Electronic Records Systems Have Not Reduced Health Costs, Report Says

The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential RAND Corporation.

Jim Wilson/The New York Times

Dr. Alvin Rajkomar tracks patient data on a Samsung Galaxy Note. A new report questions whether electronic records reduce health care costs.

Optimistic predictions by RAND in 2005 helped drive explosive growth in the electronic records industry and encouraged the federal government to give billions of dollars in financial incentives to hospitals and doctors that put the systems in place.

“We’ve not achieved the productivity and quality benefits that are unquestionably there for the taking,” said Dr. Arthur L. Kellermann, one of the authors of a reassessment by RAND that was published in this month’s edition of Health Affairs, an academic journal.

RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.

The report predicted that widespread use of electronic records could save the United States health care system at least $81 billion a year, a figure RAND now says was overstated. The study was widely praised within the technology industry and helped persuade Congress and the Obama administration to authorize billions of dollars in federal stimulus money in 2009 to help hospitals and doctors pay for the installation of electronic records systems.

“RAND got a lot of attention and a lot of buzz with the original analysis,” said Dr. Kellermann, who was not involved in the 2005 study. “The industry quickly embraced it.”

But evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services.

Health care spending has risen $800 billion since the first report was issued, according to federal figures. The reasons are many, from the aging of the baby boomer population, to the cost of medical advances, to higher usage of medical services over all.

Officials at RAND said their new analysis did not try to put a dollar figure on how much electronic record-keeping had helped or hurt efforts to reduce costs. But the firm’s acknowledgment that its earlier analysis was overly optimistic adds to a chorus of concern about the cost of the new systems and the haste with which they have been adopted.

The recent analysis was sharply critical of the commercial systems now in place, many of which are hard to use and do not allow doctors and patients to share medical information across systems. “We could be getting much more if we could take the time to do a little more planning and to set more standards,” said Marc Probst, chief information officer for Intermountain Healthcare, a large health system in Salt Lake City that developed its own electronic records system and is cited by RAND as an example of how the technology can help improve care and reduce costs.

The RAND researchers pointed to a number of other reasons the expected savings had not materialized. The rate of adoption has been slow, they said, and electronic records do not address the fact that doctors and hospitals reap the benefits of high volumes of care.

Many experts say the available systems seem to be aimed more at increasing billing by providers than at improving care or saving money. Federal regulators are investigating whether electronic records make it easier for hospitals and doctors to bill for services they did not provide and whether Medicare and other federal agencies are adequately monitoring the use of electronic records.

Technology “is only a tool,” said Dr. David Blumenthal, who helped oversee the federal push for the adoption of electronic records under President Obama and is now president of the Commonwealth Fund, a nonprofit health group. “Like any tool, it can be used well or poorly.” While there is strong evidence that electronic records can contribute to better care and more efficiency, Dr. Blumenthal said, the systems in place do not always work in ways that help achieve those benefits.

Federal officials say they are drafting new rules to address many of the concerns about the current systems.

This article has been revised to reflect the following correction:

Correction: January 14, 2013

An article on Friday about a new RAND Corporation study that found few savings from electronic health records misstated, in some copies, the name of the city in Florida that is home to a physician practice that is suing a health care technology firm that stopped supporting a system it sold to doctors in the practice. It is in Panama City, not Panama.

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Susan Nolen-Hoeksema, Psychologist Who Studied Depression in Women, Dies at 53

Susan Nolen-Hoeksema, a psychologist and writer whose work helped explain why women are twice as prone to depression as men and why such low moods can be so hard to shake, died on Jan. 2 in New Haven. She was 53.

Andrew Sacks

Susan Nolen-Hoeksema at the University of Michigan in 2003. Dr. Nolen-Hoeksema's research showed that women were more prone to ruminate, or dwell on the sources of problems rather than solutions, more than men.

Her death followed heart surgery to correct a congenitally weak valve, said her husband, Richard Nolen-Hoeksema.

Dr. Nolen-Hoeksema, a professor at Yale University, began studying depression in the 1980s, a time of great excitement in psychiatry and psychology. New drugs like Prozac were entering the market; novel talking therapies were proving effective, too, particularly cognitive behavior therapy, in which people learn to defuse upsetting thoughts by questioning their basis.

Her studies, first in children and later in adults, exposed one of the most deceptively upsetting of these patterns: rumination, the natural instinct to dwell on the sources of problems rather than their possible solutions. Women were more prone to ruminate than men, the studies found, and in a landmark 1987 paper she argued that this difference accounted for the two-to-one ratio of depressed women to depressed men.

