I Was Misinformed: The Time She Tried Viagra





I have noticed, in the bragging-rights department, that “he doesn’t need Viagra” has become the female equivalent of the male “and, I swear, she’s a real blonde.” Personally, I do not care a bit. To me, anything that keeps you happy and in the game is a good thing.




But then, I am proud to say, I was among the early, and from what I gather, rare female users.


It happened when the drug was introduced around 1998. I was 50, but after chemotherapy for breast cancer — and later, advanced ovarian cancer — I was, hormonally speaking, pretty much running on fumes. Whether this had diminished my sex drive I did not yet know. One may have Zorba-esque impulses when a cancer diagnosis first comes in; but a treatment that leaves you bald, moon-faced and exhausted knocks that out of your system pretty fast.


But by 1998, the cancer was gone, my hair was back and I was ready to get back in the game. I was talking to an endocrinologist when I brought up Viagra. This was not to deal with the age-related physical changes I knew it would not address, it was more along the feminist lines of equal pay for equal work: if men have this new sex drug, I want this new sex drug.


“I know it’s supposed to work by increasing blood flow,” I told the doctor, “But if that’s true for men, shouldn’t it be true for women, too?”


“You’re the third woman who asked me that this week,” he said.


He wrote me a prescription. I was not seeing anyone, so I understood that I would have to do both parts myself, but that was fine. I have a low drug threshold and figured it might be best the first time to fly solo. My memory of the directions are hazy: I think there was a warning that one might have a facial flush or headaches or drop dead of a heart attack; that you were to take a pill at least an hour before you planned to get lucky, and, as zero hour approached, you were supposed to help things along by thinking beautiful thoughts, kind of like Peter Pan teaching Wendy and the boys how to fly.


But you know how it is: It’s hard to think beautiful thoughts when you’re wondering, “Is it happening? Do I feel anything? Woof, woof? Hello, sailor? Naaah.”


After about an hour, however, I was aware of a dramatic change. I had developed a red flush on my face; I was a hot tomato, though not the kind I had planned. I had also developed a horrible headache. The sex pill had turned into a bad joke: Not now, honey, I have a headache.


I put a cold cloth on my head and went to sleep. But here’s where it got good: When I slept, I dreamed; one of those extraordinary, sensual, swimming in silk sort of things. I woke up dazed and glowing with just one thought: I gotta get this baby out on the highway and see what it can do.


A few months later I am fixed up with a guy, and after a time he is, under the Seinfeldian definition of human relations (Saturday night date assumed) my official boyfriend. He is middle aged, in good health. How to describe our romantic life with the delicacy a family publication requires? Perhaps a line from “Veronika, der Lenz ist da” (“Veronica, Spring Is Here”), a song popularized by the German group the Comedian Harmonists: “Veronika, der Spargel Wächst” (“Veronica, the asparagus are blooming”). On the other hand, sometimes not. And so, one day, I put it out there in the manner of sport:


“Want to drop some Viagra?” I say.


Here we go again, falling into what I am beginning to think is an inevitable pattern: lying there like a lox, or two loxes, waiting for the train to pull into the station. (Yes, I know it’s a mixed metaphor, but at least I didn’t bring in the asparagus.) So there we are, waiting. And then, suddenly, spring comes to Suffolk County. It’s such a presence. I’m wondering if I should ask it if it hit traffic on the L.I.E. We sit there staring.


My reaction is less impressive. I don’t get a headache this time. And romantically, things are more so, but not so much that I feel compelled to try the little blue pills again.


Onward roll the years. I have a new man in my life, who is 63. He does have health problems, for which his doctor prescribes an E.D. drug. I no longer have any interest in them. My curiosity has been satisfied. Plus I am deeply in love, an aphrodisiac yet to be encapsulated in pharmaceuticals.


We take a vacation in mountain Mexico. We pop into a drugstore to pick up sunscreen and spot the whole gang, Cialis, Viagra, Levitra, on a shelf at the checkout counter. No prescription needed in Mexico, the clerk says. We buy all three drugs and return to the hotel. I try some, he tries some. In retrospect, given the altitude and his health, we are lucky we did not kill him. I came across an old photo the other day. He is on the bed, the drugs in their boxes lined up a in a semi-circle around him. He looks a bit dazed and his nose is red.


Looking at the picture, I wonder if he had a cold.


Then I remember: the flush, the damn flush. If I had kids, I suppose I would have to lie about it.



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Hurt by Rivals From Asia, Dell Profit Falls 47%





SAN FRANCISCO (Reuters) — Dell’s third-quarter profit fell 47 percent, the company said on Thursday, hurt by lower PC sales and weaker demand from large corporations. But Dell said it expected revenue to grow as much as 5 percent in the current quarter compared with sales in the previous one.




The company, once the world’s top PC maker and a pioneer in computer supply chain management, is struggling to defend its market share against Asian rivals like Lenovo. It is trying to bolster growth by focusing on products and services to corporations.


