Well: Ask Well: Squats for Aging Knees

You are already doing many things right, in terms of taking care of your aging knees. In particular, it sounds as if you are keeping your weight under control. Carrying extra pounds undoubtedly strains knees and contributes to pain and eventually arthritis.

You mention weight training, too, which is also valuable. Sturdy leg muscles, particularly those at the front and back of the thighs, stabilize the knee, says Joseph Hart, an assistant professor of kinesiology and certified athletic trainer at the University of Virginia, who often works with patients with knee pain.

An easy exercise to target those muscles is the squat. Although many of us have heard that squats harm knees, the exercise is actually “quite good for the knees, if you do the squats correctly,” Dr. Hart says. Simply stand with your legs shoulder-width apart and bend your legs until your thighs are almost, but not completely, parallel to the ground. Keep your upper body straight. Don’t bend forward, he says, since that movement can strain the knees. Try to complete 20 squats, using no weight at first. When that becomes easy, Dr. Hart suggests, hold a barbell with weights attached. Or simply clutch a full milk carton, which is my cheapskate’s squats routine.

Straight leg lifts are also useful for knee health. Sit on the floor with your back straight and one leg extended and the other bent toward your chest. In this position, lift the straight leg slightly off the ground and hold for 10 seconds. Repeat 10 to 20 times and then switch legs.

You can also find other exercises that target the knees in this video, “Increasing Knee Stability.”

Of course, before starting any exercise program, consult a physician, especially, Dr. Hart says, if your knees often ache, feel stiff or emit a strange, clicking noise, which could be symptoms of arthritis.

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Well: Ask Well: Squats for Aging Knees

You are already doing many things right, in terms of taking care of your aging knees. In particular, it sounds as if you are keeping your weight under control. Carrying extra pounds undoubtedly strains knees and contributes to pain and eventually arthritis.

You mention weight training, too, which is also valuable. Sturdy leg muscles, particularly those at the front and back of the thighs, stabilize the knee, says Joseph Hart, an assistant professor of kinesiology and certified athletic trainer at the University of Virginia, who often works with patients with knee pain.

An easy exercise to target those muscles is the squat. Although many of us have heard that squats harm knees, the exercise is actually “quite good for the knees, if you do the squats correctly,” Dr. Hart says. Simply stand with your legs shoulder-width apart and bend your legs until your thighs are almost, but not completely, parallel to the ground. Keep your upper body straight. Don’t bend forward, he says, since that movement can strain the knees. Try to complete 20 squats, using no weight at first. When that becomes easy, Dr. Hart suggests, hold a barbell with weights attached. Or simply clutch a full milk carton, which is my cheapskate’s squats routine.

Straight leg lifts are also useful for knee health. Sit on the floor with your back straight and one leg extended and the other bent toward your chest. In this position, lift the straight leg slightly off the ground and hold for 10 seconds. Repeat 10 to 20 times and then switch legs.

You can also find other exercises that target the knees in this video, “Increasing Knee Stability.”

Of course, before starting any exercise program, consult a physician, especially, Dr. Hart says, if your knees often ache, feel stiff or emit a strange, clicking noise, which could be symptoms of arthritis.

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Digital Domain: Republic Wireless’s Plan Melds Wi-Fi and Network Calling





AN Android smartphone with unlimited calls, unlimited texting, unlimited data and no contract, all for $19 a month? Really?




When I first saw this offer from Republic Wireless, I rubbed my eyes and looked for an asterisk leading to fine print that detailed a huge catch. But Republic, a division of a telecom company called Bandwidth.com, delivers exactly what it advertises. It can do so because the handset technology is a curious hybrid: it uses Wi-Fi when the customer is in a Wi-Fi area and Sprint Nextel’s 3G network when it is not.


The concept brings together the best of two worlds: the low cost of voice calls carried over the Internet and the convenience of making calls to any phone number using a major carrier’s cellular network when Wi-Fi isn’t available.


In my own case, on a typical day, I use my mobile phone mostly when I’m not actually mobile: I’m either at home or at work, perfectly positioned to use Wi-Fi at both locations. And I don’t even use the phone as a phone all that much. I use it mainly for e-mail and texts, neither of which requires enough bandwidth to benefit from the power of the fastest data networks.


If you walk into a Verizon Wireless store and buy an iPhone 5, you’ll pay $60 or more a month for an unlimited talk and texting plan, depending on the data allocation for Internet use that you select to go with it. Some of that monthly charge goes toward repaying the carrier for the discounted price that makes a $649 iPhone seem as if it costs only $200. But most of the charge is for gaining access to the carrier’s wireless network.


“We were looking at a mobile industry that had begun to charge extraordinary amounts of money, and we saw an industry opportunity that everybody else was missing: Wi-Fi is the new mobile,” says David Morken, co-founder and chief executive of Bandwidth, based in Raleigh, N.C.


Smartphone apps that offer voice calls using data plans, not minutes allocated for calls, are plentiful. Just last month, Facebook quietly added an option that lets users of the iPhone version of Facebook Messenger place free voice calls to other Messenger users. But using those apps to make a call means the recipient has to run the same app, an irksome requirement that never comes up when using phones alone.


Republic buys access to Sprint’s network on a wholesale basis for calls made outside of Wi-Fi areas. Its business model assumes, however, that Wi-Fi carries the load a majority of the time its phones are used. The company says that its service, even at $19 a month, is a profitable operation on a per-customer basis.


“We don’t have to force people, or even ask people, how to behave,” Mr. Morken says. “Over 60 percent of the time that the phone is being used, on average, our users are using Wi-Fi and that number is only going up.”


Last month, I tested a Republic handset, a Motorola Defy XT. It’s a light smartphone with a small screen, acceptable sound quality and great battery life.


Republic’s Web site gently warns against acting like a “data hog” and encourages its customers to “play nice and try to use Wi-Fi as much as you can.” But scolding isn’t needed: Wi-Fi is faster than 3G, so users have an incentive to opt for Wi-Fi wherever it is available.


The Motorola handset is the only one now offered by Republic, and it costs $259. The phone runs an older version of Android, and it has some first-generation glitches, like losing a connection when a caller starts out on a Wi-Fi network and then leaves the coverage area. (With a click, the call is resumed using Sprint’s cellular network.)


Today most Wi-Fi access requires a logon. But that shouldn’t prove a great inconvenience: you can simply set up the phone once with Wi-Fi at home, then once more at the office. At other locations, users can ignore Wi-Fi availability and use 3G instead.


Mr. Morken says a solution to the Wi-Fi-to-cellular handoff problem has been worked out in the company’s lab, and should be available midyear. Later this year, he also expects to offer more handset models, including one at the high end; he says they will run the latest version of Android.


Matt Carter, president of the Global Wholesale and Emerging Solutions division at Sprint, asserted that the company was happy to serve as Republic’s supplier. When I asked whether Republic’s Wi-Fi-centric model, with its drastically lower price to the consumer, would pose a serious threat to the incumbent carriers, including Sprint, he said, “If the world operated based on just economic decisions, people wouldn’t go buy the most expensive cars on the planet, right?”


Mr. Carter listed reasons that most consumers would prefer the wireless service obtained directly from a major carrier: a wider range of devices and the convenience of placing a call without having to tinker with Wi-Fi setup.


Republic “will resonate with a sliver of the marketplace,” Mr. Carter said. He compared wireless carriers to the major airline carriers, which still control a majority of the market despite low-priced upstarts like JetBlue or Southwest, which he described as appealing only to “a certain segment of the population.”


Philip Cusick, a J.P. Morgan analyst who covers telecommunications, says he doesn’t expect a major shift of customers to Republic Wireless. The price difference isn’t as great as it first appears, he says, when one considers that 80 percent of customers of AT&T and Verizon are on family or employer-related discount plans.


MR. MORKEN of Bandwidth.com says he knows that his company must lower the price of its handset — the industry rule-of-thumb for no-contract wireless services is that a simple handset cannot cost more than $99 and a smartphone, $149. But if Republic can offer me an Android phone with a generously sized screen for a reasonable price, I don’t see why, with Wi-Fi available at work and home, I should continue to pay an expensive-sports-car price for my wireless service.


“There’s a reason why the carriers around the world don’t want you using Wi-Fi for voice and text,” Mr. Morken says. “You will soon realize you shouldn’t have to pay what you’re paying today.”


