Amazon Book Reviews Deleted in a Purge Aimed at Manipulation





Giving raves to family members is no longer acceptable. Neither is writers’ reviewing other writers. But showering five stars on a book you admittedly have not read is fine.




After several well-publicized cases involving writers buying or manipulating their reviews, Amazon is cracking down. Writers say thousands of reviews have been deleted from the shopping site in recent months.


Amazon has not said how many reviews it has killed, nor has it offered any public explanation. So its sweeping but hazy purge has generated an uproar about what it means to review in an era when everyone is an author and everyone is a reviewer.


Is a review merely a gesture of enthusiasm or should it be held to a higher standard? Should writers be allowed to pass judgment on peers the way they have always done offline or are they competitors whose reviews should be banned? Does a groundswell of raves for a new book mean anything if the author is soliciting the comments?


In a debate percolating on blogs and on Amazon itself, quite a few writers take a permissive view on these issues.


The mystery novelist J. A. Konrath, for example, does not see anything wrong with an author indulging in chicanery. “Customer buys book because of fake review = zero harm,” he wrote on his blog.


Some readers differ. An ad hoc group of purists has formed on Amazon to track its most prominent reviewer, Harriet Klausner, who has over 25,000 reviews. They do not see how she can read so much so fast or why her reviews are overwhelmingly — and, they say, misleadingly — exaltations.


“Everyone in this group will tell you that we’ve all been duped into buying books based on her reviews,” said Margie Brown, a retired city clerk from Arizona.


Once a populist gimmick, the reviews are vital to making sure a new product is not lost in the digital wilderness. Amazon has refined the reviewing process over the years, giving customers the opportunity to rate reviews and comment on them. It is layer after layer of possible criticism.


“A not-insubstantial chunk of their infrastructure is based on their reviews — and all of that depends on having reviews customers can trust,” said Edward W. Robertson, a science fiction novelist who has watched the debate closely.


Nowhere are reviews more crucial than with books, an industry in which Amazon captures nearly a third of every dollar spent. It values reviews more than other online booksellers like Apple or Barnes & Noble, featuring them prominently and using them to help decide which books to acquire for its own imprints by its relatively new publishing arm.


So writers have naturally been vying to get more, and better, notices. Several mystery writers, including R. J. Ellory, Stephen Leather and John Locke, have recently confessed to various forms of manipulation under the general category of “sock puppets,” or online identities used to deceive. That resulted in a widely circulated petition by a loose coalition of writers under the banner, “No Sock Puppets Here Please,” asking people to “vote for book reviews you can trust.”


In explaining its purge of reviews, Amazon has told some writers that “we do not allow reviews on behalf of a person or company with a financial interest in the product or a directly competing product. This includes authors.” But writers say that rule is not applied consistently.


In some cases, the ax fell on those with a direct relationship with the author.


“My sister’s and best friend’s reviews were removed from my books,” the author M. E. Franco said in a blog comment. “They happen to be two of my biggest fans.” Another writer, Valerie X. Armstrong, said her son’s five-star review of her book, “The Survival of the Fattest,” was removed. He immediately tried to put it back “and it wouldn’t take,” she wrote.


In other cases, though, the relationship was more tenuous. Michelle Gagnon lost three reviews on her young adult novel “Don’t Turn Around.” She said she did not know two of the reviewers, while the third was a longtime fan of her work. “How does Amazon know we know each other?” she said. “That’s where I started to get creeped out.”


Mr. Robertson suggested that Amazon applied a broad brush. “I believe they caught a lot of shady reviews, but a lot of innocent ones were erased, too,” he said. He figures the deleted reviews number in the thousands, or perhaps even 10,000.


The explosion of reviews for “The 4-Hour Chef” by Timothy Ferriss shows how the system has evolved from something spontaneous to a means of marketing and promotion. On Nov. 20, publication day, dozens of highly favorable reviews immediately sprouted. Other reviewers quickly criticized Mr. Ferriss, accusing him of buying supporters.


He laughed off those suggestions. “Not only would I never do that — it’s unethical — I simply don’t have to,” he wrote in an e-mail, saying he had sent several hundred review copies to fans and potential fans. “Does that stack the deck? Perhaps, but why send the book to someone who would hate it? That doesn’t help anyone: not the reader, nor the writer.”


As a demonstration of social media’s grip on reviewing, Mr. Ferriss used Twitter and Facebook to ask for a review. “Rallying my readers,” he called it. Within an hour, 61 had complied.


A few of his early reviews were written by people who admitted they had not read the book but were giving it five stars anyway because, well, they knew it would be terrific. “I am looking forward to reading this,” wrote a user posting under the name mhpics.


A spokesman for Amazon, which published “The 4-Hour Chef,” offered this sole comment for this article: “We do not require people to have experienced the product in order to review.”


The dispute over reviews is playing out in the discontent over Mrs. Klausner, an Amazon Hall of Fame reviewer for the last 11 years and undoubtedly one of the most prolific reviewers in literary history.


Mrs. Klausner published review No. 28,366, for “A Red Sun Also Rises” by Mark Hodder. Almost immediately, it had nine critical comments. The first accused it of being “riddled with errors in grammar, spelling and punctuation.” The rest were no more kind. The Harriet Klausner Appreciation Society had struck again.


Mrs. Klausner, a 60-year-old retired librarian who lives in Atlanta, has published an average of seven reviews a day for more than a decade. “To watch her in action is unbelievable,” said her husband, Stanley. “You see the pages turning.”


Mrs. Klausner, who says ailments keep her home and insomnia keeps her up, scoffs at her critics. “You ever read a Harlequin romance?” she said. “You can finish it in one hour. I’ve always been a speed reader.” She has a message for her naysayers: “Get a life. Read a book.”


