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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President Sargsyan Wins Easy Victory in Armenia Election

President Serzh Sargsyan of Armenia easily won re-election to a second five-year term, according to preliminary returns released on Tuesday by the Central Election Commission.

The preliminary results showed Mr. Sargsyan with about 59 percent of the vote, enough to win the presidency outright and avoid a runoff. The former foreign minister, Raffi Hovanessian, was a distant second with about 37 percent, the returns showed.

Armenians went to the polls on Monday with Mr. Sargsyan heavily favored to win and maintain stability in a country that has become an increasingly important, if uneasy, United States ally in monitoring Iran’s nuclear ambitions.

A veteran politician, Mr. Sargsyan, 58, is generally viewed as having presided over modest economic improvements in recent years, even as the country has struggled because of closed borders with Turkey and Azerbaijan, its enemy in a continuing war over the disputed territory of Nagorno-Karabakh.

But while Mr. Sargsyan’s victory has been predicted for months, there have been some unexpected developments in the campaign. One challenger, Andreas Ghukasian, a political commentator who manages a radio station in the capital, Yerevan, has been on a hunger strike, demanding that the incumbent be removed from the ballot.

Another challenger, Paruir A. Airikyan, was shot in the shoulder in late January in what the authorities described as an assassination attempt, although there was no known motive. He is a former Soviet dissident who promoted Armenian independence and has run unsuccessfully for president several times.

Mr. Airikyan briefly considered invoking a constitutional provision to delay the election for two weeks as a result of his injury, but he ultimately decided to allow the balloting to proceed.

Mr. Sargsyan’s second term will be watched closely for any sign of progress in resolving the war with Azerbaijan and for any indication that Armenia would reduce support for economic sanctions against Iran, as they make life more difficult in both countries.

The conflict over Nagorno-Karabakh continues at a low simmer with periodic violence along the line of contact, including frequent exchanges of gunfire and occasional casualties. Peace talks led by the so-called Minsk Group, which is led by the United States, Russia and France, have mostly stalled.

Armenia has traditionally relied heavily on Iran as an economic partner, but those ties are now constrained by the sanctions over Iran’s nuclear program. Iran insists its purposes are peaceful, but Western powers accuse Tehran of seeking the technology to build nuclear weapons and have imposed a broadening array of United States, United Nations and European Union sanctions.

Armenia has supported the measures, while continuing to engage in some trade that circumvents them, like swapping its electricity for natural gas from Iran with no money changing hands.

“Having Iran as your economic lifeline is not a good position to be in,” said one senior Western diplomat, who asked not to be identified to avoid creating any tension with players in the region.

“They have been very, very careful, very, very good, at some cost to Armenia, to honor international U.N., U.S. and E.U. sanctions against Iran,” the diplomat said. “But it’s increasingly difficult for them to do that.”

International election observers have fanned out across Armenia in recent days. Initial reports suggested that Mr. Sargsyan’s party had made some inappropriate use of government resources to promote his candidacy, a common criticism of incumbent candidates in former Soviet republics. But observers say the overall political climate has improved, with opposition candidates, for instance, enjoying better access to coverage by the news media.

Still, Armenia faces a peculiar problem when it comes to potential election fraud because of the hundreds of thousands of Armenian citizens who live abroad, including in the United States — one of the largest percentage diasporas in the world given Armenia’s population of 3.1 million, according to the World Bank.

With few exceptions, absentee balloting is not permitted. That means the Armenian election rolls are filled with the names of people who will not appear in person to vote, creating the potential for fraudulent use of those names.

Mr. Sargsyan faced relatively weak competition after his two strongest potential challengers and their parties announced last year that they would not compete — former President Levon Ter-Petrossian of the Armenian National Congress and Gagik Tsarukyan of the Prosperous Armenia Party. Mr. Tsarukyan is a wealthy businessman, lawmaker and the head of Armenia’s national Olympic committee.

Mr. Sargsyan and his wife, Rita, paused Monday to speak with reporters after voting in Yerevan. “I have voted for the security of our citizens and our families,” he said, according to aysor.am, an Armenian news site.

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Jerry Buss, Lakers' flamboyant owner, dies at 80

Jerry Buss built a glittering life at the intersection of sports and Hollywood.

