Quadruple Amputee's New Hands

It's the simplest thing, the grasp of one hand in another. But Lindsay Ess will never see it that way, because her hands once belonged to someone else.
Growing up in Texas and Virginia, Lindsay, 29, was always one of the pretty girls. She went to college, did some modeling and started building a career in fashion, with an eye on producing fashion shows.
Then she lost her hands and feet.
Watch the full show in a special edition of "Nightline," "To Hold Again," TONIGHT at 11:35 p.m. ET on ABC
When she was 24 years old, Lindsay had just graduated from Virginia Commonwealth University's well-regarded fashion program when she developed a blockage in her small intestine from Crohn's Disease. After having surgery to correct the problem, an infection took over and shut down her entire body. To save her life, doctors put her in a medically-induced coma. When she came out of the coma a month later, still in a haze, Lindsay said she knew something was wrong with her hands and feet.
"I would look down and I would see black, almost like a body that had decomposed," she said.
The infection had turned her extremities into dead tissue. Still sedated, Lindsay said she didn't realize what that meant at first.
"There was a period of time where they didn't tell me that they had to amputate, but somebody from the staff said, 'Oh honey, you know what they are going to do to your hands, right?' That's when I knew," she said.
After having her hands and feet amputated, Lindsay adapted. She learned how to drink from a cup, brush her teeth and even text on her cellphone with her arms, which were amputated just below the elbow.
"The most common questions I get are, 'How do you type,'" she said. "It's just like chicken-pecking."
PHOTOS: Lindsay Ess Gets New Hands
Despite her progress, Lindsay said she faced challenges being independent. Her mother, Judith Aronson, basically moved back into her daughter's life to provide basic care, including bathing, dressing and feeding. Having also lost her feet, Lindsay needed her mother to help put on her prosthetic legs.
"I've accepted the fact that my feet are gone, that's acceptable to me," Lindsay said. "My hands [are] not. It's still not. In my dreams I always have my hands."
Through her amputation recovery, Lindsay discovered a lot of things about herself, including that she felt better emotionally by not focusing on the life that was gone and how much she hated needing so much help but that she also truly depends on it.
"I'm such an independent person," she said. "But I'm also grateful that I have a mother like that, because what could I do?"
Lindsay said she found that her prosthetic arms were a struggle.
"These prosthetics are s---," she said. "I can't do anything with them. I can't do anything behind my head. They are heavy. They are made for men. They are claws, they are not feminine whatsoever."
For the next couple of years, Lindsay exercised diligently as part of the commitment she made to qualify for a hand transplant, which required her to be in shape. But the tough young woman now said she saw her body in a different way now.
"People used to turn and look at me when I walked down the street because of how beautiful I was," Lindsay said. "Now they turn and look at me because I'm in a wheelchair and have no hands and feet. The type of person that I was would be the type of person I would hate now. I used to care way too much about what I looked like. What does it matter what my hair looks like? What does it matter what I'm wearing so much?"
Lindsay had to wait for a donor. Dr. Scott Levin, her orthopedic surgeon at the University of Pennsylvania in Philadelphia, said if was preferable if Lindsay's donor hands were female, and had a size and skin color that matched hers.
Waiting for a donor was the part that Lindsay said she found the most difficult.
"I hate thinking about that," she said. "I think that whoever's hands will be with purpose, not just used to look pretty." "In Lindsay's case, the hookup of the new hand is relying on her nerves growing into the new muscles from the donor," Levin said. "The nerves have to grow into those muscles, takes months, it can take a year."
And there is still the possibility that the surgery can fail.
"Failure means the part that doesn't survive and we have to re-amputate the transplant," Levin said. "That's failure."
For nearly 12 hours, two separate teams of surgeons, one dedicated to the left hand, the other to the right, worked to perform an operation so cutting-edge that it has been done more than 70 times worldwide in the past 15 years.
After the surgery, Lindsay was in a cocoon of bandages. Levin said the initial signs for recovery were good.
"This is more than we could ever hope for," he said. "Her blood pressure is good, all the parameters related to how to blood flow in and out of her new arms. This is, if you will, a picture perfect course so far."
Less than a month after her surgery, Lindsay was out of the ICU and working on a therapy regime. The skin color of her new hands and arms wasn't exactly the same as her upper arms. They still looked like they belonged to someone else.
"The first couple of days I refused to look at them," Lindsay said. "It was kind of like one of those scary movie moments. I'm too scared to look because it's reality [but] I'm so grateful to have them that I just don't really think about it superficially."
Four months after her surgery, in January 2012, Lindsay's doctors said they continued to be amazed at her recovery. They said they didn't expect her to have fine motion control for another 12 to 18 months, but her muscles were reacting well. She could even pick up lightweight objects.
In February, Lindsey was allowed to go home for the first time since the surgery five months before. Levin said the prognosis for both hands couldn't be better. Even so, rejection was still a huge concern.
Tune into a special edition of "Nightline," "To Hold Again," TONIGHT at 11:35 p.m. ET on ABC to find out what happens to Lindsay and how she moves forward.