More than 99.9 percent of Mrs. Klausner’s reviews are four or five stars. “If I can make it past the first 50 pages, that means I like it, and so I review it,” she said. But even Stanley said, “She’s soft, I won’t deny that.”


The campaign against Mrs. Klausner has pushed down her reviewer ratings, which in theory makes her less influential. But when everything is subject to review, the battle is never-ending.


Ragan Buckley, an aspiring novelist active in the campaign against Mrs. Klausner under the name “Sneaky Burrito,” is a little weary. “There are so many fake reviews that I’m often better off just walking into a physical store and picking an item off the shelf at random,” she said.


Read More..

As Egypt Constitution Passes, New Fights Lie Ahead


Tara Todras-Whitehill for The New York Times


Egyptian women walk into a polling station. Millions went to the polls to pass judgment on an Islamist-backed constitution, whose passage represented an important milestone in Egypt’s chaotic two-year transition to democracy. More Photos »







CAIRO — An Islamist-backed constitution was approved on Saturday, propelling Egypt’s deeply divided political factions into a new phase in the battle over the country’s future.




After millions went to the polls for the final round of a referendum, the charter’s approval, which had been predicted by all sides, marked an important milestone in Egypt’s chaotic two-year transition to democracy. A “yes” vote of 70 percent on Saturday brought the overall margin of passage to about 64 percent, according to the Muslim Brotherhood.


But the hastily drafted document leaves unresolved many questions about the character of that democracy, including the Islamists’ commitment to individual freedoms and their opposition’s willingness to accept the results of the political process without recourse to violent street protests.


The charter’s path to the referendum has also taken Egypt to the brink of civil strife, exposing the alienation of the Christian minority, the political opposition’s refusal to negotiate and the Muslim Brotherhood’s willingness to rely on authoritarian tactics.


How those tensions are managed and the new constitution is put into effect will determine whether Egypt returns to stability or plunges further into discord, and much of the region is watching the outcome of that definitive Arab Spring revolt.


Neither supporters nor opponents of the charter said they expected an immediate end to the partisan feuding that has torn at the country in the month before the vote.


The Islamists allied with President Mohamed Morsi said they intended to rebuild trust by using the new charter as a tool to battle remnants of former President Hosni Mubarak’s government. Old laws and prosecutors, the Islamists say, are protecting loyalists and holdovers while they obstruct change from within the bureaucracy and conspire with the opposition to stir up unrest. Leaders of the anti-Islamist opposition, however, said they hoped to carry the momentum of their struggle against the draft constitution into the parliamentary elections set to be held two months from now. They accused the Islamists of using the specter of a struggle against remnants of Mr. Mubarak’s government as a pretext to demonize the opposition and take over the machinery of the state.


“If we accept the legitimacy of working within the system, they have to agree that the opposition is legitimate,” said Amr Moussa, a former foreign minister under Mr. Mubarak and a presidential candidate who has re-emerged as an opposition leader during the constitutional debate. “The ancien régime is finished. They are imagining things. They are imagining that if you say no to the constitution, as I have done, then you are part of a conspiracy to topple them.”


Both sides of the ideological divide appeared to dig in.


“A crack has emerged in Egypt; there’s a gap, there’s blood and deaths, there’s extremism,” said Ahmed Maher, who helped jump-start the revolution as a leader of the secular April 6 Youth Group and then served as a delegate in the constituent assembly that wrote a draft of the charter. “Something has happened between Egyptians that would make the results bad no matter what the outcome” of the constitutional vote, he said, predicting further clashes before the parliamentary elections.


Adding to the uncertainty about what may come next, Mr. Morsi’s vice president, Mahmoud Mekki, resigned Saturday. The draft constitution would eliminate his position, and Mr. Mekki, a former judge, said that he had originally submitted his resignation in early November before a series of crises postponed it.


“The nature of political work does not suit my nature as a judge,” he said.


The turnout for Saturday’s voting appeared to be low, as it was last week. At one polling place in the dense Mohandeseen district near Cairo, the station was empty at midday. The low turnout may have reflected a lack of enthusiasm or perhaps a consensus among Egyptians that after last week, the charter’s approval was a foregone conclusion.


Mr. Morsi’s advisers said that after the ballots were counted in the coming days he would deliver a televised address calling for unity and reconciliation. His critics said that to be credible he would need to strike a tone different from that of his previous address. In that speech, he blamed a conspiracy of foreign agents, Mubarak cronies and his political opponents for a deadly night of street fighting between his supporters and other protesters.


Read More..

The Neediest Cases: The Daughter of a Sick Woman Falls Prey to a Craigslist Scam





Sitting side by side on their living room sofa, Patricia Morales and her daughter, Katherine, could be any mother-daughter duo. Both have dark hair, dark eyes and welcoming, infectious smiles.







Librado Romero/The New York Times

Patricia Morales, 62, at home in the Bronx. Her treatment for ailments like rheumatoid arthritis and hepatitis C led to depression.




The Neediest CasesFor the past 100 years, The New York Times Neediest Cases Fund has provided direct assistance to children, families and the elderly in New York. To celebrate the 101st campaign, an article will appear daily through Jan. 25. Each profile will illustrate the difference that even a modest amount of money can make in easing the struggles of the poor.


Last year donors contributed $7,003,854, which was distributed to those in need through seven New York charities.








2012-13 Campaign


Previously recorded:

$3,375,394



Recorded Wednesday:

182,251



*Total:

$3,557,645



Last year to date:

$3,320,812




*Includes $709,856 contributed to the Hurricane Sandy relief efforts.


