Phys Ed: Getting the Right Dose of Exercise

Phys Ed

Gretchen Reynolds on the science of fitness.

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A common concern about exercise is that if you don’t do it almost every day, you won’t achieve much health benefit. But a commendable new study suggests otherwise, showing that a fairly leisurely approach to scheduling workouts may actually be more beneficial than working out almost daily.

For the new study, published this month in Exercise & Science in Sports & Medicine, researchers at the University of Alabama at Birmingham gathered 72 older, sedentary women and randomly assigned them to one of three exercise groups.

One group began lifting weights once a week and performing an endurance-style workout, like jogging or bike riding, on another day.

Another group lifted weights twice a week and jogged or rode an exercise bike twice a week.

The final group, as you may have guessed, completed three weight-lifting and three endurance sessions, or six weekly workouts.

The exercise, which was supervised by researchers, was easy at first and meant to elicit changes in both muscles and endurance. Over the course of four months, the intensity and duration gradually increased, until the women were jogging moderately for 40 minutes and lifting weights for about the same amount of time.

The researchers were hoping to find out which number of weekly workouts would be, Goldilocks-like, just right for increasing the women’s fitness and overall weekly energy expenditure.

Some previous studies had suggested that working out only once or twice a week produced few gains in fitness, while exercising vigorously almost every day sometimes led people to become less physically active, over all, than those formally exercising less. Researchers theorized that the more grueling workout schedule caused the central nervous system to respond as if people were overdoing things, sending out physiological signals that, in an unconscious internal reaction, prompted them to feel tired or lethargic and stop moving so much.

To determine if either of these possibilities held true among their volunteers, the researchers in the current study tracked the women’s blood levels of cytokines, a substance related to stress that is thought to be one of the signals the nervous system uses to determine if someone is overdoing things physically. They also measured the women’s changing aerobic capacities, muscle strength, body fat, moods and, using sophisticated calorimetry techniques, energy expenditure over the course of each week.

By the end of the four-month experiment, all of the women had gained endurance and strength and shed body fat, although weight loss was not the point of the study. The scientists had not asked the women to change their eating habits.

There were, remarkably, almost no differences in fitness gains among the groups. The women working out twice a week had become as powerful and aerobically fit as those who had worked out six times a week. There were no discernible differences in cytokine levels among the groups, either.

However, the women exercising four times per week were now expending far more energy, over all, than the women in either of the other two groups. They were burning about 225 additional calories each day, beyond what they expended while exercising, compared to their calorie burning at the start of the experiment.

The twice-a-week exercisers also were using more energy each day than they had been at first, burning almost 100 calories more daily, in addition to the calories used during workouts.

But the women who had been assigned to exercise six times per week were now expending considerably less daily energy than they had been at the experiment’s start, the equivalent of almost 200 fewer calories each day, even though they were exercising so assiduously.

“We think that the women in the twice-a-week and four-times-a-week groups felt more energized and physically capable” after several months of training than they had at the start of the study, says Gary Hunter, a U.A.B. professor who led the experiment. Based on conversations with the women, he says he thinks they began opting for stairs over escalators and walking for pleasure.

The women working out six times a week, though, reacted very differently. “They complained to us that working out six times a week took too much time,” Dr. Hunter says. They did not report feeling fatigued or physically droopy. Their bodies were not producing excessive levels of cytokines, sending invisible messages to the body to slow down.

Rather, they felt pressed for time and reacted, it seems, by making choices like driving instead of walking and impatiently avoiding the stairs.

Despite the cautionary note, those who insist on working out six times per week need not feel discouraged. As long as you consciously monitor your activity level, the findings suggest, you won’t necessarily and unconsciously wind up moving less over all.

But the more fundamental finding of this study, Dr. Hunter says, is that “less may be more,” a message that most likely resonates with far more of us. The women exercising four times a week “had the greatest overall increase in energy expenditure,” he says. But those working out only twice a week “weren’t far behind.”

