Jane C. Wright, Pioneering Oncologist, Dies at 93

Dr. Jane C. Wright, a pioneering oncologist who helped elevate chemotherapy from a last resort for cancer patients to an often viable treatment option, died on Feb. 19 at her home in Guttenberg, N.J. She was 93.

Her death was confirmed by her daughter Jane Jones, who said her mother had dementia.

Dr. Wright descended from a distinguished medical family that defied racial barriers in a profession long dominated by white men. Her father, Dr. Louis T. Wright, was among the first blacks to graduate from Harvard Medical School and was reported to be the first black doctor appointed to the staff of a New York City hospital. His father was an early graduate of what became the Meharry Medical College, the first medical school in the South for African-Americans, founded in Nashville in 1876.

Dr. Jane Wright began her career as a researcher working alongside her father at a cancer center he established at Harlem Hospital in New York.

Together, they and others studied the effects of a variety of drugs on tumors, experimented with chemotherapeutic agents on leukemia in mice and eventually treated patients, with some success, with new anticancer drugs, including triethylene melamine.

After her father died in 1952, Dr. Wright took over as director of the center, which was known as the Harlem Hospital Cancer Research Foundation. In 1955, she joined the faculty of the New York University Medical Center as director of cancer research, where her work focused on correlating the responses of tissue cultures to anticancer drugs with the responses of patients.

In 1964, working as part of a team at the N.Y.U. School of Medicine, Dr. Wright developed a nonsurgical method, using a catheter system, to deliver heavy doses of anticancer drugs to previously hard-to-reach tumor areas in the kidneys, spleen and elsewhere.

That same year, Dr. Wright was the only woman among seven physicians who, recognizing the unique needs of doctors caring for cancer patients, founded the American Society of Clinical Oncologists, known as ASCO. She was also appointed by President Lyndon B. Johnson to the President’s Commission on Heart Disease, Cancer and Stroke, led by the heart surgeon Dr. Michael E. DeBakey. Its recommendations emphasized better communication among doctors, hospitals and research institutions and resulted in a national network of treatment centers.

In 1967, Dr. Wright became head of the chemotherapy department and associate dean at New York Medical College. News reports at the time said it was the first time a black woman had held so high a post at an American medical school.

“Not only was her work scientific, but it was visionary for the whole science of oncology,” Dr. Sandra Swain, the current president of ASCO, said in a telephone interview. “She was part of the group that first realized we needed a separate organization to deal with the providers who care for cancer patients. But beyond that it’s amazing to me that a black woman, in her day and age, was able to do what she did.”

Jane Cooke Wright was born in Manhattan on Nov. 30, 1919. Her mother, the former Corinne Cooke, was a substitute teacher in the New York City schools.

Ms. Wright attended the Ethical Culture school in Manhattan and the Fieldston School in the Bronx (now collectively known Ethical Culture Fieldston School) and graduated from Smith College, where she studied art before turning to medicine. She received a full scholarship to New York Medical College, earning her medical degree in 1945. Before beginning research with her father, she worked as a doctor in the city schools.

Dr. Wright’s marriage, in 1947, to David D. Jones, a lawyer, ended with his death in 1976. She is survived by their two daughters, Jane and Alison Jones, and a sister, Barbara Wright Pierce, who is also a doctor.

As both a student and a doctor, Dr. Wright said in interviews, she was always aware that as a black woman she was an unusual presence in medical institutions. But she never felt she was a victim of racial prejudice, she said.

“I know I’m a member of two minority groups,” she said in an interview with The New York Post in 1967, “but I don’t think of myself that way. Sure, a woman has to try twice as hard. But — racial prejudice? I’ve met very little of it.”

She added, “It could be I met it — and wasn’t intelligent enough to recognize it.”

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At Ice Age End, a Smaller Gap in Warming and Carbon Dioxide

A meticulous new analysis of Antarctic ice suggests that the sharp warming that ended the last ice age occurred in lock step with increases of carbon dioxide in the atmosphere, the latest of many indications that the gas is a powerful influence on the earth’s climate.

Previous research had suggested that as the world began to emerge from the depths of the ice age more than 20,000 years ago, warming in Antarctica preceded changes in the global carbon dioxide level by something like 800 years.

That relatively long gap led some climate-change contrarians to assert that rising carbon dioxide levels were essentially irrelevant to the earth’s temperature — a side effect of planetary warming, perhaps, but not the cause.

Mainstream climate scientists have rejected that view and argued that carbon dioxide, while it did not initiate the end of the ice age, played a vital role in the feedback loops that caused a substantial warming.

Still, a long gap between increases of temperature and of carbon dioxide was relatively hard for the scientists to explain. In the political debate in the United States over global warming, the supposed gap has been invoked repeatedly by climate-change contrarians.

In 2007, for example, Al Gore was testifying to Congress about the science in his documentary, “An Inconvenient Truth.” He came under attack by Representative Joe L. Barton, Republican of Texas.

