Well: No Consensus on Plantar Fasciitis

Phys Ed

Gretchen Reynolds on the science of fitness.

There are more charismatic-sounding sports injuries than plantar fasciitis, like tennis elbow, runner’s knee and turf toe. But there aren’t many that are more common. The condition, characterized by stabbing pain in the heel or arch, sidelines up to 10 percent of all runners, as well as countless soccer, baseball, football and basketball players, golfers, walkers and others from both the recreational and professional ranks. The Lakers star Kobe Bryant, the quarterback Eli Manning, the Olympic marathon runner Ryan Hall and the presidential candidate Mitt Romney all have been stricken.

But while plantar fasciitis is democratic in its epidemiology, its underlying cause remains surprisingly enigmatic. In fact, the mysteries of plantar fasciitis underscore how little is understood, medically, about overuse sports injuries in general and why, as a result, they remain so insidiously difficult to treat.

Experts do agree that plantar fasciitis is, essentially, an irritation of the plantar fascia, a long, skinny rope of tissue that runs along the bottom of the foot, attaching the heel bone to the toes and forming your foot’s arch. When that tissue becomes irritated, you develop pain deep within the heel. The pain is usually most pronounced first thing in the morning, since the fascia tightens while you sleep.

But scientific agreement about the condition and its causes ends about there.

For many years, “most of us who treat plantar fasciitis believed that it involved chronic inflammation” of the fascia, said Dr. Terrence M. Philbin, a board-certified orthopedic surgeon at the Orthopedic Foot and Ankle Center in Westerville, Ohio, who specializes in plantar fasciitis.

It was thought that by running or otherwise repetitively pounding their heels against the ground, people strained the plantar fascia, and the body responded with a complex cascade of inflammatory biochemical processes that resulted in extra blood and fluids flowing to the injury site, as well as enhanced pain sensitivity.

But instead of lasting only a few days and then fading, as acute inflammation usually does, the process can become chronic and create its own problems, causing tissue damage and continuing pain.

This progression is also what experts believed was happening when people developed chronic Achilles tendon pain, tennis elbow or other lingering, overuse injuries.

But when scientists actually biopsied fascia tissue from people with chronic plantar fasciitis, “they did not find much if any inflammation,” Dr. Philbin said. There were virtually none of the cellular markers that characterize that condition.

“Plantar fasciitis does not involve inflammatory cells,” said Dr. Karim Khan, a professor of family practice medicine at the University of British Columbia and editor of The British Journal of Sports Medicine, who has written extensively about overuse sports injuries.

Instead, plantar fasciitis more likely is caused by degeneration or weakening of the tissue. This process probably begins with small tears that occur during activity and that, in normal circumstances, the body simply repairs, strengthening the tissue as it does. That is the point of exercise training.

But sometimes, for unknown reasons, this ongoing tissue damage overwhelms the body’s capacity to respond. The small tears don’t heal. They accumulate. The tissue begins subtly to degenerate, even to shred. It hurts.

By and large, most sports medicine experts now believe that this is how we develop other overuse injuries, like tennis elbow or Achilles tendinopathy, which used to be called tendinitis. The suffix “itis” means inflammation. But since the injury isn’t thought to involve chronic inflammation, its name has changed.

This has not yet happened with plantar fasciitis, and may not, given what a mouthful fasciopathy would be.

The evolving medical opinions about plantar fasciitis matter, beyond nomenclature, though, because treatments depend on causes. At the moment, many physicians rely on injections of cortisone, a steroid that is both a pain reliever and anti-inflammatory, to treat plantar fasciitis. And cortisone shots do reduce the soreness. In a study published last year in BMJ, patients who received cortisone injections reported less heel pain after four months than those whose shots had contained a placebo saline solution.

But whether those benefits will last is unknown, especially if plantar fasciitis is, indeed, degenerative. In studies with people suffering from tennis elbow, another injury that is now considered degenerative, cortisone shots actually slowed tissue healing.

We need similar studies in people with plantar fasciitis, Dr. Khan said. “They have not been done.”

Thankfully, most people who develop plantar fasciitis will recover within a few months without injections or other invasive treatments, Dr. Philbin said, if they simply back off their running mileage somewhat or otherwise rest the foot and stretch the affected tissues. Stretching the plantar fascia, as well as the Achilles tendon, which also attaches to the heel bone, and the hamstring muscles seems to result in less strain on the fascia during activity, meaning less ongoing trauma and, eventually, time for the body to catch up with repairs.

