Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

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

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

A Long Series of Illnesses:

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

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

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

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

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

Back to the Hospital:

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

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

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

Back to the Hospital, Again:

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

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

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

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

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

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

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

Solving the Mystery:

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

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

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Profound Weight of Layoffs Seen in Survey

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

Joe Raedle/Getty Images

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

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

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

The survey presented a bleak view of the economic future.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Child porn suspect indicted by federal grand jury

A North Hills woman whom authorities allege plied a young girl with crack cocaine and photographed her being sexually abused by an older man was indicted Tuesday on federal charges of producing child pornography and sex trafficking.

Letha Montemayor Tucker was named Tuesday in a four-count indictment returned by a federal grand jury. If convicted of all the charges, Tucker would face a mandatory minimum federal sentence of 10 years and could get up to life in prison, authorities said.

The charges come a month after authorities sought the public's help in the investigation by releasing photographs of a man and woman depicted in a set of widely circulated child pornography photos.

Tips started pouring in immediately after the photos were released, investigators said.

Tucker, who goes by the name Butterfly, was located about 10 hours after the release of the photos and taken into custody, said Claude Arnold, special agent in charge for Homeland Security Investigations in Los Angeles, a division of U.S. Immigration and Customs Enforcement.

The alleged victim, who was about 12 when the photos were taken, was found within a week of the case going public, Arnold said. She is an adult now and is cooperating with authorities, he said.

In addition to photographing the girl being sexually abused by the man, authorities said, Tucker also committed sex acts with the alleged victim.

The photos were part of a child pornography collection known as the "Jen Series."

The 40-plus photos were first discovered by investigators in the Chicago area in 2007. Investigators said images in the series have been reported about 300 times and have been found on computers across the country.

The victim "didn't even know these images were out there," Arnold said.

"The horror of child pornography is it's for life, the victimization," Arnold said. "Once the photos are there in cyberspace, they're there forever."

The girl, identified in court records only by the initials J.M.M., lived in the same Los Angeles County residential hotel as Tucker, who worked as a prostitute, authorities said.

Around 2000 or 2001, the girl stopped attending school regularly and spent more and more time in Tucker's room, smoking crack cocaine Tucker provided, according to the indictment.

The girl was present when Tucker engaged in prostitution with clients and was usually high when this happened, authorities allege. Tucker instructed the child to take off her clothes in front of the clients, prosecutors alleged in court papers.

The faces of Tucker and the girl are "clearly visible" in the photos, according to the indictment. Tucker had an eyebrow piercing and a tattoo of a sleeping cat behind her shoulder, which made her easier to identify, authorities said.

The face of the man, however, is blacked out in the photographs. Authorities are still trying to identify the man, Arnold said.

"Obviously, we want him also to answer for his crimes," Arnold said.

Arnold said the alleged victim is "going to be dealing with this for a long time."

Now that she has been identified, she will receive a victim notification every time one of the images turns up in an investigation, he said.

Tucker is being held without bond and is scheduled to be arraigned in federal court on Feb. 13. Her attorney could not be reached for comment.

hailey.branson@latimes.com

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Don't Call It a Tablet

The Surface Pro looks like a tablet, but it’s not a mobile device. It’s a portable device.

Sure, put the Surface Pro next to the Surface RT and it’s hard to spot many differences. One’s a little thicker, but their shapes are otherwise identical. Both have the same matte-black, magnesium-based casing. They both can be used with snap-in keyboards and they’re both propped up into typing position by built-in kickstands.

It’s a full-blown computer, but one that folds up into a tablet-sized package.

While the differences are blurry on the outside, if you use them both for a little while, the dissimilarities become distinct. The Surface RT is thoroughly a tablet, and it exists to directly challenge the iPad. It closely matches Apple’s larger slate in size, weight, performance and price. The Surface Pro, however — which goes on sale Feb. 9 for a starting price of $900 — is something more ambitious than a tablet. It’s a full-blown computer, but one that folds up into a tablet-sized package.

It’s also more expensive than a tablet — and comes with many hidden costs — but is far more capable since it runs full Windows 8 Pro. And though it isn’t perfect, the Surface Pro is certainly very compelling.