“CO2 levels went up after the temperature rose,” Mr. Barton said, citing a scientific paper from 2001. “The temperature appears to drive CO2, not vice versa. On this point, Mr. Vice President, you’re not just off a little. You’re totally wrong.”

But the paper published online Thursday by the journal Science, together with a string of other recent studies, suggests that Mr. Gore was right all along.

The research was led by Frédéric Parrenin of the University of Grenoble, in France. He and his colleagues took a new stab at sorting out the sequence of events at the close of the last great ice age.

Since the 1980s, scientists have been collecting a climate record from those earlier times by extracting long cylinders of ice from the ice sheets in Greenland and Antarctica.

Air bubbles trapped in the polar ice give direct evidence of the past composition of the atmosphere. And subtle chemical variations in the ice itself give an indication of the local temperature at the time it was formed.

The trouble is that the air bubbles do not get sealed off for hundreds or even thousands of years, as the snow is slowly buried and compressed. Therefore, it is tricky for scientists to put the atmospheric record and the temperature record onto a common time scale.

Early analyses had fairly large error margins. Nonetheless, they produced one of the most striking findings of modern science: an extremely tight association between the temperature and the level of carbon dioxide in the atmosphere. That is consistent with basic physics showing that carbon dioxide is a powerful greenhouse gas.

But in several reconstructions based on ice cores, local temperature increases at the poles appeared to slightly precede global increases of carbon dioxide. In the 2001 paper that Mr. Barton cited, for example, Antarctic temperature appeared to lead global carbon dioxide levels by 800 years, give or take 600 years.

Using high-precision chemical techniques, Dr. Parrenin and his colleagues have essentially reduced the error margin. Their findings suggest that increases of carbon dioxide lagged temperature increases in Antarctica by no more than about 200 years and may have even preceded the temperature increase.

“It’s a breakthrough in our concept of how past climate evolved,” Dr. Parrenin said in an interview.

It remains to be seen how well the paper will withstand scientific scrutiny. “I’m left with this uneasy feeling that the uncertainties are larger than they claim,” said Eric Steig, a climate scientist at the University of Washington.

Dr. Steig noted that Dr. Parrenin’s paper is the third in recent years to suggest that the gap in the climate records between polar temperature and CO2, if it exists at all, is relatively small. And Jeremy Shakun, a visiting scholar at Harvard, compiled a temperature record for the whole planet, not just Antarctica. He concluded that the carbon dioxide increase preceded the overall planetary warming.

A small gap poses no conceptual problems, scientists said. They have long known that the ice ages are caused by variations in the earth’s orbit around the sun. When an intensification of sunlight initiates the end of an ice age, they believe, carbon dioxide is somehow flushed out of the ocean, causing a big amplification of the initial warming.

That understanding is one of the cornerstones of the scientists’ warning that modern society is running a big risk by burning fossil fuels and pumping enormous quantities of carbon dioxide into the atmosphere.

The level has already jumped 41 percent since the Industrial Revolution began in the 18th century, and given the weakness of global efforts to control emissions, scientists say it could eventually double or triple. Even at the current concentration, the evidence suggests that increases in sea level of 25 feet or more may have already become inevitable, albeit over a long period.

“We’re just entering a new era in earth’s history,” Dr. Shakun said. “It will be an unrecognizable new planet in the future. I think the only question is, exactly how fast does that transformation happen?”

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Bits Blog: One on One: Sugata Mitra, 2013 TED Prize Winner

Are teachers keeping students from learning in the digital age? Sugata Mitra, a professor of educational technology at Newcastle University, believes so. Dr. Mitra is best known for an experiment in which he carved a hole from his research center in Delhi into an adjacent slum, placing a freely accessible computer there for children to use.

The children quickly taught themselves basic computer skills. The “hole in the wall” experiment, as it is known, led Dr. Mitra to develop the idea of learning environments in which teachers would merely be supervisors as children taught themselves by working together at computer terminals. On Tuesday Dr. Mitra was given the 2013 TED Prize, which grants him $1 million to build a learning laboratory based on this principle.

Q.

What did you learn from the original “hole in the wall” experiment?

A.

The first thing to point out is that it was done 14 years ago, at a time when few children in India had access to computers. I noticed the rich parents saying that their sons and daughters must be gifted, because they were so good with computers. And since we know that gifted kids are not born only to rich parents, why would there not be similar children in the slums? I was curious to see what would happen if I gave an Internet-connected computer to the kind of kids who never had one.

We noticed that they learned how to surf within hours. It was a bit of a surprise. Long story short, they would teach themselves whatever they had to to use the computer, such was the attraction of the machine.

Q.

What does this mean for education?

A.

In those days, the main question was what does it mean for training, because back then people were trained to use computers. So I said it looks like we don’t have to do that.

