How Science Invented a Remarkable New Harder-Than-Diamond Nanomaterial

How do you design industrial tools that can top the most heavy-duty diamond-tipped devices? Easy: you create a new material that’s even harder than diamond.

Yes, it’s an oft-misstated “fact”: Diamond is the hardest material in the world. That title has been contested for some time now, and a paper published this month in Nature offers yet another contender.

“Ultrahard nanotwinned cubic boron nitride,” describes how researchers from the University of Chicago, the University of New Mexico, Yanshan University, Jilin University, and Hebei University of Technology compressed a form of boron nitride particles to an ultrahard version.

The transparent nuggets that resulted rivaled — and even exceeded — diamond in their hardness, according to tests run by the researchers. With a Vickers score of 108 GPa, it surpasses synthetic diamond (100 GPa) and more than doubles the hardness of commercial forms of cubic boron nitride.

The secret is in the nanostructure. Yongjun Tian and the other researchers started with onion-like boron nitride particles shaped a bit like a flaky rose — or, as Tian describes them, like Matryoshka dolls. When they compressed them at 1,800 Celsius and 15 GPa (around 68,000 times the pressure in a car tire), the crystals reorganized and formed in a nanotwinned structure.

In a nanotwinned crystalline structure, neighboring atoms share a boundary, the way neighboring apartments do. And like some apartments, the twins mirror each other. Typically, to make a substance harder, scientists decrease the size of the grains, which makes it harder for anything to puncture it — small grains equals less space between them for any point to enter. But the process hit a wall: in anything smaller than about 10 nm, inherent defects or distortions are nearly as big as the grains themselves, and thus weakens the structure.

But the nanotwinning also makes substances harder to puncture, and in the case of boron nitride, maintained that characteristic strength at sizes averaging about 4 nm, explains Tian. And as a bonus, the cubic boron nitride was stable at high temperatures as well.

“In our nanotwinned cBN, the excellent thermal stability and chemical inertness are maintained with hardness competitive to or even more than diamond, making it the most desirable tool material for industry,” says Tian.

He anticipates that, with further research, the product will be comparable in price to the softer, commercial forms of cubic boron nitride that are currently available. Probable uses include machining, grinding, drilling and cutting tools, as well as scientific instrumentation.

Of course, the problem is, to accurately measure the hardness of a material, scientists take an even harder substance, shape it into a pyramid, and see how much pressure is required to drive that pyramid into the material. That doesn’t work unless you have something you’re sure is harder, so the Vickers number for Tian’s cubic boron nitride is not necessarily the final word on the measurement, notes crystallographer Natalia Dubrovinskaia in Scientific American.

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Oscar nod for protest film cheers Palestinians

RAMALLAH, West Bank (Reuters) – Oscar-nominated documentary “5 Broken Cameras” screened for Palestinians for the first time on Monday, leaving locals hopeful that their struggle with Israel for land and statehood will gain a global audience.

The low-cost film is based on five years of amateur camera work by journalist Emad Burnat as he documented weekly protests against land seizures by Israeli forces and Jewish settlers in his village of Bil’in in the occupied West Bank.

Neighbors are killed in the protests and demolition equipment mars the landscape while the filmmaker captures his infant son’s rapid loss of innocence, heralded by his first words: “wall” and “army.”

“This is a film for those who were martyred. It’s bigger than me and bigger than Bil’in. More than a billion people follow the Oscars and they will know our struggle now,” Burnat said after the viewing.

His work will compete at next month’s Oscar ceremony against four other films, including a documentary called “The Gatekeepers” that looks at the decades-old Middle East conflict through the eyes of six top former Israeli intelligence bosses.

Although the perspective is very different, both movies share a surprisingly similar message — the Israeli occupation of the West Bank is morally wrong and must end.

Burnat’s film received a standing ovation at its premier in Ramallah, the Palestinians‘ administrative capital, with the audience excited to see their seemingly endless conflict splashed on the big screen.

