About New York: One Boy’s Death Moves State to Action to Prevent Others

The action by New York has elated sepsis researchers and experts, including members of a national panel who this month formally recommended that the federal government adopt standards similar to what the state is planning.

Though little known, sepsis, an abnormal and self-destructive immune response to infection or illness, is a leading cause of death in hospitals. It often progresses to severely low blood pressure, shock and organ failure.

Over the last decade, a global consortium of doctors, researchers, hospitals and advocates has developed guidelines on early identification and treatment of sepsis that it says have led to significant drops in mortality rates. But first hints of the problem, like a high pulse rate and fever, often are hard for clinicians to tell apart from routine miseries that go along with the flu or cold.

“First and foremost, they need to suspect sepsis,” Dr. Mitchell M. Levy, a professor at Brown University School of Medicine and a lead author of a paper on the latest sepsis treatment guidelines to be published simultaneously next month in the United States in a journal, Critical Care Medicine, and in Europe in Intensive Care Medicine.

“It’s the most common killer in intensive care units,” Dr. Levy said. “It kills more people than breast cancer, lung cancer and stroke combined.”

If started early enough, the treatment, which includes antibiotics and fluids, can help people escape from the drastic vortex of sepsis, according to findings by researchers working with the Surviving Sepsis Campaign, the global consortium. The tactics led to a reduction of “relative risk mortality by 40 percent,” Dr. Levy said.

Although studies of 30,000 patients show that the guidelines save lives, “the problem is that many hospitals are not adhering to them,” said Dr. Clifford S. Deutschman, director of the sepsis research program at the Perelman School of Medicine at the University of Pennsylvania and the president of the Society of Critical Care Medicine.

About 300 hospitals participate in the study, and the consortium has a goal of having 10,000. “The case is irrefutable: if you take these sepsis measures, and you build a program to help clinicians and hospitals suspect sepsis and identify it early, that will mean more people will survive,” Dr. Levy said.

At a symposium in October, the New York health commissioner, Dr. Nirav R. Shah, said that he would require state hospitals to adopt best practices for early identification and treatment of sepsis. Gov. Andrew M. Cuomo intends to make it a major initiative in 2013, said Josh Vlasto, a spokesman for the governor. “The state is taking unprecedented measures to prevent and effectively treat sepsis in health care facilities across the state and is looking at a wide range of additional measures to better protect patients,” Mr. Vlasto said.

In April, Rory Staunton, a sixth grader from Queens, died of severe septic shock after he became infected, apparently through a cut he suffered while playing basketball. The severity of his illness was not recognized when he was treated in the emergency room at NYU Langone Medical Center. He was sent home with a diagnosis of an ordinary bellyache. Hours later, alarming laboratory results became available that suggested he was critically ill, but neither he nor his family was contacted. For an About New York column in The New York Times, Rory’s parents, Ciaran and Orlaith Staunton, publicly discussed their son’s final days. Their revelations prompted doctors and hospitals across the country to seek new approaches to heading off medical errors.

In addition, Commissioner Shah in New York convened a symposium on sepsis, which included presentations from medical experts and Rory’s parents.

At the end of the meeting, Dr. Shah said that he had listened to all the statistics on the prevalence of the illness, and that one had stuck in his memory: “Twenty-five percent,” he said — the portion of the Staunton family lost to sepsis.

He said he would issue new regulations requiring hospitals to use best practices in identifying and treating sepsis, actions that, he said, he was taking “in honor of Rory Staunton.”

The governor’s spokesman, Mr. Vlasto, said that “the Staunton family’s advocacy has been essential to creating a strong public will for action.”

Dr. Levy said New York’s actions were “bold, pioneering and grounded in good scientific evidence,” adding, “The commissioner has taken the first step even before the federal government.”

Dr. Deutschman said that initiatives like those in New York were needed to overcome resistance among doctors. “You’re talking about a profession that has always prided itself on its autonomy,” he said. “They don’t like to be told that they’re wrong about something.”

