Chinese Imports and Exports Soar in January

HONG KONG — January trade data from China on Friday showed a surge in exports and imports from a year earlier — a phenomenon that was largely due to the timing of the Lunar New Year holiday, but that also supported the view that the Chinese economy is firming.

Economic data from China are often severely distorted by the holiday, the highlight of the Chinese calendar, when many factories shut down for a week or more.

The holiday this year takes place in February — the first day of the Lunar New Year is on Sunday — but last year it fell squarely in January, cutting down on the number of working days during that month.

The trade data released Friday reflected this with a large increase compared with the year before, as analysts had expected. Exports climbed 25 percent from January 2012, according to the General Administration of Customs, and imports soared 28.8 percent.

Both figures beating expectations by a wide margin, however, supported the view that the rise was also caused in part by healthier domestic and overseas demand.

“This strong export number cannot be fully explained by the Chinese New Year effect alone,” Zhiwei Zhang, chief China economist at Nomura in Hong Kong, said in a research note.

“These data suggest that external and domestic demand are both strong, which supports our view that the economy is on track for a cyclical recovery” in the first half of this year, he added.

Dariusz Kowalcyk, an economist at Crédit Agricole in Hong Kong, said “we need to wait for February results to have the full picture of trade at the start of 2013.”

However, he added, “one trend is clear: exports have been doing very well recently. This may be a sign of improved external demand, but is also a testimony to the resilience of Chinese exporters and to their competitiveness.”

The Chinese economy has been accelerating gradually in the past few months, reversing a marked slowdown that had raised fears of a possible “hard landing” in China early last year.

Improved overseas demand, combined with a string of government-mandated stimulus measures, have gradually propped up growth and dispelled those fears.

Data released last month showed the Chinese economy expanded just 7.8 percent last year — down from 9.3 percent in 2011 and 10.4 percent in 2010 — but many analysts expect slightly faster growth again in 2013.

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Lens Blog: Sirkka-Liisa Konttinen's Photos of Her Newcastle Neighborhood

On clear days in Newcastle-Upon-Tyne, a small yet bustling working-class city in northeast England, the view from the hills of Byker can be spectacular. That shabby neighborhood’s rows of brick houses and terraced streets overlook a historic city center, the river and sometimes far beyond.

Those vistas were rare in 1969, when Sirkka-Liisa Konttinen, a 21-year-old Finnish photographer, arrived. The landscape was cloaked in an industrial fog belched from the coal and shipbuilding industries.

Despite the grayness, the laughter and vivacity that radiated from this close-knit community appealed to Ms. Konttinen. It welcomed a young foreigner whose presence stoked curiosity, but also generosity. They joked with her in pubs. Some of the older women took her under their wing — she kindled a protective instinct in them.

“People were baffled by my choice to live there,” Ms. Konttinen recalled. “Not that many people had any idea where Finland was, but if they did, they thought it such a beautiful clean country, and why would I choose to come to Byker?”

She had ventured there because of Amber Collective, a progressive documentary project that she helped found, which chronicled the lives of working people in northeast England. The group was formed in London by a handful of students who made a film following Vietnam War demonstrations at Grosvenor Square that turned violent. Titled “All You Need Is Dynamite,” it was just a student effort, but its makers found they shared a philosophy.

Before long, they had relocated to Newcastle.

The city was in decline. Urban planners sought flashy new development projects, and some sections, like Byker, were scheduled for demolition. Ms. Konttinen was unaware that she was documenting a place that was about to disappear. Not drawn to gloomy topics, she found the place spirited and interesting.

“Initially, I don’t think we ever thought that we need to document it because it will be the only thing left for people to remember the place and what the area was like,” she said. “I personally have never felt that that was my mission.”

The Amber Collective has produced an enormous amount of material, dating back decades, that is focused on the communities of northeast England, although Ms. Konttinen’s Byker pictures are probably the collective’s best-known project. That work was published as a book in 1983; Amber also released a film companion of the same name, and in 2011 her documentation was registered with the Unesco U.K. Memory of the World. For the first time in a commercial art space, photographs from the series will be shown in the United States, on view at the L. Parker Stephenson Gallery from Feb. 15 through May 11. Ms. Konttinen will also deliver a lecture at the International Center for Photography on Feb. 13.

In recent years, she returned to Byker. The new Byker is changed — more on that Friday — and the changes required her to reconsider her approach when she decided to photograph it. The newer project, “Byker Revisited,” is a result of a far more collaborative endeavor. Not that she hadn’t collaborated in other ways with a subject before. Her 1971 photo of Heather (Slide 3) brought about one such relationship.

