Health Centers Find Opportunity in Brownfields

PHILADELPHIA — The community health center rising on a derelict corner here in West Philadelphia never would have broken ground if not for the asbestos inside the building that was demolished to make way for it. Because of the contamination, Spectrum Health Services received a $2 million federal cleanup grant, the first piece of a $14 million construction financing puzzle.

When complete, the 36,000-square-foot building will provide a new home for a health center that has been squeezed into a deteriorating strip mall nearby for decades. It will also be the latest in a nationwide trend to replace contaminated tracts in distressed neighborhoods with health centers, in essence taking a potential source of health problems for a community and turning it into a place for health care. In recent years, health care facilities have been built on cleaned-up sites in Florida, Colorado, New Hampshire, Minnesota, Oregon and California.

“These health care providers are getting good at it,” said Elizabeth Schilling, policy manager for Smart Growth America, an advocacy group. “They have internalized the idea that this is an opportunity for them.”

Because these sites are contaminated, many qualify for government tax credits and grants, providing health centers with vital seed money to build. Community health centers, by design, exist to serve populations in poor neighborhoods, where there also tend to be available but contaminated properties like old gas stations, repair shops and industrial sites.

In fact, many of the country’s 450,000 contaminated sites, known as brownfields, are in poor neighborhoods, according to the Environmental Protection Agency. These tracts are disproportionately concentrated in poor communities because contaminated sites are more difficult to redevelop if property values are depressed. Banks are often reluctant to finance construction on a property that might require a costly cleanup.

“In communities where the real estate market isn’t working that well, you end up with a brownfield,” said Jody Kass, executive director of New Partners for Community Revitalization, a brownfield advocacy group.

“It’s a Catch-22,” said Phyllis B. Cater, chief executive of Spectrum Health Services. “The environmental issues are significant and yet there are scarce resources for communities to do the cleanup and remediation that’s required.”

But if the state or federal government provides the first piece of financing, other funders are more likely to fall into step.

Community health centers, in particular, are under pressure to grow. By 2015, the number of Americans who rely on community health centers for care is expected to double to 40 million from the 20 million who relied on the centers in 2010, according to the National Association of Community Health Centers. The Affordable Care Act allocated $11 billion to expand these centers. Of that, $1.5 billion was allotted to construction.

But finding a viable site is not always easy. It took Spectrum 15 years to find its new home on Haverford Avenue. The original building, an aging medical office, went up for auction in 2007 after the owner was arrested on a tax evasion charge. Spectrum bought the property for $650,000. Ms. Cater speculated that if Spectrum hadn’t bought the site, it most likely would have fallen into disrepair like the decaying row houses and the dilapidated bodega across the street that Spectrum hopes to redevelop eventually.

Spectrum currently occupies 10,000 square feet in a rundown strip mall four blocks away. The center is divided among three crowded spaces, so employees must walk outside to get from the medical offices to the billing department. The treatment rooms are dreary and cramped, with holes in the drywall and collapsing ceiling panels.

“I’ve seen better centers in rural Mississippi. This is not how you support a community,” Ms. Cater said.

When it opens next summer, the new, three-story center will have 34 exam rooms, eight dental rooms, a spacious community center and a full-service laboratory. It will also employ twice as many people as the current facility, adding 66 jobs to Spectrum’s payroll.

The 50-year-old building was in poor shape, but it was the presence of asbestos that allowed Spectrum to qualify for the critical first piece of financing: a $2 million brownfield redevelopment grant from the federal Department of Housing and Urban Development. The organization also received an additional $2 million H.U.D. loan that was tied to the brownfield grant, a $1.7 million redevelopment grant from Pennsylvania and $3.45 million in other loans.

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Moscow Journal: Book Gives Russians Close-Up of American Minutiae

MOSCOW — After 20 years of opining on weighty bilateral issues like NATO expansion and ballistic missile defense, the political analyst Nikolai V. Zlobin recently found himself trying to explain, for an uncomprehending Russian readership, the American phenomenon of the teenage baby sitter.

In Russia, children are raised by their grandmothers, or, if their grandmothers are not available, by women of the same generation in a similar state of unremitting vigilance against the hazards — like weather — that arise in everyday life. An average Russian mother would no sooner entrust her children’s upbringing to a local teenager than to a pack of wild dogs.

But of course much in everyday American life sounds bizarre to Russians, as Mr. Zlobin documents meticulously in his 400-page book, “America — What a Life!”

