Israeli Says Syria Twisted Comments by Rebel Supporter

BEIRUT, Lebanon — A public relations controversy erupted Saturday after a leading Israeli newspaper published comments from a brief interview with the leader of Syria’s main exile opposition group.

The news media outlets of the Syrian government, and its ally Hezbollah, the Lebanese militant group, reported that the opposition leader had declared that Israel had “nothing to fear” from a rebel-led Syrian government. Moreover, the reports said, the opposition was working with other countries to keep Syria’s chemical weapons away from Hezbollah, which he called a “son of the devil.”

But the opposition leader, Sheik Ahmad Moaz al-Khatib, never said any of that, according to the article in the Israeli newspaper, Yediot Aharonot, and its author, a prominent Israeli defense expert, Ronen Bergman.

Sheik Khatib was quoted in the article reiterating the opposition’s promise to keep Syria’s chemical arsenal out of “the hands of unauthorized elements,” and it was the international community, he said, not Israel, that had “nothing to fear.”

When Sheik Khatib realized that Mr. Bergman was an Israeli — after glancing at his business card — he abruptly ended the conversation, Mr. Bergman said in a Skype interview, repeating what he had written.

The original article was published only in Hebrew — and only in print — so it was the Arabic and English versions put out by the Syrian government and Hezbollah that raced around the Internet on Saturday, provoking outrage from government supporters and opponents at Sheik Khatib, who posted a message on his Facebook page denying that he had given the interview.

Yet the episode appeared to have been more than a simple misunderstanding. Syria’s conflict is not only a shooting war but also a propaganda war. Pro-government media apparently could not resist the chance to bolster their contention that the rebellion had been promoted by Israel and the West to punish Syria and its president, President Bashar al-Assad, for taking uncompromising positions against Israel.

“Unfortunately, the original text was less exciting,” Mr. Bergman said. “I would be happy if he would say something like, ‘Yes, we will make peace with Israel’ — then I would get the front page.” As it was, the article elicited little reaction in Israel.

But misrepresentation of the article suggested that it hit a nerve on one issue. An unnamed opposition member, not Sheik Khatib, called Hezbollah “sons of the devil,” according to Mr. Bergman, and said the rebel coalition was working with other countries to ensure that “not one piece of military equipment, not chemical weapons and not any other item, will pass into their hands.”

Syria is Hezbollah’s main conduit for arms, and Hezbollah has backed Mr. Assad’s bloody crackdown at great cost to its popularity in the wider Arab world.

Although Mr. Bergman said the opposition member was offering his own opinion and not presenting official policy, his comments bolstered the widely held view that a rebel-led government might halt the shipment of Iranian arms through Syria to Hezbollah. Hezbollah, a Shiite group and political party, is also concerned about the rise within the rebel movement of extremist Sunni jihadists who view Shiites as apostates.

The misleading reports appeared to be an attempt to further divide the opposition. Sheik Khatib found himself fending off critics from within the anti-Assad movement who objected to his even speaking with an Israeli reporter, though by all accounts he did not initially realize that Mr. Bergman was an Israeli.

It was the second time in a month that Sheik Khatib found himself on the defensive. He recently proposed talks with members of Mr. Assad’s government, but had not built political support for the proposal.

On Friday, Syria’s information minister, Omran al-Zoubi, gave the first official response to the proposal, saying that the government would negotiate with any opposition members who agreed to lay down their arms.

On Saturday, Mr. Assad named new cabinet ministers for oil, finance, social affairs, labor, housing, public works and agriculture, as Syria faces growing economic problems and shortages of electricity, fuel and bread.

Anne Barnard reported from Beirut, and Isabel Kershner from Jerusalem. Hania Mourtada contributed reporting from Beirut.

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Snoop Dogg blazes one during BMI songwriting panel

LOS ANGELES (AP) — Music fans who turned out to BMI's annual pre-Grammy Awards "How I Wrote That Song" discussion got a little more than they expected thanks to Snoop Dogg — a contact high.

The rapper smoked marijuana during Saturday's panel discussion, lighting up a large, Kush-filled blunt on stage at The Roxy. He briefly passed it off to B.o.B before methodically reducing it to ash over a 15-minute period. The panel also included Busta Rhymes and songwriters Luke Laird and Evan Bogart, all of whom abstained — at least on stage.

Fittingly, the conversation eventually turned to Snoop's groundbreaking work on "The Chronic."

Laird recalled growing up at the end of a dirt road 10 miles outside Conneaut Lake, a small town of 700 in rural Pennsylvania. Yet Snoop's work with Dr. Dre still infiltrated his world and that of all the other country kids around him.

"Let me just say, the album everyone was listening to was 'The Chronic,'" Laird said, noting how surreal it was to be sitting on stage with Snoop.

With acoustic guitar in hand, he played a bit of his Blake Shelton hit "Hillbilly Bone" in its original form: a rap song. The Nashville-based songwriter had everyone bobbing their heads to the beat.

"Now I feel like more than ever you see these influences crossing genres," Laird said.

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Follow AP Music Writer Chris Talbott at http://twitter.com/Chris_Talbott .

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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Business Week in Pictures

Phil Libin, the chief executive of Evernote, during a staff meeting at Evernote’s headquarters in Redwood City, Calif. Evernote is among the privately held Silicon Valley start-ups that are worth more than $1 billion. An unprecedented number of high technology start-ups, easily 25 and possibly exceeding 40, have crossed that threshold. Many employees are quietly growing rich, or at least building a big cushion against a crash, as they sell shares to outside investors. Airbnb, Pinterest, SurveyMonkey and Spotify are among the better-known privately held companies that have reached $1 billion.

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California Police Officer Manhunt

Alex Gallardo/Reuters

A police cruiser in which an officer was shot in Corona, Calif.

BIG BEAR LAKE, Calif. — The search for the former Los Angeles police officer wanted in three killings continued throughout Friday here, even as a blizzard covered the mountains with a foot of snow. But as no new traces of the suspect were found, the authorities wondered if he had somehow slipped through their fingers.

Law enforcement agencies from across Southern California had been on a regionwide manhunt since early Thursday for Christopher J. Dorner, 33, a former Navy reservist sought in connection with the shooting deaths of three people and the attempted shootings of several police officials.

Over the course of the week, since the first killing on Sunday, Mr. Dorner had been spotted all over Southern California, from Riverside to San Diego. His trail seemed to lead here on Thursday when a burned-out pickup truck found at the base of the mountain was identified as belonging to Mr. Dorner. Law enforcement followed tracks from the car into the nearby woods. With only a few routes in and out of town, they were confident they had Mr. Dorner cornered.

More than 100 law enforcement officers have spent the last two days combing the area, going door to door overnight, taking special care to investigate remote cabins and other vacation homes whose owners were away, and scanning the area by helicopter.

But they have been unable to turn up any new clues, Sheriff John McMahon of San Bernardino County, said at a news conference on Friday.

“We searched all night; we did not discover any additional evidence,” Sheriff McMahon said on Friday morning. “We will continue searching until either we discover that he left the mountain, or we find him.”

“We don’t have any evidence to suggest that he is or is not here,” he added.

For the second day in a row, local schools were closed, keeping schoolchildren and their yellow buses off the mountain roads in the midst of the search.

Still, as the search continued without new evidence, and the ski resort reopened, life in the town began to return to normal. Skiers and snowboarders flocked to the mountain to take advantage of the fresh powder. And both local residents and visitors expressed growing skepticism that Mr. Dorner was — or ever had been — in town. Instead, many thought the pickup truck was a diversion.

Cindy Johnston was in the Big Bear Lake area, about 100 miles east of Los Angeles, to ski with her family. “We’re being a little bit more careful, but that’s about it,” Ms. Johnston said. “We’re keeping the kids closer together and not going out so much at night. I think he’d be stupid if he was here, and he doesn’t seem stupid. There are too many people looking for him.”

