Unintended Consequences

"How old you are matters, but beyond that it's your interpretation that has far-reaching implications for the process of aging," said Markus H. Schafer, a doctoral student in sociology and gerontology who led the study. "So, if you feel old beyond your own chronological years you are probably going to experience a lot of the downsides that we associate with aging. "But if you are older and maintain a sense of being younger, then that gives you an edge in maintaining a lot of the abilities you prize." Schafer and co-author Tetyana P. Shippee, a Purdue graduate who is a research associate at Purdue's Center on Aging and the Life Course, compared people's chronological age and their subjective age to determine which one has a greater influence on cognitive abilities during older adulthood. Nearly 500 people ages 55-74 were surveyed about aging in 1995 and 2005 as part of the National Survey of Midlife Development in the United States. In 1995, when people were asked what age do you feel most of the time, the majority identified with being 12 years younger than they actually were. "We found that these people who felt young for their age were more likely to have greater confidence about their cognitive abilities a decade later," Schafer said. "Yes, chronological age was important, but the subjective age had a stronger effect. "What we are not sure about is what comes first. Does a person's wellness and happiness affect their cognitive abilities or does a person's cognitive ability contribute to their sense of wellness. We are planning to address this in a future study."

The North American Spine Society and the Society of Interventional Radiology have pointed to flaws in both studies. And earlier studies, published over 15 years, found major benefits to kyphoplasty and a related procedure called vertebroplasty. "We're missing opportunities for patients to receive a safe and effective treatment that can significantly reduce their pain and disability," said Malamis, an interventional radiologist. The procedures are used to treat vertebral compression fractures in patients with osteoporosis and other conditions that result in brittle bones. In a vertebroplasty, an acrylic cement is injected into a fractured vertebra. In a kyphoplasty, a balloon-tipped catheter first is inserted into the fracture. The balloon is inflated to restore the height and shape of the vertebra before the cement is injected. Neva Nelson, 74, of Naperville, Ill., said a kyphoplasty that Malamis performed in October, 2009, has greatly reduced her pain in a vertebra in her lower back that she fractured after falling on ice. Before her kyphoplasty, Nelson had to sit on cushions. Walking, and especially standing, were painful. "I had to do something," she said. "I could not go on like that." Nelson said that since undergoing her kyphoplasty, "I don't have to worry about my back any more." In the controversial studies, patients were randomly assigned to receive a vertebroplasty or a placebo-like "sham" procedure. In the sham procedure, patients received an injection of anesthetic, but no cement. However, patients in severe pain are reluctant to enroll in a trial where there's a 50 percent chance of receiving a sham treatment. In one of the studies, researchers had to screen 1,813 patients to enroll just 131 subjects. In the other study, only 78 of 219 eligible patients were enrolled. This low enrollment rate raises the possibility that the patients who did enroll were not representative. Patients experience the greatest pain during the first three months after a compression fracture. Thereafter, pain gradually subsides. Thus, a vertebroplasty or kyphoplasty provides the greatest benefit when performed within a week or two of the fracture. But the studies enrolled patients up to 12 months after fractures. In addition to reducing pain and disability, a kyphoplasty can reduce the risk of subsequent fractures by improving the angle and height of the spine. The studies evaluated vertebroplasty alone, and did not include the more innovative and very different kyphoplasty procedure. Malamis suggests the medical community wait for the results of additional studies now underway before passing final judgment on vertebroplasty or kyphoplasty. In the mean time, he notes that Medicare still covers the procedures.

