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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Gunfire and deadly crash rattle the Las Vegas Strip









LAS VEGAS — A spectacular predawn crash on the Strip — triggered when bullets fired from a black Range Rover peppered a Maserati — hit this resort city right between the eyes. In the end, three people were dead and a major intersection under lockdown during a three-state manhunt for the shooters, leaving even casino veterans used to the extraordinary scratching their heads.


The mayhem was sparked, witnesses told police, by a quarrel early Thursday at a hotel valet stand.


The two vehicles left the Aria resort hotel and were heading north on Las Vegas Boulevard at 4:20 a.m., an hour when the casino marquees shine brightly but the gambling thoroughfare is largely empty. At Harmon Avenue, occupants inside the Range Rover opened fire on the Maserati, police said.





The silver-gray sports car, which was struck several times, sped into the intersection at Flamingo Road, ramming a Yellow cab. The taxi exploded, killing the driver and a passenger. Four other vehicles in the intersection were also involved in the crash and explosion, but officers offered no details.


"Omg Omg Omg that car just blew up!" one witness tweeted shortly after the crash, posting a photo of the wreckage. "God Bless their Souls! Omg!"


The driver of the Maserati died later at a hospital, police said. A passenger in the vehicle received minor injuries and was being interviewed by investigators. At least three others were also injured.


Police in Nevada, California, Arizona and Utah were on alert for the distinctive black Range Rover SUV, described as having dark-tinted windows, black rims and out-of-state paper dealer plates.


"We are going to pursue these individuals and prosecute them," Clark County Sheriff Doug Gillespie said at an afternoon news conference. "This act was totally unacceptable. It's not just tragic but unnecessary — the level of violence we see here in Las Vegas and across America."


Authorities had not publicly identified the dead. But a Las Vegas television station late Thursday identified the taxi driver as Michael Boldon, 62, who the station said had recently moved here from Michigan to care for his 93-year-old mother.


The victim's son, who drives a limousine, told Fox News 5 that he last talked with his father after 3 a.m., and later called his cellphone shortly after the crash to warn him to avoid the Strip. But there was no answer.


The station also identified the driver of the Maserati as Ken Cherry, a rap artist from Oakland who also is known as "Kenny Clutch." The station quoted family members identifying Cherry as the driver. An Internet video of a Cherry song called "Stay Schemin" shows two men in a vehicle on the Strip.


Police had more questions than answers.


"It began with a dispute at a nearby hotel and spilled onto the streets," said Capt. Chris Jones of the Las Vegas Police Robbery and Homicide Division.


The morning's events threw the Strip into disarray all day. The gambling boulevard's busiest and best-known intersection was cordoned off by yellow police tape until nightfall, keeping traffic and curious pedestrians away from the carnage. Even skywalks were blocked off.


While slot machines beeped and card games continued inside casinos around the accident scene — including the Bellagio, Caesars Palace and Paris Las Vegas — hotel bell captains were fielding questions from tourists who had awakened to news of the crash and the Strip shutdown. The alleys and side streets between nearby hotels were clogged with pedestrians who inched along on narrow sidewalks, past delivery doors, many making their own paths between the landscaped bushes and palm trees.


Even casino industry workers were thrown into turmoil. Hotel maids and dealers who finished their midnight shifts after dawn were left without bus service home. "I'm stranded," said Tiruselam Kefyalew, 25, a maid. "What a day to leave my cellphone at home."


Limousine drivers who normally prowl the city's gambling core improvised detours. Some said the police blockade would cost them $500 or more in lost business and tips.


"Most people understand, but you have your complainers," said Jim DeSanto, a limo driver who waited for fares outside Bally's casino. "Those people will complain, even when everything is perfect."


Well after noon, guests peered out nearby hotel windows and others leaned into the street to glimpse the crime scene.


"Hey, honey, it must have happened right here," one man told his wife as they left Caesars around noon. The tourist, who would only say that he had arrived from Tampa, Fla., the previous evening, had looked out his hotel window at 4:30 to see a vehicle in flames.





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Winter Is Coming to Facebook With <cite>Game of Thrones Ascent</cite>



Ready your enchanted browser tabs and equip your clicking hand with your sturdiest gauntlets. Westeros just got social.


Although Game of Thrones Ascent, recently released on Facebook, shares many of the familiar trappings of social games — click on lots of things, watch a timer go down, and then click more things — developer Disruptor Beam says its game’s value lies in the story, and is promising fans of George R.R. Martin’s Song of Ice and Fire books that its recently released Facebook game will flesh out the world of Westeros in an interesting way.