Yvette Blunt, a Big Bear Lake resident, did not think Mr. Dorner was in town anymore, either.

“He left the car here to attract everyone here,” Ms. Blunt, 66, said. “That way, he can go somewhere else.”

This article has been revised to reflect the following correction:

Correction: February 8, 2013

An earlier version of this article misspelled, in some instances, the surname of the former police officer who the authorities say has killed at least three people as part of a rampage aimed at police officers and their families. It is Christopher J. Dorner, not Dornan.

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NBC pulls 'Do No Harm' after 2 low-rated episodes

LOS ANGELES (AP) — NBC is pulling the drama series "Do No Harm" after two low-rated episodes.

The show is a take on the story of Dr. Jekyll and Mr. Hyde, and stars Steven Pasquale of "Rescue Me." He plays a respected neurosurgeon who turns into a dangerous alter ego each night. Other cast members include Alana De La Garza and Phylicia Rashad.

"Do No Harm" started with a historically small audience for a major network debut and then dropped further in its second Thursday airing.

NBC will replace "Do No Harm" with reruns of "Law & Order: Special Victims Unit" for the next two weeks.

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

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

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

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

The Presenting Problem:

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

The Patient’s Story:

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

A Sister’s Visit:

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

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

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

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

A Long Series of Illnesses:

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

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

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

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

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

Back to the Hospital:

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

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

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

Back to the Hospital, Again:

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

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

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

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

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

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

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

Solving the Mystery:

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

Friday Feb. 8 4:13 p.m. | Updated Thanks for all your responses. You can read about the winner at “Think Like a Doctor: A Confused and Terrified Patient Solved.”

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

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

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DealBook: Southeastern Asset Management to Fight Dell's Takeover

7:44 p.m. | Updated One of the biggest investors in Dell said on Friday that it would oppose the company’s plans to go private, setting up a major potential roadblock for the biggest buyout since the financial crisis.

Southeastern Asset Management, Dell’s largest outside shareholder, argued in a letter to the board that the $24.4 billion takeover bid was too low.

The company’s founder, Michael S. Dell, and the investment firm Silver Lake, are offering $13.65 a share. Southeastern, which has an 8.5 percent stake in Dell, contends that the company is worth closer to $24 a share.

To block the “ill-advised transaction,” Southeastern laid out a range of possible tactics, including a proxy fight and lawsuits. The firm also pushed the board to “aggressively” look for alternative proposals. Dell has 45 days to solicit other bids as part of the so-called go-shop process.

A Dell spokesman said in a statement on Friday that a special committee of the company’s board had considered various options with the help of advisers before accepting the management buyout.

“Based on that work, the board concluded that the proposed all-cash transaction is in the best interests of stockholders,” said the spokesman, David Frink. “The transaction offers an attractive and immediate premium for stockholders and shifts the risks facing the business to the buyer group.”

The opposition highlights the conflict facing Dell and its investors.

Many shareholders bought the company at lofty prices, watching the value of their shares erode. Analysts estimated that Southeastern paid more than $20 a share on average, meaning that the asset management firm would lose over $800 million if the current deal was completed.

Still, the takeover values Dell at price that the company has not touched for months. Its stock has not reached $14 since late May, and it lingered below $10 for two months late last year.

The company also faces continued pressure in its operations. Its core PC business is ceding ground to lower-cost rivals, as well as new entrants like tablets and smartphones.

Additionally, its effort to sell servers to big companies has been hurt by the changing industry dynamics, including the move to cloud computing.

Management buyouts have long been regarded skeptically by investors. The concern is that they enrich executives at the expense of other shareholders. The takeovers of companies like J. Crew and Affiliated Computer Services spurred a number of lawsuits by irate investors.

Southeastern and its founder, O. Mason Hawkins, generally keep a low profile and shun the press. But the money manager, based in Memphis, has been more outspoken of late.

The firm stepped into the spotlight last year when it called on Chesapeake Energy to entertain takeover offers, after the company ran into financial difficulties and faced criticism for the compensation plan of its co-founder, Aubrey McClendon. Southeastern and another activist investor, Carl C. Icahn, eventually won seats on Chesapeake’s board. Last month, Mr. McClendon was forced to retire under pressure from the board.

In its letter to Dell’s board, Southeastern said that it would support a number of alternatives. The investor, for example, outlined a plan to pay out a special dividend to shareholders or a buyout that would allow existing investors to keep a piece of the company.

But Southeastern said the current deal, hashed out over six months, “falls significantly short,” adding that it “appears to be an effort to acquire Dell at a substantial discount to intrinsic value at the expense of public shareholders.”

Dell’s board was mindful of potential conflicts — legal and otherwise — that its founder faced in trying to buy back the company he founded nearly three decades ago. To assess the deal, it formed a special committee of its board, led by Alex J. Mandl, which was advised by two sets of financial advisers.

JPMorgan Chase served as the principal investment bank for the committee, negotiating with Silver Lake.

Evercore Partners is overseeing a 45-day go-shop period intended to flush out rival suitors for the company. The company itself was advised by Goldman Sachs.

To help further minimize conflicts, JPMorgan refrained from providing financing for the deal. And Evercore’s advisory fee is set up in a way that encourages the bank to find a higher bid.

“The go-shop process provides stockholders an opportunity to determine if there are alternatives that are superior to the present offer,” the Dell spokesman said in a statement.

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U.S. Official Faults F.A.A. for Missing 787 Battery Risk

The nation’s top transportation safety official said on Thursday that the Federal Aviation Administration accepted test results from Boeing in 2007 that failed to properly assess the risks of smoke or fire from the batteries on Boeing’s new 787 jets.

Deborah Hersman, the chairwoman of the National Transportation Safety Board, told reporters that the problems seemed to have originated in the battery, when one of the eight cells had a short circuit and the fire spread to the rest of the cells. But she said that Boeing’s tests showed no indication that the new lithium-ion batteries on its 787 planes could erupt in flame and concluded that they were likely to emit smoke less than once in every 10 million flight hours.

Once the planes were placed in service, though, the batteries overheated and emitted smoke twice last month, and caused one fire, after about 50,000 hours of commercial flights.

“The assumptions used to certify the batteries must be reconsidered,” Ms. Hersman said.

Late Thursday, the F.A.A. said it would allow Boeing to conduct test flights with its 787 to collect data on the batteries and the plane’s electrical system. The agency said the flights “will be an important part of our efforts to ensure the safety of passengers and return these aircraft to service.” It did not immediately specify the number of test flights or when they would begin.

Ms. Hersman, at her news conference, said that before the F.A.A. certified the batteries, Boeing’s tests found no evidence that a short circuit in one of the eight cells could spread to other cells.

But Ms. Hersman said the fire on a 787 parked at an airport in Boston on Jan. 7 started with a short circuit in one cell and then spread to the others.

She said investigators had still not been able to tell what caused the short circuit in that cell and led to a “thermal runaway,” overheating up to 500 degrees, that then cascaded to the rest of the cells.

Still, she said, “This investigation has demonstrated that a short circuit in a single cell can propagate to adjacent cells and result in a fire.”

Battery experts said that the finding pinpointed one step Boeing could take to make the batteries safer: it could expand the size of the battery to create more physical separation between the cells. Ralph J. Brodd, a battery industry consultant in Henderson, Nev., said Boeing and its Japanese battery subcontractor, GS Yuasa, could make the design and manufacturing changes needed to do that fairly quickly.

But unless investigators can determine what caused the first cell to short-circuit, federal officials said, Boeing will also be required to make other changes to prevent any of the possible causes and to better contain or vent any overheated materials. And given the safety board’s findings about how poorly Boeing gauged the original safety risks, the F.A.A. is likely to take its time in assessing the validity of any new tests.