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Hagel's Defense nomination OKd by Senate Armed Services Committee

WASHINGTON — After a contentious debate, the Senate Armed Services Committee on Tuesday narrowly approved former Sen. Chuck Hagel to be secretary of Defense, moving the fight over President Obama's controversial Cabinet choice to the full Senate.

Hagel, a Republican from Nebraska, won the 26-member panel's endorsement with only Democratic votes. All 11 Republicans present voted against his nomination; one GOP senator was absent.

The full Senate will begin considering Hagel's nomination Wednesday, with a final vote possible by week's end. Several GOP senators have threatened to delay the vote, but the White House appears confident it has enough votes to prevail. Hagel, who would replace Leon E. Panetta, already has scheduled his first foreign trip as secretary for Feb. 20.

The two-hour hearing grew heated after Sen. Ted Cruz (R-Texas) complained that Hagel did not report the source of $200,000 in income, saying it may have come "directly from North Korea." Cruz acknowledged that he had "no evidence" to support that charge.

Sen. Carl Levin (D-Mich.), the chairman, countered that Hagel had complied with all the committee's financial disclosure requirements, including for foreign sources of income. He chided Cruz, the panel's most junior Republican, for offering "innuendo" without evidence.

Sen. Bill Nelson (D-Fla.) reacted more strongly, calling Cruz's remarks "out of line."

Sen. John McCain (R-Ariz.), a former close friend of Hagel who has been sharply critical of the nominee's views on Iraq, defended him. Like McCain, Hagel served in combat in the Vietnam War, and he was wounded twice in battle.

"Sen. Hagel is an honorable man. He served his country and no one on this committee should impugn his integrity," McCain said.

The tense exchange brought to the surface concerns of several members that the Armed Services Committee, which traditionally has operated in a more bipartisan fashion than other congressional panels, was losing that spirit.

Other Republican criticism focused on issues that emerged before and during Hagel's Jan. 31 confirmation hearing, including his past statements on Iran and Israel, and concerns that he will oversee a significant reduction in Pentagon spending.

Members also cited Hagel's widely panned performance at his confirmation hearing, at which he appeared tentative and unsure at times. McCain called it the worst of any Defense nominee he'd seen.

Even a supporter, Sen. Jeanne Shaheen (D-N.H.), said she wished he had appeared "feistier."

Sen. Lindsey Graham (R-S.C.), one of Hagel's chief critics, said: "The next secretary of Defense is going to have to deal with a world on fire. I just believe that the testimony of Sen. Hagel was not reassuring."

Several Republicans have vowed to delay or derail a final Senate vote on Hagel.

Sen. James M. Inhofe (R-Okla.) has said he would insist that Hagel overcome a filibuster, which would require the support of 60 senators to end debate and move to a final up-or-down vote.

Graham has threatened to hold Hagel's nomination until the White House answers specific questions about Obama's actions on Sept. 11, 2012, when armed militants stormed a U.S. diplomatic compound in Benghazi, Libya, and killed four Americans.

Other Republican senators who say they will vote against Hagel also say that they oppose a filibuster.

The White House believes all 53 Democratic senators and the two independents who caucus with the party will support Hagel's confirmation. Two Republicans — Thad Cochran of Mississippi and Mike Johanns of Nebraska — also have said they would vote yes.

michael.memoli@latimes.com

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Snapchat Publishes Self-Destructing Link to Android Beta App

Snapchat published a link to a beta version of its Android app on Tuesday and, just as the wildly popular app’s shared photos and videos self destruct, this link too was built to be destroyed. But, we’ve found a simple way around it.

In the wee hours this morning, Snapchat posted a link to snapchat.com/beta, where Android users could download a beta version of its Android app provided their settings allowed it. The only difference between the beta and what’s available in Google Play is, of course, the ability to share video — a feature that has been previously exclusive to iOS users. After 2 a.m. Pacific Time, the beta download page, which was first reported by TechCrunch, no longer offered a download. Instead, the page displays a message that reads: “the Snapchat Android Beta is no longer available.”

