‘Bloodless’ Lung Transplants for Jehovah’s Witnesses

Eric Kayne for The New York Times

SHARING HOME AND FAITH A Houston couple hosted Gene and Rebecca Tomczak, center, in October so she could get care nearby.

HOUSTON — Last April, after being told that only a transplant could save her from a fatal lung condition, Rebecca S. Tomczak began calling some of the top-ranked hospitals in the country.

She started with Emory University Hospital in Atlanta, just hours from her home near Augusta, Ga. Then she tried Duke and the University of Arkansas and Johns Hopkins. Each advised Ms. Tomczak, then 69, to look somewhere else.

The reason: Ms. Tomczak, who was baptized at age 12 as a Jehovah’s Witness, insisted for religious reasons that her transplant be performed without a blood transfusion. The Witnesses believe that Scripture prohibits the transfusion of blood, even one’s own, at the risk of forfeiting eternal life.

Given the complexities of lung transplantation, in which transfusions are routine, some doctors felt the procedure posed unacceptable dangers. Others could not get past the ethics of it all. With more than 1,600 desperately ill people waiting for a donated lung, was it appropriate to give one to a woman who might needlessly sacrifice her life and the organ along with it?

By the time Ms. Tomczak found Dr. Scott A. Scheinin at The Methodist Hospital in Houston last spring, he had long since made peace with such quandaries. Like a number of physicians, he had become persuaded by a growing body of research that transfusions often pose unnecessary risks and should be avoided when possible, even in complicated cases.

By cherry-picking patients with low odds of complications, Dr. Scheinin felt he could operate almost as safely without blood as with it. The way he saw it, patients declined lifesaving therapies all the time, for all manner of reasons, and it was not his place to deny care just because those reasons were sometimes religious or unconventional.

“At the end of the day,” he had resolved, “if you agree to take care of these patients, you agree to do it on their terms.”

Ms. Tomczak’s case — the 11th so-called bloodless lung transplant attempted at Methodist over three years — would become the latest test of an innovative approach that was developed to accommodate the unique beliefs of the world’s eight million Jehovah’s Witnesses but may soon become standard practice for all surgical patients.

Unlike other patients, Ms. Tomczak would have no backstop. Explicit in her understanding with Dr. Scheinin was that if something went terribly wrong, he would allow her to bleed to death. He had watched Witness patients die before, with a lifesaving elixir at hand.

Ms. Tomczak had dismissed the prospect of a transplant for most of the two years she had struggled with sarcoidosis, a progressive condition of unknown cause that leads to scarring in the lungs. The illness forced her to quit a part-time job with Nielsen, the market research firm.

Then in April, on a trip to the South Carolina coast, she found that she was too breathless to join her frolicking grandchildren on the beach. Tethered to an oxygen tank, she watched from the boardwalk, growing sad and angry and then determined to reclaim her health.

“I wanted to be around and be a part of their lives,” Ms. Tomczak recalled, dabbing at tears.

She knew there was danger in refusing to take blood. But she thought the greater peril would come from offending God.

“I know,” she said, “that if I did anything that violates Jehovah’s law, I would not make it into the new system, where he’s going to make earth into a paradise. I know there are risks. But I think I am covered.”

Cutting Risks, and Costs

The approach Dr. Scheinin would use — originally called “bloodless medicine” but later re-branded as “patient blood management” — has been around for decades. His mentor at Methodist, Dr. Denton A. Cooley, the renowned cardiac pioneer, performed heart surgery on hundreds of Witnesses starting in the late 1950s. The first bloodless lung transplant, at Johns Hopkins, was in 1996.

But nearly 17 years later, the degree of difficulty for such procedures remains so high that Dr. Scheinin and his team are among the very few willing to attempt them.

In 2009, after analyzing Methodist’s own data, Dr. Scheinin became convinced that if he selected patients carefully, he could perform lung transplants without transfusions. Hospital administrators resisted at first, knowing that even small numbers of deaths could bring scrutiny from federal regulators.

“My job is to push risk away,” said Dr. A. Osama Gaber, the hospital’s director of transplantation, “so I wasn’t really excited about it. But the numbers were very convincing.”