She later linked rumination to a variety of mood and behavior problems, including anxiety, eating disorders and substance abuse.

“The way I think she’d put it is that, when bad things happen, women brood — they’re cerebral, which can feed into the depression,” said Martin Seligman, a professor of psychology at the University of Pennsylvania, who oversaw her doctoral work. “Men are more inclined to act, to do something, plan, beat someone up, play basketball.”

Dr. Seligman added, “She was the leading figure in sex differences in depression of her generation.”

Dr. Nolen-Hoeksema wrote several books about her research for general readers, including “Women Who Think Too Much: How to Break Free of Overthinking and Reclaim Your Life.” These books described why rumination could be so corrosive — it is deeply distracting; it tends to highlight negative memories — and how such thoughts could be alleviated.

Susan Kay Nolen was born on May 22, 1959, in Springfield, Ill., to John and Catherine Nolen. Her father ran a construction business, where her mother was the office manager; Susan was the eldest of three children.

She entered Illinois State University before transferring to Yale. She graduated summa cum laude in 1982 with a degree in psychology.

After earning a Ph.D. in psychology at the University of Pennsylvania, she joined the faculty at Stanford. She later moved to the University of Michigan, before returning to Yale in 2004.

Along the way she published scores of studies and a popular textbook. In 2003 she became the editor of the Annual Review of Clinical Psychology, an influential journal.

Dr. Nolen-Hoeksema moved smoothly between academic work and articles and books for the general reader.

“I think part of what allowed her to move so easily between those two worlds was that she was an extremely clear thinker, and an extremely clear writer,” said Marcia K. Johnson, a psychology professor and colleague at Yale.

Dr. Nolen-Hoeksema lived in Bethany, Conn. In addition to her husband, a science writer, she is survived by a son, Michael; her brothers, Jeff and Steve; and her father, John.

“Over the past four decades women have experienced unprecedented growth in independence and opportunities,” Dr. Nolen-Hoeksema wrote in 2003, adding, “We have many reasons to be happy and confident.”

“Yet when there is any pause in our daily activities,” she continued, “many of us are flooded with worries, thoughts and emotions that swirl out of control, sucking our emotions and energy down, down, down. We are suffering from an epidemic of overthinking.”

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Susan Nolen-Hoeksema, Psychologist Who Studied Depression in Women, Dies at 53

Susan Nolen-Hoeksema, a psychologist and writer whose work helped explain why women are twice as prone to depression as men and why such low moods can be so hard to shake, died on Jan. 2 in New Haven. She was 53.

Andrew Sacks

Susan Nolen-Hoeksema at the University of Michigan in 2003. Dr. Nolen-Hoeksema's research showed that women were more prone to ruminate, or dwell on the sources of problems rather than solutions, more than men.

Her death followed heart surgery to correct a congenitally weak valve, said her husband, Richard Nolen-Hoeksema.

Dr. Nolen-Hoeksema, a professor at Yale University, began studying depression in the 1980s, a time of great excitement in psychiatry and psychology. New drugs like Prozac were entering the market; novel talking therapies were proving effective, too, particularly cognitive behavior therapy, in which people learn to defuse upsetting thoughts by questioning their basis.

Her studies, first in children and later in adults, exposed one of the most deceptively upsetting of these patterns: rumination, the natural instinct to dwell on the sources of problems rather than their possible solutions. Women were more prone to ruminate than men, the studies found, and in a landmark 1987 paper she argued that this difference accounted for the two-to-one ratio of depressed women to depressed men.

She later linked rumination to a variety of mood and behavior problems, including anxiety, eating disorders and substance abuse.

“The way I think she’d put it is that, when bad things happen, women brood — they’re cerebral, which can feed into the depression,” said Martin Seligman, a professor of psychology at the University of Pennsylvania, who oversaw her doctoral work. “Men are more inclined to act, to do something, plan, beat someone up, play basketball.”

Dr. Seligman added, “She was the leading figure in sex differences in depression of her generation.”

Dr. Nolen-Hoeksema wrote several books about her research for general readers, including “Women Who Think Too Much: How to Break Free of Overthinking and Reclaim Your Life.” These books described why rumination could be so corrosive — it is deeply distracting; it tends to highlight negative memories — and how such thoughts could be alleviated.

Susan Kay Nolen was born on May 22, 1959, in Springfield, Ill., to John and Catherine Nolen. Her father ran a construction business, where her mother was the office manager; Susan was the eldest of three children.

She entered Illinois State University before transferring to Yale. She graduated summa cum laude in 1982 with a degree in psychology.

