Florida Sinkhole Growing as Engineers Investigate

Chris O'Meara/Associated Press

An engineer wore a safety line Saturday outside the house in Seffner, Fla., where a bedroom and its occupant fell into a sinkhole.

SEFFNER, Fla. (AP) — Engineers worked gingerly on Saturday to find out more about a slowly growing sinkhole that had swallowed a Florida man in his bedroom, believing the entire house could succumb to the unstable ground.

Jeff Bush, 37, was in his bedroom on Thursday night when the earth opened and took him and everything else in his room. Five other people were in the house but escaped unharmed. Mr. Bush’s brother jumped into the hole to try to help, but he had to be rescued by a sheriff’s deputy.

Engineers returned to the property on Saturday morning to do more tests after taking soil samples and running tests there all day Friday. They said the entire lot was dangerous, and no one was allowed in the house.

“I cannot tell you why it has not collapsed yet,” said Bill Bracken, the owner of an engineering company called to assess the sinkhole. He described the earth below as a “very large, very fluid mass.”

“This is not your typical sinkhole,” said Michael Merrill, the Hillsborough County administrator. “This is a chasm. For that reason, we’re being very deliberate.”

The hole had grown to 20 feet deep and 30 feet wide by Friday night, and officials said it was still expanding and “seriously unstable.”

Officials delicately addressed another sad reality: Mr. Bush was likely dead, and the family wanted his body.

“They would like us to go in quickly and locate Mr. Bush,” Mr. Merrill said.

Two neighboring houses were evacuated, and officials were considering further evacuations. Members of the media were moved from a lawn across the street to a safer area a few hundred feet away.

“This is a very complex situation,” said the Hillsborough County fire chief, Ron Rogers. “It’s continuing to evolve, and the ground is continuing to collapse.”

Sinkholes are so common in Florida that the state requires home insurers to provide coverage against the danger. While some cars, homes and other buildings have been devoured, it is extremely rare for a sinkhole to swallow a person.

Florida is highly prone to sinkholes because of the underground prevalence of limestone, a porous rock that easily dissolves in water, creating caverns.

“You can almost envision a piece of Swiss cheese,” Taylor Yarkosky, a sinkhole expert from Brooksville, Fla., said while gesturing to the ground and the sky-blue house where the earth opened in Seffner. “Any house in Florida could be in that same situation.”

A sinkhole near Orlando grew to 400 feet across in 1981 and devoured five cars, most of two businesses, a three-bedroom house and the deep end of an Olympic-size swimming pool.

More than 500 sinkholes have been reported in Hillsborough County alone since the government started keeping track in 1954, according to the state’s environmental agency.

The sinkhole that swallowed Mr. Bush caused the home’s concrete floor to cave in around 11 p.m. Thursday as everyone in the Tampa-area house was turning in for the night. It gave way with a loud crash that sounded like a car hitting the house and brought Mr. Bush’s brother, Jeremy, running.

Jeremy Bush said he had jumped into the hole but could not see his brother before the ground crumbled around him. A sheriff’s deputy reached out and pulled him to safety.

“The floor was still giving in and the dirt was still going down, but I didn’t care — I wanted to save my brother,” Jeremy Bush said through tears Friday in a neighbor’s yard. “But I just couldn’t do nothing.”

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England Develops a Voracious Appetite for a New Diet

LONDON — Visitors to England right now, be warned. The big topic on people’s minds — from cabdrivers to corporate executives — is not Kate Middleton’s increasingly visible baby bump (though the craze does involve the size of one’s waistline), but rather a best-selling diet book that has sent the British into a fasting frenzy.

“The Fast Diet,” published in mid-January in Britain, could do the same in the United States if Americans eat it up. The United States edition arrived last week.

The book has held the No. 1 slot on Amazon’s British site nearly every day since its publication in January, according to Rebecca Nicolson, a founder of Short Books, the independent publishing company behind the sensation. “It is selling,” she said, “like hot cakes,” which coincidentally are something one can actually eat on this revolutionary diet.

With an alluring cover line that reads, “Lose Weight, Stay Healthy, Live Longer,” the premise of this latest weight-loss regimen — or “slimming” as the British call “dieting” — is intermittent fasting, or what has become known here as the 5:2 diet: five days of eating and drinking whatever you want, dispersed with two days of fasting.

A typical fasting day consists of two meals of roughly 250 to 300 calories each, depending on the person’s sex (500 calories for women, 600 for men). Think two eggs and a slice of ham for breakfast, and a plate of steamed fish and vegetables for dinner.

It is not much sustenance, but the secret to weight loss, according to the book, is that even after just a few hours of fasting, the body begins to turn off the fat-storing mechanisms and turn on the fat-burning systems.

“I’ve always been into self-experimentation,” said Dr. Michael Mosley, one of the book’s two authors and a well-known medical journalist on the BBC who is often called the Sanjay Gupta of Britain.

He researched the science of the diet and its health benefits by putting himself through intermittent fasting and filming it for a BBC documentary last August called “Eat, Fast and Live Longer.” (The broadcast gained high ratings, three million viewers, despite running during the London Olympics. PBS plans to air it in April.)

