Global Update - H.I.V. Rate Plummets in Zimbabwe

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Vibrations’ Effect on Athletic Ability Is Still in Question

But maybe it’s not so silly, exercise physiologists say. Although they don’t really know why vibrations should work, researchers report that they actually seem to slightly improve performance in the few minutes after a person gets off the machine.

The problem, though, is that there is little consensus on how fast the vibrations should be or in what direction platforms are supposed to vibrate. Some studies have failed to show any effects from vibrations. And then there is the question of what exactly vibrations are doing to muscles and nerves.

“It certainly is intriguing, and a large portion of the evidence would support that something is happening,” said Lee E. Brown, director of the Center for Sports Performance at California State University, Fullerton. But he added,“We are still trying to figure out exactly what the mechanism is.”

Meanwhile, several companies make the vibrating platforms, and they are being used at gyms and by some athletes.

One company, Power Plate, proclaims that stars like Serena Williams and the Minnesota Twins’Justin Morneautrain with its device. A testimonial for another company, Wave, says the United States ski and snowboard teams used its vibrating plates in training for the 2010 Winter Olympics.

But researcher are wary.

“There is something to it,” said William J. Kraemer, a professor ofkinesiologyat the University of Connecticut and the editor in chief of The Journal of Strength&Conditioning Research, calling it“another tool” for athletic conditioning. But he added that other conditioning methods might yield the same or better results.

“If you think of conditioning as a toolbox, there are lots of tools,” he said.“But when companies are selling something, they want to pretend that one tool does everything.”

Experts who have tried the platforms describe them in different ways. The sensation is nothing like using a jackhammer, said Hugh Lamont, a sports biomechanist at Eastern Tennessee State University. Most vibration plates move no more than 50 times a secon and feel like the vibrations in a seat over the wheel hub on a bus, Dr. Lamont said.

Others say the vibrations remind them of downhill skiing— they get the same sort of the rattling in their legs and feet. For Jeffrey M. McBride, an associate professor ofbiomechanicswho is director of the neuromuscular laboratory at Appalachian State University in Boone, N.C., the word that comes to mind is“weird.”

“You can feel your muscles contract,” he said.“It sort of fatigues you.”

But if there is an effect, the researchers said, it seems to be short-lived. People seem to be slightly faster sprinters immediately after standing on a platform. They also seem to be able to jump a bit higher. Vibrations also seem to help people warm up before more strenuous exercise.

“The effect wears off very quickly,” Dr. Brown said.“We are not talking about using this to play a 90-minute soccer match. One sprint and the effect would be gone. You’d play for one minute and still have 89 minutes to go.”

But it could make a difference, he said, if an athlete is about to try a penalty kick in soccer or swing a bat in baseball.

And Michael G. Bemben, chairman of exercise science at the University of Oklahoma, said that“one thought was if you were, say, a high jumper on your third trial in the Olympics and you are at 7 feet 2 inches and need to get to 7 feet 3, this might give you the power for that jump.”

Investigators say they can only guess why vibrations might improve performance. Their leading hypothesis is that it somehow mimics the effect of following a difficult task with an easier one— a simple technique that has been in use for years.

“If you pick up something heavy and then pick up something considerably lighter,” Dr. Lamont explained,“you might be able to throw the lighter weight farther.”

Or if you want to jump, he continued, you might first put a huge weight on a training rack, do a quarter squat, partway down, and then, for three to five seconds, try to push up and lift the weight. You would be doing an isometric contraction of your leg muscles. After that, you might jump higher.

But does it matter? Why not just warm up in the normal way, or do isometric contractions before jumping, or pick up a heavy weight before trying to throw a lighter one?

Or why not combine everything and do warm-ups on a vibrating platform, or try isometric contractions between periods of vibration?

Researchers have thought of that, and say they are investigating. Meanwhile, they say, people should be appropriately skeptical about the effects of standing on a vibrating platform.

“We don’t know a lot about prescribing it,” Dr. Kraemer said.“There’s the rub.”

And yet it is being used many times without an understanding of how to do it best or what the long-term training effects will be.

“Research,” Dr. Kraemer said,“is trying to catch up.”

