Kerry Is Hoping to Nudge Egypt Toward Reforms

CAIRO — Secretary of State John Kerry told Egypt’s political and business leaders on Saturday that it was urgent their country institute economic reforms and satisfy the conditions the International Monetary Fund has set for a $4.8 billion loan.

“It is paramount, essential, urgent that the Egyptian economy get stronger, that it gets back on its feet,” Mr. Kerry told a group of Egyptian and American business executives in Cairo. “It’s clear to us that the I.M.F. arrangement needs to be reached, that we need to give the market that confidence.”

Mr. Kerry’s visit — his first trip to an Arab capital as secretary of state — comes at a time of economic peril in Egypt. The country’s economy has teetered near collapse for months, with soaring unemployment, a gaping budget deficit, dwindling hard-currency reserves and steep declines in the currency’s value.

The fund’s loan is critical, economists say, because it would provide a seal of approval that Egypt’s economy is on a path toward self-sufficiency, allowing it to obtain enough other international loans to fill in its deficit. Both the United States and the European Union are prepared to provide substantial additional assistance if Egypt and the I.M.F. can come to terms.

But even as Mr. Kerry stressed the need for prompt economic steps — and the political peace needed to achieve those changes — some opponents of President Mohamed Morsi sought to put the spotlight on the nation’s uneasy political course.

Parliamentary elections are scheduled for April. The major opposition group, the National Salvation Front, has announced that it plans to boycott the vote to protest what it says is a push by Mr. Morsi and his Islamist allies to dominate politics.

The Obama administration has been criticized by some of Mr. Morsi’s rivals as being too supportive of the Egyptian president, as has Mr. Kerry, who was the first American senator to meet Mr. Morsi.

The delicacy of the issue was apparent when members of the political opposition were invited to a Saturday session with Mr. Kerry. Some members, including Hamdeen Sabahi, who came in third in the presidential election last year, decided not to attend. Mohamed ElBaradei, one of the leaders of the National Salvation Front, chose not to go, but to speak by phone with Mr. Kerry instead.

Those that attended, Mr. Kerry later said, engaged in a “very, very spirited” discussion.

 Mohamed El Orabi, a former foreign minister and a leading member of the National Congress Party who went to the meeting, said that Mr. Kerry had talked about the importance of democracy while driving home his message on the economy.

Mr. Kerry also met separately with Amr Moussa, a former secretary general of the Arab League and the head of the National Congress Party.

The two years of tumult that began with the ouster of former President Hosni Mubarak has sharply slowed foreign investment and tourism, and economists say the Egyptian government urgently needs a cash infusion of several billion dollars to fend off the risk of an economic calamity that could lead to more unrest and instability.

In September, the United States brought more than 100 business executives to Cairo to encourage trade and economic development. But continuing political protests, including when demonstrators scaled the walls of the American Embassy here on the anniversary of the 9/11 terrorist attacks, discouraged many businessmen from following up, Mr. Kerry noted. (The protesters that day were angry over an amateurish American-made video denouncing Islam.)

The International Monetary Fund has held on-again, off-again negotiations with Egypt for more than a year about providing the $4.8 billion.

The fund has imposed two difficult conditions. It has required the Egyptian government to commit itself to undertaking painful reforms like raising taxes and reducing energy subsidies.

It has also required a demonstration of political support for the reforms and the loan, to ensure that the government will honor its commitments in the future. That requires a dependable political process, as well as a degree of consensus that Egypt’s political factions have been unable to sustain.

On Sunday, Mr. Kerry is scheduled to meet with Mr. Morsi. The secretary of state said he would discuss specific steps the United States could take to boost the Egyptian economy if Egypt worked out a loan package with the I.M.F. That will be Mr. Kerry’s final meeting in Egypt before departing for Saudi Arabia, the seventh stop on his nine-nation tour.

The protests and street violence that have destabilized Egypt’s transition continued Saturday. The Egyptian state media reported that a demonstrator in the Nile Delta city of Mansoura was killed when he was run over by an armored police vehicle.

Violence also flared again in the Suez Canal city of Port Said, where the state media reported that protesters had burned down a police station. The Port Said protests began Jan. 26 after 21 local soccer fans were sentenced to death for their role in a deadly riot at a match last year.

But over the past month, the demonstrations in Port Said have blurred together with sometimes-violent protests in several other cities along the Suez Canal or in the Nile Delta. Some protesters are angry at Mr. Morsi and the Muslim Brotherhood, accusing them of failing to deliver fast enough on the anticipated rewards of the revolution, including economic benefits.

Michael R. Gordon reported from Cairo, and David D. Kirkpatrick from Istanbul.

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Alaska Airlines, Flying Above an Industry’s Troubles

Damon Winter/The New York Times

For decades, flights over spectacular Alaskan landscapes could end with devilishly difficult landings. More Photos »

FLYING over Alaska in the wintertime is a spectacular experience. At 35,000 feet, the state’s rugged beauty unfolds, a succession of white mountain peaks against steel-blue skies, icy lakes and frozen rivers that snake as far as the eye can see. It’s an awesome sight, wild and pristine, that glows in a thousand hues of red, orange and pink when the sun sets against the horizon.

Damon Winter/The New York Times

The pilots Dan Kaplin and Tom Peebles complete a safety check before a short flight from Wrangell, about 200 miles southeast of Juneau, to Petersburg. More Photos »

But then, you have to land.

Juneau’s airport is surrounded by mountains, the approach often buffeted by treacherous wind shear. Sitka’s one small runway is on a narrow strip of land surrounded by water. And in Kodiak, the landing strip ends abruptly at a mountainside. The airport approach is so tricky that first officers are not allowed to land there; only captains are trusted to do so.

Doug Wahto knows these airports well. He grew up in Juneau, worked as a commercial fisherman and builder and started flying with Alaska Airlines in 1970. As a pilot, he honed the art of reading wind conditions by looking at how snow blew over mountain ridges.

Mr. Wahto retired six years ago, but not before seeing the transformation of flying in Alaska and of the airline where he spent his career. Alaska Airlines is puny compared to the major carriers: it has 124 planes, while United Airlines has more than 700 and four times as many passengers. But because of the state’s topography and extreme weather, it was the first to develop satellite guidance, a navigation technique that has transformed landing at Alaska’s tricky airports. The technique is now at the heart of the Federal Aviation Administration’s plan to modernize the nation’s air traffic system, a project that is expected to cost tens of billions of dollars over the coming decades.

“It doesn’t take a rocket scientist,” Mr. Wahto says, “or a crusty old dog like me to fly these approaches anymore.”

Largely because of that technology, flying in Alaska is now remarkably reliable — even in the dead of winter, when it is snowing, when there are just two hours of daylight, when runways are made slippery by ice or sleet, when winds blow at more than 50 miles an hour and pilots can barely see out the windshield. When, in other words, no one in his right mind would want to land a Boeing 737 with 140 passengers on a 6,000-foot runway.

Alaska Airlines, in fact, had the industry’s best on-time performance for the third consecutive year in 2012, with 87 percent of flights landing on time, according to FlightStats, a data provider.

That reliability means a lot in a state where air travel is often the only option, and where Alaska is the only commercial jet carrier with in-state routes. The airline flies to 16 towns accessible only by plane or boat, and, in doing so, ferries food and medical supplies, takes thousands of oil workers above the Arctic Circle and operates as the biggest air shipper for the state’s fisheries.

This role as primary transport for in the state is still a healthy business, but Alaska Airlines has prospered by expanding its services. From its Seattle base, it now has a bigger presence than other airlines along much of the West Coast. In 2007, it moved into Hawaii; its flights to the state now account for 20 percent of its available seat miles, an industry standard for measuring capacity. That is more than the 17 percent in Alaska itself.

Megamergers, most recently of US Airways and American Airlines, have redrawn the boundaries of domestic carriers, concentrating the business as never before. Alaska Airlines, for its part, has cultivated staunch independence. Unlike carriers that have faced bankruptcy or acquisition, Alaska has turned a profit for 33 of the last 39 years. In 2012, it had a record $316 million in net income, up 29 percent from 2011.

Although it started in a sparsely populated, meteorologically unwelcoming, financially challenging corner of the country, Alaska has built a successful franchise that is the envy of many rivals.

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England Develops a Voracious Appetite for a New Diet

LONDON — Visitors to England right now, be warned. The big topic on people’s minds — from cabdrivers to corporate executives — is not Kate Middleton’s increasingly visible baby bump (though the craze does involve the size of one’s waistline), but rather a best-selling diet book that has sent the British into a fasting frenzy.

“The Fast Diet,” published in mid-January in Britain, could do the same in the United States if Americans eat it up. The United States edition arrived last week.

