Britney Spears considers long-term Las Vegas deal

LOS ANGELES (Reuters) – Pop star and former “X Factor” judge Britney Spears is in talks to sign a long-term contract to headline a show at a Las Vegas resort, Caesars Entertainment Corp. said on Friday.

“We can now confirm the company is actively engaged in discussions with Britney Spears‘ representatives regarding a potential headlining residency at Planet Hollywood Resort and Casino,” the company said in a statement.

Representatives for Spears were not immediately available for comment on Friday.

Caesars Entertainment, which owns casinos and resorts including Planet Hollywood, has hired some of the world’s top-selling artists for residencies at various Las Vegas sites.

Canadian singer Celine Dion has a three-year deal with Caesars Palace that is said to be worth $ 100 million. British singer Elton John also has a long-term commitment to perform at The Colosseum at Caesars Palace.

Singers Cher and Bette Midler had similar long-term deals at The Colosseum in recent years.

Spears, 31, shot to fame in the late 1990s with hits such as “… Baby One More Time” and has gone on to become one of the biggest pop figures of the 2000s.

She is waging a comeback after a turbulent few years in her life in which she lost custody of her children, entered rehab and shaved off her hair.

She landed a seat on “The X Factor” judging panel in May 2012, but left the show last month after one season. In the same week, she also split up with her fiancé Jason Trawick.

(Reporting By Piya Sinha-Roy and Eric Kelsey; Editing by Xavier Briand)

Music News Headlines – Yahoo! News

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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.

Friday Feb. 8 4:13 p.m. | Updated Thanks for all your responses. You can read about the winner at “Think Like a Doctor: A Confused and Terrified Patient Solved.”

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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.

Correction: The patient’s eyes were brown, not blue.

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Venezuela Devalues Currency Amid Shortages and Inflation

CARACAS — Venezuela announced Friday that it was devaluing its currency, a step that had long been deemed necessary but could push the spiking inflation even higher.

The devaluation, which lowered the currency’s value against the dollar by nearly 50 percent, was aimed at solidifying government finances and easing a tight market for dollars that has choked back imports and led to shortages of basic goods.

The move had been widely anticipated, but it had been unclear whether officials would make what could be a politically risky decision with President Hugo Chávez still out of the country after undergoing cancer surgery in Cuba on Dec. 11.

If Mr. Chávez were to die or were too ill to continue as president, a special election would have to be called, and many analysts thought that the government might try to postpone a devaluation until after that occurred.

“It is a sign of pragmatism that they carry out a devaluation even though we’re all aware there is some likelihood of a presidential election being held soon,” said Francisco Rodríguez, an economist with Bank of America Merrill Lynch. “This shows that they’re willing to correct basic economic distortions.”

The currency, the bolívar, will be set at 6.3 to the dollar. It had been set at 4.3.

Venezuela’s finance minister, Jorge Giordani, said that Mr. Chávez, who has not been seen or heard in public for more than eight weeks, had approved the measures.

“Here is the president’s signature if you want to recognize it or if you still have doubts,” Mr. Giordani said, holding up a document during a televised news conference.

The devaluation will help the government balance its books by giving it nearly 50 percent more bolívars for the dollars it earns selling oil on the world market. Venezuela’s economy is highly dependent on oil, with petroleum sales making up about 95 percent of total exports. The country is the fourth-largest foreign oil supplier to the United States.

Government spending soared last year during the campaign to re-elect Mr. Chávez, leading to a large deficit, even though, at more than $100 a barrel, the price of oil is very high.

Pressure to devalue had been building for months, as the black market exchange rate rose to more than four times the official rate. The imbalance was evident in the prices of many goods. A Big Mac at McDonald’s costs 70 bolívars, or $16.27, at the official pre-devaluation rate.

But the devaluation will also make imported goods more expensive, which will probably make inflation worse. Inflation for the 12 months ended on Jan. 31 was 22.2 percent, one of the highest rates in Latin America.

Surging inflation could cause political problems for the government. But the exchange rate had reduced the dollars available to importers, leading to shortages of goods like sugar, chicken and toilet paper. Many analysts believe that voters blame the government more for shortages than for inflation.

