Well: Exercise and the Ever-Smarter Human Brain

Anyone whose resolve to exercise in 2013 is a bit shaky might want to consider an emerging scientific view of human evolution. It suggests that we are clever today in part because a million years ago, we could outrun and outwalk most other mammals over long distances. Our brains were shaped and sharpened by movement, the idea goes, and we continue to require regular physical activity in order for our brains to function optimally.

Phys Ed

Gretchen Reynolds on the science of fitness.

The role of physical endurance in shaping humankind has intrigued anthropologists and gripped the popular imagination for some time. In 2004, the evolutionary biologists Daniel E. Lieberman of Harvard and Dennis M. Bramble of the University of Utah published a seminal article in the journal Nature titled “Endurance Running and the Evolution of Homo,” in which they posited that our bipedal ancestors survived by becoming endurance athletes, able to bring down swifter prey through sheer doggedness, jogging and plodding along behind them until the animals dropped.

Endurance produced meals, which provided energy for mating, which meant that adept early joggers passed along their genes. In this way, natural selection drove early humans to become even more athletic, Dr. Lieberman and other scientists have written, their bodies developing longer legs, shorter toes, less hair and complicated inner-ear mechanisms to maintain balance and stability during upright ambulation. Movement shaped the human body.

But simultaneously, in a development that until recently many scientists viewed as unrelated, humans were becoming smarter. Their brains were increasing rapidly in size.

Today, humans have a brain that is about three times larger than would be expected, anthropologists say, given our species’ body size in comparison with that of other mammals.

To explain those outsized brains, evolutionary scientists have pointed to such occurrences as meat eating and, perhaps most determinatively, our early ancestors’ need for social interaction. Early humans had to plan and execute hunts as a group, which required complicated thinking patterns and, it’s been thought, rewarded the social and brainy with evolutionary success. According to that hypothesis, the evolution of the brain was driven by the need to think.

But now some scientists are suggesting that physical activity also played a critical role in making our brains larger.

To reach that conclusion, anthropologists began by looking at existing data about brain size and endurance capacity in a variety of mammals, including dogs, guinea pigs, foxes, mice, wolves, rats, civet cats, antelope, mongooses, goats, sheep and elands. They found a notable pattern. Species like dogs and rats that had a high innate endurance capacity, which presumably had evolved over millenniums, also had large brain volumes relative to their body size.

The researchers also looked at recent experiments in which mice and rats were systematically bred to be marathon runners. Lab animals that willingly put in the most miles on running wheels were interbred, resulting in the creation of a line of lab animals that excelled at running.

Interestingly, after multiple generations, these animals began to develop innately high levels of substances that promote tissue growth and health, including a protein called brain-derived neurotrophic factor, or BDNF. These substances are important for endurance performance. They also are known to drive brain growth.

What all of this means, says David A. Raichlen, an anthropologist at the University of Arizona and an author of a new article about the evolution of human brains appearing in the January issue of Proceedings of the Royal Society Biology, is that physical activity may have helped to make early humans smarter.

“We think that what happened” in our early hunter-gatherer ancestors, he says, is that the more athletic and active survived and, as with the lab mice, passed along physiological characteristics that improved their endurance, including elevated levels of BDNF. Eventually, these early athletes had enough BDNF coursing through their bodies that some could migrate from the muscles to the brain, where it nudged the growth of brain tissue.

Those particular early humans then applied their growing ability to think and reason toward better tracking prey, becoming the best-fed and most successful from an evolutionary standpoint. Being in motion made them smarter, and being smarter now allowed them to move more efficiently.

And out of all of this came, eventually, an ability to understand higher math and invent iPads. But that was some time later.

The broad point of this new notion is that if physical activity helped to mold the structure of our brains, then it most likely remains essential to brain health today, says John D. Polk, an associate professor of anthropology at the University of Illinois at Urbana-Champaign, and co-author, with Dr. Raichlen, of the new article.

And there is scientific support for that idea. Recent studies have shown, he says, that “regular exercise, even walking,” leads to more robust mental abilities, “beginning in childhood and continuing into old age.”

Of course, the hypothesis that jogging after prey helped to drive human brain evolution is just a hypothesis, Dr. Raichlen says, and almost unprovable.

But it is compelling, says Harvard’s Dr. Lieberman, who has worked with the authors of the new article. “I fundamentally agree that there is a deep evolutionary basis for the relationship between a healthy body and a healthy mind,” he says, a relationship that makes the term “jogging your memory” more literal than most of us might have expected and provides a powerful incentive to be active in 2013.

