Hockey Coaches Defy Doctors on Concussions, Study Finds

Despite several years of intensive research, coverage and discussion about the dangers of concussions, the idea of playing through head injuries is so deeply rooted in hockey culture that two university teams kept concussed players on the ice even though they were taking part in a major concussion study.

The study, which was published Friday in a series of articles in the journal Neurosurgical Focus, was conducted during the 2011-12 hockey season by researchers from the University of Western Ontario, the University of Montreal, Harvard and other institutions.

“This culture is entrenched at all levels of hockey, from peewee to university,” said Dr. Paul S. Echlin, a concussion specialist and researcher in Burlington, Ontario, and the lead author of the study. “Concussion is a significant public health issue that requires a generational shift. As with smoking or seat belts, it doesn’t just happen overnight — it takes a massive effort and collective movement.”

The study is believed to be among the most comprehensive analyses of concussions in hockey, which has a rate of head trauma approaching that of football. Researchers followed two Canadian university teams — a men’s team and a women’s team — and scanned every player’s brain before and after the season. Players who sustained head injuries also received scans at three intervals after the injuries, with researchers using advanced magnetic resonance imaging techniques.

The teams were not named in the study, in which an independent specialist physician was present at each game and was empowered to pull any player off the ice for examination if a potential concussion was observed.

The men’s team, with 25 players and an average age of 22, played a 28-game regular season and a 3-game postseason. The women’s team, with 20 players and an average age of 20, played 24 regular-season games and no playoff games. Over the course of the season, there were five observed or self-reported concussions on the men’s team and six on the women’s team.

Researchers noted several instances of coaches, trainers and players avoiding examinations, ignoring medical advice or otherwise obstructing the study, even though the players had signed consent forms to participate and university ethics officials had given institutional consent.

“Unless something is broken, I want them out playing,” one coach said, according to the study.

In one incident, a neurologist observing the men’s team pulled a defenseman during the first period of a game after the player took two hits and was skating slowly. During the intermission the player reported dizziness and was advised to sit out, but the coach suggested he play the second period and “skate it off.” The defenseman stumbled through the rest of the game.

“At the end of the third period, I spoke with the player and the trainer and said that he should not play until he was formally evaluated and underwent the formal return-to-play protocol,” the neurologist said, as reported in the study. “I was dismayed to see that he played the next evening.”

After the team returned from its trip, the neurologist questioned the trainer about overruling his advice and placing the defenseman at risk.

“The trainer responded that he and the player did not understand the decision and that most of the team did not trust the neurologist,” according to the study. “He requested that the physician no longer be used to cover any more games.”

In another episode, a physician observer assessed a minor concussion in a female player and recommended that she miss the next night’s game. Even though the coach’s own playing career had ended because of concussions, she overrode the medical advice and inserted the player the next evening.

According to the report, the coach refused to speak to another physician observer on the second evening. The trainer was reluctant to press the issue with the coach because, the trainer said, the coach did not want the study to interfere with the team.

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Myanmar Security Forces Use Incendiary Devices in Raid on Protest Camp

BANGKOK — Security forces in Myanmar mounted a violent raid on Thursday against Buddhist monks and villagers who have been protesting the expansion of a copper mine. The crackdown was the largest since the civilian government of President Thein Sein came to power 20 months ago.

Witnesses said dozens of monks and other protesters were injured when security forces used incendiary devices that set fire to protesters’ encampments outside the offices of the Chinese company in charge of the project, which has a partnership with the powerful military in Myanmar, formerly Burma.

Photos from Burmese online news sites showed monks, who are highly revered in the country and are often involved in political causes, with singed saffron robes stuck to their badly seared skin.

The raid came hours before Daw Aung San Suu Kyi, the Nobel laureate and leader of the opposition in Parliament, was scheduled to visit the city of Monywa, near the mine.

Her visit underlined the widespread support the protests had engendered across the country before the raid.

Analysts said the brutal way that the crackdown was carried out could hamper Mr. Thein Sein’s efforts to persuade the country that his government has made a clean break from the military regimes that ruled the country for five decades.

“There will be political consequences,” said U Thiha Saw, the editor of Open News Journal and Myanma Danna magazine. “This may be the start of an uglier phase for the government. Things may get a little more complicated.”

The crackdown was conducted by security forces who have little experienced using modern crowd-control methods that are meant to minimize casualties. During military rule, dissent was brutally repressed and protesters on several occasions were shot dead in the streets.

In Thursday’s raid, security forces fired what one witness described to The Associated Press as “black balls that exploded into fire” to disperse the protesters, who had overstayed a Wednesday deadline set by the government to leave the area.

Factory workers and villagers, both ethnic Burmese and members of minorities, have taken advantage of new freedom under Mr. Thein Sein’s government to carry out limited demonstrations and strikes in recent months. The protests at the copper mine were by far the largest to appear since the former military junta ceded power to civilians in March 2011.

