The New Old Age: The Gift of Reading

This is the year of the tablet, David Pogue of The Times has told us, and that may be good news for seniors who open holiday wrappings to find one tucked inside. They see better with tablets’ adjustable type size, new research shows. Reading becomes easier again.

This may seem obvious — find me someone over 40 who doesn’t see better when fonts are larger — but it’s the business of science to test our assumptions.

Dr. Daniel Roth, an eye specialist and clinical associate professor at the Robert Wood Johnson Medical School in New Brunswick, N.J., offered new evidence of tablets’ potential benefits last month at the annual meeting of the American Academy of Ophthalmology.

His findings, based on tests conducted with 66 adults age 50 and over: older people read faster (a mean reading speed of 128 words per minute) when using an iPad, compared to a newspaper with the same 10-point font size (114 words per minute).

When the font was increased to 18 points — easy to do on an iPad — reading speed increased to 137 words per minute.

“If you read more slowly, it’s tedious,” Dr. Roth said, explaining why reading speed is important. “If you can read more fluidly, it’s more comfortable.”

What makes the real difference, Dr. Roth theorizes, is tablets’ illuminated screen, which heightens contrast between words and the background on which they sit.

Contrast sensitivity — the visual ability to differentiate between foreground and background information — becomes poorer as we age, as does the ability to discriminate fine visual detail, notes Dr. Kevin Paterson, a psychologist at the University of Leicester, who recently published a separate study on why older people struggle to read fine print.

“There are several explanations for the loss of sensitivity to fine detail that occurs with older age,” Dr. Paterson explained in an e-mail. “This may be due to greater opacity of the fluid in the eye, which will scatter incoming light and reduce the quality of the projection of light onto the retina. It’s also hypothesized that changes in neural transmission affect the processing of fine visual detail.”

Combine these changes with a greater prevalence of eye conditions like macular degeneration and diabetic retinopathy in older adults, and you get millions of people who cannot easily do what they have done all their lives — read and stay connected to the world of ideas, imagination and human experience.

“The No. 1 complaint I get from older patients is that they love to read but can’t, and this really bothers them,” Dr. Roth said. The main option has been magnifying glasses, which many people find cumbersome and inconvenient.

Some words of caution are in order. First, Dr. Roth’s study has not been published yet; it was presented as a poster at the scientific meeting and publicized by the academy, but it has not yet gone through comprehensive, rigorous peer review.

Second, Dr. Roth’s study was completed before the newest wave of tablets from Microsoft, Google, Samsung and others became available. The doctor made no attempt to compare different products, with one exception. In the second part of his study, he compared results for the iPad with those for a Kindle. But it was not an apples to apples comparison, because the Kindle did not have a back-lit screen.

This section of his study involved 100 adults age 50 and older who read materials in a book, on an iPad and on the Kindle. Book readers recorded a mean reading speed of 187 words per minute when the font size was set at 12; Kindle readers clocked in at 196 words per minute and iPad readers at 224 words per minute at the same type size. Reading speed improved even more drastically for a subset of adults with the poorest vision.

Again, Apple’s product came out on top, but that should not be taken as evidence that it is superior to other tablets with back-lit screens and adjustable font sizes. Both the eye academy and Dr. Roth assert that they have no financial relationship with Apple. My attempts to get in touch with the company were not successful.

A final cautionary note should be sounded. Some older adults find digital technology baffling and simply do not feel comfortable using it. For them, a tablet may sit on a shelf and get little if any use.

Others, however, find the technology fascinating. If you want to see an example that went viral on YouTube, watch this video from 2010 of Virginia Campbell, then 99 years old, and today still going strong at the Mary’s Woods Retirement Community in Lake Oswego, Ore.

