Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

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Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

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US productivity fell at 2% rate

U.S. worker productivity shrank in the final three months of 2012 although the decline was caused by temporary factors.

Productivity contracted at an annual rate of 2% in the October-December quarter, the biggest drop since the first quarter of 2011, the Labor Department reported Thursday. Productivity had risen at a 3.2% rate in the July-September quarter.

Labor costs rose at a 4.5% rate in the fourth quarter, the fastest gain since the first quarter of 2012.

Productivity is the amount of output per hour of work. It shrank in the fourth quarter because economic activity contracted while hours worked rose. The economy declined at an annual rate of 0.1 percent in the last three months of 2012, a drop caused mainly by deep defense cuts and slower restocking, changes not expected to last.

The trend in productivity has been weak for the past two years. For all of 2012, productivity rose by just 1 percent following an even smaller 0.7%  rise in 2011. Those gains were less than half the average growth that companies saw in 2009 and 2010, shortly after many laid off workers to cut costs during the Great Recession. And it's below the long-run growth of 2.2% a year dating back to 1947.

Companies may ultimately need to hire more workers if they see only modest gains in productivity and more demand for their products.

Economists predict worker productivity will be weak through 2013. Higher productivity is typical during and after a recession, they note. Companies tend to shed workers in the face of falling demand and increase output from a smaller work force. Once the economy starts to grow, demand rises and companies eventually must add workers if they want to keep up.

For all of 2012, labor costs were up a modest 0.7%. That compared to a gain of 2 percent in 2011 and a decline of 1 percent in 2010. Labor costs were rising more rapidly before the Great Recession, which triggered millions of layoffs and reduced workers' bargaining power.

The Federal Reserve closely monitors productivity and labor costs for any signs that inflation is affecting wages. Mild inflation has allowed the central bank to keep interest rates at record lows in an effort to boost economic growth and fight high unemployment.

The 0.1% economic contraction in the October-December quarter was a sharp reversal from the 3.1 percent growth rate in the July-September period. A plunge in defense spending helped push the economy into negative territory for the first time since mid-2009.

For all of 2012, the economy grew 2.2%. Many economists believe growth will be weaker in 2013. An increase in Social Security taxes is reducing take-home pay, which is likely to dampen consumer spending. And across-the-board government spending cuts could also weaken growth.

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R.I.P., Barney: How 'Barney Cam' made George W. Bush's dog a Web star

"Mr. Orr, this is the White House operator."

As a White House spokesman, I received phone calls like this all the time. But this was the first time the president's secretary had ordered me to report to the Oval Office immediately. Before 7 a.m. on a Saturday.

It was December 2003. Iraq was all over the news. We were closing in on the capture of Saddam Hussein. But — and the nation should be thankful — this wasn't my domain.

President George W. Bush had another reason for calling for me now.

Barney Cam.

How it happened

Whenever I'm asked to speak about my tenure in the White House, the conversation always shifts to Barney, the Scottish terrier whom the president regarded as the son he never had.

After Barney died Friday at age 12, I found myself thinking about how he became an Internet sensation.

In 2002, the White House was still closed to the public after the attacks of Sept. 11. I ran the White House website, and we wanted to use the Internet to better connect with citizens.

Our first attempt to bring people in to the White House — virtually — was a big hit. Millions of viewers went to our site to see President Bush give a personal video tour of the Oval Office.

During a brainstorming session, my deputy, Jane Cook, mentioned that the theme for the White House Christmas was "All Creatures Great and Small" — a tribute to presidential pets.

People liked our videos. People loved Barney. Why not strap a video camera to the first dog's head, chase him through the White House so viewers can see the Christmas decorations from his vantage point, and stream it over the Internet?

I decided to pitch the idea at the morning communications meeting in the West Wing, where a couple of dozen communication staffers gather to plan the day.

When Dan Bartlett, counselor to the president, asked me what was on my agenda, I swallowed hard and then said, "As you know, Dan, White House tours are still closed due to terrorist concerns. And the theme for this year's Christmas at the White House is 'All Creatures Great and Small.'

"So it's only logical that we have a Barney Cam, Dan, which is where we strap a video camera on Barney's head and have him run through the White House looking at decorations while Christmas music is playing in the background."

I smiled.

Dan looked at me as though I'd grown another head.

After about 10 seconds of dead silence, Press Secretary Ari Fleischer chimed in: "That. Is. Awesome."

His validation was all it took.

"Brilliant!"

