DealBook: R.B.S. Stock Drops Amid Concerns of Potential Guilty Plea in Libor Case

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Shares of the Royal Bank of Scotland stumbled on Tuesday after it emerged that federal authorities are pursuing a guilty plea against an Asian subsidiary at the center of an interest rate manipulation scandal.

Following a template developed in last year’s rare-rigging case against UBS, the Justice Department is pushing for the criminal action against the Royal Bank of Scotland, along with fines and penalties, according to two people with knowledge of the matter. The case could come as soon as next week.

The R.B.S. settlement is likely to include more than $650 million in fines levied by the American and British authorities, according to two other people with direct knowledge of the matter. At that level, the penalties would be the second largest settlement in the rate manipulation case after a $1.5 billion agreement with the Swiss bank UBS last month. Barclays paid $450 million last summer.

The Justice Department’s criminal division, which is pushing for a guilty plea with the Asian subsidiary of the Royal Bank of Scotland, could also strike a nonprosecution agreement with the parent company.

The threat of charges against the subsidiary weighed on the stock. After The Wall Street Journal reported on the potential guilty plea, the bank’s stock dropped 6 percent by the close of trading in London on Tuesday.

The settlement terms are not yet final. In particular, the Royal Bank of Scotland — which is 82 percent owned by British taxpayers after receiving a multibillion-dollar government bailout during the financial crisis — is resisting the guilty plea for the Asian subsidiary, fearful of the potential fallout. The bank, however, lacks leverage with the Justice Department, which can indict the subsidiary if it resists the guilty plea. An indictment would deliver a harsher blow to the bank and potentially set up a protracted legal battle.

“Discussions with various authorities” in the case “are ongoing,” said an RBS spokesman, adding that “we continue to cooperate fully with their investigations.”

The bank, which is based in Edinburgh, is also expected to cut its bonus pool by up to one third, or around $240 million, as it claws back funds to pay for the pending Libor settlement, according to a person with direct knowledge of the matter. A decision on bonuses has not been made, and the final figure will be released on Feb. 28 when the bank reports its next earnings.

“There is a legitimate concern that British taxpayers, who already have bailed out the bank, will be asked to pay for past mistakes at R.B.S.,” said Pat McFadden, a British politician who is a member of the British parliament’s treasury select committee that oversees the country’s finance industry. “Steps should be taken to minimize the exposure for taxpayers.”

Several senior RBS executives, including John Hourican, who runs the firm’s investment banking unit where the alleged illegal activity took place, are expected to step down amid the Libor scandal, though they have not been directly implicated in the matter, according to another person with direct knowledge of the matter.

The negotiations between R.B.S. and the regulators reflect the Justice Department’s aggressive new posture, as they look to hold banks responsible for wrongdoing in the rate rigging case. The wave of action has centered on the London interbank offered rate, or Libor, and other key international benchmark rates, which are central to determining the borrowing costs for trillions of dollars of financial products like corporate loans and credit cards. Banks are suspected of reporting false rates to squeeze out an extra profit and, in some cases, to deflect concerns about their financial health during the financial crisis.

Last month, the Justice Department secured a guilty plea against the Japanese subsidiary of UBS in a rate manipulation case. UBS also paid $1.5 billion in fines to the Justice Department, the Commodity Futures Trading Commission, the Financial Services Authority, the British regulator and Swiss authorities.

The deal with UBS sent a strong signal that authorities wanted to hold banks responsible for their wrongdoing. But it also limited the potential damage to the Swiss bank. By securing a guilty plea against a subsidiary, it sheltered the parent company from losing its charter to operate or other major repercussions.

“We are holding those who did wrong accountable,” Lanny A. Breuer, the head of the Justice Department’s criminal division, said at a news conference in December on the UBS case. “We cannot, and we will not, tolerate misconduct on Wall Street.”

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Well: Ask Well: Squats for Aging Knees

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You are already doing many things right, in terms of taking care of your aging knees. In particular, it sounds as if you are keeping your weight under control. Carrying extra pounds undoubtedly strains knees and contributes to pain and eventually arthritis.

You mention weight training, too, which is also valuable. Sturdy leg muscles, particularly those at the front and back of the thighs, stabilize the knee, says Joseph Hart, an assistant professor of kinesiology and certified athletic trainer at the University of Virginia, who often works with patients with knee pain.