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How to Think Like Sherlock Holmes: The Value of Creativity and Imagination [Excerpt]

Editor's note: The following is an excerpt from Mastermind: How to Think Like Sherlock Holmes. Reprinted by arrangement with Viking, a member of Penguin Group (USA) Inc., Copyright (C) 2013 by Maria Konnikova.
"It is surprising that people do not believe that there is imagination in science," Nobel-winning physicist Richard Feynman once told an audience. Not only is that view patently false, but "it is a very interesting kind of imagination, unlike that of the artist. The great difficulty is in trying to imagine something that you have never seen, that is consistent in every detail with what has already been seen, and that is different from what has been thought of; furthermore, it must be definite and not a vague proposition."
Imagination takes the stuff of observation and experience and recombines them into something new.
In 1968, the high jump was a well-established sport. You would run, you would jump, and you would make your way over a pole in one of several ways. In older days you'd likely use the scissors, scissoring out your legs as you glided over, but by the sixties you'd probably be using the straddle or the belly roll, facing down and basically rolling over the bar. Whichever style you used, you'd be facing forward when you made your jump. Imagine trying to jump backward. That would be ridiculous.
Dick Fosbury, however, didn't think so. All through high school, he'd been developing a backward-facing style, and now, in college, it was taking him higher than it ever had. He wasn't sure why he did it. He didn't care what anyone else was doing. He just jumped with the feeling of the thing. People joked and laughed. Fosbury looked just as ridiculous as they thought he would (and his inspirations sounded a bit ridiculous, too. When asked about his approach, he told Sports Illustrated, "I don't even think about the high jump. It's positive thinking. I just let it happen"). Certainly, no one expected him to make the U.S. Olympic team--let alone win the Olympics. But win he did, setting American and Olympic records with his 7-foot-4.25-inch (2.24-meter) jump, only 1.5 inches short of the world record.
With his unprecedented technique, dubbed the Fosbury Flop, Fosbury did what many other more traditional athletes had never managed to accomplish: he revolutionized, in a very real way, an entire sport. Even after his win, expectations were that he would remain a lone bird, jumping in his esoteric style while the rest of the world looked on. But since 1978 no world record has been set by anyone other than a flopper; and by 1980, thirteen of sixteen Olympic finalists were flopping across the bar. To this day, the flop remains the dominant high jump style. The straddle looks old and cumbersome in comparison. Why hadn't anyone thought of replacing it earlier?
Fosbury wasn't even a particularly talented jumper. It was all in the approach. Imagination allows us to see things that aren't so, be it a dead man who is actually alive or a way of jumping that, while backward, couldn't be more forward looking.
Keep Your Distance
One of the most important ways to facilitate imaginative thinking is through distance. In "The Adventure of the Bruce-Partington Plans," a case that comes quite late in the Holmes-Watson partnership, Watson observes:
One of the most remarkable characteristics of Sherlock Holmes was his power of throwing his brain out of action and switching all his thoughts on to lighter things whenever he had convinced himself that he could no longer work to advantage. I remember that during the whole of that memorable day he lost himself in a monograph which he had undertaken upon the Polyphonic Motets of Lassus. For my own part I had none of this power of detachment, and the day, in consequence appeared to be interminable.
Forcing your mind to take a step back is a tough thing to do. It seems counterintuitive to walk away from a problem that you want to solve. But in reality, the characteristic is not so remarkable either for Holmes or for individuals who are deep thinkers. The fact that it is remarkable for Watson (and that he self-admittedly lacks the skill) goes a long way to explaining why he so often fails when Holmes succeeds.
Psychologist Yaacov Trope argues that psychological distance may be one of the single most important steps you can take to improve thinking and decision-making. It can come in many forms: temporal, or distance in time (both future and past); spatial, or distance in space (how physically close or far you are from something); social, or distance between people (how someone else sees it); and hypothetical, or distance from reality (how things might have happened). But whatever the form, all of these distances have something in common: they all require you to transcend the immediate moment in your mind. They all require you to take a step back.
Trope posits that the further we move in distance, the more general and abstract our perspective and our interpretation become; and the further we move from our own perspective, the wider the picture we are able to consider. Conversely, as we move closer once more, our thoughts become more concrete, more specific, more practical--and the closer we remain to our egocentric view, the smaller and more limited the picture that confronts us. Our level of construal influences, in turn, how we evaluate a situation and how we ultimately choose to interact with it. It affects our decisions and our ability to solve problems.
In essence, psychological distance accomplishes one major thing: it engages System Holmes. It forces quiet reflection. Distancing has been shown to improve cognitive performance, from actual problem solving to the ability to exercise self-control. Children who use psychological distancing techniques (for example, visualizing marshmallows as puffy clouds) are better able to delay gratification and hold out for a larger later reward. Adults who are told to take a step back and imagine a situation from a more general perspective make better judgments and evaluations, and have better self-assessments and lower emotional reactivity. Individuals who employ distancing in typical problem-solving scenarios emerge ahead of their more immersed counterparts. And those who take a distanced view of political questions tend to emerge with evaluations that are better able to stand the test of time.

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Copying common in electronic medical records