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Haruhiko Kuroda Expected to Be Named Head of Bank of Japan

TOKYO — A financial policy expert and harsh critic of the Bank of Japan’s efforts to combat deflation is set to be the government’s choice to take over the nation’s central bank.

Toru Hanai/Reuters

Haruhiko Kuroda is a harsh critic of the Bank of Japan’s track record on deflation.

The official, Haruhiko Kuroda, a veteran of global financial circles and current head of the Asian Development Bank, will be nominated as the bank’s governor to take over next month, according to a ruling party lawmaker with knowledge of those plans.

Prime Minister Shinzo Abe has instructed ruling party officials to start negotiating with opposition parties to clear the way for Mr. Kuroda’s appointment, which must be approved by a divided parliament, the lawmaker said.

“This is a critical time for Japan’s economy, and we must avoid, at all costs, a failure to gain parliamentary approval for this appointment,” NHK, the public broadcaster, quoted Mr. Abe as telling ruling party executives Monday morning.

With Mr. Kuroda at its helm, the bank could take much bolder steps to kick-start economic growth. Mr. Kuroda has publicly criticized the Bank of Japan for not going far enough to fight deflation, and has urged the bank to adopt inflation targets and to expand an asset-buying program to pump more cash into the Japanese economy.

Mr. Kuroda’s global experience — as vice minister for international affairs at Japan’s powerful Finance Ministry from 1999 to 2003, and as president of the Manila-based Asian Development Bank starting in 2005 — could also help Tokyo navigate foreign criticism that its monetary policies are intended to weaken the yen to give Japanese exporters a competitive edge.

The yen has weakened by over 10 percent in the last three months as Mr. Abe laid out his monetary agenda, pushing the outgoing central bank governor, Masaaki Shirakawa, to start taking a more aggressive monetary stance. But Mr. Abe had indicated that a change at the bank’s top ranks was needed to break with the bank’s cautious past. On Monday, the yen fell to a 33-month low.

Kikuo Iwata, a professor at Gakushuin University in Tokyo and another vocal critic of the central bank, is set to be tapped for one of its two deputy governor spots, according to the lawmaker. Mr. Iwata is the author of several books, including “Stop Deflation, Now” and “Is the Bank of Japan Really Trustworthy?”

Mr. Kuroda beat out a fellow former senior Finance Ministry official, Toshiro Muto, who had strong backing among both bureaucrats and local politicians but lacks the top-level global contacts. Mr. Muto was also viewed as being more cautious than Mr. Kuroda on monetary policy.

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Political Memo: Fault-Finding Grows Intense as Cuts Near

WASHINGTON — First the White House and Congress created a potential fiscal crisis, agreeing more than a year ago to once-unthinkable governmentwide spending cuts in 2013 unless the two parties agreed to alternative ways to reduce budget deficits.

Now that those cuts are imminent — because compromise is not — they have created one of Washington’s odder blame games over just whose bad idea this was.

The battle lines over cuts that are scheduled to begin on Friday, known in budget parlance as sequestration, were evident on Saturday in President Obama’s weekly address and the Republican response, by Senator John Hoeven of North Dakota.

“Unfortunately, it appears that Republicans in Congress have decided that instead of compromising, instead of asking anything of the wealthiest Americans, they would rather let these cuts fall squarely on the middle class,” said Mr. Obama, who proposed a substitute mix of spending cuts and revenues from repealing some tax breaks for wealthy people and corporations.

He added: “Are Republicans in Congress really willing to let these cuts fall on our kids’ schools and mental health care just to protect tax loopholes for corporate jet owners? Are they really willing to slash military health care and the Border Patrol just because they refuse to eliminate tax breaks for big oil companies?”

For Republicans, who oppose any tax increases, Mr. Hoeven countered: “He blames Congress for the sequester, but Bob Woodward, in his book ‘The Price of Politics’ sets the record straight. Woodward says it was President Obama who proposed — and promoted — the sequester.”

What makes this debate over blame so odd is that both sides’ fingerprints — and votes — are all over the sequestration concept. The point of sequestration, in fact, was to define cuts that were so arbitrary and widespread that they would be unpalatable to both sides and force a deal.

