Pap Test May Prove Useful at Detecting More Types of Cancer, Study Suggests





The Pap test, which has prevented countless deaths from cervical cancer, may eventually help to detect cancers of the uterus and ovaries as well, a new study suggests.




For the first time, researchers have found genetic material from uterine or ovarian cancers in Pap smears, meaning that it may become possible to detect three diseases with just one routine test.


But the research is early, years away from being used in medical practice, and there are caveats. The women studied were already known to have cancer, and while the Pap test found 100 percent of the uterine cancers, it detected only 41 percent of the ovarian cancers. And the approach has not yet been tried in women who appear healthy, to determine whether it can find early signs of uterine or ovarian cancer.


On the other hand, even a 41 percent detection rate would be better than the status quo in ovarian cancer, particularly if the detection extends to early stages. The disease is usually advanced by the time it is found, and survival rates are poor. About 22,280 new cases were expected in the United States in 2012, and 15,500 deaths. Improved tests are urgently needed.


Uterine cancer has a better prognosis, but still kills around 8,000 women a year in the United States.


These innovative applications of the Pap test are part of a new era in which advances in genetics are being applied to the detection of a wide variety of cancers or precancerous conditions. Scientists are learning to find minute bits of mutant DNA in tissue samples or bodily fluids that may signal the presence of hidden or incipient cancers.


Ideally, the new techniques would find the abnormalities early enough to cure the disease or even prevent it entirely. But it is too soon to tell.


“Is this the harbinger of things to come? I would answer yes,” said Dr. Bert Vogelstein, director of the Ludwig Center for Cancer Genetics and Therapeutics at Johns Hopkins University, and a senior author of a report on the Pap test study published on Wednesday in the journal Science Translational Medicine. He said the genomes of more than 50 types of tumors had been sequenced, and researchers were trying to take advantage of the information.


Similar studies are under way or are being considered to look for mutant DNA in blood, stool, urine and sputum, both to detect cancer and also to monitor the response to treatment in people known to have the disease.


But researchers warn that such tests, used for screening, can be a double-edged sword if they give false positive results that send patients down a rabbit hole of invasive tests and needless treatments. Even a test that finds only real cancers may be unable to tell aggressive, dangerous ones apart from indolent ones that might never do any harm, leaving patients to decide whether to watch and wait or to go through surgery, chemotherapy and radiation with all the associated risks and side effects.


“Will they start recovering mutations that are not cancer-related?” asked Dr. Christopher P. Crum, a professor at Harvard Medical School who was not involved in the research.


But he also called the study a “great proof of principle,” and said, “Any whisper of hope to women who suffer from endometrial or ovarian cancer would be most welcome.”


DNA testing is already performed on samples from Pap tests, to look for the human papillomavirus, or HPV, which causes cervical cancer. Dr. Vogelstein and his team decided to try DNA testing for cancer. They theorized that cells or DNA shed from cancers of the ovaries and the uterine lining, or endometrium, might reach the cervix and turn up in Pap smears.


The team picked common mutations found in these cancers, and looked for them in tumor samples from 24 women with endometrial cancer and 22 with ovarian cancer. All the cancers had one or more of the common mutations.


Then, the researchers performed Pap tests on the same women, and looked for the same DNA mutations in the Pap specimens. They found the mutations in 100 percent of the women with endometrial cancer, but in only 9 of the 22 with ovarian cancer. The test identified two of the four ovarian cancers that had been diagnosed at an early stage.


Finally, the team developed a test that would look simultaneously for cancer-associated mutations in 12 different genes in Pap samples. Used in a control sample of 14 healthy women, the test found no mutations — meaning no false-positive results.


Dr. Luis A. Diaz, the other senior author of the report and an associate professor of oncology at Johns Hopkins, called the research a step toward a screening test that at first blush appears very effective at detecting endometrial cancer, though obviously less so at finding ovarian cancer.