The book has held the No. 1 slot on Amazon’s British site nearly every day since its publication in January, according to Rebecca Nicolson, a founder of Short Books, the independent publishing company behind the sensation. “It is selling,” she said, “like hot cakes,” which coincidentally are something one can actually eat on this revolutionary diet.

With an alluring cover line that reads, “Lose Weight, Stay Healthy, Live Longer,” the premise of this latest weight-loss regimen — or “slimming” as the British call “dieting” — is intermittent fasting, or what has become known here as the 5:2 diet: five days of eating and drinking whatever you want, dispersed with two days of fasting.

A typical fasting day consists of two meals of roughly 250 to 300 calories each, depending on the person’s sex (500 calories for women, 600 for men). Think two eggs and a slice of ham for breakfast, and a plate of steamed fish and vegetables for dinner.

It is not much sustenance, but the secret to weight loss, according to the book, is that even after just a few hours of fasting, the body begins to turn off the fat-storing mechanisms and turn on the fat-burning systems.

“I’ve always been into self-experimentation,” said Dr. Michael Mosley, one of the book’s two authors and a well-known medical journalist on the BBC who is often called the Sanjay Gupta of Britain.

He researched the science of the diet and its health benefits by putting himself through intermittent fasting and filming it for a BBC documentary last August called “Eat, Fast and Live Longer.” (The broadcast gained high ratings, three million viewers, despite running during the London Olympics. PBS plans to air it in April.)

“This started because I was not feeling well last year,” Dr. Mosley said recently over a cup of tea and half a cookie (it was not one of his fasting days). “It turns out I was suffering from high blood sugar, high cholesterol and had a kind of visceral fat inside my gut.”

Though hardly obese at the time, at 5 feet 11 inches and 187 pounds, Dr. Mosley, 55, had a body mass index and body fat percentage that were a few points higher than the recommended amount for men. “Given that my father had died at age 73 of complications from diabetes, and I was now looking prediabetic, I knew something had to change,” he added.

The result was a documentary, almost the opposite of “Super Size Me,” in which Dr. Mosley not only fasted, but also interviewed scientific researchers, mostly in the United States, about the positive results of various forms of intermittent fasting, tested primarily on rats but in some cases human volunteers. The prominent benefits, he discovered, were weight loss, a lower risk of cancer and heart disease, and increased energy.

“The body goes into a repair-and-recover mode when it no longer has the work of storing the food being consumed,” he said.

Though Dr. Mosley quickly gave up on the most extreme forms of fasting (he ate little more than one cup of low-calorie soup every 24 hours for four consecutive days in his first trial), he finally settled on the 5:2 ratio as a more sustainable, less painful option that could realistically be followed without annihilating his social life or work.

“Our earliest antecedents,” Dr. Mosley argued, “lived a feast-or-famine existence, gorging themselves after a big hunt and then not eating until they scored the next one.” Similarly, he explained, temporary fasting is a ritual of religions like Islam and Judaism — as demonstrated by Ramadan and Yom Kippur. “We shouldn’t have a fear of hunger if it is just temporary,” he said.

What Dr. Mosley found most astounding, however, were his personal results. Not only did he lose 20 pounds (he currently weighs 168 pounds) in nine weeks, but his glucose and cholesterol levels went down, as did his body fat. “What’s more, I have a whole new level of energy,” he said.

The documentary became an instant hit, which in turn led Mimi Spencer, a food and fashion writer, to propose that they collaborate on a book. “I could see this was not a faddish diet but one that was sustainable with long-term health results, beyond the obvious weight-loss benefit,” said Ms. Spencer, 45, who has lost 20 pounds on the diet within four months and lowered her B.M.I. by 2 points.

The result is a 200-page paperback: the first half written by Dr. Mosley outlining the scientific findings of intermittent fasting; the second by Ms. Spencer, with encouraging text on how to get through the first days of fasting, from keeping busy so you don’t hear your rumbling belly, to waiting 15 minutes for your meal or snack.

She also provides fasting recipes with tantalizing photos like feta niçoise salad and Mexican pizza, and a calorie counter at the back. (Who knew a quarter of a cup of balsamic vinegar dressing added up to a whopping 209 calories?)

In London, the diet has taken off with the help of well-known British celebrity chefs and food writers like Hugh Fearnley-Whittingstall, who raved about it in The Guardian after his sixth day of fasting, having already lost eight pounds. (“I feel lean and sharper,” he wrote, “and find the whole thing rather exhilarating.”)

The diet is also particularly popular among men, according to Dr. Mosley, who has heard from many of his converts via e-mail and Twitter, where he has around 24,000 followers. “They find it easy to work into their schedules because dieting for a day here and there doesn’t feel torturous,” he said, adding that couples also particularly like doing it together.

But not everyone is singing the diet’s praises. The National Health System, Britain’s publicly funded medical establishment, put out a statement on its Web site shortly after the book came out: “Despite its increasing popularity, there is a great deal of uncertainty about I.F. (intermittent fasting) with significant gaps in the evidence.”

The health agency also listed some side effects, including bad breath, anxiety, dehydration and irritability. Yet people in London do not seem too concerned. A slew of fasting diet books have come out in recent weeks, notably the “The 5:2 Diet Book” and “The Feast and Fast Diet.”

There is also a crop of new cookbooks featuring fasting-friendly recipes. Let’s just say, the British are hungry for them.

This article has been revised to reflect the following correction:

Correction: March 2, 2013

An earlier version of this article misstated part of the name of the national healthcare organization in Britain. It is the National Health Service, not the National Health System. The article also misidentified the Balsamic product that has 209 calories per cup. It is Balsamic vinegar dressing, not Balsamic vinegar.

Read More..

England Develops a Voracious Appetite for a New Diet

LONDON — Visitors to England right now, be warned. The big topic on people’s minds — from cabdrivers to corporate executives — is not Kate Middleton’s increasingly visible baby bump (though the craze does involve the size of one’s waistline), but rather a best-selling diet book that has sent the British into a fasting frenzy.

“The Fast Diet,” published in mid-January in Britain, could do the same in the United States if Americans eat it up. The United States edition arrived last week.

The book has held the No. 1 slot on Amazon’s British site nearly every day since its publication in January, according to Rebecca Nicolson, a founder of Short Books, the independent publishing company behind the sensation. “It is selling,” she said, “like hot cakes,” which coincidentally are something one can actually eat on this revolutionary diet.

With an alluring cover line that reads, “Lose Weight, Stay Healthy, Live Longer,” the premise of this latest weight-loss regimen — or “slimming” as the British call “dieting” — is intermittent fasting, or what has become known here as the 5:2 diet: five days of eating and drinking whatever you want, dispersed with two days of fasting.

A typical fasting day consists of two meals of roughly 250 to 300 calories each, depending on the person’s sex (500 calories for women, 600 for men). Think two eggs and a slice of ham for breakfast, and a plate of steamed fish and vegetables for dinner.

It is not much sustenance, but the secret to weight loss, according to the book, is that even after just a few hours of fasting, the body begins to turn off the fat-storing mechanisms and turn on the fat-burning systems.

“I’ve always been into self-experimentation,” said Dr. Michael Mosley, one of the book’s two authors and a well-known medical journalist on the BBC who is often called the Sanjay Gupta of Britain.

He researched the science of the diet and its health benefits by putting himself through intermittent fasting and filming it for a BBC documentary last August called “Eat, Fast and Live Longer.” (The broadcast gained high ratings, three million viewers, despite running during the London Olympics. PBS plans to air it in April.)

“This started because I was not feeling well last year,” Dr. Mosley said recently over a cup of tea and half a cookie (it was not one of his fasting days). “It turns out I was suffering from high blood sugar, high cholesterol and had a kind of visceral fat inside my gut.”

Though hardly obese at the time, at 5 feet 11 inches and 187 pounds, Dr. Mosley, 55, had a body mass index and body fat percentage that were a few points higher than the recommended amount for men. “Given that my father had died at age 73 of complications from diabetes, and I was now looking prediabetic, I knew something had to change,” he added.

The result was a documentary, almost the opposite of “Super Size Me,” in which Dr. Mosley not only fasted, but also interviewed scientific researchers, mostly in the United States, about the positive results of various forms of intermittent fasting, tested primarily on rats but in some cases human volunteers. The prominent benefits, he discovered, were weight loss, a lower risk of cancer and heart disease, and increased energy.

“The body goes into a repair-and-recover mode when it no longer has the work of storing the food being consumed,” he said.

Though Dr. Mosley quickly gave up on the most extreme forms of fasting (he ate little more than one cup of low-calorie soup every 24 hours for four consecutive days in his first trial), he finally settled on the 5:2 ratio as a more sustainable, less painful option that could realistically be followed without annihilating his social life or work.