“This started because I was not feeling well last year,” Dr. Mosley said recently over a cup of tea and half a cookie (it was not one of his fasting days). “It turns out I was suffering from high blood sugar, high cholesterol and had a kind of visceral fat inside my gut.”

Though hardly obese at the time, at 5 feet 11 inches and 187 pounds, Dr. Mosley, 55, had a body mass index and body fat percentage that were a few points higher than the recommended amount for men. “Given that my father had died at age 73 of complications from diabetes, and I was now looking prediabetic, I knew something had to change,” he added.

The result was a documentary, almost the opposite of “Super Size Me,” in which Dr. Mosley not only fasted, but also interviewed scientific researchers, mostly in the United States, about the positive results of various forms of intermittent fasting, tested primarily on rats but in some cases human volunteers. The prominent benefits, he discovered, were weight loss, a lower risk of cancer and heart disease, and increased energy.

“The body goes into a repair-and-recover mode when it no longer has the work of storing the food being consumed,” he said.

Though Dr. Mosley quickly gave up on the most extreme forms of fasting (he ate little more than one cup of low-calorie soup every 24 hours for four consecutive days in his first trial), he finally settled on the 5:2 ratio as a more sustainable, less painful option that could realistically be followed without annihilating his social life or work.

“Our earliest antecedents,” Dr. Mosley argued, “lived a feast-or-famine existence, gorging themselves after a big hunt and then not eating until they scored the next one.” Similarly, he explained, temporary fasting is a ritual of religions like Islam and Judaism — as demonstrated by Ramadan and Yom Kippur. “We shouldn’t have a fear of hunger if it is just temporary,” he said.

What Dr. Mosley found most astounding, however, were his personal results. Not only did he lose 20 pounds (he currently weighs 168 pounds) in nine weeks, but his glucose and cholesterol levels went down, as did his body fat. “What’s more, I have a whole new level of energy,” he said.

The documentary became an instant hit, which in turn led Mimi Spencer, a food and fashion writer, to propose that they collaborate on a book. “I could see this was not a faddish diet but one that was sustainable with long-term health results, beyond the obvious weight-loss benefit,” said Ms. Spencer, 45, who has lost 20 pounds on the diet within four months and lowered her B.M.I. by 2 points.

The result is a 200-page paperback: the first half written by Dr. Mosley outlining the scientific findings of intermittent fasting; the second by Ms. Spencer, with encouraging text on how to get through the first days of fasting, from keeping busy so you don’t hear your rumbling belly, to waiting 15 minutes for your meal or snack.

She also provides fasting recipes with tantalizing photos like feta niçoise salad and Mexican pizza, and a calorie counter at the back. (Who knew a quarter of a cup of balsamic vinegar added up to a whopping 209 calories?)

In London, the diet has taken off with the help of well-known British celebrity chefs and food writers like Hugh Fearnley-Whittingstall, who raved about it in The Guardian after his sixth day of fasting, having already lost eight pounds. (“I feel lean and sharper,” he wrote, “and find the whole thing rather exhilarating.”)

The diet is also particularly popular among men, according to Dr. Mosley, who has heard from many of his converts via e-mail and Twitter, where he has around 24,000 followers. “They find it easy to work into their schedules because dieting for a day here and there doesn’t feel torturous,” he said, adding that couples also particularly like doing it together.

But not everyone is singing the diet’s praises. The National Health System, Britain’s publicly funded medical establishment, put out a statement on its Web site shortly after the book came out: “Despite its increasing popularity, there is a great deal of uncertainty about I.F. (intermittent fasting) with significant gaps in the evidence.”

The health agency also listed some side effects, including bad breath, anxiety, dehydration and irritability. Yet people in London do not seem too concerned. A slew of fasting diet books have come out in recent weeks, notably the “The 5:2 Diet Book” and “The Feast and Fast Diet.”

There is also a crop of new cookbooks featuring fasting-friendly recipes. Let’s just say, the British are hungry for them.

This article has been revised to reflect the following correction:

Correction: March 2, 2013

A previous version of this article referred incorrectly to the national health care body in Britain. It is the National Health Service, not the National Health System.

In addition, a previous version referred imprecisely to the Balsamic ingredient that has 209 calories in a quarter cup. It is Balsamic vinegar dressing, not Balsamic vinegar.

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Fair Game: New York Fed Agreed to Testify for Bank of America

A.I.G., which is suing Bank of America to recover losses it suffered on those securities, has calculated the value of the fraud claims at $7 billion.

Late on Thursday, a copy of the actual agreement came to light. It was filed by Bank of America in a California court that is hearing the matter of who owns those fraud claims — A.I.G. or the New York Fed. The agreement was also filed by the New York Fed in a related lawsuit in the Southern District of New York, where the New York Fed asked that the court keep the agreement under seal.

A reading of the document makes it clear why.