Ms. Campbell’s glaucoma made it difficult for her to read, and for her the iPad was a blessing, as she wrote in this tribute quoted in an article in The Oregonian newspaper:

To this technology-ninny it’s clear
In my compromised 100th year,
That to read and to write
Are again within sight
Of this Apple iPad pioneer

Caregivers might be delighted — as Ms. Campbell’s daughter was — by older relatives’ response to this new technology, a potential source of entertainment and engagement for those who can negotiate its demands. Or, they might find that old habits die hard and that their relatives continue to prefer a book or newspaper they can hold in their hands to one that appears on a screen.

Which reading enhancement products have you used, and what experiences have you had?

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Afghan Law Offering Abused Women Redress Makes Slow Gains

KABUL, Afghanistan — Women who suffer violence in Afghanistan are often afraid to report abuses to government authorities and rarely see their cases taken to trial, though prosecutors regularly obtain convictions when cases do go forward, according to a report released on Tuesday by the United Nations office here.

The detailed study of the Elimination of Violence Against Women Act, enacted by Afghanistan in 2009, found that the use of that law had increased significantly, with prosecutions doubling, but still lagging far behind the growing number of complaints.

More than 4,000 reports of abuse of women were recorded by the Afghanistan Independent Human Rights Commission from over the seven months ending in October, which far outstrips the number recorded during the 12 preceding months, March 2011 to March 2012.

However, in the United Nations’ study of 16 Afghan provinces, including some of the most populous, only a small percentage of those reports were registered with the police or the courts, and prosecutors took barely a third of the complaints — just 163 — to trial. Still, they obtained 100 convictions.

The antiviolence law lists 22 acts that constitute violence against women, including rape, forced prostitution, forced marriage, child marriage, harassment or persecution, and causing injury or disability.

The reasons for the huge gap between the number of reports and the number investigated and brought to trial have much to do with Afghan culture, which discourages discussing family troubles with strangers, and with widespread discrimination against women, which leads to “acceptance of violence against them,” said Georgette Gagnon, the director of human rights for the United Nations’ Afghanistan office, who discussed the findings at a news conference.

In many places, the police and prosecutors discourage women from pressing their case in court, Ms. Gagnon said. The commitment of government authorities ranges widely, with some deeply supportive of the law — to the extent of risking their lives to help women — and others reluctant to move cases into the courts.

“Rather than following required legal procedures in all cases, police and prosecutors’ offices continue to refer numerous cases, including serious crimes of violence against women, to jirgas and shuras for advice or resolution,” she said.

Shuras and jirgas, tribal councils that rely on male elders to determine a solution, often return women to the circumstances in which they were abused, and only rarely punish the perpetrators. The use of shuras and jirgas is especially prevalent in ethnic Pashtun areas of the country, but it is not unknown in Tajik areas. Of 52 cases registered by the provincial office of the Ministry of Women’s Affairs in Nangarhar Province in eastern Afghanistan, 17 were sent to jirgas, according to the report.

The report noted that in some areas, government authorities appeared to be so reluctant to invite public attention that they reported no cases of abuse at all. That was the case in Panjshir Province, which is overwhelmingly ethnic Tajik, as well as in Wardak and Logar Provinces, which are both majority Pashtun. In Panjshir, abuse complaints were diverted to jirgas, the United Nations report said.

Women are afraid to make their troubles public in part because they fear retribution from those who abused them, Ms. Gagnon said. “Women will tell you that most of them don’t go to authorities to complain,” she said. “And how would they go? They can’t get out of the house.”

Prosecutors are most active in Herat, in western Afghanistan, and in Kabul, the two largest metropolitan areas, which together accounted for more than half of the instances of violence that were registered with prosecutors’ offices. That indicated better systems for reporting there and perhaps a greater awareness of the issues, women’s rights advocates said.

Still, the tiny percentage of prosecutions outraged the advocates, who said a major problem was a culture of impunity that allowed abusers who occupied positions of power in communities to go unpunished, discouraging prosecutions.

“Given the high number of cases of violence against women, from now on we should stop using the word ‘violence’ and use the word ‘crime’ when we talk about this,” said Selay Ghaffar, a member of the Afghan Women’s Network. “Unfortunately, those who violate women’s rights have not been punished, and they still walk free.”