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Risk and Reward in Utero - Ethics of Spina Bifida Clinical Trial

Their only access was through a clinical trial testing whether risky prenatal surgery was better than standard surgery after birth. Participating meant being randomly assigned to one surgery or the other.

“They take you to a room and a paper tells you what part of the trial you were randomized to,” said Jessica Thomas, 26, of Stansbury Park, Utah, assigned to prenatal surgery when pregnant with her son Tyson.“It was my only sense of hope to try to give him a better life.”

Amy Shapiro, 40, of Leander, Tex., was assigned to postnatal surgery, performed on her son Zachary the day after he was born.

“It was one of the hardest decisions I had to make to be in the study,” said Ms. Shapiro, who knew how disabling spina bifida was because her sister-in-law has it.“It was a big disappointment that we didn’t get the prenatal surgery because I knew that that was the surgery that was most likely going to help him the most, because otherwise why would they be doing the study? But at the same time, he could have died or been born prematurely from prenatal surgery. When they explained everything to us, I wanted to be in it regardless.”

Now, results are in: Fetal surgery, while increasing premature births and causing tearing at some mother’s incisions,made babies more likely to walkand less likely to have neurological problems or need shunts to drain brain fluid.

Besides the groundbreaking results, the seven-year study spotlights ethical dilemmas in research.

The surgery was becoming popular in the 1990s, even appearing on a Time magazine cover, and some experts believed that it might eventually eliminate most symptoms. But given the risks, others wanted proof that it was better than postnatal surgery.

“There were no systematic data regarding safety and efficacy,” said Dr. Jeremy Sugarman, a bioethicist at Johns Hopkins University who participated in early discussions.“Many things we believe to be true and right and appropriate ultimately are shown to be harmful and ineffective.” Spina bifida researchers believed that few women would participate if the surgery were available elsewhere, so they persuaded all but the three hospitals in the trial to stop doing the procedure, an unusual agreement.

“I frankly have a lot of problems when a group of physicians get together and in effect shut down everything so they can have a trial,” said Baruch A. Brody, director of the Center for Medical Ethics and Health Policy at Baylor College of Medicine.“For physicians who believe in it, why should they be pressured into stopping? For families who believe they should have the surgery, why should they be told they can’t?”

But several ethicists praised the pause.“It’s impressive to see that kind of collaboration,” said Dr. Jeffrey R. Botkin, a pediatric ethicist at the University of Utah.“The sophistication surgeons need to do this is so high, it makes sense to answer research questions by allowing it only at a few centers.”

The surgery proved beneficial enough that an independent monitoring board stopped the trial, not wanting to deny more women the opportunity for prenatal surgery. But stopping trials early sometimes limits the information researchers can collect that might benefit future patients.

Monitoring boards“walk a very fine line,” said Dr. Steven Goodman, an epidemiologist at Johns Hopkins and editor of the journal Clinical Trials.“At what point is the benefit of getting more information outweighed by the consequences of not releasing results and continuing to randomize patients?”

In some trials, if one treatment proves superior, other participants can then receive that treatment. But with prenatal surgery, that isn’t possible, said Jeffrey Kahn, director of the University of Minnesota’s bioethics center.“Some people are accepting risk for the benefit of those who will come after them.”

Still, regardless of therapy,“people who enroll in clinical trials, for the most part, do better than people who don’t, because care is controlled and monitored,” Dr. Goodman said.“You simply can’t go back and say,‘In every trial people who didn’t get the winning therapy were deprived.’”

Tyson Thomas emerged from prenatal surgery with no need for a shunt and, at 22 months old, uses a walker but is almost walking independently. Zachary Shapiro, 6, has a shunt, walks with braces, and has some attention problems. Both boys, who received their surgery at the University of California, San Francisco, need catheters.

Ms. Shapiro, a kindergarten teacher, said of her son,“I do feel like he benefited, even though he didn’t benefit from the actual surgery.”

She added,“He benefited from the research that has happened about his disability.”

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Tiptoeing Out of One’s Comfort Zone (and of Course, Back In)

First, I spoke to a group of middle-school students about journalism. It was a day when parents were supposed to come and talk about their work and discuss why what you learned in middle school was actually important in real life.