That won Republicans’ support for increasing the government’s debt limit in 2011, and averted the nation’s first default. The Republican-led House and Democratic-led Senate each passed the accord overwhelmingly, and Mr. Obama gladly signed it.

The idea for sequestration did come from the White House, as news accounts made clear at the time. Jacob J. Lew, then Mr. Obama’s budget director and now his nominee for Treasury secretary, was the main proponent.

Mr. Lew, who was a senior adviser to the House speaker in the 1980s, lifted language from a 1985 law he helped negotiate, the Gramm-Rudman law. It was conceived by two Republican senators to be “a sword of Damocles,” poised to strike both parties unless they compromised on deficit reduction.

The law was ruled unconstitutional, and afterward, the Democratic-controlled Congress and President Ronald Reagan enacted a modified version, which resulted in relatively minor cuts until 1990. That year, the law’s call for much larger cuts in the face of growing deficits helped force Congress and President George Bush to negotiate spending cuts and tax increases widely credited with contributing to balanced budgets later that decade.

Fast-forward to the summer of 2011. Mr. Obama and Congressional Republicans, once again facing deficits, were able to agree to nearly $1 trillion in reductions over a decade in “discretionary” spending programs, which cover just about everything the government does except the entitlement benefit programs like Medicare, Medicaid and Social Security.

But they could not agree on the final $1.2 trillion. The president demanded that that amount come from higher taxes on the wealthy and some reductions in entitlement spending. Republicans insisted on entitlement cuts only.

So both parties started negotiating for a trigger, as they called it — an undesirable, automatic action that would slash deficits if Democrats and Republicans could not. Mr. Obama and Democrats wanted a trigger mandating automatic spending cuts and tax increases; Republicans insisted on spending cuts only.

Democrats conceded, and that is when Mr. Lew — along with Gene Sperling, director of Mr. Obama’s National Economic Council — proposed the Gramm-Rudman sequestration. Given that law’s Republican parentage, the Obama advisers figured this kind of trigger would appeal to Republicans, and it did.

Speaker John A. Boehner and three-quarters of House Republicans voted for the agreement. To use Mr. Hoeven’s word, both parties “promoted” their compromise, including sequestration. Mr. Boehner said he had gotten “98 percent” of what he wanted.

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Major Banks Aid in Payday Loans Banned by States

Major banks have quickly become behind-the-scenes allies of Internet-based payday lenders that offer short-term loans with interest rates sometimes exceeding 500 percent.

With 15 states banning payday loans, a growing number of the lenders have set up online operations in more hospitable states or far-flung locales like Belize, Malta and the West Indies to more easily evade statewide caps on interest rates.

While the banks, which include giants like JPMorgan Chase, Bank of America and Wells Fargo, do not make the loans, they are a critical link for the lenders, enabling the lenders to withdraw payments automatically from borrowers’ bank accounts, even in states where the loans are banned entirely. In some cases, the banks allow lenders to tap checking accounts even after the customers have begged them to stop the withdrawals.

“Without the assistance of the banks in processing and sending electronic funds, these lenders simply couldn’t operate,” said Josh Zinner, co-director of the Neighborhood Economic Development Advocacy Project, which works with community groups in New York.

The banking industry says it is simply serving customers who have authorized the lenders to withdraw money from their accounts. “The industry is not in a position to monitor customer accounts to see where their payments are going,” said Virginia O’Neill, senior counsel with the American Bankers Association.

But state and federal officials are taking aim at the banks’ role at a time when authorities are increasing their efforts to clamp down on payday lending and its practice of providing quick money to borrowers who need cash.

The Federal Deposit Insurance Corporation and the Consumer Financial Protection Bureau are examining banks’ roles in the online loans, according to several people with direct knowledge of the matter. Benjamin M. Lawsky, who heads New York State’s Department of Financial Services, is investigating how banks enable the online lenders to skirt New York law and make loans to residents of the state, where interest rates are capped at 25 percent.

