Roethlisberger has rib injury too, out vs. Ravens

PITTSBURGH (AP) — Ben Roethlisberger's sprained right shoulder is just the start of his problems.

The Pittsburgh Steelers quarterback said Wednesday he also dislocated a rib while getting sacked in the third quarter of Monday night's win against Kansas City. Roethlisberger sprained the SC joint in his shoulder on the play but says the rib issue is a bigger concern.

Roethlisberger said doctors are concerned the rib could cut into his aorta. He's already been ruled out of Sunday's game against the Baltimore Ravens. Backup Byron Leftwich will start in his place, though Roethlisberger doesn't believe the injuries will end his season.

"I don't think so, I don't know though but I'm not a medical expert," Roethlisberger said. "I just know I'm going to do what I can to get back."

Roethlisberger added he's in considerable pain and has slept just four hours over the last two nights. He wore a black sling in the locker room to prevent the rib from moving around. Doctors are worried if the rib gets jostled before it heals it can cause internal bleeding.

"I can move (the arm) around, that's not the issue," Roethlisberger said. "Sometimes when I do move it the rib will kind of pop out of place again, which is pretty painful. I just try to keep it as still as I can for the most part."

The quarterback added the pain level is "nine on a scale of 1-10."

The Steelers (6-3) have won four straight to pull within a game of first-place Baltimore (7-2), but Roethlisberger left the 16-13 overtime win over the Chiefs in the third quarter after getting slammed to the ground by Kansas City linebackers Tamba Hali and Justin Houston.

The two-time Super Bowl winner underwent extensive testing Tuesday to determine the extent of the injury to his throwing shoulder. He was waiting further word on Wednesday about how to move forward because of the unusual nature of the injury.

"From what (the doctor) said he's trying to talk to experts because there is no case study over the exact same thing," Roethlisberger said. "From what I heard, from what he told me it was a 1998 rugby player or something."

Leftwich completed 7 of 14 passes for 73 yards after replacing Roethlisberger. He will be making his first start since 2009 when he played for the Tampa Bay Buccaneers.

The former first-round pick has been plagued by injuries the last two seasons and said he felt a little rusty after seeing his first regular season action in nearly two years, though coach Mike Tomlin anticipates the rust to wear off this week.

"I'll trust his assessment if that's his assessment, but I'm not overly concerned about it," Tomlin said. "We got a lot of ball in front of us this week. If he is the guy, he'll get a great opportunity to prepare and we'll expect him to play winning football."

The Steelers have managed to survive without Roethlisberger before. They are 7-5 in games without their franchise quarterback since 2005, including a 4-1 mark over the last two seasons. Roethlisberger missed the first four games of the 2010 season after being suspended for violating the league's personal conduct policy, but Pittsburgh started 3-1 behind Dennis Dixon and Charlie Batch, who will serve at Leftwich's backup on Sunday.

Batch filled in nicely last December when Roethlisberger was sidelined with an ankle injury, throwing for 208 yards in a 27-0 win over the St. Louis Rams.

Leftwich is 0-6 in his last six games as a starter, his last victory coming on Oct. 8, 2006 while playing the Jacksonville Jaguars, who selected Leftwich with the seventh overall pick of the 2003 draft.

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Filthy Water in California Farmworker Communities

Jim Wilson/The New York Times

Students at Stone Corral Elementary in Seville, Calif. The school budgets $100 to $500 a month for bottled water.

SEVILLE, Calif. — Like most children, the students at Stone Corral Elementary School here rejoice when the bell rings for recess and delight in christening a classroom pet.

But while growing up in this impoverished agricultural community of numbered roads and lush citrus orchards, young people have learned a harsh life lesson: “No tomes el agua!” — “Don’t drink the water!”

Seville, with a population of about 300, is one of dozens of predominantly Latino unincorporated communities in the Central Valley plagued for decades by contaminated drinking water. It is the grim result of more than half a century in which chemical fertilizers, animal wastes, pesticides and other substances have infiltrated aquifers, seeping into the groundwater and eventually into the tap. An estimated 20 percent of small public water systems in Tulare County are unable to meet safe nitrate levels, according to a United Nations representative.

In farmworker communities like Seville, a place of rusty rural mailboxes and backyard roosters where the average yearly income is $14,000, residents like Rebecca Quintana pay double for water: for the tap water they use to shower and wash clothes, and for the five-gallon bottles they must buy weekly for drinking, cooking and brushing their teeth.

It is a life teeming with worry: about children accidentally sipping contaminated water while cooling off with a garden hose, about not having enough clean water for an elderly parent’s medications, about finding a rock while cleaning the feeding tube of a severely disabled daughter, as Lorie Nieto did. She vowed never to use tap water again.

Chris Kemper, the school’s principal, budgets $100 to $500 a month for bottled water. He recalled his astonishment, upon his arrival four years ago, at encountering the “ghost” drinking fountains, shut off to protect students from “weird foggyish water,” as one sixth grader, Jacob Cabrera, put it. Mr. Kemper said he associated such conditions with third world countries. “I always picture it as a laptop a month for the school,” he said of the added cost of water.