The company, founded by its chief executive, Michael Dell, said that it saw “the challenging global macroeconomic environment continuing in the fourth quarter.”


Net income was $475 million, or 27 cents a share, compared with $893 million, or 49 cents a share, in the period a year earlier. Excluding certain items, it earned 39 cents a share, compared with an average forecast of 40 cents.


Revenue fell 11 percent, to $13.7 billion, slightly less than the average analyst estimate of $13.89 billion, according to Thomson Reuters.


Dell’s chief financial officer, Brian T. Gladden, said in an interview that corporate customers continued to postpone technology spending.


“It’s not clear what’s going to cause them to increase their spending in the short term, given the uncertainty in the economy,” he said.


Dell’s enterprise solutions revenue rose 3 percent to $4.8 billion, while server and networking revenue climbed 11 percent. In contrast, consumer revenue plummeted 23 percent to $2.5 billion, underscoring the plight of the broader PC market. And sales to large corporations declined 8 percent to $4.2 billion.


The consumer market is improving with the introduction of the Windows 8 operating system from Microsoft, which has been designed with touch-screen devices and Internet-based computing in mind, Mr. Gladden said.


Part of the spending weakness among corporate customers comes from worry over early next year, when trillions of dollars in tax increases and automatic spending cuts will begin to go into force unless lawmakers agree on legislation to reduce the budget deficit, Mr. Gladden said.


The cuts could take a toll on consumer and government spending and cause the economy to stall.


“I would tell you that the behavior we are seeing from our customers today is actually driven by that uncertainty,” Mr. Gladden said. “It’s not like it’s all going to happen overnight. It’s affecting our business today.”


Dell is ensuring that it has access to cash in case there is no Congressional action.


“I would say there are several things we are doing from a planning standpoint,” Mr. Gladden said, “to ensure that we are in a position to have appropriate access to liquidity.” He said Dell was making sure it would have access to lines of credit and commercial paper.


Dell shares fell around 2 percent in late trading from their close of $9.56. The shares initially rose after the release of the results.


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Israel and Hamas Step Up Air Attacks in Gaza Clash


Wissam Nassar for The New York Times


The Gaza City funeral on Thursday of Ahmed al-Jabari, the Hamas military commander, killed in an Israeli attack. More Photos »







KIRYAT MALACHI, Israel — Israel and Hamas brushed aside international calls for restraint on Thursday and escalated their lethal conflict over Gaza, where Palestinian militants launched hundreds of rockets into Israeli territory, targeting Tel Aviv for the first time, and Israel intensified its aerial assaults and sent tanks rumbling toward the Gaza border for a possible invasion.




Defense Minister Ehud Barak of Israel, expressing outrage over a pair of long-range Palestinian rockets that whizzed toward Tel Aviv and set off the first air-raid warning in the Israeli metropolis since it was threatened by Iraqi Scuds in the Persian Gulf war of 1991, said, “There will be a price for that escalation that the other side will have to pay.”


He authorized the call-up of 30,000 army reservists if needed, another sign that Israel was preparing to invade Gaza for the second time in four years to crush what it considers an unacceptable security threat from smuggled rockets amassed by Hamas, the militant Islamist group that governs the isolated coastal enclave and does not recognize Israel’s right to exist.


It was not clear whether the show of Israeli force on the ground in fact portended an invasion or was meant as more of an intimidation tactic to further pressure Hamas leaders, who had all been forced into hiding on Wednesday after the Israelis killed the group’s military chief, Ahmed al-Jabari, in a pinpoint aerial bombing. But Prime Minister Benjamin Netanyahu of Israel said he was prepared to “take whatever action is necessary.”


Although Tel Aviv was not hit on Thursday and the rockets heading toward the city of 400,000 apparently fell harmlessly elsewhere, the ability of militants 40 miles away to fire those weapons underscored, in the Israeli government’s view, the justification for the intensive aerial assaults on hundreds of suspected rocket storage sites and other targets in Gaza.


Health officials in Gaza said at least 19 people, including five children and a pregnant teenager, had been killed over two days of nearly nonstop aerial attacks by Israel, and dozens had been wounded. Three Israelis were killed on Thursday in Kiryat Malachi, this small southern Israeli town, when a rocket fired from Gaza struck their apartment house.


In a sign of solidarity with Hamas as well as a diplomatic move to ease the crisis, President Mohamed Morsi of Egypt ordered his prime minister to lead a delegation to Gaza on Friday. In another diplomatic signal, Ban Ki-moon, the United Nations secretary general, also planned to visit Jerusalem, Cairo and Ramallah, the West Bank headquarters of the Palestinian Authority, in coming days.


In Washington, Obama administration officials said they had asked friendly Arab countries with ties to Hamas, which the United States and Israel regard as a terrorist group, to use their influence to seek a way to defuse the hostilities. At the same time, however, a State Department spokesman, Mark C. Toner, reiterated to reporters the American position that Israel had a right to defend itself from the rocket fire and that the “onus was on Hamas” to stop it.


