Extended Use of Breast Cancer Drug Suggested

The widely prescribed drug tamoxifen already plays a major role in reducing the risk of death from breast cancer. But a new study suggests that women should be taking the drug for twice as long as is now customary, a finding that could upend the standard that has been in place for about 15 years.

In the study, patients who continued taking tamoxifen for 10 years were less likely to have the cancer come back or to die from the disease than women who took the drug for only five years, the current standard of care.

“Certainly, the advice to stop in five years should not stand,” said Prof. Richard Peto, a medical statistician at Oxford University and senior author of the study, which was published in The Lancet on Wednesday and presented at the San Antonio Breast Cancer Symposium.

Breast cancer specialists not involved in the study said the results could have the biggest impact on premenopausal women, who account for a fifth to a quarter of new breast cancer cases. Postmenopausal women tend to take different drugs, but some experts said the results suggest that those drugs as well might be taken for a longer duration.

“We’ve been waiting for this result,” said Dr. Robert W. Carlson, a professor of medicine at Stanford University. “I think it is especially practice-changing in premenopausal women because the results do favor a 10-year regimen.”

Dr. Eric P. Winer, chief of women’s cancers at the Dana-Farber Cancer Institute in Boston, said that even women who completed their five years of tamoxifen months or years ago might consider starting on the drug again.

Tamoxifen blocks the effect of the hormone estrogen, which fuels tumor growth in estrogen receptor-positive cancers that account for about 65 percent of cases in premenopausal women. Some small studies in the 1990s suggested that there was no benefit to using tamoxifen longer than five years, so that has been the standard.

About 227,000 cases of breast cancer are diagnosed each year in the United States, and an estimated 30,000 of them would be in premenopausal women with ER-positive cancer and prime candidates for tamoxifen. But postmenopausal women also take tamoxifen if they cannot tolerate the alternative drugs, known as aromatase inhibitors.

The new study, known as Atlas, included nearly 7,000 women with ER-positive disease who had completed five years of tamoxifen. They came from about three dozen countries. Half were chosen at random to take the drug another five years, while the others were told to stop.

In the group assigned to take tamoxifen for 10 years, 21.4 percent had a recurrence of breast cancer in the ensuing nine years, meaning the period 5 to 14 years after their diagnoses. The recurrence rate for those who took only five years of tamoxifen was 25.1 percent.

About 12.2 percent of those in the 10-year treatment group died from breast cancer, compared with 15 percent for those in the control group.

There was virtually no difference in death and recurrence between the two groups during the five years of extra tamoxifen. The difference came in later years, suggesting that tamoxifen has a carry-over effect that lasts long after women stop taking it.

Whether these differences are big enough to cause women to take the drug for twice as long remains to be seen.

“The treatment effect is real, but it’s modest,” said Dr. Paul E. Goss, director of breast cancer research at the Massachusetts General Hospital.

Tamoxifen has side effects, including endometrial cancer, blood clots and hot flashes, which cause many women to stop taking the drug. In the Atlas trial, it appears that roughly 40 percent of the patients assigned to take tamoxifen for the additional five years stopped prematurely.

Some 3.1 percent of those taking the extra five years of tamoxifen got endometrial cancer versus 1.6 percent in the control group. However, only 0.6 percent of those in the longer treatment group died from endometrial cancer or pulmonary blood clots.

“Over all, the benefits of extended tamoxifen seemed to outweigh the risks substantially,” Trevor J. Powles of the Cancer Center London, said in a commentary published by The Lancet.

Dr. Judy E. Garber, director of the Center for Cancer Genetics and Prevention at Dana-Farber, said many women have a love-hate relationship with hormone therapies.

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At War Blog: In Afghanistan, Humor Finds Its Way in Lost Translation

Funny isn’t an adjective often used to describe Afghanistan. Yet to many Afghans, the war and the foreigners waging it can present a surprising source of humor.

Afghans around the country tell anecdotes about encounters with NATO troops. The best of these are encapsulated, shared and sometimes aggrandized in the form of half-funny, half-sad tales told over warm chai or at picnics. Sometimes told with a laugh, sometimes told with a tone of bitterness, these stories tend to be about cultural mishaps and miscommunication that, 11 years after the start of the international intervention, still occur with alarming frequency.

Every province seems to have its own variations of these tales. Here, I will share three that I heard while meeting with local entrepreneurs in Bamian, Kabul and Kandahar city, respectively. All of them are based – or so my informants tell me – on actual events.

But even if they are apocryphal, these are the narratives that Afghans are telling in everyday conversations about foreigners – when the foreigners aren’t around.

1. A Disproportionate Response

Over a picnic lunch on the shores of beautiful Band-e-Amir, Afghanistan’s first national park, an 18-year-old high school student from Bamian Center laughingly told me this story:

One day, the New Zealand Provincial Reconstruction Team had lunch with some local village elders. At the end of the meal, they wanted to thank their hosts. One of them spoke on behalf of the team, saying: “Thank you for your great hospitality. The food was delicious.”

