Teenage Boys, Worried About Body Image, Take Health Risks


It is not just girls these days who are consumed by an unattainable body image.


Take David Abusheikh. At age 15, he started lifting weights for two hours a day, six days a week. Now that he is a senior at Fort Hamilton High School in Brooklyn, he has been adding protein bars and shakes to his diet to put on muscle without gaining fat.


“I didn’t used to be into supplements,” said Mr. Abusheikh, 18, who plans on a career in engineering, “but I wanted something that would help me get bigger a little faster.”


Pediatricians are starting to sound alarm bells about boys who take unhealthy measures to try to achieve Charles Atlas bodies that only genetics can truly confer. Whether it is long hours in the gym, allowances blown on expensive supplements or even risky experiments with illegal steroids, the price American boys are willing to pay for the perfect body appears to be on the rise.


In a study to be published on Monday in the journal Pediatrics, more than 40 percent of boys in middle school and high school said they regularly exercised with the goal of increasing muscle mass. Thirty-eight percent said they used protein supplements, and nearly 6 percent said they had experimented with steroids.


Over all, 90 percent of the 2,800 boys in the survey — who lived in the Minneapolis-St. Paul area, but typify what doctors say is a national phenomenon — said they exercised at least occasionally to add muscle.


“There has been a striking change in attitudes toward male body image in the last 30 years,” said Dr. Harrison Pope, a psychiatry professor at Harvard who studies bodybuilding culture and was not involved in the study. The portrayal of men as fat-free and chiseled “is dramatically more prevalent in society then it was a generation ago,” he said.


While college-age men have long been interested in bodybuilding, pediatricians say they have been surprised to find that now even middle school boys are so absorbed with building muscles. And their youth adds an element of risk.


Just as girls who count every calorie in an effort to be thin may do themselves more harm than good, boys who chase an illusory image of manhood may end up stunting their development, doctors say, particularly when they turn to supplements — or, worse, steroids — to supercharge their results.


“The problem with supplements is they’re not regulated like drugs, so it’s very hard to know what’s in them,” said Dr. Shalender Bhasin, a professor of medicine at Boston Medical Center. Some contain anabolic steroids, and even high-quality protein supplements might be dangerous in large amounts, or if taken to replace meals, he said. “These things just haven’t been studied very well,” he said.


Anabolic steroids pose a special danger to developing bodies, Dr. Bhasin said. Steroids “stop testosterone production in men,” he said, leading to terrible withdrawal problems when still-growing boys try to stop taking them. Still, the constant association of steroids with elite athletes like Lance Armstrong and Barry Bonds perpetuates the notion that they can be managed successfully.


Online, in bodybuilding forums for teenagers, boys barely out of puberty share weight-lifting regimens and body fat percentages, and judge one another’s progress. On Tumblr and Facebook, teenagers post images of ripped athletes under the heading “fitspo” or “fitspiraton,” which are short for “fitness inspiration.” The tags are spinoffs of “thinspo” and “thinspiration” pictures and videos, which have been banned from many sites for promoting anorexia.


“Lifted b4 school today felt good but was weak as hell,” wrote one boy who said he was 15 and from Tallahassee, Fla., on a message board on Bodybuilding.com in September, saying he bench-pressed 245 pounds. “Barely got it.”


Many of these boys probably see themselves in Mike Sorrentino, “The Situation” from the “Jersey Shore” series on MTV, or the Adam Sackler character, on the HBO series “Girls,” who rarely wears a shirt or takes a break from his crunches.


Mr. Abusheikh, for instance, has a Facebook page full of photos of himself shirtless or showing off his six-pack abs. At his high school, participation in the annual bodybuilding competition hit an all-time high of 30 students this year.


“They ask us about everything,” said Peter Rivera, a physical education teacher at Fort Hamilton High School who helps oversee the competition. “How do I lose weight? How do I gain muscle? How many times a week should I work out?” Some boys want to be stronger for sports, Mr. Rivera said, but others “want to change their body type.”


Compared with a sedentary lifestyle of video games and TV, an obsession with working out may not quite qualify as a health hazard. And instructors like Mr. Rivera say most boys are eager for advice on the healthiest, drug-free ways to get in shape.


With so little known about supplements, it can be difficult, particularly for teenagers, to make wise decisions.


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Which Tablet to Buy Among Dozens Confuses Shoppers





Holiday shoppers with a tablet computer on their gift list this year might be forgiven for feeling a little panicked.




Look at the tablets available online or at a consumer electronics store and it can be dizzying to choose from among the dozens of slim rectangles with touch screens — each with various sizes, features, prices and applications.


Tablets were supposed to be a simple alternative to the bloated personal computer market. And when “tablet” was synonymous with “iPad,” that was true.


But this is the first holiday season in which the iPad faces competitors that have built up a solid footing in the market. Amazon and Google introduced tablets just in time for the shopping rush. As a result, many consumers and analysts say, the new market of keyboardless computers is quickly becoming as confusing as that of the old-school PC.


“What’s different about this holiday season is that consumers have not just more choice, but really good choices,” said Sarah Rotman Epps, who studies consumer computing trends at Forrester. “There have been many iPad wannabes but no real quality alternatives, and now there are several.”


While choice is a good thing for consumers, she said, it also makes shopping “confusing and complicated.”


For the companies that make tablets, the choice means everything. The stakes are much higher than the sale of individual devices. Each company is trying to snag lifelong customers for their other products — like music, apps, e-books, movies, Web search or word-processing software.


While Apple has dominated the market until now, selling more tablets than any other company, its perch is being threatened by the newcomers.


“Apple left a lot of room for rivals to grow,” said Tero Kuittinen, an independent mobile analyst.