By dealing so forcefully with the mine protests, the government risks appearing to defend the vested interests of the old regime. The project is typical of the kinds of opaque deals often struck during military rule that have enriched many of the country’s generals. The military has been so deeply involved in business that it has its own holding company, the Union of Myanmar Economic Holdings; the company is listed as a part owner of the copper mine.

The deal between the military and the Chinese company, a subsidiary of a state-owned Chinese arms manufacturer, to expand the mine was signed two years ago when Mr. Thein Sein was prime minister under the military junta.

According to an American diplomatic cable made public by WikiLeaks, the deal was brokered by U Tay Za, a tycoon who became rich through his connections to the military regime, especially the country’s former dictator, Senior Gen. Than Shwe.

The crackdown may also complicate the investment picture for China, which has struggled in Myanmar with the perception that it is mainly interested in extracting natural resources from the country, not in aiding its development.

The Global Times, a state-owned Chinese newspaper, published an article Thursday, before the crackdown, that accused the West and advocacy groups of instigating the protests against the mine project, and said that shutting the mine down would be “a lose-lose situation” for the two countries.

“Chinese companies’ investments in Myanmar are facing huge challenges,” the article said. “What we see in the country is the inevitable impact of its democratization.”

Anti-Chinese sentiment was a major factor in the cancellation of a hydroelectric dam project last year in northern Myanmar that would have exported electricity to China. The project was suspended after an outcry.

Thursday’s raid came in the predawn hours. Ashin Visara, a 28-year-old monk who was injured in the crackdown, said security forces threw “explosive devices” into the areas where protesters were camped out.

“That started fires at the protest sites,” he said. “And then they attacked us.”

U Nway Oo, a student activist from Monywa who assisted the injured, said many protesters fled into the surrounding villages or the jungle.

“There were no medical personnel or ambulances around before the crackdown,” he said.

The mine, which is often referred to as Letpadaung for the mountains from which the copper is extracted, was initially operated by a joint venture between the Myanmar government and a Canadian company, Ivanhoe Mines. The Chinese company became involved two years ago. The expansion project would displace inhabitants of two dozen villages.

The protests have been led in part by two young women, Aye Net and Thwe Thwe Win, who reportedly escaped arrest.

The crackdown is a setback for the efforts of advocacy groups that focus on the crucial question of land rights, an issue likely to become more contentious as economic growth makes villagers’ land more attractive to companies and property developers. Land rights were the focus of a conference last weekend in the capital, Naypyidaw, that was attended by high-ranking government officials.

Wai Moe contributed reporting from Monywa, Myanmar.

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Sony sells over half a million PlayStation 3 consoles over Black Friday week

Both Microsoft (MSFT) and Nintendo (NTDOY) had a big week of console sales during Black Friday’s week of shopping madness in the U.S. So how did Sony (SNE) do in comparison? Sony Computer Entertainment of America president and CEO Jack Tretton announced on Thursday that the company sold 525,000 PlayStation 3 consoles and 160,000 PS Vita handhelds during the Black Friday week. Overall PlayStation sales of hardware, software and accessories are up 9% over the same period last year. Tretton was also happy to reveal that subscriptions to its PlayStation Plus grew 259% since last year with customer satisfaction flying high at 95% after Sony added the Instant Game Collection to the service earlier this year.

Sony’s PlayStation 3 and PS Vita sales were largely bolstered by $ 199.99 bundles packaged with free games that the company pushed to retails on Black Friday. The sell-out of the bundles within minutes at retailers such as Amazon (AMZN) is a good indicator that there is huge demand for a sub-$ 200 PlayStation 3. Currently, the lowest-priced PS3 is a second-gen 160GB slim model with an MSRP of $ 249.99. The redesigned third-gen PS3s start at $ 269.99 with a 250GB hard drive.

In terms of which home console did the best over Black Friday, it looks like the Xbox 360′s 750,000 consoles took first place, while Sony came in second with 525,000 PS3s and Nintendo came in third with 400,000 Wii U systems.

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Steelers QB Roethlisberger testing hurt shoulder

PITTSBURGH (AP) — Ben Roethlisberger can hold his newborn son Ben Jr. in his injured right arm just fine, thanks.

When the Pittsburgh Steelers quarterback will be able to say the same about a football, even he's not sure.

Roethlisberger practiced in a limited role Thursday and appears a long shot to return for Sunday's game in Baltimore.

"There's always a chance," Roethlisberger offered somewhat hopefully.

The lengthy list of issues still plaguing Roethlisberger more than two weeks after he sprained his right shoulder and suffered a dislocated rib in a 16-13 overtime win against Kansas City, however, suggests he's still a week away from giving it a go.

Though the pain isn't quite as intense as it was in the days after Kansas City linebacker Tamba Hali drilled Roethlisberger into the soggy Heinz Field turf, the two-time Super Bowl winner can still only sleep in certain positions at night. And while he's tested the shoulder this week, he's uncertain if he can make all the throws necessary to attack Baltimore's secondary.