“Probably one of the most exciting features of this approach,” Dr. Diaz said, “is that we wanted a test that would seamlessly integrate with routine medical practice that could be utilized with the same test that women get every day all over the world, the Pap smear.”


But, he added: “We can’t say it’s ready for prime time. Like all good science, it needs to be validated.”


He and other members of the team said it might be possible to improve the detection rate for ovarian cancer by looking for more mutations and by changing the technique of performing Pap tests to increase the likelihood of capturing cells from the ovary. The change might involve timing the test to a certain point in a woman’s monthly cycle, using a longer brush to collect cells from deeper within the cervix or prescribing a drug that would raise the odds of cells being shed from the ovary.


The technique also needs to be tested in much larger groups of women, including healthy ones, to find out whether it works, particularly at finding cancers early enough to improve survival. And studies must also find out whether it generates false positive results, or identifies cancers that might not actually need to be treated.


Michael H. Melner, a program director in molecular genetics and biochemistry for the American Cancer Society, called the research “very promising,” in part because it is based on finding mutations.


“It tells you not just that cancer is there, but which mutation is there,” Dr. Melner said. “As we learn more and more about which mutations are associated with more or less severe forms of cancer, it’s more information, and possibly more diagnostic.”


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Shares Rise as Companies Report Earnings


Stocks rose on Wall Street on Wednesday after corporate earnings reports got off to a good start.


The Dow Jones industrial average climbed 61.66 points to 13,390.51. The Standard & Poor’s 500-stock index gained 3.87 points to 1,461.02, and the Nasdaq composite rose 14 to 3,105.81.


Stocks are facing their first big challenge of the year as companies start to report earnings for the fourth quarter of 2012. Throughout last year, analysts cut their outlook for earnings growth in the period and now expect them to rise by 3.21 percent, according to data from S&P Capital IQ.


“Maybe earnings expectations were a little too low,” Ryan Detrick, a strategist at Schaeffer’s Investment Research, said. “You don’t need to have great earnings, you just need to beat those expectations” for stocks to rally, he said.


Early indications were decent. The aluminum maker Alcoa reported late Tuesday that it swung to a profit for the fourth quarter, with earnings that met Wall Street’s expectations. The company brought in more revenue than analysts had expected, and the company predicted rising demand for aluminum this year as the aerospace industry gains strength. Alcoa is usually the first Dow component to report earnings every quarter.


Despite the better revenue number, Alcoa’s stock performance Wednesday was lackluster. It traded higher for part of the day, then ended down 2 cents at $9.08 a share.


Other companies fared better after reporting earnings. Helen of Troy, which sells personal care products under brands like Dr. Scholl’s and Vidal Sassoon, rose 2.7 percent, up 90 cents to $34.43 after reporting a 15 percent increase in quarterly net income.


Boeing was the biggest gainer of the 30 stocks in the Dow. It jumped 3.5 percent, up $2.63 to $76.76, after two days of sharp declines set off by new problems for its 787 Dreamliner. Boeing said it had “extreme confidence” in the plane even as federal investigators tried to determine the cause of a fire on Monday aboard an empty Japan Airlines plane in Boston and a fuel leak in another Japan Airlines 787 on Tuesday.


The wireless network operator Clearwire rose 7.2 percent, or 21 cents, to $3.13, after Dish network made an unsolicited offer to buy the company, which has already agreed to sell itself to Sprint. Dish rose 88 cents to $36.85, and Sprint fell 9 cents to $5.88.


The online education company Apollo Group fell 7.8 percent after reporting a sharp decline in fall term student sign-ups at the University of Phoenix, which it operates. The stock fell $1.62, to $19.32 a share.


Interest rates were steady. The Treasury’s benchmark 10-year note rose 1/32, to 97 29/32, and the yield was unchanged at 1.86 percent.


