In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.

The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.

Most of the victims were women and were shot in the back of the head, local reports said.

A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.

Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.

No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.

Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.

Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.

While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.

Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.

Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”

In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.

Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.

“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.

About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.

Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.

Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”

Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”

Aminu Abubakar contributed reported from Kano, Nigeria.

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Tesla's electric Model S is a truly competitive premium sedan

The Tesla Model S may be a silent car, but other automakers will no doubt hear it coming.

In its first crack at a premium sedan, the Silicon Valley electric-car maker has matched or beaten the likes of the Audi A7 or Mercedes-Benz CLS — products of a century of German engineering. Similarly packaged as a sleek four-door coupe, the Model S delivers the performance and polish implied by its $89,770 price.

All that's missing is the roar of internal combustion.

Ask the folks at Tesla Motors Inc. how they pulled this off and they'll say Tesla isn't a car company. It's a tech company, headquartered in a hive of innovation that helped lure the sharp minds who conceptualized the car from an outsider's perspective.

Founded in 2003, Tesla produced its first car in 2008, the two-seat Roadster. It sold about 2,400 of them before halting production last year.

The Model S represents Phase 2 of the Palo Alto company's outsized ambitions. Unlike the Roadster, which was built on the chassis of a Lotus sports car, Tesla built the Model S from scratch. It's a showpiece of the start-up's design prowess, targeting a demanding and well-heeled niche of customers.

The third and crucial phase — if the Model S can secure the company's survival a while longer — will be to create an affordable mass-market car. That's no small feat, given that the electric-car market, littered with past failures, accounts for just one-tenth of 1% of U.S. auto sales. (For all the accolades showered on Nissan's Leaf, the company has sold just 20,000 of the cars since 2010.)

The odds against Tesla will be easier to calculate soon, when the company details sales and earnings at a shareholder's meeting expected in late February. The most recent update came last fall, when Tesla cut its revenue forecast and scaled back 2012 Model S production plans from 5,000 to about half that number.

Just 253 of the sedans had been delivered at that point.

The lowered expectations raised concern that the company will need a new influx of cash this year. The cash that produced the Model S was gathered during the Roadster era. Tesla secured $465 million in U.S. Department of Energy loans and went public on the Nasdaq Stock Market. It also started collecting Model S deposits and sold minority stakes in the company to Toyota and Daimler, the parent of Mercedes-Benz.

Now it's up to the Model S to bring in more cash.

Nearly a week spent in the car's high-tech cockpit suggests that Tesla has a legitimate shot at making automotive history with truly competitive electric cars.

If Tesla is a technology company, the evidence starts with the car's innovative infotainment system. The 17-inch touch screen controls nearly everything — including navigation, stereo, climate control and driving settings. As clear and touch-sensitive as an Apple iPad, the huge screen can easily accommodate multiple functions at once.

You can view the Google Maps-based navigation on one half of the screen while fiddling with radio controls on the other. Or swap the two. Or close one of them and bring up a new function — say, the phone or the Internet browser. Or just expand one function to cover the whole screen.

Contrast that to a car company making technology: Ford has produced its Sync system about as long as Tesla has made cars, and yet Sync remains eons behind in sophistication and ease of use.

But the most impressive technology resides in the guts of the Model S. The car overflows with torque, that delicious byproduct of electric propulsion. Despite a portly curb weight — a comparable Audi A7 weighs about 400 pounds less — the S clears zero to 60 mph in a mere 5.6 seconds.

Our test car, rated at 362 horsepower and 325 pound-feet of torque, uses an 85-kilowatt-hour battery to power the rear wheels through an electric motor. The battery comes in the premium version of the Model S — the only one currently produced, with a base price of $81,820, including delivery, before any state or federal tax incentives. Additional options on our test car included the tech package, an upgraded sound system and air suspension.

Tesla has promised two less expensive versions of the car with smaller batteries, meaning decreased power and range.

Power in the premium Model S comes from roughly 1,000 pounds of lithium-ion cells — all integrated into the car's floor pan, an innovative setup giving the Model S a low center of gravity and a stiff chassis. The underside of the battery pack forms the underside of the car.

In eager driving, the S doesn't feel exactly light, but it carries its weight well, with no excessive body roll in turns. Drivers can use the touch screen to select one of three different steering modes, although the most aggressive 'sport' setting proved a little too firm in most driving situations.

