Well: Too Young to Have a Heart Attack

The foreshadowing escaped me: The night before we left for our summer vacation in Michigan, I accidentally stepped on my Kindle — which, like my heart, I cannot live without — and broke it. Reduced to reading novels on my iPhone, I made the best of it several days later, sitting in a sunroom overlooking Eight Point Lake, where my family gathers each year with friends.

The day before, proving to my teenage sons that 48 isn’t too old for fun, I had hung on for dear life as I zoomed behind a speedboat on a ski tube. The next day, I was enjoying a few moments of solitude in those blissful minutes before the sun goes down, finger-swiping to turn the page of my novel on my phone’s tiny screen, when my left arm started hurting.

You know that childhood feeling when your mother is mad at you, grabs your arm and squeezes it as she drags you away from whatever grief you’ve been causing? It felt like that, times 10, from shoulder to wrist. My chest got slightly uncomfortable, and I started sweating profusely. For the next four or five minutes, I kept to myself. I was incredibly antsy — up, down, sitting, standing, leaning, lying; my arm and I simply couldn’t get comfortable.

I instinctively knew what was happening but wasn’t ready to say it out loud, trying to reassure myself. There was no elephant on my chest; I’m too young – no one in my family has had heart trouble before age 55; I’m 50 pounds overweight but carry it well. Nevertheless, I motioned my husband up from the dock and, cradling my arm, told him something was really wrong.

He rushed to get some baby aspirin he’d seen earlier in the bathroom, which I chewed. I noticed him quietly doing a Google search for “heart attack symptoms” on his phone as family and friends gathered around us, but I was otherwise inside my head, no longer able to focus on what anyone else was doing or saying.

Our friend drove us to the E.R., where my EKG looked normal and the first nitroglycerin pill had no effect. But 10 minutes later, about the time the second and third nitro pill were making the pain dissipate, the doctor showed up with the result of my cardiac enzyme blood test. It’s supposed to be 0, but mine was much higher. And, he said, that weird somersault feeling I was having right at that moment at the base of my throat was actually tachycardia, a rapid heart rate. Before he was even done talking, an ambulance crew was waiting to take me to a bigger hospital 30 minutes away for a cardiac catheterization.

A little balloon angioplasty through the groin? I could deal with that, and maybe I could convince them to let me go back to the cottage in time for dessert. Instead, I woke up the next day, struggling to breathe, wrists strapped to the rails of a hospital bed, hearing the word “surgery.” I was extremely agitated, confused and unable to ask questions because of the breathing tube running down my throat.

This was not the summer vacation I had planned.

It turned out my “tortuous” left anterior descending artery was 95 percent clogged, and the angioplasty effort tore the inner artery wall, making a stent impossible and creating an even more critical situation. While I was still anesthetized, a surgical team was rounded up at 3 a.m. for an emergency heart bypass. In the span of a couple of hours, I went from expecting a teeny balloon in my artery and a little puncture in my groin to having open heart surgery and an eight-inch scar bisecting my chest.

Did I ever expect this? Not really. I’d read enough to know that heart disease is the No. 1 killer of women, that our heart attack symptoms often are radically different from men’s (just ask Rosie O’Donnell, whose heart attack symptoms the same week as mine seemed more like the flu), and that a third of cardiovascular-disease deaths happen to people younger than 65. But this stuff doesn’t happen to us, right?

Not only did it happen to me; it happened to me twice. I was lucky enough to arrange a flight home on a small plane — larger planes have pressure issues, and the doctors wouldn’t let us drive — but 30 minutes into the flight, my left arm started hurting and I started sweating, not to mention crying at the thought of going through this all over again.

We made an emergency landing. Later, after five hours of tests and discussion, a doctor told me it was stress-induced angina: the symptoms of a heart attack without the life-threatening blockage. He wanted me to stay overnight for observation, but finally agreed to let me continue my trip home.