"Can I put a lot of zip on the ball, throw it really hard before people like Ed Reed and defenders can get to the ball?" Roethlisberger said. "If I can't I'm not putting us in the best situation to win the game."

The Steelers (6-5) have struggled in Roethlisberger's absence, needing overtime to beat the woeful Chiefs before looking listless at times and sloppy at others in losses to Baltimore and Cleveland. A season that looked promising after a 24-20 win over the defending Super Bowl-champion Giants in New Jersey on Nov. 4 is suddenly on very shaky ground.

Still, don't expect Roethlisberger to push too quickly. It's something he's done in the past, with less than desired results. He played on a battered right ankle in San Francisco last year, limping around in a 20-3 loss. He ended up sitting out the next week and wasn't the same when he returned.

"We've had people talk about last year in San Francisco, if I would have rested maybe I would have been better off the next couple games but to me, I live for the here and now," he said. "I'm going to do everything I can to be out there and if it doesn't work then I'll do what I can about the next week."

Offensive coordinator Todd Haley said Roethlisberger threw "a little bit" on Thursday but the team continues to prepare as if Charlie Batch will make his second straight start. Batch completed 20 of 34 passes for 199 yards and three costly interceptions against the Browns, mistakes Haley attributed to rusty timing more than physical ability.

"I don't think there's any limitations to what Chuck can do," Haley said, "or needs to do with the guys we have."

Roethlisberger remains optimistic Batch can muster some of the magic that helped him lead the Steelers to three victories since 2010 while filling in for his good friend.

"I firmly believe that," Roethlisberger said. "They know what he's capable of. He's been doing it a long time. They respect him. I think he's ready to rise to the occasion."

Something the Steelers need to do if they want to build any momentum going into the final quarter of the season. A loss in a place they struggle to play well in — no matter who is behind the center — would leave them with no wiggle room whenever Roethlisberger gets back to work.

The game's importance is not lost on Roethlisberger, who will wear "juiced up" pads to protect his shoulder, though doctors have told him the dislocated rib no longer poses a threat to his aorta.

That's welcome news for a guy in the first days of fatherhood. Roethlisberger called being a dad "pretty cool" and while he's enjoyed the time at home, he's also eager to go back to his job. If he doesn't play on Sunday he'll do what he's done the last two weeks and stand on the sideline — earbuds in place — and provide the kind of insight Batch has imparted on him so many times though the years.

"It's hard for me," Roethlisberger said. "You watched me during these games. I've been on the field more than most of the coaches because I'm just antsy to get out there."

That anxiousness, however, figures to be around for at least another week.

___

NOTES: While Roethlisberger is doubtful, S Troy Polamalu appears ready to play for the first time since Oct. 7. Polamalu practiced for the second straight day and barring a setback should be on the field in Baltimore. Polamalu has been limited to just five quarters all season due to a strained right calf ... Rookie G David DeCastro continued to make progress in his first week on the active roster after recovering from right knee surgery in August. Haley said he expects DeCastro to make an impact on the field before the end of the season.

___

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___

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Clearing the Fog Around Personality Disorders

For years they have lived as orphans and outliers, a colony of misfit characters on their own island: the bizarre one and the needy one, the untrusting and the crooked, the grandiose and the cowardly.

Their customs and rituals are as captivating as any tribe’s, and at least as mystifying. Every mental anthropologist who has visited their world seems to walk away with a different story, a new model to explain those strange behaviors.

This weekend the Board of Trustees of the American Psychiatric Association will vote on whether to adopt a new diagnostic system for some of the most serious, and striking, syndromes in medicine: personality disorders.

Personality disorders occupy a troublesome niche in psychiatry. The 10 recognized syndromes are fairly well represented on the self-help shelves of bookstores and include such well-known types as narcissistic personality disorder, avoidant personality disorder, as well as dependent and histrionic personalities.

But when full-blown, the disorders are difficult to characterize and treat, and doctors seldom do careful evaluations, missing or downplaying behavior patterns that underlie problems like depression and anxiety in millions of people.

The new proposal — part of the psychiatric association’s effort of many years to update its influential diagnostic manual — is intended to clarify these diagnoses and better integrate them into clinical practice, to extend and improve treatment. But the effort has run into so much opposition that it will probably be relegated to the back of the manual, if it’s allowed in at all.

Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh and chairman of the task force updating the manual, would not speculate on which way the vote might go: “All I can say is that personality disorders were one of the first things we tackled, but that doesn’t make it the easiest.”

The entire exercise has forced psychiatrists to confront one of the field’s most elementary, yet still unresolved, questions: What, exactly, is a personality problem?

Habits of Thought

It wasn’t supposed to be this difficult.

Personality problems aren’t exactly new or hidden. They play out in Greek mythology, from Narcissus to the sadistic Ares. They percolate through biblical stories of madmen, compulsives and charismatics. They are writ large across the 20th century, with its rogues’ gallery of vainglorious, murderous dictators.

