Gadgetwise Blog: App Smart Extra: Starry Night

Stars, galaxies, meteors and satellites were the subject of App Smart this week as I tested out astronomy apps to help identify objects in the night sky. These apps typically use your phone or tablet’s sensors to display a view of what you’re pointing your device at in the sky in real time, helping you identify planets and constellations. Here are more apps like this to try out:

Star Walk — 5 Stars Astronomy Guide is a popular iOS app, costing $3. It has the same kind of dynamic star display as other apps in its class, and it’s easy to use. It’s also jam-packed with imagery and data on the 200,000 stars and planets in its database, and has a calendar so you can keep track of interesting celestial events. I particularly like the beautiful imagery it uses to show constellations and detail on the planets.

SkySafari 3 may be useful for more experienced star gazers. It has data on 120,000 stars and 220 star clusters, nebulae and galaxies, as well as detailed information pages written by professional astronomers. The basic version costs $3 on iOS, but there’s a Plus edition for $15 that has data on 2.5 million stars and can control some wired and wireless telescopes. The Pro edition is $40 and has many more stars and features but is aimed at the serious amateur astronomer.

Alternatively, and much more simply, there’s SkEye Astronomy, available as a free Android app. It has a businesslike feel, and is slightly sparing on user interface touches like icons. But it is powerful, and essentially works in much the same way as Star Walk or SkySafari does. There’s a $9 SkEye Pro version that has more stars in its database and can help you spot satellites too. But the free edition is fine for the casual astronomer. The app is not ideal you’re a complete beginner, however, as it lacks the kind of detailed background data on stars and so on that similar apps have.

The benefit to stargazing apps like these is that they also work during the day, or in a city that’s too light-polluted to let you see more than a handful of stars. This means you can turn them on at any time to learn more about astronomy.

Quick call: The Popular instant messaging app WhatsApp has been updated to a new version for Windows Phone 8. It has better support for Windows Live Tile displays and extras like a back-up system.

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F-35 Jets Returned to Service by Pentagon





The Pentagon lifted its grounding of the new F-35 jet fighter on Thursday after concluding that a turbine blade had cracked on a single plane after it was overused in test operations.


The office that runs the program said no other cracks were found in inspections of the other engines made so far, and no engine redesign was needed.


It said the engine in which the blade cracked was in a plane that “had been operated at extreme parameters in its mission to expand the F-35 flight envelope.”


The program office added that “prolonged exposure to high levels of heat and other operational stressors on this specific engine were determined to be the cause of the crack.”


All flights were suspended last week for the 64 planes built so far once the crack, which stretched for six-tenths of an inch, was found during a routine inspection.


Pratt & Whitney, which makes the engines, investigated the problem with military experts. The company, a unit of United Technologies, said on Wednesday that the crack occurred after that engine was operated more than four times longer in a high-temperature flight environment than the engines would in normal use.


The F-35, a supersonic jet meant to evade enemy radar, is the Pentagon’s most expensive program and has been delayed by various technical problems. The program could cost $396 billion if the Pentagon builds 2,456 jets by the late 2030s.


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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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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.

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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..

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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