Read More..

Well: Exercise and the Ever-Smarter Human Brain

Anyone whose resolve to exercise in 2013 is a bit shaky might want to consider an emerging scientific view of human evolution. It suggests that we are clever today in part because a million years ago, we could outrun and outwalk most other mammals over long distances. Our brains were shaped and sharpened by movement, the idea goes, and we continue to require regular physical activity in order for our brains to function optimally.

Phys Ed

Gretchen Reynolds on the science of fitness.

The role of physical endurance in shaping humankind has intrigued anthropologists and gripped the popular imagination for some time. In 2004, the evolutionary biologists Daniel E. Lieberman of Harvard and Dennis M. Bramble of the University of Utah published a seminal article in the journal Nature titled “Endurance Running and the Evolution of Homo,” in which they posited that our bipedal ancestors survived by becoming endurance athletes, able to bring down swifter prey through sheer doggedness, jogging and plodding along behind them until the animals dropped.

Endurance produced meals, which provided energy for mating, which meant that adept early joggers passed along their genes. In this way, natural selection drove early humans to become even more athletic, Dr. Lieberman and other scientists have written, their bodies developing longer legs, shorter toes, less hair and complicated inner-ear mechanisms to maintain balance and stability during upright ambulation. Movement shaped the human body.

But simultaneously, in a development that until recently many scientists viewed as unrelated, humans were becoming smarter. Their brains were increasing rapidly in size.

Today, humans have a brain that is about three times larger than would be expected, anthropologists say, given our species’ body size in comparison with that of other mammals.

To explain those outsized brains, evolutionary scientists have pointed to such occurrences as meat eating and, perhaps most determinatively, our early ancestors’ need for social interaction. Early humans had to plan and execute hunts as a group, which required complicated thinking patterns and, it’s been thought, rewarded the social and brainy with evolutionary success. According to that hypothesis, the evolution of the brain was driven by the need to think.

But now some scientists are suggesting that physical activity also played a critical role in making our brains larger.

To reach that conclusion, anthropologists began by looking at existing data about brain size and endurance capacity in a variety of mammals, including dogs, guinea pigs, foxes, mice, wolves, rats, civet cats, antelope, mongooses, goats, sheep and elands. They found a notable pattern. Species like dogs and rats that had a high innate endurance capacity, which presumably had evolved over millenniums, also had large brain volumes relative to their body size.

The researchers also looked at recent experiments in which mice and rats were systematically bred to be marathon runners. Lab animals that willingly put in the most miles on running wheels were interbred, resulting in the creation of a line of lab animals that excelled at running.

Interestingly, after multiple generations, these animals began to develop innately high levels of substances that promote tissue growth and health, including a protein called brain-derived neurotrophic factor, or BDNF. These substances are important for endurance performance. They also are known to drive brain growth.

What all of this means, says David A. Raichlen, an anthropologist at the University of Arizona and an author of a new article about the evolution of human brains appearing in the January issue of Proceedings of the Royal Society Biology, is that physical activity may have helped to make early humans smarter.

“We think that what happened” in our early hunter-gatherer ancestors, he says, is that the more athletic and active survived and, as with the lab mice, passed along physiological characteristics that improved their endurance, including elevated levels of BDNF. Eventually, these early athletes had enough BDNF coursing through their bodies that some could migrate from the muscles to the brain, where it nudged the growth of brain tissue.

Those particular early humans then applied their growing ability to think and reason toward better tracking prey, becoming the best-fed and most successful from an evolutionary standpoint. Being in motion made them smarter, and being smarter now allowed them to move more efficiently.

And out of all of this came, eventually, an ability to understand higher math and invent iPads. But that was some time later.

The broad point of this new notion is that if physical activity helped to mold the structure of our brains, then it most likely remains essential to brain health today, says John D. Polk, an associate professor of anthropology at the University of Illinois at Urbana-Champaign, and co-author, with Dr. Raichlen, of the new article.

And there is scientific support for that idea. Recent studies have shown, he says, that “regular exercise, even walking,” leads to more robust mental abilities, “beginning in childhood and continuing into old age.”

Of course, the hypothesis that jogging after prey helped to drive human brain evolution is just a hypothesis, Dr. Raichlen says, and almost unprovable.