To ensure that you are stretching correctly, Dr. Philbin suggests consulting a physical therapist, after, of course, visiting a sports medicine doctor for a diagnosis. Not all heel or arch pain is plantar fasciitis. And comfort yourself if you do have the condition with the knowledge that Kobe Bryant, Eli Manning and Ryan Hall have all returned to competition and Mr. Romney still runs.

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Boeing Engineers Approve Pact, but Tech Workers Say No

SEATTLE (AP) — The union representing Boeing Co.'s engineers and technical workers delivered a split decision on a new contract Tuesday, with the engineers accepting their offer and the technical workers rejecting theirs and authorizing a future strike.

The union had recommended that both units reject the contract offer because it would not provide pensions to new employees. They would have a 401k retirement plan instead.

The union called that unacceptable, but the Chicago-based airplane-maker said the change was important to the company's future.

The vote came as the company is trying to solve battery problems that have grounded its new 787s. The engineers and technical workers in the union work on plans for new planes and solve problems that arise on the factory floor.

While a strike by the technical workers is not imminent, the vote means the negotiating team can call one at any time, said Bill Dugovich, spokesman for the Society of Professional Engineering Employees in Aerospace.

The engineers' vote means those 15,500 employees have a new four-year contract in place, Dugovich said. Union negotiators hope to resume contract talks soon on behalf of the 7,400 technical workers, he said.

Boeing Commercial Airplanes President and CEO Ray Conner said in a statement that the company was pleased with the engineers' vote but "deeply disappointed" in the technical workers' rejection of what he called the company's "best and final" offer.

"The realities of the market require us to make changes so we can invest in new products and keep winning in this competitive environment ..." Conner said in his statement. "That's why our proposal to move future hires to an enhanced 401(k)-style retirement plan is so important, as we have repeatedly emphasized over the course of these negotiations."

Union members rejected one previous contract offer in October. SPEEA last went on strike for 40 days in 2000.

"With this second rejection by technical workers of Boeing takeaways, it's time for the company to stop wasting resources and improve its offer to reflect the value and contributions technical workers bring to Boeing," SPEEA Executive Director Ray Goforth said in a statement. "That way, we can avoid a strike and focus on fixing the problems of the 787 and restoring customer confidence in Boeing."

The latest labor unrest is happening as U.S. regulators launch an open-ended review of the 787's design and construction. Last month, a battery on a parked 787 caught fire in Boston. On Jan. 16, another 787 made an emergency landing in Japan after another battery problem.

All 50 787s that Boeing had delivered so far are grounded until the issue is resolved.

The union's nearly 23,000 employees are mostly in the Puget Sound region. Union leaders believe a strike would shut down Boeing production lines in Everett, Wash., where its big planes are made, as well as in Renton, Wash., where it cranks out the widely used 737.

The factory-floor assembly work is done by the members of the International Association of Machinists. The Machinists approved a new, four-year contract in December 2011, after a walkout in 2008 that contributed to a 3½-year delay in delivering the first 787.

It was also a factor in Boeing opening a plant in South Carolina, where laws make it more difficult to unionize.

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Civilian deaths in war in Afghanistan drop for first time in 6 years

KABUL, Afghanistan -- Civilian deaths in the war in Afghanistan dropped in 2012 for the first time in six years, a sign of lessening hostilities, but insurgents dramatically expanded their campaign of assassinating government supporters, the United Nations said Tuesday.

The annual U.N. report on civilian casualties in Afghanistan documented a 12% decline in civilian deaths, largely due to fewer ground operations, new limits on airstrikes by U.S.-led coalition forces and fewer suicide bombings by insurgents. Coalition operations resulted in 39% fewer civilian deaths, the report said.

A harsh winter that limited combat operations and insurgent movements also contributed to the drop in casualties as the 11-year conflict shifts to a new phase in which foreign forces step back and Afghan soldiers and police, who possess less deadly weapons, are almost entirely in the lead.

In all, 2,754 civilians died in the war last year, bringing the death toll to 14,728 since 2007, when the U.N. began tracking civilian casualties.

But the report said that targeted killings -- attacks against government employees, tribal and religious leaders and Afghans involved in peace efforts -- resulted in more than twice as many deaths and injuries in 2012, in part because Taliban-led insurgents increased their use of homemade bombs that spread damage over a wider area.