“The film shows the whole world what occupation is. It wiped the happiness off the boy’s face at too young an age. This has been the experience for all of us,” said taxi driver Ahmed Mustafa, who brought his wife and child to the viewing

“It’s not all bad though. It shows that there is progress, there are victories, and that our cause is still alive and moving,” he said.

In 2007, Israel’s High Court ruled that the separation barrier built on Bil’in lands was illegal and ordered it rerouted, cheering activists. The ruling was finally implemented in 2011, but the protests continue.

ISRAELI CO-DIRECTION

Humble villagers in black-and-white chequered Palestinian scarves and smartly dressed city dwellers shared the same visceral reaction to scenes in the film that are much chronicled but seldom appear in feature-length film.

A shot of olive trees reduced to glowing embers after being torched by Jewish settlers coaxes an audible gasp from viewers.

“Oh God!” said one man.

But as Burnat’s camera captures defiant chants in the protagonists’ village accent, or rocks being hurled at fleeing Israeli jeeps, ecstatic applause filled the hall.

The film was co-directed by an Israeli activist and filmmaker, Guy Davidi. This close association has led some people to classify 5 Broken Cameras as an Israeli movie and it was rejected by a Morocco film festival for this reason.

However, Burnat said it had been shown in Iran and other Middle Eastern countries and denied that the joint production reflected any meaningful “normalization” of relations between Israel and the Palestinians.

“(Davidi) is a solidarity activist who came to the village to show his support. He was shown our material and agreed to help. This doesn’t represent Israeli-Palestinian collaboration,” Burnat said.

But the film’s action shows many examples of cooperation between Israeli solidarity activists and locals.

An Israeli photographer gives Burnat one of his five cameras, which are progressively shot or crushed in protests over the years, giving the film its name, and Israeli solidarity activists are shown helping to plan protests in Hebrew.

“Working jointly with an Israeli doesn’t diminish this work, it enhances it,” Palestinian student Amira Daood told Reuters.

“They’re not all against us. Some are opposed to what Israel is doing and the movie demonstrates that,” she said.

(Reporting By Noah Browning, editing by Paul Casciato)

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Rescuer Appears for New York Downtown Hospital

Manhattan’s only remaining hospital south of 14th Street, New York Downtown, has found a white knight willing to take over its debt and return it to good health, hospital officials said Monday.

NewYork-Presbyterian Hospital, one of New York City’s largest academic medical centers, has proposed to take over New York Downtown in a “certificate of need” filed with the State Health Department. The three-page proposal argues that though New York Downtown is projected to have a significant operating loss in 2013, it is vital to Lower Manhattan, including Wall Street, Chinatown and the Lower East Side, especially since the closing of St. Vincent’s Hospital after it declared bankruptcy in 2010.

The rescue proposal, which would need the Health Department’s approval, comes at a precarious time for hospitals in the city. Long Island College Hospital, just across the river in Cobble Hill, Brooklyn, has been threatened with closing after a failed merger with SUNY Downstate Medical Center, and several other Brooklyn hospitals are considering mergers to stem losses.

New York Downtown has been affiliated with the NewYork-Presbyterian health care system while maintaining separate operations.

“We are looking forward to having them become a sixth campus so the people in that community can continue to have a community hospital that continues to serve them,” Myrna Manners, a spokeswoman for NewYork-Presbyterian, said.

Fred Winters, a spokesman for New York Downtown, declined to comment.

Presbyterian’s proposal emphasized that it would acquire New York Downtown’s debt at no cost to the state, a critical point at a time when the state has shown little interest in bailing out failing hospitals.

The proposal said that if New York Downtown were to close, it would leave more than 300,000 residents of Lower Manhattan, including the financial district, Greenwich Village, SoHo, the Lower East Side and Chinatown, without a community hospital. In addition, it said, 750,000 people work and visit in the area every day, a number that is expected to grow with the construction of 1 World Trade Center and related buildings.

The proposal argues that New York Downtown is essential partly because of its long history of responding to disasters in the city. One of its predecessors was founded as a direct result of the 1920 terrorist bombing outside the J. P. Morgan Building, and the hospital has responded to the 1975 bombing of Fraunces Tavern, the 1993 and 2001 attacks on the World Trade Center, and, this month, the crash of a commuter ferry from New Jersey.