After earning a Ph.D. in psychology at the University of Pennsylvania, she joined the faculty at Stanford. She later moved to the University of Michigan, before returning to Yale in 2004.

Along the way she published scores of studies and a popular textbook. In 2003 she became the editor of the Annual Review of Clinical Psychology, an influential journal.

Dr. Nolen-Hoeksema moved smoothly between academic work and articles and books for the general reader.

“I think part of what allowed her to move so easily between those two worlds was that she was an extremely clear thinker, and an extremely clear writer,” said Marcia K. Johnson, a psychology professor and colleague at Yale.

Dr. Nolen-Hoeksema lived in Bethany, Conn. In addition to her husband, a science writer, she is survived by a son, Michael; her brothers, Jeff and Steve; and her father, John.

“Over the past four decades women have experienced unprecedented growth in independence and opportunities,” Dr. Nolen-Hoeksema wrote in 2003, adding, “We have many reasons to be happy and confident.”

“Yet when there is any pause in our daily activities,” she continued, “many of us are flooded with worries, thoughts and emotions that swirl out of control, sucking our emotions and energy down, down, down. We are suffering from an epidemic of overthinking.”

Read More..

Wheels Blog: The Seventh-Generation Corvette Is Unveiled in Detroit

DETROIT — The Stingray is back, in name and in spirit.

At an invitation-only gathering hours before the North American International Auto Show was scheduled to open for press previews, General Motors introduced the 2014 Corvette, the seventh generation of Chevrolet’s hallmark sports car.

Underscoring the importance of this vehicle was Chevrolet’s revival of the long-dormant Stingray badge, a name it first used on a 1959 racecar built by G.M.’s design chief, Bill Mitchell. The hope for that original Stingray racecar was to beat Europe’s best, and G.M. still seems to be thinking along those lines.

According to G.M.’s president for North America, Mark Reuss, the latest Stingray is a potential worldbeater.

“Like the ’63 Sting Ray, the best Corvettes embodied performance leadership, delivering cutting-edge technologies, breathtaking design and awe-inspiring driving experiences,” Mr. Reuss said. “The all-new Corvette goes farther than ever, thanks to today’s advancements in design technology and engineering.”

The release of a new Corvette is always highly anticipated by auto enthusiasts; speculation about “C7″ — shorthand for the seventh generation — has run high. Would it get a twin-cam turbocharged powertrain? Would Chevy switch to an exotic midengine chassis?

In actuality, the 2014 model will again have a pushrod V-8 engine in its nose, driving the rear wheels. That conservative approach might be seen as a timid compromise from a company that has just begun to get back on solid financial footing. But the front-engine, rear-drive layout has long defined the Corvette, and this car, like its C6 predecessor, may well show its taillights to cars with specs that more closely conform to what is considered state of the art.

While automakers are quick to toss around the words “all new” to describe their latest offerings, however warmed over they might be, in this case the term is justified — the 2014 Corvette shares only two parts with its predecessor.

The C7 Corvette’s styling is in keeping with the brand’s persona, yet it projects a more aggressive image than previous generations. The clean front fascia is devoid of parking lights, and is energized by a sharp edge where it meets the hood, which is itself defined by a prominent bulge and more hard edges. The curve of the front fenders peaks at yet another edge that blends seamlessly into the body side at the A-pillar. The body’s flanks are defined by character lines that race back from vents behind the front wheel, not unlike those of previous Corvettes, but here those lines are more sharply drawn, with the upper line sweeping up and back to define the shape of the rear quarter panel. The lower character line projects from the body, forming a wing of sorts that flows out of the front fender and terminates at the rear of the door. The coupe’s roofline arcs smoothly to meet the rear spoiler, rather than terminating at the rear window, as in the C6. The individual rear taillights that have long been a part of Corvette design are now paired in a deep recess on each side. Four large exhaust pipes exit center-stage, rear.

The sheet-molded fiberglass body, with carbon-fiber hood and roof panels and carbon-nano composite underbody panels, is 37 pounds lighter than the C6’s body. It rides on a new aluminum frame that is 57 percent stiffer and 99 pounds lighter than the current model’s. The wheelbase is about one inch longer than that of the C6, and the track is almost an inch wider — changes said to provide a more stable feel at high speed.

Inside the cockpit, considerable effort was lavished on upgrading what has generally been considered a blighted zone. Optional carbon fiber trim and real aluminum combine with plastic in a wraparound configuration. The steering wheel, with a 14.1 inch diameter, is smaller than that of the previous model, and two seat choices are offered, with the competition sport version providing more side bolstering to hold occupants in place in spirited maneuvers. Indicative of the car’s purpose is the inclusion of a console-mounted steel grab bar for the passenger.