The brakes on the Model S are plenty strong, and fortunately are not the regenerative variety you'll find on most gas-electric hybrids, which have a mushy, grabby feel.

Mash the go-pedal, and the Tesla plants you in your seat and rushes forward with eerily little feedback, save for the faint whir of the motor behind you. The addicting experience is not unlike being flung out of a giant sling-shot.

The trouble is that repeated demonstrations of the car's prodigious power utterly destroy its range. Tesla says this model will go 300 miles on a single charge. The EPA puts that number at 265 miles. Over four days of testing the car, we managed only about 160 miles in heavy-footed driving.

All Model S's will charge through a 120V or 240V outlet. Tesla says the former needs roughly 46 hours to recharge fully, while the latter needs eight to 10 hours. Buyers can reduce these times by adding a second on-board charger for $1,500 and buying a high-power wall connector for $1,200.

Tesla is also installing 100 of what it calls supercharging stations in the U.S. and Canada by year's end, including six already operating in California. They're free for Tesla owners, who can add half a charge in about half an hour.

There will be a lot more of those owners soon, the company says. Tesla has more than 13,000 fully refundable deposits and expects to deliver 20,000 of the cars this year. The only other morsel of intel on the company's finances came from Tesla Chief Executive Elon Musk, of PayPal fame, who cryptically tweeted in early December that the company was "narrowly cash-flow positive last week."

Established automakers should be paying attention, but they shouldn't be surprised. In a blog post dated August 2006, Musk laid out his three-step vision for Tesla. Step 1: Build a sports car. Then use that money to build an affordable car. Then, finally, use that money to build an even more affordable car.

Steps 1 and 2 are done, with mixed results. The Model S is hardly affordable, nor does it guarantee safe passage to Step 3. But strip away the financial drama, and all that's left is the best electric car ever made.

david.undercoffler@latimes.com

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Big Bear locked down amid manhunt

The bustling winter resort of Big Bear took on the appearance of a ghost town Thursday as surveillance aircraft buzzed overhead and police in tactical gear and carrying rifles patrolled mountain roads in convoys of SUVs, while others stood guard along major intersections.

Even before authorities had confirmed that the torched pickup truck discovered on a quiet forest road belonged to suspected gunman Christopher Dorner, 33, officials had ordered an emergency lockdown of local businesses, homes and the town's popular ski resorts. Parents were told to pick up their children from school, as rolling yellow buses might pose a target to an unpredictable fugitive on the run.

By nightfall, many residents had barricaded their doors as they prepared for a long, anxious evening.

PHOTOS: A tense manhunt amid tragic deaths

"We're all just stressed," said Andrea Burtons as she stocked up on provisions at a convenience store. "I have to go pick up my brother and get him home where we're safe."

Police ordered the lockdown about 9:30 a.m. as authorities throughout Southern California launched an immense manhunt for the former lawman, who is accused of killing three people as part of a long-standing grudge against the LAPD. Dorner is believed to have penned a long, angry manifesto on Facebook saying that he was unfairly fired from the force and was now seeking vengeance.

Forest lands surrounding Big Bear Lake are cross-hatched with fire roads and trails leading in all directions, and the snow-capped mountains can provide both cover and extreme challenges to a fugitive on foot. It was unclear whether Dorner was prepared for such rugged terrain.

Footprints were found leading from Dorner's burned pickup truck into the snow off Forest Road 2N10 and Club View Drive in Big Bear Lake.

San Bernardino County Sheriff John McMahon said that although authorities had deployed 125 officers for tracking and door-to-door searches, officers had to be mindful that the suspect may have set a trap.

"Certainly. There's always that concern and we're extremely careful and we're worried about this individual," McMahon said. "We're taking every precaution we can."

PHOTOS: A fugitive's life on Facebook

Big Bear has roughly 400 homes, but authorities guessed that only 40% are occupied year-round.

The search will probably play out with the backdrop of a winter storm that is expected to hit the area after midnight.

Up to 6 inches of snow could blanket local mountains, the National Weather Service said.

FULL COVERAGE: Sweeping manhunt for rampaging ex-cop

Gusts up to 50 mph could hit the region, said National Weather Service meteorologist Mark Moede, creating a wind-chill factor of 15 to 20 degrees.

Extra patrols were brought in to check vehicles coming and going from Big Bear, McMahon said, but no vehicles had been reported stolen.