Randall Stross is an author based in Silicon Valley and a professor of business at San Jose State University. E-mail: stross@nytimes.com.



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French Capture Gao Airport in Move to Retake North Mali





KONNA, Mali — French special forces took control of the airport in the Islamic rebel stronghold of Gao, the French government said Saturday, meeting “serious resistance” from militants even as they pressed northward.




Gao is one of three main northern cities in Mali that has been under rebel control for months, and the capture of the main strategic points in Gao represents the biggest prize yet in the battle to retake the northern half of the country.


French airstrikes have been pounding the city since France joined the fight at Mali’s request on Jan. 11. French troops also took control of a bridge over the Niger River on Saturday, and the capture of the airport allowed a company of French soldiers to be airlifted in on Saturday afternoon, according to Col. Thierry Burkhard, the French military spokesman.


Another French company was on the road to Gao from Sévaré on Saturday night, and Malian and other African forces had begun to arrive, he said.


He stepped back from an earlier statement by the French Defense Ministry that declared the city freed by French forces, acknowledging that the statement was “a bit overdone.” Noting Gao’s 70,000 inhabitants, he added, “it’s not with a detachment of special forces that you take over a city.”


But with reinforcements streaming in, the battle for Gao appeared imminent.


Soldiers from Chad and Niger are expected to arrive soon, the French defense minister, Jean-Yves Le Drian, said in a statement. They will be part of a contingent of 1,900 African troops who have already arrived in Mali, fighting alongside the 2,500 French soldiers deployed here.


Gao’s mayor, who had fled to Bamako, the capital, returned to his city on Saturday, Mr. Le Drian said.


In Washington, the Pentagon said Saturday that the United States would provide aerial refueling for French warplanes. The decision increases American involvement, which until now had consisted of transporting French troops and equipment and also providing intelligence, including satellite photographs.


Gao, 600 miles northeast of the capital, had been under the control of the Movement for Oneness and Jihad in West Africa, a splinter group of Al Qaeda in the Islamic Maghreb.


Al Jazeera broadcast a statement from Al Qaeda in the Islamic Maghreb in which the group said it had withdrawn temporarily from some cities it held, but would return with greater force.


Little information has come from the other two main cities under rebel control — Timbuktu, the fabled desert oasis, and Kidal, northeast of Gao — for the past 10 days because mobile phone networks have been down.


Konna was overrun by Islamic fighters on Jan. 10, prompting France to intervene, and a clearer picture has begun to emerge of the fighting. Residents and officials here said that at least 11 civilians had been killed in French airstrikes.


Charred husks of pickup trucks lined the road into the town, and broken tanks and guns littered the fish market, where the rebels appeared to have set up a temporary base.


France’s sudden entry into the fray has left the United Nations and Ecowas, the regional trade bloc, scrambling to put together an African-led intervention force that had been in the planning stages. The Mali Army, which has struggled to fight the Islamist groups, has been accused of serious human rights violations.


From Konna, it is easy to see why the Malian government pleaded for French help after the Islamist fighters took control of the town. Just 35 miles of asphalt separate Konna from the garrison town of Sévaré, home to the second-biggest airfield in Mali and a vital strategic point for any foreign intervention force.


Residents said their town fell to the rebels when 300 pickup trucks of fighters, bristling with machine guns, rolled in and pushed back the Malian Army troops who had been guarding the town after a fierce battle.


Lydia Polgreen reported from Konna, and Scott Sayare from Paris. Elisabeth Bumiller contributed reporting from Washington.



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7 Die in Fire At Factory In Bangladesh


A.M. Ahad/Associated Press


Firefighters and volunteers worked to extinguish the fire at a small garment factory in Bangladesh’s capital on Saturday.







DHAKA, Bangladesh — In the latest blow to Bangladesh’s garment industry, seven workers died Saturday after a fire swept through a factory here not long after seamstresses had returned from a lunch break. Workers said supervisors had locked one of the factory exits, forcing some people to jump out of windows to save their lives.









Abir Abdullah/European Pressphoto Agency

Relatives mourned beside the bodies of workers killed in the fire at a hospital in Dhaka.






Reuters

People sifted through the wreckage at the Smart Fashions factory.






The fatal fire comes roughly two months after the blaze at the Tazreen Fashions factory left 112 workers dead and focused global attention on unsafe conditions in Bangladesh’s garment industry. Tazreen Fashions, located just outside Dhaka, the capital, had been making clothing for some of the world’s biggest brands and retailers, including Walmart.


In the aftermath of the Tazreen Fashions fire, political and industrial leaders in Bangladesh pledged to quickly improve fire safety and even conducted high-profile, nationwide inspections of many of the country’s 5,000 clothing factories. And global brands promised they would not buy clothes from unsafe factories.


But Saturday’s fire in a densely populated section of Dhaka is a grim reminder that the problems remain. The blaze erupted about 2 p.m. at Smart Garment Export, a small factory that employed about 300 people, most of them young women who were making sweaters and jackets. All seven of the dead workers were women.


Masudur Rahman Akand, a supervisor in the fire department, said the factory’s workers were returning from lunch when the blaze erupted in a storage area. The factory was located on the second floor of a building, above a bakery, and it lacked proper exits and fire prevention equipment, Mr. Akand said.


“We did not find fire extinguishers,” he said. “We did not find any safety measures.”


With smoke filling the factory floor, workers apparently panicked. Mr. Akand said the seven workers who died either suffocated or were trampled by people trying to escape.


Eight other workers were hospitalized with injuries. Some of them told rescuers that many people could not quickly escape because one of the exits was blocked by a locked steel gate. Witnesses said people began jumping out of windows before the gate was unlocked.


Azizul Hoque, a police supervisor, said the investigation was continuing. “We do not know the reason or the source or the origin of the fire,” he said.


It was unclear whether the Smart Garment factory was making clothing for international brands or retailers. Dhaka’s industrial areas are filled with factories, large and small, that produce clothing for much of the Western world.


Julfikar Ali Manik reported from Dhaka, and Jim Yardley from New Delhi.



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Europe: Germany: Funds for Global Health Fund Reinstated





Signaling that it was pleased with changes in the Global Fund to Fight AIDS, Tuberculosis and Malaria, Germany announced Thursday that it would reinstate the annual pledge of 200 million euros (about $267 million) it had made since the fund’s early days. In 2011, Germany temporarily held back half its contribution and threatened to hold back future funds in protest against inefficiencies, thefts by some grantee countries and infighting among the fund’s top executives. Other contributions dried up, forcing the fund to cancel a planned round of grants. Since then, both the fund’s executive director and inspector general have departed, and it was run for one year by a Brazilian banker; he devised an overhaul of the grant-making process that is to take effect next month. In November, Dr. Mark Dybul, the Bush administration’s global AIDS czar, became the new executive director. The fund recently announced that it cut its operating expenses by 5 percent in 2012 while still making 26 percent more in grants than it did in 2011. Of the grants that had been audited, Dr. Dybul said, only 0.5 percent had been lost to fraud. The fund plans a new fund-raising round for later this year. The United States is the fund’s largest supporter, providing roughly a third of its budget.


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Europe: Germany: Funds for Global Health Fund Reinstated





Signaling that it was pleased with changes in the Global Fund to Fight AIDS, Tuberculosis and Malaria, Germany announced Thursday that it would reinstate the annual pledge of 200 million euros (about $267 million) it had made since the fund’s early days. In 2011, Germany temporarily held back half its contribution and threatened to hold back future funds in protest against inefficiencies, thefts by some grantee countries and infighting among the fund’s top executives. Other contributions dried up, forcing the fund to cancel a planned round of grants. Since then, both the fund’s executive director and inspector general have departed, and it was run for one year by a Brazilian banker; he devised an overhaul of the grant-making process that is to take effect next month. In November, Dr. Mark Dybul, the Bush administration’s global AIDS czar, became the new executive director. The fund recently announced that it cut its operating expenses by 5 percent in 2012 while still making 26 percent more in grants than it did in 2011. Of the grants that had been audited, Dr. Dybul said, only 0.5 percent had been lost to fraud. The fund plans a new fund-raising round for later this year. The United States is the fund’s largest supporter, providing roughly a third of its budget.


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Gadgetwise Blog: Q&A: Upgrading to Microsoft Office 2013

If I buy Microsoft Office 2010 and Microsoft Office 2013 comes out right afterwards, can I return the older version of the program for the new one?

