Health - Precautions Should Limit Health Problems From Nuclear Plant’s Radiation

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• Precautions Should Limit Health Problems From Nuclear Plant’s Radiation
• Anxiety Over Radiation Drives a Sales Surge for a Drug Against Thyroid Cancer
• Hospital Chief Facing U.S. Charges Is Fired
• About New York: Immune to Cuts: Lofty Salaries at Hospitals
• Well: Forget the Treadmill. Get a Dog.
• Special Issue: Emotional Power Broker of the Modern Family
• Special Issue: No Face, but Plants Like Life Too
• Recipes for Health: Black Bean and Goat Cheese Quesadillas
• Japan Says 2nd Reactor May Have Ruptured With Radioactive Release
• Radiation Exposure Could Curtail Workers’ Efforts
• Chávez Tries to Rally Venezuela Against a New Enemy: Breast Lifts
• Memo From Mexico City: Mexico Puts Its Children on a Diet
• Doctors Detail Giffords’s Progress
• About New York: Charges Against Health Care Executive Raise Broader Issues
• Response of W.H.O. to Swine Flu Is Criticized
• 20% Rise Seen in Number of Survivors of Cancer
• U.S. Regulators and J.&J. Unit Reach a Deal on Plant Oversight
• F.D.A. to Study Whether Anesthesia Poses Cognitive Risks in Young Children
• Well: The French Diet You've Never Heard Of
• Well: Is Fitness All in the Genes?
• Well: A New Comment System for Well
• Well: The Blind Luck of Cancer Trials
• Well: When Pets Change the Family Dynamic
• The New Old Age: Losing Sight, Then Losing Touch
• The New Old Age: Few Options for Elderly Muslims
• The New Old Age: Emergency Room for the Elderly
• Special Issue; Personal Health: Easing the Way in Therapy With the Aid of an Animal
• Prescriptions: The Debate Over Brokers’ Fees
• Prescriptions: This Week's Health Industry News
• Prescriptions: Johnson & Johnson Unit Signs Consent Decree With F.D.A.
• Recipes for Health: Mushroom Quesadillas
• Recipes for Health: Broccoli and Red Onion Quesadillas
• Recipes for Health: Fast Food for Harried Days
• Urban Athlete: Adventures of a Stair Master
• U.S. Calls Radiation ‘Extremely High’ and Urges Deeper Caution in Japan
• National Briefing | SOUTH: Virginia: Judge Orders Nutrition for Immigrant in Nursing Home
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Precautions Should Limit Health Problems From Nuclear Plant’s Radiation Posted: 16 Mar 2011 07:06 AM PDT Worsening conditions at the Fukushima Daiichi nuclear power plant in Japan have raised fears that people will be harmed by radiation. But experts say that in terms of public health, the Japanese have already taken precautions that should prevent the accident from becoming another Chernobyl, even if additional radiation is released. Enlarge This Image Wally Santana/Associated Press An evacuee was screened for radiation exposure Tuesday in Koriyama, Japan. The government has evacuated those people closest to the Fukushima Daiichi plant. Multimedia Interactive Feature Video: Japan’s Natural and Nuclear Disasters Graphic Radiation at Fukushima Daiichi and 75 Miles Away Related Japan Says 2nd Reactor May Have Ruptured With Radioactive Release (March 16, 2011) Green Blog: Questions on the Nuclear Crisis in Japan (March 15, 2011) Anxiety Over Radiation Drives a Sales Surge for a Drug Against Thyroid Cancer (March 16, 2011) Wind and Rain Steer Radiation’s Reach (March 16, 2011) Japan Says 2nd Reactor May Have Ruptured With Radioactive Release (March 16, 2011) Last Defense at Troubled Reactors: 50 Japanese Workers (March 16, 2011) The Japanese government has evacuated people closest to the plant, told others to stay indoors and distributed the drug potassium iodide to protect the thyroid gland from radioactive iodine. The great tragedy of Chernobyl was an epidemic of thyroid cancer among people exposed to the radiation as children — more than 6,000 cases so far, with more expected for many years to come. There is no reason for it to be repeated in Japan. The epidemic in Chernobyl was preventable and would probably not have happened if people had been told to stop drinking locally produced milk, which was by far the most important source of radiation. Cows ate grass contaminated by fallout from the reactors and secreted radioactive iodine in their milk. The thyroid gland needs iodine and readily takes in the radioactive form, which can cause cancer. Children are especially vulnerable. Potassium iodide pills are meant to flood the thyroid with ordinary iodine in the hope that it will prevent the gland from taking in the radioactive type. The drug may be unnecessary if people avoid drinking the milk, but for most people, there is no harm in taking it. And if radioactive iodine has already started building up in the thyroid, the pills can help get rid of it, said Dr. Richard J. Vetter, a professor emeritus of biophysics at the Mayo Clinic in Rochester, Minn. “It will always help if you’re within a month or so of the exposure,” Dr. Vetter said. “The later it is, the less it helps.” If the pills are in short supply and have to be rationed, he said, they should go first to children and pregnant women. But taking the drug does not make it safe to stay near a reactor that is emitting radiation, he said. People still must evacuate. Apart from the increase in thyroid cancer, “there is no evidence of a major public health impact attributable to radiation exposure two decades after the accident” at Chernobyl, in part because of the evacuation efforts, according to a recent United Nations report. There are several ways to tell if someone has been exposed to radiation. A Geiger counter will detect radioactivity outside the body, on clothing, hair and skin. People found to be contaminated should be advised to undress and take a shower, and their clothing should be discarded as hazardous waste, Dr. Vetter said. Another device, a sodium iodide detector, can be held an inch or so from the neck to check for radioactive iodine in the thyroid gland; if it detects any, the person may be given iodide pills. In photographs from Japan, health workers appear to be screening members of the public with both Geiger counters and sodium iodide detectors. If there is a suspicion that someone has been exposed to a large dose of radiation, the first test that doctors are likely to perform is a complete blood count, Dr. Vetter said. Abnormalities in the count — fewer white cells than would be expected, for example — can show up within a day or so, and give a ballpark estimate of how bad the exposure was. “In Japan, it’s very unlikely that a member of the public would get a dose of radiation that would result in a decrease in any blood cells,” Dr. Vetter said. “If anyone got that kind of dose, it’s likely people who are working in the nuclear plants themselves.” People with significantly lowered blood counts from radiation can be given drugs to stimulate their bone marrow to make more blood cells. Those drugs were not available in 1986, when a nuclear power plant in Chernobyl, Ukraine, blew up. Other drugs can be used to help rid the body of certain radioactive isotopes. But if the exposure was so high that the drugs do not help, people may need to be treated in the hospital — put into isolation and given antibiotics to protect them from infection, and possibly blood transfusions as well. A bone marrow transplant may be a last resort, but, Dr. Vetter said, “the patient is in real trouble at that point.” Crops can be contaminated by fallout, which can cling to surface of plants at first and later be taken up by their roots. Radioactive iodine has a half-life of only eight days — the time it takes for half of it to decay or disappear — so most of it is gone within about two months. But radioactive forms of the particulate cesium persist much longer, and in the regions affected by Chernobyl, they are still the main threats to human health and will be for decades. Wild mushrooms, berries and animals have been found to be contaminated with cesium in areas contaminated by Chernobyl, and that is expected to last for decades. Lakes and freshwater fish may also be contaminated, but experts say ocean fish are less of a worry because the contaminants are more dispersed and diluted in the ocean than in lakes.

Anxiety Over Radiation Drives a Sales Surge for a Drug Against Thyroid Cancer Posted: 15 Mar 2011 10:53 PM PDT As Japan races to avoid a nuclear disaster, some Americans and companies in the United States are scrambling to obtain potassium iodide, a drug that can protect people from radiation-induced thyroid cancer. Enlarge This Image Pascal Lauener/Reuters The Swiss Agency for Development and Cooperation with pills for the Swiss embassy in Japan. Multimedia Interactive Feature Video: Japan’s Natural and Nuclear Disasters Related Precautions Should Limit Health Problems From Nuclear Plant’s Radiation (March 16, 2011) Wind and Rain Steer Radiation’s Reach (March 16, 2011) Green Blog: Questions on the Nuclear Crisis in Japan (March 15, 2011) “We’ve sold more in the past three days than we have in the past three years,” said Jim Small, president of the American arm of Recipharm, a Swedish company that is a major supplier of potassium iodide. While some orders are going to individuals, others are going to companies that want to provide the products to their employees in Japan, the manufacturers said. Mr. Small said that Recipharm was trying to borrow tablets from governments of countries far from Japan to send there. Alan Morris, president of Anbex, another supplier, said his company was looking to donate two million expired but still effective tablets to Japan. Japan has distributed iodine tablets to evacuation centers near the nuclear plants that are leaking radiation. Potassium iodide, also known by the chemical symbol KI, is used to saturate the thyroid gland with iodine so that radioactive iodine inhaled or ingested will not be retained by the gland. For Americans trying to buy the pills, some experts say there is no need for them — and certainly no reason to use them now — because Americans are not being exposed to dangerous levels of radiation from the Japanese plants, nor are they likely to be. “There’s a huge body of water between us and Japan,” said Kathryn A. Higley, head of nuclear engineering and radiation health physics at Oregon State University. “I have two kids. I’m not concerned for my kids one iota.” Still, the situation in Japan could rekindle calls for the United States government to provide potassium iodide tablets to more people who live near American nuclear power plants. The suppliers of the three versions of potassium iodide approved by the Food and Drug Administration, none of which require a prescription, said they were struggling to keep up with demand. “We’re completely out,” said Mr. Morris, of Anbex, which sells the Iosat tablets through its Web site. Mr. Morris said the company could make millions of tablets a day after it geared up and that it hoped to have more supply by early April. Recipharm has already stopped taking orders through its Web site for its ThyroSafe tablets. Fleming Pharmaceuticals, which makes the ThyroShield liquid formulation suitable for young children, said it was shipping its product as fast as it could and was making more. Few drugstores carry potassium iodide because there is usually no demand. Still, many drugstores, particularly on the West Coast, said they were besieged by requests. “By the end of the day people were walking in and paying in advance,” said Whimsy Anderson, the naturopathic doctor at the Pharmaca Integrative Pharmacy in Los Angeles. The store quickly sold out the potassium iodide it had ordered from a dietary supplement company and then ran out of kelp capsules, which also contain iodine. Dr. Gregory Brent, president of the American Thyroid Association and a professor of medicine at the University of California, Los Angeles, said other forms of iodine might also protect the thyroid gland, provided the amounts were large enough. The recommended dose of potassium iodide for adults is 130 milligrams a day. By contrast, Americans typically get only about one thousandth of that amount from food, he said. Dr. Brent said that in rare cases, KI pills can cause hyperthyroidism or allergic reactions. Congress passed legislation in 2002 requiring the federal government to supply potassium iodide capsules to people living within 20 miles of nuclear power plants in the United States. But the administrations of George W. Bush and Barack Obama have not implemented that provision, saying the law allows for alternatives. Some states have given pills to people living within 10 miles of nuclear plants, or stockpiled the pills for those people. Representative Edward J. Markey, the Massachusetts Democrat who is the author of the 2002 legislation, said the crisis in Japan showed that the pills must be distributed beyond 10 miles from nuclear plants. “We should not wait for a catastrophic accident at or a terrorist attack on a nuclear reactor in this country to occur to implement this common-sense emergency preparedness measure,” he wrote in a letter Monday to John Holdren, the White House science adviser. The Department of Health and Human Services said in a statement that it would try to learn as much as possible from the Japanese crisis and response. “Policy options relating to KI distribution will be among the issues studied,” it said.