U.N. officials said they were particularly disturbed by a seven-fold increase in casualties among government workers, including the murders of the two top officials in the women’s affairs department in Laghman province, east of Kabul.

"Steep increases in the deliberate targeting of civilians perceived to be supporting the government demonstrates another grave violation of international humanitarian law," Jan Kubis, the U.N. special envoy to Afghanistan, said in a statement. He said the Taliban leaders’ promises to protect civilians so far amounted to "only words."

Insurgents were responsible for 81% of civilian casualties last year, compared to 72% in 2011, the report said, with improvised bombs being the single deadliest weapon.

Civilian deaths and injuries from operations by U.S.-led international forces and Afghan soldiers and police fell by 46%, the U.N. said, due largely to new restrictions by coalition commanders on airstrikes on residential dwellings.

Still, a NATO airstrike last week in eastern Kunar province reportedly killed 10 civilians in addition to four Taliban commanders, provoking fresh ire from President Hamid Karzai. The Afghan leader on Monday ordered his country’s security forces "not to request foreign airstrikes on residential areas" – a move that could further reduce civilian deaths but also hinder Afghan forces that have no air power of their own.

Marine Gen. Joseph F. Dunford, the coalition commander, said this week that his forces would comply with Karzai's order and could continue to operate effectively. The order does not apply to unilateral NATO operations, but experts say that in practice it could give U.S. forces cover for stepping back even further from combat operations as the Obama administration seeks to withdraw half of the remaining 66,000 American troops from Afghanistan by next February.

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Romanian cinema triumphs again with top Berlin award

BERLIN (Reuters) – Romania claimed another major scalp on the European film festival circuit this weekend when “Child’s Pose” won the Golden Bear in Berlin, underlining the country’s emergence as a powerhouse of hard-hitting cinema in the post-Communist era.

The film, directed by Calin Peter Netzer, tells the story of Cornelia, an obsessive mother who uses every trick in the book to prevent her son from going to jail after he kills a boy in a car accident.

It is the latest in a long list of critical hits that have enjoyed startling success at festivals like Berlin and Cannes in recent years, helping to bring Romania‘s cinema to a wider audience.

Some of Romania‘s top directors, who have enjoyed the artistic freedom that flourished after the death of Communist dictator Nicolae Ceausescu in 1989, dismiss talk of a cinematic “new wave”, saying it lumps together very different styles and stories.

But ever since Cristi Puiu’s “The Death of Mr. Lazarescu” hit Cannes in 2005, and two years later his compatriot Cristian Mungiu won the coveted Palme d’Or there for the harrowing abortion drama “4 Months, 3 Weeks and 2 Days”, Romanian cinema has been firmly on the map.

“It is an acknowledgement, I think, that Romanian cinema is still producing good quality cinema and has been for a few years and it is a good endowment that it is still like this,” Netzer told Reuters after receiving the Golden Bear for best film.

UNFLINCHING STORYTELLING

While each film differs, there is a common thread of unflinching storytelling and compelling human drama often laid out against the backdrop of a cold and uncaring society.

Netzer said “Child’s Pose” was not a critique of Romania today, despite its unflattering portrayal of flashy materialism and casual corruption among the nouveau riche.

“I think basically this is about a relationship, a kind of pathological relationship between mother and son,” he told reporters in Berlin after the closing ceremony late on Saturday.

“The rest – the corruption, the framework, the context, all of that is on a separate level and is really only a backdrop.”

Victory in Berlin is likely to give the movie a major boost in terms of distribution in Romania and beyond, although some critics wondered whether the alienating figures of both mother and son might limit its appeal.

“There’s an instant bond the audience has with the two young women in ’4 Months…’ which we are deliberately not supposed to have in ‘Child’s Pose’,” said Jay Weissberg, critic at trade publication Variety.

“The mother is a monstrous figure and her son is even worse.”

However he, like many others, was impressed by Luminita Gheorghiu’s portrayal of Cornelia, one of several standout performances in Berlin-nominated films by mature actresses making the most of the kind of parts rarely written in Hollywood.

Paulina Garcia was the popular winner of the best actress Silver Bear for her turn in Chilean film “Gloria”, in which she plays a 58-year-old divorcee who sets out to live life to the full despite her setbacks.

“We all face crossroads in our lives where we can retreat into ourselves or we can hit the dance floor,” said “Gloria” director Sebastian Lelio of his character.

The biggest surprise at the Berlin awards ceremony was the best actor prize going to Nazif Mujic, a Bosnian Roma who had never acted before and had to be talked into playing himself in a drama based on his real-life ordeal.