I’d been relatively pain-free in the hospital, but once I was home, the agony of my titanium-twist-tied sternum was startling. I’ve had to take everything — shifting positions, showering, even breathing — slowly. I’m more aware of my heartbeat, which can be a little freaky. And while I won’t be running marathons any time soon, it’s heartening to hear from friends that I look “terrific,” nothing like a person who had a heart attack five months ago.

I’ve learned many things throughout all of this. Among them, that doctors now try to use a mammary artery, from the chest, for the bypass instead of grafting one from the leg because the mammary bypasses tend to last longer. And it’s likely that a lot of my previous complaints over the past few years — extreme fatigue, lack of endurance, poor circulation, jaw pain (not T.M.J., after all), and so many other vague symptoms — were due to this growing accumulation of plaque in my artery, not perimenopause. Even though I’m far from healed yet, I feel amazingly more alert and less muddled than I did before the surgery, and many of those other symptoms suddenly disappeared.

I also quickly learned I have more friends than I realized, as people brought dinners and well wishes for weeks on end (not to mention commiseration about trying to read a book on an iPhone, a heart-attack-inducing event if ever there was one). However, I’m still coming to terms with the idea of a heart-healthy diet here in Wisconsin, the land of aged and artisan cheeses.

Perhaps most important, I’ve learned to relinquish some control. Even if your doctor says you don’t need help walking up the stairs, let your husband or children escort you anyway. When you’ve been this close to death, the recovery is as much theirs as yours.

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Shinzo Abe Selected as Japan’s Prime Minister





TOKYO — Parliament formally elected Shinzo Abe as prime minister on Wednesday, ending a three-year break from decades of near-constant rule by his conservative Liberal Democratic Party.




The victory puts Mr. Abe, 58, a former prime minister and an outspoken nationalist, at Japan’s helm as it faces the growing burden of its aging population, years of industrial decline and the challenge of an increasingly assertive China. The change in prime ministers is the seventh in six years, a high turnover that is itself a sign of the nation’s inability to escape its long economic funk.


Mr. Abe won the support of 328 members of the 480-seat lower house, a total that included votes from the Liberal Democrats’ coalition partner, a small Buddhist party.


Mr. Abe’s pro-business party won a landslide victory over the left-leaning Democratic Party in lower-house elections on Dec. 16. Earlier on Wednesday, Prime Minister Yoshihiko Noda and his cabinet resigned to make way for the new leader.


Despite Mr. Abe’s vows to strengthen control of a chain of islands in the East China Sea that both Japan and China claim, he has played down any confrontations between Tokyo and its Asian neighbors since the elections, instead focusing his agenda on lifting Japan’s economy out of recession before the upper-house elections next summer.


Mr. Abe has vowed to encourage growth quickly by offering 10 trillion yen, or about $120 billion, in public works and other emergency stimulus spending. He has also promised to force the central bank to move more aggressively to combat deflation and to weaken the value of the yen, actions that would offer relief to beleaguered export industries by making Japanese products cheaper abroad.


The measures are intended to revive the economy ahead of the elections in June, to give Mr. Abe’s party a better chance of winning the upper house and, with it, control of Parliament. Mr. Abe will have to hurry to retain the support of Japan’s weary voters, who have shown themselves quick to turn against leaders who fail to deliver on promises of change.


Immediately after the vote on Wednesday, Mr. Abe began appointing a cabinet filled with relatively young and unknown faces. While many of these appointees are Mr. Abe’s friends, the fresh lineup is also apparently intended to emphasize that the party has changed since it was driven from power three years ago.


Among the few veterans in the cabinet is Taro Aso, 72, a former prime minister, who was appointed finance minister. The post of foreign minister went to Fumio Kishida, 55, a former minister in charge of Okinawan affairs. He is expected to try to smooth ties with the United States that have been frayed by a dispute over an American air base on Okinawa.