But it is compelling, says Harvard’s Dr. Lieberman, who has worked with the authors of the new article. “I fundamentally agree that there is a deep evolutionary basis for the relationship between a healthy body and a healthy mind,” he says, a relationship that makes the term “jogging your memory” more literal than most of us might have expected and provides a powerful incentive to be active in 2013.

Read More..

Libraries Try to Update the Bookstore Model


Tyler Bissmeyer for The New York Times


Vicki Culler shops for discounted books at the Friends of the Public Library in Cincinnati.







At the bustling public library in Arlington Heights, Ill., requests by three patrons to place any title on hold prompt a savvy computer tracking system to order an additional copy of the coveted item. That policy was intended to eliminate the frustration of long waits to check out best sellers and other popular books. But it has had some unintended consequences, too: the library’s shelves are now stocked with 36 copies of “Fifty Shades of Grey.”




Of course, librarians acknowledge that when patrons’ passion for the sexy series lacking in literary merit cools in a year or two, the majority of volumes in the “Fifty Shades” trilogy will probably be plucked from the shelves and sold at the Friends of the Library’s used-book sales, alongside other poorly circulated, donated and out-of-date materials.


“A library has limited shelf space, so you almost have to think of it as a store, and stock it with the things that people want,” said Jason Kuhl, the executive director of the Arlington Heights Memorial Library. Renovations will turn part of the library’s first floor into an area resembling a bookshop that officials are calling the Marketplace, with cozy seating, vending machines and, above all, an abundance of best sellers.


As librarians across the nation struggle with the task of redefining their roles and responsibilities in a digital age, many public libraries are seeing an opportunity to fill the void created by the loss of traditional bookstores. They are increasingly adapting their collections and services based on the demands of library patrons, whom they now call customers.


Today’s libraries are reinventing themselves as vibrant town squares, showcasing the latest best sellers, lending Kindles loaded with e-books, and offering grass-roots technology training centers. Faced with the need to compete for shrinking municipal finances, libraries are determined to prove they can respond as quickly to the needs of the taxpayers as the police and fire department can.


“I think public libraries used to seem intimidating to many people, but today, they are becoming much more user-friendly, and are no longer these big, impersonal mausoleums,” said Jeannette Woodward, a former librarian and author of “Creating the Customer-Driven Library: Building on the Bookstore Model.”


“Public libraries tread a fine line,” Ms. Woodward said. “They want to make people happy, and get them in the habit of coming into the library for popular best sellers, even if some of it might be considered junk. But libraries also understand the need for providing good information, which often can only be found at the library.”


Cheryl Hurley, the president of the Library of America, a nonprofit publisher in New York “dedicated to preserving America’s best and most significant writing,” said the trend of libraries that cater to the public’s demand for best sellers is not surprising, especially given the ravages of the recession on public budgets.


Still, Ms. Hurley remains confident that libraries will never relinquish their responsibility to also provide patrons with the opportunity to discover literary works of merit, be it the classics, or more recent fiction from novelists like Philip Roth, whose work is both critically acclaimed and immensely popular.


“The political ramifications for libraries today can result in driving the collection more and more from what the people want, rather than libraries shaping the tastes of the readers,” Ms. Hurley said. “But one of the joys of visiting the public library is the serendipity of discovering another book, even though you were actually looking for that best seller that you thought you wanted.”


“It’s all about balancing the library’s mission and its marketing, and that is always a tricky dance,” she added.


Read More..

Surgery Returns to NYU Langone Medical Center


Chang W. Lee/The New York Times


Senator Charles E. Schumer spoke at a news conference Thursday about the reopening of NYU Langone Medical Center.







NYU Langone Medical Center opened its doors to surgical patients on Thursday, almost two months after Hurricane Sandy overflowed the banks of the East River and forced the evacuation of hundreds of patients.




While the medical center had been treating many outpatients, it had farmed out surgery to other hospitals, which created scheduling problems that forced many patients to have their operations on nights and weekends, when staffing is traditionally low. Some patients and doctors had to postpone not just elective but also necessary operations for lack of space at other hospitals.


The medical center’s Tisch Hospital, its major hospital for inpatient services, between 30th and 34th Streets on First Avenue, had been closed since the hurricane knocked out power and forced the evacuation of more than 300 patients, some on sleds brought down darkened flights of stairs.


“I think it’s a little bit of a miracle on 34th Street that this happened so quickly,” Senator Charles E. Schumer of New York said Thursday.