The Pentagon said late Thursday that Defense Secretary Leon E. Panetta spoke to Mr. Barak this week about Israeli operations in and around Gaza and condemned the violence carried out by Hamas and other groups against Israel.


There was no sign that either side was prepared, at least not yet, to restore the uneasy truce that has mostly prevailed since the last time the Israelis invaded Gaza in the winter of 2008-9, a three-week war that left 1,400 Palestinians dead and drew widespread international condemnation.


Denunciations of Israel for what critics called a renewal of its aggressive and disproportionate attacks spread quickly on the second day of the aerial assaults. The biggest criticism came from the 120-nation Nonaligned Movement, the largest bloc at the United Nations. In a statement released by Iran, which holds the group’s rotating presidency and is one of Israel’s most ardent foes, the group said: “Israel, the occupying power, is, once more, escalating its military campaign against the Palestinian people, particularly in the Gaza Strip.” The group made no mention of the Palestinian rocket fire aimed at Israel but condemned “this act of aggression by the Israelis and their resort to force against the defenseless people” and demanded “decisive action by the U.N. Security Council.”


Isabel Kershner reported from Kiryat Malachi, and Rick Gladstone from New York. Reporting was contributed by Fares Akram from Gaza, Rina Castelnuovo from Kiryat Malachi, Mayy El Sheikh and David D. Kirkpatrick from Cairo, Gabby Sobelman from Jerusalem, Alan Cowell from Paris and Elisabeth Bumiller from Bangkok.


Isabel Kershner reported from Kiryat Malachi, and Rick Gladstone from New York. Reporting was contributed by Fares Akram from Gaza, Rina Castelnuovo from Kiryat Malachi, Mayy El Sheikh and David D. Kirkpatrick from Cairo, Gabby Sobelman from Jerusalem, Alan Cowell from Paris and Elisabeth Bumiller from Bangkok.



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Obama Meets C.E.O.’s as Fiscal Reckoning Nears


Luke Sharrett for The New York Times


Ursula M. Burns, chief of Xerox, said the president discussed few specifics of a potential agreement but emphasized that “we cannot go over the fiscal cliff.”







WASHINGTON — President Obama extended an olive branch to business leaders Wednesday, seeking their support as he prepared to negotiate with Congressional Republicans over the fiscal impasse in Washington.




If Congress and the president cannot reach a deal to reduce the deficit by January, more than $600 billion in tax increases and spending cuts will go into effect immediately — a prospect many chief executives and others warn could tip the economy back into recession.


Even so, Mr. Obama has some fence-mending to do before he can count on any serious backing from the business community.


“The president brought up that he hadn’t always had the best relationship with business, and he didn’t think he deserved that, but he understood that’s where things were and wanted it to be better,” said David M. Cote, chief executive of Honeywell. He was one of a dozen corporate leaders invited to meet Mr. Obama at the White House for 90 minutes Wednesday afternoon, after the president’s first news conference since the election.


While Mr. Obama did not present a detailed plan at Wednesday’s meeting or reveal what he would propose in terms of new corporate taxes, he strongly reiterated that he would not allow tax cuts for the middle class to expire. The president, according to attendees and aides, said he was committed to a balanced approach of reductions in entitlements and other government spending and increases in revenue.


With time running out, many people expect the president and Republican leaders in Congress to come up with a short-term compromise that prevents the full slate of tax increases and spending cuts from hitting in January. That would give both sides more time to come up with a far-reaching deal on entitlement spending, even as they work on a broad tax overhaul later next year.


One corporate official briefed on the meeting said that the chief executives came away with a sense that Mr. Obama was poised to present a more formal proposal in the next few days, but that he did not press them for support on particular policies. “It was more of a back and forth,” he said.


The chief executives from some of the country’s biggest and best-known companies, including Procter & Gamble and I.B.M., were not unified on everything, according to one who was interviewed after the meeting.


Many of the executives who described the meeting would speak only on condition of anonymity.


The outreach to business comes as both the White House and corporate America maneuver ahead of the year-end deadline, as well as the beginning of Mr. Obama’s second term. Many executives were put off by what they saw as antibusiness rhetoric coming from the White House in his first term, and many also oppose tax increases on the rich that Mr. Obama favors but would hit them personally.


Both sides have plenty to gain from a better relationship. Business leaders want to buffer their image after the recession and the financial crisis, while Mr. Obama would gain valuable leverage if he could persuade even a few chief executives to come out in favor of higher taxes on people with incomes over $250,000.


Lloyd C. Blankfein, chief executive of Goldman Sachs, publicly endorsed higher tax rates in an opinion article published in The Wall Street Journal on Wednesday.


“I believe that tax increases, especially for the wealthiest, are appropriate, but only if they are joined by serious cuts in discretionary spending and entitlements,” he wrote.


While Mr. Blankfein and other Wall Street leaders have been speaking out about the dangers of the fiscal impasse, only one executive from the financial services industry, Kenneth I. Chenault of American Express, was at Wednesday’s meeting.


