February 6, 2013
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Well: Think Like a Doctor: A Confused and Terrified Patient
Label: HealthThe Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?
Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.
The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.
The Presenting Problem:
A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.
The Patient’s Story:
The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.
A Sister’s Visit:
The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.
“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”
His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.
For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.
A Long Series of Illnesses:
Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.
The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.
There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.
He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.
Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.
Back to the Hospital:
The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.
You can see the records from that E.R. visit here.
The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.
Back to the Hospital, Again:
Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.
When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.
On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.
His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.
You can see the notes from that second hospital visit here.
His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.
That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.
Solving the Mystery:
Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.
Rules and Regulations: Post your questions and diagnosis in the comments section
Correction: The patient’s eyes were brown, not blue.
Well: Think Like a Doctor: A Confused and Terrified Patient
Label: LifestyleThe Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?
Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.
The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.
The Presenting Problem:
A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.
The Patient’s Story:
The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.
A Sister’s Visit:
The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.
“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”
His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.
For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.
A Long Series of Illnesses:
Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.
The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.
There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.
He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.
Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.
Back to the Hospital:
The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.
You can see the records from that E.R. visit here.
The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.
Back to the Hospital, Again:
Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.
When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.
On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.
His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.
You can see the notes from that second hospital visit here.
His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.
That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.
Solving the Mystery:
Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.
Rules and Regulations: Post your questions and diagnosis in the comments section
Correction: The patient’s eyes were brown, not blue.
Gadgetwise Blog: This Robot Does Do Windows
Label: TechnologyThe robots at this year’s Consumer Electronics Show fell largely into two categories: floor cleaners and toys. But there was an exception.
That was a robot taken cleaning to new heights – literally. It is the Winbot 7 Series from Ecovacs, and this robot does do windows.
The Winbot works much like any of the floor cleaning robots, only it works on vertical surfaces. Stick it outside on your window glass and it figures out the size of your window, then travels in a zigzag pattern to clean the surface.
The Winbot has to be plugged into an electrical outlet that feeds a powerful vacuum motor that keeps it stuck to the glass as it creeps around. There is a safety tether to keep the Winbot from bombing pedestrians below if it were to lose power. If the Winbot encounters a problem it sounds an alarm.
The Winbot has a damp cleaning pad on its leading edge that is followed by a squeegee and a drying pad in back. The reusable pads could require machine washing after a single large dirty window, but more typically the company said they needed a wash every few months.
The price of replacement parts and cleaning solution have not been yet determined. The Winbot becomes available in April at a list price of $200 for the 710 model that cleans framed windows, and $300 for the 730 model that cleans framed and frameless windows.
They will be available through the Ecovacs Web site.
Panetta Speaks to Senate Panel on Benghazi Attack
Label: World
WASHINGTON — Defense Secretary Leon E. Panetta told Congress on Thursday that it would take two to three years to add the 35 new Marine security guard detachments that the United States plans to deploy to improve the security of American diplomatic compounds abroad.
“We are working with State now to identify specific locations for the new detachments,” Mr. Panetta said referring to the State Department in prepared remarks at a Senate Armed Services Committee hearing on the Sep. 11 attack on an American compound in Benghazi, Libya, which led to the deaths of J. Christopher Stevens, the American ambassador, and three other Americans.
The Marines have guard units at 152 diplomatic compounds, but did not have one in Benghazi when the assault occurred.
Mr. Panetta said that the role of the Marines detachments would be expanded beyond protecting classified information at the compounds.
“This could include expanded use of nonlethal weapons, and additional training and equipment, to support the Embassy Regional Security Officer’s response options when host nation security force capabilities are at risk of being overwhelmed,” Mr. Panetta said.
Mr. Panetta said that the Pentagon was not able to respond more quickly to the Benghazi episode because it had not received an intelligence alert about an impending attack.
