Mind: A Compromise on Defining and Diagnosing Mental Disorders





They plotted a revolution, fell to debating among themselves, and in the end overturned very little except their own expectations.




But the effort itself was a valuable guide for anyone who has received a psychiatric diagnosis, or anyone who might get one.


This month, the American Psychiatric Association announced that its board of trustees had approved the fifth edition of the association’s influential diagnostic manual — the so-called bible of mental disorders — ending more than five years of sometimes acrimonious, and often very public, controversy.


The committee of doctors appointed by the psychiatric association had attempted to execute a paradigm shift, changing how mental disorders are conceived and posting its proposals online for the public to comment. And comment it did: Patient advocacy groups sounded off, objecting to proposed changes in the definitions of depression and Asperger syndrome, among other diagnoses. Outside academic researchers did, too. A few committee members quit in protest.


The final text, which won’t be fully available until publication this spring, has already gotten predictably mixed reviews. “Given the challenges in a field where objective lines are hard to draw, they did a solid job,” said Dr. Michael First, a psychiatrist at Columbia who edited a previous version of the manual and was a consultant on this one.


Others disagreed. “This is the saddest moment in my 45-year career of practicing, studying and teaching psychiatry,” wrote Dr. Allen Frances, the chairman of a previous committee who has been one of the most vocal critics, in a blog post about the new manual, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM5.


Yet many experts inside and outside the process said the final document was not radically different from the previous version, and its lessons more mundane than the rhetoric implied. The status quo is hard to budge, for one. And when changes do happen, they are not necessarily the ones that were intended.


The new manual does extend the reach of psychiatry in some areas, as many critics feared it might. Hoarding is now a mental disorder (previously it was considered a symptom of obsessive-compulsive behavior). “Premenstrual dysphoric disorder,” a severe form of premenstrual syndrome, is also new (it was previously in the appendix).


And binge-eating disorder (also formerly in the appendix), a kind of severe, highly distressing gluttony, is now a full-blown diagnosis. This one by itself could tag millions of people considered healthy, if often overindulgent, with a psychiatric label, some experts said.


But the deeper story is one of compromise. It is most evident in how the committee handled three of the thorniest diagnoses in psychiatry: autism, depression and pediatric bipolar disorder.


The group working on depression declared early on that it wanted to eliminate the so-called bereavement exclusion, which stated that grieving the loss of a loved one should not be considered a clinical disorder, though it shares many of the same outward signs. Grief has always been a normal reaction to death, not a kind of depression.


Advocacy and support groups, such as those representing people who have lost a child, objected furiously to the idea that the bereaved might be given a diagnosis of depression.


“This was just astonishing, that they would eliminate the exclusion, and a distortion of the research on the subject,” said Jerome Wakefield, a professor of social work and psychiatry at New York University, who did not work on the manual.


In the end the committee cut a deal. It eliminated the grief exclusion but added a note in the text, reminding doctors that any significant loss — of a job, a relationship, a home — could cause depressive symptoms and should be carefully investigated.


“It’s like they took it all back,” Dr. Wakefield said. “I don’t like the way it was done — in a footnote — but it’s there.”


The debate over autism was even more furious, and it resulted in a similar rapprochement.


From the outset, the committee intended to tighten the definition of autism and simplify it, eliminating related labels like Asperger syndrome and “pervasive developmental disorder not otherwise specified,” or PDD-NOS. The rate of diagnosis of such conditions has exploded over the past decade, in part due to the vagueness of the definitions, and the committee wanted to draw clearer boundaries.


It proposed a single “autism spectrum disorder” category, with stricter requirements.


Some outside researchers raised concerns. In January one of them, Dr. Fred Volkmar of the Yale School of Medicine, who had quit the committee in protest, presented research suggesting that 45 percent or more of people who currently had an autism or related diagnosis would not have one under the proposed revision.


Autism groups reacted immediately, fearing that the change in the diagnosis would deny services to children and families who need them.


The committee countered with its own study, suggesting that the new definition would exclude about 10 percent of people currently with a diagnosis. And again, the experts took a half step back.


The new, streamlined definition was approved, but with language that took into account a person’s diagnostic history. “It’s explicit that anyone who’s had an Asperger’s or autism or PDD-NOS diagnosis before is now included,” said Catherine Lord, a committee member who worked on the new definition and who is director of the Center for Autism and the Developing Brain in New York. “Essentially everyone gets in.”


Pediatric bipolar disorder posed a different challenge.


In the 1990s and 2000s, psychiatrists began giving aggressive, explosive children a diagnosis of bipolar disorder in increasing numbers. The trend appalled many patient advocates and doctors.


Bipolar disorder, which is characterized by episodes of depression and mania, had previously been an adult problem; now the diagnosis is given to children as young as 2 — along with powerful psychiatric drugs and tranquilizers that also cause rapid weight gain. The committee wanted to stop the trend in its tracks, said experts who were involved.


Most of the children treated for bipolar disorder did not have it, recent research found. The committee settled on an alternative label: “disruptive mood dysregulation disorder,” or D.M.D.D., which describes extreme hostility and outbursts beyond normal tantrums.