NEW YORK (Reuters Health) - Most doctors copy and paste old, potentially out-of-date information into patients' electronic records, according to a new study looking at a shortcut that some experts fear could lead to miscommunication and medical errors.
"The electronic medical record was meant to make the process of documentation easier, but I think it's perpetuated copying," said lead author Dr. Daryl Thornton, assistant professor at Case Western Reserve University School of Medicine in Cleveland.
Electronic health records have been touted as having the potential to transform patient data from indecipherable scribbles into easy-to-read, searchable, standardized documents that could be shared among hospital staffers and a patient's various other health care providers.
In 2011, the U.S. government started giving financial incentives to hospitals for adopting electronic medical recordkeeping. Those incentives will expire in 2015.
Many electronic recordkeeping systems allow text to be copied and pasted from previous notes and other documents, a shortcut that could help time-crunched doctors but that could also cause mistakes to be passed along or medical records to become indecipherable, critics argue.
To see how much information in patient records came from copying, Thornton's team examined 2,068 electronic patient progress reports created by 62 residents and 11 attending physicians in the intensive care unit of a Cleveland hospital.
Progress notes are typically shared among doctors, nurses and other hospital staff and are meant to document the progression of a patient's tests and treatments.
Using plagiarism-detection software, the researchers analyzed five months' worth of progress notes for 135 patients.
They found that 82 percent of residents' notes and 74 percent of attending physicians' notes included 20 percent or more copied and pasted material from the patients' records.
In their report, published in Critical Care Medicine, Thornton and his colleagues did not examine what motivated physicians and residents to copy and paste, or whether the shortcut affected patient care.
In one case, though, Thornton told Reuters Health, a patient left the ICU and was readmitted a couple of days later. The patient's medical record included so much copied and pasted information, the new team of doctors wasn't able to decipher the original diagnosis. In the end, the new team called the physicians who originally diagnosed the patient.
Nothing about a patient - length of stay, gender, age, race or ethnicity, what brought them into the ICU or how severely ill they were - affected how often a physician copied information into the medical record.
Although residents' notes more often included copied material, attending physicians tended to copy more material between notes. They also tended to copy more of their own assessments from other notes.
Experts suggested that copying signifies a shift in how doctors use notes - away from being a means of communication among fellow healthcare providers and toward being a barrage of data to document billing.
"What tends to get missing is the narrative - what's the patient's story?" said Dr. Michael Barr, senior vice president in the Division of Medical Practice, Professionalism and Quality at the American College of Physicians. Barr was not involved in the current study.
In an unrelated editorial published this week in The Journal of Urology, Dr. Deborah Erickson points out that summarizing a patient's history at the start of notes is longstanding tradition, and it's just as easy to carry forward an error in handwritten or dictated notes as in electronic records.
Erickson worries more that repeatedly copying and pasting large chunks of text, possibly along with images and other records, will result in "a long, rambling note that does not make clear points." Moreover, for a physician's own thinking process, she writes, "It is much better for each day's note to synthesize and interpret the prior data, leaving out old information that is no longer relevant."
"If your communication isn't accurate, timely, complete and factual, then you really could be transmitting bad information forward that then creates this tumbling effect," said Ann Gaffey, president of Healthcare Risk and Safety Strategies, a consulting firm in Arlington, Virginia.
In her own study, Gaffey found copying and pasting to be common in over 50 physician practices that use five different electronic medical record programs.
Part of the problem is that doctors may not have the time to fully learn the new medical recording systems and may resort to short cuts, said Gaffey, who was not involved in the current research.
Ellen Balka, medical communications professor at Simon Fraser University in British Columbia, cautioned that copying might not lead to poor care for patients.
"In general, physicians want to provide good care," Balka, who was not involved in the current study, told Reuters Health. "If they're engaging in a practice like copying, there must be a reason for it.

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Bird flu kills 4-year-old boy in Indonesia

JAKARTA, Indonesia (AP) — A 4-year-old Indonesian boy has died from bird flu, bringing the death toll to 160 in the country hardest-hit by the deadly virus, a health official said Tuesday.
While the H5N1 bird flu virus has killed relatively few people, scientists have been closely monitoring it for its potential to mutate and affect humans worldwide.
The boy died Dec. 6 in Tangerang city, just west of Jakarta, the capital, said Health Ministry official Rita Kusriastuti. He developed symptoms of a cold and fever on Nov. 30 and was treated at a public health center before being hospitalized the same day he died.
Kusriastuti said the boy, from the West Java district of Bogor, was believed to have been infected with the H5N1 virus after having direct contact with dead fowl around his house.
Bird flu has killed at least 360 people worldwide since 2003. It remains hard for people to catch, but experts fear it could mutate into a more deadly form that spreads easily from person-to-person. So far, most human cases have been linked to contact with infected poultry.
Last week, Kusriastuti said a form of the H5N1 virus not previously detected in Indonesia had killed hundreds of thousands of ducks on the main island of Java. The type of virus has been found circulating in a number of other countries and does not indicate any change that makes humans more susceptible.
The new form of the virus is believed to have entered Indonesia through imported ducks, but Kusriastuti said it's also possible it may have evolved on its own from existing strains.
Bird flu remains entrenched in Indonesia and elsewhere. It typically flares up during the winter months in affected countries with increases in poultry outbreaks and human cases.

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Merck, GE to collaborate on Alzheimer's drug development

 Merck & Co and General Electric Co's healthcare unit have agreed to collaborate on an experimental drug for Alzheimer's disease, the companies said on Tuesday.
GE Healthcare will supply Flutemetamol, an investigational imaging agent, to Merck for use with its experimental Alzheimer's disease drug MK-8931.
The companies hope GE's imaging agent will help identify patients who might benefit from a therapy such as Merck's, which targets beta amyloid, a protein that can clump together and form plaques in the brain. Such plaques have been found in the brains of patients with Alzheimer's disease.
MK-8931 is Merck's lead Alzheimer's drug candidate and is designed to modify progression of the disease as well as improve symptoms. Alzheimer's robs patients of their memory and can cause other cognitive disturbances.
Based on promising results from an early-stage clinical trial of MK-8931, Merck plans to move forward with a larger trial, called EPOCH, at multiple sites around the world.
Flutemetamol is a positron emission tomography (PET) imaging agent that has been able, in clinical trials, to detect beta amyloid in the brain.
GE Healthcare will supply Flutemetamol to help select patients for clinical trials and evaluate the agent as a companion diagnostic tool. Financial and other terms of the agreement between the companies were not disclosed.