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Tagliabue overturns Saints suspensions

NEW ORLEANS (AP) — Former NFL Commissioner Paul Tagliabue overturned the suspensions of four current and former New Orleans Saints players in the league's bounty investigation of the club.

Tagliabue, however, found that three of the players engaged in conduct detrimental to the league. He said they participated in a performance pool that rewarded key plays — including hard tackles — that could merit fines. But he stressed that the team's coaches were very much involved.

"Unlike Saints' broad organizational misconduct, player appeals involve sharply focused issues of alleged individual player misconduct in several different aspects," said a portion of ruling released by the NFL. "My affirmation of Commissioner Goodell's findings could certainly justify the issuance of fines. However, this entire case has been contaminated by the coaches and others in the Saints' organization."

Tagliabue was appointed by his successor, Commissioner Roger Goodell, to handle a second round of player appeals to the league in connection with the Saints' cash-for-hits program run by former defensive coordinator Gregg Williams from 2009-2011. The players initially opposed his appointment.

Saints linebacker Jonathan Vilma had been given a full-season suspension, while defensive end Will Smith, Cleveland linebacker Scott Fujita and free agent defensive lineman Anthony Hargrove each received shorter suspensions.

Fujita was the only player cleared of conduct detrimental to the league by Tagliabue.

None of the players sat out any games because of suspensions. They have been allowed to play while appeals are pending, though Fujita is on injured reserve and Hargrove is not with a team.

Shortly before the regular season, the initial suspensions were thrown out by an appeals panel created by the league's collective bargaining agreement. Goodell then reissued them, with some changes, and now those have been dismissed.

Meanwhile, the players have challenged the NFL's handling of the entire process in federal court, but U.S District Judge Ginger Berrigan had been waiting to see how the latest round of appeals played out before deciding whether to get involved.

With the player suspensions overturned, the end of a nearly 10-month dispute over how the NFL handled an investigation that covered three seasons and gathered about 50,000 pages of documents could be near.

NFL investigators found that Vilma and Smith were ring-leaders of a cash-for-hits program that rewarded injurious tackles labeled as "cart-offs" and "knockouts." The NFL also concluded that Hargrove lied to NFL investigators to help cover up the program.

Goodell also suspended Williams indefinitely, while banning Saints head coach Sean Payton for a full season.

Tagliabue's ruling comes after a new round of hearings that for the first time allowed Vilma's attorneys and the NFL Players Association, which represents the other three players, to cross-examine key NFL witnesses in the probe. Those witnesses included Williams and former Saints assistant Mike Cerullo, who was fired after the 2009 season and whose email to the league, accusing the Saints of being "a dirty organization," jump-started the probe.

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News Analysis: A Debate on Coated Aspirins and Aspirin Resistance

Millions of Americans take low-dose aspirin every day to prevent heart attacks and strokes. But a study published last week challenges some cherished beliefs about the familiar remedy, leaving some consumers to wonder if they should throw out their coated pills and others concerned that they unnecessarily may be taking expensive substitutes.

The study, published in the journal Circulation, by researchers at the University of Pennsylvania, tested 400 healthy people for evidence that aspirin did not work in them, a phenomenon called “aspirin resistance.” Aspirin prevents blood platelets from sticking together, which can lead to heart attacks and strokes. Previous studies have estimated that anywhere from 5 to 40 percent of the population is resistant to aspirin’s effects.

But the study essentially found that the condition doesn’t exist: they could not document a single case of true aspirin resistance in their sample. What had appeared to be aspirin resistance, they said, actually was caused by the coating commonly used on aspirin pills intended to protect the stomach. The coating slowed the drug’s absorption into the body.

The study didn’t evaluate whether coated aspirin was less likely to prevent heart attacks or strokes, said Dr. Garret FitzGerald, one of the authors. And people who took the coated aspirin in his study eventually showed a response to it.

But people who seek out coated aspirin may be doing so unnecessarily, he said, especially since previous studies have not consistently shown that the coating even prevents gastric problems.