“I heard music coming from a derelict house,” she said. “This was one of the last terraces before the final demolition, and there were no steps left to the house, but upstairs I heard music, piano, coming out the windows.”

She entered the house, climbing a rickety staircase to where the music was coming from. She found a girl, Heather, “playing the piano, banging the notes that were kind of stuck and unstuck.”

Ms. Konttinen and Heather started talking, and Ms. Konttinen taught her a simple tune.

“I told her if she ever wanted to come and play, she could come and play it again on my piano,” Ms. Konttinen said. Heather showed up a few days later, with her little brother. On Ms. Konttinen’s piano, they played the tune together.

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Friday: Returning to Byker, in color.

Photographs from “Byker” will be on view at the L. Parker Stephenson Gallery from Feb. 15 through May 11. Ms. Konttinen will also deliver a lecture at the International Center for Photography on Feb. 13.

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Hewlett-Packard Joins Push to Limit Use of Student Labor in China

Gilles Sabrie for The New York Times

A worker checks parts of a laptop on a Hewlett Packard assembly line in Chongqing, China.

HONG KONG — Hewlett-Packard, one of the world’s largest makers of computers and other electronics, is imposing new limits on the employment of students and temporary agency workers at factories across China. The move, following recent efforts by Apple to increase scrutiny of student workers, reflects a significant shift in how electronics companies view problematic labor practices in China.

Many factories in China have long relied on high school students, vocational school students and temporary workers to cope with periodic surges in orders as factory labor becomes increasingly scarce. Students complain of being ordered by school administrators to put in very long hours on short notice at jobs with no relevance to their studies; local governments sometimes order schools to provide labor, and the factories pay school administrators a bonus.

For much of the last decade, many of the world’s big electronics companies have largely neglected the problem, beyond in some cases tracking reports of the abuses. Apple made the unusual move last year of joining the Fair Labor Association, one of the largest workplace monitoring groups, which inspects factories in China that make computers, iPhones and other devices under contract from Apple. And last month, Apple said it would begin requiring suppliers to provide information about their student workers “so we can monitor this issue more carefully.”

Now H.P. is pushing even harder. Its rules, given to suppliers in China on Friday morning, say that all work must be voluntary, and that students and temporary workers must be free “to leave work at any time upon reasonable notice without negative repercussions, and they must have access to reliable and reprisal-free grievance mechanisms,” according to the company.

The rules also require that student work “must complement the primary area of study” — a restriction that could rule out huge numbers of students whose studies have nothing to do with electronics or manufacturing.

Enforcing workplace rules in China has always been difficult, as even Chinese laws on labor practices are flagrantly ignored by some manufacturers as they struggle to keep up with production demand amid labor shortages. The Chinese government announced last month that the nation’s labor force had begun to shrink slowly because of the increasingly rigorous one-child policy through the 1980s and 1990s.

But complying with the new rules might be easier for suppliers contracting with H.P., which has relatively steady demand through the year for its products, than for suppliers working for rivals like Apple, with its big bursts of sales when new models are introduced.

Howard Clabo, an H.P. spokesman, said that the company would hold training sessions for suppliers starting in March and also discussion sessions for government officials, nongovernment organizations and academics — an initiative that could put pressure on other companies.

Tony Prophet, H.P.’s senior vice president for worldwide supply chain operations, said in a phone interview that H.P. was also capping the combined number of students and temp workers at any supplier factory at no more than 20 percent of labor during peak periods, which tend to be during summer vacations and the lengthy Chinese New Year holiday. H.P. plans to reduce that to 10 percent, but has not decided when, Mr. Prophet said.

The practice of employing students and temporary workers has been at the center of growing criticism of employment practices at Chinese suppliers used by big international electronics companies. Some of the companies are now seeing that the problems can harm their reputations.

In announcing increased scrutiny of student workers last month, Apple said in its supplier responsibility report that the “cyclical nature” of the student work “makes it difficult to catch problems.”

“We’ve begun to partner with industry consultants to help our suppliers improve their policies, procedures and management of internship programs to go beyond what the law requires,” Apple said.

Mr. Prophet of H.P. presented his company’s new rules as a sign of corporate responsibility, as opposed to a competitive maneuver. “We’re doing this because we think this is an important issue, and there are certainly concerns around it and some ambiguity around the appropriate standards,” he said.

Labor activists have been particularly critical of Foxconn, a large Taiwanese contract manufacturer that produces electronic devices for Hewlett-Packard, Apple and other companies.

Keith Bradsher reported from Hong Kong and David Barboza from Shanghai. Xu Yan contributed research from Shanghai.