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Diabetes remission possible with diet, exercise

 One in nine people with diabetes saw their blood sugar levels dip back to a normal or "pre-diabetes" level after a year on an intensive diet and exercise program, in a new study.
Complete remission of type 2 diabetes is still very rare, researchers said. But they added that the new study can give people with the disease hope that through lifestyle changes, they could end up getting off medication and likely lowering their risk of diabetes-related complications.
"Kind of a long-term assumption really is that once you have diabetes there's no turning back on it, and there's no remission or cure," said Edward Gregg, the lead author on the report from the Centers for Disease Control and Prevention.
The research, he told Reuters Health, "is a reminder that adopting a healthy diet, physically-active lifestyle and reducing and maintaining a healthy weight is going to help manage people's diabetes better."
His team's study can't prove the experimental program - which included weekly group and individual counseling for six months, followed by less frequent visits - was directly responsible for blood sugar improvements.
The original goal of the research was to look at whether that intervention lowered participants' risk of heart disease (so far, it hasn't).
But the diabetes improvements are in line with better weight loss and fitness among people in the program versus those in a comparison group who only went to a few annual counseling sessions, Gregg's team reported Tuesday in the Journal of the American Medical Association.
IS IT COST-EFFECTIVE?
About eight percent of people in the United States have diabetes, according to the American Diabetes Association. The new study included 4,503 of them who were also overweight or obese.
People randomly assigned to the intensive program had diet and exercise counseling with a goal of cutting eating and drinking back to 1200 to 1800 calories per day and increasing physical activity to just under three hours per week.
After one year, 11.5 percent of them had at least partial diabetes remission, meaning that without medication their blood sugar levels were no longer above the diabetes threshold. That compared to just two percent of participants in the non-intervention group who saw their diabetes improve significantly.
People who'd had diabetes for fewer years were more likely to have blood sugar improvements, as were those who lost more weight or had stronger fitness gains during the study.
However, less than one-third of people whose diabetes went into remission during the program managed to keep their blood sugar levels down for at least four years, the researchers found.
"Clearly lifestyle intervention is good for people with diabetes," said Dr. John Buse, a diabetes researcher from the University of North Carolina at Chapel Hill School of Medicine.
"The question is how cost-effective is it, what are the long-term consequences (and) how would it really compare with alternative approaches like bariatric surgery and drug therapy?" Buse, who wasn't involved in the new study, told Reuters Health.
Dr. David Arterburn, from Group Health Research Institute in Seattle, said some studies of weight-loss surgery, for instance, have found two-thirds of people who start out with diabetes have complete remission.
Arterburn, who co-wrote an editorial published with the new study, said anyone with diabetes - or at high risk - should consider either lifestyle interventions or surgery, if they're eligible, to reduce future health risks.
Gregg said his team was working on a cost-analysis of the current program, but that it was fairly "resource-intensive."
"If people have access to the support to make these sorts of changes, they may have the benefits that we've seen here," he said. But, "What we should remember is that more modest changes in lifestyle are also effective."

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Intensive Weight Loss Programs Might Help Reverse Diabetes

Type 2 diabetes has long been thought of as a chronic, irreversible disease. Some 25 million Americans are afflicted with the illness, which is associated with obesity and a sedentary lifestyle, as well as high blood pressure. Recent research demonstrated that gastric bypass surgery--a form of bariatric surgery that reduces the size of the stomach--can lead to at least temporary remission of type 2 diabetes in up to 62 percent of extremely obese adults. But can less drastic measures also help some people fight back the progressive disease?
A new randomized controlled trial found that intensive weight loss programs can also increase the odds that overweight adults with type 2 diabetes will see at least partial remission. The findings were published online December 18 in JAMA, The Journal of the American Medical Association. "The increasing worldwide prevalence of type 2 diabetes, along with its wide-ranging complications, has led to hopes that the disease can be reversed or prevented," wrote the authors of the new paper, led by Edward Gregg of the Centers for Disease Control and Prevention.
The study tracked 4,503 overweight adults with type 2 diabetes for four years. About half of the subjects received basic diabetes support and education (including three sessions per year that covered diet, physical activity and support). The other half received more intensive lifestyle-intervention assistance. This second group received weekly individual and group counseling for six months, followed by three-sessions each month for the next six months, and refresher group sessions and individual contact for the subsequent three years. The interventions aimed to help individuals limit daily calories to 1,200 to 1,800--in particular by reducing saturated fat intake--and to help them get the recommended 175 minutes per week of physical activity.
After two years about one in 11 adults in the intervention group experienced at least partial remission of their diabetes, meaning that a patient's blood sugar levels reverted to below diabetes diagnosis levels without medication. Only about one in 60 in the control group, which received only basic support and education, saw any remission after two years. The findings suggest that "partial remission, defined by a transition to prediabetic or normal glucose levels without drug treatment for a specific period, is an obtainable goal for some patients with type 2 diabetes," the researchers noted.
The improvement, however, was not indefinite for everyone. After four years, only about one in 30 people in the intervention group were still seeing an improvement in their condition. Researchers think that regaining weight and falling behind on diet and physical activity goals increase the risk that people will return to a diabetic state.
About one in 75 in the intervention group saw complete remission of their diabetes, in which glucose levels returned to normal without medication.
The study did not find, however, that individuals in the lifestyle intervention group had lower risks for heart trouble, stroke or death than did those in the control group. "This recently led the National Institutes of Health to halt the [trial]," noted David Arterburn, of Group Health Research Institute in Seattle, and Patrick O'Connor, of HealthPartners Institute for Education and Research in Minneapolis, in an essay in the same issue of JAMA. Similar results have come out of studies looking at more intensive medical treatment of diabetes. "A more potent intervention--bariatric surgery--already appears to achieve what intensive medical and lifestyle interventions cannot: reducing cardiovascular events and mortality rates among severely obese patients with type 2 diabetes," they noted.
As with any disease, however, prevention is the best strategy. "The disappointing results of recent trials of intensive lifestyle and medical management in patients with existing type 2 diabetes also underscore the need to more aggressively pursue primary prevention of diabetes," Arterburn and O'Connor noted. One recent study found that compared with no treatment at all, lifestyle interventions reduced the onset of type 2 diabetes by 58 percent in people with pre-diabetes (and the medication metformin reduced the onset rate by 31 percent). Bariatric surgery seemed to reduce the onset of diabetes in obese patients by 83 percent, Arterburn and O'Connor pointed out in their essay.
For people who already have diabetes, however, those who are still in the early stages and those with the biggest weight loss and/or fitness improvement had the best odds for beating the disease. And even if lifestyle interventions aren't capable of dialing back the disease entirely, any reduction--whether through lifestyle or other changes-in the need for medication and in medical complications due to diabetes can be considered an improvement in managing the disease, which already costs the U.S. health system $116 billion each year and is estimated to affect 50 million Americans by 2050.

