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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DealBook: Court Approves Dewey Bankruptcy Plan, Officially Dissolving Firm

Nine months ago, when it filed the largest law firm bankruptcy case in United States history, Dewey & LeBoeuf effectively ceased to exist. But its carcass has languished in court, as restructuring experts handled the messy task of unwinding the firm and negotiating a plan to pay back its creditors.

On Wednesday, a federal bankruptcy judge confirmed that plan, a decision that officially dissolved Dewey, the once-venerable law firm that collapsed after financial problems led to an exodus of its partners.

“The court is very pleased,” said Judge Martin Glenn at the end of a three-hour hearing before a packed courtroom. “I want to congratulate all the professionals.”

Dewey’s liquidation plan lays out how its estate will compensate creditors, which have claims totaling about $550 million. At the heart of the proposal is an innovative arrangement under which about 450 former Dewey partners agreed to return a portion of their pay, raising about $72 million for creditors.

By accepting the deal, former Dewey partners insulate themselves from future lawsuits connected to the firm’s demise.

Al Togut, Dewey’s lead bankruptcy lawyer, who has been involved in a number of law firm bankruptcies, said that the winding down of Dewey had moved far more swiftly — and less contentiously — than previous liquidations of other large law firms.

“Here we are about to make history,” said Mr. Togut, just before Judge Glenn approved the plan. “This the diametric opposite of Finley Kumble, which took 20 years, or Shea & Gould, which took nine years, and even the modern-day Coudert Brothers case, which still isn’t done.”

Also not done is a criminal investigation into possible financial misconduct at Dewey. Steven H. Davis, the firm’s former chairman, and Stephen DiCarmine, the former executive director, are the focus of an investigation by the Manhattan district attorney’s office.

Prosecutors recently indicated that the inquiry was still active when it raised the issue that Mr. Davis’s criminal lawyer, Barry A. Bohrer, had a conflict of interest in representing him, according to a person with direct knowledge of the investigation.

The unusual situation arose earlier this month after Mr. Bohrer left his law firm, Morvillo, Abramowitz, Grand, Iason, Anello & Bohrer, for another firm, Schulte Roth & Zabel. That posed a conflict of interest, the district attorney’s office advised, because Schulte Roth represented JPMorgan Chase, a Dewey lender and possible victim, in the criminal inquiry, this person said.

Mr. Bohrer declined to comment, and Mr. Davis has previously denied any wrongdoing. Ned Bassen, a lawyer for Mr. DiCarmine, said that his client had done nothing wrong, either criminally or civilly.

While the government investigation continues, the judge’s ruling is the coda of the Chapter 11 case.

Trustees will now begin the process of returning money to Dewey’s creditors, which include the firm’s lenders Citigroup and JPMorgan, as well as a car service company and an executive recruiter. A large portion of the recovery, in addition to the former Dewey partners’ contributions, will come from collecting Dewey’s outstanding legal invoices.

The hearing lacked the drama that many participants had expected after a number of onetime Dewey partners filed protests to the plan this month. Two former Dewey partners accused Martin J. Bienenstock, the former head of Dewey’s bankruptcy practice, of devising a plan that paid him $6 million in 2010 while the pay of rank-and-file partners was deferred and ultimately was subject to being clawed back.

That objection, along with a handful of others, was withdrawn just hours before the session, allowing for a smooth confirmation hearing.

In an e-mail, Mr. Bienenstock, now a partner at the law firm Proskauer Rose, congratulated the advisers on what he called “the most successful and fastest law firm bankruptcy case.” But he criticized those who tried to block the plan.

“A small number of former partners tried to get special deals for themselves by making vicious accusations of fraud against the executive committee that structured the bankruptcy, having zero basis in fact, and predictably no wrongful conduct was proven,” Mr. Bienenstock said.

During the court session, Mr. Togut praised the former Dewey lawyers who signed on to the so-called partnership contribution plan, which he called “a template for future cases.”