The agreement spells out the terms of a deal in which the New York Fed received $43 million from Bank of America’s Countrywide unit. The money changed hands to settle a narrow dispute involving cash flows on several mortgage securities held by an investment vehicle, known as Maiden Lane II. That vehicle was created by the New York Fed as part of the rescue of A.I.G., which had held the Countrywide securities. The previously confidential agreement released Bank of America from all litigation claims on the securities held by Maiden Lane II.

But in exchange for that $43 million, the New York Fed did something else for Bank of America. It agreed to testify on behalf of the bank in its legal battle against A.I.G. over fraud claims.

In that matter, Bank of America has argued that A.I.G. has no right to sue it for fraud because A.I.G. sold the securities to Maiden Lane II and so transferred the litigation rights to the New York Fed. A.I.G., however, maintains that the Maiden Lane agreement never specified the transfer of the right to sue for fraud and that an explicit transfer is required by New York law, which governs the agreement. The New York Fed provided Bank of America with two affidavits supporting the bank’s view of who owned the mortgage securities’ fraud claims.

Two weeks ago, it was unclear why the New York Fed gave Bank of America the affidavits. But now, its promise to testify “as needed,” shown in the formerly confidential settlement, addresses that oddity. It was a contractual obligation.

Interestingly, the New York Fed did not tell the California court that its affidavits came about because of its deal with Bank of America. The affidavits came from James M. Mahoney, a vice president at the New York Fed, and Stephanie A. Heller, its deputy general counsel.

But those affidavits differ from the position taken earlier by Thomas C. Baxter Jr., the New York Fed’s general counsel. In a letter to A.I.G. in October 2011, Mr. Baxter said that he and his colleagues “agree that A.I.G. has the right to seek damages” under securities laws for the instruments it sold to Maiden Lane II.

Michael Carlinsky, A.I.G.’s lawyer at Quinn Emanuel Urquhart & Sullivan, said on Friday that he found it “disturbing” that the New York Fed made a contract to “assist Bank of America in its defense of A.I.G.’s lawsuit.”

Also on Friday, I asked the New York Fed why it had included this promise of legal support for Bank of America in the settlement agreement. Jack Gutt, a spokesman, said in a statement that the New York Fed had intended to hold the litigation rights and that the declarations were true.

“The New York Fed did not agree to provide the declarations to benefit B. of A., but rather because doing so helped the New York Fed obtain the best possible settlement” for Maiden Lane II, Mr. Gutt said. “In agreeing to this provision as part of what the New York Fed believed was a favorable settlement agreement, the New York Fed was concerned exclusively with advancing the taxpayer interest.”

I also asked a Bank of America spokesman whether the bank had paid more in the settlement because of the New York Fed’s promise to testify. He declined to answer that question, saying, “Countrywide provided fair value for a complete release of claims by the Federal Reserve Bank of New York, and the Fed agreed to provide testimony standing behind what it had formally represented to Countrywide regarding the assignment of claims from A.I.G.”  

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Kerry Criticizes Turkish Prime Minister Over Zionism Remark

ANKARA, Turkey — Secretary of State John Kerry said on Friday that Turkey’s prime minister had made “objectionable” remarks when he cast Zionism as a crime against humanity in comments earlier this week.

Prime Minister Recep Tayyip Erdogan said at a United Nations meeting in Vienna on Wednesday, “Just as with Zionism, anti-Semitism and fascism, it has become necessary to view Islamophobia as a crime against humanity.”

Mr. Kerry indirectly chastised the Turkish leader for the statement in his opening remarks following a meeting with Foreign Minister Ahmet Davutoglu, saying that it was important for all leaders to encourage a spirit of tolerance.

But Mr. Kerry was more pointed when asked about the comments during a joint news conference with Mr. Davutoglo. “We not only disagree with it. We found it objectionable,” he said in response to a question.

Turkey is the fifth stop on Mr. Kerry’s nine-nation tour and the first Muslim-majority nation he has visited as secretary of state.

Mr. Davutoglu, for his part, appeared unrepentant in his news conference with Mr. Kerry. The Turkish foreign minister insisted that Turkey was not hostile toward Israel and said that the downturn in relations was Israel’s fault, referring to the 2010 episode in which eight Turks and an American of Turkish descent were killed when Israeli commandos boarded the lead ship of a pro-Palestinian activist flotilla that was trying to break Israel’s blockade of Gaza.

“What did those nine individuals do so that with an army they were attacked as if they were aboard a hostile ship on open waters?” Mr. Davutoglu asked.

“If Israel wants to hear positive statements from Turkey it needs to reconsider its attitude both towards us and towards the West Bank,” he said. A senior State Department official, who spoke under ground rules that he not be identified by name on Mr. Kerry’s flight to Ankara, expressed the American position on the Turkish comments in less diplomatic terms than Mr. Kerry, saying that the pattern of Turkish denunciations of Israel was having a “corrosive effect” on American-Turkish relations.

“This was particularly offensive, frankly, to call Zionism a crime against humanity,” the official said, referring to Mr. Erdogan’s remarks. “It complicates our ability to do all of the things that we want to do together when we have such a profound disagreement about such an important thing.”