The Youngest Donors


If your child or family is using creative techniques to raise money for this year’s campaign, we want to hear from you. Drop us a line on Facebook or talk to us on Twitter.





But the ties that bind them go beyond their genes, beyond the bodies they were born with.


“It’s called a neck ring. It’s a silver curved barbell, one inch,” Katherine, 20, said as she swept aside her shoulder-length black hair to show the piercing in the back of her neck, a show of solidarity with her mother. She had it done when she was 16. “I wanted to know what it felt like for my mom.”


Her mother then turned around and outlined with her finger two lengthy scars that run down her back.


“I’ve had a lot of physical problems,” Ms. Morales, 62, said. Shaking her head at her daughter’s piercing, she added, “I’ve had rods put in my upper and lower spine, but I could never do that.”


The rods were surgically planted to treat herniated discs, the result of having a cruel combination of osteoporosis, hepatitis C, fibromyalgia and rheumatoid arthritis. Ms. Morales contracted hepatitis C from a blood transfusion she received in 1972 after the birth of her only son, she said.


“I didn’t even know about it until 10 years ago,” she said. “My liver blood count was a little high.”


Since the diagnosis, Ms. Morales, a former schoolteacher, has ridden the arduous highs and lows common to patients with hepatitis C. Her treatments for the disease, which debilitates the liver over time, have included pills and injections that can cause depression. Ms. Morales, a single parent, found an unforgiving salve in alcohol.


“I was depressed; I was totally drunk,” she said. “I didn’t want to live anymore.”


Then, about a year ago, she reached a turning point when visiting her hepatitis C specialist.


“I was 210 pounds,” she said. “The doctor said: ‘You have to stop drinking. You have to lose weight.’ ”


To help combat the depression, her doctor referred her to Jewish Association Serving the Aging, a beneficiary agency of UJA-Federation of New York, one of the organizations supported by The New York Times Neediest Cases Fund. She began weekly counseling sessions with a social worker and started taking an antidepressant medication. The federation drew about $600 from the fund in May so that Ms. Morales could buy a mattress.


“I had a horrible bed,” she said. “I felt like I was sleeping on rocks, and with rods in my back, I was waking up every hour.”


After several months of therapy and starting a diet, Ms. Morales was on her way to losing 60 pounds. Today, she weighs 148.


Light was starting to show itself again when the family took an unexpected financial hit this summer. While taking time off from attending Hostos Community College, Katherine Morales looked for work on Craigslist.


“I saw my mom, and I realized I needed to get a job,” Katherine said shyly. “This guy asked me to be his personal assistant, and he asked me to wire money.”


Offering $400 a week, the man requested help transferring almost $2,000 from what he said was his wife’s account. He transferred the money to Katherine’s account, asking her to wire it to a bank account in Malaysia.


Shortly after she wired the money, the bank froze the account, which Katherine and her mother shared. It was then that Katherine realized she had been the victim of a scam. The money transferred into her account turned out to have been stolen, and she was responsible for repaying it.


Katherine went to detectives immediately with more than 20 pages of evidentiary e-mails, but found that she was unable to file a complaint.


“They told me it wasn’t enough,” she said. “These things happen all the time.”


They lost almost $2,000.


Ms. Morales lives on a fixed income. She receives just over $700 a month from Social Security and $200 month in food stamps. The rent for the apartment she shares with her daughter in the Throgs Neck neighborhood of the Bronx is $230, and Ms. Morales has a monthly combined phone and cable bill of $140. Ms. Morales has a son, but he is unable to help the family.


Falling behind on her bills, Ms. Morales turned once again to JASA for help paying a combined phone and cable bill of nearly $200, a grant the agency drew from the Neediest Cases Fund.


“It was terrible, because my intention was to help my mom,” said Katherine, who has since found a part-time job at a vitamin shop.


Ms. Morales has been feeling much better, but she is nervous about an appointment with her hepatitis C specialist in January.


“I’m taking things one day at a time, but I’m looking forward to someone taking care of me,” she said. “I want to live a little bit longer, but not that long.”


“Why are you putting a time limit on it?” Katherine said, jokingly. “Seventy’s the new 20!” she added, nudging her mother in the side. “Remember, the doctor said you wouldn’t live past your late 50s, but you did.”


Read More..

The Neediest Cases: The Daughter of a Sick Woman Falls Prey to a Craigslist Scam





Sitting side by side on their living room sofa, Patricia Morales and her daughter, Katherine, could be any mother-daughter duo. Both have dark hair, dark eyes and welcoming, infectious smiles.







Librado Romero/The New York Times

Patricia Morales, 62, at home in the Bronx. Her treatment for ailments like rheumatoid arthritis and hepatitis C led to depression.




The Neediest CasesFor the past 100 years, The New York Times Neediest Cases Fund has provided direct assistance to children, families and the elderly in New York. To celebrate the 101st campaign, an article will appear daily through Jan. 25. Each profile will illustrate the difference that even a modest amount of money can make in easing the struggles of the poor.


Last year donors contributed $7,003,854, which was distributed to those in need through seven New York charities.








2012-13 Campaign


Previously recorded:

$3,375,394



Recorded Wednesday:

182,251



*Total:

$3,557,645



Last year to date:

$3,320,812




*Includes $709,856 contributed to the Hurricane Sandy relief efforts.


The Youngest Donors


If your child or family is using creative techniques to raise money for this year’s campaign, we want to hear from you. Drop us a line on Facebook or talk to us on Twitter.





But the ties that bind them go beyond their genes, beyond the bodies they were born with.


“It’s called a neck ring. It’s a silver curved barbell, one inch,” Katherine, 20, said as she swept aside her shoulder-length black hair to show the piercing in the back of her neck, a show of solidarity with her mother. She had it done when she was 16. “I wanted to know what it felt like for my mom.”


