The New Old Age Blog: Taking a Zen Approach to Caregiving

You try to help your elderly father. Irritated and defensive, he snaps at you instead of going along with your suggestion. And you think “this is so unfair” and feel a rising tide of anger.

How to handle situations like this, which arise often and create so much angst for caregivers?

Jennifer Block finds the answer in what she calls “contemplative caregiving” — the application of Buddhist principles to caregiving and the subject of a year-long course that starts at the San Francisco Zen Center in a few weeks.

This approach aims to cultivate compassion, both for older people and the people they depend on, said Ms. Block, 49, a Buddhist chaplain and the course’s lead instructor. She’s also the former director of education at the Zen Hospice project in San Francisco and founder of the Beyond Measure School for Contemplative Care, which is helping develop a new, Zen-inspired senior living community in the area.

I caught up with Ms. Block recently, and what follows is an edited transcript of our conversation.

Let’s start with your experience. Have you been a caregiver?

My experience in caregiving is as a professional providing spiritual care to individuals and families when they are facing and coping with aging and sickness and loss and dying, particularly in hospital and hospice settings.

What kinds of challenges have you witnessed?

People are for the most part unprepared for caregiving. They’re either untrained or unable to trust their own instincts. They lack confidence as well as knowledge. By confidence, I mean understanding and accepting that we don’t know all the answers – what to do, how to fix things.

This past weekend, I was on the phone with a woman who’d brought her mom to live near her in assisted living. The mom had been to the hospital the day before. My conversation with the daughter was about helping her see the truth that her mother needed more care and that was going to change the daughter’s responsibilities and her life. And also, her mother was frail, elderly, and coming nearer to death.

That’s hard, isn’t it?

Yes, because we live in a death-denying society. Also, we live in a fast-paced, demanding world that says don’t sit still — do something. But people receiving care often need most of all for us to spend time with them. When we do that, their mortality and our grief and our helplessness becomes closer to us and more apparent.

How can contemplative caregiving help?

We teach people to cultivate a relationship with aging, sickness and dying. To turn toward it rather than turning away, and to pay close attention. Most people don’t want to do this.

A person needs training to face what is difficult in oneself and in others. There are spiritual muscles we need to develop, just like we develop physical muscles in a gym. Also, the mind needs to be trained to be responsive instead of reactive.

What does that mean?

Here’s an example. Let’s say you’re trying to help your mother, and she says something off-putting to you like “you’ve always been terrible at keeping house. It’s no wonder you lost my pajamas.”

The first thing is to notice your experience. To become aware of that feeling, almost like being slapped emotionally. To notice your chest tightening.

Then I tell people to take a deep breath. And say something to themselves like “soften” to address that tightness. That’s how you can stay facing something uncomfortable rather than turning away.

If I were in this position, I might say something to myself like “hello unhappiness” or “hello suffering” or “hello aging” to tether myself.

The second step would be curiosity about that experience. Like, wow, where do I feel that anger that rose up in me, or that fear? Oh, it’s in my chest. I’m going to feel that, stay with it, investigate it.

Why is that important?

Because as we investigate something we come to understand it. And, paradoxically, when we pay attention to pain it changes. It softens. It moves. It lessens. It deepens. And we get to know it and learn not to be afraid of it or change it or fix it but just come alongside of it.

Over hours, days, months, years, the mind and heart come to know pain. And the response to pain is compassion — the wish for the alleviation of pain.

Let’s go back to what mother said about your housekeeping and the pajamas. Maybe you leave the room for five minutes so you can pay attention to your reaction and remember your training. Then, you can go back in and have a response rather than a reaction. Maybe something like “Mom, I think you’re right. I may not be the world’s best housekeeper. I’m sorry I lost your pajamas. It seems like you’re having a pretty strong response to that, and I’d like to know why it matters so much to you. What’s happening with you today?”

Are other skills important?

Another skill is to become aware of how much we receive as well as give in caregiving. Caregiving can be really gratifying. It’s an expression of our values and identity: the way we want the world to be. So, I try to teach people how this role benefits them. Such as learning what it’s like to be old. Or having a close, intimate relationship with an older parent for the first time in decades. It isn’t necessarily pleasant or easy. But the alternative is missing someone’s final chapter, and that can be a real loss.

What will you do in your course?

We’ll teach the principles of contemplative care and discuss them. We’ll have homework, such as ‘Bring me three examples of someone you were caring for who was caring toward you in return.’ That’s one way of practicing attention. And people will train in meditation.

We’ll also explore our own relationship to aging, sickness, dying and loss. We’ll tell our stories: this is the situation I was in, this is where I felt myself shut down, this was the edge of my comfort or knowledge. And we’ll teach principles from Buddhism. Equanimity. Compassion. Deep inner connectedness.

What can people do on their own?

Mindfulness training is offered in almost every city. That’s one of the core components of this approach.

I think every caregiver needs to have their own caregiver — a therapist or a colleague or a friend, someone who is there for them and with whom they can unburden themselves. I think of caregiving as drawing water from a well. We need to make sure that we have whatever nurtures us, whatever supplies that well. And often, that’s connecting with others.

Are other groups doing this kind of work?

In New York City, the New York Zen Center for Contemplative Care educates the public and professionals about contemplative care. And in New Mexico, the Upaya Zen Center does similar work, much of it centered around death and dying.

People who want to read about this might want to look at a new book of essays, “The Arts of Contemplative Care: Pioneering Voices in Buddhist Chaplaincy and Pastoral Work” (Wisdom Publications, 2012).