For the banks, it can be a lucrative partnership. At first blush, processing automatic withdrawals hardly seems like a source of profit. But many customers are already on shaky financial footing. The withdrawals often set off a cascade of fees from problems like overdrafts. Roughly 27 percent of payday loan borrowers say that the loans caused them to overdraw their accounts, according to a report released this month by the Pew Charitable Trusts. That fee income is coveted, given that financial regulations limiting fees on debit and credit cards have cost banks billions of dollars.

Some state and federal authorities say the banks’ role in enabling the lenders has frustrated government efforts to shield people from predatory loans — an issue that gained urgency after reckless mortgage lending helped precipitate the 2008 financial crisis.

Lawmakers, led by Senator Jeff Merkley, Democrat of Oregon, introduced a bill in July aimed at reining in the lenders, in part, by forcing them to abide by the laws of the state where the borrower lives, rather than where the lender is. The legislation, pending in Congress, would also allow borrowers to cancel automatic withdrawals more easily. “Technology has taken a lot of these scams online, and it’s time to crack down,” Mr. Merkley said in a statement when the bill was introduced.

While the loans are simple to obtain — some online lenders promise approval in minutes with no credit check — they are tough to get rid of. Customers who want to repay their loan in full typically must contact the online lender at least three days before the next withdrawal. Otherwise, the lender automatically renews the loans at least monthly and withdraws only the interest owed. Under federal law, customers are allowed to stop authorized withdrawals from their account. Still, some borrowers say their banks do not heed requests to stop the loans.

Ivy Brodsky, 37, thought she had figured out a way to stop six payday lenders from taking money from her account when she visited her Chase branch in Brighton Beach in Brooklyn in March to close it. But Chase kept the account open and between April and May, the six Internet lenders tried to withdraw money from Ms. Brodsky’s account 55 times, according to bank records reviewed by The New York Times. Chase charged her $1,523 in fees — a combination of 44 insufficient fund fees, extended overdraft fees and service fees.

For Subrina Baptiste, 33, an educational assistant in Brooklyn, the overdraft fees levied by Chase cannibalized her child support income. She said she applied for a $400 loan from Loanshoponline.com and a $700 loan from Advancemetoday.com in 2011. The loans, with annual interest rates of 730 percent and 584 percent respectively, skirt New York law.

Ms. Baptiste said she asked Chase to revoke the automatic withdrawals in October 2011, but was told that she had to ask the lenders instead. In one month, her bank records show, the lenders tried to take money from her account at least six times. Chase charged her $812 in fees and deducted over $600 from her child-support payments to cover them.

“I don’t understand why my own bank just wouldn’t listen to me,” Ms. Baptiste said, adding that Chase ultimately closed her account last January, three months after she asked.

A spokeswoman for Bank of America said the bank always honored requests to stop automatic withdrawals. Wells Fargo declined to comment. Kristin Lemkau, a spokeswoman for Chase, said: “We are working with the customers to resolve these cases.” Online lenders say they work to abide by state laws.

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Iraq President’s Health Is Improving, Doctor Says

KIRKUK, Iraq (Reuters) - Iraqi President Jalal Talabani is now able to talk, his doctor said, adding he was hopeful the Kurdish statesman would soon be fit to return to Iraq from Germany, where he has been receiving medical treatment for a stroke.

A peace-maker who often mediated among Iraq's Shi'ite, Sunni and Kurdish factions, 79-year-old Talabani was flown abroad in December in critical condition.

"I am in continuous contact with the German team treating President Talabani," said Najmaldin Karim, who is also governor of the city of Kirkuk.

"He can talk now with the people around him and started to think in a good way. I and the German team are optimistic that he will get much better and can return back to Iraq soon."

During Talabani's absence, Iraq's political crisis has intensified, with thousands of Sunni Muslims taking to the streets in protest against the Shi'ite-led government

The veteran politician often worked to ease tensions in the country's fragile power-sharing government and negotiated between Baghdad and the autonomous Kurdistan region, which are locked in feud over land and oil rights.

(Writing by Isabel Coles; Editing by Nick Macfie)

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Adele, 'Les Miserables' cast sing on Oscar stage

LOS ANGELES (AP) — It was an extra starry, musical day at the Dolby Theatre.