Afterward, the corporate leaders seemed pleased with the tone of the meeting but cautious about the prospect of finding common ground with the White House on the budget choices facing Congress and the president.


“I’d say everybody came away feeling pretty good about the whole discussion,” Mr. Cote said. “Now, all of us are C.E.O.’s, so we’ve learned not to confuse words with results. And that’s what we still need to see.”


Ursula M. Burns, chief executive of Xerox, who was also at the meeting, said afterward that it was clear that “we’re going to have to work through some sticking points.” But while “we didn’t get into too many specifics,” she said, it was also made clear that “we cannot go over the fiscal cliff.”


Ms. Burns’s comments about the potentially dire consequences of the fiscal impasse echoed those of other chief executives, including many in the Business Roundtable, which began an ad campaign Tuesday calling on lawmakers to resolve the issue quickly. The Campaign to Fix the Debt, a new group with a $40 million budget and the support of many Fortune 500 chiefs, began its own ad campaign on Monday.


Michael T. Duke, chief executive of Wal-Mart Stores, warned in a statement after the meeting that “before the end of the year, Washington needs to find an agreement to avoid the fiscal cliff.” He said Walmart customers “are working hard to adapt to the ‘new normal,’ but their confidence is still very fragile. They are shopping for Christmas now, and they don’t need uncertainty over a tax increase.”


 


Helene Cooper reported from Washington and Nelson D. Schwartz from New York. Jackie Calmes contributed reporting from Washington.



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Recurring Lyme Disease Symptoms Caused by New Infection, Study Finds





When people who have been treated for Lyme disease recover but later come down with its symptoms again, is the illness a relapse or a new infection?




The question has lingered for years. Now, a new study finds that repeat symptoms are from new infections, not from relapses.


The results challenge the notion, strongly held by some patients and advocacy groups, that Lyme disease, a bacterial infection, has a tendency to resist the usual antibiotic treatment and turn into a chronic illness that requires months or even years of antibiotic therapy.


The conclusion that new symptoms come from new infections is based on genetically fingerprinting the Lyme bacteria in people who have had the illness more than once, and finding that the fingerprints do not match. The result means that different episodes of Lyme in each patient were caused by different strains of the bacteria, and could not have been relapses.


The study, by researchers at the University of Pennsylvania and New York Medical College, in Valhalla, was published online on Wednesday in The New England Journal of Medicine.


An estimated 20,000 to 30,000 cases of Lyme disease occur each year in the United States. The disease is caused by a bacterium, Borrelia burgdorferi, that is carried by deer ticks. It often begins with an expanding zone of red skin — a symptom called erythema migrans — around the tick bite, but sometimes in other areas too. Fever, headaches, fatigue and aches and pains often follow.


Untreated, the disease can cause heart and neurological problems and arthritis, with symptoms that can come and go for years. Advanced cases that have gone months or years before being treated are most likely to result in persistent arthritis.


But when the disease is detected earlier, treatment with an antibiotic, usually two to four weeks of doxycycline, can get rid of the bacteria, according to infectious disease experts. Even advanced cases can be cleared by the drugs, doctors say, though an extra month or so of treatment may be needed. Symptoms like pain and fatigue can linger even after the bacteria are gone, possibly because the infection caused abnormalities in the immune system.


However, some doctors, patients and advocacy groups think that the bacteria themselves can somehow hang on despite treatment, even in cases caught early, and cause a chronic infection that requires long-term treatment with antibiotics. In some cases, people with unexplained pain, fatigue and cognitive problems have been told they had chronic Lyme disease even though blood tests found no evidence of the infection.


Several controlled studies have found that long-term antibiotics did not help people who had already been treated for Lyme disease but had such lingering problems.


Despite the data, the belief has hung on that Lyme disease bacteria can cause a chronic infection even after treatment.


The researchers who conducted the new study wanted to test that idea by finding out whether people who had repeated bouts of the disease were actually having relapses. They identified 17 patients who had erythema migrans — the rash — more than once between 1991 and 2011. Most had it twice, at least a year apart, but a few patients had it three times and one had four cases. Many had other symptoms as well, and more than half had signs of widespread systemic infection. All were treated, and recovered fully.


Lyme bacteria were grown from skin or blood samples taken from the patients when they had the rash, and the researchers analyzed a bacterial gene that varies from one strain to another. For each patient, they compared the genes from different cases of the rash. The genotypes did not match, which the researchers said proved that each rash represented a new infection, not a relapse.


In an editorial accompanying the article, Dr. Allen C. Steere, a Harvard professor who was the first to identify Lyme disease, said the new study supported previous research suggesting that new infections, not relapses, were the cause of new symptoms in people who had taken antibiotics to treat earlier cases of the disease.


Dr. Steere acknowledged that symptoms, sometimes disabling ones, do linger for months after treatment in as many as 10 percent of patients. Doctors do not know why. But, Dr. Steere said, “antibiotics are not the answer.”


Read More..