Hospital Chief Facing U.S. Charges Is Fired Posted: 15 Mar 2011 10:10 PM PDT A hospital executive who has been accused of bribery in a federal corruption investigation has been ousted by his board and replaced by his second in command, the board announced on Tuesday. The executive, David P. Rosen, 63, chief executive of MediSys Health Network, was among eight people, including two state legislators, charged last week by federal authorities in Manhattan with participating in bribery schemes. In his case, prosecutors said the scheme revolved around getting favorable treatment from state officials for his health care organization. In a statement, the board of MediSys — the nonprofit sponsor of four hospitals, three nursing homes and several neighborhood health centers in Queens and Brooklyn — said it voted on Monday to appoint Mr. Rosen’s second in command, Bruce J. Flanz, to take over Mr. Rosen’s job as chief executive. Mr. Flanz, 59, had been the chief operating officer at MediSys. An official associated with the health system, who insisted on anonymity because he was not authorized to speak on the matter, said Mr. Rosen’s contract had been “terminated for cause.” Claudia Hutton, a spokeswoman for the New York State health commissioner, Dr. Nirav R. Shah, said the department would “reserve judgment” on the MediSys board’s choice of Mr. Rosen’s deputy as his replacement. But Ms. Hutton said in an e-mail that the state would be asking for a meeting with the boards of MediSys and its constituent hospitals “to discuss additional steps to ensure financial viability and the integrity of their management.” The federal complaint accuses Mr. Rosen of conspiring to bribe State Senator Carl Kruger of Brooklyn, paying more than $177,000 in bribes through a no-show consulting job to State Assemblyman William F. Boyland Jr. of Brooklyn and paying $390,000 in bribes through a sham consulting company to former State Assemblyman Anthony S. Seminerio of Queens in exchange for their influence with state officials on behalf of MediSys. Mr. Kruger and Mr. Boyland were also charged, and have not yet entered pleas. Mr. Seminerio had pleaded guilty to a related fraud charge and died while appealing his case. Mr. Rosen’s lawyer, Robert G. Morvillo, said Tuesday, “He’s very disappointed about leaving MediSys and continues to maintain his innocence, and he hopes to establish for the entire hospital community the fact that he has not breached his duties to the hospital when he gets to trial.” Mr. Rosen had served as chairman of two of the state’s most influential hospital lobbying organizations, the Healthcare Association of New York State and the Greater New York Hospital Association. He became assistant director of Jamaica Hospital Medical Center in 1970, and went on to build the MediSys organization.

About New York: Immune to Cuts: Lofty Salaries at Hospitals Posted: 16 Mar 2011 10:38 AM PDT At Bronx-Lebanon, a hospital that exists only by the grace and taxed fortunes of the people of New York State, the chief executive was paid $4.8 million in 2007 and $3.6 million in 2008, records show. At NewYork-Presbyterian, a hospital system that receives nearly half a billion dollars annually in public money, the chief executive was paid $9.8 million in 2007 and $2.8 million in 2008. Related Columnist Page In an urgent search to cut the state’s health care costs and lift revenue, a task force came up with a plan to increase the cost of a hospital stay by $5 and to limit housekeeping services for the disabled in their homes. One area of plump costs, however, remained undisturbed: executive suites where salaries and compensation run into the millions of dollars, even at the most financially struggling hospitals. A proposal to allow public financing for only the first $1 million in wages for an executive died before it even reached the task force. “It was classic how it was killed,” said Judy Wessler, director of the Commission on the Public’s Health System, an advocacy group that had suggested the limits. “We submitted the proposal in writing, met with the state staff members about it, then testified for our two minutes at a hearing,” Ms. Wessler said. “Then in the written summary of all the 4,000 proposals, they twisted the wording of ours so that it would be impossible to implement. Then they said it was not viable, so it wasn’t even put up for a vote.” State officials acknowledged that the proposal had been drastically changed from its original meaning, but did not explain how that happened. In an e-mail exchange provided by Ms. Wessler, Jason A. Helgerson, the state’s Medicaid director, apologized “for not having had the time to do all we wish to do.” Mr. Helgerson was not available for an interview on Tuesday, a spokeswoman said. The subject of executive wages would have been familiar to the task force, many of whose members came from the health care industry. One had worked as a consultant for Mount Sinai Medical Center, which received $250 million in Medicaid and paid its chief executive $2.7 million in 2008. A co-chairman of the task force, Michael Dowling, was paid $2.4 million in 2008 by North Shore-Long Island Jewish Health System, which received about $220 million from Medicaid. UNDER current policies, the State Health Department monitors executive salaries, though much of the compensation data the hospitals provide to the state do not jibe with the tax forms that they must file. In any event, the state does not regulate the salaries, viewing them as decisions that are entirely up to the hospitals’ boards. “Basically, the state does not set compensation rates for private businesses, even if taxpayer funding is a major revenue stream,” said Claudia Hutton, a spokeswoman for the Health Department. “We don’t have any authority to set compensation levels or even to advise.” New legislation proposes to give that authority to the state. Assemblywoman Deborah J. Glick, a Democrat from Manhattan, is sponsoring a bill that would limit executive salaries at publicly financed hospitals to $250,000. She suggested it would be in keeping with some other recent initiatives of Gov. Andrew M. Cuomo. “The governor is fond of caps,” Ms. Glick said. “He has suggested a cap on the salary of educational superintendents at $175,000. There are caps on pain and suffering for those who have been the victims of medical malpractice.” Ms. Glick’s district includes Greenwich Village, where St. Vincent’s Hospital Manhattan closed last year in a blizzard of problems. “I had a hospital that existed for 160 years, and there were many issues with it,” she said. “It also had some level of poor management in its final year.” The top 10 executives took home about $6 million that year. They may have gone out of business, but they didn’t go cheap. Nicholas Confessore and Jo Craven McGinty contributed reporting. E-mail: dwyer@nytimes.com. Twitter: @jimdwyernyt.

Well: Forget the Treadmill. Get a Dog. Posted: 15 Mar 2011 02:29 PM PDT

Special Issue: Emotional Power Broker of the Modern Family Posted: 15 Mar 2011 09:10 AM PDT First, he tore up his dog toys. Then shredded the furniture, clothes, schoolbooks — and, finally, any semblance of family unity. James, a chocolate-brown pointer mix, turned from adorable pet to problem child in a matter of weeks. Enlarge This Image Yvetta Fedorova Well Share your thoughts on this column at the Well blog. Go to Well » Multimedia Interactive Submit Your Family Pet Photo “The big bone of contention was that my mom and my sister thought that he was too smart to be treated like a dog; they thought he was a person and should be treated as such — well, spoiled,” said Danielle, a Florida woman who asked that her last name not be published to avoid more family pet strife. “The dog remains to this day, 10 years later, a source of contention and anger.” Psychologists long ago confirmed what most pet owners feel in their bones: that for some people bonds with animals are every bit as strong as those with other humans. And less complicated, for sure; a dog’s devotion is without detectable irony, a lap cat’s purring without artifice (if not disapproval). Yet the nature of individual human-pet relationships varies widely, and only now are scientists beginning to characterize those differences, and their impact on the family. Pets alter not only a family’s routines, after all, but also its hierarchy, its social rhythm, its web of relationships. Several new lines of research help explain why this overall effect can be so comforting in some families, and a source of tension in others. The answers have very little to do with the pet. “The word ‘pet’ does not really capture what these animals mean in a family, first of all,” said Froma Walsh, a psychologist at the University of Chicago and co-director of the Chicago Center for Family Health. The prevalent term among researchers is now “companion animal,” she said, which is closer to the childlike role they so often play. “And in the way that children get caught up in the family system as peacekeepers, as go-betweens, as sources of disagreement, the same happens with pets.” People cast these roles in part based on the sensations and memories associated with their first Princess or Scooter, psychologists say — echoing Freud’s idea of transference, in which early relationships provide a template for later ones. In many families, this means that Scruffy is the universal peacemaker, the fulcrum of shared affection. In a family interview reviewed by Dr. Walsh in a recent paper, one mother said that the best way to end an argument between siblings was to bark, “Stop fighting, you’re upsetting Barkley!” “This is always more effective than saying, ‘Stop hitting your brother,’ ” the mother said. (Barkley made no comment.) Animals often sense these expectations and act on them. In a video recording of another family discussed in the paper, the cat jumps on a woman’s lap when it senses an impending argument with her husband. “And it works,” Dr. Walsh said. “It reduces tension in both; you can see it happening.” “She’s my first child,” said Adrienne Woods, a cellist in Los Angeles, of Bella, the Husky puppy that she and her fiancé just got. “The biggest upside is this sense of inner peace. I feel like a grandma, like I have a companion I’ve been wanting for 30 years.” Yet pets can also raise tension, as millions of couples learn the hard way. The Animal Planet show “It’s Me or the Dog” is built on such cases. And Cesar Millan, a dog behavior specialist, has become a celebrity by helping people gain control over unruly hounds, bringing order into households with uncertain lines of authority. Perhaps more often, pets become a psychological wedge not from lack of boundaries but because family members have diverging views of what a pet should be. And those views are shaped by cultural inheritance, more so than people may realize. In a study of dog ownership, Elizabeth Terrien, a sociologist at the University of Chicago, conducted 90 in-depth interviews with families in Los Angeles, including Ms. Woods. One clear trend that has emerged is that people from rural backgrounds tend to see their dogs as guardians to be kept outside, whereas middle-class couples typically treat their hounds as children, often having them sleep in the master bedroom, or a special bed. When asked to describe their pets without using the word “dog,” people in more affluent neighborhoods “came up with things like child, companion, little friend, teenage son, brother, or partner in crime,” Dr. Terrien said. In neighborhoods with a larger Latino immigrant population, owners were more likely to say “protector,” or even “toy for the children,” she found. “In those neighborhoods you’ll sometimes see kids yanking around a dog on the leash, pushing and playing, the sort of behavior that some middle-class owners would think of as abuse,” she said. 1 2 Next Page »

Special Issue: No Face, but Plants Like Life Too Posted: 14 Mar 2011 10:37 PM PDT Several years ago, after having to drive for too long behind a truck full of stinking, squealing pigs being delivered for slaughter, I gave up eating meat. I’d been harboring a growing distaste for the ugliness that can be industrial agriculture, but the real issue was a long-suppressed sympathy for its — or really, my — victims. Even screaming, reeking pigs, or maybe especially screaming, reeking pigs, can evoke stark pity as they tumble along in a truck to their deaths. Enlarge This Image Yulia Saponova Multimedia Graphic A Century of Meat RSS Feed Get Science News From The New York Times » If you think about it, and it’s much simpler not to, it can be hard to justify other beings suffering pain, fear and death so that we can enjoy their flesh. In particular, given our many connections to animals, not least of all the fact that we are ourselves animals, it can give a person pause to realize that our most frequent contact with these kin might just be the devouring of them. My entry into what seemed the moral high ground, though, was surprisingly unpleasant. I felt embattled not only by a bizarrely intense lust for chicken but nightmares in which I would be eating a gorgeous, rare steak — I could distinctly taste the savory drippings — from which I awoke in a panic, until I realized that I had been carnivorous only in my imagination. Temptations and trials were everywhere. The most surprising turned out to be the realization that I couldn’t actually explain to myself or anyone else why killing an animal was any worse than killing the many plants I was now eating. Surely, I’d thought, science can defend the obvious, that slaughterhouse carnage is wrong in a way that harvesting a field of lettuces or, say, mowing the lawn is not. But instead, it began to seem that formulating a truly rational rationale for not eating animals, at least while consuming all sorts of other organisms, was difficult, maybe even impossible. Before you hit “send” on your hate mail, let me say this. Different people have different reasons for the choices they make about what to kill or have killed for them to eat. Perhaps there isn’t any choice more personal or less subject to rationality or the judgment of others. It’s just that as far as I was concerned, if eating a tofu dog was as much a crime against life as eating bratwurst, then pass the bratwurst, please. So what really are the differences between animals and plants? There are plenty. The cells of plants, and not animals, for example, harbor chloroplasts, tiny green organelles that can turn the energy of light into sugar. Almost none of these differences, however, seem to matter to any of us trying to figure out what to eat. The differences that do seem to matter are things like the fact that plants don’t have nerves or brains. They cannot, we therefore conclude, feel pain. In other words, the differences that matter are those that prove that plants do not suffer as we do. Here the lack of a face on plants becomes important, too, faces being requisite to humans as proof not only that one is dealing with an actual individual being, but that it is an individual capable of suffering. Animals, on the other hand — and not just close evolutionary relations like chimps and gorillas, but species further afield, mammals like cows and pigs — can experience what pretty much anyone would agree is pain and suffering. If attacked, these animals will look agonized, scream, struggle and run as fast as they can. Obviously, if we don’t kill any of these animals to eat them, all that suffering is avoided. Meanwhile, whether you pluck a leaf or slice a trunk, a plant neither grimaces nor cries out. Plants don’t seem to mind being killed, at least as far as we can see. But that may be exactly the difficulty. Unlike a lowing, running cow, a plant’s reactions to attack are much harder for us to detect. But just like a chicken running around without its head, the body of a corn plant torn from the soil or sliced into pieces struggles to save itself, just as vigorously and just as uselessly, if much less obviously to the human ear and eye. 1 2 Next Page » This posting includes an audio/video/photo media file: Download Now