“Our earliest antecedents,” Dr. Mosley argued, “lived a feast-or-famine existence, gorging themselves after a big hunt and then not eating until they scored the next one.” Similarly, he explained, temporary fasting is a ritual of religions like Islam and Judaism — as demonstrated by Ramadan and Yom Kippur. “We shouldn’t have a fear of hunger if it is just temporary,” he said.

What Dr. Mosley found most astounding, however, were his personal results. Not only did he lose 20 pounds (he currently weighs 168 pounds) in nine weeks, but his glucose and cholesterol levels went down, as did his body fat. “What’s more, I have a whole new level of energy,” he said.

The documentary became an instant hit, which in turn led Mimi Spencer, a food and fashion writer, to propose that they collaborate on a book. “I could see this was not a faddish diet but one that was sustainable with long-term health results, beyond the obvious weight-loss benefit,” said Ms. Spencer, 45, who has lost 20 pounds on the diet within four months and lowered her B.M.I. by 2 points.

The result is a 200-page paperback: the first half written by Dr. Mosley outlining the scientific findings of intermittent fasting; the second by Ms. Spencer, with encouraging text on how to get through the first days of fasting, from keeping busy so you don’t hear your rumbling belly, to waiting 15 minutes for your meal or snack.

She also provides fasting recipes with tantalizing photos like feta niçoise salad and Mexican pizza, and a calorie counter at the back. (Who knew a quarter of a cup of balsamic vinegar dressing added up to a whopping 209 calories?)

In London, the diet has taken off with the help of well-known British celebrity chefs and food writers like Hugh Fearnley-Whittingstall, who raved about it in The Guardian after his sixth day of fasting, having already lost eight pounds. (“I feel lean and sharper,” he wrote, “and find the whole thing rather exhilarating.”)

The diet is also particularly popular among men, according to Dr. Mosley, who has heard from many of his converts via e-mail and Twitter, where he has around 24,000 followers. “They find it easy to work into their schedules because dieting for a day here and there doesn’t feel torturous,” he said, adding that couples also particularly like doing it together.

But not everyone is singing the diet’s praises. The National Health System, Britain’s publicly funded medical establishment, put out a statement on its Web site shortly after the book came out: “Despite its increasing popularity, there is a great deal of uncertainty about I.F. (intermittent fasting) with significant gaps in the evidence.”

The health agency also listed some side effects, including bad breath, anxiety, dehydration and irritability. Yet people in London do not seem too concerned. A slew of fasting diet books have come out in recent weeks, notably the “The 5:2 Diet Book” and “The Feast and Fast Diet.”

There is also a crop of new cookbooks featuring fasting-friendly recipes. Let’s just say, the British are hungry for them.

This article has been revised to reflect the following correction:

Correction: March 2, 2013

An earlier version of this article misstated part of the name of the national healthcare organization in Britain. It is the National Health Service, not the National Health System. The article also misidentified the Balsamic product that has 209 calories per cup. It is Balsamic vinegar dressing, not Balsamic vinegar.

Read More..

Sequestration Takes Effect, but Impact Is Not Immediate

WASHINGTON — University officials, city managers, day care providers and others spent Saturday assessing how they would absorb their part of the across-the-board cuts in federal spending that began taking effect over the weekend.

But even as the institutions that depend on federal money nervously took stock, most Americans were largely unaffected by the cuts, at least for now. At Los Angeles International Airport, John Konopka, 45, suffered no delays as he arrived from Atlanta.

“This is just another travel day,” Mr. Konopka said. “I think all of it’s been talked up a bit, way too politically, to make it seem a lot worse than it is. I don’t think it’s going to be the gloom and doom that some people are saying it would be.”

Others were less sanguine. Joel Silver, 63, a retiree from the Bronx, said he feared the cuts would affect the most vulnerable. He said he was angry that President Obama and lawmakers had not prevented what he called “an invented crisis.”

“What’s the point of a Congress?” he asked. “Aren’t they supposed to sit down and talk about things and figure them out? The economy was just recovering and now it’s going to slide back.”

Across the country, the impact of sequestration, as the cuts are known, appeared to be as varied as the thousands of federal programs, big and small, that now have shrunken pots of money from which to draw.

In Baltimore, the mayor called for an emergency cabinet meeting to discuss the reductions in federal money and their impact on a city that already has a projected deficit of $750 million over the next decade.

At research universities, administrators sent e-mails to faculty members and students warning that changes were coming. Samuel L. Stanley Jr., the president of Stony Brook University, said the institution would lose $7.6 million in “vital federal funding” for research grants and other programs. The University of California, Berkeley, warned that “as sequestration translates into fewer federal grants, the campus will be forced to hire fewer researchers.”

The Air Force Thunderbirds, the elite team of F-16 pilots who perform flight maneuvers at air shows around the country, announced on their Web site that all of their shows had been canceled starting April 1.

Federal officials began sending letters to governors, informing them of smaller grants. Shaun Donovan, the secretary of housing and urban development, wrote to Gov. John R. Kasich of Ohio, “You can expect reductions totaling approximately $35 million.”

In a 70-page report to Congress accompanying the sequestration order and detailing the reductions — agency by agency and program by program — Jeffrey D. Zients, Mr. Obama’s budget director, called them “deeply destructive to national security, domestic investments and core government functions.”

Among the $85 billion in cuts for the fiscal year ending Sept. 30: $3 million less for Pacific coastal salmon recovery; $148 million less for the patent office; a $1 million cut in support by the Defense Department for international sporting competitions; $289 million less for the Centers for Disease Control and Prevention; a $1 million cut in the Interior Department’s helium fund; and $16 million less for the Sept. 11 victim compensation fund.

But even as the reductions became official, the result of a stalemate between Mr. Obama and Congressional Republicans over increasing taxes, some of the immediate impact was difficult to see.

The process of trimming government budgets is slow and cumbersome, involving notifications to unions about temporary furloughs, reductions in overtime pay and cuts in grant financing to state and local programs. Less federal money will, over time, mean fewer government contracts with private companies. Reduced overtime pay for airport security checkpoint officers will make lines longer, eventually.

And so as the first weekend began for the new, slimmer government, little of that was evident yet.

At Kennedy International Airport in New York, travelers who arrived extra early were greeted by short lines, not the drastic delays that federal transportation officials have said could emerge as security officers are furloughed to save money.

“The check-in was fine, at least for now. I’m surprised,” said Chris Achilefu, 45, who arrived at the airport four hours before his flight to Lagos, Nigeria. Normally Mr. Achilefu, an automotive exporter who lives in Upper Darby, Pa., would arrive two hours early, but he said he was concerned about lines.

“I was listening to what the president said yesterday, that it won’t kick in right away,” he said. “Hopefully the two parties will come together, hopefully they will resolve it before another month.”

At the main San Ysidro port of entry between Mexico and San Diego, traffic moved smoothly late Friday night, just hours after the sequestration began, and border lines had only a few dozen vehicles in each lane.

Vendors who line the street where cars sometimes idle for hours waiting to enter the United States perked up when they heard about the cuts.

“That’s good for business,” said Emilio Gomez, an employee at a stand selling rugs, china figurines and soda. “When people are waiting, they get bored and they buy more stuff.”

In his weekly address on Saturday, Mr. Obama acknowledged that not everyone would be affected equally. “While not everyone will feel the pain of these cuts right away, the pain will be real,” he said. “Many middle-class families will have their lives disrupted in a significant way.”

In the Republican response to Mr. Obama’s address, Representative Cathy McMorris Rodgers of Washington also called the cuts “devastating,” but said that Republicans in the House would not yield on taxes. “Spending is the problem, which means cutting spending is the solution,” she said. “It’s that simple.”

Reporting was contributed by Robbie Brown from Atlanta; Will Carless from San Ysidro, Calif.; Ian Lovett from Los Angeles; and Marc Santora and Ravi Somaiya from New York.

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Kerry Criticizes Turkish Prime Minister Over Zionism Remark

ANKARA, Turkey — Secretary of State John Kerry chastised Turkey’s prime minister on Friday for recently calling Zionism a “crime against humanity,” a comment that could frustrate Mr. Kerry’s desire to see an improvement in estranged Turkish-Israeli relations.

When Mr. Kerry set off on Sunday on a nine-nation trip, his plan was to use his visit in Turkey to consult on trade, the crisis in Syria and other Middle East issues.

But on Wednesday, Prime Minister Recep Tayyip Erdogan told a United Nations forum in Vienna that the international community should consider Islamophobia a crime against humanity “like Zionism or anti-Semitism or fascism.”

The next day, Prime Minister Benjamin Netanyahu of Israel described Mr. Erdogan’s remarks as a “dark and false statement.”

By Friday Mr. Kerry was faced with the task of trying to discourage another outburst from the Turks and salvaging some chance of an improvement in ties between Turkey and Israel — the first a moderate Muslim-majority nation and important NATO ally, and the other the principal United States ally in the Middle East.

