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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John E. Karlin, 1918-2013: John E. Karlin, Who Led the Way to All-Digit Dialing, Dies at 94

Courtesy of Alcatel-Lucent USA

John E. Karlin, a researcher at Bell Labs, studied ways to make the telephone easier to use.

A generation ago, when the poetry of PEnnsylvania and BUtterfield was about to give way to telephone numbers in unpoetic strings, a critical question arose: Would people be able to remember all seven digits long enough to dial them?

And when, not long afterward, the dial gave way to push buttons, new questions arose: round buttons, or square? How big should they be? Most crucially, how should they be arrayed? In a circle? A rectangle? An arc?

For decades after World War II, these questions were studied by a group of social scientists and engineers in New Jersey led by one man, a Bell Labs industrial psychologist named John E. Karlin.

By all accounts a modest man despite his variegated accomplishments (he had a doctorate in mathematical psychology, was trained in electrical engineering and had been a professional violinist), Mr. Karlin, who died on Jan. 28, at 94, was virtually unknown to the general public.

But his research, along with that of his subordinates, quietly yet emphatically defined the experience of using the telephone in the mid-20th century and afterward, from ushering in all-digit dialing to casting the shape of the keypad on touch-tone phones. And that keypad, in turn, would inform the design of a spate of other everyday objects.

It is not so much that Mr. Karlin trained midcentury Americans how to use the telephone. It is, rather, that by studying the psychological capabilities and limitations of ordinary people, he trained the telephone, then a rapidly proliferating but still fairly novel technology, to assume optimal form for use by midcentury Americans.

“He was the one who introduced the notion that behavioral sciences could answer some questions about telephone design,” Ed Israelski, an engineer who worked under Mr. Karlin at Bell Labs in the 1970s, said in a telephone interview on Wednesday.

In 2013, the 50th anniversary of the introduction of the touch-tone phone, the answers to those questions remain palpable at the press of a button. The rectangular design of the keypad, the shape of its buttons and the position of the numbers — with “1-2-3” on the top row instead of the bottom, as on a calculator — all sprang from empirical research conducted or overseen by Mr. Karlin.

The legacy of that research now extends far beyond the telephone: the keypad design Mr. Karlin shepherded into being has become the international standard on objects as diverse as A.T.M.’s, gas pumps, door locks, vending machines and medical equipment.

Mr. Karlin, associated from 1945 until his retirement in 1977 with Bell Labs, headquartered in Murray Hill, N.J., was widely considered the father of human-factors engineering in American industry.

A branch of industrial psychology that combines experimentation, engineering and product design, human-factors engineering is concerned with easing the awkward, often ill-considered marriage between man and machine. In seeking to design and improve technology based on what its users are mentally capable of, the discipline is the cognitive counterpart of ergonomics.

“Human-factors studies are different from market research and other kinds of studies in that we observe people’s behavior and record it, systematically and without bias,” Mr. Israelski said. “The hallmark of human-factors studies is they involve the actual observation of people doing things.”

Among the issues Mr. Karlin examined as the head of Bell Labs’ Human Factors Engineering department — the first department of its kind at an American company — were the optimal length for a phone cord (a study that involved gentle, successful sabotage) and the means by which rotary calls could be made efficiently after the numbers were moved from inside the finger holes, where they had nestled companionably for years, to the rim outside the dial.

John Elias Karlin was born in Johannesburg on Feb. 28, 1918, and reared nearby in Germiston, where his parents owned a grocery store and tearoom.

He earned a bachelor’s degree in philosophy, psychology and music, and a master’s degree in psychology, both from the University of Cape Town. Throughout his studies he was a violinist in the Cape Town Symphony Orchestra and the Cape Town String Quartet.

Moving to the United States, Mr. Karlin earned a Ph.D. from the University of Chicago in 1942. Afterward, he became a research associate at Harvard; he also studied electrical engineering there and at the Massachusetts Institute of Technology.

At Harvard, Mr. Karlin did research for the United States military on problems in psychoacoustics that were vital to the war effort — studying the ways, for instance, in which a bomber’s engine noise might distract its crew from their duties.