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Elton John, Mumford & Sons to pay tribute to Helm

NEW YORK (AP) — Elton John and Mumford & Sons will hit the Grammys stage to pay tribute to Levon Helm.

The Recording Academy announced Thursday that T Bone Burnett, Mavis Staples, Zac Brown and Brittany Howard of Alabama Shakes will also perform "The Weight" at Sunday's awards ceremony in Los Angeles.

Helm was the drummer and singer for The Band. He died of complications from cancer last year at age 71.

The performers will sing the song during the show's in memoriam tribute, which honors musicians who died last year. Grammys producer Ken Ehrlich said the lineup of performers is a representation of Helm's diverse sound.

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Duo's lofty idea yields film spotlighting downtown L.A.

Former film and television producer Leonard Hill was having lunch at Church & State bistro, on the ground floor of the Biscuit Company Lofts, when he spotted an old colleague.

Screenwriter Wendy Kout, who had worked with Hill years before, was visiting a friend who had moved into a loft in the arts district in downtown Los Angeles. Kout had created the ABC show "Anything But Love," starring Jamie Lee Curtis and Richard Lewis. After its four-season run ended in 1992, she became a playwright.

Hill, a former independent television producer and vice president of movies for ABC, gave Kout a tour of the lofts and a run-down area along Industrial Street that he and his partner had redeveloped.

PHOTOS: Location filming in Los Angeles

Kout, who lives in Sherman Oaks, was struck by the theme of transformation, both of a downtown she never knew existed and of Hill's own post-Hollywood career.

When Hill suggested they might work together again, a light went on in her head.

"I said, 'Here we are two repurposed people looking at this repurposed downtown,'" Kout said. "I said, 'Wouldn't that be a great idea for a film?' He said, 'You write it and I'll produce it.' And that's what we did."

The result is the independent feature "Dorfman in Love," a romantic comedy about a young suburbanite (played by Sara Rue, of the ABC comedy "Malibu Country") whose life is transformed when she leaves a dreary existence taking care of her father in the San Fernando Valley and moves into a downtown loft to cat-sit for a friend.

Along with the 2009 indie hit "500 Days of Summer," "Dorfman in Love" is one of the few films to spotlight the changing face of downtown L.A., which has attracted thousands of new residents over the last decade, many of them moving into new lofts and injecting new life into a city not known for having a vibrant downtown.

The film, which was directed by Brad Leong and co-stars Elliott Gould, will be released nationwide March 22 by Brainstorm Media in a limited number of theaters, including at Laemmle Theatres, and will also be made available on the same day on video-on-demand through Direct TV.

PHOTOS: Hollywood Backlot moments

"Dorfman in Love" was filmed over 20 days in the Toy Factory Lofts (using Hill's office as a location) and various downtown sites, including the Central Library, the Los Angeles Flower Market, Little Tokyo, Santee Alley, Pershing Square, Angels Flight Railway, Chinatown, Union Station and a subway line.

"We were really trying to give L.A. its due," said Hill, who became a real estate developer after a long career in the film and TV business. He began as a writer on the very L.A.-centric TV series "Adam-12."

He produced more than 50 network television movies and dramatic series, but after struggling to make it as an independent television producer he embarked on a radical career change.

In 2001, Hill and a partner acquired a former toy factory on Industrial Street and converted it into lofts. After the units were sold, they did the same to a former Nabisco bakery building across the street.

But seeing Kout again rekindled his desire to get back in the film game.

PHOTOS: All-time box-office leaders

"The truth is, old producers die hard," Hill said. "Making movies is more fun than making buildings. I really missed the creative aspect of the business."

Hill served as the film's producer, location manager and also worked with Kout on the idea for the script. He initially pitched Kout on a story called "The Loft," inspired by the classic Billy Wilder film "The Apartment."

Instead, Kout suggested an original story, partly based on her own impressions of growing up in the Valley.

For inspiration, she spent a week in Hill's loft at the Toy Factory building to soak up the neighborhood and visit downtown sites.

"I was a bit like Alice in Wonderland," Kout said. "I discovered all these places that I never knew about, like the Central Public Library, L.A. Flower Market and Angels Flight Railway."

Without glossing over the edgier side of downtown, the film attempts to highlight less familiar aspects of downtown life, such as the public transit system and the diversity of residents, Kout said.