In general, most stores will only accept software returned for a refund if the box is still sealed and the program has not been installed. Microsoft has an explanation of its own returns and refunds policy on its site.

The new version, Microsoft Office 2013, is expected very soon — possibly by the end of the month. If you need the software and just cannot wait for the newest version to arrive, however, Microsoft has an offer than allows you upgrade to Office 2013 for free even if you buy Office 2010 now.

Microsoft Office 2010 (or Office 2011 for the Mac) software purchased between October 19, 2012, and April 30, 2013, is generally eligible for the upgrade. You can find full details on the Office 2013 offer here.

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Dolours Price, Defiant I.R.A. Bomber, Dies at 61





Dolours Price, an unrepentant former member of the Irish Republican Army who went to prison for a 1973 London bombing and who recently shook Northern Ireland’s fragile calm by claiming that her orders had come from Gerry Adams, the Sinn Fein party leader and peace negotiator who denies having ever been in the I.R.A., died on Thursday at her home in a suburb of Dublin. She was 61.




The police in Dublin said the cause was not known. An autopsy was scheduled.


Ms. Price, the former wife of the Irish actor Stephen Rea, attracted more public attention than she might have expected in recent years. Since 2011, the police in Northern Ireland police have been fighting in the courts for access to audiotaped interviews that Ms. Price gave to an oral history project at Boston College in which she detailed her I.R.A. career. The United States Supreme Court has been asked to hear the case.


The police learned of the audiotapes from an interview Ms. Price gave to an Irish newspaper in 2010. She told the paper that her testimony for the college’s “Belfast Project” described kidnappings and executions that she said she helped carry out in 1972 on orders from Mr. Adams. She also asserted on the tapes, she said, that Mr. Adams had a role in conceiving the London car bombings and that he ordered her and nine other I.R.A. volunteers, including her sister Marian, to carry them out in 1973.


The explosions, at four landmark sites, including the Old Bailey Courthouse, injured 200 people and left one man dead from a heart attack. It was the I.R.A.’s first attack in London.


Mr. Adams, who has intermittently been a member of the power-sharing Northern Ireland Assembly since a peace agreement was forged in 1998, has repeatedly denied her accusations. On Thursday he said he had “no concerns, because they are not true.”


The Northern Ireland police have said that Mr. Adams is not a target in their seeking the audiotapes. The family of one suspected I.R.A. informer described by Ms. Price as having been executed has called for Mr. Adams’s arrest.


Mr. Adams expressed sorrow this week at the news of Ms. Price’s death.


"She endured great hardship during her time in prison in the 1970s,” he said.


Ms. Price spoke often of the personal toll of her terrorist activities: years of depression, alcohol and drug abuse, and post-traumatic stress disorder. Among the suspected informers she drove to their executions, she said, was a longtime family friend. In prison, she staged a 203-day hunger strike in which her jailers force-fed her every day through rubber tubing.


Suffering from tuberculosis and other ailments, Ms. Price was released from prison on humanitarian grounds in 1981 after serving seven years of a life sentence.


Ms. Price told interviewers that she might have spared herself and her victims had she known that the struggle would end with a peace that left Northern Ireland’s Catholic majority, in her view, where it had started: under British rule.


“When we starved together on hunger strike,” she wrote in a 2004 essay in Fortnight, an Irish journal, “it was not to ‘move the process forward,’ it was not for seats in a British government.” It was, she said, “to rid this land of any British interference.”


Ms. Price married Mr. Rea in 1983 and had two children with him. Mr. Rea, who portrayed an I.R.A. hit man in the 1992 film “The Crying Game,” spoke only obliquely about his wife’s past.


“You can’t be born in the north of Ireland and not be political,” he told the British newspaper The Evening Standard in 1992. “The situation there is a pollution of your thinking.”


Dolours Price was born in Belfast on June 21, 1951, into a family steeped in Irish republican politics. Her father, Albert, was an I.R.A. founding member. “My father never saw his firstborn child because she was born and died while he was interned,” she wrote.


An aunt, Bridie Price, lost both hands and her eyesight when a bomb she was assembling accidentally blew up. Her sister Marian, who was among the 10 I.R.A. members involved in the 1973 London bombings, was released from prison in the early ’80s but rearrested several years ago on charges of plotting an attack on the government.


Ms. Price was a recent college graduate and training to be a teacher when she enlisted in the I.R.A. in the early 197os. She was one of the first women assigned to carry out an armed attack and was selected for the London mission in part, she said in an interview, because she was a pretty young woman and had no arrest record.


Ms. Price’s marriage to Mr. Rea ended in divorce in 2003. She is survived by their children, Danny and Oscar; her sister Marian and another sister, Clare; and two brothers, Sean and Dino.


Ms. Price remained defiant to the end. She had no truck, she said, with those whose political views had changed over the years. “I am a republican, born and bred, as were my mother and father before me and theirs before them,” she wrote in a letter to an Irish newspaper last year. “I have no time for people who constantly change their position.”


“They are not republicans,” she wrote.


Douglas Dalby contributed reporting from Dublin.



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Johnson & Johnson Hid Flaw in Artificial Hip, Documents Show





Johnson & Johnson executives knew years before they recalled a troubled artificial hip in 2010 that it had a critical design flaw, but the company concealed that information from physicians and patients, according to internal company documents disclosed Friday during a trial over the device’s failure.




The medical device giant had received complaints from doctors about the device, the Articular Surface Replacement, or A.S.R., even as it started marketing a version of it in 2005 in the United States. The A.S.R.’s flaw caused it to shed large quantities of metallic debris after implant and the model failed an internal 2007 test in which engineers compared its performance to another company hip implant, the documents show.


Still, executives of the company’s DePuy Orthaepedics unit kept selling the A.S.R. even as it was being abandoned by an increasing number of surgeons who were working as consultants to the company. DePuy executives discussed ways of fixing the defect but apparently never did so, the records suggest.


The documents were introduced Friday in Los Angeles Superior Court by plaintiffs’ lawyers during opening arguments in the first A.S.R.-related lawsuit to go to trial. The company faces more than 10,000 lawsuits in the United States in connection with the device. An estimated 93,000 patients worldwide received an A.S.R., about one-third of them in the United States.


For their part, DePuy executives insisted before the A.S.R.’s recall in mid-2010 that the implant was working well despite years of complaints from doctors that it was failing early. In late 2009, the company announced plans to phase out the model but said it was doing so because of slowing sales, not safety concerns.


In opening arguments, a lawyer for DePuy, Alexander Calfo, reiterated those positions, telling jurors that DePuy had acted ethically throughout the entire A.S.R. episode.


“The evidence will show that DePuy acted as an extremely responsible manufacturer,” Mr. Calfo said.


But a lawyer for Loren Kransky, the plaintiff in the case, painted a far different picture of DePuy’s behavior for jurors in his opening arguments.


The lawyer, Michael Kelly, also introduced a number of internal records which suggested that the concern of company executives for profits might have exceeded their worries about patients. For example, Mr. Kelly said, DePuy officials never told doctors that the A.S.R. had failed an internal performance test against another company hip.


“They did not report the data to American doctors,” said Mr. Kelly. “They changed the test and tested it against other things until they found one it could beat.”


The A.S.R. represents one of the biggest medical device failures in recent decades. According to DePuy’s internal estimates, it will fail within five years in about 40 percent of patients who got one. That figure is eight times the failure rate of most orthopedic implants.


The A.S.R. belonged to a once-popular class of hip implants introduced about a decade ago as a way of trying to address problems associated with hips made from traditional materials like metal and plastic. But surgeons have largely abandoned them because their components can grind together, releasing metallic debris that damages a patient’s tissue and bone.


The A.S.R. was sold in two versions, one used in an alternative hip replacement called resurfacing and one used in standard hip replacement. Only the version used in standard replacements was sold in the United States.


In 2003, DePuy began selling the resurfacing version of the A.S.R. outside the United States in an effort to catch up with a competing device known as the Birmingham hip. But by 2005, some doctors began telling DePuy that the A.S.R. was failing quickly after implant and company consultants soon stopped using it, records show.


The problem, internal DePuy records indicate, was the design of the cup component that fit into a patient’s hip socket. The cup, which was used in both the resurfacing and standard versions of the A.S.R., had an inside groove against which a surgeon pressed a tool in order to implant the component.


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The New Old Age Blog: Grief Over New Depression Diagnosis

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

Traditionally, depression has been underdiagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” We don’t find depression in old age normal any longer.