Recipes for Health: Black Bean and Goat Cheese Quesadillas Posted: 16 Mar 2011 12:44 AM PDT For these quesadillas, I prefer to use my own cooked black beans, which I try to keep on hand in the freezer. Canned baked beans are also an option, but they are higher in sodium than home-cooked beans. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: Fast Food for Harried Days (March 14, 2011) Recipes for Health: Broccoli and Red Onion Quesadillas (March 15, 2011) Recipes for Health: Mushroom Quesadillas (March 17, 2011) Recipes for Health: Spinach and Goat Cheese Quesadillas (March 18, 2011) 2 corn tortillas 1/3 cup cooked black beans 1 ounce crumbled goat cheese (1/4 cup) 1/4 roasted red bell pepper or 1/2 roasted piquilo pepper, cut in strips Salsa for serving (optional) 1. In a microwave: Place a corn tortilla on a plate. Top with the beans. Gently mash the beans with the back of a spoon. Top with pepper strips. Sprinkle on the cheese, and top with the remaining tortilla. Press down gently, then microwave for 1 to 1 1/2 minutes until the cheese has melted. Remove from the microwave, cut into quarters or sixths and serve. In a pan: Place a corn tortilla in a pan. Top with the beans. Gently mash the beans with the back of a spoon. Top with pepper strips. Sprinkle on the cheese. Turn the heat on medium-high, and heat until the cheese begins to melt and the tortilla begins to brown. Place the remaining tortilla on top of the cheese, and press down lightly. Flip the quesadilla over in the pan, and heat for about 30 seconds to a minute or until the cheese has melted. Flip back over, and remove to a plate. Cut into quarters or sixths, and serve. Yield: One serving. Advance preparation: Cooked beans will keep for four to five days in the refrigerator. Nutritional information per quesadilla (with canned black beans): 266 calories; 7 grams saturated fat; 1 gram polyunsaturated fat; 2 grams monounsaturated fat; 30 milligrams cholesterol; 27 grams carbohydrates; 5 grams dietary fiber; 472 milligrams sodium (does not include salt to taste); 14 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Japan Says 2nd Reactor May Have Ruptured With Radioactive Release Posted: 16 Mar 2011 10:51 AM PDT TOKYO — Japan’s nuclear crisis intensified again Wednesday, with Japanese authorities announcing that a containment vessel in a second reactor unit at the stricken Fukushima Daiichi plant in northeastern Japan may have ruptured and appeared to be releasing radioactive steam. That would be the second vessel to be compromised in two days. Multimedia Interactive Feature How a Reactor Shuts Down and What Happens in a Meltdown Graphic Radiation at Fukushima Daiichi Interactive Feature Video: Japan’s Natural and Nuclear Disasters TimesCast | The Fight Against Disaster TimesCast | The Fight Against Disaster Close Video See More Videos » Map Evacuation Zone Around Nuclear Plant Related The Lede Blog: March 15 Updates on Japan's Nuclear Crisis and Earthquake Aftermath (March 15, 2011) Green Blog: Questions on the Nuclear Crisis in Japan (March 15, 2011) Experts Had Long Criticized Potential Weakness in Design of Stricken Reactor (March 16, 2011) In Stricken Fuel-Cooling Pools, a Danger for the Longer Term (March 15, 2011) Radiation Exposure Could Curtail Workers’ Efforts (March 15, 2011) Nuclear Plants in Europe Are Delayed (March 15, 2011) Need Overwhelms Japan After Quake and Tsunami (March 15, 2011) Related in Opinion Editorial: Japan’s Multiple Calamities (March 15, 2011) Op-Ed Contributor: Memories, Washed Away (March 15, 2011) Room for Debate: Japan's Nuclear Crisis: Lessons for the U.S. Enlarge This Image Tokyo Electric Power, via Kyodo News, via Associated Press At the Fukushima Daiichi nuclear plant, reactors No. 3, left, and No. 4, center, have been damaged. The vessel had appeared to be the last fully intact line of defense against large-scale releases of radioactive materials from that reactor, but it was not clear how serious the possible breach might be. The announcement came after Japanese broadcasters showed live footage of thick plumes of steam rising above the plant. Yukio Edano, the chief cabinet secretary, said the government believed the steam was coming from the No. 3 reactor, where an explosion on Monday blew out part of the building surrounding the containment vessel. The reactor has three layers of protection: that building; the containment vessel, and the metal cladding around fuel rods, which are inside the reactor. The government has said that those rods at the No. 3 reactor were likely already damaged. A spike in radiation levels at the plant as the steam was rising forced some of the relatively few workers left at the plant to retreat indoors, suspending some critical efforts to pump water into several reactors to keep them cool. Earlier in the morning, the company that runs the plant reported that a fire was burning at a different reactor, just hours after officials said flames that erupted Tuesday had been doused. A government official at Japan’s nuclear regulatory agency soon after said that flames and smoke were no longer visible, but he cautioned that it was unclear if the fire, at the Reactor No. 4 building, had died out. He also was not clear if it was a new fire or if the fire Tuesday had never gone out. There are a total of six reactors at the plant. The developments are troubling reminders of the difficulties the company is having in bringing the plant, which has suffered multiple explosions since Saturday, under control. And the confusion is emblematic of days of often contradictory reports about what is happening at the plant. The company, Tokyo Electric Power, says it cannot know for sure what is happening in many cases because it is too dangerous for workers to get close to some reactors. The situation became especially dire on Tuesday, when releases of radiation led the company to pull most of its workers from the plant. Among the authorities’ main concerns are pools for spent fuel rods at several reactors at the plant, including Reactor No. 4, where the pool has lost some of the water needed to keep the fuel rods stable. The rods are still radioactive and potentially as hot and dangerous as the fuel rods inside the reactors. Minoru Ogoda, the official with Japan’s nuclear regulatory agency, said a proposed plan to use helicopters to put more cold water into the pool was looking unlikely. The hole or holes in the roof caused by an earlier blast did not appear big enough to allow sufficient amounts of water in, he said. He said Tokyo Electric would probably try to spray water into the reactor building through a gaping hole in the wall blasted open by the explosion. That explosion on Tuesday was caused by hydrogen gas bubbling up from chemical reactions set off by the fuel rods in the pool, Japanese officials said. Inspectors from the United States Nuclear Regulatory Commission said they had been told by Japanese authorities that what was burning was lubricating oil from machinery near the pool. Concern remained high about the storage pools at two other reactors, Nos. 5 and 6. None of those three reactors at the plant, 140 miles northeast of Tokyo, were operating on Friday afternoon when an offshore earthquake with a magnitude now estimated at 9.0 shook the site. A tsunami rolled into the northeast Japanese coastline minutes later, swamping the plant. At least 750 workers were evacuated on Tuesday morning after a separate explosion ruptured the inner containment building at Reactor No. 2 at the Daiichi plant, which was crippled by Friday’s earthquake and tsunami. The closely spaced but apparently coincidental explosions at Reactors Nos. 2 and 4 together released a surge of radiation 800 times as intense as the recommended hourly exposure limit in Japan. 1 2 Next Page » Hiroko Tabuchi reported from Tokyo, and Keith Bradsher from Hong Kong. David E. Sanger and Matthew L. Wald contributed reporting from Washington.

Radiation Exposure Could Curtail Workers’ Efforts Posted: 15 Mar 2011 09:25 AM PDT As radiation levels rise at the crippled reactors in northern Japan, a basic question arises: how long can workers keep struggling to ward off full meltdowns? Video: TimesCast | Crisis at Japanese Reactor Interactive Feature: How a Reactor Shuts Down and What Happens in a Meltdown Related In Stricken Fuel-Cooling Pools, a Danger for the Longer Term (March 15, 2011) Japan Faces Potential Nuclear Disaster as Radiation Levels Rise (March 15, 2011) Nuclear Plants in Europe Are Delayed (March 15, 2011) RSS Feed Get Science News From The New York Times » The workers are performing what have been described as heroic tasks, like using fire equipment to pump seawater into the three failing reactors to keep the nuclear fuel from melting down and fighting the fire at a fourth reactor. They are operating in places that have been contaminated by radioactive isotopes from all four reactors. Technicians who have not been evacuated face an escalating exposure, and will have to be replaced if the fight is to go on. “If they exceed a certain amount, they can’t go back in for a day or a week or longer,” said Dr. Lew Pepper, a professor at the Boston University School of Public Health who has studied the effects of radiation on nuclear weapons workers. And the pool of available replacements is finite, he said: “What do you do? You don’t have a lot of people who can do this work.” The nuclear plants’ operator, Tokyo Electric Power, has declined to provide details about the workers. But Arnold Gundersen, a consultant who worked in American plants nearly identical to the stricken Japanese ones, said it was likely that the company was calling in retirees and workers from unaffected plants for help. And perhaps for sacrifice, as well. “They may also be asking for people to volunteer to receive additional exposure,” he said. People who are working close to the reactor — pumping water, or operating valves inside the secondary containment structure — would almost certainly be wearing full bodysuits and air packs, Mr. Gundersen said. But some forms of radiation can penetrate any gear. Gamma rays and other penetrating radiation can cause cancers and other long-term illnesses or, in high amounts, near-term illness or death. Health physicists should gauge the radiation level in the work area, and the workers would normally be told how long they can remain. “There may be a health physicist who will say, You only have an hour or two to do this job,” Mr. Gundersen said. Each worker would carry a dosimeter, which measures radiation exposure, “and they’ll be looking at it,” he added. “When it hits a certain number, they should leave.” Suits and air packs are meant to keep radioactive particles off the skin and out of the lungs until the workers return to a safer area. Workers are trained to remove the gear in a specific way to avoid leaving any particles on their skin that would result in continuing exposure. While regulations may differ somewhat in Japan, in the United States the usual radiation exposure limit for nuclear power plant workers is 50 millisieverts, or 5 rem, per year (compared with the 0.3 rem that the Environmental Protection Agency says most people get from normal background radiation). When there is an emergency, the limit can be raised to 25 rem, which is still far below the level at which people would show symptoms or get sick. The explosion at Fukushima’s Reactor No. 2 on Tuesday morning sent radiation levels spiking, to 8,217 microsieverts an hour from 1,941 about 40 minutes earlier. Later Tuesday, Japanese nuclear officials announced much higher levels and evacuated most of the emergency workers. During the Chernobyl accident in Ukraine in 1986, when the reactor caught fire, operators and firefighters received high doses of radiation, sometimes within minutes and without being made aware of the dangers. More than two dozen of them died of acute radiation illness. “People in Chernobyl were just over overexposed,” Dr. Pepper said. “The outcome for those folks was death.” Determining allowable exposure is usually based on three principles: distance, time and shielding. In the Japanese plants, extensive contamination would mean that distance and shielding are not really factors, so the controlling variable is time. Mr. Gundersen said that when he worked at the Vermont Yankee plant, which is nearly identical to some of the crippled Japanese reactors, he had one maintenance task where the “stay time,” in which workers would be exposed to their yearly limit, was three minutes. He hired local farmers, trained them on a mock-up for two weeks, and then sent them in for their brief stint. “Then I’d send them home for a year,” he said. In Japan, the plant operators do not have the luxury of time for training. “You need somebody who is familiar with the plant, because you need somebody to do it now,” Mr. Gundersen said. Japanese workers might be so committed that they might be willing to exceed accepted levels of exposure. But that might not extend to extremely high radiation. “I don’t think anyone is going to take 50 rems,” he said. “But if it’s a difference between 5 and 7, they might say: ‘I’ll take it. It’s worth the risk.’ ” This posting includes an audio/video/photo media file: Download Now