The 787 is the first commercial airplane to use large lithium-ion batteries for major flight functions. All 50 of Boeing’s 787s that were delivered to airlines have been grounded since mid-January, when a 787 made an emergency landing in Japan after the pilots smelled smoke in the cockpit. That incident occurred nine days after the Boston fire.

In searching for the cause of the fire on the plane in Boston, Ms. Hersman said the safety board was still looking at the battery’s charging mechanism and potential manufacturing defects or contamination, and whether the cells were not as isolated as they should have been.

Investigators have so far ruled out two possible reasons for the short circuit — a mechanical or electrical shock from outside the battery.

“We have not yet identified what the cause of the short circuit is,” she said. “We are looking at the design of the battery, at the manufacturing, and we are also looking at the cell charging. There are a lot of things we are still looking at.”

Boeing said in a statement Thursday that it viewed the safety board’s findings as narrowing the likely source of the problem to within the battery itself, as opposed to other components of the plane’s extensive new electric system. But company officials said they also recognized that it would take a combination of changes to restore confidence in the battery system.

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Bieber's mom trying to stay out of abortion debate

NEW YORK (AP) — Justin Bieber's mom wants to set the record straight: She's not interested in the political fray on abortion as she promotes "Crescendo," a new film she hopes will raise $10 million for centers that help pregnant girls.

Pattie Mallette, an unmarried teen herself when she had Bieber, signed on as an executive producer after the film was finished. She said Thursday that she connected personally with the story about a suicide and abortion attempt by Beethoven's mother.

"The press has been saying that I'm producing an anti-abortion film and taking this big stance. You know, I haven't shared my stance with anyone and I'm not here to make a political statement, so there's been a lot of assumptions made."

Mallette, in numerous interviews and her autobiography, "Nowhere but Up," has recounted her own suicide attempt, pressure to have an abortion when she became pregnant at 18 and struggles with drugs and alcohol before becoming a Christian.

The movie does include some producers who have anti-abortion beliefs, she said, but her goal is simple: to support residential programs like the one that helped her after her parents kicked her out of the house in Canada.

"The pregnancy center that I lived in is now closed because of lack of funds, so I thought it was a really important thing that they're doing to raise money," Mallette said.

The movie will be released Feb. 28 worldwide.

Mallette has had her share of mom moments of late with her only child, who at 18 is the youngest singer to have five chart-topping albums and will be both host and musical guest for the Feb. 9 episode of "Saturday Night Live" on NBC.

Like his Instagram photo (since deleted) of his butt crack. What ran through her head?

"I thought, I'm a mom, I don't want to see that," Mallette sighed, shaking her head. "I don't want to see him doing that kind of stuff. But, you know, he's 18. He's making some of his own decisions and he's going to make some mistakes and he's going to make some good choices, too."

What of reports of pot smoking and partying with "sizzurp"-downing hip hop singers — sizzurp being a purplish mixture of cough syrup with codeine and promethazine, a carbonated soft drink and pieces of Jolly Rancher candy.

"It's hard, you know, as a mom of an 18-year-old because that's the time when you just gotta start letting go," she said. "And, you know, I had to make some of my own mistakes. I gotta kind of let go and let him make some of his own mistakes and just hope that I put all the right things in him."

And what of Bieber's relationship with Selena Gomez?

"I have no idea if they're on-again, off-again," she said. "It's a constant thing. Today I'm not sure where they stand. I try to stay out of it. He's 18. He doesn't want me getting involved in his romantic life."

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Follow Leanne Italie on Twitter at http://twitter.com/litalie

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Well: The 'Monday Morning' Medical Screaming Match

I did not think I would ever see another “morbidity and mortality” conference in which senior doctors publicly attacked their younger colleagues for making medical errors. These types of heated meetings were commonplace when I was a medical student but have largely been abandoned.

Yet here they were again on “Monday Mornings,” a new medical drama on the TNT network, based on a novel by Dr. Sanjay Gupta, CNN’s chief medical correspondent and one of the executive producers of the show. Such screaming matches may make for good television, but it is useful to review why new strategies have emerged for dealing with medical mistakes.

So-called M&M conferences emerged in the early 20th century as a way for physicians to review cases that had either surprising outcomes or had somehow gone wrong. Although the format varied among institutions and departments, surgery M&Ms were especially known for their confrontations, as more experienced surgeons often browbeat younger doctors into admitting their errors and promising to never make them again.

Such conferences were generally closed door — that is, attended only by physicians. Errors were a private matter not to be shared with other hospital staff, let alone patients and families.

But in the late 1970s, a sociology graduate student named Charles L. Bosk gained access to the surgery department at the University of Chicago. His resultant 1979 book, “Forgive and Remember,” was one of the earliest public discussions of how the medical profession addressed its mistakes.

Dr. Bosk developed a helpful terminology. Technical and judgment errors by surgeons could be forgiven, but only if they were remembered and subsequently prevented by those who committed them. Normative errors, which called into question the moral character of the culprit, were unacceptable and potentially jeopardized careers.

Although Dr. Bosk’s book was more observational than proscriptive, his depiction of M&M conferences was disturbing. I remember attending a urology M&M as a medical student in which several senior physicians berated a very well-meaning and competent intern for a perceived mistake. The intern seemed to take it very well, but my fellow students and I were shaken by the event, asking how such hostility could be conducive to learning.

There were lots of angry accusations in the surgical M&Ms in the pilot episode of “Monday Mornings.” In one case, a senior doctor excoriated a colleague who had given Tylenol to a woman with hip pain who turned out to have cancer. “You allowed metastatic cancer to run amok for four months!” he screamed.

If this was what Dr. Bosk would have called a judgment error, the next case raised moral issues. A neurosurgeon had operated on a boy’s brain tumor without doing a complete family history, which would have revealed a disorder of blood clotting. The boy bled to death on the operating table. “The boy died,” announced the head surgeon, “because of a doctor’s arrogance.”

In one respect, it is good to see that the doctors in charge were so concerned. But as the study of medical errors expanded in the 1990s, researchers found that the likelihood of being blamed led physicians to conceal their errors. Meanwhile, although doctors who attended such conferences might indeed not make the exact same mistakes that had been discussed, it was far from clear that M&Ms were the best way to address the larger problem of medical errors, which, according to a 1999 study, killed close to 100,000 Americans annually.

Eventually, experts recommended a “systems approach” to medical errors, similar to what had been developed by the airline industry. The idea was to look at the root causes of errors and to devise systems to prevent them. Was there a way, for example, to ensure that the woman with the hip problem would return to medical care when the Tylenol did not help? Or could operations not be allowed to occur until a complete family history was in the chart? Increasingly, hospitals have put in systems, such as preoperative checklists and computer warnings, that successfully prevent medical errors.

Another key component of the systems approach is to reduce the emphasis on blame. Even the best doctors make mistakes. Impugning them publicly — or even privately — can make them clam up. But if errors are seen as resulting from inadequate systems, physicians and other health professionals should be more willing to speak up.

Of course, the systems approach is not perfect. Studies continue to show that physicians conceal their mistakes. And elaborate systems for preventing errors can at times interfere with getting things done in the hospital.

Finally, it is important not to entirely remove the issue of responsibility. Sad to say, there still are physicians who are careless and others who are arrogant. Even if today’s M&M conferences rarely involve screaming, supervising physicians need to let such colleagues know that these types of behaviors are unacceptable.

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Barron H. Lerner, M.D., professor of medicine at New York University Langone Medical Center, is the author, most recently, of “One for the Road: Drunk Driving Since 1900.”

