Italy Set to Vote for a New Parliament

ROME — As Italian voters head to the polls on Sunday and Monday to elect a new Parliament and three regional governments, the prevailing mood is one of anger and disillusionment.

The fledgling, anti-establishment parties that campaigned on promises of radical change could benefit from the voters’ discontent, but the lack of a clear winner could also leave Italy mired in uncertainty.

“Italians feel frustration, anger, but also some hope for renewal,” said Nicola Piepoli, who runs a polling company. They are frustrated, he said, because their taxes are rising but they see no improvements in their “economic and social life,” and they are angry because candidates did not address “concrete problems” during the campaign, focusing instead on “futile, absurd things.”

“But many still hope for some change,” Mr. Piepoli added, explaining the growing support for populists like the comedian Beppe Grillo and his Five Star Movement, and for smaller parties like Civil Revolution, led by Antonio Ingroia, a former prosecutor, and Act to Stop the Decline, a movement guided by Oscar Giannino, a journalist.

Mostly though, the mood is dark among Italians fed up with protracted political scandals and disinclined to believe election promises because they are so rarely fulfilled.

(On Friday, former Prime Minister Silvio Berlusconi, campaigning to return to office, made a new promise: he said that if he won, he would personally refund an unpopular property tax paid by Italians in 2012. “I will take four billion euros of my own fortune and give it to Italians,” he said on television, a pledge of about $5.3 billion.)

“There’s no one to vote for, and if I went to the polls I’d choose the least-worst candidate, so I prefer not to vote,” said Concetta Rossi, a recruiter for hotel employees in Rome. “It’s never been this bad.”

The center-left Democratic Party, led by Pier Luigi Bersani, a low-key former industry minister, is expected to place first but is unlikely to win enough seats to govern without a coalition. The centrist movement backing the current prime minister, Mario Monti, is a possible ally, but even together they might not prevail in the Senate because the electoral law allocates seats based on regional votes. Lombardy and Sicily, where polls suggest that the right is strong, are crucial.

For the past year, Mr. Bersani, a former Communist who has played up his Catholic upbringing, has supported Mr. Monti’s reformist agenda, though sometimes grudgingly. He has backed Mr. Monti’s commitments to the European Union for greater fiscal responsibility, but would review policies that might have hurt workers and retirees.

Investors and economic analysts have their own concerns about the potential instability that could emerge in the absence of a strong government.

In its 15 months in office, Mr. Monti’s technocratic government tried to pass much-needed reforms, but it failed to stimulate the economic growth required to pull Italy out of a persistent recession. On Friday, the European Commission said in its winter forecast that Italy’s economy would shrink by 1 percent in 2013, double its November estimate.

Gains made by anti-establishment parties, including the Five Star Movement, could stall Mr. Monti’s overhauls, and a strong showing by the center-right party led by Mr. Berlusconi could derail the austerity measures meant to keep Italy on a fiscally responsible track.

“The fear remains that the general election produces a significant no-confidence vote on the current austerity plan and the need to reform further,” Raj Badiani, an economist with IHS Global Insight, wrote in a research report last week. “Without the prospect of a stable coalition government with a credible reform agenda, Italy could be forced to reconstruct a technocratic government to keep the markets at bay.”

Alessandro Amadori, the director of Coesis, which conducts marketing and opinion polls, said the “emotional mapping” of Italy highlighted the population’s “disenchantment and rage,” and even its resignation. “People don’t think that much will change. They hope for a sign, but they don’t have high expectations.”

Mr. Amadori added: “These elections will probably mark a moment of transition, rather than long-term change. Italians are looking for something that will shake things up, but what will emerge, we still don’t know.”

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Jeter resumes on-field running drills in Tampa

TAMPA, Fla. (AP) — Yankees captain Derek Jeter has practiced on-field running and agility drills for the first time since breaking his ankle last fall.

Jeter worked out at Steinbrenner Field on Saturday with players that didn't travel for the Yankees' spring training opener against Atlanta.

The 38-year-old broke his left ankle lunging for a grounder in the AL championship series opener against Detroit on Oct. 1 and had surgery a week later. He expects to be ready for opening day against Boston on April 1.

Jeter had a resurgent season in 2012, leading the American League with 216 hits and batting .316 with 15 homers and 58 RBIs. He first injured his ankle in mid-September and fouled balls off his foot several times after that.

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Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

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Many States Say Cuts Would Burden Fragile Recovery

States are increasingly alarmed that they could become collateral damage in Washington’s latest fiscal battle, fearing that the impasse could saddle them with across-the-board spending cuts that threaten to slow their fragile recoveries or thrust them back into recession.

Some states, like Maryland and Virginia, are vulnerable because their economies are heavily dependent on federal workers, federal contracts and military spending, which will face steep reductions if Congress allows the automatic cuts, known as sequestration, to begin next Friday. Others, including Illinois and South Dakota, are at risk because of their reliance on the types of federal grants that are scheduled to be cut. And many states simply fear that a heavy dose of federal austerity could weaken their economies, costing them jobs and much-needed tax revenue.

So as state officials begin to draw up their budgets for next year, some say that the biggest risk they see is not the weak housing market or the troubled European economy but the federal government. While the threat of big federal cuts to states has become something of a semiannual occurrence in recent years, state officials said in interviews that they fear that this time the federal government might not be crying wolf — and their hopes are dimming that a deal will be struck in Washington in time to avert the cuts.

The impact would be widespread as the cuts ripple across the nation over the next year.

Texas expects to see its education aid slashed hundreds of millions of dollars, which could force local school districts to fire teachers, if the cuts are not averted. Michigan officials say they are in no position to replace the lost federal dollars with state dollars, but worry about cuts to federal programs like the one that helps people heat their homes. Maryland is bracing not only for a blow to its economy, which depends on federal workers and contractors and the many private businesses that support them, but also for cuts in federal aid for schools, Head Start programs, a nutrition program for pregnant women, mothers and children, and job training programs, among others.

Gov. Bob McDonnell of Virginia, a Republican, warned in a letter to President Obama on Monday that the automatic spending cuts would have a “potentially devastating impact” and could force Virginia and other states into a recession, noting that the planned cuts to military spending would be especially damaging to areas like Hampton Roads that have a big Navy presence. And he noted that the whole idea of the proposed cuts was that they were supposed to be so unpalatable that they would force officials in Washington to come up with a compromise.

“As we all know, the defense, and other, cuts in the sequester were designed to be a hammer, not a real policy,” Mr. McDonnell wrote. “Unfortunately, inaction by you and Congress now leaves states and localities to adjust to the looming threat of this haphazard idea.”

The looming cuts come just as many states feel they are turning the corner after the prolonged slump caused by the recession. Gov. Martin O’Malley of Maryland, a Democrat, said he was moving to increase the state’s cash reserves and rainy day funds as a hedge against federal cuts.

“I’d rather be spending those dollars on things that improve our business climate, that accelerate our recovery, that get more people back to work, or on needed infrastructure — transportation, roads, bridges and the like,” he said, adding that Maryland has eliminated 5,600 positions in recent years and that its government was smaller, on a per capita basis, than it had been in four decades. “But I can’t do that. I can’t responsibly do that as long as I have this hara-kiri Congress threatening to drive a long knife through our recovery.”

Federal spending on salaries, wages and procurement makes up close to 20 percent of the economies of Maryland and Virginia, according to an analysis by the Pew Center on the States.

But states are in a delicate position. While they fear the impact of the automatic cuts, they also fear that any deal to avert them might be even worse for their bottom lines. That is because many of the planned cuts would go to military spending and not just domestic programs, and some of the most important federal programs for states, including Medicaid and federal highway funds, would be exempt from the cuts.

States will see a reduction of $5.8 billion this year in the federal grant programs subject to the automatic cuts, according to an analysis by Federal Funds Information for States, a group created by the National Governors Association and the National Conference of State Legislatures that tracks the impact of federal actions on states. California, New York and Texas stand to lose the most money from the automatic cuts, and Puerto Rico, which is already facing serious fiscal distress, is threatened with the loss of more than $126 million in federal grant money, the analysis found.

Even with the automatic cuts, the analysis found, states are still expected to get more federal aid over all this year than they did last year, because of growth in some of the biggest programs that are exempt from the cuts, including Medicaid.