The official said that the United States wanted to foster a thawing in relations between Turkey and Israel, but that the current ties between those two nations were “frozen.”

“We want to see a normalization, not just for the sake of the two countries but for the sake of the region and, frankly, for the symbolism,” the official added. “Not that long ago you had these two countries demonstrating that a majority Muslim country could have very positive and strong relations with the Jewish state.”

Efforts to revive the Middle East peace process between Israel and the Palestinians and the conflict in Syria are also subjects on Mr. Kerry’s agenda here.

On Thursday, Mr. Kerry promised food and medical supplies for the armed Syrian resistance fighting to depose President Bashar al-Assad and $60 million in additional assistance to the opposition coalition’s political wing at a conference in Rome.

Mr. Kerry’s first stop here was a ceremony at the American Embassy where he paid tribute to Mustafa Akarsu, the Turkish security guard who was killed in a Feb. 1 attack by a suicide bomber at the embassy compound. Mr. Akarsu’s wife and children were in attendance as were two other Turkish guards wounded in the attack.

After his meeting with Mr. Davutoglu, Mr. Kerry headed to dinner with Mr. Erdogan. Arriving at the prime minister’s residence, Mr. Kerry apologized for being a little late, noting that he had had long discussions with the Turkish foreign minister.

Mr. Erdogan said through an interpreter that the two diplomats “must have spoken about everything so there is nothing left for us to talk about.”

“There’s a lot to talk about,” Kerry said. “We actually didn’t talk about everything.”

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'Switched at Birth' goes silent to make a point

LOS ANGELES (AP) — "Until hearing people walk a day in our shoes, they will never understand," says a guidance counselor at a high school for deaf students in "Switched at Birth."

Such insights are a staple of the ABC Family drama, a TV rarity that puts deaf characters, played by deaf or hard-of-hearing actors, at the center of the action.

But Monday's episode takes it a bold step further: Save for a few spoken words at the beginning and the end, it is silent. The actors' hands do the talking with American Sign Language, even rapping together in one gleeful sequence.

Subtitles, which are typically sprinkled throughout "Switched at Birth" episodes, keep the viewer clued in. But when a deaf character is confused because she can't hear something vital, the audience is too. It's powerfully disconcerting.

The cast, including Oscar-winner Marlee Matlin as the school counselor, are excited about what they see as a grand experiment and eager for viewer reaction.

"This is an opportunity for the hearing person to watch at home and try to experience it," said Katie Leclerc, who stars as deaf teenager Daphne Vasquez. "It's not exactly the same, but maybe you can try to imagine what your everyday life would be like."

"It's a risk," added Leclerc, who has an inner ear disorder, Meniere's disease, that can cause hearing loss and vertigo.

"A big risk," Matlin said through a sign language-interpreter. "But it's going to be an eye-opener. I'm very proud to be part of this risk-taking, history-making episode."

Matlin knows about making history. She was the first — and remains the only — deaf person to receive an Academy Award acting trophy, honored as best actress for 1986's "Children of a Lesser God."

The "Switched at Birth" episode pivots on another key moment for the deaf community: A 1988 student protest at Gallaudet University in Washington, D.C., that ended the unbroken succession of hearing presidents at the school for the deaf.

For fictional Carlton High School (inspired by real-life LA school, Marlton), more is at stake: The school faces closure because of funding cuts, which means its students will be "mainstreamed" with hearing teens.

(It mirrors a real-life trend caused by budget constraints, Leclerc said. There's also an increasing number of children being given cochlear implants to counter hearing loss, itself a controversial issue, according to series creator and executive producer Lizzy Weiss.)

The prospect is dreaded by the Carlton students, either because they've felt the sting of being an outsider or because they treasure being part of a deaf-oriented school.

"Deaf people feel that moving into the mainstream chips away at their community, which is about language and culture," said Jack Jason, Matlin's longtime interpreter and the series' on-set arbiter for correct sign-language use.

With Daphne as the driving force and invoking Gallaudet, students mobilize to take over the administration building and demand Carlton's survival. The conflict's ending will wait for the March 11 season finale.

The uprising panics parents and puts relationships at risk, including that of Daphne and Bay Kennish (Vanessa Marano), the switched-at-birth characters of the title who have come together as teenagers from two very different households.

"We started in the pilot with just one scene that was pure ASL," involving Daphne and Emmett (Sean Berdy), said Weiss. As the series developed, she and her writing team began pondering the "what-if" of an all-sign language episode for the second season.

Then ABC Family approached her with the same idea, and the challenge was on to find a logical and engaging way to realize the ASL-only goal and a big enough story to make the most of it.

Last year, a "CSI: NY" episode took a stab at a nearly silent episode, using music by Green Day for most of its storytelling before reverting to dialogue in the final act.

The solution for "Switched at Birth" was to make sure every scene included a deaf character: "The truth is, when you're around people who are deaf, it's considered rude not to sign if you know how," Weiss said.

To avoid overloading viewers with subtitles the story was designed to be highly visual, including scenes of the student protest complete with picket signs and a defiant "Take Back Carlton" banner unfurled from the occupied school building.

