Puerto Rico Races to Rescue Its Pension Fund

Puerto Rico is fighting to stay afloat in a rising sea of debt.

Its economy is sputtering. Its population is shrinking. Its recent election is disputed. Its public pension fund is perilously low on cash. The American territory has just been through a brutal five-year recession, something not experienced in the United States as a whole since the 1930s.

Desperate to raise cash, Puerto Rican officials have been selling off anything they can: two toll roads and the main airport so far.

To bring in tax revenue, they are trying to lure people out of the underground economy. Coffee shops, hairdressers, even outdoor market stalls are being required to issue printed receipts with every sale. The receipts carry a lottery number, with a chance to win cars or cash, as an incentive to get shoppers to pay the island’s 7 percent sales tax.

Though many of Puerto Rico’s problems are reminiscent of Greece’s — tax noncompliance, a stagnant economy, years of issuing long-term debt to cover short-term payments — investors have had a nearly insatiable appetite for its bonds.

But now their support is dwindling. Some big investors are pruning their holdings. That is beginning to widen the cost of borrowing for Puerto Rico relative to other states and municipalities, which are benefiting from a big decline in borrowing costs. The interest rate its 30-year bonds now pay is about 2.5 percentage points higher than other municipal borrowers’, up from a difference of just 1.5 percentage points at the beginning of 2012, according to Municipal Market Data.

The possibility of a credit downgrade also hangs in the air, something that could lead to more selling.

“There is no specific event looming on the horizon,” said Alan Schankel, a managing director at Janney Capital Markets in Philadelphia. “But it’s a problem of immense magnitude, and it’s very challenging to sit here and see how they work their way out of it.”

Puerto Rico needs to be able to issue bonds at attractive rates to cover its short-term financing needs. Perhaps more important, it has to figure out how to salvage its retirement funds. After shortchanging them for years, it now has the weakest major public pension system in America.

The main fund, which serves about 250,000 government workers, past and present, is only 6 percent funded — a small percentage of what is considered the minimum needed for a marginally healthy pension plan — and could run out of money as soon as 2014. Another fund, for about 80,000 teachers, which is 20 percent funded, will last just a few years longer if nothing is done. Police officers and teachers in Puerto Rico have opted out of Social Security and rely entirely on their pensions.

“For now, I’m not totally shaken about the possibility of the fund going broke,” said Jorge Ramón Román, a 78-year-old retired instructor for the island’s Civil Air Patrol. “But I do fear for the future, when I’ll be an even older person, more infirm and with less of a pension.”

Héctor M. Mayol Kauffman, the executive director of the pension system, said it would be impossible to cut the benefits of people who are already retired, citing court precedent.

Puerto Rican officials were racing this fall to put together a rescue plan for the pension fund. Voters, though, pushed out Gov. Luis Fortuño, who had tried austerity measures that included cutting tens of thousands of government workers along with a revamping of the fund.

They elected Alejandro García Padilla, who promised to create 50,000 new jobs in the next 18 months. But the margin was razor-thin and Mr. Fortuño has requested a recount. Mr. García Padilla’s party had dropped out of the retirement overhaul effort, but the governor-elect says he will deal with the looming pension crisis with “diligence and promptness” and has put together a task force of economists and financial advisers.

“We will not leave retired government workers stranded at a bus stop in their older years,” he said.

Since the election, yields on the island’s 30-year bonds have continued to widen.

“I don’t think that there’s a default that’s about to happen, but a default isn’t the only bad thing that can happen when you’ve got bonds,” Mr. Schankel said. Puerto Rico’s bonds are just a notch or two above junk status. If they fall to that level, at least some institutions would be forced to sell, potentially setting off a chain reaction. And individual investors could get a jolt if they saw the value of their holdings fall. Many people own Puerto Rican debt without knowing it, through their mutual funds.

“The concern is that Puerto Rico is a systemic risk to the municipal bond market because it’s so widely held,” said Robert Donahue, a managing director with Municipal Market Advisors.

Rafael Matos contributed reporting from San Juan, P.R.

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Egypt’s President Said to Limit Scope of Judicial Decree

Tara Todras-Whitehill for The New York Times

Egyptians at a burned-out school in Cairo on Monday before the funeral of an activist who was injured in a clash and died Sunday.

CAIRO — With public pressure mounting, President Mohamed Morsi appeared to pull back Monday from his attempt to assert an authority beyond the reach of any court. His allies in the Muslim Brotherhood canceled plans for a large demonstration in his support, signaling a chance to calm an escalating battle that has paralyzed a divided nation.

After Mr. Morsi met for hours with the judges of Egypt’s Supreme Judicial Council, his spokesman read an “explanation” on television that appeared to backtrack from a presidential decree placing Mr. Morsi’s official edicts above judicial scrutiny — even while saying the president had not actually changed a word of the statement.