But the cuts still pose a real risk to states, officials said. State budget officials from around the country held a conference call last week to discuss the threatened cuts. “In almost every case the folks at the state level, the budget offices, are pretty much telling the agencies and departments that they’re not going to backfill — they’re not going to make up for the budget cuts,” said Scott D. Pattison, the executive director of the National Association of State Budget Officers, which arranged the call. “They don’t have enough state funds to make up for federal cuts.”

The cuts would not hit all states equally, the Pew Center on the States found. While the federal grants subject to the cuts make up more than 10 percent of South Dakota’s revenue, it found, they make up less than 5 percent of Delaware’s revenue.

Many state officials find themselves frustrated year after year by the uncertainty of what they can expect from Washington, which provides states with roughly a third of their revenues. There were threats of cuts when Congress balked at raising the debt limit in 2011, when a so-called super-committee tried and failed to reach a budget deal, and late last year when the nation faced the “fiscal cliff.”

John E. Nixon, the director of Michigan’s budget office, said that all the uncertainty made the state’s planning more difficult. “If it’s going to happen,” he said, “at some point we need to rip off the Band-Aid.”

Fernanda Santos contributed reporting.

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Russia Sends Aid to Mali as Fighting Flares

MOSCOW — Russia sent a planeload of food, blankets and other aid to war-stricken Mali on Friday, a day after Foreign Minister Sergey V. Lavrov warned about the spread of terrorism in North Africa, which the Russian government has linked to Western intervention in Libya.

Mr. Lavrov met on Thursday with the United Nations special envoy for the region, Romano Prodi, to discuss the situation in Mali, where Russia has supported the French-led effort to oust Islamic militants. But Russia has also blamed the West for the unrest and singled out the French in particular for arming the rebels who ousted the Libyan leader, Col. Muammar el-Qaddafi.

“Particular concern was expressed about the activity of terrorist organizations in the north, a threat to regional peace and security,” the Russian Foreign Ministry said in a statement after the meeting. “The parties agreed that the uncontrolled proliferation of arms in the region in the wake of the conflict in Libya sets the stage for an escalation of tension throughout the Sahel.” The Sahel is a vast region stretching more than 3,000 miles across Africa, from the Atlantic in the west to the Horn of Africa in the east.

In a television interview earlier this month, Mr. Lavrov said, “France is fighting against those in Mali whom it had once armed in Libya against Qaddafi.”

French forces quickly drove Islamist fighters out of the population centers of northern Mali — Timbuktu and Gao, in particular — when France began a military intervention in the country last month. Those dispersed fighters, who are members of Al Qaeda in the Islamic Maghreb and several allied groups, have now begun a small campaign of harassment and terror, dispatching suicide bombers, attacking guard posts, infiltrating liberated cities or ordering attacks by militants hidden among civilians.

On Friday, suicide attackers detonated two car bombs near the town of Tessalit, in Mali’s far north, according to news reports, while Islamist fighters clashed with Malian soldiers further south in Gao, where fighting has flared in recent days.

The twin suicide bombings in Tessalit killed three fighters for the M.N.L.A., an ethnic Tuareg armed group that has allied with the French forces, a spokesman for the group told Agence France-Presse. The attackers were killed as well. On Thursday, a guard and an attacker were killed in a car bombing in Kidal, south of Tessalit, that appeared to target a civilian fuel depot, France’s Defense Ministry said in a statement.

Responsibility for that attack was claimed by the Movement for Oneness and Jihad in West Africa, an offshoot of Al Qaeda in the Islamic Maghreb. The group said it would continue to press its fight, and also intended to retake Gao, hundreds of miles to the south.

“More explosions will happen across our territory,” a group spokesman, Abu Walid Sahraoui, told A.F.P. “Our troops have been ordered to attack,” he said. “If the enemy is stronger, we’ll pull back only to return stronger, until we liberate Gao.”

In central Gao late Thursday morning, Malian and French forces killed about 15 militants from “infiltrated terrorist groups” that had seized the town hall and court, according to France’s Defense Ministry. The initial firefight involved only Malian soldiers and militant fighters, the ministry statement said, but several French armored vehicles and two helicopters were later involved.

Two militants were killed outside a checkpoint north of the city after “sporadically” attacking the Nigerien soldiers standing guard, the Defense Ministry said. As many as six Malian soldiers were reported wounded.

On Friday, sporadic gunfire and at least two rebel rocket attacks were reported in Gao, according to a Malian officer cited by The Associated Press. Most of the militants fled to the east of the city aboard seven vehicles, the officer said.

Russian officials have pointed repeatedly to the unrest in North Africa and political turmoil in Egypt as evidence that the Western-supported Arab Spring has created a dangerous and chaotic situation and potential breeding grounds for terrorists. Russia has also used the examples of Libya and Egypt to justify its opposition to any Western effort to oust the government of President Bashar al-Assad in Syria.

Russia voted in favor of a United Nations Security Council resolution authorizing the deployment of African troops in Mali, but Russia has also stressed that the resolution required the consent of the Malian government.

Russia’s state-controlled weapons company, Rosoboronexport, has been selling small arms to the Malian government and is considering a request to buy additional matériel, including armor and helicopters.

The plane dispatched to the Malian capital, Bamako, by Russian’s Emergency Situations Ministry was carrying about 36 tons of aid cargo, including 45 tents, 2,000 blankets, canned food, cereals and rice.

David Herszenhorn reported from Moscow and Scott Sayare from Paris.

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IHT Rendezvous: Europe's Jobless Youth: Should the Old Make Way?

LONDON — A British minister has advised people aged over 60 to go to university and update their skills if they want to continue working.

With youth unemployment on the rise across Europe, it might seem an odd time to be encouraging older people to keep working rather than take a well-earned break and free up jobs for a younger generation.

But with pension funds in deficit and the number of over-60s on the rise, governments and individuals are under pressure to accept that a graying work force will have to work longer.

“There is nothing stopping older people applying for university,” David Willetts, Britain’s higher education minister, said this week. “If they can benefit from it, they should have that opportunity.”

The rules have been eased to allow people of any age to take out student loans to help finance their university education.

“If people need it in order to keep up to date with changes in their jobs, that is an opportunity they are going to take,” the Daily Telegraph quoted the minister as saying.

The advice comes at a time, however, when growing numbers of young Europeans are emigrating in order to find jobs that are unavailable at home.

“From Ireland to Greece, young Europeans are now the ones desperately seeking exit strategies from economies in free fall,” according to The Guardian.

László Andor, the European Union’s employment commissioner, recently quoted jobless figures indicating that 1 in 4 young people under 25 were out of work, a total of 5.7 million, in the 27 member states.

In a special report on Thursday the EurActiv Web site said the Continent faced a digital brain drain as a consequence of a generation of educated young people leaving Europe to seek work elsewhere.

It said the situation was particularly bad in southern states where unemployment was highest. In countries such as Spain, the mass exodus of young, educated people amounted to a brain drain “the likes of which has not been seen since the end of the Spanish Civil War in 1939.”

For those who stay at home — whether they are 25 or 65 — there is clearly no guarantee that university degrees will get them jobs.

When a British coffee chain recently advertised for staff at one of its new stores, it received 1,701 applications for just eight jobs. Among the rejected candidates were a number of jobless new graduates.

Should older people be encouraged to keep working? Or should they step aside to widen the job market for jobless newcomers? Tell us what you think.

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Top detective appointed new Pistorius investigator

PRETORIA, South Africa (AP) — South Africa's top detective was appointed lead investigator in the Oscar Pistorius case Thursday, replacing a veteran policeman who was charged with attempted murder in the latest shock development to hit a case being watched closely by the nation.

National Police Commissioner Riah Phiyega promised that a team of "highly skilled and experienced" officers would investigate the killing of Pistorius' 29-year-old girlfriend. Pistorius, 26, has been charged with premeditated murder in the case.

The decision to put police Lt. Gen. Vinesh Moonoo in charge came soon after word emerged that the initial chief investigator, Hilton Botha, is facing attempted murder charges, and a day after he offered testimony damaging to the prosecution in Pistorius' bail hearing.

Pistorius, an Olympic runner whose lower legs were amputated when he was less than a year old, killed his girlfriend Reeva Steenkamp in the predawn hours of Valentine's Day. He claims he mistook her for an intruder when he shot her through a locked door in a bathroom in his home. Prosecutors say the shooting happened after the couple got into an argument and allege the killing was deliberate, carried out with no mercy.