That message pops up after a less-than-one-second delay. During this delay, the link to the Snapchat Android Beta app is present, and if you can tap it quick enough, you can download the app — as I did this morning at about 10 a.m.

Once you download the app, you’ll find that Snapchat on Android works pretty much like it does on iOS — just hold down the record button to shoot video or tap it once to snap a photo. I’ve been using the app on a Nexus 4 smartphone and it’s worked well expect for two unexpected crashes when trying to playback a video sent to me from a friend. This isn’t unexpected, after all, the app was just released, briefly this morning and is still a work in progress. But it looks like Snapchat, which recently raised $13.5 million in venture capital, is close to finally bringing its iOS and Android apps into parity.

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Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

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Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

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Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

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Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

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This post has been revised to reflect the following correction:

Correction: February 12, 2013

An earlier version of this article misstated the location of the Medical College of Wisconsin. It is in Milwaukee, not Madison.

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WellPoint Hires Joseph Swedish of Trinity Health as C.E.O.

WellPoint, one of the nation’s largest health insurers, announced on Tuesday that it had chosen an experienced hospital executive to lead it through sweeping changes created by the federal health care overhaul law.

Joseph R. Swedish, the 61-year-old chief executive of a major nonprofit Catholic-owned health system, Trinity Health, will become WellPoint’s chief executive on March 25. He will be responsible for leading the company, which operates profit-making Blue Cross plans in 14 states, into a future in which health insurers will sell insurance through state and federal exchanges and to work in new ways with hospitals and doctors.

“It truly is a transformational period,” said Mr. Swedish, who helped build Trinity Health into a $9 billion health system with 47 hospitals in 10 states. He became chief executive at Trinity Health in 2004.

WellPoint “has aggressively examined the marketplace,” he said, and is getting ready to compete for customers in highly regulated exchanges, where it must offer coverage even to people with serious medical conditions. WellPoint also bought a large insurer specializing in Medicaid, Amerigroup, last year, in its effort to adapt to the Affordable Care Act that expands the program.

Mr. Swedish succeeds Angela F. Braly, the former chief whose trouble with regulators and uneven performance led to her departure last August. WellPoint, which has a significant national share in providing insurance to individuals and small businesses, has struggled to prove to investors that it can capitalize on its Blue Cross brand in the new business environment.

“Joe’s background, in concert with our management’s insurance market expertise, creates a team uniquely qualified to manage all facets of our evolving health care system,” Jackie M. Ward, chairwoman of WellPoint’s board, said in a statement.

WellPoint’s decision to name a hospital executive “is a natural choice these days,” said Jaime A. Estupiñán, a partner at Booz & Company, a consulting firm. Given the changing nature of the business, both as a result of the health care law and the pressure to find ways to offer better care at lower cost, large health systems “are the biggest threats to insurers,” he said, and the lines between those systems and traditional insurers are blurring.

While choosing a hospital executive is not completely out of the ordinary, Mr. Swedish’s experience will be helpful as WellPoint works more closely with doctors and hospitals, analysts said.

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Dorner could face death penalty as criminal charges filed

As a massive manhunt for Christopher Jordan Dorner continued Monday afternoon, prosecutors with the Riverside County district attorney’s office filed murder and attempted murder charges against the ex-cop suspected of killing three people, including a Riverside police officer.

Dist. Atty. Paul Zellerbach said Dorner has been charged with one count of murder, with special circumstance allegations in the killing of a peace officer and the discharge of a firearm from a vehicle, in the death of Riverside police Officer Michael Crain, 34, a married father who served two tours in Kuwait as a rifleman in the U.S. Marines.

The special circumstances allegation makes Dorner eligible for the death penalty.

The former police officer also faces three additional counts of attempted murder of a peace officer for allegedly shooting and critically injuring Crain's partner and firing at two Los Angeles police officers who were in Corona to provide protection to one of Dorner's alleged targets. One of the LAPD officers was grazed on the head by a bullet.