"I was living in the San Fernando Valley, and I came to a place that was magical," she said. "I fell in love with downtown."

richard.verrier@latimes.com

Where the cameras roll: Sample of neighborhoods with permitted TV, film and commercial shoots scheduled this week. Permits are subject to last-minute changes. Sources: FilmL.A. Inc., cities of Beverly Hills, Pasadena and Santa Clarita. Thomas Suh Lauder / Los Angeles Times

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Friends, investigators seek answers in killing of O.C. couple

They met in college, two highly regarded basketball players who seemed to have the same winning touch on the court and off.

After blazing through high school and college with her outside shot, Monica Quan became the assistant women's basketball coach at Cal State Fullerton. Keith Lawrence, whose highlight shots are still there on his college website, became a campus officer at USC.

Now police in Irvine are scrambling for an explanation — and friends are looking for a way to express their shock — after Quan and Lawrence were found shot to death in their parked car on the top floor of a parking structure in an upscale, high-security condominium complex near UC Irvine.

The two had just announced their engagement and had recently moved into a condominium complex near Concordia University, where they played basketball and had gone on to earn their degrees.

Late Sunday, after a passerby noticed two people in the parked car, police said they found Lawrence slumped in the driver's side of his white Kia. Quan was next to him, also dead. The couple were shot multiple times, and authorities said they have tentatively ruled out the possibility of it being a murder-suicide or motivated by robbery. Nothing in the car, police said, seemed to be disturbed.

The couple's friends and family said they were shaken by the violent deaths of two people who seemed to have so much to offer.

Quan was a 2002 graduate of Walnut High School in the San Gabriel Valley, where she set school records for the most three-pointers in a season and a game. She played at Long Beach State and at Concordia, where she graduated in 2007. She went on to earn a master's degree before becoming the assistant coach at Fullerton.

Quan's father was the first Chinese American captain in the LAPD, and went on to become police chief at Cal Poly Pomona.

Quan was known for pulling students aside to offer encouragement, said Megan Richardson, a former player. Marcia Foster, the head basketball coach at Cal State Fullerton, described her assistant as a special person — "bright, passionate and empowering," she said.

Quan shared a love of basketball with her fiancee, Lawrence, whom she met at Concordia.

He too had been a standout basketball player, starting at Moorpark High, where he played point guard and shooting guard, said Tim Bednar, who coached Lawrence.

Bednar said that Lawrence, who came from a family of athletes, was talented, yet quiet and humble. After Lawrence graduated in 2003, he continued to participate in summer youth camps

When he returned for the camps, Bednar said, he was known as the "best basketball player that ever came through" the school.

"He was awesome with the kids," Bednar said. "They all wanted to be around Keith Lawrence."

Bednar heard from Lawrence when he needed a recommendation to become a police officer after graduating from the Ventura County Sheriff's Academy. In August, he was hired by USC's public safety department.

John Thomas, the executive director and chief of the department, said that Lawrence was an "honorable, compassionate and professional" member of the community.

"We are a better department and the USC campus community is a safer place as a result of his service," Thomas said in a statement.

On Monday night, Quan's friends gathered outside Walnut High School. One clutched a heart-shaped balloon, another carried a collage of her basketball playing days. Still another held a basketball.

Lawrence's friends and family put up a Facebook page. "RIP Keith Lawrence, you will be missed," it said simply. Within hours, 840 had left comments or indicated they "liked" it. Concordia put up a link to Lawrence's game-winning shot that carried the school into a post-season tournament.

Michelle Thibeault, 27, said in a Facebook message that she had known Quan for more than a decade. The two were on the same athletic teams and went to junior high and high school together. "Monica was loved by everyone," she said.

During a somber gathering at the Cal State Fullerton gymnasium Monday, Foster read a brief statement from Quan's brother Ryan.

"We just shared a moment of incredible joy on her recent engagement," he wrote, and then added: "A bright light was just put out."

nicole.santacruz@latimes.com

kate.mather@latimes.com

lauren.williams@latimes.com

Times staff writer John Canalis contributed to this report.

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NJ Gov. Christie, Letterman laugh about fat jokes

TRENTON, N.J. (AP) — New Jersey Gov. Chris Christie and David Letterman have shared some laughs about the many fat jokes the comedian has made about the lawmaker's ample girth.

Christie has termed his plumpness "fair game" for comedians. And during his first appearance on "Late Show with David Letterman" on Monday, the outspoken Republican and potential 2016 presidential contender read two of Letterman's jokes that he said were "some of my personal favorites."

The governor also drew loud laughs when he pulled out a doughnut and started eating it while Letterman asked him if he was bothered by the digs that have been made about his weight. Christie said he wasn't, noting that he laughs at the jokes if he finds them funny.