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Ex-cop called 'depraved,' 'cowardly'

Authorities confirmed Thursday that a door-to-door search for an ex-L.A. police officer wanted in connection with a string of shootings was underway in Big Bear after his vehicle was found burning on a forest road.

San Bernardino Sheriff John McMahon said officials matched the VIN number on the burnt truck to that of suspect Christopher Jordan Dorner, 33, the subject of an intensive hours-long manhunt that stretched across Southern California.

Big Bear Lake Fire Department Asst. Chief Mark Mills told The Times that fresh tracks spotted in the snow were believed to be Dorner's.

McMahon declined to reveal details about what was inside the truck or how it caught fire but said authorities had confirmed Dorner was not inside. He did not discuss which direction Dorner might have traveled.

Authorities were going door-to-door in the mountain community that includes a total of about 400 homes, of which authorities guessed only about 40% were occupied year-round. 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 burnt truck was a possible diversion, McMahon replied: "Anything's possible."

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

Television footage showed a fatigue-clad SWAT team combing the woods, rifles pointed, and the truck being towed away. Federal authorities later ordered media helicopters away from the area.

McMahon called Thursday a "sad and tragic day for all of us in law enforcement."

Several law enforcement agencies are involved in the manhunt for Dorner and alerts have been issued all across California and in Nevada. The Los Angeles Police Department had dispatched units across the region to protect at least 40 officers and others named in a rambling online manifesto that law enforcement officials attributed to Dorner.

Dorner, who was fired from the LAPD in 2009, is suspected of shooting three police officers, one of whom died, in Riverside County early Thursday.

Dorner also is suspected of killing a couple in Orange County earlier this week who were found shot in a car. One of the victims was the daughter of a former LAPD captain named in the purported manifesto.

Dorner was believed to be carrying multiple weapons, including an assault rifle.

Law enforcement authorities said they were concerned about Dorner's military background and weapons training. The lengthy online message allegedly written by the former Navy Reserve lieutenant threatened "unconventional and asymmetrical warfare" against police.

Dorner received awards for his expertise with a rifle and pistol, according to military records obtained by The Times. He received an Iraq Campaign Medal and was a member of a mobile inshore undersea warfare unit.
Riverside Police Chief Sergio Diaz, calling the attack a "cowardly ambush," said Dorner is suspected of opening fire with a rifle about 1:30 a.m. Thursday as he pulled up to two police officers waiting at a traffic light.

The attack was carried out about 20 minutes after Dorner wounded an LAPD officer in a shooting in nearby Corona, police said.
Early Thursday, two women delivering newspapers in Torrance were shot by Los Angeles police who were guarding an officer named in the manifesto.

The women, shot in the 19500 block of Redbeam Avenue, were taken to area hospitals, Torrance Police Lt. Devin Chase said. One suffered a minor wound, and the other was struck twice and listed in stable condition, LAPD Chief Charlie Beck told reporters.

"Tragically," Beck said, "we believe this is a case of mistaken identity."

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Is This the Secret U.S. Drone Base in Saudi Arabia?

These satellite images show a remote airstrip deep in the desert of Saudi Arabia. It may or may not be the secret U.S. drone base revealed by reporters earlier this week. But the base’s hangars bear a remarkable resemblance to similar structures found on other American drone outposts. And its remote location — dozens of miles from the nearest highway, and farther still to the nearest town – suggests that this may be more than the average civilian airstrip.

According to accounts from the Washington Post and The New York Times, the U.S. built its secret Saudi base approximately two years ago. Its first lethal mission was in September of 2011: a strike on Anwar al-Awlaki, the American-born propagandist for al-Qaida’s affiliate in Yemen, which borders Saudi Arabia. Since then, the U.S. has launched dozens of drone attacks on Yemeni targets. News organizations eventually found out about the base. But they agreed to keep it out of their pages — part of an informal arrangement with the Obama administration, which claimed that the disclosure of the base’s location, even in a general way, might jeopardize national security. On Tuesday, that loose embargo was broken.

The image of the airfield, available in Bing Maps, would be almost impossible to discover randomly. At moderate resolutions, satellite images of the area show nothing but sand dunes. Only on close inspection does the base reveal itself. In Google’s catalog of satellite pictures, the base doesn’t appear at all.