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Well: Old Age and Motorcycles Are a Dangerous Mix

If you’re over 40 and planning to hop on a motorcycle, take care. Compared with younger riders, the odds of being seriously injured are high.

That is the message of a new study, published this week in the journal Injury Prevention, which found that older bikers are three times as likely to be severely injured in a crash as younger riders.

The percentage of older bikers on the road is quickly rising, and their involvement in accidents is a growing concern. Nationwide, from 1990 to 2003, the percentage of motorcyclists over age 50 soared from roughly 1 in 10 to about 1 in 4. At the same time, the average age of riders involved in motorcycle crashes has also been climbing. Injury rates among those 65 and older jumped 145 percent from 2000 to 2006 alone.

Because of the increase in motorcycle ridership among older Americans, the researchers, led by Tracy Jackson, a graduate student in the epidemiology department at Brown University, wanted a closer look at their injury patterns. So she and her colleagues combed through a federal database of motorcycle crashes that were serious enough to require emergency medical care. That yielded about 1.5 million incidents involving motorcyclists 20 or older from 2001 to 2008.

The researchers then split them into groups: those in their 20s and 30s, another group between 40 and 59, and those 60 and older.

Over all, the study showed that injury rates for all three groups were on the rise. But the rise was steepest for the oldest riders. Compared with the youngest motorcyclists, those who were 60 and older were two and a half times as likely to end up with serious injuries, and three times as likely to be admitted to a hospital. The riders who were middle age were twice as likely as their younger counterparts to be hospitalized.

For older riders, the consequences of a collision were also especially alarming. Older and middle-aged bikers were more likely to sustain fractures and dislocations, and they had a far greater chance of ending up with injuries to internal organs, including brain damage.

The researchers speculated that it was very likely that a number of factors played a role in older riders’ higher injury rates. For one, declines in vision and reaction time may make older riders more prone to mistakes that end up in collisions. Another theory is that older riders tend to ride bigger bikes, “which may be more likely to roll or turn over,” Ms. Jackson said.

Then there is the greater fragility that comes with age. Older riders may be involved in the same types of accidents as younger riders, Ms. Jackson said, but in some cases, a collision that a 20-year-old would walk away from might send a 65-year-old to the hospital.

“Your bones become more brittle, and you lose muscle mass as you get older,” she said. “It could just be a matter of aging and the body being less durable.”

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Well: Old Age and Motorcycles Are a Dangerous Mix

If you’re over 40 and planning to hop on a motorcycle, take care. Compared with younger riders, the odds of being seriously injured are high.

That is the message of a new study, published this week in the journal Injury Prevention, which found that older bikers are three times as likely to be severely injured in a crash as younger riders.

The percentage of older bikers on the road is quickly rising, and their involvement in accidents is a growing concern. Nationwide, from 1990 to 2003, the percentage of motorcyclists over age 50 soared from roughly 1 in 10 to about 1 in 4. At the same time, the average age of riders involved in motorcycle crashes has also been climbing. Injury rates among those 65 and older jumped 145 percent from 2000 to 2006 alone.

Because of the increase in motorcycle ridership among older Americans, the researchers, led by Tracy Jackson, a graduate student in the epidemiology department at Brown University, wanted a closer look at their injury patterns. So she and her colleagues combed through a federal database of motorcycle crashes that were serious enough to require emergency medical care. That yielded about 1.5 million incidents involving motorcyclists 20 or older from 2001 to 2008.

The researchers then split them into groups: those in their 20s and 30s, another group between 40 and 59, and those 60 and older.

Over all, the study showed that injury rates for all three groups were on the rise. But the rise was steepest for the oldest riders. Compared with the youngest motorcyclists, those who were 60 and older were two and a half times as likely to end up with serious injuries, and three times as likely to be admitted to a hospital. The riders who were middle age were twice as likely as their younger counterparts to be hospitalized.

For older riders, the consequences of a collision were also especially alarming. Older and middle-aged bikers were more likely to sustain fractures and dislocations, and they had a far greater chance of ending up with injuries to internal organs, including brain damage.

The researchers speculated that it was very likely that a number of factors played a role in older riders’ higher injury rates. For one, declines in vision and reaction time may make older riders more prone to mistakes that end up in collisions. Another theory is that older riders tend to ride bigger bikes, “which may be more likely to roll or turn over,” Ms. Jackson said.

Then there is the greater fragility that comes with age. Older riders may be involved in the same types of accidents as younger riders, Ms. Jackson said, but in some cases, a collision that a 20-year-old would walk away from might send a 65-year-old to the hospital.