An easy exercise to target those muscles is the squat. Although many of us have heard that squats harm knees, the exercise is actually “quite good for the knees, if you do the squats correctly,” Dr. Hart says. Simply stand with your legs shoulder-width apart and bend your legs until your thighs are almost, but not completely, parallel to the ground. Keep your upper body straight. Don’t bend forward, he says, since that movement can strain the knees. Try to complete 20 squats, using no weight at first. When that becomes easy, Dr. Hart suggests, hold a barbell with weights attached. Or simply clutch a full milk carton, which is my cheapskate’s squats routine.

Straight leg lifts are also useful for knee health. Sit on the floor with your back straight and one leg extended and the other bent toward your chest. In this position, lift the straight leg slightly off the ground and hold for 10 seconds. Repeat 10 to 20 times and then switch legs.

You can also find other exercises that target the knees in this video, “Increasing Knee Stability.”

Of course, before starting any exercise program, consult a physician, especially, Dr. Hart says, if your knees often ache, feel stiff or emit a strange, clicking noise, which could be symptoms of arthritis.

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Google Maps’ New Target: Secretive North Korea

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Google/Agence France-Presse — Getty Images


A still image from Google shows a before and after map of North Korea's capital, Pyongyang.







SEOUL, South Korea — Google threw open its Google Maps program for North Korea to “citizen cartographers” around the world on Tuesday, urging them to contribute whatever knowledge they have about one of the world’s most secretive countries.




The new map it published at the same time, built through crowdsourcing, provides people who normally visit the site for driving directions with a look, to the street level in some cases, of places they have previously read about only in articles about the North’s nuclear program. The map of Pyongyang, the capital, shows everything from landmarks — the tower that celebrates the country’s self-reliance doctrine of Juche and the main square where military parades are held — to hotels, schools and hospitals.


Users can zoom in for photos and even to post comments, updating a map that had previously been mostly blank. The site also marks what it says are the locations of some of the police state’s notorious gulags.


The popular mapping program is focusing new attention on the North at a time when the country is locked in a tense standoff with the United States and its allies over tightened sanctions and has promised to conduct a third nuclear test.


Google’s initiative came three weeks after its executive chairman, Eric E. Schmidt, visited Pyongyang in a highly publicized yet contentious trip organized by Bill Richardson, the former governor of New Mexico. Mr. Schmidt, a proponent of Internet connectivity who likes to describe the Web as the enemy of despots, said he urged North Korean officials he met in Pyongyang to let more North Koreans use the Internet.


The map is still not very detailed in much of the country, though it does include four enormous prison camps, highlighting them in gray shading. Google Maps is unlikely to provide important new information to policy makers and others who already have satellite maps, and Google Earth views, to depend on. But the crowdsourcing project provides a tool for Internet users anywhere in the world to help identify at least some features in the isolated country that the regime in Pyongyang doesn’t want the world to know. (The regime cherishes secrecy to such an extent that its propagandists liked to boast: “When our enemies try to peek into our republic, they only see a fog.”)


At the moment, the map released Tuesday is far less detailed than North Korean maps available in South Korean bookstores, or on a digital atlas using Google Earth published on the Web site 38 North.


In recent years, Internet bloggers and activists have relied on Google Earth, and defectors from North Korea, to locate several places believed to be prison camps. In each of the gulags, international human rights groups have said, thousands of political prisoners have been forced into hard labor for crimes like criticizing the ruling Kim dynasty in Pyongyang.


“So far, Google’s efforts are largely symbolic,” said Kim Yong-hyun, a North Korea specialist at Dongguk University in Seoul. “It won’t be easy to make a Google map of North Korea of the kind you see of other countries.”


Google Maps’ basic premise — Internet users filling in information about their neighborhood to help update and perfect a map — is severely limited for North Korea. The country is cut off from the Internet, except for its tiny elite, and even that group’s access is controlled.


Google can try to enlist the more than 24,000 North Korean defectors who live in South Korea, one of the world’s most wired countries. But most of them come from the north of the country and, given the tight control on people’s movements, their knowledge of other parts of North Korea before their defection is limited.


There was no immediate North Korean reaction to Google’s announcement on Tuesday.


Google said that although its map of North Korea is incomplete, it could be important to some South Koreans who originated from the North and who could now identify their old home villages.


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Lens Blog: Lynsey Addario's Photographs of Women in Combat

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Lynsey Addario, a  photographer for The New York Times, has extensively covered the war in Afghanistan, often focusing on female soldiers. She spoke with James Estrin about the Pentagon’s recent lifting of the ban on women in combat. The conversation, which took place via Skype from her home in London has been edited.

