Gaps Seen in Therapy for Suicidal Teenagers

Most adolescents who plan or attempt suicide have already received at least some mental health treatment, raising questions about the effectiveness of current approaches to helping troubled youths, according to the largest in-depth analysis to date of suicidal behaviors in American teenagers.

The study, in the journal JAMA Psychiatry, found that 55 percent of suicidal teenagers had received some therapy before they thought about suicide, planned it or tried to kill themselves, contradicting the widely held belief that suicide is due in part to a lack of access to treatment.

The findings, based on interviews with a nationwide sample of more than 6,000 teenagers and at least one parent of each, linked suicidal behavior to complex combinations of mood disorders like depression and behavior problems like attention-deficit and eating disorders, as well as alcohol and drug abuse.

The study found that about one in eight teenagers had persistent suicidal thoughts at some point, and that about a third of those who had suicidal thoughts had made an attempt, usually within a year of having the idea.

Previous studies have had similar findings, based on smaller, regional samples. But the new study is the first to suggest, in a large nationwide sample, that access to treatment does not make a big difference.

The study suggests that effective treatment for severely suicidal teenagers must address not just mood disorders, but also behavior problems that can lead to impulsive acts, experts said. According to the Centers for Disease Control and Prevention, 1,386 people between the ages of 13 and 18 committed suicide in 2010, the latest year for which numbers are available.

“I think one of the take-aways here is that treatment for depression may be necessary but not sufficient to prevent kids from attempting suicide,” said Dr. David Brent, a professor of psychiatry at the University of Pittsburgh, who was not involved in the study. “We simply do not have empirically validated treatments for recurrent suicidal behavior.”

The report said nothing about whether the therapies given were state of the art or carefully done, said Matt Nock, a professor of psychology at Harvard and the lead author, and it is possible that some of the treatments prevented suicide attempts. “But it’s telling us we’ve got a long way to go to do this right,” Dr. Nock said. His co-authors included Ronald C. Kessler of Harvard and researchers from Boston University and Children’s Hospital Boston.

Margaret McConnell, a consultant in Alexandria, Va., said her daughter Alice, who killed herself in 2006 at the age of 17, was getting treatment at the time. “I think there might have been some carelessness in the way the treatment was done,” Ms. McConnell said, “and I was trusting a 17-year-old to manage her own medication. We found out after we lost her that she wasn’t taking it regularly.”

In the study, researchers surveyed 6,483 adolescents from the ages of 13 to 18 and found that 9 percent of male teenagers and 15 percent of female teenagers experienced some stretch of having persistent suicidal thoughts. Among girls, 5 percent made suicide plans and 6 percent made at least one attempt (some were unplanned).

Among boys, 3 percent made plans and 2 percent carried out attempts, which tended to be more lethal than girls’ attempts.

(Suicidal thinking or behavior was virtually unheard-of before age 10.)

Over all, about one-third of teenagers with persistent suicidal thoughts went on to make an attempt to take their own lives.

Almost all of the suicidal adolescents in the study qualified for some psychiatric diagnosis, whether depression, phobias or generalized anxiety disorder. Those with an added behavior problem — attention-deficit disorder, substance abuse, explosive anger — were more likely to act on thoughts of self-harm, the study found.

Doctors have tested a range of therapies to prevent or reduce recurrent suicidal behaviors, with mixed success. Medications can ease depression, but in some cases they can increase suicidal thinking. Talk therapy can contain some behavior problems, but not all.

One approach, called dialectical behavior therapy, has proved effective in reducing hospitalizations and suicide attempts in, among others, people with borderline personality disorder, who are highly prone to self-harm.

But suicidal teenagers who have a mixture of mood and behavior issues are difficult to reach. In one 2011 study, researchers at George Mason University reduced suicide attempts, hospitalizations, drinking and drug use among suicidal adolescent substance abusers. The study found that a combination of intensive treatments — talk therapy for mood problems, family-based therapy for behavior issues and patient-led reduction in drug use — was more effective than regular therapies.

“But that’s just one study, and it’s small,” said Dr. Brent of the University of Pittsburgh. “We can treat components of the overall problem, but that’s about all.”

Ms. McConnell said that her daughter’s depression had seemed mild and that there was no warning that she would take her life. “I think therapy does help a lot of people, if it’s handled right,” she said.