Mr. Schumer credited the medical center’s leadership and esprit de corps, and also a tour of the damaged hospital on Nov. 9 by the administrator of the Federal Emergency Management Agency, W. Craig Fugate, whom he and others escorted through watery basement hallways.


“Every time I talk to Fugate there are a lot of questions, but one is, ‘How are you doing at NYU?’ ” the senator said.


The reopening of Tisch to surgery patients and associated services, like intensive care, some types of radiology and recovery room anesthesia, was part of a phased restoration that will continue. Besides providing an essential service, surgery is among the more lucrative of hospital services.


The hospital’s emergency department is expected to delay its reopening for about 11 months, in part to accommodate an expansion in capacity to 65,000 patient visits a year, from 43,000, said Dr. Andrew W. Brotman, its senior vice president and vice dean for clinical affairs and strategy.


In the meantime, NYU Langone is setting up an urgent care center with 31 bays and an observation unit, which will be able to treat some emergency patients. It will initially not accept ambulances, but might be able to later, Dr. Brotman said. Nearby Bellevue Hospital Center, which was also evacuated, opened its emergency department to noncritical injuries on Monday.


Labor and delivery, the cancer floor, epilepsy treatment and pediatrics and neurology beyond surgery are expected to open in mid-January, Langone officials said. While some radiology equipment, which was in the basement, has been restored, other equipment — including a Gamma Knife, a device using radiation to treat brain tumors — is not back.


The flooded basement is still being worked on, and electrical gear has temporarily been moved upstairs. Mr. Schumer, a Democrat, said that a $60 billion bill to pay for hurricane losses and recovery in New York and New Jersey was nearing a vote, and that he was optimistic it would pass in the Senate with bipartisan support. But the measure’s fate in the Republican-controlled House is far less certain.


The bill includes $1.2 billion for damage and lost revenue at NYU Langone, including some money from the National Institutes of Health to restore research projects. It would also cover Long Beach Medical Center in Nassau County, Bellevue, Coney Island Hospital and the Veterans Affairs hospital in Manhattan.


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Surgery Returns to NYU Langone Medical Center


Chang W. Lee/The New York Times


Senator Charles E. Schumer spoke at a news conference Thursday about the reopening of NYU Langone Medical Center.







NYU Langone Medical Center opened its doors to surgical patients on Thursday, almost two months after Hurricane Sandy overflowed the banks of the East River and forced the evacuation of hundreds of patients.




While the medical center had been treating many outpatients, it had farmed out surgery to other hospitals, which created scheduling problems that forced many patients to have their operations on nights and weekends, when staffing is traditionally low. Some patients and doctors had to postpone not just elective but also necessary operations for lack of space at other hospitals.


The medical center’s Tisch Hospital, its major hospital for inpatient services, between 30th and 34th Streets on First Avenue, had been closed since the hurricane knocked out power and forced the evacuation of more than 300 patients, some on sleds brought down darkened flights of stairs.


“I think it’s a little bit of a miracle on 34th Street that this happened so quickly,” Senator Charles E. Schumer of New York said Thursday.


Mr. Schumer credited the medical center’s leadership and esprit de corps, and also a tour of the damaged hospital on Nov. 9 by the administrator of the Federal Emergency Management Agency, W. Craig Fugate, whom he and others escorted through watery basement hallways.


“Every time I talk to Fugate there are a lot of questions, but one is, ‘How are you doing at NYU?’ ” the senator said.


The reopening of Tisch to surgery patients and associated services, like intensive care, some types of radiology and recovery room anesthesia, was part of a phased restoration that will continue. Besides providing an essential service, surgery is among the more lucrative of hospital services.


The hospital’s emergency department is expected to delay its reopening for about 11 months, in part to accommodate an expansion in capacity to 65,000 patient visits a year, from 43,000, said Dr. Andrew W. Brotman, its senior vice president and vice dean for clinical affairs and strategy.


In the meantime, NYU Langone is setting up an urgent care center with 31 bays and an observation unit, which will be able to treat some emergency patients. It will initially not accept ambulances, but might be able to later, Dr. Brotman said. Nearby Bellevue Hospital Center, which was also evacuated, opened its emergency department to noncritical injuries on Monday.


Labor and delivery, the cancer floor, epilepsy treatment and pediatrics and neurology beyond surgery are expected to open in mid-January, Langone officials said. While some radiology equipment, which was in the basement, has been restored, other equipment — including a Gamma Knife, a device using radiation to treat brain tumors — is not back.