The Americans’ sternest message to the Turks was conveyed before Mr. Kerry’s plane even landed by a senior State Department official who spoke under ground rules that he not be identified by name.“This was particularly offensive,” the official said, referring to Mr. Erdogan’s comments. “It complicates our ability to do all of the things that we want to do together.”

Once in Ankara, Mr. Kerry initially approached the issue somewhat indirectly. Noting that he had attended a memorial event earlier in the day for a Turkish security guard who had been killed trying to stop suicide bomber at the American Embassy, Mr. Kerry said that this selflessness should inspire a “spirit of tolerance.”

“And that,” Mr. Kerry added, “includes all of the public statements made by all leaders.”

But in response to a question at a news conference with Foreign Minister Ahmet Davutoglu, Mr. Kerry was more direct.

“Obviously, we not only disagree with it. We found it objectionable,” Mr. Kerry said of Mr. Erdogan’s statement, noting that he planned to raise the matter Friday evening with the prime minister. The comments by Mr. Davutoglu suggested that it might not be an easy discussion.

The foreign minister insisted Turkey was not hostile to Israel and that the downturn in relations was Israel’s fault, referring to a 2010 episode in which eight Turks and an American of Turkish descent were killed when Israeli commandos boarded the lead ship of a pro-Palestinian activist flotilla that was trying to break Israel’s blockade of Gaza.

“If Israel is expected to hear positive comments from Turkey, I believe they need to revise their attitudes not only toward us but also toward the settlements in West Bank and the people of the region,” he added.

During the 1990s, Turkey and Israel enjoyed close cooperation in ties that were nurtured by the secular Turkish military and the Israeli national security establishment, Dan Arbell, a guest scholar at the Brookings Institution’s Saban Center for Middle East Policy, wrote last year.

Relations began to deteriorate after Mr. Erdogan became prime minister in 2003 and Turkey adopted a more assertive regional posture, which often involved sharp criticism of Israel’s policies. Ties between the countries reached a low point with the deadly Gaza flotilla confrontation.

American officials said they would like to find some way to foster an improvement in Turkish-Israeli relations, which the official on Mr. Kerry’s plane described as “frozen.”

“We want to see a normalization, not just for the sake of the two countries but for the sake of the region and, frankly, for the symbolism,” the official said. “Not that long ago you had these two countries demonstrating that a majority Muslim country could have very positive and strong relations with the Jewish state.”

On Friday night, Mr. Kerry dined at Mr. Erdogan’s residence. The session began inauspiciously when Mr. Kerry apologized for being a little late because of his lengthy discussions with Mr. Davutoglu.

Mr. Erdogan, who seemed irritated, said that Mr. Kerry and Mr. Davutoglu “must have spoken about everything, so there is nothing left for us to talk about.”

“There’s a lot to talk about,” Mr. Kerry said. “We actually didn’t talk about everything.”

According to a State Department official, the Turkish prime minister and Mr. Kerry discussed the gamut of Middle East issues, including the recent meeting in Rome on the Syria conflict, the situation in Iraq, Iran and the prospects for reviving the peace process between Israel and the Palestinians.

American officials did not provide details on the exchange regarding Mr. Erdogan’s Zionism comments or whether the Turkish prime minister believed they had in any way been excessive.

The two men, the State Department official said, had a “frank discussion of the prime minister’s speech in Vienna and how to move forward.”

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Bits Blog: Judge Slashes Jury Award in Apple-Samsung Case

8:45 p.m. | Updated

A federal judge on Friday weakened the blow from Apple’s legal victory in a patent case against Samsung, lopping more than 40 percent off the damages a jury awarded Apple last year.

The ruling did not shift the case — one of the most closely watched in the high-tech industry — in Samsung’s favor. While Apple has lost other skirmishes against Samsung in courts around the world, the jury award in this case has been the biggest victory for either side so far.

Even at a reduced level, these would be among the highest damages in a patent dispute.

The judge ordered a new trial to recalculate a portion of those damages, leaving open the possibility that some of them could be restored.

She also indicated that Apple was entitled to additional damages for sales of Samsung products that have occurred since the jury’s decision last summer, which could further swell the amount Apple is owed by Samsung.

Tech companies around the world are waging legal battles over patents as they compete for supremacy in the lucrative smartphone market. Apple and Samsung are the most prominent combatants in that war; the two companies divide most of the profits in the surging mobile phone market.

Samsung has soared to the No. 1 spot in the smartphone business in recent years, but Apple says that it is, in part, because the company has swiped many of Apple’s ideas.

In her review of the jury’s decisions, which originally awarded Apple more than $1 billion for patent violations by Samsung in its mobile products, Judge Lucy H. Koh of the United States District Court in San Jose, Calif., knocked those damages down by $450 million, to $599 million. The new trial will determine how much of the $450 million, if any, should be restored.

“It will be years before the parties exhaust all of their litigation avenues and options,” said Alan M. Fisch, an intellectual property lawyer with Fisch Hoffman Sigler in Washington, who is not involved in the case. “Still, some form of patent cross-license between the two would not be an unsurprising final result.”

None of Judge Koh’s opinion changed the jury’s finding that Samsung violated a series of Apple patents in its smartphone and tablet products. But the judge took issue with how the jury calculated the damages Apple was entitled to from the Samsung devices named in the case, more than two dozen of them in all.

In her 27-page opinion, Judge Koh said that the jury failed to follow her instructions in calculating damages for a certain class of patents, known as utility patents.

She also decided in Samsung’s favor in a dispute between the two parties over when Apple notified Samsung that it was infringing Apple’s intellectual property. Evidence of such notice dates are important because they help determine how hefty the damages are in a court case, once the party being notified is found guilty of infringement.

Judge Koh chided Apple for using an expert in the case who used an “aggressive notice date” — meaning, an early one — to calculate damages.

“The need for a new trial could have been avoided had Apple chosen a more circumspect strategy or provided more evidence to allow the jury or the court to determine the appropriate award for a shorter notice period,” she said in her ruling.

Steve Dowling, a spokesman for Apple, declined to comment.

In a statement, Adam Yates, a Samsung spokesman, said that the company was pleased with the judge’s decision and that it intended to seek further review of the remaining award.

Apple and Samsung, meanwhile, continue to fight ferociously in the smartphone market, where Samsung has steadily worked its way to the No. 1 position over the last few years. In the fourth quarter, Samsung accounted for 29 percent of global smartphone shipments, while Apple accounted for 21.8 percent, according to IDC.

Mark A. Lemley, a professor at Stanford Law School, called the judge’s decision “an extremely careful and thorough opinion on a very difficult and interrelated set of issues.”

Mr. Lemley predicted that Samsung would eventually win some reduction in the original $1 billion award, but “almost certainly” less than the $450 million that Judge Koh reduced it by on Friday.

“We’ll need a new trial to figure that out,” said Mr. Lemley, who has done legal work in the past for Google, maker of the Android operating system involved in the Samsung case and others. “Judge Koh has encouraged both sides to appeal first. That may clarify some questions, but it is unlikely to prevent a new trial, just delay it some.”

Read More..

Well: A Rainbow of Root Vegetables

This week’s Recipes for Health is as much a treat for the eyes as the palate. Colorful root vegetables from bright orange carrots and red scallions to purple and yellow potatoes and pale green leeks will add color and flavor to your table.

Since root vegetables and tubers keep well and can be cooked up into something delicious even after they have begun to go limp in the refrigerator, this week’s Recipes for Health should be useful. Root vegetables, tubers (potatoes and sweet potatoes, which are called yams by most vendors – I mean the ones with dark orange flesh), winter squash and cabbages are the only local vegetables available during the winter months in colder regions, so these recipes will be timely for many readers.

Roasting is a good place to begin with most root vegetables. They sweeten as they caramelize in a hot oven. I roasted baby carrots and thick red scallions (they may have been baby onions; I didn’t get the information from the farmer, I just bought them because they were lush and pretty) together and seasoned them with fresh thyme leaves, then sprinkled them with chopped toasted hazelnuts. I also roasted a medley of potatoes, including sweet potatoes, after tossing them with olive oil and sage, and got a wonderful range of colors, textures and tastes ranging from sweet to savory.

Sweet winter vegetables also pair well with spicy seasonings. I like to combine sweet potatoes and chipotle peppers, and this time in a hearty lentil stew that we enjoyed all week.

Here are five colorful and delicious dishes made with root vegetables.

Spicy Lentil and Sweet Potato Stew With Chipotles: The combination of sweet potatoes and spicy chipotles with savory lentils is a winner.

---

Roasted Carrots and Scallions With Thyme and Hazelnuts: Toasted hazelnuts add a crunchy texture and nutty finish to this dish.

