Personal Health: Keeping Blood Pressure in Check

Since the start of the 21st century, Americans have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease.

Now 48 percent of the more than 76 million adults with hypertension have it under control, up from 29 percent in 2000.

But that means more than half, including many receiving treatment, have blood pressure that remains too high to be healthy. (A normal blood pressure is lower than 120 over 80.) With a plethora of drugs available to normalize blood pressure, why are so many people still at increased risk of disease, disability and premature death? Hypertension experts offer a few common, and correctable, reasons:

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Jane Brody speaks about hypertension.

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¶ About 20 percent of affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.

¶ Of the 80 percent who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.

¶ Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.

¶ Many others do little to change lifestyle factors, like obesity, lack of exercise and a high-salt diet, that can make hypertension harder to control.

Dr. Samuel J. Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of the 71 percent of people with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages of the right ones.

Dr. Mann, author of “Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure,” says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.

Plus, he said in an interview, it can be done with minimal, if any, side effects and at a reasonable cost.

“For most people, no new drugs need to be developed,” Dr. Mann said. “What we need, in terms of medication, is already out there. We just need to use it better.”

But many doctors who are generalists do not understand the “intricacies and nuances” of the dozens of available medications to determine which is appropriate to a certain patient.

“Prescribing the same medication to patient after patient just does not cut it,” Dr. Mann wrote in his book.

The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for a patient’s hypertension, he said.

¶ Salt-sensitive hypertension, more common in older people and African-Americans, responds well to diuretics and calcium channel blockers.

¶ Hypertension driven by the kidney hormone renin responds best to ACE inhibitors and angiotensin receptor blockers, as well as direct renin inhibitors and beta-blockers.

¶ Neurogenic hypertension is a product of the sympathetic nervous system and is best treated with beta-blockers, alpha-blockers and drugs like clonidine.

According to Dr. Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he said.

One of Dr. Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Dr. Mann’s help.

After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, with side effects she could easily tolerate, and she no longer feared she would die young of a heart attack or stroke.

But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Dr. Mann said. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.

Specialists, he said, are most useful for treating the 10 percent to 15 percent of patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs, including a diuretic, and for those whose treatment is effective but causing distressing side effects.

Hypertension sometimes fails to respond to routine care, he noted, because it results from an underlying medical problem that needs to be addressed.

“Some patients are on a lot of blood pressure drugs — four or five — who probably don’t need so many, and if they do, the question is why,” Dr. Mann said.

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How to Measure Your Blood Pressure

Mistaken readings, which can occur in doctors’ offices as well as at home, can result in misdiagnosis of hypertension and improper treatment. Dr. Samuel J. Mann, of Weill Cornell Medical College, suggests these guidelines to reduce the risk of errors:

¶ Use an automatic monitor rather than a manual one, and check the accuracy of your home monitor at the doctor’s office.

¶ Use a monitor with an arm cuff, not a wrist or finger cuff, and use a large cuff if you have a large arm.

¶ Sit quietly for a few minutes, without talking, after putting on the cuff and before checking your pressure.

¶ Check your pressure in one arm only, and take three readings (not more) one or two minutes apart.

¶ Measure your blood pressure no more than twice a week unless you have severe hypertension or are changing medications.

¶ Check your pressure at random, ordinary times of the day, not just when you think it is high.

Read More..

Personal Health: Keeping Blood Pressure in Check

Since the start of the 21st century, Americans have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease.

Now 48 percent of the more than 76 million adults with hypertension have it under control, up from 29 percent in 2000.

But that means more than half, including many receiving treatment, have blood pressure that remains too high to be healthy. (A normal blood pressure is lower than 120 over 80.) With a plethora of drugs available to normalize blood pressure, why are so many people still at increased risk of disease, disability and premature death? Hypertension experts offer a few common, and correctable, reasons:

---

Jane Brody speaks about hypertension.

---

¶ About 20 percent of affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.

¶ Of the 80 percent who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.

¶ Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.

¶ Many others do little to change lifestyle factors, like obesity, lack of exercise and a high-salt diet, that can make hypertension harder to control.

Dr. Samuel J. Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of the 71 percent of people with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages of the right ones.

Dr. Mann, author of “Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure,” says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.

Plus, he said in an interview, it can be done with minimal, if any, side effects and at a reasonable cost.

“For most people, no new drugs need to be developed,” Dr. Mann said. “What we need, in terms of medication, is already out there. We just need to use it better.”