Her mother then turned around and outlined with her finger two lengthy scars that run down her back.


“I’ve had a lot of physical problems,” Ms. Morales, 62, said. Shaking her head at her daughter’s piercing, she added, “I’ve had rods put in my upper and lower spine, but I could never do that.”


The rods were surgically planted to treat herniated discs, the result of having a cruel combination of osteoporosis, hepatitis C, fibromyalgia and rheumatoid arthritis. Ms. Morales contracted hepatitis C from a blood transfusion she received in 1972 after the birth of her only son, she said.


“I didn’t even know about it until 10 years ago,” she said. “My liver blood count was a little high.”


Since the diagnosis, Ms. Morales, a former schoolteacher, has ridden the arduous highs and lows common to patients with hepatitis C. Her treatments for the disease, which debilitates the liver over time, have included pills and injections that can cause depression. Ms. Morales, a single parent, found an unforgiving salve in alcohol.


“I was depressed; I was totally drunk,” she said. “I didn’t want to live anymore.”


Then, about a year ago, she reached a turning point when visiting her hepatitis C specialist.


“I was 210 pounds,” she said. “The doctor said: ‘You have to stop drinking. You have to lose weight.’ ”


To help combat the depression, her doctor referred her to Jewish Association Serving the Aging, a beneficiary agency of UJA-Federation of New York, one of the organizations supported by The New York Times Neediest Cases Fund. She began weekly counseling sessions with a social worker and started taking an antidepressant medication. The federation drew about $600 from the fund in May so that Ms. Morales could buy a mattress.


“I had a horrible bed,” she said. “I felt like I was sleeping on rocks, and with rods in my back, I was waking up every hour.”


After several months of therapy and starting a diet, Ms. Morales was on her way to losing 60 pounds. Today, she weighs 148.


Light was starting to show itself again when the family took an unexpected financial hit this summer. While taking time off from attending Hostos Community College, Katherine Morales looked for work on Craigslist.


“I saw my mom, and I realized I needed to get a job,” Katherine said shyly. “This guy asked me to be his personal assistant, and he asked me to wire money.”


Offering $400 a week, the man requested help transferring almost $2,000 from what he said was his wife’s account. He transferred the money to Katherine’s account, asking her to wire it to a bank account in Malaysia.


Shortly after she wired the money, the bank froze the account, which Katherine and her mother shared. It was then that Katherine realized she had been the victim of a scam. The money transferred into her account turned out to have been stolen, and she was responsible for repaying it.


Katherine went to detectives immediately with more than 20 pages of evidentiary e-mails, but found that she was unable to file a complaint.


“They told me it wasn’t enough,” she said. “These things happen all the time.”


They lost almost $2,000.


Ms. Morales lives on a fixed income. She receives just over $700 a month from Social Security and $200 month in food stamps. The rent for the apartment she shares with her daughter in the Throgs Neck neighborhood of the Bronx is $230, and Ms. Morales has a monthly combined phone and cable bill of $140. Ms. Morales has a son, but he is unable to help the family.


Falling behind on her bills, Ms. Morales turned once again to JASA for help paying a combined phone and cable bill of nearly $200, a grant the agency drew from the Neediest Cases Fund.


“It was terrible, because my intention was to help my mom,” said Katherine, who has since found a part-time job at a vitamin shop.


Ms. Morales has been feeling much better, but she is nervous about an appointment with her hepatitis C specialist in January.


“I’m taking things one day at a time, but I’m looking forward to someone taking care of me,” she said. “I want to live a little bit longer, but not that long.”


“Why are you putting a time limit on it?” Katherine said, jokingly. “Seventy’s the new 20!” she added, nudging her mother in the side. “Remember, the doctor said you wouldn’t live past your late 50s, but you did.”


Read More..

As Shoppers Hop From Tablet to PC to Phone, Retailers Try to Adapt


Jim Wilson/The New York Times


Shoppers often visit ModCloth, a Web site that sells women’s clothes, on their phones but return on a different kind of device to buy something, said Sarah Rose, a vice president at ModCloth.







Ryan O’Neil, a Connecticut government employee, was in the market to buy a digital weather station this month. His wife researched options on their iPad, but even though she found the lowest-price option there, Mr. O’Neil made the purchase on his laptop.




“I do use the iPad to browse sites,” Mr. O’Neil said, but when it comes time to close the deal, he finds it easier to do on a computer.


Many online retailers had visions of holiday shoppers lounging beneath the Christmas tree with their mobile devices in hand, making purchases. The size of the average order on tablets, particularly iPads, tends to be bigger than on PCs. So retailers poured money and marketing into mobile Web sites and apps with rich images and, they thought, easy checkout.


But while visits to e-commerce sites and apps on tablets and phones have nearly doubled since last year, consumers like Mr. O’Neil are more frequently using multiple devices to shop. In many cases, they are more comfortable making the final purchase on a computer, with its bigger screen and keyboard. So retailers are trying to figure out how to appeal to a shopper who may use a cellphone to research products, a tablet to browse the options and a computer to buy.


“I’ve been yelling at customers for two years, saying, ‘Mobile, mobile, mobile,’ ” said Jason Spero, director of mobile sales and strategy at Google. “But the funny thing is, now we’re going to say: ‘Don’t put mobile in a silo. It’s also about the desktop.’ ”


The challenges are daunting, though. It is technically difficult to track consumers as they hop from phone to computer to tablet and back again. This means customers who, say, fill shopping carts on their tablets have to do all the work again on their PCs or other devices. The biggest obstacle, retailers say, is that the tools used to track shoppers on computers — cookies, or bundles of data stored in Web browsers — don’t transfer across devices.