Though details of the talks remained hazy, and it was not clear whether the opposition or the court would accept his position, Mr. Morsi’s gesture was another demonstration that Egyptians would no longer allow their rulers to operate above the law. But there appeared little chance that the gesture alone would be enough to quell the crisis set off by his perceived power grab.

Protesters remained camped in Tahrir Square, and the opposition was moving ahead with plans for a major demonstration on Tuesday.

The presidential spokesman, Yasser Ali, said for the first time that Mr. Morsi had sought only to assert pre-existing powers already approved by the courts under previous precedents, not to free himself from judicial oversight.

He said that the president meant all along to follow an established Egyptian legal doctrine suspending judicial scrutiny of presidential “acts of sovereignty” that work “to protect the main institutions of the state.” The judicial council had said Sunday that it could bless aspects of the decree deemed to qualify under the doctrine.

Mr. Morsi had maintained from the start that his purpose was to empower himself to prevent judges appointed by former President Hosni Mubarak from dissolving the constituent assembly, which is led by his fellow Islamists of the Muslim Brotherhood’s Freedom and Justice Party. The courts have already dissolved the Islamist-led Parliament and an earlier constituent assembly, and the Supreme Constitutional Court was widely expected to rule against this one next week.

But the text of the original decree had exempted all presidential edicts from judicial review until the ratification of a constitution, not just those edicts related to the assembly or justified as “acts of sovereignty.”

Legal experts said that the spokesman’s explanations of the president’s intentions, if put into effect, would amount to a revision of the decree Mr. Morsi issued last Thursday. But lawyers said that the verbal statements alone carried little legal weight.

How the courts would apply the doctrine remained hard to predict. And Mr. Morsi’s opposition indicated it was holding out for far greater concessions, including the breakup of the whole constituent assembly.

Speaking at a news conference while Mr. Morsi was meeting with the judges, the opposition activist and intellectual Abdel Haleem Qandeil called for “a long-term battle,” declaring that withdrawal of Mr. Morsi’s new powers was only the first step toward the opposition’s goal of “the withdrawal of the legitimacy of Morsi’s presence in the presidential palace.” Completely withdrawing the edict would be “a minimum,” he said.

Khaled Ali, a human rights lawyer and former presidential candidate, pointed to the growing crowd of protesters camped out in Tahrir Square for a fourth night. “The one who did the action has to take it back,” Mr. Ali said.

Moataz Abdel Fattah, a political scientist at Cairo University, said Mr. Morsi was saving face during a strategic retreat. “He is trying to simply say, ‘I am not a new pharaoh; I am just trying to stabilize the institutions that we already have,’ ” he said. “But for the liberals, this is now their moment, and for sure they are not going to waste it, because he has given them an excellent opportunity to score.”

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The Hard Road Back: Prosthetic Arms a Complex Test for Amputees

A Future Reset:
After losing his arm in an I.E.D. explosion in Afghanistan, Cpl. Sebastian Gallegos has adjusted to his prosthetic limb.

SAN ANTONIO — After the explosion, Cpl. Sebastian Gallegos awoke to see the October sun glinting through the water, an image so lovely he thought he was dreaming. Then something caught his eye, yanking him back to grim awareness: an arm, bobbing near the surface, a black hair tie wrapped around its wrist.

The elastic tie was a memento of his wife, a dime-store amulet that he wore on every patrol in Afghanistan. Now, from the depths of his mental fog, he watched it float by like driftwood on a lazy current, attached to an arm that was no longer quite attached to him.

He had been blown up, and was drowning at the bottom of an irrigation ditch.

Two years later, the corporal finds himself tethered to a different kind of limb, a $110,000 robotic device with an electronic motor and sensors able to read signals from his brain. He is in the office of his occupational therapist, lifting and lowering a sponge while monitoring a computer screen as it tracks nerve signals in his shoulder.

Close hand, raise elbow, he says to himself. The mechanical arm rises, but the claw-like hand opens, dropping the sponge. Try again, the therapist instructs. Same result. Again. Tiny gears whir, and his brow wrinkles with the mental effort. The elbow rises, and this time the hand remains closed. He breathes.

Success.

“As a baby, you can hold onto a finger,” the corporal said. “I have to relearn.”

It is no small task. Of the more than 1,570 American service members who have had arms, legs, feet or hands amputated because of injuries in Afghanistan or Iraq, fewer than 280 have lost upper limbs. Their struggles to use prosthetic limbs are in many ways far greater than for their lower-limb brethren.

Among orthopedists, there is a saying: legs may be stronger, but arms and hands are smarter. With myriad bones, joints and ranges of motion, the upper limbs are among the body’s most complex tools. Replicating their actions with robotic arms can be excruciatingly difficult, requiring amputees to understand the distinct muscle contractions involved in movements they once did without thinking.