Yet it turns out that producing precise, lasting definitions of extreme behavior patterns is exhausting work. It took more than a decade of observing patients before the German psychiatrist Emil Kraepelin could draw a clear line between psychotic disorders, like schizophrenia, and mood problems, like depression or bipolar disorder.

Likewise, Freud spent years formulating his theories on the origins of neurotic syndromes. And Freudian analysts were largely the ones who, in the early decades of the last century, described people with the sort of “confounded identities” that are now considered personality disorders.

Their problems were not periodic symptoms, like moodiness or panic attacks, but issues rooted in longstanding habits of thought and feeling — in who they were.

“These therapists saw people coming into treatment who looked well put-together on the surface but on the couch became very disorganized, very impaired,” said Mark F. Lenzenweger, a professor of psychology at the State University of New York at Binghamton. “They had problems that were neither psychotic nor neurotic. They represented something else altogether.”

Several prototypes soon began to emerge. “A pedantic sense of order is typical of the compulsive character,” wrote the Freudian analyst Wilhelm Reich in his 1933 book, “Character Analysis,” a groundbreaking text. “In both big and small things, he lives his life according to a preconceived, irrevocable pattern.”

Others coalesced too, most recognizable as extreme forms of everyday types: the narcissist, with his fragile, grandiose self-approval; the dependent, with her smothering clinginess; the histrionic, always in the thick of some drama, desperate to be the center of attention.

In the late 1970s, Ted Millon, scientific director of the Institute for Advanced Studies in Personology and Psychopathology, pulled together the bulk of the work on personality disorders, most of it descriptive, and turned it into a set of 10 standardized types for the American Psychiatric Association’s third diagnostic manual. Published in 1980, it is a best seller among mental health workers worldwide.

These diagnostic criteria held up well for years and led to improved treatments for some people, like those with borderline personality disorder. Borderline is characterized by an extreme neediness and urges to harm oneself, often including thoughts of suicide. Many who seek help for depression also turn out to have borderline patterns, making their mood problems resistant to the usual therapies, like antidepressant drugs.

Today there are several approaches that can relieve borderline symptoms and one that, in numerous studies, has reduced hospitalizations and helped aid recovery: dialectical behavior therapy.

This progress notwithstanding, many in the field began to argue that the diagnostic catalog needed a rewrite. For one thing, some of the categories overlapped, and troubled people often got two or more personality diagnoses. “Personality Disorder-Not Otherwise Specified,” a catchall label meaning little more than “this person has problems” became the most common of the diagnoses.

It’s a murky area, and in recent years many therapists didn’t have the time or training to evaluate personality on top of everything else. The assessment interviews can last hours, and treatments for most of the disorders involve longer-term, specialized talk therapy.

Psychiatry was failing the sort of patients that no other field could possibly help, many experts said.

“The diagnoses simply weren’t being used very much, and there was a real need to make the whole system much more accessible,” Dr. Lenzenweger said.

Resisting Simplification 

It was easier said than done.

The most central, memorable, and knowable element of any person — personality — still defies any consensus.

A team of experts appointed by the psychiatric association has worked for more than five years to find some unifying system of diagnosis for personality problems.

The panel proposed a system based in part on a failure to “develop a coherent sense of self or identity.” Not good enough, some psychiatric theorists said.

Later, the experts tied elements of the disorders to distortions in basic traits.

This article has been revised to reflect the following correction:

Correction: November 29, 2012

An earlier version of this article misstated the number of traits included in the proposed criteria for narcissistic personality disorder.   The final proposal relies on two personality traits, not four.

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U.S. Growth Revised Up, but Year-End Slowdown Is Feared

Even as the government said that the United States economy grew faster than first estimated in the third quarter, economists warned that the rate of expansion could slow sharply before the end of the year as worries mount about the fiscal impasse in Washington.

Nam Y. Huh/Associated Press

An employee on the assembly line this month at Generac Power Systems in Whitewater, Wis., a maker of residential generators.

The Commerce Department said Thursday that gross domestic product expanded at an annual rate of 2.7 percent in the three months ended Sept. 30, well above the 2 percent estimate it initially made in late October. But the revision was driven by increased inventory accumulation and a jump in federal spending — factors unlikely to be repeated in the current fourth quarter, economists said.

What’s more, the revised figures show spending by businesses on equipment and software declined by 2.7 percent in the third quarter, the first decrease since the end of the recession in mid-2009 and a sign of just how cautious many companies have become amid the uncertainty in Washington and slowing growth in Asia and Europe.

“It’s a nice headline number,” said Nigel Gault, chief U.S. economist at IHS Global Insight, of the 2.7 percent rate, “but it exaggerates the underlying momentum in the economy. Sustainable improvements in growth are not driven by inventories.”

The two biggest growth areas in the third quarter — inventory growth and federal spending — “are likely to be minuses in the fourth quarter,” he said. Mr. Gault expects the annual rate to sink to 1 percent this quarter, hurt by a fiscal stalemate in Washington as well as the aftereffects of Hurricane Sandy.

