Missing kit wasting nursing time

More than a third of nurses waste up to two hours a shift searching for missing medical equipment, a survey suggests.

This equates to 40 hours a month and £900m of NHS wages a year spent hunting for missing pumps, drip stands, thermometers and drugs cupboard keys.

Of the 989 nurses surveyed, nearly all had spent up to an hour locating kit.

The not-for-profit data standards group GS1 UK, which commissioned the study with Nursing Times, said bar code scanning could solve this.

Bar-coded kit could be scanned in and out of a ward and nurses could then track the equipment's whereabouts by computer.

Nine out of 10 respondents in the survey, which spoke to nurses from England, Scotland and Wales, said they would be prepared to use a computer to hunt down missing items if the information was accurate, with a similar amount willing to use a scanner to log items.

Robbing patient time

Gary Lynch, chief executive of GS1 UK, said: "The survey shows there is a problem. Nurses are wasting time trying to find missing equipment. We believe bar code systems could free up nurses' time to care for patients."

More than a third (37%) of the nurses questioned said they had spent anything from one to six hours looking for items.

And 16% said that they had given up altogether having not found what they were looking for.

One nurse said: "Some days it feels like I spend all day looking for things."

Another, Jane Smith from London, said: "I was working on a busy shift last Sunday. One of my patients' dressings needed changing and I had to spend an hour looking for a new one.

"These kinds of things happen on a daily basis."

More than half of the nurses looked for items themselves, with 23% relying on help from colleagues and 11% calling around other wards.

Only 1% of respondents used technology, such as asset-tracking systems, to help find items.

The Department of Health recommends bar-coding and similar coding technologies, saying they could aid accurate tracking of equipment. Barts Hospital in central London is planning to begin a trial of the system.

London's Charing Cross hospital is already using bar codes on patient wristbands to help reduce medication errors.

Janet Davies, of the Royal College of Nursing, said: "The first priority for any nurse is spending time with patients delivering high quality care.

"Of course, there will always be other tasks that have to be done to ensure that a ward runs smoothly, but time could be saved by better use of technology, ward clerks and admin staff.

"This lack of admin support for nurses is a problem that goes beyond access to medical supplies.

"Last year, we found that NHS nurses were spending more than a million hours every week on paperwork that could be done by a ward clerk.

"Nurses should be free to nurse, so it is crucial that employers look into this research and make sure that their systems are as effective for patients as they can be."

Sex infections continue to rise

The sexual health of young UK adults worsened in 2006 despite a concerted public health effort to turn it around, figures show.

In 2006, a total of 376,508 new sexually transmitted infections (STIs) were diagnosed - up 2.2% on 2005, the Health Protection Agency found.

Young people aged 16-24 made up the bulk of cases of some of the most common STIs, including chlamydia.

The HPA also warned of a continuing HIV and STI epidemic in gay men.

Worrying trend

Sexual infection diagnoses have been almost continually rising since the 1990s.

Experts called for more action and funding to tackle the issue.

According to the latest figures, the total number of sexually transmitted infections rose to more than 620,000 - up 2.4% on 2005. This figure includes recurrent infections.

An estimated 73,000 adults are now living with HIV in the UK. A third of the people in Britain with HIV, don't know they have the virus.

HIV transmission seems to be a particular problem among gay men - the HPA anticipates that there will have been just over 2,700 new diagnoses of HIV infection among this population in 2006.

The sexual health of young adults in general has worsened, with increases in sexually transmitted herpes and warts viruses in 2006.

One in 10 young adults screened for the sexually transmitted infection chlamydia in that year tested positive for it.

Young adults are disproportionately affected by STIs, accounting for 65% of all chlamydia, 55% of all genital warts and 48% of gonorrhoea diagnoses in genitourinary medicine clinics across the UK in 2006, the HPA found.

Professor Pete Borriello, director of the HPA's Centre for Infections, said: "We have to get the message across that a casual shag should not mean syphilis, gonorrhoea, chlamydia or any other STI.

"We need to change attitudes towards condom use. It should be clunk clip every trip."

He recommend that gay men should have regular HIV tests, STI clinic attendees should be tested for HIV at every visit and young sexually active adults should be screened for chlamydia annually and after a partner change.

Simon Blake, chief executive of the sexual health provider for young people Brook said: "This is a strong signal, yet again, that we must do more to improve the sexual health of our young people."

Nick Partridge, chief executive of HIV and sexual health charity Terrence Higgins Trust said: "Despite our best efforts and those of hard-pressed clinics, the HIV epidemic in the UK is getting worse. It's clear that we can't tackle it on our own.

"We need more investment in HIV prevention, more HIV testing in local communities and stronger national leadership. This is a real test for national government and local health services - and one we can't afford to fail."

Why you should get tested

If there's a possibility you may have an STI, it's important to get tested. Don't wait for obvious symptoms to appear. Chlamydia, for example, has few recognisable symptoms, especially in women. You can be infected and not know.

Those particularly at risk of infection are young people who've had several partners and men who have sex with other men.

You can reduce the risk of infection by always using a condom. But not all STIs are passed on by vaginal or anal intercourse. Some can be picked up through oral sex too, while genital herpes just requires skin-to-skin contact.

Growing problem

The number of STIs has increased in recent years. According to the Health Protection Agency, the number of cases diagnosed in specialist clinics in the UK rose by three per cent in 2005, to 790,443.

One of the most common infections is chlamydia. In 2005, more than 100,000 new cases were diagnosed in the UK, up five per cent from 2004.

Where to get tested

See your GP or make an appointment at the genito-urinary medicine (GUM) clinic at your local hospital.

To find a GUM clinic:

• Call the Department of Health's sexual health helpline on 0800 567123
• Use the fpa's GUM clinic search

There are also special rapid testing clinics.

Some services are aimed specifically at younger people, such as Brook.

All these services are confidential. You'll be asked your name, address and GP's name, but you don't have to give your real name and you can ask them not to contact your GP.

Diagnosis and treatment

The clinic will take a urine sample and, for women, a vaginal swab. A blood test may also be necessary.

It can take a week for test results to come back, so many clinics will diagnose you from symptoms alone (if there are any) and start treatment immediately.

Treatment can range from antibiotics (for chlamydia, gonorrhoea and syphilis) to creams (for genital warts).

You'll be advised not to have sex until you've finished the treatment. It's also important to finish any antibiotics to ensure the infection doesn't return. Most treatments are highly effective if taken properly.

Some infections, such as hepatitis B and genital herpes, can't be cured. In both cases, the virus remains in your body. But you can be vaccinated against hepatitis B - ask your GP for details.

Herpes flares up from time to time. When it does, you can treat the sores with an over-the-counter cream, avoiding sex until they've gone. Using a condom won't offer protection as it doesn't cover the entire genital area.

If tests show you have HIV, you'll receive specialist advice, counselling and treatment.

Telling your partners

If you do have an infection, you'll be asked to contact anyone you've recently had sex with, so they can get treatment.

If you don't want to do that yourself, clinic staff will contact them. They won't give your name, but will say they believe a former partner has an infection and they should seek treatment.

Screening programmes

The Department of Health is introducing an England-wide screening programme for chlamydia, offering tests to those who seek contraceptive advice and through youth clubs. To find out if this is happening in your area, call the sexual health helpline on 0800 567123.

Boots is also providing free NHS chlamydia screening for 16 to 24-year-olds in London. This scheme is due to be assessed in November 2007 and may then be implemented nationwide.

Does short hair mean women doesn't want sex?

Former actress turned therapist, Dr Pamela Connolly recently suggested that having short hair may indicate that women don't want sex any more. Hair has great social significance for human beings, and acts as an important indicator. It can denote power and status.  While long hair has suggested sex, short hair has often been seen as a mark of revolution.  So, what do our hairstyles really say about us?  Jane  is joined by the fashion historian, Caroline Cox, and Professor Stella Bruzzi.

Breast checks 'benefit over-70s'

Screening women in their early 70s for breast cancer does save lives, a Dutch study of over 860,000 women suggests.

The research, detailed at the European Breast Cancer Conference in Berlin, showed deaths fell by 30% after the upper age limit was extended.

Even though cancer risk increases with age, experts have been divided over whether the over-70s should be checked.

In the UK, there are plans to raise the upper age limit for routine screening from 70 to 73 by 2012.

The Netherlands extended its programme to cover women up to 75 in 1998.

The researchers from the Erasmus Medical Center in Rotterdam looked at breast cancer deaths from 2003 - estimating that the effect of the screening extension would be seen by then.

They found there was a steady decline in deaths from breast cancer in women aged 75 to 79 - the age group where improvements in survival would be seen.

Between 1986 and 1997 the average was 166 deaths per 100,000 women, while in 2006 it was 117 per 100,000 - a fall of almost 30%.

'Request a check'

Jacques Fracheboud, who led the research, said: "The reduction in breast cancer mortality shows that the screening has started to have a statistically significant effect."

The study also found that more women aged 70 to 74 were sent for further checks after screening, compared with those aged 50 to 69 - and a higher proportion of the older age group were confirmed to have breast cancer.

Mr Fracheboud said: "It is easier to find cancer in older women due to their breast tissue being less dense."