To bend the elbow, for instance, requires thinking about contracting a biceps, though the muscle no longer exists. But the thought still sends a nerve signal that can tell a prosthetic arm to flex. Every action, from grabbing a cup to turning the pages of a book, requires some such exercise in the brain.

“There are a lot of mental gymnastics with upper limb prostheses,” said Lisa Smurr Walters, an occupational therapist who works with Corporal Gallegos at the Center for the Intrepid at Brooke Army Medical Center in San Antonio.

The complexity of the upper limbs, though, is just part of the problem. While prosthetic leg technology has advanced rapidly in the past decade, prosthetic arms have been slow to catch up. Many amputees still use body-powered hooks. And the most common electronic arms, pioneered by the Soviet Union in the 1950s, have improved with lighter materials and microprocessors but are still difficult to control.

Upper limb amputees must also cope with the critical loss of sensation. Touch — the ability to differentiate baby skin from sandpaper or to calibrate between gripping a hammer and clasping a hand — no longer exists.

For all those reasons, nearly half of upper limb amputees choose not to use prostheses, functioning instead with one good arm. By contrast, almost all lower limb amputees use prosthetic legs.

But Corporal Gallegos, 23, is part of a small vanguard of military amputees who are benefiting from new advances in upper limb technology. Earlier this year, he received a pioneering surgery known as targeted muscle reinnervation that amplifies the tiny nerve signals that control the arm. In effect, the surgery creates additional “sockets” into which electrodes from a prosthetic limb can connect.

More sockets reading stronger signals will make controlling his prosthesis more intuitive, said Dr. Todd Kuiken of the Rehabilitation Institute of Chicago, who developed the procedure. Rather than having to think about contracting both the triceps and biceps just to make a fist, the corporal will be able to simply think, close hand, and the proper nerves should fire automatically.

In the coming years, new technology will allow amputees to feel with their prostheses or use pattern-recognition software to move their devices even more intuitively, Dr. Kuiken said. And a new arm under development by the Pentagon, the DEKA Arm, is far more dexterous than any currently available.

But for Corporal Gallegos, becoming proficient on his prosthesis after reinnervation surgery remains a challenge, likely to take months more of tedious practice. For that reason, only the most motivated amputees — super users, they are called — are allowed to undergo the surgery.

Corporal Gallegos was not always that person.

His father, an Army veteran, did not want him to join the infantry, but it was like him to ignore the advice.

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Books: Woe Is Syphilis, and Other Afflictions of Famous Writers

The old Irishman was a swollen, wheezing mess, blood pressure wildly out of control, kidneys failing, heart fibrillating. “What we have here,” said his new Spanish doctor, “is an antique cardiorenal sclerotic of advanced years.”

In fact, what the doctor had there was William Butler Yeats: the poet had a long list of chronic medical problems and experienced one of his regular cardiac crises while wintering in Spain. He still had three poetically productive years ahead of him before he died of heart failure in 1939, at age 73.

What makes antique case histories like Yeats’s so compelling to research, so interesting to read? Admittedly, they have educational value — medicine moves forward by looking back — but their major attraction is undoubtedly the operatic vigor of their emotional punch. As we contemplate the poor health of historic notables, we can sigh gustily at the immense suffering our ancestors considered routine, wince at the lunatic treatments they so innocently underwent, and marvel over and over again that the body, the brain and the mind can take such divergent paths.

These pleasures are present in abundance in the newest addition to the genre of medical biography, “Shakespeare’s Tremor and Orwell’s Cough.” Dr. John J. Ross, a Harvard physician, writes that he stumbled into the field by accident while trying to enliven a lecture on syphilis with a few literary references. The discovery that Shakespeare was apparently obsessed with syphilis (and suspiciously familiar with its symptoms) hooked Dr. Ross.

The resulting collection of 10 medico-literary biographical sketches ranges from the tubercular Brontës, whose every moist cough is familiar to their fans, to figures like Nathaniel Hawthorne, whose medical stories are considerably less familiar.

Dr. Ross’s discussion of Shakespeare is unique in the collection for its paucity of relevant data: so few details are known of the playwright’s life, let alone his health, that all commentary is necessarily supposition. Dr. Ross is not the first to note that references to syphilis are “more abundant, intrusive and clinically exact” in Shakespeare’s works than those of his contemporaries. This observation, along with the apparent deterioration of Shakespeare’s handwriting in his last years, leads to the hypothesis that Shakespeare had syphilis repeatedly as a young man, and wound up suffering more from treatment than disease.

The Elizabethans dosed syphilis with a combination of hot baths (treating the disease by raising body temperature endured into the 20th century), cathartics and lavish quantities of mercury. The drooling that accompanies mercury poisoning was considered a sign of excellent therapeutic progress, Dr. Ross writes: “Savvy physicians adjusted the mercury dose to produce three pints of saliva a day for two weeks.”