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9/11 cancer study won't settle debate over risks

 The most comprehensive study of potential World Trade Center-related cancers raises more questions than it answers and won't end a debate over whether the attacks were really a cause.
The study suggests possible links with prostate, thyroid and a type of blood cancer among rescue and recovery workers exposed to toxic debris from the terrorist attacks. But there were few total cancers and even the study leaders say the results "should be interpreted with caution."
The study involved nearly 56,000 people enrolled in a registry set up to monitor health effects from those exposed to the aftermath of the trade center attacks. Most participants volunteered for enrollment, which could skew the results if people who already had symptoms were more likely to enroll than healthier people.
Cancers diagnosed through 2008 were included in the study, but that's just seven years after the 2001 attacks, and cancer often takes longer to develop. People diagnosed with cancer before the attacks were excluded from the study.
Cancer rates were compared with those in the general New York state population. But the researchers had no data on whether people in the study had risk factors for getting cancer, including a strong family history, or if they had existing cancer that wasn't detected until after the disaster. Participants are being monitored for health issues and may have gotten more cancer screening than other people, which also could skew the results.
The increased risks were seen only in rescue and recovery workers, who likely had more direct, sustained contact with potential cancer-causing substances in the dust, smoke and debris from the attacks. But cancers weren't more common in workers who had the most exposure — a finding that would seem to contradict the theory that contact was the cause.
The study comes just a few months after the federal government added dozens of types of cancer to a list of illnesses related to the trade center attacks that will be covered by a program to pay for health coverage.
The study results "won't settle the question because it's still too early," said Dr. Thomas Farley, New York City's health commissioner. "People are very, very interested in this topic and we thought it was important to get the data out that we have even though it is early."
Marijo Russell O'Grady, dean of students at Pace University's New York City campus, was at her office near the trade center during the attacks. She also lives nearby, and said she worries about how exposure to choking dust, ash and an "overwhelming burnt plastic smell" might affect her family, including her then 1 1/2 year-old son. They are all enrolled in the health registry.
Cancer is her greatest concern and it's "always present in the back of my mind," she said.
Researchers from the city's health department led the study, which was partly paid for by the National Institute for Occupational Safety and Health. NIOSH spokesman Fred Blosser said the agency welcomes the results and that longer follow-up is needed to examine risks for cancers with that take a long time to develop.
The study appears in Wednesday's Journal of the American Medical Association.
Earlier research from the same registry linked the attacks with respiratory problems including asthma and symptoms of post-traumatic stress.
The new study involved a broader array of people, including firefighters and other emergency workers, along with residents and employees of workplaces near ground zero, Farley said.
In the new study, possible links were mainly seen with cancers diagnosed in 2007 and 2008 in rescue and recovery workers. These included 67 cases of prostate cancer, 13 thyroid cancer cases, and seven cases of multiple myeloma — all at rates higher than in the New York state population.
Donald Berry, a biostatistics professor at the University of Texas MD Anderson Cancer Center in Houston, said the study has too many limitations to draw any definitive conclusions.
"There's no evidence that 9/11 caused any of these cancers," Berry said.
He pointed out that no increased risks were found for lung cancer — a cancer that might seem plausible after breathing lots of toxic dust and smoke.

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Tattooist gives nipples, new life, to US cancer survivors

Few tattoo artists tell their clients they could win a wet T-shirt contest.Then again, few tattoo artists are quite like Vincent "Vinnie" Myers.

In his shop in a modest strip mall in Finksburg, a half-hour drive from Baltimore, Myers specializes in tattooing nipples and areolas onto women who have undergone breast cancer surgery.

Using precisely mixed pigments, he creates a perfect 3-D illusion of the real thing -- and in doing so, enables women who have undergone mastectomies to feel fully like women once again.

"It's far more rewarding than anything else I have ever done," said Myers, 49, who has dedicated the last decade of his 28 years as a tattoo artist concentrating on post-op cosmetic tattoos.

He has treated around 3,000 breast cancer survivors so far, including many referred to him by surgeons at Baltimore's prestigious Johns Hopkins medical center and other hospitals around the United States.