“There’s no rationale for you to be on coated aspirin,” said Dr. FitzGerald, who is a cardiologist and chairman of pharmacology at the University of Pennsylvania.

Some cardiologists have begun advising patients to seek out uncoated aspirin because other studies have suggested that the uncoated type may be more effective. But finding it isn’t so easy. Even cheaper store brands, like those sold by CVS and Wal-Mart, come with a so-called enteric coating. One of the few uncoated aspirins on the market is St. Joseph’s chewable variety — the old orange-flavored baby aspirin.

But other experts, like Dr. Steven E. Nissen, a cardiologist at the Cleveland Clinic, see no real harm in taking coated aspirin, which is cheap and readily available. Many major studies of aspirin have been conducted using the coated variety.

The new study also calls into question the very idea of aspirin resistance. Testing for the condition became more widespread in the early 2000s, as expensive prescription alternatives like the blood thinner Plavix (also called clopidogrel) gained popularity. Many cardiologists suspected that the timing was not a coincidence.

“Before clopidogrel, we had never heard of aspirin resistance,” said Dr. Sanjay Kaul, a cardiologist at Cedars-Sinai Medical Center in Los Angeles. “It seemed to be that this was driven mostly by marketing considerations.” The new study raises the possibility that many patients may have been falsely told that aspirin doesn’t work on them, Dr. Kaul and other experts said.

The University of Pennsylvania study was partially financed by Bayer, the world’s largest manufacturer of branded aspirin, much of which is coated. In a statement, Bayer challenged some of the study’s conclusions and methods, and also said there was evidence that the enteric coating can reduce gastric side effects.

Critics of Dr. FitzGerald’s study also argue that he should have studied aspirin resistance in patients with conditions like heart disease, rather than in healthy people.

But even these critics acknowledge that testing for resistance is probably not worthwhile. Dr. Nissen, who is critical of Dr. FitzGerald’s study, doesn’t test his patients for aspirin resistance. But he said he would be reluctant to switch a patient from another drug back to aspirin now if a test had previously shown they were aspirin-resistant. Changing treatments is always risky, he said.

“If the patient is not bleeding, is not having a complication, am I going to take it away?” Dr. Nissen wondered. “That’s the dilemma we face.”

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Michigan Legislature Approves Labor Limit

Fabrizio Costantini for The New York Times

Protesters argued on the steps of the Michigan Capitol on Tuesday as state lawmakers considered right to work legislation.

LANSING, Mich. — The Michigan Legislature approved sweeping legislation on Tuesday that vastly reduces the power of organized labor in a state that has been a symbol of union dominance and served as an incubator for union activity over decades of modern American labor history.

The two bills, approved by the House of Representatives over the shouts of thousands of angry union protesters who gathered on the lawn outside the Capitol building, will among other things, bar both public and private sector union workers from being required to pay fees as a condition of their employment.

The bills have already been approved by the State Senate, and Gov. Rick Snyder has said he intends to sign the legislation as soon as this week. Procedural maneuvering could still briefly delay the bill through calls for reconsideration.

Lisa Posthumus, a House Republican, who said her family included union members, said the legislation gave workers the freedom to make their own choices. “Yes, we are witnessing history,” she said. “This is the day when Michigan freed its workers.”

Mark Meadows, a House Democrat, had a different take. “I was hoping that this day would never come,” he said. “In the last two years there’s been a chipping away at bargaining. But today, the corporations delivered the coup de grâce.”

From a distance, there would seem no more unlikely a success for such legislation than Michigan, where labor, hoping to demonstrate strength after a series of setbacks, asked voters last month to enshrine collective bargaining into the State Constitution.

But that ballot measure failed badly, and suddenly a reverse drive was under way that has brought the state to a moment startling in its symbolism. How the home of the United Automobile Workers finds itself on the cusp of becoming the 24th state to ban compulsory union fees — and only the second state to pass such legislation in a decade — is the latest chapter in a larger battle over the role of unions in the industrial heart of the nation.

