Windows 8: A ‘Christmas gift for someone you hate’

Microsoft (MSFT) is no stranger to criticism these days, and the company’s new Windows 8 platform is once again the target of a scathing review from a high-profile user. Well-known Internet entrepreneur and MIT professor Philip Greenspun handed Windows 8 one of its most damning reviews yet earlier this week, calling the new operating system a “Christmas gift for someone you hate.” Greenspun panned almost every aspect of Microsoft’s new software, noting that Microsoft had four years to study Android and more than five to examine iOS, but still couldn’t build a usable tablet experience.

“The only device that I can remember being as confused by is the BlackBerry PlayBook,” Greenspun wrote on his blog after using Windows 8 on a Dell (DELL) XPS One All-in-One desktop PC. The acclaimed computer scientist noted that Microsoft omitted all of the best features from the most popular touch-focused platforms and instead created a user interface he describes as a “dog’s breakfast.”

“Suppose that you are an expert user of Windows NT/XP/Vista/7, an expert user of an iPad, and an expert user of an Android phone… you will have no idea how to use Windows 8,” Greenspun wrote.

He continued, “Some functions, such as ‘start an application’ or ‘restart the computer’ are available only from the tablet interface. Conversely, when one is comfortably ensconced in a touch/tablet application, an additional click will fire up a Web browser, thereby causing the tablet to disappear in favor of the desktop. Many of the ‘apps’ that show up on the ‘all apps’ menu at the bottom of the screen (accessible only if you swipe down from the top of the screen) dump you right into the desktop on the first click.”

The only praise Greenspun offered was that “some of the supplied apps are wonderful,” pointing to Microsoft’s Bing Finance application as an example.

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Jazz icon Dave Brubeck dead

Dave Brubeck changed the sound of jazz in profound ways, unexpectedly becoming something of a pop star in the process.

Starting in the mid-1950s, in fact, he emerged as a symbol of jazz in America, and well beyond, gracing the cover of Time magazine in 1954 and selling more than a million copies of “Take Five” in 1960. To this day, the puckishly syncopated tune remains one of the most recognizable in jazz, though Brubeck didn’t write it – his alto saxophonist, Paul Desmond, did.

Beneath the popular acclaim stood a brilliant, uncompromising composer-pianist who challenged conventional jazz techniques, brought the music to American college campuses and helped break down racial barriers through a music uniquely suited to that task.

Brubeck was en route to an appointment with his cardiologist when he was stricken Wednesday morning, said his longtime manager-producer-conductor, Russell Gloyd. The pianist died of heart failure at Norwalk Hospital, in Norwalk, Conn., near his home in Wilton, Conn.

Brubeck was anticipating a birthday concert Thursday, when he would have turned 92. The performance will go on, but in the form of a tribute, in Waterbury, Conn.

"Dave Brubeck was one of the giants in the music – he changed the way people listened to the music,” said David Baker, distinguished professor of music at Indiana University and a friend of the Brubeck family.

"He could swing in any time signature – it seemed like forward motion was born in his blood,” said pianist Ramsey Lewis, who played four-hand piano with Brubeck at the Ravinia Festival in Highland Park in 2010. Though the Ravinia Festival does not release attendance figures, a huge audience turned out for that concert, a celebration of Lewis’ 75th birthday.

"Playing with Dave at Ravinia was one of the most exciting moments in my life,” added Lewis.

Brubeck’s last performance in the Chicago area was a 2011 Father’s Day show at Ravinia, where the 90-year-old pianist shared the stage with four sons: pianist Darius, trombonist Chris, cellist Matt and drummer Dan. The elder Brubeck also consistently drew large audiences to Symphony Center, where he last played in 2009.

"Dave Brubeck was one of few jazz headliners who was guaranteed to bring in a large crowd,” said Nick Pullia, Ravinia Festival communications director.

Though widely beloved as an elder statesman in jazz during recent decades, Brubeck’s initial burst of immense popularity, more than half a century ago, caused a backlash. When “Take Five” made him a household name, some critics and deejays accused him of selling out, he said in a 1990 Tribune interview.

"But I had a lot of fun with them,” recalled Brubeck. “One of the most internationally known disc jockeys accused me, right on the air, of going commercial.