“The Department of Defense was prepared for a wide range of contingencies, but unfortunately there were no specific indications of an imminent attack on U.S. facilities in Benghazi,” Mr. Panetta told the committee. “Without adequate warning, there was not enough time given the speed of the attack for armed military assets to respond.”
When the attack began, the Pentagon had no forces that could be rapidly sent to Benghazi or to protect diplomatic outposts in Tunisia, Egypt or Algeria that might also have come under assault on the anniversary of the Sept. 11, 2001, attacks.
The closest AC-130 gunship was in Afghanistan. There are no armed drones thought to be within range of Libya. There was no Marine expeditionary unit — a large seaborne force with its own helicopters — in the Mediterranean Sea.
The Africa Command, whose area of operation includes North Africa, also did not have on hand a force able to respond rapidly to emergencies — a Commanders’ In-Extremis Force, or C.I.F., as it is known. Every other regional command had one at the time, but the Africa Command shared one with the European Command, and it was on an exercise in Croatia at the time.
In his prepared remarks, Mr. Panetta did not address the question of whether the Africa Command had requested any of these forces to be on hand on the anniversary of the Sept. 11, 2001, terrorist attacks. Nor did it say whether Mr. Panetta or Gen. Martin E. Dempsey, the chairman of the Joint Chiefs of Staff, had given any thought to moving forces to the region as a precaution before the attacks in September last year.
In a section of his prepared remarks labeled “Lessons Learned,” Mr. Panetta recommended helping host nations better defend American compounds, improving intelligence and adding more Marine units.
Senator Carl Levin, Democrat of Michigan and the chairman of the committee, noted that Congress had passed legislation that called for a review of Marine security guard program. “The Marine Corps did not have an element in Benghazi as it was not an embassy, but a temporary mission facility,” Mr. Levin said, outlining the need for a review.
“The four Americans our nation lost last September were the very best expression of what it means to be an Americans,” Mr. Levin said. “We honor their sacrifice, and in their name will do everything we can to prevent a repetition of Benghazi’s loss.”
DealBook: As Unit Pleads Guilty, R.B.S. to Pay $612 Million Over Rate Rigging
Label: BusinessLONDON – The Royal Bank of Scotland on Wednesday struck a combined $612 million settlement with American and British authorities over accusations that it manipulated interest rates, the latest case to emerge from a broad international investigation.
In an embarrassing blow to the bank, its Japanese subsidiary also pleaded guilty to criminal wrongdoing in its settlement with the Justice Department. The R.B.S. subsidiary, a hub of rate-rigging activity, agreed to a single count of felony wire fraud to resolve the case.
The settlement reflects the Justice Department’s renewed vigor for punishing banks ensnared in the rate manipulation case. In December, a Japanese subsidiary of UBS pleaded guilty to felony wire fraud as part of a larger settlement, representing the first unit of a big bank to agree to criminal charges in more than a decade.
As authorities built the R.B.S. case, they seized on a series of incriminating yet colorful e-mails that highlighted an effort to influence the rate-setting process, a plot that spanned multiple currencies and countries from 2006 to 2010. One senior trader expressed disbelief at reaping lucrative profits from the scheme, saying “it’s just amazing” how rate “fixing can make you that much money,” according to the government’s complaint. Another trader, after pressuring a colleague to submit a certain rate, offered a reward of sorts: “I would come over there and make love to you.”
In a statement on Wednesday, the American regulator leading the case slammed the bank for manipulating benchmarks like the London Interbank Offered Rate, or Libor. The regulator, the Commodity Futures Trading Commission, noted that R.B.S. employees “aided and abetted” UBS and other firms in the rate-rigging scheme and continued to run afoul of the law, though more covertly, even after learning of a federal investigation.
“The public is deprived of an honest benchmark interest rate when a group of traders sits around a desk for years falsely spinning their bank’s Libor submissions, trying to manufacture winning trades. That’s what happened at R.B.S.,” David Meister, the enforcement director of the commission, said in the statement.