To be sure, there were signs of optimism in Thursday’s data. Residential fixed investment rose 14.2 percent, a sign that the housing recovery is gaining steam. Indeed, a separate report Thursday from the National Association of Realtors showed pending home sales rose to a two-and-a-half-year high.

And not all economists took a pessimistic view. “The economy certainly hasn’t taken off, but it’s nowhere close to a stall,” said David Kelly, chief global strategist for JPMorgan Funds. “The economy is still underperforming its full potential, but once we get past the ‘fiscal cliff’ uncertainty, we could see stronger growth next year.”

The new estimate of growth represents a substantial increase in the level of the second quarter, when the economy grew at a rate of just 1.3 percent. It also marks the fastest rate of expansion since the fourth quarter of 2011, when the economy grew at a 4.1 percent annual pace.

This was the second of the government’s three estimates of quarterly growth. The final figure is scheduled for Dec. 20.

“Over all, it was a disappointing report,” said Michelle Meyer, senior United States economist with Bank of America Merrill Lynch.  The accumulation of inventories went from subtracting 0.1 percentage points from the initial estimate to adding 0.8 percentage points, she said.

    “A lot of that inventory build was unintentional, which suggests a downside risk for the fourth quarter,” she said.  “Businesses had expected stronger sales and consumer spending and were caught off guard."

    Ms. Meyer said she expected the economy to grow by 1 percent in the fourth quarter and 1 percent in the first quarter of 2013, well below the level needed to bring down the unemployment rate, which stood at 7.9 percent in October.

    On Thursday, the government also reported that first-time unemployment claims dropped by 23,000 to 393,000 last week. But Ms. Meyer cautioned that these figures were much more volatile than usual because of the Thanksgiving holiday as well as Hurricane Sandy.

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As Opposition Meets in Cairo, More Violence Mars Syria

The Syrian opposition pushed ahead on military and political fronts on Wednesday, as rebels shot down a government warplane in the north of Syria and a newly formed coalition started talks in Cairo on how to pick a transitional government to replace that of President Bashar al-Assad.

The coalition, whose official name is the National Coalition of Syrian Revolutionary and Opposition Forces, was formed at a meeting in Qatar earlier this month, and has already been anointed with official recognition from Britain, France, Turkey and the members of the Gulf Cooperation Council. But in order to encourage further recognition internationally, it must tackle the broader problem of uniting multiple groups in exile and rebels on the ground in Syria.

That challenge was apparent on the first day of what are expected to be two days of talks in Egypt. Disagreements emerged over the composition of the coalition when the Syrian National Council, one of its members, tried to increase the number of its representatives.

“Nothing will proceed until we work this out,” said one council member at the talks, who spoke to Reuters on condition of anonymity.

The talks took place against the backdrop of a 20-month civil war in which about 40,000 people have been killed so far in clashes between armed rebels and jihadist forces on one side and Mr. Assad’s military on the other. The conflict has flared at various times along Syria’s borders with Lebanon, Israel, Turkey and Jordan and in most of the country’s cities, including deadly car bombings on Wednesday near Damascus, the capital.

In Turkey, once an ally of the Assad government, a team of NATO inspectors visited sites on Wednesday where the alliance might install batteries of Patriot antiaircraft missiles that Turkey, a member, has requested to prevent any incursions by the Syrian air force, which has become the Assad government’s main weapon against the rebels. Patriot missiles have also been discussed as a way of enforcing a no-fly zone over rebel-held areas of Syria near the Turkish border if one is imposed.

Meanwhile, opposition politicians gathered in a Cairo hotel to shape an alternative government. Ahmad Ramadan, a member of the national council, said in an interview with Radio Sawa, an Arabic-language broadcaster sponsored by the United States government, that the talks were more likely to decide on the selection process than to choose actual candidates.

Khaled Khoja, a coalition member attending the talks, said: “I don’t think we’ll be discussing the election of a transitional government during the meeting today. We’re still discussing whether to have a government or to have committees instead.”

State media said on Wednesday that at least 34 people, and possibly many more, died in the two car bombings in Jaramana, a suburb of Damascus that is populated by minorities.

The official SANA news agency said the explosions struck at about 7 a.m. and were the work of “terrorists,” the word used by the authorities to denote rebel forces seeking the overthrow of President Assad.

The agency said the bombings were in the main square of Jaramana, which news reports said is largely populated by members of the Christian and Druse minorities. Residents said the neighborhood was home to many families who have fled other parts of Syria because of the conflict and to some Palestinian families. The blasts caused “huge material damage to the residential buildings and shops,” SANA said.

The death toll was not immediately confirmed. An activist group, the British-based Syrian Observatory for Human Rights, initially said that 29 people had died but revised the figure later to 47, of whom 38 had been identified. Of the 120 injured, the rebel group said, 23 people were in serious condition, meaning that the tally could climb higher.