When I heard about the lifting of the ban on women in combat, I thought about your coverage of female soldiers for The Times, and also about the interview we did about women covering conflict after you were freed from captivity in Libya. What was your reaction to the announcement?

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Lynsey Addario

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Lynsey Addario, who freelances for The New York Times, The New York Times Magazine and others, has previously appeared on Lens Blog.

It is a huge step historically, of course, but it’s actually just stating publicly what has been happening little by little over the past decade. Women have been fighting this war more and more, whether we acknowledge it or not.

They’re at bases all across Afghanistan, and they’re playing different roles – from black ops pilots to doing triage in forward-operating medical centers. They’re engaging women in villages of Helmand that are covered with landmines. They are getting shot at. They are dying, and they are getting injured.

Everyone can fight about whether women should be on the front lines, but the fact is that they are out there. So, at some point, you have to acknowledge it and compensate them for it or at least give them the dignity of saying “O.K., you’re out there, and thank you for it.” Instead of saying, “No, they’re not allowed,” but really, they are.

You’ve often focused on female soldiers.

Mostly in 2009 and 2010. Most of the work I shot on assignment for The New York Times when I was doing a series with Elisabeth Bumiller. And then when I was doing the big National Geographic story on women in Afghanistan, I did a few embeds focusing on female soldiers who would meet Afghan women. That work is so dear to me, and I loved shooting it.

Who are these women joining the military and wanting to be in combat?

They’re women who don’t feel inhibited by their sex, by their gender. I mean, they’re women who don’t feel limited by the fact that they were born women. They believe in fighting for their country. They want to be doing something to help fight the wars that we’ve been fighting for over a decade. And they want to be out there.

They’re no different than any of us. They have a goal, and they want to accomplish it. And they don’t want to be told they can’t do it because they’re women.

A lot of them are extremely ambitious, very dedicated. They work out all the time, very intelligent.

What made you want to do this story to pursue it so deeply?

One of the biggest challenges as a photographer is to take a subject that’s been covered for decades and to try to bring something new to it. I’ve been going on these embeds for years, and it’s very hard to make a compelling picture or something new that the reader hasn’t seen before.

When I started seeing women on the front line, I was intrigued.  It felt so strange to me, and I immediately got pulled in. I also had access to them because I was often put in the same tent or made to sleep in the room with all the women. I was always sort of pushed off with the women because on military bases, there’s a real separation. You know, you have to have separate sleeping quarters for women.

What is that you learned as you pursued this story?

I think the longer these wars go on, and the more women are inserted in these nontraditional roles in the military, the more we have to accept the fact that there are actually women on the front lines.

I myself am a woman, and I’ve been embedding for years with the military. And granted, I’m not carrying thousands of rounds of ammunition and the packs that they carry. But I do go on the same patrols that the men go on and I am able to keep up.

There are great differences between men and women in terms of strength and what we can carry and what we can keep up with, but I don’t think it’s necessary for men and women to be equal. I think that women can play a role on the front line without having to hold up the same amount of weight as men.

You said that you don’t have to look at men and women as being equal for women to contribute on the front line. What exactly did you mean?

Well, I think one of the arguments a lot of people have is that women can’t hold their own the way men can. For example, if you have a fellow soldier who’s been shot, can you carry his body alone back to a safe place? And one of the arguments is that a woman couldn’t do that. So therefore, she shouldn’t be out there.

I don’t know how you work around that. I’m not really sure what the answer is. The fact is that women are not as strong as a lot of men. There are some women who are, but I think, over all, it’s going to be a challenge to find women who can keep up with the physical endurance tests that men can. That said, I’m not sure how important that is anymore because the war is changing. The war we fight now is not the same war that was fought 40 years ago.

This is a war on terror, this is a war where the front lines are nebulous.

When we talked about your being on the front lines shortly after you were freed from Libya, you pointed to specific things you thought a woman could bring to the table. A woman may not have the same access to men, but they’re going to have much stronger access to women. And different perspectives. Is there a similar situation for female soldiers on the front line?

This gets back into the discussion about what is the front line. The female engagement teams were created to engage with Afghan women — 50 percent of the population — that we didn’t have access to before. That’s part of the whole counterinsurgency project. So, if you’re trying to win over a population and you don’t have access to 50 percent of the people, it’s going to be very hard.