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Communists and Liberals Face Off in China Censorship





GUANGZHOU, China — Protests over censorship at one of China’s most liberal newspapers descended into ideological confrontation in this southeastern provincial capital on Tuesday, pitting advocates of free speech against supporters of Communist Party control, who wielded red flags and portraits of Mao Zedong.




The face-off between liberals and leftists outside the headquarters of the company that publishes the weekly newspaper, Southern Weekend, came after disgruntled editors and reporters at the paper last week deplored what they said was crude meddling by the top propaganda official in Guangdong Province, which has long had a reputation as a bastion of a relatively free press.


With a number of celebrities and business leaders rallying online to the liberal cause, senior propaganda officials in Beijing began this week to roll out a national strategy of demonizing the rebel journalists and their supporters. The Central Propaganda Department issued a directive to news organizations saying that the defiant outburst at Southern Weekend, also known as Southern Weekly, had involved “hostile foreign forces.”


The order, translated by China Digital Times, a research group at the University of California, Berkeley, that studies Chinese news media, said that Chinese journalists must drop their support for Southern Weekend and insisted that “party control of the media is an unwavering basic principle.”


An editor at a party news organization said the term “hostile forces” had been used in an internal discussion with a senior editor about the Southern Weekend conflict. Several Chinese journalists outside Guangdong said Tuesday that a positive outcome for the frustrated Southern Weekend reporters and editors appeared uncertain, and that their call for the dismissal of Tuo Zhen, the top provincial propaganda official, who took up his post in May, was probably too radical for higher authorities to accept.


The protesting journalists at Southern Weekend blame Mr. Tuo, a former journalist himself, for ordering a drastic change in a New Year’s editorial that had originally called for greater respect for constitutional rights. The revised editorial instead praised party policies. Mr. Tuo has not commented.


A former editor at the Nanfang Media Group, which includes Southern Weekend, said negotiations continued on Tuesday between provincial propaganda officials and representatives of the disgruntled journalists and editors.


The former editor, who asked that his name not be used for fear it could jeopardize his current job, said the talks focused on the protesting journalists’ demands for an inquiry into the New Year’s episode and for the newspaper’s managers to rescind a statement that absolved Mr. Tuo of responsibility for the editorial.


“They want that statement to be removed, and they also want assurances about relaxing controls on journalists — not removing party oversight, but making it more reasonable, allowing reporters to challenge officials,” he said. “The other main demand is for an impartial explanation of what happened, an accounting so it won’t happen again.”


The former editor said a continued standoff into Wednesday could jeopardize the newspaper’s usual publication on Thursday. “In effect, it’s a strike,” he said. “It looks unclear whether it can come out on Thursday.”


So far, senior Chinese officials have not commented publicly on the censorship dispute at the paper, which could test how far the recently appointed Communist Party leader, Xi Jinping, will go in support of more open economic and political policies. “I don’t believe that Xi is totally hypocritical when he talks about reform,” said Chen Min, a prominent former opinion writer for Southern Weekend who was forced out of the newspaper in 2011 during a party-led crackdown on potential dissent.


Defenders of Communist orthodoxy turned up at the newspaper headquarters on Tuesday to make the case for firm party control of the media.


“We support the Communist Party, shut down the traitor newspaper,” said a cardboard sign held up by one of 10 or so conservative demonstrators.


“Southern Weekend has an American dream,” another sign said. “We don’t want the American dream, we want the Chinese dream.”


Most of the party supporters refused to give their names. One who did, Yang Xingfa, 50, from Hunan Province, said: “Southern Weekend belongs to the people. However, the paper always ignores the achievements of the Chinese Communist Party and asks why China isn’t more like the United States. Outrageous!”


Some of the participants held portraits of Mao; others waved the red flags of China and of the Communist Party. They said they had come on their own initiative and not at the behest of officials.


The dueling protests outside the newspaper headquarters reflected the political passions and tensions raised by the quarrel over censorship. Internet chatter about the conflict has become widespread, and finding a resolution to the standoff poses a challenge both to the central authorities and to Hu Chunhua, the new party chief of Guangdong and a potential candidate to succeed Mr. Xi in a decade.