“They essentially wanted to have some place for these kids, and D.M.D.D. was all they had in their kit,” said Dr. Gabrielle Carlson, a child psychiatrist at Stony Brook University Medical Center, who provided some outside consultation. “These are mostly kids who have A.D.H.D. or what we would call oppositional defiant disorder, but with this explosive feature. They need help; you can’t wait forever. The question was what to call it, without pretending we know enough to saddle them with a lifelong diagnosis” like bipolar disorder.


D.M.D.D. has its own problems, as many experts were quick to point out. It could be a symptom of an underlying condition, as Dr. Carlson argues. It could “medicalize” frequent temper tantrums. It’s brand new, and no one knows how it will play out in practice.


But it is now in the book — because it was the best solution available, experts inside and outside of the revision process said.


From beginning to end, many experts said, the process of defining psychiatric diagnoses is very much like finding the right one for an individual: it’s a process of negotiation, in many cases.


“That’s one of the take-aways from all this, and I think it’s a good one,” Dr. Carlson said. “A diagnosis is a hypothesis. It’s a start, and you have to start somewhere. But that’s all it is.”


One of the committee’s most ambitious proposals was perhaps the least noticed: a commitment to update the book continually, when there’s good reason to, rather than once every decade or so in a giant heave. That was approved without much fanfare.


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Fear of Fighting Haunts Once-Tranquil Damascus


Muzaffar Salman/Reuters


A portrait of President Bashar al-Assad outside the venue of a charity concert by the Syrian National Symphony Orchestra in Damascus on Nov. 21.







DAMASCUS, Syria — Business has been terrible for Abu Tareq, a taxi driver, so last week, without telling his wife, he agreed to drive a man to the Damascus airport for 10 times the usual rate. But, he said later, he will not be doing that again.




On the airport road, he could hear the crash of artillery and the whiz of sniper fire. Dead rebels and soldiers lay on the roadsides. Abu Tareq saw a dog eating the body of a soldier.


“I will never forget this sight,” said Abu Tareq, 50, who gave only a nickname for safety reasons. “It is the road of the dead.”


Damascus, Syria’s capital, is one of the world’s oldest continuously inhabited cities, a touchstone of history and culture for the entire region. Through decades of political repression, the city preserved, at least on the surface, an atmosphere of tranquillity, from its wide downtown avenues to the spacious, smooth-stoned courtyard of the Umayyad Mosque and the vine-draped alleys of the Old City, where restaurants and bars tucked between the storehouses of medieval merchants hummed with quiet conversation.


Now, though, the rumble of distant artillery echoes through the city, and its residents are afraid to leave their neighborhoods. Cocooned behind rows of concrete blocks that close off routes to the center, they huddle in fear of a prolonged battle that could bring destruction and division to a place where secular and religious Syrians from many sects — Sunni, Shiite, Alawite, Christian and others — have long lived peacefully.


For more than a week, Syrian rebels and government forces have fought for the airport road, as the military tries to seal off the capital city, the core of President Bashar al-Assad’s power, from a semicircle of rebellious suburbs. Rebels have now kept the pressure on the government for as long as they did during their previous big push toward Damascus last summer. This time, improved supply lines and tactics, some rebels and observers say, may provide a more secure foothold.


But the security forces wield overwhelming firepower, and while it has been unable to subdue the suburbs, some rebel fighters say they lack the intelligence information, arms and communication to advance. That raises the specter of a destructive standoff like the one that has devastated the commercial hub of Aleppo.


“Damascus was the city of jasmine,” Mahmoud, 40, a public-school teacher, said in an interview in the capital. “It is not the city I knew just a few weeks ago.”


Car bombs have ripped through neighborhoods, their targets and perpetrators only guessed at. Checkpoints choke traffic, turning 20-minute jaunts into three-hour ordeals. Wealthy residents find it quicker and safer to drive to Beirut, Lebanon, for a weekend trip than to the Old City.


Shells have been fired from Mount Qasioun overlooking Damascus, a favorite destination from which to admire the city’s sparkling lights. West of downtown, where the palace stands on a plateau, things are relatively quiet. But from the mountain, puffs of smoke can now be seen over suburbs in an arc from northeast to southwest.


Mahmoud, unable to find heating oil and medicine for his sick wife, said his grocer has lectured him daily on shortages and soaring prices. The once-ubiquitous government, he said, now appears to have no role beyond flooding streets with soldiers and security officers, “who are sometimes good and sometimes rude.”


People with roots in other towns have left, he said, “but what about me, who is a Damascene, and has no other city?”


The sense of claustrophobia has grown as rebels have declared the airport a legitimate target and the government has blocked Baghdad Street, a main avenue out of the city. On Sunday, it blocked the highway south to Dara’a.


In some outlying neighborhoods and nearby suburbs, the front lines seem to be hardening.


On the route into Qaboun, a neighborhood less than two miles from the center of Damascus, the last government checkpoint in recent days was near the municipal building. Less than a quarter-mile on, rebels controlled the area around the Grand Mosque.


An employee of The New York Times reported from Damascus, Syria, and Anne Barnard from Beirut, Lebanon. Neil MacFarquhar contributed reporting from Beirut.