You can’t do that with men because, traditionally in Afghanistan, men cannot go into a house and sit down with Afghan women. The female engagement teams went in, and they were able to sit down, drink tea and talk to Afghan women.

How much was accomplished is obviously up for discussion. Some people say not that much was accomplished and that they just went and drank tea. Some people say, “Well, they were able to gain trust of families that didn’t before believe that Americans were good people.”

If your doctrine is counterinsurgency, if you’re trying to win over the population, it’s probably worth the effort to go out and try to engage in a country that’s very segregated by the sexes.

I’m older than you, and I remember when there weren’t many women in the military. And there were heated discussions about how women can’t be in the military, how women can’t be captured, how it would harm the other soldiers and it would hurt morale.

Well, I remember when Elizabeth Rubin and I went to the Korengal Valley to embed with the 173rd Airborne. This was for The New York Times Magazine. And Elizabeth wanted to do a story about why, with all the firepower that we had, we weren’t winning the war? And how come there was so much collateral damage? And so basically, we lived on the side of a mountain for two months of the Korengal Outpost.

But when we first asked the press guys with the military to go to that base, they said, “It is not a place fit for women. You cannot go.” And Elizabeth and I said that’s exactly where we want to go. Now we really want to go.

And so finally, we fought so much that they sent us to the Korengal, and we were the only two women there for months. This was before the female engagement teams, and that particular outpost saw heavy fighting all the time. I mean, we were basically shot at or mortared almost on a daily basis.

We kept up with all the patrols. We went on six, seven hour a day patrols. We carried our own stuff. We were out there getting shot at as well. Now, were we carrying guns and ammunition? No. So it’s a very different thing. But we were able to keep up and we were able to live out there.

I think when you start challenging the norms and when you start pushing the boundaries a little, you realize that the boundaries can really be pushed.

Is there anything that you can think of that is a realistic boundary between male and female soldiers?

Yes. I mean, there are times where you need someone who can carry the soldier if he gets shot. Or you need someone who physically can carry a certain amount of rounds of ammunition. I’m not a commander in the military, so there’s a lot I don’t understand.

There are situations where women aren’t really fit to be in certain roles. Special Forces, for example. Do I think women can be in Special Forces? I’m not sure. The demand on the body and spending extended periods of time in the middle of nowhere, I don’t know if that’s O.K. for women.

But I do think there is space for women on the front lines, but it is always going to be defined by what exactly is that front line. Because it’s not Vietnam, we’re in a very different war.  It’s different from 30 years ago, or 20 years ago.

Is the situation of a female foreign correspondent or photojournalist on the front lines similar to that of female soldiers?

It’s different, because the military has layers and layers and layers of command. And so they take decisions as a group.

You know, when you’re dealing with the military, those are decisions that are made at a very high level and passed down. Me, I’m in charge of my own destiny. So I can decide, to a certain extent, how much I want to be in the middle of combat.

One time, we were shot at as I was walking around with one of the female engagement teams. Just because legally, they weren’t allowed to be on the front lines, they were still being shot at on the front lines.

Follow @lynseyaddario, @JamesEstrin and @nytimesphoto on Twitter. Lens is also on Facebook.

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Generous Executive Pay at Bailed-Out Companies, Treasury Watchdog Says

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WASHINGTON – Top executives at firms that received taxpayer bailouts during the financial crisis continue to receive generous government-approved compensation packages, a Treasury watchdog said in a report released on Monday.


The report comes from the special inspector general for the Troubled Asset Relief Program, the bank bailout law passed at the end of the George W. Bush administration. The watchdog, a special inspector general for the program, commonly called Sigtarp, found that 68 out of 69 executives at Ally Financial, A.I.G. and General Motors received annual compensation of $1 million or more, with the Treasury’s signoff.


All but one of the top executives at the failed insurer A.I.G. – which required more than $180 billion in emergency taxpayer financing – received pay packages worth more than $2 million. And 16 top executives at the three firms earned combined pay of more than $100 million.


“In 2012, these three TARP companies convinced Treasury to roll back its guidelines by approving multimillion-dollar pay packages, high cash salaries, huge pay raises and removing compensation tied to meeting performance metrics,” Christy Romero, the special inspector general, said in a statement. “Treasury cannot look out for taxpayers’ interests if it continues to rely to a great extent on the pay proposed by companies that have historically pushed back on pay limits.”