After growing up in poverty in Wyoming, he earned success in academia, aerospace and real estate before discovering his favorite vocation when he bought the Los Angeles Lakers in 1979. While Buss wrote the checks and fostered partnerships with two generations of basketball greats, the Lakers won 10 NBA titles and became a glamorous global brand.

With a scientist's analytical skills, a playboy's flair, a businessman's money-making savvy and a die-hard hoops fan's heart, Buss fashioned the Lakers into a remarkable sports entity. They became a nightly happening, often defined by just one word coined by Buss: Showtime.

"His impact is felt worldwide," said Kobe Bryant, who has spent nearly half his life working for Buss.

Buss, who shepherded his NBA team from the Showtime dynasty of the 1980s to the current Bryant era while becoming one of the most important and successful owners in pro sports, died Monday. He was 80.

"Think about the impact that he's had on the game and the decisions he's made, and the brand of basketball he brought here with Showtime and the impact that had on the sport as a whole," Bryant said a few days ago. "Those vibrations were felt to a kid all the way in Italy who was 6 years old, before basketball was even global."

Under Buss' leadership, the star-studded, trophy-winning Lakers became Southern California's most beloved sports franchise and a signature cultural representation of Los Angeles. Buss acquired, nurtured and befriended a staggering array of talented players and basketball minds during his Hall of Fame tenure, from Magic Johnson, Kareem Abdul-Jabbar and James Worthy to Bryant, Shaquille O'Neal and Dwight Howard.

Few owners in sports history can approach Buss' accomplishments with the Lakers, who made the NBA Finals 16 times during his nearly 34 years in charge, winning 10 titles between 1980 and 2010. Whatever the Lakers did under Buss' watch, they did it big — with marquee players, eye-popping style and a relentless pursuit of success with little regard to its financial cost.

"His incredible commitment and desire to build a championship-caliber team that could sustain success over a long period of time has been unmatched," said Jerry West, Buss' longtime general manager and now a consultant with the Golden State Warriors. "With all of his achievements, Jerry was without a doubt one of the most humble men I've ever been around. His vision was second to none; he wanted an NBA franchise brand that represented the very best and went to every extreme to accomplish his goals."

Buss died at Cedars-Sinai Medical Center in Los Angeles, said Bob Steiner, his assistant and longtime friend. Buss had been hospitalized for most of the past 18 months while undergoing cancer treatment, but the cause of death was kidney failure, Steiner said.

"When someone as celebrated and charismatic as Jerry Buss dies, we are reminded of two things," said Abdul-Jabbar, the leading scorer in NBA history. "First, just how much one person with vision and strength of will can accomplish. Second, how fragile each of us is, regardless of how powerful we were. Those two things combine to inspire us to reach for the stars, but also to remain with our feet firmly on the ground among our loved ones. ... The man may be gone, but he has made us all better people for knowing him."

With his condition worsening in recent months, several prominent former Lakers visited Buss to say goodbye. Even rivals such as Dallas Mavericks owner Mark Cuban and Clippers owner Donald Sterling hailed the passion and bonhomie of the former chemist and mathematician who lived his own Hollywood dream.

"He was a great man and an incredible friend," Johnson tweeted.

Buss always referred to the Lakers as his extended family, and his players rewarded his fanlike excitement with devotion, friendship and two hands full of championship rings. Working with front-office executives West, Bill Sharman and Mitch Kupchak, Buss spent lavishly to win his titles despite lacking a huge personal fortune, often running the NBA's highest payroll while also paying high-profile coaches Pat Riley and Phil Jackson.

"Jerry Buss was more than just an owner. He was one of the great innovators that any sport has ever encountered," Riley said. "He was a true visionary, and it was obvious with the Lakers in the 80's that 'Showtime' was more than just Magic Johnson and Kareem Abdul-Jabbar. It was really the vision of a man who saw something that connected with a community."

Ownership of the Lakers is now in a trust controlled by Buss' six children, who all have worked for the Lakers in various capacities for several years. With 1,786 victories, the Lakers easily are the NBA's winningest franchise since he bought the club, which is now run largely by Jim Buss and Jeanie Buss.