Botha acknowledged Wednesday in court that nothing in Pistorius' version of the fatal shooting of Steenkamp contradicted what police had discovered, even though there have been some discrepancies. Botha also said that police had left a 9 mm slug in the toilet and had lost track of allegedly illegal ammunition found in Pistorius' home.

"This matter shall receive attention at the national level," Phiyega told reporters soon after the end of proceedings in the third day of Pistorius' bail hearing. The case has riveted South Africa and much of the world and has placed the country's judicial system under close scrutiny.

Bulewa Makeke, spokeswoman for South Africa's National Prosecuting Authority, said the attempted murder charges had been reinstated against Botha on Feb. 4. Police say they found out about it after Botha testified in Pistorius' bail hearing Wednesday.

Botha and two other police officers had seven counts of attempted murder reinstated against them in relation to a 2011 shooting incident. Botha and his two colleagues allegedly fired shots at a minibus they were trying to stop.

Asked about Botha's court performance and handling of the investigation, Phiyega said South Africa's police force "can stand on its own" compared to others around the world.

Makeke, the spokeswoman for the national prosecution office, had said before Botha was dismissed from the Pistorius case that he should be taken off, but added that it was up to the police force to make that decision.

Makeke indicated the charges were reinstated against Botha because more evidence had been gathered. She said the charge against Botha was initially dropped "because there was not enough evidence at the time."

Pistorius' main sponsor Nike, meanwhile, suspended its contract with the multiple Paralympic champion, following eyewear manufacturer Oakley's decision to suspend its sponsorship. Nike said in a brief statement on its website: "We believe Oscar Pistorius should be afforded due process and we will continue to monitor the situation closely."

The judge is still trying to decide whether to grant Pistorius bail, and under what conditions.

During Thursday's bail hearing, Chief Magistrate Desmond Nair asked the defense of Pistorius' bail application: "Do you think there will be some level of shock if the accused is released?"

Defense lawyer Barry Roux responded: "I think there will be a level of shock in this country if he is not released."

Opposing bail, prosecutor Gerrie Nel painted a picture of a man "willing and ready to fire and kill," and said signs of remorse from Pistorius do not mean that the athlete didn't intend to kill his girlfriend.

"Even if you plan a murder, you plan a murder and shoot. If you fire the shot, you have remorse. Remorse might kick in immediately," Nel said.

As Nel summed up the prosecution's case opposing bail, Pistorius began to weep in the crowded courtroom, leading his brother, Carl Pistorius, to reach out and touch his back.

"He (Pistorius) wants to continue with his life like this never happened," Nel went on, prompting Pistorius, who was crying softly, to shake his head. "The reason you fire four shots is to kill," Nel persisted.

Earlier Thursday, Nair questioned Botha over delays in processing records from phones found in Pistorius' house following the killing of Steenkamp, a 29-year-old model and budding reality TV contestant.

"It seems to me like there was a lack of urgency," Nair said as the efficiency of the police investigation was questioned.

Botha is himself to appear in court in May to face seven counts of attempted murder. Botha was dropped from the case but not suspended from the police force, Phiyega said, and could still be called by defense lawyers at trial.

Pisatorius' behavior Thursday reflected the change of mood in the courtroom as his defense lawyers attacked police procedures and maintained his innocence.

Pistorius, in the same gray suit, blue shirt and gray tie combination he has worn throughout the bail hearing, stood ramrod straight in the dock, then sat calmly looking at his hands. On Tuesday and Wednesday, the athlete had been slumped over and sobbing uncontrollably at times as detail was read out of how Steenkamp died in his house.

"The poor quality of the evidence offered by investigative officer Botha exposed the disastrous shortcomings of the state's case," Roux said Thursday. "We cannot sit back and take comfort that he is telling the truth."

Roux also raised issue of intent, saying the killing was not "pre-planned" and referred to a "loving relationship" between the two.

He said an autopsy showed that Steenkamp's bladder was empty, suggesting she had gone to use the toilet as Pistorius had claimed. Prosecutors claim Steenkamp had fled to the toilet to avoid an enraged Pistorius.

"The known forensics is consistent" with Pistorius' statement, Roux said, asking that bail restrictions be eased for Pistorius.

But the prosecutor said Pistorius hadn't given guarantees to the court that he wouldn't leave the country if he was facing a life sentence. Nel also stressed that Pistorius shouldn't be given special treatment.

"I am Oscar Pistorius. I am a world-renowned athlete. Is that a special circumstance? No." Nel said. "His version (of the killing) is improbable."

Nel said the court should focus on the "murder of the defenseless woman."

Botha testified Thursday that he had investigated a 2009 complaint against Pistorius by a woman who claimed the athlete had assaulted her. He said that Pistorius had not hurt her and that the woman had actually injured herself when she kicked a door at Pistorius' home.

The hearing is to continue Friday morning.

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AP Sports Writer Gerald Imray contributed to this report from Johannesburg.

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Well: Getting Patients to Think About Costs

A colleague and I recently got into a heated discussion over health care spending. It wasn’t that he disagreed with me about the need to rein in costs; but he said he was frustrated every time he tried to do so.

Earlier that week, for example, he had tried to avoid ordering a costly M.R.I. scan for a patient who had been suffering from headaches. After a thorough examination, my colleague was convinced the headaches were the result of stress.

But the patient was not.

“She wouldn’t leave until she got that M.R.I.,” my colleague said. Even after he had explained his conclusions several times, proposed a return visit in a month to reassess the situation and ran so far overtime that his office nurse knocked on the door to make sure nothing had gone awry, the patient continued to insist on getting the expensive study.

When my colleague finally evoked cost – telling the woman that while an M.R.I. might ferret out rare causes, it didn’t make sense to spend the enormous fee on something of such marginal benefit – the woman became belligerent. “She yelled that this was her head we were talking about,” he recalled. “And expensive tests like this were the reason she had health insurance.”

Face flushed, he paused to take a deep breath. “Yeah, I may be all for controlling costs,” he finally said. “But are our patients?”

According to a new study in the journal Health Affairs, his concern about patients may not be far off the mark.

A growing number of initiatives aimed at controlling spiraling health care costs have been championed in recent years, aiming to replace the current model in which doctors are reimbursed for every office visit, test or procedure performed. These programs range from pay-for-performance, where doctors can earn more money by meeting predetermined quality “goals” like controlling patients’ blood sugar or high blood pressure, to accountable care organizations, where clinicians and hospitals in partnership are paid a lump sum to cover all care.

Their uninspired monikers aside, all of these plans share one defining feature: doctors are to be the key agents of change. Whether linked with quality measures, bundled payments or satisfaction scores, it is the doctors’ behavior and choice of treatments that result in savings, goes the thinking.

But as the new study reveals, doctors need to take into account more than just symptoms and diseases when deciding what to prescribe and offer. They must also consider their patients’ opinions and willingness to be cost conscious when it comes to their own care.

The researchers conducted more than 20 patient focus groups and asked the participants to imagine themselves with various symptoms and a choice of diagnostic and treatment options that varied only slightly in effectiveness but significantly in cost. They were asked, for example, to choose between an M.R.I. or a CT scan for a severe long-standing headache, with the M.R.I. being much more expensive but also more likely to catch some extremely rare problems.

When it came to their own treatment, “patients for the most part did not want cost to play any role in decision-making,” said Dr. Susan Dorr Goold, one of the study authors and a professor of internal medicine and health management and policy at the University of Michigan in Ann Arbor. Most did not want their doctors to take expenditures into account, and many made it clear that they would ask for the significantly more expensive medications, procedures or diagnostic studies, even if those options were only slightly better than the cheaper alternatives. “That puts doctors, whose primary responsibility is to their individual patients, in a very difficult position.”

A majority of the participants refused to consider the expenses borne by insurers or by society as a whole when making their choices. Some doubted that one individual’s efforts would have any real overall impact and so gave up considering cost-savings altogether. Others said they would go out of their way to choose the more expensive options, viewing such decisions as acts of defiance and a kind of well-deserved “payback” after years of paying insurance premiums.

Underlying all of these comments was the belief that cost was synonymous with quality. Even when the focus group leaders reminded participants that the differences between proposed options were nearly negligible, participants continued to choose the more expensive options as if it were beyond question that they must be more efficacious or foolproof.