"He could be anywhere at this point," McMahon said. When asked if the burned truck was a possible diversion, McMahon replied: "Anything's possible."

Dorner had no known connection to the area, authorities said.

Craig and Christine Winnegar, of Murrieta, found themselves caught up in the lockdown by accident. Craig brought his wife to Big Bear as a surprise to celebrate their 28th wedding anniversary. Their prearranged dinner was canceled when restaurant owners closed their doors out of fear.

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Alicia Keys, Bobby Brown perform at Will.i.am show

LOS ANGELES (AP) — Fergie may have been absent — but the Black Eyed Peas were joined by another female diva onstage: Alicia Keys.

Keys sang "Where Is the Love" with the pop-rap group at will.i.am's charity event Thursday night at The Avalon Hollywood in Los Angeles. British singer Estelle also sang Fergie's portion of "The Time (Dirty Bit)."

Will.i.am's TRANS4M benefit show — which assists his i.am.angel foundation — also featured Bobby Brown and Ludacris, who both earned roaring cheers from the crowd of several hundred.

Will.i.am. said at the end of the evening that he raised $3.3 million.

"We're having fun, but we're also collecting funds," he told the crowd.

Will.i.am introduced Grammy-winning Keys to the audience saying: "Are you ready for a strong woman?"

The R&B singer performed "Girl on Fire" and "Try Sleeping With a Broken Heart."

Brown sang his jams "Every Little Step" and "Tenderoni." He performed at the same event in 2011, as will.i.am and Taboo of the Peas worked as his background dancers. They did the same Thursday night.

He told will.i.am in between his set that he was proud of the musician and his charity work.

The Peas closed the night with the massive hit "I Gotta Feeling."

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Online:

http://iamangelfoundation.org .

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Follow Mesfin Fekadu on twitter.com/MusicMesfin

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The New Old Age: The Executor's Assistant

I’m serving as executor for my father’s estate, a role few of us are prepared for until we’re playing it, so I was grateful when the mail brought “The American Bar Association Guide to Wills and Estates” — the fourth edition of a handbook the A.B.A. began publishing in 1995.

This is a legal universe, I’m learning, in which every step — even with a small, simple estate that owes no taxes and includes no real estate or trusts — turns out to be at least 30 percent more complicated than expected.

If my dad had been wealthy or owned a business, or if we faced a challenge to his will, I would have turned the whole matter over to an estate lawyer by now. But even then, it would be helpful to know what the lawyer was talking about. The A.B.A. guide would help.

Written with surprising clarity (hey, they’re lawyers), it maps out all kinds of questions and decisions to consider and explains the many ways to leave property to one’s heirs. Updated from the third edition in 2009, the guide not only talks taxes and trusts, but also offers counsel for same-sex couples and unconventional families.

If you want to permit your second husband to live in the family home until he dies, but then guarantee that the house reverts to the children of your first marriage, the guide tells you how a “life estate” works. It explains what is taxable and what isn’t, and discusses how to choose executors and trustees. It lists lots of resources and concludes with an estate-planning checklist.

In general, the A.B.A. intends its guide for the person trying to put his or her affairs in order, more than for family members trying to figure out how to proceed after someone has died. But many of us will play both these parts at some point (and if you are already an executor, or have been, please tell us how that has gone, and mention your state). We’ll need this information.

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

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IRS delays issuing tax refunds; fiscal cliff to blame?

Don’t worry if you haven’t received your expected IRS tax refund. Most people haven’t -- and the fiscal cliff is to blame.

The Internal Revenue Service is far behind its normal pace in processing federal tax returns and mailing billions of dollars in refunds, according to a new report.

Through Feb. 3, the agency sent out only about $4.3 billion in refunds, according to the analysis by Nicolas Colas, chief market strategist at ConvergEx Group in new York.

That’s far behind the $26.9 billion in refunds issued at this point in 2012. That’s a difference of $22.6 billion.

And 2012 itself was a slow year because the IRS was grappling with security issues, according to Colas. Going back to 2005, the IRS normally has mailed $30 billion to $40 billion in refunds by this point.

This year’s delay is an unwelcome byproduct of Congress’ acrimonious standoff over the so-called fiscal cliff at the end of last year, according to Colas. The IRS had to wait for the year-end jockeying to conclude before it could determine exact tax policy and print the appropriate forms.