Like other fragile hospitals in the city, New York Downtown has shrunk, going to 180 beds, down from the 254 beds it was certified for in 2006, partly because the more affluent residents of Lower Manhattan often go to bigger hospitals for elective care.

The proposal says that half of the emergency department patients at New York Downtown either are on Medicaid, the program for the poor, or are uninsured.

NewYork-Presbyterian would absorb the cost of the hospital’s maternity and neonatal intensive care units, which have been expanding because of demand, but have been operating at a deficit of more than $1 million a year, the proposal said.

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Pfizer’s Profit Jumps on Sale of Nutrition Business

Pfizer Inc.'s fourth-quarter profit more than quadrupled, despite competition from generic drugs hurting sales of Lipitor and other medicines, because of a $4.8 billion gain from selling its nutrition business. The drugmaker's profit and sales both beat Wall Street expectations.

The world's biggest drugmaker said Tuesday that its net income was $6.32 billion, or 85 cents per share, up from $1.44 billion, or 19 cents per share, a year earlier.

Excluding the windfall from selling its nutrition business to Nestle SA for $11.5 billion on Nov. 30, and a total of $888 million for restructuring, legal and other one-time items, the Viagra maker would have had a profit of $3.51 billion, or 47 cents per share. That's 3 cents more than analysts surveyed by FactSet were expecting.

In early trading, the New York-based company's shares rose 26 cents, or 1 percent, to $27.10.

Revenue fell 7 percent to $15.1 billion, mainly due to generic competition to cholesterol blockbuster Lipitor. Analysts expected $14.35 billion.

"Overall, a good quarter driven by the revenue beat," BernsteinResearch analyst Dr. Timothy Anderson wrote to investors, calling Pfizer's 2013 financial forecast "a bit underwhelming."

Pfizer said it expects 2013 earnings per share of $2.20 to $2.30, excluding one-time items, and revenue of $56.2 billion to $58.2 billion. Analysts are expecting $2.28 per share and revenue of $57.55 billion.

Lipitor, which had reigned as the world's top-selling drug ever for nearly a decade, got U.S. generic competition in December 2011 and now has generic rivals in many major markets. The pill had been bringing Pfizer nearly $11 billion a year before then, down from its peak of $13 billion a year.

In the fourth quarter, Lipitor sales plunged 91 percent in the U.S. and 71 percent worldwide, to $584 million. A dozen other medicines also had lower sales due to generic competition.

Altogether, generic competition reduced prescription drug revenue by more than $2.1 billion. Unfavorable currency exchange rates lopped off another 2 percent, or $271 million.

However, several key newer drugs had double-digit sales increases, including fibromyalgia and pain treatment Lyrica, at $1.13 billion, painkiller Celebrex at $750 million, and the Prevnar 13 vaccine against meningitis and other pneumococcal infections, at $993 million. Viagra was up 6 percent at $553 million.

Altogether, Pfizer's prescription drug revenue fell 9 percent in the quarter, to $12.89 billion. The division was led by sales of primary-care medicines, which totaled $3.83 billion. Still, that was down 29 percent as Lipitor's sales in the two biggest markets, the U.S. and Japan, where shifted into the established products category. That segment, which markets off-patent drugs still popular in many countries, posted a 3 percent rise in revenue, to $2.37 billion.

Specialty products, such as Enbrel for psoriasis and rheumatoid arthritis, and hemophilia treatments Refacto AF and Benefix, had revenue dip 4 percent, to a combined $3.67 billion. Sales in emerging markets such as China and India jumped 17 percent, to $2.65 billion, while sales of cancer drugs, a newer focus for Pfizer, rose 9 percent to $370 million.

The animal health business saw revenue increase 6 percent, to $1.17 billion. Pfizer is set to sell about a 20 percent share in the business, called Zoetis, in an initial public offering on Friday.

The consumer health business saw revenue jump 16 percent, to $936 million, due to strong growth of Advil pain reliever and Centrum vitamins.