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Bits Blog: Facebook Likely to End Experiment With Democracy

A half-million Facebook users have told the social network they do not want the company to change its privacy policy. Sounds impressive, right? Well, the only way that crowd will get its way and the status quo remain intact is if an additional 300 million people vote thumbs down before Monday. Odds of that happening? About zero.

Facebook says the changes to the policy are minor and beneficial for users. One concerns the integration of Instagram data with Facebook; another changes the filters for managing incoming messages. Privacy watchdogs disagree. So do those who bothered to vote: Shortly before noon Pacific time on Friday, 476,718 were against the proposed changes. A mere 68,884 were in favor.

But the really interesting change is that Facebook is proposing to end this system of direct voting, which was implemented in early 2009 after a major privacy flap. “If we are trying to move the world to being more open and transparent and to get people to share more information, having an open process around this is ultimately the only way to do that,” Mark Zuckerberg, Facebook’s founder, said at the time in a conference call.

The problem was that more than 30 percent of all Facebook users had to vote against a proposal for it to be binding. In the last vote, in June, the no’s outweighed the yeses by a ratio of six to one, but the total votes were less than one half of 1 percent of the users. That made the vote simply advisory. And so Facebook went ahead and implemented the changes anyway.

There has been relatively little commentary, much less outrage, about the new changes. One notable exception was Michael Phillips, who wrote a much-quoted piece in BuzzFeed, “The End of the Facebook Democracy”: “By repealing Facebook Suffrage, Facebook abandons a fundamental norm — that its users are citizens in a community, and not simply datapoints on an advertising algorithm. The vote may be quixotic, but if Facebook remains the indispensable social network, you’ll want to be able to tell your grandchildren you fought for Facebook freedom.”

Some users are trying to take their privacy into their own hands. They are reproducing the following text as a status update:

“In response to the new Facebook guidelines, I hereby declare that my copyright is attached to all of my personal details, status updates, messages, photos, videos and all other personal content that I post or have posted, online, as a result of the Berne Convention, on my personal profile page, or anyone else’s page, For commercial use of the above, MY WRITTEN CONSENT IS NEEDED AT ALL TIMES WITH NO EXCEPTION.”

Perhaps this makes them feel better. But in reality, it has no legal standing at all.

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New Taxes to Take Effect to Fund Health Care Law





WASHINGTON — For more than a year, politicians have been fighting over whether to raise taxes on high-income people. They rarely mention that affluent Americans will soon be hit with new taxes adopted as part of the 2010 health care law.




The new levies, which take effect in January, include an increase in the payroll tax on wages and a tax on investment income, including interest, dividends and capital gains. The Obama administration proposed rules to enforce both last week.


Affluent people are much more likely than low-income people to have health insurance, and now they will, in effect, help pay for coverage for many lower-income families. Among the most affluent fifth of households, those affected will see tax increases averaging $6,000 next year, economists estimate.


To help finance Medicare, employees and employers each now pay a hospital insurance tax equal to 1.45 percent on all wages. Starting in January, the health care law will require workers to pay an additional tax equal to 0.9 percent of any wages over $200,000 for single taxpayers and $250,000 for married couples filing jointly.


The new taxes on wages and investment income are expected to raise $318 billion over 10 years, or about half of all the new revenue collected under the health care law.


Ruth M. Wimer, a tax lawyer at McDermott Will & Emery, said the taxes came with “a shockingly inequitable marriage penalty.” If a single man and a single woman each earn $200,000, she said, neither would owe any additional Medicare payroll tax. But, she said, if they are married, they would owe $1,350. The extra tax is 0.9 percent of their earnings over the $250,000 threshold.


Since the creation of Social Security in the 1930s, payroll taxes have been levied on the wages of each worker as an individual. The new Medicare payroll is different. It will be imposed on the combined earnings of a married couple.


Employers are required to withhold Social Security and Medicare payroll taxes from wages paid to employees. But employers do not necessarily know how much a worker’s spouse earns and may not withhold enough to cover a couple’s Medicare tax liability. Indeed, the new rules say employers may disregard a spouse’s earnings in calculating how much to withhold.


Workers may thus owe more than the amounts withheld by their employers and may have to make up the difference when they file tax returns in April 2014. If they expect to owe additional tax, the government says, they should make estimated tax payments, starting in April 2013, or ask their employers to increase the amount withheld from each paycheck.


In the Affordable Care Act, the new tax on investment income is called an “unearned income Medicare contribution.” However, the law does not provide for the money to be deposited in a specific trust fund. It is added to the government’s general tax revenues and can be used for education, law enforcement, farm subsidies or other purposes.


Donald B. Marron Jr., the director of the Tax Policy Center, a joint venture of the Urban Institute and the Brookings Institution, said the burden of this tax would be borne by the most affluent taxpayers, with about 85 percent of the revenue coming from 1 percent of taxpayers. By contrast, the biggest potential beneficiaries of the law include people with modest incomes who will receive Medicaid coverage or federal subsidies to buy private insurance.


Wealthy people and their tax advisers are already looking for ways to minimize the impact of the investment tax — for example, by selling stocks and bonds this year to avoid the higher tax rates in 2013.


