A small change

The patient shook his doctor's hand in gratitude and remarked, "Since we're the best of friends, doc, I wouldn't want to insult you by offering payment. But, you'll be pleased to know that I've mentioned you in my will.""That's very kind of you," replied the doctor. After some quick thought, the doctor added, "May I see that prescription I just gave you?""Sure, but why?" asked the patient.The doctor replied, "I'd like to make a small change..."

Toyota checks 2010 Prius brakes; no word on recall

WASHINGTON – Toyota said Thursday it is evaluating brake problems with the 2010 Prius gas-electric hybrid, but no decision has been made about a recall.

A company spokesman said the automaker is cooperating fully with a National Highway Traffic Safety Administration probe into brake problems, but said it's too soon to talk about a recall.

Earlier Thursday, the safety agency said it opened an investigation into the Prius, saying it had received 124 reports from consumers about its brakes, including four reports of crashes. The government is investigating reports that antilock brakes can fail momentarily on some 2010 models in slippery conditions or on rough roads.

The company says it made a change in the 2010 braking system last month to correct cars in production. The company has not made a decision about cars on the road.

Asked if Toyota would recall the 2010 Priuses, spokesman Brian Lyons said: "It's too soon to call at this point. We will of course fully cooperate with NHTSA in that investigation."

Lyons also said Toyota is checking other hybrid models in its lineup to see if they have the same braking system as the 2010 model, but so far he is not aware of any other models being involved.

"As part of our normal problem-solving process, we would look at similar technology in similar vehicles," he said.

The U.S. investigation, while preliminary, represents another setback for Toyota, which has been battered with two major recalls in the United States covering millions of vehicles. Those involve gas pedals that can get trapped under floor mats or become stuck on their own and fail to return to the idle position. The safety probes have challenged Toyota's long-standing reputation for building safe, quality vehicles.

The Prius was not part of the recall spanning the U.S., Europe and China over sticking gas pedals in eight top-selling models including the Camry. That recall involved 2.3 million cars in the U.S. alone.

NHTSA said investigators have talked to consumers and conducted pre-investigatory field work. The preliminary evaluation involves about 37,000 vehicles in the United States.

"Safety is our top priority," said Transportation Secretary Ray LaHood. NHTSA said LaHood spoke with Toyota president Akio Toyoda late Wednesday and was assured by the executive that Toyota was taking the safety concerns seriously.

Toyota said in a statement it would fully cooperate with NHTSA's investigation.

The U.S. investigation came after the Japanese government ordered Toyota to investigate brake problems in the Prius, the world's best-selling hybrid.

The new version of the gas-electric Prius hybrid went on sale in the U.S. and Japan in May 2009.

Paul Nolasco, a company spokesman in Japan, said the time lag for brakes kicking in felt by drivers stem from the two systems in a gas-electric hybrid — the gas-engine and the electric motor.

When the car moves on a bumpy or slippery surface, a driver can feel a pause in the braking when the vehicle switches between the traditional hydraulic brakes and the electronically operated braking system, he said. The brakes work if the driver keeps pushing the pedal, he said.

Toyota acknowledged the brake problem while reporting a $1.7 billion profit for its October-December quarter.

NHTSA said it opens 100 investigations every year and there are currently 40 open defect investigations, three of which involve Toyota. NHTSA said its defect and compliance investigations have resulted in 524 recalls involving 23.5 million vehicles during the past three years.

Toyota senior managing director Takahiko Ijichi defended the automaker's quality standards.

"We have not sacrificed the quality for the sake of saving costs," he said. "Quality is our lifeline. We want our customers to feel safe and regain their trust as soon as possible."

Toyota for the first time gave an estimate of the costs of the global gas-pedal recall. The $2 billion total represents $1.1 billion for repairs and $770 million to $880 million in lost sales.

Toyota is expecting to lose 100,000 in vehicle sales because of the recall fallout — 80,000 of them in North America.

___

Kageyama reported from Tokyo. AP Auto Writer Tom Krisher contributed to this report from Detroit.

Study: Vegetative brains show signs of awareness

NEW YORK – Scientists have detected glimmers of awareness in some vegetative brain-injury patients and have even communicated with one of them — findings that push the boundaries of how to assess and care for such people.