I am fairly self-confident about talking to a roomful of adults. But 12- and 13-year-old children made me sweat. Some looked at me intently, but others stared out the window, played with their pencils or poked their neighbors. Suddenly, I was pulled back to my middle-school years, trying to entertain the“popular” kids. I was most uncomfortable.

A few days later, we had some workers in to paint a few rooms in the house. No big deal, I thought. Except that as more rooms were draped in drop cloths and living room furniture crowded the dining room, our entire family— and two befuddled cats— retreated upstairs.

No one could find anything. Everyone was out of sorts. We were feeling decidedly uncomfortable.

Moving out of our comfort zones is supposed to be a good thing. We challenge ourselves, we grow and take on new risks. But is this always true? After all, over the last few years, many of us have been pushed out of our comfort zones, forced to seek new jobs, even careers.

First of all, I wondered, how did the term originate? In my research, I came across one theory that comfort zone was the temperature range— about 67 to 78 degrees, depending on the season— at which people were neither too hot nor too cold.

All right. I can’t test that with snow on the ground. But if we transfer that to a psychological comfort zone, it makes sense— it’s where we’re completely at home. Or as Judith M. Bardwick, author of“Danger in the Comfort Zone” (American Management Association, 1991), writes,“The comfort zone is a behavioral state within which a person operates in an anxiety-neutral position.”

She cites afamous experimentconducted by the psychologists Robert M. Yerkes and John D. Dodson, way back in 1908. Using mice, they found that stimulation improved performance, up to a certain level— what is now known as optimal anxiety. When that level is passed, and we’re under too much stress, performance deteriorates.

“We need a place of productive discomfort,” said Daniel H. Pink, author of“Drive: The Surprising Truth About What Motivates Us” (Riverhead, 2009).“If you’re too comfortable, you’re not productive. And if you’re too uncomfortable, you’re not productive. Like Goldilocks, we can’t be too hot or too cold.”

Everyone’s reaction to stress is different, of course— your comfort zone is not mine.

The objective is to reach that optimal level so that our skills increase and we become comfortable with that new level of anxiety— then we’re in an expanded comfort zone. And ideally, we will get more used to those feelings of“productive discomfort” and won’t be so scared to try new things in the future.

Brené Brown, a research professor at theUniversity of HoustonGraduate College of Social Work and author of“The Gifts of Imperfection” (Hazelden, 2010), has another definition of comfort zone:“Where our uncertainty, scarcity and vulnerability are minimized— where we believe we’ll have access to enough love, food, talent, time, admiration. Where we feel we have some control.”

The trouble is, Ms. Brown said,“When we get into times of social, political or financial instability, our comfort zones get smaller.” The more afraid we are, she said,“the more impenetrable our comfort zones buffers become.”

There was a huge shift after 9/11, she said, in just how vulnerable people were willing to be in their personal and work lives. When we feel vulnerable, she added, we often feel fear and shame.

And,“since those are some of our most difficult emotions, we want to avoid them,” she said.

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Are Doctors Too Quick to Cut? - Room for Debate

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Mustard Vinaigrette - Recipes for Health

1 rounded tablespoon Dijon mustard

1 1/2 tablespoons red wine vinegar or sherry vinegar

1 tablespoon fresh lemon juice

Salt and freshly ground pepper

1/2 cup extra virgin olive oil, or use half olive oil and half canola or grapeseed oil

1 small garlic clove

1.In a small bowl or measuring cup, combine the mustard, vinegar, lemon juice, salt and pepper. Whisk in the oil.

2.Peel the garlic clove and lightly crush, or cut down to the root end with a paring knife, keeping the garlic clove intact. Place in the dressing and allow to marinate for at least 30 minutes. Remove from the dressing before serving.

Yield:About 2/3 cup.

Advance preparation:This dressing will keep well in the refrigerator for a few days. Remove the garlic clove before storing.

Nutritional information per 2 tablespoons:184calories; 3 gramssaturated fat; 2 grams unsaturated fat; 15 grams monounsaturated fat; 0 milligramscholesterol; 1 gramcarbohydrates; 0 gramsdietary fiber; 58 milligrams sodium (does not include salt to taste); 0 grams protein

Martha Rose Shulmanis the author of“The Very Best of Recipes for Health.”