Libor Explained
The settlement represents the latest setback for Royal Bank of Scotland, which has struggled to shake the legacy of the 2008 financial crisis. The British firm already has put aside $2.7 billion to compensate customers who were inappropriately sold loan insurance over recent years. On Jan. 31, British regulators also called on the bank and other local rivals to review the sale of interest-rate hedging products after more than 90 percent of a sample were found to have been sold improperly.
The broader rate-rigging case has centered on how much the Royal Bank of Scotland and a dozen other banks, including Citigroup and HSBC, charge each other for loans. Such benchmarks, including Libor, help determine the borrowing costs for trillions of dollars in financial products like corporate loans, mortgages and credit cards.
But the Royal Bank of Scotland, like many of its competitors, corrupted the process. Government complaints filed over the last year outlined a scheme in which banks reported false rates to lift trading profits and deflect concerns about their health during the crisis.
Authorities filed the first Libor case in June, extracting a $450 million settlement with the British bank Barclays. In December, UBS agreed to a record $1.5 billion settlement with European regulators, the Justice Department and the American regulator that opened the case, the Commodity Futures Trading Commission. The Justice Department’s criminal division, which secured the guilty plea from the bank’s Japanese unit, also filed criminal charges against two former UBS traders.
Some of the world’s largest financial institutions remain caught in the cross hairs of the case. Deutsche Bank has set aside an undisclosed amount to cover potential penalties.
While foreign banks have received the brunt of the scrutiny to date, an American institution could be among the next to settle. Citigroup and JPMorgan Chase are under investigation.
In the $612 million Royal Bank of Scotland case, authorities levied the second-largest fine in the multiyear investigation into rate manipulation.
The fine included a $325 million penalty from the trading commission and a £87.5 million ($137 million) sanction from the Financial Services Authority, the British regulator, marking one of the largest financial penalties ever from British authorities. The Justice Department, for its part, imposed a $150 million fine as part of a deferred-prosecution agreement with R.B.S. In addition to wire fraud, the Justice Department cited the bank for its role in a “price-fixing conspiracy” that violated anti-trust laws.
R.B.S., based in Edinburgh, had aimed to avert the guilty plea for its Japanese subsidiary. But the Justice Department’s criminal division declined to back down, and the bank had little leverage to push back. If it had balked at a plea deal, the Justice Department could have moved to indict the subsidiary.
“Like with Barclays and UBS, the settlement with R.B.S. is much more than a slap on the wrist,” said Bart Chilton, a member of the trading commission who is critical of soft fines on big banks.
In the wake of the settlement, Royal Bank of Scotland is shaking up its management team as it moves to repair its bruised image. John Hourican, the firm’s investment banking chief, resigned on Wednesday, and agreed to forgo some of his past and current compensation totaling around $14.1 million. While Mr. Hourican was not implicated in the scandal, senior executives said he was taking blame for wrongdoing in his division.
“John is the right senior person to take responsibility for this,” the bank’s chairman, Philip Hampton, told reporters on Wednesday.
Royal Bank of Scotland, in which the government holds an 82 percent stake after providing a $73 billion bailout in 2008, also plans to claw back bonuses and other long-term compensation totaling $471 million to help pay for the rate-rigging penalty. The bank will will primarily use the figure to pay the fines from U.S. authorities, while penalties from the British regulator will be recycled back to the British government.
At a press conference in central London on Wednesday, Stephen Hester, the bank’s chief executive, condemned the illegal behavior of some of the firm’s employees, but acknowledged that Royal Bank of Scotland did not monitor its Libor submissions closely enough to catch the wrongdoing.
Mr. Hester, who has led the bank through a series of scandals and has been dogged by politicians’ demands for reductions in bonuses, admitted that the rate-rigging episode had placed the bank under a lot of strain.
“It is one of the most difficult moments over the entire period,” he said.