The events of the game run parallel with the storyline of the books, but from a separate perspective. There’s a lot of filler content and new characters, too, but for people absolutely in love with the series, keeping Ascent running in a background tab while at work might be a worthwhile way to squeeze a little more fun out of Martin’s world.


Martin has said that his relationship with Disruptor Beam predates the television show deal. Although the 64-year-old writer admits that he’s befuddled by the entire concept of social games, he’s worked closely with the team throughout the game’s development.


“I don’t have a Facebook or Twitter account,” Martin wrote on his blog in May 2012, “but I’ve been told a few people have them, and that some of those people like to play social media games.”


Martin joked that he was “told that the biggest social media game involves running a farm,” but promised that “no turnips will be involved” in Game of Thrones Ascent.


I spent some time in Disruptor Beam’s game, and it does a pretty charming job of letting you imagine what it’d be like to be a lord in Westeros: My self-created character, Lord Wilfred Hobnobber, has a pretty sweet house banner. There are also branching decision paths in the quests that definitely hold potential.


At present, however, Ascent does seem to have some glaring issues with lag. After performing almost any action in the game, there’s a massive delay before the client reacts. The game is technically in “open beta” at the moment, so that will probably be fixed in the future. But for now, for me, it’s pretty much unplayable in its current state.


Hopefully Disruptor Beam addresses technical issues more quickly than Martin writes books, or the fans might get impatient.


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Question Mark: Acne Common in Baby Boomers Too


Pimples are no surprise on babies and teenagers, but boomers?







You no longer have to gaze over a school lunchroom, hoping to find a seat at a socially acceptable table. You don’t rush to get home at night before your junior license driving restrictions kick in. And you men no longer have to worry that your voice will skip an octave without warning.




But if adolescence is over, what is that horrid protuberance staring at you in the mirror from the middle of your forehead? Some speak of papules, pustules and nodules, but we will use the technical term: zit. That thing on your forehead now is the same thing that was there back in high school, or at least a close relative. Same as it ever was (cue “Once in a Lifetime”).


We get more than the occasional complaint here from baby boomers who want to know about this aging body part or that. So you would think people would be happy with any emblem of youth — even if it is sore and angry-looking and threatening to erupt at any second. But oddly, there are those who are not happy to see pimples again, and some have asked for an explanation.


Acne occurs when the follicles that connect the pores of the skin to oil glands become clogged with a mixture of hair, oils and skin cells, and bacteria in the plug causes swelling, experts say. A pimple grows as the plug breaks down.


According to the American Academy of Dermatology, a growing number of women in their 30s, 40s, 50s and even beyond are seeking treatment for acne. Middle-age men are also susceptible to breakouts, but less so, experts say.


In some cases, people suffer from acne that began in their teenage years and never really went away. Others had problems when they were younger and then enjoyed decades of mostly clear skin. Still others never had much of the way of pimples until they were older.


Whichever the case, the explanation for adult acne is likely to be the same as it is for acne found in teenagers and, for that matter, newborns: hormonal changes. “We know that all acne is hormonally driven and hormonally sensitive,” said Dr. Bethanee J. Schlosser, an assistant professor of dermatology at Northwestern.


Among baby boomers, the approach of menopause may result in a drop in estrogen, a hormone that can help keep pimples from forming, and increased levels of androgens, the male hormone. Women who stop taking birth control pills may also see a drop in their estrogen levels.


Debate remains over what role diet plays in acne. Some experts say that foods once thought to cause pimples, like chocolate, are probably not a problem. Still, while sugar itself is no longer believed to contribute to acne, some doctors think that foods with a high glycemic index – meaning they quickly elevate glucose in the body — might. White bread and sweetened cereals are examples. And for all ages, stress has also been found to play a role.


One message to acne sufferers has not changed over the years. Your mother was right: don’t pop it! It can cause scarring.


Questions about aging? E-mail boomerwhy@nytimes.com


Booming: Living Through the Middle Ages offers news and commentary about baby boomers, anchored by Michael Winerip. You can follow Booming via RSS here or visit nytimes.com/booming. You can reach us by e-mail at booming@nytimes.com.


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Iglo and Birds Eye Pull Meals After Finding Horse Meat


LONDON — Another big food producer was ensnared in the scandal over horse meat in beef products Friday when the company that owns the Iglo and Birds Eye brands withdrew a dozen types of prepared meals from stores in four European countries.