Here in Tulare County, one of the country’s leading dairy producers, where animal waste lagoons penetrate the air and soil, most residents rely on groundwater as the source for drinking water. A study by the University of California, Davis, this year estimated that 254,000 people in the Tulare Basin and Salinas Valley, prime agricultural regions with about 2.6 million residents, were at risk for nitrate contamination of their drinking water. Nitrates have been linked to thyroid disease and make infants susceptible to “blue baby syndrome,” a potentially fatal condition that interferes with the blood’s capacity to carry oxygen.

Communities like Seville, where corroded piping runs through a murky irrigation ditch and into a solitary well, are particularly vulnerable to nitrate contamination, lacking financial resources for backup systems. Fertilizer and other chemicals applied to cropland decades ago will continue to affect groundwater for years, according to the Davis study.

“You can’t smell it,” Mrs. Quintana said of the dangers of the tap. “You can’t see it. It looks like plain beautiful water.”

Situated off the psychic map of California, lacking political clout and even mayors, places like Seville and Tooleville to the south have long been excluded from regional land use and investment decisions, said Phoebe S. Seaton, the director of a community initiative for California Rural Legal Assistance. Residents rely on county governments and tiny resident-run public utility districts. The result of this jurisdictional patchwork is a fragmented water delivery system and frequently deteriorating infrastructure.

Many such communities started as farm labor camps without infrastructure, said John A. Capitman, a professor at California State University, Fresno, and the executive director of the Central Valley Health Policy Institute. Today, one in five residents in the Central Valley live below the federal poverty line. Many spend up to 10 percent of their income on water. “The laborers and residents of this region have borne a lot of the social costs of food production,” Professor Capitman said.

Bertha Diaz, a farmworker and single mother of four in East Orosi, rises at 4 in the morning to pick grapefruit and other crops. Her chief concern, she said, was how she would afford bottled water.

She comes home to an additional chore — filling five-gallon jugs at the Watermill Express, a self-serve drinking water station in nearby Orosi with a windmill roof. When she began receiving cautionary notices from the local water district, she formed a neighborhood committee and also joined AGUA, the Spanish-language acronym for the Association of People United for Water, a network of residents working with the nonprofit Community Water Center.

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Samuel Adams Brewer Counsels Small Businesses

Gretchen Ertl for The New York Times

Jim Koch, who started brewing Samuel Adams Boston Lager at his house in 1984, and Carlene O'Garro, who runs a cake business, participate in a program in which big businesses help small ones.

Carlene O’Garro’s cake business was barely a month old when she arrived at the Samuel Adams brewery in South Boston recently to meet with business counselors, but she brought with her an agenda that hinted at outsize ambitions.

Ms. O’Garro bakes nondairy cheesecakes that she was selling at a handful of grocery stores, including two Whole Foods outlets, in the Boston area. She hoped to learn how to expand the business and distribute the cakes nationally. “I know Jim is all over the place,” she said, “and I want to be like that.”

Jim is Jim Koch, the founder of the Boston Beer Company and one of 36 advisers who spent an evening last August “speed coaching” fledgling food, beverage and hospitality businesses. In 20-minute sessions, some 95 bakers, brewers and restaurant owners peppered the coaches — Boston Beer employees and consultants who included lawyers, accountants and small-business counselors — with questions about both basic day-to-day issues and more strategic concerns.

Speed coaching is one element of “Brewing the American Dream,” a program Boston Beer established with a microlender, Accion, to help small businesses. Mr. Koch, who started brewing Samuel Adams Boston Lager at his house in 1984, remains central to these efforts even as he presides over a company with a market capitalization of $1.4 billion and annual revenue of more than $500 million. He said he had not forgotten his early days, when he struggled to find capital, get his beer into distribution networks and expand.

In six sessions that August evening, Mr. Koch spoke with perhaps a dozen entrepreneurs and then stayed another hour to visit with six or eight more. This year, Boston Beer and Accion are staging 12 speed-coaching events in 11 cities, and Mr. Koch expects to attend about half of them.

Big businesses reaching out to help smaller businesses has come into vogue since the recession. In 2009, Goldman Sachs introduced its 10,000 Small Businesses campaign. Starbucks raises money from customer donations to finance small-business loans. American Express encourages consumers to shop locally on “Small Business Saturday” after Thanksgiving. The New York Stock Exchange links small vendors with large corporations and finances loans through Accion. And several corporations have run contests — Wal-Mart, Chase Bank and Staples have furnished winning small companies with opportunities for retail distribution, capital and office equipment.

It is the latest example of what is known in corporate circles as cause marketing — hitching a brand to a social issue. “How you improve the American economy and create jobs is on everybody’s minds these days,” said David Hessekiel, founder and president of Cause Marketing Forum. “Companies know that it’s on the minds of their consumers, and they want to be seen as part of the solution, not as the enemy.”