But many doctors who are generalists do not understand the “intricacies and nuances” of the dozens of available medications to determine which is appropriate to a certain patient.

“Prescribing the same medication to patient after patient just does not cut it,” Dr. Mann wrote in his book.

The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for a patient’s hypertension, he said.

¶ Salt-sensitive hypertension, more common in older people and African-Americans, responds well to diuretics and calcium channel blockers.

¶ Hypertension driven by the kidney hormone renin responds best to ACE inhibitors and angiotensin receptor blockers, as well as direct renin inhibitors and beta-blockers.

¶ Neurogenic hypertension is a product of the sympathetic nervous system and is best treated with beta-blockers, alpha-blockers and drugs like clonidine.

According to Dr. Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he said.

One of Dr. Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Dr. Mann’s help.

After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, with side effects she could easily tolerate, and she no longer feared she would die young of a heart attack or stroke.

But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Dr. Mann said. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.

Specialists, he said, are most useful for treating the 10 percent to 15 percent of patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs, including a diuretic, and for those whose treatment is effective but causing distressing side effects.

Hypertension sometimes fails to respond to routine care, he noted, because it results from an underlying medical problem that needs to be addressed.

“Some patients are on a lot of blood pressure drugs — four or five — who probably don’t need so many, and if they do, the question is why,” Dr. Mann said.

---

How to Measure Your Blood Pressure

Mistaken readings, which can occur in doctors’ offices as well as at home, can result in misdiagnosis of hypertension and improper treatment. Dr. Samuel J. Mann, of Weill Cornell Medical College, suggests these guidelines to reduce the risk of errors:

¶ Use an automatic monitor rather than a manual one, and check the accuracy of your home monitor at the doctor’s office.

¶ Use a monitor with an arm cuff, not a wrist or finger cuff, and use a large cuff if you have a large arm.

¶ Sit quietly for a few minutes, without talking, after putting on the cuff and before checking your pressure.

¶ Check your pressure in one arm only, and take three readings (not more) one or two minutes apart.

¶ Measure your blood pressure no more than twice a week unless you have severe hypertension or are changing medications.

¶ Check your pressure at random, ordinary times of the day, not just when you think it is high.

Read More..

Media Decoder: Tsujihara to Succeed Meyer as Head of Warner Brothers

LOS ANGELES — Kevin Tsujihara will succeed Barry M. Meyer as chief executive of Warner Brothers, the studio announced on Monday, ending a disruptive and lingering competition for one of the biggest jobs in Hollywood. But, with two senior Warner executives publicly passed over, disorder at the studio could continue.

Home to Batman, Bugs Bunny, “Two and a Half Men” and TMZ.com, Warner is Hollywood’s largest movie and television studio. It has also been the industry’s most stable. Mr. Meyer, who is retiring, has led Warner since 1999; a single management team oversaw the studio for the previous 18 years.

A two-year succession contest, however, has brought escalating internal tension, a slowing of routine business and low morale, according to Warner employees and people who have had business dealings with the company. Jeffrey L. Bewkes, chief executive of Time Warner, moved on Monday to end that distraction by promoting Mr. Tsujihara, 48. Scheduled to take over on March 1, Mr. Tsujihara most recently ran Warner’s home entertainment unit, which includes video games and the online distribution of movies and television shows.

“Kevin’s experience is very balanced and has touched all parts of Warner,” Mr. Bewkes said in a telephone interview. “He also has the right temperament to be an effective unifier and leader.”

Mr. Tsujihara immediately faces the challenge of retaining the two executives he beat out for the job. They are Bruce Rosenblum, president of Warner Television, and Jeffrey Robinov, president of Warner’s movie division. Mr. Bewkes said he wanted to “keep everybody on the field,” adding that Mr. Rosenblum and Mr. Robinov both have “very big, full jobs.”

Even so, Mr. Rosenblum, who runs Warner’s most profitable division and had been seen by many in Hollywood as the leading candidate to succeed Mr. Meyer, did not hide his displeasure at losing. “Obviously, I’m disappointed; who wouldn’t be?” he said in a statement. He added that Warner “will be in good hands with Kevin.”

Mr. Robinov was more effusive about his new boss. “I am truly happy and proud of Kevin,” he said in a separate statement. “We are both good friends and colleagues, and I think he’s an excellent choice for the job.”

Will Mr. Rosenblum and Mr. Robinov ultimately leave? “We both hope they will stay and support Kevin,” Mr. Meyer, 69, said in a telephone interview. He added, however, “This is news to everybody, and I think they’re thinking it over.”