Iglo Foods Group, the parent company, said it took the action after a chilli con carne dish, produced by a Belgian company called Frigilunch and on sale in Belgium, was found to contain about 2 percent horse meat.


“As a precautionary measure, we will withdraw all other beef products produced for us by Frigilunch,” Iglo Foods said. “Whilst this is not a food safety issue, it is clearly unacceptable.”


In addition to the chilli con carne, seven more Iglo products were removed from Belgian supermarkets, and one from stores in the Netherlands. Meanwhile, three Birds Eye meals — spaghetti Bolognese, shepherd’s pie and lasagne — were withdrawn in Britain and Ireland.


The announcement came as the Food Standards Agency in Britain released updated figures for tests conducted by the food industry in that country, showing that just 1 percent of beef products sampled contained 1 percent or more of horse meat.


With food suppliers and regulators stepping up their monitoring, new cases of beef products tainted with horse meat, which is significantly less expensive than beef, are being found almost every day.


This past week, Nestlé, one of the best-known food companies in the world, said it was removing pasta meals from store shelves in Italy and Spain. Already most of the big supermarket chains in Britain have withdrawn products, including millions of hamburgers. About a dozen European countries have been touched by the scandal.


In Britain there was growing concern about the contents of school meals. On Friday, local governments in Scotland were urged by the procurement agency, Scotland Excel, “not to use any current stocks they hold of frozen beef products, including frozen beef mince, or order any new stocks, until the outcome of further, detailed investigations.”


That announcement followed the discovery of traces of horse DNA in a frozen burger taken from a school kitchen in North Lanarkshire.


There was more reassuring news Friday from the Food Standards Agency, which said it had now received 3,634 test results from manufacturers, retailers, caterers and wholesalers. These results showed an additional six products containing horse DNA since the first set of industry tests was announced last week.


Over all, the agency said, “35 results, representing 13 products, contained horse DNA at or above the 1 percent threshold. These products have already been named and withdrawn from sale.”


While the horse meat crisis has revolved around issues of fraud and mislabeling, there are worries that a powerful equine painkiller, phenylbutazone, or bute, may have entered the food chain.


Eight horses slaughtered for food in Britain tested positive for the drug, according to reports this month. Six of those carcasses had already been exported to France for human consumption.


But the Food Standards Agency said Friday that tests on samples containing horse DNA so far had not found traces of phenylbutazone.


“The overwhelming majority of results, over 99 percent, have come back negative for the presence of horse DNA above the threshold of 1 percent, which is reassuring for consumers,” said Catherine Brown, the agency’s chief executive. She said the agency’s work “is far from done,” with other testing being carried out by the local authorities on behalf of the agency already “well under way.”


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Bulgari shows off Liz Taylor's gems









It isn't easy sometimes to be an ordinary person in Los Angeles, so near to and yet so far from the city's glamorous events.


You hear about the grand Oscar parties, but you will never be invited. The award ceremony may be taking place minutes from where you live, but you watch it at home, on TV, in your sweat pants — and you might as well be in Dubuque.


Rodeo Drive too can make you feel like a scrap on the cutting room floor. As you stroll the wide and immaculate sidewalks of Beverly Hills' iconic shopping street, you pass by boutiques you'd feel self-conscious walking into. In the windows are baubles and trinkets you could never in three lifetimes afford.





Which is why it is rather nice to be invited to make a private appointment at the house of Bulgari, the fine Italian jeweler that opened its doors in 1884.


Elizabeth Taylor loved Bulgari jewels. Richard Burton, whose torrid affair with her began during the filming of "Cleopatra" in Rome, accompanied her often to the flagship shop on the Via Condotti. He liked to joke that the name Bulgari was all the Italian she knew.


So it is fitting that starting Oscar week, the jeweler is celebrating the Oscar-winning star with an exhibit of eight of her most treasured Bulgari pieces.


They are heavy on diamonds and emeralds — of rare size, gleam and value.


And Bulgari knows their value well.


After Taylor's death, it reacquired some of the gems at a Christie's auction. One piece, an emerald-and-diamond brooch that also can be worn as a pendant, sold for $6,578,500 — breaking records both for sales price of an emerald and for emerald price per carat ($280,000).


That brooch, whose centerpiece is an octagonal step-cut emerald weighing 23.44 carats, was Burton's engagement present to Taylor. He followed it upon their marriage (his second, her fifth) with a matching necklace whose 16 Colombian emeralds weigh in at 60.5 carats. Bulgari bought the necklace back too, for $6,130,500.