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DealBook: Helping Start-Ups With Local Support and National Networks

When Will Fuentes planned an extended business trip to Seattle last year, he tapped into the local chapter of a national networking group there. Within hours, Mr. Fuentes, who founded the Arlington, Va., software company Lemur Retail, had secured a work space, introductions and even restaurant recommendations via the group, the Startup America Partnership.“Before I flew out there, I already had five or six meetings set up with potential clients and other key contacts, as well as one potential acquirer,” Mr. Fuentes said.

A couple of years ago, entrepreneurs would have needed several trips to make similar connections outside their own cities. Even in this era of social networks and venture conferences, start-ups are still surprisingly disconnected on a national level.

“Each region has its ties, but in many cases, entrepreneurs are operating in silos,” said Carolynn Duncan, the chief executive of Portland Ten, a mentoring program for early-stage companies, mainly in Oregon. “An entrepreneur in Oregon doesn’t have an easy way to network with entrepreneurs in Washington D.C.”

Startup America, a nonprofit organization with an all-star cast of deep-pocketed backers, is trying to bridge the gap. The organization, which was started in January 2011 as the brainchild of AOL’s co-founder, Steve Case, and the Ewing Marion Kauffman Foundation, wanted to bring a private-sector support to start-ups — without financial strings attached.

“Supporting start-ups throughout the country is the only way to make sure the American economy is firing on all cylinders,” said Mr. Case, who is the chairman of the partnership.

Start-ups are a crucial driver for job creation in the United States. From March 1994 to March 2010, businesses less than one year old created 3.9 million jobs a year on average, according to the Bureau of Labor Statistics, though that number has declined during the recent economic weakness.

The Small Business Administration and United States Chamber of Commerce have long been a resource for start-ups, but these government agencies have a broad mandate. There is a “growing recognition,” said Mr. Case, that high-growth start-ups — those with the potential to be national or international companies — have different needs and requirements than traditional small businesses.

Startup America’s initial focus was to provide support to start-ups through deals on goods and services, like 40 percent off FedEx shipping and free flights on American Airlines. But the group quickly realized that start-ups needed more practical help, like sharing best practices and networking.

Soon after the partnership’s start, entrepreneurs around the country starting contacting Startup America, asking how they could create their own networks and reach out to counterparts in other states. “Most of these regions were already coming up with their own initiatives or thinking about them,” said the organization’s chief executive, Scott Case, a founder and former chief technology officer of Priceline.com (and no relation to Steve Case). “We’re helping to stitch together all these parts.”

Taking cues from the entrepreneurs, Startup America has turned its attention to building such a network. Nearly 12,000 members are now affiliated with local Startup America initiatives in 30 states. The partnership expects to add another 10 states this year.

Each Startup America region is spearheaded by local “champions” who come together several times a year at national conferences, communicate via Google groups and have access to an online “idea center” where they can brainstorm about, say, bringing in outside capital or hosting a start-up conference. These envoys are all “founder types” at different stages of their careers, Scott Case said. “Some have exited companies and are looking to continue to feed that creative drive. Others understand that if they can strengthen their community, they can strengthen their own company.”

Brooks Bell, founder of an eponymous 22-employee digital consulting business based in Raleigh, N.C., became involved with the partnership in 2011 after realizing that many potential clients considered her area a backwater. “I realized that was impacting my company’s brand, too,” she said.

Mrs. Bell pointed out that other national groups, like Entrepreneurs’ Organizations, offer resources for high-growth companies. Yet, their emphasis is typically on supporting individuals rather than elevating the region and networking nationally. “They also tend to focus on early-stage companies,” she said. Until Startup America, she added, “there weren’t a lot of opportunities for early-stage companies to interact with funded companies.”

Though Startup America regions work off the same blueprint, each takes a slightly different approach. In Maryland, the staff and champions volunteer virtually. Startup Tennessee partnered with the Entrepreneur Center in Nashville, which runs a nonprofit incubator program. Startup Colorado works out of Silicon Flatirons, a center for law, technology and entrepreneurship at the University of Colorado Law School, and finds partners to finance specific projects.

Although the regional chapters operate independently, they benefit from the credibility of a national organization. “It’s helping elevate our start-ups nationally and get them in front of audiences we never would have,” said Andy Stoll, an entrepreneur in the Iowa City, Iowa, area, where rebuilding from the floods in 2008 has helped generate a boom in start-up activity.

“To have the opportunity to sit in a room with their board and have Steve Case ask me, ‘What are the three things that those of us at this table can do to really help support the Indiana community?’ is amazing and a humbling experience,” said Michael Coffey, a partner at DeveloperTown, an Indianapolis design and development firm that works with companies of all sizes.

In the end, it’s all about business.

Aaron Schwartz, a co-founder of the San Francisco-based Modify Watches, initially joined Startup America for the discounts. Now, he’s also tapping into the partnership to network, including finding corporate clients who order custom watches and vendors. “I now have a contact in Tennessee who has offered to look into manufacturing our watches there,” he said

Mr. Fuentes of Lemur Retail found two potential clients, both national chains, through his connections in Seattle last year; he’s currently in talks with those companies. He’s also helping his Northwest counterparts make inroads in the Washington area. He likens the experience to a fraternity or alumni organization of entrepreneurs.

“When people contact me from my high school or college, I pick up the phone,” he said. “This is no different.”

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Tunisia Moves to Contain Fallout After Opposition Figure Is Assassinated

TUNIS — Tunisian officials moved quickly on Wednesday to contain the political fallout after a leading opposition figure was assassinated outside his home, announcing that they would dissolve the Islamist-led government and calling for a national unity cabinet as thousands took to the streets in protests that the security forces beat back with tear gas.

The killing of the politician, Chokri Belaid, one of Tunisia’s best-known human rights defenders and a fierce critic of hard-line Islamists known as Salafis, escalated simmering tensions in a society torn between its legacy as a bastion of Arab secularism and its new role as a proving ground for the region’s ascendant Islamist parties.

The explosion of anger, which led to the death of a police officer in the center of the capital, Tunis, late Wednesday, posed a severe challenge to the ruling moderate Islamist party, Ennahda, which came to power in Tunisia promising to provide a model government that blended Islamist and democratic rule.

Mr. Belaid was shot and killed outside his home in an upscale neighborhood of Tunis on Wednesday as he was getting into his car. The interior minister, citing witnesses, said two unidentified gunmen fired on Mr. Belaid, striking him with four bullets.

The killing, which was the first political assassination since the overthrow of Tunisia’s autocratic leader, marked a dark turn for the country that set off the Arab uprisings in 2011. It resonated in countries like Egypt and Libya, struggling to contain political violence while looking to Tunisia’s chaotic but orderly transition as a hopeful example.

“Confronting violence, radicalism and the forces of darkness is the main priorities for societies if they want freedom and democracy,” Amr Hamzawy, a member of Egypt’s main secular opposition coalition, wrote on Twitter on Wednesday. “Assassinating Chokri Belaid is warning bell in Tunisia, and in Egypt too.”

The response by Tunisian officials was also being closely watched. In a stunned Tunisia on Wednesday, thousands of people took to the streets of Tunis and other cities to protest the assassination. There were clashes on Avenue Habib Bourgiba in Tunis, as riot police officers fired tear gas and beat protesters in scenes reminiscent of the uprising.

The prime minister, Hamadi Jabali, called the killing a “heinous crime against the Tunisian people, against the principle of the revolution and the values of tolerance and acceptance of the other.”

Bowing to the widespread outrage, Mr. Jabali announced on Wednesday night that he was dissolving the Islamist-led government, and replacing cabinet ministers with technocrats not tied to any political party — an expected move hastened by the crisis. The country’s president, Moncef Marzouki, cut short an overseas trip to deal with the fallout.