The report charges that Treasury has failed to rein in excessive pay at the three firms. It found that Treasury approved all pay raises requested for A.I.G., Ally and General Motors executives last year, with individual compensation increases ranging from $30,000 to $1 million. It also faults the Treasury overseer for allowing pay packages above what comparable executives at other firms receive.


Moreover, the report accuses Treasury of failing to follow up earlier recommendations made by the special inspector general. A report issued a year ago made many similar criticisms, arguing that the Treasury officials “could not effectively rein in excessive compensation” because the most “important goal was to get the companies to repay” the government.


“Treasury made no meaningful reform to its processes,” it said in this year’s report. “Lacking criteria and an effective decision-making process, Treasury risks continuing to award executives of bailed-out companies excessive cash compensation without good cause.”


In a response letter included in the report, Patricia Geoghegan, acting special master for Tarp executive compensation, disputed several of its assertions. For one, the compensation packages for A.I.G. and General Motors executives were comparable to those received by executives at other firms, Treasury said. Pay packages at Ally were higher than the median due to “unique circumstances,” it said.


The Treasury also noted that the Obama administration has slashed pay for executives at bailed-out firms and required that the companies pay top employees with more stock and less cash. Treasury “continues to fulfill its regulatory requirements,” the letter argued. It has “limited executive compensation while at the same time keeping compensation at levels that enable the ‘exceptional assistance’ recipients to remain competitive and repay Tarp assistance.”


The Treasury Department is in the process of selling off its remaining shares of General Motors. In December, Treasury sold its final shares in A.I.G., bringing its and the Federal Reserve’s total profit on its investment in the company to nearly $23 billion.


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Well: Keeping Blood Pressure in Check

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Since the start of the 21st century, Americans have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease.

Now 48 percent of the more than 76 million adults with hypertension have it under control, up from 29 percent in 2000.

But that means more than half, including many receiving treatment, have blood pressure that remains too high to be healthy. (A normal blood pressure is lower than 120 over 80.) With a plethora of drugs available to normalize blood pressure, why are so many people still at increased risk of disease, disability and premature death? Hypertension experts offer a few common, and correctable, reasons:

Jane Brody speaks about hypertension.



¶ About 20 percent of affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.

¶ Of the 80 percent who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.

¶ Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.

¶ Many others do little to change lifestyle factors, like obesity, lack of exercise and a high-salt diet, that can make hypertension harder to control.

Dr. Samuel J. Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of the 71 percent of people with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages of the right ones.

Dr. Mann, author of “Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure,” says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.

Plus, he said in an interview, it can be done with minimal, if any, side effects and at a reasonable cost.

“For most people, no new drugs need to be developed,” Dr. Mann said. “What we need, in terms of medication, is already out there. We just need to use it better.”

But many doctors who are generalists do not understand the “intricacies and nuances” of the dozens of available medications to determine which is appropriate to a certain patient.

“Prescribing the same medication to patient after patient just does not cut it,” Dr. Mann wrote in his book.

The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for a patient’s hypertension, he said.

¶ Salt-sensitive hypertension, more common in older people and African-Americans, responds well to diuretics and calcium channel blockers.

¶ Hypertension driven by the kidney hormone renin responds best to ACE inhibitors and angiotensin receptor blockers, as well as direct renin inhibitors and beta-blockers.

¶ Neurogenic hypertension is a product of the sympathetic nervous system and is best treated with beta-blockers, alpha-blockers and drugs like clonidine.

According to Dr. Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he said.

One of Dr. Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Dr. Mann’s help.

After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, with side effects she could easily tolerate, and she no longer feared she would die young of a heart attack or stroke.

But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Dr. Mann said. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.

Specialists, he said, are most useful for treating the 10 percent to 15 percent of patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs, including a diuretic, and for those whose treatment is effective but causing distressing side effects.

Hypertension sometimes fails to respond to routine care, he noted, because it results from an underlying medical problem that needs to be addressed.

“Some patients are on a lot of blood pressure drugs — four or five — who probably don’t need so many, and if they do, the question is why,” Dr. Mann said.

How to Measure Your Blood Pressure

Mistaken readings, which can occur in doctors’ offices as well as at home, can result in misdiagnosis of hypertension and improper treatment. Dr. Samuel J. Mann, of Weill Cornell Medical College, suggests these guidelines to reduce the risk of errors:

¶ Use an automatic monitor rather than a manual one, and check the accuracy of your home monitor at the doctor’s office.