“Your bones become more brittle, and you lose muscle mass as you get older,” she said. “It could just be a matter of aging and the body being less durable.”

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Profound Weight of Layoffs Seen in Survey

Layoffs have touched nearly every American household in some fashion over the last few years, according to new survey data to be released Thursday by the John J. Heldrich Center for Workforce Development at Rutgers University.

Joe Raedle/Getty Images

Lissette Marquez, center, and Amiel Ali looked for jobs last week in Miami with the help of a South Florida Workforce customer service representative, Nelson Munoz, left.

While about 8 percent of Americans are unemployed, nearly a quarter of Americans say they were laid off at some point during the recession or afterward, according to the survey. More broadly, nearly eight in 10 say they know someone in their circle of family and friends who has lost a job.

“This to me is why the recession was so all-consuming and is likely to influence the American psyche,” said Cliff Zukin, a public policy and political science professor at Rutgers and co-author of the report. “Almost everyone, four out of five, were directly or one step removed from unemployment and all that goes with it financially, socially, psychologically.”

The survey presented a bleak view of the economic future.

A majority of Americans say they think it will be at least six years before the economy is made whole again, if ever. Three in 10 said the economy would never fully recover from the Great Recession.

“Despite significant improvements in the nation’s labor market, American workers’ concerns about unemployment, the job market, job security and the future of the economy have not changed much since we conducted a similar survey in August 2010,” the report said.

Just a third of Americans surveyed in this poll, conducted from Jan. 9-16, said they thought the economy would be better next year, the same share that said so two years earlier.

Of those laid off in recent years, nearly a quarter said they still had not found a job. Re-employment rates for older workers have been particularly bad, with nearly two-thirds of unemployed people 55 and older saying they actively sought a job for more than a year before finding one or had still not found work.

Not surprisingly, those who are unemployed are especially downbeat about many economic issues in addition to their own finances. Of those who were jobless and looking for work, 31 percent said their jobless benefits had run out and 58 percent said they were concerned their benefits would run out before they found work.

Of those who have found work, nearly half say their current job is a step down from the one they lost, and a slim majority say they earn less than they did in their previous job. A quarter of those re-employed said they thought that the hit to their standard of living would be permanent.

The reliance on one’s personal network and savings rather than the social safety net showed up frequently in the survey data.

More people reported borrowing money from friends and family than reported using food stamps. A third cut back on doctors’ visits or medical treatment. A quarter of the unemployed said they had enrolled in retraining programs of some kind; half of them reported paying for the education on their own or through family assistance. Twenty-three percent received some type of government financing for their training programs.

Unemployed workers were more likely than employed workers to say that the government is primarily responsible for helping the jobless. But even then, a majority of the unemployed thought that workers and employers were more responsible for getting people back to work than the government was.

Americans over all were also somewhat less critical of bankers this time than they were two years earlier. About one in three (35 percent) respondents attributed high unemployment levels to the actions of Wall Street, compared with 45 percent in 2010.

Americans were most likely to attribute high unemployment to cheap foreign labor. Four in 10 also said they believed illegal immigrants were taking Americans’ job opportunities — which does not bode well for political support for an amnesty program now being discussed in Washington.

Most people surveyed lost at least some of their savings. Asked about their financial health, six in 10 Americans said their finances would not improve in the next few years; just 16 percent said their family finances were already back to prerecession levels or suffered no loss in the first place.

More educated, better-off people were substantially more likely to report being as financially secure as they were before the recession began.

Responses are based on an online survey conducted by GfK using a nationally representative sample of 1,090 adults. The margin of sampling error is plus or minus three percentage points.

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Hagel Wouldn’t Be First Enlisted Man as Pentagon Chief

Stephen Crowley/The New York Times

Four secretaries of defense served as enlisted men before being promoted. Chuck Hagel, left, would be the only Pentagon chief to have served his entire military career as an enlisted man.

WASHINGTON — President Obama declared at the White House on Jan. 7 that Chuck Hagel, his nominee to be secretary of defense, would be the “first person of enlisted rank” to run the Pentagon. The distinction, which Mr. Obama called “historic,” quickly made its way into news media reports around the globe, including in The New York Times.

The problem is that at least four other American defense secretaries — Melvin R. Laird, Elliot L. Richardson, Caspar W. Weinberger and William J. Perry — served part of their military careers as enlisted men.