---

Carrot Wraps: A vegetarian sandwich that satisfies like a full meal.

---

Rainbow Potato Roast: A multicolored mix that can be vegan, or not.

---

Leek Quiche: A lighter version of a Flemish classic.

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Read More..

Well: A Rainbow of Root Vegetables

This week’s Recipes for Health is as much a treat for the eyes as the palate. Colorful root vegetables from bright orange carrots and red scallions to purple and yellow potatoes and pale green leeks will add color and flavor to your table.

Since root vegetables and tubers keep well and can be cooked up into something delicious even after they have begun to go limp in the refrigerator, this week’s Recipes for Health should be useful. Root vegetables, tubers (potatoes and sweet potatoes, which are called yams by most vendors – I mean the ones with dark orange flesh), winter squash and cabbages are the only local vegetables available during the winter months in colder regions, so these recipes will be timely for many readers.

Roasting is a good place to begin with most root vegetables. They sweeten as they caramelize in a hot oven. I roasted baby carrots and thick red scallions (they may have been baby onions; I didn’t get the information from the farmer, I just bought them because they were lush and pretty) together and seasoned them with fresh thyme leaves, then sprinkled them with chopped toasted hazelnuts. I also roasted a medley of potatoes, including sweet potatoes, after tossing them with olive oil and sage, and got a wonderful range of colors, textures and tastes ranging from sweet to savory.

Sweet winter vegetables also pair well with spicy seasonings. I like to combine sweet potatoes and chipotle peppers, and this time in a hearty lentil stew that we enjoyed all week.

Here are five colorful and delicious dishes made with root vegetables.

Spicy Lentil and Sweet Potato Stew With Chipotles: The combination of sweet potatoes and spicy chipotles with savory lentils is a winner.

---

Roasted Carrots and Scallions With Thyme and Hazelnuts: Toasted hazelnuts add a crunchy texture and nutty finish to this dish.

---

Carrot Wraps: A vegetarian sandwich that satisfies like a full meal.

---

Rainbow Potato Roast: A multicolored mix that can be vegan, or not.

---

Leek Quiche: A lighter version of a Flemish classic.

---

Read More..

Bits Blog: Judge Slashes Jury Award in Apple-Samsung Case

8:45 p.m. | Updated

A federal judge on Friday weakened the blow from Apple’s legal victory in a patent case against Samsung, lopping more than 40 percent off the damages a jury awarded Apple last year.

The ruling did not shift the case — one of the most closely watched in the high-tech industry — in Samsung’s favor. While Apple has lost other skirmishes against Samsung in courts around the world, the jury award in this case has been the biggest victory for either side so far.

Even at a reduced level, these would be among the highest damages in a patent dispute.

The judge ordered a new trial to recalculate a portion of those damages, leaving open the possibility that some of them could be restored.

She also indicated that Apple was entitled to additional damages for sales of Samsung products that have occurred since the jury’s decision last summer, which could further swell the amount Apple is owed by Samsung.

Tech companies around the world are waging legal battles over patents as they compete for supremacy in the lucrative smartphone market. Apple and Samsung are the most prominent combatants in that war; the two companies divide most of the profits in the surging mobile phone market.

Samsung has soared to the No. 1 spot in the smartphone business in recent years, but Apple says that it is, in part, because the company has swiped many of Apple’s ideas.

In her review of the jury’s decisions, which originally awarded Apple more than $1 billion for patent violations by Samsung in its mobile products, Judge Lucy H. Koh of the United States District Court in San Jose, Calif., knocked those damages down by $450 million, to $599 million. The new trial will determine how much of the $450 million, if any, should be restored.

“It will be years before the parties exhaust all of their litigation avenues and options,” said Alan M. Fisch, an intellectual property lawyer with Fisch Hoffman Sigler in Washington, who is not involved in the case. “Still, some form of patent cross-license between the two would not be an unsurprising final result.”

None of Judge Koh’s opinion changed the jury’s finding that Samsung violated a series of Apple patents in its smartphone and tablet products. But the judge took issue with how the jury calculated the damages Apple was entitled to from the Samsung devices named in the case, more than two dozen of them in all.

In her 27-page opinion, Judge Koh said that the jury failed to follow her instructions in calculating damages for a certain class of patents, known as utility patents.

She also decided in Samsung’s favor in a dispute between the two parties over when Apple notified Samsung that it was infringing Apple’s intellectual property. Evidence of such notice dates are important because they help determine how hefty the damages are in a court case, once the party being notified is found guilty of infringement.

Judge Koh chided Apple for using an expert in the case who used an “aggressive notice date” — meaning, an early one — to calculate damages.

“The need for a new trial could have been avoided had Apple chosen a more circumspect strategy or provided more evidence to allow the jury or the court to determine the appropriate award for a shorter notice period,” she said in her ruling.

Steve Dowling, a spokesman for Apple, declined to comment.

In a statement, Adam Yates, a Samsung spokesman, said that the company was pleased with the judge’s decision and that it intended to seek further review of the remaining award.

Apple and Samsung, meanwhile, continue to fight ferociously in the smartphone market, where Samsung has steadily worked its way to the No. 1 position over the last few years. In the fourth quarter, Samsung accounted for 29 percent of global smartphone shipments, while Apple accounted for 21.8 percent, according to IDC.

Mark A. Lemley, a professor at Stanford Law School, called the judge’s decision “an extremely careful and thorough opinion on a very difficult and interrelated set of issues.”

Mr. Lemley predicted that Samsung would eventually win some reduction in the original $1 billion award, but “almost certainly” less than the $450 million that Judge Koh reduced it by on Friday.

“We’ll need a new trial to figure that out,” said Mr. Lemley, who has done legal work in the past for Google, maker of the Android operating system involved in the Samsung case and others. “Judge Koh has encouraged both sides to appeal first. That may clarify some questions, but it is unlikely to prevent a new trial, just delay it some.”

Read More..

U.S. Aid to Syria Shows Obama’s Cautious Approach to Crisis

ROME — The food rations and medical supplies that Secretary of State John Kerry said Thursday would be provided to the Free Syrian Army mark the first time that the United States has publicly committed itself to sending nonlethal aid to the armed factions that are battling President Bashar al-Assad.

But the nature of the assistance also illustrates the Obama administration’s caution about getting involved in the Syrian crisis.

At each stop of his first foreign trip as secretary of state, Mr. Kerry has emphasized that one of his principal goals was to change Mr. Assad’s calculations about his ability to remain in power.

Mr. Assad is “out of time and must be out of power,” Mr. Kerry asserted after meeting here with Moaz al-Khatib, the leader of the Syrian opposition coalition.

The announcement of the supplies fell well short of the weapons and equipment Syrian rebels have requested and left unclear why Mr. Assad, who has fired Scud missiles at the city of Aleppo, would now conclude that he could no longer stand up to his opponents.

The nonlethal aid was just one element of the American program of assistance that Mr. Kerry unveiled on Thursday.

The United States is also providing $60 million to help the political wing of the Syrian anti-Assad coalition improve the delivery of basic services like sanitation and education in areas it has already wrested from the government’s control.

A covert effort to program to train rebel fighters, which State Department officials here were not prepared to discuss, has also been under way. According to an official in Washington, who asked not to be identified, the Central Intelligence Agency since last year has been training groups of Syrian rebels in Jordan.

The official did not provide details about the training or what difference it may have made on the battlefield, but said that the C.I.A. had not given weapons or ammunition to the rebels. An agency spokesman declined to comment.

Defending the limited program to provide medical supplies and military rations known as Meals Ready to Eat, or M.R.E.’s, to the military wing of the Syrian resistance, Mr. Kerry said that other countries would also provide help. He said that the “totality” of the effort would make an impression on Mr. Assad.

“We’re doing this, but other countries are doing other things,” Mr. Kerry said. But neither he nor any diplomats at a meeting here of the so-called Friends of Syria countries that support the Syrian resistance provided details about that effort.

Britain is planning more substantial nonlethal aid, which could include vehicles, bulletproof vests and night vision equipment, according to an American official. British officials have been consulting with European counterparts about what sort of nonlethal aid might be allowed under the terms of European Union decisions.

There is speculation that the Obama administration might expand its program of support to the Free Syrian Army to include nonlethal equipment if rebel fighters use the initial assistance effectively and do not allow any to fall into the hands of extremists.

“We’re in the Middle East. It’s all about the bargaining,” said Mona Yacoubian, a Middle East expert at the Henry L. Stimson Center in Washington. “It could be this is part of a strategy of deliberately trickling in aid, to sort of see how things are going on the ground. You start with harmless things, like M.R.E.’s. Is this a conversation starter? We might think of it that way.”

But Mr. Kerry provided no indication that the White House was committed to such a phased expansion of nonlethal support.

