women over 65 and colonoscopies for anyone over 75 — all are overused, large-scale studies have shown.

Now it appears that many older patients are also subjected to too-frequent use of the other kind of testing, diagnostic tests.

The difference, in brief: Screening tests are performed on people who are asymptomatic, who aren’t complaining of a health problem, as a way to detect incipient disease. We have heard for years that it is best to “catch it early” — “it” frequently being cancer — and though that turns out to be only sometimes true, we and our doctors often ignore medical guidelines and ongoing campaigns to limit and target screening tests.

Diagnostic tests, on the other hand, are meant to help doctors evaluate some symptom or problem. “You’re trying to figure out what’s wrong,” explained Gilbert Welch, a veteran researcher at the Dartmouth Institute for Health Policy and Clinical Practice.

For these tests, medical groups and task forces offer many fewer guidelines on who should get them and how often — there is not much evidence to go on — but there is general agreement that they are not intended for routine surveillance.

But a study using a random 5 percent sample of Medicare beneficiaries — nearly 750,000 of them — suggests that often, that is what’s happening.

“It begins to look like some of these tests are being routinely repeated, and it’s worrisome,” said Dr. Welch, lead author of the study just published in The Archives of Internal Medicine. “Some physicians are just doing them every year.”

He is talking about tests like echocardiography, or a sonogram of the heart. More than a quarter of the sample (28.5 percent) underwent this test between 2004 and 2006, and more than half of those patients (55 percent) had a repeat echocardiogram within three years, most commonly within a year of the first.

Other common tests were frequently repeated as well. Of patients who underwent an imaging stress test, using a treadmill or stationery bike (or receiving a drug) to make the heart work harder, nearly 44 percent had a repeat test within three years. So did about half of those undergoing pulmonary function tests and chest tomography, a CAT scan of the chest.

Cytoscopy (a procedure in which a viewing tube is inserted into the bladder) was repeated for about 41 percent of the patients, and endoscopy (a swallowed tube enters the esophagus and stomach) for more than a third.

Is this too much testing? Without evidence of how much it harms or helps patients, it is hard to say — but the researchers were startled by the extent of repetition. “It’s inconceivable that it’s all important,” Dr. Welch said. “Unfortunately, it looks like it’s important for doctors.”

The evidence for that? The study revealed big geographic differences in diagnostic testing. Looking at the country’s 50 largest metropolitan areas, it found that nearly half the sample’s patients in Miami had an echocardiogram between 2004 and 2006, and two thirds of them had another echocardiogram within three years — the highest rate in the nation.

In fact, for the six tests the study included, five were performed and repeated most often in Florida cities: Miami, Jacksonville and Orlando. “They’re heavily populated by physicians and they have a long history of being at the top of the list” of areas that do a lot of medical procedures and hospitalizations, Dr. Welch said.

But in Portland, Ore., where “the physician culture is very different,” only 17.5 percent of patients had an echocardiogram. The places most prone to testing were also the places with high rates of repeat testing. Portland, San Francisco and Sacramento had the lowest rates.

We often don’t think of tests as having a downside, but they do. “This is the way whole cascades can start that are hard to stop,” Dr. Welch said. “The more we subject ourselves, the more likely some abnormality shows up that may require more testing, some of which has unwanted consequences.”

Properly used, of course, diagnostic tests can provide crucial information for sick people. “But used without a good indication, they can stir up a hornet’s nest,” he said. And of course they cost Medicare a bundle.

An accompanying commentary, sounding distinctly exasperated, pointed out that efforts to restrain overtesting and overtreatment have continued for decades. The commentary called it “discouraging to contemplate fresh evidence by Welch et al of our failure to curb waste of health care resources.”

It is hard for laypeople to know when tests make sense, but clearly we need to keep track of those we and our family members have. That way, if the cardiologist suggests another echocardiogram, we can at least ask a few pointed questions:

“My father just had one six months ago. Is it necessary to have another so soon? What information do you hope to gain that you didn’t have last time? Will the results change the way we manage his condition?”

Questions are always a good idea. Especially in Florida.

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

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Ex-NASA Scientist’s Data Fears Come True

In 2007, Robert M. Nelson, an astronomer, and 27 other scientists at the Jet Propulsion Laboratory sued NASA arguing that the space agency’s background checks of employees of government contractors were unnecessarily invasive and violated their privacy rights.

Privacy advocates chimed in as well, contending that the space agency would not be able to protect the confidential details it was collecting.

The scientists took their case all the way to the Supreme Court only to lose last year.