But I got curious about the fact that the children were teaching themselves a smattering of English. So I started doing a whole range of experiments, and I found that if you left them alone, working in groups, they could learn almost anything once they’ve gotten used to the fact that you can research on the Internet. This was done between 2000 and 2006.

I came to England in 2006, and the schools said, why aren’t you doing it here? So I did, and I realized that what I’ve got has nothing to do with poor children. It probably is just a new way in which children learn in this new environment. It needs two things. First, broadband. That’s fine, everybody loves that. The second thing is, it needs the teacher to stand back.

At first I thought that the children were learning in spite of the teacher not interfering. But I changed my opinion, and realized this was happening because the teacher was not interfering. At that point, I didn’t become entirely popular with teachers. But I explained to them that the job has changed. You ask the right kind of question, then you stand back and let the learning happen.

Q.

Do schools need to be radically changed to implement this, or is this a technique that fits into the current structure of schools?

A.

At the moment I pitch it as a technique that you can bring into your schools. But that’s not the real story, which is that the current schooling system is a leftover from the Victorian age of empire. In that world, there were no computers, no telegraphs and data was carried around on ships. This meant that the pillars of education were reading, writing and arithmetic. That age is gone. The system was wonderfully engineered, but we don’t need it anymore; we need something else. But you can’t just say that without saying how you do it.

What I’m doing is I’m putting my foot in the door by saying here’s a new way. Try it. If you’re happy with it, then I’ll say let’s look at the curriculum top to bottom. If we can convert the curriculum into big questions, if we can turn assessment into peer assessment, then neurophysiology tells us that learning gets enhanced. Finally, if you add admiration — what I call the grandmother’s method, where you stand behind and encourage them. Put all of this together and you get a new way to do schooling.

Q.

So it seems that you’re saying we don’t need teachers at all.

A.

We need teachers to do different things. The teacher has to ask the question, and tell the children what they have learned. She comes in at the two ends, a cap at the end and a starter at the beginning.

Teachers are not supposed to be repositories of information which they dish out. That is from an age when there were no other repositories of information, other than books or teachers, neither of which were portable. A lot of my big task is retraining these teachers. Now they have to watch as children learn.

Q.

Is there a problem with this in that it will serve the good students well, but leave those who need more coaching behind?

A.

Well, yes, to some extent. But there are some interesting things about children working in groups if those groups are self-made. Once you let children do that, the system has a self-correcting ability. Having said that, will there be good students and bad students? Of course.

Q.

Does this work for all levels of instruction?

A.

It doesn’t work the same way with adolescents, and definitely not with adults. With 8- to 12-year-olds, that’s the age where big questions turn them on.

Q.

What are your specific plans with the prize?

A.

In order to see if this sort of self-organized learning environment is suitable I need to have one in which I have some control over and can do measurements with. So I want to build one of these learning spaces somewhere.

It will be totally automatic, completely controlled from the cloud. There will be a supervisor, but that person is not going to be a computer expert or a teacher in anything. She — and it will probably be a she — will be there only for health and safety requirements.

The rest of the school, if we call it a school, is a facility that I can hand over to a mediator from the cloud. She logs in from her home, wherever her home is, and she’s able to control everything inside, the lights, the air-conditioning, you name it. Then there are four mediators who Skype in and use the pedagogical method. That’s going to take a lot of work.

The second bit is that schools all over the world have been using this method. We need to do a massive multiplication, and TED is going to help me do that. I am going to try to put that into homes; get your children and their friends together. Then, every time they do it, I’ll ask them to collect data and send it to a Web site. If I succeed, in two years I’ll have massive data from all over the world. By that time I’ll be done building the facility and I’ll be ready to build a new model.

Q.

Where do you think this school will be?

A.

I’d like to do it in India, because I’d know how to get it done. There will be less of a learning curve, I know who the contractors are, and I know how not to get cheated. So I’d like to do it there, but it’s not set in stone.

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European Union Agrees on Plan to Cap Banker Bonuses

BRUSSELS — Bankers in Europe face a cap on bonuses as early as next year, after an agreement on Thursday to introduce what would be the world’s strictest pay curbs in a move politicians hope will address public anger at financial-sector greed.

The provisional agreement, announced by diplomats and officials after late-night talks between E.U. member representatives and the bloc’s parliament, means bankers face an automatic cap that sets bonuses at the level of their salaries.

If a majority of a bank’s shareholders vote in favor, that ceiling can be raised to two times a banker’s pay.

“For the first time in the history of E.U. financial market regulation, we will cap bankers’ bonuses,” said Othmar Karas, the Austrian lawmaker who helped negotiate the deal.

The backing of a majority of E.U. states is needed for the deal to be finalized.

Such limits, which are set to enter E.U. law as part of a wider overhaul of capital rules to make banks safer, will be popular on a continent struggling to emerge from the ruins of a 2008 financial crisis.