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Visit by Google Chairman May Benefit North Korea

BEIJING — As a work of propaganda, the images that North Korea circulated this week showing Google’s executive chairman, Eric E. Schmidt, touring a high-tech incubation center are hard to beat.

Adrian Bradshaw/European Pressphoto Agency

Eric E. Schmidt, Google’s executive chairman, at left wearing a tie, and former Gov. Bill Richardson of New Mexico spoke to reporters in Beijing on Thursday after returning from North Korea.

With former Gov. Bill Richardson of New Mexico at his side, Mr. Schmidt, who is fond of describing the Internet as the enemy of despots, toured what was presented as the hub of the computer industry in one of the world’s most pitiless police states. Both men gazed attentively as a select group of North Koreans showed their ability to surf the Web.

It is unclear what the famously hermetic North Koreans hoped to accomplish by allowing the visit. But the photos of the billionaire entrepreneur taking the time to visit the nation’s computer labs were bound to be useful to a new national leader whom analysts say needs to show his people that their impoverished nation is moving forward.

It will matter little, those experts say, that the visitors were bundled against the cold, indoors — a sign of the country’s extreme privation — or that the vast majority of North Koreans have no access to computers, much less the Web beyond their country’s tightly controlled borders.

The men’s quixotic four-day trip ended Thursday much the way it began, with some analysts calling the visit hopelessly naïve and others describing it as valuable back-channel diplomacy at a time when Washington and Pyongyang are not on speaking terms (again).

“I’m still spinning my wheels to figure out a plausible motivation for why they went,” said Daniel Pinkston, a North Korea specialist at the International Crisis Group.

Mr. Schmidt and Mr. Richardson insist they accomplished some good — showing the world has not forgotten the plight of an American detained in the North, and at least trying to nudge the tightly sealed nation a bit closer to the fold of globally connected nations.

“As the world becomes increasingly connected, their decision to be virtually isolated is very much going to affect their  physical world, their economic growth and so forth,” Mr. Schmidt told reporters after arriving at Beijing International Airport. “We made that alternative very, very clear.”

The unofficial visit, however, raised hackles in Washington, and provided rich fodder for commentators and comedians. Even before the Americans left Pyongyang, someone created an account on Tumblr, the popular social blogging site, called “Eric Schmidt looking at things,” that parodied sites (themselves parodies) featuring the country’s leaders earnestly inspecting livestock, soldiers or leather insoles. (Mr. Schmidt is shown looking intently at computer screens, “the back of a North Korean Student,” and Mr. Richardson.)

Others were less kind. Senator John McCain, Republican of Arizona, took to Twitter to call the self-appointed delegation “useful idiots,” and John R. Bolton, a former United Nations ambassador, said the delegation was unwittingly feeding the North Korean propaganda mill as it sought to burnish the credentials of Kim Jung-un, the nation’s leader, who is in his 20s.

“Pyongyang uses gullible Americans for its own purposes,” Mr. Bolton wrote in The New York Daily News.

The State Department said it did not think the timing of the visit was “particularly helpful,” given efforts by the United States to rally international support for tougher sanctions following North Korea’s recent launching of a rocket that intelligence experts say could help in the development of missiles that could one day reach the United States.

As if on cue, the North Korean news media hailed the visit by “the Google team” — which included Jared Cohen, who leads Google’s think tank — highlighting their visit to the mausoleum where Mr. Kim’s grandfather and father lie in state. There, Mr. Richardson and Mr. Schmidt “expressed admiration and paid respect to Comrade Kim Il-sung and Comrade Kim Jong-il,” the North’s main party newspaper, Rodong Sinmun, said.

Choe Sang-Hun contributed reporting from Seoul, South Korea, Claire Cain Miller from San Francisco, and Edward Wong from Beijing.

This article has been revised to reflect the following correction:

Correction: January 11, 2013

An earlier version of this article paraphrased incorrectly State Department comments about the visit to North Korea by Mr. Schmidt and Mr. Richardson. The Department said it did not think the timing of the visit was “particularly helpful.” It did not call the visit “not particularly helpful.”

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IHT Rendezvous: Top Pirate Quits as Tide Turns Against Somali Raiders

LONDON — A notorious Somali sea raider known as Big Mouth is a pirate with a retirement plan.

He announced this week that he was quitting after an eight-year career in which he and his pirate crews plagued shipping in the Indian Ocean and raised millions of dollars in ransom.

Big Mouth — Mohamed Abdi Hassan — was named in a United Nations report last year as one of the most notorious and influential leaders of a Somali pirate network.

His decision to call it a day may be further evidence that international action, including patrols by European and other navies, is at last succeeding in containing the piracy scourge off the coast of east Africa.

“I have decided to renounce and quit, and from today on I will not be involved in this gang activity,” the pirate leader said in Somalia’s northern region of Adado on Wednesday. (You can watch his valedictory press conference here.)

He said he had also successfully encouraged many of his colleagues to quit.

Mr. Hassan’s decision came in the same week in which Koji Sekimizu of Japan, head of the International Maritime Organization, said 2012 saw a sharp reduction in successful piracy incidents off the coast of Somalia and in the Indian Ocean.

During the course of the year, the sea raiders only succeeded in capturing 13 vessels, as against 49 in 2010 and 28 in 2011, a year that saw a record number of pirate attacks.

The European Union’s naval task force in the region said last April that factors in the decrease included more armed security aboard merchant vessels and the presence of foreign navies.