It seems strange, 20 years after the fall of the Iron Curtain, that ordinary Russians would still be hungry for details about how ordinary Americans eat and pay mortgages. But to Mr. Zlobin’s surprise, his book — published this year and marketed as a guide to Russians considering a move abroad — is already in its fifth print run, and his publisher has commissioned a second volume.

With the neutrality of a field anthropologist dispatched to suburbia, Mr. Zlobin scrutinizes the American practice of interrogating complete strangers about the details of their pregnancies; their weird habit of leaving their curtains open at night, when a Russian would immediately seal himself off from the prying eyes of his neighbors. Why Americans do not lie, for the most part. Why they cannot drink hard liquor. Why they love laws but disdain their leaders.

“The secret is that everyone wants to know what America is without its ideological blanket,” said Mr. Zlobin, who has lived in the United States on and off for 20 years and serves, at times, as an informal consultant to the Kremlin. “Originally I thought you had to watch the important issues, but it turns out what matters are the very basic ones.”

He is not the first Russian to engage in this exercise. In 1935, Ilya Ilf and Yevgeny Petrov, Soviet satirists, embarked on a road trip across the United States. Their book, “One-Story America,” described its residents’ earnestness (“Americans never say anything they do not mean”) their provinciality (“curiosity is almost absent”) and the ubiquity of advertising, which, they wrote, “followed us all over America, convincing us, begging us, persuading us, and demanding of us that we chew ‘Wrigley’s,’ the flavored, incomparable, first-class gum.”

That book, published less than two decades after the Bolshevik Revolution, was a touch subversive because it did not focus on the class struggle, then the Kremlin’s central talking point about the United States.

Mr. Zlobin is writing at a moment when state-controlled television casts the United States as a global bully, releasing waves of turbulence on the world and covertly undermining President Vladimir V. Putin. Mr. Zlobin does not make much effort to advance that thesis, instead suggesting, in his soft way, that Russian leaders would benefit from understanding what Americans are like.

“I often get appeals for help in Washington — ‘Get to know so and so,’ they tell me, naming some public figure, ‘We need to solve this problem,’ ” he writes. “It is difficult to explain that in the United States, in most cases, problems are not solved this way.”

Mr. Zlobin, who has lived in St. Louis, Chapel Hill, N.C., and Washington, finds his answers in middle-class neighborhoods that most Europeans never see. Readers have peppered him with questions about his chapter about life on a cul-de-sac. Most Russians grew up in dense housing blocks, where children ran wild in closed central courtyards. Cul-de-sac translates in Russian as tupik — a word that evokes vulnerability and danger, a dead end with no escape.

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New leaks suggest Microsoft Office for iOS could launch soon

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Redskins coach Shanahan says RG3 has mild sprain

ASHBURN, Va. (AP) — Washington Redskins coach Mike Shanahan said Monday that Robert Griffin III has a mild sprain of a ligament in the right knee and hasn't been ruled out for the upcoming game against the Cleveland Browns.

Shanahan said the injury is a Grade 1 sprain of the lateral collateral ligament on the outside of the knee, caused when the rookie quarterback was hit at the end of a scramble late in regulation in the Redskins' 31-28 overtime win Sunday over the Baltimore Ravens.

Shanahan says Griffin has mild swelling and is receiving treatment multiple times a day.

"He's definitely not ruled out for the Cleveland game," Shanahan said.

The LCL is one of four ligaments in the knee. A Grade 1 sprain typically means the ligament is stretched or has some minor tears.

The most severe knee injury usually associated with sports is a season-ending torn ACL, the anterior cruciate ligament. Griffin tore the ACL in his right knee while playing for Baylor in 2009, but Shanahan said Griffin's reconstructed ACL "looks great" and that there's "no problem there."

Fellow rookie Kirk Cousins will start if Griffin can't. Cousins threw a touchdown pass with 29 seconds remaining in the fourth quarter and ran in the game-tying 2-point conversion after Griffin was hurt.

"Both of them will have a game plan," Shanahan said. "And obviously Robert can do some things in the running game that Kirk can't."

The Redskins (7-6) have won four straight and trail the New York Giants by one game in the NFC East.

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Online: http://pro32.ap.org/poll and http://twitter.com/AP_NFL

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Mind: A Compromise on Defining and Diagnosing Mental Disorders

They plotted a revolution, fell to debating among themselves, and in the end overturned very little except their own expectations.