¶ Use a monitor with an arm cuff, not a wrist or finger cuff, and use a large cuff if you have a large arm.

¶ Sit quietly for a few minutes, without talking, after putting on the cuff and before checking your pressure.

¶ Check your pressure in one arm only, and take three readings (not more) one or two minutes apart.

¶ Measure your blood pressure no more than twice a week unless you have severe hypertension or are changing medications.

¶ Check your pressure at random, ordinary times of the day, not just when you think it is high.

Read More..

Well: Keeping Blood Pressure in Check

Label:

Since the start of the 21st century, Americans have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease.

Now 48 percent of the more than 76 million adults with hypertension have it under control, up from 29 percent in 2000.

But that means more than half, including many receiving treatment, have blood pressure that remains too high to be healthy. (A normal blood pressure is lower than 120 over 80.) With a plethora of drugs available to normalize blood pressure, why are so many people still at increased risk of disease, disability and premature death? Hypertension experts offer a few common, and correctable, reasons:

Jane Brody speaks about hypertension.



¶ About 20 percent of affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.

¶ Of the 80 percent who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.

¶ Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.

¶ Many others do little to change lifestyle factors, like obesity, lack of exercise and a high-salt diet, that can make hypertension harder to control.

Dr. Samuel J. Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of the 71 percent of people with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages of the right ones.

Dr. Mann, author of “Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure,” says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.

Plus, he said in an interview, it can be done with minimal, if any, side effects and at a reasonable cost.

“For most people, no new drugs need to be developed,” Dr. Mann said. “What we need, in terms of medication, is already out there. We just need to use it better.”

But many doctors who are generalists do not understand the “intricacies and nuances” of the dozens of available medications to determine which is appropriate to a certain patient.

“Prescribing the same medication to patient after patient just does not cut it,” Dr. Mann wrote in his book.

The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for a patient’s hypertension, he said.

¶ Salt-sensitive hypertension, more common in older people and African-Americans, responds well to diuretics and calcium channel blockers.

¶ Hypertension driven by the kidney hormone renin responds best to ACE inhibitors and angiotensin receptor blockers, as well as direct renin inhibitors and beta-blockers.

¶ Neurogenic hypertension is a product of the sympathetic nervous system and is best treated with beta-blockers, alpha-blockers and drugs like clonidine.

According to Dr. Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he said.

One of Dr. Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Dr. Mann’s help.

After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, with side effects she could easily tolerate, and she no longer feared she would die young of a heart attack or stroke.

But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Dr. Mann said. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.

Specialists, he said, are most useful for treating the 10 percent to 15 percent of patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs, including a diuretic, and for those whose treatment is effective but causing distressing side effects.

Hypertension sometimes fails to respond to routine care, he noted, because it results from an underlying medical problem that needs to be addressed.

“Some patients are on a lot of blood pressure drugs — four or five — who probably don’t need so many, and if they do, the question is why,” Dr. Mann said.

How to Measure Your Blood Pressure

Mistaken readings, which can occur in doctors’ offices as well as at home, can result in misdiagnosis of hypertension and improper treatment. Dr. Samuel J. Mann, of Weill Cornell Medical College, suggests these guidelines to reduce the risk of errors:

¶ Use an automatic monitor rather than a manual one, and check the accuracy of your home monitor at the doctor’s office.

¶ Use a monitor with an arm cuff, not a wrist or finger cuff, and use a large cuff if you have a large arm.

¶ Sit quietly for a few minutes, without talking, after putting on the cuff and before checking your pressure.

¶ Check your pressure in one arm only, and take three readings (not more) one or two minutes apart.

¶ Measure your blood pressure no more than twice a week unless you have severe hypertension or are changing medications.

¶ Check your pressure at random, ordinary times of the day, not just when you think it is high.

Read More..

TIMESCAST: Changes Unveiled at The New Republic

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January 28, 2013By Fritzie Andrade, Zena Barakat, Whitney Dangerfield, Vijai Singh, Elaisha Stokes and Pedro Rafael Rosado

TimesCast Media+Tech: The right to unlock cellphones expires. | Chris Hughes, publisher of The New Republic, discusses its redesign. | An animated look at how technology may change our daily routines.