But he added: "There is not necessarily an argument for continuing screening beyond 75 because many tumours found at this stage are slow-growing and may never reach the stage of causing a problem."

A spokeswoman for the NHS Cancer Screening Programmes said: "At present, women are invited for screening seven times at three yearly intervals between 50 and 70 years.

"This will gradually be extended to nine screening rounds between the ages of 47 and 73 by 2012, with a guarantee that women will have their first screening by the age of 50.

"Over 200,000 more women will be screened each year as a result."

She said older women were not currently invited in for checks because there was not conclusive evidence that was beneficial.

But she added: "All women attending their final invited breast screening are encouraged to book another appointment in three years' time, if they wish to."

Liz Carroll, clinical nurse specialist at the charity Breast Cancer Care, welcomed the raising of the upper age limit to 73, but said: "Much more must be done now to encourage women in every community to take up invitations to regular screenings and to request screening after 70."

Dr Alexis Willett, of Breakthrough Breast Cancer said: "The risk of developing breast cancer increases with age, which is why we encourage all women over 50 to attend NHS breast screening appointments when invited and for women over 70 to request their own appointment via their GP."

Many women 'do not check breasts'

Only 35% of women regularly check their breasts for signs of cancer - and 23% seldom or never do, a survey suggests.

The charity Breakthrough Breast Cancer surveyed 2,005 women aged between 18 and 64.

Over a third (37%) who reported not checking their breasts regularly said they did not know how to check - or what to look out for.

Nearly 46,000 UK women are diagnosed with breast cancer each year - making it the UK's most common form of cancer.

Breakthrough is launching a campaign to encourage more women to check their breasts regularly for changes, and to report anything suspicious to their doctor.

Early diagnosis of breast cancer offers the best chance of successful treatment.

Dr Sarah Cant, from Breakthrough, said: "We know that the earlier breast cancer is diagnosed the more likely it is that treatment will be successful.

"Checking your breasts isn't complicated and there's no need to follow a fancy routine.

"Just be familiar with how they look and feel normally."

The Breakthrough survey revealed widespread confusion over what signs to look out for when examining the breasts.

The majority of women (88%) recognised that lumps could be a possible sign of the disease.

However, only 12% of those surveyed identified changes in skin texture, such as puckering or dimpling of the skin, as a potential warning sign.

Just 7% knew that a sudden inversion of the nipple was something that should be reported to a doctor, and a mere 5% were aware that changes in the size or shape of a breast could be a sign of cancer.

In the UK, the focus is on breast "awareness", rather than more complex and involved checks.

Experts say there is no evidence that rigorous monthly "self-examination" reduces breast cancer deaths and it can lead to unnecessary biopsies.

Instead, women are advised to get to know what is normal for them, and feel their breasts regularly for signs of any changes.

Breast awareness

Your breasts

 

The breasts (mammary glands) are a pair of glandular organs that produce milk in response to the hormonal changes of childbirth. They're mainly made up of fatty tissue, which starts high on the front of the chest and extends down and around into the armpit. They are supported by ligaments and large muscles.

Each breast has 15 to 20 lobes with a number of lobules and ducts surrounded by fatty and supportive tissue. Each lobule has about 30 major ducts that open onto the nipple. The darker area of skin around the nipple is called the areola. At the edge of the areola there are large glands that produce fluid to lubricate the nipple.

In each armpit there are about 20 to 30 lymph nodes (glands), which drain fluid from the breast. These form part of the lymphatic system that helps the body to fight infection.

It's common and perfectly normal for one breast to be larger than the other. The nipples usually point forward, although they may look different on each breast. It's not unusual for one or both nipples to be turned inwards (inverted). This can be present from birth or can happen when the breasts are developing. The nipples themselves are hairless, but some women have a few hairs around the areola.

A small number of women have an extra breast or pair of breasts. These are usually in the lower armpit and are known as accessory breasts. Some women have an extra nipple or nipples. These are usually below the breast or above the belly button. Accessory breasts and extra nipples aren't usually a problem and don't need to be removed.

 

Breast development

 

The breasts are constantly changing from puberty, through adolescence and the childbearing years and into the menopause, affected by changing levels in the female hormone oestrogen.

For most girls, breasts start to develop around the age of nine to 11, but it can be earlier or later. It's not unusual for the breasts to grow at different rates. Breast lumps can occur while the breasts are developing. These are always benign and don't usually need any treatment once they've been diagnosed.

Once the breasts have developed, changes linked to the monthly menstrual cycle (cyclical breast changes) are common. Just before a period, your breasts may become larger, tender or feel a bit lumpy. After a period, this lumpiness becomes less obvious or may disappear altogether (although some women may have tender, lumpy breasts all the time). Many women also experience breast pain linked to their menstrual cycle (cyclical breast pain).

During pregnancy, the breasts get much larger as the number of milk-producing cells increases. The nipples become darker and may remain that way after you've given birth.

Around the menopause lumps are common. These often turn out to be breast cysts (benign fluid-filled sacs).

Breast tissue also changes with age. It begins to lose its firmness and the milk-producing tissue is replaced by fat, making the breasts sag. This is more noticeable after the menopause, when oestrogen levels fall. As you grow older, your breasts may change size too. If you take HRT (hormone replacement therapy) your breasts may feel firmer and sometimes quite tender.

Being breast aware

Every woman should be breast aware throughout her adult life. It's an important part of caring for your body. It means knowing how your breasts look and feel normally, so you notice any changes that might be unusual for you.

Get into the habit of looking at and feeling your breasts from time to time. There is no set way to do this. You can decide what you're comfortable with and when it's convenient for you. You don't have to look and feel at the same time.

What to look for

You need to be aware of any changes that are new or different, such as:

A change in size - one breast may become noticeably larger or lower

A nipple that has become inverted (pulled in) or changed its position or shape

A rash on or around the nipple

Discharge from one or both nipples

Puckering or dimpling of the skin

A swelling under your armpit or around your collarbone (where the lymph nodes are)

A lump or thickening in your breast that feels different from the rest of the breast tissue.

Constant pain in one part of your breast or armpit

What to do if you find a change

 

See your GP as soon as possible. Don't worry that you may be making an unnecessary fuss and remember most breast changes aren't cancer, even if they do need treatment or a follow-up.

When your GP examines your breasts he or she may be able to reassure you that there's nothing to worry about. If the change may be connected with your hormones, your GP may ask you to come back at a different time in your menstrual cycle. Alternatively, he or she may decide to send you to a breast clinic for a more detailed examination.

Breast Cancer Care has more information about what happens at a breast clinic and the tests used to make a diagnosis .

Breast screening

As 80 per cent of breast cancers occur in women over the age of 50, if you're between 50 and 70 you'll be invited for breast screening every three years as part of the National Breast Screening Programme.

You'll be sent an invitation to come for a mammogram (breast x-ray). This may not happen the year you turn 50, but will happen by the time you're 53. It's important to remember that you still need to be breast aware even when taking part in the screening programme. Report any changes to your GP without delay, even if you've had a recent mammogram.

A small number of women will be asked to come back for further investigations after attending a routine mammogram. This doesn't necessarily mean you have breast cancer. It's more likely to be because the mammogram is unclear, or because it shows up something that needs further tests. If you're sent a recall letter, it's important to attend the appointment.

If you're over 70, you won't be invited for screening but you are entitled to free breast screening every three years on request. Contact the breast-screening unit or ask your GP or practice nurse to arrange an appointment for you.

You can find out where your local breast-screening unit is by calling NHS Direct on 0845 4647 (or NHS 24 on 08454 242424 in Scotland), by contacting your GP practice or visiting www.breastcancercare.org.uk.

At present, women under 50 aren't invited for screening. This is because screening hasn't yet been shown to benefit this age group.

Breast awareness five-point code

The Department of Health recommends that instead of examining your breasts every month for abnormalities, you follow this five-point code, which is much more effective at detecting changes and abnormalities.

1. Know what's normal for you

Woman of all ages should be aware of the normal appearance and texture of their breasts. The following can be normal:

One breast bigger than the other

Nipple inversion

Accessory breast/nipple (two to five per cent)

Lumpiness

Tenderness or pain

During the menstrual cycle, some women experience enlarged, tender, lumpy breasts and these symptoms settle after the period. But some women experience lumpy, tender breasts all the time.

During pregnancy, breasts become larger as the milk-producing cells multiply. It's normal for the nipples to get darker and the blood vessels to become more prominent.

As you age, breast tissue loses its elasticity and it's normal for breasts to sag. During the menopause, your breasts may shrink (as a result of the reduction in oestrogen), although sometimes they do get larger. The nipples may alter, as the major ducts behind them get shorter and wider.

Get to know what is normal for you by:

Feeling your breasts every day until you're familiar with their texture and how it can change through the menstrual cycle

Look and feel your breasts regularly, whenever it's convenient for you

2. Know what changes to look and feel for

Once you're aware of what's normal for you, it's important to look out for changes in your breasts. You should look out for any of the following:

A change in the shape of the breast (pulling of the skin, visible swelling)

Changes in the nipple (pulling in)

Swelling in the armpit

Lumps or thickening that feels different from the rest of the breast

3. Look and feel

Whenever is convenient for you:

Look at your breasts in the mirror and notice how they fall and move as you raise your arms

Look at the position of your nipples

Feel your breasts from time to time

4. Report any changes to your GP without delay

The majority of changes will be normal. Your GP may:

Ask you to return at another time in your menstrual cycle

Refer you to a breast clinic

Invite you to attend routine screening if you're between the age of 50 and 70

5. Attend routine screening if you're 50 or over

Between breast-screening appointments, it's important that you continue to be breast aware and follow the five-point code.