Recurring Lyme Disease Symptoms Caused by New Infection, Study Finds





When people who have been treated for Lyme disease recover but later come down with its symptoms again, is the illness a relapse or a new infection?




The question has lingered for years. Now, a new study finds that repeat symptoms are from new infections, not from relapses.


The results challenge the notion, strongly held by some patients and advocacy groups, that Lyme disease, a bacterial infection, has a tendency to resist the usual antibiotic treatment and turn into a chronic illness that requires months or even years of antibiotic therapy.


The conclusion that new symptoms come from new infections is based on genetically fingerprinting the Lyme bacteria in people who have had the illness more than once, and finding that the fingerprints do not match. The result means that different episodes of Lyme in each patient were caused by different strains of the bacteria, and could not have been relapses.


The study, by researchers at the University of Pennsylvania and New York Medical College, in Valhalla, was published online on Wednesday in The New England Journal of Medicine.


An estimated 20,000 to 30,000 cases of Lyme disease occur each year in the United States. The disease is caused by a bacterium, Borrelia burgdorferi, that is carried by deer ticks. It often begins with an expanding zone of red skin — a symptom called erythema migrans — around the tick bite, but sometimes in other areas too. Fever, headaches, fatigue and aches and pains often follow.


Untreated, the disease can cause heart and neurological problems and arthritis, with symptoms that can come and go for years. Advanced cases that have gone months or years before being treated are most likely to result in persistent arthritis.


But when the disease is detected earlier, treatment with an antibiotic, usually two to four weeks of doxycycline, can get rid of the bacteria, according to infectious disease experts. Even advanced cases can be cleared by the drugs, doctors say, though an extra month or so of treatment may be needed. Symptoms like pain and fatigue can linger even after the bacteria are gone, possibly because the infection caused abnormalities in the immune system.


However, some doctors, patients and advocacy groups think that the bacteria themselves can somehow hang on despite treatment, even in cases caught early, and cause a chronic infection that requires long-term treatment with antibiotics. In some cases, people with unexplained pain, fatigue and cognitive problems have been told they had chronic Lyme disease even though blood tests found no evidence of the infection.


Several controlled studies have found that long-term antibiotics did not help people who had already been treated for Lyme disease but had such lingering problems.


Despite the data, the belief has hung on that Lyme disease bacteria can cause a chronic infection even after treatment.


The researchers who conducted the new study wanted to test that idea by finding out whether people who had repeated bouts of the disease were actually having relapses. They identified 17 patients who had erythema migrans — the rash — more than once between 1991 and 2011. Most had it twice, at least a year apart, but a few patients had it three times and one had four cases. Many had other symptoms as well, and more than half had signs of widespread systemic infection. All were treated, and recovered fully.


Lyme bacteria were grown from skin or blood samples taken from the patients when they had the rash, and the researchers analyzed a bacterial gene that varies from one strain to another. For each patient, they compared the genes from different cases of the rash. The genotypes did not match, which the researchers said proved that each rash represented a new infection, not a relapse.


In an editorial accompanying the article, Dr. Allen C. Steere, a Harvard professor who was the first to identify Lyme disease, said the new study supported previous research suggesting that new infections, not relapses, were the cause of new symptoms in people who had taken antibiotics to treat earlier cases of the disease.


Dr. Steere acknowledged that symptoms, sometimes disabling ones, do linger for months after treatment in as many as 10 percent of patients. Doctors do not know why. But, Dr. Steere said, “antibiotics are not the answer.”


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State of the Art: A Review of New Activity-Tracking Bands From Nike and Jawbone





Maybe you’ve heard: Americans are becoming less fit and more fat. There are all kinds of theories about why — bigger meal portions, omnipresent corn syrup and sugar, fewer pickup stickball games after school. But people are starting to think that in many cases, body weight might somehow be linked to diet and exercise.




Now, studies have shown that if there’s some visible, omnipresent monitor of your negative behavior — spending too much money, eating too much food, using too much power in your home — you’re far more likely to correct it.


That’s the idea behind personal activity-tracking bracelets like the Nike FuelBand ($150) and the improved Jawbone Up band ($130). They make you constantly aware of how active you are (or aren’t). They let you compare your data with friends online, establishing a friendly rivalry or at least guilt. And they therefore motivate you to make changes that add up: park farther away, take the stairs, get off one bus stop early.


There are plenty of other fitness trackers, including clip-onto-clothing trackers (like the FitBit and Striiv) and wristwatchlike gadgets (like Motorola’s MotoActiv). But the beauty of the bracelets is that you can leave them on — asleep, in the shower, shirtless or even all three — and so you’re more likely to stick with the program.


Now, those who follow the wearable, accelerometer-based fitness-tracking gadget industry are no doubt scratching their heads right about now. The Up band? Wasn’t that a bracelet that came out about a year ago, and crashed and burned in a humiliatingly public epidemic of hardware failures? Didn’t Jawbone, a company known for Bluetooth speakers and earpieces, pull Up off the market, offering a generous mea culpa (“You can receive a full refund for UP. This is true even if you decide to keep your UP band”)?