But it represents a setback for the British government, which had long argued against such absolute limits. The City of London, the region’s financial capital, with 144,000 banking staff and many more in related jobs, will be hit hardest.

As it stands in draft legislation, the cap would also apply to bankers employed by an E.U. institution but based elsewhere globally, for instance in New York, according to one official, who was not authorized to speak to the media.

There are also provisions for adjusting the value of long-term non-cash payments, so more bonuses could be paid that way without breaking through the new ceiling.

Ireland, which holds the rotating E.U. presidency and negotiated what it called a “breakthrough,” will now present the agreement to E.U. countries.

Irish Finance Minister Michael Noonan said he would ask his peers to back it at an EU ministers’ meeting on March 5 in Brussels.

The change in the law is set to be introduced as part of a wider body of legislation demanding banks set aside roughly three times more capital and build up cash buffers to cover the risk of unpaid loans, for example.

Some experts have criticized the E.U., however, for failing to keep to all of the so-called Basel III code of capital standards drawn up by international regulators to reform banking after the financial crash.

The agreement on Thursday will also require banks to outline profits and other details of operations on a country-by-country basis.

A ceiling on bonuses, the only one of its kind globally, is perhaps the most radical aspect of the new rules.

Many in banking argue, however, that such reform will do little to lower pay in finance, where head-hunters say some annual packages in London approach £5 million, or about $7.6 million.

“If the cap is implemented, it could result in significantly more complex pay structures within banks as they try to fall outside the restrictions to remain competitive globally,” said Alex Beidas, a pay specialist with the law firm Linklaters.

An earlier attempt to limit bankers’ pay with an E.U. law forcing financiers to defer bonus payments for up to five years merely prompted lenders to increase base salaries. But it would be harder for banks to raise base pay this time around.

Hedge funds and private equity firms will be excluded from such curbs, although they face restrictions on pay later this year under another E.U. law.

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Well: Think Like a Doctor: The Man Who Wobbled

The Challenge: Can you solve the medical mystery of a man who suddenly becomes too dizzy to walk?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to try their hand at solving a medical mystery. Below you will find the story of a 56-year-old factory worker with dizziness and panic attacks. I have provided records from his two hospital visits that will give you all the information available to the doctor who finally made the diagnosis.

The first reader to offer the correct diagnosis gets a signed copy of my book, “Every Patient Tells a Story,” and the satisfaction of solving a case that stumped a roomful of specialists.

The Patient’s Story:

The middle-aged man clicked his way through the multiple reruns of late-late-night television. He should have been in bed hours ago, but lately he hadn’t been able to get to sleep. Suddenly his legs took on a life of their own. Stretched out halfway to the center of the room, they began to shake and twitch and jump around. The man watched helplessly as his legs disobeyed his mental orders to stop moving. He had no control over them. He felt nauseous, sweaty and out of breath, as if he had been running some kind of race. He called out to his wife. She hurried out of bed, took one look at him and called 911.

The Patient’s History:

By the time the man arrived at Huntsville Hospital, in Alabama, the twitching in his legs had subsided and his breathing had returned to normal. Still, he had been discharged from that same hospital for similar symptoms just two weeks earlier. They hadn’t figured out what was going on then, so they weren’t going to send him home now.

The patient considered himself pretty healthy, but the past year or so had been tough. In 2011, at the age of 54, he had had a mild stroke. He had no medical problems that put him at risk for stroke — no high blood pressure, no high cholesterol, no diabetes. A work-up at that time showed that he had a hole in his heart that allowed a tiny clot from somewhere in his body to travel to the brain and cause the stroke. He was discharged on a couple of blood thinners to keep his blood from making more clots. He hadn’t really felt completely well, though, ever since. His balance seemed a little off, and he was subject to these weird panic attacks, in which his heart would pound and he would feel short of breath whenever he got too stressed. Mostly he could manage them by just walking away and focusing on his breathing. Still, he never felt as if he was the kind of guy to panic.

And he had always been quick on his feet. The first half of his career he had been in the steel business — building huge metal trusses and supports. He and his team put together 60-plus tons of steel structures every day. For the past decade he had been machining car parts. After his stroke, work seemed to get a lot harder.

The Dizziness:

A few weeks ago, he stood up and wham — suddenly the whole world went off-kilter. He felt as if he was constantly about to fall over in a world that no longer lay down flat. His first thought was that he was having another stroke. He went straight to his doctor’s office. The doctor wasn’t sure what was going on and sent him to that same emergency room at Huntsville Hospital. After three days of testing and being evaluated by lots of specialists, his doctors still were not sure what was going on. He hadn’t had a heart attack; he hadn’t had a stroke. There was no sign of infection. All the tests they could think of were normal.