By keeping its tablet prices so high, he said, Apple could lose its place as the biggest tablet seller, just as it did with smartphones when it lost the first-place position to Samsung, which makes less expensive phones using Google’s Android software. The iPad still dominates the market with a 50 percent share, according to third-quarter figures from the research firm IDC, but that is down from 60 percent a year ago. Samsung is in second place with an 18 percent share, Amazon is third with 9 percent, and Asus, which makes Google’s Nexus 7 tablet, is in fourth with 8.6 percent of the market.


But Google, which makes the vast majority of its revenue on Web ads, still lags in the tablet market, even though sales of its Nexus 7 tablet are approaching one million a month, according to Asus. About 98 percent of Web traffic from tablets comes from iPads, according to Onswipe, a digital publishing company. Google would like more of that traffic, as well as more buyers for apps and media from its Google Play store, as would Amazon and Microsoft.


“The first decision you make is what ecosystem am I in, do I want the Android Play store and content or some other?” said Hiroshi Lockheimer, Google’s vice president for engineering for Android. “So the importance of the ecosystem can’t be overstated.”


But the decisions after that are still complex.


Say, for example, that you want a tablet that runs Google’s Android operating system. There is the Nexus 7, a seven-inch tablet made by Asus, and the Nexus 10, a 10-inch tablet made by Samsung. Then there are the Samsung Galaxy Tab 2 10.1 and the Samsung Galaxy Note 10.1 (not to be confused with the Samsung Galaxy Note 2, a 5.5-inch smartphone). And that’s not to mention the dozens of Android tablets made by Lenovo, Toshiba and others.


This year, Microsoft also has a tablet, called Surface. Amazon has the Kindle Fire and Fire HD, and Barnes & Noble has the Nook HD and HD+. Once shoppers choose one, they have more choices to make, like whether they want to pay $15 more for the privilege of not seeing ads on the Kindle Fire.


Even Apple, which has always prided itself on having simple product lines, now offers the new iPad, the older iPad 2 and the iPad Mini. If you factor in the various amounts of storage and the choice of cellular data or just Wi-Fi, there are essentially 14 iPad models to choose from.


Complicating the decision on hardware, different tablets connect to different online stores for apps, music and video. If you have built your music and app collection on Apple devices, an Android tablet may mean starting from scratch, and vice versa.


The proliferation of products is nothing new for a mature market, as anyone who has stood in front of a wall of televisions at Best Buy or in a parking lot of Priuses at a Toyota dealership knows.


But some consumer electronics companies that have given their customers too many options have run into trouble, said Shaw Wu, an analyst at Sterne Agee. They include Motorola Mobility, which is trying to rescue its cellphone business by paring its lineup of 27 devices, and Research in Motion, which offers a perplexing matrix of BlackBerrys with confusing names, like the BlackBerry Torch 9810, 9850 and 9860.


Google in particular runs this risk, said Michael Gartenberg, a technology analyst at Gartner, because it gives away its Android operating system to any device manufacturer that wants to use it, resulting in an uncontrolled array of Android devices running different versions of the software. Some apps will work only with particular versions, making it difficult to know exactly what you are getting.


Google has tried to address this problem in recent months. It gave its line of Nexus products names corresponding to their screen size and began selling them in its Play store. (Google teams up with manufacturers to build the Nexus devices.) It began running ads for the tablets online, on billboards, in print and on television, which had been rare for the company, and assigned a public relations employee to focus on selling hardware to consumers.


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Israel Bombs Gaza Media and Government Sites, Warning of ‘Expansion’


Mohammed Saber/European Pressphoto Agency


Two children look through the rubble of their house after an airstrike in Beit Lahiya, Gaza, on Sunday.







GAZA CITY — Israel pressed its assault on the Gaza Strip for a fifth straight day on Sunday, deploying warplanes and naval vessels to pummel the coastal enclave and striking at two media offices here as Prime Minister Benjamin Netanyahu warned of a possible “significant” expansion in the onslaught.




His words came as militants in Gaza aimed at least one rocket at the Israeli heartland in Tel Aviv, one day after after Israeli forces broadened the attack beyond military targets, bombing centers of government infrastructure including the four-story headquarters of the Hamas prime minister.


“We are exacting a heavy price from Hamas and the terrorist organizations and the Israel Defense Forces are prepared for a significant expansion of the operation,” Mr. Netanyahu told his cabinet at its routine Sunday meeting, referring directly to the call-up of thousands of reservists that, coupled with a massing of armor on the Gaza border, many analysts have interpreted as preparations for a possible invasion.


“I appreciate the rapid and impressive mobilization of the reservists who have come from all over the country and turned out for the mission at hand,” he said. “Reservist and conscript soldiers are ready for any order they might receive.”


Mr. Netanyahu’s remarks were reported shortly after a battery of Israel’s “Iron Dome” defense shield, hastily deployed near the city on Saturday in response to the threat of longer-range rockets, intercepted at least one projectile aimed at Tel Aviv on Sunday, Israeli officials said. The episode was the latest of several salvoes that have illustrated Hamas’s ability to extend the range of its rocket attacks.


The crash of explosions pierced the Gaza City quiet several times throughout the early morning, with one attack injuring several journalists at a communications building, witnesses said. A rocket fired from Gaza ploughed through the roof of an apartment building in the southern Israeli city of Ashkelon but there were no immediate reports of casualties there.


The onslaught continued despite talks in Cairo that Egyptian President Mohamed Morsi said Saturday night he thought could soon result in a ceasefire. Prime Minister Netanyahu said he would consider a comprehensive ceasefire if the launches from Gaza stop.


The attack on the office of the Hamas prime minister, Ismail Haniya, one of several on government installations, came a day after he hosted his Egyptian counterpart in that very building on Friday, a sign of Hamas’s new legitimacy in a radically redrawn Arab world.


That stature was underscored Saturday by a visit to Gaza from the Tunisian foreign minister and the rapid convergence in Cairo of two Hamas allies, the prime minister of Turkey and the crown prince of Qatar, for talks with the Egyptian president and the chairman of Hamas on a possible cease-fire.