"We not only have lost our cherished father, but a beloved man of our community and a person respected by the world basketball community," the Buss family said in a statement issued by the Lakers.

"It was our father's often-stated desire and expectation that the Lakers remain in the Buss family. The Lakers have been our lives as well, and we will honor his wish and do everything in our power to continue his unparalleled legacy."

Johnson and fellow Hall of Famers Abdul-Jabbar and Worthy formed lifelong bonds with Buss during the Lakers' run to five titles in nine years in the 1980s, when the Lakers earned a reputation as basketball's most exciting team with their flamboyant Showtime repartee.

The buzz extended throughout the Forum, where Buss turned the Lakers' games into a must-see event. He used the Laker Girls, a brass band and promotions to keep Lakers fans interested during all four quarters. Courtside seats, priced at $15 when he bought the Lakers, became the hottest tickets in Hollywood — and they still are, with fixture Jack Nicholson and many other celebrities attending every home game.

"Anybody associated with the NBA since 1980 benefited greatly from Jerry Buss' impact on the game," Steiner said. "He had a different way of looking at things than I did, and people who had been raised in basketball."

Buss paid the Lakers' bills through both their wild success and his groundbreaking moves to raise revenue. He co-founded a basic-cable sports television network and sold the naming rights to the Forum at times when both now-standard strategies were unusual, further justifying his induction to the Naismith Memorial Basketball Hall of Fame in 2010.

"The NBA has lost a visionary owner whose influence on our league is incalculable and will be felt for decades to come," NBA Commissioner David Stern said. "More importantly, we have lost a dear and valued friend."

Showtime couldn't last forever, but after a rough stretch in the 1990s, Buss rekindled the Lakers' mystique by paying top dollar to hire Jackson, who led O'Neal and Bryant to a three-peat from 2000-02. Bryant and Pau Gasol won two more titles under Jackson in 2009 and 2010.

The current Lakers (25-29) have struggled mightily despite adding Howard and Steve Nash in a couple of moves that were typical of Buss' big, brash style. Los Angeles could miss the playoffs this spring for just the third time since Buss bought the franchise.

"Today is a very sad day for all the Lakers and basketball," Gasol tweeted. "All my support and condolences to the Buss family. Rest in peace Dr. Buss."

Although Buss gained fame and another fortune with the Lakers, he also was a scholar, Renaissance man and bon vivant who epitomized California cool his entire public life.

Buss rarely appeared in public without at least one attractive, much younger woman on his arm — at Southern California football games, high-stakes poker tournaments, hundreds of boxing matches promoted by Buss at the Forum — and, of course, Lakers games from his private box at Staples Center, which was built under his watch. With his failing health, Buss hadn't attended a Lakers game in the past two seasons.

After a rough-and-tumble childhood that included stints as a ditch-digger and a bellhop in the frigid Wyoming winters, Buss earned a Ph.D. in chemistry from USC at age 24, and had careers in aerospace and real estate development before getting into sports. With money from his real-estate ventures and a good bit of creative accounting, Buss bought the then-struggling Lakers, the NHL's Los Angeles Kings and both clubs' arena — the Forum — from Jack Kent Cooke in a $67.5 million deal that was the largest sports transaction in history at the time.

Last month, Forbes estimated the Lakers were worth $1 billion, second most in the NBA.

Buss also helped change televised sports by co-founding the Prime Ticket network in 1985, and he received a star on the Hollywood Walk of Fame in 2006 for his work in television. Breaking the contemporary model of subscription services for televised sports, Buss' Prime Ticket put beloved broadcaster Chick Hearn and the Lakers' home games on basic cable.

Buss also sold the naming rights to the Forum in 1988 to Great Western Savings & Loan — another deal that was ahead of its time.

Born in Salt Lake City, Gerald Hatten Buss was raised in poverty in Wyoming before improving his life through education. He also grew to love basketball, describing himself as an "overly competitive but underly endowed player."

After graduating from the University of Wyoming, Buss attended USC for graduate school because he loved its sports teams. He also became a chemistry professor and worked in the missile division of defense contractor McDonnell Douglas before carving out a path to wealth and sports prominence.