The surviving officer, whose name has not been released, was "in a lot of pain" and will probably need several surgeries, Riverside Police Chief Sergio Diaz told reporters Monday. It was not yet known if he will be able to return to duty, Diaz said.

Shortly after the press conference, Los Angeles Mayor Antonio Villaraigosa ordered all city flags to be flown at half-staff effective Monday afternoon to honor Crain, a spokesman said.

Funeral services for Crain are scheduled for 10:30 a.m. Wednesday at Grove Community Church in Riverside. The flags will remain at half-staff until  after the services.

Meanwhile, the full-court-press search continued, though beyond several false sightings there has been little success so far in the hunt.

Investigators have received at least 700 tips about the fugitive ex-officer, and police are continuing to dangle a $1-million reward in the hope that someone will step forward.

There have been no confirmed sightings of Dorner since the manhunt began last Wednesday, and the last known evidence pointing to his whereabouts was his burning pickup truck discovered Thursday on a forest road in Big Bear, officials said.

Hundreds of investigators are continuing to follow up on potential leads, Los Angeles Police Department Lt. Andy Neiman said at a media briefing in downtown Los Angeles. The tips are being prioritized based on the information they contain.

Neiman also stressed that the ongoing search at Big Bear, although scaled back, remains a "critical piece of the investigation," saying authorities would remain on the mountain "until we've looked in every nook and cranny."

Neiman said he does not know how much the multiagency manhunt has cost thus far but described it as a "substantial cost to the city and taxpayers."

Investigators have also been in contact with Dorner's family, Neiman said, and are hopeful that a huge reward announced Sunday would lead to Dorner's arrest. His mother and sister cooperated with Irvine police on Friday when they searched the La Palma residence believed to be his last known address.

Authorities also continued to keep an eye on border crossings and airfields.

U.S. Customs and Border Protection agents at the San Ysidro and Otay Mesa ports of entry said they are monitoring all southbound lanes into Mexico, creating hours-long delays during peak crossing times.  Agents were also stationed at all pedestrian crossings into Tijuana, said Angelica De Cima, a customs  spokeswoman.

Mexican authorities have also bolstered security at the ports of entry and notified local, state and federal police to be on the lookout for Dorner, though there's no evidence he has crossed the border.

The Transportation Security Administration is also urging pilots and aircraft operators to be alert and to watch for stolen planes or suspicious passengers. The TSA said Dorner received flight training in the military, but the level of his expertise was unclear.

An Arcadia church school connected to Dorner's LAPD training officer canceled classes Monday as a precaution, officials said, while Big Bear schools reopened after the search there was scaled back.

The shootings attributed to Dorner began Feb. 3 with the deaths of Monica Quan, a Cal State Fullerton assistant basketball coach, and her fiance, Keith Lawrence, a USC public safety officer.The two had recently become engaged and were sitting in a car in Irvine when they were shot numerous times in the head.

Quan was the daughter of a retired LAPD captain whom Dorner apparently accused online of not representing him fairly at a hearing that led to his firing. In what police said was his posting to Facebook, Dorner allegedly threatened the retired captain and others he blamed for his termination.

Members of the USC community have also set up a memorial in front of the public safety department on campus that will stay in place until Lawrence is buried. Those who knew Lawrence recall him as a young law enforcement officer with a bright future.

More that 50 LAPD families remained under police guard Monday.

"Our commitment is to finding Mr. Dorner and making this city safe again," LAPD’s Neiman said.

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Why Thousands of Spiders Are Crawling in the Skies Over Brazil

Last week, spiders descended in droves upon a town in southern Brazil — literally.

When 20-year-old web designer Erick Reis left a friend’s house on Sunday, he saw what looked like thousands of spiders overhead, reported G1, a Brazilian news site, on Feb. 8. The large, sturdy spiders were hanging from power lines and poles, and crawling around on a vast network of silk strands spun over the town of Santo Antonio da Platina.