The new 3.8 percent tax applies to the net investment income of certain high-income taxpayers, those with modified adjusted gross incomes above $200,000 for single taxpayers and $250,000 for couples filing jointly.


David J. Kautter, the director of the Kogod Tax Center at American University, offered this example. In 2013, John earns $160,000, and his wife, Jane, earns $200,000. They have some investments, earn $5,000 in dividends and sell some long-held stock for a gain of $40,000, so their investment income is $45,000. They owe 3.8 percent of that amount, or $1,710, in the new investment tax. And they owe $990 in additional payroll tax.


The new tax on unearned income would come on top of other tax increases that might occur automatically next year if President Obama and Congress cannot reach an agreement in talks on the federal deficit and debt. If Congress does nothing, the tax rate on long-term capital gains, now 15 percent, will rise to 20 percent in January. Dividends will be treated as ordinary income and taxed at a maximum rate of 39.6 percent, up from the current 15 percent rate for most dividends.


Under another provision of the health care law, consumers may find it more difficult to obtain a tax break for medical expenses.


Taxpayers now can take an itemized deduction for unreimbursed medical expenses, to the extent that they exceed 7.5 percent of adjusted gross income. The health care law will increase the threshold for most taxpayers to 10 percent next year. The increase is delayed to 2017 for people 65 and older.


In addition, workers face a new $2,500 limit on the amount they can contribute to flexible spending accounts used to pay medical expenses. Such accounts can benefit workers by allowing them to pay out-of-pocket expenses with pretax money.


Taken together, this provision and the change in the medical expense deduction are expected to raise more than $40 billion of revenue over 10 years.


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As Recovery Inches Ahead, Banks Face a New Reckoning


The nation’s largest banks are facing a fresh torrent of lawsuits asserting that they sold shoddy mortgage securities that imploded during the financial crisis, potentially adding significantly to the tens of billions of dollars the banks have already paid to settle other cases.


Regulators, prosecutors, investors and insurers have filed dozens of new claims against Bank of America, JPMorgan Chase, Wells Fargo, Citigroup and others, related to more than $1 trillion worth of securities backed by residential mortgages.


Estimates of potential costs from these cases vary widely, but some in the banking industry fear they could reach $300 billion if the institutions lose all of the litigation. Depending on the final price tag, the costs could lower profits and slow the economic recovery by weakening the banks’ ability to lend just as the housing market is showing signs of life.


The banks are battling on three fronts: with prosecutors who accuse them of fraud, with regulators who claim that they duped investors into buying bad mortgage securities, and with investors seeking to force them to buy back the soured loans.


“We are at an all-time high for this mortgage litigation,” said Christopher J. Willis, a lawyer with Ballard Spahr.


Efforts by the banks to limit their losses could depend on the outcome of one of the highest-stakes lawsuits to date — the $200 billion case that the Federal Housing Finance Agency, which oversees the housing twins Fannie Mae and Freddie Mac, filed against 17 banks last year, claiming that they duped the mortgage finance giants into buying shaky securities.


Last month, lawyers for some of the nation’s largest banks descended on a federal appeals court in Manhattan to make their case that the agency had waited too long to sue. A favorable ruling could overturn a decision by Judge Denise L. Cote, who is presiding over the litigation and has so far rejected virtually every defense raised by the banks, and would be cheered in bank boardrooms. It could also allow the banks to avoid federal housing regulators’ claims.


At the same time, though, some major banks are hoping to reach a broad settlement with housing agency officials, according to several people with knowledge of the talks. Although the negotiations are at a very tentative stage, the banks are broaching a potential cease-fire.


As the housing market and the nation’s economy slowly recover from the 2008 financial crisis, Wall Street is vulnerable on several fronts, including tighter regulations assembled in the aftermath of the crisis and continuing investigations into possible rigging of a major international interest rate. But the mortgage lawsuits could be the most devastating and expensive, bank analysts say.


“All of Wall Street has essentially refused to deal with the real costs of the litigation that they are up against,” said Christopher Whalen, a senior managing director at Tangent Capital Partners. “The real price tag is terrifying.”


Anticipating painful costs from mortgage litigation, the five major sellers of mortgage-backed securities set aside $22.5 billion as of June 30 just to cushion themselves against demands that they repurchase soured loans from trusts, according to an analysis by Natoma Partners.


But in the most extreme situation, the litigation could empty even more well-stocked reserves and weigh down profits as the banks are forced to pay penance for the subprime housing crisis, according to several senior officials in the industry.


There is no industrywide tally of how much banks have paid since the financial crisis to put the mortgage litigation behind them, but analysts say that future settlements will dwarf the payouts so far. That is because banks, for the most part, have settled only a small fraction of the lawsuits against them.


JPMorgan Chase and Credit Suisse, for example, agreed last month to settle mortgage securities cases with the Securities and Exchange Commission for $417 million, but still face billions of dollars in outstanding claims.


Bank of America is in the most precarious position, analysts say, in part because of its acquisition of the troubled subprime lender Countrywide Financial.