His real-estate portfolio grew out of a $1,000 investment in a West Los Angeles apartment building with partner Frank Mariani, an aerospace engineer and co-worker.

Heavily leveraging his fortune and various real-estate holdings during two years of negotiations, Buss purchased Cooke's entire Los Angeles sports empire along with a 13,000-acre ranch in Kern County. Buss immediately worked to transform the Lakers — who had won just one NBA title since moving west from Minneapolis in 1960 — into a star-powered endeavor befitting Hollywood.

"One of the first things I tried to do when I bought the team was to make it an identification for this city, like Motown in Detroit," he told the Los Angeles Times in 2008. "I try to keep that identification alive. I'm a real Angeleno. I want us to be part of the community."

With showmanship, fearless spending and a little drafting luck, Buss quickly succeeded: Johnson, Abdul-Jabbar and coach Paul Westhead led the Lakers to the 1980 title. Johnson's ball-handling wizardry and Abdul-Jabbar's smooth inside game made for an attractive style of play, and the Lakers came to define West Coast sophistication.

Riley, the former broadcaster who fit the L.A. image perfectly with his slick-backed hair and good looks, was surprisingly promoted by Buss early in the 1981-82 season. He became one of the best coaches in NBA history, leading the Lakers to four straight NBA finals and four titles, with Worthy, Michael Cooper, Byron Scott and A.C. Green playing major roles.

"I was privileged to be part of that for 10 years and even more grateful for the friendship that has lasted all these many years," Riley said. "I have always come to realize that if it weren't for Dr. Buss, I wouldn't be where I am today."

Overall, the Lakers made the Finals nine times in Buss' first 12 seasons while rekindling the NBA's best rivalry with the Boston Celtics, and Buss basked in the worldwide celebrity he received from his team's achievements. His partying became the stuff of Los Angeles legends, with even his players struggling to keep up with Buss' lifestyle.

Johnson's HIV diagnosis and retirement in 1991 staggered Buss and the Lakers, the owner recalled in 2011. The Lakers went through seven coaches and made just one conference finals appearance in an eight-year stretch of the 1990s despite the 1996 arrivals of O'Neal, who signed with Los Angeles as a free agent, and Bryant, the 17-year-old high schooler acquired in a draft-week trade.

Shaq and Kobe didn't reach their potential until Buss persuaded Jackson, the Chicago Bulls' six-time NBA champion coach, to take over the Lakers in 1999. Los Angeles immediately won the next three NBA titles in brand-new Staples Center, AEG's state-of-the-art downtown arena built with the Lakers as the primary tenant.

After the Lakers traded O'Neal in 2004, they hovered in mediocrity again until acquiring Gasol in a heist of a trade with Memphis in early 2008. Los Angeles made the next three NBA Finals, winning two more titles.

Through the Lakers' frequent successes and occasional struggles, Buss never stopped living his Hollywood dream. He was an avid poker player and a fixture on the Los Angeles club scene well into his 70s, when a late-night drunk-driving arrest in 2007 — with a 23-year-old woman in the passenger seat of his Mercedes-Benz — prompted him to cut down on his partying.

Buss owned the NHL's Kings from 1979-87, and the WNBA's Los Angeles Sparks won two league titles under Buss' ownership. He also owned Los Angeles franchises in World Team Tennis and the Major Indoor Soccer League.

Buss' children have pledged to continue his commitment to the Lakers' distinctive success, although their efforts haven't been rewarded in the past three years while Jerry Buss ceded many decision-making responsibilities to Jim Buss, the Lakers' executive vice president of player personnel and the second-oldest child. While daughter Jeanie runs the franchise's business side, Jim Buss now has the final say on basketball decisions.

Jerry Buss still served two terms as president of the NBA's Board of Governors and was actively involved in the 2011 lockout negotiations, developing blood clots in his legs attributed to his extensive travel during that time.

"I am blessed with a wonderful family who have helped me and guided me every step of the way," Buss said in 2010 at his Hall of Fame induction ceremony. "This support is the best anybody could ever have."

Buss is survived by his six children: sons Johnny, Jim, Joey and Jesse, and daughters Jeanie Buss and Janie Drexel. He had eight grandchildren.