Adele took the stage first Friday, followed by the cast of "Les Miserables," singing together of the first time.

Oscar nominees Hugh Jackman and Anne Hathaway, along with co-stars Russell Crowe, Amanda Seyfried, Helena Bonham-Carter, Sasha Baron-Cohen, Eddie Redmayne, Aaron Tveit and Samantha Barks rehearsed their performances on the Oscar stage. They were backed by members of the musical's stage productions from London and Broadway.

"Les Miserables" director Tom Hooper sat in the front row of the theater as his cast sang.

Moments earlier, Adele dazzled the tiny audience of show workers with her performance of the James Bond theme "Skyfall."

"I need a lot more reverb on me," she said after her first run. "You might need to get a new reverb machine."

The 24-year-old multiple Grammy winner arrived wearing a black tunic, black leggings and flats, with no makeup and her hair in a ponytail.

"I'm going to have very high heels on the night, guys," she announced from the microphone, sipping tea between verses.

"Do you need the dresses?" she asked, and a team of stylists brought out the gowns Adele is considering for her Oscar performance.

The dress producers favored? "It's very heavy — I mean I struggle to stand in it," Adele said. "Come and feel how heavy it is, so you don't think I'm a wimp!"

She performed her Oscar-nominated song five times before leaving the theater. "It's been good, yeah?" she asked producer Neil Meron, who nodded in approval.

Just after Adele wrapped, the star-studded "Les Miserables" cast took the stage. Hathaway chatted with Bonham-Carter as Jackman sang a capella. Then Hathaway checked her microphone with a quick verse.

"Ooh, that was flat," she said.

The entire cast assembled for a final run-through when Jackman spontaneously began singing "My Bonny Lies over the Ocean."

"My bonny lies over my daddy," the ensemble responded, breaking into laughter.

Other stars rehearsing Friday included Jennifer Hudson, who is set to perform a song from "Dreamgirls" at Sunday's ceremony.

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AP Entertainment Writer Sandy Cohen is on Twitter: www.twitter.com/APSandy .

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Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

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Pistorius Returns to Bail Hearing

PRETORIA, South Africa — Oscar Pistorius, the double amputee track star accused of murdering his girlfriend, returned to court on Friday for the fourth straight day of hearings about whether he should be granted bail in a case that has riveted the nation.

News reports said he slipped into the courthouse, his head covered by a jacket, some time before the start of hearings that have packed the courtroom with a scrum of journalists alongside legal teams, family members and onlookers. He took his place on Friday to a clatter of photographers’ cameras. In the latest in a series of abrupt twists in the affair on Thursday, the South African police replaced the lead investigator after revelations that he was facing seven charges of attempted murder stemming from an episode in which police officers fired at a minivan.

After widespread news reports about the charges, Gerrie Nel, the prosecutor, said at the start of a hearing on Thursday that he had just learned about them. The national police commissioner, Riah Phiyega, said later that a divisional police commissioner, Lt. Gen. Vinesh Moonoo, would be assigned to preside over “this very important investigation.” The change was announced a day after the original lead investigator, Detective Warrant Officer Hilton Botha, acknowledged several mistakes in the police work and conceded that, based on the existing evidence, he could not rule out the version of events presented by Mr. Pistorius.

The prosecution says Mr. Pistorius committed the premeditated murder of Reeva Steenkamp, a 29-year-old model and law graduate, when he fired four shots through a locked bathroom door while she was on the other side in the early hours of Feb. 14.

With his head bowed as he entered the court on Friday, Mr. Pistorius appeared to be struggling to hold back tears, his jaw clenched, the prosecutor, described Ms. Steenkamp’s plight that morning.

“I am not saying the planning of the murder of Reeva Steenkamp happened weeks ahead, days ahead,” Mr. Nel said. “I am saying the planning to kill Reeva Steenkamp happened that night.”

Ms. Steenkamp took refuge in the bathroom either to escape a fight or a gun, he said. The prosecution is seeking to persuade the magistrate, Desmond Nair, to deny the sprinter’s application be released on bail until a full trial, arguing that he might flee.