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Gaps Seen in Therapy for Suicidal Teenagers

Most adolescents who plan or attempt suicide have already received at least some mental health treatment, raising questions about the effectiveness of current approaches to helping troubled youths, according to the largest in-depth analysis to date of suicidal behaviors in American teenagers.

The study, in the journal JAMA Psychiatry, found that 55 percent of suicidal teenagers had received some therapy before they thought about suicide, planned it or tried to kill themselves, contradicting the widely held belief that suicide is due in part to a lack of access to treatment.

The findings, based on interviews with a nationwide sample of more than 6,000 teenagers and at least one parent of each, linked suicidal behavior to complex combinations of mood disorders like depression and behavior problems like attention-deficit and eating disorders, as well as alcohol and drug abuse.

The study found that about one in eight teenagers had persistent suicidal thoughts at some point, and that about a third of those who had suicidal thoughts had made an attempt, usually within a year of having the idea.

Previous studies have had similar findings, based on smaller, regional samples. But the new study is the first to suggest, in a large nationwide sample, that access to treatment does not make a big difference.

The study suggests that effective treatment for severely suicidal teenagers must address not just mood disorders, but also behavior problems that can lead to impulsive acts, experts said. According to the Centers for Disease Control and Prevention, 1,386 people between the ages of 13 and 18 committed suicide in 2010, the latest year for which numbers are available.

“I think one of the take-aways here is that treatment for depression may be necessary but not sufficient to prevent kids from attempting suicide,” said Dr. David Brent, a professor of psychiatry at the University of Pittsburgh, who was not involved in the study. “We simply do not have empirically validated treatments for recurrent suicidal behavior.”

The report said nothing about whether the therapies given were state of the art or carefully done, said Matt Nock, a professor of psychology at Harvard and the lead author, and it is possible that some of the treatments prevented suicide attempts. “But it’s telling us we’ve got a long way to go to do this right,” Dr. Nock said. His co-authors included Ronald C. Kessler of Harvard and researchers from Boston University and Children’s Hospital Boston.

Margaret McConnell, a consultant in Alexandria, Va., said her daughter Alice, who killed herself in 2006 at the age of 17, was getting treatment at the time. “I think there might have been some carelessness in the way the treatment was done,” Ms. McConnell said, “and I was trusting a 17-year-old to manage her own medication. We found out after we lost her that she wasn’t taking it regularly.”

In the study, researchers surveyed 6,483 adolescents from the ages of 13 to 18 and found that 9 percent of male teenagers and 15 percent of female teenagers experienced some stretch of having persistent suicidal thoughts. Among girls, 5 percent made suicide plans and 6 percent made at least one attempt (some were unplanned).

Among boys, 3 percent made plans and 2 percent carried out attempts, which tended to be more lethal than girls’ attempts.

(Suicidal thinking or behavior was virtually unheard-of before age 10.)

Over all, about one-third of teenagers with persistent suicidal thoughts went on to make an attempt to take their own lives.

Almost all of the suicidal adolescents in the study qualified for some psychiatric diagnosis, whether depression, phobias or generalized anxiety disorder. Those with an added behavior problem — attention-deficit disorder, substance abuse, explosive anger — were more likely to act on thoughts of self-harm, the study found.

Doctors have tested a range of therapies to prevent or reduce recurrent suicidal behaviors, with mixed success. Medications can ease depression, but in some cases they can increase suicidal thinking. Talk therapy can contain some behavior problems, but not all.

One approach, called dialectical behavior therapy, has proved effective in reducing hospitalizations and suicide attempts in, among others, people with borderline personality disorder, who are highly prone to self-harm.

But suicidal teenagers who have a mixture of mood and behavior issues are difficult to reach. In one 2011 study, researchers at George Mason University reduced suicide attempts, hospitalizations, drinking and drug use among suicidal adolescent substance abusers. The study found that a combination of intensive treatments — talk therapy for mood problems, family-based therapy for behavior issues and patient-led reduction in drug use — was more effective than regular therapies.

“But that’s just one study, and it’s small,” said Dr. Brent of the University of Pittsburgh. “We can treat components of the overall problem, but that’s about all.”

Ms. McConnell said that her daughter’s depression had seemed mild and that there was no warning that she would take her life. “I think therapy does help a lot of people, if it’s handled right,” she said.

