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 brown 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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Exelon cuts dividend by 41%

Exelon Corp. Thursday morning said it will slash its dividend by more than 40 percent in order to maintain an investment grade rating and free up money to "invest in growth."

Beginning in the second quarter, Exelon's divided will drop to $1.24 per share on an annualized basis from $2.10 per share. The company maintained the $2.10 dividend, among the highest of U.S. utilities, since late 2008.

Analysts predicted the move in light of stubbornly low natural gas prices that have been driving down the company's earnings and are largely responsible for the nearly two-thirds drop the company has seen in its stock price since a high in 2008.
 
Net income for 2012 fell to $1.16 billion, or $1.42 per share, from $2.5 billion, or $3.75 per share. In the fourth quarter, net income fell to $378 million, or 44 cents per share, from $606 million, 91 cents per share, a year earlier.

Revenue was $6.28 billion in the fourth quarter compared to $4.36 billion a year earlier. For the year, revenue rose to $23.49 billion, from $19.06 billion in 2011.

The results were within the company's guidance range.
 
Exelon said Thursday morning that lower prices for the energy it sells, as well as higher nuclear fuel costs,  diminished earnings. Storms, including Sandy, also affected earnings at its regulated utilities in Pennsylvania and Baltimore.
 
The addition of Constellation Energy's contribution to its margins since the merger and favorable weather elsewhere helped to partially offset some losses, the company said.
 
jwernau@tribune.com | Twitter @littlewern

EXC data by YCharts

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Post office to end Saturday mail service

After losing $16 billion last year, CBS News has learned the postal service wants to halt Saturday delivery of first class mail starting this summer. CBS News' Nancy Cordes reports.

Tribune staff and wire report

8:19 a.m. CST, February 6, 2013

WASHINGTON -- The Postal Service is planning to drop Saturday delivery of first-class mail by August, a congressional source said on Wednesday.

The cash-strapped mail agency will still deliver packages, said the source, who is familiar with the matter but not authorized to speak on the record.

USPS spokesman Mark Saunders could not confirm the change, but said the agency would issue a news release on Wednesday.

The move is part of the mail carrier's larger effort to aggressively to cut costs amid rising use of email and the Internet as well as looming payments for future retiree's health benefits. USPS lost almost $16 billion last year.

The 237-year-old institution has already run into its legal borrowing limit and defaulted twice on required payments to the federal government.

Reuters contributed

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Ipswich Journal: Paul Mason Is One-Third the Man He Used to Be

Paul Nixon Photography

Paul Mason in 2012, two years after gastric bypass surgery stripped him of the unofficial title of “the world’s fattest man.”

IPSWICH, England — Who knows what the worst moment was for Paul Mason — there were so many awful milestones, as he grew fatter and fatter — but a good bet might be when he became too vast to leave his room. To get him to the hospital for a hernia operation, the local fire department had to knock down a wall and extricate him with a forklift.

That was nearly a decade ago, when Mr. Mason weighed about 980 pounds, and the spectacle made him the object of fascinated horror, a freak-show exhibit. The British news media, which likes a superlative, appointed him “the world’s fattest man.”

Now the narrative has shifted to one of redemption and second chances. Since a gastric bypass operation in 2010, Mr. Mason, 52 years old and 6-foot-4, has lost nearly two-thirds of his body weight, putting him at about 336 pounds — still obese, but within the realm of plausibility. He is talking about starting a jewelry business.

“My meals are a lot different now than they used to be,” Mr. Mason said during a recent interview in his one-story apartment in a cheerful public housing complex here. For one thing, he no longer eats around the clock. “Food is a necessity, but now I don’t let it control my life anymore,” he said.

But the road to a new life is uphill and paved with sharp objects. When he answered the door, Mr. Mason did not walk; he glided in an electric wheelchair.

And though Mr. Mason looks perfectly normal from the chest up, horrible vestiges of his past stick to him, literally, in the form of a huge mass of loose skin choking him like a straitjacket. Folds and folds of it encircle his torso and sit on his lap, like an unwanted package someone has set there; more folds encase his legs. All told, he reckons, the excess weighs more than 100 pounds.

As he waits to see if anyone will agree to perform the complex operation to remove the skin, Mr. Mason has plenty of time to ponder how he got to where he is. He was born in Ipswich and had a childhood marked by two things, he says: the verbal and physical abuse of his father, a military policeman turned security guard; and three years of sexual abuse, starting when he was 6, by a relative in her 20s who lived in the house and shared his bed. He told no one until decades later.