"So I said to him, on the air: ‘OK, let’s play the (‘Take Five’) record, and you follow along and count it,’” said Brubeck, referring to its underlying rhythmic pattern, which defied the two-, three- and four-beats-to-the-bar techniques of the day.

"And there was this huge blank – he didn’t say anything.

"So I said, ‘Well, why don’t you do it?’

"And he just didn’t answer.

"At that time, hardly any musicians could play ‘Take Five.’ Now a grammar school kid can play it.

"But those were breakthroughs.”

Brubeck ventured even further afield in another piece that, to his surprise, became a popular hit, his “Blue Rondo a la Turk.” Its lush harmonies sounded exotic in the late ’50s, while its switches between offbeat rhythms and bona fide swing were like nothing yet encountered in American music.

For “Blue Rondo,” Brubeck drew inspiration from a characteristically unlikely source: “I heard street musicians playing in Istanbul,” he said in the 2010 documentary film “In His Own Sweet Way.” By transforming Eastern harmonies and regional rhythms through jazz, Brubeck hit upon an alluring sound and a signature hit.

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Brazilian architect Oscar Niemeyer dies, aged 104

RIO DE JANEIRO (Reuters) – Oscar Niemeyer, a towering patriarch of modern architecture who shaped the look of modern Brazil and whose inventive, curved designs left their mark on cities worldwide, died late on Wednesday. He was 104.

Niemeyer had been battling kidney ailments and pneumonia for nearly a month in a Rio de Janeiro hospital. His death was confirmed by a hospital spokesperson.

Starting in the 1930s, Niemeyer’s career spanned nine decades. His distinctive glass and white-concrete buildings include such landmarks as the United Nations Secretariat in New York, the Communist Party headquarters in Paris and the Roman Catholic Cathedral in Brasilia.

He won the 1988 Pritzker Architecture Prize, considered the “Nobel Prize of Architecture” for the Brasilia cathedral. Its “Crown of Thorns” cupola fills the church with light and a sense of soaring grandeur despite the fact that most of the building is underground.

It was one of dozens of public structures he designed for Brazil’s made-to-order capital, a city that helped define “space-age” style.

After flying over Niemeyer’s pod-like Congress, futuristic presidential palace and modular ministries in 1961, Yuri Gagarin, the Russian cosmonaut and first man in space, said “the impression was like arriving on another planet.”

In his home city of Rio de Janeiro, Niemeyer’s many projects include the “Sambadrome” stadium for Carnival parades. Perched across the bay from Rio is the “flying saucer” he designed for the Niteroi Museum of Contemporary Art.

The collection of government buildings in Brasilia, though, remain his most monumental and enduring achievement. Built from scratch in a wild and nearly uninhabited part of Brazil’s remote central plateau in just four years, it opened in 1960.

While the airplane-shaped city was planned and laid out by Niemeyer’s friend Lucio Costa, Niemeyer designed nearly every important government building in the city.

BECAME NATIONAL ICON

An ardent communist who continued working from his Copacabana beach penthouse apartment in Rio until days before his death, Niemeyer became a national icon ranking alongside Bossa Nova pioneer Tom Jobim and soccer legend Pelé.

His architecture, though, regularly trumped his politics.

Georges Pompidou, a right-wing Gaullist former French president, said Niemeyer’s design for the Communist Party of France headquarters in Paris “was the only good thing those commies ever did,” according to Niemeyer’s memoirs.

Prada, the fashion company known for providing expensive bags and wallets, thought the Communist Party building in Paris so cool it rented it for a fashion show.

Even the 1964-1985 Brazilian military government that forced Niemeyer into exile in the 1960s eventually found his buildings congenial to their dreams of making Brazil “the country of the future.”

His work is celebrated for innovative use of light and space, experimentation with reinforced concrete for aesthetic value and his self-described “architectural invention” style that produced buildings resembling abstract sculpture.

Initially influenced by the angular modernism of French-Swiss architect Le Cobusier, who worked with Niemeyer and Costa on a visit to Brazil in the 1930s, his style evolved toward rounded buildings that he said were inspired by the curves of Rio’s sunbathing women as well as beaches and verdant hills.