Mr. Abe will face other early challenges, like bridging a rift within his party over whether Japan should join a new regional free-trade agreement led by the United States. The pact, called the Trans-Pacific Partnership, is supported by business leaders but opposed by farmers, two groups that are among the staunchest supporters of the Liberal Democrats.


Another challenge will be responding to China’s stepped-up efforts to assert its claims to the disputed islands, which Japan calls the Senkaku and China calls the Diaoyu. Chinese ships and, more recently, aircraft now make almost daily incursions into Japanese-controlled waters and airspace near the islands, with no signs of letting up.


Mr. Abe has been vague about whether he will shift his energies to his long-held desire to rewrite Japan’s antiwar Constitution to allow for a full-fledged military.


Mr. Abe and other conservatives say such a step is needed for Japan to stand up for itself in light of China’s growing strength, and to share more of the regional security burden with the United States. However, the move could also be seen as provocative by China and South Korea, two victims of Japan’s World War II-era militaristic policies.


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Samsung expects to ship more than half a billion phones in 2013









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Denver rolls, keeps top spot in AP Pro32 rankings


NEW YORK (AP) — Peyton Manning and his Broncos are closing in on the playoffs as the top team in the AP Pro32 NFL power rankings.


Denver strengthened its grip on the top spot Wednesday following its 10th win in a row, receiving nine first-place votes and 381 points in balloting by The Associated Press panel of 12 media members who regularly cover the league.


The AFC West champion Broncos (12-3) close out the regular season at home against Kansas City (2-13), 32nd and last in the rankings. The final AP Pro32 rankings will be released next Wednesday.


The NFC South champion Atlanta Falcons (13-2) moved up two places to second with one first-place vote and 363 points. Last week, the Broncos were first by three points over San Francisco, which dropped to sixth after being blown out by Seattle.


"Eleven in a row (after KC this weekend) and primed for a Super Bowl run," Rich Gannon of CBS Sports/Sirius XM said in voting the Broncos first.


"As expected the Broncos have become a scoring machine that also has good pass rushers. Still a chance they are the No. 1 seed in the AFC," Pat Kirwan of SiriusXM NFL Radio/CBSSports.com said.


The Seahawks (one first-place vote) were up two spots to fifth after routing the 49ers 42-13 on Sunday night.


"They have scored 120 points more than their last three opponents and officially have become the team no one wants to play in the postseason," Dan Pompei of the Chicago Tribune said.


Despite the loss, the 49ers still received a first-place vote.


"Admittedly, a HUGE mulligan," said ESPN's Chris Berman in sticking with the 49ers at No. 1.


Green Bay was up three spots to third after its 55-7 rout of Tennessee, while New England dropped a place to fourth after hanging on for a 23-16 win over No. 31 Jacksonville.


"If there's any solace from an unimpressive win at Jacksonville, the Patriots also seemed disinterested in their final two regular-season games last year before reaching Super Bowl," Alex Marvez of Foxsports.com said.


"Yes, the Patriots are hard to figure out, but this isn't: They're always a Super Bowl factor as long as Tom Brady is healthy," Clark Judge of CBSSports.com said.


Indianapolis, which clinched a playoff spot with a win over Kansas City, moved up to 10th in a season in which the Colts started out No. 32 in the first AP Pro32 rankings.


"Can an assistant coach be named the NFL's coach of the year? Colts offensive coordinator Bruce Arians has put himself in that position for his interim work filling in for ailing head coach Chuck Pagano this season," Rick Gosselin of the Dallas Morning News said.


And yes, Arians can win the award.


Minnesota, meanwhile, rose to No. 12 this week, and needs a win over Green Bay to earn a playoff spot. The Vikings started the season 29th.


"Adrian Peterson is finally getting a little help from his friends," Ira Kaufman of the Tampa Tribune said.


Philadelphia began the season No. 8 and dropped three more spots to No. 27 after a 27-20 loss to Washington. The Redskins, meanwhile, went the other way, starting at No. 25 and rising to No. 9 this week.