Ever since Windows 8 launched in October of last year, Microsoft’s hardware partners have been experimenting with ways of incorporating the OS’s touchscreen capabilities into their computer designs. The result, so far, has been a flood of tablet/PC Frankenbeasts with keyboards that twist, slide, fold, or otherwise play peek-a-boo beneath the touchscreen. The success of these devices varies, but most are flimsy and awkward. They want to be tablets, but they don’t want to leave the laptop behind, and they end up stuck somewhere in the middle.

The Surface Pro is more well-constructed and thoughtfully designed than any of them. It’s the best of the hybrids. The quality of the hardware, the performance, and the simplicity of the design make it a success.

But let me be clear: The Surface Pro is not a tablet. Many people have confusedly asked me if the Surface Pro is even a good tablet. The answer is a clear and resounding, “No.” It’s heavy and thick. It doesn’t invite you to curl up with it on the couch. It’s tough to read with it in bed, and it works much better propped up on a desk than it does resting on a knee or in a lap.

And while it’s portable, it isn’t an amazing laptop, either. Microsoft’s Touch and Type covers don’t come bundled with Surface Pro — you have to pay an extra $120 or $130, respectively, if you want to avoid touchscreen typing (and trust me, you will want to avoid touchscreen typing). And with either keyboard attached, the thing is so top-heavy, it’s physically challenging to use on your lap.

So why bother? Because the Surface Pro is a Windows 8 PC through and through. It comes with an Intel Core i5 processor, and it can run all of your legacy desktop applications. You can surf using your favorite browser, you can type and save and share using the full versions of Office and all your other regular work applications. You can freely download software from the web without depending on the (still anemic) Windows Store.

Microsoft has also given the Surface Pro a killer screen. The 10.6-inch, 1980×1080 pixel resolution display is a visible step up from the Surface RT. With the same 16:9 aspect ratio, it’s great for watching movies. It feels a little silly to use it in portrait mode because it’s so tall, but text is much crisper on the higher-res display, so browsing the web and reading text is more pleasurable. It’s not quite on par with the iPad’s Retina display, but I could barely see a difference between the two. Ten-point touch gestures are supported, as well as the standard swipe gestures.

The touchpads found on both keyboard covers don’t support the standard swipe gestures. They’re accurate enough for pointing, but if you try to swipe in from the right for Charms, or from the left to switch applications, they won’t respond. You’ll need to reach up and use the screen, or buy an extra mouse or trackpad like Logitech’s Rechargeable Trackpad ($80, another additional cost).

The Surface Pro does come with a great pressure-sensitive pen that magnetically attaches to the power connector. The pen really shined in handwriting-driven apps like One Note, or the painting app, Fresh Paint. And the top of the pen acts as an eraser, which is neat.

Performance is generally excellent across all Windows 8 apps I tested. However, one thing that stuck out is a general problem with screen rotations. When switching between portrait and landscape modes, it takes about a second for the Surface Pro to register the rotations. I found this lag to be disconcerting. Also, some apps displayed rotation quirks. The worst offender was Chrome. The desktop version worked flawlessly, but when I used the version made for the tile-based Windows 8 interface, the app repeatedly refused to resize properly when I flipped between landscape and portrait modes. Likewise, whenever I put Chrome in Snap View mode — a Windows 8 trick that lets you run two applications side-by-side in a split-screen arrangement — the Chrome window got smaller and would not readjust back to full-screen size when I exited Snap View.

Otherwise, I was happy with Windows 8 Pro on the Surface. All the apps I used during my tests were super-responsive. Scrolling was smooth, and there were no input latency problems to speak of.

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Court to probe singer Chris Brown’s community service records

LOS ANGELES (Reuters) – Prosecutors on Tuesday asked a court to find R&B singer Chris Brown in violation of his probation because they say community service records stemming from his 2009 assault on girlfriend Rihanna contain “significant discrepancies.”

Brown is scheduled to appear at a hearing on Wednesday in Los Angeles, at which time a judge could decide to revoke the “Don’t Wake Me Up” singer’s probation.

But Brown’s attorney, Mark Geragos, told Reuters the allegations are “scurrilous, libelous and defamatory.”

“The prosecution has lost their collective minds,” Geragos said. “I’m going to seek sanctions against the (district attorney’s) office for bringing a frivolous motion.”

Brown pleaded guilty in 2009 to beating and punching R&B singer Rihanna and was sentenced to five years probation, 180 days of community service and domestic violence counseling.

The community service involved tasks like cutting grass, picking up trash and removing graffiti. He was allowed to complete it in his home state of Virginia.

