Alzheimer’s Tied to Mutation Harming Immune Response

Alzheimer’s researchers and drug companies have for years concentrated on one hallmark of Alzheimer’s disease: the production of toxic shards of a protein that accumulate in plaques on the brain.

But now, in a surprising coincidence, two groups of researchers working from entirely different starting points have converged on a mutated gene involved in another aspect of Alzheimer’s disease: the immune system’s role in protecting against the disease. The mutation is suspected of interfering with the brain’s ability to prevent the buildup of plaque.

The discovery, researchers say, provides clues to how and why the disease progresses. The gene, known as TREM2, is only the second found to increase Alzheimer’s risk substantially in older people.

“It points very specifically to a potential metabolic pathway that you could intervene in to change the course of Alzheimer’s disease,” said William Thies, chief medical and scientific officer of the Alzheimer’s Association.

Much work remains to be done before scientists understand precisely how the newly discovered gene mutation leads to Alzheimer’s, but already there are some indications from studies in mice. When the gene is not mutated, white blood cells in the brain spring into action, gobbling up and eliminating the plaque-forming toxic protein, beta amyloid. As a result, Alzheimer’s can be staved off or averted.

But when the gene is mutated, the brain’s white blood cells are hobbled, making them less effective in their attack on beta amyloid.

People with the mutated gene have a threefold to fivefold increase in the likelihood of developing Alzheimer’s disease in old age.

The intact gene, says John Hardy of University College London, “is a safety net.” And those with the mutation, he adds, “are living life without a safety net.” Dr. Hardy is lead author of one of the papers.

The discovery also suggests that a new type of drug could be developed to enhance the gene’s activity, perhaps allowing the brain’s white blood cells to do their work.

“The field is in desperate need of new therapeutic agents,” said Alison Goate, an Alzheimer’s researcher at Washington University in St. Louis who contributed data to Dr. Hardy’s study. “This will give us an alternative approach.”

The fact that two research groups converged on the same gene gives experts confidence in the findings. Both studies were published online Wednesday in The New England Journal of Medicine. “Together they make a good case that this really is an Alzheimer’s gene,” said Gerard Schellenberg, an Alzheimer’s researcher at the University of Pennsylvania who was not involved with the work.

The other gene found to raise the odds that a person will get Alzheimer’s, ApoE4, is much more common and confers about the same risk as the mutated version of TREM2. But it is still not clear why ApoE4, discovered in 1993, makes Alzheimer’s more likely.

Because the mutations in the newly discovered gene are rare, occurring in no more than 2 percent of Alzheimer’s patients, it makes no sense to start screening people for them, Dr. Thies said. Instead, the discovery provides new clues to the workings of Alzheimer’s disease.

To find the gene, a research group led by Dr. Kari Stefansson of deCODE Genetics of Iceland started with a simple question.

“We asked, ‘Can we find anything in the genome that separates those who are admitted to nursing homes before the age of 75 and those who are still living at home at 85?’ ” he said.

Scientists searched the genomes of 2,261 Icelanders and zeroed in on TREM2. Mutations in that gene were more common among people with Alzheimer’s, as well as those who did not have an Alzheimer’s diagnosis but who had memory problems and might be on their way to developing Alzheimer’s.

The researchers confirmed their results by looking for the gene in people with and without Alzheimer’s in populations studied at Emory University, as well as in Norway, the Netherlands and Germany.

The TREM2 connection surprised Dr. Stefansson. Although researchers have long noticed that the brain is inflamed in Alzheimer’s patients, he had dismissed inflammation as a major factor in the disease.

“I was of the opinion that the immune system would play a fairly small role, if any, in Alzheimer’s disease,” Dr. Stefansson said. “This discovery cured me of that bias.”

Meanwhile, Dr. Hardy and Rita Guerreiro at University College London, along with Andrew Singleton at the National Institute on Aging, were intrigued by a strange, rare disease. Only a few patients had been identified, but their symptoms were striking. They had crumbling bones and an unusual dementia, sclerosing leukoencephalopathy.

“It’s a weird disease,” Dr. Hardy said.

He saw one patient in her 30s whose brain disease manifested in sexually inappropriate behavior. Also, her bones kept breaking. The disease was caused by mutations that disabled both the copy of TREM2 that she had inherited from her mother and the one from her father.

Eventually the researchers searched for people who had a mutation in just one copy of TREM2. To their surprise, it turned out that these people were likely to have Alzheimer’s disease.

They then asked researchers around the world who had genetic data from people with and without Alzheimer’s to look for TREM2 mutations.

“Sure enough, they had good evidence,” Dr. Hardy said. The mutations occurred in one-half of 1 percent of the general population but in 1 to 2 percent of patients with Alzheimer’s disease.