Chávez Tries to Rally Venezuela Against a New Enemy: Breast Lifts Posted: 14 Mar 2011 10:30 PM PDT CARACAS, Venezuela — President Hugo Chávez is known to have expressed little patience for imported leisure pursuits like golf or Scotch whisky tippling. Now he has reserved some ire for another practice that is beloved in Venezuela: breast augmentation surgery. Enlarge This Image Meridith Kohut for The New York Times Dr. Peter Römer is a plastic surgeon who operates on Miss Venezuela pageant contestants, whose enhancements are a popular gossip subject. Blame for the boom in such surgeries here, Mr. Chávez said on state television over the weekend, rested with doctors who “convince some women that if they don’t have some big bosoms, they should feel bad.” He said it was a “monstrous thing” that poor women were seeking breast lifts when they had trouble making ends meet. “What is this, friend?” Mr. Chávez exclaimed to his viewers. Mr. Chávez’s comments come at a time when Venezuela has emerged as one of the world’s leading markets for breast augmentation. Between 30,000 and 40,000 women here undergo the procedure each year, according to estimates by the Venezuelan Society of Plastic Surgeons. Billboards in Caracas advertise bank loans for the surgery. Gossip blogs speculate on the enhancements done to contestants in the Miss Venezuela pageant. Last year, one candidate for the National Assembly, Gustavo Rojas, tried to finance his campaign by raffling off a breast lift (he lost anyway). “I’ve never seen more silicone anywhere else,” Mireia Sallarès, a filmmaker from Spain who focuses on feminist issues and is working on a project about Venezuela, told the newspaper Tal Cual. While Mr. Chávez lamented the amount of money spent on cosmetic breast surgery, there is also a darker side to the procedures, with reports of surgical mistakes resulting in the deaths of some patients. One 20-year-old woman, Paola Ríos, died in Caracas this month because of complications from breast augmentation surgery. Mr. Chávez’s stand on such a fixture in Venezuelan popular culture prompted swift reactions from some quarters, notably the medical profession. “I don’t think there should be any type of discrimination against these aesthetic procedures,” said Dr. Ramón Zapata Sirvent, a leading plastic surgeon here. In an acerbic editorial on the subject on Monday, the opposition newspaper El Nacional compared Mr. Chávez to Col. Muammar el-Qaddafi, the Libyan leader, who regards Mr. Chávez as a friend. “Now comes this antiquated, militaristic, coarse, repressive attitude on the freedom of women to do what they want with their bodies,” El Nacional said. The president, however, made it clear that breast augmentation did not square well with his revolutionary priorities. He said that among the thousands of letters he receives from supporters, one arrived asking for his help for a breast lift, which could cost as much as $7,000. “Of course I had to reject it,” he said. State media outlets agreed with the president on the subject. The state newspaper Correo del Orinoco contended this month that plastic surgery was “as common as dentist appointments and it is not unusual for wealthy parents to proudly buy their 15-year-old daughters breast implants for ‘coming of age’ birthday presents.” María Eugenia Díaz contributed reporting.

Memo From Mexico City: Mexico Puts Its Children on a Diet Posted: 13 Mar 2011 09:59 PM PDT MEXICO CITY — Mexico put its schoolchildren on a diet at the beginning of the year. But as often happens with New Year’s resolutions, there are many ways to cheat. Here is some of what is allowed for sale in schools under new guidelines that are intended to combat childhood obesity: lollipops, potato and corn chips (in multiple guises), and cookies (complemented by marshmallow or chocolate filling). Enlarge This Image Adriana Zehbrauskas for The New York Times Recess at Estado de Quintana Roo Elementary School. New food options include cucumber, jicama and watermelon slices. But the message is getting through, sort of. Portions verge on the miniature; sugar is limited; the chips are baked, not fried; and soft drinks are banned in elementary schools. “My doctor told me that I had to drink water to look after my health,” said Santiago Daniel Torres, a bulky 14-year-old. Gone are the grease-drenched sandwiches and fried pork rinds that he used to buy. “They banned them,” he said as classmates wandered by clutching foil packets of cookies and chips. “More water, that’s better.” By all measures, Mexico is one of the fattest countries in the world, and the obesity starts early. One in three children is overweight or obese, according to the government. So the nation’s health and education officials stepped in last year to limit what schools could sell at recess. (Schools in Mexico do not provide lunch.) The officials quickly became snared in a web of special interests led by Mexico’s powerful snack food companies, which found support from regulators in the Ministry of the Economy. The result was a knot of rules that went into effect on Jan. 1. “What’s left is a regulatory Frankenstein,” said Alejandro Calvillo, Mexico’s most vocal opponent of junk food, particularly soft drinks, in the schools. “They are surrendering a captive market to the companies to generate consumers at a young age.” Mexican officials argue that the new rules are successful, even though parts of the original proposal have been relaxed. “We managed to do the most important things, which was to pull out the soft drinks and to get the composition of foods changed,” said Dr. José Angel Córdova, Mexico’s health minister. He estimates that one-third of Mexico’s health care spending goes to fight diseases related to obesity. The snack food companies’ concerns may go beyond their sales in Mexican schools, Dr. Córdova said. If Mexico sets a precedent, he said, other governments may follow. “We had to negotiate and negotiate, and it suddenly got complicated,” Dr. Córdova said. “They tried to drag out the timing until finally we just imposed and we applied the rules.” The education minister, Alonso Lujambio, said the new rules had removed 90 percent of fried foods from schools. “That is a very aggressive change,” he said. But he stopped short at a suggestion that all junk food should be banned from schools. “The central issue is to educate children to exercise moderation in what they eat and emphasize healthier products,” Mr. Lujambio said. It is a high-minded approach at odds with the scene during a recent recess period at a downtown Mexico City middle school. When the bell rang at 10:50 a.m., children streamed onto a tiny patio, where Marisela Beltrán was selling chicken sandwiches. Mindful of the new guidelines, Ms. Beltrán has been experimenting with healthier foods, bringing oranges and once offering a salad of chopped nuts, raisins, lettuce and apples. It was not a popular offering, said her nephew Francisco Peralta, who sells the school’s packaged snack food. “When we bring things like that to the patio, they attack me in there,” he said gesturing at his closetlike store, where cookies, bran bars and juices were displayed on wooden shelves. The food companies, including multinationals in Europe and the United States, say their new portfolio of school snacks are evidence that they are committed to combating the problem. But they also complain that they are forced to compete with street vendors who gather outside school gates to sell inexpensive junk food to children as they head home. “It isn’t an issue of just a moment; it is many moments in many days,” said Luis René Martínez Souverveille, director of corporate affairs for Grupo Bimbo, a Mexican baked goods and snack company that owns several brands in the United States, including Entenmann’s. Industry officials argue that they are easy targets. “I think in some sense this is a very difficult problem, and the population, society, wants to have a magic wand and wants to blame somebody for something that at the end of the day is related to personal responsibility and personal lifestyles,” said Jaime Zabludovsky, the executive president of ConMéxico, the consumer products trade association. Difficult as the problem may be, at least one school principal has found a simple solution. The snack food salesmen “come knocking at the door, and we just say no,” said the principal, María Teresa Zamorano. Since she took over at Estado de Quintana Roo Elementary School in a working-class neighborhood of Mexico City in August, Ms. Zamorano has remade the recess menu. On one day recently, there was a hot meal of rice and tortillas, prickly pear leaves with eggs and onions, and squash with soft white cheese. Her students could choose among fresh cucumber, jicama, watermelon slices and cooked corn kernels. For dessert, there were popsicles and miniature cups of gelatin. “The most important thing is that the children learn for themselves, that they talk to their parents themselves,” Ms. Zamorano said. It seems to be working at her school. Verónica Cruz Hernández now sends her 6-year-old daughter, Fatima, to class with a packed lunch of a ham sandwich, sliced mango, cucumber sticks and water. No more soft drinks. “She doesn’t want to be fat like me,” Ms. Cruz said. At the end of the school day, the children poured out of the gates onto a narrow street cluttered with vendors selling candy, chips, nachos and ice cream. Many bought a snack for the walk home. Still, they have not forgotten the lessons from school. “Almost all of the girls eat fruit,” said Leticia García Gutíerrez, 11. Then she added: “Sometimes we eat candy. But that’s because we’re kids.”

Doctors Detail Giffords’s Progress Posted: 11 Mar 2011 10:00 PM PST HOUSTON — Representative Gabrielle Giffords is “making leaps and bounds” in her neurological recovery after being shot in the head on Jan. 8 in Tucson, her doctors said Friday at a news conference. Enlarge This Image David J. Phillip/Associated Press From right, Drs. Imoigele Aisiku, Dong Kim and Gerard Francisco spoke Friday in Houston about Gabrielle Giffords’s recovery. Related Giffords to Attend Shuttle Launch Next Month (March 11, 2011) Enlarge This Image Office of Rep. Gabrielle Giffords Ms. Giffords in a photograph taken in March 2010. Her memory and cognitive level are good, her speech is improving and her personality has re-emerged, the doctors said. One said that when it came to showing her personality, Ms. Giffords was doing “spectacularly well.” She has been receiving therapy here since late January at TIRR Memorial Hermann rehabilitation hospital here. The doctors said that she had started to walk with assistance, and that a tracheotomy tube had been removed from her throat, meaning that her airway was stable and she was able to breathe on her own. The tube had prevented her from speaking. “She is clearly saying what she wants,” said Dr. Dong Kim, director of the Mischer Neuroscience Institute at Memorial Hermann-Texas Medical Center. “She is starting to string words together. She can repeat anything we say to her; that’s an important neurological recovery fact. It means her primary language area is intact. She can speak in full sentences. She says, ‘I’m tired. I want to go bed,’ just like that. And we can have a conversation with her.” But what the doctors did not fully describe was the level of complexity of those conversations, or of Ms. Giffords’s comprehension. The bullet passed through the left side of her brain, from front to back. In most people the left brain is dominant and controls speech, so there have been lingering questions about how well Ms. Giffords will ultimately be able to speak and understand language. Experts say that most people shot in the left side of the brain suffer some type of speech deficit, unless the bullet somehow missed the speech center. The left side of the brain also controls movement on the right side of the body, and Ms. Giffords has some weakness on the right side, her doctors said. But they say she is gaining strength all the time, as evidenced by her ability to start walking again. “It’s only been two months, and she’s already walking,” Dr. Kim said. “It’s a very favorable sign that she’ll be even stronger over the next few months.” Dr. Kim said that Ms. Giffords had no memory of the shooting, but that that was normal for someone with this kind of injury. The rest of her memory seems to be intact, he said, including her long-term memories of things past and her ability to remember new events and people. He said that she recalled things from one visit to the next, and that when he came to see her he could pick up where he had left off with her during his last visit. He said that doctors and Ms. Giffords’s family had told her what happened to her, and that she understood, but he said that he thought that she had not been told much about the others who were killed or wounded during the rampage in Tucson. “Her memory is going to be great,” Dr. Kim said. Dr. Gerard Francisco, the hospital’s chief medical officer, said that Ms. Giffords had had continuous neurological improvement, which allowed the doctors to keep intensifying her therapy in terms of difficulty and type. “She is responding beautifully,” Dr. Francisco said, adding that the most aggressive therapies were geared at improving her speech and walking. He said that she spent three to five hours a day in therapy, and that the doctors were particularly pleased to see that within the past few weeks she has been able to do more and more for herself without help. Asked if Ms. Giffords ever laughed, the doctors smiled and nodded emphatically. Dr. Kim said that the doctors were seeing not mere hints or flashes of personality. “It’s Gabby,” he said. “It’s a constant, wonderful thing.” He went on: “She has a personality that’s already showing through. She’s very upbeat and focused on getting better. She hasn’t showed us depression. She has been very forward-looking. Even with speech she’s not showing much frustration. Part of that is because she’s making such progress, getting better on almost a daily basis.” Dr. Francisco agreed that Ms. Giffords was showing a lot of personality. “I feel I’ve gotten to know her very well,” he said. He also said she had a good attention span, adding, “We can engage her for a long period of time.” Dr. Francisco described her progress as “quite remarkable and better than we expected.” The doctors said Ms. Giffords understood and took pleasure in the advances she was making. Dr. Imoigele Aisiku, the institute’s director of neurocritical care, said that she knew having the breathing tube removed was a huge milestone — he called it “monumental”— and that she pumped her fist when it was done. Ms. Giffords appears to have normal vision, the doctors said, even though her injuries included a fractured left eye socket that had to be surgically repaired. Asked if Ms. Giffords had any deficits or other problems that seemed likely to be permanent, Dr. Kim said: “I think it’s too early to talk about that. I think she’s going to make an excellent recovery.” One of Ms. Giffords’s staff members has said that she would probably be taken to Cape Canaveral in Florida next month to attend the launch of the space shuttle Endeavour, which is being led by her husband, the astronaut Mark E. Kelly. The doctors, though, indicated that the trip was not a sure thing. “Our No. 1 concern is that it will be safe for her to do that,” Dr. Francisco said. But Dr. Kim added: “We think she’ll go to the launch. She would like to be there.” Doctors have yet to rebuild Ms. Giffords’s skull. Nearly half of it was removed during emergency surgery in Tucson immediately after the shooting to relieve pressure from brain swelling. The pieces were stored in a freezer. Typically, reconstruction is done about three or four months after such an injury, the doctors said. The patient’s own skull or synthetic materials can be used. The doctors said they expected to perform the surgery on Ms. Giffords sometime in May. But lacking part of her skull should not make traveling unsafe or prevent her from going to Florida, they said. Ms. Giffords was one of 19 people shot in January while she was meeting with constituents in a supermarket parking lot in Tucson; six died. The 22-year-old suspect, Jared Lee Loughner, pleaded not guilty in federal court this week to 49 counts stemming from the shooting.