After he left school, Mr. Mason took a job as a postal worker and became engaged to a woman more than 20 years older than him. “I thought it would be for life, but she just turned around one day and said, ‘No, I don’t want to see you anymore — goodbye,’ ” he said.

His father died, and he returned home to care for his arthritic mother, who was in a wheelchair. “I still had all these things going around in my head from my childhood,” he said. “Food replaced the love I didn’t get from my parents.” When he left the Royal Mail in 1986, he said, he weighed 364 pounds.

Then things spun out of control. Mr. Mason tried to eat himself into oblivion. He spent every available penny of his and his mother’s social security checks on food. He stopped paying the mortgage. The bank repossessed their house, and the council found them a smaller place to live. All the while, he ate the way a locust eats — indiscriminately, voraciously, ingesting perhaps 20,000 calories a day. First he could no longer manage the stairs; then he could no longer get out of his room. He stayed in bed, on and off, for most of the last decade.

Social service workers did everything for him, including changing his incontinence pads. A network of local convenience stores and fast-food restaurants kept the food coming nonstop — burgers, french fries, fish and chips, even about $22 worth of chocolate bars a day.

“They didn’t deliver bags of crisps,” he said of potato chips. “They delivered cartons.”

His life became a cycle: eat, doze, eat, eat, eat. “You didn’t sleep a normal sleep,” he said. “You’d be awake most of the night eating and snacking. You totally forgot about everything else. You lose all your dignity, all your self-respect. It all goes, and all you focus on is getting your next fix.”

He added, “It was quite a lonely time, really.”

He got infections a lot and was transported to the hospital — first in a laundry van, then on the back of a truck and finally on the forklift. For 18 months after a hernia operation in 2003, he lived in the hospital and in an old people’s home — where he was not allowed to leave his room — while the local government found him a house that could accommodate all the special equipment he needed.

This article has been revised to reflect the following correction:

Correction: February 6, 2013

The headline on an earlier version of this article misstated Paul Mason’s current weight relative to what he weighed nearly a decade ago. He is now about one-third of the weight he was then, not two-thirds.

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Chicago sees surge in foreclosure auctions

More than 35,000 homes and small multifamily buildings in the Chicago area completed the foreclosure process last year, the highest number since the housing crisis began, and the vast majority of them became bank-owned.

An increase in foreclosure auctions was expected since lenders shelved many foreclosure cases while state and federal authorities investigated allegations of faulty foreclosure processes. Still, the heightened level of auctions — 35,244 in 2012, compared with 20,281 in 2011 — along with an increase in initial foreclosure filings, shows the local housing market has a long road to recovery, according to the Woodstock Institute.

"There's going to be pain in the housing market in the short term," said Katie Buitrago, senior policy and communications associate at Woodstock. "There's still high levels of filings. Five years into it, there is still work to be done to help people save their homes."

The Chicago-based public policy and research group is expected to release its report on 2012 foreclosure activity Wednesday.

The year-end numbers show that, with few exceptions, all Chicago neighborhoods and suburban communities saw high double-digit percentage gains in auctions last year. Across the six-county area, 91.3 percent of the foreclosed properties were repossessed by lenders. At the same time, notices of initial default sent to homeowners, the first step in the foreclosure process, increased by 2.9 percent last year, to 66,783.

Real estate agents have worried for more than two years about a glut of foreclosed properties — a shadow inventory — that banks would list for sale en masse and cause home values to plunge. That largely has not happened, but the vast number of distressed properties in the market has kept a lid on local home values.

On Tuesday, for instance, Fannie Mae and Freddie Mac's websites listed 2,415 Cook County homes for sale that the two agencies had repossessed.

Chicago-area home prices, including distressed sales, fell 2.3 percent in December from a year ago, housing analytics firm CoreLogic said Tuesday. Illinois was one of only four states to see home-price depreciation.

The increase in auctions "is a mixed blessing," Buitrago said. "We've been having a lot of trouble in the region with vacant properties that have been languishing for years. The longer they're vacant, the more likely they are to be a destabilizing force in their communities."

Woodstock found that within the city of Chicago, there were 20 communities where more than 1 in 10 owner-occupied one- to four-unit residential buildings and condos went through foreclosure from 2008 to 2012. Five of those neighborhoods are included in the city's 18-month-old Micro-Market Recovery Program, a coordinated effort to stabilize neighborhoods and property values hit hard by foreclosures and vacant buildings.