The deal forced them to return a portion of their pay, in amounts based on a complex formula tied to their compensation. Those payments range from a minimum of $5,000 for retired partners to $3.5 million for the firm’s highest-paid lawyers.

“What makes this case so important is that this is the first time that such a large and diverse group of law partners accepted responsibility for their failed firm,” Mr. Togut said. “And they did it while they were still hurting, just after the firm failed, while they were trying to start their career and soothe unhappy spouses.”

Most former partners of Dewey, a firm that at its peak had nearly 1,400 lawyers across 26 offices globally, have landed on their feet. About 300 Dewey partners sought new employment as the firm failed; nearly all of them found homes at other large corporate firms. Winston & Strawn hired 23, led by the sports-industry litigator Jeffrey Kessler. Proskauer brought on 13 former Dewey partners.

Though the formal bankruptcy process has ended, the legal fallout from Dewey’s implosion is not over. In addition to the criminal investigation, several Dewey-related civil lawsuits are wending their way through the courts. One former partner has sued Citigroup, accusing the bank of conspiring with Dewey to hide the law firm’s true financial condition in the months before its collapse. A Citigroup spokeswoman declined to comment.

While most of the firm’s lawyers have found other employment and the bankruptcy process was declared a success, Mr. Togut on Wednesday acknowledged the sadness of Dewey’s demise.

“They say that a good settlement is where no one is happy,” Mr. Togut said. “Well, I can assure you, no one is happy.”

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U.S. Officials Propose Sharing Drone Surveillance Data With Algerian Forces

Hussein Malla/Associated Press

In a cave in Idlib Province, Free Syrian Army fighters did a traditional dance and sang songs critical of President Bashar al-Assad.

 WASHINGTON — The American ambassador to Algeria and senior counterterrorism officials have proposed sharing more information with Algerian security forces to help them kill or capture militants in their own country and in areas just across their borders.

Their approach reflects the growing support within the administration for more forceful action against extremists in the area since the attack on a gas field in eastern Algeria last month left 37 dead, including three Americans, and focused new concerns on terrorist activity in Africa.

Under one plan, information from American surveillance drones would be provided to Algerian forces to enable them to engage in operations both inside Algeria and possibly, in a limited way, across its borders. The United States is already providing surveillance information to the French-led military operation in Mali to help combat militants there who last year seized the northern half of the country.

In a cable to the State Department last week, according to administration officials, Henry S. Ensher, the United States envoy in Algiers, urged that the pursuit of the Algerian militant Mokhtar Belmokhtar, the mastermind of the gas field attack, be made a priority. Toward that end, he recommended that the Obama administration tell the Algerians that if they allowed the United States to fly unarmed drones over the border area of Algeria as well as over Mali, the Americans would share the information with the Algerian government.

There was broad agreement among policy makers and intelligence officials at a meeting of President Obama’s top national security deputies at the White House last week that Mr. Belmokhtar and members of Al Qaeda in the Islamic Maghreb should be aggressively pursued, according to one senior American official who insisted on anonymity so he could discuss internal deliberations. But no decision appears to have been reached on whether to make a formal proposal to the Algerians.

The idea of taking stronger action in the region has been supported in recent months by Michael Sheehan, the senior counterterrorism official at the Pentagon, and Daniel Benjamin, who until December was the senior State Department counterterrorism official. In the past, State Department lawyers have questioned whether the military action approved by Congress against Al Qaeda after the Sept. 11, 2001, attacks authorized efforts to target extremists who were not clearly linked to the group. But according to some officials, those legal arguments  have recently been overcome.  

The United States has long sought Algeria’s cooperation in antiterrorism efforts, and sharing information with a government that has jealously guarded its sovereignty would be a significant step toward that goal. During the siege of the gas plant at In Amenas, Algeria permitted the United States to fly a Predator surveillance drone over the complex, though it insisted that the drone be withdrawn after the assault was over.  

Mr. Obama announced last week that about 100 American troops had arrived in Niger in West Africa, next to Mali, to set up a new drone base to conduct surveillance flights in the region.