The pileup was created in part because studios want to capture some of the excitement surrounding "Avatar," the James Cameron epic released in December. At $2.4 billion in global ticket sales, it is the highest-grossing film ever. In addition to the novelty or richer experience that might drive more people to see a 3-D movie, tickets to 3-D movies also cost a few dollars more. Around the time "Avatar" came out, Warner Bros. decided to convert a remake of "Clash of the Titans" from 2-D to 3-D and push its release back a week, to April 2. That will be the third 3-D movie to hit the market in a short span. DreamWorks Animation SKG Inc.'s "How to Train Your Dragon" comes out a week earlier, and The Walt Disney Co.'s "Alice in Wonderland" hits theaters March 5. And "Avatar" might still be playing in some places too. But a limited number of theaters can show these movies in 3-D, because not all theater owners have bought new digital projectors and undertaken other upgrades necessary to show movies in the format. About 3,900 to 4,000 3-D-ready screens are expected to be available in the U.S. and Canada by the end of March. Typically a movie in wide release might be shown on 3,000 to 10,000 screens in North America. In the past, a smaller number of 3-D-capable screens was adequate when one major film at a time was being released in 3-D in addition to 2-D. Each movie had a longer run, and moviegoers who wanted to see it in 3-D could pick a convenient time to go. With three out at once, each will get less exposure because some theaters with only one or two 3-D screens will have to choose which movies to show in 3-D. "One or all three are going to suffer in some way," said Patrick Corcoran, director of media and research for the National Association of Theatre Owners. "It makes it a much harder decision on exhibitors on what to keep or what to drop or what to add and probably should have been avoided."

Cherkauer said he ran simulation models that show Indiana, Illinois, Wisconsin and Michigan could see as much as 28 percent more precipitation by the year 2070, with much of that coming during the winter and spring months. His projections also show drier summer and fall seasons. "This was already a difficult spring to plant because of how wet it was. If you were to add another inch or so of rain to that, it would be a problem," Cherkauer said. "It could make it difficult to get into fields. There's also a potential for more flooding." He calculated that winters in the four states could be 2.7 degrees to 5.4 degrees Fahrenheit warmer by 2077 than today. Summers could be 3.6 degrees to 10.8 degrees warmer. The NASA-funded study appears in the early online edition of the Journal of Great Lakes Research.

This is the largest nationally representative study to date of the toll taken by sepsis and pneumonia, two conditions often caused by deadly microbes, including the antibiotic-resistant bacteria MRSA. Such infections can lead to longer hospital stays, serious complications and even death. "In many cases, these conditions could have been avoided with better infection control in hospitals," said Ramanan Laxminarayan, Ph.D., principal investigator for Extending the Cure, a project examining antibiotic resistance based at the Washington, D.C. think-tank Resources for the Future. "Infections that are acquired during the course of a hospital stay cost the United States a staggering amount in terms of lives lost and health care costs," he said. "Hospitals and other health care providers must act now to protect patients from this growing menace." Laxminarayan and his colleagues analyzed 69 million discharge records from hospitals in 40 states and identified two conditions caused by health care-associated infections: sepsis, a potentially lethal systemic response to infection and pneumonia, an infection of the lungs and respiratory tract. The researchers looked at infections that developed after hospitalization. They zeroed in on infections that are often preventable, like a serious bloodstream infection that occurs because of a lapse in sterile technique during surgery, and discovered that the cost of such infections can be quite high: For example, people who developed sepsis after surgery stayed in the hospital 11 days longer and the infections cost an extra $33,000 to treat per person. Even worse, the team found that nearly 20 percent of people who developed sepsis after surgery died as a result of the infection. "That's the tragedy of such cases," said Anup Malani, a study co-author, investigator at Extending the Cure, and professor at the University of Chicago. "In some cases, relatively healthy people check into the hospital for routine surgery. They develop sepsis because of a lapse in infection control—and they can die." The team also looked at pneumonia, an infection that can set in if a disease-causing microbe gets into the lungs—in some cases when a dirty ventilator tube is used. They found that people who developed pneumonia after surgery, which is also thought to be preventable, stayed in the hospital an extra 14 days. Such cases cost an extra $46,000 per person to treat. In 11 percent of the cases, the patient died as a result of the pneumonia infection.