Although some moments depict the pitfalls of being a deaf person in a hearing world, Weiss said, that's balanced by positive aspects.

"If you have been anything that's in the minority — gay, Jewish, a woman, anything — you have some piece of your identity that brings with it a lot of baggage and hardship, but also a lot of pride," Weiss said. "That's what we're trying to connect with."

The episode also highlights the beauty of ASL and its "coolness," such as being able to sign across a crowded theater and have an essentially private conversation, she said.

As with a silent movie — last year's Oscar-winning "The Artist" the latest case in point — "Switched at Birth" includes music intended to reflect the characters' internal lives. A viewer could add to the silence by muting it, but Weiss said that misses the point.

The episode "is not about silence, or 'absence of' sound. It's about language and culture and seeing the world from the point of view of a deaf person, and our perspective is that deaf people's inner lives are not silent," she said.

Matlin, whose counselor is a recurring character on "Switched at Birth," said the episode is an emotional and professional high point for her, one she would like to see exceeded.

"I never thought in my life I would see this happen. But I want to go further in terms of using deaf actors. ... I want (Steven) Spielberg to say, 'Hey, we want to use deaf actors.' Why not? And, hey, let's have the same respect for actors who are deaf as for those who are hearing.

"I don't know if we'll ever get there, but never say never," Matlin said.

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Online:

http://www.abcfamily.go.com

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Lynn Elber is a national television columnist for The Associated Press. She can be reached at lelber(at)ap.org and on Twitter (at)lynnelber.

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Think Like a Doctor: The Man Who Wobbled

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

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

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

The Patient’s Story:

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

The Patient’s History:

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

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

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

The Dizziness:

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

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

You can read the report from that hospital admission below.

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

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

The Doctor’s Exam:

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

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

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

An Important Clue:

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

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

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

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

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

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

Solving the Mystery:

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

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

Friday March 1, 1:21 p.m. | Updated Thanks for all your responses! You can learn the correct diagnosis at “Think Like a Doctor: The Wobble Solved!”

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Detroit Car Sales Climb Again

DETROIT – Sales of new vehicles in the United States rose modestly in February, as consumers continued to buy more fuel-efficient cars and as businesses replaced aging pickup trucks with newer models.

Auto executives said overall industry sales for the month would improve about 2 percent over the strong results reported in the same period a year ago.

The seasonally adjusted annual sales rate – a closely watched indicator for the industry – is expected to total about 15.5 million vehicles for February.

That seasonal rate bodes well for the industry going forward, as automakers ratchet up production to meet demand for their new products.

The Detroit auto companies all posted positive results during the month.

General Motors, the largest American automaker, said it sold 224,000 vehicles in February, a 7 percent increase from the same month in 2012.

All of G.M.'s domestic brands – Chevrolet, Cadillac, GMC and Buick – had higher year-over-year sales. Cadillac led the way with a 20 percent gain, primarily because of healthy sales of the new ATS compact sedan.

G.M. also reported increases in sales of its newest small cars, like the Buick Verano and the Chevrolet Spark. But its most prominent gains were in pickup trucks.

The company said that sales of the Chevrolet Silverado pickup rose 29 percent, and the GMC Sierra increased 25 percent. Executives attributed the performance to a surge in housing starts and the need for construction companies to replace older pickups.

“A significant tailwind for our industry is new home construction, which is creating jobs and fueling the demand for pickups,” said Kurt McNeil, G.M.'s vice president of United States sales operations.

The Ford Motor Company, the second-biggest Detroit auto company, said it sold 195,000 vehicles during the month, a 9 percent gain from a year ago.

Ford said that many of its gains came from sales of sport utilities such as the Escape and Explorer. The company’s redesigned midsize sedan, the Fusion, also had a good month, with a 28 percent improvement over last year.

Like G.M., Ford also benefitted from the surging demand for pickups. Ford said that it sold 54,000 F-series trucks during the month, a 15 percent increase from February of 2012.

Chrysler, the smallest of the Detroit automakers, saw its growth rate slow somewhat after several months of reporting double-digit increases.

The company said that it sold 139,000 vehicles in February, a 4 percent improvement over a year earlier. That is a smaller increase than Chrysler has reported in previous months.

“In spite of a cautious ramp-up of some of our most popular products, which limited inventory last month, we still managed to record our strongest February in five years,” said Reid Bigland, head of United States sales for Chrysler.

Chrysler’s best performers during the month were passenger cars such as the new Dodge Dart. Sales of its Ram pickup increased 3 percent, while sales of its Jeep SUVs dropped 16 percent.

The big Japanese automakers were to report results later Friday. Analysts expected Toyota and Honda to continue their steady comeback from inventory disruptions because of the earthquake and tsunami in Japan two years ago.

Volkswagen, the German automaker that is rapidly expanding its American operations, said it sold 31,000 vehicles in February, a 3 percent increase from a year earlier.

Read More..