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Berlusconi Remains the Wild Card in Italy Race

ROME — One candidate promised to drop an unpopular new property tax and refund all prior payments in cash. Another called that proposal a “poisoned meatball,” disconnected from reality. A third suggested that Al Qaeda blow up the Italian Parliament — then backtracked — and the man generally considered the front-runner is campaigning on vague promises of stability, so has often been ignored.

With only two weeks to go before national elections, the Italian campaign has become a surreal spectacle in which a candidate many had given up for dead, former Prime Minister Silvio Berlusconi, has surged. Although he is not expected ever to govern again, with his media savvy and pie-in-the-sky offers of tax refunds, Mr. Berlusconi now trails the front-runner, Pierluigi Bersani, the leader of the Democratic Party, by about five or six points, according to a range of opinion polls published on Friday.

The polls found that the former comedian Beppe Grillo, who made the Qaeda quip as part of his antipolitical campaign, is close behind in third place, while the caretaker prime minister, Mario Monti, who made the “poisoned meatball” remark as he stepped up attacks on Mr. Berlusconi in an awkward transition from technocrat to candidate, is taking up the rear with around 10 percent to 15 percent of the vote.

Most analysts predict that the center-left will win, but with not enough votes to govern without forming an alliance with Mr. Monti’s centrists. Yet in a complex political landscape — and with significant policy differences between Mr. Monti and Mr. Bersani, who have been criticizing each other in their campaigns — nothing is a given, and the political uncertainty weighs on financial markets.

Some compare the election to a power struggle on a corporate board. “Mr. Berlusconi knows he can’t govern, but wants a strong seat at the table,” said Marco Damilano, a political reporter for L’Espresso, a weekly. The Democratic Party will have the majority of seats but will not be able to govern without making accords, he said, adding that “Monti wants the golden share,” in which his few seats count for a lot.

Many outsiders marvel at the survival skills of Mr. Berlusconi, who dragged down Italy’s finances and international standing to the point that Mr. Monti was brought on in November 2011 to lead an emergency technocratic government that lasted a year. But at least a good part of Mr. Berlusconi’s success has to do with his competition.

Mr. Monti lacks a strong party and has hit Italians with unpopular taxes, and centrists who might lean left are concerned that Mr. Bersani would be weak on the flagging economy. On top of that, Mr. Berlusconi, whose center-right People of Liberty is more a charismatic movement than a party, has true loyalists who do not know where else to turn.

“Berlusconi is politically dead, but his electorate is still there and it is looking for a new leader, and there isn’t one,” said Massimo Franco, a political columnist for the daily newspaper Corriere della Sera. “So it’s a sort of a nostalgic operation.”

In an auditorium near the Vatican, Mr. Berlusconi was greeted Thursday by rows of adoring fans, most of them retirees. “Ah,” he said. “It reminds me of the good old days.” Joking about his age, the 76-year-old former premier added: “I looked at myself in the mirror and saw someone who didn’t look like me. They don’t make mirrors the way they used to.”

In a two-hour off-the-cuff speech, he returned to familiar themes: depicting the left as unreconstructed, cold-war Communists; magistrates as politically motivated; the euro and Chancellor Angela Merkel of Germany as harming Italy; and Mr. Monti as a leader beholden to foreign interests who did nothing but raise taxes.

His supporters were mostly buying it. “Even if he doesn’t refund us the property tax, at least he’ll take it away,” said Francesca Cipriani, 70, a retiree, as she cheered Mr. Berlusconi.

“My house is worth 20 percent less,” Nicola Manichelli, 75, a retired taxi driver, chimed in.

Marcello Sorgi, a columnist for the Turin daily newspaper La Stampa, said: “Berlusconi voters fear that Monti will raise taxes, and that under Berlusconi that won’t happen. It’s not at all true, but Berlusconi’s propaganda works with his electorate.”

“His electorate still has a messianic, religious rapport with him,” Mr. Sorgi added.“Berlusconi is considered a kind of guru.”