He said Pfizer will soon launch two new medicines, rheumatoid arthritis treatment Xeljanz and — with partner Bristol-Myers Squibb Co. — potential blockbuster Eliquis, for preventing heart attacks and dangerous clots in patients with the irregular heartbeat atrial fibrillation. CEO Ian Read said Pfizer's mid- to late-stage drug pipeline "continues to strengthen with key potential opportunities," including drugs for advanced breast cancer and three other types of cancer, one for high cholesterol and a meningococcal B vaccine for adolescents and young adults.

For the full year, net income was $14.57 billion, or $1.94 per share. That was down from $10.01 billion, or $1.27 per share, in 2011. Revenue totaled $58.99 billion, down 10 percent from $65.26 billion in 2011, before generic competition slashed sales of Lipitor and schizophrenia drug Geodon.

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'Argo' producer scours for the next stranger-than-fiction story

Hunched over a desk in his spartan Westwood apartment, David Klawans squints at his computer monitor and knits his brow in concentration. "I'm perusing," he says.

His eyes dart between headlines almost indecipherable on a Web page displaying about 800 stamp-sized images of newspapers from 90 different countries.

"Two kids running? What's that?" he exclaims before clicking on a photo. "Oh, it's refugees. Whatever. Moving on."

SAG 2013: Winners | Quotes | Photo Booth | Red carpet | Backstage | Best & Worst

Nearly every day, for upward of 10-hour stretches, the independent film producer speed-reads police blogs, articles from RSS feeds and niche-interest journals in dogged pursuit of an elusive prize: a story on which to base his next movie.

His biggest hit to date is "Argo." Before the film landed seven Oscar nominations (including one for best picture) and two Golden Globes (including best drama picture), before it generated more than $180 million in worldwide grosses, "Argo" existed as a declassified story in the quarterly CIA journal Studies in Intelligence, which Klawans happens to have been perusing one day in 1998.

"It's like going on the beach with a metal detector," the self-described news junkie says of his process. "Like Kanye West looks through records to sample on his songs, I'm looking for stories to turn into films."

Klawans, 44, has established himself as Hollywood's least likely movie macher by heeding the advice of his mentor, the old-school producer David Brown ("Jaws," "A Few Good Men"): "Read everything you can get your hands on."

Indefatigable in his quest to root out oddball, overlooked true-life stories, Klawans spins material most others ignore into cinematic gold.

OSCAR WATCH: "ARGO"

"Argo" took nearly 14 years to reach the big screen after Klawans read about CIA exfiltration expert Tony Mendez's rescue of six American diplomats hiding in Tehran during the 1979 Iran hostage crisis. Mendez (portrayed in the movie by "Argo's" director, Ben Affleck) posed the group as Canadian filmmakers scouting locations for a science-fiction film, created a fictitious production company and planted articles about the bogus project in Hollywood trade papers.

Throughout the '90s Klawans was scraping by as a production assistant for an L.A.-based Japanese TV commercial firm. He didn't own a car, so he bicycled to UCLA's magazine archive to check the story. In microfiche files, he came across the CIA's planted articles in the Hollywood Reporter and Variety from January 1980. "My jaw dropped," he says.

Problem was, Mendez already had representation at Creative Artists Agency and was preparing to publish a memoir, "The Master of Disguise." Even so, Klawans persuaded Mendez to let him attempt to set up a movie project. He eventually bought the rights to Mendez's life story as well.

OSCARS 2013: Nominations

"I'm cycling to pitch meetings wearing a backpack with a change of clothes. It's summertime and I'm sweating. And I'm getting to know studio security. They call me 'bike boy,'" remembers Klawans, who would switch from bike to business attire outside the studio gates. "I would basically throw my backpack behind a bush — I was embarrassed to look like a messenger guy."

The New York University film school graduate was born in Chicago. His family moved to Belgium when he was 2 and he grew up in Europe and the U.S. consuming a steady diet of sci-fi and fantasy films including "Star Wars."

He came close to setting up the "Argo" project as a cable TV movie. But when that deal fell through, Klawans says, "it hit me that Tony had planted stories in Variety and Hollywood Reporter as a cover. For the CIA, it's all about illusions and perception. I thought, 'That's what I'm going to do. I'm going to plant an "Argo" story in a magazine.'"