But the interpreter was confused. He translated: “Thank you for your great food. We will build you a hospital.”

The elders were surprised, but delighted. But not so much when the hospital never materialized.

Later, I shared this with a friend who works for NATO. He shook his head. “That’s no joke,” he said. “I caught my interpreter making the same mistake in Daikundi last week.”

2. “Not on the agenda!”

A colleague in Kabul who works in a nongovernmental organization that does media training had a collection of linguistic mishaps to share. This one was the most memorable.

A United States military trainer was making a routine visit to an Afghan government official whom he mentored. He was excited because new computers had just been delivered, and he wanted to hear how the devices were working.

The trainer had a thick Southern accent that, evidently, his interpreter found hard to understand.

“How’s the system?” the trainer asked.

“How’s your sister?” the interpreter said, translating.

The government official was visibly angry, to the American’s confusion: “My sister?! Who are you to be asking about my sister?!” The interpreter translated the official’s response into English, but said “system” instead of “sister.”

Trainer: “Yeah, your system! We just delivered new computer systems.”

Interpreter’s translation: “Yeah, your sister. You have beautiful sister.”

The Afghan, roaring: “You better stop talking about my sister!” The interpreter kept the miscommunication going, again telling the American that the official had said “system.”

Trainer: “Hey, relax! It’s on the agenda.”

The Afghan, huffing and puffing: “My sister is most definitely NOT on the agenda!” He stormed out.

The American was perplexed. The interpreter shrugged.

3. The Best Job Ever

I recounted these anecdotes to a friend whom I was visiting in Kandahar city. After having a good laugh, this friend shared one as well. “This one is definitely true,” he said, “because my friend was the interpreter!”

Back in 2004, an officer at Kandahar Airfield hired a group of local residents to do some manual labor. When the workers arrived, the officer instructed his interpreter: “O.K., tell them to get their shovels and start working. I will be back in an hour.”

The interpreter thought it was an odd request, but he translated anyway: “O.K., he says to go shower and come back in an hour.”

And so the workers went to the local bathhouse. When the officer returned, he angrily asked the interpreter, “Where have all the men gone?”

“They went to the bathhouse,” the interpreter replied.

The officer was furious. “Why would they do that?”

“Well, because you told them to…”

The officer suddenly understood what had happened. He grabbed a shovel and shoved it at the interpreter. “SHOVEL! I said shovel, not shower!”

At least in this story, there was a moment of comprehension and a confrontation was avoided. But all these stories make me wonder: How often have hospitals been accidentally promised? And how often did those mistranslations cause bad blood? We may never know.

Eileen Guo lives in Kabul, where she runs Impassion Media, a start-up that delivers social media and mobile technology solutions in emerging markets and frontier environments. She first worked in Afghanistan as a research assistant for the military’s Counterinsurgency Training Center and wrote about her experiences for At War. You can read more of her writing about Afghanistan at her personal blog, and follow her on Twitter.

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Video Games: Little Inferno; Hitman; Assassin’s Creed III; Persona 4 Golden; Angry Birds Star Wars; My Little Pony

These edited and condensed reviews are from the writers and editors of the gaming Web site Kotaku.com. Full reviews are at kotaku.com/nytselects.

LITTLE INFERNO

Released on Nov. 18

Developed by Tomorrow Corporation

For PC, Mac, Linux and Wii U

Rated T for Teen (drug reference and crude humor)

Here’s an odd one. Little Inferno is an interactive fireplace. It’s an emotional, interactive fireplace with a story line and some notions about the dangers of amusing ourselves with distracting trifles.

At first this strange creation appears to be a simple puzzle game consisting of little more than a fireplace, a catalog of items to burn and 99 clues that challenge the player to burn these things in proper combinations. One clue is “Movie Night.” Burn the popcorn. Burn the TV. A weirder one is “Bike Pirate.” Burn the wooden bike. Burn the pirate.

As you play, an unseen character begins to send letters. They burn, too, but something seems off. The messages are alternately cheerful and sad, a wee bit wicked and increasingly desperate.

The purpose of the pyromaniac pastime becomes smoky with doubt. Why are we doing this? What are we missing? It’s odd enough to play a new video game that questions our decision to play video games. That it’s an interactive fireplace game that does this is all the stranger and more wonderful. It’s a yule log for our times.

HITMAN

Absolution

Released on Nov. 20

Developed by IO Interactive

Published by Square Enix

For PC, Xbox 360 and PlayStation 3

Rated M for Mature (intense violence, partial nudity and strong language)

It’s a vile, dangerous world in Hitman: Absolution. Nearly everyone is in need of a good killing, and Agent 47, the depilated murder machine at the center of the long-running Hitman franchise, is just the man for the job.