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State of the Art: Mixing and Matching to Create the Near-Perfect Digital Calendar - State of the Art

You know what’s kind of wild? We can identify products by their container designs. You’d know a ketchup bottle, even if it was empty and unlabeled, no matter what the brand. You’d know a pickle jar, or a milk jug, or a bottle of salad dressing, or a cereal box just by their container shapes.

Same goes for the big software categories. You’d know a spreadsheet anywhere — formula bar at the top, grid below — no matter what company made it. Or e-mail program, word processor, Web browser. They all work pretty much alike.

But there’s one software category, an incredibly important one, where there’s no standard design or set of features: calendar software. Each one seems to have evolved on its own Galápagos island.

Take the new Calendar app in Windows 8. So much of Windows 8’s touch-screen mode is modern, updated and fresh — color, gestures, typography — that you’d expect an equally modernized calendar app at its heart.

Wow, would you be wrong. Listen, Microsoft: 1990 called. It wants its calendar back.

You can’t drag vertically through the Day-view column to create an appointment. You can’t drag an appointment to reschedule it. You can’t record an auto-repeating appointment like “Monday, Wednesday, Friday” or “first Tuesday of the month.”

And incredibly, you can’t create separate categories, like Home, Work and Social. There’s no way to color-code your appointments or hide certain categories.

That same week, on another computer, I installed a Mac calendar program called BusyCal 2.0. You know what’s so brilliant? When you open it, today’s date is always in the top row, no matter what week of the month this is. You always see the next four or five weeks, even if some are in the following month.

And why not? Almost always, you open your calendar to check coming dates — so why fill the screen with dates that have already gone by? That’s a limitation of paper calendars, where every month shows 1 in the first square.

And that’s when I had my epiphany. Our electronics are capable of fantastic flexibility, features and design; why are we still modeling our digital calendars on paper ones?

Apple’s Calendar app for the Mac goes so far as to display a little leather “binding” at the top, complete with scraps of torn-off “paper” to indicate where previous months’ “pages” have been torn off. Why?

If you spend enough time with the world’s calendar apps, you can see, through the mist, a vision of the ultimate digital calendar program. If you could mix and match the best of all the motley calendar apps, here’s what you might come up with.

¶ Give us an alternative to tabbing from Start Time to End Time and typing numbers into a tiny New Event box. Let us drag to indicate a meeting’s length. Or give us speech — intelligent speech, like Siri on the iPhone. “Make an appointment next Tuesday morning at seven: tennis with Casey,” you can say. Your hands never leave the wheel, the cat or the delicious beverage.

We should also be able to type plain-English phrases like “tomorrow 1pm lunch mtg” or “4/15 730p Dinner with boss,” and marvel as it creates the right appointment on the right calendar square at the right time. (Google, Apple’s Calendar for the Mac, BusyCal and, in particular, the iPhone app Fantastical can all do this.) Here again, you’re not fiddling with a dialogue box to enter a new event.

¶ Microsoft’s greatest calendaring effort remains Outlook, the e-mail program that comes with some versions of Microsoft Office. Outlook has its detractors, but one thing it got right is integration with your e-mail and address book. What are appointments, after all, but interactions with people you know — and how better to set up meetings with them than with e-mail?¶ Some calendars, like Apple’s Calendar and BusyCal, offer a “heat map.” It’s a year view in which deepening colors in the yellow-orange-red scale indicate increasingly busy times of your life. When it’s time to figure out when to schedule time off (or time to finish writing your novel), you can easily spot the best months — those with the least red on your year calendar.

¶ Why are we limited to words when our gadgets are digital? We should be able to put pictures, voice recordings, videos and documents on our calendars, too.

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Iranian Captives Freed in Major Prisoner Exchange in Syria

ISTANBUL — More than 2,000 prisoners incarcerated by the Syrian authorities were being released on Wednesday in return for 48 Iranians freed by rebels after five months in captivity in what appeared to be the biggest prisoner swap since the uprising against President Bashar al-Assad began almost two years ago.

The exchange, brokered by Turkey and Qatar, came days after Mr. Assad warned on Sunday that he would not abandon the fight against armed adversaries pressing on the approaches to the Syrian capital, Damascus, and brushed aside calls for him to quit.

Word of the exchange dominated news in Iran, the Syrian government’s only Middle East ally, leading the Web site of the official Islamic Republic News Agency. Iran state television showed a brief clip of the released hostages at the Sheraton Hotel in Damascus, grinning, flashing victory signs and holding flowers. In an interview on Iran state TV, the Foreign Ministry spokesman, Ramin Mehmanparast, thanked those involved in the swap for the hostages and expressed happiness that “we managed to get them released.”