But Mark Regev, a spokesman for Mr. Netanyahu, denied reports that a truce was imminent.


It was unclear whether the deal under discussion in Cairo would solely suspend the fighting or include other issues. Hamas — which won elections in Gaza in 2006 and took full control in 2007 but is considered a terrorist organization by Israel and the United States — wants to turn its Rafah crossing with Egypt into a free-trade zone and seeks Israel’s withdrawal from the 1,000-foot buffer it patrols on Gaza’s northern and eastern borders.


For his part, Mr. Netanyahu spoke with the leaders of Britain, Germany, Italy, Greece, Poland, Portugal, Bulgaria and the Czech Republic, according to a statement from his office. On Sunday, he said he appreciated the “understanding they are displaying for Israel’s right to defend itself.”


As the fighting entered its fifth day, the conflict showed no sign of abating.


Palestinian news agencies reported that two children were killed in a predawn strike on Sunday in Beit Lahiya in northern Gaza. The Israeli military said it had “targeted dozens of underground launchers” overnight and also hit what it called a Hamas training base and command center. The Israeli Navy “targeted terror sites on the northern Gaza shore line,” the statement said, in repeated rounds of multiple missiles that could be easily heard.


Among the buildings Israel hit overnight were two containing the offices of local media outlets. A statement from the Israeli Defense Forces initially described one of its targets as “a communications facility used by Hamas to carry out terror activity against the state of Israel.” Within minutes, the I.D.F. recalled that statement and replaced it with one referring to “a communications antenna.”


Jodi Rudoren reported from Gaza City, Isabel Kershner from Jerusalem and Alan Cowell from London. Reporting was contributed by Fares Akram and Tyler Hicks from the Gaza Strip, Carol Sutherland and Iritz Pazner Garshowitz from Jerusalem, and David D. Kirkpatrick and Mayy El Sheikh from Cairo.



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A night of upsets and Irish, Tide rise in football

Coming into Saturday, Oregon and Kansas State had the inside track to college football's national championship and the Southeastern Conference's run of six straight BCS titles was in jeopardy.

Then No. 2 K-State got thumped 52-24 by unranked Baylor and top-ranked Oregon fell in overtime to No. 14 Stanford, 17-14.

Now the SEC is alive and well.

And how's this for a possible national title game: Alabama vs. Notre Dame.

A week after Alabama lost to Texas A&M, more upsets re-opened door for the fourth-ranked Crimson Tide, which shut out lower-division Western Carolina 49-0 on Saturday.

Georgia has a title shot, too. And so does Florida.

But the happiest of all about the Ducks and Wildcats going down had to be Notre Dame and its fans.

The Fighting Irish were third in the BCS standings and the AP Top 25, behind K-State and Oregon entering the weekend. Notre Dame was staring at what must have felt unthinkable for the storied program: Finishing unbeaten and not even getting a chance to play for the BCS championship.

The Irish took care of running their record to 11-0 with a 38-0 shutout at home against Wake Forest.

Then everything fell into place.

Oregon (10-1), the highest scoring team in the country at 55 points per games, couldn't shake free of Stanford's tough defense. The Cardinal tied it late on a juggling TD catch that was called incomplete on the field and overturned to a catch by replay.

In OT, Oregon missed a field goal and Stanford made one. The Ducks were done.

"It hurts and as I told them, you'd like to have some words that would take the pain out of it, but there aren't," Ducks coach Chip Kelly said. "We'll feel bad for a little bit of time and we'll bounce back from it."

Kansas State's first loss of the season was far more decisive. Collin Klein and the Wildcats (10-1) lost 52-24 at Baylor, and there went Kansas State's BCS title hopes and Klein's status as Heisman Trophy front-runner. He was picked off three times.

It was the first time since Dec. 1, 2007, that the Nos. 1 and 2 teams in the AP Top 25 lost on the same day. That year, Missouri and West Virginia were the upset victims, giving Ohio State and LSU a chance to play for the national title. The Tigers won the second of the SEC's six straight.

When the latest BCS standings and AP rankings come out Sunday Notre Dame almost certainly will be No. 1.

Alabama, fourth in the BCS last week, will most likely be in second place this week, followed by SEC rivals Georgia and Florida.

Notre Dame coach Brian Kelly won't need to go on television with Oprah Winfrey, as he said he would earlier this week, to plead his team's case for playing in the BCS title game. Just beat rival Southern California next week at the Los Angeles Coliseum and book the plane tickets to Miami, where the BCS national title game will be played Jan. 7.

USC, the preseason No. 1 team, lost again on Saturday, 38-28 to UCLA, to fall to 7-4. And Trojans star quarterback Matt Barkley was knocked out of Saturday's game by a hard hit. No word yet on whether he'll play next week, but if he doesn't Notre Dame's path gets even smoother.

As for the SEC, it's pretty simple.

Alabama (10-1) and Georgia (10-1) have already sealed up spots in the conference title game on Dec. 1, but both have games still to play.

The Tide plays hapless rival Auburn next week. The Bulldogs face Georgia Tech. If they both win, the SEC title game again becomes a de facto national semifinal, with the winner likely advancing to Miami, trying to extend win the league's seventh straight national crown.

Sprinkle in a Georgia Tech win and the Bulldogs beating Alabama in the SEC title game, and No. 7 Florida (10-1) could be the SEC's representative, though the Gators have to play at No. 10 Florida State (10-1).

The Seminoles aren't out of the race yet either, especially if USC shocks Notre Dame. Though if that happens, just about any team with only one loss will be making claim to be in the big game, even Oregon and Kansas State if they can win their conferences.

Or consider this.

USC beats Notre Dame, Florida beats Florida State, and either Georgia or Alabama finishes 12-1. Add it up and it could be an all-SEC championship game for the second straight year.