Under the hood, Chevrolet’s 6.2-liter small block V-8 — now in its fifth-generation design — produces an estimated 450 horsepower and 450 pound-feet of torque. At low speed, torque output exceeds that of the previous 6.2-liter engine by 50 pound-feet. The engine shares few parts with prior Corvette V-8s and is fitted with direct fuel injection that, in combination with other refinements, enables a high compression ratio of 11.5:1. Active Fuel Management, G.M.’s system for deactivating cylinders when they are not needed, lets the car cruise on four cylinders in some driving modes. Final fuel-economy numbers are not yet available.

Two transaxles will be offered: a 6-speed automatic with paddle-shift mode or a 7-speed manual with rev-matching capability — an electronic version of the heel-and-toe shifting techniques that competition drivers employ to enable smooth gear changes when negotiating twisty bits.

The Corvette driver will be able to select from among five driving modes: weather, Eco, Tour, Sport and Track; the default setting will be Tour. Changing modes alters 12 vehicle attributes, including throttle response, shift points, engagement of the limited-slip differential engagement, shock damping and more. Four-piston Brembo brakes provide stopping power, and electric power steering sets the course.

An optional Z51 performance package adds an electronic limited-slip differential that can continuously vary torque split between the rear wheels, dry-sump oiling, upgraded shock absorbers, a revised version of the automaker’s Magnetic Ride Control suspension-regulating system, close-ratio gears for the manual transmission, larger brake rotors and aerodynamic refinements that incorporate air-flow management for cooling of heat-stressed components.

Like its predecessor, the 2014 Corvette Stingray will be built at a G.M. plant in Bowling Green, Ky. The car is expected to arrive at dealerships in the third quarter of this year.

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IHT Rendezvous: Breathing in Beijing: Coping With China's Smog

BEIJING — With Beijing’s air pollution soaring to seemingly new, awful records this weekend, the classic parenting dilemma of “What shall we do with the kids?” had a grimly obvious answer: Slap on the antipollution face masks and go shopping for another air purifier.

That’s what we did on Saturday, as the Air Quality Index run by the United States Embassy in Beijing, which uses standards set by the United States Environmental Protection Agency, hit a “jaw-dropping” 755 at 8 p.m., as my colleague Edward Wong wrote. “All of Beijing looked like an airport smokers’ lounge,” Ed wrote.

According to the index, anything above 300 is “Hazardous” and above 500 is “Beyond Index.” This weekend, the readings were Beyond Index for 16 straight hours.

Even the Chinese government’s monitors, which recently have grown more accurate but still tend to measure the pollution as lower than the embassy’s, were recording scary levels of around 500.

Furious, Chinese netizens wrote on their microblog accounts that the pollution had “exploded the index,” or “baobiao.”

They reached for strong adjectives: “postapocalyptic,” “terrifying” and “beyond belief,” Ed wrote.

So it was ironic that on Sunday there was a sense of relief as the index dropped to 319 (still “Hazardous”) then down to 286: a measly “Very Unhealthy.” By Sunday afternoon, it was “Hazardous” again though, at 373.

Ordinary Chinese are appalled. And increasingly, they can say so in public, as the state appears to be relaxing its censorship of reporting on the pollution that everyone can see and smell.

Xinhua, the state-run news agency, reported on Jan. 1 that the environmental authorities were now releasing real-time air quality data from 74 cities in China, at www.cnemc.cn.

On its Weibo, or microblog, feed, CCTV, the state broadcaster, warned early Sunday that “the main air quality monitoring stations in eight city districts will be around 500, which is grade six, heavy pollution, with PM 2.5 and PM 10 the main pollutants,” referring to fine particulates and bigger particulates.

Of course, the problem wasn’t limited to Beijing. As this photograph from NASA appeared to show, pollution was severe across much of eastern China (Beijing is within the blue circle).

And on state media’s lists of the most polluted cities in China on Saturday, Beijing wasn’t even in the top 10. That honor went to Shijiazhuang and other places.

The People’s Daily online was frank, asking in a full-page spread, “What is Going on with our Air?” (Handily cached here by Sinocism, the Beijing-based newsletter.)

The scale of the problem is, quite frankly, overwhelming. A very revealing chart by Edgar, the Emissions Database for Global Atmospheric Research, from the European Commission, estimates that in 2011 China produced 9.7 million kilotons of carbon dioxide, nearly double United States’ 5.42 million kilotons.