In some ways, Mr. Tsujihara’s ascendance can be seen as a clear statement of what Time Warner thinks its studio most needs to face the challenges ahead.

While he is respected in Hollywood’s creative community of producers, writers, directors and agents, Mr. Tsujihara does not come from the trenches. Instead, he has been grappling with the Web as a disrupter of distribution and business models. He has also been Warner’s point person on piracy.

Mr. Meyer said Mr. Tsujihara’s qualifications went well beyond that. Calling Mr. Tsujihara “deliberate and thoughtful,” he underscored his successor’s creative skill. In recent years, for instance, Mr. Tsujihara has played a role in deciding what movies Warner puts into production, even routinely reading scripts, Mr. Meyer said. Mr. Tsujihara was also the executive that Warner dispatched to New Zealand in 2010 to solve a labor dispute that threatened “The Hobbit: An Unexpected Journey” and two sequels.

Speaking by telephone, Mr. Tsujihara said his immediate plans are “to do a lot of listening” and to work with his former rivals to “create the right transition and the right organizational structure moving forward.”

“I’m coming in at a great time, not a time when we have to make massive changes because we’re not successful,” he said.

Warner, which was founded in 1923, produces more than 50 television programs for various networks, including “The Ellen DeGeneres Show,” “The Middle” and “The Mentalist.” Last year Warner movies took in about $4.3 billion at the global box office, with hits that included “The Dark Knight Rises” and “Magic Mike.”

Still, the studio faces significant competition in television production from 20th Century Fox and has struggled to bring its stable of DC Comics superheroes — Wonder Woman, Green Lantern, the Flash — to movie audiences as Disney’s Marvel Studios has introduced one superhero hit after another.

Mr. Tsujihara joined Warner in 1994 to help with its interest in the Six Flags theme parks. Before taking over home entertainment in 2005, he worked in the studio’s business development and strategy department.

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Morsi Declares Emergency in 3 Egypt Cities as Unrest Spreads

Tara Todras-Whitehill for The New York Times

An Egyptian man threw a tear-gas canister back at the police in Port Said on Sunday.

PORT SAID, Egypt — President Mohamed Morsi declared a state of emergency and a curfew in three major cities on Sunday, as escalating violence in the streets threatened his government and Egypt’s democracy.

By imposing a one-month state of emergency in Suez, Ismailia and here in Port Said, where the police have lost all control, Mr. Morsi’s declaration chose to use one of the most despised weapons of former President Hosni Mubarak’s autocracy. Under Mubarak-era laws left in effect by the country’s new Constitution, a state of emergency suspends the ordinary judicial process and most civil rights. It gives the president and the police extraordinary powers.

Mr. Morsi, Egypt’s first freely elected president and a leader of the political arm of the Muslim Brotherhood, took the step after four days of clashes in Cairo and in cities around the country between the police and protesters denouncing his government. Most of the protests were set off by the second anniversary of the popular revolt that ousted Mr. Mubarak, which fell on Friday.

Here in Port Said, the trouble started over death sentences that a court imposed on 21 local soccer fans for their role in a deadly riot. But after 30 people died in clashes on Saturday — most of them shot by the police — the protesters turned their ire on Mr. Morsi as well the court. Police officers crouching on the roofs of their stations fired tear gas and live ammunition into attacking mobs, and hospital officials said that on Sunday at least seven more people died. Tens of thousands of people marched through the streets of Port Said on Sunday demanding independence from the rest of Egypt. “The people want the state of Port Said,” they chanted in anger at Cairo.

The emergency declaration covers the three cities and their surrounding provinces, all on the economically vital Suez Canal. Mr. Morsi announced the emergency measures in a stern, finger-waving speech on state television on Sunday evening. He said he was acting “to stop the bloodbath” and called the violence in the streets “the counterrevolution itself.”

“There is no room for hesitation, so that everybody knows the institution of the state is capable of protecting the citizens,” he said. “If I see that the homeland and its children are in danger, I will be forced to do more than that. For the sake of Egypt, I will.”

Mr. Morsi’s resort to the authoritarian measures of his predecessor appeared to reflect mounting doubts about the viability of Egypt’s central government. After decades of corruption, cronyism and brutality under Mr. Mubarak, Egyptians have struggled to adjust to resolving their differences — whether over matters of political ideology or crime and punishment — through peaceful democratic channels.