“After a thorough review of all documents and evidence submitted to the court it appears there are significant discrepancies indicating at best sloppy documentation and, at worst fraudulent reporting,” Los Angeles Deputy District Attorney Mary Murray said in a court filing on Tuesday.

Murray cited three occasions when she said Brown was not at the recorded location of his community service and instead performing or traveling, once on a private jet bound for Cancun, Mexico.

Brown, in another instance, never stripped or waxed the floors at a Virginia community center as a report said he did, according to the 19-page court document.

Murray also accused Virginia authorities of poor and incorrect management of the singer’s service and records, and said his community service case should be transferred to Los Angeles.

Los Angeles Superior Court Judge Patricia Schnegg in November praised Brown for “actually working diligently to complete all the things the court has required of you.”

R&B singer Rihanna and Brown have recently rekindled their romance and are dating again, Rihanna told Rolling Stone magazine last week.

Brown was in a brawl last month with fellow singer Frank Ocean outside a West Hollywood recording studio. A police report indicates he punched Ocean in the face but Ocean said over the weekend he did not want Brown prosecuted.

(Editing by Xavier Briand and Eric Walsh)

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Well: Getting Into Your Exercise Groove

Phys Ed

Gretchen Reynolds on the science of fitness.

This isn’t meant as an insult, but you are physiologically lazy. So am I. So are we all. Using treadmill testing, scientists have definitively established that, like other animals, humans naturally aim to use as little energy as possible during most movement. So when we walk or run, our bodies tend to choose a particular cadence, a combination of step length and step frequency, that allows us to move at any given speed with as little physiological effort as possible.

How we pick that cadence, though, and whether we can or would even want to change it has been unclear. But a series of recent studies involving runners, walkers, metronomes and virtual reality curtains suggests that while the tug of physiological laziness is strong, it can be controlled, or at least tweaked, with some conscious effort — and perhaps your iPhone playlist.

In the first and most revelatory of the studies, physiologists at Simon Fraser University in British Columbia asked adult volunteers to walk on a treadmill at an easy pace. Using motion capture technology, the scientists determined how many steps each person was taking per minute at this speed. A person’s pace depends, of course, on both step length and step frequency. But because the two are inextricably entwined — lengthen your stride and you’ll take fewer steps over a given distance — studying one provides sufficient information about the other, and frequency is easier to enumerate.

After establishing each volunteer’s preferred step frequency, the scientists then sped up or slowed the treadmill, and the researchers measured how quickly people’s legs responded.

The body, remember, wants things to be easy. When you increase or decrease the speed of your walking or running, various physiological changes occur; the amount of oxygen in your blood rises or falls, for instance, because your muscles start requiring more or less of the stuff. Other biochemical changes also occur within muscle cells. Sensing those changes, the body realizes that, at this new speed, your cadence isn’t ideal; you’re taking too few or too many steps to use the least possible amount of energy. Your body adjusts.

But that process takes a little while, at least five seconds or so for the oxygen levels to change and your body to recognize the alteration, says Max Donelan, a professor at Simon Fraser University who was a co-author of the study with his graduate student Mark Snaterse and others.

However, the walkers in the study were adjusting their step frequency within less than two seconds after the treadmill speed changed, Dr. Donelan points out. They then fine-tuned their pacing after that. But the first adjustment came almost instantly.

The same process occurred when the researchers repeated the experiment with runners. If the treadmill speed changed, the runners’ step frequency shifted almost immediately, too fast for internal physiology to have played much of a role.

These insty adjustments suggest that our brains very likely contain huge libraries of preset paces, Dr. Donelan and his colleagues have concluded, of idealized, “physiologically efficient” step cadences for any given speed and condition. It seems probable, in fact, that over our lifetimes, Dr. Donelan says, our brains develop and store countless templates for most pacing situations. We learn and remember what cadence allows us to use the least energy at that speed, and when we reach that speed, we immediately default to our body’s most efficient pace.

Just how the brain recognizes that we are moving at any particular speed is not completely understood, Dr. Donelan says, but almost surely involves messages from the eyes, feet, ears, nervous system, skin and other bodily systems.

Interestingly, it seems to be quite difficult to fool your brain. When Dr. Donelan and his colleagues draped shower-curtain-like enclosures around the front of a treadmill, projected a virtual reality scene of a hallway onto it and then manipulated people’s sense of the speed with which they were moving through the hallway, they found that people’s step frequency would quickly change to match this supposed new speed. But then they would settle back into their former cadence, even as the virtual hallway continued to move past them at unnatural speed.