Precise details of the exchange, including when the 48 Iranians would be repatriated, remained unclear. Mr. Mehmanparast also said two Iranian engineers who had been abducted earlier in Syria remained captive. But Prime Minister Recep Tayyip Erdogan of Turkey, a regional power broker allied to the Western and Arab nations seeking Mr. Assad’s departure, said he hoped the exchange on Wednesday would lead to freedom for more prisoners in Syria.

“We wish many other innocent people, and people in need, to be released from Syrian jails without delay,” Mr. Erdogan said in a televised news conference in Niamey, Nigeria, where he arrived on an official visit.

“This process needs to be appreciated. We are not in a position to say anything more than, ‘May this produce some good.’ ”

The exchange emerged from months of behind-the-scenes negotiations involving a Turkish charitable foundation, the Humanitarian Relief Foundation, an Islamist-leaning aid organization based in Istanbul and widely known as I.H.H.

The aid group had set up an operation center in Damascus to unite 2,130 prisoners, including 73 women, at one base while another aid team remained in Douma, near the Syrian capital, to oversee the return of the 48 Iranians.

“Captivity is a hard thing,” said Bulent Yildirim, the foundation’s director, who coordinated the exchange in Damascus.

“I saw young women crying, many people lost a lot of weight, and there were also many sick people.”

The Syrian opposition has claimed that the Iranians are members of Iran’s Islamic Revolutionary Guards Corps, but Tehran has denied the assertion, saying the captives are Shiite civilian pilgrims. The Iranians were seized in August while traveling on a bus from Damascus International Airport to a Shiite shrine on the outskirts of the capital, Iran’s Press TV said.

Opposition fighters had threatened to kill the Iranians unless Mr. Assad’s forces halted military operations. But since then the fighting around Damascus has intensified.

Iran is Mr. Assad’s main ally in a region where most Arab states and neighboring Turkey have turned against him. The Iranian captives offered the rebels holding them a source of powerful pressure on the Syrian leader to release opposition prisoners in return.

“We expect the swap to be completed in the next hour,” Huseyin Oruc, a member of the aid group’s executive board said in a telephone interview around midday. He said the captives released by the Syrian authorities included four Turks and a Palestinian.

By midafternoon it was not clear whether the 2,130 prisoners had been freed.

“It is the first time that the ‘humanitarian diplomacy’ we initiated succeeded in releasing such a large group of people at once,” Mr. Oruc said. “There are many more held captive and our efforts to free them will continue without delay.”

The Turkish aid group gained international attention in 2010 for organizing a flotilla of boats heading to Gaza, ostensibly with relief supplies, that prompted a deadly Israeli commando raid in which eight Turks and an American of Turkish descent died. At the time of the raid, the group was reported to have extensive connections with Turkey’s political elite. The episode began an unraveling of Turkey’s once close ties with Israel.

In recent months, the organization has also been part of negotiations to free smaller numbers of prisoners, including two Turkish journalists held in Syria, Reuters reported. It has been active since the early 1990s in charitable works in the Middle East and Africa, focusing most recently on Gaza.

Since the start of the uprising against Mr. Assad, the organization has also cast itself as a leading private charitable organization in Syria, delivering food and other basic supplies and pursuing what it calls “humanitarian diplomacy” to help free captive civilians.

While the numbers involved in Wednesday’s exchange seemed dramatic, some rebel commanders said more modest prisoner exchanges had become a feature of the conflict.

The leader of a rebel fighting group in the central city of Hama, reached via Skype, said pro-government militia members had captured his uncle and two other relatives in a village in the northern Idlib province more than a month ago.

 “The  only  way to release them is capturing  hostages,” the commander said, adding that negotiations were under way to win the release of his relatives in return for 12 captives held by the rebels. Two months ago, the commander said, nine members of the pro-government militia, known as shabiha, were  exchanged for five captured rebels. Syria’s uprising began in March 2011 with peaceful demonstrations, but a harsh suppression broadened into civil war with an estimated 60,000 people killed, according to United Nations estimates.

Sebnem Arsu reported from Istanbul and Alan Cowell from London. Hwaida Saad contributed reporting from Beirut, Lebanon, and Thomas Erdbrink from Tehran.