Mr. Hester, a former chief executive of the property developer British Land, has focused on paring back the bank’s operations. The C.E.O. has cut more than 30,000 job cuts since 2008, attempted to spin-off of the mergers and acquisitions unit and cut the size of its balance sheet by £600 billion since 2009. Mr. Hester also waved his $1.5 million bonus for 2011 after coming under pressure from British politicians.
In the Libor case, the wrongdoing at R.B.S. occurred on smaller scale than at other banks. The breach, authorities say, was limited to Libor submitters and traders who sought to bolster their bottom line. By comparison, top executives at Barclays knew the bank was lowballing its Libor rates to assuage concerns about its high borrowing costs.
R.B.S., which admitted that 21 of its employees altered the firm’s Libor submissions for financial gain on hundreds of occasions, either disciplined or fired most of the employees. The rest left before they were implicated. In the UBS case, the trading commission cited more than 2,000 instances of illegal acts involving dozens of employees.
Still, the government complaints against R.B.S. portray a permissive culture that allowed rate-rigging to persist for some four years.
The bank’s own records captured the scheme in striking detail, revealing how traders pressured other employees to submit certain Libor figures. Submitters and traders sat in earshot of each other on a trading desk in London, forming what authorities termed a “cozy ring.”
The bank eventually separated the employees, forcing them to communicate over e-mail and phone. A flurry of instant messages ensued, some more vulgar than others.
A trader noted in September 2009 that his requests for rates moved up and down, “like a whores drawers.” Another employee acknowledged that the Libor rate-setting process is “a cartel now.”
To get their way with employees who submitted Libor rates, traders promised “love” and affection. Others merely offered steak and sushi. One trader resorted to begging, invoking a plea of “pretty please.”
When authorities started investigating, the traders adapted. One employee noted that federal authorities “are all over us.”
The concerns prompted a more covert approach. In September 2010, after the trading commission ordered an internal investigation at R.B.S., a derivatives trader urged a colleague who requested a higher Libor rate to send “no emails anymore.”
Two months later, a Libor submitter rebuffed an instant message request to manipulate rates. But then, the submitter spoke with the trader via telephone, explaining “we’re not allowed to have those conversations” over instant message.
Their call was recorded. The employees laughed, according to a transcript, and the submitter reassured the trader that he would fulfill the request: “Leave it with me, and uh, it won’t be a problem.”
The lobbying paid off. When employees submitted bogus rates, government authorities said, Libor was altered.
Lanny Breuer, the head of the Justice Department’s criminal division, called the actions a “stunning abuse of trust.”
He also warned of coming actions against other big banks. “Our message is clear: no financial institution is above the law.”
Well: Getting Into Your Exercise Groove
Label: HealthPhys Ed
Gretchen Reynolds on the science of fitness.
This isn’t meant as an insult, but you are physiologically lazy. So am I. So are we all. Using treadmill testing, scientists have definitively established that, like other animals, humans naturally aim to use as little energy as possible during most movement. So when we walk or run, our bodies tend to choose a particular cadence, a combination of step length and step frequency, that allows us to move at any given speed with as little physiological effort as possible.
How we pick that cadence, though, and whether we can or would even want to change it has been unclear. But a series of recent studies involving runners, walkers, metronomes and virtual reality curtains suggests that while the tug of physiological laziness is strong, it can be controlled, or at least tweaked, with some conscious effort — and perhaps your iPhone playlist.
In the first and most revelatory of the studies, physiologists at Simon Fraser University in British Columbia asked adult volunteers to walk on a treadmill at an easy pace. Using motion capture technology, the scientists determined how many steps each person was taking per minute at this speed. A person’s pace depends, of course, on both step length and step frequency. But because the two are inextricably entwined — lengthen your stride and you’ll take fewer steps over a given distance — studying one provides sufficient information about the other, and frequency is easier to enumerate.
After establishing each volunteer’s preferred step frequency, the scientists then sped up or slowed the treadmill, and the researchers measured how quickly people’s legs responded.