Absolution is consistent with the setup of past Hitman games: At the start of a level, 47 is given an assassination target, and he must make his way through semi-open areas by any of a number of possible routes. The reactive artificial intelligence keeps things enjoyably unpredictable, and the best levels feel like a buffet of sadistic improvisation.

The story is pure B-movie hogwash. It’s mostly enjoyable in a certain exploitive way, but it often feels as if the writers were trying too hard.

When it gets cooking, Hitman: Absolution evokes the feeling of a deadly, measured dance. It’s a tango between you and the computer, with each party alternately taking the lead through arenas that shift and upset expectations.

ASSASSIN’S CREED III

Released on Oct. 30

Developed and published by Ubisoft

For PlayStation 3, Xbox 360, Wii U and PC

Rated M for Mature (blood, intense violence, sexual themes and strong language)

Assassin’s Creed III is really the fifth major Assassin’s Creed game. The numbering signifies that this new historical epic is a shift, as this Ubisoft series about the ancestral lives of a man named Desmond Miles leaps to its third era. Finished with the 12th-century crusades and 15th-century Renaissance Italy, Assassin’s Creed now lets us do interactive historical tourism in Boston, New York and the nearby woods of Revolutionary America.

Assassin’s Creed games are lavish action-adventure blockbusters. In this new one, we primarily play as a young, bitter, half-British, half-Mohawk greenhorn assassin named Ratonhnhaké:ton, who finds himself crossing paths and sometimes doing the bidding of Sam Adams, Paul Revere, George Washington and other real figures. Most of the bad guys are red coats with slow-firing muskets. We’re best with a tomahawk and a bow and arrow.

The new game involves a lot of climbing and killing across a sprawling landscape of bustling cities and gorgeous frontier. Add in a mix of awkwardly instituted horseback riding, homestead building, trading, trapping, hunting and, at the wheel of your own tall-masted warship, epic naval combat. There is much to do and witness in a ripped-from-the-history-books adventure that is refreshingly unwilling to ignore the unsavory aspects of America’s birth. A lengthy production cycle didn’t spare the game from a wealth of bugs that are only now being patched out.

The series’s low-key multiplayer games of competitive assassination return, but the star of this epic is something that might seem almost quaint: Assassin’s Creed III is easily the best tree-climbing simulator in history.

PERSONA 4 GOLDEN

Released on Nov. 20

Developed and published by Atlus

For PlayStation Vita

Rated M for Mature (violence, alcohol reference and partial nudity)

Persona 4 Golden is part turn-based role-playing game, part high school simulator and a rerelease of a celebrated PlayStation 2 game on the portable Vita.

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Sign Language Researchers Broaden Science Lexicon

Imagine trying to learn biology without ever using the word “organism.” Or studying to become a botanist when the only way of referring to photosynthesis is to spell the word out, letter by painstaking letter.

For deaf students, this game of scientific Password has long been the daily classroom and laboratory experience. Words like “organism” and “photosynthesis” — to say nothing of more obscure and harder-to-spell terms — have no single widely accepted equivalent in sign language. This means that deaf students and their teachers and interpreters must improvise, making it that much harder for the students to excel in science and pursue careers in it.

“Often times, it would involve a lot of finger-spelling and a lot of improvisation,” said Matthew Schwerin, a physicist with the Food and Drug Administration who is deaf, of his years in school. “For the majority of scientific terms,” Mr. Schwerin and his interpreter for the day would “try to find a correct sign for the term, and if nothing was pre-existing, we would come up with a sign that was agreeable with both parties.”

Now thanks to the Internet — particularly the boom in online video — resources for deaf students seeking science-related signs are easier to find and share. Crowdsourcing projects in both American Sign Language and British Sign Language are under way at several universities, enabling people who are deaf to coalesce around signs for commonly used terms.

This year, one of those resources, the Scottish Sensory Centre’s British Sign Language Glossary Project, added 116 new signs for physics and engineering terms, including signs for “light-year,”  (hold one hand up and spread the fingers downward for “light,” then bring both hands together in front of your chest and slowly move them apart for “year”), “mass” and “X-ray” (form an X with your index fingers, then, with the index finger on the right hand, point outward). 

The signs were developed by a team of researchers at the center, a division of the University of Edinburgh in Scotland that develops learning tools for students with visual and auditory impairments. The researchers spent more than a year soliciting ideas from deaf science workers, circulating lists of potential signs and ultimately gathering for “an intense weekend” of final voting, said Audrey Cameron, science adviser for the project. (Dr. Cameron is also deaf, and like all non-hearing people interviewed for this article, answered questions via e-mail.)

Whether the Scottish Sensory Centre’s signs will take hold among its audience remains to be seen. “Some will be adopted, and some will probably never be accepted,” Dr. Cameron said. “We’ll have to wait and see what happens.”