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DealBook: Examining the Terms of A.I.G.'s Bailout

The American International Group’s former chief executive, Maurice R. Greenberg, is contending in a lawsuit that the government treated the company’s shareholders too harshly when carrying out its 2008 rescue of the insurance giant. But a closer look at the $182 billion rescue suggests a different outcome.

Soon after the bailout, the Treasury Department substantially softened the terms of its support. This lenience made life a lot easier for A.I.G. – and arguably benefited shareholders like Mr. Greenberg.

A.I.G. is weighing whether to join the lawsuit, filed by Mr. Greenberg’s investment firm, Starr International Company. A.I.G. most likely will not end up joining forces with Mr. Greenberg, but, as a duty to shareholders, it has to at least give his suit a thorough assessment.

One of Starr International’s major arguments is that A.I.G.’s bailout terms were far tougher than those granted to other large financial firms. But A.I.G.’s cash needs and internal failings were in many ways far more serious than those of other institutions. In fact, the company was in such dire straits after the rescue that the government chose to loosen the terms of its aid.

The concessions were considerable.

In early 2009, the Federal Reserve cut the interest rate on a big loan to A.I.G. At the time, the company said that would save it $1 billion a year in interest.

The Treasury Department made another favorable change. It exchanged $40 billion of preferred shares for new ones that effectively paid no cash dividends to taxpayers. If it had paid the originally agreed 10 percent dividend on all these and other preferred shares, the insurer would have paid roughly $20 billion from the beginning of 2009 to the end 2012.

Instead, the preferred shares were converted into common stock, which the government later sold. The Treasury Department made a $5 billion return on its investments.

The government could have made more, if it had chosen to.

For example, the Treasury Department could have demanded an even bigger stake in A.I.G. in return for the dividends it did not get. This would have further diluted existing shareholders like Mr. Greenberg. If the Treasury Department had decided on further dilution, A.I.G.’s shares could have become effectively worthless, like those of Fannie Mae and Freddie Mac, the mortgage firms also bailed out by taxpayers in 2008.

Fannie and Freddie’s rescue also required that the companies pay a 10 percent dividend on its government money. But the Treasury Department never let them off the hook on that commitment. The result was that taxpayers have received more than $50 billion of dividends so far from Fannie and Freddie.

In short, A.I.G.’s shareholders may contend they got a raw deal, but it’s not that simple.

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Global Update: China Moves to Prevent Spread of Yellow Fever From Africa

In a move that underlines how many Chinese citizens now work in Africa, China’s quarantine officials recently urged greater efforts to make sure that a yellow fever epidemic now raging in Sudan does not come back to China.

Local health authorities were asked to scan all travelers arriving from Sudan for fevers. Chinese citizens planning travel to Sudan were advised to get yellow fever shots. Customs officers were told that containers arriving from Sudan might have stray infected mosquitoes inside.

Sudan’s epidemic is considered the world’s worst in 20 years. Sweden, Britain and other donors have paid for vaccinations. The United States Navy’s laboratory in Egypt has helped with diagnoses.

Estimates of the number of Chinese working in Africa, many in the oil and mining industries or on major construction projects, range from 500,000 to 1 million. Experts on AIDS have previously warned that the workers could become a new means of bringing that disease to China, which has a low H.I.V.-infection rate.

ProMED-mail, a Web site that follows emerging diseases, has tracked reports about the Sudan outbreak, with its moderators adding valuable context. China’s mosquito-killing winters make a large yellow fever outbreak there unlikely, moderators said. But Sudan’s containment efforts are troubled. For example, vaccinated people cannot get cards proving they have had shots, but the cards are reported to be for sale at police checkpoints.

Australia’s now-endemic dengue fever, according to ProMED moderators, may have come from mosquitoes arriving in containers from East Timor.

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Global Update: China Moves to Prevent Spread of Yellow Fever From Africa

In a move that underlines how many Chinese citizens now work in Africa, China’s quarantine officials recently urged greater efforts to make sure that a yellow fever epidemic now raging in Sudan does not come back to China.

Local health authorities were asked to scan all travelers arriving from Sudan for fevers. Chinese citizens planning travel to Sudan were advised to get yellow fever shots. Customs officers were told that containers arriving from Sudan might have stray infected mosquitoes inside.