The study’s findings are disheartening. But Dr. Goold and her co-investigators believe that public beliefs and attitudes about cost and quality can be changed. They cite the dramatic transformation in attitudes about end-of-life care as an example of how initiatives to improve understanding can lead people to make higher quality and more cost-effective decisions, like choosing hospices over hospitals.

“We need to begin to talk about these issues in a way that doesn’t turn it into a discussion pitting money against life, and we need to find ways of getting people to think about not spending money on things that offer marginal benefit” Dr. Goold said. “Because it’s going to be tough otherwise trying to implement any cost-saving measures, if patients don’t accept them.”

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DealBook: Carlyle's Profit Fell in 4th Quarter as Growth Slowed

11:18 a.m. | Updated Most of the publicly traded private equity giants proudly reported glowing fourth-quarter earnings.

The Carlyle Group isn’t one of them.

On Thursday, the alternative investment giant disclosed a 28 percent drop in fourth-quarter profit from the period a year earlier, as the growth of its portfolio companies slowed. That sent the company’s stock down more than 8 percent by midmorning, to $33.70.

Carlyle reported fourth-quarter profit of $182 million, expressed as economic net income, compared with $254 million in the year-earlier period. That amounts to 47 cents per unit. Analysts surveyed by Capital IQ had expected about 66 cents per unit, on average.

And Carlyle’s distributable earnings, a measure the firm prefers because it tracks actual payouts to its limited partners, fell 24 percent, to $188 million. Using generally accepted accounting principles, Carlyle earned $12 million in net income.

The results fall short of those of rivals like the Blackstone Group and Kohlberg Kravis Roberts. Private equity firms in general have gained from improvements in the markets, which have lifted the valuations of their portfolios and bolstered their core business of buying and selling companies.

Carlyle attributed the decline in economic net income to a smaller appreciation in the value of its portfolio. It reported a 4 percent gain for the quarter, compared with a 7 percent increase in the period a year earlier.

The decision to delay reaping carried interest from its latest mainstay fund, Carlyle Partners V, weighed on distributable earnings. The company opted to hold off, given the relative freshness of the fund and the influx of new investments like the buyouts of the TCW Group and Getty Images.

Carlyle highlighted its strong fund-raising and gains from selling investments. The firm raised $4.6 billion in new money for the quarter and $14 billion for the year, compared with a total of $6.6 billion raised in all of 2011. It generated $6.8 billion in realized proceeds for the quarter and $18.7 billion for the year, compared with $17.6 billion in 2011.

“We had another excellent year,” David M. Rubenstein, one of Carlyle’s co-chief executives, said in a statement. “Our performance over the past two years was marked by steady, continuous progress across our business.”

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Former Lebanon Minister and Syrian Co-Defendant Could Face Death Penalty

BEIRUT, Lebanon — A Lebanese military court judge on Wednesday charged a former government information minister and his suspected Syrian accomplice of a conspiracy to kill Lebanese political and religious leaders and foment sectarian strife, recommending the death penalty for both.

The announcement about the defendants, Michel Samaha, the former minister, and Mr. Mamlouk, a Syrian security official, came amid increased sectarian tensions in Lebanon that are directly tied to the nearly two-year-old conflict in neighboring Syria, which occupied Lebanon for nearly three decades until 2005 and still deeply polarizes Lebanese politics.

Lebanese officials have said explosives were found in a car belonging to Mr. Samaha, who was arrested on Aug. 9. Mr. Mamlouk was accused of plotting with Mr. Samaha to transport the explosives into the country. An arrest warrant for Mr. Mamlouk was issued this month. His whereabouts is unclear.

It also was unclear how long a trial would last or whether the judge’s recommendations of punishment would be followed if the pair were found guilty. But the Lebanese government’s handling of the politically sensitive case carries its own risks of aggravating sectarian tensions in this country.

On Tuesday, a group claiming to represent a faction of Syrian rebels threatened to lob mortar shells into Lebanon to attack Hezbollah, the Shiite militia that is also Lebanon’s most powerful political party, in retaliation for what rebels say is a Hezbollah military campaign against rebels in Syria. The statement warned Lebanese citizens, especially in the Shiite, pro-Hezbollah border town of Hermel, to stay away from Hezbollah positions that it said were shelling the rebels across the border.

A cross-border skirmish between Hezbollah and Syrian rebels could be a dangerous escalation in Lebanon, which has struggled to stay out of the conflict in Syria.

Representatives of the main group of rebel fighters, the Free Syrian Army, issued conflicting statements, with one saying the threat was a provocation fabricated by Hezbollah, and another confirming it and giving Hezbollah 48 hours to end its attacks or face retaliation.

Hezbollah is closely allied to the Syrian government, while its Sunni rivals in Lebanon largely support the majority Sunni rebels. Rebels say Hezbollah has stepped up its military activity inside Syria, taking over numerous villages near the border. Hezbollah says its fighters have been active only in Syrian villages where Lebanese citizens live and are defending themselves.

With the Syrian conflict threatening to destabilize the region, Russia’s foreign minister said on Wednesday that his country would work with the Arab League to bring about direct talks between Syria’s government and the armed opposition in a bid to end the deadly civil war.

Speaking after a meeting with Arab League officials in Moscow, the minister, Sergey V. Lavrov, told reporters there were “signs of tendencies for dialogue from both the side of the government and the opposition,” Agence France-Presse reported.

Russia has long called for a political solution, but Mr. Lavrov’s statement seemed to indicate a new level of engagement in pushing for talks. Syria’s foreign minister, Walid al-Moallam, is scheduled to visit Moscow on Monday for talks, and the president of Syria’s main opposition coalition, Moaz al-Khatib, is expected to visit Moscow in March, Mr. Lavrov said.

Yet it is unclear whether Mr. Moallem and Mr. Khatib have the full backing of their own sides for talks. Mr. Khatib’s group, the National Coalition of Syrian Revolution and Opposition Forces, insists that it will speak only with members of Mr. Assad’s government without “blood on their hands.” Lakhdar Brahimi, the special Syria peace envoy representing the United Nations and the Arab League, has appeared to support Mr. Khatib’s position, calling on the government to send an “acceptable delegation.”

But on Wednesday, Mr. Lavrov said that the two sides should not impose preconditions or “say that I am going to talk to this person but not that one.” He was speaking after a meeting of the Russia-Arab Forum from which the representatives of the rebels’ main Arab backers, Saudi Arabia and Qatar, were absent.

In Syria on Wednesday, rebel shells appeared to reach new areas in Damascus, activists and witnesses reported. Goran Tomasevic, a photographer for The Associated Press who has recently produced images of fighting in the Damascus suburbs as one of the few foreign journalists with rebel fighters there, described a deadly stalemate between two well-coordinated fighting forces that he said was reminiscent of wars that gutted cities like Sarajevo and Stalingrad.

“Rebel fighters in Damascus are disciplined, skilled and brave,” he wrote in an account published on Wednesday. “In a month on the front-line, I saw them defend a swath of suburbs in the Syrian capital, mount complex mass attacks, manage logistics, treat their wounded.”

But, he added, “as constant, punishingly accurate, mortar, tank and sniper fire attested,” government soldiers, often fighting at close range, “are also well drilled, courageous — and much better armed.”

Both state media and opposition activists reported on Wednesday that mortar rounds had hit the Tishreen sports stadium in the downtown neighborhood of Baramkeh. The state news agency, SANA, said the explosion killed an athlete from the Homs-based Al Wathba soccer team as he was practicing.

Government forces hit a rebel command center in a suburb east of the capital on Wednesday, injuring a founder of the Liwaa al-Islam brigade, Sheik Zahran Alloush, the brigade said in a statement.

It said the attack “won’t stop or weaken the will of the battalion” and asked for “God’s help to reach the criminals for retribution.”

Hania Mourtada and Hwaida Saad contributed reporting.

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Well: Caffeine Linked to Low Birth Weight Babies

New research suggests that drinking caffeinated drinks during pregnancy raises the risk of having a low birth weight baby.

Caffeine has long been linked to adverse effects in pregnant women, prompting many expectant mothers to give up coffee and tea. But for those who cannot do without their morning coffee, health officials over the years have offered conflicting guidelines on safe amounts during pregnancy.