Also designed to benefit hard-hit areas are the recent establishment of a Cook County Land Bank and legislation waiting for Gov. Pat Quinn's signature that will fast-track the foreclosure process for vacant, abandoned homes while providing financial resources to foreclosure prevention efforts.

mepodmolik@tribune.com

Twitter @mepodmolik

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Chicago commute one of nation's most unpredictable: study

You can predict with a high degree of confidence that the time it takes to drive from Point A to B on any given day is unpredictable.

And it's not just snowy or rainy days. It can be any day.

If there is a bright side, it's that Chicago was not the worst.

Residents of the Chicago area are accommodating that increasing uncertainty by setting aside more time each day — just in case — for the commute, new research shows.

For the most important trips, such as going to work, medical appointments, the airport or making a 5:30 p.m. pickup at the child care center to avoid late fees, drivers in northeastern Illinois and northwest Indiana should count on allotting four times as much time as it would take to travel in free-flowing traffic, according to the "Urban Mobility Report" to be released Tuesday by the Texas A&M Transportation Institute. The analysis is based on 2011 data, which are the most recent available.

It is the first time that travel reliability was measured in the 30-year history of the annual report. The researchers created a Planning Time Index geared toward helping commuters reach their destinations on time in more than 95 percent of the trips. A second index, requiring less padding of travel time, would get an employee to work on time four out of five days a week.

"If you plan only for average traffic conditions on your trip in the Chicago area, you are going to be late at least half the time," said Bill Eisele, a senior research engineer at the Transportation Institute who co-authored the study.

The constant unreliability that hovers over commuting is stealing precious time from other activities, crimping lifestyles, causing mounting frustration for drivers and slapping extra costs on businesses that rely on just-in-time shipments to manage inventory efficiently, researchers found.

The Chicago region ranked No. 7 among very large urban areas and 13th among 498 U.S. cities on a scale of the most unreliable highway travel times. The Washington area was the worst. A driver using the freeway system in the nation's capital and surrounding suburbs should budget almost three hours to complete a high-priority trip that would take only 30 minutes in light traffic, the study said.

The Washington area was followed on the list by the metropolitan areas of Los Angeles, New York-Newark, Boston, Dallas-Fort Worth, and Seattle.

Rounding out the top 10, the Chicago metro area was trailed by San Francisco-Oakland, Atlanta, and Houston.

Truck driver Frank Denk said he usually adds an hour or two to his trip through the Chicago area. Sometimes, it's not enough, other times traffic isn't a problem, he said. The one constant, Denk said Monday afternoon while taking a break at the O'Hare Oasis on the Tri-State Tollway, is that it is almost impossible to anticipate correctly.

"Job-wise, it can be very detrimental to truckers," said Denk, who is based in Green Bay, Wis. "All of a sudden, you're not able to make your delivery."

But quadrupling the time to travel back and forth each day? That's excessive, said Mike Hennigan, a 64-year-old accountant who regularly commutes from his Evanston home to his office near the junction of the Kennedy and Edens expressways. He recommends doubling the anticipated travel time.

"I can predict when it's going to be bad," Hennigan said, although he is less optimistic about his travel times when he heads toward downtown.

"Coming into the Loop can be deadly, especially later in the week," Hennigan said.

Overall, traffic congestion in the Chicago region is getting worse as the economy improves, although it's not as severe as the grip that gridlock has taken recently on some other very large metropolitan areas in the U.S., according to the report. The Washington area again topped the list, followed by Los Angeles, San Francisco-Oakland, New York-Newark, Boston, Houston, Atlanta, Chicago, Philadelphia, and Seattle.

No longer being ranked at the very top of the congestion heap provides little consolation for Chicago-area drivers.

What should be a 20-minute jaunt across town in Chicago or the suburbs if highway capacity were sufficient to permit vehicles to travel the speed limit now becomes about an 80-minute ordeal, according to the Texas A&M study. Scheduling 80 minutes for the trip would ensure an on-time arrival 19 out of 20 times, the study concluded.

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The New Old Age Blog: In Blended Families, Responsibility Blurs

Every year, Fran McDowell waited for the summer week when she would sing in a choral festival in the North Carolina mountains, then spend a few days in a lakeside cabin with close women friends.

That getaway grew more complicated to arrange — but perhaps more necessary — after her husband, Herb Beadle, was diagnosed with Alzheimer’s disease. They had a “gloriously happy” marriage — her first, his second — for 11 years, and she was more than willing to care for him in sickness as in health. But he could no longer manage alone in their Atlanta home.