The flooded basement is still being worked on, and electrical gear has temporarily been moved upstairs. Mr. Schumer, a Democrat, said that a $60 billion bill to pay for hurricane losses and recovery in New York and New Jersey was nearing a vote, and that he was optimistic it would pass in the Senate with bipartisan support. But the measure’s fate in the Republican-controlled House is far less certain.


The bill includes $1.2 billion for damage and lost revenue at NYU Langone, including some money from the National Institutes of Health to restore research projects. It would also cover Long Beach Medical Center in Nassau County, Bellevue, Coney Island Hospital and the Veterans Affairs hospital in Manhattan.


Read More..

Bolivia Makes Inroads Toward Reducing Coca Production

Meri Pintas, 30, center, harvests coca leaves with her children in the Yungas region of Bolivia. Bolivia, the world’s third-largest cocaine producer, has advanced its own unorthodox approach toward controlling the growing of coca, which veers markedly from the wider war on drugs and includes high-tech monitoring of thousands of legal coca patches intended to produce coca leaf for traditional uses.
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Libraries Try to Update the Bookstore Model


Tyler Bissmeyer for The New York Times


Vicki Culler shops for discounted books at The Friends of the Public Library in Cincinnati.







At the bustling public library in Arlington Heights, Ill., requests by three patrons to place any title on hold prompt a savvy computer tracking system to order an additional copy of the coveted item. That policy was intended to eliminate the frustration of long waits to check out best sellers and other popular books. But it has had some unintended consequences, too: the library’s shelves are now stocked with 36 copies of “Fifty Shades of Grey.”




Of course, librarians acknowledge that when patrons’ passion for the sexy series lacking in literary merit cools in a year or two, the majority of volumes in the “Fifty Shades” trilogy will probably be plucked from the shelves and sold at the Friends of the Library’s used-book sales, alongside other poorly circulated, donated and out-of-date materials.


“A library has limited shelf space, so you almost have to think of it as a store, and stock it with the things that people want,” said Jason Kuhl, the executive director of the Arlington Heights Memorial Library. Renovations going on there now will turn a swath of the library’s first floor into an area resembling a bookshop, where patrons will be pampered with cozy seating, a vending cafe and, above all, an abundance of best sellers.


As librarians across the nation struggle with the task of redefining their roles and responsibilities in a digital age, many public libraries are seeing an opportunity to fill the void created by the loss of traditional bookstores. Indeed, today’s libraries are increasingly adapting their collections and services based on the demands of library patrons, whom they now call customers. Today’s libraries are reinventing themselves as vibrant town squares, showcasing the latest best sellers, lending Kindles loaded with e-books, and offering grassroots technology training centers. Faced with the need to compete for shrinking municipal finances, libraries are determined to prove they can respond as quickly to the needs of the taxpayers as the police and fire department can.


“I think public libraries used to seem intimidating to many people, but today, they are becoming much more user-friendly, and are no longer these big, impersonal mausoleums,” said Jeannette Woodward, a former librarian and author of “Creating the Customer-Driven Library: Building on the Bookstore Model.”


“Public libraries tread a fine line,” Ms. Woodward said. “They want to make people happy, and get them in the habit of coming into the library for popular best sellers, even if some of it might be considered junk. But libraries also understand the need for providing good information, which often can only be found at the library.”


Cheryl Hurley, the president of the Library of America, a nonprofit publisher in New York “dedicated to preserving America’s best and most significant writing,” said the trend of libraries catering to the public’s demand for best sellers is not surprising, especially given the ravages of the recession on public budgets.


Still, Ms. Hurley remains confident that libraries will never relinquish their responsibility to also provide patrons with the opportunity to discover literary works of merit, be it the classics, or more recent fiction from novelists like Philip Roth, whose work is both critically acclaimed and immensely popular.


“The political ramifications for libraries today can result in driving the collection more and more from what the people want, rather than libraries shaping the tastes of the readers,” Ms. Hurley said. “But one of the joys of visiting the public library is the serendipity of discovering another book, even though you were actually looking for that best seller that you thought you wanted.”


“It’s all about balancing the library’s mission and its marketing, and that is always a tricky dance,” she added.


While print books, both fiction and nonfiction, still make up the bulk of most library collections – e-books remain limited to less than 2 percent of many collections in part because some publishers limit their availability at libraries — building renovation plans these days rarely include expanding shelf space for print products. Instead, many libraries are culling their collections and adapting floor plans to accommodate technology training programs, as well as mini-conference rooms that offer private, quiet spaces frequently requested by self-employed consultants meeting with clients, as well as teenagers needing space to huddle over group projects.