Reis did what many of us might do: He pulled out his camera and shot a video of spiders seemingly falling from the sky.

As creeptastic is it may be, “The phenomenon observed is not really surprising,” said Leticia Aviles, who studies social spiders at the University of British Columbia. “Either social or colonial spiders may occur in large aggregations, as the one shown in the video.” The reason, she and others say, is simple: This is how they hunt.

An early report suggested the swarming spiders were Anelosimus eximius, a social species of spider that weaves communal webs, lives together as adults, and shares childcare duties.

However, it appears that initial assessment may be wrong. The spiders in the video are more likely a species of colonial spider that aggregates individual webs and lives in groups only temporarily, dispersing before reproducing, Aviles said.

“The spiders I saw in the video are not Anelosimus eximius,” said Deborah Smith, an entomologist at the University of Kansas who specializes in social spiders. She notes that A. eximius is a bit smaller than the arachnids Reis filmed, and may not live that far south. “The spiders in the video are very large and robust,” she said. “It might be worth looking at Parawixia bistriata, a large, group-living orb weaver, to see if that one fits the bill.”

Arachnologist George Uetz agrees. “This is definitely not Anelosimus eximius,” said Uetz, who studies spiders at the University of Cincinnati. He notes that the spiders appear to be spread out on a colonial network of individual orb webs (rather than building a communal nest) and resemble big, orb-weaving spiders — perhaps Parawixia bistriata. “This colony is quite large,” he said, noting that the spiders aren’t actually raining down. “The web is fixed, although it is very fine and mostly invisible,” he said.

Cornell University arachnologist Linda Rayor and Aviles also agree that what’s probably being filmed is a massive P. bistriata colony. That species lives in South American savannas and spins colonial webs. A bit of good news is that their venom is not believed to be harmful to humans, Uetz said.

If this is Parawixia, or a similar species, there’s a reason the spiders may have appeared to come out of nowhere. “At night, they all collect in a colonial retreat, probably out of sight in a tree,” Uetz said. ”Then they build the colonial framework early in the day, and build individual webs upon it. They sit on these webs and capture prey.”

Whether the spiders are setting up camp or dispersing is an open question. It’s possible that Reis caught the conglomerate just as they had moved in to a new home — in which case he’ll see spiders in the sky whenever he visits his friends. At least for as long as insects are plentiful and the neighborhood is safe from birds, or until it’s time to reproduce. P. bistriata colonies dissolve before the spiders make more spiders, Aviles said. When they are clumped together, the groups tend to comprise single families.

“I suppose those can be quite large,” Aviles said. “Or, in some cases, multiple families may remain aggregated, giving rise to a colony as huge as the one shown in the video.”

It’s also possible the spiders were caught in the act of dispersing, and that the massive web overhead is temporary, though that’s more likely if the spiders are, in fact, Anelosimus eximius. An easy to make a determine which species they are is to look for the presence of an orb web, which would point toward Parawixia, Aviles said. Or better yet, snap a close-up photo of one of the spiders. Any volunteers?

Video: Acoisacoisada1/YouTube

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Health Testing on Mice Is Found Misleading in Some Cases

Evan McGlinn for The New York Times

Dr. H. Shaw Warren is one of the authors of a new study that questions the use of laboratory mice as models for all human diseases.

For decades, mice have been the species of choice in the study of human diseases. But now, researchers report evidence that the mouse model has been totally misleading for at least three major killers — sepsis, burns and trauma. As a result, years and billions of dollars have been wasted following false leads, they say.

The study’s findings do not mean that mice are useless models for all human diseases. But, its authors said, they do raise troubling questions about diseases like the ones in the study that involve the immune system, including cancer and heart disease.

“Our article raises at least the possibility that a parallel situation may be present,” said Dr. H. Shaw Warren, a sepsis researcher at Massachusetts General Hospital and a lead author of the new study.