Yes.


The company says that after months of testing and millions of dollars in research, it realized that the original band, billed as waterproof, actually wasn’t quite. Water, sweat and shower soap managed to seep inside and short out the components.


The new Up band, the company swears, is bulletproof. Or at least really, truly waterproof. The company says it redesigned 17 parts and made 28 improvements in the manufacturing process. The new band looks identical — it’s still a stiff, rubber, overgrown C in a choice of colors, with ends that overshoot each other — but inside, it’s far better shielded and enclosed. (It’s also $30 more expensive.)


The corresponding iPhone app has had some work done, too. The central conceit is a Facebook-style timeline of your life. Each “post” represents a day’s worth of activity, or a night of sleep, or a meal. (You can enter nonstep-based workouts manually, like biking or weights.) Your friends’ health developments can show up in your stream, too.


That doesn’t mean that the app is ready for its close-up. It’s fairly baffling, housing as it does duplicate hidden menus, and it has its share of bugs and quirks. Why, on a screen that’s much taller than it is wide, are your progress graphs inch-tall bars swimming in empty space? And wow — if you did a situp every time you got the “Sorry, there was an error connecting with the UP server” message, you’d have abs of concrete. (An Android app is in the works.)


What’s great, though, is that the Up’s ambitions extend beyond simple activity tracking. If you do a double press on the button at the end of the band when you go to bed, for example, the bracelet does an impressive job of tracking your night of sleep: how long it takes you to drift off, how many times you wake up, how many hours you spend in light and deep sleep.


A related, extremely useful feature: when you need a power nap (a 25-minute quick sleep, whose refreshing qualities have been well documented in studies), the band doesn’t start counting until it sees that you’re actually asleep. So you actually get 25 minutes, after which the band vibrates to rouse you. That’s something the average pedometer doesn’t do.


You can track your food intake in any of three ways: by taking a photo of what you eat, by scanning the bar code on its package (the app instantly and correctly identifies it) or by choosing from a categorized list of common foodstuffs. It’s still fairly manual — no wristband can tell what you’re shoving into your mouth — so most people probably won’t bother.


E-mail: pogue@nytimes.com



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Ending Congress, China Presents New Leadership Headed by Xi Jinping




‘Princelings’ Reshape China:
November 14, 2012 - China's "princelings" are emerging as an aristocratic class with an increasingly important say in ruling the country.







BEIJING — Completing only its second orderly hand-over of power in more than six decades of rule, the Chinese Communist Party on Thursday unveiled a new leadership slate headed by Xi Jinping, the son of a revered revolutionary leader and economic reformer, who will face the task of guiding China to a more sustainable model of growth and managing the country’s rise as a global power.




For this nation of 1.3 billion, the transition culminates a tumultuous period plagued by scandals and intense political rivalry that presented the party with some of its greatest challenges since the student uprising of 1989. On Thursday, after a confirmation vote by the party’s new Central Committee, Mr. Xi, 59, strode onto a red-carpeted stage at the Great Hall of the People accompanied by six other party officials who will form the new Politburo Standing Committee, the elite group that makes crucial decisions on the economy, foreign policy and other major issues. Before their appearance, the new lineup was announced by Xinhua, the state news agency.


“I think the emphasis is on continuity over change this time around,” said Bo Zhiyue, a scholar of Chinese politics at the National University of Singapore.


The ascension of Mr. Xi and other members of the “red nobility” to the top posts means that the so-called princelings have come into their own as a prominent political force. Because of their parentage, they believe themselves to be the heirs of the revolution that succeeded in 1949, endowed with the mandate of authority that that status confers.


“I wish to sincerely thank the whole party for the trust you have placed in us,” Mr. Xi said after walking out in a dark suit and a wine-red tie. “We will try everything we can to live up to your trust and fulfill your mission.”


Mr. Xi is facing a growing chorus of calls from Chinese elites to support greater openness in China’s economic and political systems, which critics say have stagnated in the last decade under the departing party chief, Hu Jintao, despite the country’s emergence as the world’s second-largest economy and a growing regional power.


Mr. Hu, 69, also turned over the post of civilian chairman of the military on Thursday to Mr. Xi, which made this transition the first time since the promotion of the ill-fated Hua Guofeng in 1976 that a Chinese leader had taken office as head of the party and the military at the same time. That gives Mr. Xi a stronger base from which to consolidate his power, even as he grapples with the continuing influence of party elders.


The unveiling came the day after the weeklong 18th Party Congress ended as Mr. Hu made his final appearance as party chief at a closing ceremony and seven standing committee members stepped down.


Mr. Xi is known for shunning the spotlight and being a skilled consensus builder. He spent his childhood in the leadership compounds of Beijing, but was forced to toil in a village of cave homes in Shaanxi Province for seven years during the Cultural Revolution, when his father was purged.