Information in these breast awareness pages is reproduced with the kind permission of Breast Cancer Care

Becoming a woman

Before you're born

The sex of a baby is determined primarily by the two sex chromosomes. In normal male cells, there's an X and a Y sex chromosome. In normal female cells there are two X chromosomes.

Initially, the embryonic tissue that later becomes testes in boys or ovaries in girls is undifferentiated. At around six to eight weeks of pregnancy, the presence of a Y chromosome causes this tissue to develop into testes. If there's no Y chromosome, ovaries develop.

As well as the hormones released by the testes and ovaries, which determine whether we grow into boys or girls, hormones also influence brain development and behaviour.

Most of the brain is similar in males and females, but some regions such as the hypothalamus and amygdala, which control functions related to sexuality, differ between the sexes. In these tissues there are receptors or receiving units that allow the cells to respond to androgens, or male sex hormones.

Early hormone environment permanently influences behaviour. Girls exposed to high levels of androgens in the womb show more interest in toys such as cars and less interest in dolls, are more likely to prefer boys as playmates and engage in male-typical rough-and-tumble play.

Puberty and beyond

In nature, as for any living organism, the probable sole aim of the human body is to reach maturity and reproduce before it dies, in order for the species to continue. Girls are born with all the eggs they'll ever have - in fact, the number of viable eggs falls steadily throughout life until the menopause. It takes, on average, 12 years for the female human to develop to puberty and become fertile.

It's not clear why it takes this long, although there's probably a critical weight - around 47kg (7.5st) - at which menstruation is triggered, dependent on the other hormone systems functioning properly, including growth hormone.

The changes puberty brings are vast, prompted by rapidly increasing levels of many hormones including oestrogen, progesterone and androgens.

During puberty, girls go through obvious outward changes, such as breast development, shape and hair pattern changes. The complex hormonal rhythm of the ovulatory cycle, involving brain, glands, ovaries and other organs, also begins.

Every month the body's hormones coordinate the production of an egg with a thickened uterine lining and receptive cervical mucus. If the egg's fertilised, the different series of hormonal changes that support pregnancy will follow, suppressing ovulation.

In our culture, girls of this age aren't considered emotionally mature enough for motherhood, but their bodies are capable of having children and in most cases continue to be so until the onset of the menopause between 45 and 55.

After the birth of a child, falling levels of hormone signal the brain to start the ovulatory cycle again, although if the mother is breastfeeding this will be suppressed and periods may not start for several months.

Why does it all stop?

Why women go through the menopause when they do - at what is just over halfway through their lifespan - and the exact trigger are unknown. It may be that thousands of years ago, 50 was the normal female lifespan.

Oestrogen production by the ovaries falls as the menopause occurs. This triggers the brain to release other hormones, LH and FSH, in an attempt to make the ovaries work harder. The number and quality of eggs released decreases, the lack of oestrogen means the vagina begins to dry and thin, and fertility falls.

Symptoms such as hot flushes, sweats, muscle and bone pains, irritability and poor concentration are all linked to these hormonal changes.

The extent of these symptoms varies immensely, but the end result is the same for everyone - failure of the reproductive organs and the subsequent effects throughout the body.

Think Portion Control

Super-sized fries. 16-oz Starbucks lattes. 64-oz Double Gulps. It's no coincidence that just as Americans are growing larger so is the size of their meals and snacks.

When nutritionist and NYU faculty member Lisa Young noticed this trend several years back, she took to the streets of Manhattan with scale, notebook and camera in hand. Her goal: record the size of food people were handed at delis, hot dog stands, bakeries, and all-you-can-eat buffets.

"What I found was appalling," says Young in her book Portion Teller: Smartsize Your Way to Permanent Weight Loss. "The foods we buy today are often two or three times, even five times, larger than when they were first introduced into the marketplace."
Skin Care
And, meals and packaged foods weren't the only things that had ballooned. American waistlines had expanded and everything from seats to Queen-sized mattresses―even the size of medical needles―were being adjusted to fit America's widening girth.

Then Young came up with a strategy: portion control. Just because restaurants serve up more food, doesn't mean customers have to finish every last bite. Using five basic food guidelines, Young devised ways for people to get―and stay―slim without deprivation.

Mind your mouthfuls.
Instead of worrying about the amount of carbohydrates or fat a certain meal contains, focus on the amount you consume. Just because it's brought to you doesn't mean you have to finish every last bite.

A simple way to do this is to make visual comparisons, says Young. "Think of a deck of cards as a three-ounce serving," she says. "And, a cup of rice or pasta should be about the size of a baseball." If the piece of salmon you grilled for dinner is the size of three card decks, you've met your meat quotient for the day.

Add first, then subtract
First step, fill your plate with as many portions of fresh, leafy greens and fruits as you want. Do the research and dig up some healthy recipes made with apples, apricots, plums, tomatoes, carrots, peppers, you name it.

"No one wants to be deprived or on a diet," Young says. "Before you take anything away, stock up on fruits and veggies."
Beauty & Style
Negotiate your cut backs.
"Decrease your portions of junk food," Young says. "so you're eating fewer high-calorie foods―chips, sodas, chocolate, fried foods." You don't have to eliminate your favorite foods. "If you like ice cream," says Young, "you can eat it. But, you're going to have to learn portion control."

Pack in protein.
Protein is not only good for you, and it makes you feel full. "In my research, I found that a lot of people were eating breakfast and all their meals, but weren't including protein," says Young. "And, a meal without protein not going to do it. You're never going to feel full with just bread or a bagel."

Remember, there's more to the protein category than just meat. Try slipping some yogurt, an egg, low-fat dairy, or fish into every meal.

Forget white flour.
When you eat white flour products, your body gets nothing but empty calories because the fiber, vitamins and minerals have been stripped away.

"A lot of people were under the misconception that it was carbs that were making them full and fat, when really, it was the starches," says Young.

And beware, says Young. Don't assume that because bread or other products are brown that they are healthier. They could be dyed brown with molasses. To be sure, read the label to ensure that your bread is made with 100% whole wheat or whole grain.

Fire Up Your Metabolism

It's 9:25 in the morning, and I'm lying on a twin bed at the Pennington Biomedical Research Center, one of the country's premier facilities for the study of body weight and metabolism. My room here on the outskirts of Baton Rouge boasts all the amenities of a nicely outfitted, minimum-security prison cell. Besides the bed, I have a toilet, sink, cable TV, DVD player, computer, treadmill, even a minifridge.

The latter, alas, is for storing urine samples only. Best not to forget and reach for a Mountain Dew.

Everything I can consume over the next 24 hours of voluntary incarceration is under the tight control of PBRC staff nutritionists. At established intervals, nurses will pass me premeasured portions of a "standard American diet" (15 percent protein, 50 percent carbohydrates, 35 percent fat) through a special air-locking slot in the wall.

Though I've come to think of this as my Hannibal Lecter slot, it serves a necessary scientific function: preventing atmospheric contamination of the 27,000 liters of air surrounding me. This sea of air, like my calorie intake, is under scrupulous regulation. An inflow pipe on the floor continuously pumps in exactly 60 liters of fresh air per minute ― untainted by contact with any human lungs, mine included. At the same time, 22 evenly spaced outflow holes in the ceiling siphon off my "breathed" samples for detailed analysis.
Care Your Health
"The official name of the room you're now in is a 'whole-body indirect calorimeter,' " explains PBRC biomedical engineer Tuong Nguyen, over an intercom from an adjacent lab. As he begins to deliver Calorimetry for Dummies, he simultaneously monitors me with a video camera that has infrared capability for nighttime observations. "The reason we call it indirect calorimetry is because we're not measuring your caloric burn directly. Instead, we're detecting how much oxygen your body is using at any given point, and how much carbon dioxide you're giving off."

Complicated physiological formulae, Nguyen adds, will then convert my gleaned gaseous data into a minute-by-minute count of every calorie I burn during sleep, work, meals, exercise, rest, TV viewing, and so forth. Other formulae will take the constantly shifting ratio of my oxygen use and carbon dioxide production to reveal what proportions of these calories are coming from fat and carbohydrate burning, respectively. (Note: When our bodies use protein for fuel, it's converted to carbohydrate first.)

At this point, Nguyen stops explicating and encourages me to begin resting in earnest. The steady whoosh of circulating air all but drowns out the gurgles of my gut, which has not seen food in the past 14 hours. Before I know it, my mind wanders to the octopus of air tubes hidden in the ceiling. I imagine my slow, relaxed puffs of exhaled gas wending their way through a drying agent before being measured by incredibly fine-tuned sensors.

"Okay," says Nguyen, "you can get up now and move around. Breakfast will be ready in a couple of minutes."

It's hard to believe a whole hour has passed.