Or there could be split national championship. Undefeated Ohio State is No. 6 in the AP Top 25 but ineligible to win the BCS title because it is NCAA-banned from playing in a bowl game.

If all the other contenders falter, Ohio State could be the lone unbeaten left standing and lay claim to the AP title.

Sounds crazy, but after Saturday night, nothing seems far-fetched.

___

AP Sports Writer Anne M. Peterson in Eugene, Ore., contributed.

___

Follow AP Sports Writer Ralph D. Russo at www.Twitter.com/ralphdrussoap

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The Neediest Cases: Emerging From a Bleak Life to Become Fabulous Phil





For years, Phillip Johnson was caught in what seemed like an endless trench of bad luck. He was fired from a job, experienced intensifying psychological problems, lost his apartment and spent time in homeless shelters. At one point, he was hospitalized after overdosing on an antipsychotic drug.




“I had a rough road,” he said.


Since his hospital stay two years ago, and despite setbacks, Mr. Johnson, 27, has been getting his life on track. At Brooklyn Community Services, where he goes for daily counseling and therapy, everybody knows him as Fabulous Phil.


“Phillip is a light, the way he evokes happiness in other people,” his former caseworker, Teresa O’Brien, said. “Phillip’s character led directly to his nickname.”


About six months ago, with Ms. O’Brien’s help, Mr. Johnson started an event: Fabulous Phil Friday Dance Party Fridays.


One recent afternoon at the agency, 30 clients and a few counselors were eating cake, drinking soft drinks and juice, and grooving for 45 minutes to Jay-Z and Drake pulsating from a boom box.


Mr. Johnson’s voice rose with excitement when he talked about the party. Clients and counselors, he said, “enjoy themselves.”


“They connect more; they communicate more,” he continued. “Everybody is celebrating and laughing.”


The leadership Mr. Johnson now displays seems to be a far cry from the excruciatingly introverted person he was.


As an only child living with his single mother in public housing in Bedford-Stuyvesant, Brooklyn, he said, he tended to isolate himself. “A lot of kids my age would say, ‘Come outside,’ but I would always stay in my room,” he said. He occupied himself by writing comic books or reading them, his favorites being Batman and Spiderman because, he said, “they were heroes who saved the day.”


After graduating from high school in 2003, he worked odd jobs until 2006, when he took a full-time position at a food court at La Guardia Airport, where he helped to clean up. The steady paycheck allowed him to leave his mother’s apartment and rent a room in Queens.


But the depression and bleak moods that had shadowed him throughout middle and high school asserted themselves.


“My thinking got confused,” he said. “Racing thoughts through my mind. Disorganized thoughts. I had a hard time focusing on one thing.”


In 2008, after two years on the job, Mr. Johnson was fired for loud and inappropriate behavior, and for being “unpredictable,” he said. The boss said he needed counseling. He moved back in with his mother, and in 2009 entered a program at an outpatient addiction treatment service, Bridge Back to Life. It was there, he said, that he received a diagnosis of schizophrenia and help with his depression and marijuana use.


But one evening in May 2010, he had a bout with insomnia.


He realized the antipsychotic medication he had been prescribed, Risperdal, made him feel tired, he said, so he took 12 of the pills, rather than his usual dosage of two pills twice a day. When 12 did not work, he took 6 more.


“The next morning when I woke up, it was hard for me to breathe,” he said.


He called an ambulance, which took to Woodhull Hospital. He was released after about a month.


Not long after, he returned to his mother’s apartment, but by February 2011, they both decided he should leave, and he relocated to a homeless shelter in East New York, where, he said, eight other people were crammed into his cubicle and there were “bedbugs, people lying in your bed, breaking into your locker to steal your stuff.”


In late spring 2011, he found a room for rent in Manhattan, but by Thanksgiving he was hospitalized again. Another stint in a shelter followed in April, when his building was sold.


Finally, in July, Mr. Johnson moved to supported housing on Staten Island, where he lives with a roommate. His monthly $900 Social Security disability check is sent to the residence, which deducts $600 for rent and gives him $175 in spending money; he has breakfast and lunch at the Brooklyn agency. To assist Mr. Johnson with unexpected expenses, a grant of $550 through The New York Times Neediest Cases Fund went to buy him a bed and pay a Medicare prescription plan fee for three months.


“I was so happy I have a bed to sleep on,” he said about the replacement for an air mattress. “When I have a long day, I have a bed to lay in, and I feel good about that.”


Mr. Johnson’s goals include getting his driver’s license — “I already have a learner’s permit,” he said, proudly — finishing his program at the agency, and then entering an apprenticeship program to become a plumber, carpenter or mechanic.


But seeing how his peers have benefited from Fabulous Phil Fridays has made him vow to remain involved with people dealing with mental illnesses or substance abuse.


He was asked at the party: Might he be like the comic-book heroes he loves? A smile spread across his face. He seemed to think so.


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Egypt Sends Prime Minister to Gaza in Show of Solidarity


Ilia Yefimovich/Getty Images


Smoke rose over Gaza on Friday. Israel denied launching airstrikes. More Photos »







GAZA CITY — After a night of ferocious airstrikes in Gaza and rocket fire toward Israel, Egypt on Friday launched a remarkable diplomatic initiative, sending its prime minister to show support for Palestinians in the beleaguered enclave, a move that prompted his Israeli counterpart to agree to a temporary, though flawed, cease-fire even as Israeli commanders sent armored vehicles toward the overcrowded coastal strip and called up reservists for a possible invasion.




The frail truce barely took root. Even as Prime Minister Hesham Kandil of Egypt arrived in Gaza, Israel Radio said Palestinian militants fired 25 rockets into southern Israel, with one rocket striking a house. There were no immediate reports of casualties.