About New York: Charges Against Health Care Executive Raise Broader Issues Posted: 15 Mar 2011 06:00 PM PDT We learned this week from a federal bribery case, of all places, that the going rate in 2008 to park a dying person in a hospital bed in Brooklyn was $772.80. That fee was enough to cover hospice care and, if the charges are true, a payoff to a state senator from Brooklyn. Enlarge This Image Frank Franklin II/Associated Press David Rosen, a hospital executive who was charged in a federal corruption case. Through his lawyer, Mr. Rosen said he had paid a consultancy fee, but never a bribe, to save hospitals. Related Columnist Page In a Series of Phone Calls, an Ear Into a Federal Corruption Case (March 12, 2011) Shedding Light on Influence of Hospitals on Albany (March 12, 2011) Graft Charges Depict Kruger’s Lavish Lifestyle (March 11, 2011) Brooklyn Senator and Assemblyman Face Corruption Charges (March 10, 2011) History tells us that quite a few politicians got rich by awarding contracts for the epic public works of the 19th century, and that graft gave New York City the parks, bridges and reservoirs that have defined it for the ages. Now, we have State Senator Carl Kruger, who, it is charged, was effectively getting rich on nasogastric tubes. Mr. Kruger has pleaded not guilty, and so has David P. Rosen, the hospital executive accused of being involved in the scheme. In fact, through his lawyer, Mr. Rosen says that he is more than not guilty, that he is a champion of the poor and the needy, who has moved mountains — and yes, paid a consultancy fee or two to politicians, but never a bribe — to save hospitals in Brooklyn and Queens. “The media should inquire why it would be necessary to pay bribes to ensure that hospitals in poor neighborhoods dispense quality care to the needy,” said Robert G. Morvillo, the lawyer who has been representing Mr. Rosen during two and a half years of federal investigations. “These hospitals are totally dependent for their survival on help from Albany.” This is a fair question, to which another might be added: Why it is necessary to pay between $1.5 million and $2 million annually in salary to Mr. Rosen, and proportionally robust salaries to his top assistants? He is the chief executive of Jamaica Hospital, Flushing Hospital, Brookdale Hospital, and of MediSys, a management company that oversees hospitals. The hospitals are private, but supported heavily or entirely by public financing. By comparison, the head of the city hospital system is paid $351,000. Mr. Rosen’s salary was approved by the hospital boards after a compensation firm evaluated the appropriate levels, a spokesman for MediSys said on Friday. Mr. Rosen has been working in health care since 1970, which has included periods of rapid escalation in executive salaries. Nevertheless, New York State, which pays nearly every dime of Mr. Rosen’s wages, has nothing to say about his compensation. That would not change even after an overhaul of the Medicaid system recommended by a task force working for Gov. Andrew M. Cuomo. The question of bribes to politicians by hospital executives surfaced in 2008, with the arrest of Anthony Seminerio, a member of the Assembly from Queens who had been paid more than $400,000 by Mr. Rosen as a consultant. From that point on, the hospitals under Mr. Rosen hired teams of criminal defense lawyers to represent various executives and the boards. Much of that cost has been covered through director and officer insurance — bought, of course, with taxpayer money — as well as more than $1 million in fees directly paid by the hospital. In 2009, a year into the criminal investigation, the in-house counsel for the hospitals, Margo Johnson, became concerned that the interests of the hospital were not being served by a lawyer who was reporting to Mr. Rosen on the investigation. She was fired, and has since sued. Mr. Morvillo said that her case had no merit, and that it was natural for the board and its criminal lawyer to consult with Mr. Rosen about the progress of the investigation, since they all believed that no charges were warranted. He has asked that her suit be dismissed. However, Ms. Johnson said in an e-mail that her lawsuit “will shine a light on the culture of corruption that exists in Albany and its detrimental effect on health care in New York City.” A larger question, she wrote, “is about corporate governance, the fiduciary responsibility of not-for-profit boards, and the steps individuals will take to block transparency in an effort to protect their self-interest.” The announcement of the charges against Mr. Kruger, Mr. Rosen and others has led to calls for Governor Cuomo to seize the moment and demand more ethics reform. More ethics is always good, probably, but we should not count on grafters to suddenly start listing “bribes” under “other income” on financial-disclosure forms. The Kruger case involves $1 million or so in bribes; the legal fees are several times that. The wages of sin apparently are pretty good. But poverty is a business that pays even better. E-mail: dwyer@nytimes.com

Response of W.H.O. to Swine Flu Is Criticized Posted: 11 Mar 2011 07:02 AM PST A panel of independent experts has harshly reviewed the World Health Organization’s handling of the 2009 epidemic of H1N1 swine flu, though it found no evidence supporting the most outlandish accusation made against the agency: that it exaggerated the alarm to help vaccine companies get rich. Related Times Topic: Swine Flu (H1N1 Virus) The world is still unprepared to handle a severe pandemic, and if a more dangerous virus emerges, “tens of millions would be at risk of dying,” the panel said in its draft report, which was posted on an obscure corner of the W.H.O.’s Web site on Thursday. Although millions of doses of vaccine ultimately went unused, the panel found “no evidence of malfeasance.” The virus appeared severe during its spring outbreak in Mexico City, and it was not clear how relatively mild it really was until late summer, “well past the time when countries would have needed to place orders for vaccine,” the panel said. Later, when rich nations donated 78 million doses for use in poor ones, the health agency could not deploy them because it was bogged down in negotiations with vaccine companies over liability and costs. The panel, which has experts from 24 countries and is led by Dr. Harvey V. Fineberg, president of the Institute of Medicine, criticized the agency’s “needlessly complex” definition of a pandemic, which had six levels of alert, based on the virus’s geographical spread, not its severity. At one point, the agency altered, without explanation, its online pages to remove references to severity. That “invited suspicion,” the panel said. While the names of the agency’s expert advisers were kept secret for months to shield them from pressure, the tactic “paradoxically fed suspicions that the organization had something to hide,” the panel said. Some advisers had done research for the vaccine industry, and those potential conflicts of interest “were not managed in a timely fashion,” the report said. Nonetheless, it concluded, “no critic of W.H.O. has produced any direct evidence of commercial influence on decision-making.” Communications were also clumsy. Ceasing routine news conferences after the disease was elevated to pandemic status was “ill advised,” the report said, and the agency responded “with insufficient vigor” when its integrity was questioned. Countries that needed technical help could not obtain it in enough languages, and the W.H.O. bureaucracy created “an unmanageable number of documents,” according to the report. Asking countries to submit counts of laboratory-confirmed cases created confusion, the report said, adding that knowing hospitalization and death rates would have been better. Although the W.H.O. excels at sending small teams to focused outbreaks like a village overwhelmed by Ebola, it fumbled even simple aspects of a prolonged effort, like food, lodging and child care for its staff. The panel did offer some praise. With help from national health agencies like those of the United States and Canada, the W.H.O. identified the virus quickly and got seed strains to vaccine makers. It also sent experts to countries that asked for help. The W.H.O. will not respond to the report until the final version is released in May at the annual assembly of the world’s health ministers, a spokeswoman for the agency said. Under W.H.O. rules, the draft had to be made public early to invite comment in time for the final draft. Dr. Fineberg declined to discuss the report’s conclusions, because it is a draft. His panel invited testimony from both critics and the W.H.O. staff, “but everything was voluntary,” he said. “We don’t have subpoena power.” The report also acknowledges that many problems were beyond the health agency’s control. Vaccine companies use slow 60-year-old technology, diagnostic tests are cumbersome, and virologists know too little about which mutations are the most dangerous. The panel urged the creation of a “global reserve corps” of experts for emergencies, and a $100 million fund for their use. It urged vaccine makers to reserve 10 percent of their production for poor countries. It also criticized some international rules. For example, there is no way to punish nations that needlessly close borders or curtail trade. In 2009, many countries banned pork imports in the mistaken belief that a human flu with some swinish genes could be spread by bacon. Others closed borders or forcibly quarantined visitors with fevers. This posting includes an audio/video/photo media file: Download Now

20% Rise Seen in Number of Survivors of Cancer Posted: 11 Mar 2011 10:00 AM PST About one in every 20 adults in the United States has survived cancer, including nearly one-fifth of all people over 65, according to new federal data. The numbers, released Thursday by the Centers for Disease Control and Prevention and the National Cancer Institute, indicated that the number of cancer survivors increased by about 20 percent in just six years, to 11.7 million in 2007, the latest year for which figures were analyzed, from 9.8 million in 2001. In 1971, the number of cancer survivors was three million. “There’s still a concept that cancer is a death sentence,” said Dr. Thomas R. Frieden, director of the Centers for Disease Control. But, he said, “for many people with cancer there’s a need for them and their families and caregivers to recognize that this is a stage. They can live a long and healthy life.” About 65 percent of cancer survivors have lived at least five years since receiving their diagnosis, 40 percent have lived 10 years or more, and nearly 10 percent have lived 25 years or longer. The implications, Dr. Frieden said, are that many cancers are treatable and that it is just as important for people who have had cancer not to assume that they will necessarily die early. “You might think, ‘I’ve had cancer — I don’t have to worry about eating right, quitting smoking, exercising,’ ” Dr. Frieden said. But people with cancer “need to be just as concerned about heart disease and other risks as they would otherwise,” he said. The study defined a survivor as anyone who ever received a diagnosis of cancer who was alive on Jan. 1, 2007, and it did not indicate if the person was cured, undergoing treatment, afflicted with a chronic cancer-related illness, or in the process of dying at that time. And the numbers tell only a piece of the cancer story. Some cancers, like lung cancer, are aggressive and difficult to treat. And the death rate from cancer, an indicator that many health experts consider a more accurate measure of progress in fighting the disease, has stayed virtually the same as it was in 1950 — about 200 deaths per 100,000 people a year, and about 1,000 deaths annually per 100,000 people over 65. Dr. Frieden said the increase in cancer survivors was due to several factors, some of which varied by type of cancer. In some cases of breast cancer and colon cancer, for example, improved treatment and increased follow-up after treatment have helped increase survival. In others, like prostate cancer, an explosion in screening has identified many men with the disease, but the cancer is often so slow-growing that they would be unlikely to die from it. And other cancer diagnoses are simply the consequence of the country’s aging population and improved care for other diseases — in other words, people are living long enough to develop cancer. About a million more of the survivors were women than men, partly because women live longer than men, and partly because breast and cervical cancers are often diagnosed and treated at younger ages. About 22 percent of the survivors had breast cancer, about 19 percent had prostate cancer, and about 10 percent had colorectal cancer. The study identified only the type of cancer first diagnosed in each person; additional tumors or cancer diagnoses were not recorded. Health authorities urged families and physicians to be aware of the health needs of cancer survivors. “Having cancer may be the first stage, really, in the rest of your life,” Dr. Frieden said. “We need to continue to scale up” the services available for cancer survivors.