Not so with Mr. Monti, who is beloved in Brussels, Berlin and Washington, but has been less popular with Italian voters. As he learns to campaign, Mr. Monti, an economist with no previous political experience, has sought the services of the political consulting firm AKPD Message and Media, whose co-founder, David Axelrod, President Obama’s key political strategist, visited Mr. Monti in Rome last month.

Mr. Monti, who is trying to capture the civic-minded centrists from both right and left who once voted for the centrist Christian Democrats before the party disbanded in a corruption scandal in the early 1990s, also opened a Facebook page. He uses it to post folksy musings that some critics say are undermining the authority of the slyly ironic but hardly showmanlike candidate instead of humanizing him.

Last week, an interviewer presented Mr. Monti with a puppy on live television, days after Mr. Berlusconi had appeared with one. “This is a mean blackmail,” Mr. Monti said with a smile, before stroking the fluffy pet and saying, “Feel how soft it is.”

Mr. Bersani, a longtime party veteran and former economic growth minister, speaks more to the old guard of the Italian left. He defeated Matteo Renzi, the charismatic 38-year-old mayor of Florence, in a rare party primary and has been running on the slogan “A Just Italy,” a message aimed at reassuring voters but which may not inspire them.

In a half-hour speech on Thursday to party loyalists, including municipal workers and frustrated university adjunct teachers, Mr. Bersani called attention to youth unemployment and the disconnect between the real economy and financial markets, and called for economic stimulation to help more people have steady jobs. “Europe isn’t just the fiscal compact,” he said.

Both Mr. Berlusconi and Mr. Bersani appear to speak more to their own constituencies than to the nation as a whole, long a characteristic of Italian politics. Faced with a political class that seems stuck in the past, Mr. Grillo and his antipolitical Five Star Movement have been gaining ground in the polls, campaigning in piazzas across Italy.

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U.S. Trade Deficit Shrinks

WASHINGTON — The trade deficit in the United States shrank in December to its narrowest in nearly three years, the Commerce Department said Friday, and the numbers suggested that the economy did much better in the fourth quarter than initially estimated.

The country’s trade gap narrowed to $38.5 billion during the month, the department said. Analysts polled by Reuters had expected a deficit of $46 billion.

The lower gap means that the government could revise upward its advance reading for fourth-quarter gross domestic product, which showed the economy contracted at a 0.1 percent annual rate in part because of a decline in inflation-adjusted exports. The government had released its estimate for fourth-quarter G.D.P. before the December trade data was available.

Friday’s data showed American exports surged by $8.6 billion during the month, boosted by sales of industrial supplies, including a $1.2 billion increase of non-monetary gold. In a reflection of a boom in oil output driven by hydraulic fracturing technologies, petroleum exports rose by nearly $1 billion during the month to a record high level.

A fall in petroleum imports led overall purchases from abroad to decline $4.6 billion in December.

For all of 2012, the trade gap fell by 3.5 percent to $540.4 billion. A trade deficit of any size is still a drag on the domestic economy, but rising exports help lessen the effect. Exports last year rose 4.4 percent.

While the overall trade deficit shrank, it grew with China during the year. That will be sure to raise concerns from American manufacturers who want the United States to pressure the Asian giant more to strengthen its currency.

But even the figures on China had a silver lining. While imports last year from China increased to a record high, so did America’s exports to the country. America’s December trade deficit with China for goods, which was not seasonally adjusted, narrowed by $4.5 billion on a drop in imports.

The American trade deficit increased with the European Union last year but America’s surplus with Brazil rose.

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The New Old Age Blog: 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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The New Old Age Blog: 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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Gadgetwise Blog: Q.& A.: Saving Space and Shows on a TiVo

I have a bunch of TV programs recorded on my TiVo that I don’t want to erase, but I’m running tight on drive space. Can I copy these shows elsewhere, like to a DVD?

If you have the TiVo Desktop software for your Windows PC or Mac and have your TiVo recorder connected to your home network, you should be able to transfer the recorded shows to your computer and burn them to DVDs there. Shows that have copy-protection built in will not transfer, however.