Ideally, the standardization of signs will make it easier for deaf students to keep pace with their hearing classmates during lectures. “I can only choose to look at one thing at a time,” said Mr. Schwerin of the F.D.A., recalling his science education, “and it often meant choosing between the interpreter, the blackboard/screen/material, or taking notes. It was like, pick one, and lose out on the others.”

The problem doesn’t end at graduation. In fact, it only intensifies as new discoveries add unfamiliar terms to the scientific lexicon. “I’ve had numerous meetings where I couldn’t participate properly because the interpreters were not able to understand the jargon and they did not know any scientific signs,” Dr. Cameron said.

One general complaint about efforts to standardize signs for technical terms is the idea that, much like spoken language, sign language should be allowed to develop organically rather than be dictated from above.

“Signs that are developed naturally — i.e., that are tested and refined in everyday conversation — are more likely to be accepted quickly by the community,” said Derek Braun, director of the molecular genetics laboratory at Gallaudet University in Washington, D.C., which he said was the first biological laboratory designed and administered by deaf scientists.

Since at least the 1970s, deaf scientists have tried to address the lack of uniformity by gathering common signs for scientific terms in printed manuals and on videotapes. The problem has always been getting deaf students and their interpreters to adopt them.

Often, at science conferences, “local interpreters that we never met before would often use different signs for the same terms, leading to confusion,” said Caroline Solomon, a biology professor at Gallaudet University who is deaf.

Read More..

Sign Language Researchers Broaden Science Lexicon

Imagine trying to learn biology without ever using the word “organism.” Or studying to become a botanist when the only way of referring to photosynthesis is to spell the word out, letter by painstaking letter.

For deaf students, this game of scientific Password has long been the daily classroom and laboratory experience. Words like “organism” and “photosynthesis” — to say nothing of more obscure and harder-to-spell terms — have no single widely accepted equivalent in sign language. This means that deaf students and their teachers and interpreters must improvise, making it that much harder for the students to excel in science and pursue careers in it.

“Often times, it would involve a lot of finger-spelling and a lot of improvisation,” said Matthew Schwerin, a physicist with the Food and Drug Administration who is deaf, of his years in school. “For the majority of scientific terms,” Mr. Schwerin and his interpreter for the day would “try to find a correct sign for the term, and if nothing was pre-existing, we would come up with a sign that was agreeable with both parties.”

Now thanks to the Internet — particularly the boom in online video — resources for deaf students seeking science-related signs are easier to find and share. Crowdsourcing projects in both American Sign Language and British Sign Language are under way at several universities, enabling people who are deaf to coalesce around signs for commonly used terms.

This year, one of those resources, the Scottish Sensory Centre’s British Sign Language Glossary Project, added 116 new signs for physics and engineering terms, including signs for “light-year,”  (hold one hand up and spread the fingers downward for “light,” then bring both hands together in front of your chest and slowly move them apart for “year”), “mass” and “X-ray” (form an X with your index fingers, then, with the index finger on the right hand, point outward). 

The signs were developed by a team of researchers at the center, a division of the University of Edinburgh in Scotland that develops learning tools for students with visual and auditory impairments. The researchers spent more than a year soliciting ideas from deaf science workers, circulating lists of potential signs and ultimately gathering for “an intense weekend” of final voting, said Audrey Cameron, science adviser for the project. (Dr. Cameron is also deaf, and like all non-hearing people interviewed for this article, answered questions via e-mail.)

Whether the Scottish Sensory Centre’s signs will take hold among its audience remains to be seen. “Some will be adopted, and some will probably never be accepted,” Dr. Cameron said. “We’ll have to wait and see what happens.”

Ideally, the standardization of signs will make it easier for deaf students to keep pace with their hearing classmates during lectures. “I can only choose to look at one thing at a time,” said Mr. Schwerin of the F.D.A., recalling his science education, “and it often meant choosing between the interpreter, the blackboard/screen/material, or taking notes. It was like, pick one, and lose out on the others.”

The problem doesn’t end at graduation. In fact, it only intensifies as new discoveries add unfamiliar terms to the scientific lexicon. “I’ve had numerous meetings where I couldn’t participate properly because the interpreters were not able to understand the jargon and they did not know any scientific signs,” Dr. Cameron said.

One general complaint about efforts to standardize signs for technical terms is the idea that, much like spoken language, sign language should be allowed to develop organically rather than be dictated from above.

“Signs that are developed naturally — i.e., that are tested and refined in everyday conversation — are more likely to be accepted quickly by the community,” said Derek Braun, director of the molecular genetics laboratory at Gallaudet University in Washington, D.C., which he said was the first biological laboratory designed and administered by deaf scientists.