“That is the architecture I do, looking for new, different forms. Surprise is key in all art,” Niemeyer told Reuters in an interview in 2006. “The artistic capability of reinforced concrete is so fantastic – that is the way to go.”

Responding to criticism that his work was impractical and overly artistic, Niemeyer dismissed the idea that buildings’ design should reflect their function as a “ridiculous and irritating” architectural dogma.

“Whatever you think of his buildings, Niemeyer has stamped on the world a Brazilian style of architecture,” Dennis Sharp, a British architect and author of The Illustrated Encyclopedia of Architects and Architecture, once said of Niemeyer.

LIFELONG COMMUNIST

Niemeyer’s legacy is heavily associated with his communist views. He was a close friend of Cuba’s revolutionary leader Fidel Castro and an enemy of Brazil’s 21-year military dictatorship.

“There are only two communists left in the world, Niemeyer and myself,” Castro once joked.

Niemeyer remained politically active after returning to Brazil, taking up the cause of a militant and sometimes violent movement of landless peasants. He said in 2010 that he was a great admirer of Luiz Inacio Lula da Silva, the former labor leader who was Brazil’s president from 2003 to 2010.

Niemeyer once built a house in a Rio slum for his former driver and gave apartments and offices as presents to others.

Despite his egalitarian views, Niemeyer had no illusions that his buildings were helping to improve social justice.

Far from the model city Niemeyer had envisioned, Brasilia today is in many ways the epitome of inequality. Planned for 500,000 people, the city is now home to more than 2.5 million and VIPs keep to themselves in fenced-in villas while the poor live in distant satellite towns.

“It seemed like a new era was coming, but Brazil is the same crap – a country of the very poor and the very rich,” he said in another Reuters interview in 2001.

In a 2010 interview in his office, he was quick to blame Costa for things many dislike about Brasilia, such as its rigid ordering into homogenous “hotel,” “government,” “residential” and even “mansion” and “media” districts that can make finding a newspaper or groceries a chore.

“I just did the buildings,” he said. “All that other stuff was Costa.”

Despite Niemeyer’s atheism, one of his first significant early works was a church built in homage to St. Francis, part of a complex of modern buildings in Belo Horizonte, Brazil.

That work won the confidence of the city’s mayor Juscelino Kubitschek. When he became president, he tapped Niemeyer to help realize the dream of opening up Brazil’s interior by moving the capital from coastal Rio to the empty plains of central Brazil.

Despite years of bohemian living, Niemeyer remained married for 76 years to Annita Baldo, his first wife. He married his second wife, long-time aide Vera Lucia Cabreira, in 2006 at the age of 99. She survives him, as do four grandchildren.

Niemeyer’s only daughter, an architect, designer and gallery owner, Anna Maria, died on June 6 at the age of 82.

(Additional reporting by Brian Ellsworth; Editing by Todd Benson and Kieran Murray)

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Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs might be taken for a longer duration as well.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them are in premenopausal women with estrogen receptor-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing 10 years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots, compared with 0.4 percent in the control group.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

“They don’t feel well on them, but it’s their safety net,” said Dr. Garber, who added that the news would be welcomed by many patients who would like to stay on the drug. “I have patients who agonize about this, people who are coming to the end of their tamoxifen.”

Emily Behrend, who is a few months from finishing her five years on tamoxifen, said she would definitely consider another five years. “If it can keep the cancer away, I’m all for it,” said Ms. Behrend, 39, a single mother in Tomball, Tex. She is taking the antidepressant Effexor to help control the night sweats and hot flashes caused by tamoxifen.

Cost is not considered a huge barrier to taking tamoxifen longer because the drug can be obtained for less than $200 a year.

The results, while answering one question, raise many new ones, including whether even more than 10 years of treatment would be better still.

Perhaps the most important question is what the results mean for postmenopausal women. Even many women who are premenopausal at the time of diagnosis will pass through menopause by the time they finish their first five years of tamoxifen, or will have been pushed into menopause by chemotherapy.

Postmenopausal patients tend to take aromatase inhibitors like anastrozole or letrozole, which are more effective than tamoxifen at preventing breast cancer recurrence, though they do not work for premenopausal women.

Mr. Peto said he thought the results of the Atlas study would “apply to endocrine therapy in general,” meaning that 10 years of an aromatase inhibitor would be better than five years. Other doctors were not so sure.