Mr. Belaid, who was in his late 40s, and others had accused Ennahda of accommodating the Salafis by refusing to prosecute them or crack down on the groups. In recent days, Mr. Belaid, a lawyer who had received numerous death threats including from hard-line imams, had accused Islamists of carrying out an attack on a meeting of his supporters on Saturday.

“At the end of our meeting, a group of Ennahda mercenaries and Salafists attacked our activists,” Mr. Belaid said.

There was no immediate claim of responsibility for the killing. In a statement on Wednesday, Ennahda denied any responsibility, saying the killing jeopardized the “security and stability of Tunisia.”

In Washington, the State Department spokeswoman, Victoria Nuland, criticized the killing, calling it an “outrageous and cowardly act.”

She urged the government in Tunis to conduct a “fair, transparent and professional investigation to ensure that the perpetrators are brought to justice consistent with Tunisian law and international norms.” Noting the protests that erupted in response to the killing, Ms. Nuland called on all Tunisians “to respect the rule of law, to renounce violence and to express themselves about this incident and anything else peacefully.”

As news of the assassination spread, thousands of people gathered in front of the Interior Ministry headquarters, a massive gray building that is still a hated symbol of Tunisia’s deposed authoritarian leader, Zine el-Abidine Ben Ali, to express anger at Tunisia’s new government. “The people want the fall of the regime,” a group chanted, reprising the uprising’s refrain.

“Resignation, resignation, the cabinet of treason!” others shouted.

Riot police officers fired tear gas into the crowds and plainclothes officers beat demonstrators who did not run, witnesses said.

There were reports of attacks on Ennahda offices in different parts of the country, including in Sidi Bouzid, the town where the Tunisian revolt began.

“To have an assassination at this time with a firearm at point-blank range is shocking,” said Amna Guellali, a researcher for Human Rights Watch based in Tunis.

“We’re in a climate of political violence now,” she added, saying that Human Rights Watch had documented numerous attacks against activists, journalists and political figures by Salafist and other groups. “Last month, there were various leaders targeted, various meetings of political parties disrupted and assaulted,” she said.

Ms. Guellali said that on Tuesday, Mr. Belaid had called for a national dialogue to confront political violence. “He said political violence was becoming more organized due to the laxity of the government,” she said. “This just adds to the tragedy.”

Monica Marks reported from Tunis, and Kareem Fahim from Cairo. Reporting was contributed by Gerry Mullany from Hong Kong, Mayy el Sheikh from Cairo and Brian Knowlton from Washington.

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Chris Brown returns to court for probation issues

LOS ANGELES (AP) — With the woman he assaulted throwing him a kiss, Chris Brown walked into court Wednesday to face allegations he failed to complete his community labor sentence for Rihanna's 2009 beating.

A judge asked for more information and scheduled another hearing in two months.

Rihanna, the glamorous singer whose bruised face became a tabloid fixture after she was beaten by her then-boyfriend on the way to the Grammys, has been dating Brown again.

She arrived with the R&B star, his mother and two other women and blew him a kiss as he entered the courtroom. They left together after the short proceeding in which Superior Court Judge James Brandlin set the next hearing for April 5.

Brown's lawyer, Mark Geragos, said he was disturbed about the way the district attorney handled the matter and said he would be filing a motion opposing the prosecution's move to modify Brown's fulfillment of his community labor sentence.

Prosecutors, who said they could find no credible evidence that Brown had completed his community labor in his home state of Virginia, asked that he start all over and put in 180 days in Los Angeles County.

Prosecutors have suggested there was either sloppy record keeping or fraudulent reporting.

The judge noted during the brief court session that a prosecution filing did not request revocation of Brown's probation and he, therefore, would not revoke it.

A motion filed Tuesday also raised for the first time in Brown's felony assault case several incidents that prosecutors said demonstrate Brown has ongoing anger management issues.

The motion cited a Jan. 27 fight between Brown and fellow R&B star Frank Ocean, and a 2011 outburst in which Brown threw a chair through a window after he was asked about the Rihanna attack on "Good Morning America."

The filing represents a dramatic shift in the case against Brown, who was repeatedly praised by the judge overseeing his case for his completion of domestic violence courses and his community service work in his home state of Virginia.

That changed in September, when prosecutors raised concerns about Brown's community service after he logged 701 hours in seven months — an amount that had previously taken him more than two years to achieve.

Los Angeles investigators traveled to Richmond, Va., to investigate Brown's service, which was only described in broad strokes by Richmond Police Chief Bryan Norwood, who was overseeing the singer's community labor.

"This inquiry provided no credible, competent or verifiable evidence that defendant Brown performed his community labor as presented to this court," Deputy District Attorney Mary Murray wrote.

Brown's attorney Geragos blasted the court filing, saying the prosecutor ignored interviews "where sworn peace officers stated unequivocally that Mr. Brown was supervised and did all of the community service."

"I plan on asking for sanctions from the DA's office for filing a frivolous, scurrilous and frankly defamatory motion," he said Tuesday.

Brown's case was transferred to Brandlin after a recent shuffling of judicial assignments.

After pleading guilty to the Rihanna attack, Brown was given permission to serve 180 days of community labor in his home state of Virginia, but only as long as he performed manual labor such as graffiti removal and roadside cleanup.

Given problems with documentation and statements from some witnesses who contradict Brown's claims of work, prosecutors asked Brandlin to order Brown to repeat his service in Los Angeles.

Brown spent one-third of the hours he logged in Virginia working night shifts at a day care center in rural Virginia where his mother once served as director and where the singer spent time as a child.

A detective who checked on Brown's work nine times at the Tappahannock Children's Center found the singer, his mother and a bodyguard at the center on each visit.

The records said Brown waxed floors or performed general cleaning at the center.

A professional floor cleaner contracted to work at the daycare center told investigators he had been cleaning the floors during the months Brown reported working at the facility.

"Claims that the defendant cleaned, stripped and waxed floors at that location have been credibly contradicted," prosecutors said in the filing.

Brown's mother, Joyce Hawkins, no longer had a formal role at the day care center but had her own set of keys and coordinated her son's work at the facility, prosecutors said.

Murray stated in her filing that Norwood's report on Brown's service was "at best sloppy documentation and at worst fraudulent reporting."

Richmond police spokesman Gene Lepley declined to discuss the allegations.

"We believe it would inappropriate to comment on a matter that's before the court," Lepley said.

According to the motion, officials with Virginia's probation office told investigators that Brown's arrangement to be supervised by Norwood was "extremely unusual" and had not been approved by the agency. No one from Virginia's probation department oversaw Brown's hours, prosecutors said.

The motion noted that the only records the department has to indicate Brown was supervised were officers' overtime sheets. Five of 21 days that officers logged overtime for Brown were spent providing security for the singer's concerts.

The allegations are the latest pre-Grammy controversy for Brown, who was arrested shortly after the 2009 ceremony for his attack on Rihanna. He has since returned to the awards show by performing and winning an award in 2011 for his album "F.A.M.E."

Brown and Ocean are competing against one other for the Best Urban Contemporary Album category at Sunday's Grammys.

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AP writers Anthony McCartney and Ryan Pearson contributed to this report.

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Personal Health: Effective Addiction Treatment

Countless people addicted to drugs, alcohol or both have managed to get clean and stay clean with the help of organizations like Alcoholics Anonymous or the thousands of residential and outpatient clinics devoted to treating addiction.

But if you have failed one or more times to achieve lasting sobriety after rehab, perhaps after spending tens of thousands of dollars, you’re not alone. And chances are, it’s not your fault.

Of the 23.5 million teenagers and adults addicted to alcohol or drugs, only about 1 in 10 gets treatment, which too often fails to keep them drug-free. Many of these programs fail to use proven methods to deal with the factors that underlie addiction and set off relapse.