Arrangements are pending for a funeral and memorial service, likely at Staples Center or a nearby theatre in downtown Los Angeles.

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Associated Press writers Beth Harris and Andrew Dalton contributed to this report.

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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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IHT Rendezvous: In Singapore's Immigration Debate, Sign of Asia's Slipping Middle Class?

BEIJING — Immigration is a hot-button issue nearly everywhere in the world, though the contours of the debate vary from place to place. In the United States, sweeping changes to the law may offer legal residency for millions of people who have entered the country illegally, my colleague Ashley Parker reports.

In Singapore, the debate looks somewhat different: The government plans to increase the population from just over five million to a possible high of nearly seven million by 2030, via regulated, legal immigration, and this is provoking opposition.

So much so that on Saturday, about 3,000 people turned out for what some commentators said was one of the biggest demonstrations in the nation’s history. (If the number seems small, it reflects the tight political control exerted over Singapore life by the People’s Action Party, which has run the country for about half a century and discourages public protest.)

What are the contours of the debate in Singapore?

Concern over booming immigration, often focused on new arrivals from increasingly rich China, has been simmering in the nation, with many feeling that the immigrants do not play by the same rules, that their manners are poor and that they are pushing up prices. That feeling crystallized last year when a wealthy Chinese man driving a Ferrari at high speed killed three people (including himself) in a nighttime accident.

(Similar sentiments are found in Hong Kong, as my colleagues Bettina Wassener and Gerry Mullany wrote.)

Vividly illustrating the resentment, Singaporeans sometimes call the wealthy immigrants “rich Chinese locusts,” according to an article in the Economic Observer’s Worldcrunch.

So the Singapore government’s Population White Paper that passed in Parliament earlier this month, just before Chinese New Year, was bound to stir things up.

The government is presenting the rise in immigration as a target that is needed if Singapore, where immigrants already make up about 40 percent of the population, and which has the highest concentration of millionaires in the world, is to continue to flourish, reports said. Singaporeans just are not having enough children, said the prime minister, Lee Hsien Loong.

“In my view, in 2030, I think six million will not be enough to meet Singaporeans’ needs as our population ages because of this problem of the baby boomers and bulge of aging people,” Mr. Lee said in Parliament, adding that 6.9 million was not a target but a number to be used to help plan for infrastructure.

“Do we really need to increase our population by that much?” wrote a person called Chang Wei Meng in a letter to The Straits Times, according to Reuters. “What happened to achieving the Swiss standard of living?”

Gilbert Goh, a main organizer of the rally Saturday at Singapore’s Speaker’s Corner in a public park, said the protesters had a message: “They want to tell the government, please reconsider this policy. The turnout is a testimony that this policy is flawed and unpopular on the ground,” The Associated Press quoted Mr. Goh as saying.

Yet amid the familiar rhetoric about immigrants, heard around the world – they don’t fit in, they’re rude, they’re different – might something more important be going on here?

In a blog post on Singapore News Alternative, Nicole Seah, a politician who has run for Parliament and comments on social issues, wrote: “Along with many other Singaporeans, I oppose the White Paper.”

Why? She is looking for “a society that lives in harmony, rather than tense and overcrowded conditions,” she writes.

“Not the Singapore Inc. that has been aggressively forced down our throats the past few years – a Singapore which is in danger of becoming a transient state where people from all over, come, make their fortunes, and leave.”

Not “a Singapore that has become a playground for the rich and the people who can afford it. A Singapore where the middle class is increasingly drowned out because they do not have the social clout or sufficient representatives in Parliament to voice their concerns.”

Ms. Seah’s statements raise an interesting question: Is this part of a phenomenon that the columnist Chrystia Freeland has written about so ably for this newspaper, the ascendancy of a wealthy, “plutocrat” class and the slipping status of the middle class?

As Ms. Freeland wrote last week: “The most important fact about the United States in this century is that middle-class incomes are stagnating. The financial crisis has revealed an equally stark structural problem in much of Europe.” Is it hitting Asia, too, and does Singapore’s protest speak, at least in part, to this? Hong Kong’s dissatisfaction too?