For a few years, other family members pitched in to allow Ms. McDowell her cherished vacation. Eventually, though, she had to ask her husband’s daughter, a medical professional in another state, to take him into her home for a week.

She said no, then yes. Then, the day before Ms. McDowell was to drive him there, her stepdaughter again refused, leaving no time for alternate arrangements. If this had been her biological child, “I would have said, ‘Come on, don’t do this to me,’” Ms. McDowell said. Instead, reluctant to make waves, she canceled her trip.

“I think confrontation is riskier for stepparents,” she told me. “I was the compliant one who would bite my tongue rather than say what I thought.”

Ms. McDowell never told her stepdaughter, or anyone in the family, how angry and disappointed she was, or how difficult it was becoming to care for their father, who died three years ago at 86. She told the members of her dementia caregivers support group instead.

It was that group’s leader, Moira Keller, who e-mailed me to suggest this topic. A clinical social worker with the Sixty Plus program at Piedmont Atlanta Hospital, she wrote that “one of the biggest challenges I have is blended families in later life.”

Though I’ve written about the way the 1970s’ spike in divorces could complicate caregiving for adult children — more households to sustain, more siblings to either help or hinder — I hadn’t considered the impact on the older people themselves.

But Ms. Keller seems to be onto something. “The generation most likely to have stepchildren” — the boomers — “don’t need much care yet,” said Merril Silverstein, a Syracuse University sociologist co-editing a coming issue of the Journal of Marriage and the Family on stepfamilies in later life. “The crunch will come in 10 or 20 years.”

Initially, many adult children whose divorced or widowed parents remarry seem delighted, Ms. Keller said when we spoke. “They’re thrilled that Mom or Dad isn’t alone,” she said. “It’s a wonderful thing — until somebody gets sick.”

Then, she has found, “it gets really blurry. Who’s going to do what?” Grown children don’t have much history with these new spouses; they often feel less responsibility to intervene or help out, and stepparents may be unwilling to ask. Perhaps it’s unclear whether children or new spouses have decision-making authority.

“Older couples in this situation fall through the cracks,” Ms. Keller said.

Research shows that the ties which lead adult children to become caregivers — depending on how much contact they have with parents, how nearby they live, how obligated they feel — are weaker in stepchildren, Dr. Silverstein said. Money sometimes enters the equation too, Ms. Keller added, if biological children resent a parent’s spending their presumed inheritance on care for an ailing stepparent.

Adela Betsill, another of Ms. Keller’s support group members, married her longtime partner five years ago — her second marriage, his third. She has since given up her interior design business to care for Robert who, at 72, has also developed Alzheimer’s disease. His two children have had little involvement — perhaps because she’s just 49 and presumed able to handle everything.

Thus, though Robert’s son works from an office in their home, if Ms. Betsill needed to go out and asked him to remind his father to eat lunch, “he might, or he might not,” she said. “I don’t think he realizes it’s a burden.” So she has not asked.

Would it be different if she were his biological mother and he saw her wearing out under the strain? She thinks so, but it’s hard to know. After all, biological families also experience plenty of conflict and avoidance as elders age.

Still, that sense of reciprocity we often hear from caregivers — she took care of me when I was young, so I need to help out now that she’s old — doesn’t apply in late-life stepfamilies. Ms. Betsill didn’t raise this man, or his half sister.

Older couples who marry or remarry often discuss their finances, Ms. Keller has found. (An elder attorney, Craig Reaves, discussed the legal consequences here.) But illness and dependence may prove even more difficult subjects to broach.

“If I could yell one thing from a mountaintop,” Ms. Keller said, “it’s to talk about this stuff, too. Who’s going to take care of you if you become sick? Talk about that while you’re still healthy.”

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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U.S. sues S&P over mortgage bond ratings

The federal government is embarking on one of its most ambitious efforts to assign blame for the financial crisis, going after Wall Street's biggest credit rating firm for its role in pumping up the housing bubble.

The Justice Department filed a lawsuit late Monday in Los Angeles federal court against Standard & Poor's Corp. The suit accuses the company's analysts of issuing glowing reviews on troubled mortgage securities whose subsequent failure helped cause the worst financial crisis since the Great Depression.

The action marks the first federal crackdown against a major credit rater, and it signals an untested legal tack after limited success in holding the nation's banks accountable for the part they played in the crisis.