Since at least the 1970s, deaf scientists have tried to address the lack of uniformity by gathering common signs for scientific terms in printed manuals and on videotapes. The problem has always been getting deaf students and their interpreters to adopt them.

Often, at science conferences, “local interpreters that we never met before would often use different signs for the same terms, leading to confusion,” said Caroline Solomon, a biology professor at Gallaudet University who is deaf.

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High-Speed Trades Hurt Investors, a Study Says

A top government economist has concluded that the high-speed trading firms that have come to dominate the nation’s financial markets are taking significant profits from traditional investors.

Mendoza College of Business

The economist Andrei Kirilenko’s findings are still being reviewed by peers and have encountered opposition.

Hiroko Masuike/The New York Times

Bart Chilton of the C.F.T.C. says high-speed traders are taking “some of the cream off the top.”

The chief economist at the Commodity Futures Trading Commission, Andrei Kirilenko, reports in a coming study that high-frequency traders make an average profit of as much as $5.05 each time they go up against small traders buying and selling one of the most widely used financial contracts.

The agency has not endorsed Mr. Kirilenko’s findings, which are still being reviewed by peers, and they are already encountering some resistance from academics. But Bart Chilton, one of five C.F.T.C. commissioners, said on Monday that “what the study shows is that high-frequency traders are really the new middleman in exchange trading, and they’re taking some of the cream off the top.”

Mr. Kirilenko’s work stands in contrast to several statements from government officials who have expressed uncertainty about whether high-speed traders are earning profits at the expense of ordinary investors.

The study comes as a council of the nation’s top financial regulators is showing increasing concern that the accelerating automation and speed of the financial markets may represent a threat both to other investors and to the stability of the financial system.

The Financial Stability Oversight Council, an organization formed after the recent financial crisis to deal with systemic risks, took up the issue at a meeting in November that was closed to the public, according to minutes that were released Monday.

The gathering of top regulators, including Treasury Secretary Timothy F. Geithner and Ben S. Bernanke, the Federal Reserve chairman, said in its annual report this summer that recent developments “could lead to unintended errors cascading through the financial system.” The C.F.T.C. is a member of the oversight council.

The issue of high-frequency trading has generated anxiety among investors in the stock market, where computerized trading first took hold. But the minutes from the oversight council, and the council’s annual report released this year, indicate that top regulators are viewing the automation of trading as a broader concern as high-speed traders move into an array of financial markets, including bond and foreign currency trading.

Mr. Kirilenko’s study focused on one corner of the financial markets that the C.F.T.C. oversees, contracts that are settled based on the future value of the Standard & Poor’s 500-stock index. He and his co-authors, professors at Princeton and the University of Washington, chose the contract because it is one of the most heavily traded financial assets in any market and is popular with a broad array of investors.

Using previously private data, Mr. Kirilenko’s team found that from August 2010 to August 2012, high-frequency trading firms were able to reliably capture profits by buying and selling futures contracts from several types of traditional investors.

The study notes that there are different types of high-frequency traders, some of which are more aggressive in initiating trades and some of which are passive, simply taking the other side of existing offers in the market.

The researchers found that more aggressive traders accounted for the largest share of trading volume and made the biggest profits. The most aggressive scored an average profit of $1.92 for every futures contract they traded with big institutional investors, and made an average $3.49 with a smaller, retail investor. Passive traders, on the other hand, saw a small loss on each contract traded with institutional investors, but they made a bigger profit against retail investors, of $5.05 a contract.

Large investors can trade thousands of contracts at once to bet on future shifts in the S.& P. 500 index. The average aggressive high-speed trader made a daily profit of $45,267 in a month in 2010 analyzed by the study.

Industry profits have been falling, however, as overall stock trading volume has dropped and the race for the latest technological advances has increased costs.

Ben Protess contributed reporting.

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Clinton Warns Syria Against Using Chemical Weapons

PRAGUE — Secretary of State Hillary Rodham Clinton on Monday warned President Bashar al-Assad of Syria not to use chemical weapons and said that the United States was prepared to act if he ignored the warning.

David W Cerny/Reuters

Secretary of State Hillary Clinton during a news conference in Prague on Monday.

Lynsey Addario for The New York Times

Syrian civilians fled from the village of Ras al-Ayn on Monday, after Syrian jets bombed the village.

“This is a red line for the United States,” Mrs. Clinton said. “I am not going to telegraph in any specifics what we would do in the event of credible evidence that the Assad regime has resorted to using chemical weapons against their own people. But suffice it to say we are certainly planning to take action if that eventuality were to occur.”

There have been signs in recent days of heightened activity at some of Syria’s chemical weapons sites, according to American and Israeli officials familiar with intelligence reports. Mrs. Clinton did not confirm the intelligence reports or say what sort of activity was occurring.

The Syrian Foreign Ministry, in a swift response, said the government “would not use chemical weapons, if it had them, against its own people under any circumstances.” The statement was reported on Syrian state television and on the Lebanese channel LBC.