U.S. Regulators and J.&J. Unit Reach a Deal on Plant Oversight Posted: 11 Mar 2011 02:18 PM PST Federal regulators reached an agreement on Thursday with a unit of Johnson & Johnson that would impose greater federal oversight at three manufacturing plants responsible for recalls of children’s Tylenol and many other popular over-the-counter medicines. Add to Portfolio Johnson & Johnson Merck & Company Inc Go to your Portfolio » The regulators say that the manufacturing practices failed to comply with federal law. The proposed consent decree with the Food and Drug Administration stems from recurring problems for over a year with products made by Johnson & Johnson’s McNeil Consumer Healthcare division at sites in Pennsylvania and Puerto Rico. Lawmakers and regulators have repeatedly criticized the company for its inability to manage production at these plants. “We’ve had a long engagement with McNeil over the last year with regard to their quality system,” Douglas Stearn, an F.D.A. official who helps oversee compliance by drug makers, said in an interview on Thursday. “We think this represents necessary important steps to assuring quality across the board.” Under the agreement, which needs approval from a federal judge, Johnson & Johnson would be required to hire an independent expert to determine whether operations at all three plants met federal standards and to ensure that quality systems were in place. The agreement covers a plant in Fort Washington, Pa., that the company closed last year for an overhaul amid a nationwide recall of children’s medicines; a plant in Las Piedras, P.R., that was the subject of an agency warning letter last year; and a plant in Lancaster, Pa., that makes products like Pepcid for a joint venture with Merck. McNeil cannot reopen the Fort Washington plant until an independent expert determines that the plant meets all federal standards and passes an agency inspection, according to the agreement. The agreement would also give the F.D.A. the authority to require McNeil to stop manufacturing or to institute recalls. While the agency did not levy a fine in this case, McNeil could face fines of $15,000 a day for violating the decree, up to $10 million a year. While the proposed consent decree covers a civil complaint, the F.D.A. would not comment on the status of any related criminal investigations. Last year, an F.D.A. official testified at a Congressional hearing that the agency had referred the McNeil case to its Office of Criminal Investigations. A spokeswoman for McNeil confirmed that other federal investigations were under way. Last July, McNeil filed a plan with the F.D.A. that detailed how it expected to upgrade its manufacturing and quality processes. But the terms of the proposed decree indicate that federal regulators thought the company needed outside oversight, said Erik Gordon, an assistant professor at the Ross School of Business at the University of Michigan. He likened the consent decree to a trusteeship or a receivership. Professor Gordon estimated that the agreement could be costly because of the need to hire independent consultants, who would have to inspect and certify the company’s corrective actions. “It’s a big embarrassment, and it is going to be expensive,” he said. In a statement issued on Thursday to the company’s employees, William C. Weldon, Johnson & Johnson’s chief executive, said executives were committed to addressing the manufacturing problems at the plants. While he emphasized that the company “has made important progress toward improving quality and compliance,” he said the agreement “requires additional quality assurance measures, and is a reminder that important work remains to be done.” A McNeil spokeswoman said she could not comment on how much the agreement might cost the company to put in place. Other units of Johnson & Johnson have also been experiencing problems, leading some industry analysts to raise broader questions about oversight. Last year, the company’s DePuy unit recalled two different hip implants, affecting tens of thousands of patients worldwide. Its Animas unit recalled tens of thousands of insulin pump cartridges last month because they had the potential to leak and deliver too little insulin, the company said. Also last month, the F.D.A. sent a letter to Cordis, a company device unit, warning about problems at a plant in Puerto Rico that makes heart stents. A spokeswoman for Cordis said the company was working to address the agency’s concerns. “We do not believe this issue impacts product safety and efficacy and we are confident our product remains safe and effective for use,” she said. Les Funtleyder, a fund manager at Miller Tabak & Company, which owns shares of Johnson & Johnson, said the agreement underscored concerns about the company’s ability to resolve persistent manufacturing problems. “We’re having a hard time reconciling how Johnson & Johnson got to this point,” he said. “The board has to be asking questions. If not, investors will be.”

F.D.A. to Study Whether Anesthesia Poses Cognitive Risks in Young Children Posted: 09 Mar 2011 10:40 PM PST A federal panel will meet on Thursday to evaluate growing concerns about whether anesthesia in young children, used in millions of surgical procedures, can in some cases lead to cognitive problems or learning disabilities. RSS Feed Get Science News From The New York Times » The meeting was prompted by a growing body of research, so far primarily in animals, that suggests a correlation between anesthesia exposure and brain cell death or learning problems, said Dr. Bob Rappaport, the Food and Drug Administration’s director of the division of anesthesia and analgesia products, who wrote about the issue in Wednesday’s New England Journal of Medicine. The F.D.A. advisory panel will evaluate the research, suggest further studies and discuss whether parents whose children are facing surgery should be informed of possible cognitive or behavioral risks. “We don’t know what this means for children at this time,” Dr. Rappaport said, adding, “That’s exactly why it’s so critical that we get all of the necessary information.” In the meantime, he said, “how do we communicate what we do know at this point without causing undue concern in parents and in physicians?” Medical advances are allowing more fragile and premature infants to survive birth, often to require critical surgical procedures. Studies in rodents and monkeys have shown that exposure to anesthesia at a very young age, roughly corresponding to under age 4 in humans, is associated with brain cell death. And a new study, by the F.D.A.’s National Center for Toxicology Research, found that exposing 5-day-old rhesus monkeys to 24 hours of anesthesia resulted in poorer performance on tests of memory, attention and learning. “That brings into the picture the sort of proof of concept that these drugs can cause cognitive disturbances in juvenile animals,” Dr. Rappaport said. Because of the difficulty of doing controlled clinical trials with children, human studies have mostly examined whether children with and without learning disabilities had anesthesia when younger. Such research has weaknesses because it may not account for children’s various experiences or show whether learning deficits were coincidental. Results of several of these studies suggest developmental or behavioral risks to children exposed to anesthesia, especially those who received more than one anesthetic. “You don’t have to be a rocket scientist to say, ‘Geez, if this happens in monkeys, then there’s a high probability that something like this occurs in humans,’ ” said Dr. Randall Flick, associate professor of anesthesiology and pediatrics at the Mayo Clinic, who has done some of the research involving children and is on the F.D.A. advisory panel. But, Dr. Flick said, without definitive evidence, the issue is extremely fraught because most young children receiving anesthesia critically need surgery. “What we know is that not giving anesthesia and appropriate medication to manage a child’s pain during surgery does have long-term adverse affects on a child — physical as well as emotional,” said another committee member, Dr. Jayant Deshpande, a pediatrician and anesthesiologist who is a senior vice president at Arkansas Children’s Hospital. “So because the child needs surgery today, we are going to use the best information that we have and use the anesthetics.” To galvanize research, the F.D.A. has formed a public-private partnership with the International Anesthesia Research Society. Dr. Rappaport said questions include whether possible effects vary by anesthetic (most studies so far involved ketamine, a common anesthetic), dose, age or length of exposure. Other questions include types of cognitive effects; Dr. Flick, for example, is studying whether anesthesia exposure appears related to autism or attention deficit disorder. Dr. Nancy Glass, a pediatric anesthesiologist at Texas Children’s Hospital and president-elect of the Society for Pediatric Anesthesia, wants practical answers, like “if we know that this baby needs two small procedures and two anesthetics is worse than one, then we would knock ourselves out to do it on the same day,” she said. “We’re all concerned,” Dr. Glass said, but “we don’t believe that there is data yet that says to us either that we should change our technique or that we should frighten parents about allowing us to anesthetize their children for necessary surgery.” This posting includes an audio/video/photo media file: Download Now

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Special Issue; Personal Health: Easing the Way in Therapy With the Aid of an Animal Posted: 15 Mar 2011 01:12 PM PDT We’ve all seen guide dogs that can direct blind people around obstacles and tell them when it is safe to cross the street. Perhaps you also know of guide dogs for the deaf, which can alert people to a ringing phone, a doorbell or a smoke alarm, or dogs that can warn people with epilepsy of an incipient seizure, giving them time to get to a safe place before they lose consciousness. Enlarge This Image Debbie Egan-Chin/The Daily News, via Getty Images Send Us Your Videos: How Does Your Pet Keep You Healthy? Do you dance with your cat? Play Frisbee with your dog? Sing with your bird? Send us your videos showing how your pets keep you healthy. Related More Personal Health Columns Dr. Marty Becker, veterinarian and author (with Danelle Morton) of “The Healing Power of Pets” (Hyperion, 2002), tells of a golden retriever named Dakota, who was able to warn his master, Mike Lingenfelter, that a heart attack was imminent and alert Mr. Lingenfelter to the need to leave a stressful situation and take preventive medication. “This dog is leading me through life,” Mr. Lingenfelter told Dr. Becker. “All I’m doing is following the dog.” In recent decades, there have been countless such stories of animals helping to improve and even preserve the lives of children and adults with all manner of diseases and disabilities. Trained dogs are being used to help keep children with autism safe and to break the “freeze” that can afflict people with Parkinson’s disease when they try to walk. And dogs, cats, bunnies and birds are often brought to schools and institutions, as well as to hospitals and nursing homes, where they help to relax and inspire residents and distract patients from their health problems. But the use of animals to enhance health can go well beyond individual cases and group settings. A growing number of psychotherapists are using therapy animals to facilitate treatment, especially treatment of children with emotional, social and even physical problems. Among the pioneers is Aubrey H. Fine, psychotherapist and professor at the California State Polytechnic University in Pomona, whose extensive successful use of therapy animals in treating children is documented in “The Handbook on Animal Assisted Therapy” (Elsevier/Academic Press, 2010). As Dr. Fine describes one of his first and most inspiring cases, 5-year-old Diane was brought to him because she recoiled in fright from strangers, and though she spoke at home, she refused to speak to anyone else, including her kindergarten teacher. A trained therapy dog named Puppy eventually broke the back of her selective mutism. Diane was petting Puppy, smiling and content, when Dr. Fine gave the dog a signal to walk away. Diane was crestfallen, and seeing the girl’s distress, Dr. Fine told her that all she had to do to get the dog back was to say, “Puppy, come.” Softly, the child said, “Puppy, come, please come, Puppy.” That incident became the bridge Dr. Fine needed to help the child overcome her socially disabling problem. He tells of another troubled child who finally began to speak about being physically abused when Dr. Fine told him that the misshapen therapy animal he was playing with had been rescued from an abusive home where it had been seriously injured. In another case in which a child was told where — and where not — to touch the therapy animal, the child opened up about being inappropriately touched, sexually abused, by a family member. “Children are more likely to reveal inner thoughts to the therapist because the animal is right next to them and helps them express themselves,” Dr. Fine said in an interview. In early work in a social skills program for hyperactive children, Dr. Fine found that they could be more easily taught how to behave calmly if allowed to handle his pet gerbil. “I realized this approach can have a tremendous impact in teaching because it helps to change how we relate to other beings,” he said. Although the field of animal-assisted therapy has grown a lot in the last four decades, experts readily acknowledge that it suffers from a lack of well-designed research that can establish guidelines for safety and effectiveness in various situations. For example, although using dolphins to treat autistic children has received considerable media attention, at least two studies found no evidence of benefit and considerable risk of harm to the animals and to the children, said James A. Griffin of the National Institute of Child Health and Human Development. The International Association of Human-Animal Interaction Organizations insists that members limit service and therapy animals to domestic species trained for the job. And the Delta Society, which provides training programs for the animals, will not certify wild or exotic animals like snakes, ferrets, lizards and wolf-hybrids. However, the Delta Society says it “is constantly expanding the range of species included in the Pet Partners program” when there is adequate research to document the safety of their use. To help give the field a firmer scientific footing, the Mars company, a leading producer of pet foods, initiated a research partnership with the national institute branch of which Dr. Griffin is deputy director. Among continuing studies: ¶The effects of therapeutic horseback riding on children and adolescents with autism. If safe and effective, riding is less invasive than medications used to treat common symptoms like irritability and hyperactivity. ¶A large epidemiological study to document the overall public health effects on children and adolescents of living with dogs and cats. ¶A study to determine whether therapy animals can help children with behavior disturbances attributed to attention deficit hyperactivity disorder develop better self-regulation, self-esteem and social behavior. ¶Studies using survey and genetic tools to help select the most effective cats or cat breeds to work with autistic children. Dr. Griffin acknowledged in an interview how difficult it can be to design a scientifically valid study using animals because “it can’t be a blind study — you know if the patient has a therapy dog.” But he described one recent study in which the patient, a young boy with autism, served as his own control. When he was with the therapy dog, levels of the stress hormone cortisol in the child dropped; the levels rose when the dog was taken away, and dropped again when the dog was returned. The next step would be to coordinate biochemical changes with behavioral effects — is the child calmer and easier to handle when with a therapy animal? Dr. Fine emphasized the challenges of working with therapy animals as well as documenting its effectiveness. He said, “You can’t just bring in any animal to a therapy setting. The animal has to be very well trained, reliable, obedient and have the right temperament. It can’t be overly anxious or easily startled. And the therapist has to know how to use it as a therapy adjunct, in combination with good psychotherapy. The animal is there to help support what I’m doing, to act as a catalyst and not a distraction. And, of course, animal-assisted interventions have to be safe for everyone involved — the patient and the animal.”