But the effort itself was a valuable guide for anyone who has received a psychiatric diagnosis, or anyone who might get one.

This month, the American Psychiatric Association announced that its board of trustees had approved the fifth edition of the association’s influential diagnostic manual — the so-called bible of mental disorders — ending more than five years of sometimes acrimonious, and often very public, controversy.

The committee of doctors appointed by the psychiatric association had attempted to execute a paradigm shift, changing how mental disorders are conceived and posting its proposals online for the public to comment. And comment it did: Patient advocacy groups sounded off, objecting to proposed changes in the definitions of depression and Asperger syndrome, among other diagnoses. Outside academic researchers did, too. A few committee members quit in protest.

The final text, which won’t be fully available until publication this spring, has already gotten predictably mixed reviews. “Given the challenges in a field where objective lines are hard to draw, they did a solid job,” said Dr. Michael First, a psychiatrist at Columbia who edited a previous version of the manual and was a consultant on this one.

Others disagreed. “This is the saddest moment in my 45-year career of practicing, studying and teaching psychiatry,” wrote Dr. Allen Frances, the chairman of a previous committee who has been one of the most vocal critics, in a blog post about the new manual, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM5.

Yet many experts inside and outside the process said the final document was not radically different from the previous version, and its lessons more mundane than the rhetoric implied. The status quo is hard to budge, for one. And when changes do happen, they are not necessarily the ones that were intended.

The new manual does extend the reach of psychiatry in some areas, as many critics feared it might. Hoarding is now a mental disorder (previously it was considered a symptom of obsessive-compulsive behavior). “Premenstrual dysphoric disorder,” a severe form of premenstrual syndrome, is also new (it was previously in the appendix).

And binge-eating disorder (also formerly in the appendix), a kind of severe, highly distressing gluttony, is now a full-blown diagnosis. This one by itself could tag millions of people considered healthy, if often overindulgent, with a psychiatric label, some experts said.

But the deeper story is one of compromise. It is most evident in how the committee handled three of the thorniest diagnoses in psychiatry: autism, depression and pediatric bipolar disorder.

The group working on depression declared early on that it wanted to eliminate the so-called bereavement exclusion, which stated that grieving the loss of a loved one should not be considered a clinical disorder, though it shares many of the same outward signs. Grief has always been a normal reaction to death, not a kind of depression.

Advocacy and support groups, such as those representing people who have lost a child, objected furiously to the idea that the bereaved might be given a diagnosis of depression.

“This was just astonishing, that they would eliminate the exclusion, and a distortion of the research on the subject,” said Jerome Wakefield, a professor of social work and psychiatry at New York University, who did not work on the manual.

In the end the committee cut a deal. It eliminated the grief exclusion but added a note in the text, reminding doctors that any significant loss — of a job, a relationship, a home — could cause depressive symptoms and should be carefully investigated.

“It’s like they took it all back,” Dr. Wakefield said. “I don’t like the way it was done — in a footnote — but it’s there.”

The debate over autism was even more furious, and it resulted in a similar rapprochement.

From the outset, the committee intended to tighten the definition of autism and simplify it, eliminating related labels like Asperger syndrome and “pervasive developmental disorder not otherwise specified,” or PDD-NOS. The rate of diagnosis of such conditions has exploded over the past decade, in part due to the vagueness of the definitions, and the committee wanted to draw clearer boundaries.

It proposed a single “autism spectrum disorder” category, with stricter requirements.

Some outside researchers raised concerns. In January one of them, Dr. Fred Volkmar of the Yale School of Medicine, who had quit the committee in protest, presented research suggesting that 45 percent or more of people who currently had an autism or related diagnosis would not have one under the proposed revision.

Autism groups reacted immediately, fearing that the change in the diagnosis would deny services to children and families who need them.

The committee countered with its own study, suggesting that the new definition would exclude about 10 percent of people currently with a diagnosis. And again, the experts took a half step back.

The new, streamlined definition was approved, but with language that took into account a person’s diagnostic history. “It’s explicit that anyone who’s had an Asperger’s or autism or PDD-NOS diagnosis before is now included,” said Catherine Lord, a committee member who worked on the new definition and who is director of the Center for Autism and the Developing Brain in New York. “Essentially everyone gets in.”

Pediatric bipolar disorder posed a different challenge.

In the 1990s and 2000s, psychiatrists began giving aggressive, explosive children a diagnosis of bipolar disorder in increasing numbers. The trend appalled many patient advocates and doctors.