The producer had met former L.A. Weekly staff writer and "This American Life" contributor Joshuah Bearman through friends who thought the two shared an appreciation for offbeat material. Bearman also had experience turning a magazine story into a movie; an article he reported for Harper's became the 2007 documentary "The King of Kong: A Fistful of Quarters," about two die-hard video game players vying for the world's highest score in the vintage arcade game "Donkey Kong."

Klawans handed over his research and contacts to Bearman and proposed that the journalist write "Argo" as a magazine article that would entice movie backers.

Bearman landed an assignment from Wired magazine, then interviewed everyone he could: Mendez, officials in the State Department with knowledge of the exfiltration and Ken Taylor, the Canadian ambassador to Iran who housed some of the fugitive American diplomats, as well as the six embassy "houseguests."

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The Power of Paying: What Consumer Hotshots Can Learn From Corporate Drudges

Sometimes these days interoperability seems like a lost cause in the technology world. Twitter has been making life hard for startups that make Twitter clients; Facebook has been making life equally hard for Twitter; and Google is preventing anyone else from adding content to its own social network, Google+.

But even as the aforementioned advertising-driven companies have made life hard for developers, enterprise companies have proven that software interfaces for web interoperability can be reliable and robust – powerful enough, even, to build a company on.

Leading the charge has been Amazon, whose web services and software interfaces, or APIs, have emerged as key startup building blocks. Amazon’s S3 storage service and EC2 virtual server service have been like the polar opposite of the Twitter API: Steady where Twitter has been unpredictable, scalable where Twitter has imposed tight limits, and open ended where Twitter has been closed.

But the biggest and most obvious difference between the constrictive Twitter API and the empowering Amazon API is this: The former is free, while the latter costs money. In other words, paying Amazon up front can actually reduce costs long term compared to a free API like Twitter’s, since there’s less volatility and risk in the API itself. (A fair number of startups who bet big on the Twitter API are now cursing the decision, as Wired has documented previously.)

Amazon is hardly the only example of how it pays to bet on software interfaces with a solid revenue stream behind them. Salesforce.com, for example does brisk business with its paid platform cloud Heroku and with its App Exchange, which sells software that runs on its paid core customer relationship management offering. Even Apple’s iOS app store, while essentially free for developers, illustrates how much money can be made writing for a platform that serves paying customers.

“In the consumer world, API’s are usually driven by companies who also have their own direct-to-consumer offering, and thus there is inherent potential conflict in them leveraging their data and user base versus enabling others,” says Matt Murphy, a general partner at Kleiner Perkins Caufield & Byers who has overseen the venture capital firm’s mobile-focused iFund.

Outside of the consumer world, the case for providing a robust API is more clear-cut. Murphy cited as on example of this Twilio, which offers a paid API to connect applications to phone services like text messages, recorded information lines, and conference calls.

Companies like Twilio that make lots of revenue offering software interfaces have an incentive to maintain and improve those interfaces and to keep those interfaces open and running smoothly. That means building on such interfaces is safer, as a rule.

“You need to be mindful of the competitive dynamics,” says Paul Buchheit, a former Google engineer whose startup FriendFeed built on APIs from Facebook, Twitter, Flickr, and others. “The simplest question to ask is if the platform is the product, or if it exists mainly to support another product. The Amazon Web Services platform is the product, and so it’s unlikely that Amazon would do anything to harm the platform. However, in the case of Twitter, the platform is just a feature, and so they will do whatever they believe is best for the core Twitter product, even if that means killing the platform.”

“iOS is kind of in the in-between space of platform as product and platform as feature, and the obviously exercise much more control than Amazon does. I’d be very wary of building an iOS app that somehow competes with Apple, for example.”

Of course, paying customers don’t guarantee a software interface is reliable, just nor does a lack thereof mean a software interface is flaky. Google’s App Engine, for example, offers a paid API that has been criticized as unreliable and constrictive.

GitHub, meanwhile, has built an innovative business around the native API of the free, open-source software revision tracker git.