The images show a trio of “clamshell”-style hangars, surrounded by fencing. Each is more than 150 feet long and approximately 75 feet wide; that’s sufficient to hold U.S. Predator and Reaper drones. The hangars are slightly larger, though similar in shape, to ones housing unmanned planes at Kandahar Air Field in Afghanistan. Shamsi Air Field in Pakistan, which once held U.S. drones, boasts a group of three hangars not unlike the ones of the Saudi base. No remotely piloted aircraft are visible in the images. But a pair of former American intelligence officers tell Danger Room that they are reasonably sure that this is the base revealed by the media earlier this week.

“I believe it’s the facility that the U.S. uses to fly drones into Yemen,” one officer says. “It’s out in eastern Saudi Arabia, near Yemen and where the bad guys are supposed to hang out. It has those clamshell hangars, which we’ve seen before associated with U.S. drones.”

The former officer was also impressed by the base’s remote location.”It’s way, way out in the Rub al Khali, otherwise known as Hell, and must have been built, at least initially, with stuff flown into Sharorah and then trucked more than 400 kilometers up the existing highway and newly-built road,” the ex-officer adds in an e-mail. “It’s a really major logistics feat. The way it fits inconspicuously into the terrain is also admirable.”

Three airstrips are visible in the pictures; two are big enough to land drones or conventional light aircraft. A third runway, under construction, is substantially longer and wider. In other words: The facility is growing, and it is expanding to fly much larger planes.

The growth has been rapid. When the commercial imaging company Digital Globe flew one of its satellites over the region on Nov. 17, 2010, there was no base present. By the time the satellite made a pass on March 22, 2012, the airfield was there. This construction roughly matches the timeline for the Saudi base mentioned in the Post and in the Times.

“It’s obviously a military base,” says a second intelligence analyst, who reviewed the images and asked to remain anonymous because of the sensitivity of the subject. “It’s clearly an operating air base in the middle of nowhere, but near the Yemeni border. You tell me what it is.”

If this picture does prove to be a secret U.S. drone base, it wouldn’t be the first clandestine American airfield revealed by public satellite imagery. In 2009, for instance, Sen. Diane Feinstein accidentally revealed that the U.S. was flying its robotic aircraft from Pakistani soil. The News of Pakistan quickly dug through Google Earth’s archives to find Predator drones sitting on a runway not far from the Jacobabad Air Base in Pakistan – one of five airfields in the country used for unmanned attacks. The pictures proved that the Pakistani officials were actively participating in the American drone campaign, despite their public condemnation of the strikes. Until then, such participation had only been suspected. While the drone attacks continued, the U.S. was forced to withdraw from some of the bases.

So far, reaction to the Saudi base has been relatively muted. American forces officially withdrew from Saudi Arabia years ago, in part because the presence of foreign troops in the Muslim holy land so inflamed militants. It’s unclear how the drone base changes this calculation, if at all.

The drone base’s exposure is part of a series of revelations about the American target killing campaign that have accompanied John Brennan’s nomination to be the director of the CIA. Brennan currently oversees targeted killing operations from his perch as White House counterterrorism adviser, and would be responsible for executing many of the remotely piloted missions as CIA chief.

In about to the drone base disclosure, an unclassified Justice Department white paper summing up the Obama administration’s criteria for eliminating U.S. citizens was leaked this week to NBC News; the document argues that a judgment from an “informed, high-level” official can mark an American or robotic death – even without “clear evidence that a specific attack on U.S. persons and interests will take place in the immediate future.” (.pdf) The White House has since promised to give select Congressmen the classified and detailed legal rationales behind the white paper. But Sen. Ron Wyden told Brennan at his Senate confirmation hearing that the Justice Department is not yet complying with President Obama’s promise to disclose those legal memoranda. Feinstein said she was seeking eight such memos in total.

In their hours of questioning Brennan, however, the Senators didn’t once ask the CIA nominee about the secret Saudi drone base. Perhaps that’s because they didn’t have a visual aid.

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Martial arts drama kicks off Berlin film festival

BERLIN (Reuters) – The 2013 Berlin film festival kicks off on Thursday with the red carpet premiere of “The Grandmaster”, Hong Kong director Wong Kar Wai‘s martial arts period drama set in China at the time of the Japanese invasion in the 1930s.