“I am going back to Washington with a number of thoughts and ideas that were put on the table today, and I’m confident we’re going to have a robust and ongoing conversation,” he said.

Some members of the Syria opposition said they were disappointed by the Rome session.

“It is obvious that the real support is absent,” said Walid al-Bunni, a spokesman for the anti-Assad coalition. He said what the resistance needed most was weapons. “What we want is to stop the Scuds launched on Aleppo, to stop the warplanes that are bombing our towns and villages.”

Mr. Khatib, for his part, delivered an emotional statement in which he urged establishment of a humanitarian corridor to the besieged city of Homs, and complained that many in the West were too quick to judge some members of the opposition as Islamic extremists because of “the length of a beard of a fighter.”

“Bashar Assad, for once in your life, behave as a human being,” Mr. Khatib said. “Bashar Assad, you have to make at least one wise decision in your life for the future of your country.”

One aim of the $60 million in aid is to help the Syrian Opposition Coalition, the umbrella group led by Mr. Khatib that the United States backs and has helped shape, in building credibility within the country and contesting the influence of extremist groups like the Al Nusra Front, an organization affiliated with Al Qaeda.

American officials have become increasingly concerned that the Al Nusra Front is making inroads among the Syrian population by dispersing assistance in the areas it controls.

The American assistance could also help the Syrian coalition develop the governance skills it will need to play a role in any post-Assad political transition.

The funds are to be used in areas controlled by the Syrian opposition coalition to improve education, sanitation and security. Another goal is to strengthen the rule of law in these areas and discourage vigilante justice or revenge killings. To carry out the program, the United States plans to send technical advisers to the headquarters of the Syrian opposition in Cairo. The advisers will be drawn from nongovernmental organizations.

The $60 million is on top of more than $50 million in assistance, including communications equipment, that the United States has already provided to local councils and civil activists. The new funds need to be approved by Congress, which is caught up in politics over how to cut the American budget deficit. But Mr. Kerry said that he expects Congressional approval soon.

Reporting was contributed by Mark Mazzetti from Washington, Anne Barnard and Hwaida Saad from Beirut, Lebanon, and Christine Hauser from New York.

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Bits Blog: Senator John D. Rockefeller IV Introduces 'Do Not Track' Bill

Before his planned retirement from Congress at the end of next year, Senator John D. Rockefeller IV, the West Virginia Democrat, intends to give American consumers more meaningful control over personal data collected about them online.

To that end, Mr. Rockefeller on Thursday introduced a bill called the “Do-Not-Track Online Act of 2013.”

The bill would require the Federal Trade Commission to establish standardized mechanisms for people to use their Internet browsers to tell Web sites, advertising networks, data brokers and other online entities whether or not they were willing to submit to data-mining.

The bill would also require the F.T.C. to develop rules to prohibit online services from amassing personal details about users who had opted out of such tracking.

Mr. Rockefeller proposed the same bill two years ago. But he did not push it in the Senate at the time because industry groups had pledged to voluntarily develop systems to honor the browser-based don’t-track-me flags. Last year, however, negotiations between industry groups and consumer advocates over how to execute these mechanisms essentially broke down and have since made little progress.

The new Rockefeller bill indicates that the senator believes the industry has not acted in good faith.

“The privacy of Americans is increasingly under assault as more and more of their daily lives are conducted online,” Mr. Rockefeller, the chairman of the Senate Committee on Commerce, Science and Transportation, wrote on Thursday in an e-mail sent to a reporter. “Industry made a public pledge to develop do-not-track standards that will truly protect consumer privacy — and it has failed to live up to that commitment. They have dragged their feet long enough.”

Industry representatives said that legislation was unnecessary because advertising networks and data brokers several years ago voluntarily introduced their own opt-out program for consumers, called Your AdChoices. Unlike the Do Not Track signals which would allow users to make a one-time decision about all online tracking from their own browsers, the industry program requires people to go to a site and individually select the companies, among several hundred, from whom they prefer not to receive marketing offers based on data-mining.

Stuart Ingis, a lawyer for the Digital Advertising Alliance, an industry consortium, said the program, which involves consumers installing individual cookies on their browsers, demonstrates that users already have choices about data collection.

“It’s a lot easier to use a system that is already built and works,” Mr. Ingis said.

Over the last few years, the number of companies that collect information about the reading habits, health concerns, financial capacity, search queries, purchasing patterns and other activities of online consumers has skyrocketed. Industry representatives argue that this benefits people because it enables companies to show them relevant ads, and that the ads themselves finance online sites and services that are free to consumers. Moreover, they say, the data collection is “anonymous” because online services typically use numerical customer codes, not real names or e-mail addresses, to track the behavior of individuals.

But consumer advocates warn that such profiling systems, which can collect thousands of details on nearly every adult in the United States, can be used to segment some people for preferential offers while relegating others to inferior treatment. Despite industry claims that online tracking is anonymous, a few computer scientists have reported that sites often leak information that can identify individuals, including names, addresses and other details, to third parties.

“Nowadays, there is an incredible proliferation of tracking,” said Dan Auerbach, a staff technologist at the Electronic Frontier Foundation, a digital rights group in San Francisco. “Data brokers, companies that you never heard of, are collecting massive dossiers about you as you browse around the Web and, right now, there are no limitations on the collection or use of those dossiers.”

To give people greater control over their own surveillance online, the Federal Trade Commission in a report on consumer privacy last March urged industry groups to adopt Do Not Track mechanisms by the end of 2012. In fact, the major browsers — Firefox from Mozilla, Google’s Chrome, and the more recent iterations of Internet Explorer — already offer the don’t-track-me buttons. When these options are turned on, they send out signals to sites, and third parties like ad networks operating on those sites, that certain users do not want to have their information collected.

But industry groups and consumer advocates have been at odds for more than a year over how “Do Not Track” mechanisms should be presented to users and how online services should respond to the signals. In the absence of legislation or industry consensus, companies are free to ignore those user preferences.

Some browsers have responded to this standstill by taking matters into their own hands and blocking third-party tracking cookies, as my colleague Somini Sengupta reported this week.

But Mr. Rockefeller’s bill indicates that legislative action could pre-empt voluntary industry measures.

“This is a signal that Senator Rockefeller is serious about getting Do Not Track done,” said David C. Vladeck, a professor at Georgetown Law. Until last month, Mr. Vladeck served as director of the bureau of consumer protection at the F.T.C. “I think industry writ large – browser companies, advertising networks, data brokers – are going to understand that he is serious about getting across the finish line.”

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Doctor and Patient: Why Failing Med Students Don’t Get Failing Grades

Tall and dark-haired, the third-year medical student always seemed to be the first to arrive at the hospital and the last to leave, her white coat perpetually weighed down by the books and notes she jammed into the pockets. She appeared totally absorbed by her work, even exhausted at times, and said little to anyone around her.

Except when she got frustrated.

I first noticed her when I overheard her quarreling with a nurse. A few months later I heard her accuse another student of sabotaging her work. And then one morning, I saw her storm off the wards after a senior doctor corrected a presentation she had just given. “The patient never told me that!” she cried. The nurses and I stood agape as we watched her stamp her foot and walk away.

“Why don’t you just fail her?” one of the nurses asked the doctor.

“I can’t,” she sighed, explaining that the student did extremely well on all her tests and worked harder than almost anyone in her class. “The problem,” she said, “is that we have no multiple choice exams when it comes to things like clinical intuition, communication skills and bedside manner.”

Medical educators have long understood that good doctoring, like ducks, elephants and obscenity, is easy to recognize but difficult to quantify. And nowhere is the need to catalog those qualities more explicit, and charged, than in the third year of medical school, when students leave the lecture halls and begin to work with patients and other clinicians in specialty-based courses referred to as “clerkships.” In these clerkships, students are evaluated by senior doctors and ranked on their nascent doctoring skills, with the highest-ranking students going on to the most competitive training programs and jobs.

A student’s performance at this early stage, the traditional thinking went, would be predictive of how good a doctor she or he would eventually become.

But in the mid-1990s, a group of researchers decided to examine grading criteria and asked directors of internal medicine clerkship courses across the country how accurate and consistent they believed their grading to be. Nearly half of the course directors believed that some form of grade inflation existed, even within their own courses. Many said they had increasing difficulty distinguishing students who could not achieve a “minimum standard,” whatever that might be. And over 40 percent admitted they had passed students who should have failed their course.

The study inspired a series of reforms aimed at improving how medical educators evaluated students at this critical juncture in their education. Some schools began instituting nifty mnemonics like RIME, or Reporter-Interpreter-Manager-Educator, for assessing progressive levels of student performance; others began to call regular meetings to discuss grades; still others compiled detailed evaluation forms that left little to the subjective imagination.