“That is a big effect,” Dr. Hardy said.

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Obama Meets C.E.O.’s as Fiscal Reckoning Nears

Luke Sharrett for The New York Times

Ursula M. Burns, chief of Xerox, said the president discussed few specifics of a potential agreement but emphasized that “we cannot go over the fiscal cliff.”

WASHINGTON — President Obama extended an olive branch to business leaders Wednesday, seeking their support as he prepared to negotiate with Congressional Republicans over the fiscal impasse in Washington.

If Congress and the president cannot reach a deal to reduce the deficit by January, more than $600 billion in tax increases and spending cuts will go into effect immediately — a prospect many chief executives and others warn could tip the economy back into recession.

Even so, Mr. Obama has some fence-mending to do before he can count on any serious backing from the business community.

“The president brought up that he hadn’t always had the best relationship with business, and he didn’t think he deserved that, but he understood that’s where things were and wanted it to be better,” said David M. Cote, chief executive of Honeywell. He was one of a dozen corporate leaders invited to meet Mr. Obama at the White House for 90 minutes Wednesday afternoon, after the president’s first news conference since the election.

While Mr. Obama did not present a detailed plan at Wednesday’s meeting or reveal what he would propose in terms of new corporate taxes, he strongly reiterated that he would not allow tax cuts for the middle class to expire. The president, according to attendees and aides, said he was committed to a balanced approach of reductions in entitlements and other government spending and increases in revenue.

With time running out, many people expect the president and Republican leaders in Congress to come up with a short-term compromise that prevents the full slate of tax increases and spending cuts from hitting in January. That would give both sides more time to come up with a far-reaching deal on entitlement spending, even as they work on a broad tax overhaul later next year.

One corporate official briefed on the meeting said that the chief executives came away with a sense that Mr. Obama was poised to present a more formal proposal in the next few days, but that he did not press them for support on particular policies. “It was more of a back and forth,” he said.

The chief executives from some of the country’s biggest and best-known companies, including Procter & Gamble and I.B.M., were not unified on everything, according to one who was interviewed after the meeting.

Many of the executives who described the meeting would speak only on condition of anonymity.

The outreach to business comes as both the White House and corporate America maneuver ahead of the year-end deadline, as well as the beginning of Mr. Obama’s second term. Many executives were put off by what they saw as antibusiness rhetoric coming from the White House in his first term, and many also oppose tax increases on the rich that Mr. Obama favors but would hit them personally.

Both sides have plenty to gain from a better relationship. Business leaders want to buffer their image after the recession and the financial crisis, while Mr. Obama would gain valuable leverage if he could persuade even a few chief executives to come out in favor of higher taxes on people with incomes over $250,000.

Lloyd C. Blankfein, chief executive of Goldman Sachs, publicly endorsed higher tax rates in an opinion article published in The Wall Street Journal on Wednesday.

“I believe that tax increases, especially for the wealthiest, are appropriate, but only if they are joined by serious cuts in discretionary spending and entitlements,” he wrote.

While Mr. Blankfein and other Wall Street leaders have been speaking out about the dangers of the fiscal impasse, only one executive from the financial services industry, Kenneth I. Chenault of American Express, was at Wednesday’s meeting.

Afterward, the corporate leaders seemed pleased with the tone of the meeting but cautious about the prospect of finding common ground with the White House on the budget choices facing Congress and the president.

“I’d say everybody came away feeling pretty good about the whole discussion,” Mr. Cote said. “Now, all of us are C.E.O.’s, so we’ve learned not to confuse words with results. And that’s what we still need to see.”

Ursula M. Burns, chief executive of Xerox, who was also at the meeting, said afterward that it was clear that “we’re going to have to work through some sticking points.” But while “we didn’t get into too many specifics,” she said, it was also made clear that “we cannot go over the fiscal cliff.”

Ms. Burns’s comments about the potentially dire consequences of the fiscal impasse echoed those of other chief executives, including many in the Business Roundtable, which began an ad campaign Tuesday calling on lawmakers to resolve the issue quickly. The Campaign to Fix the Debt, a new group with a $40 million budget and the support of many Fortune 500 chiefs, began its own ad campaign on Monday.

Michael T. Duke, chief executive of Wal-Mart Stores, warned in a statement after the meeting that “before the end of the year, Washington needs to find an agreement to avoid the fiscal cliff.” He said Walmart customers “are working hard to adapt to the ‘new normal,’ but their confidence is still very fragile. They are shopping for Christmas now, and they don’t need uncertainty over a tax increase.”

 

Helene Cooper reported from Washington and Nelson D. Schwartz from New York. Jackie Calmes contributed reporting from Washington.