Starring regular collaborator Tony Leung Chiu Wai as kung fu master Ip Man and Zhang Ziyi as his rival and friend Gong Er, the heavily stylized picture is a story of honor, principle, betrayal and forbidden love all set in a time of turmoil.

Wong, also president of the jury at the cinema showcase this year, said he was determined to get beneath the surface of martial arts in a way most films in the genre had not.

“‘Grandmaster’ is a film about kung fu. It tells you more than the skill,” he told reporters after a press screening and ahead of the opening night gala.

“It tells you more about these people, martial artists, the world of martial arts. What is their code of honor? What is their value? What is their philosophy?

“I hope this film can bring the audience a new perspective about martial arts, kung fu and also Chinese,” he added, wearing his trademark dark glasses and speaking in English.

The idea for “The Grandmaster” was first announced more than a decade ago and it took the notoriously slow filmmaker four years to make, involving rigorous training for both Leung and Zhang which both actors said changed them profoundly.

Leung’s character, which dominates the first part of the film, is based on a real-life master of the same name who developed the Wing Chun school of martial arts and counted Bruce Lee among his students.

Gong Er’s character gradually takes a central role, and her repressed longing for Ip Man brings to the fore Wong’s mastery of melancholy, which he showed so memorably in his best known film to date “In the Mood for Love” also starring Leung.

IRANIAN FILM DEFIES BAN

Leung, 50, said he started training for the part four years ago, and reportedly broke his arm early in the process.

“There is a spiritual side of kung fu and that side cannot be learned from books or by fact-finding,” he said. “It grows spontaneously. So that’s why I had to practice four years. You can only achieve that thing through practice.”

“The Grandmaster” marks the official start of 11 days of screenings, photocalls, interviews and parties across Berlin where hundreds of movies will be screened, reviewed and traded at a film market that accompanies the Berlinale.

Matt Damon, Anne Hathaway and Nicolas Cage are expected on the red carpet, as are European heavyweights Catherine Deneuve and Jude Law and Asian stars including Leung and Zhang.

In the main competition of 19 movies eligible for awards is “Promised Land”, about the controversial drilling technique for extracting gas known as “fracking” and starring Matt Damon directed by his “Good Will Hunting” collaborator Gus Van Sant.

Steven Soderbergh‘s “Side Effects” is in part a critique of the pharmaceutical industry and boasts Law, Channing Tatum and Catherine Zeta-Jones in the cast.

Soderbergh, an Oscar winner for his 2000 narcotics drama “Traffic”, has announced it will be his final big screen feature film, at least for the foreseeable future.

One of the most eagerly awaited pictures at the festival is “Closed Curtain”, co-directed by acclaimed Iranian director Jafar Panahi who made it in defiance of a 20-year ban on film making imposed by authorities at home.

Out of competition is 3D prehistoric animation comedy “The Croods”, featuring the voices of Cage and Ryan Reynolds, and “Dark Blood”, which River Phoenix was filming when he died aged 23 in 1993.

(Reporting by Mike Collett-White, editing by Paul Casciato)

Movies News Headlines – Yahoo! News

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Well: The 'Monday Morning' Medical Screaming Match

I did not think I would ever see another “morbidity and mortality” conference in which senior doctors publicly attacked their younger colleagues for making medical errors. These types of heated meetings were commonplace when I was a medical student but have largely been abandoned.

Yet here they were again on “Monday Mornings,” a new medical drama on the TNT network, based on a novel by Dr. Sanjay Gupta, CNN’s chief medical correspondent and one of the executive producers of the show. Such screaming matches may make for good television, but it is useful to review why new strategies have emerged for dealing with medical mistakes.

So-called M&M conferences emerged in the early 20th century as a way for physicians to review cases that had either surprising outcomes or had somehow gone wrong. Although the format varied among institutions and departments, surgery M&Ms were especially known for their confrontations, as more experienced surgeons often browbeat younger doctors into admitting their errors and promising to never make them again.

Such conferences were generally closed door — that is, attended only by physicians. Errors were a private matter not to be shared with other hospital staff, let alone patients and families.

But in the late 1970s, a sociology graduate student named Charles L. Bosk gained access to the surgery department at the University of Chicago. His resultant 1979 book, “Forgive and Remember,” was one of the earliest public discussions of how the medical profession addressed its mistakes.