Indeed, were the Chinese cement industry a country, it would be the sixth biggest emitter of carbon dioxide in the world, producing 820,000 kilotons in 2011, slightly ahead of Germany’s total carbon dioxide emissions that year of 810,000 kilotons, according to Edgar. Germany was the sixth most polluting nation in the world, with the United States the second and China the first, according to the chart.

But something else stands out here: China’s population of more than 1.3 billion is about 4.5 times that of the United States’ approximately 300 million. So though it leads the world in carbon dioxide emissions, it is still, per capita, far less polluting than the United States.

Unfortunately, that may change. China’s economy may overtake the U.S. economy sometime within the next decade or two, meaning that we may be facing a truly astonishing problem. As Ma Jun, the director of the Chinese Institute of Public and Environmental Affairs told the Hong Kong-based South China Morning Post: “It is no secret that our way of development is not sustainable and the total pollution emissions in the region have far exceeded the maximum ecological capacity.”

How does a family justify living in this? For most people in China’s cities there is no practical alternative to life in the smog, though the appalling environment is a reason cited by most who emigrate (in a recent post I noted how emigration numbers were rising all the time).

To control the risk, we have family rules: above 100, and the air purifiers – all four of them – go on. Above 200, we wear face masks outdoors. Above 300 and no one exercises or plays outside, even with a face mask on. Above 500 and we try not to go out at all. That’s hard, especially for the children.

So this weekend, we breathed at home. Watched a movie. Read. And talked. Told the kids how their generation is going to have to clean up the environmental mess caused by all the previous generations. And watched the incredulity grow on their faces as they contemplated the stupidity of adults.

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Aaron Swartz, Internet Activist, Dies at 26

Aaron Swartz, a wizardly programmer who as a teenager helped develop code that delivered ever-changing Web content to users and who later became a steadfast crusader to make that information freely available, was found dead on Friday in his New York apartment.

An uncle, Michael Wolf, said that Mr. Swartz, 26, had apparently hanged himself, and that a friend of Mr. Swartz’s had discovered the body.

At 14, Mr. Swartz helped create RSS, the nearly ubiquitous tool that allows users to subscribe to online information. He later became an Internet folk hero, pushing to make many Web files free and open to the public. But in July 2011, he was indicted on federal charges of gaining illegal access to JSTOR, a subscription-only service for distributing scientific and literary journals, and downloading 4.8 million articles and documents, nearly the entire library.

Charges in the case, including wire fraud and computer fraud, were pending at the time of Mr. Swartz’s death, carrying potential penalties of up to 35 years in prison and $1 million in fines.

“Aaron built surprising new things that changed the flow of information around the world,” said Susan Crawford, a professor at the Cardozo School of Law in New York who served in the Obama administration as a technology adviser. She called Mr. Swartz “a complicated prodigy” and said “graybeards approached him with awe.”

Mr. Wolf said he would remember his nephew, who had written in the past about battling depression and suicidal thoughts, as a young man who “looked at the world, and had a certain logic in his brain, and the world didn’t necessarily fit in with that logic, and that was sometimes difficult.”

The Tech, a newspaper of the Massachusetts Institute of Technology, reported Mr. Swartz’s death early Saturday.

Mr. Swartz led an often itinerant life that included dropping out of Stanford, forming companies and organizations, and becoming a fellow at Harvard University’s Edmond J. Safra Center for Ethics.

He formed a company that merged with Reddit, the popular news and information site. He also co-founded Demand Progress, a group that promotes online campaigns on social justice issues — including a successful effort, with other groups, to oppose a Hollywood-backed Internet piracy bill.

But he also found trouble when he took part in efforts to release information to the public that he felt should be freely available. In 2008, he took on PACER, or Public Access to Court Electronic Records, the repository for federal judicial documents.

The database charges 10 cents a page for documents; activists like Carl Malamud, the founder of public.resource.org, have long argued that such documents should be free because they are produced at public expense. Joining Mr. Malamud’s efforts to make the documents public by posting legally obtained files to the Internet for free access, Mr. Swartz wrote an elegant little program to download 20 million pages of documents from free library accounts, or roughly 20 percent of the enormous database.

The government shut down the free library program, and Mr. Malamud feared that legal trouble might follow even though he felt they had violated no laws. As he recalled in a newspaper account, “I immediately saw the potential for overreaction by the courts.” He recalled telling Mr. Swartz: “You need to talk to a lawyer. I need to talk to a lawyer.”