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France Grants Its Recognition to Syria Rebels

Javier Manzano/Agence France-Presse — Getty Images

Smoke billowed from burning tires as a Syria rebel fired towards regime forces during clashes in the Al-Amariya district of Aleppo in Syria on Tuesday.

PARIS — France announced Tuesday that it was recognizing the newly formed Syrian rebel coalition and would consider arming the group, seeking to inject momentum into a broad Western and Arab effort to build a viable and effective opposition that would hasten the end of a stalemated civil war that has destabilized the Middle East.

The announcement by President François Hollande made France the first Western country to fully embrace the new coalition, which came together this past weekend under Western pressure after days of difficult negotiations in Doha, Qatar.

The goal was to make an opposition leadership — both inside and outside the country — representative of the array of Syrian groups pressing for the downfall of President Bashar al-Assad. Although Mr. Assad is increasingly isolated as his country descends further into mayhem and despair after 20 months of conflict, he has survived partly because of the disagreements and lack of unity among his opponents.

Throughout the conflict, the West has taken half measures and been reluctant to back an aggressive effort to oust Mr. Assad. This appears to be the first time that Western nations, with Arab allies, are determined to build a viable opposition leadership that can ultimately function as a government. Whether it can succeed remains unclear.

Mr. Hollande went beyond other Western pledges of support for the new Syrian umbrella rebel group, which calls itself the National Coalition of Syrian Revolutionary and Opposition Forces. But Mr. Hollande’s announcement clearly signaled expectations that if the group can establish political legitimacy and an operational structure inside Syria, creating an alternative to the Assad family’s four decades in power, it will be rewarded with further recognition, money and possibly weapons.

“I announce that France recognizes the Syrian National Coalition as the sole representative of the Syrian people and thus as the future provisional government of a democratic Syria and to bring an end to Bashar al-Assad’s regime,” said Mr. Hollande, who has been one of the Syrian president’s harshest critics.

As for weapons, Mr. Hollande said, France had not supported arming the rebels up to now, but “with the coalition, as soon as it is a legitimate government of Syria, this question will be looked at by France, but also by all countries that recognize this government.”

Political analysts called Mr. Hollande’s announcement an important moment in the Syrian conflict, which began as a peaceful Arab Spring uprising in March 2011. It was harshly suppressed by Mr. Assad, turned into a civil war and has left nearly 40,000 Syrians dead, displaced about 2.5 million and forced more than 400,000 to flee to neighboring countries, according to international relief agencies.

“It’s certainly another page of the story,” Augustus Richard Norton, a professor of international relations at Boston University and an expert on Middle East political history, said of the French announcement. “I think it’s important. But it will be much more important if other countries follow suit. I don’t think we’re quite there yet.”

Some drew an analogy to France’s leading role in the early days of the Libyan uprising when it helped funnel aid, and later military support, to the rebels who had firmly established themselves in eastern Libya and would later topple Col. Muammar el-Qaddafi. But in Syria, rebels have not been as organized and have no hold on significant amounts of territory — at least not enough to create a provisional government that could resist Mr. Assad’s military assaults. The West has also refused, so far, to impose a no-fly zone over Syria, which was critical to the success of the Libyan uprising.

Andrew J. Tabler, a Syria expert at the Washington Institute for Near East Policy, said that the new coalition would have to create a secure zone in Syria to be successful, and that that step would require support from the United States, which was instrumental in the negotiations that led to the group’s creation but has not yet committed to giving it full recognition.

What the French have done, Mr. Tabler said, is significant because they have started the process of broader recognition, putting pressure on the group to succeed. “They’ve decided to back this umbrella organization and hope that it has some kind of political legitimacy and keep it from going to extremists,” he said. “It’s a gamble. The gamble is that it will stiffen the backs of the opposition.”

Steven Erlanger reported from Paris, and Rick Gladstone from New York. Reporting was contributed by Neil MacFarquhar and Hwaida Saad from Beirut, Lebanon; Nick Cumming-Bruce from Geneva; and Richard Berry from Paris.

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AP source: Marlins trade 3 stars to Blue Jays

MIAMI (AP) — Reacting to the Miami Marlins' latest payroll purge on Twitter, slugger Giancarlo Stanton gave it three exclamation marks.

He wasn't exaggerating. The Marlins' spending spree a year ago didn't work, so they went the salary-dumping route again Tuesday, shedding some of their biggest stars and multimillion-dollar salaries in one blockbuster deal.

The Marlins swapped high-priced talent for top prospects, trading All-Star shortstop Jose Reyes, left-hander Mark Buehrle and ace right-hander Josh Johnson to the Toronto Blue Jays, a person familiar with the agreement said.

The person confirmed the trade to The Associated Press on condition of anonymity because the teams weren't officially commenting. The person said the trade sent several of the Blue Jays' best young players to Miami.