“An Episode in the Life of an Iron Picker”, made for just 30,000 euros ($ 40,000), tells the story of how Bosnian hospitals refused to operate on his wife after she miscarried because she was not insured, despite the fact that her life was in danger.

Best director went to U.S. filmmaker David Gordon Green for his quirky road movie “Prince Avalanche” and Iranian entry “Closed Curtain” picked up the best script prize for directors Kamboziya Partovi and Jafar Panahi.

Panahi made the movie in secret in defiance of a 20-year filmmaking ban and was not allowed to travel to Berlin to collect his award.

“Tradition and culture remain, politicians come and go,” Partovi told reporters after receiving the honour.

(Reporting by Mike Collett-White; Editing by Andrew Heavens)

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National Briefing | South: Abortion Curbs Clear Senate in Arkansas

The State Senate voted 25 to 7 on Monday to ban most abortions 20 weeks into a pregnancy. The measure goes back to the House to consider an amendment that added exceptions for rape and incest. The legislation is based on the belief that fetuses can feel pain 20 weeks into a pregnancy, and is similar to bans in several other states. Opponents say it would require mothers to deliver babies with fatal conditions. Gov. Mike Beebe has said he has constitutional concerns about the proposal but has not said whether he will veto it.

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Japan Finds Swelling in Second Boeing 787 Battery

TOKYO (Reuters) - Cells in a second lithium-ion battery on a Boeing Co 787 Dreamliner forced to make an emergency landing in Japan last month showed slight swelling, a Japan Transport Safety Board (JTSB) official said on Tuesday.

The jet, flown by All Nippon Airways Co, was forced to make the landing after its main battery failed.

"I do not know the exact discussion taken by the research group on the ground, but I heard that it is a slight swelling (in the auxiliary power unit battery cells). I have so far not heard that there was internal damage," Masahiro Kudo, a senior accident investigator at the JTSB said in a briefing in Tokyo.

Kudo said that two out of eight cells in the second battery unit showed some bumps and the JTSB would continue to investigate to determine whether this was irregular or not.

The plane's auxiliary power unit (APU) powers the aircraft's systems when it is on the ground. National Transportation Safety Board investigators in the United States are probing the APU from a Japan Airlines plane that caught fire at Boston's Logan airport when the plane was parked.

The U.S. Federal Aviation Authority grounded all 50 Boeing Dreamliners in commercial service on January 16 after the incidents with the two Japanese owned 787 jets.

The groundings have cost airlines tens of millions of dollars, with no solution yet in sight.

Boeing rival Airbus said last week it had abandoned plans to use lithium-ion batteries in its next passenger jet, the A350, in favor of traditional nickel-cadmium batteries.

Lighter and more powerful than conventional batteries, lithium-ion power packs have been in consumer products such as phones and laptops for years but are relatively new in industrial applications, including back-up batteries for electrical systems in jets.

(Reporting by Mari Saito; Editing by Richard Pullin)

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Seawater desalination plant might be just a drop in the bucket

CARLSBAD, Calif. — Dreamers have long looked to the Pacific Ocean as the ultimate answer to California's water needs: an inexhaustible, drought-proof reservoir in the state's backyard. In the last decade, proposals for about 20 desalting plants have been discussed up and down the coast.

But even with construction about to begin on the nation's largest seawater desalination facility, 35 miles north of San Diego, experts say it is doubtful that dream will ever be fully realized.

"While this Poseidon adventure may work out, I don't look for a lot of that," said Henry Vaux Jr., a UC Berkeley professor emeritus of resource economics who contributed to a 2008 National Research Council report on desalination.

The reasons boil down to money and energy. It takes a lot of both to turn ocean water into drinking water, driving the average price of desalinated supplies well above most other sources.

The purified water produced by the Poseidon Resources plant will cost the San Diego County Water Authority more than twice what it now pays the Metropolitan Water District of Southern California for supplies from Northern California and the Colorado River. Over the authority's 30-year contract with Poseidon, San Diego County ratepayers will pay between $3 billion and $4 billion for the desalted water, which is expected to provide no more than a tenth of their overall supply.

Seawater desalination is not new to California. There are number of small coastal plants, used mostly for research or industrial purposes, and a few, such as one on Catalina Island, that provide municipal supplies.