That has been a particular concern for chains like Wal-Mart and Starbucks, given their longstanding reputations for forcing local competitors to close. Helping small businesses, Mr. Hessekiel said, “helps them deal with an old issue.”

The Boston Beer program actually predates the recent economic crisis. The seeds of the idea, Mr. Koch said, came to him in 2007 as he walked to his car after he and his employees had volunteered to paint a nearby community center. “I should have felt really good, and I didn’t — I felt a little depressed,” he said. “What I realized is, I’d just taken about $10,000 worth of management time and talent, and turned it into about $1,000 worth of painting. And it was pretty bad painting, too.”

Mr. Koch retooled his company’s philanthropy to take advantage of its resources, particularly its employees’ expertise. The company has committed $1.4 million to finance loans, which are handled by Accion. The loans are small, typically $5,000 to $7,000, with terms of 18 months to two years and interest rates that vary regionally. (In New England, the rate is around 13 percent, typical for microloans.) Perhaps as important as the money is the tutoring by Mr. Koch and his employees. Most microloan programs provide borrowers with rudimentary counseling, but Boston Beer is unusually “high touch,” said Shaolee Sen, vice president for strategy and development at the Accion U.S. Network.

Ms. O’Garro was one of the program’s original clients — she has had two loans, totaling $4,000 — and though she’s repaid that debt and though the muffin business it helped finance has been dormant since 2010, she continues to derive benefits from the program with her cheesecake business, Delectable Desires. She learned how to price her cakes from an employee in Boston Beer’s finance department, Mike Cramer, who went to Whole Foods and scoped out the competition. “He actually made a spreadsheet for me of how much the high-end and low-end desserts cost,” she said.

Another borrower, Sandy Russo of Lulu’s Sweet Shoppe in Boston, said that when she had questions, she sometimes called Mr. Koch’s executive assistant. Last summer, when Lulu’s opened a second location, Boston Beer’s lawyers reviewed the lease and its public relations staff wrote the news release.

Of course, it’s one thing to provide that kind of support to a handful of companies. The question facing Accion and Boston Beer is whether the program can remain as intensive as it expands nationally. “We’re really struggling with that right now,” Ms. Sen said. “The portfolio has been so small up until this point that they really are passionate about their clients.”

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White House Supports Top U.S. Commander in Afghanistan

President Obama has faith in Gen. John R. Allen, the top American and NATO commander in Afghanistan, the White House spokesman said on Tuesday, after it was disclosed that the general was under investigation for what the Pentagon called “inappropriate communication” with the woman whose complaint to the F.B.I. set off the scandal involving David H. Petraeus’s extramarital affair.

“The president thinks very highly of General Allen,” the spokesman, Jay Carney, said at a White House news briefing. “He has faith in General Allen,” and believes that he has done “an excellent job” as commander in Afghanistan, Mr. Carney added. General Allen’s recent nomination to become the supreme allied commander in Europe, Mr. Carney said, is delayed at the request of Defense Secretary Leon E. Panetta pending the investigation’s outcome.

Mr. Panetta and other officials disclosed overnight the investigation into General Allen’s e-mails with Jill Kelley, the woman in Tampa, Fla., who was seen by Paula Broadwell, Mr. Petraeus’s lover, as a rival for his attentions.

Mr. Petraeus’s affair led to his resignation as head of the C.I.A. on Friday, and the F.B.I.’s investigations into e-mails in the matter apparently led in turn to General Allen’s correspondence.

In a statement released to reporters on his plane en route to Australia early Tuesday, Mr. Panetta said the F.B.I. on Sunday had referred “a matter involving” General Allen to the Pentagon.

Mr. Panetta turned the matter over to the Pentagon’s inspector general to conduct an investigation into what a defense official said were thousands of pages of documents, many of them e-mails between General Allen and Ms. Kelley.

A senior law enforcement official in Washington said on Tuesday that F.B.I. investigators, looking into Ms. Kelley’s complaint about anonymous e-mails she had received, examined all of her e-mails as a routine step.

“When you get involved in a cybercase like this, you have to look at everything,” the official said, suggesting that Ms. Kelley may not have considered that possibility when she filed the complaint. “The real question is why someone decided to open this can of worms.”

The official would not describe the content of the e-mails between General Allen and Ms. Kelley or say specifically why F.B.I. officials had decided to pass them on to the Defense Department. “Generally, the nature of the e-mails warranted providing them to D.O.D.,” he said.

Under military law, adultery can be a crime.

The defense official on Mr. Panetta’s plane said that General Allen, who is also married, told Pentagon officials that he had done nothing wrong. Neither he nor Ms. Kelley, who is also married with children, could be reached for comment early Tuesday. Mr. Panetta’s statement praised General Allen for his leadership in Afghanistan and said, “He is entitled to due process in this matter.”

A senior Defense Department official said General Allen had denied having an extramarital affair with Ms. Kelley. But the official said the content of some of the e-mails “was of a flirtatious nature.”