As a general guideline, however, you can safely assume that if you’re not paying money for an API now, there’s a good chance you’ll be paying, somehow, for your usage later.

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“Argo” boosts Oscar chances with two weekend award

LOS ANGELES (Reuters) – Iran hostage drama “Argo” won its second big award in two days on Sunday, boosting its chances of winning a best picture Oscar next month in a race that had been considered wide open.

“Argo” won best cast ensemble, the top prize, at the Screen Actors Guild Awards, while Daniel Day-Lewis and Jennifer Lawrence took lead acting honors.

On Saturday, “Argo” won the Producers Guild Award – a key measure of Hollywood sentiment – beating “Lincoln,” “Les Miserables,” and “Silver Linings Playbook,” which are all Academy Award best picture contenders.

“There was absolutely no way I thought we would win this award,” the film’s director and star, Ben Affleck, told reporters backstage after the SAG win. “Argo” is the true story of the rescue of U.S. diplomats stranded in Tehran after the 1979 Islamic Revolution.

Asked about his movie’s Oscar chances, Affleck said he was not in the business of “handicapping or trying to divine what’s going to happen down the road.”

“I don’t know what’s going to happen, nothing may happen, but it’s a wonderful opportunity to be on the ride,” Affleck added.

The Screen Actors Guild (SAG) ceremony is among the most-watched during Hollywood’s awards season because actors make up the largest voting group in the Academy of Motion Picture Arts and Sciences, which chooses the Oscar winners. The SAG honors are selected by about 100,000 actors working in the United States.

SAG prizes acting over directing, screenplay writing and other skills that usually factor into the Oscar best picture choice.

PLAYING DOWN OSCAR HOPES

British-born Day-Lewis, who has picked up a slew of awards for his intense portrayal of U.S. President Abraham Lincoln’s efforts to abolish slavery in “Lincoln,” confirmed his status as front-runner for what would be his record third Oscar on February 24.

But the actor played down his Oscar hopes backstage. “Members of the academy love surprises, so about the worst thing that can happen to you is if you’ve built up an expectation,” Day-Lewis told reporters.

Accepting his award on stage to a standing ovation, he recalled that “it was an actor that murdered Abraham Lincoln and, therefore, it is sometimes only fitting that, now and then, an actor tries to bring him back to life again.”

In one of the most closely contested categories, Lawrence, 22, was chosen best lead actress for playing an outspoken young widow in “Silver Linings Playbook” over Jessica Chastain’s feisty CIA agent in Osama bin Laden thriller “Zero Dark Thirty.”

Tommy Lee Jones, 66, won the best supporting actor trophy for his turn as radical Congressman Thaddeus Stevens in “Lincoln,” beating strong competition from Robert De Niro, who played a gruff father in “Silver Linings Playbook.”

Anne Hathaway, 30, won her first SAG award for her supporting role as the tragic Fantine in musical “Les Miserables.”

“I got my SAG card when I was 14 … And I have loved every single minute of my life as an actor,” said Hathaway, accepting the statuette.

SAG also handed out awards for performances in TV dramas, comedies and mini-series, and gave a lifetime achievement award to actor Dick Van Dyke.

In TV drama, the British cooks and countesses period show “Downton Abbey” won best ensemble cast. “Breaking Bad” star Bryan Cranston was named best actor and “Homeland’s” Claire Danes best actress.

“Modern Family” won the best comedy cast ensemble award for a third consecutive time. Alec Baldwin won best TV comedy actor for the 8th time for his role as an egotistical executive in “30 Rock” and his co-star Tina Fey took the honors for comedy actress ahead of the show’s final episode on Thursday.

(Additional reporting by Alex Dobuzinskis, editing by Stacey Joyce)

Movies News Headlines – Yahoo! News

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Well: Keeping Blood Pressure in Check

Since the start of the 21st century, Americans have made great progress in controlling high blood pressure, though it remains a leading cause of heart attacks, strokes, congestive heart failure and kidney disease.

Now 48 percent of the more than 76 million adults with hypertension have it under control, up from 29 percent in 2000.