Visual cues simply were not strong enough to affect pacing for long.

But the scientists have found one signal that does seem effectively to override the body’s strong pull toward its preferred ways of moving: a strongly rhythmic beat. When Dr. Donelan and his colleagues fitted runners or walkers with headphones tuned to a metronome, they found that they could increase or decrease volunteers’ step frequency, even if that frequency was faster or slower than a person’s preferred step pattern. They would also maintain that pace for as long as the metronomic rhythm continued unaltered. The volunteers aligned their movement to the beat.

In practical terms, this finding suggests that music may be one of the best ways to affect the pace of your running or walking, especially if you are trying to maintain a pace with which you are not familiar or which feels awkward. Want to start jogging faster than you have in the past? Load your iPod with uptempo music, Dr. Donelan suggests (although obviously ease into any changes in training slowly, to lessen the risk of injuries).

Dr. Donelan and his colleagues even have recently launched an iPhone app called Cruise Control that allows people to coordinate their pacing with their playlists. Input your preferred running or walking speed and the app skims your music library (nonjudgmentally; if you like Nickelback, that’s your business) and strings together songs with the requisite beat, even subtly altering the tempo of songs, if needed.

But of course, if you’re comfortable with your pace as it is, stick with it. For me, the most stirring message of these recent experiments is that, left to its own devices, your body will almost always obligingly try to choose the least demanding pace for you, a goal with which I’m happy to fall into step.

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Economic Scene: Immigration Reform Issue: The Effect on the Budget

The stars could hardly have shone brighter on the prospects for immigration reform than in the early months of 2007.

The coalition pushing for change included the oddest of bedfellows — roping together business groups like the United States Chamber of Commerce with the Service Employees International Union, the fastest-growing union in the country. It had an impeccable bipartisan pedigree, including President George W. Bush and Senator Jon Kyl, a staunchly conservative Republican, as well as the Democrats’ liberal lion, Senator Ted Kennedy.

The economy was growing. The unemployment rate was at its lowest level since the dot-com bubble burst six years before. And the flaws of our immigration laws — impotent to stop a river of unauthorized immigrants drawn across the border by job opportunities — were obvious to all.

Immigration reform, however, was not to be.

Immigrants’ rights groups balked at the hurdles put in immigrants’ path toward legalization. The A.F.L.-C.I.O. hated a provision creating temporary work visas, arguing that it was a license for businesses to bring in cheap foreign labor. Then, a Senate Democrat, Byron Dorgan, offered the coup de grâce with an amendment to phase out the worker visa program after five years. Though proposed at the behest of organized labor, the amendment got the support of some of the most anti-union Republicans in the Senate. And it killed the entire enterprise, stripping away corporate America’s main reason to support a deal.

Today, the economy is not growing much. Unemployment remains stubbornly high. Yet President Obama thinks the stellar alignment may be  better than six years ago. He is proposing a wholesale change to the same flawed immigration laws. He trusts that Republicans, who lost the Hispanic vote by an enormous margin in November, cannot afford to further alienate Hispanics by voting against their top priority.

Despite the strong case for an overhaul, however, changing our immigration laws may be tougher than the president appears to believe. While we may have overcome some of the obstacles of 2007, reform will probably face deep-seated opposition from many Americans — including most conservative Republicans — to what they will view as a potentially large expansion of welfare.

President Obama’s proposal is based on principles similar to those of the 2007 attempt: a path to citizenship for millions of illegal immigrants in the country, a legal channel for future immigrant workers and their families, and a plan to better enforce the nation’s borders and immigration laws.

Yet immigration reform today means something quite different than it did in 2007. Notably, the elements needed to stop the flow of illegal immigrants north are much less important to the enterprise. The Obama administration has already spent huge amounts of money on border enforcement. Today, border policing costs about $18 billion a year — nearly 50 percent more than it did in 2006. And deportations have soared. What’s more, illegal immigration has slowed to a trickle, as Mexico has grown more robustly than the United States. The illegal immigrant population has even been shrinking in the last few years. And it may continue to do so as the Mexican population of prime migration-age people stops growing.

Also, many employers have already gotten some of what they wanted: the number of workers entering the United States on temporary visas for low-end jobs in agriculture and other industries has increased sharply.