There were also reports from witnesses in Turkey and antigovernment activists in Syria that for the second successive day insurgents had shot down a government aircraft in the north of the country, offering further evidence that the rebels are seeking a major shift by challenging the government’s dominance of the skies. It was not immediately clear how the aircraft, apparently a plane, had been brought down.

Video posted on the Internet by rebels showed wreckage with fires still burning around it. The aircraft appeared to show a tail assembly clearly visible jutting out of the debris. Such videos are difficult to verify, particularly in light of the restrictions facing reporters in Syria. However, the episode on Wednesday seemed to be confirmed by other witnesses.

“We watched a Syrian plane being shot down as it was flying low to drop bombs,” said Ugur Cuneydioglu, who said he observed the incident from a Turkish border village in southern Hatay Province. “It slowly went down in flames before it hit the ground. It was quite a scene,” Mr. Cuneydioglu said.

Video posted by insurgents on the Internet showed a man in aviator coveralls being carried away. It was not clear if the man was alive but the video said he had been treated in a makeshift hospital. A voice off-camera says, “This is the pilot who was shelling residents’ houses.”

The aircraft was said to have been brought down while it was attacking the town of Daret Azzeh, 20 miles west of Aleppo and close to the Turkish border. The town was the scene of a mass killing last June, when the government and the rebels blamed each other for the deaths and mutilation of 25 people. The video posted online said the plane had been brought down by “the free men of Daret Azzeh soldiers of God brigade.”

On Tuesday, Syrian rebels said they shot down a military helicopter with a surface-to-air missile outside Aleppo and they uploaded video that appeared to confirm that rebels have put their growing stock of heat-seeking missiles to effective use.

In recent months, rebels have used mainly machine guns to shoot down several Syrian Air Force helicopters and fixed-wing attack jets. In Tuesday’s case, the thick smoke trailing the projectile, combined with the elevation of the aircraft, strongly suggested that the helicopter was hit by a missile.

Rebels hailed the event as the culmination of their long pursuit of effective antiaircraft weapons, though it was not clear if the downing on Tuesday was an isolated tactical success or heralded a new phase in the war that would present a meaningful challenge to the Syrian government’s air supremacy.

Hala Droubi reported from Dubai, United Arab Emirates. Alan Cowell contributed reporting from Paris; Sebnem Arsu contributed reporting from Istanbul, and Hania Mourtada from Beirut, Lebanon.

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Bonds, Clemens, Sosa on Hall ballot for first time

NEW YORK (AP) — The most polarizing Hall of Fame debate since Pete Rose will now be decided by the baseball shrine's voters: Do Barry Bonds, Roger Clemens and Sammy Sosa belong in Cooperstown despite drug allegations that tainted their huge numbers?

In a monthlong election sure to become a referendum on the Steroids Era, the Hall ballot was released Wednesday, and Bonds, Clemens and Sosa are on it for the first time.

Bonds is the all-time home run champion with 762 and won a record seven MVP awards. Clemens took home a record seven Cy Young trophies and is ninth with 354 victories. Sosa ranks eighth on the homer chart with 609.

Yet for all their HRs, RBIs and Ws, the shadow of PEDs looms large.

"You could see for years that this particular ballot was going to be controversial and divisive to an unprecedented extent," Larry Stone of The Seattle Times wrote in an email. "My hope is that some clarity begins to emerge over the Hall of Fame status of those linked to performance-enhancing drugs. But I doubt it."

More than 600 longtime members of the Baseball Writers' Association of America will vote on the 37-player ballot. Candidates require 75 percent for induction, and the results will be announced Jan. 9.

Craig Biggio, Mike Piazza and Curt Schilling also are among the 24 first-time eligibles. Jack Morris, Jeff Bagwell and Tim Raines are the top holdover candidates.

If recent history is any indication, the odds are solidly stacked against Bonds, Clemens and Sosa. Mark McGwire and Rafael Palmeiro both posted Cooperstown-caliber stats, too, but drug clouds doomed them in Hall voting.

Some who favor Bonds and Clemens claim the bulk of their accomplishments came before baseball got wrapped up in drug scandals. They add that PED use was so prevalent in the 1980s, 1990s and early 2000s that it's unfair to exclude anyone because so many who-did-and-who-didn't questions remain.

Many fans on the other side say drug cheats — suspected or otherwise — should never be afforded the game's highest individual honor.

Either way, this election is baseball's newest hot button, generating the most fervent Hall arguments since Rose. The discussion about Rose was moot, however — the game's career hits leader agreed to a lifetime ban in 1989 after an investigation concluded he bet on games while managing the Cincinnati Reds, and that barred him from the BBWAA ballot.

The BBWAA election rules allow voters to pick up to 10 candidates. As for criteria, this is the only instruction: "Voting shall be based upon the player's record, playing ability, integrity, sportsmanship, character, and contributions to the team(s) on which the player played."

That leaves a lot of room for interpretation.

Bonds, Clemens and Sosa won't get a vote from Mike Klis of The Denver Post.