Last year, Bank of America paid $2.5 billion to repurchase troubled mortgages from Fannie Mae and Freddie Mac, and $1.6 billion to Assured Guaranty, which insured the shaky mortgage bonds.


But in October, federal prosecutors in New York accused the bank of perpetrating a fraud through Countrywide by churning out loans at such a fast pace that controls were largely ignored. A settlement in that case could reach well beyond $1 billion because the Justice Department sued the bank under a law that could allow roughly triple the damages incurred by taxpayers.


Bank of America’s attempts to resolve some mortgage litigation with an umbrella settlement have stalled. In June 2011, the bank agreed to pay $8.5 billion to appease investors, including the Federal Reserve Bank of New York and Pimco, that lost billions of dollars when the mortgage securities assembled by the bank went bad. But the settlement is in limbo after being challenged by investors. Kathy D. Patrick, the lawyer representing investors, has said she will set her sights on Morgan Stanley and Wells Fargo next.


Of the more than $1 trillion in troubled mortgage-backed securities remaining, Bank of America has more than $417 billion from Countrywide alone, according to an analysis of lawsuits and company filings. The bank does not disclose the volume of its mortgage litigation reserves.


“We have resolved many Countrywide mortgage-related matters, established large reserves to address these issues and identified a range of possible losses beyond those reserves, which we believe adequately addresses our exposures,” said Lawrence Grayson, a spokesman for Bank of America.


Adding to the legal fracas, the New York attorney general, Eric T. Schneiderman, accused Credit Suisse last month of perpetrating an $11.2 billion fraud by deceiving investors into buying shoddy mortgage-backed securities. According to the complaint, the bank dismissed flaws in the loans packaged into securities even while assuring investors that the quality was sound. The bank disputes the claims.


It is the second time that Mr. Schneiderman — who is also co-chairman of the Residential Mortgage-Backed Securities Working Group, created by President Obama in January — has taken aim at Wall Street for problems related to the subprime mortgage morass. In October, he filed a civil suit in New York State Supreme Court against Bear Stearns & Company, which JPMorgan Chase bought in 2008. The complaint claims that Bear Stearns and its lending unit harmed investors who bought mortgage securities put together from 2005 through 2007. JPMorgan denies the allegations.


Another potentially costly headache for the banks are the demands from a number of private investors who want the banks to buy back securities that violated representations and warranties vouching for the loans.


JPMorgan Chase told investors that as of the second quarter of this year, it was contending with more than $3.5 billion in repurchase demands. In the same quarter, it received more than $1.5 billion in fresh demands. Bank of America reported that as of the second quarter, it was dealing with more than $22 billion in unresolved demands, more than $8 billion of which were received during that quarter.


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President Mohamed Morsi of Egypt Said to Prepare Martial Law Decree


Tara Todras-Whitehill for The New York Times


Egyptian protesters stood next to a destroyed barricade near the presidential palace in Cairo on Saturday. More Photos »







CAIRO — Struggling to quell street protests and political violence, President Mohamed Morsi is moving to impose a version of martial law by calling on the armed forces to keep order and authorizing soldiers to arrest civilians, Egyptian state media announced Saturday.




If Mr. Morsi goes through with the plan, it would represent a historic role reversal. For decades, Egypt’s military-backed authoritarian presidents had used martial law to hold on to power and to punish Islamists like Mr. Morsi, who spent months in jail under a similar decree.


A turn back to the military would also come just four months after Mr. Morsi managed to pry political power out of the hands of the country’s powerful generals, who led a transitional government after the ouster of the longtime strongman Hosni Mubarak.


The flagship state newspaper Al Ahram reported that Mr. Morsi “will soon issue a decision for the participation of the armed forces in the duties of maintaining security and protection of vital state institutions.” The military would maintain its expanded role until the completion of a referendum on a draft constitution next Saturday and the election of a new Parliament expected two months after that.


Imposing martial law would represent the steepest escalation yet in the political battle between Egypt’s new Islamist leaders and their secular opponents over the Islamist-backed draft constitution — a standoff that has already threatened to derail Egypt’s promised transition to a constitutional democracy.


Calling in the army could overcome the danger of protests or violence that might disrupt the planned referendum and the parliamentary election. But resorting to the military to secure the vote could undermine Mr. Morsi’s hopes that a strong vote for the constitution would be seen as a sign of national consensus that could help end the political crisis over the Islamist-backed charter.


Mr. Morsi has not yet formally issued the order reported in Al Ahram, raising the possibility that the newspaper announcement was intended as a warning to his opponents. Although the plan would not fully suspend the civil law, it would nonetheless have the effect of suspending legal rights by empowering soldiers under the control of the defense minister to try civilians in military courts.


There was no sign of military tanks in the streets on Saturday evening, but the military appeared for now to back Mr. Morsi. Soon after the news of the plans, a military spokesman read a statement over state television that echoed the reports of Mr. Morsi’s planned decree.


The military “realizes its national responsibility for maintaining the supreme interests of the nation and securing and protecting the vital targets, public institutions, and the interests of the innocent citizens,” the spokesman said, emphasizing the “sorrow and concern” over recent developments and warning of “divisions that threaten the state of Egypt.”