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Home Tech: Devices to Monitor Physical Activity and Food Intake


STEP LIVELY Fitbit One pedometer clips onto your belt or pocket to record activity.







WHEN I received the results of a routine cholesterol test this summer, I was certain there had been some kind of mistake. I’m young, unstressed and healthy, or so I imagined. I work out, too, and most impartial observers — and some partial ones — would describe me as lean. Plus, I eat a nutritious diet, I swear. So why did my LDL levels surpass my I.Q. — or, for that matter, Einstein’s?




The facts were stark: My genes predisposed me to metabolic syndrome, my doctor told me. Like my forebears, I was on a fast path to heart disease and diabetes. My doctor ordered me to reduce my carbs and come up with a more stringent exercise plan. I’ve rarely monitored what I eat and how much exercise I get. I had no idea how to go about the logistics of it. How would I count my carbs? How would I track my fitness routine?


Of course, there are apps for that. I set out to scour the market for devices and programs to help me and any family member who wished to join me in my low-carb adventure improve our health. I found two kinds of technologies: fitness trackers to monitor physical activity, and P.C. and smartphone apps to track diet. I spent weeks testing several of them. And while I found a few to be quite helpful, they were all just short of fantastic.


I tried four high-end fitness gadgets: Nike’s FuelBand ($149), the Fitbit One ($99.95), Jawbone’s Up ($129.99) and the BodyMedia FIT wireless armband ($149). I also threw in a plain-Jane pedometer, the Omron HJ-720ITC, which I found for $31 at many stores online.


All of these devices work in a similar way. You attach them to your person (the FuelBand and Up fit around your wrist, the FIT goes around your upper arm, and the Fitbit and Omron pedometer can be placed in a pocket or clipped to your belt). Then, as you move, the devices measure your activity.


Unfortunately each device had major drawbacks. Even though I had gotten the proper size, I found that the Up and the FuelBand did not fit well around my wrist. They tapped against my desk while I typed, and they slid about uncomfortably when I washed the dishes. (They are both water-resistant.) BodyMedia’s FIT, meanwhile, is about the size of a man’s large wristwatch. Positioned directly against the skin around the upper arm, it is ungainly — I found it distracting when I was in a short-sleeve workout shirt, and strange-looking under a nice button-down shirt.


The pedometer and the Fitbit were easier to handle; I hardly noticed them crammed with my keys and phone in my pocket. On the other hand, because they are not wearable, I often forgot them on my bedside table, where they did no good.


Still, among these vast offerings, I found the Fitbit and the cheap Omron to be best. The Fitbit is an unobtrusive slab of plastic about the size of a U.S.B. thumb drive. Its software — which is available for Macs and Windows P.C.’s, as well as iOS and Android devices — is simple to learn and offers plenty of graphs and stats to track your progress. The most useful is a graph of your activity over the course of the day: you can see how many calories you burned while at work and alter your behavior accordingly. Maybe go for a brief walk after lunch?


(I was a big fan of Jawbone’s Up software, too, but I ultimately found it too limited: It works only on Apple’s iOS devices; the company has not yet made versions for P.C.’s or Android devices.)


The best thing about the Fitbit is its wireless syncing capability. It comes with a tiny receiver that plugs into your computer’s U.S.B. port; whenever your Fitbit is near your machine, it sends its data over the air, no physical docking required. It also syncs directly to your phone over Bluetooth. (You do have to plug your Fitbit in to charge it, but only rarely — you can go more than a week between charges.)


The Omron, by comparison, does not do wireless syncing, and its optional P.C. software is pretty basic. But paucity is its beauty. No setup is required. Just turn it on and leave it in your pocket. At the end of the day, peek at its screen — in large, readable type, it shows a single stat: how many steps you have walked that day. The Omron does not promise the world, but it delivers enough information to keep you healthy.


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New York’s Mental Health System Thrashed by Services Lost to Storm


Marcus Yam for The New York Times


Dr. Richard Rosenthal, physician in chief of behavioral services for Continuum hospitals, at St. Luke’s-Roosevelt Hospital Center.







When a young woman in the grip of paranoid delusions threatened a neighbor with a meat cleaver one Saturday last month, the police took her by ambulance to the nearest psychiatric emergency room. Or rather, they took her to Beth Israel Medical Center, the only comprehensive psychiatric E.R. functioning in Lower Manhattan since Hurricane Sandy shrank and strained New York’s mental health resources.