The new research suggests that standard tests may overlook patients who have some consciousness, and that someday some kind of communication may be possible.

In the strongest example, a 29-year-old patient was able to answer yes-or-no questions by visualizing specific scenes the doctors asked him to imagine. The two visualizations sparked different brain activity viewed through a scanning machine.

"We were stunned when this happened," said one study author, Martin Monti of Medical Research Council Cognitive and Brain Sciences Unit in Cambridge, England. "I find it literally amazing. This was a patient who was believed to be vegetative for five years."

Ever since a research paper four years ago showed apparent signs of awareness in a vegetative patient — one who was included in the new study — families of patients have been clamoring for brain scans, said Dr. James Bernat of Dartmouth Medical School, a spokesman for the American Academy of Neurology.

In fact, a spokeswoman for a patient advocacy group said the organization will urge families to ask about the type of brain imaging used by the researchers.

But experts said more study is needed before the specialized brain scans could be used routinely. "It's still a research tool," Bernat said.

Experts also emphasized that only a few tested patients showed evidence of awareness. And they said it is not clear what degree of consciousness and mental abilities the signs imply.

They also noted that the positive signals appeared only in people with traumatic brain injury — not in patients whose brains had been deprived of oxygen, as can happen when the heart stops. Terri Schiavo, the vegetative woman at the center of a national controversy before her feeding tube was removed and she was allowed to die in 2005, suffered oxygen deprivation.

The new work, published online Wednesday by the New England Journal of Medicine, came from researchers in Britain and Belgium. One author is Dr. Steven Laureys at the University of Liege in Belgium. He made headlines in November by showing awareness in Rom Houben, a 46-year-old man who had been diagnosed as being vegetative for 23 years. (Houben was excluded from the new study because he could not keep his head still enough in the brain scanner to produce a usable scan; his awareness was revealed by bedside behavioral tests).

The new study used brain scanning called functional MRI, or fMRI, for 23 patients in a vegetative state and 31 diagnosed as minimally conscious.

Patients are diagnosed as being in a vegetative state if they are tested and found unable to do such things as move on command or follow a moving object with their eyes. (Their eyes are open; in contrast, comatose people's eyes are closed.) Minimally conscious patients show signs of awareness, but they are minimal and intermittent.

While in the fMRI scanner, the patients were asked to imagine two situations. One was that they were standing on a tennis court, hitting a ball to an instructor; the other was that they were navigating familiar streets or walking from room to room in their homes. The two tasks produce different patterns of brain activity in healthy people.

The study found those patterns appeared in five patients when they were asked to imagine the scenes. Four of those patients had been diagnosed as vegetative.

"It just says how much we can learn from looking directly at somebody's brain," Monti said.

But he said the results cannot be taken to indicate how commonly a vegetative brain holds hidden signs of awareness. And the findings certainly don't mean all vegetative patients have that capacity, he said.

The 29-year-old, who had been injured in a traffic accident, was asked simple questions about his life, such as "Is your father's name Alexander?" He was told to answer "yes" or "no" by thinking about one or the other of the imagined scenes about playing tennis or navigating streets or his home. For five of the six questions, his brain activity matched the correct answer.

Monti and Laureys said it is not clear whether such patients have the mental capacity to answer more important but complicated questions, such as whether they wish to go on living.

"I'm trying to figure out what is the best way to tackle this," Laureys said.

Laureys also said fMRI technology isn't practical for routine assessments of vegetative patients or for enabling communication. So he is working to develop a more portable and less expensive approach based on sampling brain waves.

Now that communication has been demonstrated, it brings an urgency to finding ways to capitalize on that ability, said Dr. Nicholas Schiff at New York-Presbyterian Hospital/Weill Cornell Medical Center. Schiff is collaborating with Laureys and others on such research.

Some experts, like Dr. Ross Zafonte of Harvard Medical School, who was not involved in the study, said the brain patterns also don't reveal anything about whether patients have retained significant memory and other important mental abilities.

"But it's provocative and exciting because this is a cohort of people that everybody had given up on, and now there's reason to say ... there might be something there to manipulate," he said.

Maybe brain scans could identify patients with a better chance than others to improve with specialized treatment, he said.

Susan Connors, president and CEO of the Brain Injury Association of America, an advocacy group, said the study means there's hope for people with brain injury.