TiVo has instructions for transferring the files from a PC or Mac on its site. According to the company’s support documentation, PC owners should use the $70 Roxio Creator program and Mac users should get the $80 Roxio Toast Titanium software to transfer and burn recordings.

Depending on your home’s mix of hardware and software, you may be able to copy the shows to a disc with a connected DVD recorder or burn the shows to a DVD with other recording software. Wondershare’s $40 DVD Creator is one program that has its own online instructions (and a free trial version) for recording shows to disc and there are many others around the Web.

If the file-transfer and disc-burning process sounds too complicated, another way to make room for more shows on your TiVo recorder is to add an external drive that gives you more storage space. This approach only works with certain TiVo models, but you can find out more on TiVo’s approved method here. Companies like Weaknees sell upgrade kits for some TiVo models that can add more recording capacity as well.

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Currents: Freedom Has Its Own Constraints

NEW YORK — On the surface, all they have in common is their Sunday airtime, at least in the United States. One television show is about English aristocrats, crisp, proper, well-dressed even in bed. The other is about four young women, often lost and very often unclothed, in a setting quite different from Yorkshire: Brooklyn, New York.

But “Downton Abbey” and “Girls,” both hugely popular, sometimes seem to be talking to each other. And it is a conversation of richer importance to our politics and culture than the nudity on one show and the costumes on the other might initially suggest.

On issue after issue, Americans continue to debate the limits of individual freedom — whether to abort a fetus or own a gun or sell stocks or buy drugs. And in different ways, the two television shows address the promise and limitations of the modern, Western emphasis on — even sacralization of — the individual.

“Downton” and “Girls” serve as bookends in an era defined by a growing cult of the self. “Downton” is about the flourishing of selfhood in a rigid, early-20th-century society of roles. “Girls” is about the chaos and exhaustion of selfhood in a fluid, early-21st-century society that says you can be anything but does not show you how.

“I don’t know what the next year of my life is going to be like at all,” says Marnie, a smart, pretty, rather lost twentysomething on “Girls.” “I don’t know what the next week of my life is going to be like. I don’t even know what I want. Sometimes I just wish someone would tell me, like, ‘This is how you should spend your days, and this is how the rest of your life should look.”’

“Downton” returns us to an earlier stretch of selfhood’s arc, when too little guidance was rarely the problem.

Set on a manor in which the hierarchy and fixedness of the country — indeed, of the Empire — are especially concentrated, “Downton” is a world where there is a way to do everything, from cleaning spoons to dressing for dinner. Status has been and still seems immovable, and servants must act at least as convinced of their inferiority as the masters are. Novelty and that great leveler, money, are reflexively suspected.

The drama is this world’s cracking under the pressure of new ideas like individualism. Thus the family driver, believing in equality and marrying for love, runs away with the family daughter; thus the men wear black tie instead of white to dinner one night; thus a new generation of servants is less servile, more willing to question.

Mary McNamara, a television critic at The Los Angeles Times, has described “Downton” as “the tale of an oppressive social and economic system that is finally being called into question.” The drama comes from watching our world slowly, inevitably defeat theirs: “the bondage of social bylaws and expectation, the fear of new technology, the desire to cling to old ways.”

But now fast-forward a century, and these social upheavals, beginning auspiciously, have ended badly on “Girls.”

What begins on “Downton” as a new liberty to follow your heart, to dare love that others find unwise, has culminated in “Girls” in romantic pursuits that are dully mercenary and often unwise.

The daughters of the sexual revolution are depicted without much agency: Far from being conquerors, initiators, even equals, the girls of “Girls” are reactors, giving in to an ex who changes his mind, or a gay man wanting to try something, or a financier seeking a threesome that he manages to upgrade to traditionally twosome marriage.

What begins on “Downton” as a welcome questioning of age and status roles has snowballed by the “Girls” era into grave role confusion: parents who cannot teach their children how to live because they feel guilty about parenting, or want to be friends more than guides, or still dress like teenagers and call their offspring “prude.”