“Why are we unable to sort out these disputes?” asked Moattaz Abdel-Fattah, a political scientist and academic who was a member of the assembly that drafted Egypt’s new Constitution. “How many times are we going to return to the state of Egyptians killing Egyptians?” He added: “Hopefully, when you have a genuine democratic machine, people will start to adapt culturally. But we need to do something about our culture.”

Mr. Morsi’s speech did nothing to stop the violence in the streets. In Cairo, fighting between protesters and the police and security forces escalated into the night along the banks of the Nile near Tahrir Square. On a stage set up in the square, liberal and leftist speakers demanded the repeal of the Islamist-backed Constitution, which won approval in a referendum last month. Young men huddled in tents making incendiary devices, while others set tires on fire to block a main bridge across the Nile.

In Suez, a group calling itself the city’s youth coalition said it would hold nightly protests against the curfew at the time it begins, 9 p.m. In Port Said, crowds began to gather just before the declaration was set to take effect, at midnight, for a new march in defiance.

“We will gather every night at 9 at Mariam’s mosque,” said Ahmed Mansour, a doctor. “We will march all night long until morning.”

He added: “Morsi is an employee who works for us. He must do what suits us, and this needs to be made clear.”

Mayy El-Sheikh contributed reporting from Port Said, and Kareem Fahim from Cairo.

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Unboxed: Literary History, Seen Through Big Data’s Lens

ANY list of the leading novelists of the 19th century, writing in English, would almost surely include Charles Dickens, Thomas Hardy, Herman Melville, Nathaniel Hawthorne and Mark Twain.

But they do not appear at the top of a list of the most influential writers of their time. Instead, a recent study has found, Jane Austen, author of “Pride and Prejudice, “ and Sir Walter Scott, the creator of “Ivanhoe,” had the greatest effect on other authors, in terms of writing style and themes.

These two were “the literary equivalent of Homo erectus, or, if you prefer, Adam and Eve,” Matthew L. Jockers wrote in research published last year. He based his conclusion on an analysis of 3,592 works published from 1780 to 1900. It was a lot of digging, and a computer did it.

The study, which involved statistical parsing and aggregation of thousands of novels, made other striking observations. For example, Austen’s works cluster tightly together in style and theme, while those of George Eliot (a k a Mary Ann Evans) range more broadly, and more closely resemble the patterns of male writers. Using similar criteria, Harriet Beecher Stowe was 20 years ahead of her time, said Mr. Jockers, whose research will soon be published in a book, “Macroanalysis: Digital Methods and Literary History” (University of Illinois Press).

These findings are hardly the last word. At this stage, this kind of digital analysis is mostly an intriguing sign that Big Data technology is steadily pushing beyond the Internet industry and scientific research into seemingly foreign fields like the social sciences and the humanities. The new tools of discovery provide a fresh look at culture, much as the microscope gave us a closer look at the subtleties of life and the telescope opened the way to faraway galaxies.

“Traditionally, literary history was done by studying a relative handful of texts,” says Mr. Jockers, an assistant professor of English and a researcher at the Center for Digital Research in the Humanities at the University of Nebraska. “What this technology does is let you see the big picture — the context in which a writer worked — on a scale we’ve never seen before.”

Mr. Jockers, 46, personifies the digital advance in the humanities. He received a Ph.D. in English literature from Southern Illinois University, but was also fascinated by computing and became a self-taught programmer. Before he moved to the University of Nebraska last year, he spent more than a decade at Stanford, where he was a founder of the Stanford Literary Lab, which is dedicated to the digital exploration of books.

Today, Mr. Jockers describes the tools of his trade in terms familiar to an Internet software engineer — algorithms that use machine learning and network analysis techniques. His mathematical models are tailored to identify word patterns and thematic elements in written text. The number and strength of links among novels determine influence, much the way Google ranks Web sites.

It is this ability to collect, measure and analyze data for meaningful insights that is the promise of Big Data technology. In the humanities and social sciences, the flood of new data comes from many sources including books scanned into digital form, Web sites, blog posts and social network communications.

Data-centric specialties are growing fast, giving rise to a new vocabulary. In political science, this quantitative analysis is called political methodology. In history, there is cliometrics, which applies econometrics to history. In literature, stylometry is the study of an author’s writing style, and these days it leans heavily on computing and statistical analysis. Culturomics is the umbrella term used to describe rigorous quantitative inquiries in the social sciences and humanities.