She said her group will now add fMRI testing to the list of things they recommend families ask about after a serious brain injury.

Connors said some people might want to use such brain scans to help them decide whether to keep a loved one with a brain injury alive. But that shouldn't be the deciding factor, she said, adding that families are still going to have to rely on the person's wishes, religious and cultural beliefs and medical advice.

"This is going to give us more information, but it's not going to give us the final answer," she said.

___

Stephanie Nano in New York contributed to this report.

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On the Net:

New England Journal: http://www.nejm.org

Gov't moving into central role in health care

WASHINGTON – Government is poised to become king of the hill in America's vast health care system, with or without President Barack Obama's planned redo, according an economic report released Thursday.

Federal and state programs will pay slightly more than half the tab for health care purchased in the United States by 2012, says the analysis by Medicare number crunchers published in the journal Health Affairs.

That's even if Obama's health care overhaul wastes away in congressional limbo. Long in coming, the shift to a health care sector dominated by government is being speeded up by the deep economic recession and the aging of the Baby Boomers, millions of whom will soon start signing up for Medicare.

"This does mark a pretty stark jump in the data," said Christopher Truffer of Medicare's Office of the Actuary, which prepared the analysis.

For all the hue and cry over a government takeover of health care, it's happening anyway.

The tipping point is likely to come next year, Truffer said. For technical reasons, the report assumes that Congress is going to allow Medicare to cut doctor fees by 20 percent later this year, as required by a 1990s budget law. But lawmakers have routinely waived such cuts, and they're not likely to allow them in an election year. So government probably will end up picking up most of the nation's medical costs in 2011, instead of 2012.

The report serves as a reality check in the debate over Obama's health care plan, which has been marked by disagreements between the political parties over how large a role government should play.

Congressional Democrats want to move forward with the sweeping legislation, but are stalled over disagreements among themselves. Republicans have rejected Obama's approach as a top-down, big government solution.

Richard Foster, Medicare's top economic forecaster, said the recession has only worsened the two stubborn problems facing the U.S. health care system, lack of insurance coverage and high costs. "All that argues that some form of health care reform is a good idea," Foster said.

The Democrats' plan would expand coverage to more than 30 million people now uninsured, while taking some modest steps to slow the pace of future cost increases. It would set up a new insurance marketplace for small businesses and people buying coverage on their own, with government subsidies available for many. Denial of coverage because of health problems would be prohibited.

The report estimated that in 2009, the United States spent $2.5 trillion for health care, with government programs — mainly Medicare and Medicaid — paying $1.2 trillion. Employer health insurance and various private sources covered the other $1.3 trillion. Even as the economy shrank because of the downturn, health care spending grew by 5.7 percent from 2008. Spending by government grew nearly three times faster than private spending, closing in to overtake it.

Driving much of the government surge was Medicaid, the federal-state program for low-income people, which grew by nearly 10 percent as workers lost jobs with health insurance, and Democrats expanded coverage for children of the working poor.

The swine flu outbreak contributed modestly to higher costs in 2009, as more people went to the doctor and took antiviral medications, the report found. Total spending on prescription drugs grew by slightly more than 5 percent, as higher prices for brand name medications overpowered the widespread availability of generics.

Previous estimates had put the crossover point to a health care system financed mainly by taxpayers at about 2016. There seems to be little chance that the balance will tip back decisively in the direction of private financing, with the Baby Boom generation signing up for Medicare and the lack of health insurance at many new jobs.

Other economically advanced countries — including those with government-run health care — also have problems with costs. But the U.S. spends much more per person than any other nation, without getting better results in life expectancy and many other measures of health.

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Couples Who Say 'We' Fare Better in Fights

Couples who consistently refer to themselves as "we" may get on the nerves of singletons everywhere, but spouses who use this "couple-focused" language may fare better during conflicts than those who don't, according to a study announced this week.

The study found that using personal pronouns, such as "we," "our" and "us," when talking about a conflict was associated with more positive behaviors between the pair, such as affection, less negative behavior (like anger), and lower physiological stress levels during the disagreement.

On the other hand, using words that expressed "separateness," such as "I," "you," and "me," during the discussion was associated with marital dissatisfaction.