Timo Lange, the spokesman for the force, said recently that anti-piracy efforts had been enhanced by a European decision to allow navies to destroy pirate supplies on shore, whereas previously that power was limited to the open waters.

In May, the force performed its first shoreline operation, sending an aircraft over the Somali coast to destroy pirate equipment that had been assembled for a mission.

In Big Mouth’s case, an additional factor in his decision to quit might have been the provision of a diplomatic passport by Somalia’s transitional government as an inducement. Last year’s U.N. report said the pirate boss had used it to visit his wife and family abroad.

The biggest anti-piracy victory of the year came last month, when naval police from the breakaway province of Puntland overran a pirate stronghold and liberated the MV Iceberg, a Panama-flagged cargo vessel, and its 22 crew members, who had been held for almost three years.

Mr. Sekimuzu cautioned this week that the scourge was not yet over. Twelve vessels and 159 people were still in the hands of Somali pirates, he said.

There are also concerns that the eventual scaling back of some naval forces might encourage a resurgence.

In Britain, which is facing naval cutbacks, a consortium of business executives has set up the country’s first private navy in 200 years. This year it will start protecting shipping in the Indian Ocean and elsewhere at a daily cost of $10,000 to $12,000 per vessel.

Meanwhile, the maritime authorities are warning seafarers that a decline in piracy off Somalia is being offset by an increase in incidents off West Africa. There were 32 attacks in the Gulf of Guinea in the first half of 2012, as against 25 in the same period the previous year.

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Daily Stock Market Activity

Stocks rose on Wall Street at the opening of trading on Thursday as stronger-than-expected exports in China, the world’s second-biggest economy, raised hopes for a more robust recovery in the global economy this year.

The Standard & Poor’s 500-stock index added 0.4 percent, the Dow Jones industrial average rose 0.3 percent and the Nasdaq composite index gained 0.5 percent in morning trading.

Data showed China’s export growth rebounded sharply to a seven-month high in December, a strong finish to the year after seven straight quarters of slowdown, even as demand from Europe and the United States remained subdued.

Ford shares gained 3.2 percent after it doubled its first-quarter dividend to 10 cents a share, despite a recent drop in market share.

Adding to the bullish sentiment, Spanish benchmark government bond yields fell below 5 percent to a 10-month low on the back of a strong bond auction that raised more than the targeted amount. European stock markets were trading higher after the European Central Bank kept benchmark interest rates steady.

“The market’s more positive and it owes a lot of that to the Chinese economic data,” said Art Hogan, managing director of Lazard Capital Markets in New York, adding that the success of the Spanish auction was also of note.

Shares of the upscale jeweler Tiffany dropped 6 percent after it said earnings for the year through Jan. 31 will be at the lower end of its forecast.

Molycorp shares dropped 20 percent after the company said revenue and cash flow would be lower than expected this year due to lower rare-earth prices.

Nokia shares jumped 14 percent on Wall Street after the Finnish handset maker said its fourth-quarter results were better than expected and that the mobile phone business achieved underlying profitability.

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Flu Widespread, Leading a Range of Winter’s Ills

It is not your imagination — more people you know are sick this winter, even people who have had flu shots.

The country is in the grip of three emerging flu or flulike epidemics: an early start to the annual flu season with an unusually aggressive virus, a surge in a new type of norovirus, and the worst whooping cough outbreak in 60 years. And these are all developing amid the normal winter highs for the many viruses that cause symptoms on the “colds and flu” spectrum.

Influenza is widespread, and causing local crises. On Wednesday, Boston’s mayor declared a public health emergency as cases flooded hospital emergency rooms.

Google’s national flu trend maps, which track flu-related searches, are almost solid red (for “intense activity”) and the Centers for Disease Control and Prevention’s weekly FluView maps, which track confirmed cases, are nearly solid brown (for “widespread activity”).

“Yesterday, I saw a construction worker, a big strong guy in his Carhartts who looked like he could fall off a roof without noticing it,” said Dr. Beth Zeeman, an emergency room doctor for MetroWest Medical Center in Framingham, Mass., just outside Boston. “He was in a fetal position with fever and chills, like a wet rag. When I see one of those cases, I just tighten up my mask a little.”

Massachusetts General Hospital in Boston started asking visitors with even mild cold symptoms to wear masks and to avoid maternity wards. The hospital has treated 532 confirmed influenza patients this season and admitted 167, even more than it did by this date during the 2009-10 swine flu pandemic.

At Brigham and Women’s Hospital, 100 patients were crowded into spaces licensed for 53. Beds lined halls and pressed against vending machines. Overflow patients sat on benches in the lobby wearing surgical masks.

“Today was the first time I think I was experiencing my first pandemic,” said Heidi Crim, the nursing director, who saw both the swine flu and SARS outbreaks here. Adding to the problem, she said, many staff members were at home sick and supplies like flu test swabs were running out.

Nationally, deaths and hospitalizations are still below epidemic thresholds. But experts do not expect that to remain true. Pneumonia usually shows up in national statistics only a week or two after emergency rooms report surges in cases, and deaths start rising a week or two after that, said Dr. Gregory A. Poland, a vaccine specialist at the Mayo Clinic in Minnesota. The predominant flu strain circulating is an H3N2, which typically kills more people than the H1N1 strains that usually predominate; the relatively lethal 2003-4 “Fujian flu” season was overwhelmingly H3N2.

No cases have been resistant to Tamiflu, which can ease symptoms if taken within 48 hours, and this year’s flu shot is well-matched to the H3N2 strain, the C.D.C. said. Flu shots are imperfect, especially in the elderly, whose immune systems may not be strong enough to produce enough antibodies.