American officials also sense a possible change of heart by Algerian officials to move away from their longstanding policy not to conduct military operations outside the nation’s borders. Algerian officials recently told the United States that they were prepared to conduct operations in border areas, one American official said.

Mr. Belmokhtar, 40 — sometimes known as “Laaouar,” or the one-eyed, after he lost an eye to shrapnel —  was deemed to be a menace long before he drew international attention for last month’s attack. As the Algerians pressed their campaign against the militants, he took refuge in Mali, where he engaged in smuggling and kidnapped foreigners for ransom, including Robert Fowler, a Canadian diplomat and United Nations special envoy who was abducted in 2008.

By the spring of 2012, northern Mali had become a gathering place for Al Qaeda in the Islamic Maghreb. Other militant factions in northern Mali included Ansar al-Dine, a group largely made up of members of Mali’s nomadic Tuareg minority. Its leader, Iyad ag Ghali, has been officially designated as a global terrorist, the State Department announced  Tuesday.  The growing extremist presence in Mali became an increasing concern for Mr. Ensher as well as for Gen. Carter F. Ham, the head of the Africa Command, and counterterrorism officials at the Pentagon and the State Department.

Michael R. Gordon and Eric Schmitt reported from Washington. Mark Landler contributed reporting from Washington and Adam Nossiter from Lagos, Nigeria.

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Gadgetwise Blog: App Smart Extra: More Slide Show Apps

Last week in App Smart I talked about the many apps that promise to turn photos from your smartphone or tablet’s digital photo album into an attractive photo slide show. These apps make looking at digital photos of a vacation, or perhaps an event like a wedding, into the modern equivalent of flipping through a photo album.

On iOS, one powerful app for creating dynamic photo slide shows is ProShow (free on iTunes). The interface is easy to use, and the app tries to do much of the fiddly stuff involved in creating a new slide show by offering you themes. These themes automatically adjust settings like special effects between slides and background images. You can manually change these settings later if you prefer. The app can even include video clips. The app does require that you sign up for the company’s services, free, but this minor inconvenience gives you access to its Web site. There you can edit your slide shows and also view them online — a great option for sharing your slide show efforts with friends.

One neat option for Android is the $1 app Slideshow 5000. This app creates an unusual kind of slide show: the photos look as if they are being tossed onto a table while a camera pans above the table’s surface. Each photo is animated as if it were really falling, and even casts a shadow. You can adjust the background image and turn each of your images into a faux Polaroid snap, and it’s easy to select the photos you want. You can even turn the photo slide show into your device’s live Android wallpaper. But the show it produces is more for casual fun; it’s not really ideal for sharing treasured memories.

A simpler option for Android is the free app Slideshow Bob. This app is limited to showing photos from folders on your device, and you can’t organize them inside the app because you’re limited to sorting the photos by parameters like date or title. It does, however, have some transition options, and when it’s displaying the slide shows, it does so elegantly.

Many apps for smartphones and tablets can create photo slide shows, but their quality varies widely. I found it hard to find sophisticated apps that offer a lot of slide show control on Android devices. Luckily, many have a free or “lite” edition, meaning you could try out several before you buy.

Quick call: Lego Galaxy Squad Bug Battle is a new free game for iOS devices. It’s a 2-D scrolling space shooter that combines all the gaming fun of this genre with Lego’s cute imagery. The mission is to save humans by squashing the alien bugs. It will keep you amused when you have the odd five minutes to spare.

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Advanced Breast Cancer May Be Rising Among Young Women, Study Finds

The incidence of advanced breast cancer among younger women, ages 25 to 39, may have increased slightly over the last three decades, according to a study released Tuesday.

But more research is needed to verify the finding, which was based on an analysis of statistics, the study’s authors said. They do not know what may have caused the apparent increase.

Some outside experts questioned whether the increase was real, and expressed concerns that the report would frighten women needlessly.

The study, published in The Journal of the American Medical Association, found that advanced cases climbed to 2.9 per 100,000 younger women in 2009, from 1.53 per 100,000 women in 1976 — an increase of 1.37 cases per 100,000 women in 34 years. The totals were about 250 such cases per year in the mid-1970s, and more than 800 per year in 2009.