According to the Historical Office of the Secretary of Defense, Mr. Laird, who was President Richard M. Nixon’s first defense secretary, entered the Navy as an enlisted man before serving as a junior officer on a destroyer in the Pacific during World War II. Mr. Richardson, who served four months as Nixon’s second defense secretary, enlisted in the Army as a private in 1942. He was subsequently commissioned as an officer, and as a first lieutenant landed with the Fourth Infantry Division in Normandy on D-Day.

Mr. Weinberger, President Ronald Reagan’s first secretary of defense, entered the Army as a private in 1941, was commissioned and served in the Pacific, and by the end of World War II was a captain on Gen. Douglas MacArthur’s intelligence staff.

According to biographies on the Web site of Stanford University, Mr. Perry, who was defense secretary under President Bill Clinton, served in the Army Corps of Engineers from 1946 to 1947 and was in Japan during the American occupation after World War II. He later became an officer in the Army Reserves. Today, Mr. Perry is a senior fellow at the Freeman Spogli Institute for International Studies and the Hoover Institution, both at Stanford.

Mr. Obama’s omission of the four other defense secretaries was first reported by Robert Burns of The Associated Press.

White House officials insisted that Mr. Obama was not in error. “President Obama was precise and accurate in referring to the fact that Senator Hagel would be the ‘first person of enlisted rank’ to go on to serve as secretary of defense, and that experience on the front lines is part of the reason why President Obama chose him,” said Marie Harf, a White House spokeswoman who is working on Mr. Hagel’s nomination.

As Ms. Harf explained it, the use of the formulation “first person of enlisted rank” was meant to signal that Mr. Hagel had remained enlisted throughout his entire military career and to separate him from the other men, who had retired as officers. Mr. Hagel, who was wounded twice in Vietnam, would be the first defense secretary to have served in combat while enlisted. To Mr. Obama that distinction, at least, is crucial.

“Chuck knows that war is not a distraction,” Mr. Obama said in nominating Mr. Hagel. “He understands that sending young Americans to fight and bleed in the dirt and mud, that’s something we do only when it’s absolutely necessary.”

This article has been revised to reflect the following correction:

Correction: February 7, 2013

An earlier version of this article misspelled the surname of the World War II general for whom Caspar W. Weinberger served as an intelligence staff member. He was Gen. Douglas MacArthur, not McArthur.

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Bits Blog: Apple's iPad Dominated PC Market During Holiday Season

The iPad is defined as a tablet, but you might as well call it a personal computer. Over the holiday season, about one in six people buying computers around the world bought Apple’s tablet, according to research from Canalys.

The report, released Wednesday, said that when tablets were included, worldwide PC shipments over the fourth quarter increased 12 percent compared with the previous year. Apple led the computer market with 22.9 million iPads and 4.1 million Macs sold. Hewlett-Packard was in a distant second place with 15 million PCs shipped, and Lenovo shipped about 14.8 million computers.

Amazon and Samsung are quickly gaining traction in the computer market with their tablets. Amazon shipped 4.6 million tablets, including its Kindle Fire, over the quarter, and Samsung shipped 7.6 million. Over all, tablet shipments accounted for about one-third of the PC market over the quarter.

IDC, the research firm, reported similar numbers on PC shipments over the fourth quarter, but did not include tablets in its analysis.

Typically research firms don’t count tablets as a PC, because they are quite different from traditional laptops and desktops. But when sales of these two categories are stacked side by side, the numbers give perspective for how quickly the tablet is dissolving the old-school PC.

The Canalys report certainly makes the late Steve Jobs sound prescient. When he introduced the iPad 2 in 2011, he said tablet devices were ushering people into a “post-PC” era:

A lot of folks in this tablet market are rushing in and they’re looking at this as the next PC. The hardware and the software are done by different companies. And they’re talking about speeds and feeds just like they did with PCs.

And our experience and every bone in our body says that that is not the right approach to this. That these are post-PC devices that need to be even easier to use than a PC. That need to be even more intuitive than a PC. And where the software and the hardware and the applications need to intertwine in an even more seamless way than they do on a PC.

It appears that era has already arrived.

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This post has been revised to reflect the following correction:

Correction: February 6, 2013

An earlier version of this post incorrectly stated the number of iPads sold in the fourth quarter of 2012. Apple sold 22.9 million iPads during that period, not 27 million.

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

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

A Long Series of Illnesses:

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

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

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

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

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

Back to the Hospital:

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

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

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

Back to the Hospital, Again:

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

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

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

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

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

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

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

Solving the Mystery:

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

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

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

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

A Long Series of Illnesses:

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

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

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

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

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

Back to the Hospital:

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

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

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

Back to the Hospital, Again:

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

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

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

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

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

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

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

Solving the Mystery:

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

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

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