Instead, retailers are figuring out how to sync the experience in other ways, like prompting shoppers to log in on each device. And being able to track people across devices gives retailers more insight into how they shop.


The retailers’ efforts are backed by research. While one-quarter of the visits to e-commerce sites occur on mobile devices, only around 15 percent of purchases do, according to data from I.B.M. According to Google, 85 percent of online shoppers start searching on one device — most often a mobile phone — and make a purchase on another.


At eBags, customers are shopping on their tablets in the evening and returning on their work computers the next day. But eBags has not yet synced the shoppers across devices, so customers must build their shopping carts from scratch if they switch devices.


“That is a blind spot with a lot of sites,” said Peter Cobb, co-founder of eBags. “It is a requirement moving forward.”


At eBay, one-third of the purchases involve mobile devices at some point, even if the final purchase is made on a computer.


At eBay, once shoppers log in on a device, they do not need to log in again. Their information, like shipping and credit card details and saved items, syncs across all their devices. If an eBay shopper is interested in a certain handbag, and saves that search on a computer, eBay will send alerts to her cellphone when a new handbag arrives or an auction is about to end.


“They might discover an item on a phone or tablet, do a saved-search push alert later on some other screen and eventually close on the Web site,” said Steve Yankovich, who runs eBay Mobile. “People are buying and shopping and consuming potentially every waking moment of the day.”


ModCloth, an e-commerce site for women’s clothes, said that while a quarter of its visits come from mobile devices, people are not yet buying there in the same proportion, though they are becoming more comfortable with checking out on those devices.


“She’s visiting us more on the phone, but she’s actually transacting somewhere else,” said Sarah Rose, vice president of product at ModCloth.


For example, a shopper will skim through new arrivals on her phone while on the bus and add items to her wish list, then visit that evening on her tablet to make a purchase, Ms. Rose said.


Read More..

As Constitution Nears Approval, Egypt’s Factions Face New Fight


Tara Todras-Whitehill for The New York Times


Egyptian women walk into a polling station. Millions went to the polls to pass judgment on an Islamist-backed constitution, whose passage would represent an important milestone in Egypt’s chaotic two-year transition to democracy. More Photos »







CAIRO — An Islamist-backed constitution appeared headed for approval on Saturday, propelling Egypt’s deeply divided political factions into a new phase in the battle over the country’s future.




As millions went to the polls for the final round of a referendum, all sides predicted that the charter would win approval, marking an important milestone in Egypt’s chaotic two-year transition to democracy.


But the hastily drafted document leaves unresolved many questions about the character of that democracy, including the Islamists’ commitment to individual freedoms and their opposition’s willingness to accept the results of the political process without recourse to violent street protests.


The charter’s path to the referendum has also pushed Egypt to the brink of civil strife, exposing the alienation of the Christian minority, the political opposition’s refusal to negotiate, and the Muslim Brotherhood’s willingness to rely on authoritarian tactics.


How those tensions are managed and the new constitution is put in effect will determine whether Egypt returns to stability or plunges further into discord, and much of the region is watching the outcome of that definitive Arab Spring revolt.


Neither supporters nor opponents of the charter said they expected an immediate end to the partisan feuding that has torn at the country in the month before the vote. The Islamists allied with President Mohamed Morsi said they intended to rebuild trust by using the new charter as a tool to battle remnants of former President Hosni Mubarak’s government. Old laws and prosecutors, the Islamists say, are protecting loyalists and holdovers while they obstruct change from within the bureaucracy and conspire with the opposition to stir up unrest. Leaders of the anti-Islamist opposition, however, said they hoped to carry the momentum of their struggle against the constitution into the parliamentary elections set to be held two months from now. They accused the Islamists of using the specter of a struggle against remnants of Mr. Mubarak’s government as a pretext to demonize the opposition and take over the machinery of the state.


“If we accept the legitimacy of working within the system, they have to agree that the opposition is legitimate,” said Amr Moussa, a former foreign minister under Mr. Mubarak and a presidential candidate who has re-emerged as an opposition leader during the constitutional debate. “The ancien régime is finished. They are imagining things. They are imagining that if you say no to the constitution, as I have done, then you are part of a conspiracy to topple them.”


Both sides of the ideological divide appeared to dig in.


“A crack has emerged in Egypt; there’s a gap, there’s blood and deaths, there’s extremism,” said Ahmed Maher, who helped jump-start the revolution as a leader of the secular April 6 Youth Group and then served as a delegate in the constituent assembly that wrote a draft of the charter. “Something has happened between Egyptians that would make the results bad no matter what the outcome” of the constitutional vote, he said, predicting further clashes before the parliamentary elections.


Adding to the uncertainty about what may come next, Mr. Morsi’s vice president, Mahmoud Mekki, resigned Saturday. The draft constitution would eliminate his position, And Mr. Mekki, a former judge, said that he had originally submitted his resignation in early November before a series of crises postponed it.


“The nature of political work does not suit my nature as a judge,” he said.


The turnout for Saturday’s voting appeared to be low, as it was last week. At one polling place in the dense Mohandiseen district near Cairo, the station was empty in the middle of the day. The low turnout may have reflected a lack of enthusiasm or perhaps a consensus among Egyptians that after last week, the charter’s approval was a foregone conclusion.


Read More..

About New York: One Boy’s Death Moves State to Action to Prevent Others





Prompted by the death of a 12-year-old Queens boy in April, New York health officials are poised to make their state the first in the nation to require that hospitals aggressively look for sepsis in patients so treatment can begin sooner. Under the regulations, which are now being drafted, the hospitals will also have to publicly report the results of their efforts.




The action by New York has elated sepsis researchers and experts, including members of a national panel who this month formally recommended that the federal government adopt standards similar to what the state is planning.