The thump of airstrikes by Israeli F-16s was also audible in Gaza City. The Israeli military said no such strikes had taken place, but the Hamas health ministry reported that two people, including a child, were killed in the north of Gaza City while the Egyptian delegation was on the ground, pushing the Palestinian death toll in three days of aerial bombardment to 21.


Three Israelis were killed in a rocket attack on Thursday in Kiryat Malachi, a small town in southern Israel, when a rocket fired from Gaza struck their apartment house.


Prime Minister Benjamin Netanyahu had made the temporary cease-fire by Israel’s airplanes conditional on a corresponding halt to rocket fire from Gaza.


Mr. Kandil’s visit produced dramatic imagery to underpin Cairo’s support for Hamas, which Israel, the United States and much of the West consider to be a terrorist organization.


Mr. Kandil and Ismail Haniya, his Hamas equivalent, visited the Al Shifa hospital amid a huge scrum of bodyguards and journalists, saying they had carried the body of Mohammed Yasser, one of eight children who Palestinian health officials say have been killed in the surge of violence since a top Hamas commander was killed in an Israeli airstrike on Wednesday.


“This is the blood of our children on our clothes,” Mr. Haniyeh said as he showed spatters on his clothing, “These are the Egyptian and the Palestinian blood united together.”


Like President Mohamed Morsi of Egypt on Thursday, Mr. Kandil walked a delicate line between support for Hamas, condemnation of Israel and a quest for calm in a region increasingly threatened by the spillovers from Syria’s civil war into neighboring countries as well as by the long-festering impasse between Israelis and Palestinians.


“The aim of this visit is not only to show political support but to support the Palestinian people on the ground,” Mr. Kandil said, noting that he had brought with him a delegation from the Egyptian Health Ministry. He said a cease-fire between Gaza and Israel was “the only way to achieve stability in the region” and also called on the Palestinians to repair the rift between Hamas in Gaza and the Fatah group that dominates the Palestinian Authority in the West Bank. “We call on the Palestinian people to unite because their power and strength is in their unity,” Mr. Kandil said. “That’s the only way to liberate Palestine.”


The visit was the first of such a high-ranking Egyptian official to this coastal enclave since the militant Hamas faction gained control in 2007 and offered a potent sign of how Egypt’s revolution and new Islamist leadership since the overthrow of President Hosni Mubakrak last year has shifted the geopolitics of the Israeli-Palestinian conflict.


Egypt, Mr. Kandil said, would “save nothing to stop the aggression and achieve a continuous cease-fire on the way to having a Palestinian state with Jerusalem as its capital.”


The display of support — improbable throughout the Mubarak era — emboldened the Hamas leadership.


“The time in which the Israeli occupation does whatever it wants in Gaza is gone,” Mr. Haniyeh said. “Egypt cannot accept the aggression as before,” Mr. Haniyeh said. “I welcome Egypt for this historical visit that comes in harmony with the will of the free Egypt.” Before the visit, residents in Gaza said the night was filled with the boom and crash of airstrikes, with loud explosions at dawn on Friday, a day after Israel and the Hamas rulers of Gaza brushed aside international calls for restraint and escalated their lethal conflict. In Gaza, Palestinian militants launched hundreds of rockets into Israeli territory, targeting Tel Aviv for the first time, and Israel intensified its aerial assaults.


Defense Minister Ehud Barak of Israel, expressing outrage over a pair of long-range Palestinian rockets that whizzed toward Tel Aviv and set off the first air-raid warning in the Israeli metropolis since it was threatened by Iraqi Scud missiles in the Persian Gulf war of 1991, said, “There will be a price for that escalation that the other side will have to pay.”


Jodi Rudoren reported from Gaza City, Isabel Kershner from Jerusalem, and Alan Cowell from Paris. Reporting was contributed by Fares Akram from Gaza, Rick Gladstone from New York, Rina Castelnuovo from Kiryat Malachi, Israel, Mayy El Sheikh and David D. Kirkpatrick from Cairo, Gabby Sobelman from Jerusalem, and Elisabeth Bumiller from Bangkok.



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Miguel Cabrera, Buster Posey win MVP awards

NEW YORK (AP) — Miguel Cabrera has a Most Valuable Player award to go with his Triple Crown. And Buster Posey has an MVP prize to put alongside his second World Series ring.

The pair of batting champions won baseball's top individual honors Thursday by large margins.

Cabrera, the first Triple Crown winner in 45 years, won the AL MVP by receiving 22 of 28 first-place votes and 362 points from a panel of Baseball Writers' Association of America.

The Detroit third baseman easily beat Los Angeles Angels rookie center fielder Mike Trout, who had six firsts and 281 points.

Cabrera hit .330 with 44 homers and 139 RBIs to become the first Triple Crown winner since Boston's Carl Yastrzemski in 1967. Cabrera also led the league with a .606 slugging percentage for the AL champion Tigers.

Some of the more sabermetric-focused fans supported Trout, who hit .326 with 30 homers and 83 RBIs, and he led the majors with 129 runs and 49 steals and topped all players in WAR — Wins Above Replacement. Trout won AL Rookie of the Year earlier in the week.

"I was a little concerned. I thought the new thing about computer stuff, I thought Trout's going to win because they put his numbers over me," Cabrera said. "I was like relax. ... if he wins, it's going to be fair because he had a great season."

His victory is a win for the traditional statistics.

"At the end of the game, it's going to be the same baseball played back in the day," Cabrera said.

Posey, at a charity event at his mother's school in Leesburg, Va., followed the AL debate and Googled to find out the winner.

"I think it intrigued everybody," he said. "As a fan of the game, it was a fun race to watch."

With three fewer hits or two less homers, Cabrera would have fallen short of the Triple Crown. The last four Triple Crown winners have been voted MVP, including Mickey Mantle in 1956 and Frank Robinson in 1966.

"I think winning the Triple Crown had a lot to do with me winning this honor," he said.