“Some were of an affectionate nature,” the official said, adding that it was unclear whether the flirtatiousness expressed was from General Allen to Ms. Kelley, from Ms. Kelley to General Allen, or mutual.

“That is what makes the e-mails potentially inappropriate,” he said.

The official said that he had not read the e-mails, but had been briefed on the content, and that they did not contain anything inappropriate regarding operations or security.

But there were conflicting assessments of the content of the e-mails. Associates of General Allen said that the e-mails were of an innocuous nature. Some of the e-mails, these associates said, used terms of endearment, but not in a flirtatious way.

Pentagon officials cautioned against making too much of the number of documents, since some might be from e-mail chains, or brief messages printed out on a whole page.

The Pentagon inspector general’s investigation opens up what could be a widening scandal into two of the most prominent generals of their generation: Mr. Petraeus, who was the top commander in Iraq and Afghanistan before he retired from the military and became director of the C.I.A., only to resign on Friday because of the affair, and General Allen, who also served in Iraq and now commands 68,000 American troops in Afghanistan.

Although General Allen will remain the commander in Afghanistan, Mr. Panetta said that he had asked President Obama to delay the general’s nomination to be the commander of American forces in Europe and the supreme allied commander of NATO, two positions he was to move into after what was expected to be easy confirmation by the Senate. Mr. Panetta said in his statement that Mr. Obama agreed with his request.

Scott Shane and Thom Shanker contributed reporting from Washington.

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Verizon and HTC’s latest twist: The $199 Droid DNA

Verizon and HTC unveiled a new device that the two hope will appeal to customers during the holiday season, while helping to reverse HTC’s floundering fortunes.

The phone, the Droid DNA, sports a 5-inch screen, putting it more in the “phablet” category with Samsung‘s Galaxy Note. It runs on Android 4.1.1 Jelly Bean and includes a boatload of powerful features, including a Super LCD 3 display with 440 pixels per inch, capable of playing 1080p HD video.

HTC noted the screen rivals traditional HDTVs, while the pixel density is among the highest available on any smartphone. The iPhone 5′s Retina display, for example, is 326 pixels per inch.

The device runs on a quad-core, 1.5Ghz Snapdragon processor from Qualcomm, with 4G LTE integrated on the same piece of silicon as the application processor. Having one chip instead of two improves battery life.

The phone is also capable of wireless charging and full HD video chat. The device has an 8-megapixel rear-facing camera and a 2.1-megapixel camera in the front. HTC noted its phone features HTC ImageSense and HTC ImageChip to create faster image processing and better quality photos, as well as a quick-launch camera option.

The Droid DNA also has Beats audio and two amplifiers, one for headphone and one for speaker. And it’s equipped with near-field communications technology to share music and other content by tapping other NFC-enabled devices.

Droid DNA goes on sale on November 21 for $ 199.99 with a two-year contract. Pre-sales begin today. The phone is available exclusively through Verizon.

The hefty specs should appeal to customers looking for alternatives to the latest gadgets from Samsung and Apple during the holiday season. For HTC, it’s pretty important that they do.

The Taiwanese handset maker really needs a hit phone. Previously the darling of the smartphone world, HTC has been having a tough time lately. Samsung and Apple are dominating the industry’s profits and market share, leaving little for HTC, Motorola, Nokia, and other handset vendors. HTC also has faced litigation, though it reached a settlement with Apple a few days ago.

The company has said it plans to go bolder with its messaging to consumers and the media, relying less on joint marketing campaigns with the carriers and standing more independently to tell the HTC story. It also has said it would try to generate buzz through social media and by seeing out influential celebrities and “superfans” for endorsements. So far, it’s unclear whether such steps are paying off.

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Roethlisberger has sprained shoulder

PITTSBURGH (AP) — Ben Roethlisberger left Heinz Field on Monday night with his sprained right shoulder in a sling. When he walks back in ready to play is anybody's guess.

Tomlin called Pittsburgh's franchise quarterback "questionable" but otherwise offered little detail Tuesday, less than 24 hours after Roethlisberger was pounded into the ground by Kansas City Chiefs linebackers Tamba Hali and Justin Houston in the third quarter of Pittsburgh's 16-13 overtime victory.

"He is being evaluated," Tomlin said. "Obviously this injury puts his participation in the questionable category for this week."

Roethlisberger left the game and went to the hospital to for an MRI-exam. He underwent more tests on Tuesday to determine the severity of the sprain to the sternoclavicular (SC) joint in his throwing shoulder.

The SC joint connects the collarbone to the sternum. Treatment can range from a few days of rest and ice to as much as 4-6 weeks according to Dr. Victor Khabie, chief of sports medicine at Northern Westchester Hospital in Mount Kisco, N.Y.

"You could tape it, you could do that stuff but the reality is those ligaments just have to heal," Khabie said. "If you go throwing, you slow down the healing process."