“The discussion is in a different environment,” said Gordon H. Hanson, an expert on the economics of immigration at the University of California, San Diego. “The flow of new immigrants is not the story anymore.”

This might help the cause of reform in some ways. It could allow the discussion about work visas to focus on the highly educated workers coveted by technology companies and pre-empt the kind of argument between business and labor over visas for cheap immigrant workers that sank reform in 2007. The A.F.L.-C.I.O., for instance, has heartily embraced President Obama’s plan.

But what supporters of an overhaul of immigration law seem to be overlooking is that these very changes could also make it more difficult to build a coalition across the political divide. If reform is mainly about granting citizenship to 11 million mostly poor illegal immigrants with relatively little education, it is going to land squarely in the cross hairs of our epic battle about taxes, entitlements and the role of government in society.

It’s hard to say with precision what impact offering citizenship would have on the budget, but the chances are good that it would cost the government money. Half to three-quarters of illegal immigrants pay taxes, according to studies reviewed in a 2007 report by the Congressional Budget Office. And they are relatively inexpensive, compared with Americans of similar incomes. Their children can attend public schools at government expense — putting a burden on state and local budgets. But they are barred from receiving federal benefits like the earned-income tax credit, food stamps and Medicaid. Only their American-born children can get those.

Government revenue might not change much with legalization. Most illegal immigrants who don’t pay taxes probably work in the cash economy — as nannies or gardeners — where tax compliance among citizens is low. Costs, of course, would increase. Once they became citizens, immigrants would be entitled to the same array of government benefits as other Americans. For Social Security and Medicare alone, offering citizenship to illegal immigrants would mean losing a subsidy worth several billion dollars a year in payroll taxes from immigrants who can’t collect benefits in old age.

The White House and other backers of reform have made much of a 2007 Congressional Budget Office analysis concluding that the failed immigration overhaul would have increased government revenue by $48 billion over a decade while adding only $23 billion to direct spending on entitlements and other programs. But the report also said that including the costs of carrying out the new law would actually increase the budget deficit by $18 billion over the decade and several billion a year after that. What’s more, it noted that most of the expected new tax revenue came from new immigrant workers, not from the newly legalized population.

Our history suggests we could have much to gain by turning illegal immigrants into citizens and putting an end to unauthorized immigration. The last time we permitted illegal immigrants to legalize, in 1986, incomes jumped for those who took advantage of the opportunity. Their children became more proficient in English and completed more years of school — becoming more productive and paying more taxes over their lifetimes.

But the same history underscores how immigration sets off fears about further sharing of government resources. Ten years after the immigration reform of 1986, reeling from some public anger, Congress passed a law barring legal immigrants from means-tested government services. The same issue is likely again to be a major flash point. Professor Hanson pointed to “the older white man who sees his entitlements at risk because of the demands placed by legalization on our fiscal resources.”

Conservative Republicans set on cutting government spending share those concerns. And for all their reasons to reach out to Hispanics, they might not find making illegal immigrants legal politically advantageous. On Tuesday, Republicans in the House argued against granting citizenship to illegal immigrants at all.

Hispanics are more liberal than the general population on economic matters, polls suggest, and more supportive of Big Government initiatives. Granting them citizenship would give them the vote.

As Steven A. Camarota, director of research at the Center for Immigration Studies, an advocacy group in Washington that favors more limits on immigration, said, “They will see legalization as a voter-registration drive for Democrats.”

E-mail: eporter@nytimes.com; Twitter: @portereduardo

This article has been revised to reflect the following correction:

Correction: February 5, 2013

An earlier version misspelled the first name of one of the two United States senators from Arizona.  His name is Jon Kyl, not John.

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Brown weighs parole for Manson family member

SACRAMENTO — Gov. Jerry Brown has about a month to decide whether to release a former follower of notorious killer Charles Manson from prison.

Bruce Davis, 70, has been behind bars since 1970, convicted with Manson of the murder of a musician and a stuntman. He was not involved in the Manson family's infamous 1969 slayings of Sharon Tate and four others in a Benedict Canyon home.

For the second time, a state parole panel has determined that Davis should be freed. The parole board forwarded the decision to Brown on Friday, starting a 30-day period for the governor to agree, request a full board hearing or reverse the decision.