“Some call it computer science and some call it statistics, but the essence is that these algorithmic methods are increasingly part of every discipline now,” says Gary King, director of the Institute for Quantitative Social Science at Harvard.

Cultural data analysts often adapt biological analogies to describe their work. Mr. Jockers, for example, called his research presentation “Computing and Visualizing the 19th-Century Literary Genome.”

Such biological metaphors seem apt, because much of the research is a quantitative examination of words. Just as genes are the fundamental building blocks of biology, words are the raw material of ideas.

“What is critical and distinctive to human evolution is ideas, and how they evolve,” says Jean-Baptiste Michel, a postdoctoral fellow at Harvard.

Mr. Michel and another researcher, Erez Lieberman Aiden, led a project to mine the virtual book depository known as Google Books and to track the use of words over time, compare related words and even graph them.

Google cooperated and built the software for making graphs open to the public. The initial version of Google’s cultural exploration site began at the end of 2010, based on more than five million books, dating from 1500. By now, Google has scanned 20 million books, and the site is used 50 times a minute. For example, type in “women” in comparison to “men,” and you see that for centuries the number of references to men dwarfed those for women. The crossover came in 1985, with women ahead ever since.

In work published in Science magazine in 2011, Mr. Michel and the research team tapped the Google Books data to find how quickly the past fades from books. For instance, references to “1880,” which peaked in that year, fell to half by 1912, a lag of 32 years. By contrast, “1973” declined to half its peak by 1983, only 10 years later. “We are forgetting our past faster with each passing year,” the authors wrote.

JON KLEINBERG, a computer scientist at Cornell, and a group of researchers approached collective memory from a very different perspective.

This article has been revised to reflect the following correction:

Correction: January 27, 2013

An earlier version of this article misstated Matthew L. Jockers’s age. He is 46, not 48. 

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Ariel Sharon Brain Scan Shows Response to Stimuli

JERUSALEM — A brain scan performed on Ariel Sharon, the former Israeli prime minister who had a devastating stroke seven years ago and is presumed to be in a vegetative state, revealed significant brain activity in response to external stimuli, raising the chances that he is able to hear and understand, a scientist involved in the test said Sunday.

Scientists showed Mr. Sharon, 84, pictures of his family, had him listen to a recording of the voice of one of his sons and used tactile stimulation to assess the extent of his brain’s response.

“We were surprised that there was activity in the proper parts of the brain,” said Prof. Alon Friedman, a neuroscientist at Ben-Gurion University of the Negev and a member of the team that carried out the test. “It raises the chances that he hears and understands, but we cannot be sure. The test did not prove that.”

The activity in specific regions of the brain indicated appropriate processing of the stimulations, according to a statement from Ben-Gurion University, but additional tests to assess Mr. Sharon’s level of consciousness were less conclusive.

“While there were some encouraging signs, these were subtle and not as strong,” the statement added.

The test was carried out last week at the Soroka University Medical Center in the southern Israeli city of Beersheba using a state-of-the-art M.R.I. machine and methods recently developed by Prof. Martin M. Monti of the University of California, Los Angeles. Professor Monti took part in the test, which lasted approximately two hours.

Mr. Sharon’s son Gilad said in October 2011 that he believed that his father responded to some requests. “When he is awake, he looks at me and moves fingers when I ask him to,” he said at the time, adding, “I am sure he hears me.”

Professor Friedman said in a telephone interview that the test results “say nothing about the future” but may be of some help to the family and the regular medical staff caring for Mr. Sharon at a hospital outside Tel Aviv.

“There is a small chance that he is conscious but has no way of expressing it,” Professor Friedman said, but he added, “We do not know to what extent he is conscious.”

Read More..

Ariel Sharon Brain Scan Shows Response to Stimuli

JERUSALEM — A brain scan performed on Ariel Sharon, the former Israeli prime minister who had a devastating stroke seven years ago and is presumed to be in a vegetative state, revealed significant brain activity in response to external stimuli, raising the chances that he is able to hear and understand, a scientist involved in the test said Sunday.

Scientists showed Mr. Sharon, 84, pictures of his family, had him listen to a recording of the voice of one of his sons and used tactile stimulation to assess the extent of his brain’s response.

“We were surprised that there was activity in the proper parts of the brain,” said Prof. Alon Friedman, a neuroscientist at Ben-Gurion University of the Negev and a member of the team that carried out the test. “It raises the chances that he hears and understands, but we cannot be sure. The test did not prove that.”