This month, Dr. Nelson opened a letter from NASA telling him of a significant data breach that could potentially expose him to identity theft.

The very thing he and advocates worried about had occurred. A laptop used by an employee at NASA’s headquarters in Washington had been stolen from a car parked on the street on Halloween, the space agency said.

Although the laptop itself was password protected, unencrypted files on the laptop contained personal information on about 10,000 NASA employees — including details like their names, birth dates, Social Security numbers and in some cases, details related to background checks into employees’ personal lives.

Millions of Americans have received similar data breach notices from employers, government agencies, medical centers, banks and retailers. NASA in particular has been subject to “numerous cyberattacks” and computer thefts in recent years, according to a report from the Government Accountability Office, an agency that conducts research for Congress.

Even so, Dr. Nelson, who recently retired from the Jet Propulsion Laboratory, a research facility operated by the California Institute of Technology under a contract with NASA, stands out as a glaring example of security lapses involving personal data, privacy advocates say.

“To the extent that Robert Nelson looks like millions of other people working for firms employed by the federal government, this would seem to be a real problem,” said Marc Rotenberg, the executive director of the Electronic Privacy Information Center, an advocacy group which filed a friend-of-the-court brief for Dr. Nelson in the Supreme Court case.

In a 2009 report titled “NASA Needs to Remedy Vulnerabilities in Key Networks,” the Government Accountability Office noted that the agency had reported 1,120 security incidents in fiscal 2007 and 2008 alone.

It also singled out an incident in 2009 in which a NASA center reported the theft of a laptop containing about 3,000 unencrypted files about arms traffic regulations and wind tunnel tests for a supersonic jet.

“NASA had not installed full-disk encryption on its laptops at all three centers,” the report said. “As a result, sensitive data transmitted through the unclassified network or stored on laptop computers were at an increased risk of being compromised.” Other federal agencies have had similar problems. In 2006, for example, the Department of Veteran’s Affairs reported the theft of an employee laptop and hard drive that contained personal details on about 26.5 million veterans. Last year, the G.A.O. cited the Internal Revenue Service for weaknesses in data control that could “jeopardize the confidentiality, integrity, and availability of financial and sensitive taxpayer information.”

Also last year, the Securities and Exchange Commission warned its employees that their confidential financial information, like brokerage transactions, might have been compromised because an agency contractor had granted data access to a subcontractor without the S.E.C.’s authorization.

In a phone interview, Dr. Nelson, the astronomer, said he planned to hold a news conference on Wednesday morning in which he would ask members of Congress to investigate NASA’s data collection practices and the recent data breach.

Robert Jacobs, a NASA spokesman, said the agency’s data security policy already adequately protected employees and contractors because it required computers to be encrypted before employees took them off agency premises. “We are talking about a computer that should not have left the building in the first place,” Mr. Jacobs said. “The data would have been secure had the employee followed policy.”

The government argued in the case Dr. Nelson filed that a law called the Privacy Act, which governs data collection by federal agencies, provided the scientists with sufficient protection. The case reached the Supreme Court, which upheld government background checks for employees of contractors. The roots of Dr. Nelson’s case against NASA date back to 2004 when the Department of Homeland Security, under a directive signed by President George Bush, required federal agencies to adopt uniform identification credentials for all civil servants and contract employees. As part of the ID card standardization process, the department recommended agencies institute background checks.

Several years later, when NASA announced it intended to start doing background checks at the Jet Propulsion Laboratory, Dr. Nelson and other scientists there objected.

Those security checks could have included inquiries into medical treatment, counseling for drug use, or any “adverse” information about employees such as sexual activity, or participation in protests, said Dan Stormer, a lawyer representing Dr. Nelson.

But Dr. Nelson and other long-term employees of the lab challenged the legality of those checks, arguing that they violated their privacy rights. NASA, they said, had not established a legitimate need for such extensive investigations about low-risk employees like themselves who did not have security clearances or handle confidential information. Dr. Nelson, for example, specializes in solar system science — concerning, for example, Jupiter’s moon Io and Titan, a moon of Saturn — and publishes his work in scientific journals

“It was an invitation to an open-ended fishing expedition,” Dr. Nelson said of the background checks.

In friend of the court briefs for Dr. Nelson, privacy groups cited many data security problems at federal agencies, arguing that there was a risk that NASA was not equipped to protect the confidential details it was collecting about employees and contractors.

In 2008, the United States Court of Appeals for the Ninth Circuit in San Francisco temporarily halted the background checks, saying that the case had raised important questions about privacy rights. But last year, the Supreme Court upheld the background investigations of employees of government contractors.