“Dialogue is the best and sole way to reach consensus that achieves the interests of the nation and the citizens,” the spokesman said. “Anything other than that puts us in a dark tunnel with drastic consequences, which is something that we will not allow.”


Moataz Abdel-Fattah, a former adviser to Egypt’s transitional prime minister who is close to Defense Minister Abdul Fattah el-Sisi, suggested that the generals might have prompted Mr. Morsi to announce the possibility of martial law as a warning to all the political factions to end the crisis.


“The military is saying, ‘Do not let things get so bad that we have to intervene,’ ” Mr. Abdel-Fattah said. “In the short term it is good for President Morsi, but in the long run they are also saying, ‘We belong to the people, and not Mr. Morsi or his opponents.’ ”


The military’s return to the streets at Mr. Morsi’s request would be a turn of events that was almost unimaginable when he took office in June.


The top generals had pushed for months to maintain a role in Egyptian politics and to limit the president’s powers — in part, their supporters argued, as a safeguard against an Islamist takeover.


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The Lede Blog: Hospital Nurse in Radio Hoax With Kate Middleton Is Found Dead

Video of a statement on Friday from the London hospital where Kate Middleton was treated this week.

A nurse at a London hospital, who took a prank call from two Australian radio disc jockeys pretending to be Queen Elizabeth II and Prince Charles to get details on Kate Middleton’s medical condition, was found dead on Friday, the hospital said.

John Lofthouse, the chief executive of the King Edward VII hospital — where Ms. Middleton, the Duchess of Cambridge, was treated this week for hyperemesis gravidarum, acute morning sickness related to her pregnancy — told reporters:

It is with very deep sadness that we confirm the tragic death of a member of our nursing staff, Jacintha Saldanha. Jacintha has worked at the King Edward VII’s Hospital for more than four years. She was an excellent nurse and well-respected and popular with all of her colleagues.

We can confirm that Jacintha was recently the victim of a hoax call to the hospital. The hospital had been supporting her throughout this difficult time.

London’s Metropolitan Police Service, said in a statement that Ms. Saldanha, 46, was found unconscious on Friday morning “at work-provided accommodation” near the hospital and pronounced dead at the scene by the London Ambulance Service.

Although the police said the nurse’s death “is being treated as unexplained,” the D.J.’s were widely held responsible on social networks.

Lord Glenarthur, the hospital’s chairman, added: “This is a tragic event. Jacintha was a first class nurse who cared diligently for hundreds of patients during her time with us. She will be greatly missed.”

Ms. Middleton was released from the hospital on Thursday and went home with her husband, Prince William, for further rest. A statement from St. James’s Palace on behalf of the royal family said:

The Duke and Duchess of Cambridge are deeply saddened to learn of the death of Jacintha Saldanha. Their Royal Highnesses were looked after so wonderfully well at all times by everybody at King Edward VII hospital, and their thoughts and prayers are with Jacintha Saldanha’s family, friends and colleagues at this very sad time.

Audio of the prank phone call to the hospital, in which the D.J.’s Mel Greig and Michael Christian were provided with information on Ms. Middleton’s condition, was removed from the Web site of their radio station, 2DayFM, and the broadcaster’s YouTube channel after the nurse’s death. Excerpts from the phone conversation between the pranksters and hospital staff members were included in a news report from Britain’s ITN.

Before the call to the nursing staff was put through, the D.J.’s laughed on the air about Ms. Greig’s poor impersonation of the queen and expressed surprise about how easy it had been for them to be taken seriously. During the call, Ms. Greig, in the role of the queen, asked when a good time might be to visit, and made comedic references to her pet corgis.

“She’s sleeping at the moment and she has had an uneventful night, she’s been given some fluids … she’s stable at the moment,” the nurse on the call told the pranksters. “I would suggest that any time after 9 o’clock will be suitable.” She added: “We’ll be getting her freshened up.”

The two D.J.’s were reported to have later apologized, but seemed to welcome the international attention at first. Mr. Christian, whose @MContheradio Twitter account was later disabled, initially boasted that Conan O’Brien had noticed the prank.

In a statement, Southern Cross Austereo, the Australian media company, and 2Day FM, its radio station, said they were “deeply saddened” by news of Ms. Saldanha’s death and extended sympathies to the family and others affected. It said the company and the “deeply shocked” hosts have decided that the D.J.’s would not return to their radio show until further notice.


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Drafters of Communications Treaty Are Split on Internet Issue


PARIS — Nearly a week into a global conference to draft a treaty on the future of international telecommunications, delegates remain divided on a fundamental question: should the Internet feature in the discussions?


The United States says no, arguing that including it in an intergovernmental agreement could result in regulations that would hamper its development, which has been led by the private sector.


To try to win this point early in the proceedings, the United States delegation has pushed a proposal to restrict the application of the treaty to traditional telecommunications operators, excluding Internet companies, as well as private and government networks.


So far, however, the United States has been rebuffed.


Terry Kramer, the head of the American delegation, said the proposal, co-sponsored by Canada, had generated support from American allies in Europe, Latin America and the Asia-Pacific region. Other countries, including Russia and some African and Middle Eastern nations, have apparently resisted, favoring a broader definition of telecommunications that could include the Internet.