Though little known, sepsis, an abnormal and self-destructive immune response to infection or illness, is a leading cause of death in hospitals. It often progresses to severely low blood pressure, shock and organ failure.


Over the last decade, a global consortium of doctors, researchers, hospitals and advocates has developed guidelines on early identification and treatment of sepsis that it says have led to significant drops in mortality rates. But first hints of the problem, like a high pulse rate and fever, often are hard for clinicians to tell apart from routine miseries that go along with the flu or cold.


“First and foremost, they need to suspect sepsis,” Dr. Mitchell M. Levy, a professor at Brown University School of Medicine and a lead author of a paper on the latest sepsis treatment guidelines to be published simultaneously next month in the United States in a journal, Critical Care Medicine, and in Europe in Intensive Care Medicine.


“It’s the most common killer in intensive care units,” Dr. Levy said. “It kills more people than breast cancer, lung cancer and stroke combined.”


If started early enough, the treatment, which includes antibiotics and fluids, can help people escape from the drastic vortex of sepsis, according to findings by researchers working with the Surviving Sepsis Campaign, the global consortium. The tactics led to a reduction of “relative risk mortality by 40 percent,” Dr. Levy said.


Although studies of 30,000 patients show that the guidelines save lives, “the problem is that many hospitals are not adhering to them,” said Dr. Clifford S. Deutschman, director of the sepsis research program at the Perelman School of Medicine at the University of Pennsylvania and the president of the Society of Critical Care Medicine.


About 300 hospitals participate in the study, and the consortium has a goal of having 10,000. “The case is irrefutable: if you take these sepsis measures, and you build a program to help clinicians and hospitals suspect sepsis and identify it early, that will mean more people will survive,” Dr. Levy said.


At a symposium in October, the New York health commissioner, Dr. Nirav R. Shah, said that he would require state hospitals to adopt best practices for early identification and treatment of sepsis. Gov. Andrew M. Cuomo intends to make it a major initiative in 2013, said Josh Vlasto, a spokesman for the governor. “The state is taking unprecedented measures to prevent and effectively treat sepsis in health care facilities across the state and is looking at a wide range of additional measures to better protect patients,” Mr. Vlasto said.


In April, Rory Staunton, a sixth grader from Queens, died of severe septic shock after he became infected, apparently through a cut he suffered while playing basketball. The severity of his illness was not recognized when he was treated in the emergency room at NYU Langone Medical Center. He was sent home with a diagnosis of an ordinary bellyache. Hours later, alarming laboratory results became available that suggested he was critically ill, but neither he nor his family was contacted. For an About New York column in The New York Times, Rory’s parents, Ciaran and Orlaith Staunton, publicly discussed their son’s final days. Their revelations prompted doctors and hospitals across the country to seek new approaches to heading off medical errors.


In addition, Commissioner Shah in New York convened a symposium on sepsis, which included presentations from medical experts and Rory’s parents.


At the end of the meeting, Dr. Shah said that he had listened to all the statistics on the prevalence of the illness, and that one had stuck in his memory: “Twenty-five percent,” he said — the portion of the Staunton family lost to sepsis.


He said he would issue new regulations requiring hospitals to use best practices in identifying and treating sepsis, actions that, he said, he was taking “in honor of Rory Staunton.”


The governor’s spokesman, Mr. Vlasto, said that “the Staunton family’s advocacy has been essential to creating a strong public will for action.”


Dr. Levy said New York’s actions were “bold, pioneering and grounded in good scientific evidence,” adding, “The commissioner has taken the first step even before the federal government.”


Dr. Deutschman said that initiatives like those in New York were needed to overcome resistance among doctors. “You’re talking about a profession that has always prided itself on its autonomy,” he said. “They don’t like to be told that they’re wrong about something.”


The availability of proven therapies should move treatment of sepsis into a new era, experts say, comparing it to how heart attacks were handled not long ago. People arriving in emergency rooms with chest pains were basically put to bed because not much could be done for them, said Dr. Kevin J. Tracey, the president of the Feinstein Institute for Medical Research at North Shore-Long Island Jewish Health System. Dr. Tracey, a neurosurgeon, has made major discoveries about the relationship between the nervous system and the runaway immune responses of sepsis.


If physicians and nurses were trained to watch for sepsis, as they now routinely do for heart attacks, many of its most dire problems could be headed off before they got out of control, he said. The Stauntons have awakened doctors and nurses to the possibility of danger camouflaged as a stomach bug.


“We are with sepsis where we were with heart attack in the early 1980s,” Dr. Tracey said.


“If you don’t think of it as a possibility, this story can happen again and again. This case could change the world.”


E-mail: dwyer@nytimes.com


Twitter: @jimdwyernyt



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About New York: One Boy’s Death Moves State to Action to Prevent Others





Prompted by the death of a 12-year-old Queens boy in April, New York health officials are poised to make their state the first in the nation to require that hospitals aggressively look for sepsis in patients so treatment can begin sooner. Under the regulations, which are now being drafted, the hospitals will also have to publicly report the results of their efforts.




The action by New York has elated sepsis researchers and experts, including members of a national panel who this month formally recommended that the federal government adopt standards similar to what the state is planning.


Though little known, sepsis, an abnormal and self-destructive immune response to infection or illness, is a leading cause of death in hospitals. It often progresses to severely low blood pressure, shock and organ failure.


Over the last decade, a global consortium of doctors, researchers, hospitals and advocates has developed guidelines on early identification and treatment of sepsis that it says have led to significant drops in mortality rates. But first hints of the problem, like a high pulse rate and fever, often are hard for clinicians to tell apart from routine miseries that go along with the flu or cold.