But that means more than half, including many receiving treatment, have blood pressure that remains too high to be healthy. (A normal blood pressure is lower than 120 over 80.) With a plethora of drugs available to normalize blood pressure, why are so many people still at increased risk of disease, disability and premature death? Hypertension experts offer a few common, and correctable, reasons:

¶ About 20 percent of affected adults don’t know they have high blood pressure, perhaps because they never or rarely see a doctor who checks their pressure.

¶ Of the 80 percent who are aware of their condition, some don’t appreciate how serious it can be and fail to get treated, even when their doctors say they should.

¶ Some who have been treated develop bothersome side effects, causing them to abandon therapy or to use it haphazardly.

¶ Many others do little to change lifestyle factors, like obesity, lack of exercise and a high-salt diet, that can make hypertension harder to control.

Dr. Samuel J. Mann, a hypertension specialist and professor of clinical medicine at Weill-Cornell Medical College, adds another factor that may be the most important. Of the 71 percent of people with hypertension who are currently being treated, too many are taking the wrong drugs or the wrong dosages of the right ones.

Dr. Mann, author of “Hypertension and You: Old Drugs, New Drugs, and the Right Drugs for Your High Blood Pressure,” says that doctors should take into account the underlying causes of each patient’s blood pressure problem and the side effects that may prompt patients to abandon therapy. He has found that when treatment is tailored to the individual, nearly all cases of high blood pressure can be brought and kept under control with available drugs.

Plus, he said in an interview, it can be done with minimal, if any, side effects and at a reasonable cost.

“For most people, no new drugs need to be developed,” Dr. Mann said. “What we need, in terms of medication, is already out there. We just need to use it better.”

But many doctors who are generalists do not understand the “intricacies and nuances” of the dozens of available medications to determine which is appropriate to a certain patient.

“Prescribing the same medication to patient after patient just does not cut it,” Dr. Mann wrote in his book.

The trick to prescribing the best treatment for each patient is to first determine which of three mechanisms, or combination of mechanisms, is responsible for a patient’s hypertension, he said.

¶ Salt-sensitive hypertension, more common in older people and African-Americans, responds well to diuretics and calcium channel blockers.

¶ Hypertension driven by the kidney hormone renin responds best to ACE inhibitors and angiotensin receptor blockers, as well as direct renin inhibitors and beta-blockers.

¶ Neurogenic hypertension is a product of the sympathetic nervous system and is best treated with beta-blockers, alpha-blockers and drugs like clonidine.

According to Dr. Mann, neurogenic hypertension results from repressed emotions. He has found that many patients with it suffered trauma early in life or abuse. They seem calm and content on the surface but continually suppress their distress, he said.

One of Dr. Mann’s patients had had high blood pressure since her late 20s that remained well-controlled by the three drugs her family doctor prescribed. Then in her 40s, periodic checks showed it was often too high. When taking more of the prescribed medication did not result in lasting control, she sought Dr. Mann’s help.

After a thorough work-up, he said she had a textbook case of neurogenic hypertension, was taking too much medication and needed different drugs. Her condition soon became far better managed, with side effects she could easily tolerate, and she no longer feared she would die young of a heart attack or stroke.

But most patients should not have to consult a specialist. They can be well-treated by an internist or family physician who approaches the condition systematically, Dr. Mann said. Patients should be started on low doses of one or more drugs, including a diuretic; the dosage or number of drugs can be slowly increased as needed to achieve a normal pressure.

Specialists, he said, are most useful for treating the 10 percent to 15 percent of patients with so-called resistant hypertension that remains uncontrolled despite treatment with three drugs, including a diuretic, and for those whose treatment is effective but causing distressing side effects.

Hypertension sometimes fails to respond to routine care, he noted, because it results from an underlying medical problem that needs to be addressed.

“Some patients are on a lot of blood pressure drugs — four or five — who probably don’t need so many, and if they do, the question is why,” Dr. Mann said.

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Little Change on Wall Street

Wall Street stocks opened flat on Monday despite strong economic data and earnings results from Caterpillar, after a rally last week that took the Standard & Poor’s 500-stock index above 1,500 for the first time in more than five years.