The case was one of 9,548 “emotionally disturbed person” calls that the Police Department answered in November, and one of the 2,848 that resulted in transportation to a hospital, a small increase over a year earlier.


But the woman was discharged within hours, to the shock of the mental health professionals who had called the police. It took four more days, and strong protests from her psychiatrist and caseworkers, to get her admitted for two weeks of inpatient treatment, said Tony Lee, who works for Community Access, a nonprofit agency that provides supportive housing to people with mental illness, managing the Lower East Side apartment building where she lives.


Psychiatric hospital admission is always a judgment call. But in the city, according to hospital records and interviews with psychiatrists and veteran advocates of community care, the odds of securing mental health treatment in a crisis have worsened significantly since the hurricane. The storm’s surge knocked out several of the city’s largest psychiatric hospitals, disrupted outpatient services and flooded scores of coastal nursing homes and “adult homes” where many mentally ill people had found housing of last resort.


One of the most affected hospitals, Beth Israel, recorded a 69 percent spike in psychiatric emergency room cases last month, with its inpatient slots overflowing. Instead of admitting more than one out of three such cases, as it did in November 2011, it admitted only one out of four of the 691 emergency arrivals this November, records show. Capacity was so overtaxed that ambulances had to be diverted to other hospitals 15 times in the month, almost double the rate last year, in periods typically lasting for eight hours, officials said.


Dr. Richard Rosenthal, physician in chief of behavioral services for Continuum Health Partners, Beth Israel’s parent organization, said he was proud of how much Continuum’s hospitals had done to handle psychiatric overflow since storm damage shuttered Bellevue Hospital Center, the city’s flagship public hospital; NYU Langone Medical Center; and the Veterans Affairs Hospital. But these days, he said, as he walks on Amsterdam Avenue between Continuum’s Roosevelt hospital on West 59th Street and its St. Luke’s hospital on West 114th Street, he notices more mentally ill people in the streets than he has seen in years.


“When you have the most vulnerable folks, all you need is one chink in the system and you lose them,” Dr. Rosenthal said. “Whether they lost their housing, or the outpatient services they usually go to were closed and they were lost to follow-up, they have become disconnected, with predictable results.”


Similar patterns are playing out in Brooklyn, where Maimonides Medical Center has been overwhelmed with mental health emergencies from the Coney Island vicinity since Coney Island Hospital, one of the city’s largest acute care psychiatric hospitals, suspended operations, hospital officials said.


“Triage has reached a different level: You have to get sicker to get in,” said Dr. Andrew Kolodny, the chairman of psychiatry at Maimonides, citing a 56 percent increase in psychiatric emergency room visits there from Oct. 26 to Dec. 7, compared with the same period last year, and a 24 percent rise in admissions. The increase in admissions was possible only with emergency permission from the state to exceed licensed limits.


“Not only is there decreased capacity, because Bellevue and Coney Island are off line,” Dr. Kolodny added, “but there’s increased demand because the storm or the loss of their residence has been a stressor for mental illness.”


The storm battered a mental health system that still relies heavily on private nursing homes and substandard adult homes to house people with mental illness. Such institutions have a sordid history of neglect and exploitation, and the courts have repeatedly found that their overuse by the state isolated thousands of people in violation of the Americans With Disabilities Act.


Plans are under way to increase supportive housing — dwellings where mentally ill people can live relatively independently, with support services. But even before Hurricane Sandy, the expansion fell far short of demand.


The storm underscored the fragility of the system. Many disabled evacuees who were sent first to makeshift school shelters lost access to the psychiatric medications that kept their symptoms at bay, Dr. Kolodny said. Even those lucky enough to have the drugs they need are at greater risk of relapse as they experience crowded living conditions. “If they’re now sleeping in a gym with 100 people, that can tip them over the edge and start making them really paranoid,” he said.


On Staten Island, where the chief of psychiatry at Richmond University Medical Center says psychiatric resources have been stretched to the limit, clergy members report that mentally ill people transferred to a large adult home in New Brighton from one that was washed away in Far Rockaway, Queens, are now showing up at church rectories, begging for socks and underwear.


“It’s heartbreaking, because they just found us by chance,” said Margaret Moschetto, a missionary at the Church of Assumption-St. Paul in New Brighton. “They were just walking around the neighborhood. They really didn’t know where they were.”