“Fundamentally, to us, this conference should not be about the Internet sector,” Mr. Kramer said by telephone from Dubai in the United Arab Emirates, where the meeting is taking place under the auspices of the International Telecommunication Union. “There are some pretty big differences of opinion on this.”


Russia, as expected, has introduced a proposal to shift oversight over the Internet, including the address system, to an international body, contending that the United States wields too much influence over this. The address function is now handled by the Internet Corporation for Assigned Names and Numbers, a private body that operates under a United States government contract.


“We fundamentally disagree with that,” Mr. Kramer said, referring to the Russian proposal. “Once governments are in that role, they are in position to decide how the Internet operates, what kind of information flows there, et cetera.”


Campaigners against restrictions on the Internet have also expressed concerns about proposals to bolster security and to crack down on spam — fearing that this could be used as a pretext for censorship — as well as about a proposed technical standard for “deep packet inspection.” This refers to technology that can be used to examine the content of traffic that passes through telecommunications networks.


It is unclear which, if any, of these initiatives might make it into the final treaty. The talks are set to continue through next week, and Mr. Kramer has pledged to block any proposals that would threaten the integrity of the Internet. The telecommunication union says proposals will be adopted only if they meet with widespread support at the conference, whose goal is to update regulations that date to 1988.


Groups that favor an open Internet have criticized the process as lacking transparency. While some meetings are going on behind closed doors, the union moved to provide webcasts of the plenary sessions, in which delegates from more than 190 countries are debating the proposals.


On Wednesday, however, access to the webcasts and other material on the union’s Web site was briefly blocked; the group said hackers appeared to have been responsible.


“Some delegates were frustrated at being unable to access some of the online working documents that were being considered by the meeting,” the union said in a statement. “However, a spirit of camaraderie prevailed, with those who had access to up-to-date online versions of the texts willingly sharing with other delegates in order to keep discussions moving forward.”


So far, fears that the conference could turn raucous have not come to pass.


“The world is having a conversation,” said Sally Shipman Wentworth, senior manager of public policy at the Internet Society, whose members include Internet companies, governance groups and others. “The meeting rooms are full, and everyone wants to have a chance to be heard. It’s been pretty collegial so far.”


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U. S. and Russia to Meet on Syrian Conflict





DUBLIN — A new round of diplomacy on the conflict in Syria will begin on Thursday afternoon when Lakhdar Brahimi, the United Nations special envoy, hosts an unusual three-way meeting with Secretary of State Hillary Rodham Clinton and the Russian foreign minister, Sergey V. Lavrov.




The session, which is being held on the margins of a meeting on European security, comes amid reports of heightened activity at Syria’s chemical weapons sites and signs that Russia may be shifting its position on a political transition in Syria.


“Secretary Clinton has accepted an invitation by U.N. Special Envoy Brahimi for a trilateral meeting on Syria this afternoon with Mr. Brahimi and Russian Foreign Minister Lavrov,” a senior State Department official said Thursday morning.


This is not the first time that American and Russian consultations have spurred hopes of a possible breakthrough. In June, Mrs. Clinton, Mr. Lavrov and the United Nations’s envoy on the Syrian crisis at the time, former United Nations Secretary General Kofi Annan, appeared to be close to an agreement that a transitional government should be established and that President Bashar al-Assad give up power.


But that seeming understanding quickly broke down, with American officials complaining privately that the Russian side had pulled back from the deal. A major sticking point, it later emerged, was the American insistence that the United Nations Security Council authorize steps to pressure Mr. Assad if he refused to go along under Chapter 7 of the United Nations Charter, which could be used to authorize tougher economic sanctions and, in theory, the use of force.


It remained to be seen if the new round of negotiations would be more successful.


On the one hand, the military situation on the ground appears to be shifting in the rebels’ favor. Some Russian officials reportedly no longer believe that Mr. Assad will succeed in holding on to power and may have a new interest in working out arrangements for a transition. The changing battlefield, some experts say, may have led to a softening of the Russian position.


A senior Turkish official said that after President Vladimir V. Putin of Russia and Prime Minister Recep Tayyip Erdogan of Turkey recently met in Istanbul that Moscow was “softening” its “political tone” and would look for ways of getting Mr. Assad to relinquish power.


On the other hand, it was possible that Mr. Lavrov had, in effect, merely agreed to meet so that Russia could maintain influence over the discussions on Syria and find out what exactly Mr. Brahimi was prepared to propose.


There were indications on Thursday that Russian officials see the positions of Washington and Moscow on Syria moving slightly closer.


Deputy Foreign Minister Gennady Gatilov of Russia expressed satisfaction in a Twitter message that the United States was moving to designate Al Nusra Front, a Syrian opposition group seen by American experts as linked to Al Qaeda, as an international terrorist organization.


The aim of the American move, which is expected soon, would be to isolate radical foes of the Assad government.


With the rebels making gains on the ground, American officials have been trying to ensure that military developments do not outpace political arrangements for a possible transition. American officials have hinted that the United States would upgrade relations with the Syria opposition, possibly to formal recognition, if the coalition made progress on a political structure by the time of a meeting of the so-called Friends of Syria in Morocco.