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Danica Patrick wins pole for NASCAR's Daytona 500

DAYTONA BEACH, Fla. (AP) — Danica Patrick has made history before — as a woman and a racer, in Indianapolis and Japan.

The spotlight is nothing new. But never has it been this bright before.

Patrick won the Daytona 500 pole Sunday, becoming the first woman to secure the top spot for any race in NASCAR's premier circuit. It's by far the biggest achievement of her stock-car career.

"I was brought up to be the fastest driver, not the fastest girl," she said. "That was instilled in me from very young, from the beginning. Then I feel like thriving in those moments, where the pressure's on, has also been a help for me. I also feel like I've been lucky in my career to be with good teams and have good people around me. I don't think any of it would have been possible without that.

"For those reasons, I've been lucky enough to make history, be the first woman to do many things. I really just hope that I don't stop doing that. We have a lot more history to make. We are excited to do it."

Her latest stamp in the history books came with a lap at 196.434 mph around Daytona International Speedway. Patrick went out eighth in the qualifying session, then had to wait about two hours as 37 fellow drivers tried to take her spot.

Only four-time Cup champion Jeff Gordon even came close to knocking her off. Gordon was the only other driver who topped 196 mph in qualifying. He locked up the other guaranteed spot in next week's season-opening Daytona 500.

"It's great to be a part of history with Danica being on the pole," said Gordon, who joked that at least he was the fastest guy. "I think we all know how popular she is, what this will do for our sport. Congratulations to her. Proud to be on there with her."

The rest of the field will be set in duel qualifying races Thursday.

However the lineup unfolds, all drivers will line up behind Patrick's No. 10 Chevrolet SS.

And she knows her latest achievement will mean more public relations work.

The routine is nothing new for Patrick, who was the first woman to lead laps in the Indianapolis 500. She finished third in 2009, the highest finish in that illustrious race for a woman. And she became the only woman to win an IndyCar race when she did it in Japan in 2008.

Hardly anyone witnessed that victory.

Leading the field to the green flag in NASCAR's showcase event should be must-watch television.

"That's a huge accomplishment," team owner and fellow driver Tony Stewart said. "It's not like it's been 15 or 20 years she's been trying to do this. It's her second trip to Daytona here in a Cup car. She's made history in the sport. That's stuff that we're proud of being a part of with her. It's something she should have a huge amount of pride in.

"It's never been done. There's only one person that can be the first to do anything. Doesn't matter how many do it after you do, accomplish that same goal. The first one that does always has that little bit more significance to it because you were the first."

Even before her fast lap Sunday, Patrick was the talk of Speedweeks. Not only did she open up about her budding romance with fellow Sprint Cup rookie Ricky Stenhouse Jr., but she was considered the front-runner for the pole after leading practice sessions Saturday.

And she didn't disappoint.

She kept her car at or near the bottom of the famed track and gained ground on the straightaways, showing lots of power from a Hendrick Motorsports engine.

"It's easy to come down here in your first or second year as a driver and clip the apron trying to run too tight a line or do something and scrub speed off," Stewart said. "That's something she did an awesome job. Watching her lap, she runs so smooth. ... She did her job behind the wheel, for sure."

The result surely felt good for Patrick, especially considering the former IndyCar driver has mostly struggled in three NASCAR seasons. Her best finish in 10 Cup races is 17th, and she has one top-five in 58 starts in the second-tier Nationwide Series.

She raced part-time in 2010 and 2011 while still driving a full IndyCar slate. She switched solely to stock cars last season and finished 10th in the Nationwide standings.

She made the jump to Sprint Cup this season and will battle Stenhouse for Rookie of the Year honors.

Starting out front in an unpredictable, 500-mile race doesn't guarantee any sort of result, but securing the pole will put her in the limelight for at least the rest of the week.

She also won the pole at Daytona for last year's Nationwide race.

This is considerably bigger.

The previous highest female qualifier in a Cup race was Janet Guthrie. She started ninth at Bristol and Talladega in 1977.

"It's obviously a history-making event that will last a long, long time," Guthrie said, praising Patrick's feat. "It's a different era, of course. Different times. I can't imagine what I would do with a spotter or somebody telling me how to drive. It's rather a different sport now. Back then, there was a much greater difference from the front of the field to the back."