Sudan’s epidemic is considered the world’s worst in 20 years. Sweden, Britain and other donors have paid for vaccinations. The United States Navy’s laboratory in Egypt has helped with diagnoses.

Estimates of the number of Chinese working in Africa, many in the oil and mining industries or on major construction projects, range from 500,000 to 1 million. Experts on AIDS have previously warned that the workers could become a new means of bringing that disease to China, which has a low H.I.V.-infection rate.

ProMED-mail, a Web site that follows emerging diseases, has tracked reports about the Sudan outbreak, with its moderators adding valuable context. China’s mosquito-killing winters make a large yellow fever outbreak there unlikely, moderators said. But Sudan’s containment efforts are troubled. For example, vaccinated people cannot get cards proving they have had shots, but the cards are reported to be for sale at police checkpoints.

Australia’s now-endemic dengue fever, according to ProMED moderators, may have come from mosquitoes arriving in containers from East Timor.

Read More..

Providing a Template to Challenge Apple

TAIPEI — In the China smartphone market, Apple has seen better days.

Despite having reported record sales of the iPhone 5, the U.S. technology giant’s presence on the mainland flagged in 2012; it was pushed out of the top five smartphone makers in that market during the third quarter, with just 8 percent of the market, according to the research firm Canalys.

As Coolpad, Huawei, Lenovo, Samsung and ZTE surged ahead of Apple, a major force behind their success was MediaTek, a Taiwanese chip maker whose products have drastically reduced the cost for manufacturers of getting new phones to market.

The company entered the smartphone business late, introducing its first chipset in 2011 inside a Lenovo phone. But within a year and a half, analysts say, MediaTek has taken 50 percent of China’s market for smartphone chips.

That success has come with the adoption of what MediaTek calls a “turnkey solution.” Rather than simply provide a chip, the company also offers instructions on how to build a phone, the software architecture to run it and dedicated consultants to advise phone makers through the production process. MediaTek’s chief financial officer, David Ku, describes this as a franchise model in which all the clients have to do is “turn on the burner.”

Peter Liao, an analyst at Nomura Securities who covers the industry, said MediaTek saved phone makers the often prohibitive cost of research and development.

“It typically takes a lot of money and time to develop a new handset model, but MediaTek comes in and provides a total solution,” Mr. Liao said.

The company has proved wildly popular among Chinese phone makers. Besides supplying Huawei, Lenovo and ZTE, MediaTek also supports lesser-known manufacturers, including those that make so-called bandit phones that imitate premium models from Apple, Samsung and HTC.

TCL Communication Technology Holdings, a Chinese phone maker that sells phones primarily in Europe and Latin America, uses MediaTek’s chips. Its chief operating officer, Wang Jiyang, said that when his company works with MediaTek, its only major design tasks are to make the software more user-friendly and to tailor the look and feel of the phone.

“In general, with MediaTek’s help, we’re able to achieve almost twice as fast time to market, compared to other solutions,” Mr. Wang said.

MediaTek was founded in 1997. It started out making chips for home entertainment electronics like DVD players and televisions before moving into components for CD and DVD-ROM devices. In 2004, it began making chips for small mobile phones.

MediaTek estimates that it will lead the Chinese market by selling 110 million smartphone chips in 2012, up from 10 million chips a year ago.

By comparison, Qualcomm, the global leader in smartphone chips, is expected to finish 2012 in second place in China with 82 million chips shipped, according to the research firm DigiTimes.

MediaTek has been powered by consumers like Zhang Ying, 31, who want to try the latest technology but not pay a premium for it. Mr. Zhang, a Shanghai resident, bought a knockoff HTC phone last year. “Every person has a price point,” he said. “At a time when some of my friends were buying Samsung or iPhone, I wanted to show that I can keep up with them. A lot of domestic phones are cheap and of fairly good quality.”

People who think like Mr. Zhang are dominating sales, especially among first-time smartphone buyers. In a September report, McKinsey, the global consulting firm, estimated that 69 percent of all smartphones sold in China would cost less than 1,500 renminbi, or about $240, by the second half of 2013.

And MediaTek is taking its business model to other emerging markets. The company’s products support features that are popular in developing countries, like noise-reducing speakers and slots for two SIM cards.

In India, local brands like Spice and Micromax are rolling out lower-priced smartphone models using MediaTek parts. In Brazil, phones by Motorola Mobility, as well as local brands like Gradiente and Multilaser, will also have MediaTek chips.