Mrs. Clinton, who made her comments after meeting with Karel Schwarzenberg, the foreign minister of the Czech Republic, indicated that the two sides had discussed the situation in Syria, including the potential chemical weapons threat.

Mr. Schwarzenberg described the situation in Syria as “rather chaotic” and “highly dangerous.” He said that Czech troops who specialize in the detection of chemical weapons and decontamination were in Jordan training with forces there.

An American task force has been deployed to Jordan and has been helping the Jordanians deal with the escalating humanitarian crisis, including an exodus of more than 200,000 refugees from Syria to Jordan. The force is also planning how to respond, if necessary, to a chemical weapons threat.

Although Mrs. Clinton’s reference to a “red line” echoed a warning issued by President Obama in August, it was the most explicit warning from a ranking American official since reports of renewed chemical weapons activity began to surface in recent days.

Mrs. Clinton stopped in Prague on her way to Brussels for a meeting of NATO foreign ministers. A major topic of the NATO meeting is a Turkish request that the alliance deploy Patriot antimissile batteries in Turkey. The Turkish government is concerned about Syria’s ballistic missiles, which could carry chemical weapons, and it wants NATO to guard as many as 10 sites inside Turkey.

What exactly is happening at Syria’s chemical sites is unclear. One American official said Sunday that “the activity we are seeing suggests some potential chemical weapon preparation,” which goes beyond the mere movement of stockpiles among Syria’s several dozen known sites. But the official declined to offer more specifics.

Over the weekend, the activity in Syria prompted a series of urgent consultations among the Western nations, which have long been developing contingency plans to neutralize the chemical weapons, a task that the Pentagon estimates would require more than 75,000 troops. But there were no signs that any American action was imminent.

So far, Mr. Obama has been very cautious about intervening in Syria, declining to arm the opposition groups directly.

Anne Barnard contributed reporting from Beirut, Lebanon.

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App Maker Uber Hits Regulatory Snarl

Jack Atley for The New York Times

The Uber car-hiring app was introduced in Sydney last month.

WASHINGTON — Summoning a taxi or car service with your smartphone feels like the future. City governments around the world can agree on that. But many of them are proposing new rules that would run Uber, one of the most prominent ride-requesting apps, off the road.

James Best Jr./The New York Times

The battle between Uber and city governments underscores the tension between lawmakers and technology companies at a time when Web sites and mobile apps can outmaneuver old rules.

At a recent conference here, transportation regulators and car service operators from cities in the United States and Europe met to talk about how smartphone apps were changing the hire-a-car business. Some of these apps are integrated with dispatching systems run by the car companies, while others allow drivers to directly connect with passengers, phone to phone.

While the regulators discussed ways to clarify the legality of these apps, they also proposed guidelines that would effectively force Uber, a San Francisco start-up, to cease operations in the United States. Uber also faces new lawsuits filed by San Francisco cabdrivers and Chicago car service companies, and a $20,000 fine from the California Public Utilities Commission.

The battle between Uber and city governments underscores the tension between lawmakers and technology companies at a time when Web sites and mobile apps can outmaneuver old rules. Services like Uber, Airbnb and Craigslist can cut out the middleman and lead to more efficient markets. But regulators say they could also put consumers at risk.

Uber has rattled regulators in many cities with its unusual approach to expansion. It says that it first consults a transportation lawyer in a city on whether it is legal to operate there. When it comes to town, its employees contact local car service companies to discuss working with them; in cities where Uber works with cabs, employees put up fliers or approach drivers at airports and gas stations. Participating drivers get free iPhones that run Uber’s navigation software, which helps them find people nearby who are requesting rides with their smartphones.

The start-up, which has raised $50 million since 2010, generally does not consult transportation regulators before it starts rolling in each city. Because it is not an actual provider of rides, it says that it is not subject to such regulation. To date, this approach has generally worked for it in 18 cities, including San Francisco, Washington, New York, Chicago, Paris and Amsterdam.

Uber suffered its first serious setback in New York, where it was forced to cease its fledgling yellow cab operation in October because of what the city said were exclusive contracts with payment processors. But the company continues to work with luxury sedan companies and drivers there.

Matthew W. Daus, former chairman of New York’s taxi and limousine commission and current president of the International Association of Transportation Regulators, is one of Uber’s most vocal critics, saying the company isn’t above regulation. With the support of 15 city governments that formed a task force called the Smartphone Apps Committee, he wrote up the guidelines on laws that, if passed by the cities, would outlaw Uber’s operations.

In an interview, Mr. Daus, who practices law part-time with the firm Windels Marx Lane & Mittendorf, said that Uber was a “rogue” app, and that the company was behaving in an unauthorized, unusual and destructive way.