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The Lede Blog: Images of New Clashes in Egypt, Two Years After the Revolution's 'Day of Rage'

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Last Updated, 2:47 p.m. This post has been updated throughout the day with reports from bloggers and journalists in Egypt, where protests and clashes continued in major cities despite an attempt to impose emergency rule.

As my colleague David Kirkpatrick reports from Egypt, there were protests in the Suez Canal city of Port Said and fresh clashes in Cairo on Monday.

Video uploaded to YouTube on Sunday showed officers firing at protesters in Port Said, killing four, including a man in a wheelchair, according to Mosireen, a collective of activist Egyptian filmmakers.

Video said to show Egyptian police officers firing at protesters in the Suez Canal city of Port Said on Sunday.

As clashes continued in Port Said on Monday, despite a declaration of martial law, journalists and bloggers there uploaded video of angry chants against the government at funerals for protesters and reports of escalating mayhem.

Video said to show the funeral of protesters killed in Port Said, Egypt on Monday.

In Cairo, police fired tear gas on Sunday and Monday at protesters at the foot of the Kasr el-Nile bridge near Tahrir Square, which was the scene of an epic battle during the uprising against former President Hosni Mubarak exactly two years ago, on what was known as the revolution’s “Day of Rage.”

The activist blogger Omar Kamel shared dramatic photographs and video of the clashes by the bridge on Sunday, showing clouds of tear gas in front of the luxury hotels along the Nile Corniche illuminated by the protesters’ fireworks and lasers.

Video of clashes along the Nile Corniche in Cairo on Sunday night, posted online by Omar Kamel, an activist filmmaker.

The Egyptian newspaper El Watan uploaded video of clashes in the same area on Monday.

Video on clashes in Cairo on Monday, from hte Egyptian news site El Watan.

The Cairene blogger who writes as Kikhote uploaded video shot from above Tahrir Square on Monday that zoomed in to the foot of the Kasr el-Nil bridge, showing the location of the bridge and what looked like hundreds of protesters gathered there.

Video shot from above Tahrir Square on Monday showed the location of clashes at Kasr el-Nil bridge nearby.

Kikhote also drew attention to the activist blogger Rasha Azab’s photograph of a cloud of tear gas in the air above the heads of protesters near the foot of the bridge on Monday, in front of the distinctive salmon-colored facade of the Cairo Semiramis hotel.

Tarek Shalaby, another activist blogger, reported on Twitter that a couple of hundred protesters remained on the bridge, with dozens of officers from the Central Security Forces on the Corniche nearby, at about 2 p.m. on Monday afternoon.

A short time later, my colleague Kareem Fahim reported from the bridge that tear gas was being fired at protesters on the Cornche.

At abut 5 p.m. local time, Jonathan Rashad, a photographer, reported on Twitter that the officers had pushed protesters back from the Cornche on to the bridge and into Tahrir Square.

About two hours later, the Egyptian journalists Mohamed Abdelfattah and Simon Hanna reported from the Corniche that a protest march coming from the other direction had broken through the police lines just down the street from the Semiramis, and, after some fighting, the protesters captured a senior officer outside another luxury hotel, the Kempinski.

Witnesses also said that the protesters then took control of one police armored personnel carrier, driving it to Tahrir Square, and set fire to another.

At about 8 p.m. local time the A.P.C. that was driven into Tahrir Square by protesters was also on fire, as video posted online by the blogger Kikhote showed.

Video of an armored personnel carrier ablaze in Tahrir Square on Monday night.

As the 9 p.m. curfew imposed on Port Said approached, Rawya Rageh, a correspondent for Al Jazeera English, reported from the city that thousands of protesters had taken to the streets to defy the order — including the local soccer club’s most hardcore fans, the ultras, who were blamed for a deadly riot last year.

A blogger named Sameh Abd El-Khalek uploaded photographs to Twitter of what he said was the protest march on Monday night.

As the Egyptian blogger who writes as The Big Pharaoh noted, live television images also showed thousands of protesters breaking the 9 p.m. curfew in the city of Suez.

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Unboxed: Literary History, Seen Through Big Data’s Lens

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ANY list of the leading novelists of the 19th century, writing in English, would almost surely include Charles Dickens, Thomas Hardy, Herman Melville, Nathaniel Hawthorne and Mark Twain.




But they do not appear at the top of a list of the most influential writers of their time. Instead, a recent study has found, Jane Austen, author of “Pride and Prejudice, “ and Sir Walter Scott, the creator of “Ivanhoe,” had the greatest effect on other authors, in terms of writing style and themes.