The body, remember, wants things to be easy. When you increase or decrease the speed of your walking or running, various physiological changes occur; the amount of oxygen in your blood rises or falls, for instance, because your muscles start requiring more or less of the stuff. Other biochemical changes also occur within muscle cells. Sensing those changes, the body realizes that, at this new speed, your cadence isn’t ideal; you’re taking too few or too many steps to use the least possible amount of energy. Your body adjusts.
But that process takes a little while, at least five seconds or so for the oxygen levels to change and your body to recognize the alteration, says Max Donelan, a professor at Simon Fraser University who was a co-author of the study with his graduate student Mark Snaterse and others.
However, the walkers in the study were adjusting their step frequency within less than two seconds after the treadmill speed changed, Dr. Donelan points out. They then fine-tuned their pacing after that. But the first adjustment came almost instantly.
The same process occurred when the researchers repeated the experiment with runners. If the treadmill speed changed, the runners’ step frequency shifted almost immediately, too fast for internal physiology to have played much of a role.
These intsy adjustments suggest that our brains very likely contain huge libraries of preset paces, Dr. Donelan and his colleagues have concluded, of idealized, “physiologically efficient” step cadences for any given speed and condition. It seems probable, in fact, that over our lifetimes, Dr. Donelan says, our brains develop and store countless templates for most pacing situations. We learn and remember what cadence allows us to use the least energy at that speed, and when we reach that speed, we immediately default to our body’s most efficient pace.
Just how the brain recognizes that we are moving at any particular speed is not completely understood, Dr. Donelan says, but almost surely involves messages from the eyes, feet, ears, nervous system, skin and other bodily systems.
Interestingly, it seems to be quite difficult to fool your brain. When Dr. Donelan and his colleagues draped shower-curtain-like enclosures around the front of a treadmill, projected a virtual reality scene of a hallway onto it and then manipulated people’s sense of the speed with which they were moving through the hallway, they found that people’s step frequency would quickly change to match this supposed new speed. But then they would settle back into their former cadence, even as the virtual hallway continued to move past them at unnatural speed.
Visual cues simply were not strong enough to affect pacing for long.
But the scientists have found one signal that does seem effectively to override the body’s strong pull toward its preferred ways of moving: a strongly rhythmic beat. When Dr. Donelan and his colleagues fitted runners or walkers with headphones tuned to a metronome, they found that they could increase or decrease volunteers’ step frequency, even if that frequency was faster or slower than a person’s preferred step pattern. They would also maintain that pace for as long as the metronomic rhythm continued unaltered. The volunteers aligned their movement to the beat.
In practical terms, this finding suggests that music may be one of the best ways to affect the pace of your running or walking, especially if you are trying to maintain a pace with which you are not familiar or which feels awkward. Want to start jogging faster than you have in the past? Load your iPod with uptempo music, Dr. Donelan suggests (although obviously ease into any changes in training slowly, to lessen the risk of injuries).
Dr. Donelan and his colleagues even have recently launched an iPhone app called Cruise Control that allows people to coordinate their pacing with their playlists. Input your preferred running or walking speed and the app skims your music library (nonjudgmentally; if you like Nickelback, that’s your business) and strings together songs with the requisite beat, even subtly altering the tempo of songs, if needed.
But of course, if you’re comfortable with your pace as it is, stick with it. For me, the most stirring message of these recent experiments is that, left to its own devices, your body will almost always obligingly try to choose the least demanding pace for you, a goal with which I’m happy to fall into step.
Well: Getting Into Your Exercise Groove
Label: LifestylePhys Ed
Gretchen Reynolds on the science of fitness.
This isn’t meant as an insult, but you are physiologically lazy. So am I. So are we all. Using treadmill testing, scientists have definitively established that, like other animals, humans naturally aim to use as little energy as possible during most movement. So when we walk or run, our bodies tend to choose a particular cadence, a combination of step length and step frequency, that allows us to move at any given speed with as little physiological effort as possible.