Simultaneously, the country is seeing a large and early outbreak of norovirus, the “cruise ship flu” or “stomach flu,” said Dr. Aron J. Hall of the C.D.C.’s viral gastroenterology branch. It includes a new strain, which first appeared in Australia and is known as the Sydney 2012 variant.

This week, Maine’s health department said that state was seeing a large spike in cases. Cities across Canada reported norovirus outbreaks so serious that hospitals were shutting down whole wards for disinfection because patients were getting infected after moving into the rooms of those who had just recovered. The classic symptoms of norovirus are “explosive” diarrhea and “projectile” vomiting, which can send infectious particles flying yards away.

“I also saw a woman I’m sure had norovirus,” Dr. Zeeman said. “She said she’d gone to the bathroom 14 times at home and 4 times since she came into the E.R. You can get dehydrated really quickly that way.”

This month, the C.D.C. said the United States was having its biggest outbreak of pertussis in 60 years; there were about 42,000 confirmed cases, the highest total since 1955. The disease is unrelated to flu but causes a hacking, constant cough and breathlessness. While it is unpleasant, adults almost always survive; the greatest danger is to infants, especially premature ones with undeveloped lungs. Of the 18 recorded deaths in 2012, all but three were of infants under age 1.

That outbreak is worst in cold-weather states, including Colorado, Washington, Wisconsin, Minnesota and Vermont.

Although most children are vaccinated several times against pertussis, those shots wear off with age. It is possible, the authorities said, that a new, safer vaccine introduced in the 1990s gives protection that does not last as long, so more teenagers and adults are vulnerable.

And, Dr. Poland said, if many New Yorkers are catching laryngitis, as has been reported, it is probably a rhinovirus. “It’s typically a sore, really scratchy throat, and you sometimes lose your voice,” he said.

Though flu cases in New York City are rising rapidly, the city health department has no plans to declare an emergency, largely because of concern that doing so would drive mildly sick people to emergency rooms, said Dr. Jay K. Varma, deputy director for disease control. The city would prefer people went to private doctors or, if still healthy, to pharmacies for flu shots. Nursing homes have had worrisome outbreaks, he said, and nine elderly patients have died. Homes need to be more alert, vaccinate patients, separate those who fall ill and treat them faster with antivirals, he said.

Dr. Susan I. Gerber of the C.D.C.’s respiratory diseases branch, said her agency has not seen any unusual spike of rhinovirus, parainfluenza, adenovirus, coronavirus or the dozens of other causes of the “common cold,” but the country is having its typical winter surge of some, like respiratory syncytial virus “that can mimic flulike symptoms, especially in young children.”

The C.D.C. and the local health authorities continue to advocate getting flu shots. Although it takes up to two weeks to build immunity, “we don’t know if the season has peaked yet,” said Dr. Joseph Bresee, chief of prevention in the agency’s flu division.

Flu shots and nasal mists contain vaccines against three strains, the H3N2, the H1N1 and a B. Thus far this season, Dr. Bresee said, H1N1 cases have been rare, and the H3N2 component has been a good match against almost all the confirmed H3N2 samples the agency has tested.

About a fifth of all flus this year thus far are from B strains. That part of the vaccine is a good match only 70 percent of the time, because two B’s are circulating.

For that reason, he said, flu shots are being reformulated. Within two years, they said, most will contain vaccines against both B strains.

Joanna Constantine, 28, a stylist at the Guy Thomas Hair Salon on West 56th Street in Manhattan, said she recently was so sick that she was off work and in bed for five days — and silenced by laryngitis for four of them.

She did not have the classic flu symptoms — a high fever, aches and chills — so she knew it was probably something else.

Still, she said, it scared her enough that she will get a flu shot next year. She had not bothered to get one since her last pregnancy, she said. But she has a 7-year-old son and a 5-year-old daughter, “and my little guys get theirs every year.”

Jess Bidgood contributed reporting.

Read More..

Flu Widespread, Leading a Range of Winter’s Ills

It is not your imagination — more people you know are sick this winter, even people who have had flu shots.

The country is in the grip of three emerging flu or flulike epidemics: an early start to the annual flu season with an unusually aggressive virus, a surge in a new type of norovirus, and the worst whooping cough outbreak in 60 years. And these are all developing amid the normal winter highs for the many viruses that cause symptoms on the “colds and flu” spectrum.

Influenza is widespread, and causing local crises. On Wednesday, Boston’s mayor declared a public health emergency as cases flooded hospital emergency rooms.

Google’s national flu trend maps, which track flu-related searches, are almost solid red (for “intense activity”) and the Centers for Disease Control and Prevention’s weekly FluView maps, which track confirmed cases, are nearly solid brown (for “widespread activity”).

“Yesterday, I saw a construction worker, a big strong guy in his Carhartts who looked like he could fall off a roof without noticing it,” said Dr. Beth Zeeman, an emergency room doctor for MetroWest Medical Center in Framingham, Mass., just outside Boston. “He was in a fetal position with fever and chills, like a wet rag. When I see one of those cases, I just tighten up my mask a little.”

Massachusetts General Hospital in Boston started asking visitors with even mild cold symptoms to wear masks and to avoid maternity wards. The hospital has treated 532 confirmed influenza patients this season and admitted 167, even more than it did by this date during the 2009-10 swine flu pandemic.