PHOTOS: The Manson family murders

Davis is incarcerated at the California Men's Colony in San Luis Obispo, where he has a clean record and is active in prison ministries, his lawyer told the parole officials. A prisons panel first granted him parole in 2010, citing his record and his completion of rehabilitation programs.

Then-Gov. Arnold Schwarzenegger reversed the decision. Davis won a legal challenge to the reversal but lost last year on appeal.

Los Angeles County Dist. Atty. Jackie Lacey has urged Brown not to release Davis. In a three-page letter to the governor Jan. 24, she described Davis as Manson's "right-hand man" and said he poses an "unreasonable risk of danger to society."

"Davis has been diagnosed with narcissistic and antisocial personality traits," Lacey wrote. "He consistently blames everyone but himself for his criminal and antisocial behavior."

Davis was convicted of two counts of first-degree murder, conspiracy to commit murder and robbery for the deaths of Gary Hinman and Donald "Shorty" Shea.

Though Davis said he had a peripheral role in the murders, prosecutor Steven Kay and former Manson family member Barbara Hoyt described Davis as a prominent member of the Manson family who "wanted to be second in command."

Hinman, an aspiring musician whom Manson believed had a substantial inheritance, was held captive in his home for several days, tortured and ultimately stabbed to death. In her letter, Lacey contended that Davis held a gun on Hinman while Manson attempted to slice off the captive's ear.

A Black Panther symbol and the words "political piggy" were written on the walls of the home with what was later identified as Hinman's blood.

Shea, a ranch hand who lived with the Manson family, was killed in August 1969 because Manson believed him to be a police informant. Lacey cited witnesses who testified that Davis bragged of his part in Shea's stabbing death.

Shea's widow, Phyllis Murphy, sent her own plea to the governor.

"The details of this [heinous] murder are like a story with description of something only a very evil person would take part in," she wrote. "If Bruce Davis is set free, how safe will the neighbors be, will he be allowed to take yet another life?"

paige.stjohn@latimes.com

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Navy's Next-Gen Binoculars Will Recognize Your Face

Take a close look, because the next generation of military binoculars could be doing more than just letting sailors and soldiers see from far away. The Navy now wants binoculars that can scan and recognize your face from 650 feet away.

That’s according to a Jan. 16 contract announcement from the Navy’s Space and Naval Warfare Systems Command, which is seeking a “Wireless 3D Binocular Face Recognition System.” During a testing period of 15 months, the plan is to improve “stand-off identification of uncooperative subjects” during daylight, using binoculars equipped with scanners that can read your mug from “100 to 200 meters” away, or about 328 to 650 feet. After scanning your mug, the binoculars then transmit the data to a database over a wireless network, where the data is then analyzed to determine a person’s identity. The no-bid contract, for an unspecified amount of money, went to California biometrics firm StereoVision Imaging.

“High level, it’s a surveillance and identification system,” Greg Steinthal, StereoVision’s president, tells Danger Room. “It’s using the ubiquitous binocular for real-time identification. The data point here is that this is to be used to add objectivity to an operation that’s highly subjective. So this is not intended for kinetic action to go arrest or detain someone. It’s more a tool to put other eyes on him or her.”

It helps that the technology — at least in a more limited form — already exists. StereoVision has developed a face-recognizing binocular system called 3DMobileID, with a maximum distance of around 328 feet, or 100 meters. “You have an unfair advantage,” the company touts in one promotional video, showing images of a human face being scanned at a distance, before the background is stripped out for a blue screen and then matched up to a database.

Depending on how well the binoculars work — and there’s reason to be cautious — it could give the Navy the ability to take advanced facial recognition into a much more portable and long-distance version than many current systems. Facebook uses the technology to match faces when users upload new photos. Google has its own version as well for its its Picasa photo service, and Apple has been researching face recognition as a way to unlock smartphones. (There are apps for iOS that do this, too.)

But the ranges on most systems also tend to max out at a few feet. For the military, that can be dangerous. Close-range biometric scanners (iris scanners are currently used by soldiers in Afghanistan) can pose a danger to the operator, as a person walking up to have their features scanned from a few inches away could be preparing to detonate an explosive vest. And what if a person happens to be on the move, or is bobbing and weaving through a crowd? That can render the scanners ineffective. Once upon a time, many face scanners also depended on the relatively crude practice of scanning 2-D images of the human face, which are an imprecise method when there are varying lighting conditions.