Though small, the increase was statistically significant, and the researchers said it was worrisome because it involved cancer that had already spread to organs like the liver or lungs by the time it was diagnosed, which greatly diminishes the odds of survival.

For now, the only advice the researchers can offer to young women is to see a doctor quickly if they notice lumps, pain or other changes in the breast, and not to assume that they cannot have breast cancer because they are young and healthy, or have no family history of the disease.

“Breast cancer can and does occur in younger women,” said Dr. Rebecca H. Johnson, the first author of the study and medical director of the adolescent and young adult oncology program at Seattle Children’s Hospital.

But Dr. Johnson noted that there is no evidence that screening helps younger women who have an average risk for the disease and no symptoms. “We’re certainly not advocating that young women get mammography at an earlier age than is generally specified,” she said.

Expert groups differ about when screening should begin; some say at age 40, others 50.

Breast cancer is not common in younger women; only 1.8 percent of all cases are diagnosed in women from 20 to 34, and 10 percent in women from 35 to 44. However, when it does occur, the disease tends to be more deadly in younger women than in older ones. Researchers are not sure why.

The researchers analyzed data from SEER, a program run by the National Cancer Institute to collect cancer statistics on 28 percent of the population of the United States. The study also used data from the past when SEER was smaller.

The study is based on information from 936,497 women who had breast cancer from 1976 to 2009. Of those, 53,502 were 25 to 39 years old, including 3,438 who had advanced breast cancer, also called metastatic or distant disease.

Younger women were the only ones in whom metastatic disease seemed to have increased, the researchers found.

Dr. Archie Bleyer, a clinical research professor in radiation medicine at the Knight Cancer Institute at the Oregon Health and Science University in Portland who helped write the study, said scientists needed to verify the increase in advanced breast cancer in young women in the United States and find out whether it is occurring in other developed Western countries. “This is the first report of this kind,” he said, adding that researchers had already asked colleagues in Canada to analyze data there.

“We need this to be sure ourselves about this potentially concerning, almost alarming trend,” Dr. Bleyer said. “Then and only then are we really worried about what is the cause, because we’ve got to be sure it’s real.”

Dr. Johnson said her own experience led her to look into the statistics on the disease in young women. She had breast cancer when she was 27; she is now 44. Over the years, friends and colleagues often referred young women with the disease to her for advice.

“It just struck me how many of those people there were,” she said.

Dr. Donald A. Berry, an expert on breast cancer data and a professor of biostatistics at the University of Texas’ M. D. Anderson Cancer Center in Houston, said he was dubious about the finding, even though it was statistically significant, because the size of the apparent increase was so small — 1.37 cases per 100,000 women, over the course of 30 years.

More screening and more precise tests to identify the stage of cancer at the time of diagnosis might account for the increase, he said.

“Not many women aged 25 to 39 get screened, but some do, but it only takes a few to account for a notable increase from one in 100,000,” Dr. Berry said.

Dr. Silvia C. Formenti, a breast cancer expert and the chairwoman of radiation oncology at New York University Langone Medical Center, questioned the study in part because although it found an increased incidence of advanced disease, it did not find the accompanying increase in deaths that would be expected.

A spokeswoman for an advocacy group for young women with breast cancer, Young Survival Coalition, said the organization also wondered whether improved diagnostic and staging tests might explain all or part of the increase.

“We’re looking at this data with caution,” said the spokeswoman, Michelle Esser. “We don’t want to invite panic or alarm.”

She said it was important to note that the findings applied only to women who had metastatic disease at the time of diagnosis, and did not imply that women who already had early-stage cancer faced an increased risk of advanced disease.

Dr. J. Leonard Lichtenfeld
, deputy chief medical officer of the American Cancer Society, said he and an epidemiologist for the society thought the increase was real.

“We want to make sure this is not oversold or that people suddenly get very frightened that we have a huge problem,” Dr. Lichtenfeld said. “We don’t. But we are concerned that over time, we might have a more serious problem than we have today.”