The only abnormal finding was that when he stood up, his blood pressure dropped. Why this happened wasn’t clear, but the doctors in the hospital gave him compression stockings and a pill — both could help keep his blood pressure in the normal range. Then they sent him home. He was also started on an antidepressant to help with the panic attacks he continued to have from time to time.

You can read the report from that hospital admission below.

You can also read the consultation and discharge notes from that hospital visit here.

He had been home for nearly two weeks and still he felt no better. He tried to go back to work after a week or so at home, but after driving for less than five miles, he felt he had to turn around. He wasn’t sure what was wrong; he just knew he didn’t feel right. Then his legs started jumping around, and he ended up back in the hospital.

The Doctor’s Exam:

It was nearly dawn by the time Dr. Jeremy Thompson, the first-year resident on duty that night, saw the patient. Awake but tired, the patient told his story one more time. He had been at home, watching TV, when his legs started jumping on their own and he started feeling short of breath. His wife sat at the bedside. She looked just as worried and exhausted as he did. She told the resident that when he spoke that night at home, his speech was slurred. And when the ambulance came, he could barely walk. He has never missed this much work, she told the young doctor. It’s not like him. Can’t you figure out what’s wrong?

The resident had already reviewed the records from the patient’s previous hospital admissions. He asked a few more questions: the patient had never smoked and rarely drank; his father died at age 80; his mother was still alive and well. The patient exam was normal, as were the studies done in the E.R.

The first E.R. doctor thought that his symptoms were a result of anxiety, culminating in a full-blown panic attack. The resident thought that was probably right. In any case he would discuss the case with the attending in a couple of hours during rounds on the new patients. Till then, he told the worried couple, they should just try to get a little sleep.

An Important Clue:

Dr. Robert Centor was definitely a morning person. His cheerful enthusiasm about teaching and taking care of patients made him a favorite among residents. At 7:30 that morning, he stood outside the patient’s door as Dr. Thompson relayed the somewhat frustrating case of the middle-aged man with worsening dizziness and panic attacks. Then they went into the room to meet the patient. He was a big guy, tall and muscular with the first signs of middle-aged thickening around his middle. His complexion had the look of someone who spent a lot of time outdoors. Dr. Centor introduced himself and pulled up a chair as the rest of the team watched. He asked the patient what brought him to the hospital.

“Every time I get up, I get dizzy,” the man replied. Sure, he had had some balance problems ever since his stroke, he explained, but this felt different – somehow worse. He could hardly walk, he told the doctor. He just felt too unstable.

“Can you get up and show us how you walk?” Dr. Centor asked.

“Don’t let me fall,” the patient responded. He carefully swung his legs over the side of the bed. The resident and intern stood on either side as he slowly rose. He stood with his feet far apart. When asked to close his eyes as he stood there, he wobbled and nearly fell over. When he took a few steps, his heel and toes hit the ground at the same time, making a strange slapping sound.

Seeing that, Dr. Centor knew where the problem lay and ordered a few tests to confirm his diagnosis.

You can see the review report and notes for the patient’s second hospital visit below.

Solving the Mystery:

What tests did Dr. Centor order? Do you know what is making this middle-aged man wobble? Enter your guesses below. I’ll post the answer tomorrow.

---

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

.

Read More..

Well: Think Like a Doctor: The Man Who Wobbled

The Challenge: Can you solve the medical mystery of a man who suddenly becomes too dizzy to walk?

Every month, the Diagnosis column of The New York Times Magazine asks Well readers to try their hand at solving a medical mystery. Below you will find the story of a 56-year-old factory worker with dizziness and panic attacks. I have provided records from his two hospital visits that will give you all the information available to the doctor who finally made the diagnosis.

The first reader to offer the correct diagnosis gets a signed copy of my book, “Every Patient Tells a Story,” and the satisfaction of solving a case that stumped a roomful of specialists.

The Patient’s Story:

The middle-aged man clicked his way through the multiple reruns of late-late-night television. He should have been in bed hours ago, but lately he hadn’t been able to get to sleep. Suddenly his legs took on a life of their own. Stretched out halfway to the center of the room, they began to shake and twitch and jump around. The man watched helplessly as his legs disobeyed his mental orders to stop moving. He had no control over them. He felt nauseous, sweaty and out of breath, as if he had been running some kind of race. He called out to his wife. She hurried out of bed, took one look at him and called 911.

The Patient’s History:

By the time the man arrived at Huntsville Hospital, in Alabama, the twitching in his legs had subsided and his breathing had returned to normal. Still, he had been discharged from that same hospital for similar symptoms just two weeks earlier. They hadn’t figured out what was going on then, so they weren’t going to send him home now.