Dr. Nelson said he retired from the Jet Propulsion Laboratory last June rather than submit to a background check. He now works as a senior scientist at the Planetary Science Institute of Tucson.

NASA has contracted with ID Experts, a data breach company, to help protect employees whose data was contained on the stolen laptop against identity theft. Mr. Jacobs, the NASA spokesman, said the agency has encrypted almost 80 percent of its laptops and plans to encrypt the rest by Dec. 21. He added that he too received a letter from NASA warning that his personal information might have been compromised by the laptop theft.

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Protesters Gather Again in Cairo Streets to Denounce Morsi

CAIRO — Thousands flowed into the streets of the capital Tuesday afternoon for a day of protest against President Mohamed Morsi’s attempt to assert broad new powers for the duration of the country’s political transition, dismissing his efforts just the night before to reaffirm his deference to Egyptian law and courts.

By early Tuesday afternoon in Cairo, a dense crowd of hundreds had gathered outside the headquarters of a trade group for lawyers, and thousands more had filed in around a small tent city in Tahrir Square. In an echo of the chants against Hosni Mubarak, then the Egyptian president, almost two years ago, they shouted, “Leave, leave!” and “Bring down the regime!” They also denounced the spiritual leader of the Muslim Brotherhood, the Islamist group allied with Mr. Morsi.

A few blocks away, in a square near the American Embassy and the Interior Ministry headquarters, groups of young men resumed a running battle that began nine days ago, throwing rocks and tear gas canisters at riot police officers. Although those clashes grew out of anger over the deaths of dozens of protesters in similar clashes one year ago, many of the combatants have happily adopted the banner of protest against Mr. Morsi as well.

Egyptian television had captured the growing polarization of the country on Monday in split-screen coverage of two simultaneous funerals, each for a teenage boy killed in clashes set off by disputes over the new president’s powers. Thousands of supporters of Mr. Morsi and his allies in the Muslim Brotherhood marched through the streets of the Nile Delta city of Damanhour to bury a 15-year-old killed outside a Brotherhood office during an attack by protesters, and in Tahrir Square in Cairo, thousands gathered to bury a 16-year-old killed in clashes with riot police officers and to chant slogans blaming Mr. Morsi for his death. “Morsi killed him,” the boy’s father said in a video statement circulated over the Internet.

“Now blood has been spilled by political factions, so this is not going to go away,” said Rabab el-Mahdi, a professor at the American University in Cairo and a left-leaning activist, adding that these were the first deaths rival factions had blamed on each other and not on the security forces of the Mubarak government since the uprising began last year. Still larger crowds were expected in the evening, as marchers from around the city headed for the square. Many schools and other businesses had closed in anticipation of bedlam, and on Monday, the Brotherhood called off a rival demonstration in support of the president, saying it wanted to avoid violence.

Egypt’s Supreme Judicial Council met again on Tuesday to consider its response to the president, and the leader of Al Azhar, a center of Sunni Muslim learning that is regarded as the pre-eminent moral authority here, met with groups of political leaders in an attempt to resolve the battle over the president’s decree and the deadlock in the constitutional assembly, which is trying to draw up a new constitution.

But even as Mr. Morsi met with top judges Monday night in an effort to resolve the crisis, a coalition of opposition leaders held a news conference to declare that preserving the role of the courts was only the first step in a broader campaign against what Abdel Haleem Qandeil, a liberal intellectual, called “the miserable failure of the rule of the Muslim Brothers.” Mr. Morsi “unilaterally broke the contract with the people,” he declared. “We have to be ready to stand up to this group, protest to protest, square to square, and to confront the bullying.”

Mr. Morsi’s attempt to remove the last check on his power over the political transition had brought the country’s fractious opposition groups together for the first time in a united front against the Brotherhood. But the show of unity papered over deep divisions between groups and even within them, said Ms. Mahdi of the American University.

“This is not a united front, and I am inside it,” she said. “Every single political group in the country is now divided over this — is this decree revolutionary justice or building a new dictatorship? Should we align ourselves with folool” — the colloquial term for the remnants of the old political elite — “or should we be revolutionary purists? Is it a conflict between the Muslim Brotherhood and the pro-Mubarak judiciary, or is this the beginning of a fascist regime in the making?”

Mayy El Sheikh contributed reporting.

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Newton leads Panthers past Eagles 30-22

PHILADELPHIA (AP) — They were two words on a sponsor's banner draped behind the Philadelphia Eagles' postgame podium: Imagine. Change.

For disgusted Eagles fans, that's all they can do, especially with coach Andy Reid still running the show. They won't have to imagine much longer.