Guthrie received a lukewarm reception from fellow drivers back then.

Patrick was much more welcomed, undoubtedly because of her background and popularity.

She's comfortable being in the spotlight, evidenced by her racing career, her television commercials and her sudden openness about her personal life.

"I think when pressure's on and when the spotlight's on, I feel like it ultimately ends up becoming some of my better moments and my better races and better results," Patrick said. "I just understand that if you put the hard work in before you go out there that you can have a little peace and a little peace of mind knowing that you've done everything you can and just let it happen."

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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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Allure of Self-Insurance Draws Concern Over Costs

WASHINGTON — Federal and state officials and consumer advocates have grown worried that companies with relatively young, healthy employees may opt out of the regular health insurance market to avoid the minimum coverage standards in President Obama’s sweeping law, a move that could drive up costs for workers at other companies.

Companies can avoid many standards in the new law by insuring their own employees, rather than signing up with commercial insurers, because Congress did not want to disrupt self-insurance arrangements that were seen as working well for many large employers.

“The new health care law created powerful incentives for smaller employers to self-insure,” said Deborah J. Chollet, a senior fellow at Mathematica Policy Research who has been studying the insurance industry for more than 25 years. “This trend could destabilize small-group insurance markets and erode protections provided by the Affordable Care Act.”

It is not clear how many companies have already self-insured in response to the law or are planning to do so. Federal and state officials do not keep comprehensive statistics on the practice.

Self-insurance was already growing before Mr. Obama signed the law in 2010, making it difficult to know whether the law is responsible for any recent changes. A study by the nonpartisan Employee Benefit Research Institute found that about 59 percent of private sector workers with health coverage were in self-insured plans in 2011, up from 41 percent in 1998.

But experts say the law makes self-insurance more attractive for smaller employers. When companies are self-insured, they assume most of the financial risk of providing health benefits to employees. Instead of paying premiums to insurers, they pay claims filed by employees and health care providers. To avoid huge losses, they often sign up for a special kind of “stop loss” insurance that protects them against very large or unexpected claims, say $50,000 or $100,000 a person.

Such insurance serves as a financial backstop for the employer if, for example, an employee is found to have cancer, needs an organ transplant or has a premature baby requiring intensive care.

In a report to clients last year, SNR Denton, a law firm, wrote, “Faced with mandates to offer richer benefits with less cost-sharing, small and midsize employers in particular are increasingly considering self-insuring.”

Officials from California, Maine, Minnesota, Utah, Washington and other states expressed concern about the potential proliferation of these arrangements at a recent meeting of the National Association of Insurance Commissioners.

Stop-loss insurers can and do limit the coverage they provide to employers for selected employees with medical problems. As a result, companies with less healthy work forces may find self-insuring more difficult.

Christina L. Goe, the top lawyer for the Montana insurance commissioner, said that stop-loss insurance companies were generally “free to reject less healthy employer groups because they are not subject to the same restrictions as health insurers.”

Insurance regulators worry that commercial insurers — and the insurance exchanges being set up in every state to offer a range of plan options to consumers — will be left with disproportionate numbers of older, sicker people who are more expensive to insure.

That, in turn, could drive up premiums for uninsured people seeking coverage in the exchanges. Since the federal government will subsidize that coverage, it, too, could face higher costs, as would some employees and employers in the traditional insurance market.

Large employers with hundreds or thousands of employees have historically been much more likely to insure themselves because they have cash to pay most claims directly.

Now, employee benefit consultants are promoting self-insurance for employers with as few as 10 or 20 employees.

Raeghn L. Torrie, the chief financial officer of Autonomous Solutions, a developer of robotic equipment based in Petersboro, Utah, said her business started a self-insured health plan for its 44 employees on Jan. 1 as a way to cope with the uncertainties created by the new law.

“We have a pretty young, healthy group of employees,” she said.

In Marshfield, Mo., J. Richard Jones, the president of Label Solutions, an industrial label-printing company with 42 employees, said he switched to a self-insurance plan this year “to hold down costs that were going up because of government regulation under Obamacare.”

The Township of Freehold, N.J., made a similar decision in January to gain more control over benefits and costs for its 260 employees.

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