Now a new study published last month in the journal Teaching and Learning in Medicine looks at the effects of these many efforts on the grading process. And while the good news is that the rate of grade inflation in medical schools is slower than in colleges and universities, the not-so-good news is that little has changed. A majority of clerkship directors still believe that grade inflation is an issue even within their own courses; and over a third believe that students have passed their course who probably should have failed.

“Grades don’t have a lot of meaning,” said Dr. Sara B. Fazio, lead author of the paper and an associate professor of medicine at Harvard Medical School who leads the internal medicine clerkship at the Beth Israel Deaconess Medical Center in Boston. “‘Satisfactory’ is like the kiss of death.”

About a quarter of the course directors surveyed believed that grade inflation occurred because senior doctors were loath to deal with students who could become angry, upset or even turn litigious over grades. Some confessed to feeling pressure to help students get into more selective internships and training programs.

But for many of these educators, the real issue was not flunking the flagrantly unprofessional student, but rather evaluating and helping the student who only needed a little extra help in transitioning from classroom problem sets to real world patients. Most faculty received little or no training or support in evaluating students, few came from institutions that had remediation programs to which they could direct students, and all worked under grading systems that were subjective and not standardized.

Despite the disheartening findings, Dr. Fazio and her co-investigators believe that several continuing initiatives may address the evaluation issues. For example, residency training programs across the country will soon be assessing all doctors-in-training with a national standards list, a series of defined skills, or “competencies,” in areas like interpersonal communication, professional behavior and specialty-specific procedures. Over the next few years, medical schools will likely be adopting a similar system for medical students, creating a national standard for all institutions.

“There have to be unified, transparent and objective criteria,” Dr. Fazio said. “Everyone should know what it means when we talk about educating and training ‘good doctors.’”

“We will all be patients one day,” she added. “We have to think about what kind of doctors we want to have now and in the future.”

Read More..

Doctor and Patient: Why Failing Med Students Don’t Get Failing Grades

Tall and dark-haired, the third-year medical student always seemed to be the first to arrive at the hospital and the last to leave, her white coat perpetually weighed down by the books and notes she jammed into the pockets. She appeared totally absorbed by her work, even exhausted at times, and said little to anyone around her.

Except when she got frustrated.

I first noticed her when I overheard her quarreling with a nurse. A few months later I heard her accuse another student of sabotaging her work. And then one morning, I saw her storm off the wards after a senior doctor corrected a presentation she had just given. “The patient never told me that!” she cried. The nurses and I stood agape as we watched her stamp her foot and walk away.

“Why don’t you just fail her?” one of the nurses asked the doctor.

“I can’t,” she sighed, explaining that the student did extremely well on all her tests and worked harder than almost anyone in her class. “The problem,” she said, “is that we have no multiple choice exams when it comes to things like clinical intuition, communication skills and bedside manner.”

Medical educators have long understood that good doctoring, like ducks, elephants and obscenity, is easy to recognize but difficult to quantify. And nowhere is the need to catalog those qualities more explicit, and charged, than in the third year of medical school, when students leave the lecture halls and begin to work with patients and other clinicians in specialty-based courses referred to as “clerkships.” In these clerkships, students are evaluated by senior doctors and ranked on their nascent doctoring skills, with the highest-ranking students going on to the most competitive training programs and jobs.

A student’s performance at this early stage, the traditional thinking went, would be predictive of how good a doctor she or he would eventually become.

But in the mid-1990s, a group of researchers decided to examine grading criteria and asked directors of internal medicine clerkship courses across the country how accurate and consistent they believed their grading to be. Nearly half of the course directors believed that some form of grade inflation existed, even within their own courses. Many said they had increasing difficulty distinguishing students who could not achieve a “minimum standard,” whatever that might be. And over 40 percent admitted they had passed students who should have failed their course.

The study inspired a series of reforms aimed at improving how medical educators evaluated students at this critical juncture in their education. Some schools began instituting nifty mnemonics like RIME, or Reporter-Interpreter-Manager-Educator, for assessing progressive levels of student performance; others began to call regular meetings to discuss grades; still others compiled detailed evaluation forms that left little to the subjective imagination.

Now a new study published last month in the journal Teaching and Learning in Medicine looks at the effects of these many efforts on the grading process. And while the good news is that the rate of grade inflation in medical schools is slower than in colleges and universities, the not-so-good news is that little has changed. A majority of clerkship directors still believe that grade inflation is an issue even within their own courses; and over a third believe that students have passed their course who probably should have failed.

“Grades don’t have a lot of meaning,” said Dr. Sara B. Fazio, lead author of the paper and an associate professor of medicine at Harvard Medical School who leads the internal medicine clerkship at the Beth Israel Deaconess Medical Center in Boston. “‘Satisfactory’ is like the kiss of death.”

About a quarter of the course directors surveyed believed that grade inflation occurred because senior doctors were loath to deal with students who could become angry, upset or even turn litigious over grades. Some confessed to feeling pressure to help students get into more selective internships and training programs.

But for many of these educators, the real issue was not flunking the flagrantly unprofessional student, but rather evaluating and helping the student who only needed a little extra help in transitioning from classroom problem sets to real world patients. Most faculty received little or no training or support in evaluating students, few came from institutions that had remediation programs to which they could direct students, and all worked under grading systems that were subjective and not standardized.

Despite the disheartening findings, Dr. Fazio and her co-investigators believe that several continuing initiatives may address the evaluation issues. For example, residency training programs across the country will soon be assessing all doctors-in-training with a national standards list, a series of defined skills, or “competencies,” in areas like interpersonal communication, professional behavior and specialty-specific procedures. Over the next few years, medical schools will likely be adopting a similar system for medical students, creating a national standard for all institutions.

“There have to be unified, transparent and objective criteria,” Dr. Fazio said. “Everyone should know what it means when we talk about educating and training ‘good doctors.’”

“We will all be patients one day,” she added. “We have to think about what kind of doctors we want to have now and in the future.”

Read More..

DealBook: As Losses Mount, R.B.S. Unveils Plan to Sell Assets

LONDON – The Royal Bank of Scotland, hammered by losses, announced plans on Thursday to sell assets and pare back its investment banking business, in an effort to appease regulators and its biggest shareholder, the British government.

R.B.S. said it planned to sell a stake in the Citizens Financial Group, the American lender it bought in 1988, through an initial public offering in two years. The bank will also continue to reduce its investment banking operations, with plans to cut risky assets and eliminate jobs.

The moves are designed to help bolster the bank’s capital levels and refocus its operations, part of a multiyear turnaround effort initiated by its chief executive, Stephen Hester. In the end, R.B.S. will emerge a much smaller bank, largely focused on Britain.

“R.B.S. is four years into its recovery plan,” Mr. Hester said in a statement, “and good progress has been made. We are a much smaller, more focused and stronger bank. Our target is for 2013 to be the last big year of restructuring.”

Like many rivals, R.B.S. is struggling with the legacy of the financial crisis and a spate of legal issues. On Thursday, it reported a bigger-than-expected loss, in part tied to its legal troubles.

The bank, in which the British government holds an 82 percent stake after a bailout in 2008, posted a net loss of £5.97 billion ($9 billion) in 2012, much larger than the £2 billion loss recorded in 2011. Analysts had been expecting a loss of £5.1 billion. For the last quarter of 2012, R.B.S. reported a £2.6 billion loss, up from a £1.8 billion loss in the period a year earlier.

The rising losses reflect the bank’s regulatory and legal problems.

R.B.S. said on Thursday that it had set aside an additional £1.1 billion to compensate clients to which it improperly sold insurance products, bringing the total provision to £2.2 billion. It also estimated it would have to pay £700 million to compensate small businesses to which it improperly sold some interest-rate hedging products.

The bank agreed this year to pay $612 million to British and American authorities to settle accusations of rate-rigging. Since then, Mr. Hester has promised to tighten controls at the bank to limit the risk of future rate manipulation.

The head of R.B.S.’s investment banking division, John Hourican, resigned at the beginning of February as a result of the scandal related to manipulating the London interbank offered rate, or Libor. The bank plans to pay its fine with money clawed back from bonuses.

‘‘Along with the rest of the banking industry we faced significant reputational challenges,’’ Mr. Hester said in the statement. ‘‘We are determined to overcome the cultural and reputational baggage of precrisis times with the same focus we have applied to the financial cleanup from that era.’’

Eager to get back some of the £45.5 billion it invested in R.B.S., the British government recently increased pressure on the bank’s management to speed up the reorganization.

Some analysts said the government could start selling parts of its investment in the bank, even at a loss, before the next general election, which is set for 2015. R.B.S.’s shares are still trading at about half what the government paid for them in 2008. Some lawmakers said they would favor handing out shares to the public instead of a possible sale of the stake on the open market.