“First and foremost, they need to suspect sepsis,” Dr. Mitchell M. Levy, a professor at Brown University School of Medicine and a lead author of a paper on the latest sepsis treatment guidelines to be published simultaneously next month in the United States in a journal, Critical Care Medicine, and in Europe in Intensive Care Medicine.


“It’s the most common killer in intensive care units,” Dr. Levy said. “It kills more people than breast cancer, lung cancer and stroke combined.”


If started early enough, the treatment, which includes antibiotics and fluids, can help people escape from the drastic vortex of sepsis, according to findings by researchers working with the Surviving Sepsis Campaign, the global consortium. The tactics led to a reduction of “relative risk mortality by 40 percent,” Dr. Levy said.


Although studies of 30,000 patients show that the guidelines save lives, “the problem is that many hospitals are not adhering to them,” said Dr. Clifford S. Deutschman, director of the sepsis research program at the Perelman School of Medicine at the University of Pennsylvania and the president of the Society of Critical Care Medicine.


About 300 hospitals participate in the study, and the consortium has a goal of having 10,000. “The case is irrefutable: if you take these sepsis measures, and you build a program to help clinicians and hospitals suspect sepsis and identify it early, that will mean more people will survive,” Dr. Levy said.


At a symposium in October, the New York health commissioner, Dr. Nirav R. Shah, said that he would require state hospitals to adopt best practices for early identification and treatment of sepsis. Gov. Andrew M. Cuomo intends to make it a major initiative in 2013, said Josh Vlasto, a spokesman for the governor. “The state is taking unprecedented measures to prevent and effectively treat sepsis in health care facilities across the state and is looking at a wide range of additional measures to better protect patients,” Mr. Vlasto said.


In April, Rory Staunton, a sixth grader from Queens, died of severe septic shock after he became infected, apparently through a cut he suffered while playing basketball. The severity of his illness was not recognized when he was treated in the emergency room at NYU Langone Medical Center. He was sent home with a diagnosis of an ordinary bellyache. Hours later, alarming laboratory results became available that suggested he was critically ill, but neither he nor his family was contacted. For an About New York column in The New York Times, Rory’s parents, Ciaran and Orlaith Staunton, publicly discussed their son’s final days. Their revelations prompted doctors and hospitals across the country to seek new approaches to heading off medical errors.


In addition, Commissioner Shah in New York convened a symposium on sepsis, which included presentations from medical experts and Rory’s parents.


At the end of the meeting, Dr. Shah said that he had listened to all the statistics on the prevalence of the illness, and that one had stuck in his memory: “Twenty-five percent,” he said — the portion of the Staunton family lost to sepsis.


He said he would issue new regulations requiring hospitals to use best practices in identifying and treating sepsis, actions that, he said, he was taking “in honor of Rory Staunton.”


The governor’s spokesman, Mr. Vlasto, said that “the Staunton family’s advocacy has been essential to creating a strong public will for action.”


Dr. Levy said New York’s actions were “bold, pioneering and grounded in good scientific evidence,” adding, “The commissioner has taken the first step even before the federal government.”


Dr. Deutschman said that initiatives like those in New York were needed to overcome resistance among doctors. “You’re talking about a profession that has always prided itself on its autonomy,” he said. “They don’t like to be told that they’re wrong about something.”


The availability of proven therapies should move treatment of sepsis into a new era, experts say, comparing it to how heart attacks were handled not long ago. People arriving in emergency rooms with chest pains were basically put to bed because not much could be done for them, said Dr. Kevin J. Tracey, the president of the Feinstein Institute for Medical Research at North Shore-Long Island Jewish Health System. Dr. Tracey, a neurosurgeon, has made major discoveries about the relationship between the nervous system and the runaway immune responses of sepsis.


If physicians and nurses were trained to watch for sepsis, as they now routinely do for heart attacks, many of its most dire problems could be headed off before they got out of control, he said. The Stauntons have awakened doctors and nurses to the possibility of danger camouflaged as a stomach bug.


“We are with sepsis where we were with heart attack in the early 1980s,” Dr. Tracey said.


“If you don’t think of it as a possibility, this story can happen again and again. This case could change the world.”


E-mail: dwyer@nytimes.com


Twitter: @jimdwyernyt



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Obama Nominates Kerry for Secretary of State





WASHINGTON — President Obama nominated Senator John Kerry of Massachusetts as secretary of state, choosing an elder of the Democratic Party’s foreign policy establishment and a crucial political ally in the Senate to succeed Hillary Rodham Clinton.




“In a sense, John’s entire life has prepared him for this role,” Mr. Obama said, making the widely expected announcement at the White House. “He’s not going to need a lot of on-the-job training.”


With Mr. Kerry standing at his side, the president praised Mr. Kerry’s combat service in the Vietnam War and his three decades in the Senate, which Mr. Obama said had placed him at the heart of “every major foreign policy debate for the past 30 years.”


Mr. Kerry, the president said, had also earned the respect of his Senate colleagues and expressed confidence that he would be quickly confirmed. In recent weeks, Senator John McCain, the Arizona Republican, has jokingly referred to his colleague as “Mr. Secretary.”


Mr. Obama’s first choice for the job, Susan E. Rice, the ambassador to the United Nations, asked Mr. Obama to withdraw her name last week after Mr. McCain and other Republicans threatened to block her nomination because of statements she made after the lethal attack on the American mission in Benghazi, Libya.


In addition to Mr. Kerry’s foreign-policy credentials, Mr. Obama noted that he had supported the president’s political career at key moments — not least, he said, by inviting a “young Illinois state senator to address the Democratic National Convention in 2004.”