Hundreds of bystanders watched and took photos on cellphones as the leftists shouted at the 20 or more protesters who had gathered to denounce censorship, and shoving matches broke out between the demonstrators. The 70 or so police officers and security guards mostly watched, stepping in on occasion to separate the two sides.


At one point, leftists were showered with 50-cent renminbi currency notes, which are worth about 8 United States cents. The Fifty-Cent Party has become a popular term used to disparage pro-party leftists, who are accused by critics of taking 50 cents as payment for each pro-party message they post on the Internet.


One defender of the Southern Weekend journalists was Liang Taiping, 28, a poet who wore a mask popularized by the Hollywood movie and British comic book “V for Vendetta.” Mr. Liang said he had bought the mask after watching the movie recently on state-run China Central Television, which had surprised many Chinese with its willingness to show the film uncut, since the film advocates the overthrow of a one-party dictatorship.


“It’s the only newspaper in China that’s willing to tell the truth,” said Mr. Liang, who added that he had traveled by train about 350 miles from the southern city of Changsha to show his support. “What’s the point of living if you can’t even speak freely?”


Edward Wong reported from Guangzhou, and Chris Buckley from Hong Kong. Jonah M. Kessel contributed reporting from Guangzhou, and Jonathan Ansfield from Beijing. Mia Li contributed research from Guangzhou.



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U.S. Franciscan friars go digital, accept prayer requests via text






NEW YORK (Reuters) – The largest group of Franciscan friars in the United States is offering the faithful a new way to pray in the digital age by accepting prayer requests via text messages.


The Friars of Holy Name Province, who staff 40 parishes and have colleges, soup kitchens and food centers along the eastern seaboard, as well as groups in Peru and Tokyo, are among a few religious groups offering this type of digital service.






Its “Text a Prayer Intention to a Franciscan Friar” initiative, which is described as faith at your fingertips, is a novel way for Roman Catholics to connect.


“People are always saying to friars, ‘Can you say a prayer for me?’ Or ‘Can you remember my mother who has cancer?’” Father David Convertino, the New York-based executive director of development for the Franciscan Friars of the Holy Name Province, said in an interview.


“I was thinking that a lot of people text everything now, even more than email, so why not have people have the ability to ask us to pray for them … by texting.”


The faithful simply text the word ‘prayer’ to 306-44, free of charge. A welcome message from the friars comes up along with a box to type in the request. When the it is sent, the sender receives a reply.


The intentions are received on a website and will be included collectively in the friars’ prayers twice a day and at Mass.


It is one of several ways the friars hope to reach a younger audience, increase the number of faithful and spread the faith. They have already renovated their website and the next step is moving into Facebook and tweeting.


“If the Pope can tweet, friars can text,” said Father David.


The friars also have a presence on LinkedIn and have been streaming some of their church services.


“We’re trying,” said Father David when asked if the friars are well into the digital age, adding that they were “rushing madly into the 19th century.”


Most of the 325 friars, whose average age is about 60, are comfortable with the technology.


“We have a friar who is 80 who was texting today,” said Father David.


The friars are following the example of 85-year-old Pope Benedict, the leader of the world’s 1.2 billion Roman Catholics, whom the Vatican said had 2.1 million followers on Twitter just eight days after sending his first tweet.


The Pontiff tweets in several languages, including Arabic, and plans to add Latin and Chinese to them.


“We’re really excited about this working,” said Father David, about the new program. “I think we’ll be able to keep up (with all the intentions). That’s what we do, we pray for people.”


(Reporting by Patricia Reaney; Editing by Piya Sinha-Roy)


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Bucks coach Scott Skiles out, Boylan to fill in


MILWAUKEE (AP) — Once again, an NBA team has parted ways with head coach Scott Skiles. Once again, veteran assistant Jim Boylan is being asked to pick up the pieces.