"It's very simple for the resurgent Redskins: beat the Cowboys on Sunday, and the division is theirs," Bob Glauber of Newsday said. "Would be an incredible finish for a team that looked to be out of it at 3-6."


___


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


___


Follow Richard Rosenblatt on Twitter at: http://www.twitter.com/rosenblattap


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Q & A: Should Older Adults Be Vaccinated Against Chickenpox?





Q. Should a 65-year-old who has never had chickenpox be vaccinated against it?




A. In someone who has never had chickenpox, the vaccine would protect against a disease that is far more serious in adults than it is in children, said Dr. Mark S. Lachs, director of geriatrics for the NewYork-Presbyterian Healthcare System and professor of medicine at Weill Cornell Medical College.


After childhood chickenpox, the varicella virus is never eliminated from the body but lies dormant in nerve roots. Decades later, it may reactivate along the nerve pathway and cause the very painful rash called shingles, and later, in many cases, a persistent pain called postherpetic neuralgia, or PHN.


Therefore, for most people over 60, the Centers for Disease Control and Prevention recommends the shingles vaccine. It safely reduces (but does not eliminate) the risk of both shingles and PHN in those who have had chickenpox, Dr. Lachs said.


In someone who never had chickenpox, he said, the concern is not shingles but adult chickenpox, which has “fatality rates 25 times higher than in children.”


Such a person should instead be vaccinated against a primary infection with the varicella virus, Dr. Lachs said. The vaccine differs in strength from the one for shingles and is given in two injections, a month apart.


C. CLAIBORNE RAY


Readers may submit questions by mail to Question, Science Times, The New York Times, 620 Eighth Avenue, New York, N.Y. 10018, or by e-mail to question@nytimes.com.



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Toyota Settles Lawsuit Over Accelerator Recalls’ Impact





DETROIT — Toyota Motor said on Wednesday that it would spend $1.1 billion to settle a sweeping class-action lawsuit by owners of millions of vehicles that were recalled for problems with unintended acceleration.




The agreement, filed in federal court in California, was called one of the largest product-liability settlements in history.


If the agreement is approved by the court, Toyota would compensate current and former owners for loss of value on vehicles recalled because of faulty floor mats and other conditions that could cause sudden acceleration.


Toyota has also agreed to install special safety systems on 3.2 million vehicles that were recalled for floor-mat problems.


The class-action suit was filed in 2010 after widespread complaints were made to federal safety regulators about Toyota models that accelerated unexpectedly.


Toyota has since recalled about eight million vehicles in the United States for problems relating to floor mats and sticky accelerator pedals.


After a long investigation, the National Highway Traffic Safety Administration said there was no evidence that electronic systems contributed to unintended acceleration in Toyota vehicles.


The law firm representing Toyota owners in the class-action suit said the overall settlement was estimated at $1.2 billion to $1.4 billion.


“We are extraordinarily proud of how we were able to represent the interests of Toyota owners, and believe this settlement is both comprehensive in its scope and fair in compensation,” said Steve Berman, one of the lead lawyers for the plaintiffs.


Toyota said in a statement that it would compensate customers for loss of value of their vehicles, as well as retrofit additional cars with a free safety system that prevents unintended acceleration.


The company said it will take a one-time, $1.1-billion charge against earnings to cover the costs of the settlement and possible resolution of other pending litigation.


“This agreement marks a significant step forward for out company,” said Christopher Reynolds, Toyota’s chief United States legal officer. “In keeping with out core principles, we have structured this agreement in ways that work to put our customers first.”


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Iran Says Hackers Targeted Power Plant and Culture Ministry





Iran reported a spree of new cyberattacks on Tuesday, saying foreign enemy hackers tried in recent months to disrupt computer systems at a power plant and other industries in a strategically important southern coastal province as well as a Culture Ministry information center.