The activity in specific regions of the brain indicated appropriate processing of the stimulations, according to a statement from Ben-Gurion University, but additional tests to assess Mr. Sharon’s level of consciousness were less conclusive.

“While there were some encouraging signs, these were subtle and not as strong,” the statement added.

The test was carried out last week at the Soroka University Medical Center in the southern Israeli city of Beersheba using a state-of-the-art M.R.I. machine and methods recently developed by Prof. Martin M. Monti of the University of California, Los Angeles. Professor Monti took part in the test, which lasted approximately two hours.

Mr. Sharon’s son Gilad said in October 2011 that he believed that his father responded to some requests. “When he is awake, he looks at me and moves fingers when I ask him to,” he said at the time, adding, “I am sure he hears me.”

Professor Friedman said in a telephone interview that the test results “say nothing about the future” but may be of some help to the family and the regular medical staff caring for Mr. Sharon at a hospital outside Tel Aviv.

“There is a small chance that he is conscious but has no way of expressing it,” Professor Friedman said, but he added, “We do not know to what extent he is conscious.”

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Stanley Karnow, Historian and Journalist, Is Dead at 87

Stanley Karnow, a Pulitzer Prize-winning historian and journalist who produced acclaimed books and television documentaries about Vietnam and the Philippines in the throes of war and upheaval, died on Sunday at his home in Potomac, Md. He was 87.

The cause was congestive heart failure, said Mr. Karnow’s son, Michael.

For more than three decades Mr. Karnow was a correspondent in Southeast Asia, working for Time, Life, The Saturday Evening Post, The Washington Post, NBC News, The New Republic, King Features Syndicate and the Public Broadcasting Service. But he was best known for his books and documentaries.

He was in Vietnam in 1959, when the first American advisers were killed, and lingered long after the guns fell silent, talking to fighters, villagers, refugees, North and South Vietnamese political and military leaders, the French and the Americans, researching a people and a war that had been little understood.

The result was the 750-page book “Vietnam: A History,” published in 1983, and its companion, a 13-hour PBS documentary, “Vietnam: A Television History.” Unlike many books and films on Vietnam in the 1960s and ’70s and the nightly newscasts that focused primarily on America’s role and its consequences at home and abroad, Mr. Karnow addressed all sides of the conflict and traced Vietnam’s culture and history.

“Vietnam: A History” was widely praised and a best seller. The documentary, with Mr. Karnow as chief correspondent, was at the time the most successful ever produced by public television, viewed by an average of nearly 10 million people a night through 13 episodes. It won six Emmy Awards, as well as Peabody, Polk and duPont-Columbia awards.

Six years later, Mr. Karnow delivered his second comprehensive book and television examination of a Southeast Asian nation. The book, “In Our Image: America’s Empire in the Philippines” (1989), was a panorama of centuries of Filipino life under Spanish and American colonial rule, followed by independence under sometimes corrupt American-backed leaders. It won the 1990 Pulitzer Prize for history.

Narrated by Mr. Karnow, the three-part PBS documentary “The U.S. and the Philippines: In Our Image” traced America’s paternalistic colonial rule in the Philippines, the shared suffering of Filipinos and Americans under a cruel Japanese occupation in World War II, and Manila’s postwar independence under regimes nominally democratic but repressive, corrupt or indifferent to the miseries of its people.

Mr. Karnow also wrote “Mao and China: From Revolution to Revolution” (1972) and was a co-author of or contributor to books based on his years in Asia, including “Asian-Americans in Transition” (1992), “Passage to Vietnam” (1994), “Mekong” (1995) and “Historical Atlas of the Vietnam War” (1995).

Early in his career he lived in Paris for a decade, and in 1997 he published a memoir, “Paris in the Fifties.” A nostalgic reporter’s notebook of life among the cafe philosophers, berated musicians and pseudo-revolutionary artistes, it danced with digressions about taxes, restaurants, the guillotine, Hemingway, Charles de Gaulle and the Devil’s Island penal colony.

In its range, learning and appetite for fun, Bernard Kalb, the former CBS reporter and Mr. Karnow’s friend since Vietnam, told The Associated Press in 2009, the memoir was vintage Karnow. “Stanley has a great line about how being a journalist is like being an adolescent all your life,” he said.

Stanley Karnow was born in Brooklyn on Feb. 4, 1925, the son of Harry and Henriette Koeppel Karnow. He grew up in a city with more than a dozen daily newspapers and decided early that he wanted to become a reporter. He served in the Army Air Forces in World War II. After graduating from Harvard with a bachelor’s degree in 1947, he sailed for France, intending to spend the summer. He stayed for a decade.