Bipolar disorder, which is characterized by episodes of depression and mania, had previously been an adult problem; now the diagnosis is given to children as young as 2 — along with powerful psychiatric drugs and tranquilizers that also cause rapid weight gain. The committee wanted to stop the trend in its tracks, said experts who were involved.

Most of the children treated for bipolar disorder did not have it, recent research found. The committee settled on an alternative label: “disruptive mood dysregulation disorder,” or D.M.D.D., which describes extreme hostility and outbursts beyond normal tantrums.

“They essentially wanted to have some place for these kids, and D.M.D.D. was all they had in their kit,” said Dr. Gabrielle Carlson, a child psychiatrist at Stony Brook University Medical Center, who provided some outside consultation. “These are mostly kids who have A.D.H.D. or what we would call oppositional defiant disorder, but with this explosive feature. They need help; you can’t wait forever. The question was what to call it, without pretending we know enough to saddle them with a lifelong diagnosis” like bipolar disorder.

D.M.D.D. has its own problems, as many experts were quick to point out. It could be a symptom of an underlying condition, as Dr. Carlson argues. It could “medicalize” frequent temper tantrums. It’s brand new, and no one knows how it will play out in practice.

But it is now in the book — because it was the best solution available, experts inside and outside of the revision process said.

From beginning to end, many experts said, the process of defining psychiatric diagnoses is very much like finding the right one for an individual: it’s a process of negotiation, in many cases.

“That’s one of the take-aways from all this, and I think it’s a good one,” Dr. Carlson said. “A diagnosis is a hypothesis. It’s a start, and you have to start somewhere. But that’s all it is.”

One of the committee’s most ambitious proposals was perhaps the least noticed: a commitment to update the book continually, when there’s good reason to, rather than once every decade or so in a giant heave. That was approved without much fanfare.

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DealBook: U.S. to Sell Last Holdings of A.I.G. Common Stock

The Treasury Department said on Monday that it planned to sell its remaining holdings of common stock in the American International Group, essentially ending taxpayers’ four-year ownership of the bailed-out insurer.

The Treasury Department said that it had begun a public offering of its 15.9 percent stake in A.I.G., amounting to about 234.2 million shares. It is the latest in a string of sales by the federal government, which has quickly reduced taxpayers’ holdings over the last two years.

All that would be left is a relatively small number of warrants that give the department the right to buy additional shares in A.I.G.

If completed, the sale would represent the achievement of a long-held goal of both the Obama administration and A.I.G. itself: ending the government’s ownership of the insurer. For the Treasury Department, it would signify a complete exit from perhaps the most controversial rescue struck during the financial crisis of 2008. In return for making up to $182 billion available to the company, the government received a stake that at its peak represented 92 percent of the company.

And for A.I.G., it would represent an unambiguous transformation into a fully private enterprise, an insurer that has clambered back from the brink of annihilation. Over the last four years, the company has sold off a number of assets in an effort to repay its bailout.

While the Treasury Department did not outline a timetable for its latest stock offering, the sale is expected to be completed quickly. Unlike in previous offerings, A.I.G. is not expected to buy back any of the shares being offered.

A spokesman for A.I.G. declined to comment.

The offering is being run by Bank of America Merrill Lynch, Citigroup, Deutsche Bank, Goldman Sachs and JPMorgan Chase.

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Fear of Fighting Haunts Once-Tranquil Damascus

Muzaffar Salman/Reuters

Damascenes cling to the hope that the ethnic strife that has deepened when fighting has reached other areas will not arise in their city.

DAMASCUS, Syria — Business has been terrible for Abu Tareq, a taxi driver, so last week, without telling his wife, he agreed to drive a man to the Damascus airport for 10 times the usual rate. But, he said later, he will not be doing that again.

On the airport road, he could hear the crash of artillery and the whiz of sniper fire. Dead rebels and soldiers lay on the roadsides. Abu Tareq saw a dog eating the body of a soldier.

“I will never forget this sight,” said Abu Tareq, 50, who gave only a nickname for safety reasons. “It is the road of the dead.”

Damascus, Syria’s capital, is one of the world’s oldest continuously inhabited cities, a touchstone of history and culture for the entire region. Through decades of political repression, the city preserved, at least on the surface, an atmosphere of tranquillity, from its wide downtown avenues to the spacious, smooth-stoned courtyard of the Umayyad Mosque and the vine-draped alleys of the Old City, where restaurants and bars tucked between the storehouses of medieval merchants hummed with quiet conversation.