Accounts of the attacks in the official press did not specify who was responsible, when they were carried out or how they were thwarted. But they strongly suggested that the attacks had originated in the United States and Israel, which have been engaged in a shadowy struggle of computer sabotage with Iran in a broader dispute over whether Iran’s nuclear energy program is for peaceful or military use.


Iran has been on heightened alert against such sabotage since a computer worm known as Stuxnet was used to attack its uranium enrichment centrifuges more than two years ago, which American intelligence officials believe caused many of the machines to spin out of control and self-destruct, slowing the Iranian program’s progress.


Stuxnet and other forms of computer malware have also been used in attacks on Iran’s oil industry and Science Ministry under a covert United States effort, first revealed in January 2009, that was meant to subvert Iran’s nuclear program because of suspicions that the Iranians were using it to develop the ability to make atomic bombs. Iran has repeatedly denied these suspicions.


The latest Iranian sabotage reports raised the possibility that the attacks had been carried out in retaliation for assaults that crippled computers in the Saudi Arabian oil industry and some financial institutions in the United States a few months ago. American intelligence officials have said they believe that Iranian specialists in cybersabotage were responsible for those assaults, which erased thousands of Saudi files and temporarily prevented some American banking customers from accessing their accounts.


Defense Secretary Leon E. Panetta cited those attacks in an Oct. 11 speech in which he warned of America’s vulnerability to a coordinated computer warfare attack, calling such a possibility a “cyber-Pearl Harbor.”


The Iranian Students’ News Agency said the country’s Passive Defense Organization, the military unit responsible for guarding against cyberattacks, had battled a computer virus infection of an electric utility and other unspecified manufacturing industries in southern Hormozgan Province, home to a large oil refinery and container port in the provincial capital of Bandar Abbas.


The news agency quoted Ali Akbar Akhavan, the head of the Passive Defense Organization’s provincial branch, as saying that “with timely measures and the cooperation of skilled hackers in the province, the progress of this virus was halted.” It was unclear from the account whether any Iranian targets had been damaged.


Iran’s Fars News Agency said a cyberattack had also been made against the information center of the Culture Ministry’s Headquarters for Supporting and Protecting Works of Art and Culture, and that the attack had been “repelled by the headquarters’ experts.”


The Fars account said the attack had originated in Dallas and was routed to Iran via Malaysia and Vietnam. It did not elaborate on the significance of that information but noted that a broad array of Iranian targets had recently come under cyberattacks that were “widely believed to be designed and staged by the U.S. and Israel.”


News of the latest cyberattacks came as Western economic sanctions on Iran have been tightening while diplomatic negotiations aimed at resolving the nuclear dispute have remained basically stalled since June. There are expectations that a resumption of those negotiations will be announced soon, possibly next month.


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Rondo leads Celtics past Nets 93-76


NEW YORK (AP) — Rajon Rondo lost his cool, and any chance at history, in the second quarter when Boston last met Brooklyn.


This time, the second period featured some of the best basketball the Celtics have played this season.


Rondo scored 19 points in his first full game against the Nets this season, and the Celtics won 93-76 on Tuesday in another game with some heated moments between the division rivals.


Rondo, sidelined in the first meeting and thrown out of the second after shoving Nets forward Kris Humphries into the courtside seats, outplayed counterpart Deron Williams and helped the Celtics take control early.


"We moved the ball; we rebounded the ball," Rondo said. "They beat us pretty bad on the glass, so tonight we did an exceptional job on the glass, taking care of the defensive rebounds, and we got stops."


A month after the teams scuffled in Boston, there was another skirmish in the fourth quarter that resulted in four technical fouls. But that was the most fight the Nets put up in a disappointing performance on the national stage of the Christmas opener. They were never in the game after the first 20 minutes, and their fans headed to the exits with under 2 minutes left as a "Let's go Celtics!" chant broke out.


"It was a big game for us. It was a division rival. We were ready for a big game. It just didn't happen," Williams said.


Rookie Jared Sullinger tied a career high with 16 points and Jeff Green had 15 for the Celtics (14-13), who avoided falling under .500 with just their second victory in six games.