Before I rise, I find the remote and turn on the TV. A white-trash woman in a black bikini is yelling obscenities on Jerry Springer. I can see her cellulite jodhpurs jiggling in rage. She has to be burning serious calories here, I think ― though probably not, it would appear, the ones in her thighs.

THE SCIENCE OF METABOLISM
As you may recall from high-school biology, metabolism consists of all "the chemical processes occurring within a living cell or organism that are necessary for the maintenance of life." To struggling dieters and body-weight researchers alike, however, metabolism has come to refer more narrowly to the pitiless calculus of kilocalories, or, as we laymen tend to call them, calories.

Take in fewer calories than we use and we'll lose weight. Take in more and we'll gain it. Achieve energy balance ― wherein calories in equals calories out ― and we'll remain in equilibrium.

No Dummy's book needed to comprehend this, eh?

Alas, delve the merest sliver beneath the superficial level and you'll find that the science of metabolism quickly escalates into doctorate territory. Consider, for starters, the three major components of metabolism.

Basal Metabolic Rate (BMR)
Lorraine Lanningham-Foster, Ph.D., senior research fellow at the Mayo Clinic, in Rochester, Minnesota, explains that the technical definition of BMR is "the energy expended when an individual is lying at complete rest, in the morning, after sleep, in the postabsorptive state." Except for time of day, BMR's motionless state of do-nothing inertia seems awfully close to what I do most nights on the couch in front of my TV.

Any appearance of passivity, however, is an illusion. Indeed, for most American males, BMR is by far the largest piece of the metabolic pie ― accounting for 60 to 70 percent of total calories expended each day. Just a few of the many metabolic jobs falling within BMR's bailiwick are lung function, immune response, blood circulation, and tissue repair.

Victims of severe burns, for instance, have had BMRs exceeding 8,000 calories a day while lying motionless on hospital beds. "Even recovering from a common cold expends a large number of calories," says John Berardi, Ph.D., author of The Metabolism Advantage.

Acute injury and illness aside, the biggest power draw of all comes from basic tissue maintenance. "Three-quarters of variability in BMR is predicted by lean body mass," explains Lanningham-Foster. This includes bones and organs, which we can't change, and muscles, which we can. But as we get older, the challenge to build or even just maintain our current muscle mass becomes more difficult. The reason: We start rowing against a physiological riptide known as sarcopenia of aging. Unless they take steps to counter it with strength training, virtually all men are fated to lose 1 percent of their muscle a year starting around age 25. Most of us more than make up for this loss with fat.

"Lots of guys in their 30s and 40s will tell me, 'I've been eating exactly the same foods for 20 years ― I can't understand why I'm gaining weight,' " says Nikhil V. Dhurandhar, Ph.D., an obesity researcher at PBRC. "What they're not accounting for is that their energy requirement is dropping."

For all too many of us, the once-proud boast of youth ― "There's not an ounce of fat on this boy!" ― gradually changes to a middle-aged lament: "There's not an ounce of boy in this fat."

Thermic Effect of Food (TEF)
A second major component of metabolism is one that most people have never heard of: TEF, the caloric "handling cost" of digesting, using, and storing food energy. Depending on a guy's genes and dietary preferences, TEF can range from 10 to 15 percent of total daily metabolism. The next time you swallow a 1,000-calorie meal, in other words, you can console yourself with the fact that your body is actually netting only 850 to 900.

It takes a lot of metabolic work to convert raw foodstuffs ― from trout amandine to Snickers bars ― into forms of energy our bodies can actually use. In a simplified overview, the process begins when the digestive system breaks down nourishment into its constituent building blocks. Complex carbohydrates are reduced to simple sugars, fats to fatty acids, and proteins to amino acids.

These smaller, more manageable molecules enter the bloodstream and circulate throughout the body, being snarfed up as needed by billions of cells. Inside each cell, tiny engines called mitochondria further break down food molecules and tap their energy into forms, such as ATP and creatine phosphate, that power life's manifold jobs, from movement and procreation to fighting off germs and worrying about our weight.

The Active Life: Eat and Neat
Metabolism's third major component ― and its most variable ― is physical activity. This includes planned exercise (exercise-activity thermogenesis, or EAT), as well as the voluntary and unconscious movements we perform in the course of daily life (non-exercise-activity thermogenesis, or NEAT). Generally speaking, activity of any sort makes up 15 to 30 percent of the average man's metabolism.

There are, of course, exceptions. Manual laborers (high in NEAT), as well as men committed to large doses of exercise (high in EAT), can see their percentages skyrocket. Case in point: Tour de France riders, who have been shown to burn as many as 9,000 calories per day throughout the 3-week race.

Realistically, most of us don't work as stevedores, nor do we have anywhere near the time to get in the shape necessary to climb even a modest Alp. With work and family obligations, we're lucky to squeeze in three hard workouts a week. This, mind you, is no small feat. Still, it may not be quite as great as we smugly tell ourselves. In the 168 hours of each week, 3 hard hours represents less than 2 percent of the total.

Things were different for our hominid ancestors, says John Castellani, Ph.D., a researcher at the U.S. Army Research Institute of Environmental Medicine. In the hardscrabble past, it was the norm to run extreme energy deficits. "If you caught the buffalo," he says, "you'd be okay for a while. The rest of the time, you'd be running around half starved, trying to find something to eat."

Chances are, the only buffalo most of us will ever "catch" today are the spicy-winged variety delivered, by the bucket, to our door.

THE BODY COMPOSITION TEST
Michelle Hall, an attractive 26-year-old scan technician at PBRC, tells me to take off my clothes and change into a zipperless gown. I've just been sprung from the calorimeter, and Nguyen has arranged for me to bivouac with Hall in the DEXA (dual-energy x-ray absorptiometry) lab while he compiles my results. At Hall's instructions, I feel a spike arise somewhere deep within my metabolic physiology.

"I used to be almost a quarter pure lard," I say, emerging from the changing room in the gown, which may or may not be on backward. "You think I'm any less now?"

"Hard to tell just from looking at you," she replies with a North Carolina drawl. "We'll know more soon."

As she leads me over to a digital scale, Hall explains that DEXA was originally pioneered to diagnose osteoporosis. In recent years, it's also emerged as the most accurate way to determine body composition, supplanting the old gold standard ― underwater weighing ― at many obesity research centers.

Five years ago, I had a chance to undergo an underwater weighing. At that time, I was 184 pounds, a depressing 23.1 percent of which proved to be pure fat. The exercise physiologist in charge said that meant I was lugging 43 pounds of adipose tissue everywhere I moved ― much of this in my midsection, a pattern common in men.

Researchers even have a diagnosis for when otherwise skinny guys put on too much abdominal fat: "weight normal, metabolically obese." I hadn't reached this point ― yet.

"Okay," Hall says, pointing to a digital scale. "Step up."

Red numerals flicker around nervously before finally settling on 75 kilograms.

"Now we get to subtract the gown," she says.

A few calculations later, I get the Americanized results: 164.4 pounds, essentially identical to my college "fighting weight." When Hall next checks my height with a digital measuring stick, I brace myself for the likelihood of significant shrinkage. But once again, the news is good: 6'0.76" ― less than a quarter inch off my lifetime record. Maybe the tag team of life and gravity hasn't beaten me down quite as much as I thought. My body-mass index, or BMI, is 22.0 ― safely in the "not too fat, not too thin" zone.

Now, however, comes the real money shot: the DEXA scan itself. True, I've cut 20 pounds in the 5 years since the underwater weighing, but the question remains, what kind of pounds have I shed? If my body has simply cannibalized its skeletal muscle for fuel, something not uncommon in cases of significant weight loss, I may have only turned myself into a skinnier, weaker, slower-metabolism version of the fat guy I used to be.
Beauty & Style
"I need you to lie down here," Hall says, indicating a sliding gurney beneath a moveable QDR 4500 Hologic scanner arm. For the next 3 minutes, the arm glides back and forth, spraying my body with a piddling 5 microsieverts of radiation (the same amount we get each day just living on Earth).

Once the scan is done, I get dressed and go to look over Hall's shoulder. She's using a computer mouse to draw red boxes around my arms, legs, trunk, spine, and head. A grayish halo surrounds my bones. "That's your skeletal muscle," she says, adding that the even finer layer on the perimeter is fat.

"Maybe my eyes are getting worse with age," I say, "but I can't see much fat."

"You really don't have much at all," she replies, smiling. "The software will let us know exactly how much."

The printout proves better than I could have hoped for. I'm down to 17.1 percent total body fat, which Hall says is distributed in a healthy, symmetrical way. My leanest parts are my legs ― the left one at 14.2 percent fat, and the right one at 13.6. My abdomen, at 18.7 percent fat, is in no way suggestive of abdominal obesity, Hall says. My gut is not even my fattest body part. My head, at 20.1 percent, takes this honor.

I wonder if researchers have a diagnosis for this, too: "weight normal, fat head."

MAKING A LIFESTYLE CHANGE
At first, I admit, it wasn't a conscious decision to lose weight. The process began approximately a year ago when I decided to quit cold turkey what had become a nightly ration of three India pale ales. Not only did teetotaling slash at least 500 calories out of each day's total allotment, but it simultaneously nicked an insatiable urge to snack on pretzels and saltines to stoke my thirst. Within a couple of months, my weight had dipped by 7 pounds. A combination of greater energy and fewer headaches, in turn, added hours to each day.