Now, though, the rumble of distant artillery echoes through the city, and its residents are afraid to leave their neighborhoods. Cocooned behind rows of concrete blocks that close off routes to the center, they huddle in fear of a prolonged battle that could bring destruction and division to a place where secular and religious Syrians from many sects — Sunni, Shiite, Alawite, Christian and others — have long lived peacefully.

For more than a week, Syrian rebels and government forces have fought for the airport road, as the military tries to seal off the capital city, the core of President Bashar al-Assad’s power, from a semicircle of rebellious suburbs. Rebels have now kept the pressure on the government for as long as they did during their previous big push toward Damascus last summer. This time, improved supply lines and tactics, some rebels and observers say, may provide a more secure foothold.

But the security forces wield overwhelming firepower, and while it has been unable to subdue the suburbs, some rebel fighters say they lack the intelligence information, arms and communication to advance. That raises the specter of a destructive standoff like the one that has devastated the commercial hub of Aleppo.

“Damascus was the city of jasmine,” Mahmoud, 40, a public-school teacher, said in an interview in the capital. “It is not the city I knew just a few weeks ago.”

Car bombs have ripped through neighborhoods, their targets and perpetrators only guessed at. Checkpoints choke traffic, turning 20-minute jaunts into three-hour ordeals. Wealthy residents find it quicker and safer to drive to Beirut, Lebanon, for a weekend trip than to the Old City.

Shells have been fired from Mount Qasioun overlooking Damascus, a favorite destination from which to admire the city’s sparkling lights. West of downtown, where the palace stands on a plateau, things are relatively quiet. But from the mountain, puffs of smoke can now be seen over suburbs in an arc from northeast to southwest.

Mahmoud, unable to find heating oil and medicine for his sick wife, said his grocer has lectured him daily on shortages and soaring prices. The once-ubiquitous government, he said, now appears to have no role beyond flooding streets with soldiers and security officers, “who are sometimes good and sometimes rude.”

People with roots in other towns have left, he said, “but what about me, who is a Damascene, and has no other city?”

The sense of claustrophobia has grown as rebels have declared the airport a legitimate target and the government has blocked Baghdad Street, a main avenue out of the city. On Sunday, it blocked the highway south to Dara’a.

In some outlying neighborhoods and nearby suburbs, the front lines seem to be hardening.

On the route into Qaboun, a neighborhood less than two miles from the center of Damascus, the last government checkpoint in recent days was near the municipal building. Less than a quarter-mile on, rebels controlled the area around the Grand Mosque.

An employee of The New York Times reported from Damascus, Syria, and Anne Barnard from Beirut, Lebanon. Neil MacFarquhar contributed reporting from Beirut.

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Top 10 Tech This Week

1. Here Comes the First Real Alternative to iPhone and Android

Jolla, a Finnish startup, launched a new mobile OS called Sailfish, which the company believes will become a legitimate alternative to the Coke and Pepsi of smartphone platforms: Apple’s iOS and Google’s Android. Learn more about the new OS.

Click here to view this gallery.

[More from Mashable: Jimmy Fallon and Mariah Carey Take on ‘All I Want For Christmas Is You’]

It’s been awhile since the big tech companies launched products in time for the holiday shopping season. So this week, tech news has mostly been filled with cool scientific developments and — of course — drones.

We learned about Swiss researchers who created an underwater drone that resembles a sea turtle, and a father who built a DIY drone to track his kid walking from home to the bus each morning.

[More from Mashable: News Corp. Kills ‘The Daily’]

This week, we also took a look at new innovations: One groups of scientists created the lightbulb of the future, and another team built the largest-ever model of a functioning brain.

There was also plenty of mobile news. Read up on a new Finnish mobile OS that aims to be the alternative to iOS and Android, and about a Casio watch that syncs with your iPhone.

For these stories and more, check out this week’s Top 10 Tech gallery, above.

This story originally published on Mashable here.

Wireless News Headlines – Yahoo! News

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New tragedy rocks NFL's regularly scheduled world

The games go on.

For the second straight weekend, tragedy rocked the regularly scheduled world of the NFL. It left families, friends, teammates and coaching staffs grieving over yet another senseless loss of life. It also left the league facing questions not only about efforts to safeguard players on the field but whether it's doing enough to help them stay out of harm's way once they step outside the white lines.