One day after Milwaukee and Skiles agreed it was time for a change, the Bucks said Tuesday that Boylan will coach the team for the rest of the season. General manager John Hammond downplayed the notion that Skiles had lost control of the locker room or otherwise felt friction with management.


"Scott and I did not have a frosty relationship. Scott did not hate this team," said Hammond, who noted that more than half the season remains. "We're not a team in dire straits ... we're expecting good things to happen."


Boylan met with reporters before Tuesday night's home game against Phoenix.


"We'll do what we've been doing as far as being professional, getting ourselves ready for every game and getting out there and competing," Boylan said. "That's my job right now, to get us back on the right track, move us in the right direction and I think the guys we have on the team right now are quality people and committed to that task. That'll be our ultimate goal."


If this change sounds familiar, it should: Skiles was fired as head coach in Chicago on Christmas Eve in 2007 after the Bulls started 9-16. Boylan, an assistant in Chicago, took over and went 24-32. He was fired at the end of the season.


In an interview Tuesday with the Milwaukee Journal Sentinel, Skiles disputed the notion that he didn't like his team.


"There's always the normal coach-player friction that goes on," Skiles said in the Journal Sentinel interview. "Guys at this level are great players. This is, as NBA teams go, this is a good group of guys."


Hammond said he and Skiles had been having a number of conversations recently about the future of the team. He said there was no single factor in Skiles' departure, and that no other assistant coaches were leaving.


"It was a mutual decision. We both agreed to make this decision," he said.


Skiles had a 162-182 record in four-plus seasons with Milwaukee, with one playoff appearance — a first-round loss to Atlanta in seven games during the 2009-10 season. He was a hard-nosed, defensive-minded coach who sometimes seemed to have difficulty meshing with a roster built around volume shooters Brandon Jennings and Monta Ellis.


Jennings said he heard about the change in a phone call Monday night from Skiles and not from anyone within the organization.


"I think that's why I was a little bit frustrated at first," he said. "Just the fact that I had to hear it from my own coach and not the team. If I'm supposed to be their franchise player, why don't I hear the news first?"


Jennings said he was shocked but not upset about the change. He said he spoke with Skiles for about 20 minutes.


"We had our ups and downs, we had great times here," he said. "I have nothing but respect for him because as a rookie he did put the ball in my hands first."


Luc Mbah a Moute said he was shocked and had a great experience playing for Skiles, but coaching changes simply were part of the business of the NBA.


"I kind of had an idea of hearing that the team wasn't really happy with the way everything was going, and not just this year, you know the last couple of years with Skiles," he said. "This year we were kind of like started a good start and then went through a patch where we didn't play so great."


Boylan said the initial change he would make was to insert forward Ersan Ilyasova into the starting lineup for Ekpe Udoh.


Ilyasova re-signed with the Bucks during the summer, but saw his minutes decrease to 22 per game this year after playing 27 in the 2011-12 season. He said he was looking forward to playing for Boylan.


"For me, it's not a big deal you know, if you start or not, my concern has been about the minutes," Ilyasova said. "When you come from the season I had last year, I didn't expect to play less than last year."


Skiles' agent, Keith Glass, said it was hard to pinpoint when Skiles began thinking of stepping aside, but all parties agreed the timing was right.


"There was no blowup. There was no animosity going on. I think everybody made the right decision for their own respective sides," he said.


Two other coaches, the Lakers' Mike Brown and Brooklyn's Avery Johnson, are also out of work in this young season. Brown was fired after five games and Johnson late last month, about three weeks after being named Eastern Conference coach of the month.


The 57-year-old Boylan has been the lead assistant for the Bucks the past four seasons. In a 20-year NBA coaching career, he has also been an assistant in Cleveland, Vancouver, Phoenix, Atlanta and Chicago.