But critics of the D.S.M. 5 now argue that depression may become overdiagnosed, because this version removes the so-called “bereavement exclusion.” That was a paragraph that cautioned against diagnosing depression in someone for at least two months after loss of a loved one, unless that patient had severe symptoms like suicidal thoughts.

Without that exception, you could be diagnosed with this disorder if you are feeling empty, listless or distracted, a month after your parent or spouse dies.

“D.S.M. 5 is medicalizing the expected and probably necessary process of mourning that people go through,” said Allen Frances, a professor emeritus at Duke who chaired the D.S.M. IV task force and has denounced several of the changes in the new edition. “Most people get better with time and natural healing and resilience.”

If they are diagnosed with major depression before that can happen, he fears, they will be given antidepressants they may not need. “It gives the drug companies the right to peddle pills for grief,” he said.

An advisory committee to the Association for Death Education and Counseling also argued that bereaved people “will receive antidepressant medication because it is cheaper and ‘easier’ to medicate than to be involved therapeutically,” and noted that antidepressants, like all medications, have side effects.

“I can’t help but see this as a broad overreach by the APA,” Eric Widera, a geriatrician at the University of California, San Francisco, wrote on the GeriPal blog. “Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.”

But Dr. Kupfer said the panel worried that with the exclusion, too many cases of depression could be overlooked and go untreated. “If these things go on and get worse over time and begin to impair someone’s day to day function, we don’t want to use the excuse, ‘It’s bereavement — they’ll get over it,’” he said.

The new entry for major depressive disorder will include a note — the wording isn’t final — pointing out that while grief may be “understandable or appropriate” after a loss, professionals should also consider the possibility of a major depressive episode. Making that distinction, Dr. Kupfer said, will require “good solid clinical judgment.”

Initial field trials testing the reliability of D.S.M. 5 diagnoses, recently published in The American Journal of Psychiatry, don’t bolster confidence, however. An editorial remarked that “the end results are mixed, with both positive and disappointing findings.” Major depressive disorder, for instance, showed “questionable reliability.”

In an upcoming post, I’ll talk more about how patients might respond to the D.S.M. 5, and to a new diagnosis that might also affect a lot of older people — mild neurocognitive disorder.

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


This post has been revised to reflect the following correction:

Correction: January 24, 2013

An earlier version of this post misspelled the surname of a professor emeritus at Duke who chaired the D.S.M. IV task force. He is Allen Frances, not Francis.

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The New Old Age Blog: Grief Over New Depression Diagnosis

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

Traditionally, depression has been underdiagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” We don’t find depression in old age normal any longer.

But critics of the D.S.M. 5 now argue that depression may become overdiagnosed, because this version removes the so-called “bereavement exclusion.” That was a paragraph that cautioned against diagnosing depression in someone for at least two months after loss of a loved one, unless that patient had severe symptoms like suicidal thoughts.

Without that exception, you could be diagnosed with this disorder if you are feeling empty, listless or distracted, a month after your parent or spouse dies.

“D.S.M. 5 is medicalizing the expected and probably necessary process of mourning that people go through,” said Allen Frances, a professor emeritus at Duke who chaired the D.S.M. IV task force and has denounced several of the changes in the new edition. “Most people get better with time and natural healing and resilience.”

If they are diagnosed with major depression before that can happen, he fears, they will be given antidepressants they may not need. “It gives the drug companies the right to peddle pills for grief,” he said.

An advisory committee to the Association for Death Education and Counseling also argued that bereaved people “will receive antidepressant medication because it is cheaper and ‘easier’ to medicate than to be involved therapeutically,” and noted that antidepressants, like all medications, have side effects.

“I can’t help but see this as a broad overreach by the APA,” Eric Widera, a geriatrician at the University of California, San Francisco, wrote on the GeriPal blog. “Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.”

But Dr. Kupfer said the panel worried that with the exclusion, too many cases of depression could be overlooked and go untreated. “If these things go on and get worse over time and begin to impair someone’s day to day function, we don’t want to use the excuse, ‘It’s bereavement — they’ll get over it,’” he said.

The new entry for major depressive disorder will include a note — the wording isn’t final — pointing out that while grief may be “understandable or appropriate” after a loss, professionals should also consider the possibility of a major depressive episode. Making that distinction, Dr. Kupfer said, will require “good solid clinical judgment.”

Initial field trials testing the reliability of D.S.M. 5 diagnoses, recently published in The American Journal of Psychiatry, don’t bolster confidence, however. An editorial remarked that “the end results are mixed, with both positive and disappointing findings.” Major depressive disorder, for instance, showed “questionable reliability.”

In an upcoming post, I’ll talk more about how patients might respond to the D.S.M. 5, and to a new diagnosis that might also affect a lot of older people — mild neurocognitive disorder.

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


This post has been revised to reflect the following correction:

Correction: January 24, 2013

An earlier version of this post misspelled the surname of a professor emeritus at Duke who chaired the D.S.M. IV task force. He is Allen Frances, not Francis.

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AT&T Fourth-Quarter Earnings Hurt by Pensions and Storm


Over the holiday season, AT&T sold a record number of smartphones. But its quarterly earnings took a hit from pension costs and Hurricane Sandy.


Despite the setbacks, AT&T’s business had a strong fourth quarter. It sold more smartphones than its main competitor, Verizon Wireless. It also added many new contract subscribers and increased the revenue that it gets from mobile data, the fees that people pay to use the Internet on its network.


“We had an excellent 2012,” said Randall Stephenson, AT&T’s chief executive, in a statement. “Looking ahead,” he added, “our key growth platforms — mobile data, U-verse and strategic business services — all have good momentum with a lot of headroom.”


On Thursday, AT&T reported a loss in the fourth quarter of $3.9 billion, or 68 cents a share, up from a loss of $6.7 billion, or $1.12 a share, from the same quarter a year earlier.


The company said revenue was essentially flat at $32.6 billion.


Its adjusted per-share earnings were 44 cents a share, excluding pension costs, the impact of Hurricane Sandy and the sale of its advertising units. Wall Street analysts had expected 45 cents a share on earnings of $32.2 billion, according to Thomson Reuters.


The company, based in Dallas, said that it sold 10.2 million smartphones over the quarter, the most ever sold by any American carrier. A majority of those smartphones were iPhones: AT&T sold 8.6 million iPhones, in contrast to Verizon Wireless’s 6.2 million iPhones.


AT&T did not, however, beat Verizon in an important metric for carriers: the number of new contract subscribers, who are the most valuable type of customer. AT&T gained 780,000 new contract subscribers over the quarter, compared with Verizon’s 2.1 million. In the wireless industry, subscription growth is crucial as carriers joust for the few remaining people who do not already own cellphones.


The iPhone, the most popular smartphone in the world, has been an important weapon for carriers to get new subscribers. Although AT&T still leads as the nation’s top seller of iPhones, Verizon has been increasing its iPhone sales every quarter, and it is getting close to catching up, said Chetan Sharma, an independent mobile analyst.


“There’s always been this attachment in consumers’ minds that AT&T is the brand for iPhone,” Mr. Sharma said. “I think that’s starting to even out in the marketplace.”


Similar to Verizon, AT&T last summer started offering shared data plans, which allow customers to share a single pool of data across multiple devices, including smartphones, tablets and computers. It said on the earnings call that it already had 6.6 million subscribers on these plans, about a quarter of whom are opting for plans with at least 10 gigabytes. Thanks in part to these new shared data plans, revenue from mobile data grew 14.7 percent over the quarter, to $6.8 billion, up from $5.9 billion last year.


AT&T’s success with shared data plans is good news for the company, because they help to pry customers off flat-rate, unlimited data plans so that they eventually pay more for data, said Jan Dawson, an analyst with Ovum, a research firm. Indeed, AT&T said more than 15 percent of shared data plan customers were switching from unlimited data plans.


AT&T also saw a rise in customers for U-verse, its digital phone, television and high-speed Internet service for households. It added 609,000 U-verse customers over the quarter, bringing the total number of subscribers to about 7.7 million.


The carrier has big plans this year to attract more customers. It is in the process of a major wireless network expansion. It said late last year that it would invest an extra $14 billion to expand its wireless and broadband services through 2015. It expects that its fourth-generation network technology, called LTE, will cover 300 million people by the end of next year.