For reasons unique to the region, San Diego County will be the first to stick a big straw into the Pacific. It is at the end of the line for imported water, doesn't have much local groundwater and is perennially battling with Metropolitan, Southern California's wholesaler of imported supplies.

"I do believe it is worth it," said Tom Wornham, board chairman of the county water authority. "I would rather be apologizing to people in 10 years for the rate than the fact they would have no water."

Up the coast, other places have taken a pass on the Pacific. Los Angeles and Long Beach recently shelved seawater desalting plans after concluding that other water sources, such as conservation or recycling, are cheaper and easier to pursue.

Poseidon, a small, privately held company based in Stamford, Conn., started talking about developing a desalination plant in Carlsbad in late 1998. The road to construction has been so long and twisting that Global Water Intelligence, which covers the international water industry, last year listed the project among the "Top 10 Desalination Disasters" of all time.

It took years for the company to get the necessary state and local permits. Environmentalists filed multiple legal challenges, the last of which was only recently resolved in Poseidon's favor. A deal with a number of local water agencies in San Diego County fell apart.

In the end, the Poseidon supplies — up to 56,000 acre-feet a year — will sell for roughly $2,000 an acre-foot, more than double the company's 2004 estimate. (One acre-foot is enough to supply two average homes for a year.) The price will rise with inflation; if energy costs go up, so will the price of water.

On the other side of the Pacific, Australia offers a sobering lesson in the perils of diving too deeply into desalination.

When years of withering drought emptied the country's reservoirs, Australia commissioned six big coastal desalting plants, including some of the world's largest. Then the rains returned. Just as some of the operations were coming on line, they were no longer needed.

Four of the six plants are being idled because cheaper water is available. Australian politicians are bemoaning the desalination binge, complaining that it saddled ratepayers with "hyper-expensive" white elephants they have to pay for regardless of whether the plants are used.

"That's certainly the risk — that we build them when they're not necessary or we build them, frankly, too soon," said Heather Cooley of the Pacific Institute, an Oakland think tank.

Santa Barbara had a similar experience in the early 1990s, when it built a desalination plant during a severe statewide drought that ended before the facility was finished. The $34-million plant, with a tenth of the capacity of the Carlsbad facility, was never used beyond the testing phase, though it could still be brought into service in an emergency.

The $954-million Carlsbad project is being financed with $781 million in tax-exempt construction bonds sold by Poseidon and the water authority. The balance is coming from investors who anticipate a return of about 13%. IDE Americas Inc., the subsidiary of an Israeli firm that runs some of the world's largest coastal desalination facilities in the Middle East, has been hired to design and operate the plant, slated for completion in 2016.

The fresh water will be produced through reverse osmosis, an energy-intensive process that separates salts and contaminants from seawater by forcing it through sand filters and tightly coiled, synthetic membranes peppered with billions of tiny holes a fraction of the width of a human hair. The water will then be pumped inland for distribution — the opposite direction that drinking supplies are usually moved — requiring construction of a 10-mile underground pipeline that the water authority will own and operate.

Poseidon chose the Carlsbad location, next to the Encina Power Station, so it could draw from the power plant's cooling water discharge — thus avoiding the environmental harm of operating its own ocean intake.

But new federal and state environmental regulations are pushing coastal power plants to phase out the use of huge volumes of ocean water for cooling, thwarting that strategy. Poseidon expects the Encina station to be replaced within the decade with a new generating facility employing a different cooling system.

That will mean the desalter will have to pump directly from the ocean, sucking 300 million gallons a day. Of that, 100 million gallons will go through the reverse osmosis process, with half converted to fresh water and half to a concentrated brine. The brine, twice as salty as the sea, will be diluted in a mixing pool with the other 200 million gallons of intake and discharged to the ocean.

Destruction of marine life is a major environmental concern of ocean desalination. Raw seawater is full of tiny organisms, including plankton that form a critical part of the food chain and the young stages of fish and invertebrates. When the water they live in is pumped into a plant, they die.

The Coastal Commission is requiring Poseidon to restore 55 acres of marine wetlands in south San Diego Bay to compensate for the plant's projected effects. The State Water Resources Control Board is also developing new seawater desalination regulations that could force Poseidon to change its intake and discharge systems.

"They took a big risk in building this before the rules are finalized," said Joe Geever of the Surfrider Foundation, which tenaciously fought the Carlsbad proposal in court and argues that water agencies should turn to the ocean only as a last resort — after more environmentally benign sources such as recycling and storm-water capture have been aggressively pursued.