Boylan said he was too worried about keeping the job when he succeeded Skiles in Chicago.


"Last time, from a personal standpoint, I was too worried about trying to keep the job and it kind of restricted me as time went on," he said. "I made the determination when this happened last night, that I was going to try and enjoy this and just do what I like to do which is coach these guys, being around these guys and the coaching staff and the organization and just enjoy it.


"Have a good time with it and get the guys to play hard and compete and let the chips fall where they may at the end," he said.


Milwaukee, losers of four straight when the coaching change was announced, started out a surprising 6-2, only to lose seven of its next nine. The Bucks followed that with a four-game winning streak, the kind of wild swings that didn't sit well with a coach who values consistency — both in play and preparation.


"Considering like a week ago we were 16-12 and beat Miami, you probably wouldn't have guessed this would have happened a week later," forward Mike Dunleavy said.


Skiles did help coax a breakout season out of Larry Sanders, who has emerged as a rebounding and shot-blocking monster over the last few weeks. The demanding coach pushed Sanders to be more consistent, and the lanky forward/center has responded. He grabbed 20 rebounds against Boston on Dec. 21 to start a string of double-digit rebound nights in five of his last eight games and leads the league with 3.07 blocks per game.


Skiles' focus on defense was always going to be tested by a roster revolving around Jennings and Ellis, two flashy scorers who prefer to get up and down the court and lure opposing teams into shootouts.


Jennings and Ellis have been giving plenty of effort, but the Bucks were in the middle of the pack in points allowed per game (15th) and field goal percentage defense (18th), below Skiles' lofty expectations.


Still, the Bucks are only a few games behind Indiana in the Central Division, despite injuries to Beno Udrih and top defender Mbah a Moute, and in seventh place in the Eastern Conference playoff chase.


Skiles' departure could be the first in a series of big shake-ups for the Bucks. Hammond is in the final year of his deal, while Jennings and Ellis can both become restricted free agents after this season.


Hammond said he and team owner Herb Kohl are in discussions about an extension, but he declined to elaborate on the progress of their conversations.


As for Skiles, he is now 443-433 as an NBA head coach in 12-plus seasons, which also includes stints with Chicago and Phoenix. He started this season with a host of new players, though the biggest trade during his tenure was the deal that sent former No. 1 draft pick Andrew Bogut to Golden State for Ellis.


"I never heard Scott say a negative thing to me about that trade or anything else," Glass said. "Everybody has their own opinions on the way things are done, but Scott was always on board with — in terms of support — whatever move was made. ... And I think he liked Monta. I never heard him say a word about that at all in a negative sense."


Glass said it was too early to say whether Skiles was looking to stay in coaching.


"Today is not the day for that ... but I'm sure we will discuss that in the next month or so," he said. "But he's not burning right now."


AP Sports Writers Jon Krawczynski in Minneapolis and Andrew Seligman in Chicago and AP Freelancer DiGiovanni in Milwaukee contributed to this report.


___


Dinesh Ramde can be reached at dramde(at)ap.org.


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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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A Financial Service for People Fed Up With Banks


Steve Dykes for The New York Times


Shamir Karkal, left,







Like many people, Josh Reich got fed up with his bank after it charged him overdraft fees and he endured painful customer service calls to fight them. But unlike most people, Mr. Reich, a software engineer from Australia, decided to come up with a better way to bank.




Mr. Reich and a co-founder, Shamir Karkal, created Simple, an online banking start-up company based in Portland, Ore., that offers its customers free checking accounts and data-rich analysis of their transactions and spending habits.


Few entrepreneurs dare to set their sights on industries as large and entrenched as banking and expect to flourish. But Mr. Reich, 34, a professed data nerd who has built computers and tinkered with the innards of sophisticated cameras, holds a master’s degree in business and has a robust background in financial data analysis. He is confident that Simple’s minimalist approach — it promises not to charge any fees for any services — will draw fans and customers.