Nowhere is this overshooting truer than with the roles of the sexes. If “Downton” shows a world in which women are starting to claim their own sexuality, “Girls” portrays a sexual dystopia in which those women seem to have negotiated poorly: Men now reliably get what they want, while women must often content themselves with scraps, as when the character Hannah celebrates “almost” satiation in bed as the best she is likely to get.

The creator of “Girls,” Lena Dunham, is a self-proclaimed liberal. But her show is, as some conservatives gleefully note, full of ammunition for their side.

“There are reasons for conservatives not to like or even to refuse to watch ‘Girls,”’ Peter Lawler, a political philosopher in the conservative Catholic tradition, wrote recently, adding: “But we have to admit that things that are really revolting from a moral or relational point of view are actually portrayed quite negatively.”

If seen as a work of criticism rather than celebration, “Girls” makes Mr. Lawler optimistic: “The hope the show gives us is the persistence of relational human nature,” despite the characters’ failures, for now, to achieve it.

“Girls” is about atoms that desire in vain to form molecules; about sex lives that breed more confusion than excitement; about people with the liberty to choose every day, on various dimensions, whom to be — and who grow very tired of the choosing.

Join an online conversation at http://anand.ly and follow on Twitter.com/anandwrites

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DealBook: Ireland to Liquidate Anglo Irish Bank

LONDON – The Irish government passed emergency legislation on Thursday to liquidate Anglo Irish Bank, one of the country’s largest financial institutions.

The legislation, which was signed into law after an all-night parliamentary session, came after negotiations with the European Central Bank over swapping so-called promissory notes, which were used to bail out the Irish lender in 2009, for long-term government bonds.

The move is an effort to reduce Ireland’s debt repayments at a time when the country is still struggling under a cloud of austerity measures and meager economic growth.

The Irish Parliament rushed through the legislation to liquidate Anglo Irish, which was renamed Irish Bank Resolution Corporation after its failure and bailout, because details of the debt-restructuring plan leaked on Wednesday. Politicians had hoped to announce the deal after agreeing on new terms with the European Central Bank.

“I would have preferred to be introducing this bill in tandem with a finalized agreement with the European Central Bank,” the Irish finance minister, Michael Noonan, said in a statement.

The European Central Bank is considering the country’s latest proposals on Thursday, though European policy makers are concerned that a deal with Ireland could set a precedent for other indebted countries, like Spain, whose local banks also are facing mountains of debt.

As part of the deal to save Anglo Irish, Dublin injected more than 30 billion euros ($41 billion) into the local lender, of which around 28 billion euros is still outstanding.

The bailout has saddled the government with 3.1 billion euros in annual interest payments, or roughly the same amount Irish politicians have said they would cut in yearly government spending to reduce the country’s debt levels. The local government has been eager to reduce that multibillion-euro figure by swapping the high-interest debt into long-term government bonds that can be repaid over a longer period.

Ireland racked up huge debts in bailing out Anglo Irish and the rest of the country’s financial industry, eventually requiring a rescue package of 67.5 billion euros from the European Union and the International Monetary Fund in 2010. The authorities have demanded that Irish politicians slash government spending to reduce the country’s debt burden.

Confusion reigned on Thursday at Anglo Irish’s headquarters in Dublin, a day after employees were sent home early in preparation for the government-mandated liquidation.

Some staff members had returned to work, but the atmosphere remained tense, according to a person with direct knowledge of the matter, who spoke on condition of anonymity because he was not authorized to speak publicly.

“People have been told it’s business as usual, but it’s anything but that,” the person said.

The accounting firm KPMG has been appointed to oversee the liquidation.

Under the terms of the liquidation, Anglo Irish’s assets will be transferred to the National Asset Management Agency, the so-called bad bank set up by the government, or sold to outside investors.

Anglo Irish has been at the center of controversy since the beginning of the financial crisis. Three of its former executives, including its former chief executive, Sean FitzPatrick, are facing fraud charges in connection with loans that were improperly administered.

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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 blue 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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