As the debate over the bills intensified Tuesday, the authorities closed the Capitol after saying the building had reached its capacity of more than 2,000. That left thousands of noisy union members — many dressed in red — on the lawn outside, although the doors to the building were opened again later in the morning.

Streets around the Capitol were also closed to traffic and clusters of state police, some equipped with riot gear, kept posts throughout the building and along nearby streets.

At least two school districts around the state announced that they would close for the day, as word spread that teachers and other workers planned to protest in Lansing.

As Republicans in the state House moved uncommonly swiftly to pass the measures, union demonstrators outside — the sound of their drumbeats becoming progressively louder inside the chamber — chanted, “Kill the bill! Kill the bill!”

Once the first bill — related to public employees — was approved by a 58-to-51 vote, union supporters cried out from the gallery, “Recall! Recall! Recall!”

Republicans hold a 64-to-46 majority in the state House, and aside from a few dissenters, the vote was generally along party lines.

The second bill, covering private sector unions, was passed by the House about an hour and a half later by a 58-to-52 vote.

Democrats around the nation, including President Obama, have denounced the measures in recent days.

“You know, these so-called right-to-work laws, they don’t have to do with economics,” said Mr. Obama, during a visit to a truck factory outside Detroit on Monday. “They have everything to do with politics. What they’re really talking about is giving you the right to work for less money.”

Before the first House vote Tuesday, Democrats had sought to slow down the proceedings by employing whatever tactics they could dream up. One was to offer an array of amendments with the idea of destabilizing the bill by a thousand cuts. Among the suggestions: Send the question to a public vote. Each amendment however, was quickly rejected.

Mary M. Chapman contributed reporting in Lansing, and Steven Yaccino in Chicago.

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Morsi Spokesman Tries to Clarify Military Order

Petr David Josek/Associated Press

Demonstrators camping out in Cairo's Tahrir Square on Monday.

CAIRO — A day after President Mohamed Morsi formally directed the military to help keep public order and authorized soldiers to arrest civilians, a spokesman on Monday sought to draw distinctions between the order and the forms of martial law that the Egyptian Army had previously imposed.

The spokesman, Khaled Al-Qazzaz, said the president had called upon the military for the limited purpose of protecting polling stations during Saturday’s constitutional referendum. He also said the president had instructed the army to refer any civilians arrested by soldiers to a civilian court for trial, instead of military tribunals, reversing the blanket authorizations that the Egyptian military has long demanded when it takes on a policing role in the streets.

“This is very different from what happened under the SCAF,” said Mr. Qazzaz, referring to the Supreme Council of the Armed Forces, which ruled Egypt after President Hosni Mubarak was ousted and until Mr. Morsi took over. “What the president did with the cabinet is, anyone arrested will be referred to a normal judicial process and it will go to a normal civilian court. There will be no military trials.”

Ending military trials was a rallying cry of the opposition when the council was in charge, but it was not immediately clear on Monday how the instructions Mr. Qazzaz described might fit within the written order or the usual rules of the Egyptian military.

Heba Morayef, a researcher with Human Rights Watch, noted that the text of the order allowed the military to continue taking civilians to military courts. “Had he wanted to,” Ms. Morayef said, “President Morsi could have stipulated that the military’s jurisdiction would have been limited in this case and that every civilian will be referred to a civilian court, but he chose not to.” She also noted that the draft constitution specifically allows for the military to continue bringing civilians to military courts for trial if they disobey a military authority. “As long as the military is deployed, the military has jurisdiction under the military code of justice,” she said.

The debate over the military’s role in the referendum added to the intensifying political crisis over Egypt’s draft constitution, which the president and his Islamist allies are trying to pass quickly. After announcing its “complete rejection of the referendum” on Sunday, a coalition of the president’s opponents indicated on Monday that it was still debating whether to call for a boycott of the charter or to campaign for a vote against it.

There are also splits among Egypt’s judges, who are supposed to supervise the referendum. On Monday, a group representing administrative court judges said that under certain conditions they would agree to supervise the vote, while other judges’ clubs have said their members would boycott the referendum.