“Banks make money by keeping customers confused,” Mr. Reich said. “There’s no incentives to make the experience better.”


Of course, inviting people to trust a start-up with their money is a lot to ask. The company, which began signing up customers late last year in a deliberately slow fashion, now has 20,000 and has processed transactions worth more than $200 million.


It also has the backing of prominent venture capital firms including Shasta Ventures, SV Angel and IA Ventures and has raised more than $13 million. Simple has few, if any, direct competitors, although some services like SmartyPig and Mint offer analysis of bank accounts and financial transactions.


Simple is actually not a bank. It has deals with CBW Bank and Bancorp, federally insured banks, to hold its customers’ money.


And it has built slick apps for the Web and mobile devices to give customers an overview of their accounts and transactions. But it encourages customers to treat it as a bank, closing their more traditional accounts and only using Simple.


The company’s biggest challenge, banking analysts say, will be to persuade people to give it a try.


“It is extremely difficult to get consumers to change and leave their banks,” said Jacob Jegher, an analyst at Celent, a research and consulting firm. “Plus, although they are not a bank, they still operate like a financial institution, and they will face challenges that big banks have decades of experience with.”


After the financial crisis, smaller community banks and credit unions gained customers eager for alternatives to larger corporate banks. Experts say Simple could attract those customers as well.


Early adopters are warming to the service; during a speech last fall at a conference aimed at technology enthusiasts, designers and creative people, Mr. Reich asked how many in attendance were Simple customers. A majority of the crowd raised hands.


Mr. Reich said Simple was keeping its first group of customers small to allow it to work out any kinks. (Already there have been some flaws, like one that briefly locked several users out of their accounts in November.) At this stage, those who want a Simple account have to request an invitation on its site, though these are handed out fairly liberally to those who meet the minimal qualifications of Simple and its bank partners.


Customers receive a plain white card that can be used like a debit card. The company offers most traditional banking features, like direct deposit and money transfers. But there is plenty it does not offer, like joint or business checking accounts, or paper checkbooks, which may be a deal killer for some.


The start-up does not have physical bank branches or automated teller machines, nor does it plan to build any. As a result, Simple customers cannot make cash deposits and must rely on the Internet and phone for service.


Simple tries to make up for what it does not have with modern software design and data analysis.


Each Simple transaction is tagged with detailed information that allows customers to search their accounts with plain English commands like “Show me how much I spent on meals over $30 last month,” or “Show me how much money I spent on gifts in December.”


Customers can see transactions plotted on a map or search for all transactions in a particular state or country, something that would be difficult with a traditional bank account.


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Iran’s Oil Exports and Sales Down 40 Percent, Official Admits





Iran’s oil minister acknowledged for the first time on Monday that petroleum exports and sales had fallen by at least 40 percent over the past year, contradicting his previous denials and providing an unusual public admission that the cumulative impact of Western economic sanctions has grown more severe.




The acknowledgment by the oil minister, Rostam Qasemi, came as new restrictions from the sanctions are threatening to further choke Iran’s ability to sell oil, its most important export. Under provisions of an American law that takes effect in February, importers of Iranian oil that have been exempted from the sanctions cannot send the money used to buy it to Iran without risking penalties in the United States. The result could impound billions of dollars’ worth of Iran’s expected oil revenue in the banks of those importing countries.


Additional punitive measures, which President Obama signed into law last week, broaden the list of blacklisted Iranian industries to include all energy, shipping and shipbuilding enterprises and seek to restrict barter transactions that Iran has been using to circumvent earlier sanctions. Some critics of the new steps say they nearly amount to a trade embargo.


In another consequence of the sanctions’ impact, the Oil Ministry on Monday stopped the sale of jet fuel to Iran’s heavily indebted domestic airlines unless they pay cash. The semiofficial Mehr news agency reported that most commercial airline flights inside the country had been canceled as a result.