The World Health Organization recommends a limit of 300 milligrams of caffeine a day, equivalent to about three eight-ounce cups of regular brewed coffee. The American College of Obstetricians and Gynecologists stated in 2010 that pregnant women could consume up to 200 milligrams a day without increasing their risk of miscarriage or preterm birth.

In the latest study, published in the journal BMC Medicine, researchers collected data on almost 60,000 pregnancies over a 10-year period. After excluding women with potentially problematic medical conditions, they found no link between caffeine consumption – from food or drinks – and the risk of preterm birth. But there was an association with low birth weight.

For a child expected to weigh about eight pounds at birth, each day that the mother consumed 100 milligrams of caffeine from any source equated to a loss of between three-quarters of an ounce to an ounce in birth weight. Even after the researchers excluded from their analysis smokers, a group that is at higher risk for complications and also includes many coffee drinkers, the link remained.

One study author, Dr. Verena Sengpiel of the Sahlgrenska University Hospital in Sweden, said the findings were not definitive because the study was observational, and correlation does not equal causation. But they do suggest that women might put their caffeine consumption “on pause” while pregnant, she said, or at least stay below two cups of coffee per day.

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State of the Art: Sony’s RX1 Camera: Compact, Full-Framed and Expensive, Too

When you’re shopping for a camera, you have a million specs and features to consider. Size, weight, battery life, megapixels, zoom power. ... Can you guess which aspect consumers consider most important?

The color of the body. (“Ooh, I like the shiny red one!”)

The camera buyer for a national electronics chain told me that. We both slapped our foreheads.

Please. If you’re buying a camera, shouldn’t picture quality be the most important detail?

If so, what you should care most about is the flat, rectangular light sensor inside the “film.” In general, the bigger the sensor, the happier you’ll be with the results and the more you’ll pay.

At the low end, snapshot cameras with tiny sensors (0.4 inches diagonal) cost $150 but give you blurry, grainy low-light shots. At the high end, those professional, big, black S.L.R. cameras cost $2,000 to $6,000 but come with full-frame sensors. That is, these sensors are as big as an old piece of 35-millimeter film (1.7 inches). They deliver unparalleled low-light quality, richness of color, detail and soft-focused backgrounds.

(You can buy cameras with even bigger sensors — medium-format cameras that cost $20,000 and military cameras that cost millions — but let’s say you live in the real world.)

All of this explains why Sony’s 2013 camera/camcorder lineup is so startling. The company has put full-frame sensors into three new cameras, at prices and body sizes that nobody has ever attained.

For example, there’s the A99, which Sony says is the world’s smallest and lightest full-frame S.L.R. It’s meant to compete with professional cameras like the Canon 5D Mark III ($3,200) and Nikon D800 ($3,000) — for $2,800. (These prices are for the bodies only.)

The A99 is sort of homely, but it has a long list of distinguishing features: fast, continuous focusing, even while filming or shooting something running at you; two memory-card slots; built-in GPS function that stamps every photo with your location; 1080p, 60-frames-a-second high-definition video; microphone and headphone jacks; and an electronic viewfinder whose video shows you the results of your adjustments in real time.

Sony says the A99 is also the only full-frame camera with a screen that flips out and tilts.

Then there’s the VG900, Sony’s first full-frame camcorder. It costs $3,300 — about $10,000 less than any other full-frame camcorder, Sony says. And its sensor is about 45 times as big as a standard camcorder’s sensor.

Now, a huge sensor may not seem to make sense in a camcorder. One frame of hi-def video has only about two megapixels of resolution; what’s the point of stuffing a 24-megapixel sensor into the camcorder?

Answer: It’s about picture quality. A big sensor gives you amazing low-light video, gorgeous blurry backgrounds, greater dynamic range and better color.

Thousands of filmmakers use full-frame S.L.R. still cameras to shoot video, because of the superior quality and because they can use different lenses for different video effects. S.L.R-based camcorders like Sony’s VG900 offer the same features in a camcorder shape. They’re much more comfortable to hold, and their buttons are better placed for video operation.

The VG900 accepts Sony’s E-mount camera lenses, of which there are 13; they don’t quite exploit the full area of that jumbo sensor. But the camera comes with an adapter for the older, more plentiful A-mount lenses. Alas, those lenses don’t autofocus with that adapter.

The most astonishing new full-frame Sony, though, is the RX1. It’s the world’s first compact full-frame camera.

Now, you’re forgiven if you just spewed your coffee. “Compact” and “full-frame” have never gone together before. Everyone knows why: a big sensor requires a big lens, meaning a big camera. You can’t change the laws of physics, no matter how much photographers would love it.

E-mail: pogue @nytimes.com

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India Ink: Image of the Day: Feb. 19

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Pistorius: Thought lover an intruder in shooting

PRETORIA, South Africa (AP) — Oscar Pistorius wept Tuesday as his defense lawyer read the athlete's account of how he shot his girlfriend to death on Valentine's Day, claiming he had mistaken her for an intruder.

Prosecutors, however, told a packed courtroom that the double-amputee known as the Blade Runner intentionally and mercilessly shot and killed 29-year-old Reeva Steenkamp as she cowered inside a locked bathroom.

Pistorius told the Pretoria Magistrate's Court at a bail hearing he felt vulnerable in the presence of an intruder inside the bathroom because he did not have his prosthetic legs on, and fired into the bathroom door.

The Valentine's Day shooting in Pistorius' home in Pretoria shocked South Africans and many around the world who idolized him for overcoming adversity to become a sports champion, competing in the London Olympics last year in track besides being a Paralympian. Steenkamp was a model and law graduate who made her debut on a South African reality TV program that was broadcast on Saturday, two days after her death.

In a major point of contention emerged even during Tuesday bail hearing, prosecutor Gerrie Nel said Pistorius took the time to put on his prostheses, walked seven meters (yards) from the bed to the enclosed toilet inside his bathroom and only then opened fire. Three of the bullets hit Steenkamp of the four that were fired into the door, Nel said.

Pistorius said in his sworn statement that after opening fire, he realized that Steenkamp was not in his bed.

"It filled me with horror and fear," Pistorius said. The 26-year-old Olympian said he put on his prosthetic legs and tried to kick down the door before finally bashing it in with a cricket bat. Inside, he said he found Steenkamp, slumped over. He said he lifted her bloodied body into his arms and tried to carry her downstairs to seek medical help.

But by then, it was too late.

"She died in my arms," the athlete said.

Nel charged Pistorius with premeditated murder and said the athlete opened fire after the couple engaged in a shouting match and she fled to the bathroom.

"She couldn't go anywhere. You can run nowhere," Nel said. "It must have been horrific."

A conviction of premeditated murder carries a mandatory sentence of life in jail.

Chief Magistrate Desmond Nair ruled that Pistorius must face the harshest bail requirements available in South African law. That means Pistorius' lawyers must offer "exceptional" reasons for the athlete to be free before trial, besides simply giving up his two South African passports and posting a cash bond.

Pistorius sobbed softly as his lawyer, Barry Roux, insisted the shooting was an accident and that there was no evidence to substantiate a murder charge.

"We submit it is not even murder," he said. "There is no concession this is a murder."

Pistorius' emotional outbursts again played a part in how the hearing progessed, as it did during an initial hearing Friday. At one point, Nair stopped the hearing after Pistorius wept as Roux read a portion of the athlete's statement describing how Steenkamp bought him a Valentine's Day present, but wouldn't let him open it the night before.

"Maintain your composure," the magistrate said. "You need to apply your mind here."

Pistorius' voice quivered when he answered: "Yes, my lordship."

Affidavits from friends of Pistorius and Steenkamp described the two as a charming, happy couple. The night before the killing, they said, Pistorius and Steenkamp had canceled separate plans in order to spend the night before Valentine's Day together at his home, in a gated neighborhood.

Outside the court, several dozen singing women protested against domestic violence and waved placards urging that Pistorius be refused bail. "Pistorius must rot in jail," one placard said.

As details emerged at the dramatic court hearing in the capital, Steenkamp's body was being cremated Tuesday at a memorial service in the south-coast port city of Port Elizabeth. Six pallbearers carried her coffin, draped with a white cloth and covered in white flowers, into the church for the private service.