Read More..

Advanced Breast Cancer May Be Rising Among Young Women, Study Finds

The incidence of advanced breast cancer among younger women, ages 25 to 39, may have increased slightly over the last three decades, according to a study released Tuesday.

But more research is needed to verify the finding, which was based on an analysis of statistics, the study’s authors said. They do not know what may have caused the apparent increase.

Some outside experts questioned whether the increase was real, and expressed concerns that the report would frighten women needlessly.

The study, published in The Journal of the American Medical Association, found that advanced cases climbed to 2.9 per 100,000 younger women in 2009, from 1.53 per 100,000 women in 1976 — an increase of 1.37 cases per 100,000 women in 34 years. The totals were about 250 such cases per year in the mid-1970s, and more than 800 per year in 2009.

Though small, the increase was statistically significant, and the researchers said it was worrisome because it involved cancer that had already spread to organs like the liver or lungs by the time it was diagnosed, which greatly diminishes the odds of survival.

For now, the only advice the researchers can offer to young women is to see a doctor quickly if they notice lumps, pain or other changes in the breast, and not to assume that they cannot have breast cancer because they are young and healthy, or have no family history of the disease.

“Breast cancer can and does occur in younger women,” said Dr. Rebecca H. Johnson, the first author of the study and medical director of the adolescent and young adult oncology program at Seattle Children’s Hospital.

But Dr. Johnson noted that there is no evidence that screening helps younger women who have an average risk for the disease and no symptoms. “We’re certainly not advocating that young women get mammography at an earlier age than is generally specified,” she said.

Expert groups differ about when screening should begin; some say at age 40, others 50.

Breast cancer is not common in younger women; only 1.8 percent of all cases are diagnosed in women from 20 to 34, and 10 percent in women from 35 to 44. However, when it does occur, the disease tends to be more deadly in younger women than in older ones. Researchers are not sure why.

The researchers analyzed data from SEER, a program run by the National Cancer Institute to collect cancer statistics on 28 percent of the population of the United States. The study also used data from the past when SEER was smaller.

The study is based on information from 936,497 women who had breast cancer from 1976 to 2009. Of those, 53,502 were 25 to 39 years old, including 3,438 who had advanced breast cancer, also called metastatic or distant disease.

Younger women were the only ones in whom metastatic disease seemed to have increased, the researchers found.

Dr. Archie Bleyer, a clinical research professor in radiation medicine at the Knight Cancer Institute at the Oregon Health and Science University in Portland who helped write the study, said scientists needed to verify the increase in advanced breast cancer in young women in the United States and find out whether it is occurring in other developed Western countries. “This is the first report of this kind,” he said, adding that researchers had already asked colleagues in Canada to analyze data there.

“We need this to be sure ourselves about this potentially concerning, almost alarming trend,” Dr. Bleyer said. “Then and only then are we really worried about what is the cause, because we’ve got to be sure it’s real.”

Dr. Johnson said her own experience led her to look into the statistics on the disease in young women. She had breast cancer when she was 27; she is now 44. Over the years, friends and colleagues often referred young women with the disease to her for advice.

“It just struck me how many of those people there were,” she said.

Dr. Donald A. Berry, an expert on breast cancer data and a professor of biostatistics at the University of Texas’ M. D. Anderson Cancer Center in Houston, said he was dubious about the finding, even though it was statistically significant, because the size of the apparent increase was so small — 1.37 cases per 100,000 women, over the course of 30 years.

More screening and more precise tests to identify the stage of cancer at the time of diagnosis might account for the increase, he said.

“Not many women aged 25 to 39 get screened, but some do, but it only takes a few to account for a notable increase from one in 100,000,” Dr. Berry said.

Dr. Silvia C. Formenti, a breast cancer expert and the chairwoman of radiation oncology at New York University Langone Medical Center, questioned the study in part because although it found an increased incidence of advanced disease, it did not find the accompanying increase in deaths that would be expected.