After 14 seasons, one Super Bowl appearance, and, now a dreadful losing streak, the countdown to the end of Reid's tenure is hitting high gear in Philadelphia. Owner Jeffrey Lurie already has said that an 8-8 record would be "unacceptable" this year.

The Eagles would have to finish 5-0 just to get there after Cam Newton threw for two touchdowns and ran for two more to lead the Carolina Panthers to a 30-22 victory over the Philadelphia Eagles on Monday night.

Newton, who hadn't played up to his sensational rookie season, showed no signs of a sophomore slump against Philadelphia's porous pass defense. He finished 18 of 28 for 306 yards and had a passer rating of 125 in a matchup of teams with the worst records in the NFC.

Newton was only the latest player to shine against an Eagles (3-8) team about all out of hope. The Eagles haven't won since beating the defending Super Bowl champion New York Giants to go 3-1, a skid that has put Reid's job in real jeopardy. Unless Lurie has an implausible change of heart, Reid's run is about over, an inglorious end for the coach who led the Eagles to five conference championship games.

Lurie ducked out of a pregame press conference for the team's Hall of Fame before he could take questions from reporters. Reid said he hasn't discussed his job status with his boss.

"I'm not worried about all of the other things," Reid said. "I'm worried about winning football games and making sure I get my players coached up to where we do a better job with that."

As Philadelphia's seventh straight loss came to a close, some fed-up fans held up a banner that read, "Jeff This Is On You."

While Lurie surely joins Reid in taking a share of the blame for this ugly season, the players have been awful.

"I feel bad for Andy because he's in a horrible situation in a town that is critical, and rightly so," tight end Brent Celek said. "If I was the fans, I'd be mad, too. I don't see Andy as the problem. I see it as us."

Their latest problem was an inability to solve Newton.

Newton, the No, 1 overall pick in 2011, lived up to the hype by throwing for 4,051 yards with 21 TD passes and 14 TDs on the ground in his first year. He entered this game with only nine TD passes and four TDs rushing, a major disappointment for Panthers fans.

But Newton outshined rookie seventh-round pick Nick Foles in his Monday night debut.

Newton had a 24-yard TD toss over the middle to a wide-open Gary Barnidge for a 7-3 lead. He connected with Brandon LaFell on a 43-yard pass to make it 14-3 later in the first quarter. LaFell was wide open on the play, taking advantage of another breakdown in coverage in the secondary.

Newton led a 95-yard drive to open the third quarter, finishing it off with a 1-yard leap to give the Panthers a 21-15 lead. Newton hit Louis Murphy for a 55-yard gain on a second-and-11 from Carolina's 16.

"I think my best game is still to come," Newton said. "I'm still focused on getting better each and every week."

Carolina (3-8) went ahead 24-22 early in the fourth quarter on Graham Gano's 23-yard field goal.

"It's been a long time in coming," Panthers coach Ron Rivera said. "Lots of people contributed and made plays. Real proud of what we did and the things we did to give ourselves a chance to win."

Bryce Brown set an Eagles' rookie record with 178 yards rushing, including TD runs of 65 and 5 yards. Brown, filling in for injured running back LeSean McCoy, surpassed Correll Buckhalter's rookie mark of 134 yards rushing in his first start since his senior year at Wichita East High School in 2008. Brown also lost two fumbles, including one in Panthers' territory.

Foles was so-so in his second straight start for Michael Vick, who sat out with a concussion. Foles was 16 of 21 for 119 yards.

"The most important thing for me was for us to get the win and that didn't happen tonight," Brown said. "I felt like a lot of that had to do with my two turnovers. It really, really cost us."

After Gano's field goal put them up for good, the Panthers finally stopped Brown when it mattered most, stuffing him on a fourth-and-1 to take over on downs at their 40. Newton led them downfield, running in from the 2 to make it 30-22. Gano, signed last week, missed the extra point. But Brandon Boykin fumbled after a 44-yard kickoff return, the Panthers recovered and held the ball the final 4:29.

The Panthers have shown they're better than their record. They have lost six games by less than a touchdown, including a 2-point loss at Atlanta and a 1-point loss at Chicago.

"It's a huge stage, Monday Night Football, on the road," tackle Jordan Gross said. "It was just big for us and big for the guys on the team who haven't experienced something like this."

For the Eagles, it was simply the latest loss in a season stuffed with them. The Linc was quiet and empty except for some boos when busted coverage led to another Carolina TD. They fled for the exits once the Panthers took over for the final time.

Dwindling fan support is one thing. Losing it from Lurie is quite another for Reid.