The availability of proven therapies should move treatment of sepsis into a new era, experts say, comparing it to how heart attacks were handled not long ago. People arriving in emergency rooms with chest pains were basically put to bed because not much could be done for them, said Dr. Kevin J. Tracey, the president of the Feinstein Institute for Medical Research at North Shore-Long Island Jewish Health System. Dr. Tracey, a neurosurgeon, has made major discoveries about the relationship between the nervous system and the runaway immune responses of sepsis.

If physicians and nurses were trained to watch for sepsis, as they now routinely do for heart attacks, many of its most dire problems could be headed off before they got out of control, he said. The Stauntons have awakened doctors and nurses to the possibility of danger camouflaged as a stomach bug.

“We are with sepsis where we were with heart attack in the early 1980s,” Dr. Tracey said.

“If you don’t think of it as a possibility, this story can happen again and again. This case could change the world.”

E-mail: dwyer@nytimes.com

Twitter: @jimdwyernyt

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State of the Art: Android Cameras From Nikon and Samsung Go Beyond Cellphones - Review

But yes, that’s what it has come to. Ever since cellphone cameras got good enough for everyday snapshots, camera sales have been dropping. For millions of people, the ability to share a fresh photo wirelessly — Facebook, Twitter, e-mail, text message — is so tempting, they’re willing to sacrifice a lot of real-camera goodness.

That’s an awfully big convenience/photo-quality swap. A real camera teems with compelling features that most phones lack: optical zoom, big sensor, image stabilization, removable memory cards, removable batteries and decent ergonomics. (A four-inch, featureless glass slab is not exactly optimally shaped for a hand-held photographic instrument.)

But the camera makers aren’t taking the cellphone invasion lying down. New models from Nikon and Samsung are obvious graduates of the “if you can’t beat ’em, join ’em” school. The Nikon Coolpix S800C ($300) and Samsung’s Galaxy Camera ($500 from AT&T, $550 from Verizon) are fascinating hybrids. They merge elements of the cellphone and the camera into something entirely new and — if these flawed 1.0 versions are any indication — very promising.

From the back, you could mistake both of these cameras for Android phones. The big black multitouch screen is filled with app icons. Yes, app icons. These cameras can run Angry Birds, Flipboard, Instapaper, Pandora, Firefox, GPS navigation programs and so on. You download and run them exactly the same way. (That’s right, a GPS function. “What’s the address, honey? I’ll plug it into my camera.”)

But the real reason you’d want an Android camera is wirelessness. Now you can take a real photo with a real camera — and post it or send it online instantly. You eliminate the whole “get home and transfer it to the computer” step.

And as long as your camera can get online, why stop there? These cameras also do a fine job of handling Web surfing, e-mail, YouTube videos, Facebook feeds and other online tasks. Well, as fine a job as a phone could do, anyway.

You can even make Skype video calls, although you won’t be able to see your conversation partner; the lens has to be pointing toward you.

Both cameras get online using Wi-Fi hot spots. The Samsung model can also get online over the cellular networks, just like a phone, so you can upload almost anywhere.

Of course, there’s a price for that luxury. Verizon charges at least $30 a month if you don’t have a Verizon plan, or $5 if you have a Verizon Share Everything plan. AT&T charges $50 a month or more for the camera alone, or $10 more if you already have a Mobile Share plan.

If you have a choice, Verizon is the way to go. Not only is $5 a month much more realistic than $10 a month, but Verizon’s 4G LTE network is far faster than AT&T’s 4G network. That’s an important consideration, since what you’ll mostly be doing with your 4G cellular camera is uploading big photo files. (Wow. Did I just write “4G cellular camera?”)

These cameras offer a second big attraction, though: freedom of photo software. The Android store overflows with photography apps. Mix and match. Take a shot with one app, crop, degrade and post it with Instagram.