South Africa has some of the world's worst rates of violence against females and the highest rate in the world of women killed by an intimate partner, according to a study by the Medical Research Council. Professor Rachel Jewkes of the council said at least three women are killed by a partner every day in this country of 50 million.

Steenkamp campaigned actively against domestic violence and had tweeted on Twitter that she planned to join a "Black Friday" protest by wearing black in honor of a 17-year-old girl who was gang-raped and mutilated two weeks ago.

What "she stood for, and the abuse against women, unfortunately it's gone right around and I think the Lord knows that statement is more powerful now," her uncle Mike Steenkamp, the family's spokesman, said after her memorial.

He said the family had planned a big get-together at Christmas but that had not been possible. "But we are here today as a family and the only one who's missing is Reeva," he said, breaking down and weeping.

Pistorius has lost several valuable sponsorships estimated to be worth more than $1 million a year.

On Tuesday, the athlete was ousted from a pro-gay campaign being launched in Cape Town, organizers said. In a video axed from the campaign, Pistorius says: "You don't have to worry. You don't have to change. Take a deep breath and remember, 'It will get better.'"

And Clarins Group, which owns Thierry Mugler Perfumes, said in an email that "out of respect and compassion for the families involved in this tragedy, Thierry Mugler Perfumes have taken the decision to withdraw all of their advertising campaigns featuring Oscar Pistorius."

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Ask Well: Coaxing Parents to Take Better Care of Themselves

Dear Reader,

Your dilemma of wanting to get your parents to change their ways to eat better and exercise reminds me of an old joke:

How many psychologists does it take to change a light bulb? Answer: Only one, but the light bulb has to really want to change.

Sounds like your parents may be about as motivated as the light bulb right now. Still, there are things you can do to encourage them to move in a healthier direction. But the first step should not be to hand them a book. Unless you lay some prior groundwork, that gesture may seem almost as patronizing as an impatient tone of voice – and probably as likely to backfire.

Instead, start a conversation in a caring, nonjudgmental way. Ask, don’t tell. “Say, ‘You know, I might not know what I am talking about, but I am really concerned about you,” suggested Kevin Leman, a psychologist in Tucson, Ariz., and author of 42 books on changing behavior in families and relationships. Ask simply if there is anything you can do to help.

Leading by example is also more effective than lecturing. “The son can role-model health by inviting his parents to dinner and serving healthful items that he is fairly certain they will find acceptable, or ask them if they are interested in going out dancing with him and his wife,” suggested Ann Constance, director of the Upper Peninsula Diabetes Outreach Network in Michigan.

Pleasure is a better motivator for change than pain or threats. Use the grandchildren as bait. Ask if they want to take the grandchildren to the zoo or a park that would require a good bit of walking around for everyone. Or the grandchildren could ask them to come along on one of those 2K fund-raiser-walks that many schools hold. After all, a day with the grandchildren is always a pleasure in itself. (O.K., usually a pleasure.)

Tempted to give them the gift of a health club membership? “Save your money,” Dr. Leman said. Try a more indirect (and cheaper) approach. Create a mixed-tape of up-tempo music from their era. (“Songs they listened to from the ages of 12-to-17, which is what we all listen to for the rest of our lives,” said Dr. Leman) They will enjoy it any time — maybe even while walking.

If you really want someone you love to make a change, the key is to ask them to do something small and easy first because that increases the chances they will do something larger later. Psychologists call that “the foot in the door technique,” said Adam Davey, associate professor of public health at Temple University in Philadelphia, referring to a classic 1966 experiment called “Compliance Without Pressure.” In the study, which has been duplicated by others in many forms, researchers asked people to sign a petition or place a small card in a window in their home or car about keeping California beautiful or supporting safe driving. About two weeks later, the same people were asked to put a huge sign that practically covered their entire front lawn advocating the same cause.

“A surprisingly large number of those who agreed to the small sign agreed to the billboard,” because agreeing to the first small task built a bond between asker and askee “that increases the likelihood of complying with a subsequent larger request,” Dr. Davey explained.

Any plan for behavioral change is most likely to succeed if it is very specific, measurable and achievable, according to Ms.Constance.

And the new behavior should also be integrated into daily life — and repeated until it becomes a habit. For example, if you want to walk more, start with a 10-minute walk after dinner on Monday, Wednesday and Friday, Ms. Constance suggested. The next week, bump it up to 12 minutes.

Don’t give up, even if you meet initial resistance — it is never too late for your parents or you or any of us to change. “Taking up an exercise program into one’s 80s and 90s to build strength and flexibility can result in very tangible and enduring benefits in a surprisingly short time,” insisted Dr Davey.

As for instructive reading, Dr. Leman is partial to one of his own books, “Have a New You by Friday,” and Dr. Davey recommends “Biomarkers: The 10 Keys to Prolonging Vitality,” by William Evans. Ms. Constance recommends the Centers for Disease Control and Prevention’s Web site on physical activity and exercise tips for the elderly, as well as the National Institute of Health’s site on the DASH diet.

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Obama to Turn Up Pressure for Deal on Budget Cuts

Doug Mills/The New York Times

President Obama spoke at a White House auditorium surrounded by emergency responders.

WASHINGTON — President Obama, back from his three-day golf getaway, on Monday made use of his bully pulpit, while Congress remains out all week, to turn up the pressure for a bipartisan agreement to avoid indiscriminate across-the-board budget cuts that will otherwise hit March 1.

Speaking in a White House auditorium surrounded by blue-uniformed emergency responders to illustrate some of the jobs threatened if the cuts were to take effect, Mr. Obama warned that military readiness and vital domestic services would be hurt “if Congress allows this meat-cleaver approach to take place.”

“Changes like this affect our responsibility to respond to threats in unstable parts of the world,” the president said. “These cuts are not smart, they are not fair, they will hurt our economy, they will add hundreds of thousands of Americans to the unemployment rolls. This is not an abstraction — people will lose their jobs.”

Some Republicans in Congress have proposed alternative savings that would spare any cuts in military spending but not in domestic accounts. Mr. Obama and Congressional Democrats are calling for a mix of spending cuts and additional tax revenues by closing some tax breaks for wealthy investors and corporations.

Mr. Obama’s comments were among his harshest toward Republicans, and reflected the political frame that he has devised to try to force Republicans into compromising with him by supporting some higher revenues — something they so far refuse to do.

“The ideas that the Republicans have proposed ask nothing of the wealthiest Americans or biggest corporations, so the burden is all on first responders or seniors or middle-class families,” Mr. Obama said, adding that those proposals would “slash Medicare and investments that create good middle-class jobs.”

“So now Republicans in Congress face a simple choice,” he added. “Are they willing to compromise to protect vital investments in education and health care and national security and all the jobs that depend on them, or would they rather put hundreds of thousands of jobs and our entire economy at risk just to protect a few special-interest tax loopholes that benefit only the wealthiest Americans and biggest corporations?”

Republicans, seeking to put blame on Mr. Obama if the cuts occur, have repeatedly noted that the White House proposed the sequester idea during debt talks in mid-2011. But both parties overwhelmingly supported the proposal as part of their deal. And as Mr. Obama said on Tuesday, the purpose of the sequester was to threaten something so unthinkable that the two parties would come together to agree on an alternative.

The president’s latest deficit reduction push comes as the heads of his 2010 deficit reduction commission — former Senator Alan K. Simpson and Erskine B. Bowles, a former chief of staff to President Bill Clinton — unveil a new plan that would reduce the deficit by $2.4 trillion through a series of spending cuts and an overhaul of the tax system.

When Congress returns from a winter recess next week, just days remain before the deadline for the so-called sequester of spending cuts, a deadline that already was moved once — at the start of the year — to allow more time for the two parties to negotiate.

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India Ink: Image of the Day: Feb. 18

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Jerry Buss, Los Angeles Lakers' owner, dies at 80

LOS ANGELES (AP) — Jerry Buss, the Los Angeles Lakers' playboy owner who shepherded the NBA franchise to 10 championships from the '80s Showtime dynasty to the Kobe Bryant era, died Monday, his assistant said.

Buss died at Cedars-Sinai Medical Center in Los Angeles, said Bob Steiner, his assistant. He was 80.

He'd been hospitalized for cancer, but the immediate cause of death was kidney failure, Steiner said.