"He's as competitive as anybody and he wants to win games," Reid said. "That's what he's in this business for."

NOTES: Neither Vick nor McCoy has been cleared to return to practice. The injury-depleted Eagles lost wide receiver DeSean Jackson (sternum) and defensive tackle Fletcher Cox (tail bone) in the first half. ... The Eagles inducted five-time Pro Bowl cornerback Troy Vincent and longtime front office executive Leo Carlin into the team's Hall of Fame at halftime. ... Brown's 65-yard TD run was the longest for the Eagles since McCoy's 66-yard TD vs NYG on Nov. 1, 2009. ... Buckhalter had 134 yards rushing vs. Arizona on Oct. 7, 2001. ... Newton led the Panthers with 52 yards rushing.

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Follow Dan Gelston on Twitter: https://twitter.com/APGelston

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

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Clearing the Fog Around Personality Disorders

For years they have lived as orphans and outliers, a colony of misfit characters on their own island: the bizarre one and the needy one, the untrusting and the crooked, the grandiose and the cowardly.

Their customs and rituals are as captivating as any tribe’s, and at least as mystifying. Every mental anthropologist who has visited their world seems to walk away with a different story, a new model to explain those strange behaviors.

This weekend the Board of Trustees of the American Psychiatric Association will vote on whether to adopt a new diagnostic system for some of the most serious, and striking, syndromes in medicine: personality disorders.

Personality disorders occupy a troublesome niche in psychiatry. The 10 recognized syndromes are fairly well represented on the self-help shelves of bookstores and include such well-known types as narcissistic personality disorder, avoidant personality disorder, as well as dependent and histrionic personalities.

But when full-blown, the disorders are difficult to characterize and treat, and doctors seldom do careful evaluations, missing or downplaying behavior patterns that underlie problems like depression and anxiety in millions of people.

The new proposal — part of the psychiatric association’s effort of many years to update its influential diagnostic manual — is intended to clarify these diagnoses and better integrate them into clinical practice, to extend and improve treatment. But the effort has run into so much opposition that it will probably be relegated to the back of the manual, if it’s allowed in at all.

Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force updating the manual, would not speculate on which way the vote might go: “All I can say is that personality disorders were one of the first things we tackled, but that doesn’t make it the easiest.”

The entire exercise has forced psychiatrists to confront one of the field’s most elementary, yet still unresolved, questions: What, exactly, is a personality problem?

Habits of Thought

It wasn’t supposed to be this difficult.

Personality problems aren’t exactly new or hidden. They play out in Greek mythology, from Narcissus to the sadistic Ares. They percolate through biblical stories of madmen, compulsives and charismatics. They are writ large across the 20th century, with its rogues’ gallery of vainglorious, murderous dictators.

Yet it turns out that producing precise, lasting definitions of extreme behavior patterns is exhausting work. It took more than a decade of observing patients before the German psychiatrist Emil Kraepelin could draw a clear line between psychotic disorders, like schizophrenia, and mood problems, like depression or bipolar disorder.

Likewise, Freud spent years formulating his theories on the origins of neurotic syndromes. And Freudian analysts were largely the ones who, in the early decades of the last century, described people with the sort of “confounded identities” that are now considered personality disorders.

Their problems were not periodic symptoms, like moodiness or panic attacks, but issues rooted in longstanding habits of thought and feeling — in who they were.

“These therapists saw people coming into treatment who looked well put-together on the surface but on the couch became very disorganized, very impaired,” said Mark F. Lenzenweger, a professor of psychology at the State University of New York at Binghamton. “They had problems that were neither psychotic nor neurotic. They represented something else altogether.”

Several prototypes soon began to emerge. “A pedantic sense of order is typical of the compulsive character,” wrote the Freudian analyst Wilhelm Reich in his 1933 book, “Character Analysis,” a groundbreaking text. “In both big and small things, he lives his life according to a preconceived, irrevocable pattern.”

Others coalesced too, most recognizable as extreme forms of everyday types: the narcissist, with his fragile, grandiose self-approval; the dependent, with her smothering clinginess; the histrionic, always in the thick of some drama, desperate to be the center of attention.

In the late 1970s, Ted Millon, scientific director of the Institute for Advanced Studies in Personology and Psychopathology, pulled together the bulk of the work on personality disorders, most of it descriptive, and turned it into a set of 10 standardized types for the American Psychiatric Association’s third diagnostic manual. Published in 1980, it is a best seller among mental health workers worldwide.