Dr. Bosk developed a helpful terminology. Technical and judgment errors by surgeons could be forgiven, but only if they were remembered and subsequently prevented by those who committed them. Normative errors, which called into question the moral character of the culprit, were unacceptable and potentially jeopardized careers.

Although Dr. Bosk’s book was more observational than proscriptive, his depiction of M&M conferences was disturbing. I remember attending a urology M&M as a medical student in which several senior physicians berated a very well-meaning and competent intern for a perceived mistake. The intern seemed to take it very well, but my fellow students and I were shaken by the event, asking how such hostility could be conducive to learning.

There were lots of angry accusations in the surgical M&Ms in the pilot episode of “Monday Mornings.” In one case, a senior doctor excoriated a colleague who had given Tylenol to a woman with hip pain who turned out to have cancer. “You allowed metastatic cancer to run amok for four months!” he screamed.

If this was what Dr. Bosk would have called a judgment error, the next case raised moral issues. A neurosurgeon had operated on a boy’s brain tumor without doing a complete family history, which would have revealed a disorder of blood clotting. The boy bled to death on the operating table. “The boy died,” announced the head surgeon, “because of a doctor’s arrogance.”

In one respect, it is good to see that the doctors in charge were so concerned. But as the study of medical errors expanded in the 1990s, researchers found that the likelihood of being blamed led physicians to conceal their errors. Meanwhile, although doctors who attended such conferences might indeed not make the exact same mistakes that had been discussed, it was far from clear that M&Ms were the best way to address the larger problem of medical errors, which, according to a 1999 study, killed close to 100,000 Americans annually.

Eventually, experts recommended a “systems approach” to medical errors, similar to what had been developed by the airline industry. The idea was to look at the root causes of errors and to devise systems to prevent them. Was there a way, for example, to ensure that the woman with the hip problem would return to medical care when the Tylenol did not help? Or could operations not be allowed to occur until a complete family history was in the chart? Increasingly, hospitals have put in systems, such as preoperative checklists and computer warnings, that successfully prevent medical errors.

Another key component of the systems approach is to reduce the emphasis on blame. Even the best doctors make mistakes. Impugning them publicly — or even privately — can make them clam up. But if errors are seen as resulting from inadequate systems, physicians and other health professionals should be more willing to speak up.

Of course, the systems approach is not perfect. Studies continue to show that physicians conceal their mistakes. And elaborate systems for preventing errors can at times interfere with getting things done in the hospital.

Finally, it is important not to entirely remove the issue of responsibility. Sad to say, there still are physicians who are careless and others who are arrogant. Even if today’s M&M conferences rarely involve screaming, supervising physicians need to let such colleagues know that these types of behaviors are unacceptable.

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Barron H. Lerner, M.D., professor of medicine at New York University Langone Medical Center, is the author, most recently, of “One for the Road: Drunk Driving Since 1900.”

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DealBook: 4 Years After Crisis, Ireland Strikes Deal to Ease a Huge Debt Load

LONDON — The Irish government, trying to lighten the staggering debt burden of bailing out some of its biggest banks four years ago, reached a deal on Thursday with the European Central Bank to give the country more time to repay some of those loans.

The agreement, which came after 18 months of negotiations with the central bank, will enable Ireland to swap 28 billion euros ($38 billion) of high-interest promissory notes — a form of i.o.u.’s — that were used to bail out Anglo Irish Bank in 2009 for long-term government debt.

Although crucial details of the agreement were not disclosed, it appeared to be another important milestone in Ireland’s slow emergence from a banking and real estate crisis that had cut living standards, caused unemployment to soar and left cities scarred by half-finished building projects.

The deal could also be an important step for the euro zone, showing that it is possible for a member to survive the painful financial adjustments needed to recover from the crisis without leaving the currency union. Besides Ireland, Greece and Portugal have borrowed huge sums from the central bank and other international organizations to bail out their governments, while Spain has done likewise to rescue its banks.

By exchanging the promissory notes for government debt, Enda Kenny, the Irish prime minister, and his governing party, Fine Gael, have secured more time for Ireland to put itself on a firmer financial footing.

They have also won a significant concession from the central bank, which had repeatedly rejected Ireland’s plans to restructure some of its debt. The central bank, based in Frankfurt, has been concerned that a refinancing deal for Ireland would set a precedent that could be followed by other countries that have also bailed out big lenders.