The Atlas study was paid for by various organizations including the United States Army, the British government and AstraZeneca, which makes the brand-name version of tamoxifen.

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ICC lets ComEd delay smart meters until 2015

The Illinois Commerce Commission on Wednesday approved ComEd's request to delay the installation of smart meters until 2015 but said it will revisit the issue in April when the utility is scheduled to file a progress report on the program.

Under massive grid modernization legislation, ComEd was supposed to begin installing smart meters this year, but the ICC cut the funds ComEd was expecting to receive under the program and the utility said it could no longer afford to install the meters that quickly. The two sides are battling in court in a process that could take years.

An administrative law judge, as well as several consumer advocacy groups, had recommended the commission not accept the delay.

Jim Chilsen, spokesman for Citizens Utility Board, said a delay is not in the best interest of consumers. According to a ComEd commissioned analysis, the delay means consumers will miss out on approximately $187 million in savings that could come from the program over 20 years and will pay $5 million more for the smart meters. Chilsen said that CUB, which had urged the commission not to delay the program, will review the order once it becomes available and that it could seek to appeal the decision before the Illinois Appeals Court.

Other aspects of smart grid installation are under way, including "smart switches" used to automatically isolate outages and reroute power to customers. However, smart meters are the most consumer facing aspect smart grid and let the utility track on a computer what customers lack power and those who have had power restored.

Without the smart meters, customers must alert ComEd to an outage. Other parts of smart grid allow ComEd to see where the power is out in general.

The smart meters were a major component in ComEd's pitch to the state legislature for massive regulatory overhaul legislation that streamlines the rate-making processto give ComEd faster and more frequent rate hikes as it undertakes the multibillion-dollar grid modernization.

jwernau@tribune.com | Twitter @littlewern

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New Illinois pension fix floated by bipartisan group

SPRINGFIELD - As state government leaders struggle to reach agreement on pension reform, a bipartisan group of lawmakers is floating a plan that's a mix of new and old ideas to try to break the logjam.

State workers, teachers, university employees and legislators would have to kick in more money from their paychecks each year to underwrite their pensions, and some of them would have to wait longer to retire.

The plan also would rein in cost-of-living increases that have exponentially increased the pension burden on taxpayers and set a 30-year target date for fully funding the financially bedraggled systems.

Some rank-and-file lawmakers led by Democratic Reps. Elaine Nekritz of Northbrook and Dan Biss of Evanston, see the approach as a way forward and are scheduled to formally unveil it Wednesday.

Union members are disappointed that workers and retirees were excluded from the discussion, but hope the proposal would represent a starting point, said Anders Lindall, spokesman for the American Federation of State, County and Municipal Employees.

The proposal contains a version of the politically problematic shift of the state's costs for suburban and Downstate school teacher pensions onto local school districts over several years. That idea is pushed by House Speaker Michael Madigan, D-Chicago, but opponents have argued it would lead to property tax increases

Under the proposal, retirees would get an annual cost-of-living increase on only the first $25,000 of their pensions, $20,000 for those who also get Social Security.

Retirement ages would not rise for people 46 and older, but a phase-in would increase retirement ages by as much as five years for people 34 and under. Current retirement ages vary, such as 60 for rank-and-file state workers and 55 for prison guards.

Employee contributions would rise 1 percentage point the first year and another 1 percentage point the second year. Contributions for rank-and-file state workers now are about 7 percent, according to the union.

The proposal also would make it clear that a failure by public employers, such as the state or a school district, would be grounds for a lawsuit if they didn't make proper annual payments --- a major reason why many public retirement systems are underfunded.

New public school teachers and state university workers would be part of a cash-balance plan, sort of a hybrid between a plan that guarantees employees a certain benefit and also partly relies on investment returns.

The plan comes as Illinois faces a pension debt of as much as $96 billion, the worst in the nation. Democratic Gov. Pat Quinn has noted that increased pension payments in the coming years could cut into how much the state has left to spend on education and other government services.

rlong@tribune.com

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Huston’s “Infrared” wins Bad Sex fiction prize

LONDON (AP) — It’s the prize no author wants to win.