How we pick that cadence, though, and whether we can or would even want to change it has been unclear. But a series of recent studies involving runners, walkers, metronomes and virtual reality curtains suggests that while the tug of physiological laziness is strong, it can be controlled, or at least tweaked, with some conscious effort — and perhaps your iPhone playlist.
In the first and most revelatory of the studies, physiologists at Simon Fraser University in British Columbia asked adult volunteers to walk on a treadmill at an easy pace. Using motion capture technology, the scientists determined how many steps each person was taking per minute at this speed. A person’s pace depends, of course, on both step length and step frequency. But because the two are inextricably entwined — lengthen your stride and you’ll take fewer steps over a given distance — studying one provides sufficient information about the other, and frequency is easier to enumerate.
After establishing each volunteer’s preferred step frequency, the scientists then sped up or slowed the treadmill, and the researchers measured how quickly people’s legs responded.
The body, remember, wants things to be easy. When you increase or decrease the speed of your walking or running, various physiological changes occur; the amount of oxygen in your blood rises or falls, for instance, because your muscles start requiring more or less of the stuff. Other biochemical changes also occur within muscle cells. Sensing those changes, the body realizes that, at this new speed, your cadence isn’t ideal; you’re taking too few or too many steps to use the least possible amount of energy. Your body adjusts.
But that process takes a little while, at least five seconds or so for the oxygen levels to change and your body to recognize the alteration, says Max Donelan, a professor at Simon Fraser University who was a co-author of the study with his graduate student Mark Snaterse and others.
However, the walkers in the study were adjusting their step frequency within less than two seconds after the treadmill speed changed, Dr. Donelan points out. They then fine-tuned their pacing after that. But the first adjustment came almost instantly.
The same process occurred when the researchers repeated the experiment with runners. If the treadmill speed changed, the runners’ step frequency shifted almost immediately, too fast for internal physiology to have played much of a role.
These intsy adjustments suggest that our brains very likely contain huge libraries of preset paces, Dr. Donelan and his colleagues have concluded, of idealized, “physiologically efficient” step cadences for any given speed and condition. It seems probable, in fact, that over our lifetimes, Dr. Donelan says, our brains develop and store countless templates for most pacing situations. We learn and remember what cadence allows us to use the least energy at that speed, and when we reach that speed, we immediately default to our body’s most efficient pace.
Just how the brain recognizes that we are moving at any particular speed is not completely understood, Dr. Donelan says, but almost surely involves messages from the eyes, feet, ears, nervous system, skin and other bodily systems.
Interestingly, it seems to be quite difficult to fool your brain. When Dr. Donelan and his colleagues draped shower-curtain-like enclosures around the front of a treadmill, projected a virtual reality scene of a hallway onto it and then manipulated people’s sense of the speed with which they were moving through the hallway, they found that people’s step frequency would quickly change to match this supposed new speed. But then they would settle back into their former cadence, even as the virtual hallway continued to move past them at unnatural speed.
Visual cues simply were not strong enough to affect pacing for long.
But the scientists have found one signal that does seem effectively to override the body’s strong pull toward its preferred ways of moving: a strongly rhythmic beat. When Dr. Donelan and his colleagues fitted runners or walkers with headphones tuned to a metronome, they found that they could increase or decrease volunteers’ step frequency, even if that frequency was faster or slower than a person’s preferred step pattern. They would also maintain that pace for as long as the metronomic rhythm continued unaltered. The volunteers aligned their movement to the beat.
In practical terms, this finding suggests that music may be one of the best ways to affect the pace of your running or walking, especially if you are trying to maintain a pace with which you are not familiar or which feels awkward. Want to start jogging faster than you have in the past? Load your iPod with uptempo music, Dr. Donelan suggests (although obviously ease into any changes in training slowly, to lessen the risk of injuries).