Poseidon, which is trying to line up customers for a similar-size desal plant proposed in Huntington Beach, says it is peddling more than water. "What we're selling is ... a reliability premium that's locally controlled, drought-proof," said Carlos Riva, the company's chief executive.

But even Poseidon doesn't predict that the Pacific will become California's dominant water supply. The state has too many other sources.

"We have quite a bit of water to move around," said Peter MacLaggan, the Poseidon executive who is overseeing the Carlsbad project. "I don't think it's ever going to be a majority of supply or anywhere close to that."

bettina.boxall@latimes.com

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<cite>Halo</cite> Creator Unveils Its Next Masterpiece, a Persistent Online World

"Citadel": Concept art from Bungie's Destiny.

BELLEVUE, Washington — Destiny, the new game from the creator of Halo, isn’t just another shooter. It’s a persistent online multiplayer adventure, designed on a galactic scale, that wants to become your new life.

“It isn’t a game,” went the oft-heard tagline at a preview event on Wednesday. “It’s a world where the most important stories are told by the players, not written by the developers.”

This week, Bungie Studios invited the press into its Seattle-area studio to get the first look at Destiny. Although the event was a little short on details — Bungie and Activision didn’t reveal the launch date, handed out concept art instead of screenshots, and dodged most of my questions — it gave an intriguing glimpse at what the creator of Halo believes is the future of shooters.

Bungie was acquired by Microsoft in 2000, and its insanely popular shooter was the killer app that put the original Xbox on the map. Bungie split off from its corporate parent in 2007, and Microsoft produced Halo 4 on its own last year. The development studio partnered up with mega-publisher Activision for its latest project, which was kept mostly secret until now.

Destiny, slated for release on PlayStation 3 and Xbox 360, isn’t exactly an MMO. Activision CEO Eric Hirshberg called it a “shared-world shooter” — multiplayer and online, but something less than massive.

“We’re not doing this just because we have the tech,” Hirshberg said. “We have a great idea, and we’re letting the concept lead the tech.”

Built with new development software created specifically for Destiny, this new game is set in Earth’s solar system and takes place after a mysterious cataclysm wipes out most of humanity. The remaining survivors create a “safe zone” underneath a mysterious alien sphere called “The Traveler.”

The enigmatic sphere imparts players with potent weapons, magic-like powers and defensive technology. Thanks to these gifts, people have begun reclaiming the solar system from alien invaders that moved in while humanity was down.

Bungie fired off a list of design principles that guide Destiny’s creation: Create a world players want to be in. Make it enjoyable by players of all skill levels. Make it enjoyable by people who are “tired, impatient and distracted.” In other words, you don’t have to be loaded for bear and pumped for the firefight of your life every time you log on to Destiny.

After this brief overview, writer/director Joseph Staten used concept art and narration to outline an example of what a typical Destiny player’s experience might be.

Beginning in the “safe zone,” a player would start out from their in-game home and walk into a large common area. From here, the player would be able to explore their surroundings and meet up with friends. Then, they might board their starships and fly to another planet, let’s say Mars, in order to raid territory held by aliens.

During this raid, other real players who traveled to the same zone (like visiting a particular server on an MMO) would be free to come and go as they please. For example, a random participant could simply walk on by. They could stop and observe. Or they could get involved in the fight. In this instance, Staten suggested that a passerby would join the raid and then break off from the group after the spoils were divvied up without any user interface elements to fuss with. Walk away, and it’s done.

Bungie made a point of saying several times over that Destiny will not have any “lobby”-type interfaces, or menus from which to choose from a list of quests. Instead, players will simply immerse themselves in the world and organically choose to participate in whatever activities they stumble upon. Bungie promised solo content, cooperative content, and competitive content, though it provided no further examples of these.

The developer said that by employing very specialized artificial intelligence working entirely behind the scenes, players will encounter other real players who are best suited for them to interact with, based on their experience levels and other factors.

Staten didn’t say how many players would be able to exist in the world at the same time, but said that characters will be placed in proximity to each other based on very specific criteria, not simply to “fill the world up.”

Bungie showed off three distinct character classes throughout the day’s presentations: Hunter, Titan and Warlock. Although no differences were outlined between them apart from the Warlock being able to use a kind of techno-magic, the developer was keen to emphasize the idea that each character in Destiny would be highly customized and unique, and will grow with the player over an extended period of time.