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Face-off in Chinese City Over Censorship of Newspaper

Jonah M. Kessel for The New York Times

A free speech advocate outside of Southern Weekend newspaper in Guangzhou, China, on Tuesday.

GUANGZHOU, China — Protests over censorship at one of China’s most liberal newspapers descended into ideological confrontation on Tuesday, pitting advocates of free speech against supporters of Communist Party control who wielded red flags and portraits of Mao Zedong.

The face-off between liberals and leftists at the headquarters of a newspaper company in southern China came after disgruntled editors and reporters at Southern Weekend last week decried what they alleged was crude meddling by the head of party propaganda in Guangdong Province, which has long had a reputation as a bastion of a relatively free press.

The protesting journalists at Southern Weekend have called for the dismissal of Tuo Zhen, the top propaganda official in Guangdong Province. They blame Mr. Tuo, a former journalist, for making a drastic change in a New Year’s editorial that had originally called for greater respect for constitutional rights. The revised editorial instead praised Communist Party policies.

A former editor with the Southern Daily group of newspapers, which includes Southern Weekend, said negotiations continued on Tuesday between representatives of the disgruntled journalists and newspaper managers and provincial propaganda officials.

The former editor, who asked that his name not be used for fear it could jeopardize his new job, said the talks focused on the protesting journalists’ demands that the paper’s managers rescind a statement that denied that Mr. Tuo was responsible for the New Year editorial and for an inquiry into the incident.

“They want that statement to be removed, and they also want assurances about relaxing controls on journalists — not removing party oversight, but making it more reasonable, allowing reporters to challenge officials,” he said. “The other main demand is for an impartial explanation of what happened, an accounting so it won’t happen again.”

The former editor said a continued standoff into Wednesday could jeopardize the newspaper’s usual publication on Thursday. “In effect, it’s a strike,” he said. “It looks unclear whether it can come out on Thursday.”

Senior Chinese officials have so far not commented publicly on the censorship dispute at the newspaper, which has tested how far the recently appointed Communist Party leader, Xi Jinping, will extend his vows of economic reform into a degree of political relaxation. But self-proclaimed defenders of Communist orthodoxy who turned up at the newspaper headquarters said on Tuesday that they were there to make the party’s case.

“We support the Communist Party, shut down the traitor newspaper,” said one of the cardboard signs held up by one of 10 or so protesters who came to defend the government.

“Southern Weekend is having an American dream,” said another of the signs. “We don’t want the American dream, we want the Chinese dream.”

Some of the group held up portraits of Mao, the late revolutionary leader who remains a symbol of communist zeal, while others waved the red flags of China and of the Communist Party. Most of the party supporters refused to give their names. They said they came on their own initiative, and not at the behest of officials.

The dueling protests outside the newspaper’s headquarters in this provincial capital reflected the political passions and tensions churned up by the quarrel over censorship, which has erupted while Mr. Xi is trying to win public favor and consolidate his authority.

Hundreds of bystanders watched and took photos on mobile phones as the leftists shouted at the 20 or more protesters who had gathered to denounce censorship, and shoving matches broke out between the demonstrators.

At one point, leftists were showered with 50-cent renminbi currency notes. The “Fifty Cent Party” has become a popular term for disparaging pro-party leftists, who are alleged by critics to be willing to take 50 cents in payment for each pro-party message they send onto the Internet.

“It’s the only newspaper in China that’s willing to tell the truth,” said Liang Taiping, 28, a poet from the southern city of Changsha who said he took the train to Guangzhou to show his support for Southern Weekend, which is widely read nationwide.

“What’s the point of living while you can’t even speak freely?” he said.

About 70 police officers and security guards stood nearby. They did not try to break up the protests, but officers recorded them with video cameras and occasionally stepped in to stop shoving and fisticuffs. Later, the rival protesters broke into separate camps concentrated on different sides of the gate to the newspaper headquarters.

The protests at Southern Weekend broke out while Mr. Xi, the party’s general secretary appointed in November, has been sending mixed signals about his intentions. He has repeatedly said he supports faster and bolder reform, but on Saturday he gave a speech defending the party’s history and Mao’s standing in it.

The Central Propaganda Department, which administers the censorship apparatus, issued instructions telling news media that the dispute at Southern Weekend was “due to the meddling of hostile outside forces,” according to China Digital Times, a group based in Berkeley, Calif., that monitors media and censorship issues.