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French Capture Gao Airport in Move to Retake North Mali

KONNA, Mali — French special forces took control of the airport in the Islamic rebel stronghold of Gao, the French government said Saturday, meeting “serious resistance” from militants even as they pressed northward.

Gao is one of three main northern cities in Mali that has been under rebel control for months, and the capture of the main strategic points in Gao represents the biggest prize yet in the battle to retake the northern half of the country.

French airstrikes have been pounding the city since France joined the fight at Mali’s request on Jan. 11. French troops also took control of a bridge over the Niger River on Saturday, and the capture of the airport allowed a company of French soldiers to be airlifted in on Saturday afternoon, according to Col. Thierry Burkhard, the French military spokesman.

Another French company was on the road to Gao from Sévaré on Saturday night, and Malian and other African forces had begun to arrive, he said.

He stepped back from an earlier statement by the French Defense Ministry that declared the city freed by French forces, acknowledging that the statement was “a bit overdone.” Noting Gao’s 70,000 inhabitants, he added, “it’s not with a detachment of special forces that you take over a city.”

But with reinforcements streaming in, the battle for Gao appeared imminent.

Soldiers from Chad and Niger are expected to arrive soon, the French defense minister, Jean-Yves Le Drian, said in a statement. They will be part of a contingent of 1,900 African troops who have already arrived in Mali, fighting alongside the 2,500 French soldiers deployed here.

Gao’s mayor, who had fled to Bamako, the capital, returned to his city on Saturday, Mr. Le Drian said.

In Washington, the Pentagon said Saturday that the United States would provide aerial refueling for French warplanes. The decision increases American involvement, which until now had consisted of transporting French troops and equipment and also providing intelligence, including satellite photographs.

Gao, 600 miles northeast of the capital, had been under the control of the Movement for Oneness and Jihad in West Africa, a splinter group of Al Qaeda in the Islamic Maghreb.

Al Jazeera broadcast a statement from Al Qaeda in the Islamic Maghreb in which the group said it had withdrawn temporarily from some cities it held, but would return with greater force.

Little information has come from the other two main cities under rebel control — Timbuktu, the fabled desert oasis, and Kidal, northeast of Gao — for the past 10 days because mobile phone networks have been down.

Konna was overrun by Islamic fighters on Jan. 10, prompting France to intervene, and a clearer picture has begun to emerge of the fighting. Residents and officials here said that at least 11 civilians had been killed in French airstrikes.

Charred husks of pickup trucks lined the road into the town, and broken tanks and guns littered the fish market, where the rebels appeared to have set up a temporary base.

France’s sudden entry into the fray has left the United Nations and Ecowas, the regional trade bloc, scrambling to put together an African-led intervention force that had been in the planning stages. The Mali Army, which has struggled to fight the Islamist groups, has been accused of serious human rights violations.

From Konna, it is easy to see why the Malian government pleaded for French help after the Islamist fighters took control of the town. Just 35 miles of asphalt separate Konna from the garrison town of Sévaré, home to the second-biggest airfield in Mali and a vital strategic point for any foreign intervention force.

Residents said their town fell to the rebels when 300 pickup trucks of fighters, bristling with machine guns, rolled in and pushed back the Malian Army troops who had been guarding the town after a fierce battle.

Lydia Polgreen reported from Konna, and Scott Sayare from Paris. Elisabeth Bumiller contributed reporting from Washington.

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Digital Domain: Republic Wireless’s Plan Melds Wi-Fi and Network Calling

AN Android smartphone with unlimited calls, unlimited texting, unlimited data and no contract, all for $19 a month? Really?

When I first saw this offer from Republic Wireless, I rubbed my eyes and looked for an asterisk leading to fine print that detailed a huge catch. But Republic, a division of a telecom company called Bandwidth.com, delivers exactly what it advertises. It can do so because the handset technology is a curious hybrid: it uses Wi-Fi when the customer is in a Wi-Fi area and Sprint Nextel’s 3G network when it is not.

The concept brings together the best of two worlds: the low cost of voice calls carried over the Internet and the convenience of making calls to any phone number using a major carrier’s cellular network when Wi-Fi isn’t available.

In my own case, on a typical day, I use my mobile phone mostly when I’m not actually mobile: I’m either at home or at work, perfectly positioned to use Wi-Fi at both locations. And I don’t even use the phone as a phone all that much. I use it mainly for e-mail and texts, neither of which requires enough bandwidth to benefit from the power of the fastest data networks.