Beyond making upgrades to its wireless network, AT&T has plans to offer new services that might create new revenue streams. In March, it will begin selling its new wireless home security system, Digital Life, which will allow people to use tablets or phones to monitor their homes from afar. If a burglar trips a motion sensor in the house, for example, a user can receive a text message, then call the police. Ralph de la Vega, chief executive of AT&T Mobility, has said that he believes home security will be a big opportunity to increase revenue, because only 20 percent of American homes have security systems, leaving millions of homeowners as potential buyers.


AT&T’s Mr. Stephenson said he was excited about the “vibrant options” for phones set to arrive in the coming year, including devices with Research in Motion’s new BlackBerry 10 system.


“I’m very optimistic about BlackBerry 10,” Mr. Stephenson said. “I hope that it’s as good as it appears to be.”


This article has been revised to reflect the following correction:

Correction: January 24, 2013

An earlier version of this article published online misstated the expectation of Wall Street analysts for AT&T’s quarterly per-share earnings. It was 45 cents, not 48 cents.



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David C. Headley Gets 35 Years for Mumbai Attack





CHICAGO — David C. Headley, an American who confessed to helping plan the deadly 2008 terrorist attacks in Mumbai, India, was sentenced here on Thursday to 35 years in prison, the maximum sought by federal prosecutors.




Balancing what was described in court as a “very heinous crime” and “very significant cooperation,” the ruling came after lawyers for the government and the defense urged Judge Harry D. Leinenweber of Federal District Court to downgrade Mr. Headley’s punishment from life in prison. They said he had cooperated with the authorities and provided useful information about Lashkar-e-Taiba, the Pakistan-based militant group with which he had worked.


“No matter how good our intelligence is, no matter how technologically advanced our investigative techniques are, we need witnesses,” Gary S. Shapiro, the acting United States attorney for the Northern District of Illinois, said after the decision. “And the only way you get witnesses in this world is by threatening to prosecute them and then offering them some real incentive to provide you with that information.”


According to court documents, Mr. Headley, 52, attended Lashkar-e-Taiba training camps in Pakistan between 2002 and 2005. He later admitted to scouting targets in Mumbai for the group before the raids in November 2008, in which 163 people and 9 gunmen died. Six of the victims were American.


After his arrest at a Chicago airport a year later, Mr. Headley pleaded guilty to 12 conspiracy charges over his involvement in the Mumbai attack and a proposed terrorist plot against a Danish newspaper that published cartoon caricatures of the Prophet Muhammad. Prosecutors said that Mr. Headley immediately began sharing information that led to criminal charges against at least seven other people. He also testified against his co-defendant, the Chicago businessman Tahawwur Rana, who last week was sentenced to 14 years in prison.


In exchange for his cooperation, which is expected to continue while he is in prison, prosecutors also agreed not to seek the death penalty or extradite Mr. Headley to Pakistan, India or Denmark.


But on Thursday, some expressed concern that Mr. Headley was getting more leniency than he deserved.


Standing before the court, Linda Ragsdale, who was injured in the Mumbai attack, fought back tears as she described the gunfire she witnessed at a hotel that was raided in the militant attack.


“I know the sound of life leaving a 13-year-old child,” she said.


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DealBook: S.E.C. Pick Is Ex-Prosecutor, in Signal to Wall Street

3:30 p.m. | Updated

President Obama announced Thursday his nomination of Mary Jo White, a former federal prosecutor turned white-collar defense lawyer, to be the next chairwoman of the Securities and Exchange Commission.

In a short ceremony at the White House, Mr. Obama also said he was renominating Richard Cordray as director of the Consumer Financial Protection Bureau, a post Mr. Cordray has held under a temporary recess appointment without Senate approval for the past year. The president portrayed both selections as a way of preventing a financial crash like the one he inherited four years ago.

“It’s not enough to change the law,” Mr. Obama said. “We also need cops on the beat to enforce the law.”

Mr. Obama noted that Ms. White was a childhood fan of “The Hardy Boys,” just as he was. He added that as the United States attorney in New York in the 1990s she “built a career the Hardy Boys could only dream of.”

He noted that she prosecuted money launderers, mobsters and terrorists. “I’d say that’s a pretty good run,” he said. “You don’t want to mess with Mary Jo. As one former S.E.C. chairman said, Mary Jo does not intimidate easily.”

Mr. Obama likewise pressed the Senate to finally confirm Mr. Cordray to the leadership of the consumer agency created by the Wall Street regulation law passed in 2010. The president installed Mr. Cordray as director last January without Senate approval using his recess appointment power, but his term will expire at the end of the year unless he wins approval from the upper chamber of Congress.

“Financial institutions have plenty of lobbyists looking out for their interests,” Mr. Obama said. “The American people need Richard to keep standing up for them. And there’s absolutely no excuse for the Senate to wait any longer to confirm him.”

Ms. White and Mr. Cordray spoke only briefly. Ms. White said if confirmed she would work “to protect investors and to ensure the strength, efficiency and the transparency of our capital markets.” Mr. Cordray said that during his short tenure he has “been focused on making consumer finance markets work better for the American people” and approached it “with open minds, open ears and great determination.”

Regulatory chiefs are often market experts or academics. But Ms. White spent nearly a decade as the United States attorney in New York, the first woman named to this post. Among her prominent cases, she oversaw the prosecution of the mafia boss John Gotti as well as the people responsible for the 1993 World Trade Center bombing. She is now working the other side, defending Wall Street firms and executives as a partner at Debevoise & Plimpton.

As the attorney general of Ohio, Mr. Cordray made a name for himself suing Wall Street companies in the wake of the financial crisis. He undertook a series of prominent lawsuits against big names in the finance world, including Bank of America and the American International Group.

The White House expects Ms. White, 65, and Mr. Cordray, 53, to draw on their prosecutorial backgrounds while carrying out a broad regulatory agenda under the Dodd-Frank Act. Congress enacted the law, which mandates a regulatory overhaul, in response to the 2008 financial crisis.

Jay Carney, the White House press secretary, said Ms. White has “an incredibly impressive resume” and that her appointment along with the renomination of Mr. Cordray sends an important signal.

“The president believes that appointment and the renomination he’s making today demonstrate the commitment he has to carrying out Wall Street reform, making sure we have the rules of the road that are necessary and that are being enforced in a way” to avoid a crisis like that of 2008, Mr. Carney said.

Another White House official added that Ms. White and Mr. Cordray will “serve in top enforcement roles” in part so that “Wall Street is held accountable and middle-class Americans never again are harmed by the abuses of a few.”

Ms. White will succeed Elisse B. Walter, a longtime S.E.C. official, who took over as chairwoman after Mary L. Schapiro stepped down as the agency’s leader in December. Mr. Cordray joined the consumer bureau in 2011 as its enforcement director.

The nominations could face a mixed reception in Congress. Republicans had previously vowed to block any candidate for the consumer bureau, leading to the recess appointment. It is unclear whether the White House and Mr. Cordray will face another standoff the second time around.

Mr. Carney argued that there were no substantive objections to Mr. Cordray’s confirmation, only political ones. “He is absolutely the right person for the job,” Mr. Carney said.

Ms. White is expected to receive broader support on Capitol Hill. Senator Charles E. Schumer, a New York Democrat, declared that Ms. White was a “tough-as-nails prosecutor” who “will not shy away from enforcing the laws to ensure that markets operate fairly.”

But she could face questions about her command of arcane financial minutiae. She was a director of the Nasdaq stock market, but has otherwise built her career on the law-and-order side of the securities industry.

People close to the S.E.C. note, however, that her husband, John W. White, is a veteran of the agency. From 2006 through 2008, he was head of the S.E.C.’s division of corporation finance, which oversees public companies’ disclosures and reporting.

Some Democrats also might question her path through the revolving door, in and out of government. While seen as a strong enforcer as a United States attorney, she went on in private practice to defend some of Wall Street’s biggest names, including Kenneth D. Lewis, a former head of Bank of America. She also represented JPMorgan Chase and the board of Morgan Stanley. Last year, the N.F.L. hired her to investigate allegations that the New Orleans Saints carried out a bounty system for hurting opponents.

Consumer advocates generally praised her appointment on Thursday. “Mary Jo White was a tough, smart, no-nonsense, broadly experienced and highly accomplished prosecutor,” said Dennis Kelleher, head of Better Markets, the nonprofit advocacy group. “She knew who the bad guys were, went after them and put them in prison when they broke the law.”