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G.O.P. Sponsoring Bills to Expand Abortion Restrictions

Invoking the mantra of fiscal restraint that has dominated House action since lawmakers reconvened last month, Republicans began committee work this week on two bills that would greatly expand restrictions on financing for and access to abortions. Another bill, one that would cut off federal dollars to women’s health care clinics that offer abortions, is expected to surface later this year.

“This House is more pro-life than it’s ever been,” said Representative Joe Pitts, Republican of Pennsylvania and the author of one of the bills to limit money for abortions.

Democrats in both the House and Senate immediately fought back Tuesday, working closely with reproductive rights advocates. They have appropriated the Republican charge from last year that Democrats were working on a liberal policy agenda instead of on job creation and the economy, and turned it on its head.

“This election was about the economy,” said SenatorKirsten Gillibrandof New York, who joined with other Democratic senators Tuesday to decry the House bills Tuesday as needless and intrusive.

Over and over, Democrats said that by bringing up the abortion issue now, Republicans were going back on their word to focus on the budget.

Yet the bills that have surfaced on the House floor this year have been fiscal in nature, including the repeal of the health care law, which was later rejected by the Senate, and some measures designed to cut spending.

“Republicans are focused on creating a better environment for economic growth and job creation,” said Kevin Smith, a spokesman for SpeakerJohn A. Boehner,“and that is reflected in the legislation the House is passing,”

Still, Republicans in the House are clearly energized about using their new majority to reopen debate on an important issue for conservatives, especially in the context of the health care overhaul.

On Tuesday, RepresentativeEric Cantor, the Republican majority leader, described the new measures as“obviously very important in terms of the priorities we set out initially in our pledge to America.”

He indicated that he expected the first version of a House bill to finance the government through the rest of the year to bar spending to carry out the health care law. That provision is likely to also be attacked by the Senate and the Obama administration.

One bill, the“No Taxpayer Funding for Abortion Act,”would eliminate tax breaks for private employers who provide health coverage if their plans offer abortion services, and would forbid women who use a flexible spending plan to use pre-tax dollars for abortions. Those restrictions would go well beyond current law prohibiting the use of federal money for abortion services.

The bill, sponsored by RepresentativeChristopher H. Smith, Republican of New Jersey, has drawn fire over language that undercuts a longstanding exemption on the ban on using federal money for abortions in the case ofrapeor incest; the measure narrows the definition of rape to“forcible rape,” a term that his office has never defined. Democratic lawmakers and others repeatedly hammered on the term, saying it suggested that victims of statutory rape and other crimes could not get abortions paid for with federal money.

While Mr. Smith’s staff said last week that the term"forcible rape"would be removed from the bill, the staff of RepresentativeJerrold Nadler of New York, the top Democrat on the Judiciary Subcommittee on the Constitution, said that language remained intact as of Tuesday.

Another bill, sponsored by Mr. Pitts, addresses the health care overhaul head-on by prohibiting Americans who receive insurance through state exchanges from purchasing abortion coverage, even with their own money. The bill is essentially a resurrection of a provision in the House version of the health care law but was not in the Senate version.

The bill would also permithospitalsto refuse abortions to women, even in emergency situations, if such care would offend the conscience of the health care providers.

“Both bills are designed to drive coverage for abortion out ofhealth insuranceplans, period,” said Nancy Northup, president of theCenter for Reproductive Rights.

The bills drew immediate fire from House and Senate Democrats.“We are sending a clear message to House Republicans that their agenda on women’s health is extreme,” SenatorBarbara Boxerof California said at a news conference.“It breaks faith with a decades-long bipartisan compromise, and it risks the health and lives of women. It also punishes women and businesses with a tax hike if they wish to keep or buy insurance that covers a full range of reproductive health care.”

SenatorFrank R. Lautenbergof New Jersey, another Democrat who joined the news conference, compared the proposals to“a Third World country that’s requiring women to wear head shawls to cover their faces even if they don’t want to do it.”

As Mr. Smith’s bill provoked a spirited back and forth at a hearing of a subcommittee of the House Judiciary Committee, it also drew praise from some outside supporters.

“The federal government should not use tax dollars to support or promoteelective abortion,” Richard Doerflinger, associate director of theSecretariat of Pro-Life Activitiesof theUnited States Conference of Catholic Bishops, said in a news release.

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