Under Buss' leadership since 1979, the Lakers became Southern California's most beloved sports franchise and a worldwide extension of Hollywood glamour. Buss acquired, nurtured and befriended a staggering array of talented players and basketball minds during his Hall of Fame tenure.

Few owners in sports history can even approach Buss' accomplishments with the Lakers, who made the NBA finals 16 times through 2011 during his 32 years in charge, winning 10 titles between 1980 and 2010. The Lakers easily are the NBA's winningest franchise since he bought the club.

Few owners have ever been more beloved by their players than Buss, who always referred to the Lakers as his extended family. Working with front-office executives Jerry West and Mitch Kupchak, Buss spent lavishly to win his titles despite lacking a huge personal fortune, often running the NBA's highest payroll while also paying high-profile coaches Pat Riley and Phil Jackson.

Always an innovative businessman, Buss paid for the Lakers through both their wild success and his own groundbreaking moves to raise revenue. He co-founded a basic-cable sports television network and sold the naming rights to the Forum at times when both now-standard strategies were unusual, adding justification for his induction into the Pro Basketball Hall of Fame in 2010.

Magic Johnson and fellow Hall of Famers Kareem Abdul-Jabbar and James Worthy formed lifelong bonds with Buss during the Lakers' run to five titles in nine years in the 1980s, when the Lakers earned a reputation as basketball's most exciting team with their glamorous Showtime style.

Jackson then led Shaquille O'Neal and Bryant to a threepeat from 2000-02, rekindling the Lakers' mystique, before Bryant and Pau Gasol won two more titles under Jackson in 2009 and 2010.

Although Buss was proudest of his two hands full of NBA title rings, he also was a scholar, Renaissance man and bon vivant who epitomized California cool — and a certain Los Angeles lifestyle — for his entire public life.

The father of six rarely appeared in public without at least one attractive, much younger woman on his arm at USC football games, boxing matches, poker tournaments — and, of course, Lakers games from his private box at Staples Center, which was built under his watch.

Buss earned a Ph.D. in chemistry at age 24 and had careers in aerospace and real estate development before getting into sports. With money largely from his Santa Monica real-estate ventures, Buss bought the then-struggling Lakers, the NHL's Los Angeles Kings and both clubs' arena — the Forum — from Jack Kent Cooke in a $67.5 million deal that was the largest sports transaction in history at the time.

In January 2011, Forbes estimated the Lakers were worth $643 million — the second-most valuable NBA franchise.

Buss also helped change televised sports by co-founding the Prime Ticket network in 1985, even receiving a star on Hollywood Walk of Fame in 2006 for his work in television. Breaking the contemporary model of subscription services for televised sports, Buss' Prime Ticket put beloved broadcaster Chick Hearn and the Lakers' home games on basic cable.

Buss also sold the naming rights to the Forum in 1988 to Great Western Savings & Loan — another deal that was ahead of its time.

Born in Salt Lake City, Gerald Hatten Buss was raised in Wyoming and attended USC for graduate school, eventually becoming a chemistry professor and working as a chemist for the Bureau of Mines before his life took an abrupt turn into wealth and sports.

The former mathematician claimed his fortune grew out of a $1,000 real-estate investment in a West Los Angeles apartment building with partner Frank Mariani, an aerospace engineer.

Buss purchased Cooke's entire Los Angeles sports empire in 1979, including a 13,000-acre ranch in Kern County. Buss' love of basketball was the motivation for his purchase, and he immediately worked to transform the Lakers — who had won just one NBA title since moving west from Minneapolis in 1960 — into a star-powered endeavor befitting Hollywood.

"One of the first things I tried to do when I bought the team was to make it an identification for this city, like Motown in Detroit," he told the Los Angeles Times in 2008. "I try to keep that identification alive. I'm a real Angeleno. I want us to be part of the community."

Buss' plans immediately worked: Johnson, Abdul-Jabbar and coach Paul Westhead led the Lakers to the 1980 title. Johnson's ball-handling wizardry and Abdul-Jabbar's smooth inside game made for an attractive style of play evoking Hollywood flair and West Coast cool.

Riley, the former broadcaster who fit the L.A. image perfectly with his slick-backed hair and chiseled good looks, was surprisingly promoted by Buss early in the 1981-82 season after West declined to co-coach the team. Riley became one of the best coaches in NBA history, leading the Lakers to four straight NBA finals and four titles, with Worthy, Michael Cooper, Byron Scott and A.C. Green playing major roles.

Overall, the Lakers made the finals nine times in Buss' first 12 seasons while rekindling the NBA's best rivalry with the Boston Celtics, and Buss basked in the worldwide celebrity he received from his team's achievements. His womanizing and partying became Hollywood legend, with even his players struggling to keep up with Buss' lifestyle.

Johnson's HIV diagnosis and retirement in 1991 staggered Buss and the Lakers, the owner recalled in 2011. The Lakers struggled through much of the 1990s, going through seven coaches and making just one conference finals appearance in an eight-year stretch despite the 1996 arrivals of O'Neal, who signed with Los Angeles as a free agent, and Bryant, the 17-year-old high schooler acquired in a draft-week trade.

Shaq and Kobe didn't reach their potential until Buss persuaded Jackson, the Chicago Bulls' six-time NBA champion coach, to take over the Lakers in 1999. Los Angeles immediately won the next three NBA titles in brand-new Staples Center, AEG's state-of-the-art downtown arena built with the Lakers as the primary tenant.

After the Lakers traded O'Neal in 2004, they hovered in mediocrity again until acquiring Gasol in a heist of a trade with Memphis in early 2008. Los Angeles made the next three NBA finals, winning two more titles.

Through the Lakers' frequent successes and occasional struggles, Buss never stopped living his Hollywood dream. He was an avid poker player, frequently participating in high-stakes tournaments, and a fixture on the Los Angeles club scene well into his 70s, when a late-night drunk-driving arrest in 2007 — with a 23-year-old woman in the passenger seat of his Mercedes-Benz — prompted him to cut down on his partying.

Buss owned the NHL's Kings from 1979-87, and the WNBA's Los Angeles Sparks also won two league titles under Buss' ownership. He also owned Los Angeles franchises in World Team Tennis and the Major Indoor Soccer League.

Buss' children moved into leadership roles with the Lakers in their father's later years. Jim Buss, the Lakers' executive vice president of player personnel and the second of Buss' six children, has taken over much of the club's primary decision-making responsibilities in the last few years, while daughter Jeanie is a longtime executive on the franchise's business side — and Jackson's longtime companion.

Yet Jerry Buss served two terms as President of the NBA's Board of Governors, and was actively involved in the 2011 lockout negotiations, developing blood clots in his legs attributed to his extensive travel during that time

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Well: Twins Don't Need C-Sections

Obstetricians increasingly recommend planned Caesarean sections for women having twins, but a new study has found that a C-section for healthy twins usually provides no advantage over vaginal delivery.

Researchers randomly assigned 2,800 mothers carrying healthy twins to either a planned C-section or a planned vaginal delivery. There was no difference in outcome between the two groups. There were serious medical problems, like bone fracture or abnormal levels of consciousness, in 36 babies delivered by C-section and 35 delivered vaginally. Twenty-one babies delivered by C-section died, as did 17 delivered vaginally.

Mothers fared equally well in each group, with serious health problems in 7.3 percent of the C-section mothers and in 8.5 percent of the vaginal delivery group.

The trial was carried out in well-equipped health care settings and by practitioners experienced in multiple births. “These skills should be available to anyone trained in obstetrics,” said the lead author, Dr. Jon Barrett, chief of maternal-fetal medicine at Sunnybrook Health Sciences Center in Toronto. “This indicates the need for the current generation of obstetricians who have these skills to impart them to their students and give women the opportunity for the best choice.”

Results of the study were presented at a medical conference in San Francisco last week.

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Letter From Washington: A Sensible Deal Can Avert a 'Sequester' Disaster

WASHINGTON — Democrats and Republicans in Washington agree: It would be a disaster if the “sequester,” with its more than $1 trillion of cuts to U.S. defense and domestic spending, took effect on March 1, as scheduled.

Defense Secretary Leon E. Panetta says the reductions to the Pentagon budget would undermine national security; the cuts to already pared-down domestic spending will set back critical needs like cancer research; Head Start, the preschool program for low-income children; and funding for the Border Patrol. The U.S. economic recovery would be impeded, at a cost of as many as 750,000 jobs.