As an example, he pointed to Uber’s doubling of fares in New York after Hurricane Sandy in what the company calls surge pricing, a move that the start-up said was necessary to get more drivers on the storm-ravaged roads.

He said, “New Yorkers deserve an apology from Uber for price-gouging them during the hurricane.”

There are dozens of other car-summoning apps, some even more unconventional than Uber. Lyft, released in May by a start-up called Zimride, allows ordinary citizens to give rides to others in their own cars in return for “donations.” SideCar, another start-up, offers a similar service. Like Uber, these companies are also facing a $20,000 fine from the California Public Utilities Commission for operating without a license.

Regulators say new laws are required to protect consumers from being harmed by such apps. But Uber, aside from the hurricane troubles, is generally adored by customers who say they are willing to pay extra to summon a ride without much wait, especially in cities where cabs are scarce.

In Apple’s App Store, the Uber app has hundreds of five-star ratings. And when Washington tried to pass rules that would make Uber illegal, customers bombarded City Council members with thousands of e-mails in protest.

Uber’s 36-year-old co-founder and chief, Travis Kalanick, has a history of controversy. Scour, the file-sharing start-up he helped found, shut down after it was sued for $250 billion by media companies on complaints of copyright infringement.

He draws attention to Uber by framing it as a story of David vs. Goliath — a lean technology start-up revolutionizing a creaky business. He once referred to Cambridge, Mass., as “home to Harvard, M.I.T. and some of the most anticompetitive, corrupt transportation laws in the country.”

To Mr. Kalanick, the rules being proposed by Mr. Daus’s committee are a classic example of regulators trying to stifle innovation. He says those making the rules are more interested in protecting the taxi and limousine businesses than in helping consumers. And he says Uber’s strategy of marching into new cities without asking permission is necessary.

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Study Bolsters Link Between Routine Hits to Head and Long-Term Brain Disease

The growing evidence of a link between head trauma and long-term, degenerative brain disease was amplified in an extensive study of athletes, military veterans and others who absorbed repeated hits to the head, according to new findings published in the scientific journal Brain.

The study, which included brain samples taken posthumously from 85 people who had histories of repeated mild traumatic brain injury, added to the mounting body of research revealing the possible consequences of routine hits to the head in sports like football and hockey. The possibility that such mild head trauma could result in long-term cognitive impairment has come to vex sports officials, team doctors, athletes and parents in recent years.

Of the group of 85 people, 80 percent (68 men) — nearly all of whom played sports — showed evidence of chronic traumatic encephalopathy, or C.T.E., a degenerative and incurable disease whose symptoms can include memory loss, depression and dementia.

Among the group found to have C.T.E., 50 were football players, including 33 who played in the N.F.L. Among them were stars like Dave Duerson, Cookie Gilchrist and John Mackey. Many of the players were linemen and running backs, positions that tend to have more contact with opponents.

Six high school football players, nine college football players, seven pro boxers and four N.H.L. players, including Derek Boogaard, the former hockey enforcer who died from an accidental overdose of alcohol and painkillers, also showed signs of C.T.E. The study also included 21 veterans, most of whom were also athletes, who showed signs of C.T.E.

The study was conducted by investigators at the Boston University Center for the Study of Traumatic Encephalopathy and the Veterans Affairs Boston Healthcare System, in collaboration with the Sports Legacy Institute. It took four years to complete, included subjects 17 to 98 years old, and more than doubled the number of documented cases of C.T.E. The investigators also created a four-tiered system to classify degrees of C.T.E., hoping it would help doctors treat patients.

The volume of cases in the study “allows us to see the disease at all stages of severity and how it starts and spreads in the brain, which gives us an idea of the mechanism of the injury,” said Ann McKee, the main author of the study, who is a professor of neurology and pathology at Boston University School of Medicine and works at the V.A. Boston.

Those categorized as having Stage 1 of the disease had headaches and loss of attention and concentration, while those with Stage 2 also had depression, explosive behavior and short-term memory loss. Those with Stage 3 of C.T.E., including Duerson, a former All-Pro defensive back for the Chicago Bears who killed himself last year, had cognitive impairment and trouble with executive functions like planning and organizing. Those with Stage 4 had dementia, difficulty finding words and aggression.

Despite the breadth of the findings, the study, like others before it, did not prove definitively that head injuries sustained on the field caused C.T.E. To do that, doctors would need to identify the disease in living patients by using imaging equipment, blood tests or other techniques. Researchers have not been able to determine why some athletes who performed in the same conditions did not develop C.T.E.

The study also did not demonstrate what percentage of professional football players were likely to develop C.T.E. To do that, investigators would need to study the brains of players who do not develop C.T.E., and those are difficult to acquire because families of former players who do not exhibit symptoms are less likely to donate their brains to science.