Richard Hunter, head of equities at Hargreaves Lansdown Stockbrokers, said there were signs that Mr. Hester’s efforts to turn around the bank had started to pay off, but that “the ongoing absence of a dividend and overhang of the government stake are negatives which need to be resolved.”

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The Lede: Video of Pope Benedict’s Public Farewell

During his final farewell address, Pope Benedict XVI describes the joys and challenges of his papacy via CNN on YouTube.

As our colleagues, Rachel Donadio and Alan Cowell report, Pope Benedict XVI held his final general audience in St. Peter’s Square on Wednesday, a day before he withdraws from the public for a cloistered life of prayer and meditation.

Before tens of thousands of people gathered in the square, the pope acknowledged the difficulties he faced during his papacy, describing “moments of joy and light but also moments that were not easy.” At times, when the “seas were rough”, he said that “the Lord seemed to sleep.”

From the full text of his address:

When, almost eight years ago, on April 19th, [2005], I agreed to take on the Petrine ministry, I held steadfast in this certainty, which has always accompanied me. In that moment, as I have already stated several times, the words that resounded in my heart were: “Lord, what do you ask of me? It a great weight that You place on my shoulders, but, if You ask me, at your word I will throw out the nets, sure that you will guide me” – and the Lord really has guided me. He has been close to me: daily could I feel His presence.

[These years] have been a stretch of the Church’s pilgrim way, which has seen moments joy and light, but also difficult moments. I have felt like St. Peter with the Apostles in the boat on the Sea of Galilee: the Lord has given us many days of sunshine and gentle breeze, days in which the catch has been abundant; [then] there have been times when the seas were rough and the wind against us, as in the whole history of the Church it has ever been – and the Lord seemed to sleep. Nevertheless, I always knew that the Lord is in the barque, that the barque of the Church is not mine, not ours, but His – and He shall not let her sink. It is He, who steers her: to be sure, he does so also through men of His choosing, for He desired that it be so. This was and is a certainty that nothing can tarnish. It is for this reason, that today my heart is filled with gratitude to God, for never did He leave me or the Church without His consolation, His light, His love.

An English translation from the Vatican of Pope Benedict XVI’s last general audience before his formal resignation on Thursday.

On Twitter, the pope’s account, @Pontifex, which has more than 1.5 million followers, posted:

If only everyone could experience the joy of being Christian, being loved by God who gave his Son for us!

— Benedict XVI (@Pontifex) 27 Feb 13

Shortly after he announced his resignation, he asked on Twitter for people “to pray for me and for the church, trusting as always in divine providence.”

From St. Peter’s Square, people posted photographs from the crowd, including a shot of the pope arriving in the so-called popemobile, on his way to deliver his final farewell.

St. Peter’s Square completely full of people! #vatican #pope #last #speaking http://t.co/m2RBoGNDJy

— Marko Style (@MarkoStyle44) 27 Feb 13

This is how close I got to the Pope http://t.co/BfOXkddkrE

— Becca Liudzius (@becksky123) 27 Feb 13

As my colleague, Laurie Goodstein reports, the church faces, among its many challenges as cardinals gather to select a new pope, the wounds caused by sexual abuse cases involving minors all over the world that have been mishandled for years.

In St. Peter’s Square, the pope also spoke briefly in English to the crowd.

The pope spoke in English, and asked Catholics to pray for both him and the new pope.

I offer a warm and affectionate greeting to the English-speaking pilgrims and visitors who have joined me for this, my last General Audience. Like Saint Paul, whose words we heard earlier, my heart is filled with thanksgiving to God who ever watches over his Church and her growth in faith and love, and I embrace all of you with joy and gratitude. During this Year of Faith, we have been called to renew our joyful trust in the Lord’s presence in our lives and in the life of the Church. I am personally grateful for his unfailing love and guidance in the eight years since I accepted his call to serve as the Successor of Peter. I am also deeply grateful for the understanding, support and prayers of so many of you, not only here in Rome, but also throughout the world.

The decision I have made, after much prayer, is the fruit of a serene trust in God’s will and a deep love of Christ’s Church. I will continue to accompany the Church with my prayers, and I ask each of you to pray for me and for the new Pope. In union with Mary and all the saints, let us entrust ourselves in faith and hope to God, who continues to watch over our lives and to guide the journey of the Church and our world along the paths of history. I commend all of you, with great affection, to his loving care, asking him to strengthen you in the hope which opens our hearts to the fullness of life that he alone can give. To you and your families, I impart my blessing. Thank you!

The identity of the new pope will revealed from this balcony after the conclave, likely within 2 weeks. http://t.co/40Q9oWAz3f

— Eric Reguly (@ereguly) 27 Feb 13

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Groupon Shares Fall 25% in Late Trading

CHICAGO (AP) — Groupon, the online deals company, posted a larger-than-expected fourth-quarter loss on Wednesday and a weaker-than-expected revenue outlook, sending its shares down more than 25 percent in after-hours trading.

The forecast fed investor worry that people were tiring of the many online restaurant, spa and Botox deals that Groupon built its business on, and that the company’s efforts to broaden into an e-commerce powerhouse had not been paying off.

Groupon, based in Chicago, booked a loss of $81.1 million, or 12 cents a share, in the October to December period. That compares with a loss of $65.4 million, also 12 cents a share, in the fourth quarter a year earlier, when it had fewer shares outstanding.

Analysts expected a loss of 2 cents a share, according to FactSet.

Revenue rose 30 percent to $638.3 million from $492.2 million. Wall Street expected revenue of $639.8 million.

For the current quarter, Groupon expects revenue of $560 million to $610 million, which translates to a range of flat to 9 percent higher than in the year-earlier period. Analysts expected revenue of $646.8 million.

Gross billings, a closely watched figure that shows the total amount customers spent on Groupon’s deals, increased 24 percent in the quarter to $1.52 billion from $1.23 billion a year earlier.

“Record billings growth this quarter is a clear signal that customers love Groupon,” said Andrew Mason, the company’s chief executive, in a statement. “We will continue to invest in growth through 2013 as we see new opportunities to give our customers what they want.”

Groupon’s stock fell as much as $1.56 to $4.41 in after-hours trading. Earlier, the stock closed up 43 cents at $5.98 before the release of the earnings report.

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Global Health: After Measles Success, Rwanda to Get Rubella Vaccine

Rwanda has been so successful at fighting measles that next month it will be the first country to get donor support to move to the next stage — fighting rubella too.

On March 11, it will hold a nationwide three-day vaccination campaign with a combined measles-rubella vaccine, hoping to reach nearly five million children up to age 14. It will then integrate the dual vaccine into its national health service.

Rwanda can do so “because they’ve done such a good job on measles,” said Christine McNab, a spokeswoman for the Measles and Rubella Initiative. M.R.I. helped pay for previous vaccination campaigns in the country and the GAVI Alliance is helping to finance the upcoming one.

Rubella, also called German measles, causes a rash that is very similar to the measles rash, making it hard for health workers to tell the difference.

Rubella is generally mild, even in children, but in pregnant women, it can kill the fetus or cause serious birth defects, including blindness, deafness, mental retardation and chronic heart damage.

Ms. McNab said that Rwanda had proved that it can suppress measles and identify rubella, and it would benefit from the newer, more expensive vaccine.

The dual vaccine costs twice as much — 52 cents a dose at Unicef prices, compared with 24 cents for measles alone. (The MMR vaccine that American children get, which also contains a vaccine against mumps, costs Unicef $1.)

More than 90 percent of Rwandan children now are vaccinated twice against measles, and cases have been near zero since 2007.

The tiny country, which was convulsed by Hutu-Tutsi genocide in 1994, is now leading the way in Africa in delivering medical care to its citizens, Ms. McNab said. Three years ago, it was the first African country to introduce shots against human papilloma virus, or HPV, which causes cervical cancer.

In wealthy countries, measles kills a small number of children — usually those whose parents decline vaccination. But in poor countries, measles is a major killer of malnourished infants. Around the world, the initiative estimates, about 158,000 children die of it each year, or about 430 a day.

Every year, an estimated 112,000 children, mostly in Africa, South Asia and the Pacific islands, are born with handicaps caused by their mothers’ rubella infection.

Thanks in part to the initiative — which until last year was known just as the Measles Initiative — measles deaths among children have declined 71 percent since 2000. The initiative is a partnership of many health agencies, vaccine companies, donors and others, but is led by the American Red Cross, the United Nations Foundation, the Centers for Disease Control and Prevention, Unicef and the World Health Organization.

This article has been revised to reflect the following correction:

Correction: February 27, 2013

An earlier version of this article misstated the source of the vaccine and some financing for the campaign. The vaccine and financing is being provided by the GAVI Alliance, not the Measles and Rubella Initiative.

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