And so, when Shakespeare signed his will a month before he died with a shaky hand, was his tremor not possibly a sign of residual nerve damage from the mercury doses of his sybaritic youth? No amount of scholarship is likely to confirm this theory, but details of the argument are gripping and instructive nonetheless.

The story of the blind poet John Milton runs for a while along similar lines. Much is known about the long deterioration of Milton’s vision and other particulars of his delicate health, but Dr. Ross observes that many of his problems seem to have cleared up once he actually became blind. Was he vigorously medicating himself with lead-based nostrums in hopes of forestalling what Dr. Ross argues was probably progressive retinal detachment, then recovering from lead poisoning once his vision was irretrievably gone? Another intriguing if unanswerable question.

Just as the competing injuries of disease and treatment battered the luminaries of English and American literature, so did pervasive mental illness.

Jonathan Swift was a classic obsessive-compulsive long before he succumbed to frontotemporal dementia (Pick’s disease). Poor Hawthorne, so forceful on the page, was in person a tortured shrinking violet, the embodiment of social phobia and depression. Emily Brontë’s behavior was strongly suggestive of Asperger syndrome; Herman Melville was clearly bipolar; Ezra Pound was just nuts.

Yet they all wrote on, despite continual psychic and physical torments. Perhaps the thickest medical chart of all belongs to Jack London, who survived several dramatic episodes of scurvy while prospecting in the Klondike (he was treated with raw potatoes, a can of tomatoes and a single lemon), then accumulated a long list of other medical problems before killing himself (inadvertently, Dr. Ross argues) with an overdose of morphine from his personal and very capacious medicine chest.

Dr. Ross has not written a perfect book. The fictionalized scenes he creates between some of his subjects and their medical providers should all have been excised by a kindly editorial hand, which might also have addressed more than a few grammatical errors. Frequent leaps from descriptive to didactic mode as Dr. Ross updates the reader on various medical conditions can be jarring, like PowerPoint slides suddenly deployed in a poetry reading. True literary scholars might dismiss the book as lit crit lite, a hodgepodge of known facts culled from the usual secondary sources.

But all these caveats fade into the background when Dr. Ross hits his narrative stride, as he does in chapter after chapter. Then the stories of the wounded storytellers unfold smoothly on the page, as mesmerizing as any they themselves might have told, those squinting, wheezing, arthritic, infected, demented, defective yet superlative examples of the human condition.

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Books: Woe Is Syphilis, and Other Afflictions of Famous Writers

The old Irishman was a swollen, wheezing mess, blood pressure wildly out of control, kidneys failing, heart fibrillating. “What we have here,” said his new Spanish doctor, “is an antique cardiorenal sclerotic of advanced years.”

In fact, what the doctor had there was William Butler Yeats: the poet had a long list of chronic medical problems and experienced one of his regular cardiac crises while wintering in Spain. He still had three poetically productive years ahead of him before he died of heart failure in 1939, at age 73.

What makes antique case histories like Yeats’s so compelling to research, so interesting to read? Admittedly, they have educational value — medicine moves forward by looking back — but their major attraction is undoubtedly the operatic vigor of their emotional punch. As we contemplate the poor health of historic notables, we can sigh gustily at the immense suffering our ancestors considered routine, wince at the lunatic treatments they so innocently underwent, and marvel over and over again that the body, the brain and the mind can take such divergent paths.

These pleasures are present in abundance in the newest addition to the genre of medical biography, “Shakespeare’s Tremor and Orwell’s Cough.” Dr. John J. Ross, a Harvard physician, writes that he stumbled into the field by accident while trying to enliven a lecture on syphilis with a few literary references. The discovery that Shakespeare was apparently obsessed with syphilis (and suspiciously familiar with its symptoms) hooked Dr. Ross.

The resulting collection of 10 medico-literary biographical sketches ranges from the tubercular Brontës, whose every moist cough is familiar to their fans, to figures like Nathaniel Hawthorne, whose medical stories are considerably less familiar.

Dr. Ross’s discussion of Shakespeare is unique in the collection for its paucity of relevant data: so few details are known of the playwright’s life, let alone his health, that all commentary is necessarily supposition. Dr. Ross is not the first to note that references to syphilis are “more abundant, intrusive and clinically exact” in Shakespeare’s works than those of his contemporaries. This observation, along with the apparent deterioration of Shakespeare’s handwriting in his last years, leads to the hypothesis that Shakespeare had syphilis repeatedly as a young man, and wound up suffering more from treatment than disease.

The Elizabethans dosed syphilis with a combination of hot baths (treating the disease by raising body temperature endured into the 20th century), cathartics and lavish quantities of mercury. The drooling that accompanies mercury poisoning was considered a sign of excellent therapeutic progress, Dr. Ross writes: “Savvy physicians adjusted the mercury dose to produce three pints of saliva a day for two weeks.”