President Barack Obama says the cuts “are a really bad idea.” In a rare display of accord, the House speaker, John A. Boehner, says the “meat ax” approach would “weaken” the nation’s defense. Mr. Obama and Mr. Boehner were two of the authors of the 2011 sequester agreement, figuring a sensible alternative would have emerged by now.

It has not, and the sequester could kick in on March 1, even if only temporarily. It is a textbook case of Washington dysfunction.

Both sides created this debacle, but there is no equivalency of blame today. Any alternative must emphasize cuts in mandatory entitlement programs and add revenue. Mr. Obama, publicly and privately, has left no doubt that he will surrender the Democrats’ political trump card and accept cuts in entitlement programs like Medicare, which offers health coverage to the elderly and disabled. Republican leaders insist that they will not give any ground on new revenue, without which there can be no deal.

An impasse would be unsettling to markets and the economy in the long run, even if deficit hawks exaggerate the severity of the crisis.

“The 10-year budget outlook remains tenuous,” says Bill Gale, director of economic studies at the Brookings Institution. “Even if seemingly everything goes right — in economic terms and political terms — we are still on the edge of dangerously high debt and deficit levels.”

It is not hard to devise a feasible alternative, if the irrational politics are put aside. First, any deficit-reduction plan should wait two years. That is because, as broke as Washington is, the deficit has already been narrowed by almost $2.5 trillion over the coming decade. In the short term, the government needs to bolster the shaky recovery by spending more on infrastructure and other projects.

Then, it should put in place a long-term $1 trillion deficit-reduction package, half of which is achieved through entitlement cuts, one-third through tax increases and the rest by shrinking discretionary programs, chiefly defense, which are funded through annual appropriations from Congress. That would send an encouraging sign to markets and help the economy, but only if it is a long-term plan, rather than the one-year fix that Senate and House Democrats are proposing.

Entitlements or mandatory programs like Medicare and Social Security, the government retirement system, make up almost 60 percent of the U.S. budget and are the engine of chronic deficits. Getting $500 billion over 10 years would not be pain-free, though it does not have to hurt those who can least afford to sacrifice.

The president has said he would go along with the scope of the Bowles-Simpson deficit commission’s proposed cuts to Medicare. That is about $350 billion. It would not require cuts for the most needy but would contain a means test for more affluent senior citizens. A sensible deal would not increase the eligibility age and would introduce more stringent cost controls and hit up drug companies for a little more.

Half the remaining savings could come from changing the formula for the cost-of-living increases for Social Security and other inflation-adjusted entitlements. That is a realistic proposal if protections are carved out for the very poor and the very elderly. The Center for American Progress has offered workable specifics. The rest could come from cutting agricultural subsidies and other entitlement programs.

The White House would buy this, and it has been the dream of Republicans for years.

On taxes, Republicans contend that the fiscal cliff deal in January, which raised taxes on the wealthy by $600 billion, means any further revenue-raisers are off the table.

A number of party leaders also pay lip service to the Bowles-Simpson recommendations, which proposed $1 of new revenue for every $2 of spending cuts, after eliminating former President George W. Bush’s high-end tax cuts. If these Republicans have their way and the sequester or any alternative to it is exclusively spending cuts, that ratio would be more than four to one.

The easiest way to get those revenues would be a plan resembling the administration’s proposal to limit deductions to the 28 percent rate and then exclude charitable deductions from that cap. That would raise more than $300 billion.

The other Republican argument is that any tax changes should await broad tax reform. But limiting deductions would not narrow their options or dash their hopes of using changes to the tax code as a vehicle for lowering rates.

There are endless possibilities for curbing tax breaks in a revenue-neutral measure that also lowers rates, such as scaling back big-ticket items like the home mortgage deduction, the health care exclusion or the preferential treatment for capital gains. Other changes are politically appealing, like ending the carried-interest loophole for rich investors or the tax breaks for the oil and gas industries.

What should not be cut is nondefense discretionary spending, like veterans’ programs, medical and scientific research and education. Even without the sequester, these programs are headed toward their lowest level, as a percentage of the economy, since the Eisenhower administration.

An entitlements and revenue-based deal, however, would approximate the Bowles-Simpson targets, and engender confidence in markets and businesses. The politicians could then turn to tax reform, immigration, gun violence, maybe a modest climate-change measure, and substantive oversight.

As a bonus, a successful deal might also lessen public cynicism about Washington.

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Hirscher wins worlds slalom at home in Austria

SCHLADMING, Austria (AP) — Overall World Cup champion Marcel Hirscher won the men's slalom title Sunday on the last day of the skiing world championships for his first individual gold medal at a major event.

Cheered loudly by a home crowd of 35,000, the Austrian overcame the pressure of expectation to earn the host nation its second gold of the worlds, after the mixed team event.

Hirscher held onto his first-run lead to finish in a combined time of 1 minute, 51.03 seconds. Felix Neureuther of Germany was 0.41 seconds back in second. Hirscher and Neureuther are also 1-2 in the World Cup discipline standings.

Two-time former champion Mario Matt of Austria took third, 0.65 behind.

"It's awesome," Hirscher said. "I forced myself to think, 'There's nothing at stake, it's just ski racing, it's just a game.' That helped me to handle the pressure. The atmosphere was sensational, super. I had to be careful not to blow it all for them."

Hirscher missed the 2011 worlds because of a broken foot. On Thursday, he injured his back and neck during training but finished second to Ted Ligety in GS the next day and followed it up with Sunday's win. It was the 14th gold in slalom for Austria.

His father and coach, Ferdinand Hirscher, called it "a wonderful day."

"It was very tense as we had to change something on the setup of his boots this morning," Ferdinand said. "But Marcel always stays cool. He tries not to think about titles and championships. He just concentrates on the information the coaches are giving him before a run."

Italian great Alberto Tomba said the Austrian's achievement was "super, super."

"I said three days ago, Marcel is going to win," said Tomba, the 1996 world slalom champion. "It's super he's done it. Felix and Mario were also great."

Ligety, a three-time champion, failed to finish when the American lost his balance and his left boot clicked out of the bindings 15 seconds into his run.

Olympic winner Giuliano Razzoli of Italy skied out on the bottom part in his first run, and defending world champion Jean-Baptiste Grange of France finished 2.43 off the lead in 12th place.

Neureuther, who trailed Hirscher by 0.28 after the first run, won his first individual medal at a major competition.

"It's fantastic," Neureuther said. "I usually try to hide my emotions but I can't do that now. I've finally done what I've tried to do many times before at big events. I am really happy and proud."

Neureuther helped Germany win bronze in the team event. Maria Hoefl-Riesch, who won the women's super-combined title, added two more medals for Germany.

"Everybody was talking about this duel: Marcel vs. Felix — and that's what it was," Neureuther said. "I just tried to avoid the mistakes I made at other championships."

Matt won the world slalom title in 2001 at home and again in 2007. He led the race briefly after a strong second run but was overtaken by both Neureuther and Hirscher.

"You have to fully attack but avoid making it a useless run," Matt said. "I lost a bit of time with a small mistake on the bottom, but I have to be satisfied with bronze."

The course caused many racers problems as mild temperatures softened the top layer of snow.

"The snow felt weird," Hirscher said, and Neureuther added it was "extremely difficult to gain speed on this course. You just don't get the right feeling on it."

Ligety's attempt to win a fourth medal failed shortly after starting his first run.

"I just kind of made a mistake," Ligety said. "I wanted to go really hard forward on the ski and I just peeled it right out of the back of the binding."

Ligety, who also captured the super-G and super-combined titles, could have equaled the 45-year record held by French great Jean-Claude Killy, who won four golds in 1968.

Ligety helped the United States top the medals table, even without Lindsey Vonn, who suffered a season-ending knee injury in the opening race. Mikaela Shiffrin added another gold in the women's slalom, and Julia Mancuso took bronze in super-G.

"It was an awesome world champs," Ligety said. "Of course it was a bummer to go out in the slalom. I just had the ski peel off again, which has been happening this year ... I feel pretty good for the most part. I'm not at the level of consistency of Hirscher or Felix, but I still feel like I have good speed relative to those guys. I just don't put together runs like those guys do."

Ligety's teammates David Chodounsky and Will Brandenburg also failed to finish the opening run.

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