According to recent examinations of treatment programs, most are rooted in outdated methods rather than newer approaches shown in scientific studies to be more effective in helping people achieve and maintain addiction-free lives. People typically do more research when shopping for a new car than when seeking treatment for addiction.

A groundbreaking report published last year by the National Center on Addiction and Substance Abuse at Columbia University concluded that “the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.” The report added, “Only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works.”

The Columbia report found that most addiction treatment providers are not medical professionals and are not equipped with the knowledge, skills or credentials needed to provide the full range of evidence-based services, including medication and psychosocial therapy. The authors suggested that such insufficient care could be considered “a form of medical malpractice.”

The failings of many treatment programs — and the comprehensive therapies that have been scientifically validated but remain vastly underused — are described in an eye-opening new book, “Inside Rehab,” by Anne M. Fletcher, a science writer whose previous books include the highly acclaimed “Sober for Good.”

“There are exceptions, but of the many thousands of treatment programs out there, most use exactly the same kind of treatment you would have received in 1950, not modern scientific approaches,” A. Thomas McLellan, co-founder of the Treatment Research Institute in Philadelphia, told Ms. Fletcher.

Ms. Fletcher’s book, replete with the experiences of treated addicts, offers myriad suggestions to help patients find addiction treatments with the highest probability of success.

Often, Ms. Fletcher found, low-cost, publicly funded clinics have better-qualified therapists and better outcomes than the high-end residential centers typically used by celebrities like Britney Spears and Lindsay Lohan. Indeed, their revolving-door experiences with treatment helped prompt Ms. Fletcher’s exhaustive exploration in the first place.

In an interview, Ms. Fletcher said she wanted to inform consumers “about science-based practices that should form the basis of addiction treatment” and explode some of the myths surrounding it.

One such myth is the belief that most addicts need to go to a rehab center.

“The truth is that most people recover (1) completely on their own, (2) by attending self-help groups, and/or (3) by seeing a counselor or therapist individually,” she wrote.

Contrary to the 30-day stint typical of inpatient rehab, “people with serious substance abuse disorders commonly require care for months or even years,” she wrote. “The short-term fix mentality partially explains why so many people go back to their old habits.”

Dr. Mark Willenbring, a former director of treatment and recovery research at the National Institute for Alcohol Abuse and Alcoholism, said in an interview, “You don’t treat a chronic illness for four weeks and then send the patient to a support group. People with a chronic form of addiction need multimodal treatment that is individualized and offered continuously or intermittently for as long as they need it.”

Dr. Willenbring now practices in St. Paul, where he is creating a clinic called Alltyr “to serve as a model to demonstrate what comprehensive 21st century treatment should look like.”

“While some people are helped by one intensive round of treatment, the majority of addicts continue to need services,” Dr. Willenbring said. He cited the case of a 43-year-old woman “who has been in and out of rehab 42 times” because she never got the full range of medical and support services she needed.

Dr. Willenbring is especially distressed about patients who are treated for opioid addiction, then relapse in part because they are not given maintenance therapy with the drug Suboxone.

“We have some pretty good drugs to help people with addiction problems, but doctors don’t know how to use them,” he said. “The 12-step community doesn’t want to use relapse-prevention medication because they view it as a crutch.”

Before committing to a treatment program, Ms. Fletcher urges prospective clients or their families to do their homework. The first step, she said, is to get an independent assessment of the need for treatment, as well as the kind of treatment needed, by an expert who is not affiliated with the program you are considering.

Check on the credentials of the program’s personnel, who should have “at least a master’s degree,” Ms. Fletcher said. If the therapist is a physician, he or she should be certified by the American Board of Addiction Medicine.

Does the facility’s approach to treatment fit with your beliefs and values? If a 12-step program like A.A. is not right for you, don’t choose it just because it’s the best known approach.

Meet with the therapist who will treat you and ask what your treatment plan will be. “It should be more than movies, lectures or three-hour classes three times a week,” Ms. Fletcher said. “You should be treated by a licensed addiction counselor who will see you one-on-one. Treatment should be individualized. One size does not fit all.”

Find out if you will receive therapy for any underlying condition, like depression, or a social problem that could sabotage recovery. The National Institute on Drug Abuse states in its Principles of Drug Addiction Treatment, “To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems.”

Look for programs using research-validated techniques, like cognitive behavioral therapy, which helps addicts recognize what prompts them to use drugs or alcohol, and learn to redirect their thoughts and reactions away from the abused substance.

Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, “Get Your Loved One Sober,” with co-author Brenda L. Wolfe. It helps addicts adopt a lifestyle more rewarding than one filled with drugs and alcohol.

This is the first of two articles on addiction treatment.

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DealBook: The Politics of the R.B.S. Settlement

LONDON — The British government is taking aim at an unlikely target in the latest rate-rigging case: the British government.

The $612 million settlement that the Royal Bank of Scotland reached with authorities on Wednesday over rate manipulation will leave British taxpayers liable for part of the fine.

The government still owns a 82 percent stake in the bank, which was bailed out in 2008 during the height of the financial crisis.

The British government finds itself on the other side of its case as well because the Financial Services Authority, the country’s main financial regulator, has been part of the global investigation into the manipulation of benchmark rates like the London interbank offered rate, or Libor.

The case against the Royal Bank of Scotland has been politically charged after British politicians demanded that bankers’ bonuses should be used to pay for the settlement.

“There is a legitimate concern that British taxpayers, who already have bailed out the bank, will be asked to pay for past mistakes at R.B.S.,” said Pat McFadden, a British politician who is a member of the opposition party and part of the Parliament’s Treasury select committee that oversees the country’s finance industry. On Monday, George Osborne, the chancellor of the Exchequer, also called on the bank to use bonuses to pay the Libor fine.

To help pay for the global settlement, the British bank said it would claw back past and present bonuses totaling $471 million from both the traders implicated in the rate-rigging scandal as well as from employees in the bank’s operations, particularly its investment banking unit, which have not been part of the wrongdoing.

Bank officials said the clawbacks were related to the reputational damage caused to the bank, and would also cover potential future legal liabilities. But that money will be used primarily to pay the fines levied against the bank by the United States authorities.

The Financial Services Authority’s share of the fine is expected not to come from the bonuses. The money will, in a sense, be recycled since it will go to the British government’s coffers.

One of the casualties of the Libor scandal was John Hourican, head of the firm’s investment banking division, who resigned on Wednesday. He will forgo past and present compensation worth a combined $14.1 million. Mr. Hourican, who took over the investment banking unit in 2008 and has not been implicated in the wrongdoing, will receive a one-time payout from the bank of around $1 million.

Libor Explained

“This has been a soap opera for the last four years because of the ups and downs of this job,” the bank’s chairman, Philip Hampton, told reporters on Wednesday. “The bank was in a hell of a mess.”

The taxpayer stake in the bank sets the latest deal apart from the other two big Libor settlements. Last summer, the British bank Barclays agreed to pay $450 million to settle accusations that it reported false rates. In December, the Swiss giant UBS struck a sweeping $1.5 billion deal with authorities in which its Japanese subsidiary pleaded guilty to felony wire fraud.

But despite the vested interest of taxpayers, the Financial Services Authority did not take the government’s ownership stake into consideration when reaching the settlement, according to a person with direct knowledge of the matter who spoke on the condition of anonymity.

The renewed scrutiny on the bank, however, could hinder the government’s ability to sell its stake for a profit, as private investors remain wary of the bank’s future liabilities. Since the bailout in 2008, the bank’s shares have plummeted, and are currently trading around 32 percent below the initial purchase price.

As part of plans to sell the government’s stake in the bank, Vince Cable, the British business secretary, said Royal Bank of Scotland should have been fully nationalized when it was bailed out in 2008. In a speech on Wednesday, he added that one option could be to return shares in the bank to British taxpayers.