Roethlisberger was scrambling in the pocket to buy time on Pittsburgh's first possession of the second half when Houston wrapped up Roethlisberger's legs and Hali slammed into him, driving the quarterback's right side into the damp Heinz Field turf. Roethlisberger didn't appear to be hurt walking off the field but quickly made his way to the locker room before leaving the stadium with the game still in progress.

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

If Roethlisberger can't play, the Steelers (6-3) will turn veteran backup Byron Leftwich, who completed 7 of 14 passes for 73 yards in relief as Pittsburgh won its fourth straight game thanks to Shaun Suisham's 23-yard field goal 51 seconds into the extra period.

The 32-year-old Leftwich hasn't started a game since 2009, when he went 0-3 for the Tampa Bay Buccaneers. His last victory came on Oct. 8, 2006 when the Jacksonville Jaguars beat the New York Jets 41-0.

The former first round pick has spent most of the last six years as a backup while dealing with a series of significant injuries. He missed all of last season after breaking his arm in a preseason game and threw seven regular season passes in 2010 after hurting his knee at the end of training camp.

Though there was a bit of rust after getting pressed into service, Leftwich did guide the Steelers to a go-ahead field goal in the fourth quarter.

"I try to prepare as if I am the starter every week," Leftwich said. "Nothing will change. I wish Ben the best. I hope he is healthy. Other than that I will be ready to go."

Leftwich insists he has mastered offensive coordinator Todd Haley's playbook and Leftwich's teammates are hardly concerned if he's under center on Sunday.

"We don't have a true rookie back there that's never taken a snap before," Starks said. "We feel good about who we have back there if it is Byron. We'll move forward and wait Ben's return if that's the case."

Roethlisberger isn't the only big name that could be out on Sunday. Safety Troy Polamalu continues to be plagued by a right calf injury and Tomlin described him "doubtful" to play against the Ravens. Safety Ryan Clark sustained a concussion for the second time in three games when he took a knee to the head from Kansas City wide receiver Dwayne Bowe, though Tomlin said it appears Clark is fine.

Maybe, but it's not exactly the way the Steelers wanted to be heading into a crucial three-game stretch that includes two games against the hated Ravens in three weeks.

Baltimore (7-2) appeared ready to run away with the division after Pittsburgh stumbled to a 2-3 start. The Steelers have ripped off four straight to draw within a game and can take firm control of the AFC North at home on Sunday.

The prospect of doing it without their two-time Super Bowl winning quarterback makes that task more difficult, but not impossible.

"B-Left has been here a long time," defensive end Brett Keisel said. "If he's in there, we expect to keep rolling."

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‘Half-Match’ Bone Marrow Transplants Cure Sickle Cell in Trial

In her mid-20s, Yetunde Felix-Ukwu wore a Fentanyl patch that delivered enough narcotic to knock most adults out cold. Yet it barely kept her pain, caused by sickle cell disease, tolerable.

Even with the patch, she was hospitalized almost every month for the pain, which she said was “like being hit with a hammer, searing, throbbing, you name it.”

A debilitating genetic disorder, sickle-cell disease causes blood cells to be shaped like sickles, or crescents, and to be rigid, not pliable. Rather than squeezing in and out of capillaries and blood vessels as normal cells do, the sickle cells jam up, depriving tissues throughout the body of blood and oxygen. That can cause severe organ damage, stroke, blindness and unimaginable pain.

“Imagine heart attack pain all over the body,” said Dr. Robert A. Brodsky, director of the division of hematology at Johns Hopkins University School of Medicine. Many patients don’t live past 50.

A bone marrow transplant could help. The problem is, most patients, including Ms. Felix-Ukwu, cannot get a bone marrow transplant because they don’t have a perfect genetic match. Like a vast majority of others who have sickle cell disease, Ms. Felix-Ukwu is African-American, and the chance of an African-American finding a donor in bone marrow registries is about 10 percent, compared with a 60 to 70 percent chance for Caucasians, Dr. Brodsky said.

Dr. Brodsky and his colleagues at Johns Hopkins, however, began a bone marrow transplant trial using so-called half-match donors. The trial has found that the procedure can cure sickle cell, replacing defective stem cells that produce sickle-shaped cells with normal stem cells that churn out plump, pliable blood cells.

Since almost everyone with a sibling, a parent or a child has a genetic half match, the procedure could make bone marrow transplants available to more than 90 percent of candidates.

“It opens the opportunity for a cure for thousands of adults with the disease who previously had not had any hope of a cure,” said Dr. Michael DeBaun, director of the Center for Excellence in Sickle Cell Disease at Vanderbilt University School of Medicine. Dr. DeBaun was not involved with the half-match trial.

Beginning in high school, Ms. Felix-Ukwu, now 30, had undergone regular transfusions to dilute and temporarily replace the sickle cells in her blood, but the transfusions stopped helping. Half-match donors have been used for about a decade in bone marrow transplants for leukemia and lymphoma patients, and the doctors believed it was now safe enough to use in sickle cell patients.