Study Finds Genetic Risk Factors Shared by 5 Psychiatric Disorders

Their study, published online Wednesday in the Lancet, was based on an examination of genetic data from more than 60,000 people world-wide. Its authors say it is the largest genetic study yet of psychiatric disorders. The findings strengthen an emerging view of mental illness that aims to make diagnoses based on the genetic aberrations underlying diseases instead of on the disease symptoms.

Two of the aberrations discovered in the new study were in genes used in a major signaling system in the brain, giving clues to processes that might go awry and suggestions of how to treat the diseases.

“What we identified here is probably just the tip of an iceberg,” said Dr. Jordan Smoller, lead author of the paper and a professor of psychiatry at Harvard Medical School and Massachusetts General Hospital. “As these studies grow we expect to find additional genes that might overlap.”

The new study does not mean that the genetics of psychiatric disorders are simple. Researchers say there seem to be hundreds of genes involved and the gene variations discovered in the new study only confer a small risk of psychiatric disease.

Steven McCarroll, director of genetics for the Stanley Center for Psychiatric Research at the Broad Institute of Harvard and M.I.T., said it was significant that the researchers had found common genetic factors that pointed to a specific signaling system.

“It is very important that these were not just random hits on the dartboard of the genome,” said Dr. McCarroll, who was not involved in the new study.

The work began in 2007 when a large group of researchers began investigating genetic data generated by studies in 19 countries and including 33,332 people with psychiatric illnesses and 27,888 people free of the illnesses for comparison. The researchers studied scans of peoples’ DNA, looking for variations in any of several million places along the long stretch of genetic material containing three billion DNA letters. The question: Did people with psychiatric illnesses tend to have a distinctive DNA pattern in any of those locations?

Researchers had already seen some clues of overlapping genetic effects in identical twins. One twin might have schizophrenia while the other had bipolar disorder. About six years ago, around the time the new study began, researchers had examined the genes of a few rare families in which psychiatric disorders seemed especially prevalent. They found a few unusual disruptions of chromosomes that were linked to psychiatric illnesses. But what surprised them was that while one person with the aberration might get one disorder a relative with the same mutation got a different one.

Jonathan Sebat, chief of the Beyster Center for Molecular Genomics of Neuropsychiatric Diseases at the University of California, San Diego, and one of the discoverers of this effect, said that work on these rare genetic aberrations had opened his eyes. “Two different diagnoses can have the same genetic risk factor,” he said.

In fact, the new paper reports, distinguishing psychiatric diseases by their symptoms has long been difficult. Autism, for example, at was once called childhood schizophrenia. It was not until the 1970s that autism was distinguished as a separate disorder.

But, Dr. Sebat, who did not work on the new study, said that until now it was not clear whether the rare families he and others had studied were an exception or whether they were pointing to a rule about multiple disorders arising from a single genetic glitch.

“No one had systematically looked at the common variations,” in DNA, he said. “We didn’t know if this was particularly true for rare mutations or if it would be true for all genetic risk.” The new study, he said, “shows all genetic risk is of this nature.”

The new study found four DNA regions that conferred a small risk of psychiatric disorders. For two of them, it is not clear what genes are involved or what they do, said Dr. Smoller. The other two, though, involve genes that are part of calcium channels, which are used when nerves send signals in the brain.

“The calcium channel findings suggest that perhaps – and this is a big if – treatments to affect calcium channel functioning might have effects across a range of disorders,” Dr. Smoller said.

There are drugs on the market that block calcium channels – they are used to treat high blood pressure – and researchers had already postulated that they might be useful for bipolar disorder even before the current findings.

One investigator, Dr. Roy Perlis of Massachusetts General Hospital, just completed a small study of a calcium channel blocker in 10 people with bipolar disorder and is about to expand it to a large randomized clinical trial. He also wants to study the drug in people with schizophrenia, in light of the new findings. He cautions, though, that people should not rush out to take a calcium channel blocker on their own.

“We need to be sure it is safe and we need to be sure it works,” Dr. Perlis said.

Read More..

Donald Trump returns to the 'Apprentice' boardroom

NEW YORK (AP) — There is something Donald Trump says he doesn't know.

Trump has welcomed a reporter to his 26th-floor corner office in Trump Tower to talk about "All-Star Celebrity Apprentice." And here in person, this one-of-a-kind TV star, billionaire businessman, ubiquitous brand mogul and media maestro strikes a softer pose than he has typically practiced in his decades on public display.

Relaxed behind a broad desk whose mirror sheen is mostly hidden by stacks of paper that suggest work is actually done there, Trump is pleasant, even chummy, with a my-time-is-your-time easiness greeting his guest.

He even contradicts his status as a legendary know-it-all with this surprising admission: There's a corner of the universe he doesn't understand.

The ratings woes of NBC, which airs his show, are on Trump's mind at the moment, and as he hastens to voice confidence in the network's powers-that-be ("They will absolutely get it right"), he marvels at the mysteries of the entertainment world.

"If I buy a great piece of real estate and do the right building, I'm really gonna have a success," he says. "It may be MORE successful or LESS successful, but you can sort of predict how it's gonna do. But show business is like trial and error! It's amazing!"