“The early hope of reprivatization now looks a very long way off, unless at an unacceptable loss,” Mr. Cable said.

Government officials have held preliminary discussions with a number of investors about selling stakes in the Royal Bank of Scotland, according to a person with direct knowledge of the matter who spoke on the condition of anonymity.

The potential losses facing British taxpayers contrast with the $182 billion bailout of the American International Group in 2008. Over the last two years, A.I.G. issued a series of stock offerings to reduce the United States government’s ownership, generating profit of around $22 billion for American taxpayers.

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Ahmadinejad Visits Egypt, Signaling Realignment

CAIRO — President Mahmoud Ahmadinejad’s historic three-day trip to Egypt, the first in three decades by an Iranian leader, started pleasantly enough on Tuesday.

Egypt’s president, Mohamed Morsi, greeted Mr. Ahmadinejad with a broad smile during a red-carpet ceremony at a Cairo airport. The two talked about the crisis in Syria and how to improve the relationship between their own countries, which has been in a deep freeze since after the Iranian revolution in 1979.

“Egypt is a very important country in the region and the Islamic Republic of Iran believes it is one of the heavyweights in the Middle East,” Iran’s foreign minister, Ali Akbar Salehi, told Iran’s state-run Islamic Republic News Agency on Tuesday. “We are ready to further strengthen ties.”

Then things got testy.

During an afternoon visit to Al-Azhar mosque and university, Egypt’s seat of Sunni scholarship, Mr. Ahmadinejad was publicly upbraided at a news conference by his hosts, who accused Shiites of interfering in Arab countries, including Egypt and Bahrain, and of discriminating against Sunnis in Iran, a Shiite-majority country.

As a spokesman for Al-Azhar scolded his guest using divisive sectarian language, an aide to Mr. Ahmadinejad cut in. “We didn’t agree on this,” he said, as the Iranian leader nodded and replied: “We agreed on unity, brotherhood.”

After the news conference, a protester tried unsuccessfully to hit Mr. Ahmadinejad with a shoe, according to video of the incident by Turkey’s Anatolia news agency, which said the assailant was a Syrian man, presumably angered at Iran’s strong alliance with Syria’s president, Bashar al-Assad.

Four people were later arrested for attacking the Iranian leader’s motorcade, according to the Web site of Al Ahram, Egypt’s state-owned newspaper.

Those public setbacks aside, relations between the two countries have warmed since the toppling of Egypt’s former president, Hosni Mubarak, who was deeply hostile to Iran’s leadership and portrayed himself to his allies, including the United States, the Persian Gulf monarchies and Israel, as a bulwark against Iranian influence.

The relationship had atrophied over decades, damaged in particular by the Egyptian President Anwar el-Sadat’s granting of asylum to the deposed Iranian shah, Mohammad-Reza Pahlavi, who was given a state funeral in Cairo in 1980. When Mr. Sadat was assassinated the next year, Iran named a street after his killer, Khaled Islambouli.

Mr. Morsi, an Islamist and Egypt’s first elected leader, promised a new direction for foreign policy that he said would be more independent than his predecessors’ and would reassert Egypt’s historical leadership role. Extending a hand to Iran was seen as part of an effort to improve ties with regional powers and, more important, to broker a solution to the war in Syria.

Iranian officials were even more eager to mend the relationship, speaking of Egypt and Iran as the core of an axis of regional military powers. Iran’s supreme leader, Ayatollah Ali Khamenei, has been promoting the idea that the recent Arab uprisings were inspired by the Iranian revolution of 1979.

The first major step toward repairing the relationship came in August, when Mr. Morsi visited Tehran during the meeting of the Nonaligned Movement, in what was seen as an effort toward easing Iran’s international isolation.

But that trip also veered off script. Mr. Morsi embarrassed his hosts somewhat by delivering a stinging condemnation of President Assad, delighting Saudi Arabia and Qatar, strong financial supporters of both Egypt and the Syrian insurgency.

And in speaking about the Arab uprisings, Mr. Morsi notably avoided, as he often does, any mention of the Shiite-led revolt against Bahrain’s Sunni monarchy, further endearing him to allies in the gulf region who have portrayed the uprising as an Iranian plot rather than a popular movement.

Many analysts think it unlikely that the Egypt-Iran thaw will develop into fully restored relations, given the pressure exerted by the United States and the gulf monarchies on Mr. Morsi to keep his distance. Despite his talk of charting a new path for Egypt, “the Morsi administration is trying to avoid any direct confrontation with the international system,” said Emad Shahin, a political scientist at the American University of Cairo.

A separate attempt by the Egyptian leader to develop closer ties with Iran, by including it in a regional effort with Turkey and Saudi Arabia to solve the Syrian crisis, also faltered, after the Saudis stopped participating, diplomats said.

“Morsi is learning the constraints and the realities of the cold wars in the region — the old rivalries and local calculations,” Mr. Shahin said.

On Tuesday, Mr. Ahmadinejad squirmed as the spokesman for Al-Azhar, Hassan al-Shafei, related the details of the Iranian leader’s meeting with Al-Azhar’s grand imam, Sheik Ahmed el-Tayeb. After saying the Iranian leader was received “not only as a great guest and the president of a sister country,” but also as a “friend,” the spokesman amplified differences between Sunnis and Shiites and talked mostly about what he called obstacles to unity.

When it was over, Mr. Ahmadinejad smiled and kissed the spokesman on both cheeks.

Thomas Erdbrink contributed reporting from Tehran.

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Disney working on stand-alone 'Star Wars' films

LOS ANGELES (AP) — Disney is mining The Force for even more new films.

Walt Disney Co. CEO Bob Iger said Tuesday that screenwriters Larry Kasdan and Simon Kinberg are working on stand-alone "Star Wars" movies that aren't part of the new trilogy that's in the works.

"There has been speculation about some standalone films that have been in development, and I can confirm to you today that in fact we are working on a few stand-alone films," Iger told CNBC.

Iger said the movies would be based on "great 'Star Wars' characters that are not part of the overall saga." The films would be released during the six-year period of the new trilogy, which starts in 2015 with "Star Wars: Episode VII."

Disney confirmed last month that "Star Trek" director J.J. Abrams will direct the seventh installment of the "Star Wars" saga.

Disney bought "Star Wars" maker Lucasfilm last year for more than $4 billion.

The last "Star Wars" trilogy, a prequel to the original films, was released from 1999 to 2005.

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Online:

http://www.starwars.com/

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Well: Warning Too Late for Some Babies

Six weeks after Jack Mahoney was born prematurely on Feb. 3, 2011, the neonatal staff at WakeMed Hospital in Raleigh, N.C., noticed that his heart rate slowed slightly when he ate. They figured he was having difficulty feeding, and they added a thickener to help.

When Jack was discharged, his parents were given the thickener, SimplyThick, to mix into his formula. Two weeks later, Jack was back in the hospital, with a swollen belly and in inconsolable pain. By then, most of his small intestine had stopped working. He died soon after, at 66 days old.

A month later, the Food and Drug Administration issued a caution that SimplyThick should not be fed to premature infants because it may cause necrotizing enterocolitis, or NEC, a life-threatening condition that damages intestinal tissue.

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Catherine Saint Louis speaks about using SimplyThick in premature infants.

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Experts do not know how the product may be linked to the condition, but Jack is not the only child to die after receiving SimplyThick. An F.D.A. investigation of 84 cases, published in The Journal of Pediatrics in 2012, found a “distinct illness pattern” in 22 instances that suggested a possible link between SimplyThick and NEC. Seven deaths were cited; 14 infants required surgery.

Last September, after more adverse events were reported, the F.D.A. warned that the thickener should not be given to any infants. But the fact that SimplyThick was widely used at all in neonatal intensive care units has spawned a spate of lawsuits and raised questions about regulatory oversight of food additives for infants.