Ms. Felix-Ukwu, who lives in Lanham, Md., enrolled in the Johns Hopkins study, and her younger sister, Woma Felix-Ukwu, became her half-matched bone marrow donor.

Ms. Felix-Ukwu had to undergo a grueling course of chemotherapy, radiation and immunosuppresants before receiving the transplant.

“Those three days of chemo were the hardest days of my life, including all the pain I had been through with sickle cell,” she said. But it worked. Her body started producing normal blood cells. She continued to have some pain for another 18 months or so, for reasons that are not entirely clear, but now, three years after the transplant, Ms. Felix-Ukwu is disease-free and off all of her pain medications.

“It’s absolutely amazing,” says Dr. Brodsky, who published the study this month in Blood, the journal of the American Society of Hematology. Of the 14 patients in the study who received half-matched transplants, six were cured, meaning that their bone marrow is made up entirely of the donor’s and they are no longer producing sickle cells.

Two additional patients are still taking immunosuppressive drugs, meaning that the donor’s bone marrow took, but they still have some of their own marrow. They still have a chance of being cured.

In a half-match transplant, known medically as haploidentical transplant, only 50 percent of the pertinent genes have to match up. Testing for a bone marrow match entails looking for genes in the human leukocyte antigen, or H.L.A., system, the part of the immune system that recognizes self and not self.

In a full match, 8 to 10 H.L.A. genes need to match between donor and recipient.

“If you have disparities in the H.L.A. system and you transplant stem cells that recognize the patient as foreign, the new immune system will start attacking the patient,” said Dr. Brodsky. In half-match transplants, only half of these H.L.A. genes need to match.

But half-match transplants carry the risk that the donor’s immune cells will attack the host, a potentially deadly complication called graft-versus-host disease.

To reduce this risk, patients receive the chemotherapeutic drug cyclophosphamide after the bone marrow is transplanted. This drug kills the donor’s lymphocytes that would normally attack the recipient, but it spares the donor stem cells, which have an enzyme that makes them immune to it. The stem cells then produce new lymphocytes.

“What happens is that the new cells that are generated become tolerant to the host and will not attack it,” says Dr. Javier Bolaños-Meade, the lead author on the study and associate professor of oncology at Johns Hopkins.

“The biggest paradigm shift was the post-treatment chemo,” added Dr. Brodsky.

The other shift was the trend toward a gentler pre-treatment. In a traditional bone marrow transplant to treat cancer, patients receive high-dose chemotherapy and radiation before the transplant, not only to suppress the immune system but to kill off every last cancer cell in the body. But in sickle cell, the chemotherapy just has to suppress the immune system, so doctors can use a less intense regimen.

This could potentially open it up to many more adults. Bone marrow transplants have largely been offered to children with sickle cell, not adults, who were often too weak or debilitated to endure the more intense pre-treatments.

The half-match transplant is still experimental, and because of its toxicity, it is recommended only for those with advanced disease. It was successful in only about 50 percent of patients.

“You’re putting people through a lot, and to have half of the transplants not take must be heartbreaking,” said Dr. Jane Little, director of the adult sickle cell program at Case Western Reserve University in Cleveland. “It’s exposing patients to risk you can’t take away. But it also really expands the pool of potential recipients.”

The team at Johns Hopkins is tweaking the procedure to improve the success rate without increasing the toxicity, said Dr. Bolaños-Meade. “We are working on transplanting with a higher number of stem cells to help overcome rejection,” he said.

“Clearly it doesn’t cure everyone, but in those patients in which it works, it’s a huge, huge thing,” Dr. Bolaños-Meade said.

This August, Ms. Felix-Ukwu celebrated a year without being in the hospital. She plans to go back to law school next September.

“When I look back, I wonder how I ever made it through all that pain,” she said. “Now I feel like I’m on vacation. I finally have the freedom to be able to live my life.”

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Syrian Jet Strikes Close to Border With Turkey

GAZIANTEP, Turkey — Syria pulled both Turkey and Israel closer to military entanglements in its civil war on Monday, bombing a rebel-held Syrian village a few yards from the Turkish border in a deadly aerial assault and provoking Israeli tank commanders in the disputed Golan Heights into blasting mobile Syrian artillery units across their own armistice line.

The escalations, which threatened once again to draw in two of Syria’s most powerful neighbors, came hours after the fractious Syrian opposition announced a broad new unity pact that elicited praise from the big foreign powers backing their effort to topple President Bashar al-Assad.

“It is a big day for the Syrian opposition,” wrote Joshua Landis, an expert on Syrian political history and the author of the widely followed Syria Comment blog. Mr. Landis, director of the Center for Middle East Studies at the University of Oklahoma, wrote that the “Assad regime must be worried, as it has survived for 42 years thanks to Syria’s fragmentation.”