"Nay on all three. I think in all three cases, their performances were artificially enhanced. Especially in the cases of Bonds and Clemens, their production went up abnormally late in their careers," he wrote in an email.

They'll do better with Bob Dutton of The Kansas City Star.

"I plan to vote for all three. I understand the steroid/PED questions surrounding each one, and I've wrestled with the implications," he wrote in an email.

"My view is these guys played and posted Hall of Fame-type numbers against the competition of their time. That will be my sole yardstick. If Major League Baseball took no action against a player during his career for alleged or suspected steroid/PED use, I'm not going to do so in assessing their career for the Hall of Fame," he said.

San Jose Mercury News columnist Mark Purdy will reserve judgment.

"At the beginning of all this, I made up my mind I had to adopt a consistent policy on the steroid social club. So, my policy has been, with the brilliance in the way they set up the Hall of Fame vote where these guys have a 15-year window, I'm not going to vote for any of those guys until I get the best picture possible of what was happening then," he wrote in an email.

"We learn a little bit more each year. We learned a lot during the Bonds trial. We learned a lot during the Clemens trial. I don't want to say I'm never going to vote for any of them. I want to wait until the end of their eligibility window and have my best idea of what was really going on," he said.

Clemens was acquitted this summer in federal court on six counts that he lied and obstructed Congress when he denied using performance-enhancing drugs.

Bonds was found guilty in 2011 by a federal court jury on one count of obstruction of justice, ruling he gave an evasive answer in 2003 to a grand jury looking into the distribution of illegal steroids. Bonds is appealing the verdict.

McGwire is 10th on the career home run list with 583, but has never received even 24 percent in his six Hall tries. Big Mac has admitted to using steroids and human growth hormone.

Palmeiro is among only four players with 500 homers and 3,000 hits, yet has gotten a high of just 12.6 percent in his two years on the ballot. He drew a 10-day suspension in 2005 after a positive test for PEDs, and said the result was due to a vitamin vial given to him by teammate Miguel Tejada.

Biggio topped the 3,000-hit mark — which always has been considered an automatic credential for Cooperstown — and spent his entire career with the Houston Astros.

"Hopefully, the writers feel strongly that they liked what they saw, and we'll see what happens," Biggio said last week.

Schilling was 216-146 and won three World Series championships, including his "bloody sock" performance for the Boston Red Sox in 2004.

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AP Baseball Writer Janie McCauley and AP Sports Writers Arnie Stapleton and Dave Skretta contributed to this report.

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Well: Weight Loss Surgery May Not Combat Diabetes Long-Term

Weight loss surgery, which in recent years has been seen as an increasingly attractive option for treating Type 2 diabetes, may not be as effective against the disease as it was initially thought to be, according to a new report. The study found that many obese Type 2 diabetics who undergo gastric bypass surgery do not experience a remission of their disease, and of those that do, about a third redevelop diabetes within five years of their operation.

The findings contrast with the growing perception that surgery is essentially a cure for Type II diabetes. Earlier this year, two widely publicized studies reported that surgery worked better than drugs, diet and exercise in causing a remission of Type 2 diabetes in overweight people whose blood sugar was out of control, leading some experts to call for greater use of surgery in treating the disease. But the studies were small and relatively short, lasting under two years.

The latest study, published in the journal Obesity Surgery, tracked thousands of diabetics who had gastric bypass surgery for more than a decade. It found that many people whose diabetes at first went away were likely to have it return. While weight regain is a common problem among those who undergo bariatric surgery, regaining lost weight did not appear to be the cause of diabetes relapse. Instead, the study found that people whose diabetes was most severe or in its later stages when they had surgery were more likely to have a relapse, regardless of whether they regained weight.

“Some people are under the impression that you have surgery and you’re cured,” said Dr. Vivian Fonseca, the president for medicine and science for the American Diabetes Association, who was not involved in the study. “There have been a lot of claims about how wonderful surgery is for diabetes, and I think this offers a more realistic picture.”

The findings suggest that weight loss surgery may be most effective for treating diabetes in those whose disease is not very advanced. “What we’re learning is that not all diabetic patients do as well as others,” said Dr. David E. Arterburn, the lead author of the study and an associate investigator at the Group Health Research Institute in Seattle. “Those who are early in diabetes seem to do the best, which makes a case for potentially earlier intervention.”

One of the strengths of the new study was that it involved thousands of patients enrolled in three large health plans in California and Minnesota, allowing detailed tracking over many years. All told, 4,434 adult diabetics were followed between 1995 and 2008. All were obese, and all underwent Roux-en-Y operations, the most popular type of gastric bypass procedure.

After surgery, about 68 percent of patients experienced a complete remission of their diabetes. But within five years, 35 percent of those patients had it return. Taken together, that means that most of the subjects in the study, about 56 percent — a figure that includes those whose disease never remitted — had no long-lasting remission of diabetes after surgery.