The agency only began accepting returns from individual taxpayers on Jan. 30. And those with more complicated returns -- such as small businesses claiming depreciation credits and families with educational write-offs -- won’t even be able to file for several more weeks because the applicable forms aren’t ready yet.

Aside from the annoyance for people awaiting a return of their money, the delay could weigh on the economy in the early part of 2013.

About 80 million filers, or 58% of the total, get money back each year, Colas wrote. The average refund is $2,927, or an entire month of take-home pay for a family earning the median annual income of $50,054 (assuming a 20% tax hit).

As Colas points out, $22.6 billion equates to 900,000 new cars at $25,000 each or 113,000 new homes at $200,000 each.

“This is real money to most American households,” Colas wrote.

ALSO:

IRS to open tax-filing season 8 days later because of fiscal cliff

IRS offers YouTube videos to help last-minute income-tax filers

Beware all you millionaires, the IRS has been auditing more of you

Follow Walter Hamilton on Twitter @LATwalter

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Manhunt underway for ex-LAPD officer suspected of shooting 3 cops

A manhunt involving multiple law enforcement agencies was underway early Thursday after three police officers were shot -- one fatally -- in Riverside County. Authorities believe that the suspect is a former Los Angeles police officer already wanted in connection with two Orange County slayings.

The suspect, Christopher Jordan Dorner, 33, wrote an online manifesto threatening to harm police officials and their families, authorities said, and he is considered "armed and extremely dangerous."

The California Highway Patrol issued a "blue alert" for nine Southern California counties. Officials said Dorner is believed to be driving a 2005 blue or gray Nissan Titan, with California license plate 8D83987 or 7X09131. Police said they believe he may be switching between the two license plates. Dorner is described as a black male, 33 years old, 6 feet tall, weighing 270 pounds with black hair and brown eyes. His last known address is in La Palma.

Members of the public were warned to stay away from him if they spot him, and to call 911 immediately.

The first shooting occurred about 1:30 a.m. in Corona, where two Los Angeles Police Department officers were on "protection detail" for someone mentioned in the suspect's manifesto, officials said. One officer suffered a grazing head wound during a shootout and Dorner fled the scene, police said.

A short time later, two Riverside officers were involved in a shooting with a suspect at the corner of Magnolia Avenue and Arlington Avenue in Riverside, according to Riverside Police Officer Bryan Galbreath.

Sources told The Times that the officers were in a patrol unit and ambushed by the suspect.

One police officer was killed, the other seriously wounded, Galbreath said.

He said said there were no other officers who witnessed the shooting, and that it's only a possibility that Dorner was involved.

Irvine police on Wednesday night named Dorner as the suspect in the double slaying in the parking lot of an upscale Irvine apartment complex Sunday. Law enforcement sources said police have placed security at the homes of LAPD officials named in the manifesto and believe that Dorner has numerous weapons.

In the online postings on his Facebook page, Dorner specifically named the father of Monica Quan, the Cal State Fullerton assistant basketball coach who was found dead Sunday, along with her fiance, Keith Lawrence.

Randy Quan, a retired LAPD captain, was involved in the review process that ultimately led to Dorner’s dismissal.

A former U.S. Navy reservist, Dorner was fired in 2009 for allegedly making false statements about his training officer.

Dorner said in his online postings that being a police officer had been his life’s ambition since he served in the Police Explorers program. Now that had been taken away from him, he said, and he suffered from severe depression and was filled with rage over the people who forced him from his job.

Dorner complained that Randy Quan and others did not fairly represent him at the review hearing.

“Your lack of ethics and conspiring to wrong a just individual are over. Suppressing the truth will leave to deadly consequences for you and your family. There will be an element of surprise where you work, live, eat, and sleep,” he wrote, referring to Quan and several others.

“I never had the opportunity to have a family of my own, I'm terminating yours,” he added.

The online postings indicated that Quan served as Dorner’s representative in the review hearing. Of Quan, Dorner wrote: “He doesn't work for you, your interest, or your name. He works for the department, period. His job is to protect the department from civil lawsuits being filed and their best interest which is the almighty dollar. His loyalty is to the department, not his client.”

In the document, he threatens violence against other police officers: “The violence of action will be high. ... I will bring unconventional and asymmetrical warfare to those in LAPD uniform whether on or off duty.”

In his postings, Dorner seemed to allude to the Irvine slaying.