These diagnostic criteria held up well for years and led to improved treatments for some people, like those with borderline personality disorder. Borderline is characterized by an extreme neediness and urges to harm oneself, often including thoughts of suicide. Many who seek help for depression also turn out to have borderline patterns, making their mood problems resistant to the usual therapies, like antidepressant drugs.

Today there are several approaches that can relieve borderline symptoms and one that, in numerous studies, has reduced hospitalizations and helped aid recovery: dialectical behavior therapy.

This progress notwithstanding, many in the field began to argue that the diagnostic catalog needed a rewrite. For one thing, some of the categories overlapped, and troubled people often got two or more personality diagnoses. “Personality Disorder-Not Otherwise Specified,” a catchall label meaning little more than “this person has problems” became the most common of the diagnoses.

It’s a murky area, and in recent years many therapists didn’t have the time or training to evaluate personality on top of everything else. The assessment interviews can last hours, and treatments for most of the disorders involve longer-term, specialized talk therapy.

Psychiatry was failing the sort of patients that no other field could possibly help, many experts said.

“The diagnoses simply weren’t being used very much, and there was a real need to make the whole system much more accessible,” Dr. Lenzenweger said.

Resisting Simplification 

It was easier said than done.

The most central, memorable, and knowable element of any person — personality — still defies any consensus.

A team of experts appointed by the psychiatric association has worked for more than five years to find some unifying system of diagnosis for personality problems.

The panel proposed a system based in part on a failure to “develop a coherent sense of self or identity.” Not good enough, some psychiatric theorists said.

Later, the experts tied elements of the disorders to distortions in basic traits.

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News Analysis: St. Jude Medical Suffers for Redacting a Product Name

Peter Muhly for The New York Times

Dr. Ernest Lau holds a Durata lead from a St. Jude Medical Fortify ICD, an implanted heart defibrillator.

IS covering a product’s name in a public document a sign that a company has something to hide? And how should doctors, patients and investors react if the product at issue is one on which peoples’ lives and a company’s fortunes depend?

Such questions now loom over St. Jude Medical after the disclosure last week that its executives had blacked out the name of a heart device component when they released a critical federal report involving the product. The value of St. Jude has since plummeted more than $1 billion, or 12 percent. But the company’s actions may have a more lasting impact on its reputation and the health of patients, some experts say.

Last week’s incident was the latest development in a controversy involving the component, an electrical wire that connects an implanted defibrillator to a patient’s heart. St. Jude officials say the wire, which is known as the Durata, is safe. But uncertainty about the company’s statements is growing, underscored by its handling of the report, which involved a Food and Drug Administration inspection of a plant that makes the Durata.

St. Jude released that report in October as part of a filing with the Securities and Exchange Commission. The F.D.A. provides device makers with the reports in an unaltered form, and they may contain criticisms of a company’s procedures.

But the version of the report that St. Jude filed with the S.E.C. left some doctors and analysts uncertain about which company product or products were at issue for a simple reason — St. Jude had redacted, or blocked out, all 20 references to the Durata in it.

Company executives said they had done so based on their “good faith” interpretation of how the F.D.A. would act if it publicly released the report under the Freedom of Information Act. But both an F.D.A spokeswoman and a lawyer who specializes in medical devices took exception with that view, saying that names of approved products typically do not qualify as the type of confidential business information that the F.D.A. would redact.

Among other things, F.D.A. inspectors found significant flaws in the company’s testing and oversight of the Durata. It was those revelations and the implications that the problems could lead to further F.D.A. action against St. Jude that led to the sharp fall last week in its stock price.

In 2005, Guidant, a device maker that no longer exists, also found itself under scrutiny. Back then, its executives decided not to tell doctors that one of its defibrillators could short-circuit when a patient needed an electrical jolt to save a life. The expert who brought the Guidant problem to light, Dr. Robert Hauser, a heart specialist in Minnesota, has also raised concerns about the St. Jude wires, adding that he believes that its executives have been less than forthright.

“Patients and physicians would appreciate more information,” Dr. Hauser said.

In an earlier interview, St. Jude’s chief executive, Daniel J. Starks, said the company had hidden nothing about the Durata or another heart wire named the Riata, which it stopped selling in 2010.

“We’ve been more transparent than others,” said Mr. Starks, referring to company competitors like Medtronic.

Still, some Wall Street analysts share Dr. Hauser’s view. And if one St. Jude executive can claim credit for shaping their opinion, it would be Mr. Starks.

Earlier this year, he sought, among other things, to have a medical journal retract an article written by Dr. Hauser that was critical of the Riata. The publication refused.