If you walk into a Verizon Wireless store and buy an iPhone 5, you’ll pay $60 or more a month for an unlimited talk and texting plan, depending on the data allocation for Internet use that you select to go with it. Some of that monthly charge goes toward repaying the carrier for the discounted price that makes a $649 iPhone seem as if it costs only $200. But most of the charge is for gaining access to the carrier’s wireless network.

“We were looking at a mobile industry that had begun to charge extraordinary amounts of money, and we saw an industry opportunity that everybody else was missing: Wi-Fi is the new mobile,” says David Morken, co-founder and chief executive of Bandwidth, based in Raleigh, N.C.

Smartphone apps that offer voice calls using data plans, not minutes allocated for calls, are plentiful. Just last month, Facebook quietly added an option that lets users of the iPhone version of Facebook Messenger place free voice calls to other Messenger users. But using those apps to make a call means the recipient has to run the same app, an irksome requirement that never comes up when using phones alone.

Republic buys access to Sprint’s network on a wholesale basis for calls made outside of Wi-Fi areas. Its business model assumes, however, that Wi-Fi carries the load a majority of the time its phones are used. The company says that its service, even at $19 a month, is a profitable operation on a per-customer basis.

“We don’t have to force people, or even ask people, how to behave,” Mr. Morken says. “Over 60 percent of the time that the phone is being used, on average, our users are using Wi-Fi and that number is only going up.”

Last month, I tested a Republic handset, a Motorola Defy XT. It’s a light smartphone with a small screen, acceptable sound quality and great battery life.

Republic’s Web site gently warns against acting like a “data hog” and encourages its customers to “play nice and try to use Wi-Fi as much as you can.” But scolding isn’t needed: Wi-Fi is faster than 3G, so users have an incentive to opt for Wi-Fi wherever it is available.

The Motorola handset is the only one now offered by Republic, and it costs $259. The phone runs an older version of Android, and it has some first-generation glitches, like losing a connection when a caller starts out on a Wi-Fi network and then leaves the coverage area. (With a click, the call is resumed using Sprint’s cellular network.)

Today most Wi-Fi access requires a logon. But that shouldn’t prove a great inconvenience: you can simply set up the phone once with Wi-Fi at home, then once more at the office. At other locations, users can ignore Wi-Fi availability and use 3G instead.

Mr. Morken says a solution to the Wi-Fi-to-cellular handoff problem has been worked out in the company’s lab, and should be available midyear. Later this year, he also expects to offer more handset models, including one at the high end; he says they will run the latest version of Android.

Matt Carter, president of the Global Wholesale and Emerging Solutions division at Sprint, asserted that the company was happy to serve as Republic’s supplier. When I asked whether Republic’s Wi-Fi-centric model, with its drastically lower price to the consumer, would pose a serious threat to the incumbent carriers, including Sprint, he said, “If the world operated based on just economic decisions, people wouldn’t go buy the most expensive cars on the planet, right?”

Mr. Carter listed reasons that most consumers would prefer the wireless service obtained directly from a major carrier: a wider range of devices and the convenience of placing a call without having to tinker with Wi-Fi setup.

Republic “will resonate with a sliver of the marketplace,” Mr. Carter said. He compared wireless carriers to the major airline carriers, which still control a majority of the market despite low-priced upstarts like JetBlue or Southwest, which he described as appealing only to “a certain segment of the population.”

Philip Cusick, a J.P. Morgan analyst who covers telecommunications, says he doesn’t expect a major shift of customers to Republic Wireless. The price difference isn’t as great as it first appears, he says, when one considers that 80 percent of customers of AT&T and Verizon are on family or employer-related discount plans.

MR. MORKEN of Bandwidth.com says he knows that his company must lower the price of its handset — the industry rule-of-thumb for no-contract wireless services is that a simple handset cannot cost more than $99 and a smartphone, $149. But if Republic can offer me an Android phone with a generously sized screen for a reasonable price, I don’t see why, with Wi-Fi available at work and home, I should continue to pay an expensive-sports-car price for my wireless service.

“There’s a reason why the carriers around the world don’t want you using Wi-Fi for voice and text,” Mr. Morken says. “You will soon realize you shouldn’t have to pay what you’re paying today.”

Randall Stross is an author based in Silicon Valley and a professor of business at San Jose State University. E-mail: stross@nytimes.com.

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