Discussions regarding marital disagreements can sometimes turn into hostile interactions, said study researcher Benjamin Seider, a graduate student in psychology at the University of California, Berkeley. "And our thinking is that, using the 'we' words in that context can maybe help realign the couple, and help them to see themselves as being on the same team as opposed to adversaries," he told LiveScience.

However, since the results are based on conversations that took place in a laboratory setting, more research is needed to firm up the findings.

Conflict conversations

The study involved 154 middle-aged and older couples who were in their first marriages.

The spouses were video-taped during a 15-minute conversation regarding a conflict in their marriage. At the same time, scientists monitored the participants' heart rate, body temperature and how much they sweated, among other factors to assess their physiological state. All the data was collected back in 1989-1990 as part of a long-term marital study.

Seider and his colleagues went back and examined the tapes, looking at signs of emotional behavior, such as facial expressions and tone of voice.

In addition to finding that "we" language is linked to emotional behavior, the researchers also found that older couples used more "we" words, a result suggesting couples who have been together longer have developed a stronger shared identity with their partners than younger couples.

The overall marriage

The jury is still out, however, as to whether or not using such "we" words specifically boosts marital satisfaction. While previous studies have found such an association, the current study did not. "We were certainly surprised by that," Seider said.

The study's failure to find a link may come down to the fact that it was based on specific conversations rather than assessments of the overall marriages, according to Seider.

"The language that they're using is probably more reflective of them trying to regulate their emotions than it is about whether or not they're happy or sad in the relationship as a whole," he said.

The results were published in the September 2009 issue of the journal Psychology and Aging.

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• Original Story: Couples Who Say 'We' Fare Better in Fights

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Mardi Gras has nothing on Saints mania

(CNN) -- There's a party brewing in New Orleans that's filling up hotels and drawing the faithful to the city, but this weekend the magnet isn't Mardi Gras. The New Orleans Saints' Super Bowl debut has fans in a fever to celebrate with their brethren.

Phillip Davenporte wants to be with his people -- the "Who Dat" fans -- on Super Bowl Sunday.

"I'm a die-hard Saints fan. I've been dying hard for 43 years," Davenporte, from Mobile, Alabama, said. "Oh my goodness, it's our time."

Davenporte, 55, and his wife, Gail, plan to drive to New Orleans on Sunday morning to take in the long-awaited event with other devotees. After looking into traveling to Miami, Florida, and staying in a hotel two hours from the stadium where the New Orleans Saints will battle the Indianapolis Colts, the Davenportes decided to get into the thick of things in the Saints' home town.

They're checking into a hotel and playing it by ear about where they watch the game, but they shouldn't have any trouble finding the requisite big screen and fired up crowd: The city's notoriously good times are rolling into a frenzy that fans can't resist.

Video: Big Super Bowl for Big Easy

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• Super Bowl XLIV
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Hotel bookings over the weekend are rivaling the traditional height of the Mardi Gras season, which is under way and usually peaks the weekend before Fat Tuesday (February 16), according to the New Orleans Convention and Visitors Bureau.

Even some locals are getting rooms in the French Quarter for Super Bowl weekend to be closer to the heart of Saints mania, said Marvin Allen, who is head bartender at the Carousel Bar in the French Quarter's Hotel Monteleone.

"I really think this is the only city that has an NFL team, where the fans want to be in ... the home city, rather than actually being at the Super Bowl itself because it's going to be so much more fun here," Allen said.

The Carousel Bar will be showing the game on all its TVs, and Allen expects to be busy as soon as the doors open at 11 a.m. He'll be mixing Black and Gold Sours and Bulleit Brees bourbon cocktails in honor of the team.

"I think the mood is even greater than it is for Mardi Gras," Allen said. "People are in a much better mood, everybody's excited, everybody's wearing black and gold."

The 250 spots for the Sheraton New Orleans Hotel's Super Bowl viewing party were gone by Tuesday, said hotel employee Renee Maxwell, and rooms for the weekend are steadily filling up.

I think the mood is even greater than it is for Mardi Gras. People are in a much better mood, everybody's excited, everybody's wearing black and gold.
--Bartender Marvin Allen

Black and gold paraphernalia is flying off the shelves at Beads by the Dozen, said store owner Dan Kelly.