The appointment comes after the departure of Ms. Schapiro, who announced she would step down from the S.E.C. in late 2012. In a four-year tenure, she overhauled the agency after it was blamed for missing the warning signs of the crisis.

Since her exit, Washington and Wall Street have been abuzz with speculation about the next S.E.C. chief. President Obama quickly named Ms. Walter, then a Democratic commissioner at the agency, but her appointment was seen as a short-term solution. It is unclear if she will shift back to the commissioner role if Ms. White is confirmed.

In the wake of Ms. Schapiro’s exit, several other contenders surfaced, including Sallie L. Krawcheck, a longtime Wall Street executive. Richard G. Ketchum, chairman and chief executive of the Financial Industry Regulatory Authority, Wall Street’s internal policing organization, was also briefly mentioned as a long-shot contender.

Kitty Bennett contributed reporting.

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Well: Long Term Effects on Life Expectancy From Smoking

It is often said that smoking takes years off your life, and now a new study shows just how many: Longtime smokers can expect to lose about 10 years of life expectancy.

But amid those grim findings was some good news for former smokers. Those who quit before they turn 35 can gain most if not all of that decade back, and even those who wait until middle age to kick the habit can add about five years back to their life expectancies.

“There’s the old saw that everyone knows smoking is bad for you,” said Dr. Tim McAfee of the Centers for Disease Control and Prevention. “But this paints a much more dramatic picture of the horror of smoking. These are real people that are getting 10 years of life expectancy hacked off — and that’s just on average.”

The findings were part of research, published on Wednesday in The New England Journal of Medicine, that looked at government data on more than 200,000 Americans who were followed starting in 1997. Similar studies that were done in the 1980s and the decades prior had allowed scientists to predict the impact of smoking on mortality. But since then many population trends have changed, and it was unclear whether smokers today fared differently from smokers decades ago.

Since the 1960s, the prevalence of smoking over all has declined, falling from about 40 percent to 20 percent. Today more than half of people that ever smoked have quit, allowing researchers to compare the effects of stopping at various ages.

Modern cigarettes contain less tar and medical advances have cut the rates of death from vascular disease drastically. But have smokers benefited from these advances?

Women in the 1960s, ’70s and ’80s had lower rates of mortality from smoking than men. But it was largely unknown whether this was a biological difference or merely a matter of different habits: earlier generations of women smoked fewer cigarettes and tended to take up smoking at a later age than men.

Now that smoking habits among women today are similar to those of men, would mortality rates be the same as well?

“There was a big gap in our knowledge,” said Dr. McAfee, an author of the study and the director of the C.D.C.’s Office on Smoking and Public Health.

The new research showed that in fact women are no more protected from the consequences of smoking than men. The female smokers in the study represented the first generation of American women that generally began smoking early in life and continued the habit for decades, and the impact on life span was clear. The risk of death from smoking for these women was 50 percent higher than the risk reported for women in similar studies carried out in the 1980s.

“This sort of puts the nail in the coffin around the idea that women might somehow be different or that they suffer fewer effects of smoking,” Dr. McAfee said.

It also showed that differences between smokers and the population in general are becoming more and more stark. Over the last 20 years, advances in medicine and public health have improved life expectancy for the general public, but smokers have not benefited in the same way.

“If anything, this is accentuating the difference between being a smoker and a nonsmoker,” Dr. McAfee said.

The researchers had information about the participants’ smoking histories and other details about their health and backgrounds, including diet, alcohol consumption, education levels and weight and body fat. Using records from the National Death Index, they calculated their mortality rates over time.

People who had smoked fewer than 100 cigarettes in their lifetimes were not classified as smokers. Those who had smoked at least 100 cigarettes but had not had one within five years of the time the data was collected were classified as former smokers.

Not surprisingly, the study showed that the earlier a person quit smoking, the greater the impact. People who quit between 25 and 34 years of age gained about 10 years of life compared to those who continued to smoke. But there were benefits at many ages. People who quit between 35 and 44 gained about nine years, and those who stopped between 45 and 59 gained about four to six years of life expectancy.

From a public health perspective, those numbers are striking, particularly when juxtaposed with preventive measures like blood pressure screenings, colorectal screenings and mammography, the effects of which on life expectancy are more often viewed in terms of days or months, Dr. McAfee said.

“These things are very important, but the size of the benefit pales in comparison to what you can get from stopping smoking,” he said. “The notion that you could add 10 years to your life by something as straightforward as quitting smoking is just mind boggling.”

Read More..

Well: Long Term Effects on Life Expectancy From Smoking

It is often said that smoking takes years off your life, and now a new study shows just how many: Longtime smokers can expect to lose about 10 years of life expectancy.

But amid those grim findings was some good news for former smokers. Those who quit before they turn 35 can gain most if not all of that decade back, and even those who wait until middle age to kick the habit can add about five years back to their life expectancies.

“There’s the old saw that everyone knows smoking is bad for you,” said Dr. Tim McAfee of the Centers for Disease Control and Prevention. “But this paints a much more dramatic picture of the horror of smoking. These are real people that are getting 10 years of life expectancy hacked off — and that’s just on average.”

The findings were part of research, published on Wednesday in The New England Journal of Medicine, that looked at government data on more than 200,000 Americans who were followed starting in 1997. Similar studies that were done in the 1980s and the decades prior had allowed scientists to predict the impact of smoking on mortality. But since then many population trends have changed, and it was unclear whether smokers today fared differently from smokers decades ago.

Since the 1960s, the prevalence of smoking over all has declined, falling from about 40 percent to 20 percent. Today more than half of people that ever smoked have quit, allowing researchers to compare the effects of stopping at various ages.

Modern cigarettes contain less tar and medical advances have cut the rates of death from vascular disease drastically. But have smokers benefited from these advances?

Women in the 1960s, ’70s and ’80s had lower rates of mortality from smoking than men. But it was largely unknown whether this was a biological difference or merely a matter of different habits: earlier generations of women smoked fewer cigarettes and tended to take up smoking at a later age than men.

Now that smoking habits among women today are similar to those of men, would mortality rates be the same as well?

“There was a big gap in our knowledge,” said Dr. McAfee, an author of the study and the director of the C.D.C.’s Office on Smoking and Public Health.

The new research showed that in fact women are no more protected from the consequences of smoking than men. The female smokers in the study represented the first generation of American women that generally began smoking early in life and continued the habit for decades, and the impact on life span was clear. The risk of death from smoking for these women was 50 percent higher than the risk reported for women in similar studies carried out in the 1980s.

“This sort of puts the nail in the coffin around the idea that women might somehow be different or that they suffer fewer effects of smoking,” Dr. McAfee said.

It also showed that differences between smokers and the population in general are becoming more and more stark. Over the last 20 years, advances in medicine and public health have improved life expectancy for the general public, but smokers have not benefited in the same way.

“If anything, this is accentuating the difference between being a smoker and a nonsmoker,” Dr. McAfee said.

The researchers had information about the participants’ smoking histories and other details about their health and backgrounds, including diet, alcohol consumption, education levels and weight and body fat. Using records from the National Death Index, they calculated their mortality rates over time.

People who had smoked fewer than 100 cigarettes in their lifetimes were not classified as smokers. Those who had smoked at least 100 cigarettes but had not had one within five years of the time the data was collected were classified as former smokers.

Not surprisingly, the study showed that the earlier a person quit smoking, the greater the impact. People who quit between 25 and 34 years of age gained about 10 years of life compared to those who continued to smoke. But there were benefits at many ages. People who quit between 35 and 44 gained about nine years, and those who stopped between 45 and 59 gained about four to six years of life expectancy.

From a public health perspective, those numbers are striking, particularly when juxtaposed with preventive measures like blood pressure screenings, colorectal screenings and mammography, the effects of which on life expectancy are more often viewed in terms of days or months, Dr. McAfee said.

“These things are very important, but the size of the benefit pales in comparison to what you can get from stopping smoking,” he said. “The notion that you could add 10 years to your life by something as straightforward as quitting smoking is just mind boggling.”

Read More..

Apple’s Profits Are Flat, and Stock Drops





Apple on Wednesday reported the kind of quarter most big companies would envy, posting a profit of $13.1 billion and selling 28 percent more iPhones and 48 percent more iPads, its two biggest products.




Its stock quickly sank 11 percent.