A spokeswoman for an advocacy group for young women with breast cancer, Young Survival Coalition, said the organization also wondered whether improved diagnostic and staging tests might explain all or part of the increase.

“We’re looking at this data with caution,” said the spokeswoman, Michelle Esser. “We don’t want to invite panic or alarm.”

She said it was important to note that the findings applied only to women who had metastatic disease at the time of diagnosis, and did not imply that women who already had early-stage cancer faced an increased risk of advanced disease.

Dr. J. Leonard Lichtenfeld
, deputy chief medical officer of the American Cancer Society, said he and an epidemiologist for the society thought the increase was real.

“We want to make sure this is not oversold or that people suddenly get very frightened that we have a huge problem,” Dr. Lichtenfeld said. “We don’t. But we are concerned that over time, we might have a more serious problem than we have today.”

Read More..

BP Executive Testifies That Rig Explosion Was Known Risk

NEW ORLEANS — On the first day of testimony in the BP Gulf of Mexico oil spill trial, BP’s top executive for North American operations at the time of the disaster acknowledged on Tuesday that a well explosion had been identified as a risk before it happened.

“There was a risk identified for a blowout,” said Lamar McKay, the former president of BP America and current chief executive in charge of global upstream operations. “The blowout was an identified risk, and it was a big risk, yes.”

Robert Cunningham, a lawyer for private plaintiffs, tried to pin down Mr. McKay on BP’s responsibility for the 2010 disaster that killed 11 workers and dumped millions of barrels of oil into the gulf. Mr. Cunningham suggested that the British company’s cost-cutting and risk-taking culture were at the heart of the explosion and spill. He pressed Mr. McKay on the fact that a BP report on the accident held contractors responsible, but did not cite management failures.

Mr. McKay repeatedly responded that BP was responsible for designing the well, but that the rig, cement and other contractors shared responsibility for safety on the drilling operations.

“It’s a team effort,” he said. “It’s a shared responsibility to manage the safety and risk.”

Mr. McKay testified for more than an hour at the end of the day and will continue on Wednesday. He told the court that there were risks involved with drilling both in deep waters and in shallow waters, but that a blowout could be more difficult to control, and therefore more damaging, in deep waters. There was little, if anything, in his comments that diverged from what BP executives have said in the past.

After the April 2010 spill, internal BP documents showed that the company had struggled with a loss of “well control” in March, after several weeks of problems on the rig. And for months before that, it had been concerned about the well casing and the blowout preventer, which are considered critical pieces in the chain of events that led to the disaster.

On June 22, 2009, for example, BP engineers expressed concerns that the metal casing the company wanted to use might collapse under high pressure.

“This would certainly be a worst-case scenario,” Mark E. Hafle, a senior drilling engineer at BP, warned in an internal report. “However, I have seen it happen so know it can occur.”

Early in his testimony, Mr. McKay shifted and appeared uncomfortable on the witness stand. He acknowledged that he had never read a textbook on safety system engineering before or after the accident, or a safety report written by a BP consultant who testified earlier in the day.

Mr. McKay was the second witness to appear in a multiphase trial that will determine who was responsible for the accident, whether they were grossly negligent and how much oil was spilled. He followed Robert Bea, a professor emeritus of engineering at the University of California, Berkeley, and former safety systems consultant for BP, who largely blamed the company’s culture for the accident.

“It’s a culture of every dollar counts,” Dr. Bea said. “It’s a classic failure of management and leadership.”

The Federal District Court trial in New Orleans is bundling suits brought by the Justice Department, state governments, private businesses and individual claimants against BP and several of its contractors. Decisions on culpability and damages could be a year or more away, but they are likely to have profound effects on environmental law and on the viability of BP as a major oil company with global ambitions.

Under the Clean Water Act, fines against BP could range from $1,100 for every barrel spilled through simple negligence to as much as $4,300 a barrel if the company were found to have been grossly negligent. The federal government has estimated that about four million barrels of oil were spilled, meaning liabilities of as much as $4.4 billion to $17.2 billion. BP has claimed that the amount spilled was at most 3.1 million barrels.