The government selected Los Angeles as the venue to file the lawsuit in part because it was one of the regions hardest hit when the bottom fell out of the housing market. Hundreds of thousands of California residents lost their homes to foreclosure, and others saw their wealth evaporate as properties plummeted in value.

"The DOJ is playing hardball and they're coming at the ratings agency in a very different direction with a potentially very powerful weapon to push S&P to the settlement table," said Jeffrey Manns, a law professor at George Washington University.

In addition to the Justice Department, several state attorneys general are investigating the ratings agency. States such as California and New York are expected to pursue their own investigations and legal action, people familiar with the matter said.

S&P has faced other lawsuits from investors and the states of Illinois and Connecticut.

California is expected to sue S&P under the state's False Claims Act, one person familiar with the matter said. The law makes it a crime to defraud the state, and damages of up to three times the amount of the claim can be awarded if the victim was an institutional investor, such as one of the state's pension funds.

The federal action does not involve any criminal allegations. Critics have complained that the government has yet to send any senior bankers or Wall Street executives to jail for potential illegal behavior that led to the crisis.

But civil actions typically require a much lower burden of proof.

Investors rely in part on rating agencies to decide what stocks, bonds or other securities to buy based on the agencies' recommendations about their safety. The three major raters – S&P, Moody's Investors Service and Fitch Ratings — have all been criticized for giving perfect AAA ratings to complex bonds in 2007 that later turned out to be nearly worthless.

It was not known why Standard & Poor's was singled out in the federal lawsuit.

The government and S&P have tangled before. The rating agency in August 2011 issued a historic downgrade of U.S. creditworthiness and threatened to lower it even further.

The two sides were reportedly in settlement talks that broke down during the past week. The ratings firm could face hundreds of millions of dollars in fines and new restrictions on its business model if found liable of civil violations.

S&P, which is a unit of publisher McGraw Hill, denounced the lawsuit in a detailed and strongly worded response. The company said the claims were unjustified, adding that it acted in "good faith" to warn the world about some of the securities that went belly up.

"A DOJ lawsuit would be entirely without factual or legal merit," the company said, adding that even the U.S. government "publicly stated that problems in the subprime market appeared to be contained."

The rating firm has steadfastly maintained that it was protected under the 1st Amendment to state an opinion about certain financial products. That argument may not hold up if federal or state investigators are able to prove that the ratings agency knowingly gave improper evaluations.

The lawsuit zeros in on a series of collateralized debt obligations that were created at the height of the housing boom in 2007, according to S&P. The value of these exotic mortgage securities was nearly wiped out when the subprime mortgages they were tied to imploded.

Lawrence J. White, an economics professor at New York University's business school, believes that the housing crisis could have been more contained if ratings agencies had been more careful.

"If they had been more conservative in their ratings, fewer bonds would have been sold, the interest rates would have been higher, fewer mortgages would have been granted," White said. "There would still have been a housing bubble, but it might not have been quite so severe."

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Beyonce puts Super Bowl ring on halftime; Hudson, Keys flawless

Beyonce looked like she stepped off from the recent air-brushed perfection of her GQ magazine cover, danced like a junior Tina Turner and generally owned her 12 minutes on a worldwide stage Sunday like few Super Bowl performers ever have.

But there were a few nagging questions: Was she live or was she canned? Or perhaps more to the point: Did it matter?

Beyonce’s performance had the lip-sync police out in force. The pop star fessed up to singing with a backing tape at the presidential inauguration a few weeks ago, but that should come as no surprise. Canned performances have been business as usual at Super Bowl-sized events for decades. For most performers, the question isn’t whether to use a backing tape, but whether to sing into an open microphone while the tape serves as a kind of aural safety net.

Sound engineers note that the entire performance has to be set up in six minutes at halftime, with no guarantees that the singer will be able to hear herself or that there will be technical glitches that compromise the performance. Most artists are in it strictly to look and sound good anyway. They don’t view it as a “performance” so much as a way to promote product to more than 100 million TV viewers; in Beyonce’s case, it was a free ad for her recent reunion and greatest hits album with Destiny’s Child.

And, wow, guess what? There she was with her Destiny Child companions Kelly Rowland and Michelle Williams! Williams coyly said there was nothing to the reunion rumors a few years ago, citing her commitment to appear in a touring version of the Broadway play “Fela!,” but miraculously she found a way to clear her schedule just in time.