In the early-morning hours Saturday in Irving, Texas, 24-year-old Dallas Cowboys nose tackle Josh Brent got behind the wheel of his Mercedes alongside teammate Jerry Brown and sped off, the prelude to a one-car accident that would leave Brown dead at 25 and Brent sitting in jail facing a felony charge of intoxicated manslaughter.

All this happened little more than three years after Brent was sentenced to probation and 60 days in jail in a plea agreement following his drunken driving arrest while playing football at the University of Illinois, where he and Brown were teammates as well.

That it happened just a week after Kansas City linebacker Jovan Belcher shot his girlfriend to death, then drove to the Chiefs' training facility and took his own life with the same gun, raised questions about the league's responsibility to the young men it empowers and enriches — in some cases, almost overnight.

"I don't know that anybody has the answer, to be honest. They're human beings, kids in most of the cases like this, and they're going to make mistakes," said Dan Reeves, who played seven years for the Cowboys before launching an NFL coaching career that included four stops over four decades.

"As a coach, you've got more than 50 players, if you count practice squad guys, that you're trying to keep an eye on. And both the league and the team invest an awful lot of time and money trying to educate them about the opportunities and pitfalls that are set out in front of them. ...

"But no matter what you do, some are going to believe the bad stuff will never happen to them. And teams spend so much time together, they become like families. It's easy to get lulled into thinking you know which ones need a pat on the back and which ones a kick in the behind. Yet this shows we don't always learn the real strengths and weaknesses of some until it's too late. Everybody deals with that knowledge in their own way.

"But if you're going to play," Reeves said finally. "I don't know any other way to honor that person than to play as hard as you can."

The emotional scene that roiled Kansas City in the wake of Belcher's murder-suicide a week earlier shifted to Cincinnati, where the Cowboys arrived Saturday night to complete preparations before Sunday's kickoff against the Bengals.

The team cut short its regular two-hour meeting and made sure counselors were on hand to speak to players afterward. But when owner Jerry Jones spoke with a Fox interviewer outside the locker room shortly before the game, his eyes were rimmed red and he spoke haltingly about Brown.

"Our team loved him. They certainly are conscious of him and want his family to know and have as much of them as they can give. At the same time," he added, "they know that one of the best things they can do for him and his memory is to come to the game today, is go out and play well."

How the NFL responds to this latest tragedy remains to be seen. Earlier this summer, cognizant of both the rising number of domestic violence and DUI incidents involving players, Commissioner Roger Goodell pledged to address both problems.

"We are going to do some things to combat this problem because some of the numbers on DUIs and domestic violence are going up and that disturbs me," he told CBS Sports. "When there's a pattern of mistakes, something has got to change."

In several important ways, player conduct has already improved significantly since Goodell took over from Paul Tagliabue.

In 2006, Goodell's first season, 68 players were arrested for crimes more severe than a traffic violation. Since then, arrests for crimes including domestic violence, drunken driving and gun possession are down 40 percent.

Yet, as Goodell noted, the number of incidents in the last year have climbed at an alarming rate — according to one study, 21 of the league's 32 teams had at least one player charged with domestic violence or sexual assault — and the tragedies involving players on successive weekends has already prompted accusations that the league isn't doing nearly enough.

On Saturday in Kansas City, a dozen members of the Chiefs' organization attended a memorial service for Kasandra Perkins. Among them was general manager Scott Pioli, whom Belcher spoke with in the parking lot of the Chiefs facility to thank before turning the gun on himself. A day later, just as the Chiefs did against the Panthers last Sunday, the Cowboys rallied to win their game against the Bengals.

The team has already canceled its annual Christmas party, scheduled for Monday at Cowboys Stadium, and instead began planning a memorial service for Brown.

"From here on, they're in uncharted waters," Reeves said. "No one can point the best way forward. I was lucky in that sense: We never had to deal with the nightmare of losing a friend and teammate. One thing I'm certain of, though — it's going to haunt some of them for a long time to come."

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A Breakthrough Against Leukemia Using Altered T-Cells

PHILIPSBURG, Pa. — Emma Whitehead has been bounding around the house lately, practicing somersaults and rugby-style tumbles that make her parents wince.

It is hard to believe, but last spring Emma, then 6, was near death from leukemia. She had relapsed twice after chemotherapy, and doctors had run out of options.