And so, when Shakespeare signed his will a month before he died with a shaky hand, was his tremor not possibly a sign of residual nerve damage from the mercury doses of his sybaritic youth? No amount of scholarship is likely to confirm this theory, but details of the argument are gripping and instructive nonetheless.

The story of the blind poet John Milton runs for a while along similar lines. Much is known about the long deterioration of Milton’s vision and other particulars of his delicate health, but Dr. Ross observes that many of his problems seem to have cleared up once he actually became blind. Was he vigorously medicating himself with lead-based nostrums in hopes of forestalling what Dr. Ross argues was probably progressive retinal detachment, then recovering from lead poisoning once his vision was irretrievably gone? Another intriguing if unanswerable question.

Just as the competing injuries of disease and treatment battered the luminaries of English and American literature, so did pervasive mental illness.

Jonathan Swift was a classic obsessive-compulsive long before he succumbed to frontotemporal dementia (Pick’s disease). Poor Hawthorne, so forceful on the page, was in person a tortured shrinking violet, the embodiment of social phobia and depression. Emily Brontë’s behavior was strongly suggestive of Asperger syndrome; Herman Melville was clearly bipolar; Ezra Pound was just nuts.

Yet they all wrote on, despite continual psychic and physical torments. Perhaps the thickest medical chart of all belongs to Jack London, who survived several dramatic episodes of scurvy while prospecting in the Klondike (he was treated with raw potatoes, a can of tomatoes and a single lemon), then accumulated a long list of other medical problems before killing himself (inadvertently, Dr. Ross argues) with an overdose of morphine from his personal and very capacious medicine chest.

Dr. Ross has not written a perfect book. The fictionalized scenes he creates between some of his subjects and their medical providers should all have been excised by a kindly editorial hand, which might also have addressed more than a few grammatical errors. Frequent leaps from descriptive to didactic mode as Dr. Ross updates the reader on various medical conditions can be jarring, like PowerPoint slides suddenly deployed in a poetry reading. True literary scholars might dismiss the book as lit crit lite, a hodgepodge of known facts culled from the usual secondary sources.

But all these caveats fade into the background when Dr. Ross hits his narrative stride, as he does in chapter after chapter. Then the stories of the wounded storytellers unfold smoothly on the page, as mesmerizing as any they themselves might have told, those squinting, wheezing, arthritic, infected, demented, defective yet superlative examples of the human condition.

Read More..

Oprah Winfrey Seeks a Younger Audience to Bolster a Flagging Empire

Stephanie Diani for The New York Times

Oprah Winfrey spoke last month at a convention held by O, The Oprah Magazine, in Los Angeles.

LOS ANGELES — It’s not easy to find a fresh way to photograph Oprah Winfrey.

That’s why the editors of O, The Oprah Magazine, recently tried to create a shot that recalled the glory days of Ms. Winfrey’s syndicated talk show. They arranged to photograph her for its April 2013 issue as she stepped onstage to speak to 5,000 attendees at the magazine’s annual conference, a New Age slumber party of sorts for women held at the convention center here last month. When Ms. Winfrey confidently strode out dressed in a sea foam green V-neck dress and a pair of perilously tall ruby red stilettos, the audience collectively leapt to its feet and shrieked at the sight of her.

“I love you, Oprah,” some women shouted, while other fans brushed away tears. “I love you back,” she responded in her signature commanding voice. “It’s no small thing to get the dough to come here.”

Ms. Winfrey, who used to receive this kind of applause from fans five days a week, has had fewer such receptions since the talk show she hosted for 25 years ended 18 months ago. The cable network OWN, which she started with Discovery Communications, is emerging from low ratings and management shake-ups. And without a regular presence on daytime network television, she cannot steer traffic to her other products as easily as in the past. Her magazine, in particular, has experienced a decline in advertising revenue and newsstand sales since the talk show finished.

“She’s still Oprah. But she’s still struggling,” said Janice Peck, an associate professor of journalism and mass communication at the University of Colorado who wrote the 2008 book “The Age of Oprah.” “I think she’s scared, even though she’s very, very rich and she’s always going to be very, very rich. The possibility of failure, it’s quite scary.”

Ms. Winfrey, 58, has shown some signs of strain. She arrived at the conference with faint shadows under her eyes and announced to her best friend, Gayle King, and the audience simultaneously that she had a breast cancer scare the week before. (It was ultimately a false alarm.) When Ms. King grew visibly upset, one woman chided Ms. Winfrey for not telling her friend ahead of time and ordered her to apologize to Ms. King — all before an audience. Ms. Winfrey also did not hide her dissatisfaction with the criticism she had faced. She told the audience, “the press tried to cut me off at the knees” in its coverage of OWN, and bristled at questions about the challenges her magazine confronted.