At Brigham and Women’s Hospital, 100 patients were crowded into spaces licensed for 53. Beds lined halls and pressed against vending machines. Overflow patients sat on benches in the lobby wearing surgical masks.

“Today was the first time I think I was experiencing my first pandemic,” said Heidi Crim, the nursing director, who saw both the swine flu and SARS outbreaks here. Adding to the problem, she said, many staff members were at home sick and supplies like flu test swabs were running out.

Nationally, deaths and hospitalizations are still below epidemic thresholds. But experts do not expect that to remain true. Pneumonia usually shows up in national statistics only a week or two after emergency rooms report surges in cases, and deaths start rising a week or two after that, said Dr. Gregory A. Poland, a vaccine specialist at the Mayo Clinic in Minnesota. The predominant flu strain circulating is an H3N2, which typically kills more people than the H1N1 strains that usually predominate; the relatively lethal 2003-4 “Fujian flu” season was overwhelmingly H3N2.

No cases have been resistant to Tamiflu, which can ease symptoms if taken within 48 hours, and this year’s flu shot is well-matched to the H3N2 strain, the C.D.C. said. Flu shots are imperfect, especially in the elderly, whose immune systems may not be strong enough to produce enough antibodies.

Simultaneously, the country is seeing a large and early outbreak of norovirus, the “cruise ship flu” or “stomach flu,” said Dr. Aron J. Hall of the C.D.C.’s viral gastroenterology branch. It includes a new strain, which first appeared in Australia and is known as the Sydney 2012 variant.

This week, Maine’s health department said that state was seeing a large spike in cases. Cities across Canada reported norovirus outbreaks so serious that hospitals were shutting down whole wards for disinfection because patients were getting infected after moving into the rooms of those who had just recovered. The classic symptoms of norovirus are “explosive” diarrhea and “projectile” vomiting, which can send infectious particles flying yards away.

“I also saw a woman I’m sure had norovirus,” Dr. Zeeman said. “She said she’d gone to the bathroom 14 times at home and 4 times since she came into the E.R. You can get dehydrated really quickly that way.”

This month, the C.D.C. said the United States was having its biggest outbreak of pertussis in 60 years; there were about 42,000 confirmed cases, the highest total since 1955. The disease is unrelated to flu but causes a hacking, constant cough and breathlessness. While it is unpleasant, adults almost always survive; the greatest danger is to infants, especially premature ones with undeveloped lungs. Of the 18 recorded deaths in 2012, all but three were of infants under age 1.

That outbreak is worst in cold-weather states, including Colorado, Washington, Wisconsin, Minnesota and Vermont.

Although most children are vaccinated several times against pertussis, those shots wear off with age. It is possible, the authorities said, that a new, safer vaccine introduced in the 1990s gives protection that does not last as long, so more teenagers and adults are vulnerable.

And, Dr. Poland said, if many New Yorkers are catching laryngitis, as has been reported, it is probably a rhinovirus. “It’s typically a sore, really scratchy throat, and you sometimes lose your voice,” he said.

Though flu cases in New York City are rising rapidly, the city health department has no plans to declare an emergency, largely because of concern that doing so would drive mildly sick people to emergency rooms, said Dr. Jay K. Varma, deputy director for disease control. The city would prefer people went to private doctors or, if still healthy, to pharmacies for flu shots. Nursing homes have had worrisome outbreaks, he said, and nine elderly patients have died. Homes need to be more alert, vaccinate patients, separate those who fall ill and treat them faster with antivirals, he said.

Dr. Susan I. Gerber of the C.D.C.’s respiratory diseases branch, said her agency has not seen any unusual spike of rhinovirus, parainfluenza, adenovirus, coronavirus or the dozens of other causes of the “common cold,” but the country is having its typical winter surge of some, like respiratory syncytial virus “that can mimic flulike symptoms, especially in young children.”

The C.D.C. and the local health authorities continue to advocate getting flu shots. Although it takes up to two weeks to build immunity, “we don’t know if the season has peaked yet,” said Dr. Joseph Bresee, chief of prevention in the agency’s flu division.

Flu shots and nasal mists contain vaccines against three strains, the H3N2, the H1N1 and a B. Thus far this season, Dr. Bresee said, H1N1 cases have been rare, and the H3N2 component has been a good match against almost all the confirmed H3N2 samples the agency has tested.

About a fifth of all flus this year thus far are from B strains. That part of the vaccine is a good match only 70 percent of the time, because two B’s are circulating.

For that reason, he said, flu shots are being reformulated. Within two years, they said, most will contain vaccines against both B strains.

Joanna Constantine, 28, a stylist at the Guy Thomas Hair Salon on West 56th Street in Manhattan, said she recently was so sick that she was off work and in bed for five days — and silenced by laryngitis for four of them.

She did not have the classic flu symptoms — a high fever, aches and chills — so she knew it was probably something else.

Still, she said, it scared her enough that she will get a flu shot next year. She had not bothered to get one since her last pregnancy, she said. But she has a 7-year-old son and a 5-year-old daughter, “and my little guys get theirs every year.”

Jess Bidgood contributed reporting.

Read More..

Google Chief Urges North Korea to Embrace WebGoogle Chief Urges North Korea to Embrace Web

BEIJING — Eric E. Schmidt, the executive chairman of Google, returned from a four-day visit to North Korea on Thursday with a message for the reclusive nation’s young new leader: embrace the Web or else.

Mr. Schmidt, part of private delegation led by former Gov. Bill Richardson of New Mexico that also sought to press North Korea on humanitarian and diplomatic issues, said North Korea risked falling further behind if it did not provide more access to cellphone service and the Internet.