"Late Show" airs on CBS at 11:35 p.m. Eastern time.

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The New Old Age Blog: In Blended Families, Responsibility Blurs

Every year, Fran McDowell waited for the summer week when she would sing in a choral festival in the North Carolina mountains, then spend a few days in a lakeside cabin with close women friends.

That getaway grew more complicated to arrange — but perhaps more necessary — after her husband, Herb Beadle, was diagnosed with Alzheimer’s disease. They had a “gloriously happy” marriage — her first, his second — for 11 years, and she was more than willing to care for him in sickness as in health. But he could no longer manage alone in their Atlanta home.

For a few years, other family members pitched in to allow Ms. McDowell her cherished vacation. Eventually, though, she had to ask her husband’s daughter, a medical professional in another state, to take him into her home for a week.

She said no, then yes. Then, the day before Ms. McDowell was to drive him there, her stepdaughter again refused, leaving no time for alternate arrangements. If this had been her biological child, “I would have said, ‘Come on, don’t do this to me,’” Ms. McDowell said. Instead, reluctant to make waves, she canceled her trip.

“I think confrontation is riskier for stepparents,” she told me. “I was the compliant one who would bite my tongue rather than say what I thought.”

Ms. McDowell never told her stepdaughter, or anyone in the family, how angry and disappointed she was, or how difficult it was becoming to care for their father, who died three years ago at 86. She told the members of her dementia caregivers support group instead.

It was that group’s leader, Moira Keller, who e-mailed me to suggest this topic. A clinical social worker with the Sixty Plus program at Piedmont Atlanta Hospital, she wrote that “one of the biggest challenges I have is blended families in later life.”

Though I’ve written about the way the 1970s’ spike in divorces could complicate caregiving for adult children — more households to sustain, more siblings to either help or hinder — I hadn’t considered the impact on the older people themselves.

But Ms. Keller seems to be onto something. “The generation most likely to have stepchildren” — the boomers — “don’t need much care yet,” said Merril Silverstein, a Syracuse University sociologist co-editing a coming issue of the Journal of Marriage and the Family on stepfamilies in later life. “The crunch will come in 10 or 20 years.”

Initially, many adult children whose divorced or widowed parents remarry seem delighted, Ms. Keller said when we spoke. “They’re thrilled that Mom or Dad isn’t alone,” she said. “It’s a wonderful thing — until somebody gets sick.”

Then, she has found, “it gets really blurry. Who’s going to do what?” Grown children don’t have much history with these new spouses; they often feel less responsibility to intervene or help out, and stepparents may be unwilling to ask. Perhaps it’s unclear whether children or new spouses have decision-making authority.

“Older couples in this situation fall through the cracks,” Ms. Keller said.

Research shows that the ties which lead adult children to become caregivers — depending on how much contact they have with parents, how nearby they live, how obligated they feel — are weaker in stepchildren, Dr. Silverstein said. Money sometimes enters the equation too, Ms. Keller added, if biological children resent a parent’s spending their presumed inheritance on care for an ailing stepparent.

Adela Betsill, another of Ms. Keller’s support group members, married her longtime partner five years ago — her second marriage, his third. She has since given up her interior design business to care for Robert who, at 72, has also developed Alzheimer’s disease. His two children have had little involvement — perhaps because she’s just 49 and presumed able to handle everything.

Thus, though Robert’s son works from an office in their home, if Ms. Betsill needed to go out and asked him to remind his father to eat lunch, “he might, or he might not,” she said. “I don’t think he realizes it’s a burden.” So she has not asked.

Would it be different if she were his biological mother and he saw her wearing out under the strain? She thinks so, but it’s hard to know. After all, biological families also experience plenty of conflict and avoidance as elders age.

Still, that sense of reciprocity we often hear from caregivers — she took care of me when I was young, so I need to help out now that she’s old — doesn’t apply in late-life stepfamilies. Ms. Betsill didn’t raise this man, or his half sister.

Older couples who marry or remarry often discuss their finances, Ms. Keller has found. (An elder attorney, Craig Reaves, discussed the legal consequences here.) But illness and dependence may prove even more difficult subjects to broach.

“If I could yell one thing from a mountaintop,” Ms. Keller said, “it’s to talk about this stuff, too. Who’s going to take care of you if you become sick? Talk about that while you’re still healthy.”

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Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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Secondhand designer clothing at discount prices is in fashion

Jaclyn Shanfeld moves from garment to garment with the unbridled joy of a little girl rummaging in her mother's closet.