His first job was as an aide to a top general in Beijing. He then rose through the party ranks in the provinces, including Fujian and Zhejiang, two coastal regions known for private entrepreneurship and exchanges with Taiwan. Mr. Xi’s jobs and family background have allowed him to build personal ties to some military leaders. He is married to a celebrity singer, Peng Liyuan, and they have a daughter attending Harvard under a pseudonym.


Mr. Hu’s abdication of the military chairmanship sets an important institutional precedent for future successions and may put his legacy in a more favorable light. In Chinese politics, retired leaders try to maximize their influence well into old age, either by clinging to titles or by making their opinions known on important decisions.


Jiang Zemin, Mr. Hu’s predecessor as party chief and president, did both: he held on to the military post for two years after giving up his party title in 2002, which led to heightened friction within the party. And in recent months, he has worked to get his protégés installed on the standing committee, which is usually assembled through horse trading by party elders and leaders.


The committee was trimmed to seven members from nine. One reason for that change is that some party leaders, including Mr. Xi, believe that an overrepresentation of interests on the committee has led to gridlock in decision making. The smaller committee has also resulted in a downgrading of the party post that controls the security apparatus, which some officials asserted had grown too powerful.


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At Microsoft, Sinofsky Seen as Smart but Abrasive





On a warm night in late October, Steven Sinofsky stood on a platform in New York’s Times Square, smiling as a huge crowd roared at the unveiling of a Microsoft retail store, where Windows 8 and the company’s new Surface tablet were about to go on sale.




Less than three weeks later, Mr. Sinofsky — who, as the head of Windows, was arguably the second-most important leader at Microsoft — suddenly left the company. His abrasive style was a source of discord within Microsoft, and he and Steven A. Ballmer, Microsoft’s chief executive, agreed that it was time for him to leave, according to a person briefed on the situation who was not authorized to speak publicly about it.


Mr. Sinofsky was widely admired for his effectiveness in running one of the biggest and most important software development organizations on the planet. But his departure, which Microsoft announced late on Monday, parallels in many respects that of Scott Forstall, the headstrong former head of Apple’s mobile software development, who was fired by Apple’s chief executive, Timothy D. Cook, in late October.


Both cases underscore a quandary that chief executives sometimes face: when do the costs of keeping brilliant leaders who cannot seem to get along with others outweigh the benefits?


The tipping point that led to Mr. Sinofsky’s departure came after an accumulation of run-ins with Mr. Ballmer and other company leaders, rather than a single incident, according to interviews with several current and former Microsoft executives who declined to be named discussing internal matters.


One example of the kind of behavior that hurt Mr. Sinofsky’s standing at the company occurred this year at a two-day retreat for Microsoft’s senior executives at the Semiahmoo resort on the coast just below the Canadian border in Washington State. At the meeting, Microsoft’s various division heads were expected to make presentations on their businesses, answer questions and remain to hear their peers repeat the exercise.


When Mr. Sinofsky stood on the first day to speak about the Windows division, he told the group he had not prepared a presentation, and if they wanted to catch up on the progress of Windows 8, they could read his company blog, where he publicly chronicled the software’s development. He answered questions from the audience and then left the resort, while his colleagues remained until the next day, according to multiple people who were present.


Mr. Sinofsky’s early exit and halfhearted presentation were widely noted by his colleagues, irking even his admirers in the company. “He lost a lot of support,” one attendee said.


It wasn’t until this Monday, though, that Mr. Sinofsky and Mr. Ballmer both decided it would be best if Mr. Sinofsky left. Bill Gates, Microsoft’s chairman, supported the move, a person briefed on the matter said. Mr. Sinofsky served as a technical assistant to Mr. Gates in the 1990s.


In an e-mail to Microsoft employees, Mr. Sinofsky said the decision to leave “was a personal and private choice.” Many surprised Microsoft insiders noted that Mr. Sinofsky’s departure was immediate, an unusual arrangement for someone with a 23-year track record at the company. A Microsoft spokesman, Frank Shaw, said Mr. Sinofsky was not available to comment.


Although Mr. Ballmer grew increasingly impatient with Mr. Sinofsky throughout the year, he held back from taking any action earlier to avoid disrupting the release of Windows 8, the most important product Microsoft has unveiled in years, a person with knowledge of his thinking said.


The final decision could not have come lightly. Although many people at Microsoft viewed him as a ruthless corporate schemer, Mr. Sinofsky ran the highly complex organization responsible for Windows as a disciplined army that met deadlines, and he was respected by people on his team.


He achieved hero status within Microsoft several years ago by taking over the leadership of Windows after the debacle that was Windows Vista, a much-delayed operating system whose sluggish performance and technical problems worsened Microsoft’s reputation for mediocre software. Mr. Sinfosky led the development of a new version of the operating system, Windows 7, which was positively reviewed and sold well.


“He did great things with Windows,” said Michael Cusumano, a professor at the Sloan School of Management at the Massachusetts Institute of Technology. “That’s still the core of the company.”