"When it's completed and they see the final results, most women feel very emotional because they realize: 'The thing is over, I'm whole again,'" Myers said.

Myers, a Baltimore native, discovered tattooing when he was a US army medic in South Korea in the 1980s. In 2001, a friend asked him if he might tattoo some patients who had undergone breast reconstruction.

Typical of the women who have gone under the needle at Little Vinnies Tattoos is Susan, 58, an elegant retiree with a wish "to look as normal as possible."

"I'm doing this for me. It makes you feel prettier," she told AFP the other day as Myers pulled on a pair of blue latex gloves and prepared to work is magic.

-- 'There's a huge mental impact' --

"Any complications? Any allergies?" the tattooist asked before carefully mixing pigments in tiny pots and joking that Susan "might win" a T-shirt contest once the tattoo is done.

"We're going to go with, not peach, but more like taupe, a little bit more blue," he said, before smearing a bit of pigment onto Susan's fair skin to determine if he had mixed the exact color for her complexion.

"The perfect reconstructed breast doesn't look like a breast without a nipple," said Myers, whose fee ranges from $350 to $1,000 depending on the complexity of the task at hand.

"You get out of the shower in the morning, you look out at yourself in the mirror, and you have no nipples -- there's a huge mental impact," he said. "It's critical that the visual appearance is as close to normal as possible."

Hospitals also offer post-mastectomy tattoos, but Myers said they are typically carried out by nurses with no more than "a couple of days" training.

On average, it takes Myers two hours to complete his work, during which he will determine the color and size of the areolas of each patient.

"They will be some shade of color on the areola itself and a darker shade on the nipples because that is normally darker," he said.

"Then you do a kind of grey shadow on the bottom side to highlight the top side so as to give it some depth ... using 'trompe l'oeil' to make it look like it's three dimensional."

When he is not in Fricksburg, Myers is often on the road, treating women in New York, Philadelphia, Charleston in South Carolina and the Saint Charles surgical hospital in New Orleans.

Myers reckoned that only a handful of his fellow tattoo artists do what he does, and in order to meet a growing demand, he has already trained two others in the secrets of his unique craft.

Some 200,000 cases of breast cancer are detected in the United States every year. Half of them require breast reconstruction, even if surgeons using the latest techniques try to retain as much of the nipple area as possible.

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Spring/Summer hair trends: five new looks to try

Spring/Summer hair doesn't just have to mean tousled waves or blonde highlights, so take inspiration from the Spring/Summer 2012 catwalk shows and experiment with candy color or victory rolls.

Slicked back
Get the hair gel at the ready because slicked-back styles were all over the Spring/Summer 2012 runways, with everyone from Victoria Beckham to Mugler embracing the mullet-influenced style. Labels including Giambattista Valli, Rebecca Taylor, BCBG Max Azria and Viktor & Rolf also kept tresses smoothed off the forehead for a streamlined and almost futuristic look.

Candy color
Hair color has got bold for this season, with candy colors including purple and pink replacing classic springtime looks such as ombré tresses or beachy blondes. During the Spring/Summer 2012 shows labels including Issey Miyake, Narciso Rodriguez and Thakoon showcased the trend, with the latter painting models locks blue, orange, purple or pink. Models at DSquared2 had pink streaks in their hair, while Peter Som livened up blonde locks with orange strands. Celebrities have taken to the trend too, with Katy Perry and January Jones just some of the big names reaching for the dye.

Retro quiffs
Having already made an impact during the Fall/Winter season, the quiff has confirmed its staying power and will be back for Spring/Summer 2012 after showing up at shows from the likes of Limi Feu and Rochas. While a retro aesthetic dominated at many presentations, Haider Ackerman showcased punkier varieties and Ohne Titel worked the trend for shorter styles. Meanwhile, Jean Paul Gaultier championed the victory roll for a perfect pin-up look.

Futuristic up dos
Cone-shaped chignons offered an interesting new silhouette at the Spring/Summer 2012 shows, with Rochas, Narciso Rodriguez and Issey Miyake all sculpting long locks into the most streamlined of shapes which had a science fiction feel. Meanwhile, exaggerated silhouettes were seen at Fendi with its "fobs" (faux bobs), and Diane von Furstenberg embraced dramatic beehives. Be warned: these styles require plenty of hairspray and close attention to detail.

Experimental braids
Braids were one of the most popular up-do styles on the Spring/Summer 2012 runways, whether in messy fishtail form at Michael Kors or sleek at Peter Pilotto and Danielle Scutt. Low slung braids were seen at Ashish, while romantic plaits were wrapped around the head at Moschino and Valentino. Stars including Dianna Agron have been seen working the fishtail headband trend on the red carpet recently, while Jennifer Lawrence's The Hunger Games alter ego Katniss Everdeen's side French braid has become the subject of numerous YouTube tutorials.

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The Baby Boomer Number Game

There are 75 million baby boomers  who are on the verge of retirement. For the next twenty years, an average of 10,000 people each day will reach age 65, which has historically been the retirement phase of life.

Between 2000 and 2010, the number of people age 65 to 84 in the U.S. grew by 3.3 million. While 13 percent of Americans are currently age 65 or older, that proportion will jump to 18 percent by 2030. The current 40 million senior citizens will balloon to 89 million by 2050.

These numbers and their impact are awe-inspiring and a bit frightening. Baby boomers entering retirement age will dramatically change today's business and lifestyle landscape. Baby boomers may stay in the workforce longer than their parents did, both because they need the money and they're not ready to leave behind fulfilling careers. And when they finally do retire, their need for health care and assisted living could permanently alter what retirement living arrangements look like for generations to come.