Award-winning novelist Nancy Huston won Britain’s Bad Sex in Fiction award Tuesday for her novel “Infrared,” whose tale of a photographer who takes pictures of her lovers during sex proved too revealing for the judges.

The choice was announced by “Downton Abbey” actress Samantha Bond during a ceremony at the Naval & Military Club in London.

Judges of the tongue-in-cheek prize — which is run by the Literary Review magazine — said they were struck by a description of “flesh, that archaic kingdom that brings forth tears and terrors, nightmares, babies and bedazzlements,” and by a long passage that builds to a climax of “undulating space.”

Huston, who lives in Paris, was not on hand to collect her prize. In a statement read by her publicist, the 59-year-old author said she hoped her victory would “incite thousands of British women to take close-up photos of their lovers’ bodies in all states of array and disarray.”

The Canada-born Huston, who writes in both French and English, is the author of more than a dozen novels, including “Plainsong” and “Fault Lines.” She has previously won France’s Prix Goncourt prize and was a finalist for Britain’s Orange Prize for fiction by women.

She is only the third woman to win the annual Bad Sex prize, founded in 1993 to name and shame authors of “crude, tasteless and … redundant passages of sexual description in contemporary novels.”

Some critics, however, have praised the sexual passages in “Infrared.” Shirley Whiteside in the Independent on Sunday newspaper said there were “none of the lazy cliches of pornography or the purple prose of modern romantic fiction” — though she conceded the book’s sex scenes were “more perfunctory than erotic.”

Huston beat finalists including previous winner Tom Wolfe — for his passage in “Back to Blood” describing “his big generative jockey” — and Booker Prize-nominated Nicola Barker, whose novel “The Yips” compares a woman to “a plump Bakewell pudding.”

Previous recipients of the dubious honor, usually accepted with good grace, include Sebastian Faulks, the late Norman Mailer and the late John Updike, who was awarded a Bad Sex lifetime achievement award in 2008.

___

Online: http://www.literaryreview.co.uk

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Software Programs Help Doctors Diagnose, but Can’t Replace Them

SAN FRANCISCO — The man on stage had his audience of 600 mesmerized. Over the course of 45 minutes, the tension grew. Finally, the moment of truth arrived, and the room was silent with anticipation.

At last he spoke. “Lymphoma with secondary hemophagocytic syndrome,” he said. The crowd erupted in applause.

Professionals in every field revere their superstars, and in medicine the best diagnosticians are held in particularly high esteem. Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco, is considered one of the most skillful clinical diagnosticians in practice today.

The case Dr. Dhaliwal was presented, at a medical  conference last year, began with information that could have described hundreds of diseases: the patient had intermittent fevers, joint pain, and weight and appetite loss.

To observe him at work is like watching Steven Spielberg tackle a script or Rory McIlroy a golf course. He was given new information bit by bit — lab, imaging and biopsy results. Over the course of the session, he drew on an encyclopedic familiarity with thousands of syndromes. He deftly dismissed red herrings while picking up on clues that others might ignore, gradually homing in on the accurate diagnosis.

Just how special is Dr. Dhaliwal’s talent? More to the point, what can he do that a computer cannot? Will a computer ever successfully stand in for a skill that is based not simply on a vast fund of knowledge but also on more intangible factors like intuition?

The history of computer-assisted diagnostics is long and rich. In the 1970s, researchers at the University of Pittsburgh developed software to diagnose complex problems in general internal medicine; the project eventually resulted in a commercial program called Quick Medical Reference. Since the 1980s, Massachusetts General Hospital has been developing and refining DXplain, a program that provides a ranked list of clinical diagnoses from a set of symptoms and laboratory data.

And I.B.M., on the heels of its triumph last year with Watson, the Jeopardy-playing computer, is working on Watson for Healthcare.

In some ways, Dr. Dhaliwal’s diagnostic method is similar to that of another I.B.M. project: the Deep Blue chess program, which in 1996 trounced Garry Kasparov, the world’s best player at the time, to claim an unambiguous victory in the computer’s relentless march into the human domain.

Although lacking consciousness and a human’s intuition, Deep Blue had millions of moves memorized and could analyze as many each second. Dr. Dhaliwal does the diagnostic equivalent, though at human speed.