The Celtics took control with a 23-5 run in the second quarter of the opener of their four-game road trip. They had 11 assists on 13 baskets and outscored the Nets 34-18 in the period after dropping the previous two meetings.


"It was good to get off to this start. It was good to finally play from start to finish, especially with the way we've been playing against Brooklyn," said Paul Pierce, who had just eight points on 3-of-10 shooting. "So it was a well-balanced game, but I'm happy with the start of the trip."


Gerald Wallace and Brook Lopez each scored 15 for the Nets, who have lost four of five. Struggling to find anything that worked, they played Lopez and fellow center Andray Blatche together with three guards at one point, but Brooklyn shot just 41 percent and committed 20 turnovers that led to 25 points.


Williams had only 10 points on 3-of-7 shooting and Joe Johnson, his partner in a high-priced backcourt, shot 4 of 14 for his 12 points.


"This one hurts. We didn't play our game. They beat us from the opening tip," Wallace said. "We didn't make shots. We turned the ball over too easy. Our defense just wasn't there tonight. We were not ourselves tonight."


Boston's Kevin Garnett had eight points and 10 rebounds on the day he tied Charles Oakley for 15th place on the NBA's career list with his 1,282nd game. He was also front and center when things got testy.


Wallace was fouled with 9:31 remaining and appeared to hold onto Garnett's uniform to balance himself and not fall. Garnett was fine with that but then objected to how long Wallace hung on to his shorts, and they said something to each other as they tried to push themselves free. That led to technical fouls on the two, along with Blatche and Courtney Lee.


Garnett said he asked Wallace what he was doing but got no response.


"I don't know where in America you can (yank) somebody's pants off, or shorts off. I don't know what the hell was going on," Garnett said.


Sullinger delivered a flagrant foul on Wallace a few minutes later, but there was nothing further.


In the Nets' Nov. 28 victory in Boston, Rondo, Humphries and Wallace were ejected.


It was the second quarter of that game where things got away from the Celtics, and Rondo's frustrations soon followed when he shoved Humphries after the Nets forward fouled Garnett. That ruined the point guard's chance to extend what was then a 37-game streak with double-digit assists, tied for second-longest ever, by finishing with three. He had five assists and six rebounds Tuesday.


This time, the second period belonged to the guys in green.


With the Celtics down three, Green had six points in a 10-0 run that made it 36-29. After Johnson's basket, Boston answered with a 13-3 spurt. Jason Terry made a 3-pointer before Rondo converted a three-point play to push the Celtics' lead to 49-34 with 3:56 to go.


The Celtics opened a 21-point lead early in the third quarter and cruised from there. Terry finished with 11 points.


Notes: As with everyone playing on Christmas, players, coaches and referees wore green ribbons in tribute to the families of Sandy Hook Elementary School. ... Humphries was out with an abdominal strain and will be re-evaluated after the Nets return from Milwaukee. He had mostly been a starter but then didn't play at all Sunday against Philadelphia. ... Feeling Avery Bradley isn't ready yet, Celtics coach Doc Rivers decided not to bring the guard on the road trip so he can continue working his way back from shoulder surgery in Boston. Rivers said the shoulder is strong but that Bradley has had only 2½ practices.


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Netflix Points to Amazon to Explain Christmas Eve Outage







NEW YORK (Reuters) - An outage at one of Amazon's web service centers hit users of Netflix Inc.'s streaming video service on Christmas Eve and was not fully resolved until Christmas day, a spokesman for the movie rental company said on Tuesday.




The outage impacted Netflix subscribers across Canada, Latin America and the United States, and affected various devices that enable users to stream movies and television shows from home, Netflix spokesman Joris Evers said. Such devices range from gaming consoles such as Nintendo Wii and PlayStation 3 to Blu-ray players.