But emerging policy on the Al Nusra Front also acknowledges Russia’s longstanding argument that the Syrian opposition includes radical jihadists. Mr. Gatilov said that the American step “reflects understanding of the danger of escalating terrorist activity in Syria.”


A lawmaker with the dominant party, United Russia, told British legislators visiting Moscow that Russia saw Mr. Assad’s government struggling. “We think that the Syrian government should execute its functions,” he said, according to the Interfax news service. “But time shows that this task is beyond its strength.”


Dimitri K. Simes, a Russia expert the Center for the National Interest in Washington, said, based on conversations with top officials, that Russia has indeed softened its position in light of military setbacks for the Assad government, and it is now understood that neither Mr. Assad nor his close associates would take a central role in a new government.


However, he said Russia still wanted Iran to take part in negotiations about the transition. Iran’s presence, he said, would reassure Alawites, the Shiite Muslim minority of Mr. Assad and the core of the military, that they would be protected in the change of government.


Michael R. Gordon reported from Dublin, and Ellen Barry from Moscow. Anne Barnard contributed reporting from Beirut, Lebanon.



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Apple to Resume U.S. Manufacturing





For the first time in years, Apple will manufacture computers in the United States, the chief executive of Apple, Timothy D. Cook, said in interviews with NBC and Bloomberg Businessweek.




“Next year, we will do one of our existing Mac lines in the United States,” he said in an interview to be broadcast Thursday on “Rock Center With Brian Williams” on NBC.


Apple, the biggest company in the world by market value, moved most of its manufacturing to Asia in the late 1990s. As an icon of American technology success and innovation, the California-based company has been criticized in recent years for outsourcing jobs abroad.


“I don’t think we have a responsibility to create a certain kind of job,” Mr. Cook said in the Businessweek interview. “But I think we do have a responsibility to create jobs.”


The company plans to spend $100 million on the American manufacturing in 2013, according to the interviews, a small fraction of its overall factory investments and an even tinier portion of its available cash.


In the interviews, Mr. Cook suggested the company would work with partners and that the manufacturing would be more than just the final assembly of parts. He noted that parts of the company’s ubiquitous iPhone, including the “engine” and the glass screen, were already made in America. The processor is manufactured by Samsung in Texas, while Corning makes the glass screen in Kentucky.


Over the last few years, sales of the iPhone, iPod and iPad have overwhelmed Apple’s line of Macintosh computers, the basis of the company’s early business. Revenue from the iPhone alone made up 48 percent of the company’s total revenue for its fiscal fourth quarter ended Sept. 30.


But as recently as October, Apple introduced a new, thinner iMac, the product that pioneered the technique of building the computer innards inside the flat screen.


Mr. Cook did not say in the interviews where in the United States the new manufacturing would occur. But he did defend Apple’s track record in American hiring.


“When you back up and look at Apple’s effect on job creation in the United States, we estimate that we’ve created more than 600,000 jobs now,” Mr. Cook told Businessweek. Those jobs include positions at partners and suppliers.


Steve Dowling, a spokesman for Apple, declined on Thursday to provide additional details on Apple’s plans, referring to Mr. Cook’s interviews.


Apple has for years done the final assembly of some Macs in the United States, mainly systems that customers buy with custom configurations, like bigger hard drives and more memory than on standard machines.


Mr. Cook’s statements suggested Apple is planning to build more of the Mac’s ingredients domestically, although with partners. He told Businessweek that the plan “doesn’t mean that Apple will do it ourselves, but we’ll be working with people, and we’ll be investing our money.”


While Apple’s products are typically made in Asian factories owned by other companies, Apple itself often purchases the sophisticated manufacturing equipment required to make its cutting-edge designs, spending billions of dollars a year on such machines.


Foxconn Technology, which manufactures more than 40 percent of the world’s electronics, is one of Apple’s main overseas manufacturing contractors. Based in Taiwan, Foxconn is China’s largest private employer, with 1.2 million workers, and it has come under intense scrutiny over working conditions inside its factories.


In March, Foxconn pledged to sharply curtail the number of working hours and significantly increase wages. The announcement was a response to a far-ranging inspection by the Fair Labor Association, a monitoring group that found widespread problems — including numerous instances where Foxconn violated Chinese law and industry codes of conduct.


Apple, which recently joined the labor association, had asked the group to investigate plants manufacturing iPhones, iPads and other devices. A growing outcry over conditions at overseas factories prompted protests and petitions, and several labor rights organizations started scrutinizing Apple’s suppliers.


Almost all of the 70 million iPhones, 30 million iPads and 59 million other products Apple sold in 2011 were manufactured overseas. Apple employs 43,000 people in the United States and 20,000 overseas. An additional 700,000 people engineer, build and assemble iPads, iPhones and Apple’s other products, mostly abroad.


At a meeting with Silicon Valley executives in 2011, President Obama asked Steven P. Jobs, then the Apple chief executive, what it would take to make iPhones in the United States. Mr. Jobs, who died later that year, told the president, “Those jobs aren’t coming back.”


Nick Wingfield contributed reporting.


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