The leather-clad trio looked like a walking, strutting advertisement for a dominatrix-boutique franchise. But Rowland and Williams came off as Beyonce’s backing band, dutifully singing harmonies on one of the singer’s biggest solo singles, "Single Ladies (Put a Ring on It)." Her Destiny’s Child accomplices were part of a huge ensemble of dancers and musicians that appeared to consist entirely of women.

Otherwise, it was the high-heeled Beyonce stomping her imprint on libidos everywhere: the silhouetted opening countoff into “Crazy in Love,” topped with a firecracker-spewing guitar solo; the Jamaican dancehall flavor of “Baby Boy”; the closing, signature ballad “Halo.” On the latter, the close-up TV images suggested that the singer was indeed belting it out, at least semi-“live.” But by then the verdict was already in: Beyonce affirmed that she’s the reigning all-purpose multimedia celebrity of our era, and she knows how to entertain.

The musical prelude to the game was relatively low-key in comparison. Marvin Gaye gave one of the longest and most celebrated versions of the National Anthem at a sporting event ever in 1983 at the NBA All-Star Game. But at 2:40, Alicia Keys went six seconds longer than Gaye in her interpretation before Sunday's kickoff.

Seated at a white grand piano, Keys offered a blues and jazz-tinged version of the technically demanding song. Like Gaye, she made the song seem fragile, even poignant, the intimacy undercutting any threat of the showboating that sank Christina Aguilera’s interpretation two years ago. There are many ways to perform the anthem – Kelly Clarkson belted out a concise, fat-free version in 1:34 at last year’s Super Bowl. But Keys certainly delivered one of the best of recent vintage.

Its tone was appropriate given what preceded it: Jennifer Hudson’s “America the Beautiful.” The singer gave a dignified reading, but the focus was deservedly on her smiling choir: 26 white-shirted, beribboned students from the Sandy Hook Elementary School in Connecticut, the scene of a mass murder last year that claimed 26 lives. Hudson herself has been a victim of gun violence; her performance of the National Anthem at the 2009 Super Bowl came only months after her mother, brother and nephew were killled in their Englewood home in Chicago.

greg@gregkot.com

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Estonian pleads guilty in U.S. court to Internet advertising scam

NEW YORK (Reuters) – An Estonian man pleaded guilty on Friday in U.S. federal court for his role in a massive Internet scam that targeted well-known websites such as iTunes, Netflix and The Wall Street Journal.

The scheme infected at least four million computers in more than 100 countries, including 500,000 in the United States, with malicious software, or malware, according to the indictment. It included a large number of computers at data centers located in New York, federal prosecutors said.

Valeri Aleksejev, 32, was the first of six Estonians and one Russian indicted in 2011 to enter a plea. They were indicted on five charges each of wire and computer intrusion. One of the defendants, Vladimir Tsastsin, was also charged with 22 counts of money laundering.

In U.S. District Court in Manhattan on Friday, Aleksejev pleaded guilty to conspiracy to commit wire fraud and conspiracy to commit computer intrusion. He faces up to 25 years in prison, deportation and the forfeiture of $ 7 million.

The scam had several components, including a “click-hijacking fraud” in which the malware re-routed searches by users on infected computers to sites designated by the defendants, prosecutors said in the indictment. Users of infected computers trying to access Apple Inc’s iTunes website or Netflix Inc‘s movie website, for example, instead ended up at websites of unaffiliated businesses, according to the indictment.

Another component of the scam replaced legitimate advertisements on websites operated by News Corp’s The Wall Street Journal, Amazon.com Inc and others with advertisements that triggered payments for the defendants, prosecutors said.

The defendants reaped at least $ 14 million from the fraud, prosecutors said. However, Aleksejev’s lawyer, William Stampur, said in court on Friday that Aleksejev has no assets.

Estonian police arrested Aleksejev and the other Estonians in November 2011. One other Estonian, Anton Ivanov, has been extradited, and the extradition of the other four is pending, according to the U.S. Attorney’s office in Manhattan. The Russian, Andrey Taame, remains at large, according to the U.S. Attorney’s office.

Aleksejev told Magistrate Judge James Francis he assisted in blocking anti-virus software updates on infected computers. Francis asked Aleksejev if he knew what he was doing was illegal.

“I thought it was wrong,” Aleksejev said in broken English after a long pause. “But of course I didn’t know all the laws in the U.S.”

Francis set a tentative sentencing date of May 31 for Aleksejev.

The case is USA v. Tsastsin et al, U.S. District Court in Manhattan, No. 11-00878.

(Reporting by Bernard Vaughan; Editing by Dan Grebler)

Internet News Headlines – Yahoo! News

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