In Diabetes, a Complex of Causes

The fifth leading killer of Americans, with 73,000 deaths a year, diabetes is a disease in which the body’s failure to regulate glucose, or blood sugar, can lead to serious and even fatal complications. Until very recently, the regulation of glucose — how much sugar is present in a person’s blood, how much is taken up by cells for fuel, and how much is released from energy stores — was regarded as a conversation between a few key players: the pancreas, the liver, muscle and fat.

Now, however, the party is proving to be much louder and more complex than anyone had shown before.

New research suggests that a hormone from the skeleton, of all places, may influence how the body handles sugar. Mounting evidence also demonstrates that signals from the immune system, the brain and the gut play critical roles in controlling glucose and lipid metabolism. (The findings are mainly relevant to Type 2 diabetes, the more common kind, which comes on in adulthood.)

Focusing on the cross-talk between more different organs, cells and molecules represents a “very important change in our paradigm” for understanding how the body handles glucose, said Dr. C. Ronald Kahn, a diabetes researcher and professor at Harvard Medical School.

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Al-Qaeda In Iraq Reported Crippled

Things looking good in one aspect of the Occupation, but it may be too soon to judge.

There is widespread agreement that AQI has suffered major blows over the past three months. Among the indicators cited is a sharp drop in suicide bombings, the group's signature attack, from more than 60 in January to around 30 a month since July. Captures and interrogations of AQI leaders over the summer had what a senior military intelligence official called a "cascade effect," leading to other killings and captures. The flow of foreign fighters through Syria into Iraq has also diminished, although officials are unsure of the reason and are concerned that the broader al-Qaeda network may be diverting new recruits to Afghanistan and elsewhere.

The deployment of more U.S. and Iraqi forces into AQI strongholds in Anbar province and the Baghdad area, as well as the recruitment of Sunni tribal fighters to combat AQI operatives in those locations, has helped to deprive the militants of a secure base of operations, U.S. military officials said. "They are less and less coordinated, more and more fragmented," Lt. Gen. Raymond T. Odierno, the second-ranking U.S. commander in Iraq, said recently. Describing frayed support structures and supply lines, Odierno estimated that the group's capabilities have been "degraded" by 60 to 70 percent since the beginning of the year.

A reason to be pessimistic

For each assessment of progress against AQI, there is a cautionary note that comes from long and often painful experience. Despite the increased killings and captures of AQI members, Odierno said, "it only takes three people" to construct and detonate a suicide car bomb that can "kill thousands." The goal, he said, is to make each attack less effective and lengthen the periods between them.

Right now, said another U.S. official, who declined even to be identified by the agency he works for, the data are "insufficient and difficult to measure."

"AQI is definitely taking some hits," the official said. "There is definite progress, and that is undeniable good news. But what we don't know is how long it will last . . . and whether it's sustainable. . . . They have withstood withering pressure for a long period of time." Three months, he said, is not long enough to consider a trend sustainable.

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Ex-Commander Says Iraq Effort Is ‘a Nightmare’

“After more than four years of fighting, America continues its desperate struggle in Iraq without any concerted effort to devise a strategy that will achieve victory in that war-torn country or in the greater conflict against extremism,” General Sanchez said at a gathering of military reporters and editors in Arlington, Va.

He is the most senior war commander of a string of retired officers who have harshly criticized the administration’s conduct of the war. While much of the previous condemnation has been focused on the role of former Defense Secretary Donald H. Rumsfeld, General Sanchez’s was an unusually broad attack on the overall course of the war.

But his own role as commander in Iraq during the Abu Ghraib scandal leaves him vulnerable to criticism that he is shifting the blame from himself to the administration that ultimately replaced him and declined to nominate him for a fourth star, forcing his retirement.

Though he was cleared of wrongdoing in the abuses after an inquiry by the Army’s inspector general, General Sanchez became a symbol — with civilian officials like L. Paul Bremer III, the head of the Coalition Provisional Authority — of ineffective American leadership early in the occupation.

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Gore and U.N. Panel Win Peace Prize for Climate Work

The prize is a vindication for Mr. Gore, whose frightening, cautionary film about the consequences of climate change, “An Inconvenient Truth,” won the 2007 Academy Award for best documentary, even as conservatives in the United States denounced it as alarmist and exaggerated.