At some point last winter, it occurred to me that it just might be possible to return to the 164-pound benchmark of my 20s. The challenge was on. I resolved to devote some of my new, nontipsy hours to exercise, setting an initial goal of working out five times a week.

This training time, however, soon proved much more relaxing than Miller Time had ever been. I liked it so much that over the next several months, I increased my regimen to the point where I now take 40-minute hikes with my two dogs most days of the week; attend 90-minute masters swimming practice on Mondays, Wednesdays, and Fridays; weight-train on Tuesdays and Saturdays; and play tennis for 3 hours on Tuesdays and Sundays.
Skin Care
After a couple of episodes of "bonking" midpractice from low blood sugar, I made sure I always consumed enough food to fuel my exercise. This led me to eat more frequently and space my meals throughout the day. When I tallied up the foodstuffs I was consuming, I soon discovered I was actually eating more than I had at my grossest fat-hood ― and still losing weight.

Through personal trial and error, it seems that I had accidentally begun following the philosophy of "high energy flux" that Berardi recommends in The Metabolism Advantage. Put simply, this means eating lots of highly nutritious food, then burning it up through greatly increased activity. This may sound obvious, but many people who hit their target weights through diet and exercise believe that they need to keep their calorie intakes low to maintain their fat loss. The problem is that if they continue to exercise, they'll end up always running a calorie deficit, leaving them forever famished and, in many instances, fated to eat everything in sight and slide back into blubberdom.

"When you reach a healthy, stable weight you're happy with," says Claude Bouchard, Ph.D., president of the International Association for the Study of Obesity, "then you'll need to make sure your eating is commensurate with the extra calories you're burning." At some point, your body will achieve a new and happier homeostasis, one that will let you simultaneously work out hard, eat enough so you're not plagued by hunger pangs, and maintain your new weight without obsessing about it.

On this intake side, Berardi recommends eating every 2 to 3 hours ― the same mini-meal approach I discovered through my own experimentation. Adding protein to each of these feedings is important, too. Protein contains nitrogen, which must be stripped off and eliminated as urea by the liver. As a result of this additional metabolic step, protein's thermic effect is roughly double that of fat and carbohydrates. "Eating frequently and including at least some protein in all your meals," says Berardi, "can boost digestive metabolism all day long."

As helpful as these measures can be, the greatest benefits come on the expenditure side. Not only do forms of intense exercise ― such as running intervals and lifting weights ― burn loads of calories while you're doing them, but they also trigger a significant afterburn as your body works to cool off and repair muscle microtrauma afterward. Afterburn alone, says Berardi, can consume an extra 100 to 200 calories.

Though genes limit just how much new lean muscle mass a person can build, most of us can add at least some, especially if we take up regular strength training. And, as I noted, this in turn will benefit your basal metabolic rate. "With exercise," explains David M. Klurfeld, Ph.D., National Program Leader in Human Nutrition at the USDA, "you are also producing larger mitochondria in each muscle cell." Expanding these tiny powerhouses translates into a higher calorie burn.

"Fat tissue burns very few calories," adds Klurfeld. "Skeletal muscle, on the other hand, burns at least 10 times more calories than fat, even when we're at rest."

Heck, make lifting a lifelong habit and you may be able to entirely avoid age-related muscle loss: Septuagenarians who regularly strength-train can have more muscle mass than 30-year-olds who don't.

WALKING WHILE WORKING
As I'm typing these words, I'm also walking at a steady pace of 1 mile an hour. I've been "walk-writing" like this for the past 3 hours, burning 300 calories in the process.

The contraption allowing me to do this is a vertical desk ― a standard exercise treadmill rigged with a height-adjustable PC keyboard and monitor. The device is the brainchild of the Mayo Clinic's James Levine, M.D., who, in a much-publicized 2005 study in the journal Science, demonstrated the critical role everyday activities play in metabolism and energy balance. Dr. Levine and his fellow researchers rigged 20 volunteers with custom-made, high-tech underwear to be worn 24 hours a day for 10 days straight. These electronic undies ― I'm wearing a set right now ― sport four inclinometers arrayed on the thighs and chest, and two accelerometers near the small of the back. Together, the sensors relay 1,200 pieces of data per minute that reveal the body's orientation in space and how much or little it's moving.

As the Science study showed, NEAT levels ― like other aspects of metabolism ― vary greatly among individuals, driven by factors that include occupation, choice of leisure activities, and unconscious movement. In overweight guys, NEAT can run as low as 15 percent of total metabolism. In leaner men, it can exceed 50 percent.

Even armed with this knowledge, I was extremely skeptical when I started out this morning at the vertical desk. I've never been the kind of person who can effectively do two things at once, and expected that only tripping and gibberish would come of this experiment. But as Lanningham-Foster predicted, it took me less than 10 minutes to reach the point where my consciousness of the slow walk faded.

At 1:30, I stop my walk and take a break for lunch. In the corridor, I see Dr. Levine and a colleague walking the hallways, badges around their necks that proclaim "Walking Meeting in Progress." The labyrinths of the hospital system seem unending, and Dr. Levine's idea of holding confabs in motion has quickly caught on with numerous Mayo staffers.

I also pass several standing desks ― another calorie-burning idea that's popular at Mayo. These stations, though they lack treadmills, nevertheless allow the nursing staff to input patient data without having to sit down at computers. The difference in calorie burn just between sitting and remaining upright is no trifle: nearly 1 calorie in added expenditure per minute.

After lunch at a nearby café, I climb five flights of stairs to the NEAT lab annex and get back to work on the vertical desk. Ordinarily, I suffer a major attack of postprandial grogginess after lunch, but not so today. I walk my way through another mile of writing, then decide to take a "break." I put the keyboard down, set the treadmill to 3 mph, and luxuriate in a brisk walk for the next 30 minutes. Then I slow back down to 1 mph and resume working.

As much as I'm enjoying this gizmo, in the near term, I concede that it's about as likely to catch on with corporate America as George Costanza's "napping desk." Still, there are a myriad of other, more clandestine ways to add NEAT to a desk job.

You can, for instance, consciously choose always to park at the end of the lot instead of circling around for a closer spot. Once you arrive, just say no to the elevator and hike up the stairs when moving from floor to floor. Instead of sending an endless stream of interoffice e-mails, visit several of your would-be recipients face-to-face. And resolve to replace your desk phone with a cordless one, even if you have to buy it yourself. Then never take a call in a seated position again, opting instead to pace around whenever you're talking.

With the right attitude, you can convert your cubicle into a minigym. "Since I ride a desk chair for 8 to 9 hours a day," says Klurfeld, "I consciously attempt to 'NEATen up' my day. For instance, I flex my leg muscles, either together or in a left-right pattern, multiple times. Simply bouncing on my toes while seated is easy, too. While I'm reading something on paper, I stand to do toe raises."

Granted, overcoming sedentary seductions can take some practice. To provide yourself with regular reminders to move, buy a programmable sports watch and set it to beep every 20 to 30 minutes, then stand up and do a dozen toe raises.

Who knows? As you become leaner and fitter from NEAT, you might be inspired to use the same watch on a running track.

BANISHING SEDENTARY HABITS
Upon arriving back at my old-fashioned office in Pittsburgh, I find an individualized "regression analysis" in my e-mail. A six-color graph neatly illustrates all my movements and velocities over the 2 workdays I spent at the Mayo Clinic.

My body burned 723 more calories on day 2, working at the vertical desk, than it did on day 1, doing identical work over the same time period sitting down. As I listen to Dr. Levine explain this, I'm simultaneously pacing around my office with a portable phone, in the process deepening a path in the carpet. When the call's over, I glance over at my desk and chair, and their promise of hours of relative immobility to come.

If there's one overriding lesson I've learned from my recent forays to research labs, it's that human metabolism is bewilderingly complex, the sum of many interconnected processes that together define our status as energetic beings. Targeting one aspect of this metabolic nexus is not likely to optimize us. Rather, it's only by combining strategic nutrition and exercise with a NEAT-replete life that we can best gain the strength, endurance, body composition, and sustainable energy balance that define humans at their peak.
Beauty Woman
Each of us, to be sure, is likely to have areas that need more work than others. In my case, the lack of NEAT is most problematic. Occasional junkets to metabolic chambers notwithstanding, much of my livelihood involves cogitating in what I used to think was a necessary "parked buttocks" mode. I now know it doesn't have to be this way.

Along these lines, I cannot shake the memory of how enjoyable and paradoxically relaxing it was to walk-write my way through an entire day.

Since I work at home, there's no on-site overlord to dictate what I cannot do. It may look goofy on the outside, but to the NEAT-starved forces within, the chance to work in motion the way my ancestors did somehow feels right. After all, they evolved to spend their days wandering around in search of food. Why should I not wander around in search of words?

Before I left Mayo, I asked Dr. Levine about procuring a vertical desk for myself, but he said they weren't yet commercially available. Nevertheless, he added, people from around the country who have read about his research regularly e-mail him pictures of models they've jury-rigged themselves. "One lady even made one out of cardboard boxes," he told me.

Once again, the challenge is on. I have some planks in the garage and a friend who bought a treadmill that he never uses.