Mr. Qasemi, a former Revolutionary Guards commander who was appointed oil minister more than a year ago, had consistently asserted that Iran had no problem selling its oil. In September, in an address to the Parliament, he said that oil exports were rising, despite outside data that showed a sharp drop. At other times, he has threatened to halt all oil exports in retaliation for the sanctions, apparently in a vain effort to raise oil prices by frightening global oil traders.


Both the Organization of the Petroleum Exporting Countries, of which Iran is a major member, and the International Energy Agency, a group of mostly Western oil-importing countries, have reported that Iran’s crude exports fell to roughly a million barrels a day by the end of 2012, compared with 2.4 million a year earlier.


Other Iranian officials have said it is clear that the country’s oil exports have suffered.


Economists knowledgeable about Iran’s sanctions problems said Mr. Qasemi’s acknowledgment of the export decline, made at a parliamentary meeting on finances, was inevitable because the government must find a way to fill a large gap in the budget — a gap that revenue from oil exports had been expected to fill.


The Iranian Students’ News Agency quoted the minister as telling lawmakers that “there has been a 40 percent decrease in oil sales and a 45 percent decrease in repatriating oil money.” The agency also quoted him as forecasting further decreases without specifying how much.


“It’s common knowledge in Iran that oil exports have fallen,” said Djavad Salehi-Isfahani, an economics professor at Virginia Tech, who visited his native Iran last month. “I don’t know if the oil minister had been in denial.”


Dr. Salehi-Isfahani suggested that President Mahmoud Ahmadinejad’s government might have to resolve the budget deficit problem with an accounting maneuver that would recalculate the value of Iran’s oil sales at half the official foreign-exchange rate — 25,000 rials per dollar instead of the central bank’s artificial rate of 12,260 rials per dollar.


That change would be much closer to the rial’s actual value and essentially double the amount — in rials — gained from Iranian oil exports. But such a move would also concede the sanctions’ severe inflationary impact, which has caused a steep fall in the value of the Iranian currency this past year.


Many Iranians have suffered from the rial’s decline, which has essentially made them poorer by raising the price of imported goods. Iran’s inflation also has left many Iranian businesses unable to pay wages or bills. The problem surfaced in a new way on Monday with the abrupt cancellation of domestic flights by Iranian airlines, which had been buying fuel on credit.


The head of the Airlines Association, Seyyed Abdol Reza Musavi, told Mehr that flights in Tehran, Kish, Mashhad and other airports had been halted because the carriers failed to repay their debts, and that fuel would now be provided “on a cash-only basis.” It was unclear how long the flight suspensions would last.


The sanctions on Iran have been intensifying for the past few years because of its disputed nuclear program, which Iran says is for peaceful use but which Western countries and Israel suspect is meant to develop the ability to make nuclear weapons.


Thomas Erdbrink contributed reporting from Tehran.



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Live blog: Samsung’s new gear at CES 2013






yep thats how apple works now, but can you stream network flash players thru your i pad via apple tv , answer = no , same with google tv. hook the comp directly to the comp get a wireless keayboard and an air mouse , and fyi windows media player can be streamed wirelessly from any pc all you need is a 50 dollar blue ray player , if you want to stream media from a hard drive wirelessly it just has to be one built to the standard like any wd home drive , but dont go usb get one that connects via gigabit


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Bama starts with bang at BCS championship game


MIAMI GARDENS, Fla. (AP) — One of the most anticipated BCS championship games began with Alabama getting the ball and driving it down the field for a touchdown against No. 1 Notre Dame's vaunted defense.


Sun Life Stadium was packed and raucous for the kickoff Monday night.


The Fighting Irish won the coin toss, decided to kickoff and the Crimson Tide marched down the field with ease, driving 82 yards on five plays to take a 7-0 lead on Eddie Lacy's 20-yard touchdown run up the middle with 12:03 left in the first quarter.


It was only the third rushing touchdown Notre Dame has allowed this season.


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