The patient considered himself pretty healthy, but the past year or so had been tough. In 2011, at the age of 54, he had had a mild stroke. He had no medical problems that put him at risk for stroke — no high blood pressure, no high cholesterol, no diabetes. A work-up at that time showed that he had a hole in his heart that allowed a tiny clot from somewhere in his body to travel to the brain and cause the stroke. He was discharged on a couple of blood thinners to keep his blood from making more clots. He hadn’t really felt completely well, though, ever since. His balance seemed a little off, and he was subject to these weird panic attacks, in which his heart would pound and he would feel short of breath whenever he got too stressed. Mostly he could manage them by just walking away and focusing on his breathing. Still, he never felt as if he was the kind of guy to panic.

And he had always been quick on his feet. The first half of his career he had been in the steel business — building huge metal trusses and supports. He and his team put together 60-plus tons of steel structures every day. For the past decade he had been machining car parts. After his stroke, work seemed to get a lot harder.

The Dizziness:

A few weeks ago, he stood up and wham — suddenly the whole world went off-kilter. He felt as if he was constantly about to fall over in a world that no longer lay down flat. His first thought was that he was having another stroke. He went straight to his doctor’s office. The doctor wasn’t sure what was going on and sent him to that same emergency room at Huntsville Hospital. After three days of testing and being evaluated by lots of specialists, his doctors still were not sure what was going on. He hadn’t had a heart attack; he hadn’t had a stroke. There was no sign of infection. All the tests they could think of were normal.

The only abnormal finding was that when he stood up, his blood pressure dropped. Why this happened wasn’t clear, but the doctors in the hospital gave him compression stockings and a pill — both could help keep his blood pressure in the normal range. Then they sent him home. He was also started on an antidepressant to help with the panic attacks he continued to have from time to time.

You can read the report from that hospital admission below.

You can also read the consultation and discharge notes from that hospital visit here.

He had been home for nearly two weeks and still he felt no better. He tried to go back to work after a week or so at home, but after driving for less than five miles, he felt he had to turn around. He wasn’t sure what was wrong; he just knew he didn’t feel right. Then his legs started jumping around, and he ended up back in the hospital.

The Doctor’s Exam:

It was nearly dawn by the time Dr. Jeremy Thompson, the first-year resident on duty that night, saw the patient. Awake but tired, the patient told his story one more time. He had been at home, watching TV, when his legs started jumping on their own and he started feeling short of breath. His wife sat at the bedside. She looked just as worried and exhausted as he did. She told the resident that when he spoke that night at home, his speech was slurred. And when the ambulance came, he could barely walk. He has never missed this much work, she told the young doctor. It’s not like him. Can’t you figure out what’s wrong?

The resident had already reviewed the records from the patient’s previous hospital admissions. He asked a few more questions: the patient had never smoked and rarely drank; his father died at age 80; his mother was still alive and well. The patient exam was normal, as were the studies done in the E.R.

The first E.R. doctor thought that his symptoms were a result of anxiety, culminating in a full-blown panic attack. The resident thought that was probably right. In any case he would discuss the case with the attending in a couple of hours during rounds on the new patients. Till then, he told the worried couple, they should just try to get a little sleep.

An Important Clue:

Dr. Robert Centor was definitely a morning person. His cheerful enthusiasm about teaching and taking care of patients made him a favorite among residents. At 7:30 that morning, he stood outside the patient’s door as Dr. Thompson relayed the somewhat frustrating case of the middle-aged man with worsening dizziness and panic attacks. Then they went into the room to meet the patient. He was a big guy, tall and muscular with the first signs of middle-aged thickening around his middle. His complexion had the look of someone who spent a lot of time outdoors. Dr. Centor introduced himself and pulled up a chair as the rest of the team watched. He asked the patient what brought him to the hospital.

“Every time I get up, I get dizzy,” the man replied. Sure, he had had some balance problems ever since his stroke, he explained, but this felt different – somehow worse. He could hardly walk, he told the doctor. He just felt too unstable.

“Can you get up and show us how you walk?” Dr. Centor asked.

“Don’t let me fall,” the patient responded. He carefully swung his legs over the side of the bed. The resident and intern stood on either side as he slowly rose. He stood with his feet far apart. When asked to close his eyes as he stood there, he wobbled and nearly fell over. When he took a few steps, his heel and toes hit the ground at the same time, making a strange slapping sound.

Seeing that, Dr. Centor knew where the problem lay and ordered a few tests to confirm his diagnosis.

You can see the review report and notes for the patient’s second hospital visit below.

Solving the Mystery:

What tests did Dr. Centor order? Do you know what is making this middle-aged man wobble? Enter your guesses below. I’ll post the answer tomorrow.

---

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

.

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IHT Rendezvous: Will Turkey Make Peace With the Kurds?

LONDON — There is growing optimism that a ceasefire in Turkey’s three-decade war with Kurdish guerrillas will be declared to coincide with the Kurdish New Year in three weeks.

Under a draft plan reported on Wednesday, the rebel Kurdistan Workers’ Party, or P.K.K., would lay down its arms on March 21 and withdraw its forces from Turkish territory by August.