Cabrera became the second straight Detroit player voted MVP, following pitcher Justin Verlander in 2011, and was the first Venezuelan to earn the honor. Countryman Pablo Sandoval took home World Series MVP honors last month.

Before the season, Cabrera switched from first base to third to make way for Prince Fielder, who signed with Detroit as a free agent.

"I focused too much in spring training about defense, defense, defense," Cabrera said. "I forgot a little bit about hitting, about getting in the cage like I normally do."

In spring training, Posey's focus was just to get back on the field. His 2011 season was cut short by a collision with the Marlins' Scott Cousins on May 25 that resulted in a fractured bone in Posey's lower left leg and three torn ankle ligaments.

Posey not only returned, he became the first catcher in 70 years to win the NL batting title and helped San Francisco win its second World Series championship in three seasons.

"I definitely have a deeper appreciation for being able to play baseball," he said. "I've seen that it can be taken away quick."

The first catcher in four decades to win the NL award, Posey got 27 of 32 firsts and 422 points to outdistance 2011 winner Ryan Braun of Milwaukee, who was second with 285 points.

Pittsburgh outfielder Andrew McCutchen (245) was third, followed by St. Louis catcher Yadier Molina (241).

Posey, a boyish-looking 25, was the 2010 NL Rookie of the Year as the Giants won their first World Series since 1954. This year he set career highs with a .336 average, 24 homers and 103 RBIs as San Francisco won again.

Posey took the NL batting title after teammate Melky Cabrera requested a rules change that disqualified him. Cabrera, who hit .346, missed the final 45 games of the regular-season while serving a suspension for a positive testosterone test and would have won the batting crown if the rule hadn't been changed.

Ernie Lombardi had been the previous catcher to capture the NL batting championship, in 1942.

"I think anybody that has caught before understands the grind of catching, not only the physical, the nicks, the wear and tear of squatting for nine innings night in, day out, but just the mental grind of working a pitching staff," Posey said. "It's demanding."

NOTES: In his first season with the Angels, Albert Pujols didn't finish among the top 10 for the first time in his career. While with St. Louis, he won three times, was second four times and also finished third, fourth, fifth and ninth. ... Catchers have won the NL MVP just eight times, with Posey joining Gabby Hartnett (1935), Lombardi (1938), Roy Campanella (1951, 1953, 1955) and Johnny Bench (1970, 1972). Posey became the first Giants player to win since Barry Bonds was voted his record seventh MVP award in 2004. ... Cabrera earned a $500,000 bonus, Adrian Beltre $150,000 for finishing third in the AL and Josh Hamilton $50,000 for fifth place. Braun gets a $75,000 bonus, and McCutchen and Molina $50,000 each. The Yankees' Derek Jeter finished seventh in the AL, one place below the level where his 2014 player option would have increased by $2 million to $10 million.

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For Alzheimer’s, Detection Advances Outpace Treatment Options


Joshua Lott for The New York Times


Awilda Jimenez got a scan for Alzheimer’s after she started forgetting things. It was positive.







When Awilda Jimenez started forgetting things last year, her husband, Edwin, felt a shiver of dread. Her mother had developed Alzheimer’s in her 50s. Could his wife, 61, have it, too?




He learned there was a new brain scan to diagnose the disease and nervously agreed to get her one, secretly hoping it would lay his fears to rest. In June, his wife became what her doctor says is the first private patient in Arizona to have the test.


“The scan was floridly positive,” said her doctor, Adam S. Fleisher, director of brain imaging at the Banner Alzheimer’s Institute in Phoenix.


The Jimenezes have struggled ever since to deal with this devastating news. They are confronting a problem of the new era of Alzheimer’s research: The ability to detect the disease has leapt far ahead of treatments. There are none that can stop or even significantly slow the inexorable progression to dementia and death.


Families like the Jimenezes, with no good options, can only ask: Should they live their lives differently, get their affairs in order, join a clinical trial of an experimental drug?


“I was hoping the scan would be negative,” Mr. Jimenez said. “When I found out it was positive, my heart sank.”


The new brain scan technology, which went on the market in June, is spreading fast. There are already more than 300 hospitals and imaging centers, located in most major metropolitan areas, that are ready to perform the scans, according to Eli Lilly, which sells the tracer used to mark plaque for the scan.


The scans show plaques in the brain — barnaclelike clumps of protein, beta amyloid — that, together with dementia, are the defining feature of Alzheimer’s disease. Those who have dementia but do not have excessive plaques do not have Alzheimer’s. It is no longer necessary to wait until the person dies and has an autopsy to learn if the brain was studded with plaques.


Many insurers, including Medicare, will not yet pay for the new scans, which cost several thousand dollars. And getting one comes with serious risks. While federal law prevents insurers and employers from discriminating based on genetic tests, it does not apply to scans. People with brain plaques can be denied long-term care insurance.


The Food and Drug Administration, worried about interpretations of the scans, has required something new: Doctors must take a test showing they can read them accurately before they begin doing them. So far, 700 doctors have qualified, according to Eli Lilly. Other kinds of diagnostic scans have no such requirement.


In another unusual feature, the F.D.A. requires that radiologists not be told anything about the patient. They are generally trained to incorporate clinical information into their interpretation of other types of scans, said Dr. R. Dwaine Rieves, director of the drug agency’s Division of Medical Imaging Products.


But in this case, clinical information may lead radiologists to inadvertently shade their reports to coincide with what doctors suspect is the underlying disease. With Alzheimer’s, Dr. Rieves said, “clinical impressions have been misleading.”


“This is a big change in the world of image interpretation,” he said.


Like some other Alzheimer’s experts, Dr. Fleisher used the amyloid scan for several years as part of a research study that led to its F.D.A. approval. Subjects were not told what the scans showed. Now, with the scan on the market, the rules have changed.