Dr. Donelan and his colleagues even have recently launched an iPhone app called Cruise Control that allows people to coordinate their pacing with their playlists. Input your preferred running or walking speed and the app skims your music library (nonjudgmentally; if you like Nickelback, that’s your business) and strings together songs with the requisite beat, even subtly altering the tempo of songs, if needed.
But of course, if you’re comfortable with your pace as it is, stick with it. For me, the most stirring message of these recent experiments is that, left to its own devices, your body will almost always obligingly try to choose the least demanding pace for you, a goal with which I’m happy to fall into step.
Bits Blog: Most Facebook Users Have Taken a Break From the Site, Survey Finds
Label: TechnologyFacebook is the most popular social network in America — roughly two-thirds of adults in the country use it on a regular basis.
But that doesn’t mean they don’t get sick of it.
A new survey by the Pew Research Center‘s Internet and American Life Project, conducted in December, found that 61 percent of current Facebook users admitted that they had voluntarily taken breaks from the site, for as many as several weeks at a time.
The main reasons for their social media sabbaticals were not having enough time to dedicate to pruning their profiles, an overall decrease in their interest in the site, and the general sentiment that Facebook was a major waste of time.
About 4 percent cited privacy and security concerns as contributing to their departure. Although those users eventually resumed their regular activity, another 20 percent of Facebook users admitted to deleting their accounts.
Of course, even as some Facebook users pull back on their daily consumption of the service, the vast majority — 92 percent — of all social network users still maintain a profile on the site. But while more than half said that the site was just as important to them as it was a year ago, only 12 percent said the site’s significance increased over the last year — indicating the makings of a much larger social media burnout across the site.
The survey teases out other interesting insights, including the finding that young users are spending less time overall on the site. The report found that 42 percent of Facebook users from the ages of 18 to 29 said that the average time they spent on the site in a typical day had decreased in the last year. A much smaller portion, 23 percent, of older Facebook users, those over 50, reported a drop in Facebook usage over the same period.
Facebook’s biggest challenge revolves around figuring out how to continue to profit from its rich reservoir of one billion users — and a large part of that involves keeping them entertained and returning to the site on a regular basis. Most recently, the company introduced a tool called Graph Search, a research tool that promises to help its users find answers on everything from travel recommendations to potential jobs and even love connections.
Lee Rainie, the director of the Pew Research Center’s Internet & American Life Project, which conducted the survey, described the results as a kind of “social reckoning.”
“These data show that people are trying to make new calibrations in their life to accommodate new social tools,” said Mr. Rainie, in an e-mail. Facebook users are beginning to ask themselves, ” ‘What are my friends doing and thinking and how much does that matter to me?,’ ” he said. “They are adding up the pluses and minuses on a kind of networking balance sheet and they are trying to figure out how much they get out of connectivity vs. how much they put into it.”
IHT Rendezvous: 'Rigoletto' in Vegas, 'Manon Lescaut' in the Metro
Label: WorldBRUSSELS—The day after the Metropolitan Opera in New York unveiled a production of Verdi’s “Rigoletto” set in Las Vegas during the 1960s, I was in Belgium, where another exercise in operatic updating is underway at the Théâtre royal de la Monnaie. Here, Mariusz Trelinski’s staging of Puccini’s “Manon Lescaut” — through Feb. 8 — situates the opera in the waiting room of a subway station.
Opera goers are often incensed by productions like these, yet updating is potentially a relatively mild device. Once the new setting is established, the action can play out coherently and essentially traditionally. This happened with “La Bohème” last summer at the Salzburg Festival, staged by Damiano Michieletto.
One could object to the hovel of the bohemians’ Parisian loft, but there was something touching about seeing Anna Netrebko as Mimì crouched in the snow behind a hotdog truck near the city’s peripheral expressway, as she overheard Rodolfo and Marcello discussing her fragile health.