The paper, published Monday in Proceedings of the National Academy of Sciences, helps explain why every one of nearly 150 drugs tested at a huge expense in patients with sepsis has failed. The drug tests all were based on studies in mice. And mice, it turns out, can have something that looks like sepsis in humans, but is very different from the condition in humans.

Medical experts not associated with the study said that the findings should change the course of research worldwide for a deadly and frustrating condition. Sepsis, a potentially deadly reaction that occurs as the body tries to fight an infection, afflicts 750,000 patients a year in the United States, kills one-fourth to one-half of them, and costs the nation $17 billion a year. It is the leading cause of death in intensive-care units.

“This is a game changer,” said Dr. Mitchell Fink, a sepsis expert at the University of California, Los Angeles, of the new study.

“It’s amazing,” said Dr. Richard Wenzel, a former chairman at the department of internal medicine at Virginia Commonwealth University and a former editor of The New England Journal of Medicine. “They are absolutely right on.”

Potentially deadly immune responses occur when a person’s immune system overreacts to what it perceives as danger signals, including toxic molecules from bacteria, viruses, fungi, or proteins released from cells damaged by trauma or burns, said Dr. Clifford S. Deutschman, who directs sepsis research at the University of Pennsylvania and was not part of the study.

The ramped-up immune system releases its own proteins in such overwhelming amounts that capillaries begin to leak. The leak becomes excessive, and serum seeps out of the tiny blood vessels. Blood pressure falls, and vital organs do not get enough blood. Despite efforts, doctors and nurses in an intensive-care unit or an emergency room may be unable to keep up with the leaks, stop the infection or halt the tissue damage. Vital organs eventually fail.

The new study, which took 10 years and involved 39 researchers from across the country, began by studying white blood cells from hundreds of patients with severe burns, trauma or sepsis to see what genes were being used by white blood cells when responding to these danger signals.

The researchers found some interesting patterns and accumulated a large, rigorously collected data set that should help move the field forward, said Ronald W. Davis, a genomics expert at Stanford University and a lead author of the new paper. Some patterns seemed to predict who would survive and who would end up in intensive care, clinging to life and, often, dying.

The group had tried to publish its findings in several papers. One objection, Dr. Davis said, was that the researchers had not shown the same gene response had happened in mice.

“They were so used to doing mouse studies that they thought that was how you validate things,” he said. “They are so ingrained in trying to cure mice that they forget we are trying to cure humans.”

“That started us thinking,” he continued. “Is it the same in the mouse or not?”

The group decided to look, expecting to find some similarities. But when the data were analyzed, there were none at all.

“We were kind of blown away,” Dr. Davis said.

The drug failures became clear. For example, often in mice, a gene would be used, while in humans, the comparable gene would be suppressed. A drug that worked in mice by disabling that gene could make the response even more deadly in humans.

Even more surprising, Dr. Warren said, was that different conditions in mice — burns, trauma, sepsis — did not fit the same pattern. Each condition used different groups of genes. In humans, though, similar genes were used in all three conditions. That means, Dr. Warren said, that if researchers can find a drug that works for one of those conditions in people, it might work for all three.

This article has been revised to reflect the following correction:

Correction: February 11, 2013

An earlier version of this article misstated the position of Dr. Richard Wenzel. He is a former chairman of the department of internal medicine at Virginia Commonwealth University. He is not currently the chairman.

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Media Decoder: A CBS Deal Bolsters Amazon's Challenge to Netflix

Slowly but confidently, Amazon is building a library of television shows and movies to rival that of Netflix, much to the satisfaction of media companies like Time Warner and CBS, whose executives love to see the competition.

Although Amazon will not unveil its own original television shows until the fall at the earliest, it is spending hundreds of millions of dollars to have the exclusive Web rights to shows it can brag about on its Amazon Prime streaming service, like “Downton Abbey,” from PBS, and “Falling Skies,” from TNT.