Just beware that most of them are intended for cellphones, so they don’t recognize these actual cameras’ optical zoom controls. Some of the photo-editing apps can’t handle these cameras’ big 16-megapixel files, either. Unfortunately, you won’t really know until you pay the $1.50 or $4 to download these apps.

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Inquiry Into Libya Attack Is Sharply Critical of State Department

The investigation into the attacks on the diplomatic mission and C.I.A. annex that killed Ambassador J. Christopher Stevens and three others also faulted State Department officials in Washington for ignoring requests from officials at the American Embassy in Tripoli for more guards and safety upgrades to the diplomatic mission.

The panel also blamed the State Department for waiting for specific warnings of imminent attacks to act rather than adapting security procedures and protocols to a deteriorating security environment. By this spring, Benghazi, a hotbed of militant activity in eastern Libya, had experienced a string of assassinations and attacks, including one on a British envoy’s motorcade.

Finally, the report also blamed two major State Department bureaus — diplomatic security and Near Eastern affairs — for failing to coordinate and plan adequate security at the mission. The panel also determined that a number of officials had shown poor leadership.

In response to the panel’s findings, Secretary of State Hillary Rodham Clinton said in a letter to Congress that she was accepting all 29 of the panel’s recommendations, several of which are classified.

Mrs. Clinton is taking specific steps to correct the problems, according to officials. They say the State Department is asking permission from Congress to transfer $1.3 billion from funds that had been allocated for spending in Iraq. This includes $553 million for additional Marine security guards; $130 million for diplomatic security personnel; and $691 million for improving security at installations abroad.

On Monday, an independent panel that was established to investigate the attack presented the report to the State Department. The panel, called an accountability review board, is led by Thomas R. Pickering, a veteran diplomat. It includes four other members, among them Mike Mullen, the retired admiral who served as chairman of the Joint Chiefs of Staff. The board is authorized by a 1986 law intended to strengthen security at United States diplomatic missions.

The State Department sent a lengthy classified version of the report to Congress on Tuesday. Mr. Pickering and Admiral Mullen are scheduled to meet with members of the Senate Foreign Relations Committee and House Foreign Affairs Committee in closed session on Wednesday.

On Thursday, William J. Burns and Thomas R. Nides, both deputy secretaries of state, will testify to both panels. Mrs. Clinton, who is still recovering from a concussion she suffered last week after fainting while sick from a stomach flu, is at home this week. The head of the House panel, Representative Ileana Ros-Lehtinen, a Florida Republican, however, has made clear that she planned to ask Mrs. Clinton to testify at a future time.

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Obama Expected to Name Kerry as Secretary of State

But the announcement will be delayed, at least until later this week and maybe beyond, because of the Connecticut school shooting and what one official called “some discomfort” with the idea of Mr. Obama’s announcing a national security team in which the top posts are almost exclusively held by white men.

The American ambassador to the United Nations, Susan E. Rice, who is black and was considered Mr. Obama’s leading candidate for the job, withdrew her name from consideration last week after opposition to her nomination grew in the Senate.

For Mr. Kerry, 69, the appointment would fulfill an ambition that dates back many years. He had hoped for the post when Mr. Obama was first elected in 2008; since then, he has shepherded the passage of a critical arms-control treaty and conducted a series of quiet missions on behalf of the president, notably at moments of crisis with Afghanistan and Pakistan.

But he would be entering an administration whose primary foreign policy strategies are already set, even as it tries to use American leverage in dealing with a Middle East that is veering toward hard-line Islamist governments and an Iran that is getting perilously close to a nuclear capability.

With Ms. Rice out of the running, Mr. Kerry’s appointment “is the working presumption,” said a senior State Department official who has been preparing for the transition to a new secretary. But White House officials said the deal was not entirely done, because the lineup currently envisioned — with former Senator Chuck Hagel to head the Defense Department and the acting C.I.A. director, Michael J. Morell, likely to be named to the post permanently — looks a bit too much like national security teams of a previous era.