While many games make the same promise, Destiny’s vision of “an extended period of time” isn’t 100 hours. It’s more like 10 years.

Bungie’s plan is for the Destiny story to unfold gradually over the course of 10 “books,” each with a beginning, middle and end. Through this will run an overarching story intended to span the entire decade’s worth of games, although like many other topics covered during the day, Bungie gave little detail about how this will work.

The developer spent a lot of time emphasizing its claim that no game has been made at this scale before. Bungie says it has a whopping 350 in-house developers working on Destiny.

Senior graphics architect Hao Chen gave examples of the sort of impenetrable mathematics formulas that allow Bungie to craft environments and worlds at a speed that it claims was previously impossible.

Bungie’s malleable team system was also said to increase its output. With the ability to co-locate designers, artists, and engineers at any time, Bungie says it can go through exceptionally rapid on-the-spot iteration and improvement for each facet of the game.

Apart from highly improved technology and the basic concept of humanity taking back the solar system, there’s just not a lot of hard information on Destiny at the moment. One thing that was made quite clear is that the game will not be subscription-based. Every presenter was clear in stating that players will not pay a monthly fee to participate in this persistent world.

While fees may not be required, a constant connection to the Internet will be. Since the core concept of Destiny is exploring a world that exists outside of the player’s console and is populated by real people at all times, it “will need to be connected in order for someone to play,” said Bungie chief operating officer Pete Parsons.

Representatives from both Bungie and Activision gave vague answers when Wired pressed for further details, often stating that they “were not ready” to discuss specifics. Whether that means those things are still being kept from the press, or whether they have not yet been determined by the development team, was unclear.

Questions currently unanswered: How will players communicate? How will players interact with each other outside of combat? What content exists in the non-combat “safe zones”? Subscriptions may be out, but what about in-app purchases? Will player versus player combat be available? Will the game ship on a disc or be download only? Will its persistent world allow Xbox and PlayStation gamers to play together? What content and interactions will be possible via smartphones and tablets (which Bungie alluded to)? Will the fancy new tools be licensed to other developers?

And so on.

For now, Bungie is asking us to take it for granted that it will execute on a bold 10-year plan for a very different sort of shooter. In the history of the always-changing gaming industry, no one’s ever been able to pull off a 10-year plan for anything. Can Bungie do it?

Hey… they made Halo, right?

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Travis Barker skips Blink-182 Australia tour due to flying fear

(Reuters) – Travis Barker will skip the Australian tour of pop-punk band Blink-182, citing a long-term fear of flying that worsened after he survived a fatal crash nearly five years ago that killed two friends.

“I’m sorry to announce I won’t be joining Blink-182 on this Australian tour,” Barker, 37 and drummer for the group, wrote on Facebook. “I still haven’t gotten over the horrific events that took place the last time I flew when my plane crashed and four people were killed, two being my best friends.”

Barker was one of two survivors of the 2008 crash when a private plane he was on burst into flames during an aborted takeoff. He spent several months in hospital with injuries.

Barker said he had hoped to get to Australia by ship if need be for the tour, which starts on Wednesday in Sydney, but that schedules hadn’t worked out.

“Once again, I’m sorry to all the fans,” he said.

The band, also writing on Facebook, said Barker would be replaced on the tour by Brooks Wackerman from Bad Religion and Tenacious D.

“The band knew the chances of Travis overcoming his fear of flying, which was magnified after the horrible plane crash of 2008, would be a challenge, but we wanted to play for our fans in Australia nonetheless,” they said, adding that cancelling the tour had not been an option.

(Reporting by Elaine Lies; Editing by Paul Tait)

Music News Headlines – Yahoo! News

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Well: Health Effects of Smoking for Women

The title of a recent report on smoking and health might well have paraphrased the popular ad campaign for Virginia Slims, introduced in 1968 by Philip Morris and aimed at young professional women: “You’ve come a long way, baby.”

Today that slogan should include: “…toward a shorter life.” Ten years shorter, in fact.

The new report is one of two rather shocking analyses of the hazards of smoking and the benefits of quitting published last month in The New England Journal of Medicine. The data show that “women who smoke like men die like men who smoke,” Dr. Steven A. Schroeder, a professor of health and health care at the University of California, San Francisco, wrote in an accompanying editorial.

That was not always the case. Half a century ago, the risk of death from lung cancer among men who smoked was five times higher than that among women smokers. But by the first decade of this century, that risk had equalized: for both men and women who smoked, the risk of death from lung cancer was 25 times greater than for nonsmokers, Dr. Michael J. Thun of the American Cancer Society and his colleagues reported.