What is going on? Because of its great success in recent years, many investors have come to expect nothing short of perfection from Apple. And while it is still widely considered the most innovative company in the technology world, a maker of products that its devoted customers cannot live without, Apple is facing a range of challenges.


It is dealing with increased competition from big rivals like Samsung and Google, and with so many people already using smartphones, the market is not quite as untapped as it once was. Apple is forging into cheaper product categories, meaning lower profit margins. And given that Apple has grown so big, with sales of more than $160 billion in the last 12 months, keeping up its heady growth rate is becoming harder and harder.


Once-euphoric investors, who pushed Apple’s stock to a record high of $702.10 last September, have become nervous, and in after-hours trading on Wednesday, the stock traded at $461.30, down 34 percent from its peak.


Apple has reinvented itself several times over the last decade with groundbreaking new products, and could do so again. Television and electronic payments are among the markets where analysts believe the company could make a serious push, leading it to new heights.


“Apple has really been able to invent whole new markets,” said John Gallaugher, an associate professor at Boston College’s Carroll School of Management. “That’s where it differs from companies like Microsoft. I don’t think the mojo of this team has evaporated.”


In a conference call with analysts, Timothy D. Cook, Apple’s chief executive, said the company’s pipeline of new products was “chock-full.”


“We feel great about what we have in store,” he said, without adding details.


In the meantime, though, the love affair that investors once had with Apple is clearly waning.


“There’s nothing that can help the stock from sliding now,” said Mark Moskowitz, an analyst at J. P. Morgan Securities, who said Apple’s holiday sales met his own forecasts, even though they missed others’ predictions.


For years, Apple has offered an unusual alchemy: it was not only a large, highly profitable tech company, but one with the rapid growth rate of a start-up. It pulled this off under the leadership of Steven P. Jobs, its former chief executive who died in late 2011. He had a startling knack for finding new multibillion-dollar opportunities for Apple with the iPod, iPhone and iPad, but his death has accentuated concerns about the company’s prospects.


A big part of Apple’s challenge is that it is now so large that it seems unrealistic, mathematically, for the company to continue finding new pots of gold big enough to maintain its growth. In a recent research report, A. M. Sacconaghi, an analyst at Bernstein Research, calculated that were Apple to grow for the next five years at the same rate as the last five years, its revenue would be $1.2 trillion, or about the size of Australia’s gross domestic product.


Mr. Sacconaghi said in an interview that technology companies often enter a phase of “growth purgatory” as they shift to a slower lane. Their stocks can tumble by 25 percent or more.


“This transition is often very messy,” he said.


On Wednesday, Apple did not appear to provide a strong enough reason for investors to warm to it again. It said its profits were flat because of higher manufacturing costs, even as revenue rose 18 percent.


Apple’s net income for its fiscal first quarter ending Dec. 29 was $13.1 billion, or $13.81 a share, compared with $13.1 billion, or $13.87 a share, in the same period a year earlier. Revenue was $54.5 billion, up from $46.33 billion a year ago. Those results compared to the average estimates of $13.44 a share earnings and revenue of $54.73 billion from analysts surveyed by Thomson Reuters.


Apple’s growth in the quarter looked positively anemic compared with the huge numbers it used to deliver. For the holiday quarter of 2011, in contrast, its revenue jumped 73 percent and its profit soared 118 percent.


In its financial forecasts for the current quarter, Apple provided numbers that suggest a decline of roughly 20 percent in earnings a share, according to Mr. Sacconaghi’s calculations.


A number of analysts say they still believe the company’s good times are not over. “Sentiment has turned super-pessimistic on Apple, where they’ve gone from being able to do no wrong to suddenly being able to do no right,” said Rob Cihra, an analyst at Evercore Partners. “I tend to think the company’s momentum is a heck of a lot more solid than people are concerned about.”


Mr. Cihra said Apple’s iPhone and iPad sales missed some of the most optimistic forecasts, but “all in, it was a pretty darned good quarter.”


One factor that hurt comparisons between Apple’s most recent holiday quarter and the previous one was that its 2012 quarter was a week shorter.


Headed into the holiday quarter, analysts were especially worried about Apple’s profit margins, which the company had warned would decline as a result of a near total overhaul of the company’s product line.


While new products are routine for a company like Apple, it said the sheer number of devices it released around the holidays, including the iPhone 5, iPad Mini and new Mac computers, was unusual.


But negative sentiment has further hardened amid reports that Apple had cut orders for components with a supplier, potentially suggesting weak demand for the iPhone.


Mr. Cook cautioned that investors shouldn’t place too much significance on such reports because Apple often gets its parts from multiple sources.


“I would suggest that it’s good to question the accuracy of any rumor about our build plans,” he said.


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The Making of Yair Lapid, Israel’s New Power Broker


Oliver Weiken/European Pressphoto Agency


Yair Lapid spoke to reporters in Tel Aviv on Wednesday, a day after his centrist party became the second-largest faction in Parliament.







TEL AVIV — They pitched tents along Rothschild Boulevard and took to the streets in unprecedented numbers, hundreds of thousands demonstrating against the rising costs of gas, apartments, even cottage cheese.




Back on the genteel boulevard on Wednesday, many of those middle-class protesters from 2011 said they had taken their grievances to the ballot box the day before, helping to catapult Yair Lapid, a suave, handsome journalist-turned-populist-politician, into Israel’s newest power broker.


“He spoke out the strongest about how everything in this country is upside down,” said Elad Shoshan, 28, who works with computers and rents an apartment on a cheaper street off the boulevard.


Echoing his candidate’s mantra, Roni Klein, 52, an accountant, said, “My wife and I work, and still it is very hard for us to finish the month.”


Mr. Lapid’s new, centrist Yesh Atid party shocked the political establishment by winning 19 of Parliament’s 120 seats, becoming Israel’s second-largest faction and a crucial partner for Prime Minister Benjamin Netanyahu, whose relatively poor showing left him scrambling to form a stable coalition.


While Mr. Netanyahu remains all but assured of serving a third term — Mr. Lapid said Wednesday that he would not unite with Arab lawmakers to stop him — Yesh Atid’s ascendance promises to shift the government’s focus to pocketbook concerns despite the pressing foreign policy issues Israel faces.


Mr. Lapid’s campaign hardly challenged Mr. Netanyahu’s policies on the Iranian nuclear threat, the tumult in the Arab world or the Israeli-Palestinian conflict. This was the first election in memory in which such existential security issues were not emphasized, as a growing majority of Israelis see them as too tough to tackle. Even Mr. Netanyahu barely spoke about Iran, his raison d’être.


Instead, voters and analysts alike said Mr. Lapid had captured the hearts of Israel’s silent majority with his personal charm and a positive, inclusive message that harnessed the everyday frustrations that fueled the huge social justice protests in 2011.


One pollster found that about 40 percent of Mr. Lapid’s supporters defined themselves as right-leaning, and in Israel’s coalition system, many saw his success as a tactical move by voters not to oust Mr. Netanyahu but to nudge him to broaden the agenda.


On Wednesday, the prime minister embraced Mr. Lapid’s platform, promising a government “as broad as possible” that would bring change on three fronts: affordable housing, government reform and forcing ultra-Orthodox Jews to “share the burden” of military service and taxes.


Some saw the results as a victory for secular Jews at a time of conflict with the ultra-Orthodox over resources and religious pluralism. Mr. Lapid’s stronghold was here in coastal Tel Aviv and its bourgeois suburbs, where he won about 1 in 4 votes cast, and Modiin, a fast-growing bedroom community halfway between here and Jerusalem.


Tamar Hermann, a political scientist and vice president of Israel’s Open University, called Mr. Lapid “the epitome of the Israeli dream” and described his voters as “the mainstream of the mainstream.”


“This is the kind of voting you can take your kids to and teach them a lesson in civic fulfillment without taking any risks,” Professor Hermann said. “They are complaining, but this is a kind of the zeitgeist, not real agony, not real suffering, not real dissatisfaction with the basic cornerstone of the system. It’s just polishing here and there.”


The election results were widely seen as a rebuke to the status quo, but not necessarily a call for change in approach to contentious questions like what to do about the Palestinians. While Mr. Lapid has called for a return to negotiations, he shares Mr. Netanyahu’s skepticism about the lack of a partner, saying this week, “I don’t think the Arabs want peace.” He opposes division of Jerusalem and made his foreign policy speech in Ariel, a sprawling Jewish settlement 12 miles into the West Bank that the Palestinians see as problematic for the viability of their state.