Mr. Swartz recalled in a 2009 interview, “I had this vision of the feds crashing down the door, taking everything away.” He said he locked the deadbolt on his door, lay down on the bed for a while and then called his mother.

The federal government investigated but did not prosecute.

In 2011, however, Mr. Swartz went beyond that, according to a federal indictment. In an effort to provide free public access to JSTOR, he broke into computer networks at M.I.T. by means that included gaining entry to a utility closet on campus and leaving a laptop that signed into the university network under a false account, federal officials said.

Mr. Swartz turned over his hard drives with 4.8 million documents, and JSTOR declined to pursue the case. But Carmen M. Ortiz, a United States attorney, pressed on, saying that “stealing is stealing, whether you use a computer command or a crowbar, and whether you take documents, data or dollars.”

Founded in 1995, JSTOR, or Journal Storage, is nonprofit, but institutions can pay tens of thousands of dollars for a subscription that bundles scholarly publications online. JSTOR says it needs the money to collect and to distribute the material and, in some cases, subsidize institutions that cannot afford it. On Wednesday, JSTOR announced that it would open its archives for 1,200 journals to free reading by the public on a limited basis.

Mr. Malamud said that while he did not approve of Mr. Swartz’s actions at M.I.T., “access to knowledge and access to justice have become all about access to money, and Aaron tried to change that. That should never have been considered a criminal activity.”

Mr. Swartz did not talk much about his impending trial, Quinn Norton, a close friend, said on Saturday, but when he did, it was clear that “it pushed him to exhaustion. It pushed him beyond.”

Recent years had been hard for Mr. Swartz, Ms. Norton said, and she characterized him “in turns tough and delicate.” He had “struggled with chronic, painful illness as well as depression,” she said, without specifying the illness, but he was still hopeful “at least about the world.”

Cory Doctorow, a science fiction author and online activist, posted a tribute to Mr. Swartz on BoingBoing.net, a blog he co-edits. In an e-mail, he called Mr. Swartz “uncompromising, principled, smart, flawed, loving, caring, and brilliant.”

 “The world was a better place with him in it,” he said.

Mr. Swartz, he noted, had a habit of turning on those closest to him: “Aaron held the world, his friends, and his mentors to an impossibly high standard — the same standard he set for himself.” Mr. Doctorow added, however, “It’s a testament to his friendship that no one ever seemed to hold it against him (except, maybe, himself).”

In a talk in 2007, Mr. Swartz described having had suicidal thoughts during a low period in his career. He also wrote about his struggle with depression, distinguishing it from sadness.

“Go outside and get some fresh air or cuddle with a loved one and you don’t feel any better, only more upset at being unable to feel the joy that everyone else seems to feel. Everything gets colored by the sadness.”

When the condition gets worse, he wrote, “you feel as if streaks of pain are running through your head, you thrash your body, you search for some escape but find none. And this is one of the more moderate forms.”

Ravi Somaiya contributed reporting.

This article has been revised to reflect the following correction:

Correction: January 12, 2013

An earlier version of this article incorrectly identified the police who arrested Mr. Swartz, and when they did so. The police were from Cambridge, Mass., not the Massachusetts Institute of Technology campus force, and the arrest occurred two years before Mr. Swartz’s suicide, but not two years to the day.

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City Room: Cuomo Declares Public Health Emergency Over Flu Outbreak

With the nation in the grip of a severe influenza outbreak that has seen deaths reach epidemic levels, New York State declared a public health emergency on Saturday, making access to vaccines more easily available.

There have been nearly 20,000 cases of flu reported across the state so far this season, officials said. Last season, 4,400 positive laboratory tests were reported.

“We are experiencing the worst flu season since at least 2009, and influenza activity in New York State is widespread, with cases reported in all 57 counties and all five boroughs of New York City,” Gov. Andrew M. Cuomo said in a statement.

Under the order, pharmacists will be allowed to administer flu vaccinations to patients between 6 months and 18 years old, temporarily suspending a state law that prohibits pharmacists from administering immunizations to children.

While children and older people tend to be the most likely to become seriously ill from the flu, Mr. Cuomo urged all New Yorkers to get vaccinated.

On Friday, the Centers for Disease Control and Prevention in Atlanta said that deaths from the flu had reached epidemic levels, with at least 20 children having died nationwide. Officials cautioned that deaths from pneumonia and the flu typically reach epidemic levels for a week or two every year. The severity of the outbreak will be determined by how long the death toll remains high or if it climbs higher.

There was some evidence that caseloads may be peaking, federal officials said on Friday.