There has been speculation that Mr. Assad, feeling increasingly threatened, may deliberately seek to widen the conflict that has consumed much of his own country for the past 20 months and left roughly 40,000 people dead. Although there is no indication that Mr. Assad has decided to try to lure Israel into the fight, any Israeli involvement could rally his failing support and frustrate the efforts of his Arab adversaries.

The attack on the Turkish border, by what Syrian witnesses identified as a Syrian MIG-25 warplane, demolished at least 15 buildings and killed at least 20 people in the town of Ras al-Ain, the scene of heavy fighting for days and an impromptu crossing point for thousands of Syrian refugees clambering for safety into Turkey.

“The plane appeared in seconds, dropped a bomb and killed children,” said Nezir Alan, a doctor who witnessed the bombing. “Here is total chaos.” In a telephone interview from Ras al-Ain, he said the bombing wounded at least 70 people, 50 of them critically. Turkish television stations reported that ambulances were rushing victims into Ceylanpinar, Turkey, just across the border.

Windows of shops and houses in Ceylanpinar were shattered by the force of the bombing, and Turkish television showed people on both sides of the border running in panic, while military vehicles raced down streets as a huge cloud of smoke hung over the area.

There were no immediate reports of deaths or injuries in Ceylanpinar. But the Turkish authorities, increasingly angered by what they view as Syrian provocations, have deployed troops and artillery units along the 550-mile border with Syria and have raised the idea of installing Patriot missile batteries that could deter Syrian military aircraft.

Turkey’s foreign minister, Ahmet Davutoglu, sent a diplomatic note to Syria on Monday to protest the Ras al-Ain bombing, the semiofficial Anatolian News Agency reported.

Civilians in southern Turkey’s provinces of Hatay, Sanliurfa and Gaziantep, where the government has erected camps for Syrian refugees, have been advised not to travel close to the border.

In Israel, the military said Israeli tanks that are deployed in the Golan Heights, which the Israelis seized from Syria in the 1967 war, had made a direct hit on Syrian artillery units on Monday after consecutive days of erratic mortar fire coming from the Syrian side of the armistice line. The Syrian mortar shells caused no damage or casualties, the military said.

Military officials and analysts in Israel said that they viewed the Syrian shelling as unintentional spillover from the civil war and that Israel has no desire to get involved in the Syria conflict. But the Israelis have expressed increasing concern that after four decades of relative stability in the Golan area, the Assad government may be trying to push them into a fight that could galvanize Arab hostility toward Israel and distract attention from its own problems.

If an errant Syrian shell hit a school filled with children on the Israeli side, said Prof. Moshe Maoz at the Hebrew University of Jerusalem, a strong Israeli response would be all but guaranteed. “Assad knows very well that Israel does not have a sense of humor here and can retaliate very heavily.”

The United Nations, which monitors an armistice agreement between Israel and Syria in force since the 1973 war, has said it fears that Golan violence could jeopardize the cease-fire.

In Doha, Qatar, where Syrian opposition figures had been meeting since last week, the agreement reached Sunday on forming a new umbrella organization, which could become the basis for a provisional government, was welcomed by participants and the effort’s foreign backers, including Turkey, the United States, the European Union and the Arab League. There were expectations that the new group, called the National Coalition of Syrian Revolutionary and Opposition Forces, would be permitted to take Syria’s seat at the Arab League, which had expelled Mr. Assad’s representative.

Turkey’s Foreign Ministry released a statement saying that the agreement “would add momentum to efforts in completing the democratic transition process in line with the legitimate expectations of the people.”

In the northern Syrian city of Aleppo, a focal point of the conflict since this summer, civilians who have been living under the threat of constant shelling by the Syrian Army welcomed the opposition unity agreement and expressed hope that it signaled a turning point.

“We have been waiting for this for a very very long time,” said Abu al-Hasan, an anti-Assad activist in Aleppo who was reached by telephone. “Even if it is not perfect yet, it will save us.” But he also warned that “people do not believe this will stop the shelling like a miracle.”

There was no sign that the violence was abating elsewhere inside Syria. Activist groups said warplanes were dropping bombs in Damascus suburbs and that army snipers had taken up positions in areas where bombs had been dropped. The mayhem surrounding central Damascus made residents in that part of the capital feel increasingly isolated.

“The inside of the city is like a big prison now,” said Alexia Jade, a media activist contacted inside Damascus. “The checkpoints have increased and the lines of cars waiting to be searched are getting longer.”

Sebnem Arsu reported from Gaziantep, Turkey, and Rick Gladstone from New York. Reporting was contributed by Isabel Kershner and Jodi Rudoren from Jerusalem, and Hania Mourtada from Beirut, Lebanon.

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Lakers hire Mike D'Antoni as new coach

LOS ANGELES (AP) — The Los Angeles Lakers hired Mike D'Antoni late Sunday night, signing the former coach of the Suns and Knicks to replace Mike Brown.

The Lakers and D'Antoni's agent, Warren LeGarie, confirmed the deal two days after the Lakers fired Brown five games into the season.

D'Antoni agreed to a three-year deal worth $12 million, with a team option for a fourth season.