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Egypt’s Hamdeen Sabahi vs. Islamists and Free Markets





CAIRO — Hamdeen Sabahi was the most popular leader in the fight against Egypt’s new Islamist-backed constitution. Now he is preparing for his next battle: against Islamist leaders’ plans for Western-style free-market reforms.




Do not listen to your allies in the Muslim Brotherhood, Mr. Sabahi said he warned President Mohamed Morsi, of the Brotherhood’s political arm, in a private meeting a few weeks ago. “Because the Brotherhood’s economic and social thought is the same as Mubarak’s: the law of the markets,” Mr. Sabahi said he had told Mr. Morsi, referring to Hosni Mubarak, the former president. “You will just make the poor poorer, and they will be angry with you just as they were with Mubarak.”


Mr. Sabahi, 58, a leftist in the style of another former president, Gamal Abdel Nasser, frightens most economists. He is an outspoken opponent of free-market economic moves in general as well as of a pending $4.5 billion loan from the International Monetary Fund that economists say is urgently needed to avert a catastrophic currency collapse.


But to the dismay of some Western diplomats, Mr. Sabahi is emerging as an increasingly salient voice in Egyptian politics, in part because of the bruising race to ratify the Islamist-backed charter. Both sides now expect the anti-Islamist opposition to reap big gains in the coming parliamentary vote, set to be held in two months against the backdrop of a simultaneous debate over the I.M.F. loan.


Among Egypt’s opposition figures, Mr. Sabahi has the biggest base of support in the streets. After campaigning as a dark horse in the spring’s presidential election, he missed the runoff by fewer than a million votes, finishing the first round almost neck and neck with Mr. Morsi.


Economic overhaul now poses a critical test of Egypt’s fragile democracy. Without enough trust in government, the changes to the systems of taxes or subsidies needed to reduce the deficit could easily stir new unrest in the streets, just as such moves have in the past. But if Mr. Morsi expects his opponents to hold their fire just because economists say the need is dire, Mr. Sabahi said, the president should think again.


“Why support him, for what?” Mr. Sabahi said in an interview in the borrowed offices of an Egyptian film director, decorated with pictures of President Nasser but also of Che Guevara. “Is he a democratic ruler, is he a revolutionary? Is he a model of a president, so I want him to succeed?”


Mr. Sabahi, 58, known for writing poetry and quoting Arab literature and for his blow-dried hair, was one of the few non-Islamist politicians willing to endure imprisonment alongside the members of the Muslim Brotherhood in the struggle against Egypt’s autocracy, giving him a unique credibility among more secular leaders.


But after missing the presidential runoff this year, Mr. Sabahi declined to endorse either Mr. Morsi or his opponent, Ahmed Shafik, a former Mubarak prime minister. It was a choice between “tyranny in the name of the state” and “tyranny in the name of religion,” Mr. Sabahi said at the time in a television interview.


Mr. Sabahi argued in the interview that although Mr. Morsi won election democratically, he has failed to govern as a democrat. “He is kicking away the ladder he climbed,” Mr. Sabahi said, arguing that Mr. Morsi’s decree setting his authority above the courts, if only for a month, ended his credibility as a democrat.


The resulting discord between the Islamists and their opponents has postponed the I.M.F. loan and helped bring Egypt closer than ever to economic collapse. State media on Tuesday described a “dollarization frenzy” gripping the country as people raced to sell Egyptian pounds. The currency is at its lowest level in the past eight years.


Since Mr. Mubarak’s ouster, Egypt’s hard currency reserves have fallen to $15 billion from $43 billion as it has struggled to prop up the pound, and economists say the government now urgently needs a cash infusion of about $14 billion in order to stay afloat. The $4.5 billion I.M.F. loan is expected to act as a seal of approval for others, after the I.M.F. concludes Egypt is at least on a path to greater balance.


If that loan does not come through soon, “the risk is a disaster,” said Heba Handoussa of the Economic Research Forum. “We can’t afford to wait.”


There are other more Western-friendly faces of the opposition, like Mohamed ElBaradei, the former United Nations diplomat, and Amr Moussa, the former foreign minister. But neither has Mr. Sabahi’s following at the grass roots, and he speaks for a segment of the Egyptian public deeply suspicious of free markets and, especially, the I.M.F. A popular singer, El Manawahly, has even recorded a song and music video opposing the loan. “Oh monetary fund / Show me how to industrialize, plant and kneel.”


Mayy El Sheikh contributed reporting.



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