The potential for a breakthrough in ending the conflict, which has claimed 40,000 lives since 1984, came when the government of Prime Minister Recep Tayyip Erdogan opened talks late last year with Abdullah Ocalan, the P.K.K.’s jailed leader.

Intelligence agents made a series of visits to the prison island of Imrali near Istanbul to negotiate with the former guerrilla chief, who was once Turkey’s most wanted man.

In their latest visit, last weekend, they accompanied a delegation of Kurdish legislators from the Peace and Democracy Party, or B.D.P.

Selahattin Demirtas, the B.D.P. co-chairman, said this week that there was already a de facto ceasefire. The P.K.K. was not carrying out armed action and the Turkish army was not conducting significant military operations against the rebels.

He quoted a letter from Mr. Ocalan in which he expressed the belief that the process would lead to an eventual resolution of the Kurdish issue. “Neither we nor the state can abandon that process,” he quoted the letter as saying.

The P.K.K. has abandoned its previous demands for independence but continues to seek equal rights for Kurds within the Turkish state.

Mr. Erdogan meanwhile dramatically underlined his own good intentions by telling his parliamentary colleagues he was prepared to drink poison if it meant achieving peace.

There are reports that the P.K.K. is preparing to release 16 Turkish prisoners, possibly as early as this weekend, as part of the peace moves.

Mr. Ocalan has sought the backing of P.K.K. exiles in Europe for the peace initiative, as well as that of guerrilla fighters based in the north of Iraq.

Duran Kalkan, a senior P.K.K. commander based in Iraq, said this week that he is open to the idea of a prisoner release. “However, nobody should expect us to make a unilateral move.”

In what appeared to be a positive response to the peace moves, he told the Kurdish Firatnews: “If everybody does what is required to do, I can say on behalf of the P.K.K. that the Kurdish armed movement will never pose an obstacle to the democratization of Turkey and the solution of the Kurdish question.”

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Gadgetwise Blog: New Partnership Brings New Design for Sol Republic

Sol Republic knows a good partnership when it sees it. After Michael Phelps wore a pair of Sol Republic headphones during the Summer Olympics last year, the company quickly signed an endorsement deal with the swimmer.

Its latest collaboration is with Tokidoki, the Japanese-inspired lifestyle brand created by the Italian designer Simone Legno. Sol Republic, known for making headphones with interchangeable components, released two new designs Tuesday that are infused with Tokidoki’s distinctive style.

The new designs are part of Sol Republic’s Tracks line of on-ear headphones that allow users to mix and match headbands and cables to create their own look. The line starts at $100 for Sol Republic’s V8 sound engines, a virtually indestructible headband and cable with an in-line microphone. The headbands come in a rainbow of colors and slide into the ear cups, which hold the sound drivers. The cable connects to the bottom of the right and left ear cups, with an in-line microphone and music controls that are set in a yoke at chest level. Each component is also sold separately at Sol Republic’s Web site.

For an extra $30, you can upgrade to the Tracks HD, which come with V10 sound engines. The sound of the Tracks HD headphones that I tested was clear with a deep bass, and it got even better at higher volumes, especially for electronic and rock music.

The Tokidoki headphones, which cost $150, have the V10 sound engines, but also come with a Tokidoki bag. Sol Republic also offers a brightly hued design from Deadmau5 and a U.S.A. theme inspired by Mr. Phelps, both for $150. The Tracks line also includes a pair of $180 headphones called Ultra that are geared toward audiophiles.

The interchangeability of the Tracks headphones is a clever idea, especially if you like to wear your headphones as a fashion statement, but it comes with a drawback: the fit. The ear cups don’t swivel, and although they were comfortable, I could not get them to sit on my ears properly. The fit wasn’t perfect, but at least they looked stylish.

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Media Decoder Blog: SFX Entertainment Buys Electronic Dance Music Site

SFX Entertainment, the company led by the media executive Robert F. X. Sillerman, has agreed to buy the music download site Beatport, part of the company’s plan to build a $1 billion empire centered on the electronic dance music craze.

Mr. Sillerman declined on Tuesday to reveal the price. But two people with direct knowledge of the transaction, who were not authorized to speak about it, said it was for a little more than $50 million.

Beatport, founded in Denver in 2004, has become the pre-eminent download store for electronic dance music, or E.D.M., with a catalog of more than one million tracks, many of them exclusive to the service. It says it has nearly 40 million users, and while the company does not disclose sales numbers, it is said to be profitable.

The site has also become an all-purpose online destination for dance music, with features like a news feed, remix contests and D.J. profiles. Those features, and its reach, could help in Mr. Sillerman’s plan to unite the disparate dance audience through media.

“Beatport gives us direct contact with the D.J.’s and lets us see what’s popular and what’s not,” Mr. Sillerman said in an interview. “Most important, it gives us a massive platform for everything related to E.D.M.”