“I will accept this award on behalf of all the people that have been working so long and so hard to try to get the message out about this planetary emergency,” Mr. Gore said in a brief appearance on Friday, Alto... standing with his wife, Tipper, and four members of the United Nations climate panel. “I’m going back to work right now,” he said. “This is just the beginning.”

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The Odyssey Years

There used to be four common life phases: childhood, adolescence, adulthood and old age. Now, there are at least six: childhood, adolescence, odyssey, adulthood, active retirement and old age. Of the new ones, the least understood is odyssey, the decade of wandering that frequently occurs between adolescence and adulthood.

During this decade, 20-somethings go to school and take breaks from school. They live with friends and they live at home. They fall in and out of love. They try one career and then try another.

Their parents grow increasingly anxious. These parents understand that there’s bound to be a transition phase between student life and adult life. But when they look at their own grown children, they see the transition stretching five years, seven and beyond. The parents don’t even detect a clear sense of direction in their children’s lives. They look at them and see the things that are being delayed.

They see that people in this age bracket are delaying marriage. They’re delaying having children. They’re delaying permanent employment. People who were born before 1964 tend to define adulthood by certain accomplishments — moving away from home, becoming financially independent, getting married and starting a family.

In 1960, roughly 70 percent of 30-year-olds had achieved these things. By 2000, fewer than 40 percent of 30-year-olds had done the same.

Yet with a little imagination it’s possible even for baby boomers to understand what it’s like to be in the middle of the odyssey years. It’s possible to see that this period of improvisation is a sensible response to modern conditions.

Great Op-Ed by David Brooks

Boom Times for Dentists, but Not for Teeth

For middle-class and wealthy Americans, straight white teeth are still a virtual birthright. And dentists say that a majority of people in this country receive high-quality care.

But many poor and lower-middle-class families do not receive adequate care, in part because most dentists want customers who can pay cash or have private insurance, and they do not accept Medicaid patients. As a result, publicly supported dental clinics have months-long waiting lists even for people who need major surgery for decayed teeth. At the pediatric clinic managed by the state-supported University of Florida dental school, for example, low-income children must wait six months for surgery.

In some cases, the results of poor dental care have been deadly. A child in Mississippi and another in Maryland died this year from infections caused by decayed teeth.

The dental profession’s critics — who include public health experts, some physicians and even some dental school professors — say that too many dentists are focused more on money than medicine.

“Most dentists consider themselves to be in the business of dentistry rather than the practice of dentistry,” said Dr. David A. Nash, a professor of pediatric dentistry at the University of Kentucky. “I’m a cynic about my profession, but the data are there. It’s embarrassing.”

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Tragedy in Wisconsin

The family of Tyler Peterson, the off-duty sheriff’s deputy who the police say shot and killed six people on Sunday and injured a seventh before dying, apparently of a gunshot wound, issued a statement of apology to the town yesterday afternoon.

“We also feel a tremendous amount of guilt and shame for the horrible acts Tyler committed,” the family said in a statement read aloud at a news briefing by Bill Farr, a local pastor. “We are struggling to respond, like most of you. We don’t know what we should do.”

The Petersons’ statement went on, “There is nothing that happened before or after yesterday’s events that has given us any insight into why.”

Before 3 a.m. Sunday, state authorities said, Mr. Peterson, 20, who also served as a part-time police officer in Crandon, arrived at the home of his former girlfriend, Jordanne Murray, 18. Ms. Murray and others — most of them graduates or students of the same close-knit high school in town — were watching movies, dozing and eating pizza.

Mr. Peterson, who many people said had a tumultuous relationship with Ms. Murray and had not been invited to the gathering, argued with the group, then left, state authorities said. But he quickly returned with a weapon — a rifle similar to the type and model carried by local sheriff’s deputies, though officials said they had not yet determined whether Mr. Peterson’s work rifle was used.