The latest example came on Monday, when Amazon announced an unusual arrangement with CBS, the country’s most-watched television network, to carry episodes of “Under the Dome” just days after the series makes its debut on TV in June.

“This deal is yet another sign that the streaming marketplace is becoming more and more robust,” said Scott Koondel, the chief content licensing officer for CBS, a position that was created two months ago. “Advances in user-friendly technology from companies like Amazon and Netflix are a boon for premium content owners.”

Amazon has a long way to go to rival Netflix in terms of TV and movie selection. But in some corners of the media business, it is already perceived to be Pepsi to Netflix’s Coke. And many other companies — among them Google, Sony, Intel and a new joint venture between Redbox and Verizon — are trying to come up with a Red Bull or a Snapple they can call their own.

While Netflix has won attention for unveiling a high quality show, “House of Cards,” on its streaming service, “it is increasingly hard to ignore the progress Amazon has made in a relatively short amount of time,” Richard Greenfield, an analyst at BTIG Research, wrote two weeks ago. He predicted that Amazon would quietly spend more than $500 million on video this year.

Amazon declined to comment on that figure. Its nearly two-year-old streaming service, called Prime Instant Video, is bundled as part of its $79 annual Amazon Prime membership, which also provides two-day free shipping and a monthly Kindle e-book rental. The company says it has millions of Amazon Prime subscribers, but it will not disclose the precise number. Netflix has about 27 million streaming subscribers in the United States.

Instant Video started simply enough about two years ago, with relatively cheap acquisitions of older television shows from networks like CBS and nonexclusive rights to older films from studios like Universal. But Amazon’s recent deals have revealed the company’s ambitions.

When Netflix dropped the rights to some cable series like “Pawn Stars” last fall, Amazon swooped in and started streaming them. When Time Warner wanted to sell streams of some of its cable dramas, Amazon bought the exclusive rights to “The Closer” and “Falling Skies,” while Netflix bought “Dallas.”

“This emerging back end for cable originals is a very promising sign,” Jeffrey L. Bewkes, chief executive of Time Warner, told investors last week, “since it should result in production values for cable originals getting even better over time.”

Perhaps its biggest deal yet came last week, when it clinched the rights to past and future seasons of the PBS hit “Downton Abbey.” By July, “Downton” will be gone from Netflix.

Both streaming services mine the data of their users to determine what kinds of shows to license, and what not to. The first two seasons of “Downton” were the “most-streamed TV show on Prime Instant Video,” said Brad Beale, who oversees video acquisitions for Amazon, so it was a “pretty easy decision” to bid for seasons three and four (and five, if it is produced).

“Data is a great proxy for what our customers love,” Mr. Beale added in a telephone interview. “We’re blessed to have a platform that gives us a lot of insight into what our customers love.”

“Under the Dome” — based on the Stephen King novel and produced by Steven Spielberg’s Amblin Television — will be unique because each episode will go onto Amazon four days after its premiere on TV. CBS stands to make more money this way than it now does by streaming shows on CBS.com and attaching ads.

Analysts expect to see more such deals as broadcasters move away from the free online model made popular by Hulu. Hulu has a subscription component as well, but it has not announced any notable licensing deals the way Netflix and Amazon have done. Its owners are at odds over the future of the service, and its founding chief executive, Jason Kilar, will leave later this winter.

Netflix says it expects to compete with Amazon the way HBO and Showtime compete — with TV dramas and comedies of their own. “When it comes to competition, we not only have a superior content offering due to our larger budget, but we are further along the experience curve,” Netflix told investors last month. In other words, Amazon is cheap, off-brand Cola.

While Netflix has four more original series on tap this year, Amazon is trying out test episodes of six comedies and five children’s series. This year, Amazon will stream them and, after hearing from viewers, decide which ones will become series.

Roy Price, the head of Amazon Studios, said the pilot process will ensure quality, just as it does for traditional television networks, and make viewers and producers pay attention to Amazon’s video projects.

“All that matters is being great,” he said. “There’s no great benefit in being good; people don’t change their habits for good.”