SimplyThick is made from xanthan gum, a widely-used food additive on the F.D.A.’s list of substances “generally recognized as safe.” SimplyThick is classified as a food and the F.D.A. did not assess it for safety.

John Holahan, president of SimplyThick, which is based in St. Louis, acknowledged that the company marketed the product to speech language pathologists who in turn recommended it to infants. The patent touted its effectiveness in breast milk.

However, Mr. Holahan said, “There was no need to conduct studies, as the use of thickeners overall was already well established. In addition, the safety of xanthan gum was already well established.”

Since 2001, SimplyThick has been widely used by adults with swallowing difficulties. A liquid thickened to about the consistency of honey allows the drinker more time to close his airway and prevent aspiration.

Doctors in newborn intensive care units often ask non-physician colleagues like speech pathologists to determine whether an infant has a swallowing problem. And those auxiliary feeding specialists often recommended SimplyThick for neonates with swallowing troubles or acid reflux.

The thickener became popular because it was easy to mix, could be used with breast milk, and maintained its consistency, unlike alternatives like rice cereal.

“It was word of mouth, then neonatologists got used to using it. It became adopted,” said Dr. Steven Abrams, a neonatologist at Texas Children’s Hospital in Houston. “At any given time, several babies in our nursery — and in any neonatal unit — would be on it.”

But in early 2011, Dr. Benson Silverman, the director of the F.D.A.’s infant formula section, was alerted to an online forum where doctors had reported 15 cases of NEC among infants given SimplyThick. The agency issued its first warning about its use in babies that May. “We can only do something with the information we are provided with,” he said. “If information is not provided, how would we know?”

Most infants who took SimplyThick did not fall ill, and NEC is not uncommon in premature infants. But most who develop NEC do so while still in the hospital. Some premature infants given SimplyThick developed NEC later than usual, a few after they went home, a pattern the F.D.A. found unusually worrisome.

Even now it is not known how the thickener might have contributed to the infant deaths. One possibility is that xanthan gum itself is not suitable for the fragile digestive systems of newborns. The intestines of premature babies are “much more likely to have bacterial overgrowth” than adults’, said Dr. Jeffrey Pietz, the chief of newborn medicine at Children’s Hospital Central California in Madera.

“You try not to put anything in a baby’s intestine that’s not natural.” If you do, he added, “you’ve got to have a good reason.”

A second possibility is that batches of the thickener were contaminated with harmful bacteria. In late May 2011, the F.D.A. inspected the plants that make SimplyThick and found violations at one in Stone Mountain, Ga., including a failure to “thermally process” the product to destroy bacteria of a “public health significance.”

The company, Thermo Pac, voluntarily withdrew certain batches. But it appears some children may have ingested potentially contaminated batches.

The parents of Jaden Santos, a preemie who died of NEC while on SimplyThick, still have unused packets of recalled lots, according to their lawyer, Joe Taraska.

The authors of the F.D.A. report theorized that the infants’ intestinal membranes could have been damaged by bacteria breaking down the xanthan gum into too many toxic byproducts.

Dr. Qing Yang, a neonatologist at Wake Forest University, is a co-author of a case series in the Journal of Perinatology about three premature infants who took SimplyThick, developed NEC and were treated. The paper speculates that NEC was “most likely caused by the stimulation of the immature gut by xanthan gum.”

Dr. Yang said she only belatedly realized “there’s a lack of data” on xanthan gum’s use in preemies. “The lesson I learned is not to be totally dependent on the speech pathologist.”

Julie Mueller’s daughter Addison was born full-term and given SimplyThick after a swallow test showed she was at risk of choking. It was recommended by a speech pathologist at the hospital.

Less than a month later, Addison was dead with multiple holes in her small intestine. “It was a nightmare,” said Ms. Mueller, who has filed a lawsuit against SimplyThick. “I was astounded how a hospital and manufacturer was gearing this toward newborns when they never had to prove it would be safe for them. Basically we just did a research trial for the manufacturer.”

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Zynga at a Crossroads in Mobile Quest

SAN FRANCISCO — Zynga has been on a monumental losing streak. Hits have been rare, profits nonexistent and crucial employees are fleeing.

The story of the company, which developed the notion of social gaming and persuaded tens of millions of people to try it out on Facebook, illustrates how suddenly the fortunes of hot Internet companies can shift. Two years ago, as Zynga was first being pushed for a public offering, it was said to be worth $20 billion.

By the time the offering took place, a little over a year ago, it was for less than $10 billion. And Zynga has spent most of the time since then sliding downhill. The value of the company Tuesday, as it released mediocre but nevertheless better than expected fourth-quarter results, was about $2 billion.

In the next few months, Zynga faces a crucial test that will determine if even that sum is excessive: Can it successfully put its most popular Web games, starting with Farmville, on mobile devices?

“Do I wish that we would have gone all-in on mobile and made a bigger commitment to it earlier?” Mark Pincus, Zynga’s founder and chief executive officer said in an interview after the earnings release. “Yes.”

Mr. Pincus called 2013 “a year of investment and transition.”

“While we are excited about the long-term growth opportunity on mobile, and the opportunity to make games even more accessible to people in more parts of their day, we need to build a compelling network around it,” he said.

That is because social gaming on mobile is not necessarily social.

“It’s kind of ironic, isn’t it?” Mr. Pincus said. “You’re holding a phone, an inherently social device. Yet the experience we have is a more fragmented one.”

The pain accompanying Zynga’s transition to mobile was evident in the company’s fourth-quarter earnings report. Revenue was $311 million, flat with the year before. Daily users of the games were down 6 percent from the third quarter, a clear measure of flagging interest. More casual users dropped as well.

Earnings per share were a penny, better than the 3-cent loss that analysts had been expecting on an adjusted basis. And Zynga’s cash hoard of $1.65 billion was untouched.

For the full year, revenue was $1.28 billion, up 12 percent from 2011. Not exactly what you would expect from a growth company. Nor were its immediate prospects cheerful. Zynga warned that it would release few new games in the first quarter and that its revenue would drop from 2012.

Weak as the results were, however, they were not as bad as some feared. Zynga shares immediately rose in after-hours trading by 7 percent. In regular trading they were also up 7 percent to $2.73. That jump was fueled by an analyst upgrade from Merrill Lynch, which said the stock was so beaten down it now accurately reflected the company prospects.

Many online stock sites, by contrast, have been portraying the company as going the way of Pets.com or MySpace. “Zynga’s Earnings May Reveal Its Impending Demise” read the headline at one.

Michael Pachter, a managing director of Wedbush Securities, wrote in an e-mail that Zynga management was “definitely saying the right things, now all they have to do is execute.”

Aside from Mr. Pincus, it is a largely new team. Just last week, Zynga suffered another defection when its chief games designer, Brian Reynolds, quit, saying he wanted to experiment “more than might be appropriate for a publicly traded company.”

As recently as two years ago, Zynga had only 20 people working on mobile issues. Then the team ballooned into the hundreds. In the last few months, the team members have integrated into each game.

The central issue overshadowing even the mobile transition is whether Zynga first became successful merely because it was in the right place at the right time, a condition also known as dumb luck. Zynga’s rise was inseparable from Facebook, which gave the developer preferential treatment.

That era is over. In March, Zynga will lose its special status on Facebook.

There are other perils for Zynga, plenty of them. Analysts have been pointing to the rise of King.com’s games, including Candy Crush, which makes the latest version of Farmville look as complicated as advanced physics.

“Who thought crushing candy would have been popular?” said Brian Blau, a Gartner analyst.

King.com is touting itself as a new, improved Zynga, which underscores the volatile nature of the gaming business. “This is a hits driven industry, and Zynga could not sustain their hits,” Mr. Blau said. “Game players are fickle.”

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