“I don’t care what the form is,” Ms. Winfrey said with the conviction of a preacher. “I care about what the message is.”

With signs of progress at OWN, Ms. Winfrey now has more time to devote to other media platforms — her magazine, her radio channel on XM Satellite Radio, her Facebook page, which has 7.8 million subscribers, her Twitter account, which has nearly 15 million followers, and her latest content channel on The Huffington Post.

“It’s all an opportunity to speak to people,” Ms. Winfrey said as she sat for an interview during the conference, a pair of glittery gold stilettos slung in her hand and a couple of handlers in the corner quietly tapping away at smartphones. She pushed aside a bottle of sparkling water, a glass with a silver straw and a delicate orchid placed before her and spoke frankly about her plans.

“Ultimately, you have to make money because you are a business. I let other people worry about that. I worry about the message. I am always, always, always about holding true to the vision and the message, and when you are true to that, then people respond.”

When it comes to the magazine, Ms. Winfrey said her staff prepared her to expect a 25 percent decline in newsstand sales after the talk show ended. (It has been closer to 22 percent.) And while she acknowledged that she enjoyed “holding the magazine in my hand,” she was pragmatic about print’s future and said she would stop publishing a print magazine if it were not profitable.

“Obviously, the show was helping in ways that you know I hadn’t accounted for,” Ms. Winfrey said. “I’m not interested, you know, in bleeding money.”

Ms. Winfrey, who spoke in a conference room over the roars of an expectant crowd in the convention space below, said she knew that her brand’s strength stemmed from how she resonated with a breadth of viewers.

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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 chaotic 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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Building Start-Ups Using Stars’ Social Media Ties to Fans

You might have heard Jessica Alba on daytime TV talking about her new e-commerce company, which sells diapers and other baby supplies, or seen Kim Kardashian pitching her online shoe store in the tabloids.

The man behind the companies, Brian Lee, is far from a household name. Yet in the world of tech start-ups, he is an emerging force.

Mr. Lee, a lawyer turned entrepreneur, has a simple formula: partner with a celebrity that fans associate with a certain product, whether stilettos or baby supplies. He first did it in 1999, when he cold-called Robert Shapiro, O.J. Simpson’s lawyer, and persuaded him to join him at his first start-up, LegalZoom, for creating your own legal documents.

Hiring a famous face to represent your brand is the oldest marketing trick in the book. But Mr. Lee is doing it with an Internet twist. He uses celebrities’ social media connections with fans, coupled with recent innovations in e-commerce, to sell things in ways that were not possible just a few years ago.

The Honest Company, Ms. Alba’s start-up selling eco-friendly baby supplies, has raised $27 million from investors, including Lightspeed Venture Partners. ShoeDazzle, Ms. Kardashian’s shoe company, has raised $66 million from Andreessen Horowitz, Lightspeed and others. But despite this investment, it has recently struggled, replacing its chief executive, laying off employees and raising bigger questions about the new breed of subscription e-commerce companies.

E-commerce is going through a shift, as retailers move beyond publishing print catalogs online to creating new business models for the Web. According to the National Venture Capital Association, venture capitalists invested $2.2 billion in e-commerce start-ups last year, almost three times as much as the year before and more than they have invested since the first Internet boom, which created Amazon.com and eBay.

Mr. Lee’s companies tap the latest e-commerce trends, including selling monthly subscriptions, using software algorithms to determine personal style suggestions and eliminating middlemen by designing products in-house and selling them directly to consumers.

“Given the choice between shopping at a boutique or warehouse, if the styles were right, which would my wife choose?” Mr. Lee said, describing the strategy behind ShoeDazzle and Honest. “A large group of women would choose that kind of curated boutique.”

At Honest, customers sign up for monthly deliveries of diapers festooned with anchors or hearts as well as items like shampoo and detergent, each formulated in-house to reduce chemicals. Ms. Alba conceived the idea, along with Christopher Gavigan, former chief of the nonprofit Healthy Child Healthy World, and turned to Mr. Lee for a business model.

When ShoeDazzle was founded in 2009, it was the first of a flurry of subscription e-commerce start-ups. The shoes, generally $39.95, are suggested based on the results of a style quiz the customer takes. They are designed by ShoeDazzle and manufactured at the same factories that big shoe brands use.

But ShoeDazzle has been struggling with that model, and analysts say that could foreshadow problems for its many imitators, which, in addition to Honest, include Birchbox for cosmetics, Wittlebee for children’s clothing, JustFab for shoes and handbags, and BeachMint, which has sites for jewelry, T-shirts, skin care, shoes, home décor and lingerie. Earlier this month, Walmart joined the trend, introducing a monthly subscription box of food called The Goodies Company.