Work. Americans didn't always aim to retire early. Back in 1880, 78 percent of men over age 64 were still in the workforce. In 1934, the official retirement age of 65 was introduced. And by 1990, only 30 percent of men over 64 remained in the workforce. Now the retirement age is increasing again. In today's era of economic uncertainty, many would-be retirees will need to keep working to make ends meet and be considered fortunate if they can find or hold on to jobs.

Delaying retirement will certainly improve the finances of individual baby boomers, but could also lead to intergenerational conflict. Older employees who stay on the job longer than expected could be perceived as standing in the way of younger workers who are in search of their chance to contribute to society and make a living. And senior citizens who take up positions far beneath their experience levels could compete with students and recent graduates looking for a first job.

As more seniors stay active in or re-enter the workforce, older workers will increasingly report to younger supervisors, which can also create tension if both parties don't learn to effectively communicate with one another. Without sensitivity on both sides and a willingness to work together, conflict is likely and the welfare of the company could be jeopardized.

Living arrangements. Once they leave the workforce behind, aging baby boomers will face decisions regarding their living arrangements that will impact family and friends. In the ideal situation, baby boomers will remain able to cope with the responsibilities of home ownership, take care of themselves, and live safely where they are. But they are unlikely to remain healthy enough and sufficiently independent to go it alone indefinitely.

As they continue to age, a growing percentage of baby boomers will reach the point where they cannot completely fend for themselves. At that time, moving in with family may be an option. But challenges are bound to arise when family members must adjust their lifestyle to incorporate the quirks and habits of new residents. Parents may face scrutiny in how they raise their children, with unwanted input from the grandparents. And the physical requirements involved in caring for seniors can tax the patience and finances of the rest of the family.

When boomers require more attention than can be effectively provided by family members, nursing homes and extended care facilities will need to be considered. For families already challenged due to the economy and demands of raising a family, this can be brutal. Assisted living facilities that provide hands-on personal care for those who cannot live alone, but do not require the full-time coverage provided by a nursing home, cost an average of $3,261 per month, according to a Genworth Financial survey. Nursing homes with semi-private rooms are $5,790 per month, while those with private rooms ring in at $6,390 monthly.

Baby boomers changed the world in their youth and as working adults. Their impact continues at a relentless pace and will likely change our notions about retirement as millions move into retirement age.

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The arduous art of the chocolate taster

First study the colour, then the nose, the structure and taste: as for any good wine, tasting chocolate is both a treat and a serious art, requiring regular practice to fine-tune the senses.

And who better to offer a lesson in chocolate tasting than Pierre Herme, the French master pastry chef?

"You start by looking at the texture," he explained at a recent tasting organised in Paris by the "Chocolate Crunchers' Club" -- a 150-strong fellowship created three decades ago to celebrate a common passion for the cocoa bean.

"I rough it up a bit first -- crushing it to test its resistance," Herme said, pressing a blade onto various parts of the chocolate bonbon on his plate.

Then comes the time to taste, paying close heed to "intensity, acidity, the lightness of the texture, the finish" -- how the flavour lingers after each mouthful -- "and for flavoured chocolates the balance between the chosen aroma and the chocolate itself."

Without forgetting the most important of all: "pleasure."

Five times a year the club's members gather around some of France's top artisans to taste all manner of cocoa-based treats -- from truffle bars to mousses, biscuits, patisseries and ice creams.

The ritual is always the same: each taster needs a small knife, a glass of water and some bread to cleanse the palate.

"The knife is essential, especially for chocolate bonbons," explained Claude Lebey, the doyen of French food critics and one of the founders of the club, gathered for the occasion in a Paris mansion.

"You have to slice the sweets in two, to see the thickness of the coating. It should offer resistance, but should not be too thick either, or it stops you from tasting what is inside."

Lebey confesses to keeping chocolate stashed away in various corners of his apartment so he can indulge in a quick nibble at any moment.

"Hmm, the coffee in this one is dosed just right," he mused approvingly, sucking on a bonbon named "Brasilia", created by Jean-Paul Hevin -- a star Parisian chocolatier with his own stores in Japan and Hong Kong.

"It's a dark chocolate ganache, but I added a bit of milk to bring out the scent of the coffee," explained Hevin, who uses ground coffee from Colombia and Brazil -- rather than instant as is often the case.

The club's expert crunchers sample another bonbon, this one flavoured with Earl Grey tea.

"The bergamot could be a little more pronounced," reckoned one taster. "Yes -- but that's risky, bergamot will easily crush any other flavour," tempered another.

For Hevin, "getting the right dose between different flavours is particularly difficult, it takes months of work."

"Most often I will put the accent on the chocolate, above any other flavour."

But sometimes, on a smoked tea bonbon for instance, he does the opposite: "I am a big tea fan, so on this one I pulled out the stops so you can really taste it. I wanted something more powerful, more virile."

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Should Seniors Live Alone or With Family?

Put Grandma in the garage? Yes. But a garage transformed into a well-appointed studio apartment with skylights and a patio for morning coffee.

Home remodeling for those who can afford it is one answer to a growing issue: How do you take care of family members in their late-retirement and twilight years? And then, a tougher question: When a home solution won't work, what assisted-living or nursing home options are available?

[See The Best Places to Retire in 2012.]

Growth of multigenerational households (mostly grandparents, parents, and minor children, but also other extended-family relationships) accelerated during the economic downturn. Some families shared quarters because the unemployment rate (a 30-year high) forced some out-of-work adult children to move back home. Sometimes it was the senior generation that needed a housing solution because they were no longer able to physically or financially go it alone.