I'll call him tonight. Maybe he'll sell it to me cheap ― that is, before he learns how much it's worth.

Eat Right Without Thinking

By Tamar Haspel, Women's Health

From the instructions for some diets, you'd think losing weight was more complicated than calibrating a sextant against Orion on a cloudy night. The food diaries you need to write; the nutrition labels you need to read and pronounce and translate; the protein, fat, and carbohydrate grams you have to add up. It's time to try an easier way. No math, no more squinting at the fine print and trying to decipher those words with no vowels. Instead, just 20 everyday tactics that will get you started on your weight-loss plan and then help you stick to it. Soon enough, your diet will simply become the way you eat.

1. Always eat dessert. Yes, always. "A small amount can signal that the meal is over," says Barbara Rolls, Ph.D., author of The Volumetrics Eating Plan. She ends her meals with a piece of quality chocolate and she's a doctor.

2. Get help from a paper napkin. You can use it to blot a teaspoon of fat off a pizza slice. That may not sound like a lot, but multiply it by a slice a week, and that's more than a whole cup of fat you won't eat or wear this year.

3. Take the beltway. When junk food beckons, tighten your belt a notch. Not so you can't breathe, but so you have a gentle reminder of the size you'd like to be. "The scale isn't the only measure of weight," says Roberta Anding, R.D., a spokeswoman for the American Dietetic Association.

4. Go public. Enlist the help of friends, family, and coworkers and know they're watching. "The power of embarrassment is greater than willpower," says Stephen Gullo, Ph.D., author of The Thin Commandments.
Skin Care
5. Milk it for all it's worth. Consuming 1,800 milligrams of calcium a day could block the absorption of about 80 calories, according to a recent University of Tennessee study. Jump-start your calcium intake by filling your coffee mug with skim or 1 percent milk, drinking it down to the level you want in your coffee, then pouring in your caffeine fix. That's 300 mg down, 1,500 to go.

6. Scrape by. Always order your bagel or burger with a plastic knife. Use it to scrape off the excess cream cheese and mayo. You could shave off as many as half the calories.

7. Spice things up. Capsaicin, the substance that puts the hot in hot pepper, temporarily boosts your metabolism. Just make sure you're drinking a yogurt lassi with that searing-hot chicken vindaloo. Dairy blocks capsaicin's sweat-inducing signals better than water.

8. Case the organic section. That's where you're likely to find bread and cereal with fiber counts that put the conventional choices to shame. Thought you were doing well with your 3-grams-per-serving Cheerios? Nature's Path Slim blows it away with 10 g. (And it really doesn't taste like a shredded shoebox.)

9. Increase your a-peel. Speaking of fiber, a lot of it's in the peel, whether it's potatoes, apples, or pears. Even oranges don't eat the whole peel, but keep the pith, that white stringy stuff; it's packed with flavonoids. More nutrients, more fiber, less labor. It's a win-win-win.

10. Spend lavishly on precut vegetables at the supermarket. Sure, they cost more, but you're more likely to eat them. "Make low-energy snacks as easy as possible," Dr. Rolls says. "Keep vegetables as near to hand as you can. Make it so you have no excuse."

11. Upgrade your restaurant selection. Pick a place where you'll actually want to linger. "When the meals are not hurried, the presentation is beautiful and the portions are reasonable so you can regulate your attitude," Anding says. That means your body not the empty plate will tell you when to stop.

12. Eat a snack at 3 p.m., no matter what. "Have a 150-calorie snack [now], and it can save you 400 calories later," Anding says. An ounce of nuts or two sticks of string cheese weigh in at about 170 calories.

Beauty & Style
13. Drink with your dominant hand. If you're circulating at a party, Dr. Rolls suggests keeping your glass in the hand you eat with. If you're drinking with it, you can't eat with it, can you?

14. Plate it. Whatever it is, don't eat it out of the container and don't bring the container to the couch. "Part of satiety is visual," Anding says. "Your brain actually has to see the food on the plate, and when you reach into the jar, or the box, or the bag, you don't see it." If it's worth eating, put it on a plate. Eat what's there, then stop.

15. Send back the bread. All it takes is a wave of the hand, a smile, and a "No, thank you."

16. Start with salad. It's the holy grail of dieting eat less by eating more. Dr. Rolls's research has found that eating a salad as a first course decreased total lunch calories by 12 percent. Avoid the croutons and creamy dressings, which have the opposite effect.

17. Go out for ice cream. Or an eclair. Or even guacamole and chips. Just go out. Don't keep your danger foods in the house. You can't eat half of a carton of ice cream that's not there in the first place.

18. Give yourself a hand. Find a way other than food to work off your nervous energy. "It's behavior modification," Anding says. "Instead of grabbing a bag of chips, you pick up your knitting. Art works, woodworking works anything that occupies your hands."

19. Wait a minute. Well, 10 minutes. When your mind strays from your desk to the vending machine, it could be hunger or it could be boredom or irritation with your boss. If you're still thinking about snacking 10 minutes later, then you're probably hungry. Think of it as a chance to have one of the nine servings of fruits and vegetables you need each day.

20. Go wild once in a while. Deprivation won't make you thin or happy. Designate a meal or two a week when you can eat absolutely anything you want.

Tobacco Companies Targeting Teens, Study Says

THURSDAY, Feb. 12 (HealthDay News) -- Tobacco company ads are reaching teenagers and influencing their desire to smoke and what brands they choose, U.S. health officials report.

"We are continuing to find that Marlboro, Newport and Camel brands, among the most heavily advertised brands, continue to be overwhelmingly the preferred brands of cigarettes smoked by middle school and high-school students," said Terry F. Pechacek, associate director for science in the Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention.

"The industry will deny that they are marketing to underage youth, but our data are showing that the advertising is still reaching the kids," Pechacek said.

A spokesman for one of the tobacco companies defended its marketing program. "Kids should not use tobacco products of any kind," said Philip Morris USA spokesman David Sutton. "We take youth access to tobacco products seriously."

"We have made a significant effort, both at retail and marketing, to connect only to adult smokers," Sutton added.

The brand preferences in the report mirrors what is seen in the marketplace among adult smokers, Sutton said. "If you look at those preferences, they line up with market share among adult tobacco consumers," he said.

Each of the major cigarette companies in the United States has a leading youth brand, Pechacek said. "Industry documents show that all the tobacco companies are continuing to note that if they don't have a leading youth brand, they are in corporate trouble," he said.

Marlboro is marketed by Philip Morris, Camel is made by R.J. Reynolds Tobacco Co., and Newport is from Lorillard Inc.

The report, in the Feb. 13 issue of the CDC's Morbidity and Mortality Weekly Report, found that 78 percent of middle school students and 87 percent of high-school students prefer to smoke these three brands.

In addition, there was a considerable difference in the brands preferred by boys and girls, and blacks and whites.

Marlboro is preferred by 50 percent of middle school girls and 54 percent of high-school girls, while the brand is preferred by 38 percent of middle-school boys and 50 percent of high-school boys. Camels were smoked by 12 percent of middle-school boys, compared with 4 percent of girls.

Newport, a menthol cigarette that is primarily marketed to black communities, was the preferred brand for 60 percent of black middle-school students and 79 percent of black high-school students, according to the report.

In a recent report, the U.S. National Cancer Institute said there is sufficient evidence to conclude that tobacco advertising is directly related to getting people to smoke, Pechacek said.

"Our data in this study, without implying intention, [shows] we are finding that adolescents are being heavily exposed to advertising," Pechacek said.

In an editorial note accompanying the CDC report, researchers noted that, in 2004, 85 percent of teens saw tobacco ads in stores, 50 percent saw them in newspapers or magazines, and 33 percent saw them on the Internet. A whopping 81 percent of teens saw smoking on television or in the movies.

Pechacek noted that the U.S. National Cancer Institute report found that partial bans on tobacco advertising are ineffective, and a 2007 report by the Institute of Medicine called for stronger measures to control tobacco advertising.

The World Health Organization's Framework Convention on Tobacco Control has called for a complete ban on tobacco advertising as far as possible within constitutional restraints, Pechacek said.

Tobacco cessation programs are underfunded when compared with CDC recommendations, Pechacek said. "Are we reaching a majority of vulnerable kids? The evidence is clearly no," he said. "We are reaching some of the vulnerable kids, probably in the range of 20 to 30 percent."

There was a dramatic drop in teen smoking since 1997, Pechacek said. "But that drop stalled in 2003. For 2007, the data are indicating that the sharp decline has stopped. We are still seeing a slow pattern of possible decline. But we are stalled at probably one in five high-school students smoking," he said. "That's pretty much a replacement number for adults that quit."

Danny McGoldrick, research director for the Campaign for Tobacco-Free Kids, said this is yet another example of the reach of tobacco company marketing.

"This is one more piece of evidence that the tobacco marketing efforts affect kids, and the companies are still up to it," McGoldrick said. "For companies that claim not to market to kids anymore, they sure do a good job of getting them to use their product."

Marlboro is smoked by more high-school students than all the other brands combined, McGoldrick said. "When you are close to 90 percent market share among these three brands, they are doing something right," he said.