Now, after St. Jude’s latest misfire, Wall Street analysts, who usually agree more than disagree, are placing wildly differing bets on St. Jude, with some valuing it at $48 a share and others at $30. On Monday, St. Jude closed at $31.86 on the New York Stock Exchange.

One of those bearish analysts, Matthew Dodds of Citigroup, said he thought the Food and Drug Administration might act soon on Durata. “I believe that a lot of their actions have made the situation worse, ” he said of the company’s executives.

A St. Jude spokeswoman, Amy Jo Meyer, reiterated the company’s stance that it had interpreted agency rules in “good faith” when releasing the redacted report about the Durata. An F.D.A. spokeswoman, Mary Long, said the agency did not consider the names of approved products to be confidential. And a lawyer, William Vodra, said that while device makers try to make a confidentiality argument for product data they consider embarrassing, like injury reports, they rarely succeed.

“In my experience, the F.D.A. consistently rejects” such arguments, Mr. Vodra wrote in an e-mail.

For patients, the dilemma may become more excruciating. The company’s earlier heart wire, the Riata, has begun failing prematurely in some of the 128,000 patients worldwide who received it. And those patients and their doctors face a difficult decision: whether to leave it in place or have it surgically removed, a procedure that carries significant risks.

St. Jude executives say that the Durata, which uses a different type of insulation than the Riata, is not prone to such problems.

And with the Durata already implanted in 278,000 people, many heart specialists certainly hope they are right.

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As Rebels Gain, Congo Again Slips Into Chaos

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Yes, the Government Can Still Spy on Your Digital Life (for Now)

Ahead of a controversial Senate debate on digital privacy this week, the battle over warrantless cell-phone and Internet searches is beginning to take shape — even as law-enforcement agencies continue to carry out the searches anyway. Judges across the country have thrown out cases that used tracked digital American lives without warrants, but others haven’t, reports The New York Times‘s Somini Sengupta. A DC court, for example, compared text messages to voicemail messages, which because they can be overheard are not protected by state privacy laws, argued one judge. A Louisiana court is deciding if cell-phone records are like business records. Another court ruled that GPS cell phone tracking without a warrant was fine, too. Others, however, argue that cell phones are more than just a paper trail. One judge called cell phones “raw, unvarnished and immediate, revealing the most intimate of thoughts and emotions,” as in something that is subject to higher privacy standards. Meanwhile, we see the same inconsistencies with Internet protections, reports The Wall Street Journal‘s Joe Pallazolo. A federal court recently ruled that people who use their neighbors’ WiFi without permission forfeit privacy, opening up government officials to warrantless searches. The same ruling other courts have made for IP addresses. However, the law isn’t that clear-cut, either, argues George Washington University professor Oren Kerr. 

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Without clear rules, government agencies have continued investigations with warrantless searches. As people have started using cell phones more often and for more than just calling, law enforcement agency requests for cell-phone information have increased, reported The New York Times‘s Eric Lichtblau earlier this year. AT&T gets more than 700 requests a day from various agencies, triple what it got in 2007, he notes. Last year, the total number of requests came in at at least 1.3 million. At the same time, the application for wiretapping warrants declined 14 percent last year to 2,732, according to the Administrative Office of the United States Courts. A curious pattern considering the requests for information have gone up. Though these wireless carriers say they require a search warrant, a court order or a formal subpoena to release information, “in cases that law enforcement officials deem an emergency, a less formal request is often enough,” writes Lichtblau. Or, it’s possible that law enforcement has opted for other forms of tracking that don’t require warrants, at least not according to some judges. 

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A Senate debate beginning Thursday to make changes on the Electronic Communications Privacy Act might bring some clarity to these issues. However, it’s unclear if the revised bill will give the government more or less power, and it doesn’t sound like the vote will apply to all cell phone or Internet data. An early draft of the bill reportedly allowed warrantless e-mail searches, reported CNET’s Declan McCullagh. Since, Senator Patrick Leahy, who is spearheading the bill, has denied that the updates to the regulation will do that, however. Instead, the revised bill will require search warrants to get into email no matter how old, says Sengupta. That should presumably apply to some of our smartphone and Internet data, too. But it doesn’t address text messages or location information, other concerns of consumers.

Wireless News Headlines – Yahoo! News

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Cancer patient gets wish, Giants play like champs

EAST RUTHERFORD, N.J. (AP) — A week off, some rest and a poignant plea from a 15-year-old cancer patient got the New York Giants back on track.

Now the rest of the NFL has something to worry about. The Giants are playing like world champions again.

A refreshed Eli Manning came back from the bye week and threw three touchdown passes as the Giants embarrassed Aaron Rodgers and the streaking Green Bay Packers 38-10 on Sunday night.