The stunning agreement came less than a year after the Marlins added Reyes, Buehrle and closer Heath Bell in an uncharacteristic $191 million spending binge as they rebranded and moved into a new ballpark. The acquisitions raised high hopes, but the Marlins instead finished last in the NL East.

Salary-paring actually began in July, when the Marlins parted with former NL batting champion Hanley Ramirez, second baseman Omar Infante and right-hander Anibal Sanchez, among others. Bell, the team's high-profile bust, was traded to Arizona last month.

Under owner Jeffrey Loria, long the target of fan acrimony, the Marlins have usually been among baseball's thriftiest teams. Management pledged that would change with the new ballpark, but team officials were disappointed with attendance in 2012, and revenue fell far short of their projections.

Even so, the blockbuster deal came as a shock. The players involved must undergo physicals before the trade becomes final.

Stanton, the Marlins' precocious slugger, wasn't involved in the deal but wasn't happy about it.

"Alright, I'm (mad)!!! Plain & Simple," he tweeted shortly after the news broke.

The housecleaning was also the subject of much mirth on Twitter.

"Good trade, I think we won it," tweeted FakeSamson, a site that mocks team president David Samson.

Toronto star Jose Bautista had a different interpretation.

"Its a good day to be a bluejay!" he tweeted.

The swap was easier for the Marlins to swing because of their longstanding policy of refusing to include no-trade clauses in contracts.

The deal gave an immediate boost to the Blue Jays, who have not reached the playoffs since winning their second consecutive World Series in 1993. Toronto went 73-89 this season and finished fourth in the AL East for the fourth straight year, again falling short in a division that includes big spenders.

The Marlins changed their name a year ago but failed to change their losing ways, and instead of contending for a playoff berth, they finished 69-93, their worst record since 1999.

The Marlins drew more than 2.2 million fans but had projected attendance of nearly 3 million. Team officials blamed the difference in part on manager Ozzie Guillen's laudatory comments early in the year about former Cuban leader Fidel Castro, which antagonized a large segment of an already-small fan base.

Guillen was fired after only one season with the team and replaced this month by the Marlins' former backup catcher, Mike Redmond.

President of baseball operations Larry Beinfest hinted at a big change in direction less than two weeks ago.

"We've kind of lost our Marlins way," he said. "The real Marlins way was we always outperformed our challenges. Whatever our challenges were, whether it was playing in a football stadium or weather or a lack of fans, or lack of revenue for that matter, we always found a way to outperform our challenges."

It now appears management will field a team with the expectation players will outperform their contracts, which was the franchise model for most of the past decade. The roster shake-up during the season reduced the payroll to $90.3 million from $112 million on opening day, and now could be dramatically lower next season.

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Recipes for Health: Roasted Eggplant and Chickpeas — Recipes for Health

Andrew Scrivani for The New York Times

Eggplant is always a good, substantial vegetable to use for a vegetarian main dish. The chickpeas and the feta provide plenty of protein. Vegans can leave out the feta and substitute sugar or agave nectar for the honey.

 

1/4 cup extra virgin olive oil

2 garlic cloves, minced

1 28-ounce can chopped tomatoes, with juice, pulsed to a coarse purée

1 teaspoon mild honey (more to taste)

1/4 to 1/2 teaspoon cinnamon, to taste

Salt to taste

1 large or 2 medium eggplants (about 1 1/4 pounds), cut into 1/3-inch-thick slices

3 cups cooked chickpeas (2 cans, drained and rinsed, or, 1 1/2 cups dried – about 3/4 pound

4 ounces feta, crumbled (3/4 cup)

1 teaspoon dried oregano, preferably Greek or Turkish

 

1. Make the tomato sauce. Heat 1 tablespoon of the olive oil in a heavy skillet or wide saucepan over medium heat, and add the garlic. Cook, stirring, until it smells fragrant, about 30 seconds, and add the tomatoes, honey, salt to taste and cinnamon. Cook over medium heat until the tomatoes have cooked down and the sauce is fragrant, about 20 minutes. Taste and adjust seasonings.

2. Meanwhile, heat the oven to 425 degrees. Line a baking sheet with aluminum foil and brush the boil with olive oil. Place the eggplant slices on the baking sheet, salt lightly and brush with olive oil. Place in the oven and bake 20 minutes, or until eggplant is lightly browned and soft all the way through. Remove from the heat. Fold the aluminum foil over and crimp the edges together so that the eggplant steams as it cools. Do this in batches if you need more than one baking sheet. Turn the oven down to 350 degrees.