Since medical school, he has been an insatiable reader of case reports in medical journals, and case conferences from other hospitals. At work he occasionally uses a diagnostic checklist program called Isabel, just to make certain he hasn’t forgotten something. But the program has yet to offer a diagnosis that Dr. Dhaliwal missed.

Dr. Dhaliwal regularly receives cases from physicians who are stumped by a set of symptoms. At medical conferences, he is presented with one vexingly difficult case and is given 45 minutes to solve it. It is a medical high-wire act; doctors in the audience squirm as the set of facts gets more obscure and all the diagnoses they were considering are ruled out. After absorbing and processing scores of details, Dr. Dhaliwal must commit to a diagnosis. More often than not, he is right.

When working on a difficult case in front of an audience, Dr. Dhaliwal puts his entire thought process on display, with the goal of “elevating the stature of thinking,” he said. He believes this is becoming more important because physicians are being assessed on whether they gave the right medicine to a patient, or remembered to order a certain test.

Without such emphasis, physicians and training programs might forget the importance of having smart, thoughtful doctors. “Because in medicine,” Dr. Dhaliwal said, “thinking is our most important procedure.”

He added: “Getting better at diagnosis isn’t about figuring out if someone has one rare disease versus another. Getting better at diagnosis is as important to patient quality and safety as reducing medication errors, or eliminating wrong site surgery.”

Clinical Precision

Dr. Dhaliwal does half his clinical work on the wards of the San Francisco V. A. Medical Center, and the other half in its emergency department, where he often puzzles through multiple mysteries at a time.

One recent afternoon in the E.R., he was treating a 66-year-old man who was mentally unstable and uncooperative. He complained of hip pain, but routine lab work revealed that his kidneys weren’t working and his potassium was rising to a dangerous level, putting him in danger of an arrhythmia that could kill him — perhaps within hours. An ultrasound showed that his bladder was blocked.

There was work to be done: drain the bladder, correct the potassium level. It would have been easy to dismiss the hip pain as a distraction; it didn’t easily fit the picture. But Dr. Dhaliwal’s instinct is to hew to the ancient rule that physicians should try to come to a unifying diagnosis. In the end, everything — including the hip pain — was traced to metastatic prostate cancer.

“Things can shift very quickly in the emergency room,” Dr. Dhaliwal said. “One challenge of this, whether you use a computer or your brain, is deciding what’s signal and what’s noise.” Much of the time, it is his intuition that helps figure out which is which.

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United Dreamliner makes emergency landing in New Orleans

A brand-new United Airlines "Dreamliner" airplane bound for Newark was diverted Tuesday morning, making an emergency landing in New Orleans because of an undisclosed mechanical problem.

The highly acclaimed Boeing 787 Dreamliner recently began service in North America in a debut last month with United Airlines. United and Boeing are both based in Chicago.

On Tuesday, the 7:30 a.m. United flight 1146 from Houston to Newark was diverted to Louis Armstrong New Orleans International Airport and landed safely there at 9:25 a.m., the airline said. The plane, the third delivered to United recently, carried 174 customers and 10 crew members. Neither United nor Boeing would describe the problem except to say it was a "mechanical issue."

"We are reaccommodating the customers on a different aircraft to Newark," United said in a statement. "United will work with Boeing to review the diversion and determine the cause."

The Federal Aviation Administration "is looking into it," an FAA spokesman said.

Flights can be diverted for many reasons, from serious problems to a simple malfunction of a cockpit warning light. And flight diversions are not exceptionally uncommon. There were 816 diversions among large U.S. carriers in September alone and double that number in July, for example, according to federal statistics.

The 787 Dreamliner, a new-model aircraft that features greater passenger comforts and fuel efficiency compared with similar planes, is a big deal for both United and Boeing and has been highly touted by both the airline and the aircraft-maker.

However, any hint of a problem with a 787 is noticed. The plane has gotten mostly rave reviews, but is being delivered more than three years late because of design and production problems. The Dreamliner is different because instead of being made mostly of metal, half the plane, including the fuselage and wings, is made of strong, light composite materials.

gkarp@tribune.com

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Daley nephew indicted in '04 death of David Koschman

Chicago Tribune reporter Jason Meisner talks about how a Cook County grand jury indicted former Mayor Richard Daley's nephew on a charge of involuntary manslaughter in the death of David Koschman.