Mario Draghi, the central bank’s president, declined to comment on the Irish deal during a news conference Thursday, suggesting that reporters direct their questions to Irish officials.

Mr. Kenny was more than happy to trumpet the deal. “The promissory notes represent a highly onerous and unfair legacy of the banking crisis,” Mr. Kenny told the Irish Parliament on Thursday. “The legacy banking debt hoisted on the Irish taxpayer is a heavy burden.”

Analysts said the debt restructuring was an important step in Ireland’s recovery because the government could either repay existing debt faster than previously expected or pump the extra cash directly into the local economy.

“Ireland has been pushing hard for this deal,” said Jonathan Loynes, the chief European economist at Capital Economics in London. “It’s a victory for Ireland over the European Central Bank.”

After stepping in to save many lenders that made too many bad loans during the 2000s, Dublin eventually had to turn to the European Union and the International Monetary Fund in 2010, which provided a 67.5 billion euro rescue package.

One big part of that bailout, the nationalization of the giant bank Anglo Irish, had left Dublin with onerous annual interest payments of 3.1 billion euros. The figure is about the same amount that Irish politicians have said they need to make in additional cuts in yearly government spending to reduce the country’s debt levels. The hefty interest payments caused widespread anger across Ireland, whose population has already endured several years of tax increases and government spending reductions.

The interest rate on the new government debt is expected to average about 3 percent, instead of rates above 8 percent on the promissory notes. The restructuring also will cut the country’s budget deficit by one billion euros a year, according to a statement from the Irish Finance Ministry, though Ireland’s deficit as a percentage of its overall economy will still be one of the highest in the euro zone.

As part of the deal, the Irish government passed emergency legislation on Thursday to liquidate Anglo Irish Bank, which fell into trouble in the buildup to the financial crisis by lending billions of euros to real estate developers. Many of those loans went bad after Ireland’s real estate bubble burst. The bank had been renamed the Irish Bank Resolution Corporation after its failure and bailout.

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

Anglo Irish had 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 authorities have said were granted improperly.

The new legislation, which was signed into law after an all-night parliamentary session, had been rushed through because details of the debt-restructuring plan were leaked on Wednesday. Even as lawmakers were debating the Anglo Irish liquidation, the hashtag #promnight — in reference to the promissory notes — started to trend on Twitter as the Irish public eagerly awaited the outcome.

Politicians had hoped to wait to announce the liquidation 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.

Despite persistent questioning at a Frankfurt news conference on Thursday, Mr. Draghi resolutely declined to offer any information about the central bank’s role, if any, in helping Ireland reduce its interest payments.

He said the bank’s governing council, which concluded its monthly meeting Thursday, merely “took note” of the Irish action. Mr. Draghi may have wanted to avoid any impression that the central bank was giving a financial break to the Irish government because its charter prohibits it from financing euro zone governments.

Ireland’s multibillion-euro lifeline in 2010 came with strings attached. International creditors demanded that Ireland adopt austerity measures that would cut public spending by $20 billion by 2015.

Salaries for many public sector workers, including nurses and teachers, have been reduced about 20 percent. Welfare programs like social protection and child benefits have been cut. And a series of new taxes has been introduced to refill the government’s coffers.

At first, the cuts plunged Ireland’s economy into recession, but the country’s gross domestic product is expected to grow 1.1 percent this year, much better than the mere 0.1 percent growth projected for the entire euro zone.

Despite the gradual recovery and now a reduction in the country’s debt burden, the Irish prime minister cautioned that more work had to be done to revive the country’s economy.

“Let there be no doubt, this is no silver bullet to end all our economic problems,” Mr. Kenny said on Thursday. “There is still a long way to travel in our country’s journey back to prosperity and full employment.”

Jack Ewing contributed reporting from Frankfurt

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Obama names REI chief to lead the Interior Department

President Obama nominated REI business executive Sally Jewell to lead his second-term Interior Department.

WASHINGTON – President Obama on Wednesday nominated Sally Jewell, a former oil engineer and banker and current chief executive of a national outdoor retailer, to lead the Interior Department, making an unorthodox pick for his first woman nominee to his second-term Cabinet.