But the key to solving many of these problems could be a simple upgrade: StereoVision’s system scans in 3-D. When the system first scans you, it creates a 3-D model of your face instead of a 2-D image. That allows the system to isolate your face from a crowd, sharpen the image — which boosts the range — and then compares the image to a database. A filter also adjusts for varying degrees of light by smoothing out light across the face into a uniform pattern.

Now for the flaws in the system. The binoculars are not intended to work at night, and have difficulty scanning faces in twilight. When the binoculars can’t draw an image, it gives off a an audible beep to the operator, which is helpful. Otherwise, the process takes “about five to 10 seconds,” says Steinthal.

It’s also less effective when a subject is on the move. “[It] depends on how fast the target is walking,” Steinthal says. “We’re at walking, one-and-half meters per second. Somebody running? We’re not going to be able to do that right now.”

The concept of binoculars that scan and identify is also — perhaps unnervingly — not limited to the military. For one, StereoVision’s binoculars were developed in part with a $409,226 contract from the National Institute of Justice, and face scanners are a popular research topic for the FBI more broadly.

The FBI is spending $1 billion on a program called Next Generation Identification based around developing face scanners and combining the technology with other biometrics like the iris, voice, and fingerprints. A static face recognition system has also been installed at Toucumen International Airport in Panama City that can scan travelers’ faces and match them to criminal databases maintained by the FBI and Interpol. The Los Angeles County Sheriff’s Department and the San Diego Police Department have also tested out the binoculars, according to Steinthal, and are intended there for gang enforcement units and even to track “celebrity stalkers” in the L.A. area. Maybe if the FBI wants its special agents to also have some pretty far-out binoculars too, it should take a peek.

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Oscar night to have something for everyone, producers say

BEVERLY HILLS (Reuters) – With a high five from 9-year-old actress Quvenzhane Wallis, and a pledge that Oscar night will have something for everyone, the Academy Awards kicked into high gear on Monday at a luncheon for more than 160 nominees.

Jennifer Lawrence, Steven Spielberg, Jessica Chastain, Naomi Watts, Joaquin Phoenix, Kathryn Bigleow, Anne Hathaway and Denzel Washington were among the Oscar-nominated actors, directors and producers who mingled over cocktails and lunch at a Beverly Hills hotel before gathering for the traditional group photo of the Academy Award class of 2012.

“Beasts of the Southern Wild” newcomer Wallis, the youngest actress ever to be nominated in the lead actress category, slapped hands with Academy of Motion Picture Arts and Sciences President Hawk Koch as her name was called to join her peers for the annual photo ahead of the February 24 ceremony.

“Argo” producer-director Ben Affleck, riding high after his Iran hostage thriller took its third major award at the weekend, shrugged off being overlooked in the Best Director Oscar shortlist.

“I feel honored to be here. It’s a big party,” Affleck told reporters, adding, “I’ve had many, many nights watching (the Oscars) from home.”

Craig Zadan and Neil Meron – who will be producing the three-hour Academy Award telecast for the first time – said performances by Barbra Streisand, Adele and Norah Jones, along with special tributes to Hollywood musicals and 50 years of James Bond movies, should give the ceremony wide appeal.

The popularity of many of the nine Best Picture nominees should also help bring in big audiences at home and abroad, they said.

“It has been a great year for movies. The movies are very competitive and they have done great box office. So we feel there is more interest this year than perhaps previous years, ” Zadan said.

“Life of Pi,” “Lincoln,” “Argo,” and “Django Unchained” have made more than $ 150 million each so far at the North American box office alone, while “Silver Linings Playbook” and “Zero Dark Thirty” have grossed more than $ 70 million each.

Last year’s Best Film winner, black and white silent movie “The Artist,” took just $ 44.7 million at the box office in the United States and Canada, even after the boost from its five Oscars.

Zadan and Meron reminded the nominees that the Oscar telecast was seen by an estimated one billion people in more than 200 countries, and urged them to keep their acceptance speeches short and sweet.

“Please speak from the heart and not from a piece of paper,” Zadan told the nominees. “Be remembered for eloquence and passion.”

The Oscars is being hosted for the first time by provocative “Family Guy” creator Seth MacFarlane. But Meron and Zadan said they had no worries about MacFarlane and his reputation for risqué comedy.

“Seth has been at every production meeting. We have been collaborating on everything, so we are not going to be surprised by anything,” Zadan told reporters.

(Editing by Sandra Maler)

Movies News Headlines – Yahoo! News

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