This article has been revised to reflect the following correction:

Correction: February 26, 2013

An earlier version of this article misstated Lamar McKay’s title when he headed BP America. He was president, not chief executive. Because of an editing error, the article also misstated the federal government’s estimate of the number of barrels spilled. It is about four million barrels, meaning a liability range of $4.4 billion to $17.2 billion, not 4.9 million barrels and a liability range of $5.4 billion to $21 billion.

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Little Clarity in Italian Vote, Aside from Anger

Italians Head to the Polls:
Italians voted Sunday and Monday in a general election that is being closely watched to see whether a clear winner will emerge.

ROME — Italian voters delivered a rousing anti-austerity message and a strong rebuke to the existing political order in national elections on Monday, plunging the country into political paralysis after results failed to produce a clear winner.

Analysts said that the best-case scenario would be shaky coalition government, which would once again expose Italy and the euro zone to turmoil if markets question its commitment to measures that have kept the budget deficit within a tolerable 3 percent of gross domestic product. News of the stalemate sent tremors through the financial world, sending the Dow Jones Industrial Average down more than 200 points.

Although analysts blamed the large protest vote on Italy’s political morass and troubled electoral system, the results were also seen as a rejection of the rapid deficit-reduction strategy set by the European Commission and European Central Bank — from a country too big to fail and too big to bail out.

“No doubt Italy has an imperfect political culture, but this election I think is the logical consequence of pursuing policies that have dramatically worsened the economic and social picture in Italy,” said Simon Tilford, the chief economist of the Center for European Reform, a London research institute.

“People have been warning that if they adhere to this policy there will be a political cost, there will be backlash,” he added. “It couldn’t have taken place in a more pivotal country.”

In an election marked by voter anger and low turnout, the center-left Democratic Party appeared to be leading in the Lower House with 29.6 percent, with 99 percent of the votes counted, and in the Senate with one-third of the votes counted by midnight local time.

But that outcome did not give the Democrats a clear victory because the center-right People of Liberty Party of former Prime Minister Silvio Berlusconi was leading in several populous regions that carry more Senate seats, potentially giving him veto power and raising the prospect of political gridlock.

 Even before the final result, the election was a clear victory for the Five Star Movement of the former comedian Beppe Grillo, which in its first-ever national elections appeared to win about 25 percent of the vote in the Lower House. Italians from both right and left — and the wealthier north and poorer south — were drawn to Mr. Grillo’s opposition to austerity measures and cries to oust the existing political order.

And it was a stinging defeat for the caretaker prime minister, Mario Monti, a newly minted politician whose lackluster civic movement appeared to win around 10 percent in both houses. “Grillo had a devastating success; the rest of the situation is very unclear,” said Stefano Folli, a political columnist for the daily business newspaper Il Sole 24 Ore.

Either the Democratic Party and the People of Liberty Party “will form a grand coalition committed to reforms and changing the electoral law, which would be very difficult, or Italy will be ungovernable,” Mr. Folli added.

Mr. Monti’s caretaker government remains in place with full powers until a new government is formed. Appearing on television on Monday evening, Mr. Monti said he felt “tremendous regret” that during his tenure the political parties were not able to change Italy’s electoral law so as to guarantee more political stability. “It is a great responsibility of the political forces, and one of the reasons for the disaffection and distance from and the revindication of the political class,” he added.

Under Italy’s complex electoral laws, it is extremely hard for any one party to gain a strong ruling majority needed to manage an economy with rising unemployment and a credit crunch, let alone push through structural changes to the ossified economy. Instead, the parties have resisted change to protect their own power bases. 

The results of this election would appear to represent new depths of gridlock, and few experts expected any party to form a governing coalition strong enough to prevail for long. Nicolas Véron, an economist and a senior fellow at Bruegel, a Brussels-based research institute, said that regardless of who ultimately controls the levers of government, “The key question is whether we can have serious structural reform.”

Italy “was a work in progress before the elections,” Mr. Véron added, “and I think investors understand that it will remain a work in progress for some time.”