Today, women who smoke are even more likely than men who smoke to die of lung cancer. According to a second study in the same journal, women smokers face a 17.8 times greater risk of dying of lung cancer than women who do not smoke; men who smoke are at 14.6 times greater risk to die of lung cancer than men who don’t. Women who smoke now face a risk of death from lung cancer that is 50 percent higher than the estimates reported in the 1980s, according to Dr. Prabhat Jha of the Center for Global Health Research in Toronto and his colleagues.

After controlling for age, body weight, education level and alcohol use, the new analysis found something else: men and women who continue to smoke die on average 10 years sooner than those who never smoked.

Dramatic progress has been made in reducing the prevalence of smoking, which has fallen from 42 percent of adults in 1965 (the year after the first surgeon general’s report on smoking and health) to 19 percent in 2010. Yet smoking still results in nearly 200,000 deaths a year among people 35 to 69 years old in the United States. A quarter of all deaths in this age group would not occur if smokers had the same risk of death as nonsmokers.

The risks are even greater among men 55 to 74 and women 60 to 74. More than two-thirds of all deaths among current smokers in these age groups are related to smoking. Over all, the death rate from all causes combined in these age groups “is now at least three times as high among current smokers as among those who have never smoked,” Dr. Thun’s team found.

While lung cancer is the most infamous hazard linked to smoking, the habit also raises the risk of death from heart disease, stroke, pulmonary disease and other cancers, including breast cancer.

Furthermore, changes in how cigarettes are manufactured may have increased the dangers of smoking. The use of perforated filters, tobacco blends that are less irritating, and paper that is more porous made it easier to inhale smoke and encouraged deeper inhalation to achieve satisfying blood levels of nicotine.

The result of deeper inhalation, Dr. Thun’s report suggests, has been an increased risk of chronic obstructive pulmonary disease, or C.O.P.D., and a shift in the kind of lung cancer linked to smoking. Among nonsmokers, the risk of death from C.O.P.D. has declined by 45 percent in men and has remained stable in women, but the death rate has more than doubled among smokers.

But there is good news, too: it’s never too late to reap the benefits of quitting. The younger you are when you stop smoking, the greater your chances of living a long and healthy life, according to the findings of Dr. Jha’s international team.

The team analyzed smoking and smoking-cessation histories of 113,752 women and 88,496 men 25 and older and linked them to causes of deaths in these groups through 2006.

Those who quit smoking by age 34 lived 10 years longer on average than those who continued to smoke, giving them a life expectancy comparable to people who never smoked. Smokers who quit between ages 35 and 44 lived nine years longer, and those who quit between 45 and 54 lived six years longer. Even quitting smoking between ages 55 and 64 resulted in a four-year gain in life expectancy.

The researchers emphasized, however, that the numbers do not mean it is safe to smoke until age 40 and then stop. Former smokers who quit by 40 still experienced a 20 percent greater risk of death than nonsmokers. About one in six former smokers who died before the age of 80 would not have died if he or she had never smoked, they reported.

Dr. Schroeder believes we can do a lot better to reduce the prevalence of smoking with the tools currently in hand if government agencies, medical insurers and the public cooperate.

Unlike the races, ribbons and fund-raisers for breast cancer, “there’s no public face for lung cancer, even though it kills more women than breast cancer does,” Dr. Schroeder said in an interview. Lung cancer is stigmatized as a disease people bring on themselves, even though many older victims were hooked on nicotine in the 1940s and 1950s, when little was known about the hazards of smoking and doctors appeared in ads assuring the public it was safe to smoke.

Raising taxes on cigarettes can help. The states with the highest prevalence of smoking have the lowest tax rates on cigarettes, Dr. Schroeder said. Also helpful would be prohibiting smoking in more public places like parks and beaches. Some states have criminalized smoking in cars when children are present.

More “countermarketing” of cigarettes is needed, he said, including antismoking public service ads on television and dramatic health warnings on cigarette packs, as is now done in Australia. But two American courts have ruled that the proposed label warnings infringed on the tobacco industry’s right to free speech.

Health insurers, both private and government, could broaden their coverage of stop-smoking aids and better publicize telephone quit lines, and doctors “should do more to stimulate quit attempts,” Dr. Schroeder said.

As Nicola Roxon, a former Australian health minister, put it, “We are killing people by not acting.”

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