Major demonstrations are expected at the presidential palace again on Tuesday and Friday — ensuring that questions about Egypt’s national unity and stability will continue to overshadow debate about the specific contents of the charter. Although international experts who have studied the draft say it is hardly more religious than Egypt’s existing Constitution, opponents say it fails to adequately protect individual rights from being constricted by a future Islamist majority in Parliament.

Over the past two weeks, hundreds of thousands of people have poured into the streets to oppose the charter, crowds have attacked 28 Muslim Brotherhood offices and the group’s headquarters, and at least seven people have died in clashes between Islamist and secular political factions.

Kareem Fahim contributed reporting from Cairo.

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AP Source: WKU hires Petrino as football coach

Western Kentucky has hired Bobby Petrino as its new football coach, said a person familiar with the decision.

The person said the former Arkansas coach is expected to be introduced at a Monday afternoon news conference. The person spoke to The Associated Press on condition of anonymity because the school has not officially announced Petrino's hiring.

The 51-year-old Petrino replaces Willie Taggart, who left WKU Saturday to become South Florida's coach. Petrino had a 34-17 record at Arkansas and 75-26 overall in eight seasons as a college head coach.

He was fired by Arkansas in April for a "pattern of misleading" behavior following a motorcycle accident. Petrino had an affair with former Razorback volleyball player Jessica Dorrell, who he later hired as a football assistant had gave her $20,000 in gifts. Petrino said initially he was the only person on the motorcycle but later admitted to Dorrell's presence.

Petrino has been looking to get back into coaching since his dismissal. His name was mentioned recently in connection with several openings, including Kentucky and Auburn.

Petrino returns to the state where he successfully began his head coaching career. He coached at Louisville from 2003-06, going 41-9 and leading the Cardinals to a 12-1 mark and their first-ever BCS berth in the Orange Bowl in 2006.

From there Petrino went to the NFL.

He had a brief 13-game stint in 2007 with the Atlanta Falcons. The Falcons stumbled to a 3-10 start before Petrino left for Arkansas, announcing his departure to players in a four-sentence laminated letter attached to their lockers.

Arkansas had a losing record — 5-7 — in his first season. But Petrino and the Razorbacks improved each after that. They were to 8-5 in 2009, 10-3 with a Sugar Bowl appearance in 2010 and went 11-2 with a Cotton Bowl bid in 2011.

He takes over a 7-5 Western Kentucky team that's headed to its first bowl appearance as an FBS school. The Hilltoppers will play in the Little Caesar's Pizza Bowl on Dec. 26 against Central Michigan. WKU defensive coordinator Lance Guidry was named interim coach on Saturday will coach the team in the bowl game.

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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 virus that causes AIDS 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 about 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, said her parents, Kari and Tom. 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 were 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, the 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 Pennsylvania team and has committed $20 million to building a research center on the university’s campus to bring the treatment to market.

Hervé Hoppenot, the president of Novartis Oncology, called the research “fantastic” and said it had the potential — if the early results held up — to revolutionize the treatment of leukemia and related blood cancers. Researchers say the same approach, reprogramming the patient’s immune system, may also eventually be used 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 technique employs a disabled form of H.I.V. because it is very good at carrying genetic material into T-cells. The new genes program the T-cells to attack B-cells, a normal part of the immune system that turn 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 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 they 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 11th 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.

In patients with lasting remissions after the treatment, the altered T-cells persist in the bloodstream, though in smaller numbers than when they were fighting the disease. Some patients have had the cells for years.

Dr. Michel Sadelain, who conducts similar studies at the Sloan-Kettering Institute, said: “These T-cells are living drugs. With a pill, you take it, it’s eliminated from your body and you have to take it again.” But T-cells, he said, “could potentially be given only once, maybe only once or twice or three times.”

The Pennsylvania researchers said they were surprised to find any big drug company interested in their work, because a new batch of T-cells must be created for each patient — a far cry from the familiar commercial strategy of developing products like Viagra or cholesterol medicines, in which millions of people take the same drug.