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Ambitious makeover planned for old housing project

Denise Penegar puts a little extra effort into the teenage girls, the ones who've dropped out of high school to care for their firstborns.

Don't be afraid, the outreach worker tells them. Come down to the housing project's community center, get your GED and some job skills. Change your life.

"I was one of those girls," said Penegar, now 51 and still living in Jordan Downs, the Watts housing project where she was born.

Sometimes, she imagines how different her life might have been if someone had knocked on her door when she was 17, caring for her first baby. What would it have meant just to have "someone who is here who can help pick me up"?

Penegar is on the front lines of a bold social experiment underway at Jordan Downs, a project notorious to outsiders for its poverty, blight and violence but seen by many longtime residents, for all its problems, as a close-knit community worth preserving.

In the last year, the Housing Authority of the City of Los Angeles has begun an effort to transform Jordan that could cost more than $600 million. The plan is to turn the complex of 700 aging units into a mixed-income community of up to 1,400 apartments and condominiums, with shops and restaurants and fancy touches such as native plant gardens. The city hopes to draw in hundreds of more-affluent residents willing to pay market rate to live side by side with the city's poorest.

Spurred by changes in federal funding and policy, such "mixed use" developments have sprung up in place of infamous housing projects all over the country. But experts say Jordan is taking an approach that has not been tried on this scale.

Typically, public housing residents are moved out ahead of the bulldozers, scattered to search for new shelter. In Los Angeles, the housing authority has promised that any of the 2,300 Jordan residents "in good standing" can stay in their old units until the day they move into new ones. The project is to be built in phases, beginning with units on 21 acres of adjacent land purchased by the authority in 2008 for $31 million.

To ease the transition, the city has dispatched "community coaches" like Penegar, along with teachers, social workers, therapists — even police officers whose charge is not to make arrests but to coach youth football and triathlon teams.

In essence, officials intend to raze the buildings, not the community — and radically change its character.

It will be an enormous challenge, with success likely to be measured in tiny increments.

Only 47% of adults at Jordan reported any wages to the housing authority last year. As in many urban projects, poverty and social ills have multiplied through the generations, leaving some residents unfamiliar with opportunities and expectations beyond the neighborhood. Some rarely leave the area.

Before inviting in new neighbors with expectations of safety and comfort, the housing authority has begun flooding Jordan Downs with social services. Many of the programs are focused on women, because more than 60% of Jordan Downs' tenants live in households headed by single mothers. But men are targeted too — for job training and lessons in parenting, for instance.

By December, 10 months into the effort, more than 450 families had been surveyed by intake workers and 280 signed up for intensive services.

"Most people would say it's ambitious, but I think it's essential," said Kathryn Icenhower, executive director of Shields for Families, the South Los Angeles nonprofit that is running many of the new programs under a more than $1-million annual contract with the housing authority.

It is unknown, however, how effective the social services will be, how easy it will be to draw in wealthier residents and how many millions of dollars the federal government — a major source of funding — will provide.

Already, the housing authority has picked a development team — the for-profit Michaels Organization and the nonprofit Bridge Housing, both with respectable track records in other cities. But with financing still uncertain, it is unclear exactly how many units will be built or how much various occupants would pay.

Ultimately, a working family could pay hundreds of dollars more in rent than unemployed tenants next door for a nearly identical unit. Officials say they do not expect Watts to draw the same kind of high-income residents as the former Cabrini Green project in Chicago, which sat on prime real estate near downtown. But Jordan is in a convenient location, near the intersection of the 105 and 110 Freeways; and in a high-rent city like Los Angeles, even the steepest rates at Jordan are likely to seem a bargain.

Despite the onslaught of social services and some palpable changes — including a 53% plunge in the violent crime rate at Jordan last year — financial risks abound.

Later this spring, the authority plans to put in an application for $30 million from the federal government's Choice Neighborhoods Program as seed money. Without it, the project could be delayed.

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