The researchers found that three factors were particularly good predictors of who was likely to have a relapse of diabetes. If patients, before surgery, had a relatively long duration of diabetes, had poor control of their blood sugar, or were taking insulin, then they were least likely to benefit from gastric bypass. A patient’s weight, either before or after surgery, was not correlated with their likelihood of remission or relapse.

In Type 2 diabetes, the beta cells that produce insulin in the pancreas tend to wear out as the disease progresses, which may explain why some people benefit less from surgery. “If someone is too far advanced in their diabetes, where their pancreas is frankly toward the latter stages of being able to produce insulin, then even after losing a bunch of weight their body may not be able to produce enough insulin to control their blood sugar,” Dr. Arterburn said.

Nonetheless, he said it might be the case that obese diabetics, even those whose disease is advanced, can still benefit from gastric surgery, at least as far as their quality of life and their risk factors for heart disease and other complications are concerned.

“It’s not a surefire cure for everyone,” he said. “But almost universally, patients lose weight after weight loss surgery, and that in and of itself may have so many health benefits.”

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State of the Art: Tablets Are Hot Holiday Gifts, but Which One to Buy? - Review

From left: J. Emilio Flores for The New York Times, Jim Wilson/The New York Times, Everett Kennedy Brown/European Pressphoto Agency

From left, the Kindle PaperWhite, the iPad Mini and the  Nexus 7.

The other day, I joined NPR for a segment about high-tech holiday gifts. I was ready for the calls from listeners. I’d brushed up on cameras, phones, laptops, music players and game consoles. I was prepared to talk about limiting screen time, digital addiction, cyberbullying. I knew where to get the best deals.

But all six callers had the same question: “What tablet should I get?”

There were variations, of course. “— for my kid?” “— for my elderly father?” “— just for reading?” “— for not much money?” But in general, it was clear: the gadget most likely to be found under the tree this year is thin, battery-powered and flat.

No wonder people are confused. The marketplace has gone tablet-crazy. There’s practically a different model for every man, woman and child.

There’s the venerable iPad, of course. And now the iPad Mini. There are new tablets from Google, also in small and large. There are Samsung’s Note tablets in a variety of sizes, with styluses. There are $200 touch-screen color e-book/video players. There’s a new crop of black-and-white e-book readers. There are stunningly cheap plastic models you’ve never heard of. There are tablets for children (and I don’t mean baby aspirin).

So how are you, the confused consumer, supposed to keep tabs on all these tablets? By taking this handy tour through the jungle of tablets 2012. Keep hands and feet inside the tram at all times.

DIRT-CHEAP KNOCKOFFS You can find no-name tablets for $100 or even less. You can also find mystery-brand Chinese tablets in toy stores, marketed to children.

Don’t buy them. They don’t have the apps, the features, the polish or the pleasure of the nicer ones. The junk drawer is already calling their names.

E-BOOK READERS The smallest, lightest, least expensive, easiest to read tablets are the black-and-white e-book readers. If the goal is simply reading — and not, say, watching movies or playing games — these babies are pure joy.

Don’t bother with the lesser brands; if you’re going to get locked into one company’s proprietary, copy-protected book format, you’ll reduce your chances of library obsolescence if you stick with Amazon or Barnes & Noble.

Each company offers a whole bunch of models. But on the latest models, the page background lights up softly, so that you can read in the dark without a flashlight. (These black-and-white models also look fantastic in direct sun — now you get the best of both lighting conditions.)

The one you want is the Kindle PaperWhite ($120), whose illumination is more even and pleasant than the equivalent Nook’s.

Of course, plain, no-touch, no-light Kindles, with ads on the screen saver, start as low as $70. But the light and the touch-screen are really worth having.

COLOR E-READERS/PLAYERS Amazon and B.& N. each sell a seven-inch tablet that, functionally, lands somewhere between an e-book reader and an iPad. They have beautiful, high-definition touch screens. They play music, TV shows, movies and e-books. They can surf the Web. They even run a few handpicked Android apps like Netflix and Angry Birds.

They’re nowhere near as capable as full-blown, computerlike tablets of the iPad/Nexus ilk, mainly because there are so few apps, accessories and add-ons. But they cost $200; you’re paying only a fraction of the price.

The big two here are, once again, Amazon and B.& N. If you’re not already locked in to one of those companies’ books and videos because you owned a previous model, the Nook HD is the one to get. It’s much smaller and lighter than the Kindle Fire HD. It has a much sharper screen. And the $200 price includes a wall charger (the Fire doesn’t) and no ads (the Fire does). Or get the classy Google Nexus 7, also $200. Although its book/music/movie catalog is far smaller, its Android app catalog is far larger (but see “iPad versus Android,” below).

BIG COLOR READERS/PLAYERS This year, both Amazon and B.& N. have introduced jumbo-screen (9-inch) versions of their HD tablets. Here again, B.& N. offers a better value than its 9-inch Kindle Fire HD rival. For $270, the Nook HD+ offers a sharper screen, lighter weight, no ads, a memory-card slot and a wall charger.

E-mail: pogue@nytimes.com

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