3. Oil a 2-quart baking dish or gratin. Place the chickpeas in the baking dish and stir in 1 cup of the tomato sauce. Layer the eggplant over the chickpeas and top with the remaining tomato sauce. Sprinkle the feta over the top and drizzle on any remaining olive oil. Sprinkle with the oregano and cover tightly with foil. Bake 30 minutes. Uncover and bake another 10 minutes, until the dish is bubbling.

Yield: 6 servings

Advance preparation: The eggplant slices can be cooked up to a day ahead. Hold in the refrigerator, covered. The tomato sauce will keep for 3 days in the refrigerator and freezes well.

Nutritional information per serving: 366 calories; 16 grams fat; 4 grams saturated fat; 2 grams polyunsaturated fat; 8 grams monounsaturated fat; 17 milligrams cholesterol; 44 grams carbohydrates; 14 grams dietary fiber; 431 milligrams sodium (does not include salt to taste); 15 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health

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At Microsoft, Sinofsky Seen as Smart but Abrasive

On a warm night in late October, Steven Sinofsky stood on a platform in New York’s Times Square, smiling as a huge crowd roared at the unveiling of a Microsoft retail store, where Windows 8 and the company’s new Surface tablet were about to go on sale.

Less than three weeks later, Mr. Sinofsky — who, as the head of Windows, was arguably the second-most important leader at Microsoft — suddenly left the company. His abrasive style was a source of discord within Microsoft, and he and Steven A. Ballmer, Microsoft’s chief executive, agreed that it was time for him to leave, according to a person briefed on the situation who was not authorized to speak publicly about it.

Mr. Sinofsky was widely admired for his effectiveness in running one of the biggest and most important software development organizations on the planet. But his departure, which Microsoft announced late on Monday, parallels in many respects that of Scott Forstall, the headstrong former head of Apple’s mobile software development, who was fired by Apple’s chief executive, Timothy D. Cook, in late October.

Both cases underscore a quandary that chief executives sometimes face: when do the costs of keeping brilliant leaders who cannot seem to get along with others outweigh the benefits?

The tipping point that led to Mr. Sinofsky’s departure came after an accumulation of run-ins with Mr. Ballmer and other company leaders, rather than a single incident, according to interviews with several current and former Microsoft executives who declined to be named discussing internal matters.

One example of the kind of behavior that hurt Mr. Sinofsky’s standing at the company occurred this year at a two-day retreat for Microsoft’s senior executives at the Semiahmoo resort on the coast just below the Canadian border in Washington State. At the meeting, Microsoft’s various division heads were expected to make presentations on their businesses, answer questions and remain to hear their peers repeat the exercise.

When Mr. Sinofsky stood on the first day to speak about the Windows division, he told the group he had not prepared a presentation, and if they wanted to catch up on the progress of Windows 8, they could read his company blog, where he publicly chronicled the software’s development. He answered questions from the audience and then left the resort, while his colleagues remained until the next day, according to multiple people who were present.

Mr. Sinofsky’s early exit and halfhearted presentation were widely noted by his colleagues, irking even his admirers in the company. “He lost a lot of support,” one attendee said.

It wasn’t until this Monday, though, that Mr. Sinofsky and Mr. Ballmer both decided it would be best if Mr. Sinofsky left. Bill Gates, Microsoft’s chairman, supported the move, a person briefed on the matter said. Mr. Sinofsky served as a technical assistant to Mr. Gates in the 1990s.

In an e-mail to Microsoft employees, Mr. Sinofsky said the decision to leave “was a personal and private choice.” Many surprised Microsoft insiders noted that Mr. Sinofsky’s departure was immediate, an unusual arrangement for someone with a 23-year track record at the company. A Microsoft spokesman, Frank Shaw, said Mr. Sinofsky was not available to comment.

Although Mr. Ballmer grew increasingly impatient with Mr. Sinofsky throughout the year, he held back from taking any action earlier to avoid disrupting the release of Windows 8, the most important product Microsoft has unveiled in years, a person with knowledge of his thinking said.

The final decision could not have come lightly. Although many people at Microsoft viewed him as a ruthless corporate schemer, Mr. Sinofsky ran the highly complex organization responsible for Windows as a disciplined army that met deadlines, and he was respected by people on his team.

He achieved hero status within Microsoft several years ago by taking over the leadership of Windows after the debacle that was Windows Vista, a much-delayed operating system whose sluggish performance and technical problems worsened Microsoft’s reputation for mediocre software. Mr. Sinfosky led the development of a new version of the operating system, Windows 7, which was positively reviewed and sold well.

“He did great things with Windows,” said Michael Cusumano, a professor at the Sloan School of Management at the Massachusetts Institute of Technology. “That’s still the core of the company.”