By contrast, La Scala’s recent “Lohengrin” directed by Claus Guth, which focused on the repressiveness of German society at the time of the opera’s composition and, in Mr. Guth’s fanciful interpretation, its bizarre effects on the psyche of the title character, counts as truly radical.
The Met’s take on “Rigoletto” had a widely acknowledged antecedent in Jonathan Miller’s production of the opera for the English National Opera, which was set in New York’s Little Italy and seen in that city on a 1984 tour. The Met’s new production by Michael Mayer is reportedly less successful. Writing in The New York Times, Anthony Tommasini detected “dynamic elements in this colorful, if muddled and ill-defined ‘Rigoletto’” but noted that “there are big holes” in Mr. Mayer’s concept. The criticism is directed not so much at the updating itself but the lack of disciplined follow-through.
The updating of “Manon Lescaut,” which is specified to take place in the 18th century, comes off as inherently misguided. Boris Kudlicka’s chic-looking set is essentially all in black, although city lights are sometimes visible, as if seen from a moving train. A system map is on one wall, pay telephones on another.
The mismatch is apparent from the first measures of Puccini’s sparkling orchestral introduction to Act 1. This is music designed for the outdoors—a public square in Amiens—not a space underground. It announces something special is in the works, not dreary routine. It conveys youthful high spirits, not gloom. Also, the mores of pre-revolutionary France are important in the opera.
Whether Mr. Trelinski’s conception of Manon herself is an outgrowth of his updating, or the other way around, it robs her of her allure. When, early on, the smitten Des Grieux declares his love for her, Manon sits at the end of a bar wearing a red coat and dark glasses and smoking a cigarette—the very image of a prostitute. Manon is a material girl all right, but one with such irresistible femininity she gets what she wants from men without having to market herself. You never sense this here. Further, a demimonde element weighs on the first two acts. Manon’s benefactor, Geronte (the bass Giovanni Furlanetto, in excellent voice), is depicted as a crime figure, and there is some curious activity involving topless girls and golf clubs.
Mr. Trelinski’s approach also intensifies an acknowledged structural weakness of the opera. All the opera’s gaiety is concentrated in the first two acts, whereas Act 3 and 4—in which Manon is deported from France and then dies in the New World—are uniformly gloomy. But here, Acts 1 and 2 are gloomy too.
Mr. Trelinski, who is artistic director of the Teatr Wielki in Warsaw, where the production originated, is a respected director with some notable achievements. I have admired his double bill of Bartok’s “Bluebeard’s Castle” and Tchaikovsky’s “Iolanta,” which will be seen at the Met in a future season. His work here has some redeeming aspects, especially in Act 4. Puccini’s setting for this act—a vast desert near the outskirts of New Orleans—is one of opera’s most implausible, so it is no great loss to see it supplanted. Fascinatingly, Mr. Trelinski ensures that Des Grieux suffers here as much as Manon does, as he becomes delusional and, apparently, starts to see double. A second Manon appears, whom Des Grieux cannot seem to distinguish from the first.
Carlo Rizzi presides over a colorful reading of the score and a cast headed by an excellent pair of lovers in Eva-Maria Westbroek and Brandon Jovanovich. When the two sang their big duet in Act 2, you could forget about the production and become wrapped up in Puccini’s drama. Ms. Westbroek’s commanding soprano is a bit large for Manon, whose music can profit from greater tonal delicacy. Still, she offers some splendid singing, apart from some difficulty on top, and gives an especially gripping account of Manon’s final aria, “Solo, perduta, abbandonata.”
In this production Des Grieux emerges as the more emotionally vibrant lover, and Mr. Janovich’s clear, virile singing makes the most of the opportunity. Unfortunately, he was in ill health and departed the performance after Act 2, but the intervention of Hector Sandoval, the alternate Des Grieux, allowed the performance, which was streamed to movie theaters, to continue without a hitch. He sang well and knew intricacies of the staging, flaws and all.
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