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Recipes for Health: Mushroom Quesadillas Posted: 15 Mar 2011 09:00 AM PDT Mushrooms make a meaty quesadilla filling. If you cook them in advance and keep them in the refrigerator, you can slap these together in a pinch. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: Fast Food for Harried Days (March 14, 2011) Recipes for Health: Broccoli and Red Onion Quesadillas (March 15, 2011) Recipes for Health: Black Bean and Goat Cheese Quesadillas (March 16, 2011) Recipes for Health: Spinach and Goat Cheese Quesadillas (March 18, 2011) 1 tablespoon extra virgin olive oil 1 shallot, minced (optional) 6 ounces regular or wild mushrooms, trimmed and sliced about 1/4 inch thick 1 to 2 garlic cloves, minced 1 jalapeño or serrano chili, minced (seeded for a milder flavor) 1 tablespoon chopped cilantro or epazote Salt and freshly ground pepper 4 corn tortillas 2 ounces grated Monterey Jack, Cheddar, or mixed cheeses (1/2 cup) Salsa for serving (optional) 1. Make the mushroom filling. Heat the oil over medium heat in a large, heavy frying pan. Add the shallot. Cook, stirring, until tender, about three minutes. Stir in the mushrooms. Cook, stirring, until tender and juicy, about five minutes. Add the garlic, chili, and salt and pepper. Cook, stirring, for another minute. Stir in the cilantro or epazote, and remove from the heat. Taste and adjust seasoning. 2. In a microwave: Place a corn tortilla on a plate. Top with half the mushrooms, and spread in an even layer. Sprinkle on half the cheese, and top with another tortilla. Press down gently, then microwave for 1 to 1 1/2 minutes, until the cheese has melted. Remove from the microwave, cut into quarters or sixths and serve. Repeat with the remaining ingredients. In a pan: Place a corn tortilla in a pan. Top with half the mushrooms, and spread in an even layer. Sprinkle on half the cheese. Turn the heat to medium-high, and heat until the cheese begins to melt. Place another tortilla on top of the cheese, and press down lightly. Flip the quesadilla over in the pan, and heat for about 30 seconds or until the cheese has melted. Flip back over, and remove to a plate. Cut into quarters or sixths, and serve. Repeat with the remaining ingredients. Yield: Two quesadillas. Advance preparation: The cooked mushrooms will keep for three or four days in the refrigerator. Reheat gently before assembling the quesadillas. Nutritional information (per quesadilla): 256 calories; 6 grams saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 30 milligrams cholesterol; 18 grams carbohydrates; 3 grams dietary fiber; 232 milligrams sodium (does not include salt to taste); 11 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Recipes for Health: Broccoli and Red Onion Quesadillas Posted: 15 Mar 2011 09:00 AM PDT When you cook the red onions and broccoli, be sure to heat the pan enough to sear their edges. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: Fast Food for Harried Days (March 14, 2011) Recipes for Health: Black Bean and Goat Cheese Quesadillas (March 16, 2011) Recipes for Health: Mushroom Quesadillas (March 17, 2011) Recipes for Health: Spinach and Goat Cheese Quesadillas (March 18, 2011) 1 large broccoli crown, about 1/2 pound 1 tablespoon extra virgin olive oil 1 medium red onion, cut in half lengthwise, then sliced across the grain 1 tablespoon chopped cilantro or epazote (optional) Salt and freshly ground pepper 4 corn tortillas 2 ounces grated Monterey Jack, Cheddar or mixed cheeses (1/2 cup) Salsa for serving (optional) 1. Make the broccoli filling. Steam the broccoli crown for four minutes, then remove from the heat. Rinse with cold water and pat dry. Slice 1/4 inch thick. Heat the oil over medium-high heat in a large, heavy frying pan, and add the red onion. Cook, stirring, until tender and seared on the edges. Add the sliced broccoli. Cook, stirring, until seared on the edges, about three minutes. Stir in the cilantro or epazote, season with salt and pepper, and remove from the heat. Taste and adjust seasoning. 2. In a microwave: Place a corn tortilla on a plate. Top with half the broccoli and onions, and spread in an even layer. Sprinkle on half the cheese, and top with another tortilla. Press down gently, then microwave for 1 to 1 1/2 minutes until the cheese has melted. Remove from the microwave, cut into quarters or sixths, and serve. Repeat with the remaining ingredients. In a pan: Place a corn tortilla in a pan. Top with half the broccoli and onions, and spread in an even layer. Sprinkle on half the cheese. Turn the heat on medium-high, and heat until the cheese begins to melt and the tortilla begins to brown. Place another tortilla on top of the cheese, and press down lightly. Flip over the quesadilla in the pan, and heat for about 30 seconds or until the cheese has melted. Flip back over, and remove to a plate. Cut into quarters or sixths, and serve. Repeat with the remaining ingredients. Yield: Two quesadillas. Advance preparation: The steamed broccoli will keep for three or four days in the refrigerator. Nutritional information per quesadilla: 294 calories; 6 grams saturated fat; 1 gram polyunsaturated fat; 5 grams monounsaturated fat; 30 milligrams cholesterol; 28 grams carbohydrates; 6 grams dietary fiber; 267 milligrams sodium (does not include salt to taste); 12 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Recipes for Health: Fast Food for Harried Days Posted: 15 Mar 2011 09:00 AM PDT My son, Liam, 13, never eats lunch at school. I harp about how it isn’t healthy; I tell him that he needs some energy in the afternoon. But he wants to play basketball or football during recess, and no matter how much I nag, lunch goes uneaten. So eventually I stopped packing sandwiches for him. Recipes for Health Martha Rose Shulman presents food that is vibrant and light, full of nutrients but by no means ascetic, fun to cook and to eat. See All Recipes for Health » Visit Recipes for Health on Facebook. Related Recipes for Health: Broccoli and Red Onion Quesadillas (March 15, 2011) Recipes for Health: Black Bean and Goat Cheese Quesadillas (March 16, 2011) Recipes for Health: Mushroom Quesadillas (March 17, 2011) Recipes for Health: Spinach and Goat Cheese Quesadillas (March 18, 2011) Unsurprisingly, he is often famished and grumpy after school, so I try to get something nutritious into that growing adolescent body as quickly as possible. Quesadillas are always a good bet: It takes less than a minute to spread something good on a corn tortilla, sprinkle on some grated cheese and slap another corn tortilla on top. I zap the quesadilla in the microwave for one minute or so, cut it into wedges and it’s good to go. Liam scarfs it up, sometimes asks for more, drinks a glass of milk — and he’s human again. These quesadillas have little in common with fast-food varieties, which are made with flour tortillas and a lot more cheese. A Taco Bell cheese quesadilla has 480 calories and 1,000 milligrams of sodium; if you order cheese quesadillas at Baja Fresh, you’re asking for 1,200 calories and 2,140 milligrams of sodium. I make a meal out of quesadillas by including beans or vegetables with the cheese, and I use corn tortillas rather than flour. Another plus: Quesadillas make a great destination for leftovers. Baked Bean and Cheese Quesadillas Beans in a thick sauce make a delicious and comforting quesadilla filling. 2 corn tortillas 1/3 cup cooked baked beans, homemade or canned, with sauce 1 ounce grated Monterey Jack, Cheddar or mixed cheeses (1/4 cup) Salsa for serving (optional) 1. In a microwave: Place a corn tortilla on a plate. Top with the beans. Lightly mash the beans with the back of a spoon. Sprinkle on the cheese, and top with the remaining tortilla. Press down gently, then microwave for 1 to 1 1/2 minutes until the cheese has melted. Remove from the microwave, cut into quarters or sixths and serve. In a pan: Place a corn tortilla in a pan. Top with the beans. Lightly mash the beans with the back of a spoon. Sprinkle on the cheese. Turn the heat to medium-high, and heat until the cheese begins to melt. Place the remaining tortilla on top of the cheese, and press down lightly. Flip over the quesadilla in the pan, and heat for about 30 seconds or until the cheese has melted. Flip back over, and remove to a plate. Cut into quarters or sixths and serve. Yield: One serving. Advance preparation: Cooked beans will keep for four to five days in the refrigerator. Nutritional information per quesadilla (commercial baked beans will have more sodium): 269 calories; 6 grams saturated fat; 1 gram polyunsaturated fat; 2 grams monounsaturated fat; 25 milligrams cholesterol; 29 grams carbohydrates; 6 grams dietary fiber; 269 milligrams sodium (does not include salt to taste); 12 grams protein Martha Rose Shulman is the author of "The Very Best of Recipes for Health."

Urban Athlete: Adventures of a Stair Master Posted: 10 Mar 2011 09:10 PM PST FOR me, stair climbing is an exercise chaser. My real exercise is hard, sustained cardio, five times a week, at a gym these days, but a lifetime habit begun when I was an 8-year-old by running a half-mile before breakfast, around the block in Neenah, Wis. Enlarge This Image Chang W. Lee/The New York Times Emily Kindlon, 30, a runner and triathlete from Brooklyn, sprinting up the stairs at the 63rd Street subway station at Lexington Avenue. Still, I enjoy climbing stairs. And at work, at The New York Times building, I climb nine flights, typically three times a day, for a total of 609 steps, up but not down. The brief treks are back-loosening, head-clearing aerobic jolts — and they may be contributing more to my health than I suspect, according to exercise experts. Stairs, it seems, are a neglected asset in the fitness crusade. “There’s good scientific evidence that the activity itself is quite beneficial,” said Paul M. Juris, a kinesiologist and executive director of the Cybex Institute for Exercise Science, in Medway, Mass., the research arm of the maker of Cybex exercise equipment. Mr. Juris, a former researcher at Beth Israel Medical Center in Manhattan and a past consultant to professional sports teams, including the Dallas Mavericks of the N.B.A., pointed to stair-climbing scholarship. It concludes that a few brisk climbs a day, like my modest regimen, can increase aerobic capacity and reduce cholesterol. Most any stair-climbing routine, experts say, is a healthy step, literally, toward achieving the recommended level of physical activity for adults, according to the American College of Sports Medicine and the American Heart Association. (The goal: moderate aerobic activity — think purposeful walking — for 30 minutes five or more days a week, or vigorous activity like jogging for 20 minutes or more at least three times a week.) “It’s not all or nothing,” said Carla Sottovia, an exercise physiologist at the Cooper Fitness Center in Dallas. “Short bouts of exercise, like climbing stairs, certainly help. It all adds up.” For real athletes, there are staircase races. Once regarded as oddball curiosities, the races have increased in number and stature. Last year there were more than 160 staircase races in the world, on five continents, chronicled and celebrated on Web sites like towerrunning.com. One of the earliest races, the 86-floor ascent of the Empire State Building, begun in 1978, was run for the 34th time on Feb. 1, attracting competitors from around the world. Serious stair runners seem to be mostly marathoners and triathletes, who find stairs a related but novel challenge. For Emily Kindlon, 30, a runner and triathlete, gaining access to high-rise buildings for training is an obstacle. Frustrated by her eight-story apartment building in Brooklyn, she asks friends in loftier homes for stair privileges. Yet building managers, she said, are reluctant to open their stairs to outsiders, and one asked her to sign a legal wavier. “In case I fell and broke my neck,” she explained. “I’ve honestly considered moving to a high-rise in Manhattan for the stairs,” Ms. Kindlon said. To James Miller, 52, who runs up to 60 miles a week, stair climbing is a kind of cross-training, as if they were vertical wind sprints. “It really expands the lungs — that has to help the running,” he said. Like Ms. Kindlon, Mr. Miller participated in the Empire State Building race this year. His training was done at home, by repeatedly scaling the 17 flights of his Central Park West apartment building. The training, he said, got him thinking about the neglected stairs. “It’s not ingrained in our brains to take the stairs,” Mr. Miller observed. “But we live in New York City, and we have this great resource here — so many buildings with so many stairs.”