“As the world becomes increasingly connected, their decision to be virtually isolated is very much going to affect their physical world, their economic growth and so forth and it will make it harder for them to catch up economically,” he told reporters during a stop at Beijing International Airport. “We made that alternative very, very clear.”

Their visit, the highest-profile delegation of Americans since Kim Jong-un took power upon the death of his father in December 2011, comes at precarious time for United States-North Korean relations after the North’s rocket launch last month that drew international condemnation. North Korea insists its Unha-3 rocket is part of a peaceful space program; South Korean and American intelligence officials say the North was testing a long-range ballistic missile that could one day reach the United States.

The State Department was not thrilled with Mr. Richardson’s freelance diplomacy, at least not publicly. A spokeswoman described Mr. Richardson’s visit as not “particularly helpful” given that the United States is seeking to rally support for tougher international sanctions against the North. Some North Korea experts have characterized the self-described humanitarian mission as naïve, saying it will ultimately serve the North’s propaganda needs.

Although Mr. Richardson did not address the criticism on Thursday, he said his hosts were receptive during discussions about ways to reduce tensions on the Korean peninsula as well as his effort to seek the release of a Korean-American who was detained in November in the north of the country.

“We had a very positive reaction,” Mr. Richardson said.

The delegation did not meet with the detained American, Kenneth Bae, 44, a tour operator from Washington who has been accused of “hostile acts,” but Mr. Richardson said he was assured Mr. Bae was being treated well and that judicial proceedings would begin soon.

There was one tangible success of their visit: the authorities, Mr. Richardson said, had agreed to deliver to Mr. Bae a letter from his son.

But Mr. Richardson’s efforts to promote peace, love and understanding were overshadowed by the billion-dollar wattage of Mr. Schmidt, a vocal proponent of Internet freedom. The delegation, which included Mr. Schmidt’s daughter and Jared Cohen, a former State Department official who heads Google Ideas, the company’s research arm, made highly choreographed visits to several sites meant to display the nation’s information technology prowess.

At the elite Kim Il Sung University, computer science students showed off their ability to surf the Internet, stopping on a Web site run by Cornell University.

For most North Koreans, using a computer, let alone accessing Google, is all but impossible. Although the country has global broadband Internet, few people are allowed to use it, and if they do, their surfing is strictly monitored. Experts say fewer than a thousand people have such access, most of them software developers, government officials and well-connected party loyalists.

At the main library in the North Korean capital, Pyongyang, the Grand People’s Study House, the Americans watched as users in thick winter coats crowded around computer screens that connect to North Korea’s Intranet, known as Kwangmyong, which serves up government-approved documents, books and archival newspapers.

They later toured the Korea Computer Center, an incubator for domestic software and hardware, where they played with a homegrown tablet and other gadgetry, most of it developed with help from Russia, China and India. A quote from Kim Jong Il, the current leader’s father, graced the room: “Now is the era for science and technology. It is the era of computers.”

Since he came to power, the 20-something Mr. Kim, who was educated in a Swiss boarding school, has emphasized the importance of science and technology for economic development. And while he has called for computerizing in the nation’s dilapidated factories — and spending even more scarce hard currency on developing ballistic missiles — he has made no mention of addressing North Korea’s status as one of the world’s least wired nations.

Mr. Schmidt appears to have learned a great deal from his visit. Speaking to reporters in Beijing, he talked in some detail about the nation’s 3G cellular phone service, developed by the Egyptian telecom company Orascom. But he noted with disappointment that little more than one million of the country’s 24 million citizens had cellphones.

That system, he added hopefully, had the potential to provide Internet access but that so far the feature was unavailable. “It would be very easy for them to turn it on,” he said.

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India Ink: The Delhi Gang Rape Accused: Vinay Sharma, a 'Quiet and Simple' Boy

To keep her children warm on Wednesday night, Champa Devi tried to get a small fire going by puffing air into four pieces of wood outside their home in a South Delhi slum.

“I am heartbroken,” she said, coughing as a cloud of smoke billowed around her. “When I wake up, it feels like my heart has been torn away.”

Ms. Champa, 37, is the mother of Vinay Sharma, one of the six accused in the gang rape of a 23-year-old woman on a moving bus on Dec. 16, which resulted in her death two weeks later.

The horrific account of the rape, in which attackers beat their victim and her male companion with an iron rod and threw them naked onto a highway, sent shock waves through India.

Ms. Champa said she still can’t fathom how her son, who she says was born in March 1994, could have been involved in the gruesome crime. “He was always a quiet and simple boy,” she said. “He worked hard in school and always got top marks,” she said. “He especially liked studying English. We hoped for a good job in the future.”

Mr. Sharma, his family said, had grown up to be serious-minded man who recently registered for college. He earned 3,000 rupees, or about $54, a month as a handyman in a gym. The money went mostly to support the meager wages of his father, who works as a laborer.

The Sharma household is in the Ravidas slum, where four of the six accused lived, according to police. The slum, made up of about 300 houses, is maze of muddy alleys, next to the Bijri Khan tomb, a monument from the 15th century Lodhi dynasty.

On an early Wednesday visit to the Sharma home, no one responded to a few initial knocks on their door. “Leave them alone — haven’t they suffered for losing their son?” cried an elderly woman standing in the narrow lane. “Now what are they to do except be hounded by you media people?”