Desperate to save her, her parents sought an experimental treatment at the Children’s Hospital of Philadelphia, one that had never before been tried in a child, or in anyone with the type of leukemia Emma had. The experiment, in April, used a disabled form of the AIDS virus to reprogram Emma’s immune system genetically to kill cancer cells.

The treatment very nearly killed her. But she emerged from it cancer-free, and seven months later is still in complete remission. She is the first child and one of the first humans ever in whom new techniques have achieved a long-sought goal — giving a patient’s own immune system the lasting ability to fight cancer.

Emma had been ill with acute lymphoblastic leukemia since 2010, when she was 5, her parents, Kari and Tom, said. She is their only child.

She is among just a dozen patients with advanced leukemia to have received the experimental treatment, which was developed at the University of Pennsylvania. Similar approaches are also being tried at other centers, including the National Cancer Institute and Memorial Sloan-Kettering Cancer Center in New York.

“Our goal is to have a cure, but we can’t say that word,” said Dr. Carl June, who leads the research team at the University of Pennsylvania. He hopes the new treatment will eventually replace bone-marrow transplantation, an even more arduous, risky and expensive procedure that is now the last hope when other treatments fail in leukemia and related diseases.

Three adults with chronic leukemia treated at the University of Pennsylvania have also had complete remissions, with no signs of disease; two of them have been well for more than two years, said Dr. David Porter. Four adults improved but did not have full remissions, and one was treated too recently to evaluate. A child improved and then relapsed. In two adults, the treatment did not work at all. The Pennsylvania researchers are presenting their results on Sunday and Monday in Atlanta at a meeting of the American Society of Hematology.

Despite the mixed results, cancer experts not involved with the research say it has tremendous promise, because even in this early phase of testing it has worked in seemingly hopeless cases.

“I think this is a major breakthrough,” said Dr. Ivan Borrello, a cancer expert and associate professor of medicine at the Johns Hopkins University School of Medicine.

Dr. John Wagner, director of pediatric blood and marrow transplantation at the University of Minnesota, called the Pennsylvania results “phenomenal,” and said they were “what we’ve all been working and hoping for but not seeing to this extent.”

A major drug company, Novartis, is betting on the Penn team, and has committed $20 million to building a research center on the Penn campus to bring the treatment to market.

Hervé Hoppenot, president of Novartis Oncology, called the research “fantastic” and said it had the potential — if the early results hold up — to revolutionize the treatment of leukemia and related blood cancers. Researchers say the same approach, reprogramming the patient’s immune system, may also be used eventually against tumors like breast and prostate cancer.

To perform the treatment, doctors remove millions of the patient’s T-cells — a type of white blood cell — and insert new genes that enable the T-cells to kill cancer cells. The new genes program the T-cells to attack B-cells, a normal part of the immune system that turns malignant in leukemia.

The altered T-cells — called chimeric antigen receptor cells — are then dripped back into the patient’s veins, and if all goes well they multiply like crazy and start destroying the cancer.

The T-cells home in on a protein called CD-19 that is found on the surface of most B-cells, whether they are healthy or malignant.

A sign that the treatment is working is that the patient becomes terribly ill, with raging fevers and chills — a reaction that oncologists call “shake and bake,” Dr. June said. Its medical name is cytokine-release syndrome, or cytokine storm, referring to the natural chemicals that pour out of cells in the immune system as they are being activated, causing fevers and other symptoms. The storm can also flood the lungs and cause perilous drops in blood pressure — effects that nearly killed Emma.

Steroids sometimes ease the reaction, but did not help Emma. Her temperature hit 105. She wound up on a ventilator, unconscious and swollen almost beyond recognition, surrounded by friends and family who had come to say goodbye.

But at the eleventh hour, a battery of blood tests gave the researchers a clue as to what might help save Emma: Her level of one of the cytokines, interleukin-6 or IL-6, had shot up a thousandfold. Doctors had never seen such a spike before and thought it might be what was making her so sick. Dr. June knew that a drug could lower IL-6 — his daughter takes it, for rheumatoid arthritis. It had never been used for a crisis like Emma’s, but there was little to lose. Her oncologist, Dr. Stephan A. Grupp, ordered the drug. The response, he said, was “amazing.”

Within hours, Emma began to stabilize. She woke up a week later, on May 2, the day she turned 7; the intensive-care staff sang “Happy Birthday.”

Since then, the research team has used the same drug, tocilizumab, in several other patients.

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