In New York City, public health officials announced on Thursday that flu-related illnesses had reached epidemic levels, and they joined the chorus of authorities urging people to get vaccinated.

“It’s a bad year,” the city’s health commissioner, Dr. Thomas A. Farley, told reporters on Thursday. “We’ve got lots of flu, it’s mainly type AH3N2, which tends to be a little more severe. So we’re seeing plenty of cases of flu and plenty of people sick with flu. Our message for any people who are listening to this is it’s still not too late to get your flu shot.”

There has been a spike in the number of people going to emergency rooms over the past two weeks with flulike symptoms – including fever, fatigue and coughing – Dr. Farley said.

Mayor Michael R. Bloomberg and Mr. Cuomo made a public display of getting shots this past week.

In a briefing with reporters on Friday, officials from the C.D.C. said that this year’s vaccine was effective in 62 percent of cases.

As officials have stepped up their efforts encouraging vaccinations, there have been scattered reports of shortages. But officials said plenty of the vaccine was available.

According to the C.D.C., makers of the flu vaccine produced about 135 million doses for this year. As of early this month, 128 million doses had been distributed. While that would not be enough for every American, only 37 percent of the population get a flu shot each year.

Federal health officials said they would be happy if that number rose to 50 percent, which would mean that there would be more than enough vaccine for anyone who wanted to be immunized.

Two other diseases – norovirus and whooping cough – are also widespread this winter and are contributing to the number of people getting sick.

The flu can resemble a cold, though the symptoms come on more rapidly and are more severe.

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City Room: Cuomo Declares Public Health Emergency Over Flu Outbreak

With the nation in the grip of a severe influenza outbreak that has seen deaths reach epidemic levels, New York State declared a public health emergency on Saturday, making access to vaccines more easily available.

There have been nearly 20,000 cases of flu reported across the state so far this season, officials said. Last season, 4,400 positive laboratory tests were reported.

“We are experiencing the worst flu season since at least 2009, and influenza activity in New York State is widespread, with cases reported in all 57 counties and all five boroughs of New York City,” Gov. Andrew M. Cuomo said in a statement.

Under the order, pharmacists will be allowed to administer flu vaccinations to patients between 6 months and 18 years old, temporarily suspending a state law that prohibits pharmacists from administering immunizations to children.

While children and older people tend to be the most likely to become seriously ill from the flu, Mr. Cuomo urged all New Yorkers to get vaccinated.

On Friday, the Centers for Disease Control and Prevention in Atlanta said that deaths from the flu had reached epidemic levels, with at least 20 children having died nationwide. Officials cautioned that deaths from pneumonia and the flu typically reach epidemic levels for a week or two every year. The severity of the outbreak will be determined by how long the death toll remains high or if it climbs higher.

There was some evidence that caseloads may be peaking, federal officials said on Friday.

In New York City, public health officials announced on Thursday that flu-related illnesses had reached epidemic levels, and they joined the chorus of authorities urging people to get vaccinated.

“It’s a bad year,” the city’s health commissioner, Dr. Thomas A. Farley, told reporters on Thursday. “We’ve got lots of flu, it’s mainly type AH3N2, which tends to be a little more severe. So we’re seeing plenty of cases of flu and plenty of people sick with flu. Our message for any people who are listening to this is it’s still not too late to get your flu shot.”

There has been a spike in the number of people going to emergency rooms over the past two weeks with flulike symptoms – including fever, fatigue and coughing – Dr. Farley said.

Mayor Michael R. Bloomberg and Mr. Cuomo made a public display of getting shots this past week.

In a briefing with reporters on Friday, officials from the C.D.C. said that this year’s vaccine was effective in 62 percent of cases.

As officials have stepped up their efforts encouraging vaccinations, there have been scattered reports of shortages. But officials said plenty of the vaccine was available.

According to the C.D.C., makers of the flu vaccine produced about 135 million doses for this year. As of early this month, 128 million doses had been distributed. While that would not be enough for every American, only 37 percent of the population get a flu shot each year.

Federal health officials said they would be happy if that number rose to 50 percent, which would mean that there would be more than enough vaccine for anyone who wanted to be immunized.

Two other diseases – norovirus and whooping cough – are also widespread this winter and are contributing to the number of people getting sick.

The flu can resemble a cold, though the symptoms come on more rapidly and are more severe.

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Treasury Will Not Mint $1 Trillion Coin to Raise Debt Ceiling

WASHINGTON — The Treasury Department said Saturday that it will not mint a trillion-dollar platinum coin to head off an imminent battle with Congress over raising the government’s borrowing limit.