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Advertising: In Beyoncé Deal, Pepsi Focuses on Collaboration

Beyoncé at a Pepsi photo shoot in October. The images will appear early next year as life-size cardboard cutouts in stores.

FOR its campaign with Beyoncé next year, Pepsi doesn’t just want to sign up the telegenic pop star for another TV commercial. It also wants to get into the Beyoncé business.

In an expansion of the recent marketing experiments that have brought PepsiCo ever closer to the music industry, the company has embarked on a hybrid project with Beyoncé that will include standard advertising like commercials as well as a multimillion-dollar fund to support the singer’s chosen creative projects.

“Pepsi embraces creativity and understands that artists evolve,” Beyoncé said in a statement. “As a businesswoman, this allows me to work with a lifestyle brand with no compromise and without sacrificing my creativity.”

The campaign will coincide with a blitz of promotion for her next album, which has no title or release date so far but is expected in 2013. Sometime after she performs at the Super Bowl halftime show on Feb. 3 (also sponsored by Pepsi), Beyoncé will appear in a new TV ad — her fifth for the soft drink since 2002 — and her face will be on a limited-edition line of soda cans.

The less conventional aspects of the deal are meant as collaborative projects that indulge Beyoncé’s creative whims, and might well have no explicit connection to Pepsi products. They are still at the brainstorm stage, but could include live events, videos, “a cool photo shoot” or almost anything else, said Lee Anne Callahan-Longo, the general manager of Parkwood Entertainment, Beyoncé’s company.

For Pepsi, the goal is to enhance its reputation with consumers by acting as something of an artistic patron instead of simply paying for celebrity endorsements.

“Consumers are seeking a much greater authenticity in marketing from the brands they love,” said Brad Jakeman, president of PepsiCo’s global beverage group. “It’s caused a shift in the way we think about deals with artists, from a transactional deal to a mutually beneficial collaboration.”

The multiyear campaign is estimated at $50 million, the bulk of it for media placements and promotions around the world, and the remainder split roughly equally between Beyoncé’s fee and what Pepsi calls a creative content development fund.

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According to the tracking firm Kantar Media, PepsiCo and its archrival the Coca-Cola Company each spent about $148 million in the United States to advertise their soft drink brands in the first six months of 2012, across all measured forms of media, like television, print, digital and radio.

Over the last decade many consumer brands have been taking more active roles with artists, particularly in pop music. Converse, Red Bull and Toyota’s Scion line, for example, have become as familiar in the music business as any label or concert promoter by paying to help create and promulgate music.

Bands always risk fan disapproval when shaking hands with big corporations. But with record company budgets diminished, Madison Avenue money is often seen as essential. PepsiCo has been part of this trend through Green Label Sound, a label financed through its Mountain Dew drink, which over the last four years has paid to release free music by under-the-radar groups like Matt & Kim and the Cool Kids.

“We recognize that there have been massive disruptions in music industry: lower investment in artist development, fewer points of distribution, financial constraints,” said Frank Cooper, a top marketing executive in PepsiCo’s beverage division who has been a force for such projects. “We look at those disruptions as opportunities for Pepsi.”

These deals are not limited to music. In 2010, Jay-Z (Beyoncé’s husband) teamed with Microsoft to promote his memoir, “Decoded.” According to a case study led by Anita Elberse, a Harvard Business School professor, the publisher could contribute only $50,000 for marketing, but Microsoft paid $2 million for an elaborate scavenger hunt that promoted the book as well as its new search engine, Bing.

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Fear of Fighting Haunts Once-Tranquil Damascus

Muzaffar Salman/Reuters

A portrait of President Bashar al-Assad outside the venue of a charity concert by the Syrian National Symphony Orchestra in Damascus on Nov. 21.

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 nearby suburbs, the front lines seem to be hardening.

On the route into Qaboun in recent days, less than two miles northeast of Damascus, the last government checkpoint 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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