Evers said that the issue was the result of an outage at an Amazon Web Services' cloud computing center in Virginia, and started at about 12:30 p.m. PST (2030 GMT) on Monday and was fully restored Tuesday morning, although streaming was available for most users late on Monday.


"We are investigating exactly what happened and how it could have been prevented," Evers said.


"We are happy that people opening gifts of Netflix or Netflix capable devices can watch TV shows and movies and apologize for any inconvenience caused last night," he added.


An outage at Amazon Web Services, or AWS, knocked out such sites as Reddit and Foursquare in April of last year.


Amazon Web Services was not immediately available for comment. Evers, the Netflix spokesman, declined to comment on the company's contracts with Amazon.


(Reporting by Sam Forgione; Editing by Leslie Gevirtz)


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U.S. Civilian Is Killed at Police Headquarters in Kabul





KABUL, Afghanistan — A female police sergeant shot and killed an American civilian adviser at police headquarters in Kabul on Monday, Afghan police officials said, breaking a relative lull in the so-called insider killings that have strained the relationship between Americans and Afghans here.




The American victim was identified as Joseph Griffin, 49, of Mansfield, Ga., who had worked for DynCorp International as a police trainer since July 2011, according to a DynCorp spokeswoman, Ashley Burke.


Afghan officials identified the suspect as a woman named Nargis, a 33-year-old sergeant in the national police force who worked in the Interior Ministry’s legal and gender equality department, and whose husband is also a member of the police force.


A person at Kabul police headquarters, speaking on the condition of anonymity because he was not authorized to release information, said the attacker had shot the American adviser in the head at close range with a pistol and then was immediately arrested by other Afghan police officers. The person added that both American and Afghan officials were questioning her, and he said she was distraught. The police said they did not believe the attack was related to terrorism and that the suspect had no known connections with insurgents.


The Afghan news station TOLO cited Afghan officials as saying that the woman, who had crossed multiple police checkpoints before she fired her gun, had graduated from the national police academy in 2008, in one of its first female classes.


The effort to recruit and train female police officers has been fraught with difficulty. Eupol, the European police organization active in police training here, says there are only 380 female police officers in Kabul, and even fewer in the provinces, despite a goal by the Interior Ministry of recruiting 5,000 by the end of 2014.


Insider attacks, in which members of the Afghan security services have turned against their foreign allies, have greatly increased in the past year, with 61 American and other coalition members killed, not including the episode on Monday, compared with 35 deaths the previous year, according to NATO figures.


Monday’s attack — the first insider attack known to be committed by a woman — came after a lull in insider shootings after the military instituted a series of precautions meant to reduce them. The most recent episode was on Nov. 11, when a British soldier was killed in Helmand Province.


American and Afghan officials have been struggling to figure out how large a factor Taliban infiltration or coercion has been in such attacks. Although insurgent contact has been clear in some cases, many of the attacks have seemed to come out of personal animosity or outrage, attributed to culture clash or growing Afghan anger at what they see as an unwelcome occupation by the United States and its allies.


“The loss of any team member is tragic, but to have this happen over the holidays makes it seem all the more unfair,” Steven F. Gaffney, the chairman of DynCorp, said in a statement.


The company also released a statement attributed to the victim’s wife, Rennae Griffin. “My husband was a thoughtful, kind, generous and loving man who was selfless in all his actions and deeds,” it said.


In other violence on Monday, a coalition member was killed in an insurgent attack in eastern Afghanistan, and an Afghan Local Police commander killed five fellow officers at a checkpoint in Jowzjan Province in the north. Dur Mohammad, the commander at the checkpoint, shot and killed five officers under his command, according to Gen. Abdul Aziz Ghairat, the provincial police chief. He said the commander fled after the shooting. General Ghairat did not offer a motive, but said that Mr. Mohammad had connections with the Taliban in the area.


The Afghan Local Police program, which seeks to bring armed elements — including some former insurgents — into government service, has drawn criticism because of a series of episodes in which the armed elements have switched allegiances, sometimes repeatedly.


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