From the "wall of Chanel" Shanfeld retrieves a light pink and lavender jacket that once fetched $3,200 but was priced for resale at $750. She shows off the unmarked soles of a pair Nicholas Kirkwood boots, originally purchased for $1,500 that are now offered for $700. She unveils a sheer black, sleeveless Alaia gown bought for a special occasion — but never worn. It set back its first buyer $5,400, but it's now available for $650.

These Rodeo Drive castoffs are among the luxury clothes and accessories offered for resale in the digital consignment store Shop-Hers. The online marketplace offers shoppers the opportunity to buy previously owned designer fashions at a discount. Sellers, meanwhile, can create room in their closets and pocket a higher percentage of the proceeds than consignment stores typically offer.

PHOTOS: Celebrity portraits by The Times

"I dreamt of a site that catered to secondhand luxury, a site where one could find women all over the country that were just like them aesthetically in order to have the experience of shopping one another's wardrobe," Shanfeld, 29, said.

The online store re-creates the airy shopping experience of an upscale boutique, with fashions from such designers as Alexander Wang, Hermes, Manolo Blahnik, Tom Ford and Zac Posen. Shanfeld and co-founders Jenna Stahl and Thanh Khuu added an element of social networking to help women browse the virtual closets.

First-time users furnish a profile picture and their measurements to ensure that women of similar size can fit in the items purchased from the seller's digital closets. Then, they select their favorites from among 20 designers. The sizing and fashion preferences help the site recommend "style soul mates," women whose tastes and dimensions most closely match the shopper's own.

When an item is purchased, the seller receives an e-mail alert and has three days to ship the item to Shop-Hers. Upon receipt, the site inspects the item for authenticity and verifies that its condition is as depicted on the site. If it meets expectations, Shop-Hers ships the item to the buyer and sends a follow-up notification to the seller, indicating that the sale is complete and payment is on the way. Shop-Hers keeps an 18% transaction fee.

"I love the site," said Diane Nagler, a publicist who owns her own firm in Denver and was among the site's earliest users. "My first purchase was this amazing, emerald green patent leather Max Mara clutch. I got it for $70 but it retailed for $600 to $800."

Secondhand shops once carried the taint of the declasse, said Adele Meyer, executive director of the National Assn. of Resale Professionals. But now the resale industry accounts for annual revenue of about $13 billion, according to First Research. Online, EBay alone enabled $7.9 billion worth of sales last year of new and used clothing and accessories.

STUDY: Majority of consumers watch TV and surf Web simultaneously

The digital consignment market is showing momentum. In 2011, e-commerce veteran Julie Wainwright launched the RealReal, a members-only website that acquires new and vintage luxury apparel from stylists in Los Angeles, with backing from well-known venture capital firms. Other ventures caught the attention of Silicon Valley's investment community, including Threadflip, Twice and Thredup, which specializes in children's clothing. Poshmark offers an app that allows iPhone users to resell items from their closets.

Shanfeld launched Shop-Hers.com in November, backed by such notable investors as Brian Lee, founder of Shoedazzle; David Lee, a Silicon Valley angel investor who also backed Twitter; and Shana Fisher, managing partner of High Line Venture Partners, a New York fund that was an early investor in Pinterest.

"Jaclyn's a really extraordinary person, as a founder," Fisher said. "She stands out among the best of them."

Shop-Hers had its genesis when Shanfeld left her job at Vision, a modeling agency where at age 23 she was scouting talent, developing the models' careers and booking jobs.

"Once I left the agency, my salary plummeted. I wasn't making money, but I was used to being able to buy designer clothes," said Shanfeld, who grew up in Beverly Hills, the daughter of a screenwriter and real estate developer — and granddaughter of the late comedian Phil Silvers.

Shanfeld found herself attending a series of weddings and recycling the same dresses. A catty remark from someone she knew — "I saw that dress before. Where did I see it? On you, at a wedding last weekend!" — prompted Shanfeld to explore ways to refresh her wardrobe.

Shanfeld began developing the concept of a high-end online resale store where the women who shop runway shows and designer boutiques could sell the unwanted items crowding their closets — and keep as much as 82% of the proceeds. A mutual friend introduced Shanfeld to Stahl, who had overseen the design of Nordstrom's website. Stahl flew down from her home in Seattle, and they worked for a week designing a mock-up of the site. As Stahl and Khuu, the company's chief technical officer, worked on the site, Shanfeld began assembling the inventory.

"I started thinking who in my life has the kind of closet I would love to tap into," Shanfeld said. "So I made a list of every woman that I knew of that had a fantastic wardrobe."