Mr. Pistorius has said that he opened fire believing there was an intruder in his home, in a gated community in Pretoria, and that he had no intention of killing Ms. Steenkamp, 29, a model and law school graduate.

On Thursday, Mr. Nel labeled Mr. Pistorius’s account “improbable.”

“What we can’t forget is the applicant is charged with murdering a defenseless, innocent woman,” Mr. Nel said.

Mr. Pistorius has said that he did not realize Ms. Steenkamp was no longer in bed as he rose to check for an intruder, shouting to her to call the police.

“You want to protect her, but you don’t even look at her?” Mr. Nel said on Thursday. “You don’t even ask, ‘Reeva, are you all right?’ 

On Thursday, a police brigadier, Neville Malila, told reporters that Detective Botha was scheduled to appear in court in May on the attempted murder charges in connection with an episode in which Mr. Botha and two other police officers fired at a minivan.

“Botha and two other policemen allegedly tried to stop a minibus taxi with seven people,” Brigadier Malila said. “They fired shots.” While the charges were initially dropped, “we were informed yesterday that the charges will be reinstated,” he said.

Medupe Simasiku, a spokesman for the National Prosecuting Authority, told reporters that the decision to reinstate the charges was made on Feb. 4, long before Ms. Steenkamp was killed.

Lydia Polgreen reported from Pretoria, South Africa, and Alan Cowell from London.

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Oscar animators ready to be taken seriously

BEVERLY HILLS, Calif. (AP) — In the animated feature film category at this year's Oscars, there's a film set in medieval Scotland, another that features old-school video game characters, one that relies heavily on dry British humor, while the other two take inspiration from the supernatural.

It's not exactly kid stuff — and that's how the directors like it.

"I think this year with these films — and so many more — the envelope for animation is being pushed," said "Brave" director Mark Andrews at an Academy Awards event Thursday night honoring the animated feature film nominees. "We keep seeing more risky, deep films that we wouldn't have seen 10 years ago coming out. I wanna be one of those guys pushing it more and more and more because it's not only an awesome medium, but there's so many more stories that we can tell."

The Scotland-set "Brave," a darker fable from Pixar about a rebellious red-headed princess named Merida, will face off against four other animated films at Sunday's 85th annual Academy Awards. The category was first introduced at the 2002 ceremony, with "Shrek" winning the inaugural trophy.

Despite the less lighthearted tone of this year's animated nominees, none cracked the best picture category for a spot alongside the likes of "Argo," ''Lincoln" and "Zero Dark Thirty." (Only three animated films have ever been nominated for best picture at the Oscars: "Beauty and the Beast," ''Up" and "Toy Story 3.")

"Edward Scissorhands" and "The Nightmare Before Christmas" mastermind Tim Burton could take home his first-ever Oscar at the Dolby Theatre ceremony for "Frankenweenie," his black-and-white stop-motion film based on his 1984 live-action short film of the same name.

"Frankenweenie" is among three of the five Oscar nominated films this year that employ stop-motion, the intricate and time consuming animation method that use miniature sculptures and sets. Despite a strong stop-motion presence at this year's Oscars, Burton cited finances, not the omnipresence of computer animation, as the reason that more stop-motion films aren't produced.

"In the case of 'Frankenweenie,' it's not like it was a studio wish-list to-do: 'Let's make black-and-white stop-motion animation,'" said Burton. "You hope it can survive. We all love it."

The other stop-motion nominees are the English seafaring comedy "Pirates! Band of Misfits" from director Peter Lord and the undead tale "ParaNorman" from directors Sam Fell and Chris Butler.

"Wreck-It Ralph" director Rich Moore told the crowd at the motion picture academy's Beverly Hills headquarters that he never envisioned the video game adventure from Disney as a musical, but "Book of Mormon" co-writer Robert Lopez and his wife Kristen Anderson-Lopez did create an original song for the film.

"It didn't work, so it's not in the movie," said Moore. "That's our process. We try lots of stuff. We throw it against the wall, and the stuff that sticks stays in the movie. It's a very organic process making films like this."