He loves to recall the iffy prospects for "The Apprentice" when it debuted in January 2004. With show biz, he declares, "You NEVER know what's gonna happen."

Except, of course, when you do.

"I do have an instinct," he confides. "Oftentimes, I'll see shows go on and I'll say, 'That show will never make it,' and I'm always right. And I understand talent. Does anybody ask me? No. But if they did, I would be doing them a big service. I know what people want."

So maybe he does know it all. In any case, lots of people wanted "The Apprentice." In its first season, it averaged nearly 21 million viewers each week.

And it gave Trump a signature TV platform that clinched his image as corporate royalty. He presided in a mood-lit stagecraft boardroom where celebrity subjects addressed him as "Mr. Trump" and shrank at that dismissive flick of his wrist and dreaded catchphrase, "You're fired."

The two-hour premiere of "All-Star Celebrity Apprentice" (Sunday at 9 p.m. EST) starts by rallying its 14 veteran contenders in the even more evocative setting of the 2,000-year-old Egyptian Temple of Dendur at the Metropolitan Museum of Art.

There, grandly, Trump receives such returning players as Gary Busey, Stephen Baldwin, LaToya Jackson and reality mean queen Omarosa.

Soon, teammates are chosen by team leaders Bret Michaels and Trace Adkins. Their first assignment: concoct a winning recipe for meatballs, then sell more of them than the rival team.

This is the 13th edition of the "Apprentice" franchise, which has now slipped to less than one-third its original viewership, according to Nielsen Co. figures. But even an audience matching last season's 6.26 million viewers would be pleasant news for NBC, which has recently fallen to fifth place in prime time, behind even Spanish-language Univision.

"I could probably do another show when I don't enjoy 'The Apprentice' anymore," says the 66-year-old Trump, mulling his TV future. "I have been asked by virtually every network on television to do a show for them. But there's something to sticking with what you have: This is a good formula. It works."

Years before "The Apprentice," Trump had hit on a winning formula for himself: Supercharge his business success with relentless self-promotion, putting a human face — his! — on the capitalist system, and embedding his persona in a feedback loop of performance and fame.

Since then, he has ruled as America's larger-than-life tycoon and its patron saint of material success. Which raises the question: Does he play a souped-up version of himself for his audience as Donald Trump, a character bigger and broader than its real-life inspiration?

He laughs, flashing something like a you-got-me smile.

"Perhaps," he replies. "Not consciously. But perhaps I do. Perhaps I do."

It began as early as 1987, when his first book, "Trump: The Art of the Deal," became a huge best-seller.

And even without a regular showcase, he was no stranger to TV. For instance, in the span of just 10 days in May 1997, Trump not only was seen on his "Miss Universe Pageant" telecast on CBS, but also made sitcom cameo appearances as himself on NBC's "Suddenly Susan" and ABC's "Drew Carey Show."

Meanwhile, as a frequent talk-show guest then (as now), he publicized his projects and pushed his brand.

"I'll be on that show for 20 or 30 or 60 minutes, and it costs me nothing," he notes. "When you have an opportunity for promotion, take it! It's free."

No one has ever accused Trump of hiding his light under a bushel. But his promotional drive (or naked craving for attention) has taken him to extremes that conventional wisdom warns against: saying and doing things that might hurt your bottom line.

Item: Trump's noisy, even race-baiting challenge to President Barack Obama to prove his American citizenship. This crusade has earned Trump the title from one editorialist as "birther blowhard."

For an industrialist and entertainer, where's the profit in voicing political views that could tick off a segment of your market or your audience?

"It's a great question, and a hard question to answer, because you happen to be right," Trump begins. "The fact is, some people love me, and some people the-opposite-of-love me, because of what I do and because of what I say. But I'm a very truthful person. By speaking out, it's probably not a good thing for me personally, but I feel I have an obligation to do it."

But isn't he being divisive with some of his pronouncements?

"I think 'divisive' would be a fair word in some cases, not in all cases," he replies. "But I think 'truthful' is another word."

The publicity he got from his political activism reached a fever pitch during his months-long, media-blitzed flirtation with running for president that seemed conveniently to dovetail with the Spring 2011 season of his TV show.

That May, he announced he would not run. For some, it was the final scene of nothing more than political theatrics.

"They weren't," Trump says quietly. "I was very seriously considering running. It was a race that the Republicans should have won. I made a mistake in not running, because I think I would have won."

He says he has no designs on this year's race for mayor of New York. But his politicizing continues apace. In his Twitter feed, with 2 million followers, he continues to bash China and rant about Washington. He phones in to Fox News Channel's "Fox & Friends" each Monday morning to vent his spleen.

"I believe in speaking my mind," he says, "and I don't mind controversy, as you probably noticed. I think sometimes controversy is a good thing, not a bad thing."

Last summer saw the opening in Aberdeen, Scotland, of Trump International Golf Links after a bitter, yearslong fight waged by environmentalists and local residents against government leaders and, of course, Trump.

A man for whom it seems no publicity is bad publicity, Trump insists the controversy helped the project.