The rate of this change is worth noting. In 2008, 6.2 million intergenerational households resided in the United States. That's 5.3 percent of all households. That number jumped to 7.1 million households, or 6.1 percent, by 2010. The two-year increase marked a faster rate of growth than the previous eight years combined, according to AARP's Public Policy Institute.

Even if the economy improves, it's a trend that looks to stick as families address graying baby boomers who may be facing an underfunded retirement, according to aging and financial professionals.

In the best and worst of times, the benefit of companionship and shared household duties, such as childcare, can't be dismissed. For some families, living together is not a solution to a problem but an exercise in bonding. There are also different cultural interpretations of the social value of multigenerational households. But for many families, finances are certainly a factor in their decision to merge under one roof.

Kevin Young, a certified financial planner with Young Wealth Management in Davis, Calif., sees an increasing number of "sandwich generation" clients in his tax practice. "They're taking care of aging parents and children at the same time, sometimes working multiple jobs to accomplish that," he says.

[See How to Avoid Being a Financial Burden on Your Children.]

Young says some boomers and their parents are still playing retirement savings catch-up as corporate America (and the public sector too, in some cases) shifts from defined benefits such as pensions to market-reliant 401(k)s and other individual retirement accounts (IRAs). Others just dropped the ball and didn't save enough.

Options. George Yedinak, editor and publisher of trade newsletter and blog Senior Housing News, sees an industry boom coming to meet the needs of multigenerational and senior housing. This includes concepts such as Greenhouse Project (modest stand-alone homes that include high levels of healthcare), senior villages, co-housing (unrelated seniors sharing space to reduce costs), in-law apartments, and other communal living solutions.

Yedinak notes that regulation of these housing models isn't currently as comprehensive as regulation nursing homes and other traditional care facilities. Regulation catch-up could bring a mixed impact--more scrutiny of care but also reduced incentive for industry growth.

As for home modifications, those are on the rise, too. "Those living in single-family homes will invest capital in their homes as more parents move in with their adult children. Using home office spaces, basements, attics and other existing solutions will make way for more formal renovations including the 'grannie apartment' as either an add-on or standalone," he blogs. "Unlike additions for bathrooms or kitchens, the resale value of 'grannie' renovation should be discounted greatly. Others may opt for pre-fab cottages or PODs as solutions that can be moved, stored, or re-sold when a senior needs to move to a more comprehensive care community."

The longevity conundrum. Healthcare presents a mixed picture for boomers; active lifestyles and treatment developments are helping stave off some disease, but longer living also raises the odds of multiple serious conditions in advanced years and the need for body maintenance, such as joint replacement.

Some households are able to accommodate parents with physical issues and the care industry is responding with more flexibility, often traveling to see patients. But eventually, no matter how welcoming younger generations are to opening their homes to the seniors, they may just not be able to handle the level of care needed.

The home versus care-facility debate welcomes a whole new round of cost concerns. According to Genworth Financial's 2011 Cost of Care Survey, while the cost to receive care in an assisted living facility or nursing home increased over the past year, the cost to receive care in the home, Americans' preferred long-term care setting, remained unchanged. Nationally, the median annual cost of long-term care in an assisted living facility is $39,135, an increase of 2.4 percent from 2010. The comparable cost for a private nursing home room rose 3.4 percent, to $77,745. At $18 per hour for homemaker services and $19 an hour for home-health aide services, the median hourly cost to receive care in the home remained flat over the past 12 months.

[See Should You Buy Long-Term Care Insurance?]

Aging consultancy Age Wave says some older Americans cling too much to the notion of independence in their own home and don't fully weigh the costs and benefits of retirement facilities.

Based on a study, the group offers a list of five myth-busters that may help families make these tough decisions:

-- My current home will be the best place to live in retirement. Many retirees believe remaining in their house gives them the most freedom and independence. But the reality is that by staying at home, they spend twice as much time doing housework and shopping as someone in a retirement center.

-- My current home is the best option to lead an active life and stay connected. Among those over 80, nearly half report suffering from loneliness--twice the rate of younger adults. Depression, alcohol abuse, and obesity can follow.

-- Home is less expensive. Among homeowners older than 65, 84 percent have paid off the mortgage. Still, a house is expensive. Taxes, utilities, upkeep, and insurance really add up.

-- It would be easy to get any care I might need at home. This may be true. But home-health care can further isolate anyone unable to get out. It is also expensive and can add to burdens on extended family.

-- Retirement centers are filled with people who are sick and dying. This may be the most off-putting myth. Today's centers are not where old people go to die. This is partly because most centers require new residents to be in good health and be able to live independently when entering the community.

Let's talk. Families are challenged to communicate their needs and desires for a housing solution. Cultural differences certainly determine the "acceptance" of multiple generations in a single household, but for the most part, the concept has moved in and out of trend in the United States. Needless to say, it's a touchy subject.

In a Metlife Mature Market Institute online survey of 2,123 Americans ages 21 to 65, conducted from June 29 to July 20, 2011, nearly half--46 percent across generations--believe children have a responsibility to provide financial support to their own parents or in-laws if they experience financial difficulty later in life. For many, this means allowing a parent to live with them if he or she is not healthy enough to live alone without caregiving (58 percent overall call this a strong or absolute responsibility), or allowing a parent to live with them if he or she is having financial trouble (50 percent). At the same time, however, many parents say they would not accept financial assistance from their children in old age.

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