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Follow AP Entertainment Writer Derrik J. Lang on Twitter at http://www.twitter.com/derrikjlang.

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Governors Fall Away in G.O.P. Fight Against More Medicaid

Under pressure from the health care industry and consumer advocates, seven Republican governors are cautiously moving to expand Medicaid, giving an unexpected boost to President Obama’s plan to insure some 30 million more Americans.

The Supreme Court ruled last year that expanding Medicaid to include many more low-income people was an option under the new federal health care law, not a requirement, tossing the decision to the states and touching off battles in many capitols.

The federal government will pay the entire cost of covering newly eligible beneficiaries from 2014 to 2016, and 90 percent or more later. But many Republican governors and lawmakers immediately questioned whether that commitment would last, and whether increased spending on Medicaid makes sense, given the size of the federal budget deficit. Some flatly declared they would not consider it.

In Florida, where Gov. Rick Scott reversed his position and on Wednesday announced his support for expanding Medicaid, proponents say that doing so will not only save lives, but also create jobs and stimulate the economy. Similar arguments have swayed the Republican governors of Arizona, Michigan, Nevada, New Mexico, North Dakota and Ohio, who in recent months have announced their intention to expand Medicaid.

The shift has delighted supporters of the law.

“I think this means the dominoes are falling,” said Ronald F. Pollack, the executive director of Families USA, a consumer group. “The message is, ‘Even though I may not have supported and even strongly opposed the Affordable Care Act, it would be harmful to the citizens of my state if I didn’t opt into taking these very substantial federal dollars to help people who truly need it.’ ”

 Nationwide, Medicaid covers 60 million people, most of them low-income or disabled. The Congressional Budget Office has estimated that 17 million more people could be enrolled if all states took the expansion option. So far, 22 states have said they will expand the program, 17 have opted against it, and 11 have not yet decided, according to Avalere Health, a consulting firm.

Some Republican governors remain firmly opposed to the expansion of Medicaid. In her State of the State address, Gov. Nikki R. Haley said, “As long as I am governor, South Carolina will not implement the public policy disaster that is Obamacare’s Medicaid expansion.”

Gov. Rick Perry affirmed that “Texas will not expand Medicaid” and said he was proud that Texas did not follow other states “scrambling to grab every tax dollar they can.”

The change of heart for some Republican governors has come after vigorous lobbying by health industry players, particularly hospitals. Hospital associations around the country signed off on Medicaid cuts under the health care law on the assumption that their losses would be more than offset by new paying customers, including many insured by Medicaid.

Politics could also be a factor in states where Republican governors have decided to expand Medicaid. Mr. Obama won all of those states except Arizona and North Dakota in last year’s election, a fact that may have influenced several of the governors’ decisions. Some of the seven are also up for re-election next year.

Religious leaders have added a moral dimension to the campaign in some states. The Roman Catholic bishops of Salt Lake City and Little Rock, Ark., for example, have urged state officials to expand Medicaid.

The Obama administration has tried to win over skeptical state officials by offering new flexibility to manage Medicaid as they like. On the same day that he agreed to expand Medicaid in Florida, Mr. Scott got federal permission to move more Medicaid beneficiaries into private managed care plans.

Mr. Scott’s support for expanding Medicaid is particularly significant — Florida is the fourth most populous state — and surprising. A onetime hospital executive, he has been among the most strident critics of the health care law, and his opposition to it was a cornerstone of his 2010 campaign for governor.

The battle is not over, however. In Florida, as in many other states, expansion is subject to approval by the Legislature, whose Republican leaders have expressed misgivings. The legislative session begins next month, and advocates say they plan to press ahead with a lobbying campaign.

Leah Barber-Heinz, a spokeswoman for Florida Chain, a health advocacy group, said it was trying to inform lawmakers and the public about who would benefit from an expansion of Medicaid. More than one-fifth of Florida residents, roughly 4 million of 19 million people, lack health insurance.

“There are so many misperceptions about the uninsured,” Ms. Barber-Heinz said. “So we’re trying to show faces of who would be impacted: people who have been hit by the recession, people who have been laid off, educated people, people who own homes.”

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