U.S. Calls Radiation ‘Extremely High’ and Urges Deeper Caution in Japan Posted: 16 Mar 2011 12:50 PM PDT WASHINGTON — The chairman of the United States Nuclear Regulatory Commission gave a significantly bleaker appraisal of threat posed by the Japanese nuclear crisis than the Japanese government, saying on Wednesday that the damage at one crippled reactor was much more serious than Japanese officials had acknowledged and advising to Americans to evacuate a wider area around the plant than ordered by the Japanese government. Multimedia Interactive Feature How a Reactor Shuts Down and What Happens in a Meltdown Graphic Radiation at Fukushima Daiichi Interactive Feature Video: Japan’s Natural and Nuclear Disasters Map Evacuation Zone Around Nuclear Plant Related The Lede Blog: Latest Updates on Japan's Nuclear Crisis and Earthquake Aftermath (March 16, 2011) Green Blog: Questions on the Nuclear Crisis in Japan (March 15, 2011) Experts Had Long Criticized Potential Weakness in Design of Stricken Reactor (March 16, 2011) In Stricken Fuel-Cooling Pools, a Danger for the Longer Term (March 15, 2011) Radiation Exposure Could Curtail Workers’ Efforts (March 15, 2011) Nuclear Plants in Europe Are Delayed (March 15, 2011) Need Overwhelms Japan After Quake and Tsunami (March 15, 2011) Related in Opinion Editorial: Japan’s Multiple Calamities (March 15, 2011) Op-Ed Contributor: Memories, Washed Away (March 15, 2011) Room For Debate: What Aid Makes Sense for Japan? Room for Debate: Japan's Nuclear Crisis: Lessons for the U.S. Enlarge This Image NHK Japanese television showed what appeared to be steam rising from reactor No. 3 at the Fukushima Daiichi plant about 10 a.m. Wednesday. Gregory Jaczko, the chairman of the commission, said in Congressional testimony that the commission believed that all the water in the spent fuel pool at the No. 4 reactor of the Fukushima Daiichi Nuclear Power Station had boiled dry, leaving fuel rods stored there completely exposed. As a result, he said, “We believe that radiation levels are extremely high, which could possibly impact the ability to take corrective measures.” If his analysis is accurate and Japanese workers have been unable to keep the spent fuel at that inoperative reactor properly cooled — covered with water at all times — radiation could make it difficult not only to fix the problem at reactor No. 4, but to keep workers at the Daiichi complex from servicing any of the other crippled reactors at the plant. Mr. Jaczko said radiation levels may make it impossible to continue what he called the “backup backup” cooling functions that have so far prevented full nuclear meltdowns at the other reactors. Those efforts consist of dumping water on overheated fuel and then letting the radioactive steam vent into the atmosphere. The emergency measures are all that has prevented the disaster at Daiichi from becoming a full blow meltdown. Mr. Jaczko’s testimony came as the American Embassy, on advice from the Nuclear Regulatory Commission, told American to evacuate a radius of “approximately 50 miles” from the Fukushima plant. The advice represents a far more grave assessment of the situation at the stricken reactors than the decisions made by the Japanese themselves, who have told everyone within 20 kilometers, about 12 miles, to evacuate, and those between 20 and 30 kilometers to take shelter. And the recommendation comes as the Japanese government has said it will be giving less information about the situation. Earlier in the day, Japanese authorities announced another escalation of the crisis at Daiichi when they said that a second reactor unit at the plant may have suffered damage to its primary containment structure and appeared to be releasing radioactive steam. The break, at the No. 3 reactor unit, worsened the already perilous conditions at the plant, a day after officials said the containment vessel in the No. 2 reactor had also cracked. The possibility of high radiation levels above the plant prompted the Japanese military to put off a highly unusual plan to dump water from helicopters — a tactic normally used to combat forest fires — to lower temperatures in a pool containing spent fuel rods that was dangerously overheating at the No. 4 reactor. The operation would have meant flying a helicopter into the steam rising from the plant. But in one of a series of rapid and at times confusing pronouncements on the crisis, the authorities insisted that damage to the containment vessel at the No. 3 reactor — the main focus of concern earlier on Wednesday — was unlikely to be severe. Yukio Edano, the chief cabinet secretary, said the possibility that the No. 3 reactor had “suffered severe damage to its containment vessel is low.” Earlier he said only that the vessel might have been damaged; columns of steam were seen rising from it in live television coverage. The reactor’s operator, Tokyo Electric Power Company, said it had been able to double the number of people battling the crisis at the plant to 100 from 50, but that was before the clouds of radioactive steam began billowing from the plant. On Tuesday, 750 workers were evacuated, leaving a skeleton crew of 50 struggling to reduce temperatures in the damaged facility. An increasing proportion of the people at the plant are soldiers, but the exact number is not known. 1 2 Next Page » Hiroko Tabuchi contributed reporting from Tokyo, and Keith Bradsher from Hong Kong.

National Briefing | SOUTH: Virginia: Judge Orders Nutrition for Immigrant in Nursing Home Posted: 11 Mar 2011 10:00 PM PST A judge ordered Friday that a Rwandan immigrant whose feeding tube was removed three weeks ago against her family’s wishes be given nutrition and hydration immediately. Rachel Nyirahabiyambere, 59, who has been in a vegetative state since suffering a major stroke, lay close to death in a Maryland nursing home early Friday, said her son, Jerome Ndayishimiye. Her family had felt powerless to save her after a court-appointed guardian ordered her feeding tube removed; the guardian, Andrea J. Sloan, believed that Ms. Nyirahabiyambere should be receiving only palliative care because she was “profoundly vegetative” and had no chance of recovery. After The New York Times published an article about her case, the Alliance Defense Fund, a Christian legal alliance, petitioned Judge Nolan B. Dawkins of Alexandria Circuit Court on behalf of her children. He ordered her feeding tube reinstated while the legal issues were weighed.

New View of How Humans Moved Away From Apes Posted: 13 Mar 2011 11:10 PM PDT Anthropologists studying living hunter-gatherers have radically revised their view of how early human societies were structured, a shift that yields new insights into how humans evolved away from apes. RSS Feed Get Science News From The New York Times » Early human groups, according to the new view, would have been more cooperative and willing to learn from one another than the chimpanzees from which human ancestors split about five million years ago. The advantages of cooperation and social learning then propelled the incipient human groups along a different evolutionary path. Anthropologists have assumed until now that hunter-gatherer bands consist of people fairly closely related to one another, much as chimpanzee groups do, and that kinship is a main motive for cooperation within the group. Natural selection, which usually promotes only selfish behavior, can reward this kind of cooperative behavior, called kin selection, because relatives contain many of the same genes. A team of anthropologists led by Kim R. Hill of Arizona State University and Robert S. Walker of the University of Missouri analyzed data from 32 living hunter-gatherer peoples and found that the members of a band are not highly related. Fewer than 10 percent of people in a typical band are close relatives, meaning parents, children or siblings, they report in Friday’s issue of Science. Michael Tomasello, a psychologist at the Max Planck Institute for Evolutionary Anthropology in Germany, said the survey provided a strong foundation for the view that cooperative behavior, as distinct from the fierce aggression between chimp groups, was the turning point that shaped human evolution. If kin selection was much weaker than thought, Dr. Tomasello said, “then other factors like reciprocity and safeguarding one’s reputation have to be stronger to make cooperation work.” The finding corroborates an influential new view of early human origins advanced by Bernard Chapais, a primatologist at the University of Montreal, in his book “Primeval Kinship” (2008). Dr. Chapais showed how a simple development, the emergence of a pair bond between male and female, would have allowed people to recognize their relatives, something chimps can do only to a limited extent. When family members dispersed to other bands, they would be recognized and neighboring bands would cooperate instead of fighting to the death as chimp groups do. In chimpanzee societies, males stay where they are born and females disperse at puberty to neighboring groups, thus avoiding incest. The males, with many male relatives in their group, have a strong interest in cooperating within the group because they are defending both their own children and those of their brothers and other relatives. Human hunter-gatherer societies have been assumed to follow much the same pattern, with female dispersal being the general, though not universal, rule and with members of bands therefore being closely related to one another. But Dr. Hill and Dr. Walker find that though it is the daughters who move in many hunter-gatherer societies, the sons leave the home community in many others. In fact, the human pattern of residency is so variable that it counts as a pattern in itself, one that the researchers say is not known for any species of ape or monkey. Dr. Chapais calls this social pattern “bilocality.” Modern humans have lived as hunter-gatherers for more than 90 percent of their existence as a species. If living hunter-gatherers are typical of ancient ones, the new data about their social pattern has considerable bearing on early human evolution. On a genetic level, the finding that members of a band are not highly interrelated means that “inclusive fitness cannot explain extensive cooperation in hunter-gatherer bands,” the researchers write. Some evolutionary biologists believe that natural selection can favor groups of people, not just individuals, but the idea is hotly disputed. Dr. Hill said group selection, too, could not operate on hunter-gatherer bands because individuals move too often between them, which undoes any selective effect. But hunter-gatherers probably lived as tribes split into many small bands of 30 or so people. Group selection could possibly act at the level of the tribe, Dr. Hill said, meaning that tribes with highly cooperative members would prevail over those that were less cohesive, thus promoting genes for cooperation. The new data on early human social structure furnishes the context in which two distinctive human behaviors emerged, those of cooperation and social learning, Dr. Hill said. A male chimp may know in his lifetime just 12 other males, all from his own group. But a hunter-gatherer, because of cooperation between bands, may interact with a thousand individuals in his tribe. Because humans are unusually adept at social learning, including copying useful activities from others, a large social network is particularly effective at spreading and accumulating knowledge. Knowledge can in fact be lost by hunter-gatherers if a social network gets too small. One group of the Ache people of Paraguay, cut off from its home territory, had lost use of fire when first contacted. Tasmanians apparently forgot various fishing techniques after rising sea levels broke their contact with the Australian mainland 10,000 years ago. Dr. Chapais said that the new findings “validate and enrich” the model of human social evolution proposed in his book. “If you take the promiscuity that is the main feature of chimp society, and replace it with pair bonding, you get many of the most important features of human society,” he said. Recognition of relatives promoted cooperation between neighboring bands, in his view, allowing people to move freely from one to another. Both sons and daughters could disperse from the home group, unlike chimp society, where only females can disperse. But this cooperation did not mean that everything was peaceful. The bands were just components of tribes, between which warfare may have been intense. “Males could remain as competitive and xenophobic as before at the between-tribe level,” Dr. Chapais writes. This posting includes an audio/video/photo media file: Download Now

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