D'Antoni got the high-profile job running the 16-time NBA champions only after the club's top brass extensively discussed the job with former Lakers coach Phil Jackson.

The 11-time NBA champion coach met with Lakers owners Jerry and Jim Buss and general manager Mitch Kupchak on Saturday to weigh a return for a third stint on Los Angeles' bench.

The Lakers instead went with D'Antoni, a respected offensive strategist who coached Lakers point guard Steve Nash in Phoenix during the best years of their respective careers. D'Antoni was less successful during four seasons in New York, but at least restored the once-moribund Knicks to competence before resigning last March.

"Dr. (Jerry) Buss, Jim Buss and Mitch Kupchak unanimously agreed that Mike was the best coach for this roster at this time," Lakers spokesman John Black said.

The 61-year-old D'Antoni underwent knee replacement surgery earlier this month, and could be physically limited early in his tenure. Black said the Lakers aren't certain when D'Antoni will travel to Los Angeles to begin work.

Interim coach Bernie Bickerstaff will continue running the Lakers until D'Antoni arrives. Los Angeles beat Sacramento 103-90 on Sunday night, improving to 2-0 under Bickerstaff after a 1-4 start under Brown.

The Lakers' next game is Tuesday night against San Antonio at Staples Center.

After Brown's dismissal, Nash and Kobe Bryant both expressed enthusiasm about the prospect of playing for D'Antoni, although Bryant also campaigned eagerly for Jackson.

Bryant idolized D'Antoni while growing up in Italy, where D'Antoni was a star player for Olimpia Milano in the Italian pro league. D'Antoni also has been an assistant coach on various U.S. national teams featuring Bryant, including the gold medal-winning squad at the London Olympics.

Nash won two MVP awards while running D'Antoni's signature up-tempo offense for the final four seasons of the coach's five-year tenure with the Suns.

Nash and D'Antoni won at least 54 games each season and reached two Western Conference finals — and they eliminated Bryant's Lakers from the first round of the playoffs in 2006 and 2007, still the only first-round exits of Kobe's 17-year career.

D'Antoni then coached New York to just one playoff appearance and no postseason victories. He also coached the Denver Nuggets during the lockout-shortened 1998-99 season.

But his NBA accomplishments can't measure up to Jackson, who won five titles and reached seven NBA finals during two stints totaling 11 seasons with Los Angeles.

Jackson walked away from the club 18 months ago after a second-round playoff sweep by Dallas, and Brown led Los Angeles to a 41-25 mark followed by another second-round playoff defeat last summer.

The Lakers then traded for Nash and Dwight Howard, setting up a season of enormous expectations for Brown — but the Lakers struggled to learn his new, Princeton-influenced offense while playing mediocre defense.

After the Lakers stumbled out of the gate while Howard and Bryant missed preseason games to preserve their health, Nash incurred a small fracture in his leg during the Lakers' second regular-season game, keeping him out of the lineup for their past five games and for at least another week.

The Lakers have improved to 3-4 under Bickerstaff after following up their winless preseason with four losses in their first five regular-season games, the club's worst start since 1993.

Despite his reputation for offensive acumen, D'Antoni's NBA teams typically have played fairly solid defense, statistically speaking — and they never had the imposing Howard or defensive stopper Metta World Peace in their lineups.

Nash had his best NBA seasons as the versatile quarterback of the Suns' offense under D'Antoni, and point guard Jeremy Lin became a star on the Knicks last season while filling much the same role.

D'Antoni resigned late last season following a six-game losing streak, surprising many observers, and former assistant coach Mike Woodson led the Knicks to the playoffs.

Phoenix visits Staples Center on Friday.

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Global Update: A Solar Device to Help Sterilize Instruments

Solar power can steam-sterilize surgical instruments, according to a new study — but the contraption needed to do so is not pocket-size.

Sterilizing instruments needed in surgical emergencies like Caesarean births or appendectomies can be a problem in rural clinics in Africa: There may be no electricity, jugs of bleach or tanks of propane.

So a Rice University team recently modified a prototype of an old solar stove to power a simple autoclave, which is a pressure-cooker for instruments, and tested it in the Texas sun.

On all 27 attempts, it reached United States government sterilization standards.

How practical it is awaits African trials; it is nearly 12 feet long and 6 feet tall and has bright curved mirrors to focus sunlight on a water-filled pipe. On sunny days, it can make steam at 150 degrees Celsius (302 degrees Fahrenheit) from about 9 a.m. to 3 p.m.

Douglas A. Schuler, above, a Rice business professor and lead author of the study, published in The American Journal of Tropical Medicine and Hygiene, said he “married into the project.” His French father-in-law designed the solar stove years ago after a student trip to West Africa. But women in Haiti, where they tested it, “just hated cooking on it,” Dr. Schuler said, so they found a different use for it.

The initial setup costs about $2,100. But sunlight costs nothing, making five years of operation about $2,000 cheaper than using propane.

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