For Mr. Obama, a national security team led by Mr. Kerry and Mr. Hagel, and their longtime colleague in the Senate, Vice President Joseph R. Biden Jr., would be deeply experienced but also, in many ways, deeply conventional. All three came to the Senate long before Mr. Obama. All describe themselves as pragmatists rather than ideologues, and all became skeptics, then critics, of the American experiment in Iraq from the early days of the war.

Still, administration officials said, for now there are no serious candidates for the State Department job other than Mr. Kerry. He would be the first white man to serve in the post since Warren Christopher left the job in early 1997. His successors have been Madeleine K. Albright, Colin Powell, Condoleezza Rice and Mrs. Clinton.

Mr. Kerry’s colleagues in the Senate have said that he would sail through confirmation hearings. Senator John McCain, Republican of Arizona, has already begun jokingly calling Mr. Kerry “Mr. Secretary.” Both men are veterans of the Vietnam War and worked together to provide President Bill Clinton with political cover to grant diplomatic recognition to Vietnam. Mr. McCain said of Mr. Kerry recently that he would most likely win a large number of Republican votes for confirmation.

The issue of the composition of Mr. Obama’s team arose anew when Ms. Rice withdrew. If she keeps her current post as ambassador to the United Nations, she will remain in Mr. Obama’s cabinet and on his national security team. She is also considered the likely successor to Thomas E. Donilon as national security adviser. But Mr. Donilon does not intend to leave that post for a year or two, his friends say, unless he is named White House chief of staff.

Michèle A. Flournoy, a former under secretary of defense for policy, remains a candidate to become the first female defense secretary. But in internal discussions, White House officials have said that the challenge of the next few years will be working with Congress to shrink the defense budget and kill some major cold war-era weapons systems. For that, Mr. Hagel, a Republican from Nebraska, is seen as better able to win votes from his former colleagues.

Ms. Flournoy has also been mentioned as a possible C.I.A. director, but Mr. Morell, who ran the analysis division of the agency, is the favorite of C.I.A. officials. “Mike has been concerned about the over-militarization of the C.I.A.,” a senior military officer who has dealt with him said recently. “And so are many at the agency, who fear they have wandered too far from the job of analyzing trends and obtaining secrets.”

John Brennan, a close aide to Mr. Obama and a former agency station chief in Saudi Arabia who has directed counterterrorism activity from his basement White House office, is also a candidate for C.I.A. director. But officials note that his current post already gives him sway over all 18 intelligence agencies.

Mr. Kerry has worked hard to deepen his relationship with Mr. Obama. The president has at times considered him long-winded and a throwback to a previous generation of diplomats, aides said. But Mr. Kerry impressed Mr. Obama and Mr. Donilon when he was sent to deal with Hamid Karzai, the famously unpredictable president of Afghanistan, after Mr. Karzai’s supporters rigged a presidential election in 2009 and refused a second round of voting.

Mr. Kerry also visited Pakistan several times to try to ease recurrent tensions, including a two-week visit after the raid that killed Osama bin Laden. Pakistani officials tried to get Mr. Kerry to write what they called a “blood oath” that the United States would never take action to seize Pakistan’s nuclear arsenal. Mr. Kerry found a diplomatic way out, saying the United States had no “designs” on Pakistan’s weapons.

“It meant nothing,” a member of Mr. Obama’s national security team said later. “And it solved the crisis. Quite artfully.”

This article has been revised to reflect the following correction:

Correction: December 18, 2012

An article on Monday about the possible nomination of Senator John Kerry, Democrat of Massachusetts, to be secretary of state described incorrectly the time frame during which former Senator Chuck Hagel, a Republican from Nebraska, served in the Senate. Mr. Hagel, who may be named defense secretary, was elected in 1996, so he did not serve “during the cold war.”

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