The U.S. Food and Drug Administration needs to have the authority to regulate tobacco marketing, McGoldrick said. "The FDA regulates food, drugs and even cosmetics, but doesn't regulate a product that kills half the people that use it, and 90 percent of the users start as children," he said.

McGoldrick thinks more money is needed to counter tobacco company marketing. "The states aren't using their tobacco settlement or tax dollars to fund the programs we know work to counter tobacco industry marketing and promotion," he said.

U.S. mothers avoiding foods containing peanut butter

ATLANTA (Reuters) - Almost half of U.S. mothers are avoiding food made with peanut butter even if products are not among more than 1,800 recalled because of a salmonella outbreak that has sickened 600 people, according to a survey released on Thursday.

The online survey showed that 23 percent of consumers questioned said the most recent food scare would change their long-term buying habits. The survey was released by public relations company Burson-Marsteller and Penn, Schoen & Berland Associates, units of WPP Plc.

The salmonella outbreak, linked to 9 deaths, has been traced to a plant in Blakely, Georgia, operated by Peanut Corp of America. The company closed a plant in Texas after tests showed possible contamination in some of its products, Texas state health officials said this week.

Consumers "are clearly willing to quickly change eating or buying habits, for some people, well beyond the actual parameters of a government or a company recall," said Bill Zucker, managing director of Burson-Marsteller.

Almost all of the 501 consumers surveyed (93 percent) said they had recently read about or heard of food safety issues and recalls.

The survey showed that while 68 percent of people questioned believed instances of food contamination had increased in the past five years, 87 percent felt that the United States had one of the best food safety systems in the world.

Companies with strong brands were more likely to withstand an incident of food contamination than companies not as well known, according to the survey.

Consumers were also more likely to judge an incident of food contamination at a well known company as an isolated event than a similar incident at a lesser known company, the survey showed.

Love It or Hate It, Stimulus Spurs Profits From Stocks In 2009

You and I both know the recently-passed stimulus package is far from perfect.

Only the naïve could've thought that such a massive piece of legislation wouldn't get riddled with pet projects and favors.

But whether we agree with the entire package or not is irrelevant. The government support it offers to a few choice market segments will be more than enough for investors to walk away with nice gains.

And I'm not one to throw the baby out with the bathwater. So I'll tolerate the bad while using the good to transform Wall Street and Washington resentment into pure profits.

One of the best ways I've found to do that is by investing in infrastructure, because the government is virtually guaranteeing a robust market for years to come.

They'll funnel billions into road and bridge construction, electricity grid improvement, and water infrastructure upgrades.

And the companies executing the projects are going to make a fortune... on the taxpayers' dime.

Why not personally profit in the process?

Congress and the White House are busy hashing out the final details, and the full bill could be signed by Monday, the 16th.

When that happens, the sectors receiving handouts will surge on the Street. So you need to be prepared today.

America is - quite literally - falling apart.

Consider this recent example - one that could've come straight from a Hollywood disaster flick:

On December 23, 2008 at about 8 a.m., a 60-inch water main burst along a major road in Bethesda, MD, hurtling 135 million gallons of water per minute over streets and lawns.

Without a second to prepare, drivers in this sprawling D.C. suburb were stricken with terror as a 5-foot wave of icy water - 60 feet wide in some areas - barreled down, trapping them in their cars...

Boulders, trees, and even cars were suddenly swept up in the flood. Cell phone calls from panicked motorists overwhelmed even the 911 dispatchers.

The street called River Road turned into an actual river.

But here's what's truly horrific...

This was just one of 1,357 water main breaks in Montgomery County, Maryland in 2008 (down from 2007's record 2,129 breaks)... In many of these cases, homeowners were left without water or electricity.

In fact, another pipe recently burst there, closing over 800 restaurants and leaving tens of thousands of people hunting for water clean enough to drink.

And water main breaks just like the ones above attack roughly 255,500 locations every single year across the U.S.

What if the same road you've driven thousands of times over... was the next one to cave in?

Truth is, it's all part of...

America's Underground Epidemic

... And we have no choice but to fix it. Here's why:

The oldest pipes in our nation's infrastructure date all the way back to the late 1800s, are made of cast iron, and typically last about 120 years.

During the Roaring '20s, more pipes were laid to accommodate our expanding population. But these pipes normally start to crumble long before their 100th birthday.

The last major installation of pipes came during the boom after World War II. These pipes are scheduled to last 75 years.

A quick look at the following table will tell you just how real this scenario is:

Installed	Durability	Replacement
1890s	120 years	2010-2020
1920s	100 years	2020-2030
1940s	75 years	2015-2025

By all measures, we've reached critical mass when it comes to having to replace the bulk of the country's water pipes.

On average, 700 water main breaks happen every day in North America, and the results are often disastrous...

• On December 26, 2006, a several-ton Portland city truck nose-dived into a massive sinkhole, injuring two workers, rupturing a water line, and causing a natural gas leak...

• On May 2, 2007, a broken water main in Seattle caused a 10-foot deep and 20-foot wide sinkhole that swallowed a car and a minivan, and flooded a neighboring district with water and mud...

• A Hollywood water main break this New Year's Eve damaged the roofs of two apartments and left 60 to 70 residents without water...
  

• Last April, 294,000 gallons of untreated sewage flowed into Seattle's Lake Washington after a pump failure went undetected for 3 days...

• And just this month, a million-dollar court case was settled involving a misplaced sewer line in Milwaukee drained groundwater and rotted wood pilings beneath an office building during a construction project.

But within America's monstrous infrastructure problem lies a billion-dollar "shovel-ready" solution... one that's virtually guaranteed to make informed investors like you exceedingly wealthy.

How so?

Just imagine how much money you could make, knowing which specific companies will be hired to fix this rapidly expanding problem... before they're called to do it.

Even better, imagine also knowing the specific date that a national project to fix them all starts.

Timing it right, you'd be setting yourself up to collect an absolute fortune!

And it all starts with...

The $697.3 Billion Problem

The money about to flow into infrastructure projects is going to dwarf the amount spent on some of the biggest events in U.S. history (adjusted for today's dollars).

Today, the Louisiana Purchase would cost a mere $217 billion. And we could go to the moon and back 4 times with the gobs of dough about to be spent on transmission lines and sewer pipes alone.

Bringing the country's fundamental support systems up-to-date will be recorded in the history books, along with The New Deal, as one of America's greatest moments.

The profits made from it will be equally legendary. And you can be a part of it all.

You see, our nation's infrastructure is in need of a drastic overhaul.

Take the Seattle sinkhole I just mentioned... the water main at fault was installed in 1912. And the pipe behind the Bethesda flood was installed in 1964.

But frankly, that's just the norm.

(In fact, some of the water pipes running under our streets here in Baltimore date back to the 19th century. Some of them are even wooden.)

But the U.S. government has ignored the problem for so long that water - the most essential substance on earth - has now become a multi-billion dollar dilemma.

The EPA estimates that the necessary upgrades to wastewater treatment and collection, sewage, and storm water management systems will cost a bare minimum of $202.5 billion over the next 20 years... And that's not including the $276.8 billion investment we'll need to upgrade our drinking water systems.

But these inadequate water systems aren't the only symptom of our crumbling infrastructure...

• It would take 40 cents a gallon more in gas taxes over the next five years to keep our nation's highways in their current condition... and even still, they'd be subpar...
• One quarter of U.S. bridges are structurally deficient or functionally obsolete, and bringing them up to code will cost $140 billion...
• The Texas Transportation Institute says highway congestion costs us $78 billion each year due to the 4.2 billion hours and 2.9 billion gallons of gas we waste being stuck in traffic...

Even our telecommunications system is far slower than the broadband speeds of competing countries. But these problems mean more than just hellish rush hour traffic or poorly streaming YouTube videos...

Our Failing Infrastructure Is a Threat to Our Economy

Just look at California...

New federal restrictions on the Sacramento-San Joaquin Delta could cut water supplies in half for some citizens of the Golden State.

That combined with the drought that has dried California's reservoirs to their lowest levels in years and the economic crisis that continues to grip the entire country, could have drastic consequences...

According to a recent study commissioned by The Association of California Public Water Agencies, "the economic impact of a 30% water supply cutback could range from $500 million annually to more than $3 billion during prolonged dry periods." 

And as California boasts America's largest GDP - and is one of the ten largest economies in the world - such a massive hit to its economy will soon be felt by us all...

As Oregon Congressman Peter DeFazio, put it, "We're basically sliding toward Third World status. It's pathetic."

And the American Society of Civil Engineers (ASCE) couldn't agree more...

The United States Is a D-List Country

That's because America is nearly last in line to take the infrastructure bull by the horns.

China, for instance, is constructing a new 53,000-mile national highway system, while our own roads are checkered with potholes, cracks, and uneven pavement...

In fact, according to Pennsylvania's transportation secretary Allen D. Biehler, "China is spending 9% of its GDP on infrastructure, and we're spending something like 1% or 2%."

Plus, Japan, Taiwan, and 17 other nations have already beaten us in broadband deployment.

And for America to play catch up, the ASCE estimates we'll need $1.6 trillion in government investment over the next 5 years...

But with foreign nations making these major infrastructure investments first, more and more U.S. jobs could be moved overseas... in what could be a punishing blow to our already-unstable economy.