Dr. Fleisher’s first patient was Mrs. Jimenez. Her husband, the family breadwinner, had lost his job as a computer consultant when the couple moved from New York to Arizona to take care of Mrs. Jimenez’s mother. Paying several thousand dollars for a scan was out of the question. But Dr. Fleisher found a radiologist, Dr. Mantej Singh Sra of Sun Radiology, who was so eager to get into the business that he agreed to do Mrs. Jimenez’s scan free. His plan was to be the first in Arizona to do a scan, and advertise it.


After Dr. Sra did the scan, the Jimenezes returned to Dr. Fleisher to learn the result.


Dr. Fleisher, sad to see so much plaque in Mrs. Jimenez’s brain, referred her to a psychiatrist to help with anxiety and suggested she enter clinical trials of experimental drugs.


But Mr. Jimenez did not like that idea. He worried about unexpected side effects.


“Tempting as it is, where do you draw the line?” he asks. “At what point do you take a risk with a loved one?”


At Mount Sinai Medical Center in New York, Dr. Samuel E. Gandy found that his patients — mostly affluent — were unfazed by the medical center’s $3,750 price for the scan. He has been ordering at least one a week for people with symptoms ambiguous enough to suggest the possibility of brain plaques.


Most of his patients want their names kept confidential, fearing an inability to get long-term care insurance, or just wanting privacy.


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BBC Failures Show Limits of Guidelines





LONDON — It was 2004, and the British Broadcasting Corporation was gripped by a crisis over journalistic standards that had led to Parliamentary hearings, public recrimination and the resignations of its two top officials. Vowing change, the corporation established elaborate bureaucratic procedures that placed more formal responsibility for delicate decisions in the hands not of individual managers, but of rigid hierarchies.




The corporation also appointed a deputy director general in charge of news operations; established a “journalism board” to monitor editorial policy; issued numerous new guidelines on journalistic procedures; and put an increasing emphasis on “compliance” — a system in which managers are required to file cumbersome forms flagging dozens of potential trouble spots, from bad language to “disturbing content” like exorcism or beheadings, in every program taped for broadcast.


More crises would follow — the history of the BBC can be measured out in crises — and with each new one, the management team under Mark Thompson, director general from 2004 through mid-September 2012, added more guidelines and put more emphasis on form-filling and safety checks in news and entertainment programs. An organization already known for its bureaucracy became even more unwieldy (the editorial guidelines are now 215 pages long).


But it is these very structures that seem to have failed the BBC in the most recent scandal, in which its news division first canceled a child abuse segment it should have broadcast, and later broadcast one it should have canceled. In the first instance, it appears that people overseeing the program were too cautious, so that top managers were left unaware of its existence; in the second, managers may have relied too much on rigid procedures at the expense of basic journalistic principles.


“They burned their fingers,” said Tim Luckhurst, a journalism professor at the University of Kent who worked at the BBC for 10 years. “They wanted systems that could take responsibility instead of people.”


The recent scandal has had a number of immediate results. Mr. Thompson’s successor as director general, George Entwistle, resigned after just 54 days on the job. (Mr. Thompson is now president and chief executive of The New York Times Company.) Outside investigators were appointed to interrogate BBC employees in at least three different inquiries. A number of lower- and midlevel managers had to withdraw temporarily from their jobs and, facing possible disciplinary action, hired lawyers. And, once again, the BBC is talking about reorganizing structures.


Through a spokesman, Mr. Entwistle declined to comment on the scandal or the BBC’s management practices, saying he was “not doing any media interviews at present.” Mr. Thompson also declined to comment.


But Mr. Entwistle’s temporary successor, Tim Davie, who had previously been director of BBC Audio & Music, acknowledged that changes had to be made. “If the public are going to get journalism they trust from the BBC I have to be, as director general, very clear on who’s running the news operation and ensuring that journalism that we put out passes muster,” Mr. Davie said in his first week on the job. The first thing to do, he said, was to “take action and build trust by putting a clear line of command in.”


This is a complicated scandal in two parts. The first part was over the BBC’s decision last December not to broadcast a report saying that Jimmy Savile, a longtime BBC television host, had been a serial child molester, and instead to broadcast several glowing tributes to his career. The second part was its decision on Nov. 2 to accuse a member of Margaret Thatcher’s government of being a pedophile, an accusation that turned out to be patently false.


But both exposed the problems in a system that seems to insulate the BBC’s director general — who is also the editor in chief — from knowledge of basic issues like what potentially contentious programs are scheduled for broadcast. And both decisions were the result, it seems, of a system that failed in practice, even as it was correctly followed in theory.


Ben Bradshaw, a former BBC correspondent and now a Labour member of Parliament, said the 2004 scandal, touched off by reporting about British intelligence on Iraqi weapons of mass destruction, had created a system based on “fear and anxiety.” The BBC, he added, became “even more bureaucratic and had even more layers, which exacerbated the problem of buck passing and no one being able to take a decision.”


Speaking of the Nov. 2 broadcast, the chairman of the BBC Trust, Chris Patten, said in a television interview that the piece went through “every damned layer of BBC management bureaucracy, legal checks” without anyone raising any serious objections.


Matthew Purdy contributed reporting from New York, and Lark Turner from London.



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R.A. Dickey, David Price win Cy Young awards

NEW YORK (AP) — R.A. Dickey languished in the minors for 14 years, bouncing from one team to another before finally perfecting that perplexing knuckleball that made him a major league star.

David Price was the top pick in the draft and an ace by age 25, throwing 98 mph heat with a left arm live enough to make the most hardened scout sing.

Raised only 34 miles apart in central Tennessee, Dickey and Price won baseball's Cy Young awards on Wednesday — one by a wide margin, the other in a tight vote.

Two paths to the pantheon of pitching have rarely been more different.

"Isn't that awesome?" said Dickey, the first knuckleballer to win a Cy Young. "It just shows you there's not just one way to do it, and it gives hope to a lot of people."