Mr. Kerry, 69, was his party’s presidential candidate in that election, losing to George W. Bush. He is chairman of the Senate Foreign Relations Committee and has carried out several diplomatic missions for the Obama administration, helping to persuade President Hamid Karzai of Afghanistan to agree to a runoff election in 2009. Early in the administration, he also tried to engage President Bashar al-Assad of Syria, who has waged a brutal crackdown on his own people as he fights to cling to power.


During the last campaign he also played the role of Mitt Romney in Mr. Obama’s debate preparations.


“Nothing brings two people closer together than two weeks of debate prep,” the president joked. “John, I’m looking forward to working with you rather than debating you.”


Mr. Kerry has long coveted the job of secretary of state.


Mrs. Clinton, who is recovering from the effects of a concussion, did not appear at the White House announcement.


“Hillary wanted very much to be here today, but she continues to recuperate,” the president said. “I had a chance to talk to her earlier today, and she is in good spirits and could not be more excited about the announcement that I’m making.”


Mr. Obama still has to fill two other key openings in his national security team, finding replacements for Secretary of Defense Leon E. Panetta, who intends to resign; and David H. Petraeus, director of the Central Intelligence Agency, who resigned in November because of an extramarital affair.


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U.N. Suspends Polio Campaign in Pakistan After Killings of Workers


B.K. Bangash/Associated Press


A Pakistani woman administered polio vaccine to an infant on Wednesday in the slums of Islamabad. Militants have killed nine polio workers this week.







LAHORE, Pakistan — The front-line heroes of Pakistan’s war on polio are its volunteers: young women who tread fearlessly from door to door, in slums and highland villages, administering precious drops of vaccine to children in places where their immunization campaign is often viewed with suspicion.




Now, those workers have become quarry. After militants stalked and killed eight of them over the course of a three-day, nationwide vaccination drive, the United Nations suspended its anti-polio work in Pakistan on Wednesday, and one of Pakistan’s most crucial public health campaigns has been plunged into crisis.


The World Health Organization and Unicef ordered their staff members off the streets, while government officials reported that some polio volunteers — especially women — were afraid to show up for work.


At the ground level, it is those female health workers who are essential, allowed privileged entrance into private homes to meet and help children in situations denied to men because of conservative rural culture. “They are on the front line; they are the backbone,” said Imtiaz Ali Shah, a polio coordinator in Peshawar.


The killings started in the port city of Karachi on Monday, the first day of a vaccination drive aimed at the worst affected areas, with the shooting of a male health worker. On Tuesday four female polio workers were killed, all gunned down by men on motorcycles in what appeared to be closely coordinated attacks.


The hit jobs then moved to Peshawar, the capital of Khyber-Pakhtunkhwa Province, which, along with the adjoining tribal belt, constitutes Pakistan’s main reservoir of new polio infections. The first victim there was one of two sisters who had volunteered as polio vaccinators. Men on motorcycles shadowed them as they walked from house to house. Once the sisters entered a quiet street, the gunmen opened fire. One of the sisters, Farzana, died instantly; the other was uninjured.


On Wednesday, a man working on the polio campaign was shot dead as he made a chalk mark on the door of a house in a suburb of Peshawar. Later, a female health supervisor in Charsadda, 15 miles to the north, was shot dead in a car she shared with her cousin.


Yet again, Pakistani militants are making a point of attacking women who stand for something larger. In October, it was Malala Yousafzai, a schoolgirl advocate for education who was gunned down by a Pakistani Taliban attacker in the Swat Valley. She was grievously wounded, and the militants vowed they would try again until they had killed her. The result was a tidal wave of public anger that clearly unsettled the Pakistani Taliban.


In singling out the core workers in one of Pakistan’s most crucial public health initiatives, militants seem to have resolved to harden their stance against immunization drives, and declared anew that they consider women to be legitimate targets. Until this week, vaccinators had never been targeted with such violence in such numbers.


Government officials in Peshawar said that they believe a Taliban faction in Mohmand, a tribal area near Peshawar, was behind at least some of the shootings. Still, the Pakistani Taliban have been uncharacteristically silent about the attacks, with no official claims of responsibility. In staying quiet, the militants may be trying to blunt any public backlash like the huge demonstrations over the attack on Ms. Yousafzai.


Female polio workers here make for easy targets. They wear no uniform but are readily recognizable, with clipboards and refrigerated vaccine boxes, walking door to door. They work in pairs — including at least one woman — and are paid just over $2.50 a day. Most days one team can vaccinate 150 to 200 children.


Faced with suspicious or recalcitrant parents, their only weapon is reassurance: a gentle pat on the hand, a shared cup of tea, an offer to seek religious assurances from a pro-vaccine cleric. “The whole program is dependent on them,” said Mr. Shah, in Peshawar. “If they do good work, and talk well to the parents, then they will vaccinate the children.”


That has happened with increasing frequency in Pakistan over the past year. A concerted immunization drive, involving up to 225,000 vaccination workers, drove the number of newly infected polio victims down to 52. Several high-profile groups shouldered the program forward — at the global level, donors like the Bill and Melinda Gates Foundation, the United Nations and Rotary International; and at the national level, President Asif Ali Zardari and his daughter Aseefa, who have made polio eradication a “personal mission.”


On a global scale, setbacks are not unusual in polio vaccination campaigns, which, by dint of their massive scale and need to reach deep inside conservative societies, end up grappling with more than just medical challenges. In other campaigns in Africa and South Asia, vaccinators have grappled with natural disaster, virulent opposition from conservative clerics and sudden outbreaks of mysterious strains of the disease.


Declan Walsh reported from Lahore, and Donald G. McNeil Jr. from New York. Ismail Khan contributed reporting from Peshawar, Pakistan.



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