But while Mr. Sinofsky was effective, Mr. Cusumano said, he could be secretive and difficult to get along with, as he learned while dealing with Mr. Sinofsky while Mr. Cusumano was writing a book on Microsoft in the early 1990s. “I could imagine that he burned a lot of bridges and created a bunch of enemies,” he said.

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Afghan Warlord Ismail Khan’s Call to Arms Rattles Kabul

Bryan Denton for The New York Times

Mujahedeen commanders at a gathering in Herat, Afghanistan, to address the threat to security posed by the Taliban.

HERAT, Afghanistan — One of the most powerful mujahedeen commanders in Afghanistan, Ismail Khan, is calling on his followers to reorganize and defend the country against the Taliban as Western militaries withdraw, in a public demonstration of faltering confidence in the national government and the Western-built Afghan National Army.

Mr. Khan is one of the strongest of a group of warlords who defined the country’s recent history in battling the Soviets, the Taliban and one another, and who then were brought into President Hamid Karzai’s cabinet as a symbol of unity. Now, in announcing that he is remobilizing his forces, Mr. Khan has rankled Afghan officials and stoked fears that other regional and factional leaders will follow suit and rearm, weakening support for the government and increasing the likelihood of civil war.

This month, Mr. Khan rallied thousands of his supporters in the desert outside Herat, the cultured western provincial capital and the center of his power base, urging them to coordinate and reactivate their networks. And he has begun enlisting new recruits and organizing district command structures.

“We are responsible for maintaining security in our country and not letting Afghanistan be destroyed again,” Mr. Khan, the minister of energy and water, said at a news conference over the weekend at his office in Kabul. But after facing criticism, he took care not to frame his action as defying the government: “There are parts of the country where the government forces cannot operate, and in such areas the locals should step forward, take arms and defend the country.”

President Karzai and his aides, however, were not greeting it as an altruistic gesture. The governor of Herat Province called Mr. Khan’s reorganization an illegal challenge to the national security forces. And Mr. Karzai’s spokesman, Aimal Faizi, tersely criticized Mr. Khan.

“The remarks by Ismail Khan do not reflect the policies of the Afghan government,” Mr. Faizi said. “The government of Afghanistan and the Afghan people do not want any irresponsible armed grouping outside the legitimate security forces structures.”

In Kabul, Mr. Khan’s provocative actions have played out in the news media and brought a fierce reaction from some members of Parliament, who said the warlords were preparing to take advantage of the American troop withdrawal set for 2014.

“People like Ismail Khan smell blood,” Belqis Roshan, a senator from Farah Province, said in an interview. “They think that as soon as foreign forces leave Afghanistan, once again they will get the chance to start a civil war, and achieve their ominous goals of getting rich and terminating their local rivals.”

Indeed, Mr. Khan’s is not the only voice calling for a renewed alliance of the mujahedeen against the Taliban, and some of the others are just as familiar.

Marshal Muhammad Qasim Fahim, an ethnic Tajik commander who is President Karzai’s first vice president, said in a speech in September, “If the Afghan security forces are not able to wage this war, then call upon the mujahedeen.”

Another prominent mujahedeen fighter, Ahmad Zia Massoud, said in an interview at his home in Kabul that people were worried about what was going to happen after 2014, and he was telling his own followers to make preliminary preparations.

“They don’t want to be disgraced again,” Mr. Massoud said. “Everyone tries to have some sort of Plan B. Some people are on the verge of rearming.”

He pointed out that it was significant that the going market price of Kalashnikov assault rifles had risen to about $1,000, driven up by demand from a price of $300 a decade ago. “Every household wants to have an AK-47 at home,” he said.

“The mujahedeen come here to meet me,” Mr. Massoud added. “They tell me they are preparing. They are trying to find weapons. They come from villages, from the north of Afghanistan, even some people from the suburbs of Kabul, and say they are taking responsibility for providing private security in their neighborhood.”

Habib Zahori and Jawad Sukhanyar contributed reporting from Herat, Afghanistan, and an employee of The New York Times from Kabul.

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Roethlisberger hurt, Steelers survive Chiefs 16-13

PITTSBURGH (AP) — The Pittsburgh Steelers are right where they expected to be heading into a vital three-week stretch that includes two games against the AFC North-leading Baltimore Ravens.

They're just not sure quarterback Ben Roethlisberger will be along for the ride.

The Steelers survived a scare from lowly Kansas City on Monday night, winning 16-13 in overtime when Lawrence Timmons intercepted Matt Cassel on the second snap of the extra session and Shaun Suisham hit a 23-yard field goal one play later.

It took some of the sting out of watching Roethlisberger head to the locker room — and ultimately the hospital — with a busted right shoulder after getting slammed to the turf by a pair of Kansas City linebackers in the third quarter.