Hearing the commotion, a teenage girl emerged from a nearby house and first identified herself as a neighbor. “He was a really good guy who was led astray,” she said about Mr. Sharma. But the emotions on her face betrayed her, and she quickly admitted to being Manju Sharma, his sister. The 14-year-old, who has burn marks on her face, described her brother as deeply caring about his three siblings.

“After I was burned as a baby, he always made sure I stayed away from the stove,” she said. “As kids, he used to gently pinch me on my feet and he often played hide-and-seek with our small brother.” Ms. Sharma said that her brother also paid for the medicines needed to treat her diabetes.

Later in the evening, the accused’s mother agreed to an interview. She said that she had spent the day standing in a long hospital line to get her daughter’s medicine. Without a regular dosage, she faints and can’t attend school, she said.

“It costs 100 rupees a week and we can’t afford it without Vinay,” said Ms. Champa. “Without him, how will get the girls married?”

While it isn’t surprising for Mr. Sharma’s family to speak well of him, his neighbors and friends give similar accounts.

“I’ve known Vinay since he was a boy and played with my children,” said a middle-aged shopkeeper in the slum, who declined to give her name to avoid any further media attention. “He just isn’t the kind to make trouble.”

Anil, 14, who declined to give his last name, recalled his friend had only one interest: cricket. “When Vinay wasn’t at work, he would play some fun matches,” he said.

A short distance from the slum, another middle-aged woman who knew the family agreed to speak on the condition of anonymity to avoid upsetting them. She said she hoped none of the four men returned.

“Vinay may have been a good boy, but now even he can’t be trusted,” she said. “As a woman, I wouldn’t feel safe. What if they tried something on me?”

Mr. Sharma confessed to beating up the woman’s male friend in a December court appearance and asked to be hanged, according to local media reports. He and another defendant, Pawan Kumar, a fruit seller from the same slum, also volunteered to become witnesses for the government, a Delhi police official said.

Mr. Sharma’s friends and neighbors say they blame Ram Singh and Mukesh Singh, two brothers who are also accused in the rape case, for leading the other men astray.

Some residents of the Ravidas neighborhood said they clearly remembered the night of Dec. 16, and that they sensed that Ram and Mukesh Singh, who also lived in the area, were in a mood to make trouble after they had drunk alcohol.

Ms. Sharma said that her brother was playing marbles with the neighborhood children. When it grew dark, his mother recalled, he came into the house and watched television.

“He was eating a sweet bun and laughing over cartoons with his siblings,” she said. “Then, the fruit seller boy came to call him and he left,” she said. “That was the last time I saw him.”

India Ink is profiling the men accused in the Delhi gang rape case. This is the second. Read the first here.

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DealBook: Former Analyst Cooperates in Insider Trading Case

A former analyst at SAC Capital Advisors, the hedge fund owned by the billionaire investor Steven A. Cohen, has given federal agents the names of about 20 people he said had engaged in insider trading, according to a court filing.

The disclosure of the extraordinary cooperation by the former SAC analyst, Wesley Wang, emerged in a pleading filed by federal prosecutors. In a letter to a judge, the government credited Mr. Wang with substantial assistance in its broad insider trading crackdown.

In addition to the 20 names, the government said information provided by Mr. Wang had contributed to the criminal convictions of more than 10 people.

Hedge Fund Inquiry

The letter, which was filed in connection with Mr. Wang’s sentencing, named 12 individuals who have already been charged or identified in public as part of the investigation. But the section that gave specifics about Mr. Wang’s help — and named other people, according to a person with knowledge of the letter — was heavily redacted.

Prosecutors emphasized that Mr. Wang’s help was still yielding fruit.

“The full extent of Wang’s information and cooperation remains to be fully realized,” the government said in the filing. “Even taking into account what has been developed to date, it is exceptional.”

Prosecutors praised Mr. Wang’s assistance in advance of the sentencing, which is scheduled for Wednesday afternoon in Federal District Court in Manhattan. They urged Judge Jed. S. Rakoff to hand down a lenient sentence. Government cooperators have been vital to prosecutors in the insider trading investigation, which has resulted in the guilty pleas or convictions of more than 70 individuals since mid-2009.

A lawyer for Mr. Wang, Michael Celio, declined to comment.

Mr. Wang is one of a number of former traders and analysts previously associated with SAC Capital, which manages $14 billion and has one of the best investment track records on Wall Street. At least six former SAC employees have been tied to insider trading while at the fund, which is based in Stamford, Conn. The most recent case — an indictment of a former SAC portfolio manager, Mathew Martoma — connects Mr. Cohen to questionable trades.

Mr. Cohen and SAC have not been charged with any wrongdoing, and Mr. Cohen has told his employees and clients that he believes he and the firm acted appropriately at all times. The Securities and Exchange Commission has warned SAC that it may file a civil action against the firm in connection with the Martoma case.

The case against Mr. Wang, a journeyman hedge fund analyst who spent just a couple of years at SAC nearly a decade ago, has largely gone unnoticed.

A native of Taiwan, Mr. Wang, 39, of Berkeley, Calif., worked as a technology stock analyst at the SAC unit Sigma Capital from 2002 to 2005. The F.B.I. first learned about Mr. Wang’s insider trading in 2008 from another cooperator. Agents approached him in early 2009 and he almost immediately began cooperating, agreeing to wear a wire in meetings and also recording telephone conversations with his Wall Street and corporate contacts.

“While these meetings caused Mr. Wang considerable stress, he nonetheless maintained his composure throughout them,” the prosecutors wrote in the sentencing letter.