Through emails and in-person appeals — sometimes she would show up at homes with cupcakes and a bottle of wine —– Shanfeld began finding sellers. Among the first was noted Los Angeles art collector Rosette Delug, whose wardrobe includes Balenciaga, Givenchy, McQueen, Maniac and LJB. For years, she would visit family in Turkey, bringing suitcases of clothes, shoes and purses for her sister and nieces. Then, her daughter began mining for treasures in her mother's closet.

"Now with Jaclyn, I get to clean the rest of my closet and get paid for it!" Delug said in an email interview. "She took the items with her, professionally uploaded, labeled and priced images onto her website. Next thing I know, I was receiving steady deposits of money for items I didn't even miss."

As soon as the checks began arriving, Delug said, she celebrated — by buying a new Chanel leather biker jacket and boots.

dawn.chmielewski@latimes.com

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Suspected child molester left L.A. archdiocese for L.A. schools

A former priest and suspected child molester left employment with the Los Angeles archdiocese to work for the L.A. Unified School District, officials confirmed Sunday.

The former clergyman, Joseph Pina, did not work with children in his school district job, L.A. schools Supt. John Deasy said. He added that, as a result of the disclosures, Pina would no longer be employed by the nation's second-largest school system.

Over the weekend, Deasy was unable to pull together Pina's full employment history, but said the district already was looking into the matter of Pina's hiring.

"I find it troubling," he said of the disclosures about Pina. "And I also want to understand what knowledge that we had of any background problems when hiring him, and I don't yet know that."

L.A. Unified itself has come under fire in the last year for its handling of employees accused of sexual misconduct.

Pina, 66, was laid off from his full-time district job last year, but returned to work episodically to organize events. One event he may have helped organize was a ribbon-cutting Saturday for a new education facility. School district officials over the weekend, however, could not confirm that. Pina did not attend the event, and the district could not confirm payment for any help he may have provided.

Pina's name emerged in documents released by the archdiocese to comply with a court order. His case was one of many in which church officials failed to take action to protect child victims and in which first consideration was given to helping the offending priests rather than their victims, according to the documentation.

A just-released, internal 1993 psychological evaluation states that Pina "remains a serious risk for acting out." The evaluation recounts how Pina was attracted to a victim, an eighth-grade girl, when he saw her in a costume.

"She dressed as Snow White ... I had a crush on Snow White, so I started to open myself up to her," he told the psychologist. "I felt like I fell in love with her. I got sexually involved with her, but never intercourse. She was about 17 when we got involved sexually, and it continued until she was about 19."

In a report sent to a top Mahony aide, the psychologist expressed concern the abuse was never reported to authorities.

Pina's evaluation also includes a recommendation "to take appropriate measures and precautions to insure that he is not in a setting where he can victimize others." Pina continued to work as a pastor as late as March 1998.

School district officials could not verify Pina's hiring date over the weekend, but he took a job with L.A. Unified as the school system was carrying out the nation's largest school construction program. His job involved community outreach, building support for school projects, while also finding out communities' concerns and trying to address them, officials said. Such work was crucial to the program, because even though communities wanted new schools, their locations and other elements could prove controversial. Such projects frequently involved tearing down homes or businesses, environmental cleanups, and the blocking of streets and other disruptions.

"His duties were to rally community support and elicit community comments regarding schools in a neighborhood," district spokesman Tom Waldman said.

Pina's work did bring him into contact with families, frequently at public meetings organized to hear and address their concerns.

Projects that Pina worked on included a new elementary school in Porter Ranch and a high school serving the west San Fernando Valley, Waldman said. The high school, in particular, generated substantial public debate as a district team and a local charter school competed aggressively for control of the site.

The $19.5-billion building program is winding down, and, as a result, many jobs attached to it have come to an end. Pina's was among them.

The dedication he may have helped organize Saturday was for the Richard N. Slawson Southeast Occupational Center in Bell. Participants told KCET-TV, which first reported Pina's school employment, that he had assisted with community outreach on that project. The adult education and career technical education facility has 29 classrooms as well as health-career labs and child care for students. The school opened in August 2012.

Pina "was slated for some additional temporary work when the issue came to our attention last week and that work was canceled," Deasy said.

It may have been Pina who first alerted district officials that his name appeared in disclosed documents, Deasy said. Pina called a senior administrator in the facilities division. So far, no untoward issues have emerged regarding Pina's work for L.A. Unified.

howard.blume@latimes.com

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