Coach Mike Tomlin declined to speculate on Roethlisberger's status, though backup Byron Leftwich sounds like he's planning to be pretty busy over the next few days.

"I don't know the situation with Ben, but I got to make sure I'm ready if he can't go," Leftwich said.

The Steelers (6-3) have won four straight and can move into first place next week if they can beat the Ravens (7-2). The showdown takes on a different hue with Roethlisberger's health in question.

"You obviously worry about it because that's your starting quarterback, you want to see him out there," Pittsburgh linebacker James Harrison said. "But at the same point in time you've got a guy, two guys that are behind him can do the job just as well if not better."

Roethlisberger completed 9 of 18 passes for 84 yards and a touchdown before leaving. Leftwich, playing for the first time in the regular season in nearly two years, completed 7 of 14 passes for 73 yards and led the Steelers to a go-ahead field goal in the fourth quarter.

"After four or five plays, it was like riding a bike," Leftwich said. "I took a few hits. I hadn't hit the ground in a while. It was a whole lot of things I hadn't done in a while. It was good."

Even if Roethlisberger was not. Tackle Max Starks didn't think the notoriously gritty Roethlisberger was in any real danger when he stood up after getting sandwiched between Tamba Hali and Justin Houston.

"It didn't seem like a tough hit ... but he came to the sideline and next thing you know he was gone," Starks said. "I'm hoping it was nothing serious. Honestly it didn't seem like it."

While the Steelers ponder their postseason prospects with Roethlisberger uncertain, the Chiefs (1-8) are simply wondering when they're going to win another game.

Jamaal Charles ran for 100 yards and a score but couldn't stop Kansas City from dropping its sixth straight.

The Chiefs had their chances, taking their first lead in regulation all season in the first half then overcoming a series of embarrassing miscues to tie the game at 13 at the end of regulation.

Taking over at the Kansas City 20 with 1:51 remaining, Cassel led the Chiefs 52 yards — converting a fourth-and-15 in the process — to set up a 46-yard field goal by Ryan Succop as time expired.

"I thought our guys played and competed all night long," Cassel said. "We went up against a good football team and unfortunately we weren't able to pull it out in the end, but I thought the way the guys handled the environment of Monday Night Football was great."

Kansas City's only other victory this season came in overtime, a stunning upset in New Orleans in September. Any chance at a repeat faded when Cassel's pass on the second play of extra period landed in the hands of Timmons, who returned it 23 yards to set up Suisham's second game-winning field goal of the season.

It was sweet vindication for a Pittsburgh defense that allowed AFC lesser lights Tennessee and Oakland mount fourth-quarter comebacks earlier this season. Though the Steelers only managed to get the Chiefs — last in the NFL in turnover differential — to cough it up once, timing is everything.

"We got the one that count baby," linebacker Larry Foote said. "We got the one that count. They did a good job tonight, but we got the one that was big time."

NOTES: The Steelers have won 15 consecutive home games on Monday night ... Roethlisberger topped 1,000 career rushing yards with a 13-yard scramble in the first half ... Pittsburgh S Ryan Clark left the game in the fourth quarter with a concussion.

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Online: http://pro32.ap.org/poll and http://twitter.com/AP_NFL

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Lance Armstrong Cuts Officials Ties With His Livestrong Charity

In the wake of being stripped of his seven Tour de France titles for doping, Lance Armstrong last week cut all official ties with Livestrong, the charity he founded 15 years ago while he was treated for testicular cancer.

On Nov. 4, he resigned from the organization’s board of directors; he had previously stepped down as the chairman of the board Oct. 17. He has distanced himself from the charity to try to protect it from any damage caused by his doping controversy, the new board chairman, Jeff Garvey, said in a statement.

“Lance Armstrong was instrumental in changing the way the world views people affected by cancer,” Garvey said. “His devotion to serving survivors is unparalleled, and for 15 years, he committed himself to that cause with all his heart.”

Garvey said that the Armstrong family had donated nearly $7 million to the foundation and that the organization under Armstrong had raised close to $300 million to serve cancer survivors.

Last month, the United States Anti-Doping Agency made public its evidence in its doping case against Armstrong, saying he had doped and encouraged his teammates to dope so they could help him win races. He was subsequently barred from Olympic sports for life and was stripped of all the cycling titles he won from August 1998 on.

Since then, Armstrong has spent several weeks in Hawaii, out of the public eye. On Saturday, though, he posted a photograph on Twitter showing him at home in Austin, Tex. He is lounging on a couch with his seven yellow Tour jerseys framed on the wall in the background.

In the post, he said, “Back in Austin and just layin’ around.” The photograph had more than 400,000 page views as of Monday evening, with many people posting negative comments on the page.