But while Mr. Sinofsky was effective, Mr. Cusumano said, he could be secretive and difficult to get along with, as he learned while dealing with Mr. Sinofsky while Mr. Cusumano was writing a book on Microsoft in the early 1990s. “I could imagine that he burned a lot of bridges and created a bunch of enemies,” he said.


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Kidney Donors Given Mandatory Safeguards


ST. LOUIS — Addressing long-held concerns about whether organ donors have adequate protections, the country’s transplant regulators acted late Monday to require that hospitals thoroughly inform living kidney donors of the risks they face, fully evaluate their medical and psychological suitability, and then track their health for two years after donation.


Enactment of the policies by the United Network for Organ Sharing, which manages the transplant system under a federal contract, followed six years of halting development and debate.


Meeting at a St. Louis hotel, the group’s board voted to establish uniform minimum standards for a field long regarded as a medical and ethical Wild West. The organ network, whose initial purpose was to oversee donation from people who had just died, has struggled at times to keep pace with rapid developments in donations from the living.


“There is no question that this is a major development in living donor protection,” said Dr. Christie P. Thomas, a nephrologist at the University of Iowa and the chairman of the network’s living donor committee.


Yet some donor advocates complained that the measures did not go far enough, and argued that the organ network, in its mission to encourage transplants, has a conflict of interest when it comes to safeguarding donors.


Three years ago, the network issued some of the same policies as voluntary guidelines, only to have the Department of Health and Human Services insist they be made mandatory.


Although long-term data on the subject is scarce, few living kidney donors are thought to suffer lasting physical or psychological effects. Kidney donations, known as nephrectomies, are typically done laparoscopically these days through a series of small incisions. The typical patient may spend only a few nights in a hospital and feel largely recovered after several months.


Kidneys are by far the most transplanted organs, and there have been nearly as many living donors as deceased ones over the last decade. What data is available suggests that those with one kidney typically live as long as those with two, and that the risk of a donor dying during the procedure is roughly 3 in 10,000.


But kidney transplants, like all surgery, can sometimes end in catastrophe.


In May at Montefiore Medical Center in the Bronx, a 41-year-old mother of three died when her aorta was accidentally cut during surgery to donate a kidney to her brother. In other recent isolated cases, patients have received donor kidneys infected with undetected H.I.V. or hepatitis C.


Less clear are any longer-term effects on donors. Research conducted by the United Network for Organ Sharing shows that of roughly 70,000 people who donated kidneys between late 1999 and early 2011, 27 died within two years of medical causes that may — or may not — have been related to donation. For a small number of donors, their remaining kidney failed, and they required dialysis or a transplant.


The number of living donors — 5,770 in 2011 — has dropped 10 percent over the last two years, possibly because the struggling economy has made it difficult for prospective donors to take time off from work to recuperate. With the national kidney waiting list now stretching past 94,000 people, and thousands on the list dying each year, transplant officials have said they must improve confidence in the system so more people will donate.


The average age of donors has been rising, posing additional medical risks. And new ethical questions have been raised by the emergence of paired kidney exchanges and transplant chains started by good Samaritans who give an organ to a stranger.


Brad Kornfeld, who donated a kidney to his father in 2004, told the board that it had been impossible to find good information about what to expect, leaving him to search for answers on unreliable Internet chat rooms. He said he had almost backed out.


“If information is power,” said Mr. Kornfeld, a Coloradan who serves on the living donor committee, “the lack of information is crippling.”


Under the policies approved this week, the organ network will require hospitals to collect medical data, including laboratory test results, on most living donors to study lasting effects. Results must be reported at six months, one year and two years.


Similar regulations have been in place since 2000, but they did not require blood and urine testing, and hospitals were allowed to report donors who could not be found as simply lost.


That happened often. In recent years, hospitals have submitted basic clinical information — like whether donors were alive or dead — for only 65 percent of donors and lab data for fewer than 40 percent, according to the organ network. Although the network holds the authority, no hospital has ever been seriously sanctioned for noncompliance.


“It’s time we put some teeth into our policy,” said Jill McMaster, a board member from Tennessee.


By 2015, transplant programs will have to report thorough clinical information on at least 80 percent of donors and lab results on at least 70 percent. The requirements phase in at lower levels for the next two years.


Dr. Stuart M. Flechner of the Cleveland Clinic, the chairman of a coalition of medical societies that made recommendations to the organ network, said 9 of 10 hospitals would currently not meet the new requirement.


Donna Luebke, a kidney donor from Ohio who once served on the organ network’s board, said the new standards would matter only if enforcement were more rigorous. She noted that the organization was dominated by transplant doctors: “UNOS is nothing but the foxes watching the henhouse,” she said.


Another of the new regulations prescribes in detail the medical and psychological screenings that hospitals must conduct for potential donors. It requires automatic exclusion if the potential donor has diabetes, uncontrolled hypertension or H.I.V., among other conditions.


The new policies also require that hospitals appoint an independent advocate to counsel and represent donors, and that donors receive detailed information in advance about medical, psychological and financial risks.


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