Both supporters and critics of Southern Weekend journalists have claimed that Mr. Xi would back their cause.

“I don’t believe that Xi is totally hypocritical when he talks about reform,” said Chen Min, a prominent former opinion writer for Southern Weekend who was forced out of the newspaper in 2011.

“The Southern Weekend journalists have said that they accept party control, but the question is what kind of control and how far should it go unchallenged,” Mr. Chen added.

Jonah Kessel reported from Guangzhou, China, and Chris Buckley from Hong Kong. Mia Li contributed reporting from Guangzhou, and Patrick Zuo from Beijing.

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Virtual U.: Massive Open Online Courses Prove Popular, if Not Lucrative Yet

Online Learning, En Masse:
More top colleges are offering free massive open online courses, but companies and universities still need to figure out a way to monetize this tool for democratizing higher education.

MOUNTAIN VIEW, Calif. — In August, four months after Daphne Koller and Andrew Ng started the online education company Coursera, its free college courses had drawn in a million users, a faster launching than either Facebook or Twitter.

The co-founders, computer science professors at Stanford University, watched with amazement as enrollment passed two million last month, with 70,000 new students a week signing up for over 200 courses, including Human-Computer Interaction, Songwriting and Gamification, taught by faculty members at the company’s partners, 33 elite universities.

In less than a year, Coursera has attracted $22 million in venture capital and has created so much buzz that some universities sound a bit defensive about not leaping onto the bandwagon.

Other approaches to online courses are emerging as well. Universities nationwide are increasing their online offerings, hoping to attract students around the world. New ventures like Udemy help individual professors put their courses online. Harvard and the Massachusetts Institute of Technology have each provided $30 million to create edX. Another Stanford spinoff, Udacity, has attracted more than a million students to its menu of massive open online courses, or MOOCs, along with $15 million in financing.

All of this could well add up to the future of higher education — if anyone can figure out how to make money.

Coursera has grown at warp speed to emerge as the current leader of the pack, striving to support its business by creating revenue streams through licensing, certification fees and recruitment data provided to employers, among other efforts. But there is no guarantee that it will keep its position in the exploding education technology marketplace.

“No one’s got the model that’s going to work yet,” said James Grimmelmann, a New York Law School professor who specializes in computer and Internet law. “I expect all the current ventures to fail, because the expectations are too high. People think something will catch on like wildfire. But more likely, it’s maybe a decade later that somebody figures out how to do it and make money.”

For their part, Ms. Koller and Mr. Ng proclaim a desire to keep courses freely available to poor students worldwide. Education, they have said repeatedly, should be a right, not a privilege. And even their venture backers say profits can wait.

“Monetization is not the most important objective for this business at this point,” said Scott Sandell, a Coursera financier who is a general partner at New Enterprise Associates. “What is important is that Coursera is rapidly accumulating a body of high-quality content that could be very attractive to universities that want to license it for their own use. We invest with a very long mind-set, and the gestation period of the very best companies is at least 10 years.”

But with the first trickles of revenue now coming in, Coursera’s university partners expect to see some revenue sooner.

“We’ll make money when Coursera makes money,” said Peter Lange, the provost of Duke University, one of Coursera’s partners. “I don’t think it will be too long down the road. We don’t want to make the mistake the newspaper industry did, of giving our product away free online for too long.”

Right now, the most promising source of revenue for Coursera is the payment of licensing fees from other educational institutions that want to use the Coursera classes, either as a ready-made “course in a box” or as video lectures students can watch before going to class to work with a faculty member.

Ms. Koller has plenty of other ideas, as well. She is planning to charge $20, or maybe $50, for certificates of completion. And her company, like Udacity, has begun to charge corporate employers, including Facebook and Twitter, for access to high-performing students, starting with those studying software engineering.

This fall, Ms. Koller was excited about news she was about to announce: Antioch University’s Los Angeles campus had agreed to offer its students credit for successfully completing two Coursera courses, Modern and Contemporary American Poetry and Greek and Roman Mythology, both taught by professors from the University of Pennsylvania. Antioch would be the first college to pay a licensing fee — Ms. Koller would not say how much — to offer the courses to its students at a tuition lower than any four-year public campus in the state.

“We think this model will spread, helping academic institutions offer their students a better education at a lower price,” she said.

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