"If there wasn't controversy surrounding it, I don't think anybody would even know it exists," he says, laying out the alternative: "I could take an ad: 'Golf course opening.'"

Trump even seems to profit from the harsh attention focused on his hair.

"I get killed on my hair!" he says, with no trace of remorse. But he wants everyone to know, "It's not a wig!" Nor is it an elaborately engineered coif to hide a hairline in retreat, as many Trump-watchers imagine.

To prove it, Trump does a remarkable thing: He lifts the flaxen locks that flop above his forehead to reveal, plain as day, a normal hairline.

"I wash my hair, I comb it, I set it and I spray it," he says. "That's it. I could comb it back and I'd look OK. But I've combed it this way for my whole life. It's become almost a trademark. And I think NBC would be very unhappy if I combed it back, 'cause — you know what? — maybe I wouldn't get as high a rating."

___

Online:

www.nbc.com

___

Frazier Moore is a national television columnist for The Associated Press. He can be reached at fmoore(at)ap.org and at http://www.twitter.com/tvfrazier

Read More..

Study Finds Genetic Risk Factors Shared by 5 Psychiatric Disorders

Their study, published online Wednesday in the Lancet, was based on an examination of genetic data from more than 60,000 people world-wide. Its authors say it is the largest genetic study yet of psychiatric disorders. The findings strengthen an emerging view of mental illness that aims to make diagnoses based on the genetic aberrations underlying diseases instead of on the disease symptoms.

Two of the aberrations discovered in the new study were in genes used in a major signaling system in the brain, giving clues to processes that might go awry and suggestions of how to treat the diseases.

“What we identified here is probably just the tip of an iceberg,” said Dr. Jordan Smoller, lead author of the paper and a professor of psychiatry at Harvard Medical School and Massachusetts General Hospital. “As these studies grow we expect to find additional genes that might overlap.”

The new study does not mean that the genetics of psychiatric disorders are simple. Researchers say there seem to be hundreds of genes involved and the gene variations discovered in the new study only confer a small risk of psychiatric disease.

Steven McCarroll, director of genetics for the Stanley Center for Psychiatric Research at the Broad Institute of Harvard and M.I.T., said it was significant that the researchers had found common genetic factors that pointed to a specific signaling system.

“It is very important that these were not just random hits on the dartboard of the genome,” said Dr. McCarroll, who was not involved in the new study.

The work began in 2007 when a large group of researchers began investigating genetic data generated by studies in 19 countries and including 33,332 people with psychiatric illnesses and 27,888 people free of the illnesses for comparison. The researchers studied scans of peoples’ DNA, looking for variations in any of several million places along the long stretch of genetic material containing three billion DNA letters. The question: Did people with psychiatric illnesses tend to have a distinctive DNA pattern in any of those locations?

Researchers had already seen some clues of overlapping genetic effects in identical twins. One twin might have schizophrenia while the other had bipolar disorder. About six years ago, around the time the new study began, researchers had examined the genes of a few rare families in which psychiatric disorders seemed especially prevalent. They found a few unusual disruptions of chromosomes that were linked to psychiatric illnesses. But what surprised them was that while one person with the aberration might get one disorder a relative with the same mutation got a different one.

Jonathan Sebat, chief of the Beyster Center for Molecular Genomics of Neuropsychiatric Diseases at the University of California, San Diego, and one of the discoverers of this effect, said that work on these rare genetic aberrations had opened his eyes. “Two different diagnoses can have the same genetic risk factor,” he said.

In fact, the new paper reports, distinguishing psychiatric diseases by their symptoms has long been difficult. Autism, for example, at was once called childhood schizophrenia. It was not until the 1970s that autism was distinguished as a separate disorder.

But, Dr. Sebat, who did not work on the new study, said that until now it was not clear whether the rare families he and others had studied were an exception or whether they were pointing to a rule about multiple disorders arising from a single genetic glitch.

“No one had systematically looked at the common variations,” in DNA, he said. “We didn’t know if this was particularly true for rare mutations or if it would be true for all genetic risk.” The new study, he said, “shows all genetic risk is of this nature.”

The new study found four DNA regions that conferred a small risk of psychiatric disorders. For two of them, it is not clear what genes are involved or what they do, said Dr. Smoller. The other two, though, involve genes that are part of calcium channels, which are used when nerves send signals in the brain.

“The calcium channel findings suggest that perhaps – and this is a big if – treatments to affect calcium channel functioning might have effects across a range of disorders,” Dr. Smoller said.

There are drugs on the market that block calcium channels – they are used to treat high blood pressure – and researchers had already postulated that they might be useful for bipolar disorder even before the current findings.

One investigator, Dr. Roy Perlis of Massachusetts General Hospital, just completed a small study of a calcium channel blocker in 10 people with bipolar disorder and is about to expand it to a large randomized clinical trial. He also wants to study the drug in people with schizophrenia, in light of the new findings. He cautions, though, that people should not rush out to take a calcium channel blocker on their own.

“We need to be sure it is safe and we need to be sure it works,” Dr. Perlis said.

Read More..