Dickey said he jumped up and yelled in excitement, scaring one of his kids, when he saw on television that Price edged Justin Verlander for the American League prize. Both winners are represented by Bo McKinnis, who watched the announcements with Dickey at his home in Nashville, Tenn.

"I guess we can call him Cy agent now," Price quipped on a conference call.

The hard-throwing lefty barely beat out Verlander in balloting by the Baseball Writers' Association of America, preventing the Detroit Tigers' ace from winning consecutive Cy Youngs.

Runner-up two years ago, Price was the pick this time. He received 14 of 28 first-place votes and finished with 153 points to 149 for Verlander, chosen first on 13 ballots.

"It means a lot," Price said. "It's something that I'll always have. It's something that they can't take away from me."

Other than a 1969 tie between Mike Cuellar and Denny McLain, it was the closest race in the history of the AL award.

Rays closer Fernando Rodney got the other first-place vote and came in fifth.

The 38-year-old Dickey was listed first on 27 of 32 National League ballots and totaled 209 points, 113 more than 2011 winner Clayton Kershaw of the Los Angeles Dodgers. Washington lefty Gio Gonzalez finished third.

Cincinnati right-hander Johnny Cueto and Atlanta closer Craig Kimbrel each received a first-place vote, as did Gonzalez. Kershaw had two.

Dickey joined Dwight Gooden (1985) and three-time winner Tom Seaver as the only Mets to win the award. The right-hander went 20-6 with a 2.73 ERA, making him the club's first 20-game winner since Frank Viola in 1990, and became the first major leaguer in 24 years to throw consecutive one-hitters.

Perhaps most impressive, Dickey did it all during a season when the fourth-place Mets finished 74-88.

"It just feels good all over," he said on MLB Network.

Dickey switched from conventional pitcher to full-time knuckleballer in a last-ditch effort to save his career. It took him years to finally master the floating, darting pitch, which he often throws harder (around 80 mph) and with more precision than almost anyone who used it before him.

"I knew what I was going to be up against in some regard when I embraced this pitch," Dickey said.

He was the first cut at Mets spring training in 2010 but earned a spot in the big league rotation later that season and blossomed into a dominant All-Star this year. He led the NL in strikeouts (230), innings (233 2-3), complete games (five) and shutouts (three) — pitching through an abdominal injury most of the way.

"I am not a self-made man by any stretch of the imagination," Dickey said. "The height of this story, it's mind-blowing to me, it really is."

A member of the 1996 U.S. Olympic team and a first-round draft pick out of Tennessee, Dickey was devastated when the Texas Rangers reduced their signing-bonus offer from more than $800,000 to $75,000 after they discovered during a physical that he was missing a major ligament in his pitching elbow.

Undeterred, perseverance got him to the big leagues anyway. When he failed, the knuckleball brought him back.

Among those he thanked ceaselessly for helping him on that long and winding road to success were all his proud knuckleball mentors, including Charlie Hough, Tim Wakefield and Hall of Famer Phil Niekro.

"It brings a real degree of legitimacy I think to the knuckleball fraternity and I'm glad to represent them and I'm certainly grateful to all those guys," Dickey said. "This was a victory for all of us."

Dickey said he received 127 text messages and 35-40 phone calls in the moments immediately following the Cy Young announcement.

The only call he took was from Niekro, a 318-game winner from 1964-87. The first texts Dickey responded to were from Wakefield and Hough.

"Most well-deserved," Niekro said in a comment provided by the Hall of Fame. "I'm super proud of him, as a pitcher and as an individual."

Dickey has one year left on his contract at $5.25 million and New York general manager Sandy Alderson has said signing the pitcher to a multiyear deal is one of his top offseason priorities. Alderson, however, would not rule out trading his unlikely ace.

"I believe the Mets are going to be a lot better and I want to be part of the solution," Dickey said, adding that he hopes the sides can strike a deal and he'd be happy to end his career in New York.

"I want to be loyal to an organization that's given me an opportunity," he said. "At the same time, you don't want to be taken advantage of. I've been on that side of it, too, as a player."

Price went 20-5 to tie Jered Weaver for the American League lead in victories and winning percentage. The 27-year-old lefty had the lowest ERA at 2.56 and finished sixth in strikeouts with 205.

Verlander, also the league MVP a year ago, followed that up by going 17-8 with a 2.64 ERA and pitching the Detroit Tigers to the World Series. He led the majors in strikeouts (239), innings (238 1-3) and complete games (six).

Price tossed 211 innings in 31 starts, while Verlander made 33. One factor that could have swung some votes, however, was this: Price faced stiffer competition in the rugged AL East than Verlander did in the AL Central.

"I guess it's a blessing and a curse at the same time," Price said. "There's not an easy out in the lineups every game. It feels like a postseason game."

The No. 1 pick in the 2007 amateur draft out of Vanderbilt, Price reached the majors the following year and has made three straight All-Star teams.

Despite going 19-6 with a 2.72 ERA in 2010, he finished a distant second in Cy Young voting to Felix Hernandez, who won only 13 games for last-place Seattle but dominated most other statistical categories that year.

The two MVP awards will be announced Thursday. Verlander's teammate, Triple Crown winner Miguel Cabrera, is a leading contender in the American League.

NOTES: The last AL pitcher to win back-to-back Cy Youngs was Boston's Pedro Martinez in 1999 and 2000. San Francisco RHP Tim Lincecum did it in the National League in 2008-09. ... Price and Dickey became the fourth pair of Cy Young winners born in the same state, according to STATS. The others were Jim Lonborg and Mike McCormick in 1967 (California), Viola and Orel Hershiser in 1988 (New York) and Pat Hentgen and John Smoltz in 1996 (Michigan). ... Niekro and his brother, Joe, both finished second in Cy Young voting, as did fellow knuckleballer Wilbur Wood.

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