“Subscriptions were the hot trend in the last year, but I think some of that energy has really flattened,” said Sucharita Mulpuru, an e-commerce analyst at Forrester.

While subscriptions have worked well at companies like Amazon.com and Diapers.com for necessities like toilet paper and diapers, shoppers might find it harder to justify a recurring credit-card charge for colorful suede booties.

ShoeDazzle switched to a nonsubscription model this year, so shoppers log on whenever they are in the mood to shop instead of receiving monthly boxes. In September, the company replaced its chief executive, Bill Strauss, with Mr. Lee. He laid off 20 of its 220 employees and cut expenses like corporate apartments. Both Honest and ShoeDazzle are capital-intensive because they design, store and ship their own inventory.

“We lost our way,” said Jeremy Liew, managing director of Lightspeed Venture Partners. “But there’s real value in this company and customers love the product.”

Mr. Lee said ShoeDazzle would approach $100 million in revenue this year and become profitable next year. Honest is not yet a year old, but its founders say it has proved popular with shoppers. Mr. Lee is the right person for the job, Mr. Liew said, because he has a Hollywood sensibility that Bay Area executives lack.

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Agency Investigates Deaths and Injuries Associated With Bed Rails

Thomas Patterson for The New York Times

Gloria Black’s mother died in her bed at a care facility.

In November 2006, when Clara Marshall began suffering from the effects of dementia, her family moved her into the Waterford at Fairway Village, an assisted living home in Vancouver, Wash. The facility offered round-the-clock care for Ms. Marshall, who had wandered away from home several times. Her husband Dan, 80 years old at the time, felt he could no longer care for her alone.

Thomas Patterson for The New York Times

Gloria Black, visiting her mother’s grave in Portland, Ore. She has documented hundreds of deaths associated with bed rails and said families should be informed of their possible risks.

But just five months into her stay, Ms. Marshall, 81, was found dead in her room apparently strangled after getting her neck caught in side rails used to prevent her from rolling out of bed.

After Ms. Marshall’s death, her daughter Gloria Black, who lives in Portland, Ore., began writing to the Consumer Product Safety Commission and the Food and Drug Administration. What she discovered was that both agencies had known for more than a decade about deaths from bed rails but had done little to crack down on the companies that make them. Ms. Black conducted her own research and exchanged letters with local and state officials. Finally, a letter she wrote in 2010 to the federal consumer safety commission helped prompt a review of bed rail deaths.

Ms. Black applauds the decision to study the issue. “But I wish it was done years ago,” she said. “Maybe my mother would still be alive.” Now the government is studying a problem it has known about for years.

Data compiled by the consumer agency from death certificates and hospital emergency room visits from 2003 through May 2012 shows that 150 mostly older adults died after they became trapped in bed rails. Over nearly the same time period, 36,000 mostly older adults — about 4,000 a year — were treated in emergency rooms with bed rail injuries. Officials at the F.D.A. and the commission said the data probably understated the problem since bed rails are not always listed as a cause of death by nursing homes and coroners, or as a cause of injury by emergency room doctors.

Experts who have studied the deaths say they are avoidable. While the F.D.A. issued safety warnings about the devices in 1995, it shied away from requiring manufacturers to put safety labels on them because of industry resistance and because the mood in Congress then was for less regulation. Instead only “voluntary guidelines” were adopted in 2006.

More warnings are needed, experts say, but there is a technical question over which regulator is responsible for some bed rails. Are they medical devices under the purview of the F.D.A., or are they consumer products regulated by the commission?

“This is an entirely preventable problem,” said Dr. Steven Miles, a professor at the Center for Bioethics at the University of Minnesota, who first alerted federal regulators to deaths involving bed rails in 1995. The government at the time declined to recall any bed rails and opted instead for a safety alert to nursing homes and home health care agencies.

Forcing the industry to improve designs and replace older models could have potentially cost bed rail makers and health care facilities hundreds of million of dollars, said Larry Kessler, a former F.D.A. official who headed its medical device office. “Quite frankly, none of the bed rails in use at that time would have passed the suggested design standards in the guidelines if we had made them mandatory,” he said. No analysis has been done to determine how much it would cost the manufacturers to reduce the hazards.

Bed rails are metal bars used on hospital beds and in home care to assist patients in pulling themselves up or helping them out of bed. They can also prevent people from rolling out of bed. But sometimes patients — particularly those suffering from Alzheimer’s — can get confused and trapped between a bed rail and a mattress, which can lead to serious injury or even death.

While the use of the devices by hospitals and nursing homes has declined as professional caregivers have grown aware of the dangers, experts say dozens of older adults continue to die each year as more rails are used in home care and many health care facilities continue to use older rail models.