The president and CEO of Recreational Equipment Inc., Jewell has no government and little public policy experience, and has spent her career far from Washington. But her resume has elements that appealed to both of the two feuding interests that consume much of the debate at the department that controls public lands: the oil and gas extraction industries seeking access to public lands, as well as environmentalists seeking to preserve them.

Jewell, 56, started her career as a petroleum engineer working in the oil fields of Oklahoma and Colorado for Mobil Oil Corp. She then moved to the corporate banking industry, and joined the REI board in 1996,  becoming chief operating officer four years later.

PHOTOS: President Obama’s past

She has been credited with expanding the Washington state-based retailer's Internet operations and contributing the membership cooperative’s resources to environmental stewardship. Jewell, an avid outdoorswoman, serves on the board of the National Parks Conservation Assn. as well as the Board of Regents of the University of Washington.

In announcing his choice, Obama cast her as someone who would seek a balance between protection and economic development of public lands. 

“She knows the link between conservation and good jobs,” Obama said in remarks at the White House. “She knows that there’s no contradiction between being good stewards of the land and our economic progress, that in fact, those two things need to go hand-in-hand. She’s shown that a company with more than $1 billion in sales can do the right thing for our planet.”

In fact, little is known about Jewell’s policy positions. And while environmental groups largely praised her nomination, Republicans and some Democrats withheld judgment.

“The livelihoods of Americans living and working in the West rely on maintaining a real balance between conservation and economic opportunity,” said Sen. Lisa Murkowski (R-Alaska), the ranking member of the Senate committee on energy and national resources.  “I look forward to hearing about the qualifications Ms. Jewell has that make her a suitable candidate to run such an important agency, and how she plans to restore balance to the Interior Department.”

PHOTOS: President Obama’s second inauguration

If confirmed, Jewell will replace Ken Salazar, who served in the post throughout the president’s first term and led a period of expansion of oil and gas drilling on public lands. Salazar plans to return to Colorado. Obama on Wednesday praised the former senator as a close friend and trusted advisor.

Salazar, he said, had “ushered in a new era of conservation of our land, our water and our wildlife.”

“He’s opened more public land and water for safe and responsible energy production – not just gas and oil, but also wind and solar – creating thousands of new jobs and nearly doubling our use of renewable energy in this country,” Obama said. 

Jewell is the first woman to be named to lead a Cabinet-level department in the second term. After naming a few white men to top jobs, Obama said the next round of nominees would include more women and be more racially diverse.

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Kathleen.hennessey@latimes.com

Twitter: @khennessey

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Microsoft Teases Future Surface Pro Accessories With Extra Battery Power

Days before Surface Pro’s release date, Microsoft is already teasing the types of accessories we’ll see for the device.

In a Reddit AMA hosted on Wednesday, members of the Surface Team responded to user questions, and suggested that a Surface Pro cover that would double as an extra battery pack is in the works. Good thing, too, since we found that the Surface Pro could barely get around four hours of normal usage.

Naturally, that’s a major concern for people considering buying the computer — Reddit members brought it up on multiple occasions. Asked about the new connectors at the bottom of the Surface Pro on either side of the cover port, a Microsoft rep said, “At launch we talked about the ‘accessory spine’ and hinted at future peripherals that can click in and do more. Those connectors look like can carry more current than the pogo pins, don’t they?”

The cryptic answer was fleshed out in another response. A redditor specifically asked if Microsoft plans to make a thicker keyboard with an extra battery pack.

“That would require extending the design of the accessory spine to include some way to transfer higher current between the peripheral and the main battery. Which we did,” a Surface Team member replied.

Considering that Microsoft already has released two covers for Surface Pro and Surface RT, along with a Surface-branded Wedge Touch Mouse, it’s not hard to imagine the company expanding its Surface accessory lineup. It’s a natural next step as the company continues to focus on its hardware division, which has traditionally offered accessories like mice and keyboards.

The Reddit AMA also covered issues like Surface Pro’s lack of storage space and whether the company plans to release a 3G or 4G Surface. The latter answer was a roundabout “no.” As for storage space, the Surface Team’s Marc DesCamp said, once again, that you can extend storage through the USB 3.0 port and microSDX card slot. He also mentioned that initial reports of available storage space (23GB for the 64GB model, and 83GB for the 128GB model) are conservative; you actually get around 6 to 7GB more than that.

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