Infrastructure, as it turns out, is...

America's Defining Crisis. And It's the New Way to Build a Massive Fortune.

All told, failing infrastructure could be the crisis that defines the U.S. Its impact on our country could overshadow the effects of both peak oil and climate change...

But the lucrative investment opportunities to emerge from this crisis will assuredly be plentiful.

You see, behind the scenes, billions of dollars are already pouring into solving this national epidemic...

And just as savvy investment minds took advantage of skyrocketing oil prices not long ago...

I want to show you how you can personally benefit from...

The $825 Billion "Green Infrastructure Stimulus"

Chances are, you've already heard about our 44th President Barack Obama's plans to invest $825 billion in our nation's infrastructure...

An investment that will more than dwarf Dwight Eisenhower's interstate highway system launch of the 1950s.

And as you can plainly see, this investment is long overdue.

In fact, history has proven that now is the time for an infrastructure overhaul...

President Roosevelt invested $11.4 billion in the Works Progress Administration (WPA) during the Great Depression (that's about $175 billion in today's dollars)...

And despite the 25% unemployment rate, that WPA investment created 8.5 million jobs between 1935 and 1943.

That means President Obama's $825 billion "green infrastructure stimulus" is really just history repeating...  

But solving modern problems means investing in modern solutions. Which is why Obama is putting such a major emphasis on renewable energy with his stimulus package...

In fact, Obama's plan is set to double clean energy generating capacity over the next three years. That's enough to power 6 million American homes...

More importantly, it's 3 years of easy profits for those who know where to get in now...

And for every $1 billion invested in infrastructure, an estimated 35,000 jobs will be created... And those 28.9 million jobs will have, as Biehler puts it, "a strong multiplier effect on the larger economy."

... But the really good news is you can take a direct cut of this massive stimulus fund for your own private portfolio.

For instance, $100 billion of the "green infrastructure stimulus" has already been earmarked for upgrading America's electricy grid with 3,000 miles of new transmission lines.

And word from the White House is the work will be underway this President's Day--- February 16. 

Now, if you wanted to profit from this massive project, you'd need to know the names of the companies responisble for the installation now...

And that's precisely why I'm writing to you today.

So, let me show you exactly how to land a...

302% gain in Less Than 5 Months There's No Better Time to Load up Than Right Now

I'm sure you know by now: things always begin brewing behind the scenes long before the mainstream media breaks the story.

This "green infrastructure stimulus" is no exception...

Those in the know have already booked some impressive gains in the green infrastructure sector.

Why, in the water industry alone, you could've made:

65% in 7.5 months on Tetra Tech

302% in less than 5 months on Lindsay Corp.

273% in 8 months on Calgon Carbon Corp.

185% in 7 months on Flowserve Corp.

129% in 7 months on Badger Meter

But now that Barack Obama's plans for an $825 billion investment have gone public...

Well, remember what happened when the financial bailout was passed? Financial institutions like Citi, AIG, and Barclays saw their stock values increase by 50% or more.

The "green infrastructure stimulus" is doing the same, only on a grander scale.

That's because, rather than bailing out failing financial institutions, it's going to create jobs and pump up the economy as a whole.

To put it simply, it's a sure bet.

And I'll prove it to you...

The Alternative Energy Speculator

My name is Nick Hodge. And I'm the managing editor of the Alternative Energy Speculator.

All through 2008 - even during one of the absolute worst markets in recorded history - I've helped investors like you avoid the pitfalls of this full-blown market meltdown, while successfully leading them to double- and triple-digit gains in the alternative energy and infrastructure sectors.

From a 121% gain on a Canadian marine energy play to a 262% gain on a tiny thin-film solar company (not to mention all 5 of the water-industry winners I just told you about), Alternative Energy Speculators were cashing in while the Dow nose-dived into oblivion... and Wall Street ran for cover.

And because we've been so successful this year, I decided to put together two brand-new special reports - Infrastructure Investing: Sky-High Underground Profits and Water: Profiting from the Disappearance of the World's Most Valuable Resource - to help my readers get off to the best possible start in 2009.

With these reports, my readers will be able to strategically position themselves to get as much out of this $825 billion government investment as they can...

You see, I've found 10 specific water and electric infrastructure stocks that will deliver the quick boost your portfolio surely needs after one of the worst years in market history.

In fact, I've put together two additional special reports that spell out specifically...

Which 10 water and electric infrastructure stocks will deliver the biggest (and fastest) gains...

How you can turn the "Clean Water Atlanta" program into 9 months of steady profits...

How to boost your portfolio with the company that powers both the water and energy industries from behind the scenes...

Which innovative power-systems supplier will be leading the renewable energy charge for the largest municipal utility in the country...

And much, much more.

My readers will know how to profit from every angle of the infrastructure boom, from bridges to bandwidth...

And I want you to join them.

So to get you started, I'm giving you access to both of my special reports absolutely FREE.

You'll learn how to use all this information to your advantage - pouncing at just the right time, and riding these stocks for a very long and profitable run.

Of course, this is nothing new for us.

Just take a look at some of the gains the Alternative Energy Speculator portfolio saw in 2008:

Arise Technologies (TSX: APV) - 262%

Solarfun Power Holdings (NASDAQ: SOLF) - 182%

Emcore Corporation (NASDAQ: EMKR) - 156%

Xantrex Technologies (TSX: XTX) - 25%

Sierra Geothermal (TSX-V: SRA) - 90%

And there's more to come in 2009.

I promise you, the 10 infrastructure picks I'm going to reveal to you in my free special reports are just the beginning...

I've got my sights on a whole year's worth of money-making infrastructure plays... because with Barack Obama's backing, this is sure to be one of the most exciting - and one of the most profitable - years in the history of alternative energy.

In fact, at this very moment we have 14 new stocks in our queue.

That means at any moment, we're going to issue as many as 14 new recommendations...

And that's why I want to send you both free reports right away - so you can claim each and every one of these upcoming gains, starting NOW.

With these reports to guide you, you'll have the chance to join us as we continue exploiting every opportunity afforded to us by the ongoing alternative energy revolution and Obama's $825 billion "green infrastructure stimulus."

And all you have to do to claim your place in this growing market today is accept a no-risk charter membership to the Alternative Energy Speculator.

Not only will you have access to these special reports immediately...

But you'll also receive a username and password for the Alternative Energy Speculator web site. This will give you unlimited access to past issues, help you keep track of the stocks in our portfolio, and allow you to read all of our other reports...

And in addition to these reports, every week you'll also receive detailed updates on the companies in the Alternative Energy Speculator's portfolio... including the 7 solar energy stocks that are currently making our subscribers a mint.

You'll learn how these and all our open positions are doing, the latest in their research, and any breakthroughs that come in the sector.

Plus, the second we decide to add or sell a company, I'll contact you - instantly.

You'll know at what price to get in, how much you should expect to make and, most importantly, when to sell.

These instant alerts are simply too important for the weekly issue.

But that's still not all!

Because this is a charter membership offer, I want to extend a one-time deal to you...

You see, with all the time that goes into uncovering these little-known energy plays found in the Alternative Energy Speculator, and the substantially larger gains involved, we had no choice but to make it somewhat pricier than our flagship Green Chip Stocks service.

In other words, we had to cover our own cost of unearthing these gems. Since we do a great deal of travel, meet with CEOs, and inspect many of the companies with our own eyes, it tends to get pricey... especially when you consider how many opportunities we turn down before we actually find one worth getting excited about.

That's why the membership fee to the Alternative Energy Speculator is $499 a year...

But if that's too heavy a lump sum, you can register for our quarterly auto-renewal service for only $139! Your membership will be automatically updated every quarter for the life of your subscription. That means you won't miss a single pick or buy/sell recommendation. And even better: no annoying renewal notices.

Now, there's no way I can keep an offer like this on the table for too long...

In fact, after February 16th, I'll have to bump the price back to its normal level...

That's the date Obama himself has set for the launch of his stimulus plan, and that's when the starter pistol will go off for these infrastructure companies... and once they're off, the profits will go to the investors who got in early.

But if you sign-up now, you'll be ready to claim every penny of profit from Obama's $825 billion infrastructure boost.

And whichever subscription plan you choose, you'll still get your two free reports, weekly emails, urgent buy and sell updates, and full access to the Alternative Energy Speculator website...

And there's still more...

I'll even throw in a copy of my newly-released book: Investing in Renewable Energy: Making Money on Green Chip Stocks, which I co-authored with energy experts Jeff Siegel and Chris Nelder (a $27.95 value).

So, here's the final tally:

Membership in the Alternative Energy Speculator

Access to our 2 latest reports

nstant updates and recommendations

And a FREE copy of my new book...

All for just $139 if you accept this offer today!

And here's my promise to you:

I will give you 30 days to examine our top-notch research and investment philosophy. If you decide that the Alternative Energy Speculator is not for you at any time during this trial period, simply let me know, and I'll completely reimburse you every penny. That's right - every penny.

You can even keep the book. It's my gift to you.

So if you're ready to join this elite group of infrastructure and alternative energy insiders, just click the subscribe button below.

But I urge you to act fast.

February 16 is just moments away. So time is not a luxury if you want to make the most of your portfolio in 2009.