Since those first warnings in 1995, about 550 bed rail-related deaths have occurred, a review by The New York Times of F.D.A. data, lawsuits, state nursing home inspection reports and interviews, found. Last year alone, the F.D.A. data shows, 27 people died.

As deaths continued after the F.D.A. warning, a working group put together in 1999 and made up of medical device makers, researchers, patient advocates and F.D.A. officials considered requiring bed rail makers to add warning labels.

But the F.D.A. decided against it after manufacturers resisted, citing legal issues. The agency said added cost to small manufacturers and difficulties of getting regulations through layers of government approval, were factors against tougher standards, according to a meeting log of the group in 2000 and interviews.

Read More..

Agency Investigates Deaths and Injuries Associated With Bed Rails

Thomas Patterson for The New York Times

Gloria Black’s mother died in her bed at a care facility.

In November 2006, when Clara Marshall began suffering from the effects of dementia, her family moved her into the Waterford at Fairway Village, an assisted living home in Vancouver, Wash. The facility offered round-the-clock care for Ms. Marshall, who had wandered away from home several times. Her husband Dan, 80 years old at the time, felt he could no longer care for her alone.

Thomas Patterson for The New York Times

Gloria Black, visiting her mother’s grave in Portland, Ore. She has documented hundreds of deaths associated with bed rails and said families should be informed of their possible risks.

But just five months into her stay, Ms. Marshall, 81, was found dead in her room apparently strangled after getting her neck caught in side rails used to prevent her from rolling out of bed.

After Ms. Marshall’s death, her daughter Gloria Black, who lives in Portland, Ore., began writing to the Consumer Product Safety Commission and the Food and Drug Administration. What she discovered was that both agencies had known for more than a decade about deaths from bed rails but had done little to crack down on the companies that make them. Ms. Black conducted her own research and exchanged letters with local and state officials. Finally, a letter she wrote in 2010 to the federal consumer safety commission helped prompt a review of bed rail deaths.

Ms. Black applauds the decision to study the issue. “But I wish it was done years ago,” she said. “Maybe my mother would still be alive.” Now the government is studying a problem it has known about for years.

Data compiled by the consumer agency from death certificates and hospital emergency room visits from 2003 through May 2012 shows that 150 mostly older adults died after they became trapped in bed rails. Over nearly the same time period, 36,000 mostly older adults — about 4,000 a year — were treated in emergency rooms with bed rail injuries. Officials at the F.D.A. and the commission said the data probably understated the problem since bed rails are not always listed as a cause of death by nursing homes and coroners, or as a cause of injury by emergency room doctors.

Experts who have studied the deaths say they are avoidable. While the F.D.A. issued safety warnings about the devices in 1995, it shied away from requiring manufacturers to put safety labels on them because of industry resistance and because the mood in Congress then was for less regulation. Instead only “voluntary guidelines” were adopted in 2006.

More warnings are needed, experts say, but there is a technical question over which regulator is responsible for some bed rails. Are they medical devices under the purview of the F.D.A., or are they consumer products regulated by the commission?

“This is an entirely preventable problem,” said Dr. Steven Miles, a professor at the Center for Bioethics at the University of Minnesota, who first alerted federal regulators to deaths involving bed rails in 1995. The government at the time declined to recall any bed rails and opted instead for a safety alert to nursing homes and home health care agencies.

Forcing the industry to improve designs and replace older models could have potentially cost bed rail makers and health care facilities hundreds of million of dollars, said Larry Kessler, a former F.D.A. official who headed its medical device office. “Quite frankly, none of the bed rails in use at that time would have passed the suggested design standards in the guidelines if we had made them mandatory,” he said. No analysis has been done to determine how much it would cost the manufacturers to reduce the hazards.

Bed rails are metal bars used on hospital beds and in home care to assist patients in pulling themselves up or helping them out of bed. They can also prevent people from rolling out of bed. But sometimes patients — particularly those suffering from Alzheimer’s — can get confused and trapped between a bed rail and a mattress, which can lead to serious injury or even death.

While the use of the devices by hospitals and nursing homes has declined as professional caregivers have grown aware of the dangers, experts say dozens of older adults continue to die each year as more rails are used in home care and many health care facilities continue to use older rail models.

Since those first warnings in 1995, about 550 bed rail-related deaths have occurred, a review by The New York Times of F.D.A. data, lawsuits, state nursing home inspection reports and interviews, found. Last year alone, the F.D.A. data shows, 27 people died.

As deaths continued after the F.D.A. warning, a working group put together in 1999 and made up of medical device makers, researchers, patient advocates and F.D.A. officials considered requiring bed rail makers to add warning labels.

But the F.D.A. decided against it after manufacturers resisted, citing legal issues. The agency said added cost to small manufacturers and difficulties of getting regulations through layers of government approval, were factors against tougher standards, according to a meeting log of the group in 2000 and interviews.

Read More..