They are in the exhibit, along with Burton's engagement ring to Taylor and a delicate brooch — given to her by husband No. 4, Eddie Fisher — whose emerald and diamond flowers were set en tremblant so that they gently fluttered as Taylor moved.


The jewels are not for sale.


On Tuesday night, actress Julianne Moore wore the Burton necklace, with pendant attached, at a gala for Bulgari's top clients. At the dinner hour, guests were escorted along a lavender-colored carpet to a nearby rooftop that had been transformed into a Roman terrace.


Those honored guests, of course, got private viewings of Taylor's jewels.


But so did Amanda Perry, a healer from West Hollywood who arrived the next morning for one of the first appointments available to the public.


Someone had emailed news of the collection to the 35-year-old Taylor fan. She walked in off the street Tuesday, when the exhibit was open only to press — and Sabina Pelli, Bulgari's glamorous executive vice president, fresh from Rome, was taking sips of San Pellegrino brought to her on a silver tray between back-to-back interviews that started at 5 a.m.


The camera crews were long gone when Perry came back Wednesday. She had the exhibit, and handsome sales associate Timothy Morzenti of Milan, entirely to herself.


In a black suit, still wearing on his left hand the black glove he dons to handle fine jewels, Morzenti whisked Perry off via a private elevator to the exhibit on the second floor. The jewels stood in vitrines mounted high off the ground. Behind them were photos and a slide show of Taylor, bejeweled.


"Which piece would you like to see first?" Morzenti asked her as a security guard stood by. "I personally love the emerald ring."


Then he proceeded at leisure to explain Bulgari-signature sugar-loaf cuts and trombino ring settings, while tossing in occasional Taylor stories.





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White House Must Respond Publicly to Ban on Mobile-Phone Unlocking











The President Barack Obama administration must enter the mobile-phone-unlocking fray.


Thanks to a whitehouse.gov petition reaching 100,000 signatures Thursday, the administration must respond publicly about a recent decision by copyright regulators making it illegal to unlock mobile phones purchased after January 26.


What’s this all about?


Unlocking enables a phone to operate on a compatible carrier of a consumer’s choosing.


Four months ago, the U.S. Copyright Office ended the practice of granting an unlocking exemption to the Digital Millennium Copyright Act. The DMCA makes it illegal to “circumvent a technological measure that effectively controls access” to copyrighted material, in this case software embedded in phones that controls carrier access.


The petition demanded that the White House “champion a bill that makes unlocking permanently legal” or, in the alternative, require the administration to ask copyright regulators to reverse course.


Under the latest White House policy, the administration will publicly respond, at undisclosed times, to whitehouse.gov petitions reaching 100,000 signatures in a month.


For more background on the topic and DMCA rule making, see this story.




David Kravets is a senior staff writer for Wired.com and founder of the fake news site TheYellowDailyNews.com. He's a dad of two boys and has been a reporter since the manual typewriter days.

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Follow @dmkravets and @ThreatLevel on Twitter.



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Living With Cancer: Arrivals and Departures

After being nursed and handed over, the baby’s wails rise to a tremolo, but I am determined to give my exhausted daughter and son-in-law a respite on this wintry evening. Commiserating with the little guy’s discomfort — gas, indigestion, colic, ontological insecurity — I swaddle, burp, bink, then cradle him in my arms. I begin walking around the house, swinging and swaying while cooing in soothing cadences: “Yes, darling boy, another one bites the dust, another one bites the dust.”

I kid you not! How could such grim phrases spring from my lips into the newborn’s ears? Where did they come from?

I blame his mother and her best friend. They sang along as this song was played repeatedly at the skating rink to which I took them every other Saturday in their tweens. Why would an infatuated grandma croon a mordant lullaby, even if the adorable one happily can’t understand a single word? He’s still whimpering, twisting away from me, and understandably so.

Previously that day, I had called a woman in my cancer support group. I believe that she is dying. I do not know her very well. She has attended only two or three of our get-togethers where she described herself as a widow and a Christian.

On the phone, I did not want to violate the sanctity of her end time, but I did want her to know that she need not be alone, that I and other members of our group can “be there” for her. Her dying seems a rehearsal of my own. We have the same disease.

“How are you doing, Kim?” I asked.

“I’m tired. I sleep all the time,” she sighed, “and I can’t keep anything down.”

“Can you drink … water?” I asked.

“A little, but I tried a smoothie and it wouldn’t set right,” she said.

“I hope you are not in pain.”

“Oh no, but I’m sleeping all the time. And I can’t keep anything down.”