“I know most of you who personally know me are in disbelief to hear from media reports that I am suspected of committing such horrendous murders and have taken drastic and shocking actions in the last couple of days,” he wrote.

“Unfortunately,” he added, “this is a necessary evil that I do not enjoy but must partake and complete for substantial change to occur within the LAPD and reclaim my name.”

Quan, 28, and Lawrence, 27, had recently become engaged and moved into the condominium complex near Concordia University, where they had played basketball and received their degrees, authorities said. Lawrence worked as a campus officer at USC.

Dorner’s LAPD case began when he lodged a complaint against his field training officer, Sgt. Teresa Evans. He accused her of kicking a suspect named Christopher Gettler. An LAPD Board of Rights found that the complaint was false and terminated his employment for making false statements. He appealed the action.

He testified that he graduated from the Police Academy in February 2006 and left for a 13-month military deployment in November 2006.

“This is my last resort,” he wrote online. “The LAPD has suppressed the truth and it has now led to deadly consequences.”

Dorner said it was the LAPD’s fault that he lost his law enforcement and Navy careers, as well as his relationships with family and close friends. Dorner wrote that he began his law enforcement career in February 2005 and that it ended in January 2009. His Navy career began in April 2002 and ended this month.

“I lost everything,” he said, “because the LAPD took my name and knew I was innocent.”

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Robin Roberts set to return to 'GMA' on Feb. 20

NEW YORK (AP) — ABC News says Robin Roberts will be back on the job at the "Good Morning America" anchor desk on Feb. 20. Her return will be five months to the day since her bone marrow transplant to treat a rare blood disorder.

Roberts has gotten the all-clear from her doctors, according to the announcement made Thursday on "GMA." She reached the critical 100-day benchmark in December.

In January, she began a series of dry runs at the "GMA" studio to re-acclimate herself to the work routine.

Her last day on "GMA" was Aug. 30 before she started her medical leave.

About a year ago, Roberts began feeling the symptoms of her illness, known as MDS.

She said in a statement: "What a difference a year makes."

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Online:

http://abcnews.go.com/

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Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

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Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

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US productivity fell at 2% rate

U.S. worker productivity shrank in the final three months of 2012 although the decline was caused by temporary factors.

Productivity contracted at an annual rate of 2% in the October-December quarter, the biggest drop since the first quarter of 2011, the Labor Department reported Thursday. Productivity had risen at a 3.2% rate in the July-September quarter.

Labor costs rose at a 4.5% rate in the fourth quarter, the fastest gain since the first quarter of 2012.

Productivity is the amount of output per hour of work. It shrank in the fourth quarter because economic activity contracted while hours worked rose. The economy declined at an annual rate of 0.1 percent in the last three months of 2012, a drop caused mainly by deep defense cuts and slower restocking, changes not expected to last.

The trend in productivity has been weak for the past two years. For all of 2012, productivity rose by just 1 percent following an even smaller 0.7%  rise in 2011. Those gains were less than half the average growth that companies saw in 2009 and 2010, shortly after many laid off workers to cut costs during the Great Recession. And it's below the long-run growth of 2.2% a year dating back to 1947.

Companies may ultimately need to hire more workers if they see only modest gains in productivity and more demand for their products.

Economists predict worker productivity will be weak through 2013. Higher productivity is typical during and after a recession, they note. Companies tend to shed workers in the face of falling demand and increase output from a smaller work force. Once the economy starts to grow, demand rises and companies eventually must add workers if they want to keep up.

For all of 2012, labor costs were up a modest 0.7%. That compared to a gain of 2 percent in 2011 and a decline of 1 percent in 2010. Labor costs were rising more rapidly before the Great Recession, which triggered millions of layoffs and reduced workers' bargaining power.

The Federal Reserve closely monitors productivity and labor costs for any signs that inflation is affecting wages. Mild inflation has allowed the central bank to keep interest rates at record lows in an effort to boost economic growth and fight high unemployment.

The 0.1% economic contraction in the October-December quarter was a sharp reversal from the 3.1 percent growth rate in the July-September period. A plunge in defense spending helped push the economy into negative territory for the first time since mid-2009.

For all of 2012, the economy grew 2.2%. Many economists believe growth will be weaker in 2013. An increase in Social Security taxes is reducing take-home pay, which is likely to dampen consumer spending. And across-the-board government spending cuts could also weaken growth.

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