Kelly, 60, a Saints season ticket holder and president of the Mardi Gras Krewe Endymion, has never seen anything like the Saints euphoria in New Orleans.

"You can't describe what it's all like. But everybody, anywhere you go -- even in doctors' offices -- everybody's wearing black and gold and high-fiving people," he said.

It's a boost the city needed along the long road to recovering from the devastation wrought by Hurricane Katrina in 2005.

"You know whether we win or lose, the city has something to hold onto now. We have something we can hang our hat on," Kelly said.

Mardi Gras parades will be rolling over the weekend, after a bit of schedule shifting to avoid Super Bowl overlap. Tourism officials haven't had time to poll hotels about booking levels for next weekend -- the weekend before Mardi Gras Day and typically the season's busiest -- but win or lose, the city will be celebrating.

A parade for the Saints will be held on Tuesday after the Super Bowl, and Saints quarterback Drew Brees and team owner Tom Benson will ride with the Bacchus and Endymion krewes next weekend.

Davenporte feels good about a win. "We are ready. It is our time. Peyton Manning is gonna have to wait."

And if the Saints are victorious?

"I'm sure that if the Saints win there's going to be many more people coming to the city to help celebrate that weekend and make Mardi Gras probably the biggest Mardi Gras that I've ever seen in my 60 years," said Kelly.

ATMs a waste of time: customers

VietNamNet Bridge – Huynh Cong Ly was enjoying a pleasant Sunday afternoon in HCM City until he joined the long queue of shoppers wishing to withdraw money from an automatic teller machine at a supermarket.

Huynh Cong Ly was enjoying a pleasant Sunday afternoon in HCM City until he joined the long queue of shoppers wishing to withdraw money from an automatic teller machine at a supermarket.

However, it was the only ATM for miles around so he patiently waited his turn. But when Ly, 35, who works for a garment maker in Binh Thanh District, eventually got round to inserting his card in the machine, he could not withdraw money. It was a particularly frustrating experience because Ly was on his way home to Rach Gia City in Kien Giang Province to celebrate Tet with his family.

His experience however is far from unique.

"There are only a few ATMs in my hometown. They are far from my home and usually out of order," Ly said, "I have tried to withdraw cash from three ATMs near my company but all failed. I need money for Tet which is coming soon. Is this what they call a revolution in financing?" he said furiously.

At this time of year, just before Tet, demand for cash soars. However, ATMs, even when working properly, can only dispense a maximum of VND2 million (US$100) at a time.

Demand for ATMs grew significantly in 2008 when the Government decided to pay salaries electronically. Employees in processing zones and industrial parks are also paid directly in their bank account.

Trendy bankcards

"Yes, like every employee who is paid into their back account, I used to think it was more convenient to use an ATM because of their safety and privacy," Ly said. "For example, when my company decided to pay us this way, nobody could know what others were being paid."

Tran My Chi, who works as a check-in clerk for Vietnam Airlines, said ATMs were far from convenient. "I have had a lot of trouble with withdrawing cash. Last month my supervisor didn't know why she lost VND10 million from her account. After payday, she went to get some cash but the machine said there was nothing in her account. The bank refused to compensate her because they had proof the money was withdrawn.

"I don't know if there was fraud, whether her account had been hacked or there was some technical errors but I have heard of this type of thing happens frequently. Now I never keep more than VND2 million ($100) in my account. We need more secure ATMs," Chi said.

In Viet Nam, there are 26,000 people per ATM compared with 2,700 people per machine in Singapore. There are currently just 125,800 cash machines, with most being in major cities. The first started appearing 10 years ago.

An official from the State Bank of Viet Nam, who wished to remain anonymous, said: "Bank customers can rarely use ATMs from other banks due to a lack of co-operation among different banks or for technical reasons. The result is that machines are overburdened at peak times, such as on pay day, during holidays or on the weekend.

"Many ATMs are outdated and break down causing trouble for those who want to withdraw or deposit money. Bad security, wrong withdrawals and occasional losses of data caused customers to lose money," he added.

Tran The Nam, director of Asia Commercial Bank's ATM centre, said there were a lot of pitfalls in the current banking system.

"Criminals forge bankcards to withdraw clients' money. It's time banks did something," Nam said.

VietNamNet/Viet Nam News