“Neither the Treasury Department nor the Federal Reserve believes that the law can or should be used to facilitate the production of platinum coins for the purpose of avoiding an increase in the debt limit,” Anthony Coley, a Treasury spokesman, said in a written statement.

The Obama administration has indicated that the only way for the country to avoid a cash-management crisis as soon as next month is for Congress to raise the “debt ceiling,” which is the statutory limit on government borrowing. The cap is $16.4 trillion.

“There are only two options to deal with the debt limit: Congress can pay its bills, or it can fail to act and put the nation into default,” Jay Carney, the White House press secretary, said in a statement. “Congress needs to do its job.”

In recent weeks, some Republicans have indicated that they would not agree to raise the debt limit unless Democrats agreed to make cuts to entitlement programs like Social Security.

The White House has said it would not negotiate spending cuts in exchange for Congressional authority to borrow more, and it has insisted that Congress raise the ceiling as a matter of course, to cover expenses already authorized by Congress. In broader fiscal negotiations, it has said it would not agree to spending cuts without commensurate tax increases.

The idea of minting a trillion-dollar coin drew wide if puzzling attention recently after some bloggers and economic commentators had suggested it as an alternative to involving Congress.

By virtue of an obscure law meant to apply to commemorative coins, the Treasury secretary could order the production of a high-denomination platinum coin and deposit it at the Federal Reserve, where it would count as a government asset and give the country more breathing room under its debt ceiling. Once Congress raised the debt ceiling, the Treasury secretary could then order the coin destroyed.

Mr. Carney, the press secretary, fielded questions about the theoretical tactic at a news conference last week. But the idea is now formally off the table.

The White House has also rejected the idea that it could mount a challenge to the debt ceiling itself, on the strength of the Fourteenth Amendment to the Constitution, which holds that the “validity of the public debt” of the United States “shall not be questioned.”

The Washington Post earlier published a report that the Obama administration had rejected the platinum-coin idea.

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India Ink: New Focus on Village of Delhi Rape Victim's Father

MEDAWARA, Uttar Pradesh — A makeshift helipad was being built this week in this remote dusty village in eastern Uttar Pradesh. The potholed single-lane road that leads the village was under repair, and journalists, district officials and local politicians had come to call.

Medawara, population 2,000, has never seen this kind of action and attention before, residents said.

A brutal rape took place 600 miles away in New Delhi that shook the conscience of the nation and sparked angry nationwide protests. The rape victim, who struggled for her life for 12 days before dying, belongs to Medawara village. Her family came here to perform 13 days of death rituals.

The family’s presence in the village brought members of the media, which in turn brought politicians who were apparently eager to make political capital out of the situation. And the visits of the politicians brought other government officials.

The village is 7 kilometers (4 miles) from a real road and gets electricity for only three to five hours a day. There are no health facilities, and a government primary school up to fifth grade and a private school up to eighth are the only means of education. No other signs of development are visible in the village.

Residents largely depend upon agriculture for their livelihood, and they grow wheat, sugarcane, pulses, rice, potatoes and onions. The village lies in the floodplains of the Ganges River and its tributaries, and it experienced massive floods in 1972, 1982 and 1994.

Like the family of the rape victim, many others from the village have migrated to Delhi, Mumbai and Ahmedabad, Gujarat for to earn a living.

Local politicians who were visiting the village this week told journalists “facts” about the village that were easy to disprove.

“The village gets electricity for 16 to 18 hours a day” said one, speaking to journalists sitting the victim’s family courtyard. “The village has a government high school” said another. Villagers who were there gave sceptical looks, but did not correct his statement.

“They do their dirty political games in every situation” one man who had lived in the village his entire life said after the politicians had  left the family courtyard.

After decades of being ignored, though, this week backhoes were levelling the ground and tractors were bringing bricks to construct the makeshift helipad in a private school ground. Road rollers were pressing the freshly put growl to fill the road potholes. Chief Minister Akhilesh Yadav was coming to visit, villagers said.

The locals were not immediately impressed by all the work.

“What will the helipad give to the village?” asked Ashwani Kumar, the founder of the private school. “If the big leaders would have come by road at least they will see the road condition and the backwardness of the area.”

Mr. Kumar is also worried that no one will remove the makeshift helipad from the school playground, leaving his students nowhere to play.

The state government was spending 3 million rupees ($55,000) sprucing up the village and its connecting road, a local official told India Today.  Earlier, the state government said it would give 2 million rupees to the family of the rape victim.

On Friday, the chief minister touched down, carrying a check for that amount. He also promised development of the village, including construction of a primary health center.

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