Last summer, Mr. Wang appeared in a federal court and entered a guilty plea, admitting to leaking confidential information about technology stocks to a former Sigma portfolio manager, Dipak Patel, and to the former head of Whitman Capital, Douglas F. Whitman.

A jury convicted Mr. Whitman in August. He has yet to be sentenced. The government has not charged Mr. Patel.

Mr. Wang testified at Mr. Whitman’s trial. He said that he obtained inside information about Cisco Systems and passed it on to Mr. Whitman, who in turn shared secret data about other companies.

In the sentencing letter, prosecutors said the information provided by Mr. Wang led to their being able to approach certain other people who then also agreed to cooperate. They included Karl Motey, a crucial figure in the government’s extensive investigation into expert network firms — middlemen connecting traders to public company employees — that led to dozens of convictions.

Prosecutors emphasized that they still had plenty of work to do with all of the information supplied to them by Mr. Wang, and requested that his continued cooperation be made a condition of his sentencing.

“Wang has also identified a number of individuals involved in insider trading whom the F.B.I. has not yet approached and/or whom the government has not yet charged,” the letter said.

A version of this article appeared in print on 01/09/2013, on page B1 of the NewYork edition with the headline: Ex-Analyst Cooperates In Insider Trade Case.

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Gaps Seen in Therapy for Suicidal Teenagers

Most adolescents who plan or attempt suicide have already received at least some mental health treatment, raising questions about the effectiveness of current approaches to helping troubled youths, according to the largest in-depth analysis to date of suicidal behaviors in American teenagers.

The study, in the journal JAMA Psychiatry, found that 55 percent of suicidal teenagers had received some therapy before they thought about suicide, planned it or tried to kill themselves, contradicting the widely held belief that suicide is due in part to a lack of access to treatment.

The findings, based on interviews with a nationwide sample of more than 6,000 teenagers and at least one parent of each, linked suicidal behavior to complex combinations of mood disorders like depression and behavior problems like attention-deficit and eating disorders, as well as alcohol and drug abuse.

The study found that about one in eight teenagers had persistent suicidal thoughts at some point, and that about a third of those who had suicidal thoughts had made an attempt, usually within a year of having the idea.

Previous studies have had similar findings, based on smaller, regional samples. But the new study is the first to suggest, in a large nationwide sample, that access to treatment does not make a big difference.

The study suggests that effective treatment for severely suicidal teenagers must address not just mood disorders, but also behavior problems that can lead to impulsive acts, experts said. According to the Centers for Disease Control and Prevention, 1,386 people between the ages of 13 and 18 committed suicide in 2010, the latest year for which numbers are available.

“I think one of the take-aways here is that treatment for depression may be necessary but not sufficient to prevent kids from attempting suicide,” said Dr. David Brent, a professor of psychiatry at the University of Pittsburgh, who was not involved in the study. “We simply do not have empirically validated treatments for recurrent suicidal behavior.”

The report said nothing about whether the therapies given were state of the art or carefully done, said Matt Nock, a professor of psychology at Harvard and the lead author, and it is possible that some of the treatments prevented suicide attempts. “But it’s telling us we’ve got a long way to go to do this right,” Dr. Nock said. His co-authors included Ronald C. Kessler of Harvard and researchers from Boston University and Children’s Hospital Boston.

Margaret McConnell, a consultant in Alexandria, Va., said her daughter Alice, who killed herself in 2006 at the age of 17, was getting treatment at the time. “I think there might have been some carelessness in the way the treatment was done,” Ms. McConnell said, “and I was trusting a 17-year-old to manage her own medication. We found out after we lost her that she wasn’t taking it regularly.”

In the study, researchers surveyed 6,483 adolescents from the ages of 13 to 18 and found that 9 percent of male teenagers and 15 percent of female teenagers experienced some stretch of having persistent suicidal thoughts. Among girls, 5 percent made suicide plans and 6 percent made at least one attempt (some were unplanned).

Among boys, 3 percent made plans and 2 percent carried out attempts, which tended to be more lethal than girls’ attempts.

(Suicidal thinking or behavior was virtually unheard-of before age 10.)

Over all, about one-third of teenagers with persistent suicidal thoughts went on to make an attempt to take their own lives.

Almost all of the suicidal adolescents in the study qualified for some psychiatric diagnosis, whether depression, phobias or generalized anxiety disorder. Those with an added behavior problem — attention-deficit disorder, substance abuse, explosive anger — were more likely to act on thoughts of self-harm, the study found.

Doctors have tested a range of therapies to prevent or reduce recurrent suicidal behaviors, with mixed success. Medications can ease depression, but in some cases they can increase suicidal thinking. Talk therapy can contain some behavior problems, but not all.

One approach, called dialectical behavior therapy, has proved effective in reducing hospitalizations and suicide attempts in, among others, people with borderline personality disorder, who are highly prone to self-harm.

But suicidal teenagers who have a mixture of mood and behavior issues are difficult to reach. In one 2011 study, researchers at George Mason University reduced suicide attempts, hospitalizations, drinking and drug use among suicidal adolescent substance abusers. The study found that a combination of intensive treatments — talk therapy for mood problems, family-based therapy for behavior issues and patient-led reduction in drug use — was more effective than regular therapies.

“But that’s just one study, and it’s small,” said Dr. Brent of the University of Pittsburgh. “We can treat components of the overall problem, but that’s about all.”

Ms. McConnell said that her daughter’s depression had seemed mild and that there was no warning that she would take her life. “I think therapy does help a lot of people, if it’s handled right,” she said.

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