“Would you like a visit? Is there something I can do or bring?” I asked.

“Oh, I don’t think so, no thanks.”

“Well,” I paused before saying goodbye, “be well.”

Be well? I didn’t even add something like, “Be as well as you can be.” I was tongue-tied. This was the failure that troubles me tonight.

Why couldn’t I say that we will miss her, that I am sorry she is dying, that she has coped so well for so long, and that I hope she will now find peace? I could inform an infant in my arms of our inexorable mortality, but I could not speak or even intimate the “D” word to someone on her deathbed.

Although I have tried to communicate to my family how I feel about end-of-life care, can we always know what we will want? Perhaps at the end of my life I will not welcome visitors, either. For departing may require as much concentration as arriving. As I look down at the vulnerable bundle I am holding, I marvel that each and every one of us has managed to come in and will also have to manage to go out. The baby nestles, pursing his mouth around the pacifier. He gazes intently at my face with a sly gaze that drifts toward a lamp, turning speculative before lids lower in tremulous increments.

Slowing my jiggling to his faint sucking, I think that the philosopher Jacques Derrida’s meditation on death pertains to birth as well. Each of these events “names the very irreplaceability of absolute singularity.” Just as “no one can die in my place or in the place of the other,” no one can be born in this particular infant’s place. He embodies his irreplaceable and absolute singularity.

Perhaps we should gestate during endings, as we do during beginnings. Like hatchings, the dispatchings caused by cancer give people like Kim and me a final trimester, more or less, in which we can labor to forgive and be forgiven, to speak and hear vows of devotion from our intimates, to visit or not be visited by acquaintances.

Maybe we need a doula for dying, I reflect as melodious words surface, telling me what I have to do with the life left to be lived: “To love that well, which thou must leave ere long.”

“Oh little baby,” I then whisper: “Though I cannot tell who you will become and where I will be — you, dear heart, deliver me.”

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Ramping Up U.S. Production, Ford Expands in Ohio


DETROIT — Ford Motor Company is adding 450 jobs and expanding an engine plant in Ohio to feed the growing demand for more fuel-efficient cars and S.U.V.'s in the American market.


Ford, the nation’s second largest automaker after General Motors, said Thursday it would spend $200 million to renovate its Cleveland engine plant to produce small, turbocharged engines for use in its top-selling models.


The move is the latest by automakers to expand production in the United States, where sales have increased 14 percent so far this year compared with 2012.


Last month, G.M. announced plans to invest $600 million in its assembly plant near Kansas City, Kan., one of the company’s oldest factories. And Chrysler, the smallest of the Detroit car companies, is adding a third shift to its Jeep plant in Detroit.


The expansions are another tangible sign of the steady recovery in the American auto market, which fell to historic lows during the recession.


Both G.M. and Chrysler were forced to declare bankruptcy in 2009 in exchange for big government bailouts. While Ford survived the industry’s financial crisis without help, it still cut thousands of jobs and shuttered several factories to reduce costs and bring production more in line with shrinking sales.


But the tide has turned in car showrooms across the United States, prompting automakers to strategically increase output in their remaining plants.


In Ford’s case, the company added about 8,000 salaried and hourly jobs last year, and has said it plans to hire about 2,200 white-collar workers in 2013. Ford is also moving some vehicle production from Mexico to a Michigan plant, where it will add 1,200 jobs.


The investment in Cleveland is indicative of how Ford and other carmakers have trimmed labor costs in the United States and improved productivity since the recession.


Just a few years ago, the company was forced to consolidate two engine plants into one in northern Ohio and to close a major component operation.


“No question we have been through a lot in northern Ohio,” said Joe Hinrichs, the head of Ford’s Americas region, in an interview. “But now our North American business is very competitive with the best in the world.”


Ford plans to centralize production of its 2-liter, EcoBoost engine — used in popular models such as the Fusion sedan and Explorer S.U.V. — at the Cleveland facility by the end of next year. Currently, the company makes the engines at a plant in Spain and ships them to America.


While Ford is adding jobs and production domestically, it is racing to reduce costs in its troubled European division. Workers who previously built the small engines in Spain will be moved to a nearby assembly plant that is taking on work from a plant to be closed in Belgium.


Mr. Hinrichs said that a new agreement with the United Automobile Workers union local in Cleveland paved the way for the expansion there. The plant now employs about 1,300 workers.


“This is about servicing more demand in the U.S.,” Mr. Hinrichs said. “And with our competitive labor agreements, we can bring business to the U.S. from Spain and Mexico.”


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