The win snapped a two-game losing streak and gave the Giants (7-4) a two-game lead in the NFC East with five games left in the regular season. The dominating performance also ended a five-game winning streak for the Packers (7-4), who fell a game behind Chicago in the NFC North.

"We just had to go out there with a lot of confidence and play like we are capable," Giants center David Baas said. "I felt we did that. We showed everybody. People that counted us out, they better wake up."

No one was more pleased with the Giants than Adam Merchant. The 15-year-old fan from Barre, Vt., attended Friday's practice and Sunday's game, thanks to the Make-A-Wish Foundation.

Merchant spoke to the team after practice and seemed to remind them what it's all about.

"I told them to go out and play like world champs," he said, sitting at a locker next to defensive captain Justin Tuck.

When asked why he gave the message, he shot back:

"Because we really needed to go out and play like world champs."

Against the Packers, the Giants did.

Manning, who had not thrown a touchdown in three games, had scoring strikes of 16 yards to rookie Rueben Randle, 9 yards to Victor Cruz and 13 to Hakeem Nicks. The last one gave him 200 for his career, breaking the team record held by Phil Simms.

"The thing I'm most proud of tonight is the way we played and getting a win," said Manning, who was 16 of 30 for 249 yards. "This was a big game, we needed to come out and play well and get a win. We finally got back to playing offense, defense, special teams, all of us playing at a high level, playing as a team, and hopefully we can build off of this momentum."

Everybody seemed to contribute. Ahmad Bradshaw ran 13 yards for a touchdown and went 59-yards with a screen pass to set up Andre Brown's 2-yard TD run on the opening drive.

The defense sacked Rodgers five times and set up 10 points with Corey Webster's pick leading to Lawrence Tynes' field goal and Osi Umenyiora's strip-sack and Jason Pierre-Paul's 10-yard return setting up Bradshaw's TD run that gave New York a 31-10 lead.

The 31 points were the most scored by the Giants in a half this season, and it pretty much decided the game.

The only negative was Brown broke his left leg in the second half and his season looks done.

The Packers were done before that, at as far as this game.

"I think this is a game that makes everybody look inside and find out what you're about," coach Mike McCarthy said. "I haven't felt like this since the first game I coached as a Green Bay Packers head coach. Beaten very thoroughly tonight. It doesn't taste good. It doesn't feel good."

Rodgers got Green Bay off to a great start, connecting with Jordy Nelson on a 61-yard scoring pass on its first series. There was little else to celebrate in a game where he finished 14 of 25 for 219 yards, an interception and a lost fumble.

"You win five in a row and everyone is happy, but like I said last year during the run, there are things that go under the radar that need to be handled," Rodgers said "Sometimes it takes a loss. ... We need to remember this feeling and not have this kind of embarrassment happen again.

The Packers were missing such key starters as linebacker Clay Matthews, defensive back Charles Woodson and receiver Greg Jennings, and it showed as they were manhandled by the Giants for the second straight time. New York beat them 37-20 in the NFC semifinal, a game some Packers said they lost more than the Giants won.

This one, there was no doubt who was the better team.

"We went out there and proved it," Merchant said.

Manning was impressed with the way Merchant handled himself, saying players felt it was special that the youngster had one wish and chose to spend time with the Giants.

"He had the opportunity to come out and talk to the team, so Coach Coughlin does a great job and all the players do a great job of making him feel welcome and fired up," Manning said. "It can be kind of nerve-racking to come talk to your favorite team and have a little pep talk, but he did a great job and he said to go show everybody you're the world champions and why you're the world champions and play that way. I think it got everybody fired up and obviously we came out and played the way that we know we can."

The Giants never trailed after Manning's touchdown pass to Randle, the first of his career. Webster's interception set up Tynes' field goal for a 17-7 lead and Cruz capped a 61-yard drive early in the second quarter to push the lead to 24-7.

A short field goal by Mason Crosby got Green Bay within two touchdowns, but Umenyiora's forced fumble set up Bradshaw's TD run and the game was over by halftime.

NOTES: The Giants lost safety Kenny Phillips with a knee injury in the third quarter. He was making his first appearance since Week 4. ... Giants right tackle David Diehl sustained a stinger in the first half. ... Green Bay lost safety M.D. Jennings (rib), DE C.J. Wilson (knee), and RB Johnny White (concussion). ... Giants tight end Martellus Bennett caught a fan who leaned too far over the lower railing trying to grab a glove Bennett was giving a child after the game. The fan was arrested.

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