A special Cook County grand jury indicted former Mayor Richard Daley's nephew on a charge of involuntary manslaughter in the death of David Koschman in a drunken confrontation on the city’s Near North Side, the special prosecutor said today.

The grand jury found that Richard J. Vanecko "recklessly performed acts which were likely to cause death or great bodily harm to another" in Koschman’s death in 2004, according to the indictment.

Koschman, 21, had been drinking in the Rush Street nightlife district early on April 25 2004 when he and friends quarreled with a group that included Vanecko. During the altercation, Koschman was knocked to the street, hitting the back of his head. He died 11 days later.

Former U.S. Attorney Dan Webb, appointed special prosecutor in the case last spring, noted that at 6-foot-3 and 230 pounds, Vanecko towered over Koschman, who was 5-foot-5 and 125 pounds. There is no statute of limitations on a charge of involuntary manslaughter.

Koschman’s mother, Nanci Koschman, told a news conference that she planned to visit her son's grave and "I'm going to tell David tomorrow that he can finally have peace."

She said she refused to believe, over the years, that the fight was her son's fault, as detectives had told her. "You have to find the strength to go on," Koschman said. "I wanted his name cleared."

Koschman said she never sought vengeance, but accountability. "I want to thank the grand jury," she said. But she added, "It doesn't bring David back. And that's all I wanted."

Vanecko’s attorneys issued a statement saying they were disappointed by the indictment. According to the lawyers, Koschman’s blood-alcohol content was nearly three times the .08 legal limit for motorists – though he was on foot at the time of the confrontation.

Koschman “was clearly acting in an unprovoked, physically aggressive manner,” Vaneckos’ legal team said. “We are confident that when all the facts are aired in a court of law, the trier of fact will find Mr. Vanecko not guilty.”

Vanecko’s lawyers defended the work of police and prosecutors, saying “these agencies professionally investigate these types of incidents on a daily basis.”

“These decisions were not because of favoritism but because the facts did not warrant felony charges,” the lawyers said.

Vanecko, who currently lives in California, is expected to appear for arraignment at 9:30 a.m. Monday at the Leighton Criminal Court Building at 26th Street and California Avenue. Plans call for him to post $10,000 cash bond and be released pending trial. He faces 2 to 5 years in prison, or probation, if convicted of involuntary manslaughter.

Lawyers for Koschman’s mother sought a special prosecutor last year after an investigative series by the Chicago Sun-Times raised questions about whether police and prosecutors intentionally concealed evidence for political reasons.

In a statement released this afternoon, Webb said the grand jury continues “at a vigorous pace” to look into how authorities handled their investigation of Koschman’s death.

Locke Bowman, an attorney with Northwestern University's MacArthur Justice Center who represents Nanci Koschman, said he was encouraged that the investigation was continuing.

"Why has this taken so long?" he asked, wondering if the the clout of the powerful Daley family was at work. "Clearly, we need to have answers."

Webb said thousands of documents have been reviewed and more than 50 witnesses interviewed so far in the seven-month investigation.

Among the  issues Webb was tasked to sort out were whether clout tainted the original investigation in addition to whether Vanecko, now 38, should be charged criminally in connection with the death.

Judge Michael Toomin took the rare step of appointing Webb as a special prosecutor in April after concluding that Chicago police and county prosecutors mishandled the investigation.

The charges mark a dramatic twist in a case that seemed to fizzle out in 2004 as the investigation went nowhere.

Police initially said that witnesses gave conflicting accounts of what occurred and some claimed Koschman was the aggressor in the confrontation.

Almost two weeks after Koschman died of his injuries, a top prosecutor in the Cook County state’s attorney’s office was called to the Belmont Area headquarters on the day detectives put Vanecko in several lineups, all of which police said ended with witnesses failing to identify him as the assailant.

Vanecko had come to the station with his attorney, Terence Gillespie, who told police his client would not answer questions.

Dan Kirk, chief of staff for current State’s Attorney Anita Alvarez told the Tribune in an interview earlier this year that there was no admissible evidence that could have been used to file charges at the time.

Kirk said police had no positive identification from any of the lineups they conducted, no statements from the main suspect, no statement from the victim and no physical evidence.

jmeisner@tribune.com

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