“The majority of Israelis came to the conclusion that there will be no new Middle East,” Mr. Lapid said over cappuccino here last month. “What we want is not a happy marriage, but a decent divorce.”


Instead, the change voters were seeking was more about the nature of politics itself.


Irit Pazner Garshowitz contributed reporting.



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DealBook | The Trade: An Asset So Toxic They Called It ‘Nuclear Holocaust’

On March 16, 2007, Morgan Stanley employees working on one of the toxic assets that helped blow up the world economy discussed what to name it. Among the team members’ suggestions: “Subprime Meltdown,” “Hitman,” “Nuclear Holocaust” and “Mike Tyson’s Punchout,” as well a simple yet direct reference to a bag of excrement.

Ha ha. Those hilarious investment bankers.

Then they gave it its real name and sold it to a Chinese bank.

We are never going to have a full understanding of what bad behavior bankers engaged in in the years leading up to the financial crisis. The Justice Department and the Securities and Exchange Commission have failed to hold big wrongdoers to account.

We are left with what scraps we can get from those private lawsuits lucky enough to get over the high hurdles for document discovery. A case brought in a New York State Supreme Court in Manhattan against Morgan Stanley by a Taiwanese bank, which bought a piece of the same deal the Chinese bank did, has cleared that bar.

The results are explosive. Hundreds of pages of internal Morgan Stanley documents, released publicly last week, shed much new light on what bankers knew at the height of the housing bubble and what they did with that secret knowledge.

The lawsuit concerns a $500 million collateralized debt obligation called Stack 2006-1, created in the first half of 2006. Collections of mortgage-backed securities, C.D.O.’s were at the heart of the financial crisis.

But the documents suggest a pattern of behavior larger than this one deal: people across the bank understood that the American housing market was in trouble. They took advantage of that knowledge to create and then bet against securities and then also to unload garbage investments on unsuspecting buyers.

Morgan Stanley doesn’t see the narrative as the plaintiffs do. The firm is fighting the lawsuit, contending that the buyers were sophisticated clients and could have known what was going on in the subprime market. The C.D.O. documents disclosed, albeit obliquely, that Morgan Stanley might bet against the securities, a strategy known as shorting. The firm did not pick the assets going into the deal (though it was able to veto any assets). And any shorting of the deal was part of a larger array of trades, both long and short. Indeed, Morgan Stanley owned a big piece of Stack, in addition to its short bet.

Regarding the profane naming contest, Morgan Stanley said in a statement: “While the e-mail in question contains inappropriate language and reflects a poor attempt at humor, the Morgan Stanley employee who wrote it was responsible for documenting transactions. It was not his job or within his skill set to assess the state of the market or the credit quality of the transaction being discussed.”

Philip Blumberg, the Morgan Stanley lawyer who composed most of the names, meet the underside of a bus, courtesy of your employer.

Another Morgan Stanley employee sent an e-mail that same morning, suggesting that the deal be called “Hitman.” This might have been an attempt to manage up, because “Hitman” was the nickname of his boss, Jonathan Horowitz, who helped head the part of the group that oversaw mortgage-backed C.D.O.’s. Mr. Horowitz replied, “I like it.”

Both Mr. Blumberg and Mr. Horowitz, now at JPMorgan, declined to comment through representatives at their banks.

In February 2006, Morgan Stanley began putting together the Stack C.D.O. According to an internal presentation, Stack “represents attractive business for Morgan Stanley.”

Why? In addition to fees, another bullet point listed: “Ability to short up to $325MM of credits into the C.D.O.” In other words, Morgan Stanley could — and did — sell assets to the Stack C.D.O., intending to profit if the securities backed by those assets declined. The bank put on a $170 million bet against Stack, even as it was selling it.

In the end, of the $500 million of assets backing the deal, $415 million ended up worthless.

“While investors and taxpayers all over the world continue to choke on Wall Street’s toxic subprime products, to this day not a single major Wall Street executive has been held accountable for misconduct relating to those products,” said Jason C. Davis, a lawyer at Robbins Geller who is representing the plaintiff in the lawsuit. “They are generally untouchable, but we are pleased that the court in this case is ordering Morgan Stanley to turn over damning evidence, so that the jury will get to see what Morgan Stanley really knew about the troubled nature of its supposedly ‘higher-than-AAA’ quality product.”

Why might Morgan Stanley have bet against the deal? Did its traders develop a brilliant thesis by assessing the fundamentals of the housing market through careful analysis of the public data? The documents suggest something more troubling: bankers found out that the housing market was diseased from their colleagues down the hall.

Bankers were getting information from fellow employees conducting and receiving private assessments of the quality of the mortgages that the bank would purchase to back securities. These reports weren’t available to the public. It would be crucial information for trading in securities backed by those kinds of mortgages.

In one e-mail from Oct. 21, 2005, a Morgan Stanley employee warned a banker that the mortgages Morgan Stanley was buying from loan originators were troubled. “The real issue is that the loan requests do not make sense,” he wrote. As an example, he cited “a borrower that makes $12K a month as an operation manger (sic) of an unknown company — after research on my part I reveal it is a tarot reading house. Compound these issues with the fact that we are seeing what I would call a lot of this type of profile.”

In another e-mail from March 17, 2006, another Morgan Stanley employee wrote about a “deteriorating appraisal quality that is very flagrant.”

Two of the employees who received those e-mails joined an internal hedge fund, headed by Howard Hubler, that was formed only the next month, in April 2006. As recounted in Michael Lewis’s “The Big Short,” Mr. Hubler infamously bet against the subprime market on Morgan Stanley’s behalf, a fact that Morgan Stanley’s chief financial officer conceded in late 2007. Mr. Hubler’s group was supposed to be separate from the rest of Morgan Stanley, but the two bankers continued to receive similar information about the underlying market, according to a person briefed on the matter.

At no point did they receive material, nonpublic information, a Morgan Stanley spokesman says.

I struggle to see how the private assessments that the subprime market was imploding were immaterial.

Another of Morgan Stanley’s main defenses is that it couldn’t have thought the investment it sold to the Taiwanese was terrible because it, too, lost money on securities backed by subprime mortgages. As the Morgan Stanley spokesman put it, “This deal must be viewed in the context of a significant write-down for Morgan Stanley in 2007, when the firm recorded huge losses in its public securities filings related to other subprime C.D.O. positions.”

This is a common refrain offered by big banks like Citigroup, Merrill Lynch and Bear Stearns to absolve them of any responsibility.

But does losing money wipe away sin?

Yes, Mr. Hubler made his bets in what turned out to be a deeply disastrous way. As part of a complex array of trades, he bet against the middle slices of subprime mortgage C.D.O.’s. He bought the supposedly safe top parts. The income from the top slices helped offset the cost of betting against the middle slices. But when the market collapsed, the top slices — called “super senior” because they were supposedly safer than Triple A — didn’t hold their value, losing billions for Mr. Hubler and Morgan Stanley. Mr. Hubler did not respond to requests for comment.

So Morgan Stanley lost a great deal of money.

But let’s review what the documents suggest is the big picture.

In the fall of 2005, bank employees shared nonpublic assessments of how the subprime market was a house of tarot cards.

In February 2006, the bank began creating Stack in part so that it could bet against it.

In April 2006, the bank created its own internal hedge fund, led by Mr. Hubler, who shorted the subprime market. Among the traders in this internal shop were people who helped create Stack and other deals like it, and at least two employees who had access to the private due diligence reports.

Mr. Hubler’s group had no investment position in Stack, according to the person briefed on the matter, but it sure looks as if the bank saw what was coming and tried to position itself for a subprime market collapse.

Finally, by early 2007, the bank appeared to realize that the subprime market was faring even worse than it expected. Even the supposedly safe pieces of C.D.O.’s that it owned, including its piece of Stack, were facing losses. So Morgan Stanley bankers set to scouring the world to peddle as a safe and sound investment what its own employees were internally deriding.

Morgan Stanley declined to comment on whether it made money on its Stack investments over all. But it looks to have turned out well for the bank. In Stack, it managed to fob off a nuclear bomb to the Taiwanese bank.

Unfortunately for Morgan Stanley, it had so many other pieces of C.D.O.’s, so many nuclear warheads, that it couldn’t find nearly enough suckers around the world to buy them all.

And so when the real collapse came, Morgan Stanley was left with billions of dollars in losses.

That hardly seems exculpatory.


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