He sprayed the apartment with at least 30 rounds of gunfire. Ms. Murray died. So did five others, ranging in age from 14 to 20, including two young men whom schoolmates said Mr. Peterson considered close friends. A seventh person, Charlie Neitzel, 21, was wounded and remained hospitalized.

The state authorities, who took over investigation of the case given Mr. Peterson’s ties to both of the local law enforcement agencies, did not speculate on a motive for the shootings. But many residents and family members of the dead said Mr. Peterson had been angry about his separation from Ms. Murray, and seemed particularly jealous.

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Painkillers in Short Supply in Poor Countries

A survey of specialists in Africa, Asia and Latin America has produced a disturbing portrait of the difficulties in offering pain relief to the dying in poor countries. Many suffer routine shortages of painkillers, and the majority of specialists got no training in pain relief or opioid use during their medical education.

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Spreading Homework Out So Even Parents Have Some

Mr. Frye, an English teacher at Montclair High School, has asked the parents to read and comment on a Franz Kafka story, Section 1 of Walt Whitman’s “Song of Myself” and a speech given by Robert F. Kennedy in 1968. Their newest assignment is a poem by Saul Williams, a poet, musician and rapper who lives in Los Angeles. The ninth graders complete their assignments during class; the parents are supposed to write their responses on a blog Mr. Frye started online.

If the parents do not comply, Mr. Frye tells them, their child’s grade may suffer — a threat on which he has made good only once in the three years he has been making such assignments.

The point, he said, is to keep parents involved in their children’s ’ education well into high school. Studies have shown that parental involvement improves the quality of the education a student receives, but teenagers seldom invite that involvement. So, Mr. Frye said, he decided to help out.

“Parents complain about never getting to see their kids’ work,” he said. “Now they have to.”

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Secret U.S. Endorsement of Severe Interrogations

No surprise here.

Mr. Gonzales approved the legal memorandum on “combined effects” over the objections of James B. Comey, the deputy attorney general, who was leaving his job after bruising clashes with the White House. Disagreeing with what he viewed as the opinion’s overreaching legal reasoning, Mr. Comey told colleagues at the department that they would all be “ashamed” when the world eventually learned of it.

Later that year, as Congress moved toward outlawing “cruel, inhuman and degrading” treatment, the Justice Department issued another secret opinion, one most lawmakers did not know existed, current and former officials said. The Justice Department document declared that none of the C.I.A. interrogation methods violated that standard.

The classified opinions, never previously disclosed, are a hidden legacy of President Bush’s second term and Mr. Gonzales’s tenure at the Justice Department, where he moved quickly to align it with the White House after a 2004 rebellion by staff lawyers that had thrown policies on surveillance and detention into turmoil.

Ahmadinejad, at Columbia, Parries and Puzzles

The story of the day yesterday.

His speech at Columbia, in advance of his planned speech today at the United Nations, produced a day of intense protests and counterprotests around the campus. It was a performance at once both defiant — he said Iran could not recognize Israel “because it is based on ethnic discrimination, occupation and usurpation and it consistently threatens its neighbors” — and conciliatory — he said he wanted to visit ground zero to “show my respect” for what he called “a tragic event.”

And he said that even if the Holocaust did occur, the Palestinians should not pay the price for it.

He began the afternoon on the defensive.

Lee C. Bollinger, the president of Columbia, under intense attack for the invitation — one protester outside the campus auditorium where Mr. Ahmadinejad spoke passed out fliers that said, “Bollinger, too bad bin Laden is not available” — opened the event with a 10-minute verbal assault.

He said, “Mr. President, you exhibit all the signs of a petty and cruel dictator,” adding, “You are either brazenly provocative or astonishingly uneducated.”

Sarkozy, a Frenchman in a Hurry, Maps His Path

“I can’t be criticized for wanting first place for France,” Mr. Sarkozy said in an interview with The New York Times and The International Herald Tribune, his first with English-language news organizations since becoming president in May. He added, “If France doesn’t take the lead, who will?”

This projection of French power is like that of de Gaulle, in the 1950s and 60s, and every French leader since. But Mr. Sarkozy departs from classic Gaullist doctrine by suggesting that the path to that goal sometimes lies in aligning France — and Europe — alongside Washington rather than as a counterpoint to it.

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