“Lance, you have no moral conscious and it’s obvious many of your followers don’t either,” said one person who went by the Twitter handle “irobot,” who also posted that Armstrong needed “professional help.”

A person posting under the name “Aumann” said: “An art thief enjoying all his da Vincis.”

Other people posted words of support, including many who said they still thought Armstrong was the top cyclist in history.

“TomShelton” said of Armstrong’s seven Tour titles, “You earned all 7 of them no matter what is being said about you!”

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False Posts on Facebook Undermine Its Credibility

SAN FRANCISCO — The Facebook page for Gaston Memorial Hospital, in Gastonia, N.C., offers a chicken salad recipe to encourage healthy eating, tips on avoiding injuries at Zumba class, and pictures of staff members dressed up at Halloween. Typical stuff for a hospital in a small town.

But in October, another Facebook page for the hospital popped up. This one posted denunciations of President Obama and what it derided as “Obamacare.” It swiftly gathered hundreds of followers, and the anti-Obama screeds picked up “likes.” Officials at the hospital, scrambling to get it taken down, turned to their real Facebook page for damage control. “We apologize for any confusion,” they posted on Oct. 8, “and appreciate the support of our followers.”

The fake page came down 11 days later, as mysteriously as it had come up. The hospital says it has no clue who was behind it.

Fakery is all over the Internet. Twitter, which allows pseudonyms, is rife with fake followers, and has been used to spread false rumors, as it was during Hurricane Sandy. False reviews are a constant problem on consumer Web sites.

Gaston Memorial’s experience is an object lesson in the problem of fakery on Facebook. For the world’s largest social network, it is an especially acute problem, because it calls into question its basic premise. Facebook has sought to distinguish itself as a place for real identity on the Web. As the company tells its users: “Facebook is a community where people use their real identities.” It goes on to advise: “The name you use should be your real name as it would be listed on your credit card, student ID, etc.”

Fraudulent “likes” damage the trust of advertisers, who want clicks from real people they can sell to and whom Facebook now relies on to make money. Fakery also can ruin the credibility of search results for the social search engine that Facebook says it is building.

Facebook says it has always taken the problem seriously, and recently stepped up efforts to cull fakes from the site. “It’s pretty much one of the top priorities for the company all the time,” said Joe Sullivan, who is in charge of security at Facebook.

The fakery problem on Facebook comes in many shapes. False profiles are fairly easy to create; hundreds can pop up simultaneously, sometimes with the help of robots, and often they persuade real users into friending them in a bid to spread malware. Fake Facebook friends and likes are sold on the Web like trinkets at a bazaar, directed at those who want to enhance their image. Fake coupons for meals and gadgets can appear on Facebook newsfeeds, aimed at tricking the unwitting into revealing their personal information.

Somewhat more benignly, some college students use fake names in an effort to protect their Facebook content from the eyes of future employers.

Mr. Sullivan declined to say what portion of the company’s now one billion plus users were fake. The company quantified the problem last June, in responding to an inquiry by the Securities and Exchange Commission. At that time, the company said that of its 855 million active users, 8.7 percent, or 83 million, were duplicates, false or “undesirable,” for instance, because they spread spam.

Mr. Sullivan said that since August, the company had put in place a new automated system to purge fake “likes.” The company said it has 150 to 300 staff members to weed out fraud.

Flags are raised if a user sends out hundreds of friend requests at a time, Mr. Sullivan explained, or likes hundreds of pages simultaneously, or most obvious of all, posts a link to a site that is known to contain a virus. Those suspected of being fakes are warned. Depending on what they do on the site, accounts can be suspended.

In October, Facebook announced new partnerships with antivirus companies. Facebook users can now download free or paid antivirus coverage to guard against malware.

“It’s something we have been pretty effective at all along,” Mr. Sullivan said.

Facebook’s new aggressiveness toward fake “likes” became noticeable in September, when brand pages started seeing their fan numbers dip noticeably. An average brand page, Facebook said at the time, would lose less than 1 percent of its fans.

But the thriving market for fakery makes it hard to keep up with the problem. Gaston Memorial, for instance, first detected a fake page in its name in August; three days later, it vanished. The fake page popped up again on Oct. 4, and this time filled up quickly with the loud denunciations of the Obama administration. Dallas P. Wilborn, the hospital’s public relations manager, said her office tried to leave a voice-mail message for Facebook but was disconnected; an e-mail response from the social network ruled that the fake page did not violate its terms of service. The hospital submitted more evidence, saying that the impostor was using its company logo.

Eleven days later, the hospital said, Facebook found in its favor. But by then, the local newspaper, The Gaston Gazette, had written about the matter, and the fake page had disappeared.

Facebook declined to comment on the incident, and pointed only to its general Statement of Rights and Responsibilities.

The election season seems to have increased the fakery.

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