These two were “the literary equivalent of Homo erectus, or, if you prefer, Adam and Eve,” Matthew L. Jockers wrote in research published last year. He based his conclusion on an analysis of 3,592 works published from 1780 to 1900. It was a lot of digging, and a computer did it.


The study, which involved statistical parsing and aggregation of thousands of novels, made other striking observations. For example, Austen’s works cluster tightly together in style and theme, while those of George Eliot (a k a Mary Ann Evans) range more broadly, and more closely resemble the patterns of male writers. Using similar criteria, Harriet Beecher Stowe was 20 years ahead of her time, said Mr. Jockers, whose research will soon be published in a book, “Macroanalysis: Digital Methods and Literary History” (University of Illinois Press).


These findings are hardly the last word. At this stage, this kind of digital analysis is mostly an intriguing sign that Big Data technology is steadily pushing beyond the Internet industry and scientific research into seemingly foreign fields like the social sciences and the humanities. The new tools of discovery provide a fresh look at culture, much as the microscope gave us a closer look at the subtleties of life and the telescope opened the way to faraway galaxies.


“Traditionally, literary history was done by studying a relative handful of texts,” says Mr. Jockers, an assistant professor of English and a researcher at the Center for Digital Research in the Humanities at the University of Nebraska. “What this technology does is let you see the big picture — the context in which a writer worked — on a scale we’ve never seen before.”


Mr. Jockers, 46, personifies the digital advance in the humanities. He received a Ph.D. in English literature from Southern Illinois University, but was also fascinated by computing and became a self-taught programmer. Before he moved to the University of Nebraska last year, he spent more than a decade at Stanford, where he was a founder of the Stanford Literary Lab, which is dedicated to the digital exploration of books.


Today, Mr. Jockers describes the tools of his trade in terms familiar to an Internet software engineer — algorithms that use machine learning and network analysis techniques. His mathematical models are tailored to identify word patterns and thematic elements in written text. The number and strength of links among novels determine influence, much the way Google ranks Web sites.


It is this ability to collect, measure and analyze data for meaningful insights that is the promise of Big Data technology. In the humanities and social sciences, the flood of new data comes from many sources including books scanned into digital form, Web sites, blog posts and social network communications.


Data-centric specialties are growing fast, giving rise to a new vocabulary. In political science, this quantitative analysis is called political methodology. In history, there is cliometrics, which applies econometrics to history. In literature, stylometry is the study of an author’s writing style, and these days it leans heavily on computing and statistical analysis. Culturomics is the umbrella term used to describe rigorous quantitative inquiries in the social sciences and humanities.


“Some call it computer science and some call it statistics, but the essence is that these algorithmic methods are increasingly part of every discipline now,” says Gary King, director of the Institute for Quantitative Social Science at Harvard.


Cultural data analysts often adapt biological analogies to describe their work. Mr. Jockers, for example, called his research presentation “Computing and Visualizing the 19th-Century Literary Genome.”


Such biological metaphors seem apt, because much of the research is a quantitative examination of words. Just as genes are the fundamental building blocks of biology, words are the raw material of ideas.


“What is critical and distinctive to human evolution is ideas, and how they evolve,” says Jean-Baptiste Michel, a postdoctoral fellow at Harvard.


Mr. Michel and another researcher, Erez Lieberman Aiden, led a project to mine the virtual book depository known as Google Books and to track the use of words over time, compare related words and even graph them.


Google cooperated and built the software for making graphs open to the public. The initial version of Google’s cultural exploration site began at the end of 2010, based on more than five million books, dating from 1500. By now, Google has scanned 20 million books, and the site is used 50 times a minute. For example, type in “women” in comparison to “men,” and you see that for centuries the number of references to men dwarfed those for women. The crossover came in 1985, with women ahead ever since.


In work published in Science magazine in 2011, Mr. Michel and the research team tapped the Google Books data to find how quickly the past fades from books. For instance, references to “1880,” which peaked in that year, fell to half by 1912, a lag of 32 years. By contrast, “1973” declined to half its peak by 1983, only 10 years later. “We are forgetting our past faster with each passing year,” the authors wrote.


JON KLEINBERG, a computer scientist at Cornell, and a group of researchers approached collective memory from a very different perspective.


This article has been revised to reflect the following correction:

Correction: January 27, 2013

An earlier version of this article misstated Matthew L. Jockers’s age. He is 46, not 48. 



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