The S.&P. 500 was off about a point in early trading, the Dow Jones industrial average gained 4 points, and the Nasdaq composite index added 0.1 percent.

Caterpillar, a Dow component, rose 2.5 percent after it reported adjusted fourth-quarter earnings that beat expectations, though revenue was slightly below forecasts. The heavy machinery maker also said it remained cautious on the economy despite recent improvements.

“You can’t find more of a global bellwhether than Cat, and people are pleased with the number, which suggests there could be less concern about slowing growth in China after this,” said Wayne Kaufman, chief market analyst at John Thomas Financial in New York.

Thomson Reuters data through Friday showed that of the 147 S.&P. 500 companies that have reported earnings so far, 68 percent exceeded expectations. Since 1994, an average of 62 percent of companies have topped expectations, while the average over the past four quarters stands at 65 percent.

A strong start to the earnings season has bolstered equities, with major averages rising for four straight weeks. The S.&P. has gained for eight straight days, its longest winning streak in eight years, and closed at its highest since Dec. 10, 2007. The Dow ended at its highest since Oct. 31, 2007.

The S.&P. 500 is about 4.1 percent away from its all-time closing high of 1,565.15 on Oct. 9, 2007.

The Commerce Department said Monday that orders for durable goods jumped 4.6 percent in December, a pace that far outstripped expectations for a rise of 1.8 percent.

“We continue to have a parade of better-than-expected economic reports. All in all, it’s a good picture. I think there’s a good chance we’ve reached a point of recognition where people don’t think the economy will crater,” Mr. Kaufman said.

In addition to a push from earnings, equities have also risen on an agreement in Washington to extend the government’s borrowing power. On Monday, Fitch Ratings said that agreement removed the near-term risk to the country’s AAA rating. Previously, the agency said the lack of an agreement would prompt a review of the sovereign rating.

Keryx Biopharmaceuticals said a late-stage trial of its experimental kidney disease drug met the main study goal of reducing phosphate levels in blood, sending shares up 41 percent.

In Europe, stocks were generally ahead in afternoon trading.

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Death toll in Brazil nightclub fire hits 245

BRASILIA, Brazil—

A fire swept through a crowded nightclub in southern Brazil early Sunday, killing at least 245 people and leaving at least 200 injured, police and firefighters said.

Police Maj. Cleberson Braida told local news media that the 245 bodies were brought for identification to a gymnasium in the city of Santa Maria.

That toll would make it one of the deadliest nightclub fires more than a decade.

The cause of the fire is not yet known, officials said. Officials earlier put the death toll at 180.

Civil Police and regional government spokesman Marcelo Arigoni told Radio Gaucha earlier that the total number of victims is still unclear and there may be hundreds injured,

The newspaper Diario de Santa Maria reported that the fire started at around 2 a.m. at the Kiss nightclub in the city at the southern tip of Brazil, near the borders with Argentina and Uruguay.

Rodrigo Moura, whom the paper identified as a security guard at the club, said it was at its maximum capacity of between 1,000 and 2,000, and partygoers were pushing and shoving to escape.

Ezekiel Corte Real, 23, was quoted by the paper as saying that he helped people to escape. “I just got out because I'm very strong,” he said.

“Sad Sunday”, tweeted Tarso Genro, the governor of the southern state of Rio Grande do Sul. He said all possible action was being taken and that he would be in the city later in the day.

Santa Maria is a major university city with a population of around a quarter of a million.

A welding accident reportedly set off a Dec. 25, 2000, fire at a club in Luoyang, China, killing 309.

At least 194 people died at an overcrowded working-class nightclub in Buenos Aires, Argentina, in 2004.

A blaze at the Lame Horse nightclub in Perm, Russia, broke out on Dec. 5, 2009, when an indoor fireworks display ignited a plastic ceiling decorated with branches, killing 152

A nightclub fire in the U.S. state of Rhode Island in 2003 killed 100 people after pyrotechnics used as a stage prop by the 1980s rock band Great White set ablaze cheap soundproofing foam on the walls and ceiling.

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