Since the company was revived last year, SFX has focused mostly on live events, with the promoters Disco Donnie Presents and Life in Color; recently it also invested in a string of nightclubs in Miami and formed a joint venture with ID&T, the European company behind festivals like Sensation, to put on its events in North America.

In the 1990s, Mr. Sillerman spent $1.2 billion creating a nationwide network of concert promoters under the name SFX, which he sold to Clear Channel Entertainment in 2000 for $4.4 billion; those promoters are now the basis of Live Nation’s concert division.

Matthew Adell, Beatport’s chief executive, said that being part of SFX could help the company extend its business into live events, and also into countries where the dance genre is exploding, like India and Brazil.

“We already are by far the largest online destination of qualified fans and talent in the market,” Mr. Adell said, “and we can continue to grow that.”

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Well: What Housework Has to Do With Waistlines

Phys Ed

Gretchen Reynolds on the science of fitness.

One reason so many American women are overweight may be that we are vacuuming and doing laundry less often, according to a new study that, while scrupulously even-handed, is likely to stir controversy and emotions.

The study, published this month in PLoS One, is a follow-up to an influential 2011 report which used data from the U.S. Bureau of Labor Statistics to determine that, during the past 50 years, most American workers began sitting down on the job. Physical activity at work, such as walking or lifting, almost vanished, according to the data, with workers now spending most of their time seated before a computer or talking on the phone. Consequently, the authors found, the average American worker was burning almost 150 fewer calories daily at work than his or her employed parents had, a change that had materially contributed to the rise in obesity during the same time frame, especially among men, the authors concluded.

But that study, while fascinating, was narrow, focusing only on people with formal jobs. It overlooked a large segment of the population, namely a lot of women.

“Fifty years ago, a majority of women did not work outside of the home,” said Edward Archer, a research fellow with the Arnold School of Public Health at the University of South Carolina in Columbia, and lead author of the new study.

So, in collaboration with many of the authors of the earlier study of occupational physical activity, Dr. Archer set out to find data about how women had once spent their hours at home and whether and how their patterns of movement had changed over the years.

He found the information he needed in the American Heritage Time Use Study, a remarkable archive of “time-use diaries” provided by thousands of women beginning in 1965. Because Dr. Archer wished to examine how women in a variety of circumstances spent their time around the house, he gathered diaries from both working and non-employed women, starting with those in 1965 and extending through 2010.

He and his colleagues then pulled data from the diaries about how many hours the women were spending in various activities, how many calories they likely were expending in each of those tasks, and how the activities and associated energy expenditures changed over the years.

As it turned out, their findings broadly echoed those of the occupational time-use study. Women, they found, once had been quite physically active around the house, spending, in 1965, an average of 25.7 hours a week cleaning, cooking and doing laundry. Those activities, whatever their social freight, required the expenditure of considerable energy. (The authors did not include child care time in their calculations, since the women’s diary entries related to child care were inconsistent and often overlapped those of other activities.) In general at that time, working women devoted somewhat fewer hours to housework, while those not employed outside the home spent more.

Forty-five years later, in 2010, things had changed dramatically. By then, the time-use diaries showed, women were spending an average of 13.3 hours per week on housework.

More striking, the diary entries showed, women at home were now spending far more hours sitting in front of a screen. In 1965, women typically had spent about eight hours a week sitting and watching television. (Home computers weren’t invented yet.)

By 2010, those hours had more than doubled, to 16.5 hours per week. In essence, women had exchanged time spent in active pursuits, like vacuuming, for time spent being sedentary.

In the process, they had also greatly reduced the number of calories that they typically expended during their hours at home. According to the authors’ calculations, American women not employed outside the home were burning about 360 fewer calories every day in 2010 than they had in 1965, with working women burning about 132 fewer calories at home each day in 2010 than in 1965.

“Those are large reductions in energy expenditure,” Dr. Archer said, and would result, over the years, in significant weight gain without reductions in caloric intake.

What his study suggests, Dr. Archer continued, is that “we need to start finding ways to incorporate movement back into” the hours spent at home.

This does not mean, he said, that women — or men — should be doing more housework. For one thing, the effort involved is such activities today is less than it once was. Using modern, gliding vacuum cleaners is less taxing than struggling with the clunky, heavy machines once available, and thank goodness for that.

Nor is more time spent helping around the house a guarantee of more activity, over all. A telling 2012 study of television viewing habits found that when men increased the number of hours they spent on housework, they also greatly increased the hours they spent sitting in front of the TV, presumably because it was there and beckoning.

Instead, Dr. Archer said, we should start consciously tracking what we do when we are at home and try to reduce the amount of time spent sitting. “Walk to the mailbox,” he said. Chop vegetables in the kitchen. Play ball with your, or a neighbor’s, dog. Chivvy your spouse into helping you fold sheets. “The data clearly shows,” Dr. Archer said, that even at home, we need to be in motion.

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