Gaia Pianigiani contributed reporting from Rome, and Nicola Clark from Paris.

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HTC Settles F.T.C. Charges Over Security Flaws in Devices

WASHINGTON — More than 18 million smartphones and other mobile devices made by HTC, a Taiwanese company that is one of the largest sellers of smartphones in the United States, had security flaws that could allow location tracking of users against their will and the theft of personal information stored on their phones, federal officials said Friday.

The Federal Trade Commission charged HTC with customizing the software on its Android- and Windows-based phones in ways that let third-party applications install software that could steal personal information, surreptitiously send text messages or enable the device’s microphone to record the user’s phone calls.

The action is the first attempt by the commission to police a manufacturer of mobile devices. As smartphones and tablets become a common way for consumers to shop, bank and chat online, personal information and privacy will need to be guarded.

HTC America, based in Bellevue, Wash., agreed to settle the civil suit with the commission by issuing software patches that close the security holes, and by creating a security program that will be monitored by an independent party for the next 20 years. The F.T.C. does not have the authority to assess fines in consumer protection cases.

“The company didn’t design its products with security in mind,” Lesley Fair, a senior lawyer in the commission’s Bureau of Consumer Protection, wrote in a blog post. “HTC didn’t test the software on its mobile devices for potential security vulnerabilities, didn’t follow commonly accepted secure coding practices and didn’t even respond when warned about the flaws in its devices.”

An HTC official said Friday that the company had already started to update its software and distribute it to users of some, but not all, of the affected phones.

“Working with our carrier partners, we have addressed the identified security vulnerabilities on the majority of devices in the U.S. released after December 2010,” Sally Julien, an HTC spokeswoman, said in a statement. “We’re working to roll out the remaining software updates now and recommend customers download them once available.”

“Privacy and security are important,” the statement added, “and we are committed to improving practices that help safeguard our customers’ devices and data.”

The trade commission charged that the security flaws resulted from HTC’s modifying the operating system software used on most of the affected phones. In the case of Android, created by Google, the system is designed to protect sensitive information and phone functions through what is known as a permission-based security model.

That requires a user, when installing an application that is not a standard part of the operating system, to be notified and to agree that the application could gain access to certain information or functions.

HTC, however, preinstalled certain apps on its phones in a way that, in addition to preventing consumers from removing them, disabled the permission-based model and allowed newly installed apps to have immediate access to personal data.

“The analogy isn’t exact,” wrote Ms. Fair of the F.T.C., “but it’s like giving a friend the combination to a safe only to find out he’s handing it over to anyone who asks.”

That security hole could, for example, let the rogue software secretly record users’ phone conversations or track their location.

Flaws in the security system could also give third-party apps access to phone numbers, contents of text messages, browsing history and information like credit card numbers and banking transactions. Those flaws also affected HTC phones that used Windows-based operating systems.

While HTC’s actions introduced numerous security vulnerabilities to its phones, a commission official said it was not clear how many users experienced illegal incursions into their phones and personal information.

The flaw in the company’s phones has been known since at least 2011. HTC acknowledged the problems at that time and developed software patches for at least some of the deficiencies that year.

But the problems were far from minor. The F.T.C. said that text-message toll fraud, in which a hacker causes a phone to send text messages to a number that charges the user for delivery of the message, “is one of the most common types of Android malware,” or malicious software.

HTC’s user manuals either said or implied that a user was protected against malware because of the permission-based security, the commission said.

The commission will collect public comments on the proposed remedies for 30 days, after which it will decide whether to formally carry out the order. If HTC subsequently violates the order’s restrictions and requirements, it faces civil penalties of up to $16,000 a violation.

This article has been revised to reflect the following correction:

Correction: February 25, 2013

A picture with an earlier version of this article was published in error. The settlement between HTC and the F.T.C. involves phones running Windows Mobile; it did not involve the later operating system Windows 8, which the phone in the picture was running.

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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, which will provide the vaccine and help pay for the campaign.

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.

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