“It’s a gambler’s game to try to predict what percentage of the population has this,” said Chris Nowinski, a co-author of the study and a co-director of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine. “Many of the families donated the brains of their loved ones because they were symptomatic. Still, this is probably more widespread than we think.”

Researchers expected the details in the study to dispel doubts about the likelihood that many years of head trauma can lead to C.T.E. The growing connections between head trauma and contact sports, though, have led some nervous parents and coaches to assume that any concussion could lead to long-term impairment. Some doctors say that oversimplifies matters. Rather, the total amount of head trauma, including smaller subconcussive hits, as well as how they were treated, must be considered when evaluating whether an athlete is more at risk of developing a disease like C.T.E.

“All concussions are not created equal,” said Robert Cantu, a co-author of the study and a co-director of the encephalopathy center. “Parents have become paranoid about concussions and connecting the dots with C.T.E., and that’s wrong. The dots are really about total head trauma.”

Read More..

Study Bolsters Link Between Routine Hits to Head and Long-Term Brain Disease

The growing evidence of a link between head trauma and long-term, degenerative brain disease was amplified in an extensive study of athletes, military veterans and others who absorbed repeated hits to the head, according to new findings published in the scientific journal Brain.

The study, which included brain samples taken posthumously from 85 people who had histories of repeated mild traumatic brain injury, added to the mounting body of research revealing the possible consequences of routine hits to the head in sports like football and hockey. The possibility that such mild head trauma could result in long-term cognitive impairment has come to vex sports officials, team doctors, athletes and parents in recent years.

Of the group of 85 people, 80 percent (68 men) — nearly all of whom played sports — showed evidence of chronic traumatic encephalopathy, or C.T.E., a degenerative and incurable disease whose symptoms can include memory loss, depression and dementia.

Among the group found to have C.T.E., 50 were football players, including 33 who played in the N.F.L. Among them were stars like Dave Duerson, Cookie Gilchrist and John Mackey. Many of the players were linemen and running backs, positions that tend to have more contact with opponents.

Six high school football players, nine college football players, seven pro boxers and four N.H.L. players, including Derek Boogaard, the former hockey enforcer who died from an accidental overdose of alcohol and painkillers, also showed signs of C.T.E. The study also included 21 veterans, most of whom were also athletes, who showed signs of C.T.E.

The study was conducted by investigators at the Boston University Center for the Study of Traumatic Encephalopathy and the Veterans Affairs Boston Healthcare System, in collaboration with the Sports Legacy Institute. It took four years to complete, included subjects 17 to 98 years old, and more than doubled the number of documented cases of C.T.E. The investigators also created a four-tiered system to classify degrees of C.T.E., hoping it would help doctors treat patients.

The volume of cases in the study “allows us to see the disease at all stages of severity and how it starts and spreads in the brain, which gives us an idea of the mechanism of the injury,” said Ann McKee, the main author of the study, who is a professor of neurology and pathology at Boston University School of Medicine and works at the V.A. Boston.

Those categorized as having Stage 1 of the disease had headaches and loss of attention and concentration, while those with Stage 2 also had depression, explosive behavior and short-term memory loss. Those with Stage 3 of C.T.E., including Duerson, a former All-Pro defensive back for the Chicago Bears who killed himself last year, had cognitive impairment and trouble with executive functions like planning and organizing. Those with Stage 4 had dementia, difficulty finding words and aggression.

Despite the breadth of the findings, the study, like others before it, did not prove definitively that head injuries sustained on the field caused C.T.E. To do that, doctors would need to identify the disease in living patients by using imaging equipment, blood tests or other techniques. Researchers have not been able to determine why some athletes who performed in the same conditions did not develop C.T.E.

The study also did not demonstrate what percentage of professional football players were likely to develop C.T.E. To do that, investigators would need to study the brains of players who do not develop C.T.E., and those are difficult to acquire because families of former players who do not exhibit symptoms are less likely to donate their brains to science.

“It’s a gambler’s game to try to predict what percentage of the population has this,” said Chris Nowinski, a co-author of the study and a co-director of the Center for the Study of Traumatic Encephalopathy at Boston University School of Medicine. “Many of the families donated the brains of their loved ones because they were symptomatic. Still, this is probably more widespread than we think.”

Researchers expected the details in the study to dispel doubts about the likelihood that many years of head trauma can lead to C.T.E. The growing connections between head trauma and contact sports, though, have led some nervous parents and coaches to assume that any concussion could lead to long-term impairment. Some doctors say that oversimplifies matters. Rather, the total amount of head trauma, including smaller subconcussive hits, as well as how they were treated, must be considered when evaluating whether an athlete is more at risk of developing a disease like C.T.E.

“All concussions are not created equal,” said Robert Cantu, a co-author of the study and a co-director of the encephalopathy center. “Parents have become paranoid about concussions and connecting the dots with C.T.E., and that’s wrong. The dots are really about total head trauma.”

Read More..